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Welcome to the Five Codes Podcast, where we discuss evidence-based methods to elevate yourself to the next level, through optimizing the way you look, move, perform, feel, and connect. - Welcome to today's episode of the Five Codes Podcast. I'm really excited to share my conversation with Dr. Christopher Meadows with you. Dr. Christopher Meadows is double board certified in regenerative medicine and in physical medicine and rehabilitation. And the reason I'm so excited to share with you is because Dr. Meadows essentially has my practice, but in the regenerative medicine space. What I mean by that is he is very much next level, thinks very differently, he's very progressive, but he's also very grounded in his thinking. He has a lot of discretion. He's not a magical thinker. He's really doing things that are evidence-backed, but also very, very, very much ahead of the curve. So he's got this beautiful mixture. I have just the utmost confidence in him and I love picking his brain because every time I do, I pull something out that I didn't know be I'm at the 99.9th percentile already, but he's just at a level above me. And so I can't wait to share a lot of that with you today. I think you're gonna pull a lot of very interesting information out of here, some fun facts and a lot of things that will apply to your daily life. If you're having a procedure, if you're exercising, if you know that there's just some other level that you can be at a little bit, Dr. Meadows holds a lot of those keys to unlock that for you. So I hope you enjoy the conversation as much as I did. Dr. Chris Meadows, thank you for being here today. - Yeah, thank you for having me. - I appreciate you having here. I love chatting with you. We're literally just chatting offline. I could go on forever about this, but I just wanna kick off with a very simple question with you, which is looking at the world of stem cells. Let's call it through my lens and my patients' lens often. And that is this idea of, I'm pulling all the levers that I can pull in my real life, I'm exercising, I'm eating as well as I can. I'm not drinking, I'm doing all those things that I wanna do. And in my world, I look in the mirror and I don't see the exact thing that I would expect to see or that I want to see, that is what I feel inside, which is what drives people to me. And I love that, it's my job, is to make the match up, take away that dissonance and do it seamlessly. Nobody knows. What does that look like in your world from a stem cell standpoint? - Yeah, it's an interesting point that you make. Most of the patients that come to me are having that physical impairment. They're noticing, I'm just not as strong as I was, or I don't have that energy level that I used to have. And so they're coming to me feeling like, gosh, you know this, I'm not able to push to the level, to the limit that I used to in the gym and I can tell that my strength is not quite there. And so they're trying to pull on these levers of exercise and mobility and staying active, but something is limiting them or they just feel, I've just lost it over time and how can I get that back? So there's a portion of patients where they have an injury and we're trying to get that back. We're trying to return function, we're trying to reduce pain. And there's a preventative side of that too, where it's like, yeah, I used to have some pain here, I had this previous injury and I just want to make sure that we don't have, I don't want to have any symptoms from that, not today, not tomorrow, not ever. And so they are really kind of feeling the limitations and some of that aging process and hoping to reverse that. And like you said, patients are already utilizing a lot of the other levers that are there, whether it's supplements, hyperbaric, all of those tools that are available and now we have a really powerful tour of stem cells that we can deliver systemically throughout the body to give you that immune support, to give you that energy support, the cognitive support, or a local injection to focus in on a single area of limitation and help to reverse that process. Yeah. So in a sense, as I hear that, well it's kind of the same thing that I'm hearing is I don't look how I feel, but you're getting this like my rubber meeting the road, quite literally, feet meeting the ground, maybe is not what I feel like I should be doing. Yeah, I mean, knowing that you have the capacity to do something, but then having some governor on you that's limiting you can be very frustrating. And so whether it's pain or just an overall energy level, you feel like, gosh, I should be able to do this. Yeah. And you're just not meeting that capacity, you're not meeting that threshold that you want to. And we look into why that's happening and then we look for ways to reverse that. Okay, so that opens up a whole new box of questions for me because I think at least in my world, when we work together, because we work together in the operating room sometimes, meaning like my patients under anesthesia about to have a procedure with me and you're in there doing your injections. I've seen you inject spines and hips and shoulders and like everything, basically. So I think of your practice from my world is largely musculoskeletal. Then you help my patients recover after surgery too. Like a very acute physical metabolic physiologic event. I call it, you know, it's a purposeful metabolic stress, mitochondrial stress, whatever. You're helping them recover from that too. But when I, you mentioned like cognitive performance and so I think of this like physical performance, musculoskeletal, I think of the recovering from this acute injury. I mean, I guess what you just said is like novel like, oh yeah, that would make sense too. So what does a treatment with you look like for, you know, for me, the people watching this. What does that mean? - Yep, yeah, and it's very depending on what the patient is looking for. So a majority of the time there's going to be some focal area of discomfort. My knee hurts, I can't squat, I can't run because of my knee or even things like hiking or playing with kids, you know, so that's a focal area. Then there are other patients who I mentioned previously who will say, you know, I know I had this injury and it's probably going to continue to bother me at some point and know that the progression is going to be, and we have conversations about what the natural course of these injuries are and how we can divert that or slow the progression. And there's also a world of general health and wellness where patients are just trying to be proactive. Maybe they have something in the medical history that they are trying to be proactive and prevent or alter the course and that could be things from cognitive decline. It could be things from hormonal changes. It could be energy level, immune support. And so the field of regenerative medicine, although we do a lot of work in the space of orthopedics is really expanding to be full body, preventative and performance enhancing to, again, support patients, progression and aging process and to try to limit what could be an issue in the future. So that's really interesting for me because then I think, okay, you know, this idea of what it looks like who's coming in, I think this gets into a lot of, I'm going to challenge you here in a second, a little bit, but there's so many different, it's a confusing landscape, how about that? So many different types of stem cells, options of what to do with them from IV infusion to local injection, both of which it sounds like you've mentioned a little bit. But the first question I'm going to ask you, and I know you'll be able to do this because somebody who's a crazy expert in something, one of their best things is to be able to break down to a very simple answer, you're unprompted on this by the way, I know that I'm about to put you on the spot. But if you could like, readers digest one line, two line version for me, I want to ask you, what is a stem cell to you? What does that even mean? And then what are the different types of stem cells? And we can maybe come back to this, different types, and then like what do they do? Because I think there's this idea that stem cell goes in you then it like lives or something, but it's not exactly that's happening, right? - Yeah, excellent questions. So fundamentally a stem cell is a cell that can self replicate, so think about yourself becoming a twin and has the capacity to turn into other tissues, can turn into bone, cartilage. So these are cells that have the fundamental definition of those is it has those two properties. So relatively simple, but also relatively broad, because there's a lot of different cells, cell types that can fit into that category. - 'Cause that almost sounds scary to me when you say that, like I don't want some turning to bone. - I got it, exactly, exactly. So you want it to, in many cases, have a specific pathway to regenerate a certain type of tissue. If I want to regenerate cartilage, I want to make sure it's going to be cartilage and not bone or heart or liver or something else. And that goes back to, we can talk about embryonic cells, which is your question about different types of stem cells. Yes, there's a whole spectrum. And a cell can maintain its definition as a stem cell, despite having gone through a development process, through which it's range of potential tissue types that it can develop into, narrows. So it can still develop into multiple tissue types, but the further back in the lineage you go, the more wide that is. And that goes all the way to an embryonic stem cell, which is designed to create an entire human, an entire organism, right? So it was very early on realized that embryonic stem cells are not a great source because they develop different types of tissue within one region. And we don't want that. So we've now realized that we can actually take other types of cells that, again, maintain