Ep. 506 Your Immune System Is Aging Faster Than You Think – The Most Powerful Longevity Protocols to Reverse It with Dr. Elizabeth Yurth

Today, I am thrilled to connect with Dr. Elizabeth Yurth. Dr. Yurth is double board-certified, as a physician in physical medicine and rehabilitation in addition to anti-aging and regenerative medicine. With over 30 years of clinical experience, Dr. Yurth continues to lead the way in orthopedics, cellular and regenerative medicine, and the future of aging.

In our conversation, we explore immunosenescence and its implications for longevity. We discuss the off-label utilization of medications, including low-dose naltrexone, rapamycin, and GLP-1s, and examine other types of peptides, growth hormone secretagogues, and thymic peptides. We speak about hormones and anabolics, highlighting the benefits of anabolics for the bone health of those with osteopenia and osteoporosis. Dr. Yurth also shares her favorite supplements and outlines the key elements for optimal brain health.

This episode is the first of a series of conversations with Dr. Yurth. She will join us again to dive into cardiovascular disease and explore powerful ways to support healthy aging at the cellular level.

IN THIS EPISODE, YOU WILL LEARN:

• Why the thymus gland shrinks with age and what that means for immunity

• How thymic peptides support immune health, healing, and recovery

• The role thymosin alpha-1 plays in modulating the immune system

• Why thymosin beta-4 must be cycled for safe healing support

• How IGF (Insulin-like Growth Factor) decline impacts muscles, joints, and the brain with aging

• How growth hormone secretagogues can safely raise IGF

• How BPC-157 (a gastric peptide) aids gut repair, musculoskeletal healing, and brain protection

• Why mitochondrial peptides matter for energy, recovery, and repair

• How anabolics support bone strength and recovery

• How creatine and choline support the brain and muscles

Bio:

Elizabeth Yurth, MD, ABPMR, ABAARM, FAARM, FAARFM, FSSRP, is Co-Founder and Chief Medical Officer of Boulder Longevity Institute, where she has been providing Tomorrow’s Medicine Today to her clients since 2006. 

Dr. Yurth obtained her Medical Degree from the University of Southern California Keck School of Medicine, completed her residency at the University of California – Irvine, and her Fellowship in Sports and Spine Medicine from Stanford-affiliated Sports Orthopedics and Rehabilitation (SOAR) in Palo Alto, CA., along with her 30 years as a practicing orthopedist specializing in sports and spine medicine. 

Dr. Yurth has made it her mission to learn and share the latest scientific research on how to truly heal the body at the cellular level. She is Fellowship trained in Anti-Aging, Regenerative, and Cellular Medicine. She has completed +500 hours of CME training focused on Longevity, Nutrition, Epigenetics, Bioidentical Hormone Replacement Therapy, Regenerative Peptide Treatments, and Regenerative Orthopedic Procedures. 

Dr. Yurth continues to serve as a thought leader in Cellular Medicine, speaking at longevity events across the world and teaching others through her position as a founding faculty member for Seeds Scientific Research and Performance Institute (SSRP), which leads the way in connecting the latest research to clinical practice.

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“The thymus gland is actually training your lymphocytes to go out there and fight disease.”

– Dr. Elizabeth Yurth

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Transcript:

Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

[00:00:29] Today, I had the honor of connecting with Dr. Elizabeth Yurth. She is a double board-certified physician in Physical Medicine and Rehab as well as Antiaging and Regenerative medicine with over 30 years of clinical experience and continues to stay at the forefront of orthopedics, cellular medicine, regenerative medicine and the future of aging. 

[00:00:47] We started the conversation diving into immunosenescence which is the aging of the immune system as it pertains to longevity. We spoke about off-label utilization of certain medications including low-dose naltrexone, rapamycin and GLP-1s. We spoke about other types of peptides including growth hormone, secretagogues, thymic peptides as well as hormones and anabolics and how anabolics can be very beneficial for bone health in those that are osteopenic and osteoporotic. Key supplements that she likes to utilize including creatine monohydrate, choline and many others. And lastly, key things to look for for brain health. This is the first in a series of conversations with Dr. Yurth. She will be coming back to deep dive into cardiovascular disease and ways that we can augment the changes that are occurring at a cellular level with the aging process.

[00:01:46] Dr. Yurth, I've been so looking forward to this conversation. I'm so glad we're able to bring it to fruition. 

Dr. Elizabeth Yurth: [00:01:51] Cynthia, thank you for having me. I love the audience you're talking to. They're my passion and I'm excited to talk to you. 

Cynthia Thurlow: [00:01:57] Yeah, I would love to talk about how the immune system ages with us. I think many of us, because it's not tangible, we can't touch it, we can't see it per se. What is changing with our immune system as we are navigating perimenopause and menopause because it's quite significant and I don't see enough focus for most people that are talking about the perimenopause and menopause transition. Not enough of us are talking about how these changes in our immune system really regulate how we interact with the world and how healthy or unhealthy we are. 

Dr. Elizabeth Yurth: [00:02:31] Yeah, let's first talk about how critical our immune system is to longevity. In fact, Stanford actually started this study looking at what system was really the most critically important. We have all these studies now that are looking at, is it gut, is it-- If you were to pick one system that was in charge of aging, it would be our immune system. And when our immune system starts to fail, everything else goes awry. If our immune system is really hard-- when you've got your best immune system at puberty, so our immune system is robust and you don't see a lot of bad things happening at puberty. People are pretty much in a pretty good state of health. Maybe emotionally unsound, but in pretty good state of health. 

[00:03:09] They don't get sick very often. You don't see them dying of viruses. You don't see them getting cancer very often. As we get older, that gets worse and worse. And it's really because our immune surveillance becomes dysfunctional. We don't recognize self anymore. We don't recognize cancer cells anymore. So, Stanford actually came up with a test that I've been following for a long time called the iAge test. Instead, people are doing these robust, okay, what is my biologic age? You could actually just look at immune age as probably the primary marker. And they came up with about six different things to look at that really predicted immune age. And I think that's why when we look at what's affecting our immune system as we age, what happens? Well, there's lots to that. 

[00:03:51] But if we talk about, for instance, as we get older, actually even-- I say older, but really our hormones start to get dysfunctional even in our 30s. We start to see imbalances of estrogen and progesterone. One of my sons has a girlfriend who's in her 30s. He's in his 20s, but his girlfriend's in her 30s. And I was talking to her about things and I said, you're already, she's like 36, 37, but she's already obviously showing some signs of progesterone, estrogen imbalance. So, I think we forget that this starts much earlier than the 50-year-old who oftentimes presents to us feeling, fat and tired and everything. It really starts in our 30s. We start to see this decline because our progesterone starts to decline, really, sometimes in late 20s, as does our testosterone. 

