Welcome to today's podcast! Our guest is Dr. Manuj Agarwal, an expert in oncology, cell biology, and fitness, who is pioneering the field of longevity and integrative health. Based at MedCoShare's King of Prussia office, Dr. Agarwal is here to discuss his transition from traditional healthcare to his new venture, Blue Wealth, and share insights on how we can not only extend our lifespan but also enhance our quality of life. Dr. Agarwal, welcome to the podcast.
Ronak 0:00
Today's guest is Dr. Manuj Agarwal, a seasoned expert in oncology, Cell Biology and fitness. He passionately leads the way in longevity and Integrative Health. His new venture is blue wealth, based in MedCoShare's King of Prussia office. Dr. Agarwal, welcome to the podcast. I'm very excited to speak with you today. I've been reading Dr. Peter Attias’ book Outlive, and one of the things that struck me is how we can significantly improve our lifespan with changes in behavior and mindset. And it's not just about how long we live, but how well. So with that, tell us about your background and your decision to transition to longevity health.
Dr. Manuj Agarwal 0:35
Thank you for the introduction and thank you for having me. It's always a pleasure to have a platform to speak more about longevity, which I'm very passionate about. So I've been outside of residency now for about 10 years. Worked in radiation oncology for folks on the call who are not fortunate to not know about radiation oncology, it's the use of X-ray based radiation to help patients who have cancer for the most part. So I've been doing that for about 10 years, and I got to a point where many patients were coming in with things that I thought, I didn't want to see them in the clinic, because there were so many things that could have been done to potentially prevent this from happening. And then, on the flip end, I felt that there were many opportunities to prevent patients from coming back. The health care institution is very good at taking care of acute illnesses. It's very good at treating disease, but there's a big gap in prevention, and there's a big gap in what to do on the flip end as well, to prevent patients from coming back. So we see patients in follow up, and I'd have a lot to say in terms of things that they could do to to apply to their lives, but the model did not incentivize that for the patient or for the physician, and increasingly, the follow up care was being offloaded off the physician to increase the efficiency of the healthcare system. So I chose to leave the traditional healthcare model, because I felt more and more physicians were becoming what I call assembly line workers. We had a defined task. We did our task on this assembly line where a patient was coming in and they were handed off only to only be seen again when there's an acute problem. And I've been passionate about health and wellness for a very long time. I've applied it to my life. I apply it to my family's life. My friends and colleagues will tell you how passionate I am about this space. You brought up Peter Attia, and Peter Attia has done a tremendous job at making longevity mainstream, giving a title of longevity. Giving it a platform for us to speak about, and to make it accessible to everyone. And as Peter's story was a little similar to mine, in that he was getting frustrated that his surgical oncology training, he felt like he wasn't really helping people, and I got to a point in radiation oncology that, of course, the work that I was doing was very important for that patient who had cancer, but I got to a point where I felt like I'm not doing enough and I want to do more.
Ronak 3:12
Yeah, no, absolutely. So what are some of the primary factors that lead to someone not only living a long life, but a longer, healthier life, right? So, you see people all the time that they may live to 80 or 90, but in the last couple of decades, they might have a disease that they're just trying to manage, and they're not really living their best life. So I think the goal is really to extend the period of where disease actually takes hold and ultimately leads to death. So, what are some of the things that people can do right now to live a longer, healthier life?
Dr. Manuj Agarwal
Yeah, I think you hit the nail on the head. I think when many people think of long lives. They think of old age. You think of suffering. Inevitably, you have witnessed this with a family member, maybe your grandparents. You've seen someone who did not live well towards the end of their life. And we tend to make that connection and think, I don't want to live that way. I don't want to live long because of that. But that suffering is not inevitable. It's something that can be prevented. So we all have to die at some point, but disease throughout the course of our life is optional, and by making everyday decisions in terms of thinking about your longevity, you can actually push that off into the distance. So when you study long lived people and long lived populations, when you look at people in these blue zones, it's not that they never get heart disease, it's not that they never get cancer, it's that they're able to push it off decades beyond what we do here in America. So returning to your question, what are the things that we can do? There are a couple of domains that we can focus on to help push these diseases off and to keep ourselves healthy and robust longer. Number one is going to come down to nutrition. Nutrition, including, not just food you take in, but also a variety of different beverages and spices and things of that nature. Number two is going to come down to exercise. Number three would be sleep. Number four would be our mental and emotional health. And number five would come down to any medications or supplements that we might need to address current problems, to push things, to help augment things, but also as general, what we call general protection, which would be general drugs that can help delay the process of aging.
