Why This Top Hospital Doctor Is on a Mission to Bring Back Concierge Care: Mauricio Jalife MD

I love what you said to me. I want to be able to be that guy that when you're sick, I can come to your house.

It was a little bit unusual for me when I moved to the US and I see how medicine was here because in Mexico medicine it was all concierge. Let's get into GLP-1s. It's a great medication. I do think it's been getting over abused. We're becoming skinnier but we are also becoming weaker. The weight that we're losing 25 to 45% is lean mass. You're a passionate person. You really care about taking care of patients. What motivates you is the fact that you can change people's lives. I think that's what life is for, right? To help each other, to make each other happy. That's that's why we're here.

Mauricio Jalife, MD, welcome to the Pathway to Peak Performance. So great to have you in, my friend.

Thank you so much. Thank you for having me. It's a pleasure to be here with you.

Oh, it's always always great to spend time with you. You know what? You are a hard man to track down. So busy all the time in the hospitals and doing all the work that you're doing, plus your practice, uh, which is just doing so well. It's so so great to see that. Uh, and you have a new venture on top of that that you're doing now, uh, with David Oella. The guy's a rock star. Uh, so cool to see you guys doing that. I saw you in the gym not too long ago. You guys are working out. It's like, uh, you're really you're really on it.

Thank you so much. Yeah, trying to do a little bit of everything. And trying to do a little bit of everything I can relate to because, you know, with all the companies we have, it's one of those things where you're you're you have to be super intense in those moments uh where you are when you're there. And I think it's it's really great for guys like us who want to be like that in that moment. So, it's a a tremendous opportunity. Uh first things first, your charity is Direct Relief.

Oh, yeah. Great. Great charity. Love Direct Relief.

Yeah. You know what? It's uh it's a popular one on this show and I guess you know in the medical community a lot of people really love it uh and for great reasons. All right, so the show is sponsored by KetoneAid. This is the true BHB ketone ester. I know you're well familiar with ketones.

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And there we go.

Cheers.

Thank you for having me again.

Like a shot.

Yeah.

Perfect.

Definitely unique, right?

Yes. Yes. The taste is good actually compared to the other ones that I have tried.

Yeah.

It has like a little bit sweetness.

Yeah. It's a It's a good mix. I like it.

Um, they have another product, K2. It's a little more sweet, uh, which tastes to me like maple syrup. It's always interesting to hear what people have to say about it because, you know, everybody has a different pace, a taste profile. All right, so it is, uh, 11:28 and we are going to see how we feel in about 20 to 30 minutes. Zach is going to chime in and say, "Hey, it's time." And then we're going to find out. Today we have a live studio audience, which is great. Always fun to have that. And um we're going to talk a lot about you, my friend, because you are an extraordinary person on a pathway to peak performance that few people can ever achieve. And um I'm always so impressed with you, you know, wherever wherever we are, wherever I see you, you're always going for it, you know, putting it giving it everything you've got. So I would imagine the patients that see you in the hospital must feel that. What's it like to balance your life?

So I'm trying to get used to it. Trying to get used to it. So I like to be busy all the time. So I did my residency in Philadelphia and I was planning to do cardiology or dermatology. I like both. And uh then I decided to go for cardiology. So I did internal medicine. And for the type of visa that I had, I needed to do a three years of primary care. And uh then thankfully UCSF offered me a job, offered me the green card as a hospital medicine. So I started to do hospital medicine and I I really like the lifestyle that I was able to achieve different things in business or different pathways. So I decide to stay as a hospitalist and not pursue to go to my fellowship.

But I always have like the this like um I always wanted to do something regarding dermatology too and I have been studying a lot of laser in my free time and then I moved to Tiburon and it's like oh my god like maybe this is a good place to do some cosmetic medicine. So we open Jeunesse Tiburon and I have like a little bit of balance which which I love because in the hospital I I love it intellectually. I love the connection with the patients and everything, but sometimes it's only bad news or bad news to not that bad news and having the balance to come in here to have people who come with a smile and live with a smile and it's different type of stress. I I really like it and I really like uh you know having the my patients who are unhoused in the hospital and try to help them in that way and patients here in Tiburon with completely other needs.

Yeah, I think it's that's an interesting balancing, right? Because you probably wouldn't be ha completely happy with if one was missing. Uh you probably need both to actually feel like you you you've got it uh just balanced out the right way. The laser side of the world is just so interesting what you can do with lasers today. Uh there's a lot of talk um with dermatologists about preventative uh laser work uh for skin cancer on the face and also that you're creating a concierge practice too for people who really want I love what you said to me. I want to be able to be that guy that when you're sick I can come to your house.

Exactly.

You know, and that's like the old medicine that everybody wants. That's the return to the kind of uh you know care that people really really want. And I think as we see people moving away from they look at insurance and they say to themselves well sure I need catastrophic but this notion of having primary you know primary insurance that doesn't you know you don't get the the visits that you really need most of the time. I think this is a really great opportunity in a in a community where you'll definitely find the people that want that.

Yes, totally. And and actually it was a little bit unusual for me when I moved to the US and I see how medicine was here because in medi in Mexico medicine it was all concierge. Literally we have everybody we have the WhatsApp of all our doctors and every time you need something you text the doctor and they are happy to to help you out. And here like a little bit it can be frustrating that for example if you have a cold uh Saturday afternoon there's nothing you can do. It's either you deal with it stay with your symptoms go to buy whatever over the counter or you go to the ER wait hours and hours and get a big bill. So I I wonder if we can do something to change that. And also obviously I mean I do internal medicine, I do hospital medicine and we focus a lot on treat diseases. We focus a lot on prevent complications but we don't prevent uh diseases itself. So I think like what concierge can give us is trying to we can do a better preventive medicine in every way.