[00:04:31] So, when we look at the influence of things like that on immune health, really our T-cell function, our lymphocyte function, our natural killer cells, which are the cells that go off and fight cancer. It's absolutely critical. For instance, progesterone is a really clear immune modulator. We know that it affects the immune system to stabilize it, to keep it from going haywire and attacking self. So, we know that progesterone is really critical there, as is estrogen. Probably more critical is that balance between the two. And as we see, we hit this point, where that balance becomes very skewed to estrogen. So, it's not necessarily always low estrogen that's a problem. It's that imbalance between estrogen and progesterone. So, as progesterone's dropping, estrogen often stays high for a long time, then we start to see this immune imbalance. 

[00:05:18] And then I think the forgotten hormone in all this is testosterone. Because when you look, women have much more autoimmunity than men. You see much more autoimmune disease, thyroid disease, rheumatoid arthritis, you see in women over men. And largely that's because testosterone is a very protective effect for the immune system as well. And so, men will start developing autoimmunity much later as their testosterone levels drop. Women start developing it very young. Our testosterone levels are really in our 20s peaking, and then they start to drop. And if you do things like birth control pills, which completely deplete testosterone, then you're really in trouble. You give you this very high doses of estrogen, no progesterone and birth control pills, just progestins, and you've suppressed testosterone because it increases binding of testosterone. 

[00:06:00] So, we get these women who are really starting to see dysfunctions with their immune systems even at a very young age. So, you can imagine if that's going on now for 10, 20, 30 years, what happens? We're going to see people with thyroid, the autoimmune thyroiditis, right? We see a lot more people with eczema. We see a lot more cancers starting to develop. So, I think that we really forget that plan. I'm so glad you brought it up, because we really forget, number one, that the immune system is the top of the pyramid and well, I'll say maybe the bottom of the pyramid. It's the base of everything and that the hormones are a critical player there.

Cynthia Thurlow: [00:06:37] Yeah, you bring up so many good points. And something that I think about a lot is certainly my generation, almost every single female friend I had was put on oral contraceptives early. 

Dr. Elizabeth Yurth: [00:06:47] Yeah. 

Cynthia Thurlow: [00:06:48] So, we had our teens.

Dr. Elizabeth Yurth: [00:06:50] 12 and 13 sometimes, right? 

Cynthia Thurlow: [00:06:52] Yep. [Dr. Yurth laughs] So, think about over time, how much our bodies were not being sensitized to estradiol, testosterone, progesterone. And thinking about the net impact. I don't have any girlfriends who do not have multiple autoimmune conditions. Not one. And I wonder-- [crosstalk] 

Dr. Elizabeth Yurth: [00:07:10] Is astounding. 

Cynthia Thurlow: [00:07:12] Yeah. It just makes me wonder what are the long-term effects? And obviously I always say this in the podcast, like, “Women need reliable contraception.” Full stop. But certainly, my generation just was not aware of the effects. 

Dr. Elizabeth Yurth: [00:07:27] I'm a little generation ahead of you but birth control pills were easy. They made sense. Nobody told you there was any risks to them. Everybody took birth control pills. And then we started using them to treat acne and we started using them to treat mood disorders and we started throwing everybody on them. And I'd like to say it's gotten better, but I think it's maybe better. There's a little bit more awareness, still not a lot. If you still look, it's huge amount of population who's put on birth control pills, right? 

Cynthia Thurlow: [00:07:53] Look at all the middle-aged women that are-- [crosstalk] 

Dr. Elizabeth Yurth: [00:07:56] Who are still taking them. Literally are still, I see, in their 50s, right, still taking birth control pills. They've been on it literally since they were 20. And they're like, “Well, my doctors suggest keep taking them because they're giving me the hormones I need now.” No, they're not actually. They're giving you a whole bunch of estrogen and nothing else. 

Cynthia Thurlow: [00:08:12] Yeah, well, and it is interesting how sometimes patients will come into our practice and they're like, “Yes, my provider put me on HRT” and I'm like, “Great, what are you taking?” And they list down, I'm like, that's not HRT. [Dr. Yurth laughs] HRT and oral contraceptives are different dose- [crosstalk]

Dr. Elizabeth Yurth: [00:08:27] Very different, right. 

Cynthia Thurlow: [00:08:27] -medications, different hormones. And so, if anyone's listening, just to provide clarity, oral contraceptives are not hormone replacement therapy or hormone replenishment therapy or whatever terminology we're using right now. I think that's an important distinction to make because there are people who-- [crosstalk] 

Dr. Elizabeth Yurth: [00:08:45] Who really do think that.

Cynthia Thurlow: [00:08:46] Because they don't know any better. When we're thinking about factors, items that impact supporting our immune system as we're getting older, obviously the hormone piece is certainly important. What are some of the medications that you're seeing being utilized to buffer the immune system? This can be inclusive of peptides, this can be, rapamycin, low-dose naltrexone, lot of these drugs that we're seeing that are being discussed and talked about that maybe not necessarily every prescriber is utilizing, but we're seeing good data on and good results with patients.

Dr. Elizabeth Yurth: [00:09:23] Right. So, I think that when you look at low-dose naltrexone, I love low-dose naltrexone. For those of you guys who don't know, naltrexone at a high dose is an opioid antagonist. It blocks opioid receptors. But we're talking about microdosing it. We're not using it in 40 mg doses. We're using it in like 1 to 5 mg doses. And what it does then is as when you tickle the opioid receptors, you actually modulate the immune system. And the word modulate is key here because it's not going to spike up the immune system or suppress the immune system, it's going to stabilize the immune system. And that's why it's so incredibly useful for people with emerging autoimmunity-type pictures. It's been well documented now with ulcerative colitis, Crohn’s, some of the GI issues. 

[00:10:09] I put most of my autoimmune thyroid people on low-dose naltrexone with significant benefits and it's really well tolerated. When you first start taking it, you have to start slow because it can give you nightmares, keep you awake a little bit. But over time people adapt to it really well and it's probably going to have anticancer effects. The long-term immunomodulation is going to be good for a whole bunch of things. I think the only risk of this drug is sometimes if you're on it and you have a surgery that now you need opioids, you might have to stop the drug or take more of the opioid to counteract it. And sometimes the docs will be like, “Oh my God, you're taking all this medication,” you know, why? Why? 

