Philip Pape: 0:01

If you're over 40 and wondering about blood work for cardiovascular health, the effect of hormone therapy on your heart, or which peptides actually work for recovery and heart health, this episode is for you. My guest today is a functional cardiologist who works with lifters and athletes. He's going to reveal exactly which labs and biomarkers you should be tracking beyond things like cholesterol, the real cardiovascular risks and benefits of HRT, and which peptides have actual evidence behind them for recovery and heart health. You'll also learn whether calcium scoring is worth it, how much lifestyle changes move the needle, and the latest misconceptions about lifting and heart health so you can focus on what matters. Welcome to Wits and Weights, the show that helps you build a strong, healthy physique using evidence, engineering, and efficiency. I'm your host, Philip Pape, and today we're going to get specific about what you need to track and monitor for cardiovascular health. What is cardiovascular health, especially if you're over 40? My guest is Dr. Abid Hussein, a triple board certified cardiologist specializing in functional and integrative medicine at Boulder Longevity Institute. Unlike, I'll say, conventional cardiology that only looks at very specific measures like cholesterol panels, I believe Dr. Hussein is a bigger thinker. He's a systems thinker. He uses advanced diagnostics. He works specifically with athletes and lifters like us to optimize performance and longevity. He's also an athlete himself. So in this conversation, you're going to learn which specific biomarkers, labs, things like that matter beyond the basics. You're going to learn the risks and benefits in terms of heart health for things like hormone replacement therapy from someone who prescribes it. We're going to learn which peptides have legitimate evidence because there's so many out there. And things like calcium scoring, is that worth it? How to think about the balance between lifestyle and therapeutic options. So you're going to come away with a practical roadmap to monitor and protect your heart while still pursuing the things we love when it comes to fitness. Dr. Hussein, welcome to the show.

Dr. Abid Husain: 2:11

Thank you for having me, Phil. It's great to be here and uh happy Halloween.

Philip Pape: 2:15

Happy Halloween, yes. Yeah. It's uh it's a supernatural kind of day. And we're gonna hope hopefully ground it in things that are super and natural today. That's right. And I want to start, I always like defining terms, right? So we use engineering thinking here. We want to be very objective and data driven. And when we talk about a healthy cardiovascular system, I was grossing out my daughters the other day. We saw a video of the heart like unraveled. And I understand it has kind of this spiral shape when you unravel the entire muscle and they were kind of grossed out. I find that so fascinating. Of course, I even talk about where our food comes from and they get grossed up. But uh, what do we mean physically and mechanically? What does a healthy heart and cardiovascular system look like? And then I guess at the system level, what does it mean to have a healthy heart in a way that can be measured or observed, if that makes sense?

Dr. Abid Husain: 3:07

Yeah. Well, I love that you started with that analogy of the heart uh unraveling and uh having a spiral sort of uh topography or morphology to it. Uh that's not something that's really well talked about or well known. You know, the the heart, it's certainly a pump, but it is an incredibly efficient, chemodynamic and mechanical system. And the way it's put together, that it's got cross fibers of muscle. And in the placement of those cross fibers, the torsion optimizes the ability of the heart to get the most amount of squeeze per amount of movement. It's incredibly fascinating. Uh so it's not just a mechanical pump like uh a piston sort of a thing that we might imagine from a car. It is a really dynamic torsion-based system that spirals the blood out. So if you start thinking about how just the hemodynamics of the heart, the way the heart is put together with the rest of the system is like that. It's not just a binary sort of you know serial addition of components. There are additive components that amplify or reduce risk, and this is what combines with our systemic, you know, circulation and inflammation, uh, metabolism, all of these things. They're not just additive, they're they either amplify in a logarithmic fashion or not. So it's a it's a really incredible organ. And uh, you know, there are when we think about it that way, it's really naive to think that we can assess heart health based on one marker, which is cholesterol. You know, that's what the the uh the traditional viewpoint is. Go to your doc, cholesterol is high. Okay, you're screwed, put you on a statin. You know, that's not the way the heart works. You know, we've got to look at it potentially mechanically, but biochemically with risk amplifiers or risk reducers.

Philip Pape: 5:04

Okay, I love that you took it there. And yeah, I agree. Having talked to a few other heart experts and seeing the state of the healthcare industry and people who have issues with their heart and being in the life, the world of lifestyle where I understand the benefits of things like strength training for all this, yeah, I know there's a more complex interconnected web of systems. And you mentioned uh bio, I think you said biochemical, right? You said not just mechanical, but biochemical. So kind of tie that together to the term health when we say heart health, because people get confused between cardio health, like with running and movement type of health, VO2 Max and resting heart rate versus heart attacks and plaque and arterial blockages and statins. And like how does it all come together when we think cardiovascular health without getting too complicated and overwhelming?

Dr. Abid Husain: 5:52

Yeah. Well, you know, when we look at VO2 Max and we're looking at performance, those are indicators of heart health, but they don't necessarily give us an indication of what's going on at baseline. You know, those are peak performance indicators, and they have specific roles in helping us understand what capacity a person has, you know, what we can push them to. It doesn't necessarily give us a, and it is associated with all-cause mortality, uh, cardiovascular events, but that's at a certain level, and then it can start to be a uh a J-shaped curve where if we go too high or if we push ourselves too far, they we can start to get uh degradation. Now, how do we measure that? How do we look at that in a more day-to-day baseline status? That's when we take a look at things like more of the biochemical markers, things like C reactor protein, uh, myeloproxidase. Uh, there are, you know, there are we can look at the cholesterol profile actually and see the morphology of the LDLs and see if they are going to a more pro-inflammatory state or a less inflammatory state. And that's simple, some simple calculations looking at LDL and APOB. You know, when you look at really extreme athletes that push themselves really hard and too far to the point of extreme fitness, they actually have the same biochemical makeup as people on the other end of the spectrum who don't do anything. So we see similarities in their blood panels, you know, on either end of the spectrum. So that's why, you know, those markers like a VO2 max or performance markers are great to understand how we can push them and develop their performance. But when we look at vascular health, cardiovascular health, it's important to tie in those biochemical markers to see how far we're pushing them.

