Ben Greenfield [00:00:00]: My name is Ben Greenfield, and on this episode of the Boundless Life podcast.

Dr. Cameron Chesnut [00:00:05]: Sometimes you've chosen your surgeon very carefully.

Ben Greenfield [00:00:07]: Yeah.

Dr. Cameron Chesnut [00:00:08]: And you show up at the surgery center or hospital and you quite literally have no idea who your anesthesiologist is going to be, which is kind of like, mind blowing when you really think about that being the truth. You have no idea.

Ben Greenfield [00:00:18]: Well, a lot of people are blissfully unaware of what you've just described and just assume anesthesia is anesthesia.

Dr. Cameron Chesnut [00:00:23]: Right.

Ben Greenfield [00:00:24]: Welcome to the Boundless Life with me, your host, Ben Greenfield. I'm a personal trainer, exercise physiologist, and nutritionist. And I'm passionate about helping you discover unparalleled levels of health, fitness, longevity, and beyond. Hey, everybody. Today's podcast is with my friend, brilliant cosmetic surgeon with a deep understanding of all things beauty, hair, anesthesia, flow states, and more. Enjoy this discussion with Dr. Cameron Chestnut of Clinic 5C in Spokane, Washington. And the URL for the show notes is BenGreenfieldLife.com CAM2025 CAM 2025.

Ben Greenfield [00:01:13]: Hopefully this doesn't get too off the hook. I just put in the first nicotine pouch I've put in my mouth for like two months. Oh, yeah, I was filling up the truck.

Dr. Cameron Chesnut [00:01:20]: How's that doing?

Ben Greenfield [00:01:21]: So far so good. It's only 3 milligrams.

Dr. Cameron Chesnut [00:01:23]: Oh, man.

Ben Greenfield [00:01:24]: I had to put 25 gallons of diesel in the truck and was bored at the gas station and wandered in. There was. So my head explodes during this show. I've got water.

Dr. Cameron Chesnut [00:01:35]: Highly beneficial, slash highly addictive.

Ben Greenfield [00:01:37]: I mean, yeah, nicotine, highly beneficial, highly addictive. The. There's a new variant kind of going around called cyto choline. I think it's called cyto choline or no, not cytocholine. Conitine. Some company called Set, they'd send me a bunch of pouches of that. It's non FDA approved, apparently, like a less addictive form of nicotine. But like, my.

Ben Greenfield [00:01:59]: My philosophy is I don't like to be beholden right to anything. And I got to the point where I was probably like throwing in like 4, 4 milligram patches in a day.

Dr. Cameron Chesnut [00:02:11]: Interesting.

Ben Greenfield [00:02:11]: And for me, it's just like, you know, you're addicted once I think you've gotten above like 10 milligrams. So.

Dr. Cameron Chesnut [00:02:18]: Yeah. Anyways, was getting off of that difficult then? No, no, Just no willpower, basically.

Ben Greenfield [00:02:23]: I think part of it is your mentality. Like, you do a lot of like. I mean, we'll talk about this. Like, you do cold. The. You do hard workouts and you do jits and you swing kettlebells. I think if you understand blood, sweat and tears biologically it's pretty easy to just like stop anything and shut up the inner in the same way that you do when you walk into a gym sleep deprived and know that you just got to hit it anyways.

Dr. Cameron Chesnut [00:02:46]: Yeah. So I've been thinking about incorporating it post surgically for anesthesia recovery because there are certainly benefits to those sort of receptors. But I'm concerned with well, the way it makes people feel when they first take it, myself included, and how to dose it and then of course the.

Ben Greenfield [00:03:03]: What would be the benefits? Like post surgically?

Dr. Cameron Chesnut [00:03:05]: Well, so this is, this is very new to me. This is like as we talking, things I'm excited about is all the post anesthesia when we talk about post operative cognitive dysfunction or things like that, it really gets into neuroinflammation microemboli. And so there's some evidence that nicotine can have some neuro anti inflammatory benefits and activate some inflammasome or like inhibit some inflammasomes that are important into neuroinflammation. So it could potentially, potentially decrease post operative cognitive dysfunction beyond just the stimulant effect of.

Ben Greenfield [00:03:36]: Yeah. Have you messed around at all with like any of the neural anti inflammatory peptides that kind of cross over into the neural piece like KPV or PVA or even BPC to a certain extent.

Dr. Cameron Chesnut [00:03:45]: Exactly right. So I do have a peptide stack that I cocktail or alter a little bit and pre and post operative. And the post op edition is a kpv.

Ben Greenfield [00:03:55]: Yeah.

Dr. Cameron Chesnut [00:03:56]: For that reason.

Ben Greenfield [00:03:57]: Yeah, yeah. I mean leaky gut, leaky brain crosses blood brain barrier.

Dr. Cameron Chesnut [00:04:01]: Exactly.

Ben Greenfield [00:04:02]: That's in. I don't want this to turn into like a commercial, but there's level up health has like a neural anti inflammatory peptide mix that's got all of the things that help the quell neural inflammation and they've got all those peptides in it which is great if you're sleep deprived or. I don't know about post surgically.

Dr. Cameron Chesnut [00:04:21]: Well, that's like. It's even more pertinent in that period for sure.

Ben Greenfield [00:04:24]: Yeah. I want to talk about the post operative. What do you call post operative cognitive dysfunction. Okay, I want to talk about that. But back to shutting up the inner bitch.

Dr. Cameron Chesnut [00:04:31]: Okay.

Ben Greenfield [00:04:32]: You convinced me that when I come up here today that you want to do a pool workout. We haven't done it yet, so I guess that's for dessert after the podcast. So is this like a new thing for you?

Dr. Cameron Chesnut [00:04:43]: Well, I mean, the whole, like, Laird.

Ben Greenfield [00:04:45]: Hamilton, Gabby Reese, cool thing came full.

Dr. Cameron Chesnut [00:04:48]: Shout out to Laird and Gabby. You know, they're the. The father, the king and queen, let's say, of this for sure. And I definitely got into it through them, and we just built a new home and moved into it, you know, this. This summer, a few months ago.

Ben Greenfield [00:05:00]: And the pool, the home you've been building for the past 12 years or something like that.

Dr. Cameron Chesnut [00:05:05]: Yeah. Not barely exaggerating, but the pool is purpose built for these sort of workouts that we're gonna.

Ben Greenfield [00:05:10]: Oh, yeah, you mean, like, purpose built, like the depth or depth, the shape.

Dr. Cameron Chesnut [00:05:14]: The structure, how the bottom is shaped, how the outside is, where the workout space is. It's. It was purpose built for us.

Ben Greenfield [00:05:21]: What about. Cause when I've done the workout at Laird and Gabby's, and people who might not be familiar with this, you're like, hoisting dumbbells at the bottom of the pool and you're up and down and there' withhold components and proceed at your own risk and have a partner around. While we're saying this, we should probably get that. That out of the way. The. The bottom of the pool, though, can be slippery. Did you.

Dr. Cameron Chesnut [00:05:43]: Oh, yeah, it's very.

Ben Greenfield [00:05:44]: Like, add some kind of attraction or.

Dr. Cameron Chesnut [00:05:46]: Like, treat the concrete sandy. Okay. Yep. Like a sandy finish to it to be really grippy but comfortable on bare feet.

Ben Greenfield [00:05:51]: Yeah. So for people who haven't done a workout like that and who haven't had the pleasure of just, like, going to Laird and Gabby's on a particular weekday morning, what's it look like when you hop in there?

Dr. Cameron Chesnut [00:06:02]: Well, there's a. I would say there's. Depending on what you're doing, there's a few main components to it. The real one is, like, forced breath work. I would say that's the most unique part of it is, like, we all try to control our breathing when we're lifting or doing yoga or something, anyway. But I would say, personally, I wasn't very good at that, or I'd lose focus on my breath. And you can't do that when you're in the water because your breaths only come at very specific time frames in the workout. And then there's just the, you know, going to your dark place a little bit and kind of suffering through knowing, like, okay, I'm going to get a breath, but it's going to be four seconds from now, whatever that may be, which builds a whole bunch of metabolic flexibility, specifically, like a hypercapnic tolerance.

