This discussion is intended for informational purposes only and does not constitute medical advice or establish a doctor-patient relationship. Information shared on the podcast should not replace consultation with a healthcare provider. Always consult your physician or a qualified health provider with any questions about a medical condition or before making health decisions based on this content.
Dallas Kingsbury, MD, is the medical director for two companies:
- Danford Works is a virtual platform that combines personal data analysis and 1:1 coaching to empower people to live their healthiest and most active lives.
- Fountain Life (Naples Center in Florida) is a company dedicated to proactive and personalized medical care via cutting-edge artificial intelligence-enhanced diagnostic testing.
He has been a teaching assistant professor of Rehabilitation and Sports Medicine in the Rusk Rehabilitation department at NYU Langone Medical Center in New York City.
His interests range from interventional sports & regenerative medicine to in-depth consultations on maximizing a healthy lifespan.
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John: Welcome to another edition of the Impact Podcast. This is a very special edition because I’ve got my good friend with us and my doctor with us today. The doctor is in the house: Dr. Dallas Kingsbury. Welcome back to the Impact Podcast, Dallas.
Dr. Dallas Kingsbury: Thank you so much, John. How are you today?
John: I’m great. We might have covered some of this ground before when you were on last time, but for our listeners and viewers who haven’t had the benefit of meeting you or listening to you before, I just want to give them a little bit of color and context on the Dallas Kingsbury background. Where did you grow up, and how did you get on this really fascinating, important, and timely practice of regenerative and longevity medicine—the journey that you’re on right now?
Dr. Dallas: Well, thank you, John. I grew up in New Jersey, and I’ve always been interested in health and wellness. My dad’s a chiropractor, and I grew up in a family that was very interested in everything from nutrition to exercise, meditation, and yoga. So, I kept that interest. I went to Johns Hopkins for my undergrad degree and did a master’s in neuroscience. And I was always interested in, again, still interested in health and wellness and exercise. So, I decided to transition from neuroscience into medicine. I did my initial medical training at Robert Wood Johnson Hospital, and then I did my residency in physical medicine and rehabilitation at Mount Sinai in New York City. I did a sports medicine fellowship at a hospital for special surgery, which is the number one orthopedic hospital in the world. In my medical residency and fellowship, I was involved in several research studies that involved using platelet-rich plasma, a derivative of your own blood. It’s something we may talk about today, using platelet-rich plasma to treat tendonitis and arthritis. I continued some of that interest, and my medical career started at NYU Langone Hospital in Manhattan, where I practiced interventional sports and spine medicine. Now, I’m the medical director for two different companies involved in health, wellness, and longevity.
John: It seems as though, with the growth of podcasts, especially the podcast rock stars like [inaudible], Galpin, and Layne Norton, regenerative medicine and longevity might be two of the biggest trends in all of medicine right now. Is that how you see it as well?
Dr. Dallas: It really is. And I don’t know if it’s the Instagram algorithm that just knows that’s what I’m interested in. So maybe it seems like that’s in my face all the time, but it does seem very much like that’s what everybody’s talking about. At least, I know that when I go to a party, more or less, that’s what everybody asks me about.
John: That’s a great thing. You’re in a field that everyone wants to know about, and it seems to be in the media every day—whether it’s with the Gary Breckas of the world and the Brian Johnsons of the world, or just on some of the great breakthroughs that are happening right now, that Peter Diamandis platforms. It just seems like health, wellness, regenerative medicine, and longevity are trends that are here to stay. Let’s get into a couple of the different topics that I want to discuss with you for our listeners’ sake. One of the hottest topics always, whether it’s in ‘People’ magazine, ‘Us’ magazine, CNN, or Bloomberg, is this whole issue of GLP-1 and these peptides—BPC-157, GLP-1, Ozempic, Mounjaro. It’s coming at us faster than we can keep up. Is this new weight loss phenomenon using peptides here to stay? And where do you weigh in on the beneficial use of peptides for people to lower their diabetes risk, cardiovascular risks, and other risks that come with obesity and other health problems that come with being grossly overweight?
Dr. Dallas: Thank you. So first, it’s a phenomenal question. It is what everyone’s talking about. So just to define a few things before we get to it. You’re perfectly correct in the fact that you said that the GLP-1 medications are peptides. And that’s true—they are. GLP-1, glucagon-like peptide 1, is a peptide. So first, what is a peptide? It’s a short string of amino acids. It’s generally defined as about 40 or 50. I’ve seen it in different places. Anything greater than that, you can start defining it in other ways, like it’s usually a protein or a large molecule. Now, the reasons for that definition are interesting. We can get into that later. So what you’re talking about, though, is these weight-loss peptides. These GLP-1 now medications are FDA-approved drugs, whereas I think when many people are talking about ‘peptides’, they’re talking about minimally regulated peptides that you can get from compounding pharmacies. Again, some of those are you can get from compounding pharmacies, and then other ones you can sort of sometimes get from a prescription at a pharmacy if your doctor knows what he’s doing. But just to hone in on those GLP-1 medications, it’s a huge topic that many people have covered at length in 2, 3-hour podcasts. So, we don’t have to get into it deeply. But what I will say in terms of the mechanism of action, who will benefit, and the risks of all those things, and again, I can answer all those questions. I think what you were interested in a little bit more of was, I guess number one, have they been effective? Absolutely. I think anybody that’s doing this as a physician and is treating people who are interested in wellness and weight loss and living longer, and if they have the indications for going on those medications, and they’ve tried everything they can do to lose weight, and they’re having trouble. There’s very few people, doctors now who haven’t at least been trying to use this and seeing how effective they are at helping people lose weight. So no question that they’re effective. But I think you were interested in some of the some of the some of those myths, right?
John: I don’t know how you fall out on it. First of all, you do you agree the benefits outweigh the risks? And is that something that your patients would be using under your care?