Ronak 5:54
Yeah, so I think the number one thing you mentioned was food. And do you see a big difference between vegetarians and meat eaters?
Dr. Manuj Agarwal 6:04
Yeah, good question. So that's currently kind of a hot button topic in longevity. So I think there's two camps in that space. I think everyone will agree upon the need for adequate protein in our diet. And, as we age, we think about frailty, and it's important for us to address frailty earlier, to help prevent it. So if you want to maintain strength as we age, we need to maximize our strength now. And part of building muscle is having adequate protein. The debate that comes in is whether those sources should be animal based or plant based. When you look at long lived populations, when you look at the five blue zones, there are a couple things that they have in common, and these were outlined by Dan Buettner in his book Blue Zones, for those who haven't heard of Dan Buettner. He was a journalist, previous cyclist, who went out and studied these areas that had long lived populations. And there's a Netflix special on it too, if you don't want to read the book. But he published a couple of things that he held in common, and one thing was what he called a plant tilt, and that most of these populations were mostly plant based, and when they had meat, it was very seldom, it was maybe once a year, maybe max, once a month. And some of that was because of geographic isolation, and that they didn't have access to plants, and that they grew up in areas, or they lived in areas that the economy wouldn't support. So they live mostly off the land. And these are the populations that have lived the longest. There's no population that we can think of that has eaten as much meat as we eat. That have lived long. Out of the five blue zones, there's one population that listeners of this podcast can identify more closely with, and that would be the pocket in California in Loma Linda. So these are Americans who have created their own Blue Zone. These are a group of Seventh Day Adventists who have a belief that caring for their body is part of being closer to God. And in their practice, they limit meat, and there's a large percentage of vegetarians. So the Seventh Day Adventists live longer than the average American. The average American lives to about 78, the average Seventh Day Adventist lives to about 83-84 but there's a discrepancy between the vegetarian and the meat eating Adventists, and there's about a five year difference there, 4-5 years. So the vegetarian, purely vegetarian Adventists live to about 78 sorry, 87-88 and the non vegetarian lived to about that 84. Now that non vegetarian group, they also seldom eat meat. So it's not that we're looking at a population that eats meat every day or with every meal, but also maybe once a week versus not eating at all.
Ronak 9:23
Wow, is that the only blue zone in the US?
Dr. Manuj Agarwal 9:27
There are pockets that are developing. So Dan Buettner also ran an experiment of sorts, where he went to a town in middle America and he created a Blue Zone to kind of show the fact, though, that this can be done if we had incentives to do so, and it was organized to do so. One other point I want to make is that when you talk about vegetarianism or eating vegetarian diet, versus not, most of human evolution, for most of human evolution, we have lived off of the planet. There's a popular diet called the paleo diet where you're eating kind of like what people ate back then, which is popularized as a lot of meat. But what's come out in the last 10 or so years is that these are ancient ancestors who lived in that era, and the Stone Age era, they ate a lot more plants and fruits than we thought. And it's just that, as we have fossils, the plants are mostly water based, so you can't identify that much, but through some more advanced methods, they found that they lived largely off the land, and they ate upwards of 110 to 115 grams of fiber each day. To put that into perspective, the recommended intake is about 25 to 35 grams. And only 3% of America actually consumes that much fiber. The majority of people are in the low teens. So going back to what's worked for us, living off the planet has worked for us. And people back in that Stone Age era, up until the 1900s didn't live very long. So I don't think we have any data that suggests that eating animals will help us live a long life.
Ronak 11:19
Right, and I think also one of the things that gets missed is, you're going back to what our ancestors ate, but they didn't have a sedentary lifestyle. It was a very active lifestyle, and they didn't have access to food 24/7. So for this modern world that we live in where you have access to everything 24/7, and we're not hunting for our animals, so to speak, right? It's, the mindset needs to change, because our bodies have not adapted to that different environment that we're living in now. I've been a meat eater for most of my life, but I recently became, I don't want to say vegetarian, but, it's more like pescatarian, simply because I realized that if I'm not going to work out five times a week, I don't need to constantly have this protein intake. My body just does not need it. And it's something that, I'm in my 40s, I've come to realize now as I get older, but, we're fed this myth where, okay, you need to have X amount of proteins to live and to be healthy. And I just don't think that's true. And I feel that. And I feel the difference in my body.