Dr. Cameron Chesnut [00:06:39]: We think of Hypoxia, low oxygen, and interestingly, much more of it is about building up CO2, not getting low on oxygen.

Ben Greenfield [00:06:48]: Building up CO2 tolerance would be an effect of the pool workout.

Dr. Cameron Chesnut [00:06:52]: Exactly. Exactly. That's, like, probably, for me, the main effect of what I'm after. So I'm not blowing off CO2 then trying to hold my breath as long as I can. That's where you get shallow water blackouts, and things get dangerous. And that's also not applicable to real.

Ben Greenfield [00:07:04]: Life generally, because the presence of carbon dioxide would be a signal for your body to take a breath. And when you breathe it off, you're able to do the whole Wim hof hold your breath for a long period of time thing. But that's also dangerous if you're submerged.

Dr. Cameron Chesnut [00:07:19]: In 12ft of water, if you're underwater. Yep. And, you know, with. Even going back to Laird specifically, like, the birthplace of this was to improve his, I guess, making him harder to kill in the ocean.

Ben Greenfield [00:07:30]: Right. Like, if you're at the bottom of the ocean with a surfboard, like, tangled around your feet or whatever, and you.

Dr. Cameron Chesnut [00:07:34]: Don'T get to hyperventilate before that, you go down and then you're struggling. And I love. My favorite question that I've ever seen Laird get asked was, you know, how long can you hold your breath? And very classic Laird answer was like, I don't know. Long enough so far.

Ben Greenfield [00:07:46]: Yeah.

Dr. Cameron Chesnut [00:07:48]: It's like, oh, beautiful.

Ben Greenfield [00:07:50]: Yeah, yeah, yeah. The interesting thing about the CO2 tolerance, I interviewed this guy named Anders Olson. He's. He's one of the guys out there. He's written a breathwork book, and he's one of the breathwork physiology guys who has a lot to say about it. And we talked about CO2 tolerance, and he talked about how the ability to withstand CO2 can be correlated positively to stress resilience. Right. Your ability to be able to just, like, not freak out when a problematic email winds up in your inbox.

Ben Greenfield [00:08:20]: And he developed, like, a. A machine that attaches to a carbon dioxide tank with a mask that allows you to breathe anywhere from 3 to 7% CO2 just while you're at your desk to build up CO2 tolerance passively while you're in your office.

Dr. Cameron Chesnut [00:08:37]: Yeah. That's interesting. That's an extreme way of doing it. You know, I mean, with my kids even, you know, we talk about how to breathe properly through their nose, whether they're sleeping or exercising, but that's one of the benefits of. And I try to get my patients to do this, too. Is, you know, in their weeks leading up to surgery, they don't need to be murdering themselves, but I want them to build up their hypercapnic tolerance. It makes their anesthesia better, makes their recovery better, makes their brain more protected. But it's sometimes it's simply just like light.

Dr. Cameron Chesnut [00:09:02]: Zone one, zone two, walking, but breathing through your nose while you're doing it instead of breathing in your kids.

Ben Greenfield [00:09:09]: Mouth tape, patient's mouth tape. Do you do that, you mouth tape?

Dr. Cameron Chesnut [00:09:12]: I do, yeah. Yeah, I do. I've also gotten to a point where I don't really need to as much anymore. Changed, broke that habit loop for me a little bit. But I'll still find myself sometimes, like, oh, I definitely was mouth breathing. And then, yeah, switch over.

Ben Greenfield [00:09:25]: Yeah, well, what happened to me was I did. So I've done podcasts on mouth taping before. So inevitably, you know, the hostage tape and inhale and Respire and all these companies just like sent boxes of nasal strips and. And so I felt like I had to use them because they're around the house. So now every night, like right after Jess and I finish our evening prayers, I. I already have the nasal strip on, which actually I was surprised because I did mouth taping for a while, added the nasal strip, and you feel more oxygenated during the night. And when you wake up just with the presence of the nasal strip, there's a new one that's like. It's like a couple of magnets that you apply to either side.

Ben Greenfield [00:10:07]: And then there's a plastic piece that expands the nostrils. It's the most effective. Yeah, it's the clunkies to put on.

Dr. Cameron Chesnut [00:10:12]: But I found one that I really like too, that's different. And I use this when I sleep. But I think the most unique place I use it is I put it under my surgical mask because I'm tuned into surgery and I'm hyperfocused, flowing for eight, 10 hours. And I have glasses, my loupes, they're called sitting on my nose. I've got a mask sitting on my nose. I'm covered up. And I find myself mouth breathing, doing that sometimes because everything's compressing on my nose. And so there's an intranasal stent which actually comes from the.

Dr. Cameron Chesnut [00:10:41]: This is something I don't do, but the rhinoplasty world, to kind of hold the nose open after surgery. And there's an ear, nose and throat doctor. I'm completely unaffiliated. I have nothing to do with this. It's called Hale H A L E. I believe and they. They're these, like, little intranasal stents that you put in there. Rubbery plastic, kind of hold your nose open.

Dr. Cameron Chesnut [00:10:55]: They're very simple, very straightforward. They have three different sizes. And I now have them sitting next to my bed. I have them in the operating room. It's sort of the. Like, I kind of hide. It's the last thing I do before surgery.

Ben Greenfield [00:11:05]: Outsides on the inside. This is like the turbine that Chris. Is it Chris Flume, the Tour de France cyclists. He used those during the Tour de France one year. And it's like a little yellow plastic piece that goes inside the nostrils and shoves them apart from the inside.

Dr. Cameron Chesnut [00:11:19]: Yeah. Because when we think anatomically, again, this is not my world as much, but when we think about nasal flow, we have what we call the external valve at the very bottom where the air comes in, and then there's an internal valve that's a little bit higher up. We can define the anatomic walls of that. The traditional nasal strips are focusing more on that internal valve, and this one's kind of more focused on the external.

Ben Greenfield [00:11:37]: So you're saying all of the overachieving biohackers out there could.

Dr. Cameron Chesnut [00:11:41]: I hadn't thought of that. But I guess you can get it.

Ben Greenfield [00:11:44]: All up, and somebody's gonna do it. Cameron Chestnut has been a guest on this podcast three times. This is fourth time with me. I'll link to all of our previous shows where we take a deep dive into his history and cosmetic surgery. How to grow your hair and keep it from graying and get the face more beautiful. He's done extensive work with my wife, Jessa, so I will link to all that if you go to BenGreenfieldLife.com CAM2025 like C A M 2020. You guys don't get a deep dive into Cameron's whole backstory on today's show. You just gotta go listen to those other shows.

Ben Greenfield [00:12:18]: But back to the pool workout cam, you. You use that as a way to build up CO2 tolerance. But what's it look like? Like boots on the streets when you jump in.

Dr. Cameron Chesnut [00:12:27]: Yeah. So a little light warmup. First thing we'll usually do is go into something light where we're really getting into the rhythmic breathing part of things, just to get facile and used to that, because there's a. Certainly a bit of Even a technique to exhaling on the way up to the surface. So that's that you. Every second or millisecond, your mouse above the water is inhaling. You're not exhaling and inhaling at the same time. That's very much basic.

Ben Greenfield [00:12:48]: Similar to free diving or spearfishing. You surface with empty lungs.

Dr. Cameron Chesnut [00:12:53]: Exactly. Same idea. Exactly. Yep. And so that can be hard to wrap your head around at first for people to purposefully let their air out underwater before they're getting a breath. And so that's usually like first things first kind of going over some basics about not hyperventilating and things like that. So little rhythmic warmup like that. Then the way that I said my pool is purpose designed.

