 All right, Dr. Sane, we're live and it is great to have you here. We have known each other in the same functional circles for a while, but recently, I think it was last year, we had coffee and I just loved getting to know you and what you're doing and so much alignment with functional medicine. You're a cardiologist trained and I will share your official bio, just a little housekeeping for those of you watching and listening. This will be recorded. You can watch it later if you don't catch it all. You'll be here on Facebook live and it will also be on my YouTube channel, which is just under my name, Jill Carnahan, so you can find us there. You can feel free to share this if you find it interesting with your friends and family. I want to introduce my friend, Dr. Abid Hussein. He's an established cardiologist in the conventional healthcare system, but he realized like we all do, the limitations of providing highly impactful preventative care. He decided to educate himself in functional medicine and cutting edge research of the biotechnologies of anti-aging. If you stay tuned today, we're going to talk about some really cutting edge things that we're doing in not only internal medicine, but cardiology and pretty much all realms. What I love is just like you, Dr. Hussein, you're trained in cardiology, so you obviously have this really wonderful specialty, but this whole realm applies to all of our patients no matter if they have heart issues or not, so it'll be interesting to dive into there. He's among the revolutionary few who are changing the way cardiovascular disease is addressed, and you know, I always find it's so fun to talk to specialists that are functional trained because a lot of us are internal medicine, family medicine background, but when we find a colleague like you who's had the extra training, rheumatology, cardiology, gastroenterology, it's really, really special because you've got all this great conventional wisdom, and I always feel like we're adding to our toolbox, right? For me, I still have a great conventional doctor, I still want to make a great differential diagnosis, use all the great tools we have, but what we have now is we have a bigger toolbox with more things to use at the disposal of our patients. He's triple board certified, and he's an accomplished painter, mixed martial artist, and he has so many cool assets to his life, so thank you again for joining us, I'm so glad to have you here. Yeah, thank you for having me, this is a real honor to be here. Yeah, so what I always like to start with is a little bit about your story because we all have kind of a way that we traveled into medicine, and how did you get interested first in just medicine and cardiology, and then how did you find a way to functional medicine? Well, my journey has always had this intertwined path with the arts, so when I was in college, it was easier for me to sort of go into the medical profession, as my father was a physician and my brother also, but I really wanted to do the arts, and I was considering being a comic book illustrator, and then I took a gross anatomy class, and then all of a sudden something just went off in my head that made me really interested, and I thought, all right, this is something that I really love doing, and at the same time satisfies a lot of other responsibilities in my life, so it was a great fit, and then 20 years later, I was in fellowship and finishing that up, and got my training in cardiology, and starting the practice. I love that, and what I love is what I really learned, you know, in medicine, it's a very analytical, systemic field, and very left-brained, but you're an artist, and you're an artist at heart, and I feel like I have the same kind of bent as far as I'm actually an intuitive, you know, a lot of more creative pieces, and those combine so beautifully, because that little medicine at the root there, it's problem-solving, so we use that left-brain analytical part, but honestly, it's creative problem-solving because you have to really take a whole different approach to this to really understand complexities, so I bet you find that your artist background brings a whole different level of skill to your cardiology and your integrative and anti-aging practice. Yeah, it does, instead of it being protocol-based, which is what a lot of conventional medicine has become, it really brings the artistry back into it, and I think that's one of the things that functional medicine really has provided, you know, there's an element of artistry to it, every person is different, and every treatment is individualized, and so there's also a trial and error period, and that requires being able to understand and read what people are telling us, and their symptoms, and knowing what to take as a priority and what not to, so, you know, and those are all, it brings the artistry back into it for sure. Yeah, I really found that because I remember in medical school being so ashamed of my creativity and intuition because that wasn't scientific, right? So I really learned to kind of push that aside, we can't trust our gut, and now the last decade in practice, I feel like that intuition in their science to back this, but an intuitive sense of kind of the gestalt of where to go with a patient as you listen to their story, you know, it's right on, and it's almost 100% of the time I'm really in touch with that, or even the sense of like, oh, we're missing something, or I need to know more direction, right? And I'm sure you navigate that way too, but as I've actually pulled back in the intuitive right brain part of myself, I feel like I'm a much, much better practitioner, and I get, you know, a bigger, and even the sense of how they're feeling, and what was