Concierge Medicine: 40 Patients Instead of 2,500

If you've ever walked out of a doctor's appointment with more questions than answers, concierge medicine may be the solution you haven't heard about. Board-certified neurologist and U.S. Navy veteran Dr. Ryan Williamson, MD, pulls back the curtain on what relationship-based care delivers when a physician manages 40 patients instead of 2,500. This episode is for anyone tired of 7-minute appointments, rushed diagnoses, and a healthcare system built around billing codes instead of health outcomes.

Dr. Williamson explains why a one-degree shift in daily habits compounds into decades of better brain function, how a single supplement changed our host's cognitive performance in under three months, and what longevity medicine means beyond adding years to life. You'll also hear the stark reality of what happens when quality of life is sacrificed for quantity, and why having a target for your senior years is the first step most people skip.

Start with one of the three simple levers Dr. Williamson recommends this week. 

Hosted by Antoinette Berrafato, the New Normal Big Life podcast host who used nature therapy to recover from physical limitations after a traumatic-brain injury and a boken back, finding passion, purpose, and people as a recipe for mental health.

Chapters

• 0:00 Concierge Medicine: Why Appointments Leave You Confused
• 1:02 Broken Healthcare System: A Neurologist Explains
• 2:44 Healthspan Before Lifespan: Longevity Explained
• 9:00 Creatine Brain Health & The Power Of Small Habits
• 13:22 Sleep Regularity & Wearables For Longevity
• 17:26 VO2 Max: Never Too Early, Never Too Late
• 29:22 Cognitive Decline: Testing Before Symptoms
• 38:38 Concierge Medicine: Cost, Value & Tradeoffs
• 44:44 Healthcare Future & Final Takeaways

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Transcript

Why Appointments Leave You Confused

SPEAKER_00 0:00

If you've ever walked out of a doctor's appointment with more questions than answers, this episode is your turning point. Today on New Normal Big Life, board certified neurologist Dr. Ryan Williamson pulls back the curtain on concierge medicine, longevity medicine, and what real relationship-based care looks like when a doctor has 40 patients instead of 2,500. We're answering the questions you've been searching. What is concierge medicine? Is a concierge doctor worth it? And how do you truly live longer and protect your brain for life? Stay with me while this worries, because by the time you're done with this episode, you'll know exactly what to expect and how to find care that's built around your outcome, not billing codes. Welcome to the New Normal Big Life Podcast. We bring you natural and integrative health information and stories about nature that we hope will inspire you to get outside an adventure, along with a step-by-step plan to help you practice what you've learned to create your own new normal and live the biggest life you can dream. I'm your host, Antoinette Barrafato, the wellness warrior. Let's get into today's topic.

Dr Williamson On Broken Healthcare

SPEAKER_00 1:02

Dr. Ryan Williamson, welcome back to New Normal Big Life, my friend. Why don't you tell us who you are, what you do, and the one big thing you want to leave us with today?

SPEAKER_01 1:10

Thank you, Antoinette. It's a pleasure to be back with you so soon. We had such a great conversation last time. And I guess a quick overview for uh those who haven't had a chance to catch our first episode. Uh, I am a board certified neurologist by training and through a career in the military after being in the Navy for 12 years and serving with the Marines, I went back to travel medicine and just realized how truly broken our healthcare system is. And I think anybody that's had an interface or interaction with the healthcare system knows what I'm talking about, unfortunately. And, you know, it's it's largely reactive. They're there are long waits, and it's just it's very backwards, just a bad system. So through a about a two-year process of reflecting and writing a book and having some coaching programs, I have ultimately decided to pivot into concierge medicine, largely at the request of friends and people in our network. And I I just I think today this at least the best answer that providers and and patients who can afford this have come up with to be able to have more time with a physician who knows them, who understands what they're going through, and where they're not just a number in a line where you get five to seven minutes with a provider, your questions aren't answered, and then you're you're back out in the real world with probably more questions than answers and feeling very uncertain about your healthcare.

SPEAKER_00 2:28

So, listener Julia had a question about concierge medicine. So we're dedicating this episode to you, Julia. Thank you so much for listening and watching. We appreciate you. So, Dr. Williamson, let's start with a word that everyone uses, but they never define

Longevity Means Health Span First

SPEAKER_00 2:44

it. When we talk about longevity and longevity medicine, what do you really mean? Are we adding years to life or life to years? And where does health span fit in?

