Description

Hormone replacement therapy, testosterone, GLP-1 medications and peptides are changing how women approach menopause, metabolic health and longevity. Dr. Shoma Datta-Thomas explains how declining hormones can affect brain fog, sleep, insulin resistance, visceral fat, muscle mass and cardiovascular health, and why hormone health extends far beyond reproductive health.

We explore the evolving science of HRT after the Women’s Health Initiative, testosterone therapy for women, GLP-1s for metabolic optimization, resistance training, peptides, supplements, advanced lab testing and the growing role of AI in personalized longevity medicine.

LET'S CONNECT

Guest: Dr. M. Shoma Datta-Thomas, MD, FACOG

Website: https://www.next-health.com/team/dr-shoma-datta-thomas

Instagram: https://www.instagram.com/shomadatamd/

Host: Orshi McNaughton

Website: https://orshimcnaughton.com/

Instagram: https://www.instagram.com/orshimcnaughton

Substack: https://substack.com/@orshimcnaughton

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We probably overlook the low testosterone because it happens very early, so it can even happen in our 30s.

I'm curious, how do you define hormone health?

I think very generally you can think of hormones as the body's Master signaling network.

Dr. Dada trained institutions like John Hopkins and Monsignide and have spent two decades practicing as an obgyn.

What is the preferred way of replacing testosterone?

This is again part of the know your baseline.

How did you figure out that there's a relationship to long term cardiovascular, cognitive, metabolic health?

It's not just menopause symptoms, that it's all correlated.

It's so much more than just a reproductive.

Welcome to the Optimized Woman where we explore the future of longevity.

I'm Your host, Orshi McNaughton and I bring you conversations with the pioneers advancing human performance and health optimization.

And I share what I discover as I explore this rapidly evolving field myself.

Let's get into it.

And it's just I saw that as patients were going through, we're very focused on pregnancy, of course, and getting pregnant.

And after that, what happens, especially as you're a doctor who's aging alongside your patients, you're seeing that, or at least for me, I was seeing that some of the tools maybe were not there in as a robust way.

What happens along what you have to modify for your life, lifestyle, your diet, your exercise, your stress, your sleep, all of those things that I were seeing, I was seeing really in more and more patients coming up as really debilitating factors.

And I wasn't seeing that.

I had that really strong focus on those aspects to support people through that.

And so that led to, wait a second, hormone health is at the basis of all of this as well.

So it really was a very natural transition.

As I got more curious about kind of the bigger holistic approach to health healthcare for me, I was very focused on surgery.

So robotic surgery was the basis of my practice.

And especially endometriosis, fibroids and fertility and those pillars of lifestyle medicine was really what came up as maybe a differentiator for some of my outcomes.

So do these big massive surgeries.

But there was a difference from my patients who had all of that in place, maybe also alongside hormone replacement or the other lifestyle factors as well.

And I could really see a big difference.

So I got very curious about those gaps that I was not filling for my own patients with all of the lifestyle.

So as I get curious about it more than 10 years ago now, it has now evolved into this term of longevity medicine.

But for the hormone Health or any experts in hormone health, I think we feel it's a very natural transition and maybe happy that I always say women's health is the girl finally getting asked to the dance.

Right.

We're finally in the spotlight and I hope it holds because it is so important.

But that transition between women's health from a hormone aspect, GYN and especially GYN aspect was a very natural transition into longevity.

Yeah.

And at some point, when midlife hormone changes, once you get into hormone therapy, how did you figure out that there's a relationship to long term cardiovascular, cognitive, metabolic health?

It's not just menopause symptoms, that it's all correlated?

Yeah.

I think, and I would even say it's fair to say before I really got into the field deeply when I was deciding and as a student, you really think of OB gyn, women's health as just reproductive science.

Right.

So when we think of hormone health, I realized, first of all, I was just hearing the number one issues that women were coming to me with and I, I had a small boutique practice I was setting up.

I was thinking I was going to do procedures and more, more up my alley types of things.

But the women who kept showing up were really struggling with debilitating symptoms.

And they.

Now I realize we're all just really smack dab in the middle of perimenopause.

But it's tricky because these symptoms can look different for everybody.

They can be addressed differently.

But the symptoms I kept hearing over and over, and I am a little embarrassed to say it, but I'm just going to, because I can't be the first OB gyn.

But when I first graduated residency, now quite a while I didn't make the connection of the brain fog, the change in weight composition like that midsection change and change in muscle mass, the insulin resistance, all of those, I did not connect.

And I was never really, I would even go as far as saying I was never really trained in that way, that these are all symptoms of the same process and this really complicated systemic change that's happening with perimenopause and menopause.

So as I was listening with, gosh, I keep hearing about brain fog, sleep disruption, change in weight, and now I'm seeing, oh, they're having high cholesterol, they're having prediabetes.

It really was through my patients that I was seeing, where are they struggling and understanding, hey, this is something that is a pattern and very consistently an issue that is causing these metabolic shifts, not just this regular period or no longer in the age where it's easy to get pregnant.

But it was so much more beyond that.

And I realized even in myself, I wasn't addressing that with my patients proactively.

I was just observing.

I really love the framing of hormone health as a foundation of longevity.

And hormones is a longevity system, not just reproductive system.

I think our entire body, everything is connected to everything else.

So looking at it more as a systems approach is so important.

But I'm curious, how do you define hormone health?

As women, we go through different stages of life.

Obviously, depending on how old you are, your hormone health will look very different.

So maybe you could just tell me first of all, what is, what do you consider hormone health in different ages?

Yeah, I think very generally you can think of hormones as the body's master signaling network.

Right.

Because when we, sometimes when we think of hormones, we think of estrogen, progesterone, testosterone, those are really the category of sex hormones.

But we are often not including.

And when I started opening up the vision a little bit around it, insulin, cortisol, our stress hormones, there's thyroid hormone, there's a whole complex orchestration of what's happening in addition to those sex hormones.

And they really are all a fine network of signaling molecules.