that, what was the significance of that event in your life? And then you find out, well, that was the time their palm flooded, and then there was water damage, and then they had, you know, whatever kinds of things that, so we're listening. So then you cardiology, conventional cardiology, amazing, and triple board certified, tell me just a little bit more about that, what's your board certifications in? Well, there's internal medicine and cardiology, those two, they go hand in hand, we have to go through internal medicine before we can finish cardiology, so those are two, and then there's my functional medicine board certification. I didn't get that until after, I'd say about 10 years of practicing, you know, I was practicing in Las Vegas, and that's probably one of the epicenters of cardiovascular disease in the country, because you have unhealthy, unhealthy lifestyles, people getting cardiovascular disease at a young age, and then you have a lot of retirees that already have cardiovascular disease. So it's a bit of a, you know, a heart sandwich over there, so it was busy, and I got burned out after about eight years, and there was a, you know, there was a feeling of just sort of fixing the symptom, and you know, we were putting in stands, you know, we were giving people statins, and it felt, you know, they were getting better, but they weren't really getting the outcomes that I wanted, and you know, that combined with just a huge workload, I got burned out, and I decided to take a sabbatical, and you know, I continued to work per diem, but I took a majority of my time off and went and was called back to the arts, and I went to do three years of studying with a master painter in Santa Fe, and I also did some traveling internationally to different places to study, but I did that for three to four years, and was just, you know, continuing to practice medicine to continue my, keep my skills relevant, and then it was after that I had, you know, I created this sense of satisfaction in one part of my life, and medicine still wasn't really satisfying me in the way that it had when I first encountered it when I was young, and I was just searching around for different options, and that's when I ran into functional medicine, and that's what pinged me, it really brought back a lot of interest, and it brought back this sense of continuing learning back in my life, like now I really enjoy and search for the time to continue to do the research, whereas before it was more an obligation. Yes, oh gosh, there's so many pieces I want to talk to you about in your story, because already, so first of all, you kind of went back into creativity, still kept your license, and the temporary kind of you work up to keep that, I know how that goes, but what was interesting is I bet that getting back into the creative really enhanced when you got back into medicine functional medicine. What would you say, what, first of all, I want to say when I first sat down to lunch with you last year, I remember hearing about your artist background and seeing some of your art, you are amazingly talented, like I love what you've done, and to me that was so impressive, because so often you have a very analytical left brain engineer, doctor, accountant, great, right? But they don't have the breadth or the depth of talent, and again, like we talked about at the beginning, I think it's actually the heart of the intuitive artist that really brings that ability to see things at a different level with our patients and actually find answers to very complex problems, because they aren't, I always think of it as we have a limited ability to process data in our analytical mind, but we have an unlimited ability to process data with our subconscious, right? So we can take in a lot more data points and process it at that level. What did going back to the arts and then coming back to medicine, what did that bring different for you to medicine that you maybe didn't have as much before? Was there anything that that changed the way you practiced? It, yeah, it did, just touching on what you were saying, it was there was a lot of integration of data. It was interesting, you know, the part, the type of painting that I do is painting from life, and life, especially visual data has, there's a tremendous amount of information we're taking in visually, and most of it is not, we're not aware of most of it, most of it is subconscious, and there is an element of not being able to understand what I'm seeing and then recreate it on a canvas. And so by going through that process of recreating it, it helps me to really formulate and understand what it is that I'm seeing on a really fundamental level. So when I start to see after doing that, when I now I apply that to other areas. So whether it's movement in my exercises or in, you know, in studying in, in studying clinical trials or practicing medicine, there's an element of trial of taking all this volumes information and taking it and filtering it down distilling it to the important parts that I need to use to organize the picture I'm putting together. You have just so eloquently talked about how we, how functionalism works best because it really is its observation and attention to detail, isn't it? Like you're just watching and you're watching when they flinch when you talk about a certain event in their life or you watch when they, you know, pause and they're having trouble getting the words out about something or like there's something there. But it's all those details that if we're going at the fast analytical pace we might miss. And I'll patients know what they need. If we listen carefully enough, don't they usually kind of tell us what direction to go. They're the author and they're the, you