Dr Rupy: Darshan, I'm really excited to talk about healthy ageing and for you, I reckon what I'd love to dive into is almost like a checklist for people in their 40s, 50s and beyond and things that they should be thinking about when it comes to longevity, i.e. increasing healthspan. So I want to run it like this. If you had 45 minutes with someone to walk through a longevity checklist, what would you walk them through?
Dr Darshan Shah: Yeah, it's a great question. So just like you, I have pillars that I try to get people to focus on and these pillars are different branches of medicine that I feel have been ignored or not focused on in typical Western medicine. So stuff people wouldn't normally get from their doctor, right? And those pillars are number one, lifestyle medicine. So these are, you know, include things like diet and exercise and movement and sleep. Pillar number two is functional medicine. So a lot of people have not usually, in my experience, a lot of people in their 40s have not even really heard of functional medicine. And you and I, we live in this world, but I try to introduce them to functional medicine and how this really needs to become a core of their health journey. Functional medicine to me means bringing in some of the root cause reasons of why we get sick, particularly as we age. So these are hormonal health issues, the build-up of toxins, gut health issues. All of these start to deteriorate in your late 30s, early 40s. And if you can focus in on some habits that can maintain these root causes of health in your lifestyle, then you can avoid chronic disease in the future. Now, the third pillar that we talk about is preventive medicine. Okay? So now we got to get really, really intentional about preventing chronic disease and preventing death from chronic disease specifically. So that's cardiovascular health, neuro health, brain health, okay, metabolic health and immune health. And immune health means also mitigating against cancer. Okay? So you know, there's this, the CDC publishes this list of the top 10 reasons human dies, right? Humans die because of heart attacks, number one, cancer, they die of consequences of diabetes, right? And also many people are now dying of Alzheimer's disease as well. So how do we protect against those? And lastly, the last thing that I try to bring into people's life, and specifically I bring this in last because it needs to be kind of like the cherry on top of the cake, if you will, is longevity medicine. What are some of the more advanced techniques that you can use to improve your healthspan and maybe add extra more productive years to your life? So those are the four pillars that we can talk about today.
Dr Rupy: That sounds great. Okay. That's not like a good structure to you? That sounds perfect. This is exactly what I wanted to talk to you about because obviously this is your bread and butter, you do this every single day. Let's briefly touch on lifestyle because I think our audience in the Doctor's Kitchen, right, largely UK audience, but we've got a big chunk in America. I think they've heard me talk about, okay, got to get your fibre in, got to get enough protein, got to eat an anti-inflammatory lifestyle, like cook from scratch, de-process your diet, move every single day. Um, are those, would you agree with those as the sort of basic tenets of lifestyle medicine or would you go one step further in any of those domains?
Dr Darshan Shah: No, those are definitely 100% you got to follow all of those tips, techniques, rules, habits that you talk about on your podcast so well. But I think after the age of 40, which is what we're talking about here, you got to get really intentional about three main topics here. I would say number one is really de-processing your diet. I mean, processed food, you know, our biology is so resistant to even the crappiest diet, right? Until you turn 40. And then this ultra-processed food really starts to affect you. And there's a lot of reasons for that. Number one is what we don't realise comes with ultra-processed food beyond just low nutrient density is the toxins that come with it. Okay? So this chemically manufactured food, those chemicals start doing a lot of damage as we age, all right? Because it's built up over time. So de-processing your diet is even more important. On the topic of movement is the whole topic of strength training. Okay? I think you really got to add strength training into your routine for sure after the age of 40. And what I find is a lot of my patients, they actually are very focused on cardio versus strength training. And I'm not saying cardio is bad, but if you're doing a mostly cardio exercise routine, which most of my patients I see, especially women, women are really focused on cardio. And I think you really got to cut that in half and make the other half strength training. It's so important because you and I both know, muscle mass tends to decrease after the age of 40. You have to build up a large store of muscle mass so you have some extra muscle in the bank. But if you're not using it, you're definitely losing it after the age of 40. We're genetically programmed to break down muscle at a much faster rate. And that's why so many people end up like a little old man, a little old lady, because they have just, they're just not using their muscle. And so strength training is extremely important. And the third thing I would say is really getting intentional about your sleep. So, you know, for many of us, when we're 20s or in our teenage years, we can fall asleep on a dime. We'll sleep 10 hours and feel incredible the next day.
Dr Rupy: I remember those days.
Dr Darshan Shah: Remember those days? But sleep quality exponentially deteriorates after the age of 40. And there's a lot of different reasons for that. A lot of things, you know, you can attribute it to stress, you can attribute it to staying up late and not living in our circadian rhythm, melatonin levels decreasing. But the reality of the situation is it's also genetic. As we age, genetically, we just sleep less. And that decrease in sleep time and also the decrease in sleep quality is almost pre-programmed into our genetics. And no one really knows why, but you have to mitigate against it. And so I think when I when I say getting your sleep right after the age of 40, you really have to get some sort of tracking device to tell you what direction you're headed in. And so whether it's an Oura ring, I think we're both wearing Oura rings here, or a Whoop band, really understanding how your sleep breaks down into sleep cycles and deep sleep. A lot of my patients after the age of 40, they're surprised once I put a tracking device on them and they're getting like 5, 10 minutes of deep sleep a night versus the hour and a half or so that we aim for. And they're like, what? I thought I'm getting like eight hours of sleep. I'm I thought I was sleeping great. And really their sleep quality has really decreased. So, you know, there's a lot of ways to improve on your sleep. There's sleep routine things that you can do, sleep environment. You talk a lot about these in your podcast, but getting intentional about that after the age of 40 is important.
Dr Rupy: I found it very demotivating for me when because I've been wearing my my ring now for like seven or eight years, like a long, long time. I found it really demotivating over the last year since having our first child that my sleep's just been completely decimated. My resting heart rate is slightly higher, I think by like four or five beats per minute, which is a big amount considering my resting heart rate is about 50. Um, so for certain people, I feel like sleep tracking might be the like it might get a bit too overwhelming. Have you ever had that experience in clinic with certain people who like look at the number in the morning and the their whole day is like just derailed because of it? And how do you mitigate against that?