Dr. Dallas: Yeah, I use them quite frequently now. The benefits absolutely outweigh the risks, of course, assuming that somebody has the clinical indication for using them. Those are defined as specifically the classification of piece of obesity based on BMI, or being overweight with several different comorbidities, things like type two diabetes or cardiovascular disease. And that’s all sort of defined in the guidelines. Generally speaking, the long-term risk of living with obesity and those metabolic and cardiovascular complications is just so much greater than what we’ve seen the potential downside or side effects or long-term possible effects of these medications. The benefits clearly outweigh the risks. Now, I will say that the risks, at least there’s a way to do this, where you can mitigate some of those risks, or evaluate for some of the main, I guess, problems that some detractors of using this have indicated, like, for example, I think you mentioned like a loss of muscle mass, right?
John: Yes. Well, let’s talk about this. I’ve heard of Ozempic face, Ozempic butt. And then the other things that the people throw stones at: Ozempic or Mounjaro, the other GLP-1s is, people then look like they’re losing muscle mass or something when they’re losing all this weight. How do you respond to some of those criticisms?
Dr. Dallas: Okay, you got it. So Ozempic face, Ozempic butt, fine. We’re going to touch on that in just a second. We’ll take one step back and say that when I first started using this, and when some of the original outcome trials came out in the New England Journal of Medicine for semaglutide, I guess we haven’t even talked about this yet. So these GLP-1 medications include semaglutide right now, which is [inaudible] the blockbuster one that came out in 2021, at least from this New England Journal of Medicine article. The brand names for that are Ozempic and Wegovy. And then the newer one is called Tirzepatide. Those brand names are Mounjaro and Zepbound. The reason why there’s two for each of them, is one is branded for type 2 diabetes, and then one of them is branded for just weight loss. Now, when that huge New England Journal of Medicine article came out, it really put semaglutide on the map. At that early time in 2021, 2022, there was concern over a few things: one, pancreatitis, meaning inflammation of the pancreas, and then certain types of cancers like thyroid cancer, something called medullary thyroid cancer, and then a few other things. And so it took a few years for outcome studies, and this was, by the way, based on older versions of these GLP-1 medications. So we’re talking about years and years ago, something called exenatide and liraglutide under the brand name Trulicity. Some people will recognize those. Through the years of research and animal models, and then some of those studies, there was this question as to whether or not it could cause thyroid cancer. And so now, with these newer medications like semaglutide and Tirzepatide, there’s been some newer outcome studies. We’re talking, like, 8,000 people, which are placebo-controlled trials. I believe there were 8,000 people in both groups, like 16,000 people in the whole thing. They basically saw no increased incidence of pancreatitis, any kind of cancer, including that medullary thyroid cancer that was initially a concern, and then a whole host of other things that turned out to not be a major risk for the medication. So at least with regard to those initial concerns of side effects, it doesn’t look like that’s actually a problem. Now, again, we want to be looking for those future outcome trials and future safety trials. We always want to be cautious, but it looks like that’s not a concern. Then, now, you mentioned the Ozempic face, muscle mass and all that. First of all, when you’re talking about the amount of weight loss that people can get using these—some of the first semaglutide and Tirzepatide, you’re talking about somewhere between 15 to 20% of your total body weight. If somebody’s overweight, let’s say 200 pounds, that means that some people will lose up to 30 pounds, up to 40 pounds on these medications, of course, if they’re overweight or obese. And in studies that have shown a similar weight loss with any different modality, so we’re talking again over the last 20, 30 years: aggressive diet and exercise, oral medications for weight loss (none of which actually helped you lose that much weight), but again, like fen-phen, for example, and bariatric surgery. When people are able to lose a significant amount of weight, they’ve already done studies dating back decades doing DEXA scans before and after weight loss. So a DEXA scan being a whole-body X-ray that can determine how much muscle you have and how dense your bone is. And so a DEXA scan before and after, they’ve shown already that when people lose or are in that sort of a weight loss phase, that they can lose 20, 30, 40% of the weight that they lose coming from muscle or lean body mass. Let’s say somebody lost 20 pounds on whatever intervention they were doing—aggressive diet and exercise for a year or bariatric surgery—they lose 20 pounds. Easily, 10 pounds, up to 10 pounds, could be from muscle or lean mass. So we knew that already. And then all of a sudden, what happened was when these GLP-1 medications started coming out—and again, now DEXA scans and body composition scans are much easier to come by because a lot of longevity physicians and it’s in sort of the zeitgeist to measure this—people are saying, “Oh, I lost X amount of lean mass.” And I even saw that in my practice. We’ve got to take that into context with the fact that we knew this was going to happen in the first place. So it shouldn’t be a surprise to anybody. But now I have heard that some people are going back and looking at the old literature and then saying, “Oh, yeah, look at this. This was the thing we knew about.” Now, even though we can expect it, it doesn’t mean it’s good. I have some phenomenal case examples within my own practice where I’ve had people aggressively coached by myself and exercise coaches and health coaches that I work with, where we actually get patients to do a few things. Number one, which is to consume adequate protein—daily protein intake and tracking it and actually achieving it—and daily or weekly resistance training exercise, like very deliberate, a well-constructed resistance training program, weightlifting. And if we just hold those two things pretty constant, I’ve seen people actually gain muscle while losing body fat. So that’s not going to happen to everybody. If you’re losing 30 pounds, it’s pretty hard to not lose any lean mass. But I’ve seen people come pretty close. I’ve seen people lose 30 to 40 pounds and lose almost no lean muscle mass.