Philip Pape: 7:42

Okay, I love that. And I think I heard a podcast by Brad Kearns recently talking about elite marathon runners and how they have like symptoms, measurable biomarkers of heart of a heart attack after they're done with their race, and it, you know, and the body adapts back and recovers and like everything's usually okay. But we know it's a highly, highly stressful thing. We're gonna assume that the listener is maybe not in the elite regime right now and they're just concerned about day-to-day heart health. So there's a couple of topics I want to unravel. One will be more about the biochemical markers. But before we do that, is it true to say that heart disease, which again, we can define what that means because I understand there's different elements, yeah, is a disease of obesity primarily, or because I get into these debates with some people, is there a subset of the population where it's genetic, where it has nothing to do with obesity? Like help us understand that.

Dr. Abid Husain: 8:31

Yeah. I think that uh, so when we talk about heart disease, what we're really talking about is atherosclerosis. That's the number one killer, the development of plaque in our coronary arteries or in our brain, anywhere in our body, really. That's the number one killer globally. That's what causes heart attacks. So let's that's what we're talking about primarily in this sort of in this part of the conversation. Other cardiovascular issues like hypertension, arrhythmias, they do have some crossover with these same systems, with these same pathophysiologies, but this is about uh mostly about atherosclerosis, because that's what kills us. When we talk about obesity, it's not necessarily a it's about caloric excess. It's about energy excess. You know, obesity is that's what we're talking about when we're looking at obesity. And when our system is flooded with excess amounts of calories, energy, we're gonna store it and we're gonna store it in fat, but it also that trickles down to oxidative stress that happens on a molecular level. Our body has an ability to manage energy very well when it's done in balance. If we have excess, that excess energy starts to leak into areas that it shouldn't, and then our body has to figure out how to manage it. Is that part of obesity? Definitely. Uh, and it's part of what we're eating too. It's part of the macros. If our energy is coming from sources that are highly refined and glucose rich, carbohydrate rich, that's gonna challenge our ability to uh to metabolize those. And we metabolize those with a higher toxin load. And that leads to the obesity part of it is not only about the higher energy component, but it's about uh managing, it's about the uh the toxin that that builds up. We end up putting on fat to try and manage that. So that is the majority of what we see because we live in an overly nourished society. There is a genetic component to it. There are people that do have a predisposition, and if they know about that, then it's even more vital for them to take care of what they're putting in to manage at least these energy management systems. So is it a problem exclusively obesity? I mean, when you talk about obesity, then you gotta talk about type 2 diabetes, type 1 diabetes, you know, the genetic component, type 1 diabetes, is what we see predominantly when we're looking at uh the genetic part of uh glucose intolerance. Some people do develop type 1 diabetes in adulthood, and that's uh an emerging condition also. But the majority of what we see is type 2, and that is associated with obesity, but it doesn't have to be. You know, those are people that because of inflammation, maybe it's inflammation specific to the liver, they may have uh liver and pancreas, then they may have uh development of uh of glucose intolerance and sort of this type 2 pattern. So we do see thin people with diabetes. So it's it's there is an overlap. It's not primarily a disease of obesity, but obesity is part of the characteristics of what we see show up.

Philip Pape: 11:38

Yeah, no, I always like to ask that because I care about the autonomy and the self-efficacy of the listener in terms of what they can do, right? And obviously, we can't control our genetics. And if there was a narrative that heart disease is this random thing that can be highly influenced by genetics, that would be kind of a scary thing. Whereas I think in reality, if you went back a hundred years pre, you know, massive obesity, you would see far less heart disease. So, you know, not to say that you don't see any at all, which means means that's powerful because we can do do something about it with our lifestyle, which is what we're gonna get to eventually here. Okay. So plaque and arteries, that's heart disease, but we also have markers along the way we want to look at. Now, you mentioned some of the inflammatory markers. So C reactive protein, you also mentioned APOB. You did say cholesterol panels are still helpful in context. So help break that down. If we want to track these things, the listener's like, I want to get labs tomorrow and start measuring before and after. What would they be looking at?

Dr. Abid Husain: 12:37

The panels that we look at look at high sensitivity C reactive protein. We look at APOB, APOA, and along with that goes the uh the LDLs and the HDLs, triglycerides. And then when we when we go back to the inflammatory markers, there are a few additional ones that can give us some insight into what's going on into the vascular system. That's uh there's one called LPPLA2, sometimes also known as PLAC plaque, and then there's oxidized LDL, myeloperoxidase. These are like a list of inflammatory markers that can give me an idea of what's happening in the vascular lining as well as what type of metabolic situation is going on uh systemically to create the cholesterol. Uh because cholesterol is is really in it's an energy delivery tool. It's got it's used for so many different things, and it when we try and look at how it's being made, like the body makes it for a reason and it's gonna make it at a higher a higher amount for a reason. Usually it's delivering fuel to something, like the immune system, like cells that need it for their membranes. So it's doing it and it's delivering it at a higher amount because maybe there's inflammation, or the the uh liver is cranking it out in a capacity or in a way that it can't do it efficiently and it's got to just pump out smaller, more dense particles. So that's what we're that's what I'm looking for. When I look for what kind of uh what kind of metabolic profile a person has, I take a look at LDL and APOB, and there's a ratio. The LDL to APOB ratio, the cutoff is 1.2. If it's below 1.2, this is this means that you have a predominance of small dense LDLs. If it's greater than 1.2, you have a predominance of large buoyant LDLs. Why is that important? They're at two ends of the spectrum. Small, dense LDLs are like cannonballs. So you've got little dense bullets, cannonballs bouncing around inside the arteries, causing damage, digging into the lining, and creating what is the beginning of plaque. Large buoyant LDLs are beach balls, they bounce around, deliver cholesterol energy where it needs to go to, and then don't penetrate and oftentimes get back to the liver and get recycled. So that's part of the problem. When we have a lot of these small, dense ones, there's a lot of problem problems with it. It's not just that they're prone to getting under the lining, they get inflamed faster, they get clear, it's more difficult to get them cleared, they stay in our system longer. And then these become, you know, these are the characteristics of inflammatory metabolism. And then when we add something like a C reactive protein to that, ideally a pie sensitivity C reactor protein, I want less than one. And uh that is going to give me an idea of how much inflammation is associated with these LDL particles. Um, now this is now C reactive protein is a global inflammatory marker, so it doesn't give me an idea of specifically what's going on in the lining of the artery, and that's where things like uh MP uh myeloperoxidase, plaque, and oxidized LDL come in handy. You know, oxidized LDL is the inflamed LDL, and and it will oftentimes be uh elevated in the wall if there's inflammation, but maybe not in the serum. But if I do see elevations of oxidized LDL, I'm guaranteed that it's in the wall as well as in the serum. So when you look at if C-reactive protein is elevated, if oxidized LDL is elevated, these are risk amplifiers. I know this person has high degrees of inflammation. So we got to track these, bring them down. The other what creates oxidized LDL is that plaque, LPPLA2. It's an enzyme that converts the LDLs into something more inflamed and atherogenic. Uh and and then it in the plaque, it can also create what's what are called the foam cells, which expand the uh the inflammation and the size of the plaque. So if we see that, that's actually a really good lifestyle indicator. Sometimes if patients have that elevated, it means it can be elevated with smoking, high carbohydrate diets, inactivity. So, you know, this is and sometimes LDLs themselves can elevate it. So, you know, there are multiple things that we can look at to kind of tease apart what a person needs to do more of or less of. Uh, and then lastly, the myeloperoxidase also looks at the lining of the artery, a little bit more of a vascular inflammatory marker. It's sort of the first uh the first responder of the immune system because it's it's an enzyme that's associated with the neutrophils. And if there is acute inflammation or inflammation that's just beginning in those in the lining, sometimes we see myeloperoxidase elevated. So I can, you know, by looking at those and tracking those, I can see where uh it things are either improving, reducing, maybe dial in, what else needs to be done? The you know, when we look at uh, as I said, with the LPPLA2, there are medications that will reduce that and then activity, exercise. Well, that's a lot of lifestyle changes can impact that, C reactive protein, basically all of these markers.