Dr. Cameron Chesnut [00:13:12]: There's different depths that are all about 18 inches different, descending from 10ft all the way up to 4. And using, I like to kind of use those different stations for different amounts of weight. Like let's say today we might do a hip hinging workout. Right. So in the deepest sections, you're using a little bit lighter weights, but you have more distance to cover. And by the top, you know, where it's seven feet over our head or whatever. Or maybe holding 50 pound dumbbells and doing single leg pistol squats or squat lunges or something. But trying to get those breaths each time.

Dr. Cameron Chesnut [00:13:41]: Yeah. Then there's the component of. And those are like very, those could be very traditional types of workouts. But then there's just the very unique underwater components of just like taking weights distance underwater without breathing. That's the hypoxic part or the building up CO2 hypercapnic part.

Ben Greenfield [00:13:56]: It's really old school. Like I'm going to carry a rock on the bottom of the ocean.

Dr. Cameron Chesnut [00:13:59]: I mean, type on some level. This is where all that comes from. Surfers have been doing this. It's. Those are the coolest images, right. They're holding a rock between their arms, running on the sandy bottom. It's all, you know, that's the grandfather of it all. Flared's the father for sure.

Ben Greenfield [00:14:12]: Yeah, there's. There's like this link between, you know, being in an anaerobic, acidic or glycolytic state and that being unfavorable to long breath hold times and being in a state of like fat oxidation, ketone utilization, maybe a little bit more alkalinity being conducive to burning through less oxygen or having higher CO2 tolerance. So diet is like kind of a component of this. I mean, when I went down into the freediving course in Fort Lauderdale, I tested this with a bottle of those like exogenous ketones. And my static breath hold time, absence of ketones was about 20 seconds lower than when I kind of like artificially Induced a state of ketosis by. By drinking my blood ketone levels up. Do you mess around? I mean, either for your surgical focus, like you're talking about, or these pool workouts, like what's the. What's the dietary component for you?

Dr. Cameron Chesnut [00:15:08]: Yeah, those all tie together. I first became aware of this via, I think a mutual acquaintance of ours, Justin Lee, who lives in Hawaii and is like a free diver. Is incredible to have to check out his bow Hunter too great everything hunter. He's a few times epic, right. He swam with the University of Washington, so he was like a Division 1 athlete in a very traditional sense, but is now, you know, remarkable. Knows, you know, Peter Atiya very well. Know they were looking at ketones and his breath hold time, that was like a really cool interlink of theirs. But so I became aware of it then.

Dr. Cameron Chesnut [00:15:35]: And you know, the root of this for me is all. When it really boils down to, is all peak performance for me in the operating room, that's where everything boils down to. That's why I'm getting in the pool, you know, to be at my best. That's why I go to jiu jitsu on some, you know, like I just want to be a good human and, and a good father and hard to kill. But it all boils down to how I can be at my best in the or. And ketosis as part of that is it's a noticeable difference in a workout, especially underwater or an endurance workout or something like that. But in the operating room, that's the state that I want to be in. When I'm in ketosis going into surgery, it's that sense of like, this is how I'm supposed to be.

Dr. Cameron Chesnut [00:16:13]: Clear, crisp, making good decisions, which obviously you want your surgeon doing. It's just really hard to get into or stay in ketosis without a lot of exogenous use, you know?

Ben Greenfield [00:16:24]: Yeah. Why did I see a video of you on Facebook or Instagram or something a couple weeks ago eating sardines?

Dr. Cameron Chesnut [00:16:31]: Oh, yeah.

Ben Greenfield [00:16:31]: In your scrubs.

Dr. Cameron Chesnut [00:16:32]: Yeah, very much so. I'll usually going into a surgical state. Like I have a big routine that I do from getting in a flow state the day of surgery, but in the days leading in. So I know my surgery schedule next week. I'm already preparing for it with when I'm timing workouts, how I'm doing everything. But I'll use a fasting protocol, something simple like a 48 hour fast leading into surgery. And then when I refeed, I'm doing things to stay in ketosis. At that point.

Dr. Cameron Chesnut [00:16:58]: And Dominic d', Agostino, the king of ketones, I would say, when I spent some time with him, really got into this idea of, you know, sardines and olive oil, which are actually pretty delicious.

Ben Greenfield [00:17:11]: Yeah.

Dr. Cameron Chesnut [00:17:12]: And, you know, 22 grams of protein.

Ben Greenfield [00:17:13]: Once you're sitting next to you on the airplane.

Dr. Cameron Chesnut [00:17:15]: Well, yeah, maybe they're a great airplane snack, though. But that's a great way to, like, get the protein that it needs. Day in ketosis and kind of be in that performance.

Ben Greenfield [00:17:23]: Yeah. Do you mess around with, like, the exogenous ketones? Yeah, obviously, Dom has his variety. There's a lot of them out there.

Dr. Cameron Chesnut [00:17:30]: Yep. Yep. So I do. I use one called keto Start. That's the one that I'll take preoperatively. Even if it's a time where I'm not in ketosis, I'll take those leading in. I like those for my patients as well.

Ben Greenfield [00:17:40]: Yeah. Do you know what that is? Like, what?

Dr. Cameron Chesnut [00:17:42]: It's a ketone tablet. It's a salt. It's a beta hydroxybutyrate. And salt versus an ester. Right. That's a whole other thing. But I like my patients on those going in as well, even if they're ketone naive. And that gets into a little bit.

Dr. Cameron Chesnut [00:17:56]: We keep, like, hinting at this, but.

Ben Greenfield [00:17:57]: Ketone naive, meaning they could be having Cheerios for breakfast and a sandwich for lunch and sweet potatoes for dinner. But if they have those keto ketones are still able to maintain some semblance of ketosis.

Dr. Cameron Chesnut [00:18:06]: Yeah. Yeah.

Dr. Cameron Chesnut [00:18:07]: Whether.

Dr. Cameron Chesnut [00:18:07]: And I'm encouraging metabolic flexibility before they come in so that they can use ketones if they're.

Ben Greenfield [00:18:12]: Yeah. You don't have an egg with your Cheerios.

Dr. Cameron Chesnut [00:18:14]: Right. Yeah. If your body's unfamiliar with those. I think I have a sampling error where most of my patients are not, I would say, ketone naive, or they're very metabolically flexible. Just because the world that I live in is very, like, high performance, and a lot of them are. And so they've figured out that you can't eat, you know, Cheerios and cereal.

Ben Greenfield [00:18:31]: And then typical patients swinging by Taco Bell on their way in.

Dr. Cameron Chesnut [00:18:34]: No.

Ben Greenfield [00:18:34]: Yeah.

Dr. Cameron Chesnut [00:18:35]: Absolutely not. And so having them with ketones on board pre surgery helps them recover from their anesthesia via some of the same mechanisms we'll talk about with neuroinflammation, which is what, you know, Dominic kind of built the whole world around is understanding how much ketones can stabilize us neurologically.

Ben Greenfield [00:18:51]: Yeah. When you're looking at the effects of anesthesia, just Because I feel like, at least from my perception and the few discussions I've had with surgeons, even that alone, you know, the diet and the, the post surgical interventions aside, does the type of anesthesia you use like kind of fit into the equation at all? And this is like how good someone feels or how bad someone feels after the surgery.

Dr. Cameron Chesnut [00:19:19]: The biggest factor is biggest, oh, 100% the anesthetics use. And you know, I am a surgeon, not an anesthesiologist, but I'm a surgeon in a setting where I'm operating in my operating room, my space. I purpose built it. You know, I'm hiring the team. I'm not just like at a hospital or something and get assigned who I'm working with. And so I get to choose very carefully who I'm having administer my anesthesia. People of a similar like, like mindset. Right, okay.