know, most important part of their story. Well, I love that. And then you mentioned the functional medicine. Most people I've talked to, including myself, and it sounds like you, when we really understand and find functional medicine, there's kind of an aha because the reason we really went into medicine in general is to solve problems, help people heal and really understand root cause. Did you have that kind of aha when you discovered a functional medicine like this is what I've been looking for? Yeah, it did. It was, I had the aha when I was doing, when I was studying the functional medicine, I realized it was making me a better physician overall, because it was complimenting both internal medicine and cardiology. And it continues to do so. The more I study, and the more I study, the more impactful things I learn, the more I keep having, you know, these aha moments just keep getting, keep coming and they keep getting bigger and bigger. It's not like it just happened once, you know, they, yeah. It's like I've tapped into a vein and now all of a sudden I say, I just keep following that back and it's, it's, it becomes more exciting. Yeah. And like you said, the joy comes back because we actually went into medicine to help solve problems, help people, versus just, there's nothing wrong with drugs and surgery. I prescribe them frequently. But if that's the end point all the time when there's no actually solution-based medicine, it gets to be a little bit discouraging really for what we do. Yeah. So let's talk about some of the cutting-edge things you're seeing. I know you do a lot of anti-aging, so you deal with cardiology patients, but you're also looking at people like a lot of our listeners who just want better performance, whether it's brain, physical health, optimal performance in sports and athletics. I mean, you see quite a few athletes too. I do. Yeah, I take care of a lot of athletes and that's been where they're, I enjoy taking care of athletes and that's been where I started a lot of my practice and a lot of bio-identical hormone replacement. And it's a rewarding way to help people because a lot of the, a lot of athletes generally are pretty healthy and we don't have too much to tackle so we can add on to what they're doing and have some sort of practices that are some sort of practice and consistency with what they're doing. But what's interesting is after working with those people and deciding that, all right, I'm prescribing testosterone, prescribing estrogen, progesterone, I've really got to know the nuts and bolts of what these are doing and there's a lot of myth about testosterone out there. What it does, what it doesn't do, does it help the cardiovascular system? It doesn't it? Same thing with estrogen. There's these trials that are from 30 years ago that say we shouldn't be taking oral, you know, parlor replacement and then we have trials that say we do. So it became, I was compelled to say, all right, I'm prescribing this and I'm a specialist in this arena. I have to know the nuts and bolts of what's going on and really find out definitively for myself what it is. And so that has led into a real kind of gold mine in understanding what hormones can do for our cardiovascular health and how they're being under utilized. I'd love to talk a little bit about that because I do the same. I think you probably even more to an extent use them and I feel the same way like they are powerful when used appropriately. Yeah. And as long as we know those guidelines. So let's talk about a typical, say, you know, 55 year old woman with no history of breast cancer, no high risk, just going through menopause, starting to have menopausal symptoms, worried about her heart health. How would you console her and would you consider estrogen, testosterone, progesterone? How would you look at that kind of a case? And then I want to talk about a man too. Yeah. Yeah, definitely. I mean, so a woman coming in with, you know, menopausal symptoms, premenopausal, leading up to or even in full blown menopause. I would start by doing, you know, a full blood panel and that would include thyroid also because the thyroid is just as important in cardiovascular health. And that's what I do for most of my patients, actually all of them. I start with at least a sex hormone panel and a thyroid panel and, you know, assuming that their numbers would come back consistent with what we expect if they're having symptoms of menopause and their progesterone is low and the testosterone, progesterone and estrogen are low, as is their testosterone. So, and there's a lot of data to support not just replacing the three hormones, but replacing them up to physiologic levels. I have, I started using topical estrogen in the beginning and as we were trained in an A4M and then a lot of the research that I'm looking into recently is saying that oral estradiol is safe. Oral estradiol is probably more powerful and allows for better delivery as well as easier testing. So I've shifted to oral estradiol and then oral progesterone, these are all bio identical. And that's a very important point because all of the old studies, and this is where things have gotten confounded, is they're using synthetic estrogen or estrone or they're using equine estrogen, which is ridiculous. We're talking about, you know, horse estrogen for women, it's, you know, and then synthetics, which have a longer half-life and they're also stronger when they bind the receptors. So naturally it's going to cause an abnormal reaction or a side effect. But if we use bio identical estrogen, our bodies can manage the half-life, they can manage the lifespan of these, and then use some sort of feedback mechanism to use it appropriately. Same thing goes with