John: So you’re saying in regards to GLP-1s if you use them correctly with the right type of protein intake and also the right type of prescribed, custom-made exercise program, the results will be a lot more ideal than if you just took the GLP-1s on their own and just said, “Okay, I lost a bunch of weight and I’m less of a risk for cardiovascular disease and for diabetes.” But you might’ve also, along the way, become a little bit saggy or flabby because of the fast weight loss, and that wasn’t accompanied with the right amount of protein or the right amount of re-muscle configuration.
Dr. Dallas: That’s exactly right.
John: Talk a little bit about protein intake. You hear so many things out there. What’s the science-backed approach to protein intake versus body weight?
Dr. Dallas: So this is an answer, and again, this is so interesting that it’s come back up again in the zeitgeist of health and wellness and social media. But a lot of these studies were done several decades ago, and they were done in bodybuilders, generally, who were in these studies of weight loss and protein intake. And we learned a lot from that. So there’s a few different heuristics. Now, what’s the RDA of protein intake? It’s like point eight grams of protein per kilogram of body weight or something like that. Some people, like Layne and Andy, as mentioned, have gone through excruciating detail as to why that’s probably way too low for people. At least what I settle on that’s really practical for my patients is there are a few ways to do it. My preferred way and this is just loose, I believe the real number is something like one point six grams of protein per kilogram of body weight, which is tough because, again, you’re now multiplying one point six, and you’ve got to figure out your weight in kilograms. And all of our scales are in pounds. So there’s a few ways to do it. You can simply just go with the number of pounds you see on the scale and then have it be that many grams of protein. I’ve seen people do it that way. That tends to be quite a bit of protein. It probably overshoots a little bit, again, because if you convert kilograms to pounds, it’s like that factor of two.
John: A one-to-one basis, you’re saying, is sort of safe.
Dr. Dallas: A one-to-one basis is overshooting it if you’re going [inaudible] grams of protein to the number of pounds you weigh on the scale. So the way that we do it, because we measure DEXA scans on all of our patients, a much more approachable number is something like the number of grams of protein you eat per day is equal to the number of pounds of lean body mass you see on your DEXA scan. If you don’t have a DEXA, then just say, how much do you weigh on the scale? And then cut back a little bit round down quite a bit by, I don’t know, 20 or 30 grams of protein. That will probably kind of get you there. Again, it all depends, though. If you have a lot of excess body weight, then you’re going to have to peel off a lot more.
John: So I weigh 175, so I should take between 140 and 150 grams of protein every day, or 120 or something like that.
Dr. Dallas: If you’re pretty lean, that works really, really well.
John: Got you.
Dr. Dallas: Of course, if you’re really light or really heavy, then you’ve got to work with somebody on figuring it out, but that’s a rough estimate.
John: Talk a little bit about the importance of protein, notwithstanding the issue of GLP-1s and things of that sort, just the issue of aging and reducing the risk of sarcopenia and other aging maladies that strike folks like me who are 62 and not getting any younger. Why is the amount of protein that we intake so important to health, wellness, and also longevity?
Dr. Dallas: It’s super interesting because there have been a few theories about aging and protein consumption. There was a long-standing theory, I think based on some old research that looked at the ability to absorb and utilize literally the same amount of protein. It seems like it gets absorbed and utilized better when you’re younger versus when you’re older. If you’re a little kid or a teenager, you don’t need as much protein, and you’re currently in this big muscle-building and growth phase, you still don’t need as much protein to grow and maintain as you do when you’re older. That’s sort of the zeitgeist. And there are all these reasons for why. Is it something happening in the gut? Is your gut not absorbing as much because an older person’s gut doesn’t function like it does when you’re younger? Or could it be something like your muscle cells just don’t respond to that signal? When you eat protein, actually, there is a little bit of a signal there through the brain and the body that just generates a little bit of muscle building all by itself. And maybe that signal is a little bit weak. I think the jury’s still out as to exactly what mechanism that is. Regardless, I tend to round up if I’m talking about people who are in their, let’s say, 60s, 70s, 80s, and older. Start to round up if you’re trying to hit like 150 grams of protein and you start getting up there, I’m like, “Maybe round up a little bit, give it an extra five or ten.” Again, this gets difficult though. I will just say that when people are talking about the number of grams of protein eat[?] per day, for people who are eating a relatively normal diet and aren’t eating like a bodybuilder where they’re boiling chicken and chopping it up and having it in these little pre-prepared meals and eating it all throughout the week.
John: [inaudible].
Dr. Dallas: Yeah. If you haven’t been doing this and aren’t doing this all the time, this doesn’t come easily, which is why when I work with people like myself, my health coaches, nutritionists, and the like, we really spend a lot of time just breaking it down for people like, “This is what your plate looks like for breakfast, lunch, and dinner.” If you’re really focused on protein, and almost everybody who’s not used to it is like, “Wow, that’s very different. I’m not used to thinking about eating this or that at every meal.” And so it’s a bit of a mental shift to just do it, which is why for many of our people, when they start getting focused on this, it starts slow. Sometimes it’s not even about tracking. We tell people to track. We just say, “Hey, just try to make these substitutions.” It can be very difficult for people at first.
John: And this goes for men and women. Both men and women should be monitoring and keeping protein levels up.
Dr. Dallas: Yeah. However, I find it naturally difficult for women because it has to do with a little bit of how the math works. Because men are generally bigger, you’d think it would scale just because you’re bigger, you have more muscle, therefore you need more protein, but there are some other factors that are involved. For men, it’s a little bit easier to hit their protein targets because their maintenance calories are higher. And so, it tends to be easier to get in all that extra protein. For women, who just don’t need as many calories, and therefore just generally aren’t hungry enough to consume that much protein. You get into an issue there. So it’s a lot of coaching, really.
John: For our listeners and viewers who just joined us, we’ve got with us today Dr. Dallas Kingsbury. He’s my doctor. He’s the medical director at two very well-known longevity and regenerative medicine clinics. He’s a real expert in regenerative and longevity medicine. Doc, you mentioned at the top of the show some of your legacy study work when you were a student, with regards to the efficacy and testing of PRP—platelet-rich plasma. How is that now part of the longevity and regenerative medicine trend? Are more and more people using it, and why?