Philip Pape: 18:06

Yeah, okay. A lot going through my head because one question I had as you were saying that is which of these are leading versus lagging indicators? Like obviously the cholesterol, once it shows up, that's kind of a lagging indicator. But you meant, I think you said the myeloperoxidase maybe is a leading because it tells you your lifestyle. So I like that you know, there's a pattern to these things, and as each of them get progressively worse, as you get toward that end state of like before it becomes too late, let's say, I imagine you see the pattern shifting toward that, and then you can shift it back with your lifestyle and maybe medications we'll get into. You mentioned neutrophils, you mentioned CRP. A lot of people have autoimmune conditions, which I know uh present themselves through a lot of these markers. It sounds like, and this could be a simple yes or no question or may require explanation. Sounds like when you take all of these markers together, that's how you're playing detective to piece apart that the CR, the global CRP is related to this and not that. Is that a fair way to put it?

Dr. Abid Husain: 19:02

It is, exactly. Yeah, because if I will if I have patients that have autoimmune conditions, and certainly patients will show up with elevated CRPs because of a temporary illness, you know, and so that's when they got their labs done. So it can be something chronic, it can be something acute, but there is a global uh inflammatory burden, but it doesn't affect their vascular system as much. So their plaque and MPO may not be elevated, oxidized LDL may not be elevated. So these are really good uh tools to tease that apart. Uh and and it and they change in a day-to-day, sometimes hour-to-hour fashion. Like C-reactive protein will change within a few days. And uh, but something like uh well, something like plaque, maybe a little longer, oxidized LDL, a few days longer. So, you know, these do have a time frame to them, also, which helps.

Philip Pape: 19:56

All right. I do want to ask one more thing about cholesterol. Well, maybe a couple. One is I know there's a big genetic component to cholesterol. There are just people that have higher baseline LDL, let's say. And I I definitely have seen debates on this, even among medical doctors, of whether a high LDL, if it's your normal baseline, is as much a concern as someone whose LDL got to that point over time. So I guess let's give you a thought experiment. If you had a 15-year-old come in who one, let's say two 15-year-olds, because I want to I want to start young here. One is got excess body fat, right? And one seems healthy in terms of body fat, and they both have elevated cholesterol. And that could be elevated total, elevated LDL, even even HDL, even though we call it the good, you know, could be high, uh, say 220, 250. I don't know what the number would be where you'd be get concerned. How would you what's kind of your first thoughts about those two different patients?

Dr. Abid Husain: 20:52

I go back to those markers. I see what the breakdown is, what the APO B numbers are, and I look at the uh Apo B to A1 ratio, because that helps me determine how well the system is calibrated to remove the cholesterol that might be getting deposited. Uh so if there's large fluffy LDLs, not too much to worry about. If there's dense LDLs, then I then something to be addressing. Um if they have borderline inflammatory markers, someone that age should not have any real inflammation. So there are definite ways to tease apart who is at risk and who isn't. And if the finances are available, do genetic testing on them to see if there's any any uh uh issues with protection of the lining of the artery. Uh, because there are specific gene SNPs that show deficiencies in compounds like nitric oxide, which are vital for the the anti-inflammatory effect and relaxation effect of the endothelium, the lining of the artery. So if they have deficiencies in that, that's important. I'm gonna look at their diet, I'm gonna look at their activity level, all that stuff. Yeah. Um, you know, I think a big part of the debate uh right now is there's an interesting subtype of people that are called lean mass hyper responders. And these are athletic, lean individuals that have extremely high elevated LDLs. You know, and we're talking about in the 200s or more, not total cholesterol. I'm talking about LDLs. Uh and then their but their HDLs are equally elevated. The the curious thing is when they go into a keto diet, they sh their their LDLs go even higher, and their but their HDLs uh tend to stay flat. So they don't do real well with a uh with a keto diet. But the question is, do we need to treat them with statins or lower that cholesterol? And you know, the the studies show that even these people with that super high LDL, they may show an accelerated amount of plaque in a small period of time. So there is something to be said about just being cognizant of higher amounts of LDL. And this goes back to that statement I was making about energy. You know, if LDL and cholesterol is an energy delivering tool, delivering too much energy on its own can still be a problem. You know, we need to our system works best in a window in homeostasis. So when we go outside that window and each individual has a different window, then we can create a problem that's maybe you know a more hyper energy type of problem that creates inflammation.

Philip Pape: 23:33

Yeah, yeah, it makes total sense. I mean, there are lots and lots of issues when we have a hyper caloric. I always get them wrong. Too many calories and uh store body fat, and then there's the visceral fat concern as we get older. And if you're sedentary, not using those calories, it gets even worse. So actually, let's hit on that real quick because you mentioned keto, you know, I know you listened to a little bit of this podcast, and we're you we're we're diet agnostic. We're we're, you know, obviously diet is highly personalized, it's got to be flexible and depending on your goals too. So when we're talking with athletes or people who lift weights, you know, they seem to respond really well to moderate to high carbs versus somebody who's not using those carbs, right? Uh and conversely, I'm pretty sure high saturated fats is definitively now linked with high LDL. But just reiterate that for us or tell me that I'm wrong.

