Anna Emanuel MD - Medicine 4.0: Next Health's Dr. Anna Emanuel on the Future of Preventative Care

Hey friends, welcome to the Future of Fitness, a top-rated fitness and wellness industry podcast for over five years and running. I'm your host, Eric Malzone, and I have the honor of talking to entrepreneurs, innovators, and cutting-edge technology experts within the extremely fast-paced industries of fitness, wellness, and health sciences. If you like the show, we'd love it if you took three minutes of your day to leave us a nice supporter review wherever you consume your podcast. If you're interested in staying up to date with the Future of Fitness, go to futurofitness.co to subscribe and get weekly summaries dropped into your inbox. Now on to the show. In an industry full of noise, with more features, more screens, more promises, eGim is focused on something far more meaningful. Progress that counts. eGim is a global fitness technology leader, building the infrastructure behind real results. Their open ecosystem connects smart strength equipment, AI-powered software, and data-driven services to turn fitness into measurable, repeatable progress for members, trainers, operators, and communities. Now what really excites me is how EGM brings its ecosystem together with WellPast, their corporate wellness platform. By combining their strength equipment with AI-powered software and their corporate wellness platform WellPast, they're leading the shift to proactive, preventative health. Isn't that what we all want? That's why we're here. The result? Members feel more confident and motivated, trainers have better tools to support people, operators see stronger retention and growth, and employers benefit from healthier, more engaged teams. This isn't innovation for show. It's progress you can see, measure, and repeat. To learn more, please visit eGym.com. All right, here we go. Dr. Anna Emanuel, welcome to the future of fitness.

Hi, thanks for having me. I know we've been trying to get this on the books for a few months now. So happy to be here.

Yeah. We're going to talk about a lot of things that are trending very heavily within our industry right now. And I guess give a special thank you to Brian Von Aken at the Wellness Growth Mastermind for getting us connected. We're both members there. And it was a real treat to kind of see recommended as a guest within the community. And there's so much to chat about what you guys are doing next health and your background. And you know, I'm just coming off of the Connected Health and Fitness Summit where longevity, you know, functional health, preventative medicine, health optimization, whatever term you want to use, is very much at the forefront of the conversations taking place right now. So you are right in the thick of it with the advancements in our industry. And moreover, so we're going to get into a lot of different stuff. GLP ones, of course, gut health, how to scale a really successful medical model. I think that's the biggest thing that you are tasked with at this point is, you know, high-quality medical services at scale. That's no simple thing. So before we get into all that, I'm going to do a short intro for you. You let me know if I'm if I screw anything up here, Dr. Emanuel. So Dr. Anna Emanuel is a double board certified physician in family medicine and integrative medicine based in Los Angeles. You're focused on longevity, peak performance, hormone optimization, digestive gut health, and cardiometabolic health. You trained at Loma Linda University for medical school and residency, and you completed an integrative medicine fellowship at the University of Wisconsin. And you also hold certifications in medical acupuncture and as a yoga instructor. Very well-rounded. And you currently serve as a clinical leadership role at Next Health Los Angeles, as we just said. So there you have it. I just think you know what you're talking about.

Yeah.

Yeah. Thank you. Thank you. I'm working on those. Let's start with this because you and I were talking and about medical 4.0. I think it's a nice framing for what you guys are doing at Next Health and what you're trying to achieve there. You know, I was telling you I was monitoring a panel last week at the summit, and it was called Health 4.0. I didn't come up with a name. But I asked everyone around in the room who knows what health 4.0 is, and no one raised their hands. I'm like, okay, kid, I wasn't the only one. So we had to educate a little bit. I don't know if that term is normal, but you, as soon as I brought that up to you, you're like, well, it's medicine 4.0. And I'm like, I've now that I've actually heard of. So maybe give us a walk through recent history and how we got to medical 4.0 and medicine 4.0 and what exactly that that is.

Yeah, I'd love to. And it's extremely relevant because at Next Health, we coined the term medicine 4.0. And it really all started with medicine 2.0. I guess we could go back. That's what Western medicine is, right? It's there for a reason. We have surgeries, we have antibiotics when we really need them. That's the medicine 2.0 framework where there's symptoms and then we treat them in, you know, in a pretty like protocolized way that we learn in medical school. Then there's medicine 3.0, which was actually coined by Peter Atia. And that started to include more of the prevention piece. So we were adding on, you know, how do we prevent cardiovascular disease, metabolic health dysfunction, cancer, and Alzheimer's. So those were, those were the focus because those are the four things that really are preventable and can help improve our lifespan. And then medicine 4.0 is something that I would say we did coin as next tiles. And the way we approach it is utilizing one lifestyle medicine. So nutrition, sleep, and exercise. Two is preventative medicine. So again, looking at those, you know, those really preventable causes that can be caught early and that we can really improve health span and lifespan with by addressing early. Three is functional medicine. And functional medicine, I think, you know, there's a lot of definitions for what that means. But the way I think about it is symptom management. So how do we manage symptoms through a more holistic lens? And that could be hormone health, gut health, detoxification, fatigue, energy, performance. I mean, anything someone comes in with that they want addressed, we're looking at it through that functional medicine lens. And then 4.0, yeah, I'm sorry, the fourth piece of 4.0 is longevity medicine. So this is where we add the really fun things. We add in peptides, we add in things like GLP1s, things like stem cells, exosomes, plasma exchange, ozone therapy. So now we're utilizing advanced technologies to help either support symptoms or performance or long-term outcomes.