Dr Darshan Shah: Absolutely. It's such a great question because, you know, there are certain people that love the data and they're constantly making adjustments with the data. I don't find that's most people. Like you were saying, you got demotivated. I also get demotivated looking at my my ring. And what I tell people is don't look at it every day. We want to find trends over time. And what you'll see is, you know, after your eight-month-old turns into a one and a half year old and they get sleep trained, you're going to sleep a lot better and you'll see the trend get back to normal. And so it's more of a it's more of a long-term play. What was demotivating to me was when I got COVID and um, you know, this was about five years ago now, it decimated my resting heart rate, my HRV. And um, but I would have never known if it wasn't for this tracker, right? And so when I saw this kind of change in my biology, I started putting actions into place to turn this around. And I would have never known if I wasn't tracking. And so yeah, I mean, I think, you know, there is data overwhelm, there are people that get stressed out wearing it. Sometimes I take the sleep tracker off of people, but usually what I tell people, you know, leave it in, leave it in Bluetooth off mode, airplane mode, and just use it for long-term um, long-term kind of adjustments, right? If you're one of these people. And a lot of my patients, we don't even look at the data until they come in to see me and then we look at it together. And we look at it maybe once a month versus on a day-to-day basis.
Dr Rupy: That's a great hack. I haven't heard anyone talk about that, that sort of long-term trend. So I I can see that as like a way to sort of mitigate against the the issue around the sleep score. Um, you mentioned strength. So strength training, I think is becoming a lot more popular, particularly amongst women. I think the message is getting out there that we need to stave against things like sarcopenia and build up muscle bulk and and quality, not just bulk, but quality. In terms of like what you might prescribe, what's the ideal sort of strength training regimen on a weekly basis that you would suggest to both male and female patients?
Dr Darshan Shah: Yeah, great question. So it really depends on where you're starting, right? If you're starting with zero, even doing two days a week of 30 minutes is going to be a massive change for you, right? And so, uh, two to three days a week, 30 minutes of strength training is going to be a really great minimum effective dose for most people to aim for. Okay? So, once you get there, just and that's just just going to the gym and lifting some weights. Okay? I don't care how much you're lifting. Um, you know, all the different things we talk about, which I'm going to talk about next, is not even um, really uh applicable until you get that routine in there. Okay? Now, obviously, when you first start going to the gym, you want to focus in on using full body type of exercises. So things like squats and deadlifts and um, and and using machines to do these safely, right? Bench presses where you're using multiple muscle groups versus isolation because if you're only there for 20 or 30 minutes, you want to work out as many muscles as you can, right? Now, as you get more used to going to the gym, instead of adding more time, you want to add more efficacy. How do you do that? You want to start looking at every set as a a goal to get to a higher weight. This is called progressive overload, right? And so, um, a lot of people talk about how many reps you should do within a set. What I've really landed on over years and years of giving people advice on what's actionable and also preventing injury, okay, is is going to be trying to get to 10 reps, but the last two reps of that set are really hard. Okay? Now, if you're getting to where it's so hard after three reps, you're going to hurt yourself. And so you want to lower the weight and get a little bit more. But if you're doing 10 reps and it's like barely a challenge, you're not getting that progressive overload in and you're not creating the stimulus to build muscle, right? So, getting more efficacy in the gym by by getting to this um, one rep in reserve or two rep in reserve is the uh, kind of technical, you know, bodybuilding term for it. But it's really just getting it, getting that weight so hard that you can barely do it on the last rep of 10 reps. And then tracking this, okay? So pick five machines, pick five exercises, five dumbbell exercises, whatever have you, pick five that you're tracking your progress over time. And once you're doing 10 reps and they're getting easy with that weight, add another five pounds. And just keep doing that over time.
Dr Rupy: Love that. Okay. So there are compound exercises. It sounds like your favourites are squats, deadlifts, bench. Are there any other ones that you think are like the ones?
Dr Darshan Shah: Leg press is really, yeah, leg press and the machine is usually one of my favourites. Yeah, those are and then um, uh, doing the lateral pull downs as well. Yeah, those are my big, my big five.
Dr Rupy: And so you want to be aiming for progressive overload. And I love that that sort of um, uh, the idea of like getting to the 10th set, but like the last two are like, you know, you're really, you're really pushing yourself. If you find yourself like, okay, you're doing the bench, right? And you're doing these 10 sets and you get, you, you, people plateau. Do you suggest going to a different exercise, maybe like an incline bench or a decline bench or something like that to like mix it up once you get to this level of, okay, I've been doing this for three months now.
Dr Darshan Shah: Right, and I'm not making any improvement. Absolutely. Yeah. So, you know, once you've been going to the gym that you're actually finding yourself plateauing, that's actually great. You should look at that as a success. Like you are going enough that you've got to a point where now you need to do something to get past the plateau, right? Um, so I look at that as a celebration rather than something that's a negative.
Dr Rupy: I love that.
Dr Darshan Shah: And there's ways to get past the plateau. Um, one way is doing what you're saying, varying the exercise or a different type of exercise. A really good way, uh, in addition to that to get past the plateau is going backwards a little bit and then um, almost like taking some weight off, okay, going down to where for two or three weeks you're going to 10 reps pretty easily and then trying to push it again. All right? And the third way is get a trainer. Now, this is a really good time to find a professional to help you, right? And so, look, I don't think everyone needs to pay a trainer all the time, but this is a nice time to pay someone to really help you get past the plateau. They can teach you some new things, they can teach you new movements. You can add a functional movement in instead of just a weight lift. I think those are all ways to get past. What I love for a lot of people too is adding a a mobility day. So these are not just using weights or machines. This is actually doing things like sled pushes, sled pulls, pull-ups, um, farmer carries, you know, these are all ways to get past a plateau, but also adding more functional mobility to your routine.
