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Episode 4: An Integrative Approach to Age Reversal with Josiah Smith, PA-C

Updated: Jan 15

Podcast Drop Date: 11/16/22

Amber Warren, PA-C: Welcome to Functional Medicine Foundations podcast, where we explore root cause medicine. Engage in conversation with functional and integrative medicine experts and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper. Hi. Welcome back. Amber Warren here with Functional Medicine Foundations. I have the honor of being here today with Josiah Smith. He is a physician assistant. He graduated with his Bachelor of Science degree in PR Studies from Drexel University in 1998, and he graduated with his master of physician assistant studies in 2007. He was a medical officer with the Army National Guard and earned the rank of captain. He has been doing a lot of family practice, emergency medicine. Urgent care found his way into functional and integrative medicine about six years ago. He has a number of different specialties that he claims to fame and we are so proud to have him on our functional Medicine Foundations team. So he joins us coming here from Vegas.

Josiah Smith, PA-C: Las Vegas.

Amber Warren, PA-C: Last year. And again, we're honored to have him. Thank you. So I'm really excited to dig into today's talk, really. Doctor Halas and I were talking about this in a previous episode, talking about men and women's hormonal health. And we kind of were talking about how, you know, opening the door for us in functional medicine to more of this kind of anti-aging, integrative, regenerative, regenerative approach has been a very natural progression. And we've learned from practitioners like you that there's a really awesome way to to add it to what we're already doing from a functional medicine foundation perspective. So we just kind of want to touch on anti aging. I know you don't love the term anti-aging, so why is that?

Josiah Smith, PA-C: Well, you think about anti-aging is so I think mis overrepresented. Okay. It means so many different things to so many different people. I look at it this way. We talk about functional medicine and lifestyle medicine. It's a foundation, but there are interventions that will move the needle where just that lifestyle will not because as we age, it's a progressive decline in cellular function. And I like to look at it as more of an age reversal. How can we optimize at a cellular level so we can have optimal function, so we can bring the best version of ourselves every day to the world? That's the way I look at it. But we have so many insults with toxins in the environment over eating bad relationships, stressors. I mean, you just name it. You can't be average today to actually feel your best.

Amber Warren, PA-C: And you can't live in a.

Josiah Smith, PA-C: Bubble.

Amber Warren, PA-C: You have to be exposed to negative people and toxins. It's it's it's also building resiliency in our lives. But we have to be able to work with those things and detox them from our body. And yeah, you're you're spot on there. So you view aging as a disease, not just you as a medical community. We view aging a disease.

Josiah Smith, PA-C: We do. And it's been defined if you think conventional medicine and we know this again from a functional standpoint, it treats symptoms. You have a specialty which is in a silo and the body is a complex system. Right. Okay. In 2013, there were nine hallmarks of aging that were determined through the literature, but they were still focus on certain areas. And in 2019, Dr. Sinclair, out of Harvard University, upped the ante and looked at those hallmarks as symptoms. So aging is a biological decline or processes in the body. We we're all going to age. I mean, that's it. But at what pace are we going to age? And it comes down to all of these hallmarks. Being a complex system is inflammation or inflammation, which is a low grade chronic stress on the body, which accelerates different organ systems to age quicker than they naturally should be. Yeah.

Amber Warren, PA-C: So how do you, as a functional, integrative practitioner, identify, diagnose aging?

Josiah Smith, PA-C: Yeah, well.

Amber Warren, PA-C: Or inflamm aging inflammation from aging.

