Dr. Sajad Zalzala

About

Dr. Sajad Zalzala is medical physician and co-founder of Qalytude, a US-based online clinic that specializes in prescribing metformin and other anti-aging prescription therapies.

Dr. Sajad Zalzala's Biohack Stack, Regimens, Routines

Interview with Dr. Sajad Zalzala

Hello, Dr. Zalzala! What’s your background, and what does your company do?

QALYtude is an online clinic dedicated to providing easy access to longevity and healthspan therapies. Part of our mission is to accelerate the development of longevity therapies by supporting and participating in research.

The QALY part of the name is a health economic terms - Quality Adjusted Life Years - whereby 1 QALY = 1 perfect year of health. We want to empower our patients, and society more generally, to adopt the attitude to have more QALYs.

I am leveraging my experience with other telemedicine companies to make longevity prescriptions as easy to obtain as Viagra.

What was your motivation behind Qalytude? How did the company start?

Ever since my first year in medical school, I gravitated towards holistic or integrative medicine. I find the field of prevention much more appealing than trying to treat diseases after they occur. Delaying the effects of aging is the mother of all prevention, as aging is at the root of almost all chronic diseases.

How does the Qalytude prescription process work? Is it legal?

Yes, QALYtude is perfectly legal. We take advantage of fairly recent change in telemedicine laws to allow prescribing using an internet-only encounter. For those few states that have phone/video requirement, we adhere to those regulations by asking patients to book a brief consultation with the prescribing physician. We have physicians licensed in all 50 states, as well as US-based pharmacy partners based that ship to all 50 states.

Delaying the effects of aging is the mother of all prevention, as aging is at the root of almost all chronic diseases.

I know many people are curious about taking metformin for longevity (myself included). In your opinion, what factors should we be weighing in a decision to take metformin or any other (potentially) anti-aging prescription therapy? Should we wait for the results of the TAME trial (or similar FDA trials) before deciding?

Our goal at QALYtude is not to persuade anybody to start longevity therapies. We want to present the science and the studies and hope that people will make their own informed decisions. Once they have made up their mind that this is something they want to do, we make it easy for them to take action.

Metformin currently has enough data for me personally to feel comfortable not only taking it myself (and my wife), but also recommending it to my patients. I believe there will never be enough evidence to convince every skeptic on metformin and other longevity therapies - that's just how science (and life in general) works. Every individual will need to review the data and make a decision whether metformin and other therapies are right for them.

When we look to introduce other therapies, we work with a panel of expert advisors to vet out therapies that hold the most promise, but also a good safety protocol and are appropriate for prescribing by telemedicine.

Our goal at QALYtude is not to persuade anybody to start longevity therapies. We want to present the science and the studies and hope that people will make their own informed decisions. Once they have made up their mind that this is something they want to do, we make it easy for them to take action.

How safe is metformin? What can I expect if I decide to take metformin for anti-aging? Are there any useful biomarkers worth tracking while taking it?

Metformin is, in my opinion and experience, one of the safest prescriptions that a physician can prescribe. We have close to or more than 1 billion patient-years worth of data on metformin and it has been prescribed for over 60 years. Side effects from metformin are usually mild and can be remedied by adjusting the dose, or simply discontinuing. Serious side effects to metformin are rather rare. In the thousands of prescriptions I have written for metformin, I have not seen a single serious side effect.

The biggest concern with metformin is a condition called lactic acidosis - however, large studies have shown that it was not the metformin that caused lactic acidosis, but other comorbid conditions such as heart failure, hypoxia, sepsis, etc. that predisposes to lactic acidosis. In fact, the author of a 2004 Diabetes Care article concluded "when metformin is used as labeled, the increased risk of lactic acidosis is either zero or so close to zero that it cannot be factored into ordinary clinical decision making."

In terms of biomarkers, the easily accessible ones would be things like fasting glucose and insulin as well as a glucose/insulin oral glucose challenge test (where you take a certain amount of glucose "challenge" and check both glucose and insulin levels are certain time points - usually 30, 60, 90, and/or 180 minutes). We are also introducing soon the FreeStyle Libre CGM (continuous glucose monitoring) sensors that will give real-time and trackable data on glucose levels. More sophisticated testing will include DNA methylation testing such as the Horvath or GRIM clock tests that look at the "age" of a patient's DNA.

What’s your take on the possibility that metformin blunts adaptation to aerobic exercise?  Do you recommend taking metformin at night (like Peter Attia) or on non-exercising days (like David Sinclair)?

I suspect ALL longevity therapies will come with some kind of trade-off. The key will be to find therapies that do much more good than any potential harm. On our FAQ page we address this issue. For patients who are performance athletes or working on a goal that involved lean body weight gain, I would recommend they skip metformin for that time. Or we tell patients to skip metformin on days where they are doing intense exercise (as per David Sinclair). As for everybody else, I think this study has very little clinical relevance.