[00:10:48] And you have to either stop the low-dose naltrexone, which I always hate to do, or tell the doc, “Listen, that's because I'm on a drug that's blocking these, I need more.” So, I think that's really the only downside of those drugs, otherwise they're hugely beneficial. We look at drugs like rapamycin. Rapamycin, we don't have a whole lot of clear data on. We know that it's really good for some things, we know that it's great for ovarian aging. At least in animal model, it appears to be really great for ovarian aging. In most animal models, it appears to delay onset of menopause, which is nice. 

[00:11:20] So, I actually will use it a lot in my young females who are 35, 33, and haven't met a guy yet, and they know they want to have kids. I'll actually put them on rapamycin to preserve fertility. Now, do we know for sure it's going to work in humans? No, we're actually doing some research with a group right now trying to figure out if that's true, but hopefully it will. And I think the downsides are pretty minimal as far as an immune modulating agent. Again, remember, rapamycin is a cancer drug in high doses. So, it's designed to kill cells in high doses. So, we use is a micro dose used once a week with the hope that what we're doing is getting rid of damaged cells and allowing good healthy new cells to form. So, basically, I look at it like cleaning house. You accumulate all this trash all week. You have to throw out the trash. You accumulate trash, you throw out the trash.

[00:12:11] So, it's basically inducing autophagy of a lot of the damage. And you can see reflection of that in some of the labs. For instance, you can look at something called a mean cell volume on the labs, which is the size of the cells. And if that gets bigger and bigger and bigger, probably there's more senescent bad cells and we can see that it gets smaller on rapamycin. So, I do think there's some key points there. And basically, in blocking this mammalian target of rapamycin or mTOR, we are modulating the immune system as well. Now, the problem is in some people it's very hard to figure out the dose that modulates without suppressing, because in a higher dose, this drug is immunosuppressant. 

[00:12:48] And I have had people who, even at the dose we typically use, which might be something like 6 mg a week, will start getting cold sores or start getting sick more often or start getting a drop in their lymphocyte count. So, the problem, the hard thing about rapamycin is finding the right dose for people. And we don't really have a, like, well, 6 mg a week. For some people, that's too much. Some people need 3 mg a week. So, it can be a little bit of a tricky drug to find the sweet spot of. I think right now it has huge promise. I think we still don't quite know, are we giving enough of it, are we giving too little of it? 

[00:13:26] It's only going to be time, this PEARL study is going to be published. It should start giving us more information. We're doing the studies. It just takes a long time to study aging in humans. You can study it in mice, you can study it in dogs. It's very hard to study in humans. 

Cynthia Thurlow: [00:13:39] Yeah. And I think perhaps for listeners, not really appreciating that, sometimes we have animal model research and we extrapolate that into human research. Human research is a little more complicated, a little more complex than rodents who have a different lifespan, different gestational, timing frame. 

Dr. Elizabeth Yurth: [00:13:56] Right. 

Cynthia Thurlow: [00:13:56] And so, I find all this absolutely fascinating because for me, I think that these are certainly never things we learned in medical training. It's been this evolution of a functional, personalized, integrative medicine approach that I find really fascinating is, as you were astutely saying, each patient may actually need a different dose, but it's figuring out what the right dose is for each individual. 

Dr. Elizabeth Yurth: [00:14:19] And again, to study longevity in humans takes a long time. We live a long time. So, you're talking about looking at people over 70 years, and so it's going to be hard to figure out. And so, that's what we rely on tests maybe the true age testing, these biologic age markers, but we don't actually even know if they're very accurate for these things. Like I said, your biologic age could look great. Somebody says, “Oh my gosh, you're 25.” And then if you look at the immune age, it's 85. Well, if I weigh immune age much more than your kidney age or your cardiac age, then you're not going to do so well, right? 

[00:14:54] And that's the problem is we don't quite know how to weigh these different things when we're doing these biologic age tests, methylation markers and things like that. So, people are putting a lot. We hear all the time, right, from Bryan Johnson and all these people, “My biologic age is 35,” honestly, doesn't mean much because again, you could have one organ that's 18 and one organ that's 80, and which of those organs is more important to you. So, when they average these things out, there are a few labs that are doing that a little bit better. Like Generations Lab is looking more organ specific at things. So, you can say, “Okay, this is what's going to kill me.” 

[00:15:28] But I still think we're a long way from being able to rely on those tests and say, “Okay, this drug really has the right impact.” So, I think that you mentioned, we're relying a lot on animal data which may or may not mount to human studies. I think the main thing to think about, because I know that scares people, is that most of these things like rapamycin has been tested at very high doses, right? It's safe. So, we do have safety profiles for a lot of these things or maybe using naltrexone. We know it's safe. So, we're using drugs that at least has, lots of times, a safety profile that's been pretty well documented and using them in a purpose that's just different from what they were designed for.

[00:16:10] So, I think that is the upside and why you can adopt these things. Because if you're not an early adopter, well, maybe you've lost, the footing on it. Maybe at this point you're not going to get any value because you started it too late. So, I think you have to be a little bit cautiously early adoptive of things as long as things are safe. And I think that's where it does help a lot to work with a provider who can look at labs and say, “This drug is not doing the right thing for you.” I can see changes in your [unintelligible 00:16:32] wrong direction or liver. There's lots of little subtle things we can look at in labs that say this is not the right drug for you. 

[00:16:40] If we look at a drug that I think is probably you're going to start seeing, we already seen it, but that gets forgotten in the immune world. It's the GLP-1 agonist. So, GLP-1s I know have gotten a really bad rap. Now they're being sued for blindness. There’s all the people who end up in the hospital with constipation. That's because when these drugs are used inappropriately, which unfortunately is happening widespread and used for rapid weight loss, then problems are going to happen. But a microdose of GLP-1s when you're using them at maybe a quarter of the weight loss dose where you have no side effects, no symptoms, you feel completely normal, your appetite is still fine. They have really good immune-modulating properties. 

[00:17:22] There are GLP-1 receptors on immune cells, so it actually stimulates normal immune function. So, we actually get better T-cell activity. We think they're going to have some good anticancer properties as well. That's always been shown. We've documented them for neurodegeneration. We've documented them for osteoarthritis. So, it's actually-- in my mind I'm actually using the GLP-1s at a low dose, even a little bit more than I use rapamycin now because I do feel like they have such a widespread benefit beyond longevity. 

Cynthia Thurlow: [00:17:49] Well, I think it's so interesting because they've been around for a while, whether people acknowledge this or not. 

Dr. Elizabeth Yurth: [00:17:56] Right, exactly.

Cynthia Thurlow: [00:17:57] My mom was on Byetta like 10 years ago. 

