“There’s two kinds of doctors: doctors who prevent the problem, and doctors who manage the disease.” Dr. George Shapiro, President of Cenegenics NYC, shares his vision for what medical care is supposed to be and describes how he and his team are already achieving that for his patients. Through combining the knowledge gleaned from understanding the human genome with their cutting-edge diagnostic testing equipment, the team at Cenegenics NYC works with their patients to develop a customized and proactive approach to aging that focuses on prediction and prevention. Dr. Shapiro shows us that the future of health care is exciting – and accessible today.
In this deep dive, you will learn …
Who goes to Cenegenics of NYC and what do they experience (0:18)
- Three types of patients: 1) very fit and healthy and wants to stay that way, 2) spent their life working and now wants to take care of themselves, 3) health problems with an underlying illness that can’t be fixed through a typical doctor
- Full-day evaluation with non-invasive testing, analysis with the doctor, review of nutrition, exercise, hormones, metabolism
- Ongoing blood testing program to analyze improvements, fluctuations
- Evidence-based diagnostics and testing and a focus on technology that helps identify problems that can be addressed to slow aging
- Dr. Shapiro has recently focused heavily on exosomes and stem cells, which he sees as the future of medicine
What kind of results do patients see (5:25)
- Increased energy, weight loss, increased muscle, improved cognition, better sleep, improved sexual function
- This is the result of a comprehensive program
The tour of technology Cenegenics uses (6:20)
- VO2 Max – measures cardiovascular fitness and the exchange of gasses
- Hand grip dynamometer – measures upper body strength, works many upper body muscles
- DEXA scan – measures body composition, body fat percentage, how much muscle, fat, organs, bones, and adipose tissue you have throughout your body – this is the gold standard in body composition
- It looks at blood vessels and biomarkers of heart disease
- The DEXA scan is highly instructive for patient recommendations
- VENDYS – checks the distribution of blood to make sure it goes to all the right parts of the body and in the right amounts
- CIMT – distributes oxygen and nutrients, removes waste
- AlignaBod – for body alignment and improved posture
- CNS Vital Sign test/WAVi – brain age and capacities
Nutritionist on staff (20:35)
- Gut microbiome specialist who customizes a nutrition program
- Testing for food allergies, sensitivities to ensure they are catering a plan specific to the needs of each patient
The optimism and future of Cenegenics (21:34)
- The ability to prevent disease through whole genome testing
- Examining everything about the individual to optimize their body
- in 2019, no one should have a heart attack
- They are doctors who prevent the problem not manage the disease
- Through a holistic approach, they are able to slow aging
- Living until 150 is a very real possibility
- Preventive care is the future of medicine
- Patient ages will be younger and younger because they want to prevent disease
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George Shapiro: Hi, I’m Dr. George Shapiro of Cenegenics in New York City. At Cenegenics, we basically have three types of patients. The first patients we consider like a Type-A patient, a patient who is exercising every day, nutritionally optimized, they’re in great health, they have low body fat, they’re really fit, they’re educated on nutrition and exercise, and they just want to come to us to stay that way. They want to stay fit, they want to stay younger, they don’t want to get older, or slow down aging. So the healthy patient wants to stay healthy.
George Shapiro: The second type of patients we see are typically the patients who have been working hard their whole life, 40-hour work week back and forth, putting money away, putting their kids through school, just working, working, working for everybody else, and now it’s “me” time. Now they want to take care of themselves, so they come here, and it’s their time. The third type of patient is a patient who comes in with a real health problem, a patient who has some underlying illness that they can’t get diagnosed by a typical doctor.
George Shapiro: A typical day for a patient at Cenegenics is a full-day complete evaluation at our VIP center. We do non-invasive testing, like I showed you before. After the testing is all completed, the patients will sit down with me for about two hours, face to face. During that time, we analyze, we explain the results. Most patients have issues with not just one hormone or a metabolic pathway. It’s an interrelationship between multiple hormones, multiple metabolic pathways. We are not the Low T center, we’re not the HGH center. We’re a company that really looks at the underlying health issues and look at everything as a whole. Besides their hormones and metabolism, we look at their nutrition, we look at their exercise. Many patients have problems in all areas. It’s a complete program.