Now with natural aging, of course, we do see for, see changes with that.

So a reminder that, you know, for estrogen, for example, estrogen receptors are in hundreds of tissue types that we have.

So yes, of course it's in the typical reproductive organs, but also the brain, the heart, liver, skeletal muscle, our inside of our gut lining, all of them have estrogen receptors.

So that just shows you how important it is through across all systems, not just the reproductive.

So really I'm just taking that as one example.

But this careful orchestration and network of our signaling factors of the hormones is really what I consider hormone health broader than just sex specific hormones.

But they all influence each other.

It's really amazing how interconnected they all are.

And these I think are the reasons that we do see and one great example, one really high quality study we look at actually fairly recently, 20, 23 in the SWAN study did show that change in the acceleration of those metabolic shifts.

So cardiovascular risk markers, the visceral fat accumulation, when it's going to the midsection, which a lot of women note, even if that's never been an issue before, and insulin resistance.

And so we see it as a systemic aging.

Right.

Fueling the fire of aging.

So if we think about it there we have a lot more, we have a lot more of an empowered approach to target it with tools, it's a.

Big symphony orchestra with all the different hormones.

Right.

You could have one little instrument that's out of tune and it really affects everything else in the system.

I love that analogy.

It's very, it can be very harmonious or not.

Right.

It could be very disharmonious as well.

So I think that's actually the perfect analogy.

Yeah.

Because as you said, I think a lot of women think of hormones as sex hormones, but they don't think of their adrenals or their thyroid or when I'm fatigued, related to my sleep or my circadian rhythm or how that's all actually correlated with the within the symphony.

Right, Absolutely.

And the sex hormones being just one piece of that puzzle.

But talking about sex hormones, we have to just mention quickly the Women's Health Initiative, which sort of dramat shaped how physicians view hormone therapy for two decades.

And as the science has evolved since, what do you think clinicians understand differently today?

I think it's funny because with the timing, I was finishing up training just as that data came out and it was the fear of God in us to start these new prescriptions.

And I think the more it went on, you just saw in front of your eyes, wow, these women are really struggling.

But the some, the few who did get the hormone therapy I just saw were leaps and bounds above in quality of life.

And then longer term I saw the metabolic health.

So it just wasn't making sense that it was just such an absolute blanket statement.

And the truth of the matter is these were good investigators who was medically sound.

The initial goal was actually to think about more of the long term and if it contributed to higher mortality.

Right.

So what they did was sound.

And.

But in the investigation, kind of the interpretation and the data got ahead of the medicine, which often happens, and the messaging became a little twisted.

And unfortunately it's had probably about two decades of repercussions.

Very sadly now I see women who.

Are.

And now they're just.

First of all, they've struggled with sleep, bone density, intimacy, mood, all of these things for so long now.

So to answer your question, how, how should we think of it now?

I think the biggest, maybe data backed entry point can be the critical window.

Right.

The critical window of timing of 10 years within menopause or under age 60.

And I think even the all the societies agree on that data.

The reality is whi that the groups were averag of 61, 62, 63.

But that's not our average patient who's coming to us.

Typically it's late 30s, 40s, 50s, and the risk is much less in that period of time.

And again, actually some Danish data had really supported that the earlier you can give it in the course of perimenopause and menopause, the more metabolic advantage you had in terms of those health factors we talked about it is a shift.

I think timing is important and it's a really an individualized risk assessment based on family history, personal history, what their goals are, what your symptoms are.

And so I think it's just, it should be an open discussion.

I think that's the biggest thing is I started realizing, hey, why am I not talking about this as something to expect with my patients when they're in the late 30s, in the about to hit the 40s when we see the start of these changes, it should be counseling that's actually ongoing.

It doesn't mean every single person has to get on hormone therapy.

But I think as doctors, it's a real miss if people aren't prepared.

And I think I even realized that patients said to me all the time, gosh, we always talk about puberty and pregnancy, but what about this thing that God willing, if we reach that age, we'll also get to as well?

Why does anyone prepare us for this?

And that just really shows where the system has had a big gap.

So I started every time I was seeing my patients in their late 30s, just talking about signs of early menopause, signs of perimenopause, signs of late perimenopause and then menopause.

And just to say, hey, these are things you can expect, these are ways to manage it, even from a lifestyle point of view, even from some non hormonal therapy point of view, and then some obviously more I'm pretty pro hormone replacement where it's safe having those discussions early because a lot of women come to us and they can't sleep, they can't be intimate, they have maybe bladder infections and the brain fog.

Unfortunately, this is a time when.

These.

Patients may be dealing with a lot on their plate professionally, a lot on their plate at home.

And it's just the worst time to be dealing with this type of added challenge.

So all of those are really great aspects to have foresight on.

Right.

It's not terrifying when you're feeling the brain fog.

It's not terrifying when you're feeling those palpitations.

It's Not a complete mystery while you're doing all the same things and your weight is gaining or your weight is shifting to the midsection.

Right.

So going in educated and then talking about pretty early if you are somebody who's a candidate or not, for what types of therapy Is hormone therapy something that is in the cards as a choice and then you can make that decision when you get there.

But it shouldn't be this under pressure, really suffering type of point of view where you're going into it.

Thank you for educating people because this is what I'm trying to do too with the podcast is just putting the word out because the allopathic system really hasn't caught up yet, even though the FDA began rolling back some of the legacy box warning language on hormone therapy, especially around cardiovascular disease, breast cancer, dementia.

But it feels like the signal that the field is finally moving, hopefully beyond the shadow of the WHI arrow.

But it seems like the allopathic space really hasn't caught up yet completely.

And it's probably going to take a decade.

I think it just moves, usually really slowly when it comes to standard of care.

How do you see that?

Yeah, I think one thing I'm seeing versus, say, the first 10 years of my career is that just information is so much more available, so very much thank you to podcasts like yours and other voices out there.

It's much more of a conversation getting into people's homes and sometimes it gets into their homes before it even gets to the doctor's office.

And I really think that's okay because I don't think it's something where it's questioning.