Dr. Manuj Agarwal 12:38
To make a comment on what you were just mentioning. You're right. I mean, if you look at every single organism on this earth has evolved on a rotating earth with periods of darkness and periods of light, and only in the last couple of generations did we have access to food 24/7. The light bulb wasn't invented until a couple generations ago. The refrigerator was not invented. I mean, our ancestors, if they went out at night, they became dinner, right? So we were designed to have periods of rest, periods of feast and periods of rest. But you're right. I think again, protein is something that's highly debated. At the very least, there's what's called the RDA protein, which is about one gram per or 0.8 grams per kilogram. And that's the bare minimum to prevent muscle lacing. And many would argue that you should get much higher than that in order to maximize muscle gain, getting close to a gram per pound. Exercising is an important part of longevity, and it doesn't necessarily have to be going to the gym and hitting it hard. Like you mentioned, our ancestors are moving around a lot. They were hunters and gatherers and herders. So incorporating movement into your day as a default is more important than this, than going to the gym and banging out 30 to 60 minutes of a workout.
Ronak 14:09
Yeah, are there some exercises that you'd recommend more than others to to live longer? And then also, are there differences for men and women in terms of what exercises they need to focus on?
Dr. Manuj Agarwal
Yeah, great question. So I'd say yes and no to that first question, and no for the second question. So it depends on what your goals are. For most people, when they think about what they want in life, both now and later. They want to maintain their quality of life, right? You want to maintain your independence. You don't want to rely on anyone else for your needs. You'd like to, you know, many people like to travel. Being able to travel involves walking a lot, it involves carrying certain things. Both in your hand at your side, like a suitcase, but also potentially putting things above you into an overhead storage. So there's going to be a certain amount of strength you need for that. You also need to maintain mobility, right? You need to be able to move, and you need to have stability. You want to be able to traverse surfaces that are imbalanced and not fall and hurt yourself, climb a step, go down a hill, go up a hill, all that's going to require a certain degree of strength, and it's also going to require a certain degree of cardiovascular endurance. So if we want to do those things in our older age, knowing that we're going to decline, it's inevitable. And as after age, 30 to 40, we're all declining. In terms of our performance, no matter how hard you work, there's going to be some decline. I'm declining. You're declining. It's inevitable that we can control our pace, but we can't control the fact that we will not be as good at 50 as we are at 40 for the most part. So that being said, we all should have strength training. We should all, have some cardiovascular endurance as a baseline. And cardiovascular endurance doesn't necessarily mean going and doing a HIIT workout for 30 minutes, because when you get older, you're not going to have 30 minutes of extreme exercise, and then you're going to sit down for the rest of it, you're going to probably have long periods of sustained activity. So that's the same approach that I do in my exercise, and that I recommend for clients, is long, sustained, kind of low threshold exercise, which is what we call zone two exercise. There's five zones or seven zones, depending on the type you look at, for the most part, five zones and zone two is that threshold where we want to keep our heart rate in order to maximize our endurance. So that would be the cardiovascular strength training, of course, full body. And then what gets overlooked commonly is mobility and stability, flexibility being part of that. If someone wants to go out and start doing certain exercises, but they have no mobility in their hips, they're going to hurt themselves, and that's the last thing people want.
Ronak 17:16
And do you recommend someone do this daily or every other day? Or what's the frequency of these exercises?
Dr. Manuj Agarwal
Yeah, good question. So we have to make it practical, right? So if someone says, Hey, Doc, I can work out, I can probably commit to four days a week, and in those four days I can do 45 to 60 minutes. Okay, great. Let's do an even split of cardiovascular and even split away training, and let's make that happen. And on the off days, what are some things you can get in? Are you at the very least able to get some steps in? Are you at the very least able to, if you're going to work and if you happen to go to an office and your office is on the fifth floor? Can you take the stairs to the fifth floor, both when you walk in, when during lunch, and things of that nature. Can you take a standing meeting? Can you take a walking meeting, incorporating, those kind of methods in.
Ronak 18:14
Right, no, that's great advice. So going back to genetics, right, and how that can influence lifespan. I mean, we're, we're both Indian and, cardiovascular disease is an epidemic in our culture. What influence does genetics and culture, impact our desire to just live a longer, healthier life?