the definition of stem cell can become new tissue, but it narrows that field such that we don't get such heterogeneous or such varied types of tissue when we see their growth in development. I got you, because in my head, I always feel like people are like, oh, the earlier up the lineage, it is the better. I like though, it's a, which nobody is using truly embryonic stem cells. That's not what's happening. But in reality, kind of the further down the line, more towards the target, its shooting of the target tissue that we're after is actually better, which is, I think, a little bit counterintuitive to what, I think a lot of people think, or what, maybe even is put out there. So with that, as we get towards shooting at these targets, what does that look like? What, where are these stem cells coming from? Yeah, and I think if we take a step back and think about the broader world of regenerative medicine, which, again, this is spanning kidney disease, this is spanning heart disease, lung disease, and so with the cord injury. Exactly, neurologic, exactly. So each of those likely have a unique stem cell that would be most opportunistic to develop that tissue type, if that's what we're seeking to find. Gotcha. But now we really have to take a step back where we do on humans, and in the clinic, or when we're actually treating patients with stem cells, the question then becomes, are the stem cells that we are administering actually becoming new tissue? Because we see that in the lab, and this is the whole idea of translational medicine, is what we see in the lab, which is taking cells in a peach-regid dish, giving them specific signaling molecules to become a tissue, the same thing we're seeing in humans. And that's a challenge to determine. How do we know if I'm putting a stem cell into your knee, and I want it to become cartilage? I can take an MRI or an ultrasound before that procedure, do another one after, and I can see cartilage growth. Great, that's amazing. But the question still lingers. Is that because the stem cell that I administered got into the tissue embedded and planted and actually became new cartilage? Or was it bringing on your own stem cells, recruiting on your own healing capacity, and kind of reinforcing what your body was attempting to do many years ago when you got the first injury, and it just halted or it stalled, because it didn't have the resources needed to completely heal. And that question still remains. That question is still not really answered, because it's a difficult question to answer. How can I prove that that's the same stem cell? You'd have to probably put some radio label on it, or you would have to take a tissue sample, and nobody would subject themselves to a tissue sample. You're going to get a deep, deep, gorgeous tip. Yeah, exactly. So you would lose that. But at the end of the day, this is what I talk with patients about, is does that matter? Is that really the-- is it matter which direction we had that healing, or does it matter that we actually got to that goal? And now you're able to run. And now you're able to lift. And so that's the ultimate goal that we're trying to get at. Even if I don't necessarily see a significant change in pre and post imaging, if you're functionally feeling better and doing more, we got to where we're trying to go. But all that to go back to your question is we do in the orthopedic space tend to utilize MSCs, which traditionally have had the label of mesenchymal stem cells, but now have transformed into this terminology of medicinal signaling cells because of their capacity to signal. And so now that changes the whole game, because again, if we're just signaling and we're actually just recapturing your body's capacity to heal and harnessing the power to heal based off of its signaling capacity, I mean, that's hugely beneficial. And it starts to kind of circle back to eliminating the risk of what we talked about earlier, which is, is it going to be something bad? Is it going to be something else? Is it going to morph into something else? And we're not seeing that clinically. This comes out as we're seeing literature that's getting farther and farther out. Five years, 10 years, 15 years. We're not seeing those types of transformations that we had seen when utilizing embryonic stem cells early on in this course. So we're not having those complications, and we're not seeing those downsides for that. And likely it's because these stem cells are doing a lot of signaling, probably less likely in planting and staying there, doing some signaling, and then probably getting cleared by the immune system. So in our world, our overlapping world a little bit, that I had sort of already mentioned, where sometimes you're in the OR injecting with me before procedures, then oftentimes my patients who are-- a lot of them, almost all of them, are getting my version of an immediate stem cell rich fat transfer. Harvest fat, use it for my purposes. I'm making different types of fat. I'm isolating stem cells from their own fat to use for the regenerative capacity for my purposes. But now often we are banking those stem cells as well, which are MSCs, two different acronyms. It sounds like that we can go down with that, which gives them a reservoir kind of for life if we decide to choose that. But they can kind of memorialize their current stem cell state and have it in perpetuity moving forward. How-- are there differences between the different types of stem cells that you use, whether they're from me or from someone else, whether they're signaling, or do those things make differences? How do you choose that? What does that look like for? Yeah, that's a good question. So if we look at the sources of stem cells, there are three main sources of MSCs. OK, these mesenchymal stem cells or medicinal signaling cells, there are three main sources. There's a plenty full source in the bone marrow, in adipose tissue, and then in the umbilical cord. So when we talk about bone marrow and adipose tissue, we're talking about what's referred to as autologous. So kind of a tricky word there. But all that means is coming from you and we're using it for you. So we would not take your bone marrow and put it somewhere else and not your adipose tissue and somewhere else. But when it comes to the umbilical cord stem cells, the MSCs, they do have the capacity to be utilized in other individuals. So we call that allergenic or allergenic. And so they all maintain very similar properties. They all have this capacity to what we call home or homing, meaning if they're administered into the body, whether IV or injection, they can find areas of micro trauma, micro injury, micro inflammation, things that you would not catch, generally speaking, on your basic blood work or even on MRI. So it has the capacity to see these smaller regions of injury and go into that area to allow the signaling cascade and healing. So all of them have that capacity. And there is not really-- when we look at the literature from an orthopedic standpoint, all of these have been used and all of them have equal efficacy. So there's a lot of good efficacy and outcomes from all of them. Now, we try to look at trying to predetermine the functional capacity of a stem cell. So how do I measure how good a stem cell is actually going to be quality? Yeah, exactly. So is there a way to do that? And there's some laboratory work where you can try to introduce a stem cell to a certain environment, maybe an inflammatory environment, and see what is it releasing? How is it responding to that? And so from that, you can try to predict what a stem cell will do in your body. But again, it's hard to know for sure if that's what's happening. So all we can lean back on, which is the most important data, again, is the clinical outcomes. What's happening with patients? Are we changing the structure? Are we seeing change in cartilage? Are we seeing regrowth of tissue? And are patients feeling better and able to do what they want to do? And across the board, we are seeing that they seem to be equal or similar efficacies. But there are some conversations around if you do a bone marrow harvest, how many cells do you get? Which is different from an adipose tissue. Quantitative. Exactly. Exactly. So-- And then further, if you look at the hallmarks of aging, the hallmarks of aging at a cellular level, you can look at those. What is the telomere length? What is telomerase activity? What's the methylation of the stem cells? And from there, you can try to extrapolate, again, quantitatively, well, that looks younger. It's a younger cell. So we would assume that that would have a better efficacy. And that was one of the arguments that made adipose tissue slightly in favor over bone marrow, was because bone marrow stem cells just have had replication. They've been replicated a number of times because the bone marrow is so metabolically active. Whereas your adipose tissue is not metabolically active. It's intended to be a storage. It's intended to be, you know, sit there and wait until needed. And so those stem cells tend to have longer telomeres. And they tend to demonstrate characteristics that would support their impression of being younger. And then, of course, on the Biblical core, you're saying, well, these are the youngest of them all. They are fresh from a brand new delivery of a baby. And they're going to be fresh. And so-- A live, normal birth. Yes, yes, exactly. These are full-term pregnancies, consented mothers. Everything is normal. And then it's the tissue that usually is discarded. But we know that's a good, plentiful source of growth factors in stem cells. So it's being utilized. But yes, otherwise, everything is normal and healthy. So again, we're saying these are very young stem cells. There are no hallmarks of aging being seen in any of these cells. And so-- and there is some benefit, we should say, you don't have to undergo the procedure of a bone marrow, harvest, or a mini liposuction, even though