I think as doctors we have to be humble enough.

And I try to be, obviously, I try to keep up.

We graduate residency and fellowship and it's not as easy to keep up with all the academic data.

You're very busy.

But I think it is a duty to understand that there may be new things and if you didn't learn it in med school or residency, there are a rise.

These things are going to change.

And constantly trying to at least keep to keep up with some of the more updated data, which is already hard, especially in the system right now.

There's a lot of work life imbalance and a lot of pressure and dissatisfaction, but we do have to keep up.

But I also try to use sometimes my patients as educators too.

They.

And I'm not.

I'm very open.

I haven't heard of that, that, I don't know, supplement or that study or whatever it is, but then we can be More collaborative.

And I think it's honest.

And I will always, sometimes I'll even say, hey, you know what, that's something new to me.

Let me look into this and I'll bring back to you what I found.

And then we can make a shared decision.

I think as doctors, we're so afraid to say that something requires further investigation or further thought.

And if the first time.

There's plenty, there's, I would say, a good number of things these days that maybe patients will know about beforehand because of social media, podcasts, AI, they can look up their own symptoms and treatment options and hey, but let's use that to our advantage, right?

We don't have to use that as something that's a threat.

And maybe we can make the whole situation better all around us.

So that's how I address the opportunity for education.

It may just not be in the way that we thought it would once be, where doctors are always educating patients.

But again, I don't think that's a bad thing.

I think it can be a group effort.

So with women, you mentioned that hormones are the foundational longevity layer.

What are the other major biological system we should be looking at for women's just health optimization and longevity?

Sure.

I first had this idea because I found myself saying a lot of times, hey, now that we're in perimenopause or even in 40s, we have to really prioritize heart, brain and bone.

And I just kept saying that over and over.

Heart, brain and bone.

Now of course that's not an exhaustive list and other, other systems are very important.

Gut health is a very important part of how our hormones and neuro, neurotransmitters are regulated.

But I always have the focus there because if you think of most of the preventive health, or I would even say preventive health opportunities based on what are the highest rates of mortality.

That is heart disease as number one.

And so for what we see for heart disease, again, we know there's estrogen receptors and everything on the cardiovascular tissue as well, but we, I think it's been overlooked because typically the, the most serious sudden cardiac outcomes were in men in their 50s.

But women still have some degree of estrogen protection there.

So for us it's more coming up in the 60s.

And it also looks different.

It's not the made for TV like clutching the chest and all of these very typical signs, but it's a more silent.

What are the top three signs of heart disease for women?

There are definitely.

Yeah, there definitely still is.

Of course, a Generalized chest pressure.

But a lot of times actually in retrospect what women will realize was yes, I was just getting much more generally fatigued, much more kind of generalized discomfort, sometimes even more nausea, sometimes more heartburn type of feeling or more associated with like digestive types of symptoms.

And it may not be very focused.

Crushing chest pain rating down the left arm, those can be there but oftentimes these can be sometimes even silent.

So we have to stay on our data because it may, it's not always going to present ourself and I think it was maybe about 40 to 50% of cardiac events can be silent and the major in the majority women present that way.

So we have to just understand it's something different.

This is one of the reasons.

So how do you test for it or how do you screen?

Yeah, I definitely and something that I was attractive to me as a doctor working at Next Health was really centering, testing early and often.

And I will tell you when I was in residency or training it was a little bit of the opposite.

We were gating lab data and lab work.

And I think it's reasonable that you don't need a ton of lab work, you don't need these expensive cash pay panels and very extensive things.

But I do think it's a miss that thinking of myself even as an OB gyn, we weren't doing blood work every year, we weren't checking on them and I think it doesn't mean that something has to be wrong.

But even getting your own baselines and your foundational understanding of actually my hemoglobin A1C what actually is that?

Or even look thinking about sex hormones.

Oh wow.

I'm starting to see this little bit of fluctuation or trending down.

So looks this is something that's happening for me in the numbers.

So I think some very basics I always talk about are I, I, I do really like to test hormone levels.

So around our estrogen, our total levels, our fsh, our MH is very tied to our fertility.

But I always think one thing I was missing a lot was also testosterone.

So testosterone and free testosterone.

And I know you'd have had that talked about here before but that I, I always say testosterone for women is the hill I will die on because I did not treat it or even test it or acknowledge it for women a good portion of my practice.

But once I was going and doing the self education and realizing how much women were struggling, it's something that kept coming up and over again and that's especially I think I Probably we probably overlook the low testosterone because it happens very early.

So it can even happen in our 30s.

And then the progesterone is the first.

Once we're having more perimenopausal changes that peri.

Then the progesterone is declining and then estrogen.

But we're very focused on the estrogen in general.

But we may have been undergoing 10 years plus of hormone changes with testosterone.

So that's another opportunity that's really highlighted when you're testing early and often if you don't have access to the testing, we can obviously still make very good educated guesses based on your symptoms, your period, all of those things.

But I do think if you have the resources and access getting those at least once a year when once or twice a year even for screening when you're in more of the 30s, late 30s.

And then if you're course correcting or as you're getting closer, like every six months, I think it's good to know it's not a must.

I absolutely agree it's not a must, but it can be very empowering and seeing the data long term for yourself and tracking your own path.

You mentioned testosterone.

How often do you test it?

Impair menopause versus menopause.

A lot of women, I think testosterone can really fluctuate, like even day to day.

And based on if you worked out or what you did, like your testosterone level can be very different.

How do you get that dialed in?

How do you figure out sort of the right amount for the right person?

And do you at Next Health, do you guys do more like a compounded cream or injections?

And what is the preferred way of replacing testosterone for women?

Again, if we.

This is again part of the know your baseline even when you don't need to know.

Right.

And I think the same for men too, to be honest, for everybody, anybody with men in their lives that they love.

I think it's also something that is changing a lot in our 30s across, across genders and something to know where your level's at.

So that way those little fluctuations to your point that are happening daily, monthly, year, yearly are a little bit more obvious.