Dr Rupy: Yeah, I love this. Honestly, you're so motivational, you should be a trainer yourself. I love that the plateau is success because whenever I've hit plateaus before in the preceding few years, I always find it like demotivating. But the fact that you're like, no, plateau is good, like this shows that you're progressing. That's great. That's really, really good actionable advice. So, I think we've covered lifestyle, de-process your diet, strength, sleep, all areas that I feel like I need to work on myself. Um, let's go for pillar number two, functional, functional medicine. So for folks who haven't heard about functional medicine, maybe like, you know, a couple of lines about what this means to you and what kind of things that we should be leaning into when it comes to longevity.
Dr Darshan Shah: Right, right. So, you know, functional medicine, big picture description of this is root cause medicine. How do you figure out what's affecting you at a root cause to avoid all disease? You know, you and I both trained in healthcare and or you know, as traditional MDs, and we have books full of hundreds and thousands of diagnoses, right? But as you learn about functional medicine, you find out that all these diagnoses, they really come down to eight or so root causes, inflammation, metabolic health abnormalities, mitochondrial dysfunction, gut health issues. All of these scientific terms for why we have disease in the first place. So what I try to do is make it real simple for my patients. And I say, you can, you can really affect yourself from a root cause functional level by focusing on obviously the lifestyle pillars, but adding a few extra pillars there. Those pillars are hormones, gut health, detoxifying your life, and also emotional health. Okay? And all of these tend to decrease after the age of 40 for a variety of reasons as we talked about. Um, hormones, all right? Men and women, women go through menopause, um, men go through andropause at around this age. And it's really important to number one, get your hormones checked. And preferably, you know, I'm telling a lot of my patients now this, you probably, even if you have a younger audience, get your hormones checked even in your 20s. Number one, sometimes we're surprised, we find people in their 20s with hormone deficiencies. But also now you have a baseline of where you were in your 20s. And that's where you want to aim for in your 40s and 50s and beyond because that's your hormone levels at supposedly your maximum level of health. Okay?
Dr Rupy: Do you have any hormones from back then? From when you were 20?
Dr Darshan Shah: So I don't have any hormones from when I was in my 20s, but my recent test looking at testosterone and free test were, I think they were normal, but I can't remember them off the top of my head. But I remember thinking I was quite happy with them. And like, I do all the right things. I strength train and like, you know, I sleep well. My my hormones are probably going to be completely skew-whiff right now because I'm in the middle of it, but that's why I'm not testing them. But I but I also think, you know, you could do all the right things, but you could your exposome can also have an impact on your hormones, right? So I mean, we'll talk about this in a second, which is why detoxify is one of the pillars or the the sort of sub-pillars. But um, but it is really important to get that baseline because that way you've got your blueprint for what's normal for you. And this is something we don't do very well in traditional medicine, right?
Dr Darshan Shah: Exactly. We try to pigeonhole everyone into one level. And testosterone is a perfect number for this for men and women is, you know, we've been taught that there's a certain number that's normal in quotations for when you're 40. And really what that is is for the entire population in this moment in time, what's the average, right? But we know this moment of time is not really the healthiest time in human history, right? And so this number has gone down in the laboratory's normal range over the last 50 years. And that's unfortunate. And so understanding where you're at in your 20s is important. But if you don't have that, it's still really beneficial to understand what are your oestrogen, testosterone, free testosterone, LH, FSH. These are all numbers that you should know what they are. And I think if your doctor is not going to measure a hormone panel on you, even if you're insisting on it, you should either measure one yourself. These are now readily available now to you can go to labs and get them done and you don't have to get a doctor's order anymore in the United States.
Dr Rupy: Is it like that in the UK as well? Can you get?
Dr Darshan Shah: You can do, there are some like testing kits that you can get online. But I think one of the things that people struggle with is I can get the testosterone, I can get my free test, I can get, I have no, like who's going to interpret this stuff for me? Like, you know what I mean? Like I can get all the numbers, but like I don't know if this is good or bad. This this number's red, does that mean that I need to worry about it? Or this one's green, so does that mean like I'm I'm completely fine? Like the interpretation of this, I think is somewhere a lot of people might slip up.
Dr Darshan Shah: And we are in an incredible moment of history now where we can actually have help with this. And um, you know, this brings up a really important point that I talk to all of my patients about that you should do this as soon as you hear this podcast. Commit to becoming the boss of your own biology. And what I mean by that is, if you're a CEO of a company, you don't run your company without looking at numbers every day, every week, every month, right? There are certain biomarkers that we have the technology to test and we've had this technology for, you know, since you and I have trained in medicine, 50 plus years. But people don't know what those numbers are and what they mean. And I think that everyone needs to get empowered by understanding what are 10 critical biomarkers that you need to follow, what they mean, why they're important, and what is the optimal range, not just what is disease. So I put together a free guide for my patients and you can get these on my website, drshah.com/biomarkers. And it'll explain to you what are those critical biomarkers, why they're important, and what they mean and what is the optimal range. Okay? And so it doesn't need to be, you know, we, you know, in medicine, we can measure thousands of biomarkers. You don't need a thousand. You need like 10, maybe max 15 to 20. They're in this guide, it's free, um, and you can do this yourself wherever you are, either asking your doctor for these blood tests or you can get them through mail order or through um, labs. Now, that gives you enough knowledge to be dangerous, right? At least you can now ask your doctor the right questions. And that's where you want to get to. You don't want to outsource your health so far that you don't even know what questions to ask, you don't even know what's not in the right place. There's another tool that just became available in the last year, which is AI. And AI has gotten really good now to where you can upload the PDF of your blood test result and ask it, what do you think? What should I ask my doctor about? Obviously, don't make any medical decisions using AI. We're not there yet, but at least you know what to ask about, what you need to focus, and what lifestyle changes you can make. And you know, your app is awesome. Like you can ask Dr. Rupy questions now on your app. So I think these are all tools we have available to us and we can really empower our health journey and not just live in this kind of cloud of what's really happening and I hope everything is okay. I think it's so important to be become a master of your health destiny.