Josiah Smith, PA-C: So let's talk about a couple of things here. Let's back up for a second. Okay? We talk about genetics, the genome project realize we are all 99% have the same genetic makeup. There's a 1% differentiation. And that genetic code and genes, we realize now that again, the gene theory of even aging and that you had a family history, you were it was a determination that you would be stuck with an autoimmune condition, diabetes, whatever it is, that's not the case. Okay? We have the ability and the power to change the phenotype or the genetic expression. So genes is like a gun. Okay. The trigger are those environmental things that we have some control over. There are some things we don't, but we can change the expression turn genes on or off, which signal positive or negative. And we have three big buckets I like to look at with genetic expression. I'm just going to keep it super simple. And if we look at it from this way, we can affect how we age. Okay, The first one is something called mTOR. This is has to do with rapamycin and mTOR is growth in building. And we want growth, you know, as children we want to grow. But if there's too much stimulation in that growth, you don't have a chance to turn things off to recover. So it's a vicious cycle and you can do that with today's obesity epidemic. With eating, we eat from when we get up to when we go to bed. There's no time to digest and recover. So there's that one bucket. The other bucket is called Ampk. Ampk is the opposite. It will turn off or mute the mTOR and growth, and that is insulin sensing human growth hormone. And if that is a longevity component and the last one are two ones, these are longevity genes. There are seven, there are five mammals, and these are expressions of at the cell level, like with nad nutrient sensing and things like that, and how well we can enhance how well long we live.

Amber Warren, PA-C: I love that. So let's start with them to what are some of the favorite ways that you help to naturally improve mTOR and modify mTOR?

Josiah Smith, PA-C: Well, firstly mTOR, it's not eating from sun up to when you go to bed. That's number one. And I think the easiest actionable step anyone can take is the window you eat. No matter what diet or fad you believe in. This could be a simple step where we it's time restricted eating where you have a window. Ideally it starts at the 12 hour mark, but if you can work on not eating anything for a, say, 16 hours and compress the eating window to 8 hours, your body is going to have a chance to digest, to recover. And we talk about circadian rhythms. We have biology flows with the rise and fall of the sun and the moon. Look, you see that through women's menstrual cycles, you know, and we do that. There's more energy expenditure in the morning. So if you eat in the morning and say just the reverse, a lot of people say, hey, we're fast and noontime last meal, say 8:00 at night. But if you do the reverse, you have greater energy expenditure in the morning that eating and say the last meal is, you know four, 5:00 in the evening, you're going to have tremendous you're going to decrease your caloric intake, you're going to give your body a greater chance to rest. But I look at it this way. It's it's life. You know, we have to live by the 80, 20 principle. 80% of the time you're on it. The other 20%, you know, we socialize around food. So and I think that's important. So I think that is one simple thing that you could do from a lifestyle standpoint.

Amber Warren, PA-C: Yeah. And there's my favorite aspect, one of my favorite aspects of intermittent fasting, besides all the amazing benefits, is there are so many different ways to do it. Yeah, it doesn't have to be done every day. You know, you can get in or out. There's so much metabolic flexibility that can happen within that and there's just a lot of different ways to approach that.

Josiah Smith, PA-C: There is. And I think you made a perfect term metabolic flexibility. I love when as opposed to, look, we have to we need glucose, we could burn fats, you know, and you know, this ketogenic, this and all these other things. But if you can be your body can be trained to be flexible and you do want to have that, you know, that piece of pizza or, you know, if you can have a little bit of alcohol, not say alcohol is the best thing for you. There's a lot of debate on that. Right. Is that affects circadian rhythm and other things Contrary and your gut, contrary to what maybe, you know, some of the lay science may say, yeah, but allows you to jump back without missing a beat.

Amber Warren, PA-C: Yeah. No, it's really important to get to that. That point of metabolic flexibility. How about mTOR and exercise? Can we go there? Oh, yeah, I knew we could.

Josiah Smith, PA-C: Yeah. Yeah. So exercise. Well, let's just get a little clarification with some Mythbusters. Okay? I'm. We're going to do two personas of two individuals. Let's do a long distance runner that runs marathons and a sprinter. I'll look at their body composition. The sprinter is very muscular. Okay? And so, first of all, muscle is a currency of life. It's going to burn calories quicker. It's going to take up insulin. When you're taking in insulin through food as opposed to a chronically inflamed, skinny, malnourished, muscle waisted long distance runner. If you look at a long distance runner, not to say, you know, that's. Yes. Something everyone should be doing. But if you look at internal physiology, there's a lot of damage being done. So when we talk about exercise, I look at high intensity interval training and more is not always better. There's overtraining which can cause significant, you know, that chronic inflammation, inflammation we're talking about and it can accelerate the aging process. You know, it can affect your hormones. It can affect. It can actually as a protective measure, you can you feel like you're exercising so much, but yet you still have that adiposity and that belly tear. That's cortisol and that's a protective mechanism.

