Semaglutide and mortality ⎮CLEERLY yes or no ⎮ Ketone devices ⎮Meet Dr. Neil Paulvin ⎮ Mastermind BTS

Your sneak peek into the world of Longevity Docs.

Sep 08, 2024

Hey Docs,

We’re just 4 weeks away from the Longevity Docs Mastermind! I'm beyond excited for our second edition, though there’s still plenty to prepare. I’ll be sharing behind-the-scenes (BTS) updates to keep our community in the loop.

One thing that stood out to me during ARDD was how many doctors, despite knowing the importance of health, often put their own well-being on the back burner. I used to do the same. Remember to carve out time for yourself—when you’re at your best, so is your ability to care for others. Personally, I find exercising while traveling to conferences a great way to stay active and enjoy the city.

This week in our newsletter:

Community:

Mastermind BTS updates
Meet our speaker: Dr. Neil Paulvin

Buzz in the Chat:

CLEERLY - on target or overshoot?
Lumen vs. Biosense: How do they compare?

Publications:

Semaglutide and its impact on mortality and COVID-19
Compounded peptides and obesity medicine
Global study on adiposity and hypertension
Endothelial glycocalyx regeneration for cardiovascular health
Coronary artery calcium and risk stratification
LDL cumulative exposure hypothesis
Atherosclerotic plaque in zero calcium score patients
BPC 157 as a potential therapy for glaucoma
Spermidine’s role in autophagy and longevity

Press:

FDA-approved drugs reduce overall mortality
Whole Foods founder John Mackey enters the longevity space
RISE-THRIVE initiative focuses on immunology and healthspan
Flexibility and increased lifespan

While scrolling our chat every day, I’m constantly amazed by the energy and generosity of our members—supporting and learning from one another. This is what medicine should feel like!

Looking forward to seeing you all in New York on October 5th.

Happy Sunday!

David Luu

🚨 Longevity Docs News

🧠 Mastermind BTS

I know you all being asking but we are still working on the agenda!!! We’ll have keynotes, Oxford-style debates, and roundtables, but we’re also focused on creating opportunities for connection. We’ve included more networking time, plus movement and mindfulness sessions to help build bonds and encourage peer learning. We are working as well on a special dinner experience — don’t tell anyone!

🎤 Dr. Neil Paulvin will speak at the Longevity Docs Mastermind NYC on October 5-6

Meet Dr. Paulvin

We are thrilled to announce that Dr. Paulvin, a trailblazer in Functional Medicine, Integrative Sports Medicine, and Regenerative Medicine, will be joining us as a speaker. With expertise in Osteopathic Manipulation and Craniosacral Therapy, Dr. Paulvin offers a groundbreaking approach to health that identifies the root causes of symptoms and crafts individualized treatment plans.

His innovative methods blend lifestyle modifications, cutting-edge diagnostic tests, supplements, and, when necessary, prescription medications to optimize health swiftly and effectively. Whether you’re an athlete, entrepreneur, or executive aiming to elevate your performance, Dr. Paulvin specializes in human optimization and biohacking, delivering tailored plans to help you achieve peak wellness.

Don’t miss the chance to hear Dr. Neil Paulvin share his insights into personalized health and cutting-edge treatments!

Book Early-Bird Ticket

💬 Buzz in the Chat

CLEERLY - on target or overshoot?