Dr Rupy: I completely agree. You know, like I I was trained in the UK medical system and in the NHS, there is a culture of not over-testing, which is I think is different to the US. I think in the US, you sort of, uh, you test before you really think about management and you know, there is an abundance of tests because there's a different healthcare system. So I think my, I've always been reserved about testing, but the more I learn about lifestyle medicine and functional medicine, I realise actually there is a lovely balance to be had. And I like the fact that you've got a guide that I'll I'll link to for sure in the show notes for 10 biomarkers because right now, I think we're in an interesting point in time where like you said, you can get so many different ones. There's like a hundred here and there are companies that are like, oh, we do a thousand, you do this like two times a year. It's like it's so overwhelming. I can get just a microbiome test, you have like 60 pages worth of stuff. It's far too much for the regular doctor, let alone the the a person who doesn't know anything about medicine. So I think having 10 biomarkers, you're like, I need to keep these in order. These are almost like compound exercises. They give you the most bang for your buck. I'm assuming there's an inflammation marker, there's HBA1C. So, you know, it's like cardio metabolic health. So as long as these 10 are good, I can be like 95% sure I'm on the right track. You know? I love that.
Dr Darshan Shah: Exactly. And then you measure more if you need to, but for sure. And and what you just mentioned, right? There are biomarkers for inflammation in there, biomarkers for metabolic health. These are all the root causes of diseases. And that's what we really want to track. Am I setting myself up for a problem later on down the line rather than testing for each individual of thousands of diseases, right? And so HSCRP is a marker, marker of inflammation, haemoglobin A1C is a marker of metabolic health. And you know, a lot of people might be listening to this and it might already sound overwhelming, but it's really not. If you follow 10 numbers, I mean, you follow your bank account, right? So you don't run out of money. You follow, you know, you follow the temperature outside so you know how to dress. These are these are certain markers, maybe following them once every quarter, every six months can be massively empowering and change your entire life.
Dr Rupy: That's such a good parallel. Like I know exactly how much petrol there is in my car because I don't want to run out of gas. Like you don't want to run out of life years either. So, yeah, having a good steer, a handle on these numbers, I think it's a really, really good, really good idea. So, so we we talked about hormones within this functional medicine kit. Um, detoxification.
Dr Darshan Shah: Yeah, super important. This, in my mind, needs to become a pillar of our health journey. You know, we have these pillars like diet, exercise, sleep. If we don't make detoxification a pillar of our health, we're going to be constantly chasing our tail. Okay? And the reason I say this is we now live in a time in history where we have dumped 150,000 chemicals into our environment with no testing to see if these are safe or if they are leading to human health deficiencies. Except now we now know finally that many of these chemicals are endocrine disruptors, meaning they affect your hormones. They're immune disruptors, meaning that they can affect your immune system, leading to just not just infections, but also to cancers. And they also affect your ability to think and and your cognition. Okay? So they're brain disruptors. Um, and it might this also might seem overwhelming to people because, you know, you can't see these toxins, you can't smell them. They're they might be in that glass of water, you know? And um, unless you understand that there are some specific actions that you can take to detoxify a big portion of your life, you're just going to kind of live in this soup of toxins and then you're going to suffer the consequences 30 years from now. And my whole goal with patients is to empower them with the positive here. The positive is there's a few simple things that you can do to detoxify most of your life and then you're way ahead of the game. And your body can handle the rest a lot of times, you know? You know, our bodies are incredible. We have a liver, we have kidneys, we have our skin. These are detoxifying um, I would say pearls of of technology that we're built with, you know? And so let them do their job by giving them less to deal with and they'll do the rest for you.
Dr Rupy: Yeah, that that already sounds like quite reassuring actually for me because I think when you when we start thinking about us living in a soup of 150,000 chemicals and like, you know, you and you know, it could be in this water, straight away, like alarm bells and like stress and we know that's not good for people either. So the fact that there are some simple strategies to detoxify the majority of these and the fact that we can tolerate the rest of them. Like I always remind people of the fact that, you know, from my from my medical career, I've seen people smoke in their 20s, 30s, 40s. Rarely have I seen people actually have the issues in their 20s. It's usually further down the line. So that shows us that we can inhale a known type one carcinogen 10, 20 times every single day for decades before we succumb to something like cancer. So our detoxifying organs are incredible. They are incredible, but we don't want to overwork them. And this is what I I hope you're going to enlighten us about ways in which we can detoxify even more so.
Dr Darshan Shah: Yeah, make it super simple for people. Pareto principle definitely applies here. What are the 20% actions that will give you 80% of the result? Air, water, food, skin. Let's make it up into four categories. Your air, where do you spend the most time? Probably for you in the podcast studio. Most people in their office or their bedroom at night where you sleep. If you live in a city or an environment where the air quality outside is good, which is now reported on every single weather app on your phone, open your windows. That's all you got to do. Open the windows, super easy. However, many times the air is not that good, maybe it's in the yellow range. Both of these environments need to have a high quality air filter system. You spend 10, 15 hours in these two environments, that's 15 hours out of your life that you've detoxified the air quality, right? So you do that one simple action, open the windows or get an air purifier, two air purifiers, one for each one of those environments, you've achieved a big part of the goal. Now, there's other things that you can do, for example, in your car, um, changing out HEPA filters in your house, but don't worry about those first. Let's at least get the windows open. Um, let's talk about water. The water you're drinking actually does not have toxins. The reason is is that's reverse osmosis water. Okay?
Dr Rupy: Talk to us about reverse osmosis because I don't think many people in the UK have actually heard of this and it's certainly not as popular as it is here in the in the states.