Dr. Elizabeth Yurth: [00:17:59] Yeah, I know. People forget these drugs are actually old. 

Cynthia Thurlow: [00:18:02] Yes. And so, I really think that there are individuals, I don't want to sound pejorative but there are people out there that are in these weight loss mills that are putting everyone on a protocol. They're not bio-individualizing the dosing, they're not monitoring and not every person needs a full dose. And so, what I've come to find and I'm taking it personally just for anti-inflammatory immune support and I was saying-- [crosstalk] 

Dr. Elizabeth Yurth: [00:18:27] You and I are both thin, right. We don't want the weight loss. We want the other benefits of it. 

Cynthia Thurlow: [00:18:31] Right. And so, even my husband is now taking it and he was saying for him he's on tirzepatide. He said it just quiets the brain just enough. And not that he didn't need to lose weight either, but it's fascinating-- [crosstalk] 

Dr. Elizabeth Yurth: [00:18:44] It is fascinating. It's weird, right? Some of the things-- I won't say I had a coffee addiction but I liked drinking coffee, but I must have had a little addiction because now I could take it or leave it. So, does some weird things to your brain on things that you know that maybe you have a little bit of a propensity to be using in a purpose beyond just enjoying them. So, they are very interesting drugs. Or if you would have stuck a plate of French fries in front of me, I would probably eat French fries. But you just don't have a desire to. And again, I’m taking a dose where I don’t know-- I need to eat, I need protein. So, I take a very low dose. But I want the neuroprotective effects. My mom had dementia. I don't want dementia. I have an autoimmune disease, so I need the immune modulation. 

[00:19:27] So, I'm using these in almost all of my patients. And I think we're going to see the advent of things like that and the SGLT inhibitors like Jardiance, which is another basically diabetes drug that we're finding has all these other immune benefits. I think we're going to find some of these drugs probably start surpassing rapamycin in the longevity world.

Cynthia Thurlow: [00:19:47] Yeah. Again, this is why these conversations are so, important, just to expose listeners to different perspectives. And I think GLP-1s have just taken such a hit because [crosstalk] they're used inappropriately, not judiciously. And yet I actually said to a previous guest earlier, I really think that at some point there will be a clinical indication at micro doses or at these personalized doses for just about every person. Not in a way that people are dependent or people are using it because they're dealing with latent eating disorders. They've even heard about that. I had a nurse practitioner colleague who said, I lost 40 pounds. I'm going to take this till the day I die. Because it's the only thing that's helped me, like, turn the food noise off. 

[00:20:32] I think for a lot of individuals, it's just understanding that there's different ways that we can utilize these drugs-- [crosstalk] 

Dr. Elizabeth Yurth: [00:20:40] Utilize these drugs, right. Probably the scariest study that came out recently was the blindness study. And I deep dive that because all my patients came to me like, “Oh, my God, this is horrible” because obviously that's the biggest fear you wake up blind, right? And that study had at least a little bit of validity too-- but all the people were brittle diabetics, not all big weight loss jumps, but all of them had a very big rapid drop in blood sugar, which can cause retinopathies and other problems. So, in the normal person who is healthy, we're using these for its protective benefits those are not risks that we're going to see. I think that to scare people away from these drugs, unfortunately, because of all the bad press from being used inappropriately or for different reasons, is a disservice to us. 

Cynthia Thurlow: [00:21:28] Look at-- we know that negative information is what feeds the machine of social media. The news and so, if it bleeds it leads as they sometimes will say. So, anything that's fear mongering is going to of course resonate for sure.

Dr. Elizabeth Yurth: [00:21:44] It's going to sell more to-- This drug causes blindness versus this drug is going to be protective of your immune system. 

Cynthia Thurlow: [00:21:51] So, well, they're like, “Oh, that's not sexy because I don't even understand what the immune system is.” And maybe this is a good segue into other types of peptides that you are utilizing with middle-aged patients. The options obviously are endless, but what are some of your favorites that you like to utilize with your middle-aged female patients?

Dr. Elizabeth Yurth: [00:22:09] Let's keep on that immune health. Because if you think about the other big reason our immune system takes a hit, it's because we have this giant gland we're born called the thymus gland. Huge gland in your chest. If you do an x-ray of a baby, they have this huge mass in their chest, that's thymus gland. The thymus gland is actually training your lymphocytes to go out there and fight that disease, not you. So, they're training self versus non-self. And about puberty, which is why puberty, probably your best immune system, it starts shrinking. I'm in my 60s. By the time you're my age, it's just a fatty nub. So, what does the thymus gland do? Well, it makes what we call thymic peptides. 

[00:22:49] And thymic peptides are at the base of immune health-- the root of immune health and healing and recovery. So, there's two main ones that we really like. One is called Thymosin alpha-1. Thymosin alpha-1 is the big immune modulating agent. And again, we make a ton of it when we're young, we don't make it anymore or very little of it because we don't have a functioning thymus gland to make it. In France they try eating sweet breads, right? They try eating thymus gland. [Cynthia laughs] We can't really eat it and get the benefits. But this-- you guys who, think, oh peptides-- Do all your listeners know what peptides are Cynthia? 

[00:23:24] So, basically Axin is actually a drug. It's widely used in Asia. It's used in other countries. It's an approved drug for helping with cancer patients, for helping with immune patients with vaccine, intolerance. They give it, they help with viral and using for hepatitis. So, basically this is a drug in other countries, not available here sadly. It's just going through the whole FDA process, just takes such a long time. It takes 17 years to get a drug profile to actually get FDA approved and some of these companies don't have the money to do it. So, Axin has made a huge impact in other countries, especially Asia, India and you can go there and get it very easily. But here it has to be compounded. It's hard to find, but it is the number one stimulus of getting the immune system healthy. 

[00:24:14] If I have somebody who truly has a severe autoimmune disease, it's going to be my go to and a relatively high dose. You can't really even overdose on Thymosin alpha-1, You could take it IV at high doses and it wouldn't bother you. And then the other peptide the thymus gland makes is called Thymosin beta-4. A lot of your listeners have heard of TB-500. TB-500 is really a fragment of Thymosin beta-4. It's not really the right drug, got that name from some horses that it was used on, but Thymosin beta-4 is actually the full peptide and that's what you really want. And again, that's another big piece of our thymus gland. And what Thymosin beta-4 does is it initiates healing response. 

