Loooongevity: Which Treatments & Therapeutics Actually Work?

Hi everyone –

I hope you had a great Thanksgiving. Mine was spent at home in Brooklyn, cooking a largely gluten-free, dairy-free meal with my husband for our kids and parents, and having some much needed downtime. If you went somewhere fantastic or braved the holiday travel crush – I salute you..and have zero FOMO.

As we head into the holiday season, today’s hottest wellness topic, Longevity, is top of mind for many of my patients. Health optimization and longevity have long been core to our practice at Parsley – I was even just named one of the 8 Top Female Longevity leaders by SheKnows. We’re probably the only place you can get everything celebrity longevity doctor Peter Attia offers in his practice at the same quality with top board certified doctors, including all the advanced tests, prescriptions, supplements and personalized care, but a fraction of the price and for many covered by insurance. NBD:-)

The Keys To Longevity

The keys to longevity—primarily those within your control—revolve around diet, physical activity, sleep quality, stress management (whether constructive or destructive), and exposure to environmental toxins. During certain times of the year, such as holidays, summer, personal and work travel, and winter, many of these “keys” are often temporarily disregarded. This isn’t a novel observation. However, I’ve recently noticed an increasing number of patients, friends, and followers turning to medical longevity treatments as a sort of “cleanse.” They view these treatments as a quick fix to compensate for periods of unhealthy living. As new clinics and practices emerge to meet this demand, I also observe people investing in these therapeutics without fully understanding what they’re purchasing, both in terms of value and safety.

To help you navigate this trend, let’s discuss some of these treatments, their potential value, and provide a foundation for deciding whether to try them.

What Are Longevity Therapeutics?

Medical longevity therapeutics encompass a broad range of treatments and therapies, including exosomes, Wharton Jelly stem cell injections, Hyperbaric Oxygen, Ozone therapy, and Ketamine IVs. Injectable peptides would also be on this list, had they not been recently prohibited by the FDA. These treatments are administered in medical settings under the supervision of physicians (hopefully) and represent a step beyond popular biohacker choices like cryotherapy and nutritional IVs.

A recent patient of mine underwent several Ketamine treatments, Wharton Jelly and exosome injections for injury areas, Ozone therapy (blood), NAD+ IVs, and Stellate Ganglion blocks at a specialized doctor. This cost her thousands of dollars. When she asked for my opinion on undergoing all these procedures, I asked her:

“Why did you go? What were your health goals? And how do you feel now?”

She sought to repair joint injuries, alleviate osteoarthritis pain, boost energy and mental clarity, and essentially “reboot” after a stressful work period.

When I asked if it worked, she said it was too soon to tell.

How I Would Prescribe Longevity Therapeutics

Do I recommend these therapeutics? My response varies—sometimes yes, sometimes no. But the most crucial aspect is our approach to them. Undergoing multiple therapeutics simultaneously makes it challenging to discern what is effective, where the true value lies, and what isn’t working. My concern is that some medical longevity clinics are more inclined to offer “the works” rather than identify which therapeutics are most pertinent and effective based on clinical history. They often lack involvement in ongoing medical care, leaving patients unsupported in the event of side effects or for follow-up evaluations. I would have preferred my patient to start with one therapeutic at a time, repeating and assessing the benefits of each, to truly understand the impact.

All Of The Longevity Therapeutics You May Be Hearing About And What You Need To Know

If you’ve been tempted to try some of these, or are hearing about them, it’s important to understand the evidence, if any, behind each and what they are for before you go out and spend a lot of money or risk a negative side effect. So let’s take them one by one:

  1. Ketamine Therapy. Ketamine is a non-psychedelic dissociative drug used in anesthesia that has been researched to also be effective in mood disorders. Most effective for chronic or major depression, chronic anxiety. Best if offered in a series of 3-5 sessions, with integration therapy afterwards each time.
    Mechanism of Action: Believed to be the increase in synaptic connections (think new neural pathways in the brain) mediated by glutamate receptor activity
    My POV: Ketamine, along with its psychedelic cousins, is a tool not a cure, is much more effective delivered IV in a therapeutic setting then mailed to you at home as a nasal spray and requires an experienced therapist for integration to deliver its full value.
  2. Wharton Jelly Injections. Wharton Jelly is connective tissue that comes from the umbilical cord, and is highly dense with mesenchymal (meaning non-embryonic) stem cells.
    Mechanism of Action: Injection of various sources of stem cells including adipose tissue, bone marrow and Wharton’s Jelly, has been used in the field of regenerative medicine and has been shown to incite a healing response, through lowering inflammation, and through signaling pathways too complex to summarize quickly here that result in localized repair of damage.
    My POV: In my experience, stem cell therapies are more effective for soft tissue injury (rotator cuff, MCL tear) and less effective for osteoarthritis, and even then can be hit or miss. I see them work about 50% of the time. I believe they are very promising — including for osteoarthritis — but more research is needed in how to best harvest and use them to make their impact more reliable.
  3. Exosome Therapy. Exosomes are extracellular vesicles — ie, microscopic bubbles that encase various chemical messengers such as proteins, RNA, DNA, and enzymes. Think of them as a school bus of sorts transferring a set of messages from one cell to another. Exosomes derived from mesenchymal stem cells, the same types of stem cells found in Wharton’s Jelly, are a new promising tool in regenerative medicine.
    Mechanism of Action: Exosomes derived from stem cells appear to elicit the same kinds of anti-inflammatory, immunomodulating and tissue repair response when injected to injury sites as the stem cells themselves. My POV: Nanotechnology enabling the targeted use of exosomes – both cell derived and even lab engineered versions – are super exciting – and early. Same POV as for stem cells themselves, their impact can be hit or miss and more research is needed to make these therapies reliable.
  4. Stellate Ganglion Block. This is an injection of anesthetic into a sympathetic nerve bundle (the fusion of 2 nerve bundles, a cervical bundle and thoracic bundle) on both sides of the neck. It’s typically used to treat chronic neuropathic pain, cluster headaches, to improve circulation in conditions like Raynaud’s, and recently is being trialed for mental health conditions including PTSD. It’s often a treatment of “last resort” when a cause is unknown. Usually most effective if done multiple times, and often lasts only weeks to months.
    Mechanism of Action: Believed to be the reduction of sympathetic (think fight or flight) tone in the nervous system.
    My POV: Absolutely worth a shot in chronic pain syndromes while evidence is mixed, if administered by experienced hands.
  5. Ozone Therapy. Ozone, or O3 (three Oxygen molecules together as opposed to two which is the type of oxygen we breathe) can be produced by a medical grade machine that converts O2 to O3 and is either administered rectally where it can be readily absorbed into the bloodstream by the thin GI lining, or by removing 250-500 cc of blood via IV, mixing in Ozone in a sterile IV bag, and re-injecting the ozonated blood back through the IV. This therapy has a limited evidence base and the FDA warned against it in 2019, however it is more commonly used in Europe as a therapeutic where it is regulated as such.
    Mechanism of Action: Theoretically germicidal/antibacterial, anti-inflammatory, and incites cellular repair
    My POV: I’ve seen this treatment be highly therapeutic in some cases of mold, lyme and chronic fatigue but the evidence base is limited and I don’t prescribe it.
  6. Hyperbaric Oxygen. This therapy has been around for a while, for treatment of everything from carbon monoxide poisoning to slow healing wounds. Lately this therapy is increasingly popular in regenerative medicine for stimulating stem cell proliferation and immune function.
    Mechanism of Action: Breathing in oxygen in a tank that creates high atmospheric pressure allows the lungs to absorb much more oxygen into the bloodstream than at regular atmospheric pressure. The oxygen itself once in the bloodstream is toxic to bacteria and other underlying infections and also appears to stimulate stem cell production and other growth factors involved in tissue healing.
    My POV: Well understood and long used for wound healing, I’ve seen HBOT be very effective for specific patients with chronic lyme, mold toxicity and chronic pain. I’ve also seen it fail for other patients with these conditions. When it comes to general wellness/regeneration, I’d put it in the ‘unlikely to hurt, might help’ bucket – in theory it’s strong but the evidence base isn’t there..yet.
  7. NAD+ IV. NAD+ – nicotinamide adenine dinucleotide – is a key coenzyme in the synthesis of ATP, the energy molecule of the body. It’s also critical to energy metabolism in general, meaning how you break down various substrates to create energy, and it influences immune function and cellular repair. In fact, over 300 enzymes rely on the presence of NAD+ to function. In addition, NAD+ appears to be related to aging, and using NAD+ to reverse or slow age-related body changes may be effective. (By the way, I am wildly oversimplifying here for the sake of keeping this short and digestible).
    Mechanism of Action: NAD+ delivered intravenously is thought to restore NAD+ levels and thereby improve healthspan by bypassing your stomach, where NAD+ molecules are broken down, and instead traveling directly to the tissues of your body, providing a natural boost of energy, as well as enhanced mood and awareness levels.
    My POV: Also in the unlikely to hurt, might help bucket. I’d love for there to be better trials on this because a “shortcut to aging” like NAD+ would be amazing. I just rarely see an IV like this be enough on its own to undo or compensate for not eating well, managing stress and moving.

Understanding the Scope of Longevity Therapies

Each of these therapies could warrant its own detailed newsletter. You might wonder, why doesn’t Parsley Health offer these therapies? We do prescribe Hormone Replacement Therapy (HRT), including testosterone, DHEA, and both synthetic and bioidentical forms of HRT. I’ll delve into this topic in a future post. Additionally, we assist in heavy metal detoxification for patients with high levels of metals like mercury and lead, as confirmed by validated diagnostic tests. We also implement various antioxidant and pro-cognitive protocols aimed at memory enhancement and Alzheimer’s prevention, and we treat conditions such as migraines and chronic pain. Furthermore, we advocate for evidence-based supplementation, particularly when we have clinical evidence of its efficacy in improving health or remedying a deficiency.

However, many of these novel longevity therapies lack a substantial real-world evidence base.

At Parsley, we are dedicated to evidence-based care. Our focus is on treating patients with chronic diseases, coupled with health optimization and prevention strategies. Most of these objectives can be effectively achieved through prescription drugs, diagnostic tests, and personalized nutrition, supplement, and lifestyle interventions. Guided by an experienced doctor, these methods can provide 99% of the benefits in terms of longevity. It’s a fact: exercise is the most potent longevity drug available.

While additional therapeutics can be transformative for some patients, we believe they should be pursued cautiously, under the care of responsible, board-certified doctors. The goal should be to achieve specific health outcomes—such as healing a damaged joint, treating long-standing depression, or eradicating an infection—rather than a full-on “kitchen sink” approach. This strategy not only saves you money but also ensures that you receive value from the treatments you choose.


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