Dr. Abid Husain: 24:21

You know, the the debate about saturated fat is uh, you know, it started way back in the 50s with the seven country study, you know, and that's been difficult to reproduce. So, you know, the question about Ansel Keys?

Philip Pape: 24:35

Yeah.

Dr. Abid Husain: 24:36

Yeah, that's right.

Philip Pape: 24:37

Yeah, yeah, yeah, yeah. Right. With all the selective cherry picking of data, yeah, I understand.

Dr. Abid Husain: 24:40

Yeah, and so and even the follow-up data that tried to reproduce it actually showed that it was not the issue. And you know, saturated fat is not necessarily the demon that they thought it would be, and uh sugar is the problem. So, you know, if we look now at what is saturated fat really associated with atherosclerosis, I think it really depends on the individual. You know, there's certain there's certain genotypes that do don't do well with uh high amounts of saturated fat. And these are Apo E4 genotypes. Okay. Um, and that's a pretty easy test to get. They also have a higher risk of of Alzheimer's because what happens is they don't manage, they don't have the cholesterol transport mechanisms as well uh as robust as the rest of the population. And so the cholesterol tends to get a little more inflamed. The reservoir with the most cholesterol is our brain. So that's how the association with Alzheimer's occurs. But these patients, these people don't do well with a saturated fat diet. You will see their cholesterol jump up and then their inflammant inflammatory markers will start to change also. So it's very individualized. So I'm very cautious to make like a an overarching uh uh blanket statement about diet. And but I don't, as long as the fats are wild caught and not uh and farm-raised, organic, then I'm okay with saturated fat. And I'm gonna follow those markers because I don't have a full genome uh assessment on all my patients. I don't necessarily need to, and I can let them adjust their diet and we can do that together and follow some of these markers uh and then track what's going on and make sure that it's working for them.

Philip Pape: 26:25

Yeah, the genetic component's interesting. I've talked to a few folks on the show from different companies because I know it's it's a little bit of Wild West still, but there's some interesting work happening. And uh I have had some of those tests done myself and uh the APOE four, you said, right? I believe I have isn't there two SNPs, and you can have one or you can have two, and having two is like the highest risk, and I think I have one or something. Um, so I think I'm I'm susceptible to that. But I also have found personally when I measure blood work, dropping body fat tends to move everything in the right direction, and then you know, and building muscle moves everything in the right direction. And I've seen that with clients as well. And so I I do like the idea of it is personalized, you should experiment. I would say if anything is like way out there, let's say it's saturated fat and 50% of your fat is saturated fat, that could be a concern and you want to try, but same goes for too much sugar or too much anything else. Um, not too much protein, though, guys. I think you're good there. That's right for the most part.

Dr. Abid Husain: 27:19

We gotta hit our protein goals.

Philip Pape: 27:21

So, okay, all right. I want to move into a couple other topics and then kind of tie them together a little bit more deeply because we we also wanted to mention um hormone replacement therapy. This is not a very good segue, but maybe it is. A lot of folks listening are older and we talk a lot about bioidentical uh HRT, uh, especially a lot for women in peri postmenopause and for men with testosterone. And people are concerned about always concerned about risks. A lot of it probably comes from misinformation, like the women's health initiative. Exactly. You know, and and uh conflating, you say, synthetic with biodential and animals versus humans and stuff. So, what are the actual risks from a cardiovascular perspective of any of these, if there are any?

Dr. Abid Husain: 28:02

Yeah. The risks are actually when we have deficiency of the hormones. So when we look at individuals with, you know, testosterone, specifically, these were studies we're done in men with uh testosterone below, I think, or around 250 total, they have a significant increase in all-cause mortality and cardiovascular death. Not only that, but they also have an increase in risk of prostate cancer, particularly aggressive prostate cancers. So, and then when we when we kind of uh take that one step further and look at deficiencies in estradiol, progesterone, again, associated with adverse outcomes. So when we're replacing testosterone, estradiol, progesterone, doing it to physiologic ranges is perfectly safe. And in fact, in in my mind, it's therapeutic. You know, we are we are replacing deficiencies that the body has lost, but the the body is incurring over the years. You know, the hormones are our original regenerative tools. This is why we can bounce back when we're young. This is why we can develop muscle very quickly, because we have the hormones to stimulate muscle protein synthesis. We have the hormones to protect our vascular lining. As we get older, because of you know, mitochondrial deficiencies, because of just stress uh oxidative stress, wear and tear, whatever you want to call it, these systems start to become less efficient. And the most sensitive systems are our hormone systems. We lose those first. So as we get older, the first thing you're gonna lose as a male is testosterone, testicular function. That's why your libido drops when you're stressed because you don't have the reserve and it's gonna take away that accessory function. So um replacing testosterone to physiologic and even maybe super mildly superficial. Physiologic levels is safe. The caveat here is we want to look at dihydrotestosterone levels. Those, you know, that has some mixed data, whether elevated levels are beneficial, benign, or if, you know, there is it associated with other cardiovascular issues. We know dihydrotestosterone is an anabolic hormone. It's gonna, it's involved with protein deposition, with muscle development. And that way we want it there. But when it's in excess, it may contribute to LVH, left ventricular hypertrophy, maybe arrhythmias. There's a few studies that allude to that, but don't necessarily say it. And it doesn't give us a specific cutoff. You know, we also know that elevated dihydrotestosterone is associated with male pattern baldness. So, you know, multiple reasons why we want to just kind of keep that in check and maintain it within a physiologic or mildly superphysiologic level. But wholeheartedly, I support the use of bioidentical hormones. I don't see a risk from a cardiovascular standpoint. If we take a step back and look at what it's doing to the vascular system, not only testosterone, but estradiol improve nitric oxide and enos nitric oxide recruiting systems. They improve the endothelial health and the ability to stimulate endothelial progenitor cells, which are those endothelial stem cells. So if you get damage done to your vascular system, you can repair better when you're on these hormones. And they also help uh regulate your, you know, your that cholesterol metabolism, you know, like the the that that cholesterol that goes to small and dense, part of that is hormones being deficient.

Philip Pape: 31:46

Yeah, it's all interconnected. So I'm glad you brought it to that. Well, you mentioned physiologic ranges that therapy is perfectly safe once we're in there. I guess there's confusion about what those ranges are because we've seen the quote unquote normal ranges on like your GPs labs uh change over the decades. You know, I I know there's some misinformation about oh, men produ are just way lower in testosterone than they used to be. I know there's some, there's some half-truths there. Maybe we can get into that, but I know the population range seems to have either broadened and dropped or whatever. You can help us clarify that. And then there's like performance ranges, and then there's like guys who want to get jacked and hope it's really up here. So I have to get TRT ranges. That's a difference. Yeah. Well, what do we make of that? And for women as well. Like for all the hormones, what range can we trust? And what does that mean? Physiological, you know, because a doctor might say, Oh, you're 300 testosterone. Well, that's right in range. That's fine.