[00:24:53] So, if you have wounds, if you have an injury, if you have a brain trauma, Thymosin beta-4 really comes into play for growth, healing, getting new blood vessels. Thymosin beta-4 is one of those peptides that I use a lot for healing and I'll cycle it in and out for people because it does like-- my rule for treating people for longevity is let's replace the things that we've lost. We've lost all our hormones, let's replace those. We've lost our thymic peptides, let's replace those. So, I'll cycle people through the thymic peptides at least a few times, three or four times a year. Because I feel like, “Okay, I'm going to keep them when they were at their healthiest at puberty levels.”

[00:25:30] But you have to be careful because Thymosin beta-4, anything that causes a lot of growth and new blood vessel formation. If you keep doing that constantly, could you encourage cancer cell growth? Maybe we don't know, but possibly, so always with the mind of safety in the background, we cycle Thymosin beta-4. We don't do it for long periods of time where you could do Thymosin alpha-1, particularly if you had an autoimmune disease ongoing forever and wouldn't hurt you. So, those are the big peptides I go to because those are the ones that are so critical to healing. So, let's look at other peptides that drop as we age. So, when we think about peptides, we think about there's some foreign thing out there that somebody made us and we took like a medication. 

[00:26:07] But many-- not all, but many of the peptides we use are endogenous, meaning your body makes them like these cyanic peptides. So, what other peptide does our body make that basically is dropping as we age? Well, the main one there is going to be our IGF. Now my IGF or insulin like growth factor comes from growth hormone. So, our pituitary basically stimulates growth hormone production. Growth hormone tells the liver to make insulin like growth factor. Insulin like growth factor goes everywhere to help heal, to help your brain, to help your immune system. So, IGF is another thing that really drops that as we age. So, IGF is basically a peptide and we can stimulate it, you can use growth hormone. But the hard thing about growth hormone is that dosing it, so it doesn't get side effects, can be really difficult. 

[00:26:58] The other problem with growth hormone is that it will cause uncontrolled growth of certain things, particularly your organs. So, you guys remember the old bodybuilders, those really protruding guts. They had muscle on the outside, look like six pack, but they would stick way out. That's because they would take growth hormone. And so, it wasn't that they were fat. Their liver and spleen had enlarged to the point where their bellies stuck out like this. It was covered with muscle, but the bellies would stick out. So, we don't really want to use high doses of growth hormone ongoing. So, we can use what I call growth hormones or secretagogues. We can use just peptides that basically tell my pituitary, make more growth hormone. It will keep it at a physiologic level and make more IGF. 

[00:27:37] Higher levels of IGF are shown to be preventative of neurodegeneration, preventive of neuro decline, preventative muscle sarcopenia, muscle loss, preventative osteoarthritis. So, that's is probably something that most people should as they age consider being on, at least cycling on and off. You can use them continuously. You just have to take two days off a week. So, you can do a five day on, two day off cycle or you could do a three-month cycle, a month off. Lots of ways to do these, but it's a very safe way to get IGF levels up. IGF has a sweet spot. Like you can measure IGF super high as we get older, might not be conducive to longevity. Super low is certainly not.

[00:28:14] So, there's somewhere a happy medium in between that seems to be the best for longevity and preventing decline in my health. And then the other peptide our body makes a lot of when we're young and not much of as we get older. Especially, lot about gut. This is a peptide that comes from our gut. It's called body protective compound or BPC-157. It's actually a gastric peptide. So, our gut makes it. So, if you think about-- our gut is always getting injured by things. There's lots of things. You eat something bad, you get a bacteria, something injured. So, BPC is there as a protective. Basically, it helps heal the lining of the gut, so these bacteria can't invade. 

[00:28:50] It basically helps recover, but it then can circulate out of the gut to other places in the body to do the same thing. So, if I hurt myself, BPC is like, “Oh, I'm going to head there and help her fix her shoulder, I'm going to head there and help the brain.” So, basically, I think, and again, BPC levels, you monitor them over time they drop, especially around of menopause, in both men and women, they'll drop. So, give back BPC now and then, right. Give back those things that we know are contributing to our health falling apart. And orally, it's great for the gut, orally, so good for the gut to really get other effects. It's better injectable, it still has effect orally.

[00:29:29] So, you can buy it really as a supplement orally, you don't even need a prescription for it, you can buy it as a supplement. But injectable does a little bit better for joints, muscles, brain. BPC, there's some great studies with mice where they took mice and they dropped a little weight on its head and if the mouse was on BPC, it came out unscathed. If it was not on BPC, they had significant brain trauma and they couldn't do their little maze afterwards. So, we know that BPC is really neuroprotective. So, I love, like my athletes, you've got kids who are playing football or something like that, have them do a little BPC just before they play and they're going to be protected in case they get hit in the head. 

[00:30:05] We need to always be thinking this, how do we protect ourselves from the long-term damage? So, I think those are the mainstay is the thymic peptides, the growth hormones, secretagogues and BPC. And if you want to get a little more fancy, the last thing that really starts to decline in us is our mitochondrial function which is why you watch your 5-year-old running all over the place. You're like, “Oh my God, how do they have that much energy?” Because they have a ton of really healthy mitochondria and we don't. So, mitochondria produce their own peptides and there's a few of them, there's MOTS-c, SS-31, there's Humanin. And they all have a little bit different purposes as we age and we have less mitochondria, we have less of these mitochondrial peptides.

[00:30:48] And really, you learned in school the nucleus was in control of the cell. It's not, it's the mitochondria. So, the mitochondria sends out these messages to the nucleus. “Hey, do more of this, do less of this.” So, that's the control center. And if we don't have as much of these things being produced, I'm not going to have such normal metabolic function. So, we can use things like MOTS-c to stimulate mitochondrial function. SS-31 is a reparative peptide we use that a lot in our post COVID people. So, these peptides can be used now to regenerate my mitochondria. And again, if I preemptively-- even if I'm feeling great, if I preemptively know these are dropping, what if I just do it a couple of times a year. Then I'm going to be a whole lot better off when I'm 80. 

Cynthia Thurlow: [00:31:29] I think this is such a fascinating conversation because I feel like peptides are the icing on the cake when you already have someone that's dialed in on lifestyle and then you're adding in hormones and then the next layer of functionality. And when we were talking before we started recording, you said, I think a lot of people are jumping automatically to a peptide when there's all this foundational work that still needs to be done. To your point about the thymic peptides and then looking at these growth hormone secretagogues, obviously there's different types of growth hormone secretagogues and I think a lot of women that listen to this podcast will say to me, “I lift weights, I eat enough protein, I get good sleep, I'm on HRT. I'm struggling to build muscle.”