Like testing just too frequently is a thing, but if it's just at longer intervals and you can trend your data, and we know some general trends, right.

It's gonna peak in the morning.

It will be affected by all of the things you mentioned, even sleep, stress, all of those things will affect it too.

But I think you can have a general sense of where your levels are and where they're trending over time.

Symptom, symptom question.

I guess questioning around symptoms and understanding symptoms is obviously a huge part of it.

And I think for hormone health, equal to, if not more important because it really does tie in.

And I think you use both of them because there can be a little overlap.

So testosterone with some of the things we see immediately change in body composition, energy, mental focus, clarity, mood, irritability, libido, sexual function and response.

So all of those things are things that patients may not share proactively.

So really opening up those conversations around some things that sometimes may be more hard to discuss but may not even.

Sometimes the dots have not been connected yet.

Oh yeah, actually I do have that sleep disruption.

Oh yes.

I have started noticing these little things.

So really asking the right questions around the symptoms combined with the lab biomarkers I think is really where the magic happens.

And for me goes beyond just looking at one or the other.

I really do like that combination.

For me, I've used that, that combined approach a lot more.

But you can definitely do a lot with just symptom discussion and management.

And if you have to minimize the.

Blood work, when someone comes to you and you're trying to put them on a hormone replacement therapy program, do you try to get their estrogen progesterone dialed in first and then add testosterone later, or you do everything all at once?

Typically, we'll see an earlier change in baseline levels with testosterone.

So if they're on the younger side or very early perimenopause, that's usually the conversation I'm having first because oftentimes the estrogen and progesterone biomarkers are fine, but they're still having these symptoms.

And in that range, it's usually more tied to the testosterone.

I didn't answer from your last question what types we use.

So I should be clear that today there is no FDA approved testosterone replacement for women.

So we either have to use male versions and dose it down for our females.

So that can be done with some FDA approved forms for men like testosterone gel, and then just use a fraction of the dose that they use.

I do use compound pharmacies.

I've worked with compound pharmacies for quite a while now, over 10 years.

And the honest truth is when you have a good compounding pharmacy partner, you learn a lot from them.

And I've learned a lot actually about hormone health from compound pharmacists.

And obviously you have to veri.

You know, to have the discussions early.

When we diligence vendors or New pharmacy partners about their sourcing and like good, good consumer practices and the facility approvals and certifications.

And so all of that is important.

But compounding has been a pretty big staple for hormone hormones and a lot for a long time.

And I find you can really dose very specifically, very individualized, really well for the patients.

And it's not everybody's thing, but I think there, there is a lot of opportunity there when you have a good partner.

Typically either using a gel that has been approved for males, there are compounded topical creams that you can use and sometimes they can even be combined with your other like anestradiol.

There are in injections but again of course this is off label.

So there are male injectable solutions for testosterone sapinate and you can use like these really micro doses, not as common, but I've actually been seeing it a lot more more recently.

And then there's even pellet therapy.

So where there's a small, a small little compounded, again all compounded pellet that's put right under the skin.

And so again I think for the right patient, if you have a very forward discussion and even with pellets or these other forms even versus five years ago, I think patients are very aware now of these options and how to assess them, when is it right for them.

But you obviously still as have as that shared decision making have to be very upfront about.

These are, this is the regulatory status of it.

This is not, this is the thing.

These are the things we look for and how we use it.

But we've been doing that for hormone health for quite a while with the pellets.

I think they get a bad rap in my opinion because we put them in the hands of anybody.

Right.

So when I learned pellet therapy I was, I was already an OB GYN doing extensive hormone therapy for over 10 years.

And I understood when they, if there were side effects, how to manage them, what were the issues, what were the risks and for each patient.

But I was seeing a lot who were not familiar with hormone health at all just doing this.

And so honestly I think we just didn't put, always put it in the right hands.

And like many things I can get maybe not used in the most expert ways.

So it does make a difference.

But yeah, so we have a lot of therapies of course, even just to stay at next health.

We also use the very traditional methods, patch, micronaus, progesterone, all of those are staples as well.

So after you got the hormones figured out and you have a Midlife woman comes to you, what other highest impact interventions do you have besides hormone replacement therapy?

Something that you think about immediately?

Yeah, and luckily I think we're hearing a lot more about the dialogue, although it can be as an individual hard to know what applies.

There's still one other aspect of prescription that's been really interesting and we're seeing some synergies with this category of GLP medications in terms of even now having like even data from either semaglutide or tirzepatide on the synergistic effect of using both.

Because sometimes that weight optimization component has not quite corrected yet and this can be the way to level up on it.

That combination can also be very interesting and we're seeing more data on that now and then obviously a lot of data on the GLP category in.

And are you saying that the semiglutide and tirzepatite together, is that what you meant by.

No, no.

Together with the hormone therapy.

Oh, together with the hormones.

I see combination.

Once the hormones are dialed in, somebody still have some metabolic health challenges or need to lose weight.

That's when you maybe introduce.

Yep, you can still consider it.

So most of the outcomes we're looking at weight loss, but we do know then looking more into the glps is also an advantage for this patient based on the anti inflammatory effect.

The what we're seeing with cardiovascular protective effects, we're also now seeing it although the data is mostly around diabetics or those with full disease, around liver health, kidney health.

This just really the scope is pretty promising, I think.

So that is another great.

Since we're talking about prescriptions now back to the basics though of what you're asking the other interventions.

So we always start with the basics around diet, movement, sleep and stress.

So diet, of course I think I see a lot of talk around improving your protein intake and really managing.

I like to frame diet in terms of how are we optimizing your individual insulin metabolism.

Right.

Because that's really what I see.

Another hot take is insulin management as kind of our gateway into optimizing longevity.

And so that really has a lot to do with number one, the changing insulin sensitivity of anybody with natural aging.

Meaning how well are we managing our blood sugar and our glucose as energy, as storage, as using it for fuel and all of the downstream effects that it has.