Amber Warren, PA-C: How about that data on overtraining, especially our endurance athletes and leaky gut?

Josiah Smith, PA-C: 100%.

Amber Warren, PA-C: It's amazing data.

Josiah Smith, PA-C: Yeah. And then that goes to leaky skin, leaky brain, leaky organs and all these things. So as we age too, we lose 1% of body muscle mass. So after age 30 and the decline of hormones, as we age, there's increased risk for sarcopenia hip fractures. So variable resistance training weights, high intensity interval training and stretching yoga type of things I think are very important to be sustainable.

Amber Warren, PA-C: Yeah, balancing it out. Right. We talked we touched a little bit in one of our previous episodes on just how yoga, tai chi, Pilates and just what it can do for mobility to prevent injuries as we age as well.

Josiah Smith, PA-C: And I'll give you a perfect I practice what I preach. Okay, I'm going to be 53 real soon. And for the last 30 years, I don't miss a beat or a day. If I'm not working out, I'll have a 15 to 20 minute stretch yoga routine.

Amber Warren, PA-C: So that's like your rest day.

Josiah Smith, PA-C: Well, that's every day. And I will still do that on the days I work out too. It's just my it's my morning java or coffee that gets me out of bed. And I always like to brag. I'm in this middle aged man that can still do splits. You know, that's so sometimes I will show off this one talent I have. And you can.

Amber Warren, PA-C: Do a full splits.

Josiah Smith, PA-C: Both ways.

Amber Warren, PA-C: That's amazing. Yeah. Okay. I'm kind of a competitive person, so I might be working on that and then we might have a little competition in the next couple of months. Sounds good. How about nutrition, protein and mTOR? Yeah. What do you advise there?

Josiah Smith, PA-C: So protein is needed for muscle building. It all comes down to the amino acid composition because you know, there are essential non essential things that the body needs and doesn't need. Okay. But remember mTOR senses amino acids and again there's that overstimulation, too much protein sensing, you're going to have too much growth and that's not a good thing either. So there's a balance. So if you're a very active as we get older, our protein intake and needs change based on age and gender and how active you are in exactly what you're doing. And there's varying science and thoughts on that. So that's another topic we could go down another wormhole on. But protein is is important because they're building blocks of life. Remember, protein breaks down in polypeptides and then into peptides, which we may talk about and they're signaling agents. So you need them as signals to grow and to communicate things and messages to the rest of the body.

Amber Warren, PA-C: Do you recommend supplementing amino acids in some of your patients when we're trying to stimulate 100%.

Josiah Smith, PA-C: So I actually yes, and it depends what the goals are. Yeah, the collagen peptides can be an amazing benefit and additive when we are trying to enhance or reach an outcome. So yes, I think peptide supplementation, the form how it's used. So there are different ways it could be utilized. Optimize health 100%.

Amber Warren, PA-C: I love that. Sleep. Let's touch on sleep. As it plays a role in this age reversal, stimulating mTOR optimizing body composition. I mean hormones. We could go on and on and on.

Josiah Smith, PA-C: Yeah, if you want to keep it real simple. I used to. Hey, look, sleep is overrated. I used to burn the candle at both ends. I could be up for 8 hours working and get through. But the older I get, I'm realizing. Sleep is imperative if you're looking for one thing to prioritize sleep. Yeah. And it's also the routine of going to sleep. Because we have so much stimulation, we can't calm the brain down and that will affect recovery heart rate variability. So sleep should definitely be prioritized. And with that, it's important to remember you don't want to eat right before you go to bed. Yeah, because all the energy expenditure is going towards your gut.