Awesome. That was very sank. Thank you. Next Health is you're scaling up to roughly 20-ish give or take locations this year in 2026. So you're you're just you're seeing some pretty good traffic coming through. And I'm I'm curious. Well, it's kind of a two-part question. Dr. Manuel is like, what is what is the member client-patient experience? You know, I guess you could probably define what you call the people who walk into your doors. And then what are some of like let's start with that. Let's start with the experience and I'll bring in my next question.

Yeah, what makes Next Health stand out is that we're a brick and mortar model. And that sets us apart, especially post-COVID, especially now where human connection is not a usual type, you know, a usual case in in medicine. Telehealth has become a huge piece of even just the traditional model. And especially these clinics that do GLPs, hormones, all of that is very much in this telehealth national kind of at a national level. And with Next Health, we, you know, we do that really well, where when someone comes in the door, we we have everything on site. So let's say Eric, you would come in, we would do first blood work, we would also do advanced testing, which includes brain age scan, we have VO2 max testing. So we're trying to utilize different data points for our members. And then when the results come back, we have you review them with a provider who's within one hour provides you with guidance that's individualized and personalized to you. And we have a model where we kind of that 4.0 model, we call it the wellness wheel. And that includes nutrition, sleep, stress, hormone health, gut health, immune health, detox, aesthetics. There's 12. I'm probably missing a few, but what I'm trying to get at is a lot of times people try to DIY this. So with TikTok, with ChatGPT. And so what makes what makes us stand out is that you don't have to DIY it anymore. You have a team that understands these important pillars of health and can help you address it. The wellness wheel is also a great reference point because a lot of times we can get very reductionistic in health, right? And we saw that with the functional medicine movement. For me, it it became the same kind of reductionistic approach where instead of metformin, now you are just taking berberine. And instead of trying to understand the entire picture behind your metabolic dysfunction. So by by referencing the wellness wheel, we're keeping things in perspective that all of these pieces matter. And we may be focusing on one piece, you know, at this time. And in a few months, we may need to revisit another one. But the perspective is really what provides us, I think, with longevity and and outcomes. The other, I would say the other huge philosophy for us is helping our patients be the CEO of their own health. So part of medicine, you know, we're going back to that medicine 2.0, even 3.0 approach is there was a lot of outsourcing of our medical decision making to someone else being someone, another practitioner or doctor, right? And now with medicine 4.0, a big piece of it for us is having agency over your own health, over your own health decisions, understanding that just because our parents or grandparents had a certain disease, had a certain disorder doesn't mean that's going to be the case for us. And we're finding that genetics is really just, you know, you can check the different data points. Anywhere from we can say anywhere from 15 to 25% is genetics contributing to our health. That means that up to 75, 85% of our health outcomes are the decisions that we make on a daily basis. So, so creating that that narrative of you are the CEO of your own health, that's also what we always bring it back to at Next Health.

And that's good news, right? That like 85%, 80 to 85% is what we do with it. You know, it's not exactly the the cards we were dealt, it's how we play the game. And I think that's I like that that makes me feel good because I don't have the best genetics coming down the park. That's amazing.

Yeah.

Yeah. So when you look at like the people walking into your doors, and kudos to you for saying, like, I've been promoting that people take agency over their own health for many years, and I feel like they kind of have to now. Like, you know, that the typical, you know, sick care model that we have, you don't get a lot out of it. You know, you kind of do your checkups and you show up when when something goes wrong, it's amazing. The system does a really good job, right? When like you break a leg, you get something like that something catastrophic, like it, that system, boom, it performs really well. But like in order to like stay out of that cycle or get into those situations, well, broken leg is different, that's a bad example. But you know what I mean, like catastrophic health issues or metabolic issues. You know, it's it people questioning it, they're not getting where they want. So they're really starting to take agency. And I think that's where we're starting to see like ChatGPT and stuff like that becoming almost like a front line for a lot of people on how they do their health. I've used this quote so many times now since it came out, but the ChatGPT health uh announce that they made a couple of months ago, I think it was in January, and one of the things that said in there, Dr. Manuel, was like 230 million people every week have health-related inquiries into ChatGPT. 230 million people every week. So, what is that telling you? It's like the consumer is kind of ready. Like they they want to take ownership of all this, which is outstanding. So I'm gonna get to my second question I have for you, which was the people coming through your doors. Um, what are some of the most prominent and individual cases of of sickness or the problems that they have? And what are some of the most common treatments that you're using to address those?

