Transcript
Claudia von Boeselager [00:00:00]:
Welcome to the Longevity and Lifestyle podcast, Ashley. It's such a pleasure to have you on today, my dear friend.

Ashley Madsen [00:00:06]:
I am honored to be here. I'm honored to be your friend, and this is just such an amazing platform. So thank you for having me.

Claudia von Boeselager [00:00:14]:
Well, my absolute pleasure and dear audience. Actually, since the moment I met her, I've just been blown away because she literally knows every biomarker and what needs to be in an optimized state. And, like, you name it, as she's, like, done a deep dive into it. So, so excited to bring Ashley and her wisdom to you as part of our conversation today. And, Ashley, I'd love to start with. Maybe you can share with my audience why you transitioned from a more traditional medicine to approach right. And how things were being done, and why did you decide to dig into preventative and regenerative medicine? What was your main driver?

Ashley Madsen [00:00:48]:
Absolutely. So I had a very traditional medical training, like I think a lot of your guests have had, where we wanted to help more people. And the best way to do that is to go into healthcare. And so I loved surgery because I loved the precision. I loved the outcomes. I loved that you got to see immediate results with your patients. So, basically, the first ten years of my life in my career was basically specialties in surgery in New York City, and I loved it. And what I was starting to see, and I was working with kids all the way through adults, is that instead of having them come in for very specific reasons that were addressed with surgical intervention, they're coming in with more multisystem disease.

Ashley Madsen [00:01:32]:
And as somebody who loves their patients, who's completely invested and passionate, it was really bothersome to me that I could help them from a very small angle, but not the full picture. And I was seeing people basically going from subspecialist to subspecialist to subspecialist, but no one was really tackling a lot of foundational core principles. And so I started to do my own research for them. And eventually, you know, you get that to that point where surgery's on the door, and if you're not doing surgery, then you gotta, you know, you gotta move on. So what I did is I transitioned to into personalized medicine, which is more the proactive approach to looking at a person from a 360 degree view. And that was really huge, huge turning point for me, and understanding. Wow. There's so much that we don't know.

Ashley Madsen [00:02:18]:
And the more that you know, the more that you realize you don't know. Extremely humbling. And then when I think you are in science, you have to understand that what you're taught in your training or in your medical field is certainly not the whole picture. And so I really wanted to help more people on the greatest platform possible and do it in a way that was, you know, sensical. And a lot of those foundational principles were being lost in the shuffle of specialist, specialist, specialist, which, thank goodness, we have. Right. We love reactive medicine when we need it, but there's so much that can be done before those people get to that point.

Claudia von Boeselager [00:02:56]:
And what were some of the trainings that you went to that really opened your eyes where you were like, okay, there is so much more possible. And what were some maybe patient stories that you saw that really shifted your perspective?

Ashley Madsen [00:03:09]:
Yeah, absolutely. So, for me, I initially, when I was doing my surgical training and I was actually working full time, I started just doing a lot of reading. I started to read a lot of the people that we end up knowing right now and understanding a little bit about foundational principles in nutrition and stress and exercise and sleep. Right. Those sort of those really foundational pillars. Then I started doing training certifications. I entered into the Institute for Integrative Nutrition, then Institute for Functional Medicine. I started studying cellular medicine, peptide therapy, iv nutrient therapy, hormone replacement.

Ashley Madsen [00:03:44]:
I got into and I realized that everything is very much connected. So when I started working with patients and I was connecting these dots, right? So I was seeing someone that came in and they were presenting this way, but then when I started to ask them questions, right, because you don't know the answers unless you know the right questions to ask, as you know. As you know. And I started to realize, like, I started to understand that. My goodness. Like, there's so much that we're just focusing on physical ailments or physical symptoms, but we're not asking the questions as to what is driving this in that individual. Where did it start happening in their life? Was it after stress? Was it after a really difficult moment in their life? Was it something that they dealt with from childhood? And so I started working with different patients. I have one patient in particular who came in and was just so lost and sad.

Ashley Madsen [00:04:37]:
And I really felt what really felt for him because he had been passed along sort of the rheumatologist route in the surgical route, and he was on all of these medications. And when I started to work with him and I ran his blood work, and I looked at biomarkers that his primary care doctor never ran or any of his specialists ran, I realized that he had really significant insulin resistance. And then we started to uncover he had significant hormonal issues, meaning he had very low testosterone, he had very high insulin, he had very high triglycerides. And he really formed into this understanding of, like, hey, you fit metabolic syndrome criteria, which in conventional medicine, we make everything into a criteria, right? Everything. You have to check off a mark. But he was sort of being passed around, and all he was being told was, you just need to eat less and exercise more. And his body was on fire. His joints hurt him, he was exhausted, did.

Ashley Madsen [00:05:36]:
He had very little quality of life. He barely was able to get to work every day and take care of himself. And that really pains me because those are the people that end up just getting lost in the shuffle and being told, this is what you should be doing. And everyone shakes their finger at them saying that you're the problem, and that's not the case. There are a lot of underlying issues that drive concerns, drive symptoms that are not people's fault. You know, it's not because he's eating too much or that he's not exercising enough. It's like, you know, if you don't have energy, if you don't have fundamental nutrient balance, you don't have hormones to help with all of these processes that are in optimal range, you're not going to be able to do these things. So even if you exercise more and you eat less, your body is going to rebel against you in those areas.