Dr Darshan Shah: And it's not even popular in the states. So yeah, I'm I'm spreading the word. This is a you know, people have heard of reverse osmosis. We all did this in like a fourth or fifth grade experiment in school, right? And so reverse osmosis is a technique to pretty much eliminate all toxins from the water that you're drinking. It completely separates out the H2O molecule from most toxins, almost 99% plus toxins. And um, basically, it's a filtration system, but a highly effective filtration system that you can get for your home and your office as well that either you have a plumber attach it to your underneath your sink and it just takes your tap water and puts it through the filter and serves you very, very clean water or there's even tabletop units that are a couple hundred dollars, right? And so, you look, I hate having to have people buy things. Um, I think a lot of people are sceptical about buying another thing. But I promise you, this is one of the most effective things that you can do to detoxify your water. Unfortunately, tap water has a lot of toxins in it, especially in the United States. And a lot of the piping now that we use to um, in our plumbing is made out of plastic. And so there's a lot of plastics in there. Reverse osmosis is the key to eliminating most of these. So you want to drink out of glass as much as possible, not plastic bottles and drink mostly reverse osmosis water.
Dr Rupy: Yeah, well, I I do three things. So my my water bottle is made out of um, uh, glass in the studio. I have a coffee cup um that doesn't have any plastic or particularly as we're putting hot uh materials into that. So I don't want any leaching. And we do actually have a tabletop uh reverse osmosis filter in the in that I had to ship over from Germany. Um, because I would get the under the plumbing, but we're we're in a rental, so we can't do that. But it's very it became more apparent to me since having our son that we were, you know, making water for him and we were doing a mixture of formula and breastfeeding because we were able to, uh, that I wanted to give him the best quality water. And I know at that critical time point in his first couple of years of of life that they're exquisitely sensitive to toxins and plastics in the in the water and any environment. So.
Dr Darshan Shah: Yeah, I think, you know, most homes, you know, we're all so used to having a coffee machine at home. Having a reverse osmosis machine costs about the same and you get clean water every single cup of coffee, every single baby bottle, everything you drink, you know? So it should be one of those core um appliances we have in our home.
Dr Rupy: And just really quickly, um, you know, uh food, you can look up ewg.org, it'll tell you what the dirty dozen are of food. You know, you want to eat organic as much as possible. A lot of things you talk about, focusing on whole foods, eliminating ultra-processed food. Anything in packaging, the packaging is also leaching microplastics and toxins into your food. And then your skin. This is something very, very important. Most women use about 14 on average different cosmetics on their skin. Men is about eight. Um, because we forget, soap, toothpaste, these are all chemicals that are manufactured that we're using to supposedly clean ourselves. But instead, what we're doing is we're adding more toxins for our skin to mitigate for. And it's super easy. There's apps out there, apps like Think Dirty, EWG Skin Deep, um, the Yuka app, I think it is. Yeah, these are awesome apps that you just scan the barcode, it tells you how much the toxin level is in that particular cosmetic. It suggests to you a a non-toxic version. Now I don't know about you, but I haven't switched my soap for years, right? Once you find something that smells good and you're like, I'll just keep buying it. Switch it one time and then forever you're switched and you can be confident that you have something that has less toxins for your body to deal with.
Dr Rupy: Yeah, it's a very good point because I don't think we are conscious about the source of toxins that we put on our body every single day. This became, I was really aware of this when I started doing like, you know, in uh, functional medicine training and all the rest of it. And I it was a bit of an eye opener for me, but I I also had like an air of scepticism. Like, how much is this actually going to have an impact? How much is like, you know, me changing the soap? But it's not about the individual swaps itself. It's about the burden and the combination of all these different chemicals and all the different pesticides and all the toxins in the water and all these things. So we need to chip away at this balance so we get a lower toxic burden. We won't be able to eliminate it completely, but that's good enough and that may actually lead to benefits down the line.
Dr Darshan Shah: Exactly. It's adding in multiple doses from multiple places every single day. That's the problem. It's not the one time that you're using it. It's the multiple sources every single day. Um, and so on this too, like, you know, I'm like you, like I made all these tools for my patients and then yours turned into a book, right? So I've created all these, like I have this thing of 52 week guide to detoxifying your life on my website too. So that's at drshah.com/toxins. And every week you can just pick one thing and check it off. And after 50, after a year, you have set up the rest of your life to have 90% plus less toxic exposure than most humans do.
Dr Rupy: That's a great, that's a great guide. I'm going to download that. 52 weeks to detoxify.
Dr Darshan Shah: Yeah, some of it is just like simple, easy things that you can do in like a second. Some of it takes a little bit more effort, like getting a reverse osmosis. But I mean, anyone can do this, right? And I can guarantee you like the whole list, 52 weeks worth will cost you less than a $500 to do this stuff. It's just being aware and then getting into the routines.
Dr Rupy: Love that. Okay. And so quick question. So what what soap do you use? I'm going to try, I'm going to buy some on my way home.
Dr Darshan Shah: Yeah, yeah. So the the the soap that um, I use is uh what what okay, it's called from Branch Basics. So Branch Basics, I I'm, you know, they're in the United States, one of my favourite brands out there. And they make detoxified versions of soaps, cleaners for your home. This is where a lot of our toxins come from is from cleaners that we use at our home. I've noticed, yeah. You know, like the whole industry is so messed up. They've convinced us that we need five different types of cleaner, one for your furniture, one for your glass, one for your dishes. It's not true at all. You can get one cleaner, use it in different concentrations and clean your home with minimal toxic exposure. So if you just go to branchbasics.com, um, I have, you know, I don't get anything by recommending them, but I just use it in my home.
Dr Rupy: Yeah, I use a couple that we can we can find in the UK. So Seep do cleaning materials. So it's like uh the scourers and they do copper wire things and they do everything's without plastics in it. So I think there's there's benefits of on the environment, but also on on obviously um your exposure. Um, but then my mother-in-law has been telling me about and my my mother as well, vinegar, like is amazing for everything. Exactly. Vinegar sorts everything out. You can put it on glass, you can put it on your worktops and stuff. So you actually can save money with this technique of actually detoxifying your your cleaning materials. And actually like, you know, it's it's a lot more environmentally sustainable and like and actually genuinely cleans your your kitchen. So a little bit of DIY actually goes a long way, right?