Amber Warren, PA-C: So I think we underestimate how, how much work it takes our body to digest food. It is a very energy dependent process, right? Which is why there's really cool data on intermittent fasting and gut healing because it's like an athlete that's always trying to train you give you give the got a break and into where it's not having to work all the time. Those tissues can heal. So yeah, sorry I went a little bit.

Josiah Smith, PA-C: No, no direction but that's okay But you know, prioritizing sleep allows. Okay listen, if you have weight loss resistance for an example, if you're not getting sleep, that may be one of the barriers that's preventing you from losing weight. Yeah. Okay. Because remember, all the healing repair recovery happens at night and we find those that are shift workers, sleep deprived, higher incidence, obesity, cardiovascular disease, type two diabetes, you know, the chronic ailments that are plaguing our world right now.

Amber Warren, PA-C: Yeah. How are you? So can we touch on circadian rhythms a little bit? 100%, Yeah, because I'm you know, I have that conversation with my patients a lot. Melatonin, cortisol always in flux, right? We need very specific curves of each, you know, waking up, opening the windows, a lot of natural light with that first morning light. Don't wear sunglasses when you go for your morning walk, get that sunlight into your pineal gland so the body knows make cortisol feel awake. Don't be making melatonin right now. What are other things that you are recommending to your patients to really optimize those circadian rhythms? Because so many of our patients come to us. I can't sleep, I'm tired. Give me some to sleep. Give me something to feel better. But there but there. We live in a society where we're under fluorescent lights. Fluorescent lights all day.

Josiah Smith, PA-C: 24 seven, all.

Amber Warren, PA-C: Day on our screens all night.

Josiah Smith, PA-C: We can keep it real simple. I'd hold during the wintertime. It's a little tough because the sun comes up so late. If you want to reset your circadian rhythm one keep a rhythm of the time you get up and the time you go to bed, even on weekends. Good. We feel like we can catch up on weekends, but that's not how the body works. So reset to reset your circadian rhythm. I think natural light first thing in the morning if you can get it and I get it a couple of days a week when I'm able to. And this also, you know, infrared light and some other things. But keeping it simple, yeah, the light exposure, if you think about it, it affects vitamin D levels. And vitamin D levels is not a vitamin. It's a pro hormone. The vitamin D is a precursor to serotonin, which is a neurotransmitter, and that serotonin affects melatonin at night for sleep. So I think natural exposure first thing in the morning, in the evening, if you can get it, it's not always possible that and keeping awake and sleep time. Those are some very simple things that you can do. And also caffeine. We're big caffeine consumers. Some may be genetically slow processors of caffeine. Others may not have any issues. So caffeine intake and cutting it off maybe two in the afternoon would also be a consideration. So those are a couple super simple things. In just a high level part of how the body works with those different hormones or neurotransmitters.

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Amber Warren, PA-C: How about bedtime routines? Wendy, recommend shutting the screens off. Do you recommend the blue light blocking glasses? Do you think they work? What's your approach there in the evening?

Josiah Smith, PA-C: They do. Do I have some? Yes. Do I use them on occasion? Yes.

Amber Warren, PA-C: On occasion. What?

Josiah Smith, PA-C: Yeah, well.

Amber Warren, PA-C: I know, I know. To, like, walk into the bedroom and throw them at my husband when he's.

Josiah Smith, PA-C: I have purchased more gadgets for sometimes and there are some things I'm very consistent with, but no 100%, you know, you talk to your teenagers, to your blue in the face, but that bedtime routine, it's the overhead lights 100%. You do not want to overstimulate the brain to think that you're still awake. You want to naturally increase your melatonin. So, yes, screen time is huge. One and 2 hours before you go to bed. Meal timing. Dim the lights. We use salt lamps in our bedroom just so we don't have the overhead lights.

Amber Warren, PA-C: I love that. I love that idea. Yeah.

Josiah Smith, PA-C: It also room temperature. People are different temperatures, but I find I sleep so much better when room temperature is 68 degrees. 67 somewhere right around there. One of the times even better at the house drops down to about 60 to 63. Yeah, you don't want to get out of the covers and that can play a huge benefit for falling asleep.