Dr. Dallas: Great question. So platelet-rich plasma—the studies that I did on it involved arthritis, specifically of the shoulder joint, and tendonitis or tendinopathy in various parts of the body. First of all, what is platelet-rich plasma? Well, platelets are tiny, a-nuclear (meaning cells without a nucleus) that flow throughout our bloodstream and contribute to the normal function of how our blood works. So think about the bloodstream as like a highway. The cars going back and forth are like red blood cells transporting things. Maybe the cops on the road are like white blood cells, looking for bad actors or something like that. Platelets are like the road crew repairing the blood vessels, meaning repairing the road in this analogy. And so the platelets that you have in your blood are mainly responsible for repairing little tiny tears and injuries to the blood vessel wall. They do that by having an extremely powerful sensing mechanism and adherence mechanism to the sidewall of an artery if it gets injured, and then this signaling of a repair process. So once there’s an injury, platelets aggregate at that site of the injury, and then they send out these homing signals to other cells in the region, even local stem cells. Also, those signaling molecules themselves are pro-regenerative. We’ve known about this for obviously decades. In the 90s, maybe even the late 80s, I have to go back and look, some of the fields of regenerative like oral maxillofacial surgery—surgery of jaw and oral conditions—classically, there are these conditions that were really difficult for jaw bone to heal. Awful jaw surgery. That’s when some of these interesting physicians got into this started using platelets and platelet-rich plasma to treat that. Now, all platele-rich plasma is: you go and get a blood draw. The blood gets taken out of your body and it gets put into a centrifuge, which spins very quickly in over either one or two different spins. It separates those platelets out from the rest of the blood fluid called plasma and the red blood cells and white blood cells, which I mentioned before. So then that’s tiny little layer there. You get platelets. And because it’s so much of a small fraction of the total bit, we call it platelet-rich plasma. Ever since that was discovered and the early work was done in the 90s, there really started to become a heyday and interest in using platelet-rich plasma for things like orthopedic conditions, sports medicine conditions like arthritis, tendinopathy, maybe even some nerve injuries because of that inherent natural healing signaling milieu that’s extruded by platelets. And we can go into why and how.
John: Let’s go into some more popular things. Rotator cuff, labrum tears, ACL, meniscus. You’ve been working with me all year on my trimalleolar fracture to my ankle and PRP. Is it applicable to these very common ailments that so many of my friends, relatives, acquaintances suffer from or get injured from, and they’re playing pickleball or whatever they do for their lifestyle—tennis elbow? Is this what PRP is being applied for?
Dr. Dallas: Yeah. In the early days, there was a ton of excitement that this was just going to be the holy grail of regenerative medicine. Anecdotally, it was doing great and people were doing great. But over time, when they started doing rigorous randomized controlled trials, they realized the effect size was relatively modest and there was a few reasons why. In general, people are heterogeneous. Not everybody’s elbow pain is the same kind of tendon problem. And not everybody’s shoulder plate pain is even arthritis to begin with. So because diagnoses are complex and not perfect, that’s one reason why in general studies have been, we’ll say, mixed to slightly positive. If I had to sum up all the literature on regenerative, or just platelet-rich plasma for tendons and joints, I’d say it’s somewhere between mixed and slightly positive. And that’s why. People are heterogeneous, they’re different and all their diagnoses are slightly different. It’s hard to do a study with everybody with the same exact tendon problem. The other issue is that the preparation of platelet-rich plasma has evolved over time. And so it seems like the most current up-to-date understanding of what differentiates good PRP from maybe ineffective PRP is the number of platelets. And without totally going crazy on it, we’re talking about somewhere between 3 to 10 billion platelets in a single infusion, injection into a joint versus hundreds of millions or something like that. That difference apparently, at least now of October 2024, my understanding is that that essentially separates the treatments that have been ineffective to ones that have been actually very effective. Now, this is for pain. Everybody was also hoping, Well, these platelets are so regenerative,” they do all this great stuff in a test tube. Is it going to knit together my rotator cuff tear? Is it going to knit together my labrum tear? Is it going to regrow my cartilage? You can get that to happen in a Petri dish. You can get that to happen in an animal sometimes. At this point, I’ve heard of some partial tendon tears maybe healing, I don’t know, but generally speaking, you’re not going to regrow a new joint or a new tendon just with platelet-rich plasma alone. However, if you get the right dose and you have a doctor inject it properly, you’ve got a good shot at getting pain improvement from a tendon or joint problem.
John: Well, let’s take it a little further. So first of all, you’re saying it has to do with the amount of platelets in the injection. That’s number one. And these platelets are coming from ourselves?
Dr. Dallas: Right, you’re just getting a blood draw.
John: So the risk level is sort of low. It’s from within us. So let’s take it one step further. Not only does it have to do with the quality and the amount of platelets that are in the injection, but also, is it fair to say the efficacy and the quality and the experience of the practitioner also administering this practice?
Dr. Dallas: Hundred percent.
John: So that being the case, Dallas, and given that I know you believe in it enough that you’ve recommended it to me, and I’ve used this with a couple of great practitioners you’ve put me with; for our listeners and viewers out there who are interested in getting some relief or trying it on themselves, how do they find the right practitioners that are doing it with the higher-level platelets that are being injected, but also being done the right way? Because I want you to walk our listeners and viewers through the issue of unguided PRP injections versus guided PRP injections.