SPEAKER_01 2:55

That's a great question. And this is something that comes up all the time in our practice and with our transcendent health members. And you know, I think it really is an individual answer. And, you know, longevity looks different for everybody depending on what your goals are. And when I wrote The Incredible Brain last year, I literally chapter one is is titled Find Your Why. And the the reason I start there is that, you know, if we don't understand our purpose and we don't have a vision for what's important to us, what does our life look like? What do we want life to look like? You know, all the what and the how in the world as far as the the healthcare end of it, there's nothing to connect it to. So it doesn't really matter. It doesn't really have context. But the the way that I define it, or at least the way I think about it, is probably a little bit of both. You know, the health span, for those that aren't familiar with that definition, is defined as years that we live well. So think about what your highest and best performance is with your respect to your cognition, your physical function, your ability to do the things you love. I think all of us, if you asked, any of us want to maintain that for as long as possible and ideally not accept the inevitable age-related decline that we're so familiar with, that we see so many of our older peers suffer from eventually in the last couple decades of life. So pushing that curve out as far as we can. And we when we do that, when we really dig into what elevates health span and what helps us maintain better health, that often results in an improved lifespan as well, or how long we live. So our chronological age. And I mean, we've I think the healthcare has had a weird fixation with prolonging life at all costs, even if that quality of life is abysmal. And this is unfortunately something that I get called about regularly when I've, as a neurologist, when I practiced in the hospital, I'm called to the bedside after terrible traumatic brain injuries or car accidents, out of hospital cardiac arrests, or people that are just really, really sick with sepsis or some terrible infection. And the question becomes hey, this this person hasn't woken up or shown signs of any kind of higher neurologic function. So what they they ask, they ask me, what what do you what do you think? What's your opinion? Or can can we even do do we know? And that's a terrible place to be because prognostically it's not always clear, number one. Uh, but but number two, I mean, you know, if if we get to a point where somebody's late in life and they already have a handful of chronic diseases that have been just smoldering for decades, oftentimes the the prognosis or the potential outcome doesn't look very bright. And prolonging that kind of life with such a low quality of life is just, I think, missing the forest for the trees.

SPEAKER_00 5:32

So as you were talking, I wanted to make sure that I make this point clear for wellness warriors who are listening, in that if you don't have a goal in mind for what you want your senior years to look like, you don't have a target to focus on. But if you establish a goal, for me personally, I want to be like my aunt Liz. I'd like to live to be 106 years old, never have dementia, never go into a nursing home like 70 of people with cognitive decline, dementia, Alzheimer's. You can correct me if I'm wrong on that statistic. We'll end up in a nursing home. And since I'm a TBI survivor, I fit that profile, but I'm doing everything I can not to be that person. I want to be like Aunt Liz and pass in my bed. And I want to live an active life. All the things that I love doing outdoors, I'd love to be able to do that until the day before it's my last breath. So have a goal, write it down, because the goals that you write down are the ones you're more likely to achieve, and then make those lifestyle choices that Dr. Williamson is going to tell us about now.

SPEAKER_01 6:38

Love that. And that that is 100% correct. If if we don't have a target, what what are we moving towards? And I've also found that with any goal, whatever it is that you know we talk about, if it's a financial goal, if it's a health goal, a relationship goal, a career goal, whatever, when you when you have the target, it becomes fairly straightforward to reverse engineer a plan to get you there. And if if we don't, if we don't have that target in mind, we're we're sort of like a ship adrift in the ocean without a bearing or a compass heading. And you could end up any number of places unintentionally without knowing where where you're going. And something that I I think surprises a lot of people when I when I share this is that it really it really takes minor adjustments and this small level of effort day in and day out to actually meaningfully shift that outcome, or at least the probability of the outcome to get to your goal. And I mean, people that are intentional about this and they wake up every day and they they're meaningful about movement, but they have a they have a meal plan as opposed to swinging through the drive-thru because they don't know what to eat or what to do. People that are intentional about healthy relationships, people that perhaps track their health or their fitness with a wearable device, whether that's an aura ring or a whoop or whatever your preferred device is, helps them get better sleep. People that are mindful of this day in and day out, these are very minor things that people just don't think about and certainly don't think about very often because a lot of this is just integrated into my daily routine and many of my patients' daily routines. But Antoinette, over 10, 30, 40 years and beyond, the people that end up maintaining that health span and achieving or getting close to that goal or or not, I mean, they there's a wide gap between them. And again, I I have seen this year in and year out in the hospital where I see people, unfortunately, at end of life that that show up with a lot of problems, most of which are preventable, versus people that I just meet out in a social setting or at an event or on the street that that are 102, 105, and are still golfing and dancing and walking around and are just just thriving at life. And it's because they do all the little things every day. Sure, maybe some luck there, maybe some good genes are thrown in the mix. I mean, we we we can't knock that, but the vast majority when we look at the medical literature really comes down to lifestyle

Creatine And The Power Of Small

SPEAKER_01 9:00

and what you're doing every day.

SPEAKER_00 9:01

So I am a year and a half away from being 60. Oh my gosh, I can't even believe I'm saying that. You don't like it till my thank you. I I say my age all the time, and I still have these guns. In case you're listening, that was a bicep I'm talking about. But but what I noticed is people need proof that what you're saying is not just some doctor who's just blah blah blah, right? So, wellness worries, I'm gonna give you proof of what Dr. Ryan is seeing and how effective listening to him is. About six months ago, you told me about adding creatine monohydrate to my morning and evening routine, which I did the very next day. In only three months, my video editor and my husband said, something is happening to your brain. It is working so much faster. Your word recall. My husband, who is a traumatic brain injury survivor, also is like, you're like bz, bz, bz, bz, bz. I can't even keep up with you. I'm gonna start doing what you're doing. And then my in-laws started doing it, and they're seeing a a difference. So just that one simple change, even though I was already doing a lot of the right things in air quotes, but that one simple change that you told me about has really, I think, reversed some of the damage to my brain, to my injured brain.