Claudia von Boeselager [00:06:30]:
I think that's such a fundamental thing, and I just want to really hone in on that. And I think a lot of people who are suffering or not feeling really well, and then they get this sort of somewhat flippant, like, exercise more, sleep more, and you'll be fine, and sort of sent again out the door, and they're like, my body's not working. And as someone who's had gut health issues and chronic fatigue, how the problem is that even adrenal fatigue, right. And if you push yourself, it's causing more inflammation, and you're going even further down that route and you're thinking, but I have to do this. What is the path, actually? What should people do if they're listening and they've been maybe brushed or pushed from one doctor to the next and no one really knows and like, oh, you're fine, just eat more salad and sleep an extra hour? Sort of very blase things, but they know that there's inflammation and it's burning inside. Where should people start? What should they be looking at?

Ashley Madsen [00:07:24]:
No, I think that's fantastic. You know, the problem is we do have a gaslit medical system where if it's something that I haven't seen before, it doesn't exist. And I think a lot of clinicians need to get back to the understanding of, we are scientists at the end of the day, and research does not push forward unless we start to think outside the box and color outside the lines at times. Right. And I think we get so concerned about legalities and FDA approved that we forget about the person that's sitting in front of us and being able to care about them. And I think that also comes back to clinician burnout, which we can talk about at another time. But a lot of also stress is put on the providers who need to see a certain amount of patients and have to drive forward and aren't spending that time with their patients to really get to know them. I think they're burned out, too.

Ashley Madsen [00:08:12]:
But if I was working with someone, and, you know, I would say the first thing is really do what you can control. Right? If you can read, if you can do the, you know, read the different books or look at blogs and try to find practitioners or providers that are in institutions or connected to different certifications that have a more open mind and understanding approach. The Institute for Functional Medicine has a whole clinician portal, also for women. I think women get lost in the shuffle a lot. We talk about hormone replacement therapy and how that has been absolutely demonized. Menopause society offers menopause certified clinicians, and they're also now the good thing is we are learning to democratize care. You and I have talked about this before, also in some of our endeavors, but there's also more that people can do to advocate for themselves and work in conjunction with outside companies or entities to get deeper blood work, to get a different analysis, a different understanding, a different eye set on their labs and understanding. So I think there's definitely more in our reach now that we have an Internet, we have people who are listening to podcasts and these types of conversations where you and I can talk about them.

Ashley Madsen [00:09:27]:
It makes people think like, you know what? Maybe I don't have to live this way. Maybe, you know, there are other options for people. And the more that we're getting it out there, it also makes it more affordable, because it used to be that only a certain demographic, a certain pocketbook could afford these outside tests. And now the more that we're talking about it and we're taking the stigma away from it, it's becoming more accessible from a financial standpoint and also an.

Claudia von Boeselager [00:09:54]:
Accessibility standpoint, which is so important and so wonderful because, and you and I, we've had this conversation, but, like, longevity or there's different definitions, right. But increasing your health span today and living really well for longer, put it that as the definition, it should be everybody's birthright and not just a select few. And so, yes, at the moment, testing is not everybody's budget. Right. But it's understanding a, I believe it starts with the curiosity, is there another way? What else could I be doing? What else is out there? And then searching out what are the books, who are the people to educate, who are the podcasts, et cetera.

Ashley Madsen [00:10:32]:
Trusted experts.

Claudia von Boeselager [00:10:34]:
Trusted experts. And I think I recently I just saw something from, I think it was Jolene Brighton. Like, if your doctor's telling you just to sleep more and do this, whatever, find another doctor. Like give menopause symptoms or something.

Ashley Madsen [00:10:45]:
So just, like pushing her cortisol, progesterone, you know, that is also so lost in translation. I think a lot of people also don't know who to go to, which is a specialist who treats this. So everyone kind of piles into their primary care doctor or who they think is a person. And many times, clinicians don't order tests because they don't know how to interpret them. Right. So they either don't know about them or they're like, well, how is this going to change my treatment? And do I know how to take care of this problem? Right. So definitely, I agree with you. And that's why sometimes, you know, going to these other entities can be helpful.

Ashley Madsen [00:11:22]:
I think there are certain biomarkers that I do encourage people to ask for. And if your clinician is still pushing against you asking for the test, then you got to find a new person, because you have to have that open conversation. You have to feel comfortable. You have to feel like you're being seen and you're heard and you're working with somebody who may not know the answers. And I don't think every provider, every medical professional should know the answers. It's impossible. But at least be open and say, listen, I believe you, let's do this, or at least I can try and send you somewhere where I think they could best help you.

Claudia von Boeselager [00:12:00]:
So, Ashley, what are those biomarkers? Can you share? What are the ones everybody should be looking at, what they should be testing for? What are some of the modalities that you love to see and do people straightaway?

Ashley Madsen [00:12:14]:
Absolutely. So I think the biggest ones that I see as repeat offenders when I start working with people is not having a fasting insulin level. So when we look at metabolic health, we talk about metabolic health, but people don't really know what metabolic health means. And I like to talk about this because we throw this term around, and a lot of people use metabolic health, but most people don't know what that actually means. And so it's really classified at looking not only at carbohydrate metabolism, meaning your blood sugars, your glucose, your hemoglobin, a one c, but also your insulin levels. That's a really important number to ask for. And it's covered by insurance. You can get it at pretty, pretty much any lab under the sun, and it's not expensive, even if you were to choose to have it paid out of pocket.