they're relatively minor. So there's some benefits there. But collectively, to come back to your question about how do you select those, there's a number of things that go into that selection process. Some is just patient preference. Patients sometimes are just saying, I don't want to go through that procedure, just use what you have. And others are very much saying, I want to use what's mind. These are my cells. And they have a lot of value in that, which is totally respectful. And so taking that into consideration, if there are other conditions that have some data to support that a unique stem cell is going to be most favorable, then, of course, I'll go in that direction. But again, holistically speaking, we don't tend to see great variations in clinical outcomes from any of them. So with this idea of efficacy, I have a question for you. In my patients, where I'm doing fat transfer back to that, in their face, also usually in the same area that I'm operating on same day. So they have a very unique version of fat transfer. It's not like every other one that they might just go get. From a facial fat transfer standpoint, it's very focused on the stem cell density. This is evolved for me over more than a decade, as I've seen changes in it. And one of the changes that I see is that the more stem cell density I put in their fat transfer-- not only does the fat transfer more reliable and do better in its own right, but it also changes the course of their postoperative recovery in that very local location. Because I think it's remarkable and fascinating. Like you just said, that they're sort of like little smart bombs. They'll go to the areas of inflammation. Well, I know where the area of inflammation is. I'm creating it, right? Inflammation in a good sense, healing inflammation. And now I've also bathed the area in a large number of their own stem cells. And I notice faster healing, better healing. And it's interesting in that over the years of doing this, I've approached this conversation with patients as though I'm controlling the quantity of the stem cells that you're getting, partially based off of how much fat we're getting and how I process and harvest it. Meaning I can get more stem cells from certain areas of the body, thighs, abdomen, flanks, things like that. I know that. So that's the quantity. I get to control that. The quality is usually up to them. And I know there's age basis to this. I know there's metabolic health. I see this. My patients tend to be very metabolic healthy. It's a selection bias in a way. Like, you know, sharing mindsets. And if somebody's valuing what I can do for them, they're often relatively metabolic healthy. Because I want to fit into that overall lifestyle. I'm not trying to transform people. I want to rejuvenate and regenerate people. And so I tend to have this more metabolically healthy group in general. But with that, I see a significantly greater efficacy, almost across age spectrums. Because I know my average patient age is like 40s to 60s. And I do have it 30s and 70s. But most people fit in that little more narrow range. And I see really great stem cells, almost regardless of age in that space. And so that was a long story. But the question being like, is my visualization or my perception of this probably a better way to say it, is that correct? Like, even the age part and the metabolic health, is that affecting the stem cell quality that much? Yes, absolutely. So what you're speaking to is a couple of things. The underlying metabolic health of a patient is absolutely going to be a factor here. So you want to have patients that are going to have good metabolic-- underlying-- no underlying metabolic diseases, I should say. So having even the good BMI is going to be helpful in the excess. And so I know that's a little bit of a confounder because having a little bit of extra adipose tissue makes the procedure easier. But as you and I have both seen, the quality can be dramatically different. Oh my gosh, my 4% to 10% body fat patients. These are super low ones. I'm always like, well, I can't get as much. But it's like these are warriors. Very high quality, exactly right. And so then you're speaking a little bit to the age as well. And this is a very interesting concept. And so again, we can kind of go back to this idea that you can look at some of the hallmarks of aging of the stem cells and try to make some sort of prediction of their efficacy based off of the age. But there's literature out there where patients are using their own stem cells north of 70 years old. And there's still great outcomes. So again, the presumption is that their underlying health is good. So we make some assumptions that they're taking care of themselves. So maybe again, there's some selection bias there as well. But the age of the stem cell seems to not be a major factor. But at the same time, when we're thinking about banking, it's still going to be more beneficial to try to get your stem cells banked earlier. Yeah. I mean, life happens. There's changes in your health as you age and whatnot. But the quality of the stem cell at an earlier age and the changes that can potentially happen with the stem cell over time is just going to be highlighting the factors that a banking at an earlier age is going to be overall better. But so anyways, but you can still have-- I don't want to say, you know, kind of speaking on both sides. Because on the one hand, we want to get them in earlier because we know that the quality-- and if you're metabolically healthy, the quality is going to be higher. But again, we're seeing that it's almost like there's never too late sort of a deal that you can still utilize your own stem cells at a later age and still actually get pretty significant benefit, which is remarkable. Yeah, absolutely. Because I'm basically encouraging all my patients at any age to bank because then we have them available forever. But this led to an interesting question. I think that's applicable to anybody having any surgery. So let's tune this in for this. It kind of turns into a self-exquestion. So I'm like, well, can I make my patients stem cells better before they come see me in a shorter time period? Because in my world, about-- call it six weeks prior, even in these really, really healthy patients who are coming to see me. Everybody's traveling to see me. Everybody's traveling to see you, too, basically. So I'm asking, kind of, do you do this, too? But in the six weeks leading into come seeing me, we have like putting one specific supplements and cleaning up their lifestyle in any little way that I could before anti-inflammatory, different cleaners, the oils that are eating, whatever it may be. I'm trying to get them as metabolically optimized. In call it four to six weeks before they come see me. In my world, question one, am I changing appreciably their stem cell quality in six weeks? Part two to this question for people that aren't seeing us that are just like maybe having some other surgery. Can they move the needle for their inherent stem cell ability-- I'm not pulling it out and putting it back in-- for whatever surgery they're having, is that-- I call it pre-covery, pre-habilitation. Is that doing something from a stem cell standpoint? Yeah, there's a good question. So I think this hinges around one of the aspects about stem cell function, which is the environment with which they're in. And this is critical to me. And I feel like this is of high importance to understand, because if you put a stem cell in a toxic environment, it's not going to do well, regardless of its age, regardless of its hallmarks of it, whatever the quality is of that stem cell, if it's not surrounded by an environment that's favorable to it, it's not going to be successful. So when we think about the overall health of a patient, yes, any direction or any manner with which you can positively improve the patient's overall health is going to improve the stem cell function, because the overall health of the patient is better. So maybe we've reduced blood glucose to a more favorable region. Maybe we've reduced inflammation to a more favorable region. We've reduced the cytotoxin burden. And so all of those things that we're doing in anticipation of the surgery is absolutely helping this function of the stem cells that are already inherent within you. And the second portion of that is there are a number of different tools that you can utilize to help mobilize the stem cells. And so we talk about that a lot, which is we know, with aging, the number of stem cells within circulation reduces. OK, well, how do we get that number back up? And you can do that via diet. You can do that via exercise. You can do that with things like hyperbaric and red light therapy. And these are all things that have been shown to improve the number of circulating stem cells without us even doing anything. So we have any-- We have any-- --separation. --the patient. Yeah, exactly. Yeah, exactly. So when you put those two together, I'm reducing inflammation. I'm creating a more favorable environment for the stem cells to function. And similarly, I'm putting more out there. You put those together. And yes, you're absolutely impacting the potential outcome of a surgical invention or a procedure or both. You know, we'll do it together. So those are instrumental in preparing the patient for-- and you see it, right? And this is how you see-- not only do you see that the patient had a better outcome, but they come out and they think, wow, I'm just-- I'm feeling pretty good. And I'm only 24 hours. Or they see day one, to day two, is just such a dramatic difference in their recovery. So all of these things just support that, yes, everything that we've done leading up to that is showing its impact after. Yeah, for sure. And my practice that looks like I was saying, all these things coming in. But even like, immediately before, we're using fasting sometimes to increase circulating stem cell levels, hyperbarics, like immediately