Amber Warren, PA-C: I came across something I can't remember where it was, but they were presenting data on like if you have a TV in your bedroom or a speaker in your bedroom or like the tiniest little light and how that can impact melatonin production at night, right? If it's if it's just getting.

Josiah Smith, PA-C: 100% and we purposely do not have a TV in our bedroom and the bedroom should only be used for sleeping and other fun activities.

Amber Warren, PA-C: Other activities at night. Yeah, no, I agree. I think that's really well known. Yeah, that's awesome. Let's talk about supplements you use to help with circadian rhythms. Are you a fan of melatonin to help people get into these more natural, better sleep wake cycles?

Josiah Smith, PA-C: It it can be used 100% as I would use it as a second line option. Once you try some of these other things, melatonin and there are some you know how you do melatonin, there's the oral, there's Lysol and even rectal suppositories that significantly high doses. And even with traveling and going in different time zones, it can definitely be used. But the most important thing is as we age, you know, there is atrophy, the pineal gland which produces melatonin. So believe it or not, there, you know, we'll talk about there's there are some other cutting edge therapies with like peptides. You know, it's a pretty cool buzzword that will reset the sleep cycles and enhance the pineal gland. And two, there's one called Epithelial On and there's another one called SIP delta sleep inducing peptide. So you can signal the pineal gland to enhance its ability to produce melatonin because that does go down. Our deep sleep decreases with age and that deep sleep is important for restful healing, repair and recovery. So, you know, those are a couple of things that could also be done.

Amber Warren, PA-C: Well, I love that so much. Where else are you utilizing peptides in your practice?

Josiah Smith, PA-C: Oh my gosh. I want to hear that. Any different areas? Yeah, but remember, you cannot replace a supplement, a hormone or a peptide for a crappy lifestyle. Okay. People want the one magic pill or bullet that's going to transform their life or help them meet their goals. You have to have your stuff dialed in to some degree. Okay. So but to enhance your ability to optimize your health and well-being, I believe for those that are needed, hormonal optimization, like for myself, I'm on testosterone optimization therapy and that definitely has made a difference. Okay. And with the decline, there's also human growth hormone peptides that are also used, which I utilize, which can be life changing for people. So we're not looking at increasing your levels, but effectively enhancing how well the brain chemistry functions. So it's all about enhancement and optimization, not necessarily going super physiologic or to levels that are unnatural because I think that can be dangerous. We're just tweaking physiology so it's optimized. Those are a couple of things that we utilize. And with healing, we have something called beep 157. It's called the Wolverine Peptide. There's a whole plethora of peptides that can be utilized to enhance anything from sleep, longevity, performance, sexual wellness, aesthetics, hair growth, so many different things.

Amber Warren, PA-C: How about weight loss and peptides?

Josiah Smith, PA-C: Oh, why weight loss? Well, make sure you have all those other things dialed.

Amber Warren, PA-C: In your foundation.

Josiah Smith, PA-C: Your foundations, and we know what those are. So there are several things you can utilize. There's a real hot one called Semaglutide, which ozempic and has a clinical indication for weight loss, but there can be some GI side effects with that too, and some people can't use it. But it's it's an easy once a week injection. But there are things you we talk about stacking things, so there are things you can stack that will enhance when you have your lifestyle and semaglutide can be utilized. There are some other things. There's a peptide called DNP ten, which works on the gut with leptin and ghrelin, the sensing for hunger. You know, when we overeat and it causes caloric restriction, so it forces the body to feel full sooner and something very safe. And when you hands that with some of these other things, you'll have a more profound immediate results in a shorter period of time. But at the end of the day, how are these things sustainable? I use going to get off the wagon and, you know, weight loss programs. It was 85, 90, 95% fail after a year. Yep. So and those are all things you know you have to take into consideration absolutely this yeah.

Amber Warren, PA-C: Yeah leptin is is is an interesting one I love that you know I check leptin on on a lot of my new patients coming in this concept of leptin resistance. It's interesting and it can be really hard to move that needle. I didn't know there were peptides that can.