George Shapiro: So one of the big benefits of our program is we follow up our patients after they get their full-day evaluation, and we have an ongoing supervised program where they do ongoing blood testing. We speak on the telephone for the busy patient. A lot of our clients have demanding lifestyles, so we have a fully customized program for the executive with a demanding lifestyle.
Saad Alam: What are some of the things you do to help optimize and to actually, we’ll call it, stop aging in its tracks?
George Shapiro: To answer the question, what do we do to stop aging in its tracks, we can’t stop aging in its tracks. We can slow down aging, we can manage it. One of the benefits of our program is we do state-of-the-art diagnostics and science testing. All our protocols are evidence-based on science that’s published in peer-reviewed medical journals. There’s no hocus-pocus medicine here. We’re strictly science, and in order for you to become a Cenegenics physician, most of our doctors are from highly trained institutions. Only 1% of the physicians who apply to Cenegenics actually get in to be a Cenegenics doctor. They’re not part-timers. They really adhere to all the Cenegenics protocols.
George Shapiro: We do ongoing, cutting-edge testing and cutting-edge innovations. I’m basically in charge of the … I’m the chief of the Cenegenics innovation program. I’ll go to conferences twice a year, strictly on aging, and basically speak at most of these conferences on major topics. One of the things that I look at are what’s hot and new in the world of technology regarding aging. One of the things that we’re looking at right now are exosomes. Exosomes are extremely important. Exosomes are the next little big thing. The exosome particle is a vesicle. They’re nanovesicles. They’re about a million times smaller than the diameter of a hair follicle.
George Shapiro: Exosomes are in cells. We can call them the brains of stem cells. The important thing about exosomes is they communicate. They communicate with cells that are older, cells that are inflamed, cells that are infected. The beauty of an exosome is we can engineer them, and we can have them make hair, cartilage, repair disease. Eventually, I believe exosomes are going to be involved in cancer cures. We can have biomarkers through exosomes, and we can target diseased cells and cancer cells through exosomes. The future of medicine is going to be related to obviously stem cells and exosomes.
Saad Alam: What are the kind of results you’ve seen from patients?
George Shapiro: Most of the patients we take care of … You can talk about me, for example. I started Cenegenics as a patient 15 years ago. More energy, weight loss. I lost body fat, from 44% down to 14. Increased lean muscle. Your brain starts to work better. You start to really get motivated and use more of your brain. I became the CEO of a few different companies. Able to multitask. You sleep better, and you deal with stress better.
George Shapiro: One of the beauties of this program is drive and motivation, focus, attention. Mentally, you have improvements. Physically, you have improvements. And sexual dysfunction is significant to that. I see a lot of patients who come in with various forms of sexual dysfunction. At Cenegenics, we’re on the cutting edge of repairing some of these, such as GAINSWave therapy or the P-Shot or the O-Shot. We do exosome shots.
George Shapiro: It’s not about a magic pill. It’s about a comprehensive approach. Patients also need to invest energy and time in themselves. All our patients who come in here, it’s not just about getting a shot. It’s about a whole program that’s comprehensive. But they need to invest their time, they need to focus on nutrition, exercise, and getting themselves to what their goals are.
George Shapiro: As part of our state-of-the-art diagnostic testing, I’d like to introduce Joshua D’Alessandro, who is one of our experts in exercise physiology and nutrition. Josh, can you explain what this machinery is and what it does and the purpose of it?
Joshua D: Yeah, so here we have the VO2 max test, and what we’re going to be doing here is actually measuring cardiovascular fitness, among other things. So what this machine does is it actually takes in the oxygen that our patients are breathing and sends it to the machine and measures exchange of gases, so oxygen, carbon dioxide, which actually indicates carbohydrate use, different intensities of exercise, and then it gives us a number that shows us what this particular person’s anaerobic threshold is. When we exercise, if the intensity gets high enough, we build carbs quite a bit, and then we also build up that lactic acid, which causes that burning sensation.