red light. There's some supplements, even like some herbal supplements. You can take that mobilize it. So pretty cool there. And I will say, like, to your-- there's been this very exciting trend that I've started to see, which as I've had more patients banking stem cells, and now I kind of get to do these subsequent procedures on them where I'm getting to use them. Sometimes it's you using them for musculoskeletal things or hair restoration or facial rejuvenation. But when I'm having patients who are now like, down the road, away from their initial procedure, we have their bank stem cells. We call them out. And they come back for another little laser resurfacing or a subsequent fat transfer. And this is not a huge number of patients. We're not talking hundreds and thousands of patients. But we're talking about a significant enough number that me having done thousands of those types of procedures to do it now when I have 60 million stem cells added-- of their own stem cells-- added to this next procedure. And the patients had this done before too. Prior to maybe they had something two years ago, and we're touching it up, and we're doing another subsequent thing, the recovery is gangbusters different. So-- and it's a spectrum, probably, to some degree. And I'm still feeling out the right numbers and things like that within it. But, again, correlation causation, whatever. But like, wow, it's so different to see the cell-assisted bipolar transfer and how that recovers with a laser versus just what is normal. Yeah, it's from up in the different. Well, you'll know this better than I do. But as I've been in the OR with you and learned about-- you kind of run into the same issue, right? I mean, you're doing a fat transfer. And your goal is that that fat embeds and stays and maintains its appearance. And it's been very clear in the literature that cells, stem cells in particular, help support that. And so now we have the capacity to utilize a greater number of local-- I mean, I think of it in the same way, right? I know that we can do a systemic treatment of stem cells. But if I'm trying to treat your knee, I'm not going to get the biggest impact of treating your knee with systemic therapy. I mean, that's one of the limitations of treating a knee is that the vascular supply is not great. And that's why it doesn't heal as well. So I want to deliver the stem cells directly to that region. Well, same with you. It's like, I'm treating this one area. I'm doing a fat transfer. I want this to stay. I want it to maintain its texture and contour. And the cellist's delightful transfer is what has been really the game changer to help maintain those outcomes. And now, if you're able to get significantly more numbers of stem cells by having them banked and they're coming back and utilizing them, I mean, it just changes the success rate when the outcomes dramatically. And I think it just illustrates what they're doing in other types of tissue, like in your world, more than mine as well. Because when you were talking earlier about not having a great answer as to what happens when the stem cells inject it, if the stem cell turns into cartilage or if it stimulates local in my fat transfer world, we actually have that a little bit better because I'm not just using stem cells. I'm also using live younger, I would say, young versus old, kind of the maturity of the fat cell, the adipocyte. I'm usually kind of getting rid of the old ones. Sorry guys, and I'm using the young ones in the stem cells together. But when we radio label and look at that, it's interesting because we see that the improvement in the fat as a soft tissue qualitative and quantitative structure. And when we look, we're like, yeah, some of those fat cells took, lived, which is largely interestingly driven by the stem cell density because it may help some create their new blood supply instead of shop. But then there's also an improvement in the overall that outweighs the benefit that just those new adipocytes did. So there is unquestionably a signaling cascade that happens immediately because the fat pads get bigger, better, stronger, more structural. That's what I'm looking for. I'm not looking for size as much as I'm looking for structure and some volume to them. And they get better disproportionately to the number of stem cells that stay, or the number of facels that stay. And then that clock continues to tick forward over years. So it's not just the immediate stem cells that, firework did release their growth factors one way. The new stem cell rich fat that has taken also drives years long, like para crann communication, to make the fat and the skin, overlying the fat better over time. So it's not specific even to just the fatty tissue. So it's this very unique kind of like conglomerate of all of these things happening. It's really interesting, and again, kind of coming back to the orthopedic space, because when you do a fat transfer, you have already what we are trying to, we're trying to carry that over, because you have the scaffold, right? That's the scaffold. And what we mean by that is you have a structure that inherently just keeps the cells there, right? The fat just kind of absorbs, it's kind of a stickiness to it, that supports the stem cells, and any new recruiting stem cells, or healing cells that come in from the immune system, they maintain that presence and keep them there longer. And in the orthopedic space, it's how do we create that same deal, right? In a non-surgical manner, right? You could do surgery, and we can create some sort of artificial moniskus and put some stem cells in, et cetera, but that's what we're trying to avoid is the surgical intervention. Right. So when we do a bedside procedure as an injection, it's like how do we create that same thing? How do we create that scaffold? How do we create the environment to maintain those stem cells and all of the immune cells that come in to support the healing cascade for that longevity, to maintain that healing cascade, not just for the next 24, 48 hours or week, but for the years to come. So that's really where it goes into, again, this conversation about the environment that you're putting stem cells in, and how you can maintain their presence for longer periods of time. Yeah. So I'm going to change gears on that a little bit, because I feel like we've talked a lot about my practice and how it all fits into my lens. And I'm grateful for your help with that all the time, quite literally, as of last week here. Anyway, what does it look like? I'm going to ask some questions like, what it looks like in your practice, right? Because you've gone from, you've worked with the highest level athletes, professional athletes. And now you're working with a lot of my, essentially, the same thing, honestly. They're just not maybe competing in sports, but these are incredibly high-performing people doing all the right things. What does, just I guess, rubber being the road, help paint a picture for, say, your me, you've never done stem cells. I want, I have these, my knees, mobility is this and so on. And I'm coming to see you. What, and your patients are traveling in, and they're doing these sort of like, I call them stem cell makeovers in my world again. But what does it look like? What are treatments with you look like? Sure, sure. Well, it's been a easier evolution than you might think, because it's been a transformation of who I am as an individual. I've always felt like I was this high-performing athlete athlete when I was in college. And I, UCLA, I tried to perform at a high level. I felt like I did. And then you get into the professional world, and you start to think, my athletic ability is one aspect. But there are so many aspects of who I need to be, as an adult, as a husband, as a father, as a professional. And there's other areas that I want to maintain these high level of function and capacity for years to come. And so that's kind of been my evolution and a refocusing or reshaping of how I'm trying to approach that personally, as opposed to thinking about what my 40-yard dash type is. Now I'm thinking about how my ultrasound skills are and my procedural skills and how I'm focusing on that. And so it's been a little bit of an easier transformation. And so a majority of the patients that I come to are in that similar phase of life. Of, you know what, I used to play, or I'm a runner, or I like to hike, or we're in the Northwest Pickleball is extremely popular anyway. And patients are coming in and saying, I want to maintain that. This is who I am. This is my identity. And this is what, if I lose this, I'm losing a part of who I am. It's my social network. It's my profession. And so I really relate to that. And so that's the goal for me and my patients is oftentimes finding what's the limiting factor here and what can we do to reverse what's limiting, but also set you up for success, not just for the next year, but years to come. And so that's kind of my perspective on how I approach patient care is really setting this kind of framework and this goals of, that's what you want to do. That's what we're going to accomplish. So then what are the strategies to get there? And so again, if it's a focal area, I like to do pickable, but every time I cut here, just cut, man, my knee just bites me. So of course, we go into the diagnostic component, figure out what the cause is, and then it gets in the treatment. And how are you doing the diagnostic part? So it's a number of different things. It starts with a really good physical assessment. So I'm watching patients move, I'm seeing, I'm assessing the strength. Watching the move, yes, of course. Of course, because everything comes, and this comes back to my history as an athlete, as a trainer, I, you know, force comes from the ground up. You have to be seeing people on their feet and seeing how they move and how they transmit force. Because ultimately, the direction, everything is ground reaction forces. That you put force