Dr Darshan Shah: It really does. It really does.
Dr Rupy: Okay, great. Um, and then emotional health. So I'm glad we're talking about this because this is within the functional medicine toolkit. So we've talked about hormones, detoxification, emotional.
Dr Darshan Shah: Yeah, so there's a lot of aspects of emotional health and, you know, we become less and less resilient again as we age, you know? And so I think if you don't have some intention around your emotional health, that it can really go in the wrong direction. And um, there's a few different aspects of this. Number one is it's probably a good time if you haven't addressed traumas in your life to look into different methodologies for addressing trauma. Okay? And um, there's a lot of different ways to do this and you know, people can Google Google how to address trauma in my life. What I would say is before you go the psychedelic route, please try some of the other ways like therapy, also um, you know, there's journaling is another way. But another big aspect of um, emotional health, I think is giving yourself mental space, right? And we don't do this anymore because we get busier and busier as we move forward through life. Once a child enters your life, financial stress enters your life, and you have to be so intentional about giving yourself space to focus in on yourself. You can call it self-care. Um, but it's really just focusing in on the self again. So, um, what I recommend is a daily habit of finding time to either meditate or do breath work and journaling. Um, I recommend a also a daily habit of going to the gym or finding some way of self-implementing self-care into your day. I recommend a weekly habit of spending um, at least an hour doing something purely for yourself, whether it be going to get a massage or going for a walk in the woods by yourself. Um, you know, I think being by yourself is such a critical piece of this equation, um, to really understand like where do you sit in life, you know, where you're sitting at this moment. Putting that into your weekly routine is extremely important. My personal habit that I do is I go for an hour hike by myself in nature with no headphones and just go out there and just walk for an hour.
Dr Rupy: I love that. Yeah, yeah. I think it's interesting, isn't it? Because whilst there is like an epidemic of loneliness, there is also the counter to this where we're just constantly simulating and we actually need to intentionally find space in our week and our months to actually find a bit of solitude. And I I guess it's the uh the approach you take to that solitude, how you are viewing that through the lens of this is good for my emotional health, whilst also, you know, maintaining social relationships and social cohesion and community and purpose, which I think is so fundamental to the human experience.
Dr Darshan Shah: Right, right. Yeah, it's two sides of the same coin and you know, as humans, we need both sides of the coin in many aspects of our life. And so, you know, I'm a very gregarious, like social person. Like I love being around other people. It gives me energy. But then I found myself for maybe two years, I look back, I'm like, I haven't spent any time by myself in two years. And so when I put it back in, it was initially very uncomfortable for me, but then I got through the discomfort and I saw tremendous benefits in my own personal mental health. Just even just, you know, being having the ability to drop off negative people from my life because I had the time to sit there and understand like what was negatively affecting my emotional state. And if you don't give yourself that time and that space to do that, you can't make these positive changes.
Dr Rupy: Yeah, yeah. That's amazing. I think that's going to be super impactful for people. Um, okay, so we've done lifestyle medicine, functional medicine. Are we are we have we have we touched on that root cause or is there anything else within functional medicine?
Dr Darshan Shah: There's also gut health, but I think you talk a lot about that in your podcast, you know, fibre is super important, cutting out ultra-processed food. It becomes much more important as we age. And you know, as you age, you need more fibre. You want to keep your gut bacteria healthy. You also end up as you age, you get convinced that aches and pains are normal and you should take Advil. You know, this is not normal. The reason you have aches and pains is because you've lost mobility, you're spending more time sitting in a chair. You want to add mobility and don't take the Advil and find use that ache and pain as a reason, as almost like a biomarker to increase your mobility routines so you can get rid of it, you know? A lot of back pain, a lot of hip pain, shoulder pain is due to lack of mobility, not not a lack of Advil, you know?
Dr Rupy: Gotcha. Yeah, it's a really good point. I mean, there is this general decline in the microbial diversity as we age. And I think that's something that we need to counter with, like you said, fibre, probiotic rich foods, diversity of different foods. So it becomes even more important to look after your gut as you age. And that also has a knock-on effect on inflammation as well.
Dr Rupy: So that's functional medicine approaches. So, you know, within this consultation of someone like myself, I'm trying to look after my my uh my health and and and age as gracefully as possible and and keep my energy levels. Um, what's the next step?
Dr Darshan Shah: Okay, preventive medicine now is extremely important for you, being 40. Now you really got to ratchet up your routine of making sure your heart, your brain, and your immune system are staying maximally functional. How do you do this? Um, number one, um you have to screen more, you have to get your screenings in order. Okay? So in the United States, you know, colonoscopies are extremely important. Um, skin cancer screenings, um, whether you do this with a dermatologist, which I don't recommend, I think it's much better to do this on yourself with your partner. Um, yeah, looking looking for moles, educating yourself on what a skin cancer look like, the ABCD's of moles. Very important. Women need to go see their gynaecologist every year. They need to um get their mammograms. Men need to make sure they're having their PSA level checked for prostate cancer. All these cancer screenings are really, really important. Now, the other test that's really important for cardiovascular health, it goes way beyond knowing your cholesterol levels. That's like 1980s, right? We got to get we got to get into modern medicine. There's a scan called the coronary calcium score. Um, this is available, you know, definitely throughout the United States. I know it's available in the UK because I've had some patients go get it. Every person who's 40 years old should get this quick, easy score done of their heart. It's a CAT scan. It tells you how much plaque is built up in your heart. We're very surprised with the results, even at the age of 40 on people, right? And now you need to start putting into place um ways to decrease your cholesterol burden over time. Um, another cholesterol marker that everyone should be following is ApoB. This is a blood test of all the bad kind of forms of cholesterol combined into one, LDL, VLDL, LP little A. ApoB is a really important marker. Um, and then as far as uh brain health goes, um, also there's online tests that you can take that measure your level of cognition, measure your level of memory, measure your reaction speed. I like one that's put out by Dr. Dale Bredesen. Um, it's called mycognoscopy.com. And this can kind of give you um some big picture indications of where you're doing on these three aspects and if there's something you need to watch out for, you know? And a lot of people um they don't understand that Alzheimer's disease is the end result of 30 years of doing um routines and habits that are negatively affecting your brain, whether you have the gene for it or not. So just because you have a gene for Alzheimer's, doesn't mean you're going to get Alzheimer's. It's because of all the things that you're doing that can lead up to this, right? And so, you know, a lot of you might think 40 is too early. I don't. I think 40 years old is a time to start screening for it, to become aware of this, and to start getting the ship in the right direction and keeping it in the right direction to avoid Alzheimer's disease and Parkinson's and other neurodegenerative diseases that exist out there.