Ashley Madsen [00:13:00]:
So understanding those three markers, because in a vacuum, it's very difficult to look at someone's fasting glucose and say there's a problem. And then hemoglobin a one c, can also be actually manipulated by many factors, including macrocytic anemia and microcytic anemia. And let me assure you, as somebody who clinically practices, and I work with a lot of women, is that majority of women that I'm treating right now have iron deficiency anemia and men, too. And we can have a whole other conversation about why that might be. But a lot of women, especially if they're still cycling and they may actually be in perimenopause, their hormones are changing, they may have heavier menses, or they're not having those iron rich foods. And sometimes that can also be because of if I'm vegetarian or I'm vegan. But then you also have to have a healthy gut for you to absorb that iron and then utilize that iron. So there are many different issues that we're working with in modern society right now.

Ashley Madsen [00:13:57]:
But I also work with people who have significant B vitamin deficiency. And so I have some people who have hemolytic anemia or macrocytosis, or macrocytic anemia. And that can be from a variety of different reasons as well. Again, we get back to nutritional basics, nutritional insufficiencies and deficiencies, and why are people having these? But they can translate into abnormal blood cells, abnormal red blood cells and normal findings. And when we look at hemoglobin a one c, right, it's hemoglobin. It's looking at the glucose molecule that's attached to the hemoglobin. And if that hemoglobin, those red blood cells are being destroyed very quickly or too long, that will affect falsely the hemoglobin a one c. So I yes, I obviously take hemoglobin, a one c, into great account, but not completely if I'm seeing other changes.

Ashley Madsen [00:14:49]:
And rarely do I also see someone actually run an anemia panel, which includes your b twelve, your folate levels, your ferritin levels. Those are really important numbers to also look at when we're thinking about health. Fasting insulin, very important. There are many times I actually just had a gentleman I worked with, he had a fasting insulin of 77 and. Right, exactly.

Claudia von Boeselager [00:15:12]:
Scary.

Ashley Madsen [00:15:12]:
So if anyone doesn't know fasting insulin, if you're fasted for ten to 12 hours, you should have very little circulating insulin. Right. Because insulin is secreted to help drive glucose into the cells. It basically, it's that balance of glucose and insulin. And that's why insulin resistance is such a big problem and driver to the horseman of disease. But what happens is, if you have very high insulin, even if you have a decent a one c, that's you're on a course for significant disease in your future. And what a lot of physicians or clinicians don't realize is that even if somebody is not pre diabetics, if they have a, a one c of 5.5, you're very close to 5.7. And if you're pre diabetic, 5.7 is very different than 6.3, or 6.26.2 is considered not diabetic, but it's very close to diabetic.

Ashley Madsen [00:16:00]:
And so I think we're so thought into ranges, ranges, ranges, and not understanding well, what are those ranges really mean and what's the trajectory of that patient's care? So, fasting insulin, full iron panel. And also the other one is thyroid. I catch a lot of thyroid dysfunction. Everyone's testing just tSh. That is awful. Again, came from surgery. All the anesthesiologists would want a tshirt. What does a tsh tell you? It tells you if someone's really, really out of balance, but it doesn't give you the full answer.

Ashley Madsen [00:16:33]:
So I actually look at. I look at free t four, I look at free t three, I'll look at reverse t three, and I'll use all of those to really understand how is that person's thyroid functioning.

Claudia von Boeselager [00:16:45]:
Are you seeing a lot of, especially women with thyroid issues? I think it's like, predominantly in women, right?

Ashley Madsen [00:16:51]:
I am, but I'm also seeing a lot of men now. And we can talk about reasonings. Right. We could talk about, again, nutritional insufficiencies and deficiencies. So there are certain nutrients that are very important for thyroid function, I see across the board, usually, iodine is low. I see selenium issues, I see vitamin D, magnesium, I see the b vitamins. And, you know, all of this is very important for our systems to function properly. But absolutely, I'll see an increased rise in autoimmune disease.

Ashley Madsen [00:17:22]:
And if someone has one autoimmune disease, please make sure you're looking for a second, because that's a high likelihood. So sometimes I'll see people who come in and they have rheumatoid arthritis, or they'll have Hashimoto's and they'll end up being dismissed with other entity or other symptoms. You know, a lot of clinicians don't understand that if you have one autoimmune disease, there's likelihood of having a secondary absolute, especially if that person's not being cared for properly or supported properly.

Claudia von Boeselager [00:17:48]:
Yeah. And I think it's just so important for people to realize, like, the seriousness, because it's like you're surviving, you're surviving, you're surviving, and then there's a tipping point, and then that's where things just exponentially get worse. And some people are like, oh, well, this is expensive, and that's expensive, but if you actually understand the cost, and this is like my mother with her dementia. Right? Like the cost of the infrastructure. What goes into a patient when they are really sick with a chronic disease? It's just a whole nother ballpark. So it's, you know, everyone listening, please, please, please, you know, get on top of things, understand where you are, and then make those changes and steps with nutrition, with sleep, with different lifestyle interventions that are possible, or if needed, some supplementation, etcetera, like you were, too.

Ashley Madsen [00:18:29]:
And then a Dexa scan. I also just talk about other tests. You know, Dexa scans are typically not ordered for men. They're typically ordered for women in their menopausal years because estrogen drops. Right. We know there's a whole risk. There's. I mean, that's a whole nother topic.