Dr. Abid Husain: 32:38

Yeah. You know? It goes, it comes back to what your goals are.

Philip Pape: 32:42

Yeah.

Dr. Abid Husain: 32:42

Yeah. Like you said, it's if you're wanting to get big, then we've got to push those not only your total testosterone up into 1500s. You know, I I will say that what we look at less, we don't look at total, we look at free testosterone levels. So that's uh, you know, the the total is what everybody kind of keeps in mind in that ranges, in those ranges, but it's the free that we really want to focus on because that's what's available for your muscle protein synthesis and development. And the same thing for women too. Uh, and it's it's highly subjective, and it depends on your goals. Uh, you know, women are a perfect example of this. I have women that can tolerate a total testosterone in the 500s and don't have any problems with hair growth, hair loss, you know, acne, and they feel fantastic, and they will kill me if I reduce that dose. And then I have women that that are, you know, I'll put them on a minimal dose and they will start to get acne, and it will be in and their test total testosterone might be touching 100, and their free is touching five, you know, and it's it's highly subjective. So it's hard to give a a generalized sort of range, but I will say that for the most part, I like to shoot for a free of about 30 to 35 in men, maybe 25 to 35 if picograms per milliliters, yeah.

Philip Pape: 34:08

Okay, 20. You said 20 to what? About 20 to 35, depending on their goals. I have personal interest in this, that's why I'm asking. Yeah, because I think mine's around 20, so you know, which is not bad, but it's no, it's not.

Dr. Abid Husain: 34:19

And so, you know, you can if you're looking to put on masks, then it's gonna be in a higher range. If you want to just stay fit and uh and all this is is is a healthy range. It's okay for your cardiovascular system. If you want to uh just maintain, maybe stay a little lean and muscular, then stay on, you know, you can hover in that mid-range. Uh, women, I tend to go up to about a free of 10, maybe a little higher. Uh, and when I go higher than that, then you know, that's more often than not, there might be some symptoms, but it's around that range. But uh again, highly subjective and depends on your goals.

Philip Pape: 34:55

Okay, cool. All right. So, some other things that the community is really interested in is peptides, uh, and also rife with information, misinformation out there. Um, even I'm trying to sort it all out, and I see requests from supplement companies all the time, and just everybody's pushing their peptides. I I want to I want to get the story from you about the evidence and how we can kind of focus this and think what are these? What's the benefit? Yeah, why would we use peptides?

Dr. Abid Husain: 35:22

Well, I mean, I guess just to give you a little bit of background, I mean, I've been working in the peptide industry for probably seven to ten years, you know, and so very steeped in it and use it on a daily basis on most of my patients. So it comes with a lot of experience. I love working with peptides even more so than supplements. Uh, I feel like peptides are very they're incredibly bioactive compounds. You know, the the promise of what we think is going to happen with supplements doesn't often happen, but it happens with peptides. So because they are compounds that our body knows how to use and it gets into the cellular space where it's supposed to, where where the action happens. That's why I think they're so fantastic. You can imagine them, you can conceptualize them as like mini hormones. Hormones large molecules that need middlemen, you know, receptors to do to send their message and do the action that they do. Usually it's something on the cell surface, binds a hormone, transmits it downwards. Peptides don't need a middleman, they can go into the cell and talk directly to either uh DNA or pathways that are in the cell, which is why they're so powerful. You know, the in this community, I would say the peptides that uh should probably get the most attention are the basic ones. It's BPC157, thymus and beta-4, and then the secretagogs, GHRHs and GHRPs, growth hormone releasing hormones, growth hormone releasing peptides. The most common combination that you guys see in the in that category is CJC and ipamerelin or tesimerolin, ipamerelin. So let's unpack all three of those. BPC is derived from gastric juice, but it stimulates so many different gene pathways. It stimulates a nitric oxide pathway, so it preserves vascular function. It can actually improve blood cell formation. It works on the cellular cytoskeleton. So it helps the immune system uh deliver compounds to where it needs to go, deliver immune cells to where it needs to go, and it strengthens the cytoskeleton. And it does it, so this is why it's so good when you're healing. It lays down parallel collagen as opposed to disorganized collagen that might happen to form scar tissue. So it's a magical compound that works in so many different places, everything from brain health down to uh you know ligamental health. Thymus and beta 4 is a great addition to that because it also works on the cytoskeleton in a different compound, but together they are really potent in helping heal from any types of injury. And uh and it is also so thymus and beta 4 focuses more on immune cells, platelets, uh, and actually BPC does on platelets too, but uh more on immune cells, but also but definitely plays a part in that cytoskeleton. Uh and then when you're looking at the secretagogs, those so CJC and ipermoralin, they influence growth hormone. And you can think of those like one of them is filling the tank, filling the amount of growth hormone you have to be able to release, and the other one increases, optimizes how much you release. And so by improving growth hormone, you improve IgF1, which is our major healing hormone. So many like trickle-down effects of growth hormone benefits.

Philip Pape: 39:00

Yeah, no, that was that was a good summary. I was definitely familiar with a couple of those, like BPC 157, which I briefly took from my shoulder. I don't know personally that it was overly beneficial, but I had other mechanical stuff going on that I'm still dealing with. But are these still um because some of the logistical issues were like, well, they're injectable and and it's hard to like find practitioners you can work with and to get it legally because there's this whole underground of buying the powder and getting it mixed and all that. What's the state of that today, both with access and also form, you know, form? Because I'm hearing about liquids and and and oral and all this stuff now.