Josiah Smith, PA-C: Oh yes there stimulate. There are some other failed drugs that have been used. And I'm not, you know, against utilizing prescription therapeutics. There's a time and a. Not always my first go to, but there are some some drugs like metformin for instance, as an anti we call about anti-aging, something called the tame trial and how that affects Ampk. Yeah. And you know but that's one thing that can be utilized so yeah it's just it's all perspective patients goals and what's the best approach you know to addressing.

Amber Warren, PA-C: Yeah autophagy can we go there. That's kind of a hot buzzword right now So you know, time restricted feeding, intermittent fasting can definitely help help with autophagy. And it fits really nicely into this concept that we're talking about of age reversal. So how do you how do you educate and do autophagy?

Josiah Smith, PA-C: Well, if you think about it, everything slows down as we age cells have a pre programmed lifespan, like a red blood cells, 90 days. I mean, every cell in the body, there's a different lifespan. But once you get towards the end of the lifespan autophagy, you know, the body's supposed to consume its cell programmed death and you get new cells. And as we age, these cells linger a lot longer than they should. And again, we'd like to use the term zombie cells, like the zombie apocalypse. If you get by his army, you just produce more zombies. So now you have more zombies than you do humans. So they are hanging out. Not they're accumulating, not going away. And it causes again that inflammation being that low grade inflammation. So right time restricted eating, fasting, mimicking diet can get rid of that. But there are things called analytics. These are cutting edge therapeutics, like myosin is one which is used for organ rejection. So, you know, if you need an organ transplant, that's one of the drugs that is used. But at a very low dose, it's found to be a it gets rid of these zombie cells quicker. And there are some other more natural substances like Quercetin Satine, which.

Amber Warren, PA-C: What is Quercetin not do.

Josiah Smith, PA-C: I know? Can we.

Amber Warren, PA-C: Be honest? Like, oh my goodness, it's such an amazing, powerful.

Josiah Smith, PA-C: Yeah. So and if you think about accumulation, if you have joint aches and pains and if you do, you don't want to continually, you know, be honest, analytic. Yeah. Once a week, once a month and rotating through, you know, so like those that have advanced loss to arthritis that accumulation of cells we finding osteoarthritis is potentially an autoimmune condition to think about it as opposed to wear and tear, which does play a component. But analytics can help reverse aging process that inflammation that's causing pain autoimmune, I mean, just so many different things.

Amber Warren, PA-C: That's amazing. Going back to intermittent fasting autophagy, I'm really impressed. A lot of it's not really new data but some of the statistics on. Intermittent fasting and cancer, right. Or doing a 48 hour water fast prior to chemotherapy and how that protects your good cells from the damage, you know, from the work that the chemotherapy is trying to do or even like a seven day water fast and how it can decrease your risk of cancer. And that's all autophagy, right?

Josiah Smith, PA-C: Yeah, it is. Yes. But there are some other caveats to that. To sustain even a seven day water fast during cancer is probably not sustainable for most people.

Amber Warren, PA-C: Yeah, not during cancer. Sorry. That was preventative. I was speaking preventative.

Josiah Smith, PA-C: Yeah. And you may lose muscle mass and nutrients. And, you know, I think the basic thing with the time restricted eating. Yeah. Could you do intermittent, I mean intermittent fasting. I think the definition is being without food for 24 hour period of time. Yeah, but there are some other food therapeutics. We can talk about this briefly if we to talk about. Yeah. Fasting, even like what mimics a water fast is something called prolonged Dr. Longo. He studied centurions and a lot of the blue zones, and he's been publicly funded hundreds of millions of dollars to research where you can have calories still, but the body senses them as not being calories, but actually a fast and have the same benefit and effects without starvation or lose loss of muscle mass.

Amber Warren, PA-C: So is that concept of not eating for long period of time is is can be really overwhelming for our patients and uncomfortable, especially in today's society. Right. Go without food. What right. So I think these new this prolong and some of these new therapies are really interesting and yeah for our patients so speak a little bit so tell us a little bit more about prolong.