Ashley Madsen [00:18:45]:
But ask for Dexa scan, even if you're in your thirties. I have caught. I can tell you I've caught celiac disease. I've caught a lot of significant issues looking at a Dexic scan on somebody. I've seen men with osteoporosis and ask for the full body. Have them not only look at your hips, have them do your wrists, have them look at the spine. You can do a vertebral fracture also.

Claudia von Boeselager [00:19:09]:
Assessment.

Ashley Madsen [00:19:09]:
I've caught compression fractures in a lot of my patients. And so these are tests that mostly are covered by health insurance in the United States. And if not, they're not a huge, you know, huge cost. But I think a Dexa scan is great. Really, like, understand your baseline, understand where you're going, because a lot of this can be picked up early, and if you do have a problem, it can be treated in a way that maybe reverses course or at least slows it down. Yeah.

Claudia von Boeselager [00:19:37]:
How did you pick up celiac disease from a Dexa scan? I'm curious.

Ashley Madsen [00:19:41]:
So this was a gentleman who came in who had. He was mildly overweight when you talk. Mildly overweight, right. He had high visceral fat area, if you want to talk about it. But he came in, and he was like, listen, I'm just tired, and, you know, I play basketball, and I have some knee pain. You know, he was. He was in his forties, but he's like, but I have a family history of colon cancer, so I do have a gastroenterologist. I'm up to date on my colonoscopies, but no one's ever done an endoscopy on him.

Ashley Madsen [00:20:10]:
And so part of the protocol that we had in place was that everyone gets a Dexa scan, and we try and do it annually. So, looking at his dex again, he had actually osteoporosis. And for a man in his forties to have osteoporosis is unheard of. Or it used to be unheard of. Right now, it's not so much unheard of. And so when we then we did some deeper celiac testing on him, and he ended up having full blown celiac antibodies elevated. No one had ever tested him, and he had some mild GI issues, which I think a lot of people can have. They're like, oh, yeah, sometimes I get gas and bloating, sometimes a little diarrhea, but he could never connect it, and it was never severe enough where he ended up in an emergency room or doubled over in pain, which is actually also more common than it's not.

Ashley Madsen [00:21:01]:
And then we're seeing that. So his markers were super through. We sent him back to his GI. Gi did an endoscopy, confirmed he had celiac disease, and his GI was like, whoa, how did you guys pick up on this? This is incredible. So, lo and behold, Dexa scan, when you see significant bone loss or bone changes in density, is usually, and especially in a younger person and a man, has to do with nutritional deficiencies. And with celiac disease, you're not absorbing nutrients from your diet properly, so you're going to have a lot of those, those concerns in terms of deficiency. So again, nutritional insufficiency versus deficiency is also different. So some people come in and they're like, I'm an athlete, or I'm a worried well person, call them worried well, where they're like, I'm really well read, I'm following a really good day diet, I'm very blue zone, I'm very much eating my plant points and doing all the things, but that's only one step of the equation.

Ashley Madsen [00:21:58]:
So what you choose to ingest is one, but what you digest, what you actually absorb, what you transport, and then what you utilize is a whole different train. Whole different train. And so a lot of that can happen to gut dysfunction like dysbiosis and different leaky gut issues, right? It can also be. The fact is that our food is not as nutritious as it once was, right? We can talk about that too. A lot of people are importing food, right? So every day it's off the vine or away from itself. SteM is starting to lose nutritional value across the board and then also the amount of those foods, right? We're not having as much diversity in our diet. So all of this plays a factor and then you can have genomic issues. So this is another part of what I do in practice is I look at people's genomic SNP's and I look at what we call a polygenomic picture.

Ashley Madsen [00:22:52]:
So there's not just one SNP, but there's different SNP's. So if somebody is not getting enough of this, it can affect this downstream pathway or it doesn't affect this receptor site. And so we can also look at genomics to understand how much of that nutrient does that person actually probably need because they have these concerns or these snp's that were variants that are affecting their absorption, their transport and their utilization.

Claudia von Boeselager [00:23:20]:
So actually this is such an important point because I think the topic of functional genomics and how personalized it is as well, so essential for people to begin to grasp. And I know we've heard a lot about epigenetics and how the environment impacts you, but obviously we methylate differently and our genes are expressed in a different way. So can you break down like what you are looking at when you're looking at different people's SNP's and maybe even expand? Like what, what are SNP's, what are we talking about here? And what are you looking for and how precise can you actually go?

Ashley Madsen [00:23:51]:
Exactly. We have genes, right? I think most people probably on your podcast know that we have genetic, you know, genes and DNA. Basically, the combination of those letters are basically going to create a story for our body. Now, just because what happens is that when we call SNP's or variants, those means that it doesn't always mean something bad. It means that something, it's not the classic way of how those things are paired. There's a little change in that Alphabet, there's a little change in that story, and it doesn't always mean that it gets expressed. So that's why we always talk about how genes are not your destiny, right. But they do play a big part in how we can help ourselves and what we can do.

Ashley Madsen [00:24:38]:
And I think we get really caught up on one gene, one power. Like, we talk about MTHFR. My gosh, I think most people don't even know what Mthfr is, but they. Oh, I have mthfR. Well, there's a lot that has to do with MTHFr, but God bless them so that they even, you know, know some of that. Or we talk about apple e four, right, which I know you're extremely, you know, knowledge about. But when I look at somebody's genes and I see that there's a variant, I care about it, but I want to understand what does that mean in their life? What does it mean compared to the other genes that they have? Because one snp doesn't always mean the whole story. It doesn't mean like, oh, we have to be concerned.