Dr. Abid Husain: 39:34

Yeah, yeah. This is this is a hot new market right now. Um, there's a lot of companies that are trying to bridge this gap so so that we don't have to use injectables. And you know, the problem with this industry of injectables is that there's all these internet companies that are research only, you know, and when you get a research-only peptide, you are getting no guarantee that this is a safe compound. In fact, it will say on the label, not for human use. For human use. And not for veterinary use, not even for use on your pets. Okay, so be careful if you're getting that. I mean, they're they claim that the sources are reliable and they will have third-party testing, but ultimately they're not being held accountable for any adverse events. So, and that's dangerous when you're injecting something. When you're doing something orally, you could probably get away with a little bit more, there's a little more flexibility there because it's only getting into your gastrointestinal tract and you'll be able to get it out. It's not a sterile situation. There are a host of companies that are now creating oral forms. Some are liposomal, some are uh buckle-derived oral strips, and some are just you know uh capsules. Most peptides, unless they have specific binders to them, and we don't know actually, most peptides do not survive the gastric environment. There are a few that do. BPC is one of them, and we still don't have a definitive way to make most of those survive the gut. There are some technologies that are trying to keep them preserved and deliver them through the gut lining better. And then there are some claims that liposomal technologies preserve it so that it can get through into this into the circulation better. Problem is we don't have any real data to support if that's actually happening. We don't have uh pharmacologic data or biochemical data to see if it, you know, what the levels are, you know, after it's absorbed. And part of the problem is the nature of peptides. Peptides are such short-lived compounds, most of the time their peak action occurs within less than an hour, 20 minutes. So it's really hard to measure levels in the system. Uh, you know, there the wada screens for peptides in all their athletes. The reality is that I don't even know if wada has a definitive way to measure peptides.

Philip Pape: 41:54

So the short half-life. Yeah.

Dr. Abid Husain: 41:56

Yeah, because it's such a short half-life. So making uh, you know, a randomized control study to actually verify that is very difficult. There are some companies that are looking at that right now. My advice would be if you're gonna get it, try and get it through a practitioner that uh knows what they're doing. It uses a compounded pharmacy that has a tracking method as well as guarantees sterility. And if you're gonna try orals, you know, you could give it a shot, but know that unless it's BPC right now, the data is is not out there, and you'll have to decide on your own by trial and error if it's working. You know, there are many different uh delivery mechanisms that are being tested right now. And I'm I'm curious to see which one kind of pans out. And I'm excited too, because this actually makes access for all of these much easier.

Philip Pape: 42:46

So, related to the ones you mentioned, you said it would be relevant to this audience and you gave a little bit of an overview.

Dr. Abid Husain: 42:51

Yeah.

Philip Pape: 42:52

What's the context for these? Because, you know, one one message that I always have is 8020, right? Like, like fix the foundations, work on the big things. Don't try to just get 10 different solutions to a problem in parallel, right? Like build your lifestyle, lift weights, move. Like there's some big hitters that will move the needle a lot for individuals. Yes. Uh, before necessarily going to even supplementation, but at the same time, there's certain supplements that I would say, hey, from day one, this could be helpful, whether that's creatine or fish oil or magnesium if you're deficient. And I imagine peptides have a similar story where, you know, I know there's a recovery and rehab piece of it, an injury rehab, and then there's a performance. Like, when should someone say, This is the decision point when I should consider peptides?

Dr. Abid Husain: 43:39

Anytime you got an injury, consider a peptide. Okay. All right, because it will improve your recovery time. That combination, BPC, TV4, and then some sort of secretagog, that will do a lot. Uh if you're cycling up to prepare for an event, that's a time to consider using peptides as long as you know that they're not testing. Or if it's a substance positive event, so to speak. You know, if you're a recreational athlete, they're not going to test you, and you can use peptides to increase your performance, increase your increase your personal times. And then if you may want to use it periodically, uh just to within your down training cycles, because it will they help recovery. I mean, when do you want to start? It really depends. So I'll say this start using peptides when you start feeling like your system is not recovering the way it used to or the way you want it to, to meet your goals. If your goals are you have a race or a competition coming up, then that's a great time to start using it as you're training up because then you can allow yourself to be more resilient. If you have an injury, then definitely a time to use those as options because they're readily available now. So I, you know, it's really it depends on where you are in your trajectory. Yeah. I can tell you for myself, about five years ago, six years ago, I mean, I've I've been an athlete my whole life, and I just started noticing uh a downward trajectory in a lot of my performance, or it kind of plateaued, and um I started saying, okay, I've never really used supplements and these tools. It's probably longer than that ago, about 10 years ago. Yeah. So uh once I started feeling that, I said, okay, I've got to support my system. How am I gonna do this? I started with the basics, I started with the right supplementation, tried that, that didn't work, or if that held for a little while, then I went to hormone replacement therapy and then added on peptides. So go in stages, start with the tools that have the widest benefit. And that would be first starting with testosterone, basic hormones, and then add on to those afterwards.

Philip Pape: 45:58

Okay, so that's interesting because that it sounds a little ambiguous to me, no offense, right? Like there's not like blood mark blood tests that would be like you should take B2PC because of this blood test. Yeah, maybe we'll get to that. But you that's an interesting comment about the testosterone. So, what about a guy like me? Because this is what I love about podcast interviews, is I get some free coaching. Um no, seriously, where I think my total testosterone is 600, my free is 20, decent. You know, I'm 45. Um, it's actually gone up a little bit over the years naturally, which is cool. But you say use testosterone or use consider TRT. Am I a candidate where I'd be like, hey, there's a performance element here that I care about and it's still safe to have TRT, or is it like, look, I don't have symptoms, libido is good, all that. Like, jump to peptides, or maybe I don't need either because recovery is fine. Like, where would a 45 or 50 year old like that is fairly healthy fall on that spectrum?

Dr. Abid Husain: 46:50

What's your goal? That's I guess that's the question.

Philip Pape: 46:53

I'm building muscle, keeping lean, you know, performing. I don't have any sports personally that I'm into, but um, you know, I have kids, just want to be healthy.

Dr. Abid Husain: 47:00

Yeah, what I would do for you is give you something to stimulate your system's ability to make a little bit more testosterone, and then see how that works for you, see what kind of changes you have, and then add on a couple of peptides, you know, because the performance aspect of testosterone is significant, and you don't have to jump to using testosterone replacement. There are plenty of ways to optimize what your body can do as long as it's still functioning, and yours is. So every cell in your body, except for your sperm, responds to testosterone. There's a reason for that, and uh, and so that's why I feel like that is a useful foundational tool. And we don't have to sacrifice your ability to make testosterone. We can actually just amplify it a little bit and then see if that gets you a little more muscle, gets you some PRs. And if it does, great. And you don't have to do it permanently, you can do it in cycles. See how you do for three months. You know, somebody that's is already an athlete will respond pretty quickly to it.

Philip Pape: 48:04

So now the listener's like, what the heck is he talking about? What stimulates testosterone? Because there, there again, is another area rife for taking advantage of people, right? Because there's been testosterone boosters for years that are that are BS. Let's be honest. Um, what are you talking about?