into the ground, it's going to respond and come back to you. And injuries happen when there's, it's just like electricity, right? It's going to go the path of least resistance. Force is going to go through the path of least resistance. And if there's a muscle weakness in area of deficit, a dysfunctional area, well, where do you think that force is going to go? You're not able to maintain that structure. It's going to come out your back. It's going to come out your hip, your knee, et cetera. So you have to be able to see that. It is not uncommon for me to see a patient that has hip pain, but you look at their gait and you see that's hip pain because of your knee and ankle stability. So we have to go down the chain or oftentimes, similarly with low back pain. I mean, that's very common. It's like, you know, this is a gait mechanic where you're twisting or you're tilted here, maybe some scoliosis. So you have to really look at the kinetic chain in order to understand the potential risks. And again, because I'm looking at the lens of it's here today, but what are the risks of injury for the future? How can we be preventative such that you don't have a subsequent injury somewhere else? I mean, I'm treating you right knee, but what's to stop your left knee from doing the same thing? So you really have to kind of understand that kinetic chain to do that. And so it's part of the exam that I do. I look at patients, I watch them move. I understand their biomechanics. I do manual muscle testing. I'm really kind of honed in on what their strength is, what their weaknesses is. I'm going to let them find the out here or sec, because that is very different than what it was typically-- like as you're saying this, I'm super excited/terrified at the same time. So I'm like, oh, yeah, the electricity, the force. I think of these typical situations of you like travel to Mexico. And they might do some imaging on your sore hip. Let's go to that example. And they're like, yep, sore hip, inject it. Do your hyperbaric treatments, get your juice cleanses, stay in cobb-- whatever you're doing. They're not generally going-- like as you say, I want somebody to watch me walk and squat. And look, it's actually not your SI joint, it's your knee. That's what I want. And so that's just a very different level. Just to put a pin in that, highlighting it for everybody. That's not a normal course. So continue. I mean, I just think that that's an important part of the evaluation process. And yes, it does set us apart as far as what the outcomes are going to be, because if you're not treating the source of this discomfort, then we're just going to be back in the-- I mean, I can do and I'm sure patients go overseas, and they get an injection, and it helps. But we're not treating the underlying biomechanics and the super root root. Exactly. What led to this, then we're going to be back here in a year or two years or whatnot. There's going to be some window with which we're just going to go back to, because it's a regression to the mean. That's all about going back to where we got. So that's an important aspect in what I do, because that leads into the next portion, which is my imaging phase, which I do a lot of diagnostic ultrasound. I love looking at tissue under the ultrasound, because it just gives me a direct access. I don't have to wait for an X-ray. I don't have to wait for an MRI. I can do it at the best radiation, too. Less radiation. No radiation. No radiation. So I can look at structural abnormalities, and this is where the two have to go together, right? Because I can get an MRI, or I could just jump into an ultrasound. And I'm going to find pathology. It's not a matter of whether I'm not going to find it, middle-aged person, 40, 50 years old, previous injury. I'm going to find something. In fact, I'm probably going to find a lot of things. The question is, which one is the source? Is it one of these? Is it all of them? Some combination. So that's where you need to put these two together. You can't rely on just one. And in this fit-- in the world of medicine that's been transforming from-- you're often hearing, this is the end of the physical exam, right? Nobody's doing a physical exam anymore, because we have all of these advanced imaging techniques that, what do I need an exam for? Here it is. It's the MCL and the meniscus. But again, you really want to understand which of these structures, because you're going to see so many different things. There's always something to find. And you want to be able to really isolate what is the actual source generator, because that's what I want to treat. That's what I'm going to go and target. And that's what's ultimately going to lead to the most efficacious outcome. And you just don't see that in other areas. And I think it's very limited when you are seeing somebody overseas, or you're seeing somebody that you travel abroad to, because you don't have that opportunity to return. So is that return, or at least some form of touch base after to see where we at, where we had successes? And then the other part of that is, OK, I see all these abnormalities. This is where it's coming from. I want to treat that. But now does it make sense to also treat to some degrees some of these other areas, because although it's not symptomatic now, do we anticipate it to be symptomatic later? And that's another conversation with patients. Because sometimes the answer is yes. Sometimes the answer is no. Of course, with that we're thinking about, OK, what's the exercise regimen going to be after this? How are we going to fortify the treatment we're doing, but also treat the other areas that we want to be preventative in? And so there's portions of physical exercise and rehabilitation that goes into that. But for some patients, it's just treating a specific area, or for others, it's being a little bit more exhaustive and saying, I want to be preventative. And that kind of feeds into this whole idea of stem cell whole body rejuvenation, or the whole stem cell makeover as you refer to it. I like that. So paint this picture for people that are listening. I know it from the patients that we've shared. Sometimes it's at the time of. Sometimes they're coming back for their six-month follow-up with me, and then they're kind of doing their makeover and whatever bad word, that they're wrong word, maybe with you. Even from what that experience is like, they're staying in the same retreat homes that my patients are staying in. There's in the same hyperbaric chambers that we're sitting in this beautiful area with fractal patterns of mountains and lakes. And so they got all those beautiful healing things built in into our, I guess, travel infrastructure. But what does the whole experience look like? Sonas, modalities, what does it look like when they come to treatment? I guess, please mix this with a typical and what your ideal would be. - Yeah, that's a good question. Typical is kind of very depending on what patients are interested in in their availability, their schedules. So there's always just logistical aspects, but patients come in, they can do hyperbaric again, 'cause we talked about the mobilization of stem cells prior to a treatment, they can do that also after the window with which they stay with us as a major factor, but oftentimes we're getting a lot of hyperbaric treatments in there, we're doing sauna and we're doing the physical rehabilitation component, again, to fortify the procedure itself. And then the ideal, an ideal world, if I could, you know, your question is always, wave a magic wand, right? - Right, that's the question. - Yeah, yeah, so ideally would be at least a seven day window, maybe a five to seven day window where we can do a very thorough multi-day physical assessment, not just of critiquing what I would see as a risk factor or an impairment, but also just seeing what's your physical capacity as a whole, right? What's your physical functional level, what's the strength? And then we get into the metrics of longevity, right? - Yeah, and your VO2 max and your zone two, and how long you can hang and how much you can deadlift, et cetera, because those are ultimately, right? I mean, it comes back to the initial question for me, it's like, what are we trying to achieve here? I want to be functional for this, for X period of time, right? If I think about it for myself, I want to be highly functional so that I can maintain my health and longevity and watch my kids grow up and watch them get married and be a grandparent, et cetera, et cetera, be successful in my career, et cetera. So these are the things that I'm doing, and oftentimes it hinges on all the same things. It's preventing disease, it's living long, it's maintaining health, and so these are the metrics that we can utilize to help support that pathway. Just as you know, you cannot just kind of fumble long success. You don't just kind of trip and be there. You create a plan, you have an outline, you have a trajectory, you have goals, but it starts with ultimately creating the initial metrics of where you're at. So again, we have a specific area of need, we're gonna address that, but that's fits into the bigger picture of your general health and wellness and what strategies can we utilize to move the needle for you, but starting with those initial assessments. And so if I had, again, that would be some metrics in advance of a treatment, assessing what the pathology is, assessing where the areas of need, maybe it's one area, maybe it's multiple, and then doing a procedure, doing the recovery after, and some therapy, some initial recovery, therapeutic exercises after the fact to kind of get a patient on their way to their ultimately returned home. - Wow. So I'm gonna just like put this in real context, also selfishly. So I'm a 40-something year old, very high-performing surgeon, obsessed with my life, my results, my family, I have some SI joint that flares up on me every once in a while, but I know it's probably related