Dr Rupy: Yeah, it is really the defining disease of our time, you know, it's the number one killer in the UK. It's number one or number two in the US, I believe as well. So it's something that we really need to be start to start thinking about early in the same way we do with cardiovascular disease, but I don't think we're as hot on it with dementia at this point and and you know, other neurodegenerative diseases. Just on the note about uh cancer in terms of the preventive medicine pillar here for me, this is really, really important. So the colonoscopy, how often do you recommend people have a colonoscopy? Because there are associated risks, obviously, user dependent, like perforation, etc. Obviously, it's it's quite uncomfortable, but you do get the treatment and the screening at the same time. So you get a twofer rather than just a one. Um, how often do you recommend colonoscopies?
Dr Darshan Shah: It's very N of one here for me. Um it depends on if you have a family history, it depends on your diet, it depends on um what they find at the last colonoscopy that you did. Um, what I will tell you is that across the world, colon cancer is occurring more frequently and in much younger ages now. And we have to kind of step up our testing regimen. Now, if you're eating a Dr. Rupy diet and you don't have colon cancer in your family and you had a colonoscopy at the age of 40 and there's no polyps, you could probably still wait five years, right? But if you're, you know, still eating a lot of ultra-processed food, you have low fibre, um, you don't move around too much, um, and um, maybe they found a polyp, I mean, I would definitely step it up and do it um, a little bit more frequently. And, you know, finding a really good progressive gastroenterologist that keeps track of this is extremely important. Now, there are other tests that you can do at home actually that could um help kind of fill in the gaps between colonoscopy. You can actually get a what's called a FIT test at home, which is a stool test that you can buy online. They're not very expensive and you can test your stool once a year for blood. And this is an indicator of possibly a polyp or a cancer. And so I have a few of these sitting around in our cabinet and every January I do one of these on myself.
Dr Rupy: Gotcha. Yeah, yeah. That's that's really good advice. And would you say the more frequent would be like two to three years or in some cases more frequently than that, but
Dr Darshan Shah: Um, colonoscopy? Yeah, I think the the frequency every two or three years definitely is a good is a good level if you have risk factors.
Dr Rupy: And with the skin and moles, um, have you you've probably aware of these like the these sort of scans that you go in, you can just quick. Are you a fan of those at all or do you think it's
Dr Darshan Shah: I actually haven't tried one. Um my dermatology buddies are looking into those and a lot of them have them in their clinics now too. I think they're great. I think access is an issue right now. There are some great apps though that you can scan a mole and it can tell you the risk of it. Yeah, yeah, yeah. The key here is you need to have someone that's looking at your skin with you, you know? Um, you know, this might be a romantic partner or not. Just someone who you can, you know, share a lot with. Exactly, exactly. Because you know, there are, you know, nooks and crevices that can be checked that most you don't have the the dermatologist doesn't have time to do this. And so, you know, getting into a habit once a year maybe, every January, doing this together, getting finding an app that works, scanning some moles and seeing where they're at. I think it's it can be very beneficial.
Dr Rupy: It's a really good point you make about, you know, people learning the ABCDs about skin, you know, the asymmetry, the border, the colour, like these are things that we were taught at medical school, but like people should know this because it is very simple. And that way you can be a lot more aware. And if you're second guessing it, go to see your primary physician. They're always really happy to see you for any mole or anything that you're worried about or a tag. So I think that's great advice. Um, in terms of the the coronary calcium score, right? So I haven't had mine done yet. So I definitely want to do that because I've seen a lot of people and they have like plaque. So this is an end state. This is quite a late stage, I would say of coronary disease, right? Are there any sort of investigations in between then that you think we should be at least leaning into if we have the um, uh, the financial means to do so? So looking like more specifically at the the lining, the endothelia or like, you know, the any narrowing that might not be because of plaque that fossilized, like something earlier.
Dr Darshan Shah: Right, right. So you make a really good point there. A coronary calcium scan is going to tell you kind of like the end result of plaque over time because plaques calcify over time and that's what the scan picks up. Um, and that's our body's attempt at healing these plaques, right? Now, there's a newer test called the Cleerly scan. This is a coronary CT angiogram. Basically, what cardiologists used to do, if you came in with a heart attack or chest pain, is they would shoot dye into an artery in your body after they put a catheter through that artery all the way to your heart and look at your coronary vessels, right? And very dangerous, not something you want to do unless you absolutely have to do it. Now, using AI, we can take a CAT scan and look at every single one of your four major arteries of your heart and see exactly how much plaque you have in there, both old calcified plaque and new plaque. This scan is revolutionary and we are doing it on many of our executive patients. Um, in the United States, health insurance does cover it if you have a reason to get it done. And the AI is like an additional 500 bucks or something like that to the scan. Um, I think that um this has been a game changer for cardiology. Every cardiologist that uses it now tells you this has revolutionized cardiology. And as we get better and better with the technology, we can do the scan faster, so there's less radiation dose. So what I do now is for people that have a coronary calcium scan that's positive, and positive means anything over zero, but definitely anything over 100, um, we get a Cleerly scan done now. Okay. Gotcha. Especially if you have risk factors.
Dr Rupy: Okay, brilliant. Um, and ApoB, definitely agree, you know, everyone should be getting their ApoB. How often do you think uh the the coronary calcium score should be done?