Dr. Cameron Chesnut [00:19:44]: And so I kind of have approached this the same way that I would with Jessa or with my wife, which is like this. If I were having surgery with a family and it was something like elective or non essential, but important to me, this is what I would want it to be. And so it's been an evolution, honestly, over time. The first steps were getting rid of narcotics or opioids, better said opioids, and benzodiazepines, which are generally for small procedures. The staple anesthetics used, benzodiazepines are like Valium.

Ben Greenfield [00:20:16]: Fit into that category.

Dr. Cameron Chesnut [00:20:17]: Yep, exactly. So the diazepam, lorazepam, these are like the, you know, the generic names of those types of drugs. But you know, in the anesthesia world, people wonder, oh, fentanyl and Versed. These are like the opioid and the benzodiazepine mixed together. You give them IV and you get your colonoscopy or whatever. It's going to be like very standard, but also habit forming, not great for your respiration, cause significant amount of neuroinflammation and cause a lot of what everybody knows. We call it post operative cognitive dysfunction. That fogginess afterwards, difficulty finding words, not feeling like yourself, super disrupted sleep, which is completely under talked about.

Dr. Cameron Chesnut [00:20:55]: That's a whole nother part of it. But those are like very, you know, big culprits in that thing. And it's supposed to be a very simple gentle anesthesia. You're getting a colonoscopy, it's easy. It's twilight sedation type of thing, right?

Ben Greenfield [00:21:06]: Yeah.

Dr. Cameron Chesnut [00:21:06]: On the other end of that spectrum we have these inhaled gases and these would be like the general Anesthetics, the very classically used things still use very much now which cause same thing, like a ton of neuro inflammation and little microemboli post operatively.

Ben Greenfield [00:21:20]: Is that like laughing gas? Like same concept?

Dr. Cameron Chesnut [00:21:22]: No, not, not nitrous. These would be like more volatile types of inhaled gases which are, you know, they work beautifully for what they do, you know. And so you have these two ends of the spectrum with like this very global general anesthesia that, you know, metaphorically sort of like just pushes you to the bottom of the ocean. You are out, you're unconscious, you're not breathing. You got things breathing for you. Like it's a whole. You're just completely shut off. And then you've got the ones that are supposed to just kind of like sedate you or make you unaware so that you can have your procedure done.

Dr. Cameron Chesnut [00:21:53]: But both of those have cognitive issues or at least take some little tax on our brain. We all have a cognitive reserve that, you know, if you and I get anesthesia, anesthesia, we're going to get it and we're going to recover and we're going to be fine afterwards. But there's a period in there where we will have this essentially metabolic insult to our brain that we have to recover from. And we know that that is not transient and temporary. There is some long term price tag to that. And if we are 85 years old and we get it done, that price tag can push us out of budget. We're over. And we all hear stories of people getting anesthesia never recovering.

Dr. Cameron Chesnut [00:22:28]: They were never the same afterwards. You and I get it and we recover. But that doesn't mean that we didn't, you know, take this metabolic insult along the way that, you know, essentially could have cost us some neurons along the way.

Ben Greenfield [00:22:39]: Right. Almost the same type of mentality you've had. You'd have about, I don't know, like the radiation from a CT angiography is like how many of these do I want to do over the course of a lifetime? Can I space them out? And would like. Maybe I want to get a carotid intima media thickness score, ultrasound instead. For the majority of procedures I get you've got a similar approach to anesthesia. It's like, well, yeah, like a certain variety or flavor will allow you to get the procedure done pain free. But there's still a biological cost that you should be thinking about if you're going to be on this planet for like 70, 80, 90 years.

Dr. Cameron Chesnut [00:23:10]: 100% very, very, very well said. And a good way to think about it because, you know, I don't mean to also make people fearful of anesthesia because it's incredible. Like you need a hip replacement or an appendectomy or like these are incredible drugs. And it's an incredible process that we can get those types of procedures done.

Ben Greenfield [00:23:28]: Yeah.

Dr. Cameron Chesnut [00:23:29]: Where I cross into it a little bit is that I'm doing elective cosmetic based things. And it's not worth kind of tapping into that reserve for something that's so elective, Especially when there's other options that exist in the sort of area between, you know, the opioid and benzodiazepine and the inhaled gas, general anesthetic. There's this whole world in between that I live in and play in. And I have some freedom to do that because of all the things I mentioned before about controlling it. But also I'm not functioning in an insurance based environment.

Ben Greenfield [00:23:59]: You're not amputating legs, you're doing like earlobe lifts.

Dr. Cameron Chesnut [00:24:03]: Thanks, Ben. But yeah, I'm functioning in a world where it's facial based and I can be really great with local animations, anesthesia, and do nerve blocks. And then I can control consciousness and comfort in a way that I don't have to have this big neurologic insult. And there's some very specific drugs in there that are more difficult to work with, maybe more expensive, whatever it may be. And that's why I kind of mentioned this insurance aspect is like, it's really to do the way I do it is very intensive and challenging and focused. And in the world of reimbursement for anesthesia, for regular procedures, it's just not reimbursed. It's like, why would you do that? Why, you know, human nature? Why would you do the hard thing? You can do the easy thing. Right.

Dr. Cameron Chesnut [00:24:40]: But where I'm living is, you know, kind of like this is what I would want. And so I'm gonna, you know, do it and further it and talk about it.

Ben Greenfield [00:24:47]: Pay more money to come see you.

Dr. Cameron Chesnut [00:24:48]: Right, exactly. Well, and again, it's like it, there's more to it, but you know, getting back to it's the agents that are the real thing. And. And it's really complex and interesting and complicated and you can get a bunch into the neuroanatomy and the neurotransmitters involved, but there's a few key players, some of which are familiar to people that they've heard about, like ketamine and propofol, but then some are very unfamiliar.

Ben Greenfield [00:25:11]: Ketamine and propofol would Fit into the category something you think is less damaging.

Dr. Cameron Chesnut [00:25:15]: They for sure are less damaging. But interestingly there's a dose paradox to both of those ones. And then something that not a lot of people, or at least lay people have heard about, called dexmedetomidine, which are called Precedex is the brand name, which is very fast. Fascinating from you know, in our world I would say because it's a very central acting alpha 2 agonist. Very specific for a Alpha being a sympathetic mimicker, but central nervous system and Alpha 2, not Alpha 1.

Ben Greenfield [00:25:42]: Anybody who's ever had like a muscle cramp has felt an alpha motor neuron reflex.

Dr. Cameron Chesnut [00:25:46]: Exactly. Yep. And in our central nervous system when it's hitting that, it's basically telling our brain to kind of chill like and it puts a, causes a sleep like state, like non rem delta wave type of sleep. So it's super relaxing and you're out. But it doesn't affect your peripheral blood pressure or your breathing or anything like that. It's mimicking. And if we look at what it does from a restoration standpoint, it mimics this non REM type of sleep. Right.

Dr. Cameron Chesnut [00:26:11]: So if we can focus on that as our main anesthetic, we are not having those neuro inflammatory issues. In fact it downregulates some very important inflammasomes in our brain and the inflammatory cascade that fluoride follows, which is what causes a lot of that post operative cognitive dysfunction is neuroinflammation and like I said, some microemboli. And so it's a great sort of like that's the base, if you will, of your cocktail that you're choosing this. And it's more challenging to work with like a little bit of a slower onset. And so you have to be really comfortable and diligent working with it. And then sprinkling in ketamine and ketamine being dose dependent in the low dose Ketamine is very neuroprotective. It works on a completely different system. We talked about alpha here.

Dr. Cameron Chesnut [00:26:56]: When we get into ketamine we're getting into more like nmda, like the glutamate receptors, which is an excitatory neurotransmitter. Right. And so in low doses, and this is really important in low doses, ketamine is very neuroprotective. It's a little bit of a dissociative, has helps with like pain and awareness and consciousness types of things. So it's beautiful in that sense. Doesn't really, really mess with your respirations Actually kind of helps your lungs dilate, but in high dose flips over and becomes very pro inflammatory. So you gotta be careful about that. And this probably carries over into the other parts of the therapeutic and recreational world.