Absolutely. I think that's the key right. What I love about what you're doing is that the same way that Dr. Rankin thinks about um hey you know we need to be thinking about how can we really be in a health care model not a sick care model.

Exactly.

And there are a lot of things that are happening now and the world has changed uh more things are becoming available for people so that they can live their lives in a preventative way. Let's go to the basics, though, because something I really like about you is that you're really big on the basics and the pillars of hydration, nutrition, sleep, and exercise. Uh, and then I'm sure you've got some mindfulness in there and all those types of things as well, but that's really, I think, the core of it. And so often times people are looking for some sort of magic pill or magic supplement or whatever it might be to fix this whatever they think that is needs to be fixed. I think we have to return to the the foundational level of things.

Totally. Totally. And there's a combination of everything. There actually was a this very interesting article published in 2024 in the American Journal of Nutrition where they grabbed 700,000 patients from the VA and they tried to see which uh factor decrease mortality the most after 40 years old. And what they saw is that by far the most important it was physical activity which decreased mortality by 46%. Never smoking by 30%. Then it was good food. There would it was no alcohol and social interactions which is very important. Decreased mortality by 8%. Which is interesting right? Because you know before we never talk about it, right? Before we thought that health was the absence of disease and and that's not it's the literally the well-being physically, psychologically, spiritually, emotionally uh and not just the the absence of disease.

So So true. And I think you have when you when you sort of add that whole all together, you know, the spirituality portion of it. Um and then also the notion of you know really that social interaction that many people find that in church, people find it in other places and other ways. Um you know some people find it in a bar. you know, the notion of sort of really having a practice around that and helping people to see that. I think the fitness portion of it is so so big because I I feel sometimes in many ways the fitness portion if you start there and then it's like, you know, okay, just focus on your protein, just focus on your protein and then it kind of just leads is like a little bit more, a little bit more, a little bit, and then it adds up. I'm sure you see that with patients and that's super exciting. I want to talk to you about something that is really uh a big component of this in in the exercise side of things which is recovery and how important sleep is. You in you know in your residency and um you know in the hospital you know you suffer from you know long periods of lack of sleep right?

Yeah, for sure. And it's extremely important. I'm not following very well. Like sometimes the doctors we are the worst patients on how busy we get, but sleep is extremely important for every way, you know, like one for complete recovery on your muscles, on your mind, neurotransmitters, but there has been a lot of data how a poor night of sleep actually decrease muscle synthesis. Just a bad night of sleep, one night decreased muscle synthesis by 18%.

And uh you know if this keep happening it's just more difficult to build muscle more difficult to like for cognition etc. So sleep is extremely extremely important and let's think about this right so we know as we get older we develop anabolic resistance uh and you know our insulin sensitivity goes down right so these two colliding together and then people have a harder time maintaining their circadian rhythm and staying you know asleep at night. So they had this fragmented sleep. So it's sort of like this perfect storm of things working against you maintaining skeletal muscle mass and that is the wrong way to be going as you get older.

So this notion of focusing on those things uh and being aware of them is so so important. as the sleep portion. I think the more I clue into it, the more I go, man, for so many years, it was like a badge of honor, right? I'm, you know, I'm going to work work work work and sleep when I'm dead type thing, right? And that was our generation, right? We we really believed in that. And now I look back on it, I go, "Oh man, that was just not good." Might have been in the gym training and all those things. When you think about it and you have the science now to show, hey, you drink alcohol, it's going to kill your muscle protein synthesis for for days, right?

Yeah.

Uh you you have poor night of sleep, one poor night of sleep. That's why, you know, on my ring, I'm tracking it. I'm looking at it. I'm saying, what's the sleep quality? What's the deep sleep? What was the REM sleep? What was the interval? You know, what was the uh what was going on there? Because it's so so important to know exactly kind of what you're doing. It's so interesting, too. And you can feel the difference totally.

And as you say, you know, when when we sleep is when we have increase in uh in the growth hormone IGF-1 all our anabolic hormones increase during sleep. When we have a poor sleep, we have increased cortisol, increase insulin resistance, increase chronic inflammation and all of those things.

I mean the cortisol piece, right? the sleep the sleep deprivation the cortisol side of things then leads to wanting to eat more uh to offset that. I'm curious um there's been a lot of talk about creatine one of the most studied you know supplements out there and I tend to use a little bit more than you know the standard five grams and the cognitive side of it now is starting to prove out that you can beat a bad night's sleep every so often with a little extra creatine. I'm curious, how much creatine do you take personally? Not that you would recommend that to any patient or anything. And we're not giving medical advice here. You're not giving medical advice, but what do you take?

Normally, at least 10 grams a day because the muscle obviously absorbs the majority of the creatine. So, you need to feed the muscles first in order for the creatine to go to the brain. So, in order to have a a good cognitive function with the creatine, you need at least 10 grams a day.

Yeah. And as you said there is like very good data how uh how actually uh taking creatine re uh in improve cognition after a bad night of sleep. So it's kind of like a some way of compensating obviously is you're not going to compensate it fully but something that you can do.