Dr Darshan Shah: Um, once again, it's very N of one. Yeah, yeah, it just depends on your risk factors and family history and how you're eating, sleeping, moving. But definitely at least once and then if it's zero, definitely in the next five years, I would do another one.
Dr Rupy: Okay. Just to make sure.
Dr Darshan Shah: Brilliant. Um, anything else within the preventive pillar before we wrap up?
Dr Rupy: I think we hit the big high points and then once everyone's done with all of that, I'm like, now we can start talking about some of the newer things in regenerative medicine, peptides, stem cells, um, you know, some of these biohacks. I think it's really important to know that longevity is booming right now. Everyone's talking about cold plunges, saunas, peptides, all these things. Those are the icing on the cake. They are the cherry on top of the pie, you know? Like if you don't have those basics that we talked about addressed at a very high level, trying to do some of these other things are going to have minimal effect or no effect. And you're wasting your time, money and energy. Biohacking should be done at the right time and place and then they can be extremely beneficial, but it's really about getting um the pyramid built up and that being the the top of the pyramid. And the base of the pyramid is preventive, the base of the pyramid, sorry, is lifestyle medicine. The next level of the pyramid is functional medicine, the next level is preventive, and the last is the biohacking.
Dr Rupy: Love that. Okay. So we've done all these pillars. These are the things to optimize. And then if you have time within all this stuff that you're doing, you're going to the gym, you're doing your resistance training, you're eating clean food, you've got all this stuff. Let's do a quick round of the things within longevity medicine that you're perhaps more bullish on than others. So you mentioned a couple there. Where would you like to start? We'll go through three.
Dr Darshan Shah: Okay, so I would say number one is um, at our next health clinics, we have what we call the longevity circuit. And this is where you do the sauna and then you go into a cryotherapy, which is for three minutes of cold exposure, and then we have an LED light bed. Now, um, a lot of the the the basic kind of uh thought around doing these is creating these little mini stresses that your body has to recover from. Okay? And so these mini stresses are so beneficial for us at a cellular level. They help us remake new mitochondria, new cells and get rid of old ones. Okay? And so what I would say is find opportunities to do these mini stresses. So a cold shower works. If your gym has a sauna, get in that sauna for 20 minutes, right? Um, if you have the opportunity to find an LED bed somewhere, this can work, but another great kind of proxy for that is just getting out into the sun, you know? So I think you can do these things um in your day-to-day life and they can really kind of add um that little bit extra bump into your energy levels, into your longevity, into your healthspan. They can be very beneficial. There's a lot of science around this. Number two, I would say is peptides. I think peptides are a new class of drug that um were previously ignored until the recent giant boom of GLP-1s. GLP-1 is one of hundreds of peptides we can use. So keep your eye out on that. Um, and then um, I would say lastly is supplementation. There's some great supplements out there to boost NAD. Um, Niacin is one of them. Great gut health supplements out there like um, I would say, um, Akkermansia, which is made by a company called Pendulum. This is a microbiotic that is excellent. Um, there's uh supplements out there that can regenerate mitochondria like Timeline has one called Urolithin A. These are three of my kind of like favourites to put on top of like a core regimen of just magnesium, vitamin D and omegas because there's a lot of science behind them having a beneficial effect after you got the basics right.
Dr Rupy: Yeah, gotcha. Two quick questions to before we wrap up. Magnesium, what kind of what type of magnesium and what dose?
Dr Darshan Shah: So there's, I think you're alluding to because there's all different types of magnesium, right? And it depends on what you need to do. And I like to take a combo form of magnesium actually. Um, a lot of uh companies uh make a combo form of magnesium. One is called BioOptimizers magnesium. Um, and um, then you get a lot of different types in. And then if you really want to focus in on like sleep, taking some magnesium glycinate at night is good for that. If you're having gut health issues, magnesium citrate is good for that. So you can add magnesium as well. Um, but um, yeah, that that's that's and and the dose is really dependent on what your end goal is going to be. So I think the, I think the standard dose is like what, 300 milligrams, is that right? Yeah, but some people need more.
Dr Rupy: Yeah. Okay, great. Um, and lastly, uh, creatine.
Dr Darshan Shah: Yeah, I love it.
Dr Rupy: What's your, yeah, you love it. Yeah. What what what's your uh your go-to on creatine?
Dr Darshan Shah: Yeah, one of my favourites, um, you know, in the kind of category of beyond the basics, creatine, ton of science behind it. Helpful not just for muscle, but also for brain health as well. People that do creatine have less of a chance of developing neurodegenerative disease. So men and women, five to eight grams of creatine a day, really easy to mix in um with your coffee or your morning shake. I think it's really beneficial.
Dr Rupy: Amazing. These are all incredible insights. I really, really appreciate you sharing this and going into detail about the minimum effective dose and like how you use it and also just making sure people are aware that look, you got to do the the pillars before this before you even think about getting Urolithin A sent over from America from this specific company. Like you've really got to get things in the order of your needs state. And this is super, super impactful. Um, you know, I'd love to find out your personal supplement stack. We'll do that afterwards after the pod. But uh, you know, to figure out how you get so much energy and you have so much life and positivity. It's it's amazing. Like, you know, meeting you is rubbing off on me.
Dr Darshan Shah: Oh, I love it. Thank you. My personal supplement stack, I have it on an app called Subco. This is an awesome app. And so they asked me to put my stack on there because it tells you the quality of the supplement as well as the types. And so they have a rating system for supplements, just like that Yuka app has for your skin care products. It's a great app. I'm a scientific advisor for them and my stack is on there.
Dr Rupy: Fab. I'm going to check that out. Subco. Awesome. Thank you so much, Darshan. This has been brilliant.
Dr Darshan Shah: Awesome, Rupy. Yeah, this was so fun.
Dr Rupy: Can't wait for dinner later on as well.
Dr Darshan Shah: Yeah, I can't wait to learn more from you and uh, yeah, let's continue the conversation. Thank you so much.
Dr Rupy: Absolutely. Thank you, man. It's my pleasure. My pleasure.