SPEAKER_01 10:27

Wow. I I'm so glad to hear that. And I the the I I I I live for stories like this, really. And it just makes me so, so happy to think about what again, what a minor shift, right? This is not, we're not talking about having to go run a marathon every day. I mean, this is literally just taking a scoop of creatine and a glass of water, and that's it. And now it's habit and it's it's there every day. But that minor shift, these are the things I'm talking about that just a very, very subtle one degree pivot has these massive compound benefits over several months. And and again, think that that's just a four, six months. I mean, you know, think about extrapolate that to a year, five years. I mean, to what you're doing with your podcast and your business and everything we were just talking about offline. I mean, there's there's a lot of opportunity here or opportunity cost to not doing these things. And and they're simple. I mean, this is just this very, very basic. And this, and again, there's there's quality data for for those out there that have any questions about this and traumatic brain injuries, especially in in the acute setting. So right after somebody's in the middle of a head injury, we can actually push that dose quite high. So closer to maybe 20 or 30 grams a day for a period of a month or two. And we we think at least that this helps lower neuroinflammation. This helps with in increased neurogenesis, so reforming connections in the brain, and certainly on the maintenance front, provides more energy, more in the form of ATP to help our neurons function better. And again, you're you're living proof of that result, which is very exciting to hear. So thank you for sharing that.

SPEAKER_00 11:58

Yo, you're so welcome. Thank you for the tip. And for those unfamiliar, when Dr. Williamson talks about more ATP, he's talking about more energy at the cellular level. Is that right, Dr. Williamson?

SPEAKER_01 12:11

Yes, I I do not mean to speak over anyone's head here. Yes, ATP is the energy currency in our body. Uh, we we make it largely from sugar or glucose, but creatine helps that system along and helps us recycle that ATP faster. And to Antoinette's point here, if anybody takes above five grams a day, so kind of in that maybe 10 gram range, uh, which is currently what I take as well, we can actually increase the availability of that creatine to cross our blood-brain barrier, which is this selectively permeable covering that sits around our brain and keeps harmful molecules out and allows things to pass that that we need to get into the brain. But but there's actually a transporter called the creatine transporter that helps us shuttle that creatine across to get to our neurons, to, to help with brain function. And again, on a molecular level, that's that's all fine and good and and would probably make everyone's eyes glaze over if I go any further. But in terms of quality of life, it it shows up as things like better energy, better mood, more cognitive sharpness, focus, better sleep for a lot of people, better strength, endurance at the gym. I mean, there's just the the list goes on and on. So yeah.

Sleep Regularity And Wearables

SPEAKER_00 13:22

So for the wellness we're listening who wants to live longer and keep their mind sharp, what are the first levers that move the needle? We know creatine is one of them. And what is a realistic outcome for someone to control starting this week?

SPEAKER_01 13:36

Well, even again, taking a scoop of creatine and water is very simple, but I one of my favorite places to start with people is to work on optimizing their sleep. Um, you know, we we can talk about exercise, we can talk about nutrition, we can talk about all these other things, but you know, that a lot of that takes more effort. And sleep is something that we all do. And turns out our brains need. And depending on who you are and and what your circumstances are, everybody's brain needs somewhere between six and a half and eight hours every 24-hour cycle. And you know, so so if you're getting less than that, that can be a problem. If you're getting more than that, believe it or not, that can actually be a problem. Um, so there is a there's an optimal window, and interestingly enough, not just duration, but regularity. So, meaning not not having a haphazard sleep schedule to maintain what we call our circadian rhythm. There's actually some evidence that sleep regularity is as important, if not more important, than sleep duration, which I think is something that a lot of people don't think about. And if if this sounds familiar to anyone in your audience, you know, many of us work Monday through Friday, and then when it comes time for the weekend, our sleep schedules are very different because we stay up later and maybe eat and drink later and sleep in more. And if if that if that shift is about really any more than about an hour in either direction, so meaning trying to maintain about a within an hour of what when you went to sleep or when you woke up the night before, that can actually have a very negative impact on our health long term, if we think about this. So again, another another minor shift, but really focusing on proper sleep hygiene and sleep regularity. This this pays dividends for people over time.

SPEAKER_00 15:15

Oh, that's really enlightening because what I find is that one day a week my body kind of forces me to sleep for 10 hours. And I was wondering what kind of effect that would have on my longevity and my circating rhythms. And now I know. So thanks for that answer.