So I think that really does support the higher protein, higher fibrous vegetables and fruits that really do keep the blood sugar varying, stable.

Because when we see that's really giving you spikes and big ups and downs, that's when we're triggering a lot of level inflammation that can affect our fasting insulin levels, our hemoglobin and A1C, our three month average levels.

And that's very closely tied to our chronic inflammation.

Our cholesterol panel, we know that's very tied into heart disease outcomes, diabetes outcomes.

So it really is tied in together.

So with the diet, diet, like the general framework, eating for your insulin management does tie into high protein, high fibrous fruits and vegetables.

And then resistance training of course has been a big thing.

I think we're recovering from the, the days of just cut your calories, cut the number on the scale, cut your, your kind of caloric intake and just go to the minimal and then just do cardio all day.

Right.

So there's obviously the good role for cardio, good role for all of it.

And I always say no, any movement is better than none.

Right.

And then as you have more of the opportunity, we're busy.

So if you're trying to think of where to put the bandwidth, that's really when we see more out of the movements that support more of our lean muscle, which tends to be strength and resistance training.

And for women, not only for strength and structure.

Right.

So I always say muscle is definitely a part of that and knowing issues around just mobility, posture, all of those things, things long term strength and structure is very important for muscle, but it is in and of itself helping how we manage and, and how we manage our glucose intake, how we transport glucose throughout the cells.

It very much is its own organ in many ways in terms of signaling around inflammation, hormones, anti inflammatory factors.

So that's, it's not only for strength and structure, but it's very much a metabolic tool.

Sleep is obviously very disrupted for many people and we know that's very to many things, obviously energy, fatigue.

But if you think about what I was saying about heart, brain, bone, that's where for our, I call it our clean out with the glymphatic system around our brain.

If we think about memory consolidation and just getting rid of metabolic debris in the brain, it happens during sleep also we know that all of the disruption triggers so many other things during sleep.

Your cortisol, your insulin, all of those are affected.

So it very much is a metabolic problem.

And then stress, as I said, this is a very key time in women's lives that we're undergoing all of this.

And there's also a metabolic process behind stress.

But I, even though as much as we talk about metabolism and for stress, obviously things like our breath work, our downtime.

The reality is we're not going to be able to often manage away our stress.

So it's more about how we take it in, how we mentally process it, how we physiologically process it, where we're bringing in community support network.

This is such a crucial factor and we see over and over again how much community and engagement keeps keeps longevity healthy.

It's nice that there is really this holistic approach.

And that's actually the next thing I was going to ask you is to describe the core philosophy behind sort of the Next Health clinical model.

I think you covered a lot already, but what does this look like for the listeners that don't know?

Next Health is a longevity clinic franchise that's rapidly expanding across the US with beautiful clinics.

So how would you briefly describe the core philosophy behind the clinical model?

Yeah, I think at the core of it we really are focused on optimizing vitality.

So that's across many different systems.

And we're really coming at it from an approach of true proactive management and true optimization.

So we are not for everybody and we fit in somewhere on the bench for people differently.

But what we do is go in a few different segments.

So thinking of how we bring in our preventive health, really focusing on what we can do early for our heart, our bone, our brain, our bone, all of those kind of early on.

So the, the, the core is often the lifestyle medicine, nutrition, movement, sleep and then the preventive medicine.

So heart health, brain health, immune health, which includes cancer, functional medicine, which is where we have a lot of the concepts around our gut health health, our hormone health, those types of axis which are a little bit, I feel different from the traditional medical system.

And then the longevity medicine, which is sometimes I say our shiny new toys or more of the innovations around things like stem cells, exosomes, plasmapheresis, peptides, all of these things.

So that for kind of lifestyle medicine, preventative medicine, functional medicine, longevity medicine, that's at the core of a model called our wellness wheel, which Dr. Shah, Darshan Shah founder, co founder had developed.

And we really try and take every visit or every evaluation kind of for patients through that wheel and just say where are we doing great?

Can we do better?

Or where are we needing to course correct.

And it tends to cover a lot of bases.

For all the bases, longevity medicine could theoretically include hundreds of interventions.

How do you in index help?

How do you decide which treatment categories actually belong in a longevity clinic?

I think we cover a lot, which is not easy.

Anything From a vitamin shot to plasmapheresis and stem cells.

So it's a big range.

But we do pride ourselves on being able to meet all comers wherever people are in their, their health journey.

Also, let's be honest, in this longevity world, there's a difference in terms of budget and what people are capable of doing.

But we try to get engaged in an ongoing relationship with our patients.

So as members thinking of this as a, we don't want it to be a one and done visit or a one time treat treatment and then you're out the door.

It really is planning a meaningful maybe even timeline of a year or so and maybe quarter at a time.

But that way you can really understand what is the testing showing us, what are the first things we have to look at, right?

So often I'll just say, hey, let's just pick two or three things.

This is what we're going to focus on for month zero to three and then we can start layering in the next steps we need.

And then eventually, hopefully we can take advantage of the wide range of things that we have at the right time.

So what do we need to focus on first?

If we're course correcting, that's always going to be the first quarter.

And then how do we continue to optimize and stack in our treatments so that we're continuing to build on that framework?

And so we talk about building layers of makeup or something like that.

We're really building layers of what the best approach is towards optimization for each person.

I think people always want to have everything all at once, but it takes time.

And I think the framework I'd like to, to explain to people is it took you a decade to get to this point in your life where you have all these issues.

It's not something we can solve overnight.

And it takes time to kind of unpack all that.

So I appreciate that approach.

Now one of the tensions that I see in longevity medicine, functional medicine optimization, is personalization versus sort of scalability.

How do you standardize care across, across a growing clinic network while still offering precision medicine?

It's very hard.

And I have a role where I'm, I see patients 20 to 40% of the time and then I have an operations role.

So I'm the VP of medical operations across the company.

So I'm very involved in our franchising and it is not easy to prioritize as a company.

Brick and mortar locations and medical providers at every location.

And I do say that with a lot of pride because, because those are not easy Things to put in place financially, training wise, finding the right personnel.