Yeah. It's funny. Um I remember talking to William Dement uh Dr. Dement so the godfather of sleep medicine. Uh so we were talking about how like people who were sleep deprived actually there were more accidents um that were attributed uh at the NTSB attributed to sleep deprivation than drunk driving. So when you think about how much it can impair you cognitively um and then all the cascade of other things that are associated with a bad night's sleep, it's so great to see now that people are really uh tuning into that. So one of the procedures you do in your practice. So this laser and the soft palate. So we know the soft palate has some laxity as we get older and as that comes down it inhibits our ability to breathe at night. Uh so tell us about this procedure because I'm really excited to learn about it.

Sure. So one of the most common reasons of snoring or sleep apnea is when the soft palate becomes very loose. So when it becomes loose mainly when you're when you're awake probably there's not much issue but when you're sleeping especially on your back the airway gets blocked intermittently many many times. So at if the level is significant that can produce sleep apnea right and when we have sleep apnea it has a lot a lot of complications you imagine if you are like under the water for example and you cannot go out. So what happened your you start shooting a lot of adrenaline or adrenaline your heart rate goes up your blood pressure goes up. So imagine this over and over and over and over and over every single night.

So obviously can increase the risk of high blood pressure, can increase the risk of heart disease, can increase pulmonary hypertension, can affect the right ventricle of the heart, can cause arrhythmias because of this high amount of catecholamines. And also uh you know your levels of oxygen goes down over and over and over. When your level of oxygen go down, there's more red blood cells that increase the the the pressure in the capillaries and that increases blood pressure and and problems in the future. So actually is one of the causes of high blood pressure and arrhythmia most important which sometimes we underdiagnose.

You know what's so interesting too is the stroke side of it, right? If we have that you know higher mass of blood cells and pressure um you know going to have a stroke from that.

Yeah, totally. We we we have increases in increasing viscosity which it can cause decreasing blood flow but also the increase in adrenaline and noradrenaline will cause vasospasm and also the chronic uh this can cause a state of chronic inflammation. As you know, chronic inflammation can cause cellular senescence that can cause worsening inflammation that can cause chronic vascular disease, strokes, heart attack, peripheral vascular disease, you name it like any any any chronic problem. So yeah, address this is very important.

What we do with the laser is uh so it can be done with different laser. The laser that we have that we do this is a non-ablative Er:YAG which nonablative means that you're not cutting that you're just trying to deposit heat in the in the tissue. So what the heat does when you put the laser it it creates shock proteins that that tight the fiber of collagen causing a little bit of tightening but but in the future it the heat induces the fibroblast to produce your own collagen. So when when you do it in the soft palate you can increase the the collagen to cause more elasticity and get the soft palate to attach to the wall. So in that way we open the airway. So that's one of the things that we do first.

Then we try to do the Er:YAG stay uh non-ablated belong the tongue to c tightening in the anterior part of the tongue to try to protrude the tongue forward. And then we can c with uh the the other laser with the Nd:YAG uh like a slow heating with where can shrink the tonsils and the posterior tongue. So in that way we try to open the airway as much as we can. It has good results is is is approved for snoring and for mild to moderate sleep apnea. Uh still obviously the the the gold standard is CPAP. How many people can't sleep with a CPAP, right? Like it's it's hard to get used to.

Yeah. I think the sleep apnea piece is um you have these people that are doing orthognathic uh jaw surgery for the folks that don't know what orthognathic means, but jaw surgery which is you know obviously advanced quite a bit in the years and it's not as crazy as it once was. uh the results are phenomenal for those people have the recessed mandible and then need to uh move the maxilla forward. That's a great procedure, but you know, it's it's a pretty dramatic procedure. And so, the notion of being able to use lasers maybe as a first step in conjunction with the CPAP, uh, and also, you imagine if you're using a CPAP plus this particular procedure, you can get such great results from it. And one of the things I uh have said over and over again, everyone should have a sleep study

100%.

To understand because you could go years with sleep apnea and not know it. Uh you know, and then all of a sudden one day you have a problem. Um and you you know that again that's the sick care model. That's not the preventative care model.

Exactly.

So you really on this particular procedure can do something that I'm so excited about this. I think it's really phenomenal and amazing. When you told me about it, I was like, "Wow, man. I have never heard of that before." And it seems like something that should be on its way into being utilized as much as possible. Like imagine like healthcare uh one like how many people is has chronically fatigue and we cannot explain it right and is one of the most common cause of chronic fatigue. also how many people uh ended like costing to the health care system for untreated sleep apnea or for complications that we can do a fast procedure 30 minutes no downtime and potentially prevent all these complications.

Yeah. Amazing amazing stuff. Then on the um you know on the laser side of things with regards to just skin and uh you know people it's interesting to see how much uh it's become accepted. Um you know it used to be only women would do these cosmetic procedures only women would have lasers and guys weren't doing that. Now the numbers are up so dramatically because it's like oh wow you know what this really is has limited downtime and I can get a really great result. I mean, some of the laser results I see, I'm like, "Wow, that's incredible." It's incredible what you can do with those.

Yeah. And and it also help you to reach your full potential, right? Because it's not that you're putting anything in in in your body. It's like literally is heat to stimulating your own tissue to to produce collagen to to produce elastin to get younger. uh you can do an ablative procedure as you said a little bit before like it it actually help in preventing some type of skin cancer because what you do is like literally you remove the the superficial area of the skin and you stimulate cell turnover. So if there's like a pre premalignant lesion at some point start start going to the surface and it prevents it can prevent cancer. So it's it's it like it's amazing in the aesthetic part, but it's way way above the aesthetics. It's like having a healthier skin, preventing cancer.