Yeah, that's a great question. I'll I'll first comment on the chat GPT piece. I love when people have researched their health problems on chat GPT because that means the person sitting in front of me is very engaged. They are aware of what's going on and we can problem solve together. So for me, it's it's actually a great, it's a it's an even better experience when someone has some kind of perspective on what's going on. The second piece is it's great for the general consumer who doesn't have access to a place like Next Health because say you have some complicated recurrent symptoms. When you see a provider in a regular Western sick care model, they really have upwards of maybe 10 minutes to spend with you. And the nuances of a lot of these symptoms that are presenting, it takes much longer than 10 minutes to get to the bottom of. Especially, you know, I had a patient recently who had recurrent episodes of vertigo. And it seems like that no one spent the time with her to understand it. And it was labeled as BPPV as a blanket statement. And and just digging a little more into the symptoms, it was actually a less common cause of vertigo. And now she's on a much better trajectory to have to not have recurrent symptoms because we spent a little more time exploring those. So I think it's just it it is a simp of it is a vector of time in terms of how the quality of care that someone will receive. And Chad GBT spends as much time with you as you want it to to really understand the nuances of symptoms. And it has a good way of asking follow-up questions too, right? You know, when is this happening? How often? So it helps people try to really think about the the the context of of what's going on as well. So in terms of your question, we really see a a large spectrum of of patients. Some patients are just excited to prevent. So they feel good and they want to make sure that there's nothing going on under the surface. So these are patients who, you know, sometimes their labs are completely normal. Other times there is something surprising that we find. The second bucket is patients who do have symptoms that haven't been addressed before. Um, the third bucket I would say is the longevity biohackers who are wanting to try everything. They feel pretty good, but they want to feel better. So I would say the the the performance seekers are also in that category as well.

So in that second category, you mentioned people who just don't know yet, like something's uncovered, or I guess that's probably what I think people are kind of fine. We're feeling we're funny things as creatures as humans, but like we kind of want to find that there's something wrong just so that like we feel like we uncovered it. You know what I mean? Like we're gonna spend all this like a lot of people go through assessments, like, there was nothing wrong. Like, oh, well then why do I feel like shit? Well, you know, they they want a reason when it's maybe it's just maybe there's nothing. Maybe you're you're actually feeling fine. So when you're seeing some of these things come through in that second category, like what what is what are the most common stories that you see? Is it, you know, metabolic dysfunction? Is it you know early signs of heart disease or dementia? Like what are you guys uncovering with this early detection?

Yeah. It the the psychology of it is is funny. Some people do want to find something, others don't. And it's it's navigating this complex relationship of us with our health. And my goal is to always empower that you have a team that's taking care of you. So whether we find something or we don't, you're not in it alone. You have a quarterback who's going to take care of you. In terms of symptoms, a lot of it is fatigue, so energy. The second, I would say, is body composition. So wanting to either physically just look better or physically perform better and be more fit. Three is a lot of gut health problems. So bloating, constipation, those are very common symptoms. And then four, I would say is hormone health. So both men and women, whether it's 40s, so for women, it would be more of the, you know, perimetopause, menopausal era. For men, we can call it andropause. So they feel like their body is slowing down and they they want to get ahead of some of the the decline that happens from decade to decade. So those I would say those are the what those would be the main main symptoms.

Well what's do you guys within your guidance and service offerings, do you do like fitness prescriptions where you tell people like, hey, you should also be lifting weights twice a week and you know, maybe some some, you know, some some rather loose guidelines, or is that something? And the reason I ask is like, is this a partnership opportunity for people who do specifically that? Like a lot of people, you know, I was at your telling you I was at your Beverly Hills location, beautiful from the outside. It was, I think it was closed by the time I walked by it. But there's also like I'm not gonna say there's the Equinox, but they probably do this stuff on their own. But like other gyms or health club institutions, right, who could partner with the next health. And I think there's a lot, like I that to me, I've talked to a lot of longevity experts who aren't gonna say that they haven't had the opportunity to be educated on like fitness prescriptions specific to like types of weight training, mobility training, you know, all kinds of things that go really well alongside what you guys do. So yeah, do you guys do that stuff? And is there partnership opportunities for people in our industry to work with Next Health and and offer that as well?