We do have to rely on a lot of education and so that means all the way from people who may be the first person to talk to that patient is often at the front desk.

How are we educating even from that level all the way up to your experience with your provider.

And again no medical provider is coming in having measured in longevity.

Right.

We are still very much putting this together in terms of what the expertise is and we also do procedures on top of that.

So we have, we attract providers with specialties, typically with some type of procedural background.

So we've a lot of us have been through.

So I had a very, I was an obgy mind but very surgical background.

Our Dr. Shah was actually a surgeon.

So a lot of our providers, medical providers have had some type of hands on which is interesting because then they can kind of do the fun procedures at the space also.

But we really try to have a lot of focused training starting with the medical provider because that's who is going to set up the treatment plan.

So where do we go?

And it's a mixture really very much.

It's a very much a mix of the traditional medicine, so the cardiovascular metabolics, the traditional, sorry the more of the traditional health principles.

And then it is now this arising field of longevity which also has some functional medicine into it, some of the procedures.

So it's very specific that we have to set up this training opportunities for, for the medical provider teams.

And so we have training once a week, we have our meetings and so there's operational updates.

But we drew Torah to put some form of training in every, every hour meaning too because the honest truth is we need it.

We've also released a lot of new types of technologies and innovations and we're still startup style in many ways.

So we have to really be on top of how we are changing our offerings.

So that is a big challenge I think for our medical providers too is keeping up with it.

But that's why we really look for providers who are living it right.

Most of us in the longevity world are listening to all the podcasts, doing a lot of self experimentation or with a partner or with a family member.

We live it on the clock and off the clock and so we realize we have the responsibility of constantly advancing our knowledge because this is definitely an ever changing field.

So the training is a huge way and in this that sense we hope to be able to deliver more of a universal experience at every next health you go to.

That's amazing.

I know the Clinical government structure must be very com.

Like difficult to come up with because as you said, it's such a emerging space where you have new therapies like peptides and regenerative medicine and advanced TTOX technologies.

And you mentioned plasmapheresis and things that are very new.

And I'm sure most doctors and mid levels coming into your practice are not familiar with a lot of at least a good portion of what you do.

So you have to train them.

Yeah.

And so we need good partners.

We are very diligent with all of our anywhere in our supply chain, whether it's bigger pharmacies or a new lab test or, or plasmapheresis devices.

We really engage very closely with all of our partners because we have to train, like I said, from our person answering the phone to the nurse, delivering the treatment to the medical provider recommending the treatment.

There's a lot of levels of training and so we want to number one know that these partner companies are in it for that quality of delivering the services.

And we get a lot of support from partners like Vibrant Wellness, the Optia Spectra is the TPE that we use.

Our pharmacy vendors, we do a lot of education with them.

So it's an ongoing process and I think we'll never stop learning.

But that's very much this, this field, but doing it collaboratively.

The thing that's been really exciting with developing the provider team is we have so many kind of in house experts on different aspects of this already.

So some are actually hormone health trainers themselves or some cell trainers are coming from different backgrounds.

So I do feel lucky that we can really learn from each other as we're all figuring out this, this common field.

And you touched on peptides already.

We talked about GLP1s briefly, but they are just Peptides as a category is one of the fastest growing area in longevity medicine.

But they're also somewhat of a regulatory gray zone.

How do you approach peptide therapies responsibly?

And I think that's really the key is doing it responsibly.

We basically, and this goes across all of our prescript and all of our therapies is that you do have to do it alongside a medical provider recommendation.

So everybody, whether you're doing hormones that are very old therapy or something like plasmapheresis and now with peptides relaunching them actually as a company, everything is done alongside.

So it's not just a mail in questionnaire and then peptides show up at your door or even less regulated.

So our process is you have a standard blood Panel, a consultation with a provider and then they are individualized for your goals.

And then we continue to check in and have check ins every quarter and labs like when appropriate.

So at least every six months or so.

And again we do a lot of training.

One really great partner has been Progress Pharmacy New BioAid.

They're very committed to training.

So we take training anywhere we can get.

And when we find good partners with good integrity, that's really who we'll go go with.

When we diligence our pharmacies, we also have certain documentation, certification, all, everything around all of our ingredients.

And even then it's tricky and there's new players all the time.

But we really do require a certain level of proof of different certification and different quality assurance.

And again that availability on their end too of that it's medically backed, medically guided.

They have medical directors, they have their own protocols in place and are very, very involved in the process of distributing it to patients.

And then the honest truth is we still have to have very honest conversations with our patients.

And most, I would say most that come to us asking for peptides understand that this regulatory landscape is quite complicated and tricky.

So we always have to, we always say kind of where we get it from.

They can have the information obviously as some of them have even reached out to the pharmacies themselves for massive push for transparency and understanding.

Hey, this is just what this is right now.

I think the FDA regulation, while it was intended to promote safety, did and I think this is one of the quotes that it did create the gray market and they again just kind of the cock got out of the bag ahead of medical regulation.

So I'm excited because I think this is an area that again is an area around signaling molecules.

And again these actually we have naturally a lot of them and we tend, we tend to see patients do very well, sometimes even better tolerated than hormones, a little easier, easier in many ways.

But we do have to do it with clinical diligence to have a medical oversight there.

My approach is three pronged.

One is training.

So we have all of our providers trained in some of the more established peptide training programs.

Our marketing is very responsible and we don't want to falsely mislead anybody or make any claims or anything like that that are not representative and that we just don't know because that is the truth.

Sometimes long term outcomes and long term clinical data is not there in the most robust randomized controlled trial way.

We probably have more real world data than that type of clinically rigorous data.

And then the last is our sourcing.

So really having very specific onboarding requirements and diligencing process.

So those three.

So marketing, training, sourcing has been how we approach it and.

And as is consistent with everything we do, it's very medically led and always requiring consults and blood work.

Yeah.

I just want to reiterate when you said of training and sourcing and these partnerships that you form are.

