LIFTS Episode 121 – If Aging Is a Disease… Can We Cure It? | with Dr. Jonathann Kuo

0:00We have a lot of clinical experience and first hand knowledge on just like what these things are and how they work. You know, I the social media, it's like, you know, a lot of these they're not physicians. They don't have this, you know, they'll actually like see what, you know, when you do an intervention like this is what's going to happen. And this is what happens when you do this thing for, you know, years on end. And obviously, you know, the clinical experience is what, you know, differentiates us from social media influencers or even some doctors that are, you know, the more time you spend on social media, the less time you're seeing patients.

0:36Wellness to us meant fitness memberships. It meant supplements. And recently, I would say in the last decade, it meant adding wearable, maybe recovery. Now we're watching wellness get a lot more clinical, get a lot more personalized and candidly a lot more expensive. However, consumers are increasingly willing to pay out of pocket, not just for feeling better, but to get more data, to get more access, and really to get more control over the health span.

1:07Matthew Januszek:Welcome to this week's episode of LIFS. I'm Matthew Januszek. I feel like I'm back in the hot seat again after several months of traveling. And I'm here with my co-host Mohamed Iqbal. So Mo, how are you doing back today in your brand new flashy studio? I built this thing. I've been talking about it for about a year. And finally, we were traveling for a few weeks. We went to a few events. The last one we were at was HFA. So we're coming back from that. So given that I wasn't working in my home office for a couple of weeks, I said, let me take the corner that I've always wanted to do and make it a mini podcast studio.

1:44So this is my first recording in this newly still in progress podcast area of this office. So I'm excited.

1:52Matthew Januszek:Well, we've got a very special guest today. We've been talking about that. Actually, from my perspective, I was just talking to Dr. Kuo, but I was this this conversation goes back to connected fitness we had quite a while ago. And I was with one of his colleagues and we were chatting around around around dinner and I had lots of amazing things. So I'm really excited about what we're going to hear and talk about today. But even from February to when that recording was to now, this category just feels like it's moving at something that's been on the edge to really the center of wellness culture.

2:27And what we're talking about is things like concierge health, longevity clinics, advanced diagnostics, peptides, and all the interventions that sits between traditional medicine and modern wellness. For a long time, in our industry, and Matthew, you've been in this for decades longer than I have, wellness to us meant fitness memberships, it meant supplements, and recently, I would say in the last decade, it meant adding wearable, maybe recovery. Now we're watching wellness get a lot more clinical, get a lot more personalized, and candidly, a lot more expensive. However, consumers are increasingly willing to pay out of pocket, not just for feeling better, but to get more data, to get more access, and really to get more control over the health span.

3:12So today's conversation that I'm incredibly excited about and been really planning on this for some time, sits at the intersection of healthcare, wellness, and performance. What used to once be considered niche, considered physicians, regenerative therapies, advanced biomarker testing, peptides will get into hyperbaric oxygen as well, is increasingly entering mainstream wellness culture. These are terms that a lot of people who are just into fitness now know about. And the numbers also support it. In the US, wellness spend is now over $500 billion annually, and it continues to grow. Younger consumers, in particular, are reshaping this category with Gen Z and millennials driving 41 % of wellness spending despite making up only 36 % of the adult population.

3:59At the same time, more of the medicalized part of wellness, which we'll be talking about today, is taking off. The U.S. concierge medicine market is already measured in the billions and is projected to grow in double-digit rates in the coming years. Med spas, as we all know, are a huge business in their own right, and longevity-focused platforms are increasingly positioning themselves as the front door to healthcare. And then you layer in things like policy and the cultural conversation. Recently, I heard a Joe Rogan episode where he interviewed, I believe it was on the February 26th or 29th episode, where he interviewed RFK Jr., where RFK Jr.

4:39talked positively about peptides. And NPR reported that the administration may lift or loosen restrictions on some compounded peptides that had been more tightly restricted right now. So whether you agree or disagree with that direction, it just tells you something important. These therapies are no longer on the fringe. They're not part of the national health and wellness conversation. And what's fascinating about this is that consumers are increasingly funding this themselves. Average U.S. out-of-pocket healthcare spending hit$1 ,600 per person in 2024. But the premium wellness consumer is often spending many, many more times that.