SPEAKER_01 15:32

It's a complex and nuanced topic. And uh, and certainly if you're underslept one night and you know, don't and you need to sleep in the following day, that's fine. So, I mean that the brain can recover some. Intuitively, if we're tired, we sleep more. I think we all we all understand this. But in general, as best we can, we really want to try to keep that as regular as possible. And I'm very much of the opinion that that a wearable device can help us do this in terms of setting up best practices for keeping the sleep environment nice and cool, making sure that we're avoiding alcohol at well, ideally altogether, but for sure within three to four hours of bedtime, because that can that can wreck a sleep cycle, making sure that again, our our last calories are consumed at least three hours before bedtime. So our gut is inactive and keeping our brains awake, making sure we're in a dark, quiet environment. I mean, there are all these best practices for sleep hygiene and some devices that can really help with this too. But if you track your sleep with with any kind of wearable technology, you you can actually see, oh, last night I, you know, maybe I did eat or a little late or stayed up later, and you can see the impact this has on your resting heart rate, your heart rate variability, both of which are measures of stress in the body indirectly. You can see what more or less get a basic sense of a sleep study and was I properly cycling through my sleep stages or not, how much deep versus light versus rem. I mean, it's it's amazing what what can fit on your wrist or your finger that that previously took essentially a hospital room full of equipment to diagnose or monitor this. And this is available now to all of us as consumers, which at some point maybe we'll touch on the future direction of healthcare. But back to that compound effect, I mean, staying as healthy as we can today, I think is is one of the most important things we can all do to be ready for what's coming in the next decade, because the the rate of change in technology and healthcare is like nothing I've seen my entire career, and it's only accelerating. This is a very, very exciting time to be in this field.

SPEAKER_00 17:24

We'll need to make time for

Never Too Early Never Too Late

SPEAKER_00 17:26

that. If you need some information about the best uh wearable, healthcare wearable devices, AI assisted devices, also. There's a whole episode about that, so you can catch that on New Normal Big Life. So here's something our data surprised us with. We analyze who's binge listening and watching New Normal Big Life, and it's men as young as 18, and both men and women 35 and up. They're devouring our episodes on longevity and aging well at that young age. So let me ask you directly at what age should someone start thinking about longevity? And is there an age where it's too late? You've already done too much damage, just it is what it is.

SPEAKER_01 18:10

That's that's funny you mentioned this, and that's very interesting insight. I was actually telling my wife, Corey, earlier today, I was in the sauna after we did yoga together. So we did a group exercise class and then uh did did sauna separately. But I was talking to this guy who's 27, and he's reeling off all these facts about just longevity and wellness and wearables and you know, peptides and this and that. And I was like, wow, I mean, it to me, 2027 is is very young to be to be actively thinking about these kinds of things. He's a very fit guy. So 18. I'm that that is so impressive to hear that your listeners, as young as 18, are tuned into this and that this is important to them because the the point being, it's never too early to start any of this. I mean, by by definition, our bodies start aging from the moment we're born, arguably from the moment we're you know of of conception, our cells start dividing and aging. Not not something we think about, and there's a lot of resilience built in, of course, in the early years, but but the earlier we set healthy habits and the earlier we become more intentional about these routines, the the longer, again, the higher probability we push the health span lifespan curve, for sure. So that never too early. That's number one. Number two, in a way, it's also never really too late. And a favorite example that I love to give my my grandfather was an orthopedic surgeon, uh, World War II, Army Air Corvette, certainly my hero. And uh he he practiced orthopedic surgery for gosh decades. But his medical partner, who's still alive, is he's about 90 now. But about two years ago, he was experiencing just a ton of muscle loss, frailty, he was having balance issues, he was falling. And this is a person who was very cognitively active and socially active, but but never really exercised much. And for the first time in his life at age 88, he hires a personal trainer, he starts doing leg press, lunges, starts lifting weights. And Antoinette, we we went out to dinner with him and his wife, and he walked up to me like an 18-year-old, shook my hand, and about broke it. His grip was unbelievable. And and he's I mean, here's this spry, active, happy, healthy human who, again, at even at his age, is just a remarkable specimen of a person. And again, maybe maybe some luck had gotten him that far and didn't have a handful of chronic diseases. That that's for sure. You know, didn't didn't smoke, didn't drink, did some right things. But man, I mean, to take somebody at that age and have that kind of a transformation, our bodies are very impressive. So it's never too late. I want to be clear about that, but also never too early.

SPEAKER_00 20:40

Yeah, you know, it's so important for people to remember that our bodies are designed to heal itself when we give it the right things. And I love the story about an 88-year-old who reversed sarcopenia, muscle loss, and regained probably 10 more years of life, if not longer. And, you know, just the fact that he has a very strong grip strength shows that he has a very strong heart. So there's all these little factors. And let's spend a little more time on sarcopenia because a listener is having trouble with maintaining a regular blood sugar, their blood sugar spikes high, even though they're reading labels, they're walking, they've lost a lot of weight. They asked me what I thought, and I think sarcopenia, a loss of muscle mass when they l also lost weight. They lost it naturally, not with a GLP one, but I think that given the other lifestyle choices that they're making, could it be muscle mass that's throwing off their metabolic system?