progesterone. And then often under-recognized is testosterone for women. It's so important, you know, it's part of their lean body mass. Lean body mass is important for maintaining cardiovascular health in the sense of insulin sensitivity and then vascular health, things like that. So not only that, but then recovery, we talked about muscle mass briefly, and then libido, important. So bone health. So I usually, you know, I give all three to my patients, but I don't often give straight testosterone to women. I give DHEA, which is well converted to testosterone. Yes. I love that review because people are so afraid. And of course we do this with informed consent with the patients, you know, understanding of what, because there's always some risk with everything we do. But I agree with you 100%. And what I've really found is I look at the research, the surprising thing in the last maybe five years is the data on testosterone and auto-immunity and why women get auto-immune at least four or five times that of men, testosterone is one of the factors. And I've actually used that, especially with clear serum levels that are basically undetectable in women, to start to reverse auto-immunity with a good, you know, we're dealing with the gut. We're dealing with all the other functionalists and pieces, but I've seen testosterone be a key component in women in helping to reverse auto-immunity. So I couldn't read more. And like you said, I love DHEA. Once in a while, they're really pushing stress hormones in the cortisol pathway. They're converting that to cortisol or they'll have breakouts or they'll have some conversion issues. And I'm assuming like in the blood work, you're checking free and total testosterone, DHEAS, and then maybe even DHT to make sure that they're not having pattern baldness or any of those kinds of things. Sure, sure. Yeah. Yeah, I do that, especially for the men. The DHT is, I mean, of course women, yeah, hair for both. Yeah, I checked DHT at home. So let's talk about the men then, because clearly, similar pathway, but what do you look for in men? And are you looking for estrogen to make sure it doesn't go too high? Tell us a little about the typical man. Yeah. So, man, with the similar age, I'll do the same panel and I'm checking the same markers. For them, it's primarily they're concerned about testosterone. And rightfully so, I'll check the free and total testosterone. And if their numbers are low, meaning below around 350 depending on the lab, then that means they meet criteria to start right away without even worrying about their symptoms. But if they're within low normal, like below 500, and they have symptoms, then I will start them on anyway, because that also meets criteria as long as you have symptoms. So starting them on testosterone, and when starting testosterone, I prefer to start them on not only this isn't injectable, because it's the most effective way to give it, unfortunately, through injections. Once you get used to it, it's not a big deal. Once a week is what I prefer. And then I add another agent to help stimulate the body to make its own testosterone. So what ends up happening is if we give testosterone, it's going to suppress our body's capacity or desire to make testosterone, because if it's already there, why do we need to make it? So what we want to do is what I want to do is I want to give them something that will stimulate the brain to send the neuro hormone to create a little more testosterone. The reason for that is that we don't suppress the ability for the testes to make testosterone overall. Because if you do that for years at a time, then restarting your ability to make testosterone can be difficult. So that helps to boost the testosterone a little bit and keep your physiology working the way it's supposed to. Yeah, and clearly with both of these situations, there's a clear heart benefit, right? Can you tell us what about like for a woman optimizing hormones and is not going to cut up an age like should we be concerned after 70 or after 65 or after? What's kind of your threshold for men or women and hormones and is there a concern with informed consent? What would you take us with that? Yeah, well, let me finish with men and then I'll take you to that. So finishing, you know, the second part of the man is the estrogen. Now I don't I will estrogen and progesterone, I will replace their estrogen and progesterone if it's low. Oftentimes giving testosterone because it gets converted to estrogen means that we don't have to do that. But that's where their cholesterol panel comes in. I check their cholesterol panel and if they have they have high LDLs or I also check inflammatory markers. If they have markers that look for oxidized LDL, you know, F2 isoprostane or elevated LP little A, these are all extra markers. These are markers that look at bad plaque being created in your arteries. And I look at others too, if those are elevated, then we need to act on their cholesterol aggressively. And that means, you know, if they're open to it, because sometimes a discussion of starting estrogen for men is not something they want to hear. But when they start it, there is great data to show that the estrogen actually helps improve your HDLs, lower your LDLs, and then improve what's called a cholesterol efflux, which is the ability for our body to pull cholesterol out and then get get rid of it. So so and then progesterone helps it help them sleep, you know, if their sleep is off, you know, it helps everybody sleep. So why not give it to men also? So I was just going to mention for people listening, that makes GABA, your progesterone GABA is like the same thing as an alcohol or benzodiazepines, but naturally you make this GABA when you take