It's so incredibly valuable because a lot of clinics, like they don't realize like how much work and effort it takes to find the right partner, the right sourcing of like peptides and different things that you offer in your clinic and the right compounding pharmacies and the right really the right partners that can deliver the quality, that quality and consistency that you're offering to your patients.

So that is a huge value that people can get.

And I think that's one of the beauty of standardization like across a franchise that when you create that, it's like when a clinic opens in another state, they know they are tapping into already these established relationships and sourcing and which is very important.

And I think a lot of people that may not be familiar with like random clinics that they're just led by one physician or doctor, it really varies.

So much of depends on the that particular practitioner's training, what they've learned, how much they practice, like how much experience they have.

Working with people, what kind of relationships they have themselves is just.

This is why I think a lot of people have gone to so many doctors and physicians and may have not seen great results because really the quality varies so much of who you go to to in this space.

And so I think for like creating a trusted environment and hopefully that's what next health will bring in this layer of trust when you go in and you know, you can expect a certain level of standard of care when it comes to standard of care for functional medicine, longevity medicine, which is a new standard just being created now.

It's not something that existed ever before.

Right, so this is something brand new that you guys are pioneering.

Yeah, absolutely.

And a lot of the.

The blueprint is not there yet for us.

So I think we feel even more responsible that we have to do it with great diligence and intention.

And another component, we always try because there's so much regulation around this.

We do try.

We incorporate a lot of legal guidance and have a legal team as well.

What is it now?

What is it today?

So we can stay on top of it and protect from that aspect as well.

But all of this is hard all of this is hard work.

So I think sometimes you have to make decisions that are maybe not good for business, but they're good for the patients.

And that's always the way we have to go and the way we'll lead and then everything else will follow.

But we really have to say just beyond patient centered.

I like to try and think of being patient obsessed and if you are asking questions and if you're trying to make decisions, because there's a lot of decision fatigue going on, but if you can really pan out and just say, oh, okay, how is this affecting the patient?

It will lead you to this, the right next question, or they will lead you to the right solution in most cases.

And it may sound a little naive saying that, but that has to be the North Star as a healthcare company, especially where we are, where we're really again, flying without a map sometimes and have to figure out the course along the way.

So good partners, high integrity, prioritizing and being patient obsessed and finding partners who think that way has been really important for us.

I also wanted to just touch on supplements and nutraceuticals in general because that's another area where there's a lot of variability.

How do you create sort of a standardized approach?

Is that practitioner driven?

Is it lab testing driven?

How do you work with supplements?

It's a very tricky area right now, I think, I think it's really exploded without.

Not because we've advanced so much in the science of it, just because the commercial appeal and this, this interest.

So again, probably lacking the regulation we ideally want.

And I go again, I.

At this point, it's funny, I think I take patients off supplements more than put them on, is the reality of the patients we see these days.

And when I ask why this one or why that one?

It's a lot of times I saw it on Instagram or my friend is taking it or all of these kind of, of these, these funny decision making.

But it just shows me it's just because there's really lack of guidance and understanding.

Right.

So there are obviously some, some nutritional recommendations across populations, but again, it's across populations.

So that can incorporate a lot of different, a lot of different types of patients and medical issues.

So I find people don't always know what to focus on.

I think there are some really good core, core supplements that we see.

So like a vitamin D, omega 3, you know, magnesium, something for the gut, maybe a probiotic, maybe glutamine.

That covers a lot of, a lot of the basics that we see.

Multivitamin I often at this point, if somebody has a very good solid diet, I will often go buy more of the micronutrient testing because I don't want to throw things at you that you don't need.

Right.

So I look at what actually is a gap right now.

First try to replace it with food because that's often something that you can do.

And then if not then we'll add in a focus supplement also.

And again testing is interesting here because we will find sometimes things issues around methylation or something like that in some of our genetic testing.

And that's a great tie in to actually supplements and a good reason to test because that tells me that your metabolism around your B vitamins and certain processes like that is a little bit different.

So we can pick your supplements wisely.

And then I guess just to say I want proof that we need it is the way that I think of it.

It has to be appropriate for your risks by age, your individual risks.

What we're seeing is deficient in your testing and if you don't have testing, that's okay just going by, going by the general like age related needs.

And I also will routinely rotate.

So let's have a certain focus just for a short period of time because I think people start a protocol and then add on and then add on.

And then add on.

Then you're taking this huge menu here.

So you know, it can be something you're rotating in and out.

But when I think just ask yourself like really why do I need this and what's the proof more than getting targeted.

Maybe in your social media you mentioned lab testing.

Is there like a standard lab testing that people start out with or is it it's exclusively depending on their particular goals or symptoms that they come in with.

Yeah, we do have a standard one called our baseline actually our baseline.

And so that's definitely, I would say already multiples of what the typical will unfortunately the typical of what insurance based practices will offer at this point.

But we're a little testing forward and there can be very small panels, there can be very big ones.

But a baseline is, is essentially the nutritional focus.

So more around like the blood sugar metrics and then there's the cardio metabolic metrics, our hormone panel which is definitely again men and women and the sex hormones and the kind of supporting hormones as well, including thyroid and then inflammatory markers.

One piece that I actually probably just added more.

Being at Next Health and seeing what my patients results are is I've been adding a lot more toxin to my testing.

And so heavy metals, mold, environmental toxins like pesticides and some pesticides and different, maybe some plastic metabolites, things like that.

I don't, I had never done that before being a practitioner at Next Health so that I think as a baseline, maybe once or twice a year based on again your risks and your results is not a bad idea.

And I think we're just beginning to understand the impacts of some of those, those conditions, those metabolic contaminants for us.

But I think knowing is better than not.

In addition to your baseline, it's giving you a good what's happening now?

But some metrics around it.

When we put our treatment plans together, that helps us as another layer is the genetic testing.

So some lifestyle testing, gene snip testing really helps me prioritize.

Okay, here's this panel.

But now knowing the genetics, I know we have certain vulnerabilities or areas of sensitivity that I can help now focus.