SPEAKER_01 21:45

It certainly could. There's a lot on the table there. And by the way, Anton, I'm incredibly impressed with your your knowledge of all of this with sarcopania and metabolic health. This is fantastic. Grip strength. I mean, I have a medical background. I love this. So insulin resistance is often. Underdagnosed and it flies under the radar. And it's estimated that about 50% of U.S. adults are insulin resistant. So that yeah, about half. So that's pretty concerning. 93% of Americans are estimated to be metabolically unhealthy, which has either to do with glucose or high cholesterol, increased abdominal circumference, that there's a whole handful of factors that play into this. So but unregulated blood pressure, et cetera. So most of us have at least one of those, if not several of them, happening. And insulin resistance to me is perhaps one of the most concerning, because to your point, sarcopenia, which is defined as age-related muscle loss. So we all we all lose muscle mass as we age. Aging to me is not normal. I'm re-reframing my view of normal there. Yes. That's my new normal, right? How about that? But but if if we don't combat, it is something that happens. And we preferentially lose what are called type 2 fibers first, which are the strength fibers. This is kind of a whole lecture. I'll try to keep this high level, but type two for strength, type one for endurance. But the type two fibers, once they, once they go away, they they don't come back. So we've got to maintain them. But there is no question that our muscles are the largest sink for glucose in our entire body or sugar. So when we ingest carbohydrates, our our blood sugar naturally rises. That's normal as our intestines absorb that sugar. And if we don't have enough muscle to help lower blood glucose by our muscles essentially being hungry and saying, hey, we know we've got enough mass here to take care of and work to do, because we've trained our muscles to lift weights or walk or run or do all these things. So we store that glucose in the form of something called glycogen. If we don't have enough muscle mass for that process to take hold, we rely on our pancreas. And one of the main hormones from our pancreas is insulin. And if our bodies are trying to excrete insulin, excrete insulin, excrete insulin, and our glucose isn't dropping, our tissues become insulin resistant. And this is a major problem because this underlies a host of chronic medical conditions, not just diabetes, but cardiovascular disease, Alzheimer's, believe it or not. I mean, there's just a whole host of accelerated aging processes in the body that contribute to poor health and adequate muscle mass is a major fix for this. So if you are not an active person, I would highly encourage you, at minimum, to walk three or four miles a day because that's one way that we can actually, in most cases, regulate blood glucose. Sounds like this person's maybe having some trouble with this, but certainly dedicated cardiovascular endurance and also weight lifting are two other ways to do this. Another, again, this, I'll try to keep this high level, but a mistake I see a lot. I just want to share this because this is common. For people that do cardiovascular work, they often slip into work that's actually too intense. And this sounds very counterintuitive. So I want to be clear about this. But there are five what we call cardiovascular zones. So zones one through five. Zone one is walking, zone two is a notch above that, where you're just doing maybe some jogging or some running, depending on how fit you are. And then all the way up to zone five, which is like an all-out sprint, right? Zone two is the zone, is the heart rate zones to find a 60 to 70% of our maximum heart rate. That's the zone where we gain the largest amount of metabolic flexibility, where we can combat this insulin resistance and we can tell our muscles to be able to switch from sugar metabolism to fat oxidation, where we burn fat. This is critical because a lot of people end up training into zones three and four where that benefit largely diminishes. And even in endurance training, where you look at marathon runners or, you know, tour de front cyclists, all these people, they don't train in those zones. They're considered junk miles because their bodies aren't undergoing the actual physiologic adaptations to change their muscles to get all of these physical and metabolic benefits. No question, zone five helps too. That that helps boost what's called our VO2 max, which is perhaps the strongest predictor of all-cause mortality if that's if that's elevated. I wanted to spend a minute on that because a lot of people end up over-training and pushing themselves into these zones three and four, thinking that harder is better. And this is actually a conversation that I have with with the Marine Corps and the military regularly about hey, training harder is not always training smarter. I mean, we can elevate the performance of our active duty service members by actually training less in some ways, which is a very counterintuitive thought.

unknown 26:31

Right.

SPEAKER_00 26:32

And you mentioned something that I wanted to go back to, VO2 Max. Can you talk just a little bit about VO2 Max and its importance?

SPEAKER_01 26:42

Absolutely. So this is another kind of nerdy concept, so just hang with me, folks. But VO2 Max is thought of as our our body's efficiency or at least the level of efficiency that we can extract oxygen from our bloodstream. That's measured in milliliters per kilograms per minute. So it's a very complex calculation. And to really understand this or get this right, this has to be done through what's called a cardiopulmonary exercise test. So basically, if you ever see somebody in an exercise lab with the big mask on and they're on the treadmill and they're hooked up to all the leads, that's that's that test. Why is this important? Why do you need to know this number? There's a there have been a handful of studies that have looked at this, but there was a large landmark study, I believe it was around 2018, that looked at, goodness, I mean, thousands of people, and they compared the the top two and a half percent of elite athletes around the world to the the least fit people on the planet. So the the lowest quarter of fitness as measured by this VO2 max number. When we compare those two groups, there's literally a 500% difference in all-cause mortality or the risk of dying of anything between these two groups. For perspective, if we have a drug trial and there's a 10 or 15% improvement in symptoms, like we get excited about that. So a 500% decreased risk of dying of anything is like mind-blowing when we look at numbers. And uh the reason I think that's so important and the take-home message here for everybody is that metabolic reserve and just fitness in general is truly that important when we look at our body's ability to buffer against disease, so against chronic disease, all the things we're talking about, avoiding insulin resistance, diabetes, maintaining our cholesterol levels, maintaining a healthy weight, decreasing visceral fat, which is pro-inflammatory, which can increase cardiovascular risk and strokes and heart attacks. If we're critically ill, we don't think about this a lot. But if we end up with an ammonia or a sepsis in the ICU, people that have that are more fit going into the ICU or that have more muscle mass, period, actually have a much higher, like a three or fourfold chance of actually making it through that critical illness versus people who don't, which is a very scary thought. I mean, just no matter how you look at this, it is the single most powerful indicator of who lives a long, healthy life and something I think we should all strive for. And again, the if you don't have access to one of these CPET tests with the mask and all of this, just know that by putting the appropriate training protocol in place, focusing on strength, focusing on endurance, you will you will elevate your VO2 max for sure, and you'll be moving towards that upper tier for sure.