That is the key there, right? I mean, if you think about it more as a healthcare procedure and even an aesthetic procedure, even though it is aesthetic, it is something that you can do to to protect yourself in a way that previously just wasn't available that way. And so the notion of now we're cluing into hey there are just better ways to do things and if you're really wanting to achieve results you do it this way rather than the old way and it's all over the the world is changing so rapidly. Uh it's so cool to see that.

Um so I want to ask you about um your thoughts. We've talked about creatine. I want to I want to talk to you about your thoughts about how people go about supplementation. You know, one of the things that happens to me all the time is people are always asking me, "Oh, what uh what supplement should I take?" And I'm like, "Hey, you don't want to talk to me about what I do. I'm N of one." And the reality is you should be working with your provider. You should be talking specifically to your provider that's based on your blood work, your genomics, all of those things.

And so I really hope that you can explain to people why it's so important to start with a physician on on you know a health journey, a course of exercise, whatever it may be.

This is a great question. Uh so first of all like the most the most important thing is I always say to my patients supplements are supplements. Food is the most important. You're going to get your main nutrients in food. You can use supplement just to to fill the gaps that you couldn't fill with food. Uh when you choose your supplements, supplements are not are not drugs, right? So it doesn't go through FDA. It doesn't go through a serious regulation. So so supplements get regulated same as food.

So you you can put whatever you want in the label and not precisely is what you have in the pill. So we can we have seen many times that you that it can have like 10 times the dose. It can it can have nothing. It can have like many chemicals. It can have different components. When I started my residency, I I started in the liver unit transplant service. And I remember this like I started to get very interesting after this case because I have a patient uh a bodybuilder who came into the who came into the service with acute liver failure. He was dying. He needed a transplant and we were trying to dig into the history. What did you get? And he was getting a preworkout.

I'm not going to to name the brand, but we sent that pre-workout to test and it come it came with like a lot of anastrozole. It came like uh a lot of tamoxifen. It came like oral oral anabolic steroids. There were like a lot of things that it didn't mention obviously in the ingredients. So, it's something very important for the patients to know because in in general you you you trust it, right? You go to the pharmacy, you say like, okay, supplements, they say to the they sell it to the pharmacy, everything that it says it must be accurate. And that's not the case. The majority, 99% of the brands are actually not tested. So, you don't know what you're getting into your body.

Yeah. And this brings us to another really interesting point. I buy all I really try whenever possible to always buy all of my supplements direct from the manufacturer. And the manufacturer is somebody is a is a company that is really I know is the highest quality. It's gone through rigorous third party testing. It's uh you know GMP compliant and NSF certified. So I know that it's really high quality stuff. Um and I try not to ever order anything through Amazon. And not that I think Amazon's about, you know, but like let's imagine you say to me, Jock, I need you on 10,000 IUs of uh vitamin D and K2, right? you're deficient in vitamin D and uh you need the K2 so it doesn't have a calcium problem. I want you to be on this and then I go and I order on Amazon and it doesn't have it in it.

Yeah. Right.

Yeah.

You know, so I think what's exciting is in your practice, you know, I think there there was a point in time where people would think, oh, if a doctor had supplements in their practice, um they must you they're just trying to sell me something. Now, I think it'd be like, oh, the most trusted place you could buy your supplements is from your doctor is where you could go to get those from your actual provider because they've ordered direct in in, you know, a bulk quantity from the manufacturer and now they have it. I don't know if you're planning on doing that or not, but I I hope you will.

Yeah, I work with a brand it called Design for Health. They normally sell to providers. They are very high quality and they are third party tested. So, I I I completely trust it. I still I don't know if everybody needs all the supplements. In general, we don't need that many. Like I I focus based on the levels or on the symptoms. Uh but yeah, like if you're going to get uh a supplement, that's one of the brands that I totally recommend.

Yeah, it's funny. My provider says that uh the fish oil from them is like one of the best.

Yes.

And um they I'm I'm using krill oil, so I'm just going to run that out and then I'm switching over. I love what you had to say. Supplementation is supplementation. And when you're eating a really high quality uh whole food diet, you're really focused on, you know, eating the right way. Uh you you may only need to supplement a little bit, but it should be done in conjunction with your provider. I think that's one of the most important things people should understand.

Yeah, 100% 100%.

Yeah. You get the blood work. You know, I use Function Health and you know, uh, a lot of people say that's just overkill, right? You don't need all of that. I like it because I want to actually have the smoke signals. I want to actually because I know the what the value, you know, hey, my C reactive proteins up. Why is that? You know, I want to be looking for those types of things. So, I'm looking at those values and um, you know, it's something that I like to do. But, you know, there's a lot of stuff I can get from just a basic cardio panel workup, right? Just interesting that you can get so much from a certain amount of labs and when you get to know the patient, you really know. I think that's one of the things about internal medicine, right? People need to understand what that truly means. Internal medicine. That's a big specialty. That's a it's a really interesting place to be. It really allows you to see the patient in, you know, a holistic fashion, right?

Yes. Totally. Yeah. You you see like pretty much you see everything in adults, right? uh so you see everything that is not surgical. So for example when like as a primary care you try to to deal with every single aspect or every single disease that the patient may have or what I like about this about this combination is for example internal medicine is a lot of evidence-based medicine is everything evidence based, what is published and what is not, and we have now like this other contrast that uh a lot of people is like have like all this completely naturopath picture, and I don't think they need to fight to be fight each other, you know, and I think you can bring the best of both worlds.