Dr. Abid Husain: 48:19

I'm talking about uh enclomebe, talking about HCG, I'm talking about uh the ones that are over the counter that are that are supplement-based or herb-based, you're at best gonna get maybe a 150-point increase in your total testosterone, and that doesn't guarantee that it's uh it's increasing your free. So marginal benefits with those. Mostly what you get you what if you're gonna do that, you've got to work with you with uh pharmaceutical agents. Yep. Okay. HCG is injectable and clomophene is oral, but uh and that's a uh second generation of Clomid. But these are used by fertility fertility clinics and they help improve sperm count as well as testosterone production. So interesting.

Philip Pape: 49:03

Yeah, yeah, clomid. Uh that that that takes me back to some some dark days uh my wife and I with on on her end, but anyway. Okay, no, that's good that's good for people to know, and that's why we're talking through all this because there are a lot of options I think people aren't uh familiar with, and also you guys need to seek out professionals who understand this and who do this in a controlled, like you said, there's sterile methods that are necessary, there's some medical knowledge that's necessary in some cases. Obviously, we're gonna I'm gonna pump you up as we end the show in a bit and have see where people can reach you, Dr. Hussein. But a couple other things on my notes that people were wondering about. Yeah, one was the calcium scoring, because I had one of those years ago. It costs like a hundred bucks at an imaging place. My wife was told to get one, and I I even told her, I said, I don't know, we're in our 40s. I've heard that like it's not gonna tell you anything unless it's, I guess, really bad. Like if it's a non-zero high score when you're that young, maybe it's not worth it. But what's the deal?

Dr. Abid Husain: 49:59

Yeah. So if we take this back to the beginning of our conversation and talk about what I would do in addition to or what needs to happen in addition to those lab markers, you need to get imaging. You need to get some sort of assessment of your atherosclerotic burden and the coronary arteries. Why is that? Because cardiovascular disease is still the number one killer globally, cardiovascular disease meaning atherosclerosis. And of that, the subpopulation that dies the most is the sudden cardiac death portion of it. That's 50% of the population that dies of heart disease, of atherosclerosis, never makes it to the hospital because they didn't know they had dangerous plaque and they died before they could get help. So, keeping that in mind, when you're getting an assessment of risk, blood tests will only go so far because even though it's 2025, we are still in a barbaric age of medicine. We don't have all the pieces, we don't know how to connect it all together, we have an idea of what's going on, but we can't get a definitive marker, you know, a definitive pass-through, like line through of the process. So that's why you got to take pictures. We got to see what's at the end of the line. The two options right now are calcium score and a CT coronary angiogram. If you told me 10 years ago, you were if you asked me 10 years ago, should I get a calcium score? The answer unequivocally was yes. Get a calcium score because at least we get some information. We can see if you have a lot of calcium, then you are a high-risk person and we need to treat you aggressively. Calcium scores look at only the calcium portion of plaque. There is that whole other portion of plaque that's not that's being missed, and that's the cholesterol portion. What's in the plaque that's cholesterol is what causes heart attacks, and that's what's being missed when you get a calcium score. So if you have a high calcium score, you probably have a lot of cholesterol, you're at risk. If you have a low calcium score, yeah, you don't know.

Philip Pape: 52:06

You don't know.

Dr. Abid Husain: 52:07

You don't know. So that's why right now we have, you know, and and this has taken years for the CAT scan technology to come to speed up to speed. It is now up to speed, and on top of that, we can do we can take those images and process them with AI software. There's multiple companies that do it now to really get specific granular details about the plaque composition and the severity. That is so that CCTA, and and then the one that is used very commonly is called Clearly. There's other ones that are going to be available, Carrie Heart, Heartflow. All of these companies do an AI-based processing that looks at plaque and tells us exactly how much calcium, cholesterol, and inflamed cholesterol there is. So uh, and that's where it's important because when we see cholesterol and inflamed cholesterol, if I see that, I know that's a person at risk, and I can correlate that with lab data and say, okay, this is where I'm connecting the dots. I can start these therapies and then track the lab data as time goes on, repeat the scan in a year, two years, what have you, depending on the severity. So if you have a choice, get the CCTA because it gives us a much more uh uh robust assessment, it gives us a global assessment, and it tells us if you are one of those people that's at risk for a sudden event.

Philip Pape: 53:39

So is that uh something anybody at just about any age should get a baseline, or is there a minimum that you would do it, or if you're at risk, like who should do that baseline?

Dr. Abid Husain: 53:50

I think at uh if there's family history or risk, I would say do that as a baseline and probably do it before your 40s. Because if you get an assessment before your 40s, and and that will be probably before you there, it's severe, but it'll tell us that stuff is building up. We need to do it early. If you don't have uh risks, if you you know, like a family history or no no and and your lifestyle is pretty well managed, ideally I'd say in the 40s, but I like everyone to get it by 40.

Philip Pape: 54:20

Okay, well, I missed that window, but still. Yeah. No, no, that's good, that's good. Yeah, I've done I've done episodes where it's like, when should you think about menopause in your 30s? And all the women are like, I'm already it's okay. It's okay. We're just talking about you know what you can do when give it starting where you're at. Yeah.

Dr. Abid Husain: 54:36

All right. So one thing I will add, there's there are some concerns about radiation with the with this CAT scan. Done in the right hands, it's the equivalent of two mammograms. And if you don't have to do it, you know, once every what five to ten years, then it's minimal overall. But the information is important.

Philip Pape: 54:56

Good. No, that's good to know. Is that done with contrasts?

Dr. Abid Husain: 54:59

Yes.

Philip Pape: 54:59

Yeah, okay. Is that the galadium contrast or the one that people are concerned about? More iodine-based iodine. Okay. All right, cool. All right. So, really to tie this up, the one thing we didn't get much into, but is really important to the audience here is the lifestyle versus the therapeutic. We've talked a lot about uh peptides and hormones, and you mentioned briefly some medications, right, like statins. Where is the balance between all of this and lifestyle? And from a medical professional's perspective, you know, we know that the vast majority of the population is just does not live a healthy lifestyle. Sadly, that's just the case. Where what's the escalation process? People who are listening who are trying to clean their life up a little bit right now, where should they, what should they prioritize, in your opinion?