progesterone orally, which is amazing for sleep. So go ahead. Sorry. So I'll start with about one milligram for men, sometimes a half a milligram, and it's not that that much estrogen. And generally, they it's tolerated very well. And if they do get some symptoms, then we ease back on it and, you know, and monitor it the way we would, you know, monitor it, see how they feel. If we need to, we can add some, you know, some dim or some other sort of supplement to help the metabolism drive it the way we want to. And then, you know, if they are on a lot of a lot of hormone replacement, I'll do a metabol, you know, hormone metabolism study also. Usually, you know, there's some salivary tests or urine tests that will look at the metabolic pathway to see how they're metabolizing their hormones. And that can be helpful to see, you know, if they need supplements to guide the metabolism in the right way. So yeah, so that's how I would, you know, finish up with men. So then if we're looking at cardiovascular health, like if somebody's coming to me and they're middle aged, and they don't have a family history, then, and they've never looked at their cholesterol, then I'll do that. I'll do a thorough cholesterol panel. If they've already looked at that, and their primary care physician has said, okay, your cholesterol is good. I will ask for the numbers, the data, make sure, verify, and if it's okay, I don't necessarily need to do anything in their middle ages, unless they want me to dig into it further, unless there's a need to. If somebody comes to me that's a little older, and they've already passed the phase of menopause, or if they're older men, I will still recommend starting the hormones, because there's no age is too late. The caveat is that for women, the longer the years they have in menopause, the more their risk starts to equal men of the same age. So once they lose their protective effect of estrogen, they start to develop plaque. Adding estrogen at higher doses can cause the plaque to become unstable in the first year, and that's it. So that's why in studies we see the first year has maybe higher levels of heart attacks, angina, acute coronary syndrome, and that's because they've been getting really high doses of estrogen, and that causes, yeah, and so those plaque get a little bit weaker, and more prone to rupturing. So what we do is we start out low, or we start with cream, get them used to it, and then increase it slowly, and then and and generally one milligram to two milligrams is still within a range that it doesn't cause the plaque to get too unstable. So start with maybe one milligram, half a milligram for the first year, and then as they their system has time to really stabilize, and then the next year will, you know, we increase it, but we look at those inflammatory markers at the same time, and measure them to see where they're going. And the one that I'm looking at in particular is called myeloperoxidase. Yes, yes, there's an oxidative stress marker, right, which a lot of doctors don't look at. So it's MPO for short, if you're asking your doctor for that. Now I know I can get specialty panels with that. Can that be done at a traditional lab like our hospitals or Quest or Lab Corps that MPO, or is that just specialty? No, that's actually a quest has. So Cleveland Heart Labs was doing that before, then they got up, but they got bought out by Quest, and they maintain their, they're still set, they still maintain themselves as a separate entity, but you can get MPO or all these markers through Quest anywhere now. Is that the cardio IQ panel that they have? Is that what? So yeah, they have a, they have a, it's, it's used to be called an NMR, I think it's called a smart lipid panel with particle sizes. And that's the one I use. This is great. Yeah, me too. So I have a question because this is getting as a clinician and you're the expert here for me to learn too. The LP little a, I have the understanding that there's a much bigger genetic component of that. And for me, it's a little bit harder to budge, but it sounds like you think that or the hormones could potentially, is there anything else? So LP little a patients who have that high, obviously there is a big genetic piece. What else could we do for that? That you might be able to shed some light on it? There's, well estrogen has some is shown to be to be effective with LP little a to help reduce some of that. You know, LP little a is a little bit of a conundrum. There are some folks that have elevated LP little a that don't have premature coronary disease. So, so it doesn't necessarily mean that you have, you know, you're going to get coronary disease. So I think that that there's, so that's a caveat that should be said, but it should be taken seriously because that's the minority instead of the most patients. But estrogen helps. And then, you know, we start looking at, you know, there's other potential options. There's some peptides that may be able to help with LP little a or at least help the utilization of fat more effectively. And, you know, when we talk about peptides, we're talking about protein molecules that help the body do the things that it normally does, but more efficiently. Yes, I'm a huge fan of peptides. So we could talk a little bit about that if you'd like. I use some of the the main ones that are super common for raising HGA, human growth hormone, some other ones that help immune system help natural cells, a lot of the ones that help repair and recovery. So injuries, tendons. And for me, the thing that I need to know as a clinician is, are any of these causing rapid cell division growth, because those are the ones usually want to use for a specific amount of time, you know, with not overdoing