Josiah Smith, PA-C: Prolong again prolonging longevity. That's exactly what that is. And from the clinical side, they have 20 clinical research studies in cancer type two diabetes. There are some with some autoimmune conditions. So when you go through a fast remember we talk about that rest repair recovery, you're giving your body a sense of rest recovery. And again, towards the end it effects inflammatory markers. The autophagy we talked about, it affects human growth hormone and that will continue even after the five days. And studies have shown it's helped with like CRP, which is a blood test for low grade inflammation.

Amber Warren, PA-C: That we test on.

Josiah Smith, PA-C: Everybody. Correct. Weight circumference, blood, systolic blood pressure, triglycerides. So that in itself you could, you know, under supervision if it's medically appropriate, because there are some contraindications, it can make a huge impact and like a reset, you know, where it's done once a month for three months or once a quarter if you don't want to do anything else. Yeah.

Amber Warren, PA-C: That's great. It's awesome. Data. We were talking offline a little bit and I honestly this is very new to me about some tests that we can do to check true age. Yeah. In our patients. Tell me more.

Josiah Smith, PA-C: Well, let's have a conversation. These are definitions. Yeah. Through what is first of all chronological age that your birthday candles. My birthday is coming up. I have 53 birthday candles coming up. I'm proud to say almost 53.

Amber Warren, PA-C: It honestly doesn't matter. You can do the splits both ways. Got like I don't put it I don't put an age to amazing that.

Josiah Smith, PA-C: But here's the thing. So that's your birthday candle now you can measure and this is through methylation. Dr. Horvath And there are some others where you can measure biological age, which is your internal cellular age. And that's more important. Yes, because if your pace of aging, if your biological pace of aging exceeds your chronological age, which means so like I'm age 53, but my biological age is 5859, there's increased risk all cause comorbidities like death and disease processes. And it's been clinically shown that with these markers and true ages, one of them that you can see your pace of aging. And if your pace of aging, your biological age is seven years less than your chronological age, there's a 50% decrease of all cause health, chronic disease issues. Think about that for a second. And it also can tell when you may die. Some people may be like, I don't want to know that. But that can be empowering because you can quantify interventions, which means these lifestyle interventions and we know the science is there. Lifestyle interventions can reverse that biological age a couple of years, some of these other therapeutics and, you know, diets and, you know, peptides, DHEA and some of these other things, if you can reverse that, how much more vibrant are you going to be your health span That's yeah, and think about that. We have our lifespan. We have more people today. The last 20 years of their lives are living in disease, sickness and pain. Now, if you can condense that 20 years to maybe six months to a year and you're done, how much more vibrancy are you going to have without being chronically ill?

Amber Warren, PA-C: Quality of life, right.

Josiah Smith, PA-C: The quality of life. And you can actually quantify these interventions. So maybe a test you could do twice a year and we give you a baseline, maybe six months and the cost is coming down.

Amber Warren, PA-C: Yeah, I was going to ask about cost. That's obviously always.

Josiah Smith, PA-C: Usually a couple hundred dollars, but it's getting.

Amber Warren, PA-C: Worse. That's reasonable.

Josiah Smith, PA-C: It is, but it's getting to the. Probably in the next couple of years when you can basket know multiple people with a little it's just a little finger prick of blood where it will become even more affordable over time.

Amber Warren, PA-C: It's kind of, you know, we've been able to test genes like a Bowie, right, for a long time. That helps us assess an individual's risk of of getting Alzheimer's dementia. Right. Which is a big deal nowadays. A lot of my patients, when I offer it, they don't want to know, Oh, that'll bring me anxiety and I can understand that. And of course I respect that. But it's also like knowledge is power 100%. And if I knew that I was high risk for Alzheimer's or genetics because I have a, you know, an apple e for for I'm probably going to focus more on my life on brain health and controlling my insulin and blood sugar levels. That's that's really powerful that you can do that instead of just haphazardly kind of going through life guessing where you should focus your your health interventions.