Dr. Abid Husain: 55:46

I would prioritize movement and I would prioritize the quality of food. Okay. All right. If you can start with those two things, that will take you very far. Adding to that would be stress management and stress management and emotional well-being. I think that uh that gets under underrepresented and it has a significant uh effect on our overall health. The movement aspect of it is going to improve not that's one of the most powerful tools we have because improving muscle health will improve glucose management. The muscle itself releases a host of anti-inflammatory myocines. You know, I think the audience here knows enough about this. I don't have to go into that. Um, but muscle is the currency of health. So movement is gonna develop that. We need to develop that, and then it also helps with energy management. So moving, say, after you have a meal, just light movement, you know, it helps to digest the food, helps to reduce the glucose spikes, uh, and help manage energy a little bit better. And it's gonna keep you more resilient as you get older.

Philip Pape: 56:52

Yeah, let's sit on that for a bit because the audience has heard I've talked their year off about muscle mass and strength training and all that. So we don't have to go into masterclass about that. It's super, super, super important. The movement side, I've been kind of surprised the more I've learned about that, not just the walking after meals being so powerful for like blood sugar regulation and insulin sensitivity, like compared to even diabetes medication. I wish my dogs weren't barking right now. Um, but then the uh the thing that I learned about like movement snacks, you know, not sitting, like not sitting as an independent risk bearable. And I'm telling people all the time, get up every half hour, not even every hour, get up every half hour, walk for two minutes. Yep. And because there was an actual study that looked at that specific intervention and showed just a whole swing in everything muscle protein synthesis, you know, how you use glucose, nutrient partitioning, insulin sensitivity, and then even uh the myokines and the inflammatory markers kind of inverting when you just move a little bit. So I mean, tell us about all that because people need to understand how it's easy and powerful to do.

Dr. Abid Husain: 57:54

Yeah, yeah. The you know, it's it when you access the muscoskeletal system, when you just start moving and engage the ability to pull glucose in, reduce your glucose spikes, and then improve uh your I mean you're improving blood flow. There in every aspect, you're improving your your global metabolic health. It's from multiple systems. So, like you said, it's it's from your muscle functioning better. It's giving your because when the muscle is uh and when your system is sedentary, then at baseline, uh you're going to potentially develop you know the toxins may build up, you may get infl some inflammatory burden. The idea of sitting and uh and just sort of uh being in and being inactive, it's not what our system is meant to do. And so by just amping it up slightly, we get these little pulses of activity that don't cause any breakdown of tissue, but help manage, say, inflammatory load, stress, you know, all of these little burdens that occur while we, and especially in this in in the modern era where when we're sitting, we're probably looking at something, we're doing something, engaging our emotion, our our sensory system that is creating some sort of stress, work, some sort of burden. You know, these little exercise snacks serve as a like a pop-off valve to purge some of this and allow our parasympathetic nervous system to be more regulated, heart rate variability to go up, to get blood flow to the muscles, improve nitric oxide without having to do a you know a high-intensity interval workout. You know, these help maintain baseline health more than just you know the high intensity hour that we get from working out. Because going back to what we talked about in the beginning, that's the performance aspect of it. That hour of pushing ourselves improves our performance. The exercise snacks improve, it lifts the baseline so that our General health is better.

Philip Pape: 1:00:01

Yeah, I love that. I love the baseline of health and longevity. Built on that is the performance. And then you could even widen that baseline of performance because your health is better. And it's kind of a nice cyclical, or you know what I'm trying to say, thing. So, okay, let why don't we end on there's so many topics we could get into. I've enjoyed this conversation. End on the emotional well-being because people know I can be like almost delusionally optimistic. I have an optimism bias, but I own it. And I actually encourage people to try to be like optimistic about things to a fault because I think I think there's better health outcomes for well-being between that and having social connection. Totally. And of course, the physical health leads to the mental health as well. There's so many things. So tell us about that. And again, cardiovascular health and emotional well-being and what the connection is to finish here.

Dr. Abid Husain: 1:00:49

Direct correlation between stress management, emotional health, and cardiovascular health. If I want to draw an easy through line, think about it this way. Every time you think about something bad, you get stressed, you get depressed, you're going to release epinephrine and norepinephrine. Epinephrine and norepinephrine are stress hormones that make your blood vessels contract. They are pro-inflammatory and they will reduce your heart rate variability, increase your heart rate, increase your blood pressure. I mean, the idea is that they are designed to be used during stress situations so we can perform better for short periods of time and heal if we need to. All right. In our current society, in our current lifestyle, it's constantly being activated. And by doing that, we create an overall higher inflammatory burden that then trickles down to our vascular system, our brain health, cortisol, because if we release enough epinephrine constantly, then we're going to release cortisol that goes along with these stress hormones, and that will affect our brain health as well. So it's a it's a cascade. And we have the ability to manage that on some level by understanding, okay, I don't need to get worked up about this. I can have a positive attitude about this. I can reframe this thing that happened into looking at the positive things that have come out of it. You know, in and these are really powerful tools. I I can I can go and spend time with people I love because that calms me down and it reduces the sympathetic burden. So, you know, there there are therapies that you can do to help get you to that place. There's neurotherapies, there's injectables, there's psychedelics, there's, you know, there's so much that you can do. But at home, every day, I think keeping a positive attitude, regulating your emotions, and knowing that that really helps your your overall health is so powerful because that lifts the baseline, makes you more resilient, and I mean, it just makes life better.

Philip Pape: 1:02:59

I love that. It makes life better, it gives you meaning and purpose and physically allows you to function. And honestly, anybody out there who who has family and others they depend on, because we don't live in a vacuum. Yeah, that's part of the social fabric that allows us to be there for others and live a long life and not be a burden to others as well, if that's a goal of yours. So uh, Dr. Hussein, this has been incredible. I think we got it. There's so many topics we could dive into like as separate episodes practically, but uh, where do you want folks to reach out to you for either education or to contact you or anything else?

Dr. Abid Husain: 1:03:29

Yeah. Um let's see. I'm at Boulder Longevity Institute. So um I see patients there three days a week. You can email me there and uh look for me if you want to connect. Uh, I also do a lot of education in uh different lectures with the organizations. Uh there's uh New BioAge and then um Vibrant Health. And so look for me there if you want to get some some other ways to connect with me.

Philip Pape: 1:03:58

All right, cool. We'll we'll definitely include that stuff in the show notes for listeners to find you, and and anybody who wants to reach out to uh Dr. Sane can also let me know and I'll connect to with them. Yeah. Thank you so much for coming on. I mean, this is important information.

Dr. Abid Husain: 1:04:11

Hey, thank you. This has been a real pleasure. I appreciate it.

Philip Pape: 1:04:14

It's been awesome. Thank you.