Yeah, we definitely need to touch on fitness. And this is a huge passion of mine. So I was a competitive swimmer in through college, did gymnastics, did dance. So movement fitness has been a huge part of my life. And before Next Health, I actually helped, I was part of the founding team, the founding physician team at Love Life. So that has also a functional medicine component and a gym. And so I absolutely believe in the integration of medicine and fitness. Next health, the medicine that we do is so advanced. And part of the counseling around exercises is really supporting clients to be more well-rounded in their exercise. We do VO2 max testing, we do grip strength testing. Those are the two best physical markers of longevity. So we do track those when patients come in. We do blood work and all the additional physical testing every three months. So there is longevity with with the data that we gather for our patients. But when it comes to exercise, honestly, most people they have access to some kind of a gym. I think it's a lot of it is continuing to have the discussion of balance, right? So that the it's very important to include weightlifting and cardio and mobility work. There's there's kind of been a shift. And that's what happens with with social media. You've probably seen the shift, Eric, that it was a lot of cardio before and hit, and now it's all weightlifting. And so I find that a lot of patients do not do any cardio. They certainly don't do HIT and they probably don't do much cardio at all. So so it's just continuing to discuss that. I think weightlifting does offer a lot of mobility work. So that's usually surprising to most people that mobility is, you know, with with complex movements. You're actually, you're actually getting that as a part of it, but still incorporating things like yoga Pilates and encouraging them to create a more balanced workout schedule throughout the week. There's always opportunities, I would say, in terms of partnership, just to provide the tools to patients. But I would say it's more of a motivation issue than than an access issue to a lot of our patients when it comes to fitness and and and the narratives that are that are out there for what kind of activity they should be doing.

Yeah, well said, it is a motivational issue. It's not access. You know, I mean you could go most places you could go to a park nowadays, and there's a good amount of stuff that you could do to get a really, really good workout, right? And what I want to go back to your swimming. What was your event? Oh, okay.

These were my two events.

True and I stuff. Yeah, I was 200 free and 100-free. So a little across the road. Yeah, yeah. I don't miss it really. I don't really miss ch chasing a black line. Um, but yeah, got me through college. So grip strength is always one that's confused me a little bit. And I I read Atia's book, right? And uh Read a couple things. And I don't know, is it like a is it a correlation or like what in your mind, what what is the the connection between grip strength and longevity? How do you explain that to people?

Yeah, the connection is that you're that it it's sort of like minor muscles, right? Because we when you think about longevity, you may think of quads, glutes, hamstrings as being the largest muscle groups in the body. They do support hormone health and metabolism the most. So if if if I tell patients, you have to do squats, you, you know, even if you have to do some kind of like deadlifts, because those are going to be the biggest muscles to support your body. Grip strength when it comes to like what you're looking at is hand strength, forearms. So I think it's it's like a combination between how you're using these smaller muscles and to how you're able to just move around. So pick things up, you know, lift yourself. It's sort of a proxy for the upper body strength.

Yeah. It makes sense. I mean, as you get older, you know, the the biggest, the biggest, scariest thing is falling.

Yeah.

And you know, what's most of the time going to stop you from falling is if you know you're gonna fall, you're gonna grab something. If you can grab it, great, or if you can, you know, hold on to what's supporting you. It it does make sense. I've just always been curious about the direct science on that. With GLP ones, are you guys putting those forth into your practice? Is that becoming a pretty substantial piece of working guys through?

Absolutely are. Yeah. GLPs have been a miraculous option for the metabolic crisis in the US. So in terms of when you look at the stats, 80% of Americans are metabolically unhealthy. And GLP ones offer a way to support that directly and indirectly to some of these, some of the like complex sequelae that come along with metabolic dysfunction. So, yes, they really help blood sugar. But what I'm finding is that we're seeing a decrease in inflammation, even a decrease in reactivity. So some people have histamine responses. So now we're talking about immune function. GLPs work in kind of a multifactori. So, so we uh I use them in as a tool to support what I'm seeing with a patient. They also can help indirectly with like uh heart disease and fatty liver disease. So Zempic has been FDA approved for fatty liver disease. And so at Next Health, when we are checking, we we have a liver scan at the West Hollywood location. So utilizing the liver scan, the in-body lab work, we can really make informed decisions about is a GLP right for this patient and how do we help this patient get the best metabolic health. I would say we've also kind of hacked the muscle loss piece of the conversation because yeah, I think, you know, my thought is when you look back at the initial telehealth companies, they would be increasing the dose for patients across the board. It was just part of an algorithm. So you would go from minimum dose to max dose, kind of regardless of who you were. And with these rapid weight loss shifts, that's where you're getting the loss of buckle fat. So ozempic face, you're getting, you know, the risk of like gallstones, gallbladder disease, that's a huge risk factor with rapid weight loss. And then of course, muscle loss. So someone comes in and they want to have a more toned body, and next thing you know, they've lost 20 pounds and most of it is fat, or most of it is muscle and not fat because you're not supporting the body's natural physiology. And so by being understanding of, you know, my first my first question is always how do you feel in your body? What's a weight that feels really good to you? And what is the discrepancy between current weight and goal weight? And then how do we create a plan to get there in a very sustainable way? If you're telling me 20 pounds, that we're looking at one to two pounds a week. So we're looking at two and a half to about like five months, right? And so when you think about just the first month, it can feel a little discouraging. But thinking about it in a larger perspective, now we're gonna hit a really, really healthy weight loss of 20 pounds at three to five months. And that's going to be something that can be sustainable and maybe we can even get off the GLP one. You're also hacking the brain's natural signals, right? So by injecting a GLP one, you're not really hungry and you're not really thirsty. So a lot of my counseling goes around you have to tell yourself, I'm not getting signals to eat or drink, but I have to and I have to make healthy choices. So I think understanding, you know, what is this drug doing for me? What is it telling my body, and how do I still make informed decisions to reach my goals is the most important thing. Otherwise, you fall into that trap of losing muscle, feeling really fatigued, nutrient deficiencies that lead to hair loss, if we don't know, you know, how to how to use it as a tool instead of just like as a as a one-shot wonder of an answer to reach some, you know, maybe to reach a really, really valid goal, but not in the way that is sustainable. And then people can come at that point, you know, when you think about just historically looking at GLP ones, people would stop the medication, gain all the weight back. And in my mind, they're actually worse off than they used to be because now they've they're down several pounds of muscle and they're more fatigued and nutrient deficient than they were at the beginning. So it's there's a large spectrum of using the drug very poorly, which I think we all saw several years ago, and then how we're using it now.