[00:32:13] And so, I start to think about not only am I starting to consider that this might be the next thing for me to layer in, but I'm sure you have a methodology because there's different types of growth hormone secretagogues. When you're looking at your middle-aged patients, whether it's Tesamorelin or CJC, some of these other peptides, how do you go about making a decision as to which is a better choice for the individual? If we're looking at the average middle-aged menopausal female.

Dr. Elizabeth Yurth: [00:32:42] So, some of it's what their goals are and some of it is what their levels of IGF are. So, I base a lot of things off lab work, right? So, if I see somebody who comes in and we see this a lot, where everything's optimized, everything should be great. And then you get an IGF level and it's 50, we want this thing at 190, we don't want at 50. So, when you see an IGF level of 50, I probably am not going to get there with CJC and ipamorelin. So, usually there's two kinds of growth hormone secretagogues. There's growth hormone releasing hormone and growth hormone releasing peptides. They work best synergistically. So, growth hormone releasing hormones are CJC and tesamorelin. And then growth hormone releasing peptide is ipamorelin. 

[00:33:24] The growth releasing hormones tell my pituitary, make a little more growth hormone. The growth hormone releasing peptides are stepping on the gas. So, one fills the gas tank, one steps on the gas. So, if you use them synergistically, you get a lot better effects than either one independently. So, usually I'll use CJC with ipamorelin or tesamorelin with ipamorelin. So, growth hormone releasing hormone with a growth hormone releasing peptide and that's by far your best effect. But tesamorelin is much stronger than CJC. And so, if I have somebody who's really low, who I really need to bring up, usually I'll head to tesamorelin or tesamorelin is really good for visceral fat. It's actually an FDA-approved drug. It's called Egrifta. So, those of you who are scared of it not being FDA, this is an FDA-approved drug used for what we call lipodystrophy. 

[00:34:08] The HIV patients, the drugs they get on makes them accumulate visceral fat. And so, this drug's utilized to counteract that effect. So, it has an approval for getting rid of visceral fat. So, if I see somebody who has a big old gut, a lot of visceral fat, fatty liver disease, I'll go to tesamorelin because it's more documented to have an effect there. For a lot of us, the tesamorelin is just like, if I take it, I get bad side effects, it's strong and I'll get edema, I'll start to get carpal tunnel symptoms almost like what growth hormone might do. So, for me it's just a little too strong. Even at a low dose, I don't do well on. So, you have to find that, particularly men seem to like tesamorelin better. 

[00:34:48] For some women, tesamorelin just might be pushing that IGF a little bit too much or surging it a little bit too much, in which case CJC is just a little more physiologic. Again, am I going to get the IGF from 50 to 190 with CJC? Probably not, but sometimes you do. So, I'll often start there and then work my way up. It is a little less expensive than tesamorelin 2, so, oftentimes it's just the easier choice to use on people ongoing. So, I do CJC and ipamorelin ongoing five out of seven days. The hard thing about the growth hormone security guide is you do have to take them on an empty stomach. So, you have to find the right time. 

[00:35:23] The best time is either before you go to bed because that's when our growth hormone naturally surges up. But if you really want muscle building effects, it's really nice to do them right after a workout. So, then you have that problem. Okay, well I want to take that right after I work out, but I want to get my protein loading in. How do you time that? So, I just-- I actually have it in my car. [laughs] I take some and then when I get home, get ready, then I have my protein. So, it’s using my protein's within two hours still. So, that's the tricky thing about some of these things. But nighttime is great because it will help with sleep. [crosstalk] 

Cynthia Thurlow: [00:35:52] That was my question, I bet you improves deep sleep.

Dr. Elizabeth Yurth: [00:35:56] Improves deep sleep quite dramatically. Helps with recovery, people-- so, that's probably the more common time to take it. If I have somebody who really wants to work on muscle building, lots of times I'll have it even twice a day post workout and before they go to bed. 

Cynthia Thurlow: [00:36:07] Yeah, I mean-- [crosstalk] 

Dr. Elizabeth Yurth: [00:36:08] They really are so valuable. You're exactly right. If you're not putting on muscle and you're on all these things and vice versa. I had a guy who was huge. He had huge muscles. [Cynthia laughs] And he's like, “I'm pretty sure my testosterone is low.” And I looked at him like, “There's no way your testosterone's low.” He was giant. And sure enough, his testosterone was low. But his growth hormone, his IGF was sky high. So, it was protecting his muscle growth even in the face of this low testosterone. So, IGF plays a really big role in muscle growth. 

Cynthia Thurlow: [00:36:34] I think this is important because we get a lot of questions, and certainly this is not my area of expertise. I know a little bit enough to facilitate a conversation, but how many women I talk to that are like, “I'm doing all the right things and I'm lifting heavy enough and I'm eating the protein and I'm-- it's like a job and I'm just not building muscle.” 

Dr. Elizabeth Yurth: [00:36:55] Yeah, I would encourage all people go check an IGF level. 

Cynthia Thurlow: [00:36:58] Yeah-- [crosstalk] 

Dr. Elizabeth Yurth: [00:36:59] IGF level that's less than 100, it's going to be much harder to put on muscle. 

Cynthia Thurlow: [00:37:02] Yeah. And I think, we talk a lot about body composition testing and why that's so important. And the one thing I always get from those readings is you need to put on 5 pounds of muscle. I'm like, “Dude, I am trying. It's like a second job.” I think--[crosstalk]

Dr. Elizabeth Yurth: [00:37:14] Right, right. 150 g of protein and feel like it's so hard. 

Cynthia Thurlow: [00:37:14] Yes, exactly. And why very transparently I'm known for intermittent fasting, but it's not something I do regularly anymore because in order to get all that protein in-- [crosstalk]. 

Dr. Elizabeth Yurth: [00:37:27] Protein in, I'm in the same boat as you, I just can't keep my protein stores up. And I'm like you. I'm thin, I have a harder time putting on muscle. And so, I feel every time I would do like fast, it would unfortunately be detrimental. And I'd be like, okay, now I'm down. So, I still make sure I have 12 hours between eating, but I got rid of the longer fast for me because I was finding it was not good for me. I needed the protein too much. 

Cynthia Thurlow: [00:37:48] Yeah. And I think a lot of women are certainly figuring that out. As we're navigating this conversation, it always comes back to estradiol, progesterone, testosterone, and then considering anabolics, because, again, a lot of questions came in about anabolics. Where does that fit into the milieu or conversation when you're working with your perimenopause and menopause females? Because I do know that there are women just very transparently that have shared that they're taking anabolics and they're using them very conservatively with a really excellent physician provider. But how do we know how these all fit together when you're making clinical decisions about your patients in particular?