Yeah. I think that as long as uh you know what you're getting into and you're working with a pro provider who's really done, I mean, I know that you do the education that's outside of, you know, you go to places and you speak and you're involved in, you know, things. Um, but let's get into GLP-1s.

Okay.

All right. GLP-1s are awesome and they have a lot of a lot of benefits uh for people um not just uh insulin sensitivity, which was the original indication with those um weight loss was the side effect, right? Uh, but now we're seeing that they have neurocognitive benefits, they have cardiovascular benefits, there are all sorts of things that are GLP-1s. Some people are starting to talk about GLP-1s as just being a maintenance thing that somebody would take uh to try to, you know, maintain their life and the healthiest way. I'm curious where you come out on this.

So, well, I I've seen I I have been working with them for many years because they, as you said, like has been there for diabetes for a while, and I have been seeing amazing results as you say, not only in the decrease in the A1C and the control of diabetes, but mainly because of the weight loss. A lot of people have been living longer, less cardiovascular disease, less chronic issues. Um and and as you say like sometimes they do like they started to do microdosing, which it it has have a good results in inflammation, in cognitive function, in cardiovascular protection, because of like it decreases the spike. One of the mechanisms is by decreasing the the the insulin spikes, the multiple insulin spikes that can be extremely pro-inflammatory. So this can decrease the the level of the spikes.

All right. Um, so yeah, I think it's a great medication. Um, I have seen uh good results. I do think it's it's have been getting over abused and hasn't been taken in the right way by many people. Um, there's like a lot of studies that like more than 20 randomized trials that it shows that actually from the weight that we're losing, losing 25 to 45% is lean mass, which that's a problem because we're we're becoming skinnier but we are also becoming weaker. It we need to be very careful on this.

Yeah. I think it's crazy when you think about it, when you see the different studies that are out there and you become aware that people are being prescribed GLP-1s. Uh, so we first start with, you know, semaglutide and then we have with the GIP. Uh, and now we've got the new one coming out. I guess we probably can't talk about it because it's not FDA approved yet, but uh there's some great clinical trials coming out around cardiology around that. Uh, where you're adding the third component in. Um, you know, it's just going to be really interesting to see what happens with this.

But one thing that is really clear is that they've been prescribed the typical weight loss patient, right? Wants to use them. Man, they're on board for that and they start they start losing a lot of weight and uh then they're like, "Oh, this is great." There's some downstream effects from that that aren't that great. Uh, loss of skeletal muscle mass, number one, that's a huge problem, right? We're trying to we're trying to maintain it uh for as long as we can. There's a reason why we're in the gym. It's like we're not trying to be bodybuilders, man. You know, we're trying to actually maintain our capability as we age.

And you see this uh where it's like people don't understand that, yeah, man, it's going to it's going to work. Those drugs work. They work really well. They're peptides that actually have a tremendous impact and they're going to blunt your hunger and they're going to blunt your thirst signal, too. So, I'm curious where you come out on the hydration portion because, you know, for me, hydration is so so important. I'm like, I'm always making sure that I'm hydrating at the highest level I possibly can. And we've talked about this before, but I I'd love for you to talk about it here.

Yes. I mean, it's it's extremely important, right? Sometimes, uh, we don't have any symptoms of dehydration until it's already too late. Like, we feel foggy, we feel tired, we don't perform well at the gym. So it's very important to keep a good hydration. I mean, one of the worst mistakes that I can do uh that I do often is like I wake up, I take a cough, I drink a coffee, and then I go right away to the gym and then I feel tired and foggy the whole day. And why? Because know I drink coffee that uh decreases the antidiuretic hormone. I start to pee. I don't drink enough water and then I feel like cognitive fatigue. So when I started to change that to do electrolytes first thing in the morning, completely everything changed, like my brain function and everything, I I became way more more active, like more sharp.

Yeah. And I think also when we realized that, hey, uh, if we're not hydrated, you know, we can't really be in anabolic state, we're going to be in a catabolic state, uh, and so we're breaking down more muscle. It's just it's it's just so interesting. The science is so fascinating at this point in time. And there's so much information out there.

Um, I think the GLP-1s are fantastic. Um, still lots to learn there. They've been out there and people know about them. They've been formulated in compounding pharmacies. They've certainly been uh put out there um on the black market, in the gray market, which is dangerous. You know, there there people around, right? And they come up to you and they say, "Hey, what do you think of this peptide?" And I'm like, "Well, where are you getting it?" That's the first question I always ask. Where are you getting it? Uh, just order it online. No. Then I don't care what. No, that's like the worst place that you can possibly go. You should be getting it from your provider, from a compounding pharmacy, should be working, and it should be for a very specific thing, and that's not you don't want to fool around with that.

Yeah, exactly. It's something that in general the majority of them you're injecting it, right? So you don't know even if it's sterile. You don't know what you're putting. They don't know like with what they are mixing them with, how they are isolating them. So you you have no idea. So if you if you get them, and like, at least try to get them from a compounding pharmacy that is 503B or is FDA approved. I'm not going to talk about what uh like if they are good or not. Many they are, and I have my my own belief if FDA hasn't approved many of them. But uh if you're getting them, at least make sure that what they are claiming is what you are actually getting and what you're actually taking. Same way of the vitamins, right?