Yeah, the the people that I know that I I definitely respect their opinions in this category is you know, a lot of it's just about titration, right? Is doing it properly. Because I think, I mean, correct me if I'm wrong, is it when it first came out, or maybe it's still is it's just mega doses that people are getting. Like they're just throwing everything at it, right? And that's what causes these dramatic effects. And now everyone's talking about micro-dosing GLP ones, which I always, whenever I hear these terms, I'm like, well, what's micro? Like, isn't it just dosing? Like, is it can we just call it that? Like, what so maybe explain, shed some light on that? Like, people, this is like, you know, anyone who's a longevity influencer, quotation marks people, it's talking about microdosing their GLP ones. And what is what does that mean exactly? Is that a valid course forward, or is it just basically we're just doing smaller doses of GLP ones and where we should have been all along?

Yeah, people you don't hear very great answers to this question on podcasts. What microdosing is, is using less than the recommended initial starting dose. And that could be like half. I've seen five pounds of weight loss on even half the initial starting dose. Sometimes it's a quarter of the starting dose if that person is just getting too much of these signals of a fullness, and even just like if they're if they're they're feeling like they're not hungry, they're not thirsty, they don't feel good with some of these, you know, they don't feel like there's a balance between what they can eat and some of the weight loss, then we can even go down lower. And I I I I think about it for every drug. When I worked with very, very astute, this is going like in a very different direction, but I've worked with astute concierge, really intelligent psychiatrist. And they would prescribe Adderall. The initial dose is 10 milligrams, but they knew that there's going to be people who respond to two and a half, and then there's people who respond to like 120. And these this is an incredibly large variation, right? That the we have very different ways of metabolizing drugs, right? We're all very, very individual. You know, we need an individualized, personalized approach because our our genetics are the way our you know our liver is able to metabolize drugs, the enzymes, the activity of our enzymes is all very different from individual to individual. So I'm not so stuck on the actual number. I'm stuck on how are you feeling? You know, are you able to overcome these like nausea, appetite signals? What does the scale look like? What is what is your I love progress pictures too. I think sometimes, you know, it's not just your the weight, but I think it's a combination of the body composition scans and even progress pictures that give us the best picture of how our body recomp journey is going. So I use as many data points as possible, and then that helps me dictate the dose versus being so stuck on this as the initial, you know, starting dose. And in our longevity concierge world, we do have the benefit of doing this because there's we there's access to compounded medications, but even the brand names, Ranjaro, Ozembic, you can get them in a vial. So it's different when there's a pen, the pen just has one dose that, you know, you don't have a way around that. But using the vials, you can actually individualize the dose. And I think, like you're saying, being extremely, extremely just precise with the titration is where you're going to get the best benefits. I use the same philosophy for hormones. So being extremely being my being open to the number, not being, you know, that it has to be from this to this to this, but there's there's still in-betweens that we can use to get the results.