Dr. Dallas: Absolutely. Maybe I’ll take the second question first. So regarding how to get, how to know that you’re getting a procedure with somebody who is going to do the best job for you. The first is that you basically want to make sure that you’re getting image guidance for everything. Generally, you’re paying for platelet-rich plasma procedure out-of-pocket. Insurance doesn’t cover this. There’s lots of reasons why, but ultimately this is an out-of-pocket procedure. I guess if you’re doing any procedure, you want to make sure if you’re getting an injection for a rotator cuff tendon, they put it in the rotator cuff. I think that goes without saying, especially doubly, triply because you’re paying for it. So imaging guidance. Now, first of all, you may think, “Well, wait a minute, why wouldn’t someone use either an ultrasound or an X-ray to make sure the needle’s in the right spot?” Classically, up until, I guess, the mid-2000s, that wasn’t the convention. The convention for all of medicine was that you saw a doctor that hopefully kind of knew anatomy and they palpated, poked around, or felt like they put their finger close to the spot that they said, “Okay, this is that tendon, this is that joint space,” and then they put the needle in right there. Now, it turns out that across the body, even in the most expert hands—so they’ve done blinded trials where they have orthopedic surgeons who supposedly know orthopedic anatomy better than anybody in the world—were successful at getting the needle into the area. Look, for some very, very easy areas, they’re in there 90% of the time or more, but for some tricky regions, we’re talking 20% of the time they’re actually getting the needle in the joint if they’re using what’s called landmark-guided injections or blind-guided injections. So because of that, and because the barrier to using ultrasound to literally guide the needle into the region of the tendon or joint is so easy now, this has become standard of care. And there even has been some research studies showing a better efficacy of certain injections to an ultrasound-guided. So at this point, if you see a doctor and they’re talking about doing a regenerative medicine procedure for you—let alone a cortisone injection, I’m just saying—do you use ultrasound to put the needle in the right spot? And if they don’t, maybe you find another doctor. I don’t want to talk badly about other physicians, but again, if I [inaudible] or one of my patients or even one of my family members, I’d say, “Just don’t see that person. See someone who can use ultrasound.”
John: I’m a layman here. Dallas, isn’t it fair to say if someone’s trying to give you a cortisone shot, a PRP injection, without ultrasound guidance, it’s almost like saying, “Let’s go to a shooting range together. You’re going to shoot at the target with your eyeglasses on, and I’m going to shoot with a blindfold over my eyes—something close?
Dr. Dallas: Yeah. [inaudible]. You’ll get blind[?].
John: It’s common sense. You’ll get one, maybe. But even a broken clock is right twice a day, but it’s really not the way to practice the best, most efficacious type of medicine with regards to PRP. It’s really not the best way to do it unguided. So talk a little bit about, how do you find the docs that are having the best results: A, they’re doing it the right way, and then B, they’re also doing the most rich platelet-rich injections.
Dr. Dallas: That’s a little tough because you got to kind what you’re asking about, and there’s fewer of these people out there who have these physicians doing procedures where they are either measuring the amount of platelets at the point of care, where the doctor needs a hematology analyzer in their practice. Very few have that. I just can’t say. However, there are ones out there, and if you call and ask around, you may have to travel. But there are ones out there that actually can measure the amount of platelets they’re injecting point of care. Shy of that, you at least would want to make sure that they’ve done some work ahead of time, sending a few of their samples to a lab to make sure what they’re concentrating is at that proper efficacy. So saying, “Hey, have you tested your own stuff? Do you know if your centrifuge concentrates and gets this degree of concentration?” Many good regenerative medicine doctors are doing that now. But I can’t guarantee it.
John: This comes back to why people need to have a doctor like you that they work with because you’re the one who actually has guided this process and the picking of these professionals. For me, I was lost out there. And that’s part of what is part of your practice. Is that not true?
Dr. Dallas: Yeah, absolutely. You got to know people.
John: Which then leads me into then the next issue of talking about picking the right doctors and how do you do it? And what’s this all about? What seems to be some of the most promising part of longevity medicine and regenerative medicine, but also maybe the wildest West part of longevity medicine, stem cells. Not a week or a month that goes by that I turn on my podcast playlist, including the great Joe Rogan, who talks about stem cells and how he believes positively affected his life with regards to some shoulder injuries he’s had and other things, and some friends that he’s had that have had great results, including Tony Robbins, who’s been very open and talked about his use of stem cells and some great resolutions that he’s had. Where are we with regards to stem cells in relation to the application of stem cells in the United States and outside of the United States? And where are we going? What’s the state of the union right now with regards to stem cells, regenerative medicine, and longevity medicine?