5:19So for the audience listening in here on Lyft, this is not just a healthcare conversation. It's tightly integrated with fitness and wellness, which is, I know, what we typically talk about. So given all that, I want to introduce our guest today, Dr. Jonathan Kuo, who is the founder of Extension Health. He has built one of the more visible platforms in this fast-forward category, bring together conscious medicine, advanced diagnostics, longevity-focused care, and interventional treatments into a premium model. I actually had a chance to visit his office a couple months ago. In fact, I didn't want to interrupt you because you were eating lunch, but I was sitting in Dean's office and I had a tour of your location.

5:59I'm really fascinated by it and excited for this conversation. So welcome to Lyfts. Thank you. Thank you. It's a pleasure to be here happy and excited to chat with you guys today well dr quo one of the things i

6:12Matthew Januszek:thought we would start have start with is is getting a bit of a definition on the category because there's a number of players in the space you've you've got the people like yourself at extension health that are i guess very high-end concierge providers of new innovative technology that that from what i understand through looking you know looking into you very very well researched you've got the i guess what's probably been driving this for quite some time is you've got also a lot of the i'll call them social media influencers so the the dave aspreys the um brian johnsons of which uh you know sort of reading some of your social media posts like you you seem to have a view and opinion on what some of these guys are doing and and and i i guess from a consumer perspective it really is quite confusing and and in particular most mentioned things like peptides where uh you know i was chatting to my daughter at um we went for dinner the other day and and there's there's kids that she's competing with and you know they're young teenagers and they're they're sort of asking about getting on peptides and i was you know speaking to people's dads and brothers and uncles about you know what they should be taking for there wrestling and things like that so i think it's a very interesting space there's a number of different i guess channels that that are emerging but there's also seems to be a lot of concern certainly from where i stand in in terms of how people are reading into this and particularly when it comes to some of the um messaging that that is coming out from social media so first question and quite a big one is is how do you define this category that you're in and and where does your business sit along the spectrum of some of the people that i've just referred to uh great question i mean this is um you know longevity medicine is truly a pretty new specialty it's only within the past several years that this has kind of been like on the tip of everyone's tongue.

8:19You know, we've kind of been doing this for quite a while now. It's six or seven years since I kind of branched off from my first career, which was interventional pain management. I'm trained as an anesthesiologist and an interventional specialist. So for many, many years, I was treating people in chronic pain and then kind of branched out from that into regenerative medicine because I really wanted to, you know, like most doctors actually solve a problem rather than slapping band-aids on things uh and that kind of led me into things like you know interventional mental health then into peptides then into some of the interventional therapeutics that we do these days and now that's just all kind of lumped into what we call this you know it's a longevity medicine and so kind of practice this medicine properly yeah so you do need very kind of detailed longitudinal care with an entire care team in place because the data is very complex the you You know, the things that you're looking for constantly changes, new therapeutics, new diagnostics all the time.

9:19And so it is, you know, it's a very fascinating field to be in. I guess, you know, everyone has their own kind of definition of longevity. You know, the way we practice here is more on the interventional side. You know, as in like, you know, we assess a lot of the newer technologies and newer things that are in the pipeline. We do a lot of, you know, FDA clinical trials for a lot of these newer modalities. And so, you know, we have a little front row seat on what is out there, what actually works and, you know, doesn't. What's kind of more bang for the buck.

9:55Matthew Januszek:And just a quick follow up on that then. So we're probably just going into a little bit more detail then about the other areas within this space. And so, you know, I mean, I know you've been that you sort of have a bit of a I'm not sure whether you have a sort of social media debate with some of these leading influences. But what you know, what what place how to where you sit relate to some of these people that have almost like self-proclaimed experts in within the field that may be researching some of these new technologies. And you could argue that it is so new that there are no real experts because this technology is just sort of hitting the streets and people are experimenting and then sharing with them some of those experiments.

10:36Matthew Januszek:Just give me a little bit of an idea about that as well. Yeah, yeah, sure. I mean, you know, we're very clinical. We have a team of five doctors here. We've been doing this. We see, you know, lots of patients every day. We have experience with thousands of people on peptides and a lot of these modalities with doing therapeutic plasma exchange for years, ozone therapy for years, hyperbaric for a little while as well. Regen medicine for, you know, close to 10 years now. So we have a lot of clinical experience and firsthand knowledge on just like what these things are and how they work. You know, I, the social media, it's like, you know, a lot of these, they're not physicians.