Josiah Smith, PA-C: And I find it's interesting because prevention and knowing is power. So if you don't want to know and then you actually get the disease, now you're in a situation where it's going to be much more difficult to course correct when you can do it years.

Amber Warren, PA-C: And that's where I mean, that's kind of the lynch point of conventional medicine versus functional medicine, right? We wait until we get the disease and then we as quickly as we can intervene. We're functional medicine, integrative medicine. I mean, regenerative, whatever you want to call it. We're looking upstream. We're trying to identify things before they happen, identify triggers and markers and components of someone's story to to help to help prevent symptoms. Disease, aging. Right. Sorry. I know I use the word you don't like. I'm sorry.

Josiah Smith, PA-C: You know that that's fine. But I think it all comes down to as opposed to looking for the easy answer, the magic pill, the quick fix. It's taking personal responsibility as opposed to pushing it off to someone else to be self resilient, self reliant. I look at it this way. My position, I'm a coach. Okay. The Doctor of the Future and Sachin Patel, he's a functional medicine practitioner out of Canada. He said the doctor The future is not me, it's the patient. It's, you know, 80% of the decisions come from lifestyle. And if you can be empowered to make changes, you will be a beacon on a hill, almost like a lighthouse. You will be an example to others, to your community of influence. Like there's something different about you. You're more energetic, vibrant, you have more vitality. But again, when you come to see us, we have other things we can offer, but it's most of it is in the hands of ourselves individually by taking personal responsibility.

Amber Warren, PA-C: I have a lot of patients that come back and see me three or four or six months into their protocols. Thank you so much. You finally fixed my fatigue. You finally got my gut, you know, healed my gut. And I'm like, I didn't I didn't do it. You did the work. I was just guiding you, right? Like, I just have been so blessed to have learned from some amazing, amazing functional medicine practitioners and researchers and scientists. And just I'm in this position where we can yeah, we can just guide people on their health journey. It's an honor. It really is an honor. I like to end each one of my conversations, interviews with this question, if there's one and this is difficult, but if there's one piece of advice that you can offer your patient that can make the biggest impact in their in their health, what is it?

Josiah Smith, PA-C: Well, and I reflect this at my journey in life right now, years younger, not knowing, being able to burn, thinking I could burn the candle at both ends and sleep, you know, is not is not important. Yeah, I could get three or 4 hours in function. I could when I was younger. Yeah, but the older I get, I realize how important it is. And so many people do not get the sleep they need. And in the last 20, 30 years we have decreased sleep overall by about 30 minutes to an hour. And that impacts the quality of our life resiliency and our ability, again, to wake up, feel refresh and again. I mean, who doesn't want to bring the best version of themselves to the world? I mean, it's more there's more to it than that. But I think if there's one takeaway prioritizing, optimizing sleep, some of those things that we discuss about timing, going to bed, getting up about the same time, optimizing the circadian rhythms when you eat sunshine exposure, last meal of the day, you know, keeping the room temperature a little cooler, lights not having you know, you're looking at your iPhone right before you go to bed and get there are some simple strategies you can do and being consistent. And I think once you act, 30 days are consistent. So it takes 30 days to entrain the brain for performing habits. There will be a huge difference. And I think just how you feel energetically, physically, mentally and even emotionally.

Amber Warren, PA-C: Mm hmm. Yeah, we know a little bit too much to be dangerous to think we can get away with. Not as much sleep as functional medicine providers, right? We we nerd out on the science. And when you look at the science of sleep deprived individuals, it's like, Oh, my goodness, yeah, don't put me in that camp. Thank you. This has been such an awesome conversation for me. I'm so excited You're offering some really just exciting revolutionary things within our practice that we really can't wait to announce. So stay tuned for further episodes on other things Josiah is doing from a regenerative functional medicine approach. And thank you so much for tuning in.

Josiah Smith, PA-C: Thank you.

Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundations podcast. For more information on topics covered today, programs offered at FMF and the highest quality of supplements and more. Go to Fun Med Foundations.

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