Ashley Madsen [00:25:18]:
But if you have like an apoe four plus a bche variant, plus you have Tom 40, which, and I'm throwing these gene names out, then I need to be a little bit more concerned about that person. Maybe developing Alzheimer's dementia, having more neuroinflammation in their body. When I look at genomic SNP's, when it comes to nutrition, which I don't think is widely talked about, I think we always talk about the pathological genes. And when we talk about pathological genes, we mean that if you have that gene, you're going to get that disease. It is very rare. There are very few actual genes that actually are true pathogenic genes. Certainly in the neurological degenerative world there are certainly. But for most people, you have a lot of control.

Ashley Madsen [00:26:02]:
And I think that's really the important message here.

Claudia von Boeselager [00:26:05]:
Really important.

Ashley Madsen [00:26:05]:
Know about it, right. And then a lot of people, again, well, do I want to know about it? For me, I want to know about it, because if you can control something and it lights a fire in you and it helps you with maybe that move to changing from this food or to that food or taking that supplement over this one, or making sure I'm going for my yearly tests or some of those more progressive tests that we're now offering out there, like whole body mris and we're doing coronary CTA angiograms and clearly scores and looking at all that stuff, I want to know about it because I want to be healthier. I want to improve my health span, not just my lifespan. And if I can decrease my own suffering or the suffering of my loved ones, because, you know, it's not just about yourself. It's about spillover on the people that you love. Right? I want to do that, you know?

Claudia von Boeselager [00:26:53]:
Yes.

Ashley Madsen [00:26:54]:
And most people that I work with that are coming to me are there for a reason because they want to do that. So I think there's a lot that value that comes with it. Now, I will caution people is that there are amazing, you know, online versions that you can do yourself. And I'm not going to name them per se, but I rather people work and use real medically grade genomics. So going to a functional medicine practitioner or a precision medicine practitioner or somebody who utilizes and prescribe them is great. Or, you know, making sure that you're not just doing sort of the one that you can sign up online and just gives you, like, your ancestry, you know, because that's not going to be always very helpful. You want to make sure that the testing is really medical grade, that they're making sure that it's not just one test. They're doing multiple tests to make sure that that gene SNP is really accurate.

Ashley Madsen [00:27:45]:
And then the interpretation and the report is done by people who study genomics. So if, you know, I think we talk about three x four is great and intellix DNA, who I use and I've trained with, they are really legitimate, wonderful groups. And there's much more out there that I'm not aware of. But I think I really want to caution people is just don't use some random company that you find online because you see an infomercial, you know, you can get a lot of these really great tools because, again, you can get the information, but what do you do with the information? And the most, you know, conventionally, you know, trained medical providers are not taught anything about genomics. Yes, we learn about the flies and, you know, whatever medallions, but we're not, we're not learning about true genomic research and understanding what I mean means. And also, I don't want people to get scared because they see one thing. You know, I think that also can get misinterpreted. So you may get your cardiac genomics run.

Ashley Madsen [00:28:40]:
I use different advanced laboratories and they'll test for certain genes that are associated with increased risk for atrial fibrillation or perhaps, you know, plaque formation and things of that nature. But again, it really needs to be used knowing that person, knowing what else is going on in their body. And the polygenomic picture, meaning not just one, you're looking at the full picture of different genomic SNP's to then make a very personalized plan for that person. But those genomic SNP's can make a really big point. Like, I'll use an example. Not to digress too much, but I have a patient that I worked with and he's amazing. I love him, I love my patients, but he came to me and he had gone to all of these amazing clinics all over the world and had the means to do it financially. So he came and worked with us and he was my patient.

Ashley Madsen [00:29:32]:
And I said, let's run your genomics and let's see what's cooking here. And he had some increased risk for cognitive issues. He had some, you know, of course, low testosterone. There was other things going on, some insulin resistance that we wanted to address. But generally speaking, he was in the gym, he's doing resistance training. He had a very clean diet. He was working previously with some really well known folks in the field, but no one really investigated his genomic snips. And he was starting to notice more brain fog.

Ashley Madsen [00:29:59]:
He was getting more exhausted, and he was in his seventies. So he was like, I know everyone keeps telling me that this is normal, but I'm not normal. I want to be optimal. And I was like, he's my kind of guy, this is my kind of person. I said, normal. Who wants to be normal? Normal is not what we're looking for. And he actually, out of all things Claudia, responded the best with going on high dose methyl b twelve. And because he had two homozygous snp's in what we call the tcn one and tcn two pathways.

Ashley Madsen [00:30:32]:
And these are two genes that affect the absorption and utilization of b twelve and transport to the brain. So basically he case in b twelve, but he has a problem transporting it to the brain and around to the peripheral tissues. He was taking a lot of beach, he was eating really well, but his numbers were not where they needed to be. So when you test blood levels, they don't always equate to what that person actually needs. So that's why I love, yes, biomarkers are great and you're falling in your normal range, but those aren't always optimal ranges for that person. Those are based on population ranges of a very unhealthy population. So for his b twelve, we actually had to get it towards the upper range of at least 1500 and above because he needed high blood levels for it to actually get transported to the brain and around his brain. And b twelve, we know, is water soluble.