Brain Health Tests Before Symptoms

SPEAKER_00 29:22

And when we talk about the importance of brain health, why is brain health often missed on a checkup?

SPEAKER_01 29:29

Well, so this is a very interesting fact about the brain is we have what we uh what neurologists and neuroscientists call our cognitive reserve. And cognitive reserve basically is a buffer between a level of insult and a clinical symptom. So, meaning our brain can take a fair amount of abuse and we can lose a fair amount of neurons or brain cells over any number of years before the first symptom ever shows up, which is very surprising. So when we think of a condition like Alzheimer's, for example, which is a neurodegenerative disease where we lose neurons by the millions and eventually billions, I I I conventionally I was trained to not even think about this until somebody shows up in my clinic with memory loss, or maybe they have some language dysfunction or something like this. And we go through this workup and go, oh, well, got to do an MRI and all this blood work and rule out all these other things. And when all that's normal, we go, ooh, it's probably Alzheimer's. And this is gonna be a really tough one-way street for the next five to ten years, if we're lucky, as people slowly lose their identity and their sense of purpose and self and physical function and ultimately succumb to that disease. So it's a terrible, terrible existence, very sad, and something that I see all the time. The reason that's missed is that we we haven't had the right tools to look upstream, not downstream, from when these people show up. And Antoinette, that that has changed. I am really yeah, I'm very excited to share that for the first time we now have tools to obtain brain imaging on somebody. So we can get an MRI of someone's brain, where the again, the gold standard has been a radiologist, a board-certified radiologist, looks at this and says, Yeah, well, there looks like there's some atrophy or shrinkage here, or get a neurologist involved, and we go, yeah, that sounds about right. But but the sort of that's that stop there. We now have AI-assisted tools that can actually look down to the percentile at the volumetric size of each brain lobe and compare this to a set of age-matched controls. So think somebody's cognitively normal, they don't have the first symptom, uh, they're they're totally normal. That's a 50-year-old, high performing person, we scan their brain, and compared to every other normal 50-year-old, they've got temporal lobes that are in the 10th percentile, which is very low. So they've they're they're lower than 90% of their peers. That that raises my eyebrow. We can now do a series of blood tests, one of which is called a PTau 217, so PTau 217. And this with a very high sensitivity and specificity, or at least high diagnostic accuracy, can correlate to the level of amyloid and tau burden in the brain, both of which are hallmarks of pathologic changes in the brain for Alzheimer's. So, meaning we can make a essentially a preclinical diagnosis of Alzheimer's now with an MRI and a blood test in totally normal people. And this is incredibly meaningful because we now have a runway to aggressively modify the the lifestyle and the treatment plan of these people before they've lost so many brain cells that that we're stuck down the Alzheimer's path.

SPEAKER_00 32:34

That's incredible. And is there any discussion of this becoming kind of a standard test that you have on a physical once you reach a certain age?

SPEAKER_01 32:44

Yep, there sure is. So yeah, and that's part of the trouble is this isn't very valid until maybe somebody's in their late 40s, early 50s. So there's this is still being worked out as far as this being a standard panel, but it is a test that I run with with my concierge patients because I believe in it and I believe this is very important information for people to have. So you can you can go to your doctor and ask for one of these. Again, if you're 18 to certainly 40, probably gonna be negative. So probably gonna be a waste of a couple hundred bucks if you're cash pay. That's about what the test costs $200 ish dollars most places. And insurance may pick it up if you have memory loss or something like this. So that's that's worth the conversation. So I don't want everybody, all your 18-year-olds rushing out going getting PTAL 217s. Don't do that. But but certainly once we're a little older and we've had more time for some of those proteins to potentially accumulate. This is very relevant for people to know. I do think everybody, however, should have what we call the ApoE genotype tested. So what is that? That's that's a risk gene for Alzheimer's. We get one copy from one copy from dad, and there's basically a low, a medium, and a high risk version of this thing. Most people sit somewhere in kind of the medium risk category, but about 25% of the population carries at least one copy of the high-risk version, and a very small about a two and a half percent of the population has has two copies of the high-risk gene. So why does that matter? Well, one copy increases the relative risk of developing Alzheimer's later in life by about two to threefold, and two copies raises that by about 10 to 12 fold. So if you fit in one of those camps, that's worth knowing because lifestyle became that much more important. And those people need to be very mindful of everything we're talking about: sleep, nutrition, exercise, BO2 max, avoiding smoking, avoiding alcohol, cultivating healthy relationships. If you've had a traumatic brain injury, taking your creatine, all these things, right?