The Future of Fitness podcast is proudly brought to you by EGM. In an industry full of noise, with more features, more screens, more promises, eGim is focused on something far more meaningful. Progress that counts. EGM is a global fitness technology leader, building the infrastructure behind real results. The Open Ecosystem connects smart strength equipment, AI-powered software, and data-driven services to turn fitness into measurable, repeatable progress for members, trainers, operators, and communities. Now, what really excites me is how the gym brings its ecosystem together with WellPass, their corporate wellness platform. By combining their strength equipment with AI-powered software and their corporate wellness platform WellPass, they're leading the shift to proactive, preventative health. Isn't that what we all want? That's why we're here. The result, members feel more confident and motivated, trainers have better tools to support people, operators see stronger retention and growth, and employers benefit from healthier, more engaged teams. This isn't innovation for show. It's progress you can see, measure, and repeat. To learn more, please visit eGim.com. Yeah, I mean you look at at least uh the world of male hormone replacement, and you know, you talk to people and they want to jack you up to like 900 or 1000 or more. And you know, whenever I talk to people, I'm like, well, I don't I don't think I was ever there. Like, why why would I want to jack just get to this really surreal thing? So people focus on the number very much. I know in that category, it's just changing very quickly as well. And you know, I want to stay, I want to stay on GOP1s as far as the category of peptides, but kind of broaden it out a little bit with you. So in this year, 2026, you know, when you hear the term peptide, I feel like it's coming with a lot of weight. People just throw it around, they don't really, there's there's so many. I had Jim Laval on this podcast last week, and he gave me a real thorough introduction into the complete, the wild world of peptides and how many there are. So when you hear that term peptides, like what's legit, what's overhyped, what's kind of irresponsible in in the media nowadays?

Yeah, so peptides are small chains of amino acids and they are signal molecules to our body. People always ask, are they natural? Yes, they are natural, but in order, if we would have to extract them from an animal, it would be extremely, extremely expensive. So we make them in the lab. That it's the exact same molecule. I think that what GLPs did for the world of peptides is pretty awesome because we saw what GLPs have done and the incredible shifts physiologically that they offer. And so I think that offered a door for all the other peptides, right? And so compounding pharmacies got very excited. But also every other random pharmacy and supplier got very excited. And that's where the danger falls into. I think the first thing is don't inject something that one, you don't know where it's coming from, two, it could be filled with endotoxins. Three, you don't know if what's in it is actually in it and if there's other things that are in it that they're not telling you. So sourcing is extremely important. And when you have the right sourcing, now I think it's just a matter of figuring out, you know, what signaling your body could use. Some of the categories that we have really good data on, I think the the biggest one is Tesla Moreland. It's FDA approved for one specific condition. But generally, that is something that most of the longevity companies offer because you know, we have we have a lot of data around it. BPC157 has been used pretty widely as well. And then the the other growth hormone analogues, so CJC ipomorlin, in addition to the Tesomorlin, I would say those are the ones that are yeah, most heavily used. And I'm seeing pretty good benefits. Back to individuality, right? I've seen patients have no benefit from a growth hormone analog. And I've had a some I've had a patient who put on 12 pounds of lean muscle within a month on a growth hormone analog. And he's an actor, you know, he's going on a big, he's about to film a big show. So this man, he he was tracking his, you know, every his body composition very, very, very, you know, religiously week to week. So I think it's just a matter of how your body responds to it. And that means that I can take a little bit of trial and error. Same with BPC 157. It's used most frequently for just these nagging chronic tendon ligament injuries. It is also used for gut health support. And I've had patients who have like complete resolution of shoulder pain, others don't. I also had a patient, really interesting scenario. He didn't really notice any difference on the growth hormone analogs, but he lost 10 pounds on BPC 157 because for him it was all inflammation.

All inflammation.

Yeah. And this is something I don't think that's talked about as much either on podcasts, right? I think social media podcasts, we don't hear these really unique success stories. I think you just hear the same narrative over and over again that this is the magical pill, this is the magical injection. But it really depends from person to person how they're going to respond. It's amazing that we have so many options now to support our physiology. You know, in the past, we didn't have all this amazing, all these amazing ways to support gut health, like we do now with BPC 157 and KPV. And this is now we can add it on to protocols and really make a difference in terms of long-term outcomes for gut health. So it's a matter of how we use it, you know, apart from obviously the sourcing, which I think is should be the biggest part of the conversation. The second piece is just how do we intentionally use that as part of an entire protocol to help with our health goals?

Yeah, it's there, there's so many different peptides and so many different combinations and so many, you know, it's not like it's just a switch that you flip on one particular thing. It's like, oh, knee injury, BCP 157 switch, right? Like, sure, I'm sure it'll help heal you faster. But there's gonna be a multitude of things that are gonna happen with that medication or that peptide being administered. And I guess it's like you said, to the point, and just like everything, like it's always been, it's it's highly individual. And you know, you you brought up gut health, and I actually haven't talked about gut health and the advancements in gut health on this show in quite some time. Maybe give some insights, like I guess roughly like what percentage of the people who walk in your doors, Dr. Manuel, I'll think you think probably have some kind of gut issue or gut limitation. And what are some of the bigger advancements over the last few years in gut health as far as you know, what the longevity space is pushing?