Yeah. I mean, if you if you were to look at something and says not for human consumption, research chemical, and the certificate of authenticity is essentially like, you know, you could it's it's like the photoshopped version of, right, it's it's insane. And so, you know, I I just think that there's the right way to do it. I think we're on the same page. Clearly, we are incredible potential for those. Um, but again, the foundation is where it's at. That's the deal. And those are supplements. Those are little things you add too, right?

And also remember about the peptides. I mean, there's almost many of them there are not FDA approved. We don't know because they are not claiming something and we're not we're don't have enough studies about them. But uh many of them when they sell it, like the dose is not what is accurate where they have shown in clinical trials that actually work for something. I actually seen from even many compounding pharmacies that they send a random dose that in order to have the results that they are claim that that the the research claim, you need 10 or 20 times the dose. So mainly what you're putting is placebo many times. So just make sure if you if somebody does it, like make sure it's with a health care professional who does what who knows what they are doing.

Yeah. And I think there are a lot of what I'll quote say quote unquote peptide pushers. They're not even, you know, I I mean, I have a problem with the big box sort of like uh I'm not going to name the companies, but that you just go online and order whatever it is that you want and that's just now you're just completely outside of the care of a of a physician.

They're not looking at you holistically. They don't have your labs. They don't have any of that. So, it's it's an insane proposition. And and why that it's allowed to continue, I don't know. I don't I can't explain it, but uh I guess it is what it is.

All right. Um, in the pathway to peak performance, it requires a passion. I knew that the first time I met you. You're a passionate person. You really care about taking care of patients. You really want to get the right results. It's something like you're willing to sacrifice a lot to do that. What motivates you?

I guess it's like the, you know, is is is the fact that you can change people's lives. Like is have this satisfaction that you help somebody else. At least I think that's what life is for, right? To help each other, to make each other happy. That's that's what we're here for. To share love.

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So true. I mean that that's the that's the spice or the the juice of life, if you will. That's the key. Um, so tell me what you think is going to happen with regards to um your practice here in Tiburon as it grows. Uh, will you get to a point in time where there just isn't enough space? You have to bring more providers to the table.

Yeah. So, what I'm like now I'm focusing like the practice here is kind of my side gigs and we're focusing more. We started with aesthetics. Now we we have an a new machine in trying to uh like become more a bit more medical. We're trying to increase muscle tone in every part of every part of the muscle to help with people with ambulatory dysfunction, help with people with urinary incontinence to strengthen the

What is a shock wave?

So it's it's similar. So what it is is a magnetic wave and that penetrates the tissue, goes to the motor neuron, stimulates the motor neuron, the polarize to contract the muscle. It cause heats high intensity Tesla stimulation.

Okay.

So, so you you stimulate the motor neuron and the motor neuron contracts the muscle. And the way that it does it is in a way that called supra maximal contraction. So, normally normally when you do a a movement uh you don't recruit all the fibers, you recruit some of them. So with this you literally recruit all the fibers innervated by certain nerves and you can re you can stimulate it in a in a frequency that normally you cannot reach or an intensity that you cannot reach without uh hurting your joints. So pretty much like doing uh 20 minutes is like doing uh 1,000 reps in maximum intensity.

You know, this is so so interesting. And I've been studying a lot about this fast twitch, slow twitch and the activation between the two. You have to exa exhaust the fast twitch before you're going to get to the slow twitch recruitment. Um, this is really interesting stuff. Uh, when did you start putting this in the practice?

Yeah, we like we have been there like for a year and we have ch we have on some of the patient check body composition with a dexa scan before and after, and there is actually studies about it, and there there is an there can be an increase in lean muscle by 25 to 30%, decreasing fat by by 30%. So it's is very promising. We can use it, comes with a chair, so you can use this for the pelvic floor, you know, the urinary incontinence, stress urinary incontinence in woman after pregnancy is something that they deal with and they don't share much, you know, when they are coughing or something like that or doing effort, a little bit of urine leaks. So this um stimulates the pelvic floor. It's kind of like doing many kegles but just like sitting and and and relaxing.

You know what's uh wild about that is I sat in a pelvic floor chair uh once and it increases your urinary flow as a male um dramatically. It was like I was like, wow, this is intense. This thing is like it doesn't, you know, you just feel like this stimulation and then they had this incredible result from it. So you're that is really fascinating, and you think for older people, you just brought up the key point. There is this issue with people, we get our joints get worn out, you know, like this morning when I was first lifting, like I've got to start with the dumbbells at 30 lbs just to get the actual, you know, for the wrist through the elbow through the back end of the shoulder, because I've just got to get it warmed up. It's clicking, you know, I got to slowly work up. That is so incredible for people who cannot make those movements happen. The joint isn't functioning but you can increase muscle by 30%.

Yes. Yes. That's that's very that's very interesting. And what you can do is also it because you go directly to the nerve, because also we have uh electromyio stimulation for a long time, right? You put the pad, you put it on the muscle and you it stimulates directly the muscle, it contracts the muscle. But but if you want to go to the deeper fibers, you need to increase the power. And if you increase the power, the superficial fibers contracts more than the deeper fibers. So it's like uneven. So with this, you actually get into all the fibers including that that that small muscles that normally you cannot reach with a or is hard to reach with a regular workout. Uh, we use it for for some type of back pain, for example, uh it can strengthen the muscles between the spine, the small muscles between the spine, and that kind of separates the disc, gives you some label.

Exactly.