Dr. Manuj Agarwal 18:41
Great question. So this is saying that genetics loads the gun, but epigenetics pulls the trigger. Epi stands for above. So it’s epigenetics means above the genome. What that means is that we may think that our society puts a lot of emphasis on genetics, and knowing your genetic risk is very important. But when it comes to longevity, only about 20, maybe 25% of your longevity is dictated by your genetics. So 75% or so of your potential longevity is based on decisions that you make day in, day out. There's a woman named Sonia, and her last name begins with an L, and I don't commonly pronounce it right, so I'll leave it at that. And she had some instrumental studies that showed that maybe about 50% of happiness is genetically programmed, and the remainder is based on what you choose to do. And her updated data suggests closer to 35 to 40% of happiness is genetic so it just kind of reinforces that what you do can play a huge role in how you feel and how long you live. So those lifestyle decisions are actually important for men like us and women who are South Asian or people who have genetic predisposition to certain things, our threshold to be lax needs to be even tighter. So there's many, I shouldn’t say many, but some studies that looked at why South Asians have increased cardiovascular risk. It's understudied, and I think we probably could do better to find out why that is. But no one can argue that that's the case. There's, we have our parents and potential family members and what have you, they have that increased risk in their host countries. But when you look at, let's say, for example, pulling back a little bit, you look at long lived populations. Historically, for example, the Japanese have one of the longer lifespans when they emigrate to the US within one to two generations. They assume our longevity. They assume our health risks, showing how powerful, where we live, and how we live affects longevity. So bringing it back to the South Asian context, if we are, if we have a predilection based on something genetic that we're again understudied, and we take that high risk, and we combine it with this American lifestyle, it's a recipe for disaster. So I think that we have to be even more stringent with how we live and how and what we do, the thresholds for targets for certain biometrics need to be even tighter. And I think we also need to take into account these risk calculators that will say you can plug in your numbers into any one of these risk calculators online. There's many good ones out there, but like many of the other studies, these are mostly done in a representative sample of Americans, mostly white men and white women, and they either under or overestimate risk for other risk groups. So for example, when you plug in your blood pressure, your cholesterol, your age, your demographics, into one of the more robust calculators by the American colleges of cardiology, it'll give you your 10 year risk and your 30 year risk of cardiovascular disease, which is great. I love going over this with my patients, but there's a little disclaimer there that says that this may underestimate risk for South Asians. Wow. So whatever you have there, I multiply by a factor and say your risk is actually much higher, and you need to be even more stringent with how you live.
Ronak 22:53
Wow. That's great to know. So going back to, you mentioned genetics play a part in happiness, right? And I was reading a study where positive people live a little bit longer than people who are negative. So what role does mental health and just having a positive attitude factor into living longer?
Dr. Manuj Agarwal 23:19
Yeah, there's like you said, I think having that, that outlook on life, that optimistic outlook that has been shown time in the time out, to predict for better outcomes as a whole, when you look in the inverse, we as physicians, when we see a patient come in with a serious diagnosis and they're alone, you kind of intuitively know, man, that person's probably not going to do as well, or they're going to have a hard time, compared to that person who comes in has tons of family support. There's this really great researcher at MD Anderson named Lorenzo Cohen, and he wrote a book called Anti Cancer Living. And he details something he calls a mix of six. And these are six factors that one can, can work on in terms of their lifestyle to prevent getting cancer, or the flip side, prevent recurrence. And the foundation of that is having strong social support and emotional support, and that plays a huge role in maintaining your emotional and mental health. But I think beyond having social support, beyond having strong family support, individual practices are extremely important, because whether we achieve something in life or we don't, comes down to our belief in ourselves, and it comes down to not just learning about things, but application. Many listeners to this podcast, you've gotten great content out of this podcast and many other podcasts that precede this, we also consume other media. Read other books, other podcasts, watch videos and learn about health, learn about all these amazing things that are happening, progress we’d made, things that you can do, but actually doing it is a different thing, right? The learning, the translating of knowledge and insight into action, that's the hard part. And I think having silence and stillness and thinking through things, identifying what the barriers are, looking at your habits and how those habits are either holding you back or helping you, those periods of having what we call, quote, what do you call it, mindfulness practice? That's where the magic happens. I think, unless we have a foundation of a mindful thought, you repeat the same, actions over and over again. And I forgot who said it, but they said that the definition of insanity is doing the same thing over and over again and expecting a different result. So through mental health and mindfulness, we can break out of that habit, and we can achieve more. Beyond that, if there are real diagnoses or things of that nature that are affecting your mental health, that's really important for you to address with your physician if you're feeling down or depressed, of course that's going to affect everything that you do.