Ben Greenfield [00:27:27]: Yeah, especially when you take into consideration like the pharmacogenetics of ketamine and the fact that like some people are toast from a neuroinflammatory standpoint on like 20mgs.

Dr. Cameron Chesnut [00:27:35]: Exactly.

Ben Greenfield [00:27:36]: And then others will not feel anything.

Dr. Cameron Chesnut [00:27:38]: Unheard of, right? Yep. And that would be you know again yearsly dosing per kilogram, but that would be like pushing that like you know, more of more upper limit. When I'm using it, it's like a drip or a sprinkle kind of along the way or certain aspects of the procedure. And then propofol which is, you know, everybody is Propofol. A lot of people have heard of is famous Michael Jackson, all kinds of things like that. Interestingly, the reason that Michael Jackson was using it was for sleep because in some low doses propofol has been slown to shown to improve some sleep architecture. In high doses it can be more like a general anesthetic, have that neuroinflammation. But when I'm using propofol I'm sort of using it to kind of turn us into almost like a low power mode to decrease the oxygen needs or capacity of the brain a little bit because then we're protected a little bit in our needs.

Dr. Cameron Chesnut [00:28:22]: So again that's probably the order of which they're prioritized in my operating room because I talk about this and often get asked, well, how do you do it? What agents do you use? Especially for my colleagues and in a short social media type of form it's difficult to talk about those things. But in a long form like we're out here, that would be a very general recipe as to how I like to use them.

Ben Greenfield [00:28:44]: So if somebody was gonna get a procedure done and they're listening, they're not gonna get a procedure done by you. Is there something they can say to their doctor or some kind of advocacy they can take to ensure they're not risking as high a level of post operative cognitive dysfunction?

Dr. Cameron Chesnut [00:29:02]: Such a good question, and I should have said this at the beginning, but these are applicable to every single type of surgery. There is nothing along the spectrum where these at least principles wouldn't be worth asking about. Right. If you are having a brain surgery or huge orthopedics like okay, you're probably going to be into the general anesthetic part of things. But you can certainly let your. This is the challenging part to navigate. Your doctor and your anesthesiologist know that you're interested in these types of things and that you're aware and that you're wanting to minimize these afterwards. Can I have a regional nerve block instead of a general anesthetic or something along those lines? A regional nerve block being local anesthesia, which is the dream, because then there's no pain signal ever sent.

Dr. Cameron Chesnut [00:29:46]: Right. Because I should mention this with my area too, is a lot of what I'm doing is really good local anesthesia. You just can't feel anything in the first place, which really helps. This is a whole nother conversation with post operative pain because if there's never a signal sent from the periphery to the central nervous system to start with, those pathways never get primed. And then post operatively, when the anesthesia is worn off and sort of the pain stimulus is gone, there's not as open a pathways for postoperative pain. So it's better.

Ben Greenfield [00:30:12]: Right.

Dr. Cameron Chesnut [00:30:13]: And we know this even with general.

Ben Greenfield [00:30:14]: Unless you're that crazy athlete who gets a regional nerve block and decides you're going to go out and do heavy squats the next day because you can't feel anything.

Dr. Cameron Chesnut [00:30:21]: Have you heard of people do it?

Ben Greenfield [00:30:22]: Be careful. I have also been guilty of messing around too much with a regional nerve block and, you know, seeing how far.

Dr. Cameron Chesnut [00:30:30]: You can push it. Yeah, yeah. That's a different story. But yeah, you push yourself into rap though, that way.

Ben Greenfield [00:30:35]: Yeah, exactly.

Dr. Cameron Chesnut [00:30:36]: Yeah. But with any, you know, going into any procedure, sort of navigating who to talk to. Because sometimes you've chosen your surgeon very carefully.

Ben Greenfield [00:30:44]: Yeah.

Dr. Cameron Chesnut [00:30:44]: And you show up at the surgery center or hospital and you quite literally have no idea who your anesthesiologist is going to be, which is kind of like mind blowing when you really think about that being the truth. You have no idea.

Ben Greenfield [00:30:54]: Well, a lot of people are blissfully unaware of what you've just described and just assume anesthesia is anesthesia.

Dr. Cameron Chesnut [00:31:00]: Right, Right. So if you can find somebody who's a little bit more progressive. I find that if you have somebody who's curious enough and you talk to them about this, they're kind of willing to like, let's play, let's figure out the best way to do this.

Ben Greenfield [00:31:10]: But there's not like some website collecting of anesthesiologists that you can look up who are trained in your ways or preach what you preach.

Dr. Cameron Chesnut [00:31:17]: Exactly.

Ben Greenfield [00:31:17]: Just send your doctor this podcast, basically.

Dr. Cameron Chesnut [00:31:19]: Yeah, well, I mean, it's not what. The way I do it is not common. Yeah. And it is, you know, like I said, it's just a little bit more involved, more challenging to do it that way. But it's definitely worth asking if it is a situation where your surgeon's getting involved with your anesthesia. It's much more likely to happen versus just who you get assigned to that day type of thing. And this is the other crazy thing. In like, I don't know, some hospital settings, the person administering your anesthesia will likely rotate out throughout your procedure, like who's on shift kind of going on.

Dr. Cameron Chesnut [00:31:47]: So it's difficult. But these are. They're best had preemptively.

Ben Greenfield [00:31:54]: So this. I'm going to save myself a lot of syllables. Pocd.

Dr. Cameron Chesnut [00:31:57]: Right.

Ben Greenfield [00:31:57]: That's the cognitive dysfunction thing. Correct. Maybe a loaded question. I don't know. But what else do you do besides the pre. Metabolic dietary suggested modifications, the anesthetic modifications to mitigate that.

Dr. Cameron Chesnut [00:32:14]: Yeah. So just to summarize, those pre things coming in are everything from peptides to something like creatine, which is an interesting and fun discussion, to ketones. I've been using creatine preoperatively for years. For a decade.

Ben Greenfield [00:32:28]: You were ahead of the curve on.

Dr. Cameron Chesnut [00:32:29]: On that then. Well, it's. This is the crazy thing, I would say over the. And at first it would be like, you know, 10% of my patients came in on creatine predominantly working with women. Right. You know, there's 15, 20 of my patients are men, most are women. So I found that, you know, 10 were on creatine coming in now, I would say over the last 18 to 24 months. I was probably.

Dr. Cameron Chesnut [00:32:49]: The ratio's flipped. It's 80% plus.

Ben Greenfield [00:32:52]: Rhonda Patrick and Andrew Hooverman, the public science educator. And are you modifying the dosage or suggesting that based on the idea that once you exceed 10 grams or so, you see a little bit more of the cognitive enhancement.

Dr. Cameron Chesnut [00:33:05]: Exactly. Yep. So I'm usually trending towards 15.

Ben Greenfield [00:33:08]: Okay.

Dr. Cameron Chesnut [00:33:09]: Coming in again. I find most people now are sort of on that.

Ben Greenfield [00:33:14]: Just like 15 grams creatine powder spread throughout the day.

Dr. Cameron Chesnut [00:33:17]: Exactly.

Ben Greenfield [00:33:18]: Yeah.

Dr. Cameron Chesnut [00:33:18]: Yep. And you know, even, like which brands we're recommending here, you know, kind of spaced into it. But the. I think that one's fascinating because when we think back to our youth of creatine, it was athletic performance, muscle gain, you know.

Dr. Cameron Chesnut [00:33:33]: Yeah.

Ben Greenfield [00:33:34]: And it was 5 grams.

Dr. Cameron Chesnut [00:33:35]: Right. If I.

Ben Greenfield [00:33:35]: Unless you're doing a loading.