Yeah. So question for you. Let's let's now let's take an example of somebody who's rigorously training, like I train six days a week and even on my off day, on my active recovery day, I pushed a thousand active. So I was you know what I mean? You have somebody who's really working out. How do you work that into a schedule? How do you work that now into like, okay, you're going to assess how they work out and then you're going to add it in. How do you how does that all

Yeah. And actually that's a great question because you it's not a substitution of workout. You should you should keep working out. Uh and I have incorporated in different patients. I don't know. You met David, right?

Yeah.

Uh so he has been working out every day for many many years. We did the we did this machine on the on the abs and it it increased significantly the toning. So it gave him more strength to be able to do his regular workout. It it helps him to to become more explosive too.

I love it. You know, I spend an entire dedicated an entire day to core. Uh and I still feel like I don't get all of it right. Um I think that there's I could spend more time uh doing that, but you have to be so careful with that. Um, I have an S1S2 disc issue and if I'm not careful, you know, I want to be able to continue to squat, right? The squat is super important to me. So, I have to be so careful about how I do things and um, man, that is really exciting. I didn't know that you had that.

You should try it now. Like, you should come in the office and you'll tell me about it.

You got to put me on the plan. I got I want the uh I want the monthly subscription.

Yeah, totally. And actually we do it like now that we were talking about GLP-1 and how people lose muscle. We use it a lot in people who are in on GLP-1. One of the things that GLP-1 have is like you know you decrease muscle and then when you decrease muscle when you stop taking them remember that muscle helps you to control the metabolic rate at at rest right. So if you have less muscle it's harder to burn calories at rest. So that's why people becomes accumulate a lot of fat when they stop.

This is like the next level actually if you think about it especially people who what is the big challenge for those folks right if they're going onto that medication and they are sedentary. It's like they they don't know how to go into the gym and train. I I'm sure you I'm sure you see this every day right?

Oh I did it with my I I show it with I saw it with myself like long time ago when I was a primary care. Uh I used to be friend with a Novartis rep and she used to give us samples and I was seeing how my patient had like amazing control of A1C and they were losing weight. This still was not approved for weight loss and I was like I'm going to try it and I tried a little bit and I just felt very tired and especially the first weeks the first couple of weeks I was I was weak. I was tired. I was not hungry. So I couldn't I didn't want to go to the gym.

Yeah. Right. So that's one of the things that that happen a lot with these medications too. It's not just like we're losing muscle. We're like people are becoming tired so they are not do they don't want to do the work.

Yeah. And this is a great bridge. It's actually now I'm kind of putting these pieces together. I start to think like wow that's a huge piece. Um so let's go back. Let's rewind. You've got some great things happening with stuff that's sleep apnea related, which is a massive issue in the United States or or worldwide, right? But in the United States, uh it's not something that's really tested for unless you, you know, your primary care starts to think like, hey, there's something really off here and then eventually they send you for a sleep study.

Uh now UCSF, they just send you home with a little thing and see how many times you stop breathing at night, right? um you have the ability to basically dramatically augment what someone would would happen have happen with a CPAP, right? Using a CPAP is is uncomfortable once you get used to it. You love it, right? Once you get used to you cannot live without it.

No way, man. You know what? It's like the next morning you feel you look at yourself and you go, "Oh no, I just didn't." You know what I mean? If I fall asleep, you're finally rested.

Yeah. Yeah. You know what is rest? It's huge. It's huge. I think for all those years, all those airplanes, you know what I mean? All that time in in in the airplane seat, just I think that that had a huge impact on on me and, you know, just being tired all the time was really um huge.

And now to think like, you know, as as my life has progressed, I'm getting more and more into like the fine, you know, fine tuning everything. I'm in a phase of my uh program right now which is called Calibrate and that is to track every single thing. So every bit of food, every bit of sleep, every single weight, every single rep, every set, everything's tracked, right? It gives me sort of a 360 to understand, okay, you know, hey, where is my insulin sensitivity? How am I actually because I I mean we know that is so so important, right?

Totally. And and I mean and if you can if you can do it and you don't get anxious about the result because it's not for everyone.

No. Right.

That's true. That's not for everyone. There's like some patients that they become really anxious that they see in the Apple Watch that the heart rate goes a little bit higher and then like you know just they become restless and it's is is not good. But for the right patient keeping track of everything is is amazing.

You're you're right. It's not for everybody, but I think you go through that for a period of time. Uh my my periodization is 49 days of it. So 49 days of tracking. It gives me a good picture on where I am and how things are working. And in that I've got my labs, I've got my DEXA, InBody. Um I'm taking a look at my CPAP app, you know, the CPAP uh machine and the results from that. Uh I'm checking my VO2 max. Um, so, uh, man, I, you know, the interesting thing is I could talk to you all day long about so many things. Will you come back?

Yeah, of course. I would love to.

You know, I think you should be like a regular a regular guy on the show because we could just talk like once a quarter about, hey, what's new? What's come up? This whole thing with the myofhibular stimulation. I did I mean, I am fascinated by this. I can't wait to see it. I think this is absolutely phenomenal. And there's a whole elderly population that are dealing with incontinence. Um, not just the, you know, the people postpartum, uh, women postpartum, but the elderly population that are dealing, that's why there's the pens down at CVS, right?