to an old knee injury. I think it is, and my knee, like doesn't actually bother me, but I think that's my weak point in the chain. And I'm super concerned with my long-term metabolic health and neurodegenerative disease, cardiometabolic risks. I'm wearing a CGM as we speak. I'm doing all these things, and even, I mean, I know you well, but even as you're saying, gosh, we gotta do this, I wanna do this. We're gonna do a VO2 max test literally later today together. So if I'm engaging to come see you, I hear five to seven days, and I'm like, that sounds pretty life-changing in five to seven days, because what are we gonna do? What am I gonna leave with? What is that, in those five to seven days, I'm gonna have my VO2 test, and some strength stuff, you're gonna watch me move, which is wild to think about, like having a super expert on me. You're gonna treat me. I'm gonna get to do all these other, kind of, honestly, bougie fun types of modalities. I'm gonna be in a beautiful place. When I go home, am I sort of like, actually in a better spot from that, well, maybe I got IV stem cells too, or something. Am I gonna go home like, I know I'm gonna go home with more information, but I'm gonna go home probably in a better spot, maybe with some more specific workout, types of exercise things I need to do, knowing my VO2, because it's been, it sounds like I have some maybe lab work in VO2 things that I can, like, one follow with longitudinally, like that. - Yeah, exactly. Well, first of all, I think you hit it on the head, which is, you have more information. Again, that's the first piece of the puzzle that you need, because if you're gonna do anything actionable, you need to know what it is that you're gonna act on. And I always feel like what's measurable is modifiable, right? Otherwise, we're working in kind of gray space. We don't really know where we're going. And so having that foundational information, I mean, for some, it's not even knowing why that information is important. What impact does having, what does it mean to me to have a VO2 max of 40 versus 50? Like, how does that impact me? And so that's the start, and then when we identify those areas, how do we move the needle in the positive direction? And that's where we start to think about, okay, when you get home, here's what the map looks like for you. And everybody has different perspectives or different, you know, availability and resources. And so whether or not they're getting a personal trainer or they're just doing the gym on their own, they have at least an outline to help guide them on what is gonna be most favorable and most efficient, because that's the other part, right? We wanna be efficient with our time at the gym or our time when we're prepping meals, like how are we most efficient to get the most out of it? And not sacrifice the time, you know, to do other things. So creating that framework helps patients have that vision, have that goal, and yes, we can always return, we can always repeat the metrics, and that's how we know whether or not the modifications that we implemented are actually having the effect that we want. - So that's really interesting, 'cause my magic wand is coming and you fix me. (laughing) - Right, which, I mean, I get that's like, you know, that kind of a joke, 'cause, you know, the magic wand and my patients come to see me, would be coming and you fix me, and I'm sort of like, well, I do. I slide you back up your aging curve, I don't stop anything, you look natural, everything's sort of like set back stealthly and it's like this incredible new place that you're at, but in reality, you're still 51 years old or whatever arbitrary thing it was, you just started a much better spot with a much better trajectory ahead, 'cause I've modified not just where they are on their aging curve, but I've also modified the steepness of their aging curve, which is analogous, it sounds like, to what's happening here, they still have to do the work. - Yes. - Like, he metabolically afterwards, so that resonates with me a little bit as to what I would get, but I guess, you know, when I think of like, all of the, I keep talking about these overseas, like going to Mexico, or wherever to get, you know, 'cause those places, you know, they're overlapping with some of my stuff a little bit, where there's like, which, I know you do as well, with some like, you know, facial cosmetics, hair restoration, sexual health, muscular skeletal, how do you mix all those things in? - Yeah. - I mean, there are opportunities for utilization of stem cells and stem cells, I should just say regenerative therapies as a whole, whether it's PRP or exosomes, whatever is chosen to be the most efficacious tool for that specific area. - You're customizing that based on the product. - Correct, yeah, right, exactly, based off of your needs, and again, it goes back to what your interests are, and yes, it does span the space of hair loss and we talked about just general health and wellness as with the IV portion comes in, but also if there's sexual health concerns, all of those fit together, and it goes back to our conversation of the modifications that we do going into a procedure, right? These modifications, these levers that we're pulling on to support a surgical outcome are the same ones you would want for all of those areas. - Yeah, right. - You know, all of those, getting metabolic health is gonna support your sexual function. Getting metabolic health is gonna support a treatment for hair growth, you know? So they all fit into the same category, and again, when I'm thinking about treating a patient in that regard, I'm not in the silo of we're just focusing on this one area. That's one aspect of a bigger picture of the patient that I'm working with. And so that's kind of the framework that I look at when I think about patients, and so oftentimes those conversations do lead to, you know what, by the way, I also have this, and I'm like, is that something you do? And it's like, well, matter of fact, yeah, we do actually do that too. And so it can be this wider, full body, full health, assessment and treatment. - Can I just come into you and just say, I mean, you know, the metaphorical me, can I just come in and be like, literally do everything? - Yeah. - Because I mean, my left knee doesn't actually bother me, but I've used it a lot. - Correct. - Or I'm a 40-something year old guy. There's approximately, correct me if I'm wrong, close to 100% chance that I have some shoulder, you know, rotator cuff tear. And so can you just like literally run through me and touch everything? - Yep, yep, there's absolutely. - Absolutely. - I've got real spine issues, but can you get after that? - Yeah, the whole space of preventative, and this is very novel where we're just, we're being proactive, we're trying to prevent, you know, having limitations later in life. And we know, you know, again, this is kind of the framework that I look at, it's, what are the most common injuries that really plague us, right? I mean, we think about that from a longevity space. What are the most common causes of death? Well, I can narrow that in into the muscular skeletal space and say, what are the most common injuries that I see? I see tons of low back pain. I see tons of neck pain. I see rotator cuff pathology. The dreaded Achilles tendon rupture that everybody fears, patellar tendon ruptures. So those are areas that you really wanna pay higher degree of focus that's also what plays into thinking about your exercise regimen. I mean, when I'm in the gym, yes, I want to get stronger and I wanna do this, but I'm also thinking about tendon health. Like, when it was the last time I really did a strong isometric to my Achilles, right? Oh, I haven't done that in a while 'cause I like to play basketball, and I need to make sure I'm protecting that. So we want to be proactive in thinking about what are the dangers here? And those are kind of some of the, that's like the list that I have in my mind when I'm thinking about patients saying, okay, these are the areas that we really need to pay attention to. Put that into the context of what's your activity level, what's your job and what position do you tend to be in 'cause that's gonna put you in high risk. Yeah, right? So the occupational side of that. Exactly. So putting those all together to say, this is an area that I think we really need to be proactive in. And sometimes that's a focal area, but sometimes yes, that can't span to be more exhaustive. Yeah, I will say this too. You just peeked me on this. I've worked out a lot my entire life done every type of workout. You know, I feel very well versed in that. I'm like so multilingual. Yet I will tell everybody working out with Dr. Meadows is a different animal. Even then I'm like, I'm like 99.9th percentile in this. I literally, I can't imagine, but working out he is a little bit different. Sometimes I'm like, well this is weird. I've never, like I don't ever get to say that. I've never done this before. Like it's very different. So in that whole like, you know, five to seven day experience, it's pretty cool. Yeah, yeah. I think I've tried to accumulate the knowledge that I've grown from various aspects again, from the early years of being in high school and college where there's a single goal here, which is bigger, faster, stronger. Yeah, that's what it comes down to. But it's transformed for me. And unfortunately I've had my share of injuries and the mentality is now, how can I prevent that? I mean, getting injured, being sidelined, not being able to perform on your peak, it's just devastating, you know, in multiple levels. And so I really incorporate that heavily into my exercise regimen and thinking about how are we going to strengthen tendons, right? Everybody thinks about the muscular component of exercise or the lung capacity, the cardiovascular, all good things, all things to think about. But we also have to take into consideration tendon health, which is hugely important. Ligament