Dr. Cameron Chesnut [00:33:36]: Unless you were loading and you have a little glucose with it or whatever, we used to do. Then the more recent discussion of the cognitive benefits. Right. Which sort of makes sense. It's not isolated in our muscle. We know it's in our neural tissue, central nervous system. And this is I think part of the future is now I see it benefiting like skin changes. So this is going to turn into a beauty supplement as well because our fibroblasts, the cells that are creating and healing our skin are energetically demanding.

Dr. Cameron Chesnut [00:34:05]: Especially after what I'm doing like let's say something like a laser resurfacing. So if I can help those cells metabolically, you know, but be more efficient, I'm going to get better results. There are studies right now looking at creatine and skin and no stimulus and showing improvements in skin structure. So that's going to be a really, really fun evolution over time. We're just going to find out more.

Ben Greenfield [00:34:26]: About that as opposed to what is the opposite of no stimulus.

Dr. Cameron Chesnut [00:34:31]: Well, I'm stimulating, I'm using like a laser resurfacing or like a laser contact part of what I'm doing.

Ben Greenfield [00:34:36]: Gotcha. So you would load someone with, with creatine collagen and then aggravate with.

Dr. Cameron Chesnut [00:34:41]: Exactly. I'm making, I'm creating even more metabolic.

Ben Greenfield [00:34:44]: Supplement line like the CCCC Cameron Chestnut creatine collagen cocktail.

Dr. Cameron Chesnut [00:34:49]: You're not going to catch me getting too into selling supplements and or skin care. Not my areas as much but I.

Ben Greenfield [00:34:55]: Do appreciate what we can do. So creatine ketones, what was the other thing you said?

Dr. Cameron Chesnut [00:35:01]: Peptides, dietary things.

Ben Greenfield [00:35:03]: The peptides would be like the PEA.

Dr. Cameron Chesnut [00:35:05]: KPV, BPC, Common Anti Inflammatory Peptides, TB4 and GHK Copper. And the post op is often where I'm adding more of the KPV and types of things into the preoperative stack. This preoperative stack might be two to four weeks before I get this question. A lot depends a little bit on the procedure of the patient. If we're doing ideally if we're doing an injectable form versus a sublingual form. Because if we get to sublingual of the peptide. Yeah. Then we lose bioavailability.

Dr. Cameron Chesnut [00:35:34]: But it's also someone's not poking themselves. So this is all consumption like the.

Ben Greenfield [00:35:38]: Gastric neural anti inflammatory effect.

Dr. Cameron Chesnut [00:35:40]: Exactly. And that's going to be different with different peptides as to what ones have benefit there. So then afterwards, and I'm talking about neuroinflammation a little bit with something like KPV mixed in there and then this is I think the coolest part, I have a very regimented post operative. I call it my optimized recovery protocol that I have my patients do after their surgeries or procedures, whatever it may be. All of my patients are traveling to see me. So we, you know, where we're sitting, just down the street, we have three homes on the water, beautiful views.

Ben Greenfield [00:36:10]: Coeur d', Alene, Idaho, by the way.

Dr. Cameron Chesnut [00:36:11]: Coeur d', Alene, Idaho. Yeah.

Ben Greenfield [00:36:12]: And Spokane, Washington.

Dr. Cameron Chesnut [00:36:13]: Yep, yep. Where my patients stay after their procedures. It's a retreat. They're, you know, it's just a beautiful, wonderful setting for them. But then they're doing things like hyperbaric oxygen every day, targeted IV nutrition. And some of that's targeted towards the healing from surgery, and some of it's targeted towards the anesthesia, like glutathione afterwards or, you know, Coq 10 or whatever we're doing very specifically.

Ben Greenfield [00:36:34]: You mean almost like detoxification from the anesthesia. Even though what you've described is less damaging, you still want that, right?

Dr. Cameron Chesnut [00:36:40]: Yeah, I want any neuroinflammation taken away and taken care of. Even the hyperbaric oxygen, which has a wild benefit to just soft tissue recovery, fat pads, skin, muscle after an injury. It also helps with the neural inflammation, which is why it's used in traumatic brain injury, or people are exploring it with autism spectrum types of things. And so it's this wild, beautiful double benefit. And I kind of love to talk about this, just is that everything meets in the mitochondria at that point. We just really, whether you're healing from surgery, whether you're recovering from anesthesia, all of these things become really beneficial. And again, this is not unique to the types of surgeries that I'm doing. If you have any type of procedure, you have, have soft tissue and sometimes bone healing, that needs to happen afterwards and you have to.

Dr. Cameron Chesnut [00:37:25]: Your brain needs to recover from that. Anesthesia.

Ben Greenfield [00:37:27]: Yeah. What about red light therapy using that?

Dr. Cameron Chesnut [00:37:29]: I like red light therapy and different benefits to it. One of the things I'm targeting often is skin or skin of the face. And so again, I've created more metabolic demand in that particular tissue. Let's go to that word. And I love red light for that particular purpose because I've, you know, the more efficient that tissue is metabolically, just like what I talked about with creatine, we know that red light's enhancing that in the mitochondria. It's going to get better healing. And we can read better healing in this case as a better collagen structure, not necessarily more we want collagen, but we really want. Is elastin.

Dr. Cameron Chesnut [00:38:04]: Elastin is the other fibril in our skin that gives our skin its elasticity. We talked about collagen. Collagen. Collagen, which is great, but that's the structural strength of our skin. And that's often not what's failing as much as a skin losing its ability to recoil after it's stretched, which is hanging skin, basically.

Ben Greenfield [00:38:20]: Yeah. Yeah. I would be remiss then, not to ask you what you think about the overpriced Asian imported red light face masks that are all the rage nowadays.

Dr. Cameron Chesnut [00:38:30]: It's hard. Well, this is like, how do you separate the pearl from the poo there? A little bit. Right. There's so many out there. And what's doing what. And, you know, it's. It's a big challenge to know, like, to really get into the science of the wavelengths and the irradiance and. And, you know, the spectrum, you know, because you'll see all these, like, individual wavelengths listed, which is cool.

Dr. Cameron Chesnut [00:38:49]: But these aren't lasers. They're not individual wavelengths. These are just peaks in the spectrums. Right. And so you dang near have to have a physics degree to, you know, to understand the photons, to know what's best. And that, you know, honestly, is like, kind of look for the reputable brands. And, yeah, you're not shopping for a deal as much with your red.

Ben Greenfield [00:39:04]: Yeah, I have one. I use it well. Jessa has one, too. And I haven't taken a deep dive into these brands in terms of putting on the physics hat, but when I look at the radiance at the wavelengths and at the power, they seem like they should work. She has one. She uses, like, the face and the neck one by. What's it called? Mido Red.

Dr. Cameron Chesnut [00:39:29]: Yeah, I think.

Ben Greenfield [00:39:29]: And then I have one called Iris Store, and it does, like, a purple wavelength, the blue wavelength. Red wavelength.

Dr. Cameron Chesnut [00:39:34]: Yep. And that Iris Store has a lot of hair data behind.

Ben Greenfield [00:39:38]: Yeah, their helmet, too. Yeah.

Dr. Cameron Chesnut [00:39:39]: Yep. And, you know, I like. Again, no affiliation with any of these brands, but I like. You know, there's one called Bon Charge. Therabody makes one.

Ben Greenfield [00:39:46]: Actually, you know what? No, I take it back. Bon Charge is the one Jesse uses.

Dr. Cameron Chesnut [00:39:49]: Charge, yeah. They have that neck attachment to theirs. Yeah, that's a great one.

Ben Greenfield [00:39:52]: Okay.

Dr. Cameron Chesnut [00:39:53]: Body or Thera Face has Therabody, obviously a brand that's.

Ben Greenfield [00:39:58]: I think there's Thera Light, I think is the same company as Therabody.

Dr. Cameron Chesnut [00:40:01]: I think their face line is called theraface. So then A Canadian company called Kala K A L A Kala Therapy makes a really great red light. And I like them because in my sauna, which you'll see today, those are the red lights that I put in my sauna. Very. I dove deep, deep into, like, what are the best sauna red lights. And.