SPEAKER_00 34:34

And to to impress that point further, my aunt Liz lived to be 106. Her two brothers, my dad and his twin brother, my dad developed Alzheimer's, his twin brother did not. So two out of three siblings did not develop Alzheimer's. And I do believe my dad was at high risk because he had a brain injury, multiple brain injuries in the military. And then later, for one year of his life, one year out of his entire life, he didn't practice good lifestyle choices. Not eating. Well, he ate good food, high quality food, uh whole foods, but not too much of it. He gained a bunch of weight, of course, that added inflammation, and then the inflammation I think over that one year is the difference. Because the rest of his life and his brother's lives were pretty much the same. That was the one thing of my dad's bad lifestyle choices for one year of his life.

SPEAKER_01 35:39

I'm so sorry to hear that. And uh it is interesting to think about these things and context. And I think you bring up a great point here because even though we know a whole food plant-based diet or even a Mediterranean diet or mind diet, those probably have the top three in terms of evidence for for lowest all-cause mortality. And certainly I'm I'm personally more fan of the Mediterranean diet for brain health. Me too. Because it allows for more, yeah, more omega-3s, more, more healthy fats, which 60% of our brain is fat. So very, very important. And about 40% of that fat's DHA, which is one of the two molecules in omega-3s. So omega-3s are very important. If you're not getting enough fish in your diet, would highly encourage everybody to seek out a high-quality omega-3 supplement. I think that that can have pay dividends on cardiovascular health and decreased risk of Alzheimer's. But but the point that I wanted to make is that you you can do all that. You can have a whole food plant-based diet. You can be on a Mediterranean diet, but if you overconsume and we're not mindful of caloric balance, then it does lead to metabolic issues. And now we're back in the insulin resistance camp, the visceral fat camp, the hypertension or high blood pressure camp. So we that balance and knowing what our energy needs are is every bit as important as what we put in our bodies. And I just think we don't talk about that enough as a as a society. Our general uh education around nutrition is is quite poor. And it and it shocks people to hear this, but I did not have a single nutrition course in medical school. Think about that. The doctors do not that this is this is changing, at least so I'm told. But in my era and certainly before, doctors do not receive a single course on nutrition, which is mind-blowing.

SPEAKER_00 37:14

Really is.

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SPEAKER_00 37:15

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Concierge Medicine Cost Value Tradeoffs

SPEAKER_00 38:38

So you mentioned concierge medicine, and I've said it several times. Let's define the model. What is concierge medicine? How is a concierge doctor different from a traditional primary care or direct primary care experience that most of us grew up with? And is it worth it?

SPEAKER_01 38:56

Great question. So we in in our broken system, when somebody goes to see a primary care doctor, family medicine, internist two member, those doctors often have panels of several thousand patients at a time. And that's where it gets into this just churn and burn of, you know, five to ten minute visits, if that, and you're you're just a number in a line. That's where we've gotten. And I will try to stay off my soapbox about this, but it has a lot to do with insurance companies, drug companies, management, private equity takeover. Could do a whole nother episode on that, right? However, to have a concierge model, which is again our direct primary care model, which has emerged as an answer to this. Doctors are burnt out, patients don't feel taken care of. So I think just a sort of this free market model that's emerged is doctors that break off and say, I'm not taking insurance, or perhaps only billing insurance for select tests or procedures. And people can basically pay a subscription fee to have a doctor that doesn't manage several thousand people, but maybe several hundred people. And that largely improves the level of access and the the expediency of being able to get a hold of your doctor to have a meaningful conversation about whatever's going on with your health. That's major, major difference.

SPEAKER_00 40:21

And here's the new model. The patient saw this choice as you just want more money out of my pocket and you want me to pay up front. And I don't think it's worth it. I tried to convince the listener that they are going to get better care from their doctor. See if you can do a better job than I can.

SPEAKER_01 40:41

Yeah. No, you hit the nail on the head. I mean, and this is something I truly struggle with ethically, because this is going to not be available to everybody. And if people can't afford this model, there's a very valid argument, in my opinion. That's unfair. So if somebody has the financial resources, I know some programs are close to $100 a month, some are hundreds of dollars a month, and some even into the thousands of dollars a month, depending on the level of access and the level of testing that people offer, and even upwards from there in the ultra, ultra niche spaces. I would encourage people to frame it this way: think about what do you spend on your grocery bill? What do you spend on a cell phone? What do you spend on a car payment or rent? Look at your monthly budget and think about where your money and your dollars go and what do you allocate to different things in your life. And I recognize that most of those things are essential for people. Most people need a car to get to their job. We all need shelter and a place to live. We all need sustenance. I fully recognize that. But I'm very passionate about financial education as much as I am health education. And I think we all miss that too. Doctors get zero financial education either through our entire trading pipeline. And doctors are abysmal at managing money for what that's worth. Just as a side note, that so are, I think, the rest of our fellow citizens. So just as a basic exercise, I would encourage everybody to just get a pen and piece of paper out, look at what you spend every month, and see where is my money going. And this isn't just a concierge argument. This is just for life in general to actually build wealth and to add some cushion to your life. And I think it surprises most people when they do this to go, my gosh, you know, I'm eating out X number of times a month, or my money's going here. It's very easy to recover some of those dollars and reallocate them towards investing, saving. Of course, I'm biased here because it's what I do for a living, but I think there's no more important investment than any of us could make than in our health, because our health, we can't do any of the things we're talking about anyway. So it's a bit of a reframe on how we think about this, but I think it's an exercise worth doing. And again, when people actually look at the total cost compared to what they're actually getting and the value when it comes to this compound trajectory for their health span, their lifespan, et cetera, I think it's an obvious choice.