Ashley Madsen [00:31:25]:
You can have super, super high b twelve levels from supplementation. It's completely fine. It's safe. If you have super high b twelve levels without supplementation, then we get a little concerned. But he was a person that we needed to get a certain range. He did not even in our optimal range. Well, that was not enough for him. He needed to be supra therapeutic for him to actually transport that b twelve his brain.

Ashley Madsen [00:31:48]:
He did that. He called me up, he was like almost in tears. He said, ashley, I have to tell you, I've never felt better. He goes, I'm keeping up in the gym. I'm sharp as a tack. I don't need my afternoon naps. I completely am focused. He also had a history of some adhd issues.

Ashley Madsen [00:32:04]:
He actually was like, I was able to get off my adhd med meds event. You know, obviously he was doing it in a very tailored course. But he said out of everything that we did, it was b twelve. And for me, that just proved how amazing it is when you're able as a clinician to see all of these different parts and have a patient, have a client who's willing to do the work with you, right? Because it's a handshake. And that really just made my, I still talk about it. This was like a couple years ago and he just, he still, to this day, he calls me up and he'll be like, I just want to let you know. I tell everyone about you. I tell everyone that I've gone all over the world, I've seen all of these amazing specialists, actually figured out my issues.

Claudia von Boeselager [00:32:50]:
And that's very, so brilliant, Ashley. I mean, honestly. And this is the challenge, right? Because there are so few practitioners who have gone to the trouble of understanding nutrition and genetic testing and functional genomics and optimal ranges and plus, plus, plus, plus, right? And so how, you know, is that possible going forward? Now, there might be some doctors listening as well that are looking at certain specialities, which typically in medicine is more siloed. You focus on what areas, what do you think is needed going forward in order to allow more people to have their medical practitioner support them better in their journeys?

Ashley Madsen [00:33:30]:
Yeah, I think we're in a really powerful age of clinicians being able to utilize AI, different apps, different organizations in conjunction with their practice. It's not in competition, it's in collaboration, and I want to put that out there. This is not to replace primary care, this is not to replace your specialists. But there's so much information and it's just impossible for to know all of it. I mean, it's changing with a day. Like, I am humbled, as I mentioned, every single day where I'm like, man, light bulb moment, and then the next day I'm like, you know, there's something else that I need to figure out, and I think that's really powerful, but I think we need to harness different tools to help us. And we can't know everything. We're not going to know everything.

Ashley Madsen [00:34:15]:
And a lot of us work. We don't have a huge collaborative practice. We don't have a bunch of people where we can have a clinical rounds every, you know, and discuss different cases all the time who have different areas of expertise. So I think, you know, I think clinicians need to understand that there are different tools that you can implement into your practice to help with this. Number one, help with ordering the tests, but also interpretation of the tests and harnessing all of that data and helping to give you guidance and how you may want to utilize it with your patients. Because in a classic, you know, faculty practice, conventional medicine route, you're seeing 40 patients a day. It's insurance based. Yes, that is a difficult area, but there are other clinicians out there that are like, listen, I'm exhausted by the insurance module.

Ashley Madsen [00:35:04]:
I rather actually try and come up with a price point that maybe I can be more concierge, that's more affordable for the everyday person, but then be able to use these tools, too, in practice. So I think there's two different things. I don't think you're going to be able to fit this all the time in a person who's been doing this for 30 years. And it's like, I see patients in five minute increments. I certainly am not, you know, Pollyanna about that, but I think that you can certainly find more and more providers and clinicians out there to help. And if you are a provider clinician, and if you want to learn about some of these tools, there are amazing trainings out there. And if it's not something that you want to train on, then at least then you know, who to refer to, to do some of these tasks, tests. And I think that network is super powerful.

Ashley Madsen [00:35:50]:
And so if somebody has, if someone's listening on here and they want to reach out, they want to learn more, if I don't know the answer, I can reach out to some of my networks. But I think that's a really important dynamic is that clinicians can harness tools outside of themselves to take off some of the workload.

Claudia von Boeselager [00:36:07]:
Yeah. And I think also to, you know, increase our network. I think it's such a fundamental piece as well. Like what you were saying there, like, even going to conferences, I mean, we, you and I speak at, you know, these different longevity and health optimization conferences. And many a time, you know, I'll be speaking with a doctor disillusioned with traditional medicine. I don't want to be at the sick care end of life end of the spectrum. Like, how do I transition to longevity? How do I move forward? And I think it's building that network of people who are in the space, educating themselves and, you know, doing their best effort to help people stay in an optimal state so that they don't go down that path of. Of sickness and disease, which nobody wants.

Claudia von Boeselager [00:36:44]:
Right.

Ashley Madsen [00:36:44]:
So, yeah, I hear it all the time is that I meet wonderful clinicians, and some of them are like, I am just exhausted. And, you know, that's why you see some, some of, like, if you talk about, like, some of the colleagues that we know came from other areas of medicine, they came from emergency medicine, they came from surgery, they came from, you know, dermatology. But. And people are shifting into, yes, I want people, instead of being sick care and being like, this is what I have to treat them with. And being basically run by these bureaucratic agencies and being saying, well, if they have this, you must prescribe this. Well, how about we talk? Yes, and I love pharmaceuticals when I need to use them, so I'm certainly not against one or the other. And I think you can certainly support someone with lifestyle and still use medications in an artful way. But there's a synergy that needs to exist, and that comes down to, number one, education, desire to learn, and the time.