Joshua D: So in this situation, it can actually tell us what heart rate that particular person needs to reach to push themselves, and also shows us what their overall cardiovascular fitness is for health purposes, how they need to improve, should they go more intense, should their workouts be longer, and a lot of other really good information, too.
George Shapiro: So from a cardiology standpoint … I’m a cardiologist … one of the good benefits of this is it gives us our functional cardiac output. What that means, in simple terms, it gives us your heart muscle pump function at exercise, which indicates whether you have open arteries or not. We look at oxygen pulse. If your oxygen pulse is adequate and great, it tells us that your arteries are open. So this is cardiopulmonary fitness. It tells us how fit you are.
George Shapiro: Most of our patients who come into this program, either they’re very fit and they want to stay fit, or they’re not fit and want to get fit. This helps us customize a program where they can burn fat 10 times faster while increasing muscle mass, which is hard to do. You need to do that at your anaerobic heart zone. And as Josh mentioned, this gives us your anaerobic heart rate where you’re optimizing and burning fat and increasing muscle mass.
Joshua D: And if I was going at 150 beats per minute, and Dr. Shapiro was going at 150 beats per minute, that means two completely different things because we’re two different human beings with different physical capabilities. So without using this machine, you might not be pushing yourself hard enough, which is not a waste of time, but you could certainly be optimizing your time in workouts.
George Shapiro: And Josh, there’s a lot of other equipment in this room, too. When a patient comes for a Cenegenics evaluation, what other tests or evaluations do you do in here?
Joshua D: Yeah, so we do a combination of a lot of different things. When it comes to fitness and exercise, if you’re a one-trick pony, you’re probably not going to last as long as a five-trick pony, right? So strength and conditioning, we do in here. We do a lot of endurance work, so we do push-ups, we do sit-ups, some upper body strength testing, so push-ups, for example. Planks, which is, if you ask me, the greatest stabilizing exercise you could possibly do, because it engages every exercise and every muscle.
Joshua D: And what I can do through using these tests is I can assess individual weaknesses, I can assess mobility problems. Poor glute activation, I can literally see it when they’re planking. So we learn a lot about people in this room, from a standpoint of every aspect of fitness, which you can’t leave anything out if you want optimal health.
George Shapiro: So in simple terms, it’s a way to see how fit a person is before they start the Cenegenics program, so we can actually customize an exercise program. We also do grip strength in here, as well.
Joshua D: Yeah, so this is the famous hand grip dynamometer. It’s a pretty good measurement of upper body strength because when you’re keeping it at 90 degrees, the way you’re supposed to, it engages pretty much all of your upper body muscles, so your pecs, anterior delts, post delts, all of it. So simple squeeze, big squeeze. We always tell our patients to think of something that makes them angry, and that tends to work pretty well. So this is a good assessment, too.
George Shapiro: Cynthia, stay in here. I’m coming in here in a minute.
Cynthia Barrett: Okay.
Joshua D: Some of our patients actually take on personal training, as well, because when they find out this information, they’re excited to make progress quickly. But a lot of them have never really worked out before, so we put them in this environment, which is more comfortable, and it’s a little bit more individualized, which a lot of our patients greatly appreciate.
George Shapiro: So the time that it takes to do all this fitness assessment, the strength assessment, the VO2 testing, how much is that?
Joshua D: That typically takes … I mean, I’ve had patients that are really eager to keep learning, so I can sometimes be in these two rooms here for up to two, two and a half hours. And I’ll have patients sit down with me afterwards, after they’ve spoken to Dr. Shapiro, for another hour. Some people really, really want to squeeze as much as possible out of this experience, and I definitely encourage that because we have a lot of information and knowledge to share with these people.
George Shapiro: Let’s go to the next room and look at some of the more diagnostic tests that we do. Some more tests that we do is endovascular testing, which is very important. It gives us a good indication whether you have premature coronary atherosclerosis, or a good assessment of your endothelial function. In addition, I’m going to have Josh explain the other machines here, the DEXA scan and some of the other tests that we do in this room.