It would be a great live zoom discussion to have, including case studies with rationale and collegial debate. Otherwise it seems what’s being done here simply good guessing as we sure don’t have any organizational or national guidelines here .
I imagine everyone is doing pre-and post renal function?.. as well as at the very least giving a hydration protocol?
Amount and type of contrast matters as well. Baseline kidney function at minimum - and since so cheap and insightful, would include in that kidney function blood and at least a spot urine albumin/creatinine ratio - with post test GFR/Cystatin C being confirmed.
Some contrast injury info of possible interest. Please note, I think we all hear, disagree or otherwise, agree that we are all with the best of intentions and trying to help people live healthier, and hopefully a bit longer, lives.
I think contrast induced nephropathy is largely overstated. There are good studies that show similar rates of kidney injury after contrast vs noncon CT. The biggest driver of the kidney injury is likely illness/disease for which a CT is being ordered and less the contrast material. Agree that older contrast medium was higher risk, and that repeated big doses in short time frame could be problematic.
Caution in established CKD, DM, hear failure, etc. But for otherwise healthy outpatients, I make sure I have a baseline eGFR in the last few weeks/month, and I don’t recheck.
For patients undergoing contrast imaging, GFR is a critical factor in preventing contrast-induced nephropathy. Generally, contrast is safe for those with a GFR ≥60 mL/min/1.73 m².
Caution is advised for GFRs between 30-59 mL/min/1.73 m², and for
GFR <30 mL/min/1.73 m², contrast should only be used when absolutely necessary.
Most modern contrast media are low-osmolar or iso-osmolar, designed to reduce the risk of nephrotoxicity compared to older high-osmolar contrast agents. In the U.S., no radiology centers use high-osmolar agents, ensuring a safer approach for patients, especially those with impaired renal function, though caution is still necessary for those with significantly reduced GFR.
until we have RCT data it cannot be dismissed. If we are talking about doing CLEERLY on people to discriminate significant stenosis in those with zero artery calcium score, low CIMT (<25th percentile like myself) and totally clear triphasic LE arterial Dopplers, then we need to be much more sensitive re risk.
There’s no prospective RCT evidence at critical mass necessary to unequivocally prove value. We are running in an unofficial “expert recommended“ zone. Even if it’s a very small risk, one cannot be discounted until contention proven. Only then can it be accepted as routine. Until then I suggest paying good attention to pre-post hydration. I think this could even reduce the risk to virtually zero. Dehydration substantial increases contrast nephropathy risk.
Personally, I used to use CIMT ...I am finding CLEERLY to be finding more pathology in terms of non-calcified plaque where cimt was fine.
That said recently had a chat with CCTA radiologist who called me about a cleerly that showed <25% stenosis and the CCTA showed >50%! She said that she sees that alot where cleerly underestimates stenosis. Anybody else seen this??
I’m a CLEERLY evangelist, it’s caught lots of scary disease in a few of my patients in their 40’s. Outside of cost, and given no renal disease, I advocate strongly for almost all of my age appropriate patients to get one.
I agree 100%
I think the contrast is not an issue with normal renal function and good hydration.
I feel the radiation dose meets risk/ benefit criteria since we are dealing with an extremely prevalent disease with a very high mortality & morbidity.
I have seen so much bulky plaque in the Left Main and Proximal LAD, that I do not feel comfortable relying on peripheral arterial disease evaluation.
The way I look at it is the cost we pay for living in the US with significant traditional and non- traditional risk factors, is 1 mSV of radiation.
Recent studies show a significant amount of micro plastic in excised plaque underlies the non-traditional risk factors we face and have very little control over.
Since CAD dwarfs all other causes of death ( cancer prevalence is 50% of CAD) we need to be extremely proactive, especially since recent data has shown a slowing or reversing of trends of decreased CV risk.
I use CIMT and other measures of peripheral arterial disease as an adjunct, not replacement for CCTA/CLEERLY.
The last point is cost - but this is where Iferl that out wealthier patients are coming contributing to future cost reductions by volunteering and paying for the study now - costs will come down as this form of testing becomes more widely available.
I have a healthier patient population. I think CACs are generally useless if I’m looking for soft plaque in 40-50 year olds. I check a cystatin c and creatinine level on my patients.
I agree - I think CAC are essentially of no use.
Of course, one has to be selective and contrast nephropathy can be avoided - In those cases I am very aggressive in lowering ApoB.
This brings up the point of how much to lower ApoB or ApoB/A1. If there is evidence of plaque peripherally , and there are risk factors for kidney injury, and the patient is agreeable then I will simply maximize the lipid lowering regimen.
It has been my experience that most patients do not opt for this plan unless there is good evidence and the cost may be side effects of the medications (ie mitochondrial dysfunction).