Dr. Elizabeth Yurth: [00:38:29] I definitely prescribe anabolics and I'll tell you why for a couple reasons-- So, anabolics are going to be harder course steroids. These things nandrolone or oxandrolone sort of big in the bodybuilding world. I lectured at Olympia. I know the bodybuilding world. I work with bodybuilders. So, these are pretty commonplace to really get that bodybuilder look is hard to do without anabolics. Obviously, you don't want to go overboard on anabolics or you'll look like some of those. You've seen them, they look like guys I see them at Olympia all the time. You're like, wow, yeah, there's nothing girlish about that person anymore. So, you can't go heavy on the anabolics. But at a conservative dose, they are super helpful for building lean muscle and bone. 

[00:39:11] One of the main places we use them for in our practice is our osteoporotic or osteopenic people, because they are very anabolic to muscle and bone. So, you can actually put on significant amount of bone on some of these little frail people who don't want to go on a stupid bisphosphonate drug that's going to create bad bones. This creates nice, good, strong bone along with muscle. And then you can dose it at a dose where you will see some, good advantages from your workouts. You have to still work out. If you don't lift weights, nothing will happen. But you can definitely see more advantage. And again, you don't use them for like six to eight weeks at a time. Take time off, cycle on and off of them. Use a conservative dose that gets you to where you want to be.

[00:39:54] So, I use nandrolone more than oxandrolone partly because it has more medical literature to support it. There are studies that show it for postop recovery. It actually was a go to drug for a long time for low bone density. It just got abandoned as we came up with some of these pharmaceuticals. But it really was the go-to drug. And if you look at it from recovery from surgery too, people recover much faster like from a joint replacement or rotator cuff repair or things like that if they take anabolic along with. We use it a lot in our practice.

[00:40:27] My background is orthopedics. So, we use it a lot in our healing and recovery of our patients. I use it a lot in my women who are sarcopenic that just have poor muscle mass. And I think that yes, you don't want to be overusing these things, but to be absolutely terrified of them and then you read about them, like all these horrible things, they're actually very safe to use appropriately and really can have a lot of advantages. I think again, much like our GLPs. Those scare tactics scare us away from these things when they can be so helpful for treating some of these disorders in a much safer fashion, to treat nandrolone for bone density than to put something on a bisphosphonate which we know as you get increased risk of fractures and jaw resorption, all these bad things. 

Cynthia Thurlow: [00:41:06] Well, and I think because of your background in particular, because you were an orthopedic surgeon for such a long period of time, I would imagine the utilization of some of these drugs very targetedly, conservatively, can yield really incredible results. Because how many women write into the podcast and they're like, I'm osteoporotic, I'm osteopenic, I don't want to take the bisphosphonates. We know there's a lot of side effects. I'm not telling anyone listening to stop their medications. I'm just saying we know that they don't necessarily build and lay down good healthy bone.

Dr. Elizabeth Yurth: [00:41:39] Exactly. 

Cynthia Thurlow: [00:41:40] So, understanding that there are other options that are out there. I think that's quite significant because I think-- [crosstalk] 

Dr. Elizabeth Yurth: [00:41:47] It's huge because women don't and doctors don't know anything about it. The doctors don't know anything about using these other things that you can utilize. Again, hormones still forefront of that-- Those of you guys who have not had bone density studies really, I encourage everybody probably starting in your 40s now, because we're seeing low bone density so early in women and partly because your generation, my generation, the super skinny, nobody ate, the low-fat diets, that unfortunately most your healthy bone formation occurs up until about 25 and then you actually start to lose it. 

[00:42:20] So, any of you guys who were really skinny, I was super skinny in high school and didn't eat, you're on that whole bandwagon of just skinnier is better. That's a bad thing for your bones. I really encourage if you guys have not-- I don't see doctors ordering DEXA scans enough. You really need to take that in your hands and know if your bone density is low because fractures kill people.

Cynthia Thurlow: [00:42:40] Yeah, I think a lot of people don't realize that. When someone falls and breaks their wrist or breaks their hip or hits their head and those frailty indicators are things that if you don't get ahead of it, it becomes problematic because you actually will lose strength before you lose muscle and that's the physiology. Like I jokingly say, I'm the only female in my house and I never let anyone open anything for me. I'm like, [Dr. Yurth laughs] if it's a jar, anything, I'm like, I have to be able to do it myself. It is very important. We don't want to lose strength.

[00:43:10] In terms of supplements or ergogenic aids that you are excited about or you use regularly with your patients, do you have specific things that you really enjoy? I know from other podcasts, I know some of your preferences, but I'm curious, what are things that you're using with some regularity with your patients that you enjoy and think that they can be multipurpose? That's the things that I like to use. 

Dr. Elizabeth Yurth: [00:43:32] Well, obviously there's the basics everybody needs. You need D3 with K2. Everybody needs magnesium. Everybody needs a good B complex. Those will sort of take [unintelligible 00:43:39] these are just the baseline that everybody needs, but we are getting more and more recognition both for muscle and brain health of creatine. Creatine has so many benefits. Everybody needs 5g of creatine if you're taking the concrete version-- liposomal, you can use less. But everybody needs at least 5g of creatine. If you're working out hard, you may need up to 10g. I add a scoop of it to my water while I'm working out in the morning. I have another scoop during the day that I'm drinking. So, I think that that is absolutely critical. It's a no brainer at this point.

[00:44:11] The studies are so huge for methylation too. We forget that we need-- for methylation, we have to have creatine and if we don't have enough that we actually can't methylate well. So, some people have these high homocysteine levels. They're like, “Well, I'm taking all my B vitamins, I'm doing everything.” If you have to add creatine on board too. And so, that's when I think it's forgotten. The other big thing is this is not really a supplement as much as it is food. You can take it as a supplement, but the supplement's not as good as food. And that's choline. So, we now know the cell membrane for all of our myelin. We need phosphatidylcholine. A problem with plant based-- If you buy phosphatidylcholine as a supplement, it comes from sunflower lecithin.

[00:44:51] It is plant based that doesn't actually have the ability to cross the blood brain barrier and help the brain and really help neuromodulation. Really the best way I tell everybody you need at least two to three eggs a day. So, that's the best way to get choline a good amount. Everybody needs two, three eggs a day. I don't have time with breakfast. A lot of times it's my dinner. So, it's an easy thing to make for dinner. Make some scrambled eggs for dinner. If you still have young kids at home, that never goes over well. But now my kids are over-- [Cynthia laughs] So, make sure you're getting enough choline. I think one of the things I'm looking at a lot now is alpha-ketoglutarate. 