health. And you can't actually get these stronger. You can't actually reverse tendon opathies and ligamental injuries by incorporating some popular unique strategies. They're very different. But they're effective. They're very different. And it's not what people normally do. And this is where the 99.9th becomes the hundredth. And these are those little things that I'm like, I've never done this. And it's funny that you say the injury prevention, because honestly, I see that carrying over into my performance and into my enjoyment of the activities that I'm doing. I have a bruise on my face from Jiu-Jitsu. I love to ski. I love to surf. I do play pickleball. I view sometimes our workouts as my sport at that time. So I definitely feel that. Yeah. All right. So transitioning into a bit more of the esoteric here, we've talked about types of stem cells. We've talked about traveling overseas. And this brings up some real questions for me. Want you to lay it off for me. If someone travels overseas versus to see you, my real question is, are they actually doing anything different? But getting into that, we're-- it's me in the road-- is like, are they actually able to do anything different-- different outcomes wise? Could more happen versus coming to see you? Because honestly, just coming to see-- I know you. So it's very easy for me to be like, you're like, I want to see. Because I trust you, I believe, and you have seen what you can do. But was there any limitations? Things you can't do. When the rubber meets the road, is it the same? Yeah, this is a very common question that I get. It's like, oh, buddy of mine went overseas. Or I hear that they're not legal in the United States. Yeah, yeah. A lot of those questions. And it often just requires a reframing. Because the term legal is probably not the right word to use. It's not that they're illegal per se. But we have pathways in the United States that offer a safe, regulated manner with which the quality of the donor, as well as the handling, the modifications, the manipulations, between the harvest and the treatment is very much overseen by a regulating body to ensure safety for the patient. And that's a good thing. Yeah. It's good to have those protocols in place. So we don't frame them with. It's nice to know that the treatments that you're getting are going to be safe. Let's put away efficacy for a minute. And let's just say it's safe. And that's priority number one. And that's where going overseas is more difficult to assess because those same regulating bodies are not necessarily present. And so you don't really know the quality and safety of the cells that you're getting, or even the source for that matter. So it just creates some question marks regarding what the safety of these various products that you're getting, and who's overseeing them, or if you're just purely at the mercy of the person who's treating you. And so that's one aspect. And then the other aspect that people oftentimes talk about is, well, so and so went to overseas and they got 100 billion stem cells, something. So some just dramatically high number. And so the correlation is that more is better. And so that's another area where-- Just not true, Chris. Yeah, well, exactly. So that's another area where we're starting to see that there's not necessarily more as better. There's probably an ideal number against thinking about the specific condition. What is it that's the opportune number? And we saw the same thing. This is not new for us. We saw the same thing when it came to PRP-- Yes. --and it's plasma. So the idea was like, we need more and more and more and more. And how can we hyper concentrate this to even greater levels? And ultimately, saw that there was no significant benefit-- We can have the metal. --of the baby. Yeah, exactly. So there's potentially some negative side effects. And so it's the Goldilocks effect, just like anything else. There's going to be this middle ground. And so those are just some of the things. I think some of the mentalities that people have about overseas and why they're associating that these two factors are going to be resulting in better outcomes. And I think that when I hear from patients that have gone overseas and their experience of what that looks, well, first of all, they end up in my clinic. So that's one kind of red flag there. I can relate to that. I can relate to that. It's like, well, what brought you back. And part of it is the fact that there's not really that true patient physician interaction. And to be fair, it's hard to develop. Somebody comes and they just spend a weekend with you. What can you really gain if you don't have the follow-up? I'm going to see you again in two, three weeks. I'm going to see you in six months. And so those are just some of the challenges that I see. But you build that in, correct? Yours a bit more than what someone would find overseas. Yeah, exactly. Yeah, you want to have the ability to check in with patients and see where they're progressing. I mean, it is-- I often tell patients-- it's a goal of mine that I do one procedure and I high five you and we never see each other again. That's great. I mean, that's the best outcome I could possibly have. But I don't know that unless I continue to establish that relationship and have you back and have the opportunity to see where you're at beyond that. I mean, selfishly, I want to know the outcome. If I never see you again, I don't know if you got better or worse. But if you come back in clinic and we're high-fiving because you had this remarkable outcome and you're going back and you're doing what-- I'm back with the pickleball court again, that's amazing and that's gratifying for me and that solidifies that we're doing the right thing. So if you don't have that, it's hard to even-- how do you assess your own personal outcomes if you don't have that follow-up to know? And I'm smiling because it's funny for me. I think I've joked about this before where in patients that I'm following up for their cosmetic procedure, where you also treated them the same day that I did. And I've actually had more follow-up because mine's a little bit more acute, right? And they come back and see me and we're hugging. I'm a hug or not high-fiving as much, but we're hugging and whatever. And they so commonly, it's turned into a joke that they're like, and my knee is incredible. And I can knock up a downstairs and all of the other-- and I'm like, well, what about your face? They're like, oh, yeah, this is great, but my knee is also. And I'm like, the perspective of like, this was a big deal, not that this isn't a big deal, but like the outcomes that you deliver and these are so mentionable, even in a scope of like a pretty incredible other outcome. So I get that feedback, too, for you. But it's just, I think those are awesome outcomes because not only are they looking physically better, but they're feeling physically better. And I mean, it's just a nice combination of, I feel confident, I look at myself in the mirror and I just have this whole new perspective. And I can go out and move and dance and do the things that I enjoy. So it's just really life changing for a lot of these patients. I mean, you would know better than I do, is there another cosmetic practice that offers that same type of treatment collectively? Absolutely. Yeah, it's very, very one of a kind of, you know, that's like a unique kind of marriage that we have, which is cool. And helps my patients. So there's the selferside of things that's like, they recover better because of our relationship and because of our interaction. And I have a heavy level of curiosity that you feed, basically, which causes me to become more curious. And so everything, I mean, I'm treating my red light with fat to affect the side of chrome, see oxidase, you know, factor four of the electron transport, like, this is not a normal thing, right? But this is all fueled by that sort of like co-curiosity. And I'm going to carry into the next question that kind of like, I think, bridges off a little bit of what I was saying, because, you know, over the, you know, decade plus of my practice being really in the space even before, you know, we were working together, was sort of like, okay, you go overseas, you go to Mexico, and they're like heavily replicating 10 billion stem cells off this like line that they're just pulling off of all the time. And that was like, oh, everybody's like, you know, 10 billion cells off this line. And then I felt the pendulum swinging a little bit towards like, we'd call like, earlier replication or zero replication. So, back to the umbilical derived stem cells, they've never replicated their zero. Or the ones that I'm using in my practice, essentially zero replication. They have not been put in addition then like, you know, kind of like mushed to like replicate, replicate, replicate. And so I felt the pendulum swinging to like, actually these are better quality, no matter the quantity, these are better quality stem cells because they haven't replicated as much or ever. And we know that no matter what is said, even from a stem cell standpoint, that every replication to some degree depletes the quality, this is my high level, but not as high as yours, understanding. Where is that pendulum at right now? And honestly that plays into this like overseas versus US because they're relying on how long has that line been replicated literally decades, literally decades, or hundreds of thousands of replications versus like zero. And where are we at right now? >> Yeah, that's such a good question. This is an important factor because this does have implications. We talked a lot about cellular aging and how do we assess the quality of a stem cell? And the replication number is a clear indicator of a loss of function as that number gets higher. And we call that a P number, which is how many passages, right? How many times has a cell been replicated? And one time it's been replicated, we call that