Joshua D: So a lot of the times, before … If you go to a gym, for example, you’re going to have the basic tests. They’ll do push-ups there, they’ll do bench max, et cetera, but they have methods of body composition at these gyms, but a lot of them are inaccurate. They’re simple machines. They’re skin calipers, which can be subject to human error.
Joshua D: With this machine here, this is called the DEXA scan, and what it’s measuring is not just body composition. It’s not just telling us what your body fat percentage is. It tells us how much muscle in grams you have, how much fat-free mass you have, so bones and organs as well, and how much fat mass you have or adipose tissue through your entire body, so in your head, your trunk, your legs.
Joshua D: And then it also gives us specified bone mineral density, because as we age, the lumbar spine and the hips tend to become either arthritic or osteoporosis-ridden. So this will tell us if people are close to that, and then we can implement training programs and different supplements that we have here to kind of counter and reverse the effects of that aging process. So this is, to me, this and maybe Bod Pod are the gold standards in body comp. It doesn’t really get better than the DEXA scan.
George Shapiro: So one of the things that’s really important about a DEXA scan is to find out if a patient actually has sarcopenia, loss of muscle mass. Sarcopenia occurs with aging, and as we get older, our muscles go through many regulatory functions. Our body wants to break down muscle with one of the regulatory factors called GDF8, also known as myostatin. So one of the benefits of our program is we have myostatin blockers that can basically stop the breakdown of muscle, so as we’re building muscle, we keep that muscle. Extremely important.
George Shapiro: Aging and frailty are highly associated with sarcopenia, loss of muscle mass. This machine allows us to exactly tell us what your lean muscle mass is compared to your fat, your total body fat, your android fat, which is belly fat. And obviously, the belly fat is where all that inflammation is that leads to chronic disease, so the goal of our program is to get rid of the toxic, deadly, visceral belly fat.
Joshua D: Once again, this is one of those machines like … There’s no other piece of body comp technology that’s going to tell us that android region fat. I’ve had plenty of people come in that, on the surface, look skinny and have 35%, 40% visceral fat, which is incredibly risky for health. These days, people assume obesity is the only way to have a lot of fat, but that’s not true at all. You don’t have to be obese to be very unhealthy, so this machine allows us to differentiate all that information, which is really good.
George Shapiro: Excellent. And fat, body fat in men should be under 19.5%. Olympic athletes, around 5%. A lot of our Cenegenics patients start out at 44%, 45% body fat and wind up coming down to 10% to 15% body fat. This other machine here, why don’t you describe this? It’s the carotid intimal-medial thickness test.
Joshua D: Yeah, so what we do with this test is we actually use ultrasound technology to scan both sides of the neck, so we’re going to get the carotid artery. We can actually see the thyroid gland on here too, so if there’s anything that comes up on the scan, dark masses or white spots, we can actually kind of pinpoint that as something to worry about. So we can actually look at the carotid artery, see if there’s any plaque buildup at the bifurcation, and then when we turn the probe, we actually get a surface area view of it to see endothelial thickness.
Joshua D: Now, naturally as we age, there’s going to be thickness because the veins and the arteries face blood pressure changes. But if there’s abnormal thickness, whether it’s plaque or severe damage, that’s when we need to take a much further look, and this machine really gets in there and gives us a lot of good information, too.
Saad Alam: Pull the tools out of the machine.
Joshua D: Yeah. So this is the wand that we use. Just like a regular ultrasound for a woman who’s pregnant, that’s the technology that we use, and it literally goes right here on the neck and gives us that image. We’ve actually had a couple situations where we’ve discovered things about patients that was immediately urgent. We had a couple patients maybe a couple months ago that we were like, “We’ve got to take care of this right now,” so this can be a lifesaver.
George Shapiro: What’s really interesting about the technology is we have 60,000 miles of blood vessels in our body. The endothelial system, which is the inside lining of these vessels, is one of largest organ systems, and this is what produces nitric oxide that keeps our blood vessels dilated. As we get older and develop cholesterol plaques, we have less nitric oxide.