Yeah, I love talking about gut health because with these new trends, right, we sometimes forget about the foundations. And one of those is cardiovascular disease that is not getting as much airtime these days, and two is gut health. I would say about one in four people come in with gut health concerns, and that can include symptoms from acid reflux, floating, constipation, diarrhea, indigestion. And that's the exact list I run through with patients. And I think it's just a matter of understanding where, you know, the context in which these symptoms are happening, and then the now we can utilize the the many solutions that we have. So one, I say this because no one asks about gut health. And patients come in who've been bloated for 10 years, and no one's taken it seriously. I had a patient who had the loose stools for 10 years and no one did anything about it. And that is a massive source of your like nutrient deficiency, right? You're not, you're eating, you could be eating the best food. You're not absorbing any of it. You're not absorbing any of those macronutrients or micronutrients, in fact. So it always surprises me that it's not part of the larger conversation, even in functional medicine. So, so that's I would say the first piece. The second piece is we do have pretty great opportunities for testing now. So at Next Health, we offer a microbiome test. And microbiome test helps us understand the actual bacterial profile of the gut. So do you have enough of the good bacteria? Do you have enough of the bad bacteria, or do you have too much of the bad bacteria? Do you have an overgrowth of inflammatory bacteria? Do you have any viruses, parasites, protozoa, and fungi, fungi, you know, small intestinal fungal overgrowth. So this helps me understand the actual milieu of the gut. And then from there, I can be way more intentional with actually treating the root cause of what's going on. Sometimes it is a matter of diet. So just certain a few dietary tweaks can make a difference. Sometimes giving the body a break with just not drinking alcohol for a little while. It doesn't have to be forever, but sometimes just abstaining from alcohol for a few months can reset things. And then we also have, you know, sometimes it is SIBO, so small intestinal bacterial overgrowth or small intestinal fungal overgrowth. And that is not often discussed and can can show up as continued nutrient deficiency. So if someone comes in with low vitamin D, low B12, low iron, low folate, you know, I, you know, it's it's it's pointing to something, especially if this person is eating a good diet. Um, and then of course, we have the options now of peptides to help support the actual intestinal barrier. But I love talking about gut health. One, like I said, it's it's not talked about. Two is people live with it thinking that it's normal and that, you know, it is what it is. Three is it makes a huge difference in our outcomes because 70% of our immune system lives in the gut. Now, with things like, you know, especially in the time of COVID, having a good having good health gut gut health was actually protective to the immune system. And we found that a lot of patients who had a dysfunctional gut were more at risk for developing long-term issue concerns with from COVID like like long COVID, so M E CFS related type of symptoms. And it's it's extremely important part of the discussion. And I'm I love that at NextTel that is part of our wellness wheel, and that is something that if you see a provider at Next Helps, they that's something that will be addressed.

Yeah. It's I think it's pretty wild how many people walk around with gut issues. I mean, I had for I was uh there was a period in my mid 30s where it was I was overtrained, I had gut problems, I was a mess. Outside, you would look at me and be like, that guy's looking good, right? He's doing all right, he's in shape, he's moving well. But on the inside, it was just a hot mess. And once I it took me like probably like a year to kind of get it under control. But really, it was like I had to de-stress. I had to do a lot of different things differently. But I feel like nowadays I probably would have had a faster acceleration to success and feeling better with what's available now, which is which is pretty exciting.

Yeah. I wanted to that's I'm glad you bring that up because gut health is actually a huge issue with professional athletes. So overtraining can lead to significant gut issues. The two things I think about with professional athletes, one is just the cortisol, you know, the cortisol response and the stress on the end on the endocrine system. And then two is is gut health because you're constantly shuttling blood away from the gut into the muscles. And there is a big recovery piece that unfortunately, if you're competing at that level, there's only, you know, you can only get so much recovery with how much how you know how intensely you're performing. And so the gut tends to suffer. So that is something that I discuss with professional athletes a lot, even if they don't have symptoms, right? Because it's still showing up, it can show up as immune dysfunction. When you think about prevention too, right? A lot of people are have cancer on top, you know, you know, at like top of mind in terms of family history and wanting to prevent. And I always say if 70% of the immune system is in the gut, having good gut health is your number one just window into cancer prevention. And you don't need to have symptoms to have a very dysfunctional gut. That is also a misnomer. It's, I think it's easier for those of us who do to get actual support versus others who don't have symptoms, but that there's still a lot of disarray. So, in you know, in light of that, I would say we should all get some kind of microbiome testing that looks at at the balance and that supports our gut health long term.

Yeah, well said. You know, and just anecdotally, you know, n equals one, my own personal experiments is like when my gut starts to worse than it's generally because I'm being super active, I'm traveling a lot, probably ate like shit, drank a little bit too. Like, you know, all the normal things, right?