Ben Greenfield [00:40:19]: Oh, for people who aren't going to be in your sauna later today, what'd you do?

Dr. Cameron Chesnut [00:40:22]: So I put eight big panels in my sauna. My sauna.

Ben Greenfield [00:40:25]: So this is a dry sauna.

Dr. Cameron Chesnut [00:40:26]: So it's a. I have a beautiful hum hive, like dry sonic heater.

Ben Greenfield [00:40:30]: Yeah.

Dr. Cameron Chesnut [00:40:30]: I have the home heater that's like, beautiful. Wonderful. It's like maybe the best balance of aesthetics and function of anything. You know, they're so pretty. And then I have infrared panels as well against sort of one of the walls. And then I have the red light sort of like domed around it. So you can have the infrared. You can have the.

Ben Greenfield [00:40:47]: You have the heat of a dry sauna, but then you have put red light and infrared light in the sauna as standalone lights.

Dr. Cameron Chesnut [00:40:54]: Exactly. And you can work out in there. So it's built to work out in.

Ben Greenfield [00:40:58]: Yeah.

Dr. Cameron Chesnut [00:40:58]: Yep.

Ben Greenfield [00:40:59]: Oh, I can't wait to see it.

Dr. Cameron Chesnut [00:41:00]: Yes. Cool. Okay.

Ben Greenfield [00:41:00]: All right, cool. Is there not to belabor this point too much, but for the home engineers, do you have to look into, like, heat resistance of the bulbs and choose specific brands?

Dr. Cameron Chesnut [00:41:13]: This is where.

Ben Greenfield [00:41:13]: Have you written about this? Or can you just, like, tell people?

Dr. Cameron Chesnut [00:41:15]: Well, this is where Kala came in is looking at. Because with any red light device, there's really great ones out there that the issue is dissipating heat. They get hot. Right. So how do you function in a sauna that's 200 degrees and have the light function enough to be beneficial?

Ben Greenfield [00:41:30]: Safety goggles just in case they shatter.

Dr. Cameron Chesnut [00:41:32]: Right. Yeah. And not turn off.

Ben Greenfield [00:41:34]: Right.

Dr. Cameron Chesnut [00:41:34]: Because if they can't dump heat, they'll just shut themselves off. That's where the KALA ones came in. Kala. Like kala K A L A.

Ben Greenfield [00:41:40]: Okay.

Dr. Cameron Chesnut [00:41:40]: Kala therapy. Yeah. And they're really great in the heat and they put out enough irradiance to be like, you know, wildly beneficial. And.

Ben Greenfield [00:41:48]: Yeah.

Dr. Cameron Chesnut [00:41:48]: It's honestly just where they came from. I have no. No affiliation other than they're really great.

Ben Greenfield [00:41:52]: And they do red and infrared.

Dr. Cameron Chesnut [00:41:54]: They do red near infrared. Yep.

Ben Greenfield [00:41:56]: Okay.

Dr. Cameron Chesnut [00:41:56]: And you know, they have a peak at about 660 for their red. 660. 670 is usually ideal for what I'm looking at, my purposes of surgical recovery.

Ben Greenfield [00:42:04]: Yeah.

Dr. Cameron Chesnut [00:42:05]: And then, you know, lots of. Of Them will have multiple kind of peaks in their spectrums.

Ben Greenfield [00:42:09]: Yeah. Is there anything else that is high up on the priority list from a recovery standpoint?

Dr. Cameron Chesnut [00:42:14]: Yep. So I really, you know, in addition to those basics of like, very targeted IV nutrition, which I kind of just mentioned some of the ingredients of, but most of the time when my patients are coming in, I have a relatively robust laboratory and often genetic profile for them as well that they're coming in with. And so I can see how they methylate and look at. Okay, what are we putting in their IVs, do they have any micronutrient deficiencies, things like that? So their IV nutrition is very targeted to them. We have hyperbarics, we have red light. I love pemf. I think PEMF is underutilized in all types of surgical recovery. It's one of the things from a data standpoint that has FDA indications for healing from non and malunion of bones.

Dr. Cameron Chesnut [00:42:56]: So in an orthopedic setting, like your bone doesn't heal after a break. The PEMF helps it heal, which is incredible. But it's not unique to bony healing. It happens in our soft tissues as well, because the way that the electromagnetic fields work is by stimulating the extracellular matrix outside of the cells to heal better. So it does great with soft tissue healing, helps with swelling and things like that. And then I have a few other little things I'll use, like a biocharger and a nanov and those kind of down the line of like, getting a little bit more esoteric into the, like, you know.

Ben Greenfield [00:43:28]: So when is the PEMF face mask gonna come out?

Dr. Cameron Chesnut [00:43:31]: Right. Yeah. So the. The.

Ben Greenfield [00:43:32]: Seems like that should be a thing.

Dr. Cameron Chesnut [00:43:33]: The PEMF I'm using now has a large focus on the face. When we're doing it, there's like, kind of different, you know, paddles you can use with it.

Ben Greenfield [00:43:40]: Okay. Are you. Do you have the pulse centers?

Dr. Cameron Chesnut [00:43:42]: One.

Ben Greenfield [00:43:42]: Okay.

Dr. Cameron Chesnut [00:43:43]: Yeah.

Ben Greenfield [00:43:43]: That's, I think, the most powerful.

Dr. Cameron Chesnut [00:43:45]: Well, yeah, the first time I ever experienced that.

Ben Greenfield [00:43:47]: So you can take like the paddles from that and kind of like put them pretty close to the.

Dr. Cameron Chesnut [00:43:50]: Exactly.

Dr. Cameron Chesnut [00:43:50]: Yep.

Ben Greenfield [00:43:50]: There's.

Dr. Cameron Chesnut [00:43:51]: Yep.

Ben Greenfield [00:43:51]: But you still need like, kind of like an apparatus to hold them up there. So I wasn't going to hold them up to their face.

Dr. Cameron Chesnut [00:43:55]: Exactly. And. And we got that pretty invention idea. Yeah. We have like a little bracket that.

Ben Greenfield [00:44:00]: We just like, license whatever. Whatever it is you've made.

Dr. Cameron Chesnut [00:44:02]: We just kind of grouper it, you know?

Ben Greenfield [00:44:04]: Yeah, yeah, yeah. And then from a dietary standpoint, are you just maintaining the whole like ketone, creatine, collagen rich foods, anti inflammatory type of approach.

Dr. Cameron Chesnut [00:44:15]: Exactly. I try the anti influence. I try to get the anti inflammatory set before people come in if they're not doing it already. But again, sampling error. That's one that people are pretty dialed with already post operatively. I usually just kind of base this. I love nutrition. I was a nutrition undergraduate.

Dr. Cameron Chesnut [00:44:29]: I love that aspect.

Ben Greenfield [00:44:29]: Oh, I forgot about that.

Dr. Cameron Chesnut [00:44:30]: Yeah. And I just kind of will go with what do you do before. I'm not changing people's diets per se to if they're a vegan, I'm not trying to convince them to be a carnivore and vice versa. I believe just looking at my teeth that we're meant to eat a lot of different types of foods. And so whatever you're sort of used to, we're going to optimize that in the postoperative period, which is predominantly making sure that we have enough protein. Right. And when we get into the micronutrients and things like that, we're testing for that beforehand. We want our vitamins D status, very basic things to be good.

Dr. Cameron Chesnut [00:45:05]: That's maybe the most basic supplement before anybody having any surgery. If your vitamins, vitamin D optimized going into your surgery, your risks of all the bad things of surgery are so much lower afterwards. Like post operative infection. The way you heal things really.

Ben Greenfield [00:45:18]: And you're not just saying that like.