Dr. Dallas: So stem cells, it’s an incredible topic. Let me just take a step back or just define exactly what we’re talking about. Stem cells are cells that are in our bodies and have a particular function that is very different when somebody is an adult versus when you’re developing as an embryo, a fetus, et cetera. So let’s just get fast all the way forward and let’s talk about when somebody is an adult. So a small percentage of the cells in most tissues and organs of our bodies, you can take on the definition of a stem cell. We have stem cells in most parts of the body, including the brain, actually. The brain does have some resident stem cells, I think in the olfactory, the sense of smell organ in the nose, and also in the olfactory region of the brain and in the hippocampus, which is a part of the dentate gyrus of the hippocampus, the part of the brain that’s involved in learning and memory. So, everywhere else, muscle tissue, adipose tissue, wherever you go in the body, there are tiny little populations of resident stem cells. These stem cells are unique in that they can actually divide and give rise to new cells. So now, if you want to talk about those cells that are in an embryo, if you think of these different types of stem cells as having a lineage, at the very top are the ones that are in an embryo and they could become any kind of tissue type. As that lineage starts to differentiate into more and more mature tissue types and then finally, when you look at your own, for example, skin or muscle stem cells, those stem cells in your skin or muscle will never be able to become any other tissue because they’re already differentiated. So that’s what I’m talking about with regard to stem cells. And so then when you’re talking about what you can get in terms of what’s legal to get done, whether it’s in the United States or abroad, you got to know what kind of stem cell you’re talking about. So this now gets into the discussion of the different regulatory pathways of what the FDA has used to clear the use of biological products. Basically, there are two different pathways: 351 and 361. 351 is a drug pathway. You need an investigational new drug and a biologics application for the FDA. You got to do rigorous clinical trials. At this point, the only FDA-approved uses of stem cells for this purpose are in very rare cancer therapies, for example, where they take somebody’s stem cells out of their body and modify them and then re-inject back into them. That’s something called CAR T-cell therapy. I don’t know if they’re stem cells, but they’re modified cells in your body that are taken out, modified, and then used to kill cancer. [inaudible] interesting topic, actually, but that has undergone a drug development pathway. If you’re talking about the 361 pathway, now we’re talking about cells or biological products that have to be used for what’s called homologous use, meaning it’s got to be used for the same thing. For example, you can use umbilical cord blood to treat blood disorders because that’s the same thing. You can make the argument that using bone marrow progenitor cells can be used, for example, for orthopedic conditions because of a sort of homologous use application. That’s at least the idea that falls under the 361 pathway. Platelet-rich plasma kind of falls under this homologous use, and so it’s okay. It doesn’t have to go through FDA clearance. If you’re talking about using this umbilical cord tissue, which is where a lot of this comes from, or amniotic fluid-derived stem cells, or placental stem cells, which is typically what people are getting when they’re going to the Caribbean. As far as my understanding is, in October of 2024, no company has gotten approval to do any of these stem cell procedures for people for any condition using umbilical cord tissue. And especially what it’s being used for now, either anti-aging or joint injections or tendonitis or arthritis. That’s the current state of what’s legal to do in the United States.
John: Let’s break it down. So, if I called you, doc, and I said, “I want to get stem cells into my ankle, which had been broken earlier this year in three places, and I wanted to get stem cell intravenous and also stem cell into the joint or the cartilage and the ligament areas to help it improve in the United States.” Right now, as we know it, there’s nobody who’s legally administering stem cells in the lower 48 of the United States, or even all 50 states in the United States.
Dr. Dallas: Right. Nobody’s doing that with umbilical cord or placental tissue, perinatal tissue. That’s what’s not being done in the U.S.
John: Let’s break that down. It’s important to talk about that. These three forms of stem cells, correct? I want you to go into all three forms. Those that are derived from our own bodies, those that are perinatal, and then those that are coming from healthy, young, 25-young teenagers or something that have been scrubbed and looked at and genetically reviewed.
Talk about the three different sources and if it’s not in the United States, where are they then legally being administered or at least being done with efficacy and also within the limits of the law?
Dr. Dallas: Yeah. So, first of all, you can just divide those. Autologous, meaning from yourself, versus allogeneic, basically, or non-autologous. That’s either from an adult human or a perinatal tissue—a fetal tissue. So, the autologous one you can get from yourself, you can get that for an orthopedic condition in many places in the country right now. So that is, you can get bone marrow aspirated from your pelvic bone and centrifuged just like PRP and a small percentage of those cells will have a sort of stem cell classification. There’s maybe a little bit more detail, but I don’t need to get into it. We’ll just say they’re called MSCs, but whatever, we’ll say they’re bone marrow stem cells. These bone marrow stem cells, theoretically, and according to some research studies, have benefit for using them for tendinopathy, tendinitis, arthritis, maybe some nerve injuries, things like that. Now, because those stem cells have a signaling property, almost they act like these extremely powerful signaling powerhouses, they are able to theoretically reduce inflammation and engender a healing or regenerative response or at minimum, a pain relief response when injected into a painful joint or a painful tendon. Above and beyond that would be capable of platelet-rich plasma. Now, amazingly, for as long as we’ve been doing these bone marrow injections, stem cell injections for people, now it’s been over a decade, there haven’t been rigorous controlled trials even showing that that beats PRP. But let’s just assume for a second that almost everybody agrees there’s a lot of potential there. That’s allowed, and you can get that type of procedure at many advanced, we’ll call them sports medicine, regenerative medicine clinics. In almost every major city, there’s somebody that’s doing bone marrow stem cell procedures.
John: Can we pause right there? Can I just [inaudible] a little bit? [inaudible] the argument that, given that you’re around the age of 40 and I’m 62 in another couple of weeks or so, is there an argument to say that if we both had an ankle issue and we did that type of taking out the bone marrow at a very good doctor, same doctor, take out both of our bone marrows and use that stem cell treatment into our ankles that are healing—your stem cells, given your age, could be more efficacious and have a greater impact given that mine are now 62. They’ve been beaten up and knocked up a little bit and have a couple more dents and bruises in them and could have a little less impact than yours, which is why we’re then going to go into the next subject of stem cells that come from outside of our own bodies. Is that statement pretty much the state of the union right now?
Dr. Dallas: That’s what is commonly talked about by people that are doing these stem cell procedures and outside the U.S., saying the stem cells you’ll get from your bone marrow if you’re over 50 or something like that, are weaker and more defective, more or less, than more youthful stem cells. In studies, in petri dishes, and animal studies, that’s true just to the degree that they can measure the function of stem cells. Yeah, there is some truth to be told there. However, and I want to say this, it’s promising, but there are no human-controlled trials comparing perinatal or more youthful stem cells to that you can get from your own bone marrow. Regardless of your age, there’s just no head-to-head trials. So, we really don’t know. And so, I just want to put that out there, that it’s a common trope that you’ll hear people who run, let’s say, Caribbean clinics saying, “Oh, these are so much better, they’re so much more powerful.” I just want to say, “Okay, show me the data. I’m willing to believe it, but show me,” and it’s just not ready yet. So, it’s interesting. And then the other thing you mentioned was the difference between, I think, the ankle and an intravenous infusion. Maybe you’ll ask me.