passage number one. And so you want to know that number. >> Are people keeping track of that? >> Well, so that's we do. >> Yeah, we do. >> Okay, so when we talk about our stem, obviously I don't know that from your own stem cells. So we were to do, you know, many liposuction, I don't know what that number is, but the passage number starts after that. >> We assume that's a P zero. >> Exactly, exactly. So it's how many times it's been cultured in the cell or in the lab and the P tree dis is, how many times have we replicated that? And we tend to see a reduction in quality or function of stem cells after passage number 10. You see a clear reduction in the number of exosomes or growth factors that are released and their ability to transform into tissue, right? So these are the two factors that we talked about of cellular function. It's like, okay, well, we want those to be maintained as high as possible. So when we talk about, you know, the cells that we work with or the labs that we work with, we don't want to be anywhere near that, right? So that's a prime question that you would want to know is what passage number or around what passage number to are your cells that prior to treatment. And that's also true when we talk about our stem cell banking program because in the same manner, you have your tissue sample that's sent out and they do want to start to draw out these cell lines, but for each of those you don't want to go beyond a certain passage number, usually around 10, we ensure that it doesn't go beyond five. And so we want to make sure that we're not even getting close, so we don't lose that functional capacity of the stem cell just by replicating. But yes, we can run, you can see that there will be individuals because if we think, oh, we just want, as many number of stem cells as possible to get to the billion number, you sacrifice that on the back end, which again probably speaks to why there is this gold elox effect. There's some threshold with which we're reaching that you go above this number, it's not that the cell that your treatment area wouldn't benefit from more, but you just have more that are just exhausted, it's cellular exhaustion, right? It just goes into cellular senescence, right? So we want to avoid that as much as possible, so we do pay very close attention to how many passages prior to treatment. So our bullseye is ideally lining up perfect number of actual stem cells, low P numbers or high quality or function, whatever we want to call it. That's our, you got it. Are the, I guess I don't know this exactly, but what's a P number at your Mexico clinic? I'm not sure, I'm not sure they had tracked that. I don't know. I mean, but over time, I don't think I'm exaggerating when I say that some of these have been using the same cell lines for that is likely many, many, many, many years to decades, right? Yeah. So that would be P's and the four or five digits, yeah. Or more. Potentially. Potentially. OK. That answers a lot right there. OK. We'll put you on the spot again. You can take this wherever you want to take it, which is what, and sort of this quest for, now or like, out of stem cells even, quest for peak performance, quest to optimize your relationships, your life, your health, your appearance, your whatever. What is the unique piece that you could give to our listeners, advice, phrase, idea? It would be uniquely Dr. Chris Meadows. That's not somebody else couldn't give. So I'll just say that, getting into this space initially, I was not a big fan of the term biohacking. It kind of rubbed me the wrong way. Because when I interpreted that term, it seemed like people were looking for shortcuts. I'm going to usurp a good sleep regimen, or I'm going to usurp a good exercise regimen. Yeah, it's a hacking, right? And what's been interesting to me is as I've gotten more and more involved with patients who would call themselves biohackers and gotten more into the community, it's been-- really, you're not seeing people who are looking for shortcuts. You're looking for-- You're seeing people who are actually like, I'm doing everything that I can to move the needle and to be as productive as I can and maintain youthfulness, et cetera, et cetera. So it's been a fun kind of transformation and perspective of what the term biohacking means and how to implement that. And what I would say is you have to have the fundamentals. You have to be-- I'm always about really coming back to the fundamentals, and there are no shortcuts. And so that's kind of like, we cannot lose sight of the basic pillars of our health. And think that we can try to overcome them. However, what I've experienced personally also is that there are times of my life that I just can't pull those levers, whether I'm traveling or whether I get sick. And that's where I lean on these other modalities harder because they can help to at least bridge that gap until I can get back into it. I mean, so at the end of the day, my message is that there are no shortcuts, but also pull every lever. Oh, a little too hard things. Yeah, yeah. I will go back to this and just say that you had me at cellular optimization. And what I mean by that is, and we were first talking and just sort of spitballing, because we were sort of like colleagues communicating before we started actually working together. And when I say we work together, we have very parallel practices and they're kind of like coinciding every once in a while. But I remember you talking about the idea of like cellular optimization kind of in lieu of biohacking or is it synonym to you? And I was like, yeah, that is what it is. And that then carries forward for me because when I'm putting my patients in hyperbarics, red light, PMF, these are evidence back things after their surgery that are improving them. I'm not hacking anything. I am optimizing a process that's already happening to happen more efficiently faster. So there is that hack mentality. I was like, oh, happens faster, happens better. But it's the same process. We're just optimizing the cellularity of it. So I loved that when you-- thanks for sharing that. Yeah, yeah. I mean, health starts from the cellular level. So you want yourselves to be whether it's a stem cell or not, an adult cell, whatever. You want them to be functioning at the highest capacity possible. And that's what's going to see the outcomes physically functioning cognitively. So it comes down to the cell. And it's been amazing to see the evolution of health and health care, health care administration start to really recognize that these are at science-based. There's evidence behind them. They're effective. And beyond that, risk and side effect profiles are effectively zero for most of these things. So it's almost like why not sort of deal. So it's been a fun evolution for me personally going into this space and really seeing how it's impacting patients moving forward. Well, I will thank you from a unique standpoint that I have seen you in a space that is, I feel like there's a spectrum. And some of the most successful people in this space, the spectrum is of like discretion versus adoption and belief and magical thinking. And I feel like actually a lot of people end up on this magical thinking end more. Those are the more successful people in the space. I think you are an exception to that rule, where I would say you're a very discretionary thinker, enough to be very open-minded, but also really dig and look for it. Because sometimes the scientific studies lack behind what's happening in real life by a decade or more. You're a randomized controlled trial for some of these things is either not feasible, never going to happen, lacking. And it's so obvious that this is my world too a little bit. And so I will thank you for being discretionary within that to a degree. It makes me very comfortable sending you people that are very near and near to me, which are my patients. I have a-- I'm all relationship in that sense. And so when I send somebody to you, it's like sending a family member to you in a sense. And I have no second thoughts about that versus sometimes I'm like, oh, I don't know. What are they going to do? And so I think you have this very beautiful marriage of like, I know that they're getting the best, the most cutting edge, but also the real and the safe. I think you kind of talked about that earlier, which is not always the case, interestingly. So yeah, thank you for that. Yeah, I appreciate that. It's novel therapies. There's a lot that we know and we're learning. And there's a lot that we don't know. But I appreciate that sentiment. We do our best to do the best for patients. It's all about patient outcomes. And that's the space that I enjoy being in. And it's fun being at the forefront. You've said a few things about regulations and whatnot. And that's probably good for future. So I look forward to coming back. Yeah, I have more conversations about what that looks like. Because you're opening up on another-- yeah, a whole 'nother can of worms there. But I appreciate it. It's a pleasure working alongside you. And I always enjoy getting into the OR and working with you and all your patients and hearing those stories. So it's a fun marriage. Thanks for your help. Thank you. Appreciate it. If you have any questions or topics you would like me to explore further, please leave them in the comments. I read them all. And they often help shape the future conversations here. If you would like to learn more about my surgical practice, you can visit clinic5c.com where you will find additional information on my approach to surgery, recovery, and performance focus care. I also want to be clear that the views shared on this podcast are my own and are not associated with or representative of my clinical teaching affiliation with the University of Washington School of Medicine. Nor should this be taken as individual medical advice. Thank you for spending your time with me. I appreciate you being here. And I will see you on the next episode.