So when you're asking about how do you know what to do first?

That is one component that I can know as more of the precision medicine.

And the tests give us really meaningful information on what's important as the individual how to prioritize treatment plans so your.

Patients will get a lot of data or the practitioner ends up with a lot of data from all these lab tests.

And as longevity medicine evolves, where do you see AI playing a role?

Is it clinical decision support, is it data analysis or is it something else entirely?

I am most looking forward to and already seeing some good products, but most looking forward to especially for us, as you mentioned in Longevity, because we do have so much data, not only that we're collecting, but that the patient's collecting.

Right.

Like the wearables and everything like that.

It's fantastic.

But how do we piece it all together in a way that we, that we've covered everything and seen everything and accounted for everything.

So I'm most looking forward to the clinical support, clinical data analysis and being able to bring it all together.

How we're using it now I think we're seeing is a little bit more on the administrative level.

AI scribes, charting those are so important because we know that one of the biggest, if not biggest pain point for doctors and medical practitioners is the administrative load around charting.

So this, it takes a huge, takes a huge portion of it away.

And I have no ego to say they do a very good job with these AI scribe programs at even compiling the note and even starting outlining the treatment plans and they're just getting better and better.

Getting the right medical terminology, getting the right context.

Can even read now your warmth, evaluating patient motivation.

They're really getting quite elevated.

And so I think the last piece and it's again I'm starting to see some products all have a little bit of a different focus on it.

But the how to accumulate and tabulate all of the data together and bring up a plan that's actionable and meaningful for the patient.

I think it will only be as good as what we teach it of course.

Right.

As with you still need.

I think I still believe human in the loop is the most important approach.

But, but I think what I've seen maybe is not quite there, but it's really getting quite close and I think it's going to be very.

A meaningful tool for us very soon.

Yeah.

I think what patients don't realize is that it's just an overwhelming amount of information even just to look at people's charts.

If you really, even if you have a good charting tool, like if you had several visits with this person, you have 20 pages of information about this person.

Right.

And for you as a practitioner to read all that plus look at all their lab data and correlate all that just to prepare for a consultation is incredible.

It's just so much to ingest for one person that I think AI will become essential almost to really help us connect the dots.

And then of course you still need a practitioner that has the experience of how to apply and really put together protocols.

But just to connect the dots, it's going to be so important.

Do you guys have anything that you already internally developing any type of system or any type of third party tool that NextHealth is looking to use?

Yeah, we actually are on our second product that is a as a third party vendor for a version of an AI scribe that creates the chart note.

And now we even have things that have help us create the communications back to the patient.

We just also released our own app which formulate, you know, which formulates right now the basic things like our information repository for the patients, your labs, your scheduling, things like that.

But the eventual and what's in the works and in the pipeline are versions that incorporate your labs, trend them, talk about, incorporate your discussions with your provider and more of the comprehensive planning around that.

So honestly, for something like a longevity company, that's table stakes, right?

Not do you have it, it's how good is it really after a while.

And that's definitely what I see happening and very open to the collaboration of technology and medic in medicine.

I think a lot of now the question is, oh my gosh, am I going to be replaced by AI as a doctor?

And the honest truth is it's going to get probably 70, 80% there in kind of bringing information together, data together, helping maybe even put a treatment plan in protocol.

But you still need the human touch, you still need the nuance, you still need to understand what, how to really get that last 10 to 15% together, which is where again all the magic happens.

So it's really an important point.

But is it something I'm very positive about?

I think I really see it as something I'm really excited about and something to incorporate.

I hope I can incorporate it more and more.

Just looking 10 years ahead, do you see Next Health still remain sort of a niche wellness center or actually become a new model of preventive of health?

I definitely think that's the goal.

I think Next Health to be a household name and for it really to lead the way in preventive health and very proactive health and to be hopefully as we expand and really how we expand the field, the goal is to be more accessible and more of a mainstay for people in the average household.

So I do really underscore that goal for us to be a neighborhood place eventually where you can, can start your health journey, start your health optimization.

And then we are not opposed to the traditional medical system, but I think it's designed, thank goodness we have it for those cases where there are medical needs around managing disease, diagnosing disease, cancer, trauma treatment, surgery, all of those we need it.

But where the system had was just not capable and not set up.

And a lot of challenges, also challenges working in an insurance restricted system.

The preventive health kind of got minimized.

Right.

Because of many different things I think.

But hopefully really expanding the opportunity around those first steps.

Yeah, this is so exciting.

Dr. Dada, thank you so much for your time.

Where can people find you and connect with you?

Yeah, so just the regular Instagram, I'm just omadatamd.

I actually started a little baby podcast too.

My husband and I and I my husband's a sports rehab chiropractor of 20 years.

And with my field we get a lot of questions together from our patients, our family, our friends.

And so we just wanted to bring something, deliver some education together because it's like the, the body longevity, the musculoskeletal aspects, the fitness protocols, the functional movement and then for me kind of the metabolic partner to that.

So it's been some really fun conversations.

We also bring in how we do it in our lives with a blended family.

And then that's called Everyday Longevity Collective and then at Next health so we're next-health.com I see patients in our New York office and I'm the medical director is there as well.

But obviously I know our whole provider team very well.

We really have I really think a special level of excellence in all of our medical providers.

So mostly based in California at this time.

But also we just came to Bellevue, Washington, Peoria, Arizona, Chicago, Miami.

We're going to be opening up Boston a lot of exciting opportunities.

So we so please look for us.

And if it's something either you're come to us on your travels or we're now in your home state, we would love to again.

I think we really can meet almost anybody where they are in their on their health journey.

And even if it's something that you need something more intensive than us.

That's a question we get a lot is once if there is a real problem diagnosed or something like that.

We really prioritize having making some local networks so we can help make connections and everything once you're beyond just the preventive health.

So we really want to be able to help anybody either in house or with next steps.

You'll find this episode's show notes my writing and links to everything I'm creating@Optimize Women.com thanks for drawing being here.

I appreciate you more than you know.

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