Ashley Madsen [00:37:44]:
And the time commitment. Right. To do that and to not only learn about it, to implement it.

Claudia von Boeselager [00:37:49]:
Yeah. And I think part of what we're building with Athena Healthspan, where we have actually also involved in, too, is really to support clinicians to. And as you said, it's like an assistant. Right? So not see it as competition, but actually as a tool to better understand all the different components and variables that can be brought together with an AI that is trained specifically on the different modalities around the patient as well. So that the conversation a clinician can have with the patient is much more profound because you're understanding, and it's not just, what did you do in the last three months? How is your health? What's going on? And your average person is like, oh, I think I'm okay. I kind of forgot. Oh, I had a terrible gut health issue, but I think I'm okay. So it's bringing it all together and then supporting the clinician to understand what is really, you know, important to focus on as well.

Claudia von Boeselager [00:38:38]:
So.

Ashley Madsen [00:38:38]:
And you're really excited. Different tools like cgms. I mean, I just want to talk about. I know, you mention it, and we talk about different companies. CgMs, ultimately, which were basically utilized for diabetic patients, are absolutely, absolutely, 110%. I don't care what anyone says. Absolutely helpful and life changing for people to use, regardless if you're diabetic, not diabetic, because we have to understand, people don't become diabetic overnight when they're type two. We are seeing a huge wave of metabolic disease in our country.

Ashley Madsen [00:39:15]:
And a lot of that, most of it is driven by insulin resistance. And yes, although it doesn't check for insulin, we can surmise that when we follow glucose levels, that it's also correlating with insulin levels because insulin, again, glucose, they follow each other. So, clinicians, we can certainly use these tools, and you can use them in app based programs. There's a whole bunch that can be harnessed there, but they're so powerful. And I even use them for women before fertility journeys. I use it for people who are literally just, again, wanting to know, check in about themselves. But right now, and the CDC and the who, they published this data that children born in the year 2001 in three of those kids are going to go on to develop type two diabetes.

Claudia von Boeselager [00:40:02]:
Wow. That should not be. That's so scary.

Ashley Madsen [00:40:06]:
Absolutely terrifying right now. You know, in the published data, only about 12% of american adults are considered metabolically healthy.

Claudia von Boeselager [00:40:15]:
Wow. 12% are healthy.

Ashley Madsen [00:40:17]:
12% are metabolically healthy. 88% are under that. In every single category. They're in their optimal range. And I have to tell you, optimal range for conventional medicine, very different than optimal range when we're thinking about longevity medicine and science. So you can only imagine, right? And what I see, again, I love data, I love reading papers. I love understanding. But what I see in my clinical practice and why I see my outcomes, I actually take more faith in.

Ashley Madsen [00:40:43]:
So when I look at patients, I start working with them, and I run the gamut of testing, and I see that they have so many abnormalities in these areas, or, you know, and it breaks my heart. I'm happy they're there with me, but I think about all these other people that get lost because they're, you know, they don't have that access, and they're on that road to cancer, cardiovascular disease, dementia, you know, all of these issues.

Claudia von Boeselager [00:41:07]:
Preventable diseases.

Ashley Madsen [00:41:08]:
Preventable diseases of aging.

Claudia von Boeselager [00:41:10]:
Yeah. So what would you recommend, Ashley? Do you think everyone should sort of slap on a CGM for two weeks, for four weeks, just to see what's happening in their body? I mean, I know I did and found it for, you know, super interesting. A. My sweet potato was, unfortunately causing too much of a glucose spike. So that sweet potato soup is just not that it's a rare treat, let's say. And second was that I was having hypoglycemic episodes during the night because I was intermittent fasting over prolonged periods of time. And so, you know, no wonder that despite my sleep optimization, I was still feeling groggy and etcetera, I was having cortisol responses during the night. So is it that powerful? Like, would you share that? And maybe you can share some of the brands that you really like in case people are interested in acquiring them.

Ashley Madsen [00:41:56]:
Sure. So, cgMs, I think, are super powerful for anyone. I usually recommend a month to, you know, each monitor typically is about two weeks, and then you change them out if you know. So that's usually the typical. And Abbott. The Libra three is my preference. It's a little, tiny, tiny little guy. There's larger ones, too, that libra makes, but the three is the most inconspicuous.

Ashley Madsen [00:42:20]:
It sits on the posterior aspect of your arm. It runs on Bluetooth with your phone. It's very simple. The other one that I love is Dexcom. Dexcom has the g seven, also a really tiny model. It used to only be on the abdomen, but now you can also wear it on the back of your arm, too. So, again, it depends on the person and what their comfort level is. Both are connected to your phone.

Ashley Madsen [00:42:42]:
They both have skin in the game. They're super excellent, and they also are connected to outside apps. So, again, a lot of people don't know how to interpret the data and then what to do with the data. Right. So, again, you know, we have to think about those things. So there are also different apps that utilize cgMs, and they help guide you. They give you education, they give you feedback. You put your food in, you can scan your food.