them, because of course, they could could lead unrestrained growth of cells, which could lead to cancer. Yeah, I feel like with the types of ways we're using them, like either Monday through Friday off on the weekend, or for six months off. Tell me a little bit about I know like CJC B'moreland is one of our classic favorites. Is that that's one that you would probably use for six months, and then take a break any caveats on using that? The the only, I mean, there's no real caveat, like I guess I will say one caveat about cell division. I don't really know of any studies specifically that looks at what growth hormone does to tumor tissue. This is just this just theoretical. And the only study that we know, that actually looked at what growth hormone did was it was Tessa Morellen in AIDS patients that had Kaposi sarcoma. And that actually reduced the Kaposi sarcoma load. So, you know, so even that is is to be questioned, you know, we don't necessarily mean this is we're stimulating our body's ability to do what it normally does. And giving growth hormone is is what we made a lot of when we were young. When we were young, we could fight off a lot of disease, we could fight off cancer, you know, so it makes sense that this may be able to help fight those things off in adulthood too. Yeah, no, I totally agree with you. And I've seen just such impressive results with peptides, I know like you as well. Any new and upcoming ones that we might want to be thinking about or on the radar? Yeah, there's a there's a lot of you know, a lot of what's on the on the radar is looking at cellular senescence and mitochondrial efficiency. Like five and one of the yeah, yeah, everything seems to be pointing to the to that sort of link the bridge between nucleus and the mitochondria and the rest of the and how that communicates with the rest of the cell. So all there's a whole list of mitochondrial peptides, there's MOS, MOTSC, there's five Amino 1MQ, there's the Fox, whether you were talking about Fox 04, you know, these are these are peptides that are designed to and then there's also something called human in which is really interesting that you know, these all these are designed to bring health back to mitochondria and make them into these really powerful energy producing organelles and then help it communicate with the rest of the body and the nucleus effectively and efficiently. And there's so many ways it's being done. I mean, one of them looks at the bioelectric current in the inner membrane and and fix it, you know, puts these peptides into place to make it even more bioelectrically make the act the potential more bioelectrically, you know, stronger. And you know, so if you imagine that, you know, is if we're going to close our eyes and visualize this, I mean, that's that's a really powerful sort of image of something that's electrically moving along the surface of our organelles. I guess that's just the artist to me talking, but I love it because I did just so fascinating to see like the potential of some of these therapies are really powerful. I have a young woman who has a kind of a unknown cause of cardiomyopathy. And with peptides, we've seen some massive reversal, the 40 something year old dentist, you know. And I'm assuming you've seen some of the same kinds of things is really at the level of the heart is probably the biggest purveyor of mitochondria and energy. Yeah, brain, right? So I'm assuming with heart kinds of conditions, you're looking at mitochondrial peptides, because that's where the power is. Yeah, definitely. Yeah. How exciting that we have these. So I'm getting a few questions on the Facebook on fish oil and thoughts because that went all different ways. I know we use it. What's your thoughts on EPA, DHA benefits for brain and heart? Do you still use them? Yeah, I do. Yeah, I don't use supplements unless unless they're really indicated and DHA, EPA is definitely one of those that I do recommend still. It helps triglycerides, it high doses, important fundamental building blocks for brain health, important for our hormones, because we use the fats to make our hormones. And EPA and DHA are great. I do would say I would like to make a caveat that Omega sixes are also important too, you know. And the linoleic acid is also an anti-inflammatory Omega six and we need that to help membrane health. So Omega three is definitely very important and very healthy. Don't forget the Omega sixes and a great source is evening primrose. You can get that pretty, get that pure and it can help augment the Omega threes. Especially if you have eczema or some of the skin conditions, asthma, eczema, atopic stuff, typically GLA is deficient. And it's interesting, arachidonic acid is a metabolite of an inflammatory pathway of fatty acids, so we don't want that high. Sometimes fish oil can bring that down. Have you ever seen arachidonic acid low and is there anything you would do if it was too low related to fish oil or I don't know, but if you've ever come across that? I haven't really seen it that much. I mean, because most of the time, you know, fish oil is something that's so ubiquitous right now and most people take it. They take it as a sort of just as a reflex. In fact, what I see is the other way, other end where arachidonic acid is often too high and it suppresses the use of the Omega sixes and of the ability of the Omega sixes to leak, to get into the cell and try and improve membrane health. Awesome. So what are some of the any upcoming things that you've seen that you feel like might be really game changing and cardiovascular disease, especially in the realm of integrative and functional medicine and tips or tricks? Well, you know, I'm still working on getting people to want to