SPEAKER_00 42:47

You know, I pay for out of pocket when the coverage that I get from my insurance and, you know, from the VA, when I am not getting answers to my biggest health challenges, I am willing to take money out of my household budget, out of my pocket to go pay for a second, third, and fourth opinion. Sometimes it's telehealth, sometimes it's within my community, and I also pay for, I'm not big on taking medications. Like I don't take any medications at my age, is amazing. But impressive. Thank you. But, you know, when I had uh what is it called? Valley fever, which on an x-ray looks like cancer, you know, the big C, and you're very afraid, but you also realize that if it is the big C, you have an expensive bill ahead of you, and you also are going to put your body through a lot. You want to make sure that's what it is. And it was not in my case. I would not have known that if I had not paid out of pocket to get another opinion, and then an $8 prescription out of my pocket was the fix. So that That I hope impresses upon you that health is wealth. And without your health, none of your life's plans are possible.

SPEAKER_01 44:08

I couldn't agree more. And and to take that a step further, if anybody just has access to the internet, certainly with where AI is headed. I mean, I, you know, we've got to be careful about relying on AI for health advice on its own. But I mean, there there's some emerging data and some studies that show that it's it's getting very close and I think can help people really navigate a complex healthcare landscape who otherwise wouldn't necessarily have access to a concierge doctor to at least help them make more informed decisions for themselves. So there's that emerging angle as well that that certainly is a lower cost alternative that I think could be helpful.

Healthcare Futures And Final Takeaways

SPEAKER_00 44:44

So tell us in our last few minutes, what is exciting news in healthcare for the future?

SPEAKER_01 44:50

My gosh, so much. What what used to me to be, I don't know, every every few months, you know, we would see something, some some new breakthrough, some earth-shattering study or groundbreaking research. This is happening like multiple times per week. I mean, in terms of the the rate of accelerated change. So I think the the next five to ten years, perhaps even sooner, are going to bring some of the most exciting changes we've ever seen in terms of access, costs coming down, better therapeutics available. I mean, the list goes on. We can do a whole episode on that too, but but I'm very, very optimistic about where our field's headed and I think the future's bright.

SPEAKER_00 45:26

Wow, I'm excited to hear about the costs coming down and greater access because uh, you know, seven minutes is just not enough time. And what I noticed is that there's a doctor that I go to and they're always so friendly and welcoming and patient with you talking about your symptoms and what you're trying and what's working and not working. And my last two appointments are shorter and shorter. And I am watching this very kind person's personality change, not for the better, I think because of the time constraint. So I really like the idea of concierge medicine, and I have planned to take more money out of my budget to use it more often.

SPEAKER_01 46:12

Again, if it's affordable, which I think it might surprise people how affordable it can be when they do that financial exercise, I would highly encourage everybody to take a look because I think they'll be pleasantly surprised at what they find, and even more so at the results of the care.

SPEAKER_00 46:25

So, Dr. Williamson, what more do you want to leave us with?

SPEAKER_01 46:28

Take care of yourselves, folks. I mean, you get you're issued one brain and one body, and you know, there's a lot that we can do to optimize it. And unfortunately, we're not born with the operating manual. So you've got to listen to great shows like this to get some of this information. But I certainly hope this is valuable. And uh again, I do my best to provide free education for people. So if anybody wants to check us out, we'll include our social media links in the show notes, transcend healthmedical.com is our site. We're in the middle of rebranding RyanWilliamsonMD.com. We'll have more of the educational piece that should be up hopefully soon and in the next week or so, or maybe even by the time this show is out. So we'll include that as well. But uh yeah, just wish everybody a healthy, happy life.

SPEAKER_00 47:05

That's beautiful. And are you taking new patients in case anybody's like, I really want to work with this doctor?

SPEAKER_01 47:12

We sure are. Yes. We we opened our doors about a month ago, and uh, we do have spots left. So if that's of interest, again, if anybody heads to any of the websites, Transcend Health Medical, or again, we'll include our email as well. Happy to reach out, happy to happy to chat.

SPEAKER_00 47:25

Sounds great. Thank you so much for joining us. This has been so delightful and enlightening. Thanks, Antoinette.

SPEAKER_01 47:30

The information in this podcast is not medical advice and should not be treated as such. Always consult your physician or healthcare professional before pursuing any health related procedure or activity.