Yeah.

And my resting heart rate shoots up. No, yeah, my resting heart shoot rates up, my HRV drops. And as soon as I give myself a few extra days of recovery, everything kind of normalizes again and my gut feels better. And coincidence, probably not, right? From what you've seen in your research. So yeah, but I I'm probably overdue for a full biotest. So maybe I'll get that done with you.

I would say just the barrier was the sample collection, but now they're they're they're make they've made it a lot easier and and more accessible in that sense. So I think, yeah, I think at this point everyone should really, should really get microbiome testing. And what's cool too is just the AI integrations, right? Because we are outnumbered by the bacteria in our gut, right? There's more bacteria in our gut than we have human cells. So really tending to that environment is is important. And with AI, we're able to really pull from lots of studies about looking at specific organisms, how they can contribute to health. So now we're getting a lot more data and a lot more personalized, individualized recommendations versus, you know, I think in the past, you know, we we talked about maybe a few species, but now AI can can really pull from continuous ongoing studies that are being, you know, that are being published that as humans, it's it's it's impossible to even keep track of with just from all these different labs in the world. So I I just love, I think there's going to be continued innovations in gut health just with the access that we have to data in AI.

Yeah, very cool. Uh here's a last question I have for you. It's kind of a fun one. You ready? So let's say uh I don't know, someone in their 20s. If they, you know, if if this research keeps going forward and they take a reasonably good do a reasonably good job of taking care of themselves, what do you think we'd be looking at for that generation as far as lifespan and health span? As far as years?

Good. This is a tough question.

Well, it's impossible, but it's fun to ask.

Yeah. But and I say that I'm saying that because we I'm I'm I think that there's at least a hundred. My my thought, just based on what I'm seeing reading, at least a hundred to even 120 for for lifespan, right? And I think the the more exciting thing is health span. Because in the old days, you know, before we would say 60, 70, you know, hormones are are tanking, immune system is suffering. But now, just with all these advances, people are living into 70, 80 pretty robustly. And I think 90 is where we're going to see the biggest shift, even in the next decade or two, that 90s are going to look a lot different. And so I think hundreds are going to look even different when we're looking in like 20, 30 years. The advancements are happening so quickly. So I'm just very excited about every it's just the most exciting field to be in because year by year, I think in five years, medicine is going to look completely different in a very, very exciting and good way because we'll have more answers. In my world, there's still a lot of unknowns with symptoms, with disease processes. And we've gone so far already. We've helped so many people. So many people feel like they have their health back. And I think this will continue, even with some of the more rare conditions, as we have access to more technology and then more advanced computing mechanisms through AI.

Right on. I love it. I love it. So I'm gonna hold you to it. I'm gonna be skiing like a savage when I'm 95 because you said I will. That's exciting. Well, Dr. Mayo, it's it's been an elabstic pleasure. If if there's any place you want people to go after this online to follow you or email or whatever it is, what um yeah, where would you like them to go?

Yeah, I have a an Instagram, so you can tag that Anna Emanuel MD. And then in terms of website, you can visit next-health.com. And we're very, very excited to be scaling. I think it's just exciting to offer this type of medicine across the US. Selfishly, now when I travel, I like to jump into where the next health locations are for a little tune-up for an IV. So it's just a great just community to be a part of as a patient. But really just providing this next generation 4.0 approach where we're integrating uh multifactorial data, performance metrics, biological age metrics, lab work, and we're able to continue to make huge impacts for our patients through this individualized approach. So check out the website and then please come into a Next Health location if there's one near you, so that we can get your biomarkers and help you optimize your health and longevity.

Awesome. Well said. Really appreciate it. This has been a lot of fun. Uh, it's such a cool field, and it's such a crazy time to be alive. So it's been a lot of fun asking your questions. Thank you. Ladies and gentlemen, Dr. Anna Emanuel.

Thanks for having me.

Hey, wait, don't leave yet. This was your host, Eric Malzone, and I hope you enjoyed this episode of Future of Minutes. If you did, I'm gonna ask you to do three simple things. It takes under five minutes and it goes such a long way. We really appreciate it. Number one, please subscribe to our show wherever you listen to it, iTunes, Spotify, Castbox, whatever it may be. Number two, please leave us a favorable review. Number three, share. Put it on social media, talk about it to your friends, send it in a text message, whatever it may be. Please share this episode because we put a lot of work into it and we want to make sure that as many people are getting value out of it as possible. Lastly, if you'd like to learn more or get in touch with me, simply go to the feature of fitness.co. You can subscribe to our newsletter there, or you can simply get in touch with me as I love to hear from our listeners. So thank you so much. This is Eric Malzone, and this is the Future of Fitness. Have a great day.