take the estrogen, you know, and then the trick is to combine that with with the peptides. And there's a lot of peptides that help, they help insulin sensitivity and they also help, they also help the lean body mass. And so, you know, there's one that is used by Big Pharma called Victoza and used to be, it used to be available as via compounding pharmacists. It's not anymore, but in patients with diabetes or even if we can get it approved, you don't have to have diabetes and it's a great medication to use because it can actually help vascular health significantly. It can reduce intimomedial thickening, which is, you know, when we get older and we have, if we have hypertension or we have aged vascular anatomy, it gets thicker and getting thicker is a sign where it gets stiffer and then promotes hypertension. Well, well, Victoza or their Glutide is one of the few medications that's actually shown that it can reduce intimomedial thickness and help, help them, you know, the insulin metabolism very well. So, so by reduce, it can reduce the effect of hypertension and, you know, improve vascular health. So I think being able to add that and use that more liberally is something that I that is something that I'm trying to do when I can with patients. It's, it's difficult because it's an injectable and it's an inexpensive medication. I love that you're talking about lyrical glutide. I wrote an article a few months ago on lyrical glutide. It's a GLP1 agonist and what I wrote about was, yeah, it's for diabetes, but if you look at the studies on lung function, heart function, diabetic reversal, insulin resistance, et cetera, et cetera, there's so many different areas and acts on so many different tissues. So it's very pleotrophic in its nature and how powerful. And you talk about self, self senolence. Same thing. There's some studies with lyrical glutide and self senolence, which basically means the cells that are programmed to die start to, you know, get back to life and give you some, you know, energy and traction. So I'm a huge fan and for me, my population is a lot of environmental toxicity and mold related illness. And what I see there, men and women, they will get toxic mold exposure and then go right into a very severe leptin resistance. So they'll have 20, 30, 40, 50 pounds of weight gain, no change in activity. They're not quite diabetic or they'll even start to become metabolically resistant and insulin resistance because of the toxic exposure and their healthy weight and their exercising and their eating right and they can't lose weight. So that weight resistance, that weight loss resistance, that leptin resistance is just a sign that metabolically they've got some dysfunction. And it's because those toxins hit the leptin receptors on the cells and basically block the ability to burn fat. So I found leyrical glutide to be a huge reversal agent for that. But like you said, the difficulty is it's very expensive and we used to be able to compound it now to get it approved is really difficult. So that's always my rate limiting factor and using it as if the patient can afford it or if we can find a way to get it. But I love it and I feel like I love using it off label for these other indications because it really does work. And with peptides, it's amazing. So I love the image in that. Yeah, I mean, there's a lot of valid on label uses. I mean, it's indicated for weight loss. It is for obesity and for diabetes and for, yeah, so that's exciting. Well, any last bits of tips or advice or so if patients are looking for a more integrative approach, you are taking new patients, right? Fantastic. And where's your office out? Is it Denver? It's south of Denver in Englewood. Okay, fantastic. Where can people find you? What's your website? Yeah, but my website is interlinkedmd.com. So that's i-n-t-e-r-l-i-n-k-e-d-m-d.com. Awesome. And I'm going to make sure you guys that we have those links posted so you can jump right on there interlinkedmd.com. Thank you so much for your time today. It's so fun to talk to you about peptides and heart health and all of these things. Any other bits of just basic advice for the patient who has heart disease, who's struggling even with their conventional doctor, where could they get started? What would you recommend if they maybe don't have someone like you yet in their corner? What are some of the very basics that they should be doing? The basic things they can do are start with, well, make sure they're taking their omega-3 fatty acids, coenzyme Q10, and magnesium. Those are the three big ones that, those are the three big ones I would recommend for heart health. And then start, make sure you're walking after dinner or after, you know, get up and walk around, move around a little bit. You don't have to be, you don't have to be going to a gym, but improving how your body metabolizes your food right after you eat is one of the most important things you can do. So after you eat, do not sit down and watch TV. If you've got a yard, go outside, do some yard work. If you have, if you can go for a walk, then go for a walk. But that's probably the first most important thing you can do because that will help your body metabolize the sugar better. And then it'll give you a little bit of, you know, time to get at it. It'll give you a little bit of fitness too. But movement is so important. Yeah. Oh, that's a great advice. And I'm assuming then you don't want to do like the sumo wrestlers and eat and then go straight to bed either, right? Oh, fantastic. Unless your job depends on, their job depends on it. Yeah, exactly. Well, thank you so much for your time. It has been a pleasure to have you. We'll have to do this again. And yeah, thanks for having me. You're welcome.