11:13They don't have this, you know, they don't actually like see what, you know, when you do an intervention, like this is what's going to happen. And this is what happens when you do this thing for, you know, years on end. Obviously, you know, the clinical experience is what, you know, differentiates us from social media influencers or even some doctors that are, you know, the more time you spend on social media, the less time you're seeing patients. So I think clinical experience still is important. Which I think is a big point of differentiation. Recently, there's been a lot of pushback with folks like Peter Atiyah for non-healthcare related stuff.

11:52But then all of a sudden people have realized that he's actually not board certified. He never completed his residency. same with the likes of Andrew Huberman or Brian Johnson, Gary Breck, Dave Asprey, and so on. So I just think that there is validation and a lot of consumers are backing that, that the fact that you do have clinical experience does carry a lot of weight. For those listeners who are meeting you and maybe hearing about Extension Health for the first time, I'm just curious to understand what led you to build Extension Health and what problem were you trying to solve that traditional healthcare wasn't solving?

12:26Most doctors know that the traditional healthcare system fails in many ways, right? It's based on treating disease and really not much on prevention. And so I treated, you know, my clinics saw over 50 ,000 patients in chronic pain. And the only thing insurance companies will pay for is a steroid injection and some little, maybe some gel in the knee and maybe a little neuroflation. But those things aren't fixing people. like you you would just say i would see the same patient for 10 years in a row and they just slowly get worse and worse and worse and worse and like that's not really what i want to do as a doctor right and so how do you actually go around and truly try to make a difference in someone's life that led me into the peptides the regen medicine you know i was just solving a problem that honestly almost every one of us has we just you know is aging a disease yes i mean i Like, you know, if you can halt or slow down the progress of aging and, you know, deal with a lot of your systematic dysfunction from a very earlier point in time, you're like, I'm really making a difference.

13:33Okay. Whether it's, you know, preventing people from getting diabetes or cancer or making sure they're metabolically fit, hormonally optimized, mitochondrally optimized. Like those are the things that really make a difference. And, you know, I'm happy to say that most of our patients on our programs like do feel very noticeable changes in their lives.

13:53Matthew Januszek:Today's episode of the Lyfts podcast is sponsored by eGym. eGym delivers smart strength solutions that help gyms and health clubs attract, engage and retain members while improving health outcomes at scale. From intelligent equipment to AI powered training programming and corporate wellness by WellPass, eGym is leading the way in smart fitness. Visit eGym.com to learn more. I love that you said aging is a disease. I'm not sure I've heard that before, but I can really relate to that. We had a guest on a couple of months ago speaking about slowing down the growth of telomeres and that if you could potentially slow the growth of that facet down, potentially could help slow down or in some cases even reverse the impact of aging.

14:43You've got buy hackers out there. I think Brian Johnson is probably the most prominent. I don't know if he said this anymore or not, but he's on this don't die campaign and wants to live until he's well beyond 100. So I'm just curious when you think about the consumer, I had a chance to look at your facility, maybe speak a bit more about your packages. From what I understand, you've got a reboot package that is 15K to something that is more exclusive and more all-encompassing for about 250 ,000. Who is the consumer that is showing up for this type of model of extension health? Is it primarily still executives and athletes and high net worth individuals, or do you see it broadening out to a more mainstream consumer?

15:27I see it broadening out. I see it broadening out. Yes, we have very expensive therapeutics here and yes we have you know a lot of people in that high membership tier um that we've honestly been taking care of for several years now um you know it's my my wish and desire for things to be more accessible to the public uh at lower price points i mean but you can start off with a simple peptide consult and walk you know and just some simple peptides could be your entryway to longevity and then you kind of have little tiers you know you maybe start with some peptides and you're interested a little more okay well let's do a little longevity console where we kind of take a look at all your existing labs versus the next tier where you start doing diagnostic packages so we have three tiers of diagnostic packages depending on how kind of deep you want to go into your own biology but you know at the very deepest end we have uh entire you know office that has like the latest 3t mris cardiac screening.