And, and not only that, I mean, there's how many of these people have like some ambulatory dysfunction, chronic back pain, uh, like have arthritis, right? So, and and we know that muscle increased muscle decrease mortality. Now, it's like it's huge, right? People with the with the g weakest grip has like 67 increased mortality than other people. The slowest walkers have three times increased mortality than than regular people. But, and we're telling these people, you need to get stronger. It's like okay, but how do I go to the gym? So it it has like this technology have helping to give them a little bit the strength for them to be able to go to the gym and work out. It's kind of like the the bridge.

Yeah. Huge. You know, that is that is an absolute I mean it's almost mind-blowing, right? to think about the two things we discussed today that I think are just absolutely like um out of this world that you do uh that I w I wasn't aware of either one of them until recently. The notion of improving somebody's airway is huge. That is just massive. And then the the notion of being able to take people who are joint disabled or you know have issues with joints. Lord knows. I mean, I've had nine surgeries, so I kind of got an idea of what the joint issue is.

Um, and be able to actually stimulate the muscle for them if they're using a GLP-1 and they're not feeling it and they can't kind of get it going and they don't know what to do in the gym. I see people training in the gym every day. They have no idea for years and years and years and it's insane, man. I'm like I always want to come up to them and say if you'll just move your elbows a a little bit just change this a little bit ch you know p pull your shoulders down you know and do less weight.

Yeah I know these guys it's like you know what I mean I I look at it now it's like I'm happy you know just to press a less weight for more reps uh and get the best the muscle doesn't know the difference.

Yeah. I mean as long as you're fatiguing it right.

Yeah. That's it. Yeah. I do a lot of RIR rep uh you know sort of like you know reps in reserve uh work just sort of in certain periods and then sometimes we're going to take it all the way to failure and push it to an absolute max. But you know I think you got to really know how to train and that just comes from years and years and years of doing it.

Right. A lot of those people don't know what they're doing.

Yeah. No. So they can come see you improve their airway get the muscle stimulation.

Yeah. That's exciting to me talking to you. I normally don't get this exciting. Oh wait. We didn't check in on the ketones. Oh, did you feel them?

I feel great. They're awesome, right? I feel great. I feel I feel like uh with my coffee, but without being restless, if that makes sense.

Yeah. It's like a toned down focus, right?

Yes. Yes. Yes. Yeah. I I use them every day, three times a day. When I first wake up in the morning, I use them a little midday and then a little tiny bit before I go to sleep just to for the anti-catabolic uh capabilities, just having a little bit there uh at night. Uh cuz I usually go to bed, I've eaten pretty early and by the time I'm going to bed, that hunger started to kick in.

I need to I need to uh I need to get your routine. I I like I you know in Mexico we used to have dinner at 10 11 p.m. and I'm just used to that. You know it's terrible.

Yeah. We were talking about this the other day. You know certain cultures really that's just the way of life right for me. Uh you know I was lucky I had kids. I still have them but they're older. Yeah. You know and that there was like five o'clock was when you ate, right? So I just got used to eating early and now I want to always get my eating out and done. And then I want to get some sort of postprandial walk or ride in so that I can get the, you know, the glucose to sink into the muscle because we know, hey, once that glucose is in the muscle, it's not coming back out to the liver, right?

Yeah. And and that's actually really cool, right? Like normally, uh, at rest, uh, we need insulin to get this glucose into the muscle, but not with activity. So that's your insulin levels, man.

You know what? It's it's so fun hanging out with you. I was I always have a blast. This has been great and I I can't wait to uh to talk to you more about a whole bunch of other things. There were like 10 other things I wanted to cover today. So, you're going to have to come back.

Yeah, we'll we'll talk more about the concierge and what we're creating. Uh yeah, I think you're going to like it. It's interesting.

So, last thing before you go today, we know that many diseases are diseases of decades, right? So what do you say to the 20-year-old kid today who thinks that they have 15 years of playtime and without consequences?

It's not. It's not. What I would tell these kids is work out. Have social interactions. Go outside. Be outside of your social media. Uh it's very very important. Uh interact with other people. Uh don't do stupid things. you know. Yeah. You may not feel it now, but you will at some point.

Yeah. And it's so interesting to see how many kids are not going the alcohol route. It's interesting right now. It's it's interesting that switch that you're seeing that somehow is good. But some of these guys that they are not going into the alcohol route is because they are not going out. So they are staying in the in in their social media without interacting with other people. And that's not good actually.

Yeah. You know when uh Dr. Richard Lewis Miller, another favorite on the show here said we're living in an epidemic of loneliness, isolation, and alienation.

Yes. And you're the piece that you brought up about the social component is really coming into the longevity community in a way that is really powerful. That social interaction is required. You need to be interacting with your friends. You need to be able to talk to them and have that and and the texting. You know, for so many years I had all these friends in LA. You never talk to them on the phone. You don't talk to them on the phone. They just they text. That was the cool thing. Nobody's nobody else is really talking.

I think it's what you've said is really really powerful and I really appreciate all the sh all the things that you've shared today. Uh and I look forward to uh seeing you next time we're back on the show. Uh I will have had the procedure for the soft palate and I will have tried the myofilm stimulation.

Yes.

To see how we'll see how much muscle mass I can put on.

Yeah. Let's try it now this afternoon if you're free. Yeah. You you'll tell me how it feels. Cuz what I love also is that while you're doing it, it it increases the blood flow. So you don't produce that much lactic acid because imagine to do 1,000 squats, right? You wouldn't be able to walk the next day. Uh, the way that it contracts, it avoids that.

That's great. I'm so excited to try it. Dr. Jalife, thank you.

Thank you so much for having me.

Thank you for coming.