Ashley Madsen [00:43:06]:
It can give you some back, you know, information and understanding about how to think about it. Different. Differently. For women who are cycling and have childbearing age, I absolutely think CGMs are amazing, especially if you are trying to improve health, improve, you know, body composition, and you're in that perimenopausal state. Or if you're a woman who cares about her fertility still, you know, and I think all of us should care about her fertility. It's not so much about babies, but it's about ovarian function. Ovaries are the fastest aging organ in a woman's body. We have genetic times of, like, your ovaries are going to tinker out, but whatever we can do to support our own hormonal production is always going to be key there.

Ashley Madsen [00:43:52]:
But also we have to understand when we're thinking about exercise and nutrition, that's going to look different across the board. So this is where people can really find personalized guidance. Keto is not going to work for everyone. Intermittent fasting, to your point, Claudia does not work for everyone, or how you intermittent fast is going to be different. But we have to understand women, especially if you have. I'm just going to use a 28 day cycle as sort of the example here. Of course, that can fluctuate for each woman, that depending we have a 28 day cycle, men have a 24 hours cycle. It's a very different breed.

Ashley Madsen [00:44:25]:
And most studies, most recommendations are built off of men, not women. So although I find great value in time restricted eating or intermittent fasting and hormetic activities like cold plunge, I find those are great, but only if you're utilizing them in a way that makes sense for that woman and where you're doing it in that cycle. That's the difference between something that's being beneficial versus being harmful. And so we can use cgms to understand how our bodies are responding to different stressors help from our food to our sleep, to where we are in life. In our second half of our cycle, in the luteal phase, this is the phase right before we get our period, we tend to have the PM's, we tend to maybe have sleep changes, maybe we get some breast tenderness, different things like that. That's a time where our stress resiliency is very low. That is a time where we tend to be more insulin resistant for a reason. Progesterone is trying to be made.

Ashley Madsen [00:45:24]:
And it's our body's way of saying, hey, we need to, like, relax. We need to nourish our bodies. This is not the time to be going to spin class seven days a week or doing cold punch therapy every day, or doing significant fast, like doing a two to three day fast. So when we know that knowledge and we see why we don't feel good, we can actually help our PM's, we can actually change. Maybe we're breaking out, maybe we're having heavy menses, maybe we're, you know, booty. Right. You know, I've been there, done that to work. And so when you know those types of things, there are different tools and different things that we can do to mitigate that.

Ashley Madsen [00:46:00]:
And CGM's can help with that really significantly.

Claudia von Boeselager [00:46:03]:
So, and it's so personalized as well, which is the beauty of it, why I think with wearables as well, that's that beautiful added on layer of understanding what is happening with oneself. So I think it's understanding the fundamental mental. Right. Having that testing, then understanding what's your personalized optimization journey, right. To ideally be reversing your biological age and being in peak form and like you're 70 something year old. You were saying? He's like, I feel the best ever. And then incorporating that with your wearable devices to understand. I mean, he sounds like a rock star.

Ashley Madsen [00:46:37]:
Solid person, too. I hope he listens. Shout out to him.

Claudia von Boeselager [00:46:44]:
I love it. Ashley, we could talk for so much longer, but I'll have to do a round two. I'd love to have you back on to continue the conversation, but where can people follow you and what you're up to? Where can they find you online?

Ashley Madsen [00:46:57]:
Yeah, absolutely. You know, I use social media, so I do post a lot of content on there, and I'm very accessible. Certainly my instagram is, it's ash p the. Oh, my gosh, I can't even remember ash the pa. But also my email, I don't know, Claudia, if you want to share it, I'm happy to share it with, you know, if you're a clinician, if you have. Okay, maybe not.

Claudia von Boeselager [00:47:22]:
Okay, so tell me. If you could just delete that, I wouldn't put an email address on because this is even a long tail, it goes on for years. So, yeah, maybe Instagram, I can tell you.

Ashley Madsen [00:47:31]:
Okay, yeah. So social media is the best. Yeah, social media is the typically, probably the best way. I do try to pull post content on there. If I'm speaking at conferences, if we have anything like that, different events. Those are really probably what I use the most is Instagram. It's ash the pa.

Claudia von Boeselager [00:47:49]:
Perfect. And we'll link that in the show notes as well. Ashley, do you have a final ask or recommendation or any thoughts or message from my audience today?

Ashley Madsen [00:48:01]:
I say, anything that you can do to bring joy to your life and decrease your stress is the ultimate pillar for wellness and longevity. So you can eat the most perfect diet, you can run the marathon, but if, if you don't have joy, purpose and passion, you know, I never want to restrict that for my patients and for, for myself, for my family, my loved ones. So I always say is that find a community, find a hobby, find a passion, something that lights you up in life, decrease your stress in whatever way that you possibly can, and understand that no one's perfect. You don't have to do every single thing perfect. It's not how we're meant to be. We're dynamic beings. We're chemistry labs. We're shifting.

Ashley Madsen [00:48:52]:
We're not just bank accounts of calories in and calories out. But if you're able to, to harness the joy, you're able to do things that you love and you can pick things that make sense for your lifestyle, I think you're going to be on a great trajectory. And, you know, just be a good person, do good things.

Claudia von Boeselager [00:49:11]:
Beautiful. Ashley, thank you so much for coming on today. Thank you, everybody, for listening and tuning in. Such a joy and pleasure as always. So thank you so much for taking the time.

Ashley Madsen [00:49:21]:
I'm so glad we did this. Thank you so much, Claudia, so beautiful.

Claudia von Boeselager [00:49:25]:
Thank you.