16:28We can even do functional MRI brain scans and know your neurotransmitter chemistry in your brain down to full exome sequencing, genetics, mitochondrial testing, and obviously all the basic kind of blood testing and DEXs and VO2s. So we do combine all of that in very long diagnostic packages, which then generate thousands of data points. And we have AI systems that we've trained up to kind of ingest all of this alongside with our care team to really kind of provide the most accurate health report and picture and so that's kind of what you know we do but you can see that there's multiple steps on the ladder you can start with like the very basics to the most comprehensive diagnostics and therapeutics dr quo i um one of the things that

17:16Matthew Januszek:myself and probably some of the listeners are relatively um leaning towards is the is is some of the fundamentals which is uh diet uh good good diet nutrition exercise and and recovery sleep um with for the for the average person like it sounds like you you're the typical clientele is is certainly a clientele that has to be relatively affluent to be able to afford some of these treatments um and i and i guess you know if someone's affluent does it mean that they necessarily have a high level of um knowledge and expertise probably in some cases maybe but i also guess that a lot of the people that i tend to come into contact with are exploring a lot of this stuff and it and it really sounds very futuristic when when i even hear some of the terminology that you made about the treatments that you offer there but where where do you bring people in and And how do you connect some of the real essential basics that I think people generally skip over to get to some of the shortcuts that are going to turn them into Superman that are going to live to 115?

18:25Matthew Januszek:Where do you sit on that? And what do you do at Extension Health, if anything, to address some of those things that science has proved probably for longer than anything are really effective? first of all there are no shortcuts all right so if you can't get diet sleep and exercise right then don't even bother with some of these things that we're doing um you know where do we sit on this like you know we have the diet sleep and exercise are the absolute fundamentals that accounts for like 75 80 of your health genetics plays a little part but then um you know the rest is like a little cherry on top that you can optimize beyond what diet, sleep and exercise do.

19:07And that's kind of where we sit in. Yes, most people kind of see us. I'll be honest, we see two kind of patient populations. One is like, you know, you're affluent, already really quite healthy individuals that have excellent medical care that just want to take it to the next level, because traditional medicine doesn't really address any of these, these, these newer interventions or therapeutics or diagnostics. And then you have another category, which is like the chronically ill, like the chronic Lyme mold, long COVID that I've seen, you know, a dozen doctors. And so I have a cohort of those patients as well, because actually treating both these cohorts involves many times the same exact modalities, because all we're doing is just improving basic physiology, improving cellular health.

19:57And so those are kind of my two pockets of patients. You know, the way we deliver care is we have a care team with a longevity strategist and a longevity care coordinator. And we have a dietician, a registered dietician on staff. And so we do go over the basics of sleep hygiene, diet, exercise. We do make plans for patients, but a lot of people are really looking up to us for complex peptide plans, plasma exchange, ozone, hyperbaric, you know reversing your central clock like those are the things that you know we are kind of you know more sought out for you make it sound in some ways so simple you got to focus on the fundamentals before you get on anything else at the same time your clientele list I'm not going to disclose specific names but includes owners of NFL teams royalty very well-known celebrities that are coming to you and you would think that they've got access to private chefs, the best of medical care, the best of really even environmental things within their homes or how they travel.

21:03Yet they're still coming to you for therapy and for checkups. What is it that Extension Health offers that maybe the rest of us could maybe take a learning of that we could apply? Because maybe it's reinforcement of the fundamentals, or maybe it's a combination of how you're looking at all the data? Great question. I mean, it is a combination of how we look at all the data, the kind of experience that we have in putting together protocols, different kinds of protocols, when you stack protocols together, such as all the modalities that I just talked about, in very specific ways, you get better outcomes.

21:40I wouldn't say anything is proprietary. It's just a, you know, a logical, fundamental kind of physiological way to approach some issues that people might have. Um, you know, it's, uh, just, I would also say just the breadth of services that we have, you know, it's, it's, it's not just me, myself and I, it's like, you know, we have a sports medicine orthopedist, we have a gastroenterologist, I have a nephrologist, I have a critical care specialist. I have an internist on staff. And so it's a kind of a team-based approach to develop protocols together. We evaluate technologies together and we have like a nice little system where it's, you know, we share a lot of knowledge and train our AI systems.

22:24Matthew Januszek:Prior to us coming on, you were talking about some new technology that you're quite excited about that seems to work on the brain. From my experience when talking to everything from celebrity trainers, coaches, they always seem to come back to, regardless of what you're using or training with the client, whether it's a diet, exercise routine, in order to get their performance. one of the biggest parts that influences whether they'll be successful or not is what happens in their brain and mind and what's going on in their head um this this sort of uh mind reset tool that you are referring to that does any does that or any other treatments that you uh are involved with or have seen out there help people to change some of the mental triggers or influences that are essentially causing them to be in the state that they're in?