Ronak 26:52
Yeah, I mean, you touched on something really important there, and that's that we have the knowledge. It's that lack of action that really, I think, is a problem. I mean, we have more knowledge now than ever in the history of the world, but you still see people that are sick and unhealthy and have so many problems, it's just because of that lack of action. So we live in the Northeast, and I feel like a lot of us are living in a rat race. I see it with my family, my friends. We're chasing money, we're chasing a career. We're definitely not taking as much time off as we should. And I feel like a lot of it's because we want to have a good life when we retire, but the focus is really just on the financial aspect, like, oh, I need X amount of money to live a good life once I retire. No one's really focusing on what their health is going to be like when they reach that stage, right? So what advice would you give to someone who obviously has a desire to make money and excel, but also, to be able to utilize it when they do retire. Like okay, you need to have good health to spend time with your family and friends, with your kids. You need to have good health to spend all that money. And I see it all the time where people work but they're not able to enjoy it. So what's your advice for someone to have more of a balanced life?
Dr. Manuj Agarwal 28:27
Yeah, great question. So my business is called Blue Wellth, and with wealth, there's a little play on the spelling there. It was spelled W, E, L, L, T, H, and I feel like that may resonate with some folks, because we all know what it means to be wealthy in terms of financial achievement, and we need a certain like you mentioned, you may have a certain target of money you need in all your accounts when you retire to have a comfortable life. But what value is it to have to be financially well off, but to suffer in terms of how you feel, in terms of your health, money cannot buy you better health. The balance of achievement. At the same time, maintaining your health is achievable, but it requires balance. And I think all too often, we make the choice towards our career over everything else. If you have a choice between, I made an extreme example, but if there was an important meeting, as opposed to being at your child's XYZ. It's a tough decision to make. Many I would hope would say I need to be at my kids thing. But many of the people say this is important for my career and we need to do this. Our default in this culture is to strive at all costs. But it's coming at a cost. So I think it comes down to striking a balance and having some boundaries in terms of, what is acceptable in my career, what is not. And I think, the last couple years, there's been more of an emphasis on, wellness in the workplace, de-emphasizing these recurring meetings, limiting meetings, trying to do things that having meetings and early things of that nature can help towards wellness. But I think in a more practical standpoint for what the listeners are doing or what the listeners want here is that what I recommend, and what I do myself, is I will schedule my wellness during the week. Like a calendar that's color coded, coded in Google where, work, business, will be one color, family's another color. Fitness is a color. And, like well being is another color. So every one of those things have to be scheduled, the fitness, the exercise, is going to be scheduled during the week. So it's a non negotiable. It's in my calendar, and I will not accept the meeting when I have that there. If there's something important that comes out, I need to be able to reschedule that to fit it in later in the week. But by scheduling those things, it becomes achievable, and my schedule gets a bit complicated, but I really do try to pack it in. It could be as simple as my 30 minute walk-the-dog is in the schedule, because not only am I taking care of my animal, but I'm also getting 30 minutes of steps in too. So I think being super tight with your schedule, but also prioritizing would be that one piece, but the other piece also tying in the mental health and accountability is really taking an assessment, taking an inventory of how things are going. You pick when you want to do that, whether it's at the end of each day or at the end of a week. I like Sunday mornings. I typically wake up early before everyone, take a look at my last week. How did I perform? What did I not do? What did I not achieve? And what do I need to do this week to be better, to achieve these things, and through these regular assessments by actually pausing, as opposed to just continue going on the rat race, then we can actually take inventory of how things are going, and then see if we like it or not, because I think all too common we kind of know what we want in our life. We know what kind of person we want to be, we know what kind of man you want to be, what kind of woman you want to be, what kind of spouse you want to be, what kind of parent you want to be. But life happens, and we drift from that. So these periods give you an opportunity to reset yourself.
Ronak 32:49
So in a given week, what’s your ratio like? How many hours do you spend working? How many hours do you spend with your family? How many hours do you spend working out?