George Shapiro: This machine can give us a good idea of how thick the intima and media is, and that’s where it gets its name, carotid intimal-medial thickness. Over 0.6 nanometers is abnormal, so we can actually measure that. And if we see that it’s abnormal, we’ll do further testing, such as our advanced heart disease and stroke prevention profile, to look at specific biomarkers of heart disease to see if a patient’s at risk. In addition, we can look at genetic markers at risk for heart attack, such as Mef2 alpha genes.
George Shapiro: Also one of the benefits of looking at this test is to give us a good idea of all your arteries. Just looking at the neck will tell us if you have blockages in other areas. It’s one system. A lot of people confuse it, if they think they have a blockage in the carotid artery, they’re free everywhere else. Usually, if you have a blockage in one vessel, you have blockages everywhere. It’s a systemic disease, not a focal disease. So this is a great predictor of events to come, along with this test, which is our VENDYS endovascular test. So why don’t you discuss this test, Josh?
Joshua D: Yeah, so the VENDYS allows us to discover blood return and basically distribution throughout the body. So if there is a blockage … The system of blood and circulation is ongoing all the time. It’s one of those things that we don’t have to control, because the human body does us a lot of favors that people don’t realize. So this machine allows us to check the distribution of blood and make sure that the distribution to muscles, et cetera, and return is actually healthy, because if we notice any irregularities in the pulse rate or any distribution itself, that could be an immediate indication of blockage, as well.
Joshua D: So this machine, the CIMT, and the VO2 max are all great ways to make sure that blood is being distributed correctly, because it distributes oxygen, it distributes nutrients, it helps us remove waste, so if we’re not doing that correctly, it’s a recipe for disaster eventually.
George Shapiro: Right, and the cardiovascular system is a very important system. It’s responsible for one death in every 23 seconds. The number-one killer in this country and globally is heart disease. And as a cardiologist, my goal and focus is to reduce heart disease and eventually try to cure heart disease with some of the new, innovative technologies that Cenegenics has to offer. In addition, Josh, why don’t you tell us about this equipment over here, the AlignaBod?
Joshua D: Yeah, so like I said, we try to learn as much about our patients as possible. Individualizing nutrition and exercise is simple sometimes. It’ll be like, “Oh, you like this exercise this person doesn’t. Let’s try it.” Here at Cenegenics, we don’t take it as a very simple individualizing process. We learn as much as we possibly can. So this is just a regular scale, obviously, but the number that comes up on here definitely does not tell us enough. We have people that are 30, 40 pounds overweight but 15% body fat, which is very healthy, so they have a lot of muscle. So we use this number, we get waist-to-hip ratio, which is another indication of distribution of mass.
Joshua D: And then if you come over here, we have this board here. It’s called the AlignaBod. As I was saying inside, we notice a lot of discrepancies in posture, alignment, and hip … So hip alignment, for example, I’m sure you’ve heard tons of people talk about low back pain all the time, and their ability to fix it usually comes down to stretching the back, rolling the back. I can tell most of the time, by using this board, that it’s not the back, it’s the hips, it’s the ankles, it’s the shoulders.
Joshua D: So they do squats in front of this, they’ll just do some basic postural movements, and I can learn things about their muscles that they’ve never even thought about, which I’ve used a lot of the times to relieve and get rid of back pain, because most of the time it’s just a strength thing from the glutes. So that’s what a lot of this stuff helps us do, as well.
George Shapiro: So these two rooms basically look at muscle function, bone function, vascular function. We do other testing. We have a brain test called CNS Vital Sign test, and soon to be a device called WAVi that looks at brain age and looks at higher brain functioning, such as neurocognitive index, verbal memory, visual memory, composite memory, executive function, processing speed, focus, attention, concentration. As we age, we lose this. So one of the benefits of our Cenegenics program is to really establish a good baseline, from a mental standpoint, so we can improve on that with certain supplements that can help improve neurotransmission of impulses, vitamins and hormones, as well as exercise and nutrition.
Cynthia Barrett: I have my doctorate in physical therapy. I am a certified nutrition specialist as well as a strength and conditioning coach. I focus on the gut microbiomes, so I test for food sensitivities, I test for food allergies, I see if you have any micronutrient deficiencies. And then from there, we put together a custom nutrition program for our clients. A lot of our clients come in, they want to lose weight, they may want to gain weight, but overall in general, most people suffer from chronic inflammation in their gut, and that’s what we do to put together a nice custom nutrition program addressing their deficiencies and filling in the gaps of where they’re having their chronic health issues.