John: Injection versus intravenous, what does that look like? What’s better? Or are both good depending on the injury or the effect we’re looking to achieve?
Dr. Dallas: Go back to autologous use, meaning your own stem cells. It’s perfectly fine and legal to have your bone marrow taken out, centrifuged, and those cells injected into your ankle or your tendon or whatever. Orthopedic injection, sports medicine injection. Once you decide to do something with that, like inject it into, let’s just say an intravenous infusion, now you’re doing something for anti-aging or something like that. Now you’re talking about transitioning away from that homologous use. You’re no longer using it for something similar. And now you get into trouble. There’s also some trouble with intravenous infusions just in general and the safety there. So, not only is there sort of a safety and sort of legal use question, but then you start to transition to what is happening when you infuse millions of stem cells into somebody’s vein, and what’s the purpose of it? So, this is what’s interesting. And I’d say on the pro side, this is why some people do it. Because some studies, again, mostly in animals and things like that, show that if you injure a tissue, you injure an arm or a leg or a hand or even like the brain or whatever in an animal, and you infuse stem cells into that animal and you label those stem cells with some sort of radiological tie, then you watch where those stem cells migrate once they’ve been infused, they will be found. They will largely aggregate at the site of an injury, which is like, “Wow, this is how you can heal injuries and things.” So it’s very interesting. And what do those stem cells do once they get there? Generally, what happens is they undergo a process of engraftment where they sort of stick to various tissues and cells within tissues and release these pro-regenerative and anti-inflammatory factors. And that is so very compelling that people have now taken some of that animal research and said, “I’m going to go and get an IV infusion of placental stem cells or umbilical cord stem cells because they’re going to home to the site of an injury or my aging cells and help reduce inflammation.” While that’s a phenomenal idea, there haven’t been human-controlled trials that show any outcome in this whatsoever. I’m sure they’re being done, or I know there’ve been trials enrolled, but nobody’s reported outcomes in humans just getting IV stem cell therapy for general purposes of anti-aging or [inaudible] reversal. Now, there are ongoing and even reported clinical trial outcomes of infused stem cells. I’d have to see what exactly those stem cells are, because they’re different study for things like heart failure, neurodegenerative conditions like dementia, and autoimmune conditions like rheumatoid arthritis and even MS—multiple sclerosis. Now, those studies are somewhere between mixed and positive. Some positive studies, some like “eh” studies, and it’s very compelling. It’s extremely compelling. The problem is, it’s not so amazing that everybody’s just sort of dropping their illness and walking out the door and saying, “I’m done, I’m healed.” It’s not that powerful, and there’s always just more research to be done. So, because of that, a lot of people have just taken it into their own hands and said, “I’m going to go get stem cells in Tijuana.” It’s hard. It’s hard to know what to say to people when we’re still in this gray zone of is it effective or not.
John: Well, as we say, you’re in the gray zone, we’re in the Wild West, but there’s folks like me that want to try it. I have you on my side, so I have the luxury of leaning on you for advice and consent to who to go see. How do our listeners and viewers who are trying to make their way through what has become a little bit of a weird world out there with the advent and growth of social media, sometimes those who are saying their pursuit of health and wellness and how they can help potential patients isn’t in pursuit of the truth, it’s more in pursuit of the clicks. So how do we help our listeners and viewers avoid some of those people and make better decisions when it comes to the right practitioners, when it comes to this very interesting opportunity of stem cells, which still has a long way to go in terms of its applications?
Dr. Dallas: It’s a great question. I guess what I’m going to do is I’m going to sort of partially dodge it.
John: That’s okay.
Dr. Dallas: I definitely can’t recommend anybody. I don’t think there’s any perfectly safe way to do this, and I can’t recommend anybody even [inaudible] finds a safe way to do something that is just so unregulated. However, what I will say is that there are some clinical trials being done. And so definitely I would not say it’s safe because that’s why if you enroll in a clinical trial, you’re signing a big form saying, “I’m getting informed consent, and this may not be safe.” However, if people are just totally decided and that they’re going to try something that’s experimental—let’s just not even say we’re talking about stem cells, but of course, that’s kind of what we’re talking about, but it could be anything—you want to be seeing a practitioner who’s working with an institution that’s gathering data and actually promised to not only monitoring outcomes and reporting side effects and gathering data but committed to publishing that data. So I’ll just say there probably are trials out there, clinical trials, looking at intravenous stem cells and other stem cells for various different conditions. So if you really were interested in this, find a clinical trial and enroll in an FDA-approved or properly enroll in a clinical trial where they’re going to measure outcomes, report those outcomes, and say whether or not it’s actually helping people. Not only that, they’re committed to reporting adverse effects, and potentially serious adverse effects. That’s my concern, that people have gone to Mexico, the Caribbean, even Europe, or Eastern Europe for various stem cells. I will say, in my experience, having worked at the various different places I do some of my work at, that patients of mine have come to see me after having gotten intravenous stem cell infusions, not through me, but just elsewhere. And on their way through in this whole trip, they ended up at our center, they got a lung scan, and it turns out that they had a pulmonary embolus in the lung. Now, is it because they were just flying? I don’t know. Maybe it’s just because they were on a long plane flight and you can get a blood clot. But as we said before, and as I will say, when you get an intravenous stem cell infusion, those stem cells—yes, there’s a homing effect and they will go to areas of the body that are injured. Fine. But they undergo what’s called the first-pass effect. And in an IV infusion, the first-pass effect is the lung. Over 80%, or about 80%, of at least in some studies show, that when you get an IV infusion, 80% of those stem cells get caught up in the lung circulatory system. Anyway, my point though, saying all this is that, were those stem cell clinics notified of those adverse effects, that somebody had a pulmonary embolism right afterward? Were they reporting it to anybody? Were they gathering that data? The answer’s probably no. And that’s my concern. I know I kind of dodged your question. I hope that answered that.