[00:45:23] And the hard thing about alpha ketoglutarate is that it's very short lived in our system. So, you want probably what's called a calcium alpha-ketoglutarate. But we're now in fact I just saw a study that just came out on alpha-ketoglutarate and dementia. I think it came out like yesterday. But alpha-ketoglutarate we know is a critical player in mitochondrial health. It actually feeds into the Krebs cycle at a different point, so we can make more energy. So, really more energy, more muscle, more brain function. So, I think alpha-ketoglutarate needs to be moved up is something people need to be looking at more. I think we're supposed to be more and more stuff come out of it. The biggest trick is that it isn't long lived in the system, so you probably need to take it a couple times a day, even the calcium alpha-ketoglutarate form.

[00:46:06] Talking to a company who tells me they have a much longer acting form, we'll see but that's when I want to put high up on the list too. And depending on your age something a lot of people don't know about is plasmalogens. So, plasmalogens are a specialized phospholipid. We talk a lot about the phospholipids. Phospholipids are so critical. It's why you don't want your cholesterol to get too low. Phospholipids make up your myelin, your cell membrane. They're responsible for everything that's getting in and out of your cell. And so, choline is a critical player there but so, are the plasmalogens. The plasmalogens actually coat all your cells and your myelin. They act as this kind of protective coating and you can't really eat them. 

[00:46:42] So, you're what you're born with or how much your peroxisomes make is what you've got. So, basically as they drop, we know that we start to see more numbness and tingling and energy and fatigue and brain. Dr. Dayan Goodenowe who studied the most about plasmaogens has shown that people who have high levels of plasmalogens do not develop dementia. These been studied since 2006, even people with the APOE4 genotype. So, these are absolutely probably going to be a critical player especially if you're over the age of 45. Problem is again there's not any supplement you can take. But he made what's called a plasmalogen precursor that can cross the blood brain barrier and become plasmalogens in your brain.

[00:47:20] So, I actually think those are something people don't know about, that people need to investigate and understand more. It's a whole conversation about them because they can do so much for both protection but also help inflammatory things, autoimmune diseases, great for heart, great for brain, great for eyesight. So, I think plasmalogens need to be something people be more aware of too. I'm trying to think of things that like people haven't really thought of that. I have in my regimen that I think are pretty critical because I hear so much about the basics, but I think those are some of the pretty critical ones. 

Cynthia Thurlow: [00:47:48] No, I mean two of these are new. So, for me I'm like, I'm glad I eat eggs every day. Not a problem. Creatine checkbox. The other two not as familiarized, but definitely-- [crosstalk]

Dr. Elizabeth Yurth: [00:47:57] Yeah, I think we're just really getting aware, it's funny when I was doing a talk recently on long COVID and looking at where alpha-ketoglutarate could really come in and be a huge player just because this whole cycle, the Krebs cycle, where it feeds in, it saves a whole lot of energy. You can make a lot more energy with less energy expended. So, it's actually really an interesting player. And again, I think we start to see more and more data on it. That and again, the plasmalogens you need to look into, especially over the age of 50, especially if you know anybody who's an APOE4, either 1 APOE4 or 2, they need lots of plasmalogens.

Cynthia Thurlow: [00:48:31] Well, and I think it's one of those things where I think the older I get, the more conscientious I am about brain health in general, especially in talking to most of my colleagues I think everyone's greatest fear is that they're [crosstalk] to going to have some neurocognitive deficits doing all the things to help protect our brain. 

Dr. Elizabeth Yurth: [00:48:49] It's so, horrible, right? And I think the brain gets a little neglected. We're getting more aware of it now, but it gets a little neglected. And we're seeing a tsunami of neurodegenerative diseases, Parkinson's, ALS, Alzheimer's, COVID, the spike protein appears to be a big player here. It seems to cause a lot of brain stuff. This is getting worse and worse and worse. And so, we really have to get into. I think our focus needs to be, yeah, let's all look good and have great muscles and but we got to start focusing a little bit more on brain health. 

Cynthia Thurlow: [00:49:22] Yeah. And I think that there are so many things we can do proactively. It doesn't have to turn into this doom and gloom. Like this just happens to me. I feel like in a lot of ways I just got back from a wellness retreat that I went to and they were doing all sorts of brain testing and body composition testing and I was joking and saying to them, you had me doing memory testing on a day where I got three hours of sleep. I was like, probably better to test me on a day when I've gotten a little bit more sleep. And so, they retested me and I was fine. But the point is we definitely want to be doing things that are helping preserve neuroplasticity, are helping to improve brain health, brain metrics and not being afraid to learn new things, which I think is-- [crosstalk] 

Dr. Elizabeth Yurth: [00:50:05] Yeah. And then exercising our brains. We forget that too that you need to be reading new things, learning new things, playing games, playing on your online games. Things that work your reflexes too. Those lights up and you have to hit one light, a certain color. Those are actually really important. We go and exercise our bodies, but we don't really exercise our brains, especially you what people have left the workforce. And they're not getting that stimulation every day and they're like, “Well, I'm retired, I'm just traveling around.” Your brain starts to go.

Cynthia Thurlow: [00:50:37] Yeah. Well, it's interesting. My mother-in-law is 81 and God bless her, she still does Sudoku like every day. 

Dr. Elizabeth Yurth: [00:50:42] Yeah, my dad in his 90s does crossword puzzle every single day. 

Cynthia Thurlow: [00:50:47] Yeah. Takes great pride in that. I would love to invite you back. I'd actually love to unpack cardiovascular risk protection and heart health because that is such a huge issue for women, number one cause of death, one in three women. And certainly, the role of nitric oxide, endothelial dysfunction, the loss of estrogen and how that impacts our risks of developing cardiovascular disease if you're open to it. 

Dr. Elizabeth Yurth: Yeah, I'd love to talk about that. And then some of the new screening tools we're using too to figure out because you guys who are getting your coronary calcium score at 0, it means nothing. So, we have to educate people around, what are we looking at? What are we looking at when we're looking at lipid numbers? What is a healthy lipid profile? So, I think it's a fascinating conversation. Again, the cardiac world, there is so, many things you could do to clean the GLP-1s. 

Cynthia Thurlow: [00:51:34] Absolutely. Well, Dr. Yurth, this has been an incredible conversation. Like I said, I'm hoping we can do a round two diving into heart health, because I think we just can't do enough to help patients understand what their real risks are and what they need to be doing beyond traditional lipid panels, which are largely garbage. 

Dr. Elizabeth Yurth: [00:51:51] Thank you. Thank you for sharing all this information. Appreciate you. 

Cynthia Thurlow: [00:51:55] Thank you so much. 

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