Saad Alam: Can you talk about, real quickly, what are the kind of results you see when you reduce the inflammation in the gut?
Cynthia Barrett: So when you reduce inflammation in the gut, you find you have improved energy, improved sleep, your bowel movements are better, you find in general your skin is glowing, and you just feel an overall general sense of wealth and health and wellbeing.
George Shapiro: We’re the Apple store. Patient will come in, and we’ll basically say, “Okay, we have something else.” We have telomeres, we have exosomes, we have food allergy testing. Genomic testing is very big. Because of the human genome, we can now basically find out your whole exome or whole genome sequence, and based on that, we can predict disease and prevent disease. No one should have a heart attack today. In 2019, no one should have a heart attack today.
Saad Alam: Are you getting this? This is good.
George Shapiro: With today’s technology that we have, when I hear of patients having heart attacks, it’s they didn’t come to the right place or have the right doctor. You can prevent diseases, and that’s one of the things that we do. We’re proactive. Cenegenics is a proactive program that basically focuses in on preventing the problem before it occurs.
George Shapiro: There’s two kinds of doctors: doctors who prevent the problem, and doctors who manage the disease. When I went to medical school, that’s what we learned, how to take care of the disease, how to take care of the heart attack, how to take care of the diabetic, hypertensive, or a patient with elevated cholesterol. Medicine has shifted today. If we can prevent the problem by taking care of the younger patient to prevent the disease in the future, we can save a lot of problems. We can save a lot of money, we can save a lot of problems.
George Shapiro: The benefits of our program is a proactive approach to aging by slowing down and preventing illnesses that occur with bad diet, bad exercise, improper nutrition, improper exercise, slow metabolism that usually occur with aging. Unfortunately, the endocrine system degenerates as we get older, and as a result, the interrelationship between the thyroid gland, the adrenal gland, the pancreas, different hormones, insulin, cortisol, testosterone, prolactin, melatonin. There’s a lot of different things involved. It’s not just one hormone, it’s not one metabolic pathway. It’s a whole series. We have neurotransmitters, biomarkers, genetic markers.
George Shapiro: You need to look at the whole approach, and what we’re actually doing is focusing in on the younger patient staying young, or the older patient, getting them healthy and reversing the problem. It’s easier to prevent it, but we can also reverse some of the problems that people have today.
Saad Alam: Two quick questions. One, where do you see this industry going 10 years from now?
George Shapiro: Where is this industry going 10 years from now? Since we know the human genome, we can now predict and prevent problems and slow down the dysfunction of the endocrine system and endocrine disruptors. By doing that, you can probably live till 150 in about 10 years. And Time magazine, a few years ago, had a big article: can this baby live till 150 years of age? With exosome technology, genetics, microbiomics, metabolomics, genomics, with all these new things and names that we didn’t have before, we basically can achieve a long healthy lifestyle. But we’re living younger, not older, basically. We’re not … We’re slowing down disease and preventing the disease.
George Shapiro: So before a patient ages and is on five medications, how about treating them so they never need those medications? A lot of physicians today do disease management, and we need those doctors. I was that type of doctor for about 18 years, and I still do that in my private office up in the suburbs. I still do … I have an active cardiology practice where I’m taking care of the disease. In New York City, at Cenegenics, we’re preventing and being proactive with diseases.
Saad Alam: Do you think it’s crazy for a 36-year-old that’s healthy, like me, to come to you?
George Shapiro: Let’s talk about age of patients that come to Cenegenics. I have patients as young as their upper 20s and low 30s who come here because they’re smarter, they’re educated. We have the internet. They can Google. They know what’s going to happen. They want to prevent it. I have a larger patient base now of patients in their 30s, compared to when I first started medicine 30 years ago, where the average patient was 60 and 70 and 80 years old, 80 years of age. Now I’m seeing a younger patient who wants to stay young and prevent the problem.