What’s your opinion on other potentially anti-aging therapies like NMN & NR, NAD+ therapies, rapamycin, Dasatanib, resveratrol, and quercetin? How do you decide which ones to offer through Qalytude?

We are huge fans of NAD+ - so much so that we are soon launching NAD+ patches that will be closest thing you can get to IV NAD+ infusions but at a much more affordable cost and convenience. For now, we are staying away from over-the-counter therapies since there are plenty of excellent (and sometimes not so excellent) companies providing these products.

More experimental therapies such as rapamycin and dasatinib are definitely on our radar and are very promising. But we are working with research organizations to provide these under a clinical trial setting in order to ensure proper safety and monitoring protocols, as well as to collect the data that is needed to help advance these therapies

What has been the biggest challenge for Qalytude so far?

I think our biggest challenge is helping people change the way they think of their healthcare - to try to shift patients away from reactive "sickcare" into more proactive healthcare. The early adopters get it and these are our first customers. But we are a strongly entrenched system of diagnosing and treating diseases.

Another challenge is trying to show the value of the therapies we offer. Going back to that entrenched system - almost everybody wants to use that shiny insurance card in their wallet. But most do not realize that it provides "sick" insurance and not "health" insurance. We operate outside of the insurance system, but use technology to make our therapies convenient and affordable.

..shift patients away from reactive "sickcare" into more proactive healthcare. The early adopters get it and these are our first customers.

What’s in your personal biohacking stack right now?

Currently, I take Metformin as the only medication. I use a CGM to try to keep my blood sugar as low as possible. I recently started using the NAD patches, which is not technically a medication but is only available by prescription. I find the NAD patches boost my energy and help with mental focus. The metformin helps keep my appetite under control and makes it easier for me to not gain weight so easily as I am prone to - it also puts a leash on my sweet tooth.

I tend to rotate the supplements I take, and change them up from time to time depending on a variety of factors including new research. On a fairly regular basis, I take: Omega-3, turmeric, resveratrol, vitamin K2, magnesium, CoQ10
I do blood tests and hair mineral analysis to optimize my mineral and micronutrient levels. Sometimes this means taking a small bowl full of supplements for a few months at a time to get my levels optimized.

I track my visceral fat levels and other aspects of my body composition using the gold standard DXA scan through DexaFit (disclosure: I own the DexaFit Detroit location and I am medical director of several other locations around the country)
I went gluten free in 2011 and haven't looked back (well, I am 95% gluten free). I try to adhere to a Paleo-style eating habit (I dislike the word diet) - though I do enjoy dairy.

I try to do intermittent fasting at least twice a week. And every year for Ramadan I fast for 30 days (no food or water from sun up to sun down).

My main source of exercise is running after my 3 kids.

I try hard not to neglect my sleep. Some of my friends tease me because I go to sleep so early (9 or 10pm depending on the season), but I hope to outlive them so the joke is on them :-)

I like trying stuff I read or hear about that have sound science. I subscribe to numerous podcasts, attend several conferences throughout the year, and do a lot of reading on new studies.

What aspect of your life are you working to optimize the most?

I work hardest trying to keep my blood glucose levels low. I was overweight as a child, and that has set me up to being prone to gaining weight easily - I still have more weight on me than I care to admit. I find that if I eat just a little bit too many carbs, the weight comes back easily.

What process do you use to evaluate what biohacks work for you?

As I have mentioned before, I use CGM to track my blood glucose, DXA scan to track my visceral fat, hair mineral analysis to track my mineral levels, and a comprehensive blood chemistry panel to make sure my thyroid and other hormones are optimized.

What are the most impactful biohacks that worked for you and would recommend others check out?

By far the most impactful change that I have implemented was going gluten-free and switching to a Paleo style eating habit.

What’s next for Qalytude? What are you excited for?

Currently, we are offering therapies that will help potentially delay the onset of age related disease. The really exciting longevity therapies have not even been developed or explored yet - things like senolytics that rid the body of "zombie cells" that seem to accelerate aging. I am excited to be a part of or support the research on these and other therapies. As well as other therapies that are being developed by much smarter people than me - those companies will need a platform to make their newer and stronger longevity therapies accessible, and we hope they will come to QALYtude.

Is there anything else you want to let us know about Qalytude? Where can we learn more about you and your company?

My dream would be to see QALYtude become a platform to help optimize human health - though this remains a concept at the moment.
Also, QALYtude is registered as a PBC - a public benefit corporation. We are on a mission to help improve society and humanity.

Are you founder or leader in the biohacking or longevity industry? We would love to interview you for your own profile on Biohack Stack. Please email us at nathan@biohackstack.com