Does anyone here use Lumen? Does it give a ketone level like Biosense?

gives score of carbo vs fat burning (1-5). "high" "med" "low" flexibility (low = no fat, high = fat burning) scored 0-21 in 3 groupings
Thank you. No direct ketone level though? What about Keto Mojo? Biosense apparently just went belly up.
It can be quite useful when combined with CGM. It’s actually how you can measure true insulin resistance vs physiologic responses
Glucose spike plus carb burn equals no problem. Lots of people think foods are “spiking them” when in fact it’s physiologic; and vice versa
Which ketone meter are you using?
I don’t actually use a ketone meter unless I have someone in an active keto diet; but I use ketomojo for that purpose. There are several CKMs approved in Europe that I’ve been wanting to try. If any of our European friends wants to give me a hand ;)
None are great yet tbh. Uses RER which is what lumen does, measures what you’re burning for energy. Sounds helpful, except the best determinant of that is what you last ate.
Only scenarios I see it being helpful are when you should be burning fat and are burning carbs (post a meal with high fat or post prolonged fast) and not active.
This one ? I could bring you one in New-York if you like ?
Have you tried it?
I’ve only heard bad feedback
I can’t speak personally and I’d be tempted to try it but feedback has been poor
One challenge is validation, validating against blood is a different compartment - so whilst it’s our only option the kinetics are different.
I can’t speak to the quality but don’t forget breath acetone isn’t blood BHB
I’m a little rusty on it but I thought breath acetone went up and then down as BHB went up.
Yes absolutely, breath acetone analysis is more for me about the ability of the liver to produce a bolus of ketones, like on the morning after an overnight fast and the reflect of metabolic flexibility. And need to be monitor at the same time everyday for comparaison.

🩺 Publications

The Effect of Semaglutide on Mortality and COVID-19–Related Deaths: An Analysis From the SELECT Trial

JACC - Recommended by Dr. Giovanni Campanile

Frequently asked questions to the 2023 Obesity Medicine Association Position Statement on Compounded Peptides: A call for action

Obesity Pillars - Recommended by Dr. Steven Murphy

General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants

Lancet - Recommended by Dr. Steven Murphy

Regeneration and Assessment of the Endothelial Glycocalyx To Address Cardiovascular Disease

I&EC Research - Recommended by Dr. Giovanni Campanile

Coronary Artery Calcium for Risk Stratification Among Persons With Very High HDL Cholesterol

JACC - Recommended by Dr. Tom Rifai

The LDL cumulative exposure hypothesis: evidence and practical applications

Nature Reviews Cardiology - Recommended by Dr. Tom Rifai

Atherosclerotic Plaque in Patients with Zero Calcium Score at Coronary Computed Tomography Angiography

Arq Bras Cardiol. - Recommended by Dr. Giovanni Campanile

Stable Gastric Pentadecapeptide BPC 157—Possible Novel Therapy of Glaucoma and Other Ocular Conditions

Pharmaceuticals (Basel) - Recommended by Dr. Desmond Ebanks

A surge in endogenous spermidine is essential for rapamycin-induced autophagy and longevity.

Autophagy- Recommended by Dr. Guenloe Addor

🤝 Job Board

The Mayo Clinic Florida is seeking a highly reputable, forward-thinking, and innovative Medical Director to lead the newly established Longevity Department at Mayo Clinic, Florida.

🗓️ Events & conferences

👉 Longevity Docs Mastermind: NYC - October 5,6
RAAD Festival - Anaheim CA - September 5-8
Biomarkers of Aging Conference - November 1-2, Boston, MA
Peptide Therapy Certification - September 6-7, Orlando, FL
A4M Fest - December 13-15, Las Vegas
Cannes Longevity Festival: Cannes, France - June 25,27 2025

About Longevity Docs Mastermind

The Longevity Docs Mastermind is a physician-only event focused on precision and evidence-based longevity medicine. This is where the medical leaders of today shape the future of longevity.

New York City - October 5-6, 2024

Convene 101 Park Avenue, NYC

Book Your Ticket Now