23:20Matthew Januszek:Because my guess is even with celebrities, they certainly the experience I've had talking to people that work with them, they always seem to have some underlying challenges that have probably driven them to be super successful, but also screwing up other parts of their life, whether it's drinking too much, eating too much, or probably not being as healthy as what they should be. So what are you seeing in that area? And have you found anything that sort of addresses some of those underlying mental issues? Yeah, great question. I mean, yes, I mean, my second career was building an interventional mental health clinic because mental health and, you know, your physiology are very intertwined.

23:57We all know that chronic stress can really kill you. And so, you know, there's quite a few procedures that we can do for that these days. One of the procedures that I do a lot of is something called this neuro reset. It's a shot here in the neck that resets your fight or flight system. And we also inject the vagus nerve as well. And so that combination of therapies seeks to rebalance your autonomic nervous system, that fight or flight and the rest of relaxed state. There's a lot of people, especially in modern day ages and a lot of successful people are chronically on the go, stressed. They can't turn off their fight or flight, right?

24:35Your body always thinks it's kind of being chased by a tiger. And so you can actually physically reset that. It's like hitting a reset button on your computer just by getting some shots in the neck. So we do a series of two shots here in the neck and then we hit the vagus nerve. A lot of times we try to do this on both sides. But we've done thousands of these cases. A lot of people kind of come in for me to do that for them. But it helps with anxiety, stress, PTSD. it just calms down your nervous system. So, you know, a lot of people can benefit from that. Anxiety stress is like prevailing through society these days.

25:11I mean, another point, the, you know, talking about brain cognitive optimization. Yes, that's, that's absolutely fundamental for having a sharp mind for athletes, for all, you know, everything that's your central nervous system for a reason. Right. And so there are ways these days to really, you know, do very deep diagnostics. All right. So we have a 3T MRI machine that does functional MRI and spectroscopy. What that really means is we can actually look in your brain, figure out a lot of things. All right. The vascular flow, how that balances with oxygen, what your neurotransmitter levels are, what your lymphatic drainage is like, what centers are active.

25:54We can diagnose ADHD. We can see if you have calcifications in your pineal gland. And then from all this knowledge, we can then have a much more comprehensive plan. Do you have mitochondrial dysfunction in your brain? Are you low on neurotransmitters? Are you having poor lymphatic drainage because you lack deep sleep? And then we can kind of address those things very specifically. And addressing them is, yes, via either pharmaceuticals or small molecules, but we also have a device now where we can actually take your brain, map it out, figure out the areas that we need to kind of rejuvenate, and then we create this 3D mask based on your brain.

26:31And we can target certain structures like your hypothalamus or your hippocampus. And so those things, like for instance, the hypothalamus is the central clock of your body. As we age, your hypothalamus becomes less functional. The hypothalamus governs melatonin, growth hormone secretion on all of these things. And so by targeting the hypothalamus, which is a small one millimeter structure, like seven or eight centimeters deep in your brain, We target that with focused ultrasound, which then opens up a ligand so that you can actually attract more regenerative properties, regenerative molecules that you deliver either intravenously, intranasally, directly into the hypothalamus.

27:12And so this is like, you know, published in nature. You can actually rejuvenate and reset your central clock. And so that helmet kind of looks like this. This is a custom 3D helmet. This is an ultrasound probe for my hippocampus. This is an ultrasound probe for my hypothalamus. And basically I would stimulate, deliver small molecules or regenerative therapies, and then stimulate again, and then go in the hyperbaric chamber. And so that's like one of our brain health protocols that we use here. Which is incredible. That is just incredible. I was not aware, one, how small that was within your brain, because it's often talked about.

27:52So you always think that it's a larger part of the brain. Yeah. The question I have, as I'm hearing you talk about assessments, is really that. So when you have someone that comes in, and let me frame this for you a little bit, we're seeing, and I have a follow-on question here, because we're seeing, obviously, places like Remedy Place come up that just offer hyperbaric chambers and therapies and things like that. We're seeing fitness centers build in almost mini med spas and clinics. In fact, we had Adam Sedlap from UFC a couple weeks ago talked about he's doing that at a UFC gym. But a lot of them are just offering a specific therapy or suite of therapies without being prescriptive.

28:37And something that I've always talked about is there's an importance of assessment. You have to understand what is going on in you before you could prescribe a therapy to it. Otherwise, you're just flying blind. And it sounds like you've got a particular protocol when a new patient comes in on depending maybe on what effects they're feeling, where you walk them through assessments. Talk about the different assessments that you do and why that's so important before you simply dive into a peptide or an ultrasound treatment. Yeah. I mean, I think by now we all know the kind of basics of longevity diagnostics.