John: No. I’m going to put it a different way. Stem cells—exciting future probably, but this is baseball season. This is World Series season. Where are we? Is it just the top of the first inning, bottom of the first, or are we just on the way to the stadium and we haven’t even started the game yet when it comes to this whole journey of stem cells that are still yet in front of us?
Dr. Dallas: I think that’s a great analogy. We are somewhere between on the way to the stadium to just throwing out the first pitch.
John: So it’s early. It’s still so early.
Dr. Dallas: If you think about it, there’s so many better ways we can do this. Number one, you can engineer the stem cells better. You can probably make them more potent. You can make them less likely to cause an immune reaction in somebody’s body. Some of that’s already been done. But you can make them more tissue-specific. What organs and tissues really do need to get regenerated in some people? Do you need to get all those stem cells going first to your lung if you really want them in your rotator cuff or in your lumbar spine? Or if you’re dealing with kidney problems, you would want them to be infused directly into the kidneys. Could the delivery payload be optimized? Of course. Could the delivery mechanism be optimized? Absolutely. All of those things are, I think, in the future of where stem cell therapy is going to be. So for now, I think we’re just working with such a kind of primitive theory, hypothesis as to how these things are going to help people either get over pain or reduce inflammation, or reduce their biological age. To me, it’s just the kind of generic IV infusions, like a haphazard shotgun that’s going to maybe have an effect, but it just seems like we’re just at the very beginning. This can’t possibly be the best of what we’ll eventually be able to do with this technology.
John: Got it. Dallas, do you mind if I take a turn now? And I want to give some actionable opportunities to our listeners and viewers—things that have helped me, my friends, my relatives, my colleagues, working with you. Some very, very simple steps people could take when they’re on a health and wellness journey to just be the best they can be. Your protocol of blood testing, DEXA scans, full-body MRIs. Can you share a little bit about the importance of measuring what’s going on inside of your body, tracking it, and working with a great practitioner like you and your team to optimize the best that we can be based on the genetics that we were given and the environment that we live in?
Dr. Dallas: Yeah, sure. You got it. And we’ll do a quick on that.
John: Yeah, a little review for some actionable steps for our listeners and viewers.
Dr. Dallas: We spent this whole time talking about therapeutics and regenerative medicine.
John: [inaudible].
Dr. Dallas: And so, where I would go with this is that if you just think at the very beginning, why would we want to do any of this? It’s to sort of feel better and potentially treat conditions. Where we typically start is, first, let’s just make sure there’s not anything that’s currently really putting you at risk. In a lot of different models, we basically start with the idea that there’s four major leading disease categories that affect most people. Generally speaking, if you have to bet on it—85% of people, if you had to broadly say, are going to die from an artery plaque problem like a heart attack or stroke, cancer, Alzheimer’s disease, dementia, and then lastly, things like frailty, low muscle mass, falls, accidents, fractures, things like that. The interesting thing about all those major leading causes of death is that there are identifiable either direct diseases or the metrics or risk factors that underlie those diseases that are detectable decades before they become a problem. For example, if you’re talking about artery plaque problems, there are tests—not only blood tests but also imaging tests—that can identify artery plaque at the very earliest stages, well before they become a heart attack or a stroke. And we can determine if you’re a good candidate for that imaging, if you’ve got the appropriate blood tests. One of them could be, for example, not just your cholesterol panel but also a test like LP(a), lipoprotein(a), which dramatically increases somebody’s risk of developing coronary artery disease. That’s just a simple blood test. And you can go down that risk factor or sort of trajectory and determine if you need to get any scans further. For people of a certain age, there are compelling reasons to get early diagnostic cancer tests—things like a full-body MRI and an early cancer detection blood test. It goes well beyond the scope of this conversation. But if you’re thinking, “Hey, I’m willing to take the risk of a false positive diagnosis because I want to be proactive,” you can make the argument that you may want to do some of those things. And then, lastly, things like the diseases of frailty but also the underlying metrics that put people at risk for cardiovascular disease, dementia, and Alzheimer’s disease would be a physical fitness assessment with something like a VO2 max test where you can measure your aerobic fitness. We know that people with low aerobic fitness for their age, compared to high aerobic fitness, have somewhere between a 250 to 400% increased risk of dying of any cause if they just have very, very low cardiovascular fitness. So that underlies all of those conditions. And so, getting your fitness measured and having somebody help you improve it is, again, one way to approach healthspan. A DEXA scan, like you said, looking at your bone density and muscle mass—there are very, very key metrics you can get out of a DEXA scan that, when you review it with somebody who knows what they’re looking at, can help you see, “Wow, I’m really low in this for my age. This is something I really want to focus on because I have a limited amount of time before things become difficult where I can actually gain muscle and regain strength.” Not to mention things like balance and stability that can prevent the risk of age-related falls, fractures and other types of injuries. So that’s kind of an idea of where early diagnostic testing can come in to spur action.
John: That’s what you do with a lot of your patients, correct?
Dr. Dallas: Yeah.
John: That’s awesome. Dallas, I’m going to put in the show notes how our listeners and viewers can contact you if they want to become a patient of yours and other information about the longevity and regenerative centers and clinics that you’re the medical director of. I want to thank you again for your time today and your wisdom. It’s always fun to have you back to get an update on where this fascinating world of longevity and regenerative medicine is going. I’m just very lucky that I have a chance to work with you. So, I want to thank you again for your time today and for all the great work you’ve done for me, my family, and a lot, a lot of people that I know. You’ve definitely made our lives much better and healthier and allowed us to be the best that we could be. Thanks again for your time today. Thanks again for your wisdom today. It’s always a joy to have you on the show.
Dr. Dallas: Thanks, John. Have a good one. Talk to you soon.
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