Dr. Manuj Agarwal 33:01
Good question, so I typically work out six days a week. The workout is about an hour. That excludes walking the dog or walks in general. You can probably tell from listening but I’m a bit of an overachiever. So during the walk, I’ll sometimes throw a rock sack on so I’ll have a more cardiovascular walk than a regular walk. So I never kind of counted the ratios here, I try to get the workout in the morning before the family is up. And then, typically after I drop my daughter off to school, at 9:30 till 4 or so tends to be work. If I was not able to get the workout in the morning, I’ll work in the morning and swap out that time. At 4:30 till about 9, it’s all family time. I try to put the phone away, not look at the phone unless there’s something urgent. And after my daughter goes to bed, if I can spend some time with my wife, great, if there’s other work that needs to be done we’ll see if that needs to be done.
Ronak 34:20
And how much sleep are you getting?
Dr. Manuj Agarwal 34:22
So I’m in bed for at least eight to eight and a half hours. My app tells me, of that time my sleep efficiency is pretty good, it’s probably 85-90% of actual sleep during that time. I attribute that to just being exhausted from doing so much. But also for those who struggle with sleep, having good sleep hygiene is also great. Trying to limit stimulation before bed, eliminating light exposure, blue light exposure from your phone, but also sleeping in complete darkness and trying to keep things as quiet as possible.
Ronak 35:04
Yeah I definitely need a dark room that’s cool, I think I’m guilty of keeping my phone on a little too long. The days where I’m tired and I don’t have my phone an hour before bed I definitely get better sleep, so I just gotta be consistent with that. So tell us a little bit about Blue Wellth, how it works, and the different plans and pricings around that.
Dr. Manuj Agarwal 35:30
So Blue Wellth is a bespoke practice, it’s what I call concierge wellness to some degree. It is a custom tailored practice to the individual that I see. There’s no cookie cutter approaches here, it’s one-to-one care, focused on alleviating some current problems, but also with a future focus. Identifying these risks that you have now, that can pose a threat for you not immediately, maybe not in five years, maybe down the road and really working on those things. In addition to what longevity medicine is in most people’s eyes, we also apply integrative medicine to this as well. It’s a bit of a hybrid approach in terms of future focus but also getting deep into the root cause of certain problems. So for example, inflammation is one of the big things that drives disease so we really try to characterize inflammation, drive that information. The program offers in-depth longevity risks assessment, really getting a sense of what it is that is most likely to get you and then pushing that off. But also addressing the why behind it, when times get tough, having that deep desire and clear meaning as to “Why am I doing this, why is it important for me?” is gonna be the driving force. When you don’t feel like going to the gym, when it’s raining outside and you don’t want to get your steps in, when you’re presented with this giant blueberry muffin in the morning and your kid’s having it. Those are the times you are gonna come down and say “Why am I doing this, what do I want to achieve?” We also have integrative health coaching as well to help people really get down to that why and break through some limitations in terms of thinking and what’s holding you back from achievement. Nutrition as well, we do remote patient monitoring, everyone has a wearable for the most part, so not only having them learn more about what that data means, but also having that integrated into a platform so I can see it and give some feedback on how things are going. So certain things like you’re doing your heart rate exercises but also looking at your for example, CGMs, continuous glucose monitors, seeing how certain foods are impacting your blood glucose and giving feedback on how your specific body reacts to that. In fitness as well, coming up with customized fitness plans, before we do that, I always do a functional movement screen to make sure that whatever I am recommending to patients isn’t gonna hurt them. So if someone has something identified on their movement screen, I would adapt the exercises to prevent that from causing injury but also have something focused towards that issue that will correct that deficiency.
Ronak 38:47
Makes sense, are there tasks that you recommend? So if I’m a patient that’s struggling and other than the initial screening and assessment, are there any testing that you would recommend to get a better picture?
Dr. Manuj Agarwal
For sure, there will be some standard blood work, some blood work can be done at your regular lab but it's also some functional integration medicine lab work that will get a little more deeper that’s done through a separate lab. That’s fairly standard. And depending on a patient’s complaints, we may have some other blood work added to that as well, it could also be stool studies to check the microbiome. Depending on the individual there may be some imaging that we also recommend. Everyone’s a bit different but options can include a whole body MRI, better characterizing carotid arteries, some AI enhanced technology, a dexa scan to look at body composition will be another thing we think about and also VO2 max testing.
Ronak 39:50
Amazing, Dr. Agarwal I really enjoyed this conversation, where can patients find you?
Dr. Manuj Agarwal 39:55
Bluewellth.com would be the best place to learn more and of course here in this space
Ronak 40:00
Awesome, thanks for coming on!
Dr. Manuj Agarwal 40:01
Thank you for having me!