Dr. Cameron Chesnut [00:45:19]: There'S actual research that's like the most. It's like so basic, overlooked. Like every, you know, people who are maybe not in the same space that I am who like love this to the degree that I do. Every surgeon knows or should know that, you know, vitamin D like most, you know, rural general surgeon doing everything in the world. Every procedure like vitamin D vitamin.

Ben Greenfield [00:45:39]: Yeah. And assuming pretesting doesn't indicate levels are already elevated or even excessive, you know, most of the time the recommendation is anywhere from 2000 to 4000 IU. Are you increasing that going into a surgery?

Dr. Cameron Chesnut [00:45:53]: Yeah, so I'm looking. I usually have those numbers before. Again, this is one of the luxuries of my practice. And so I'll do 5 to 10,000 IUs with K2 for people going into it just depending on where their baseline levels are. And I honestly find that I don't really need to do that that much anymore. This is one of those fun, more than a decade of evolution of looking at those things. And it's one of the things that I noticed people's vitamin D levels in my world are getting better. I'm not saying globally that's reflective, but as people have become more aware and again, in the selective high performer group, people are kind of doing better with their vitamin D supplementation.

Ben Greenfield [00:46:28]: Yeah, yeah, you said that. That the sleep is going to have some. Is going to be impacted sleep architecture to a certain extent with the traditional anesthetic methods, I'm assuming there's still an impact on sleep from something like ketamine and propofol.

Dr. Cameron Chesnut [00:46:45]: Yeah.

Ben Greenfield [00:46:45]: Are you doing anything as far as sleep goes like melatonin or anything else?

Dr. Cameron Chesnut [00:46:49]: Yeah. Thanks for bringing it back. That's a really good point. Because of those agents, those unique things I talked about, really only the dexmedetomy and the presidex is the one that's really helping sleep architecture. Ketamine and propofol are neutrals to negatives. More on the negative end still. They're not, you know, depending on the dose. But precedex is the one that's really protecting.

Dr. Cameron Chesnut [00:47:09]: Right. But no matter what in that cocktail, we're still disrupting sleep to some point. We just want to disrupt it as little as possible so that we can get back on a normal sleep architecture. If we 30,000 foot view zoom out, we know for any stress, metabolic, emotional, whatever it is, that sleep's wildly important to that healing. And so to ignore that as part of a huge lever to pull in the surgical recovery period is just missing it. Right. So anything we can do to start thinking about it from the anesthetics, we're choosing to something very simple like melatonin beforehand at 10 milligram dose of melatonin or 5 milligram dose. You also get an antioxidant benefit to it as well.

Dr. Cameron Chesnut [00:47:48]: So it's kind of this like double benefit to it. I don't love relying on sleep aids afterwards. I have patients coming from different time zones all over. So we're taking that into consideration even like when we're doing their surgery and planning their follow up, because we want their sleep so optimized afterwards. And you know, some people are good sleepers coming in and some aren't. And we're, we're trying to make that a really strong part of our recovery.

Ben Greenfield [00:48:12]: Yeah. So when you're talking about the time zone thing, do you mean like you wouldn't do like a later afternoon or early evening surgery for someone who's coming like three or four hours from back east?

Dr. Cameron Chesnut [00:48:20]: Yeah, exactly. Yep. And again, it's all the same thing. Like, you know, we'd love to start Everybody's recovery at 8 o' clock in the morning. Because the day that they come, the days that they come in, basically every day after surgery, they're with us for maybe five or six hours to get through this whole sort of regimen and process every day. It's very passive from a physicality standpoint, but it's very committed. Right?

Ben Greenfield [00:48:40]: Yeah.

Dr. Cameron Chesnut [00:48:40]: And so, you know, but if 8:00 clock is, you know, midnight your time or 2:00am Someone's coming from, you know, Europe or something like that, we're trying to like be thoughtful about when we're planning that on their circadian rhythms.

Ben Greenfield [00:48:53]: Yeah, yeah. We've talked a lot in other episodes about some of the different protocols that you do. You know, probably the, the, what you call it, the laser resurfacing is the correct terminology being the one that I think people are the most curious about. Maybe it's because my wife's been very vocal on social media that she did it and that seems to be the one that, that turns the most heads like a month or two later once the effects have kind of kicked in for sure. But as far as like future advances in cosmetic surgery, I know you go to a lot of the conferences and events and have your finger on the pulse of this, what's coming down the pipeline that you think is cool.

Dr. Cameron Chesnut [00:49:28]: So I would say it's interesting because when I think about this, from what I said, see coming in the cosmetic world as a whole, right. And I think of then where I'm at and where, you know, kind of maybe thinking a step ahead of that in the cosmetic world right now. I just went to our big national or American Academy of Facial Plastic and Reconstructive Surgery conference and I gave a standing room lecture only on peptides and regenerative medicine, which for your audience is going to be very like ho hum, like yeah, of course. Peptides and regenerative medicine. We got to remember we're talking about an entire academy, an entire world catching up with it. And we're talking about a dynamic, cash based, free flowing, not reliant on insurance type of academy catching up with it. Facial plastic surgery, that's not happening in a lot of other surgical specialties yet. You might find a few orthopedists or general surgeons who have hopped onto that, but they're so far away from that.

Ben Greenfield [00:50:16]: Happening.

Dr. Cameron Chesnut [00:50:18]: In a world tipping scale. That's what's starting to happen. Regenerative medicine is beyond buzzword and we're starting to get into like, what, why, how, how do we use it best, what's it doing things like that. Right. And then in my world, you know, I start getting into, you know, if I start subdividing that out. For me, a lot of my regenerative medicine is using somebody's own stem cells for their surgical healing and recovery. Because I'm already accessing their fat to do facial fat.

Ben Greenfield [00:50:46]: Oh, yeah, you're doing like the whole liposuction. Put the fat in the, the face thing. So you've. You've already got access to the stem cells.

Dr. Cameron Chesnut [00:50:51]: Exactly, right, yeah. Yep. And so autologous.

Ben Greenfield [00:50:53]: Like, like somebody's own stem cells.

Dr. Cameron Chesnut [00:50:55]: Their own stem cells. The liposuct. Just to clarify, the liposuction is very gentle, very small. It's not like what people think of with liposuction. This is very, like focal, you know, minimal, leave no trace type of thing.

Ben Greenfield [00:51:07]: Right. But you have like a lightsaber and a chainsaw. Yeah.

Dr. Cameron Chesnut [00:51:10]: Which I think is what people think.

Ben Greenfield [00:51:11]: About, because they're thinking about this person.

Dr. Cameron Chesnut [00:51:13]: Like, doing this and sucking out, like, massive amounts of fat. I'm using very low quantity, high quality types of things. But now for me, it's like, okay, I have these stem cells. Who are they from? Where are they from? How are they performing? How can I make them work best? Where can I use them? It's beyond just rejuvenating fat pads with fat, which is cosmetically incredible. Right. That we can replace, like, for, like, and make your fat pads stronger, more structural, age better. But then it's also, well, how can I use this to help from the surgical healing process? How can I use them to help from the laser process, make the skin better? All these paracrine mediated communication effects, you know, that's like, one thing, and I'm always working to improve that. And then, you know, in this, in the world as well, like, just as an example, recently went down this, like, microplastics rabbit hole in the operating room, realizing, like, we are using a lot of plastic in the operating room.

Ben Greenfield [00:52:07]: Well, did you, did you see, it was like last year, there was several news reports and research coming out showing that, like, just intravenous administration alone from the tubes.

Dr. Cameron Chesnut [00:52:19]: Right.

Ben Greenfield [00:52:19]: Was such an issue that they were encouraging physicians to like, run the first, I think, like 30 milliliters or so before they actually put it into the patient. Just to get rid of some of the plastics and the tubing.

Dr. Cameron Chesnut [00:52:31]: Exactly. That's. That this, all of that was the original impetus to be like, oh, yeah, yeah. Think of, think of all the plastic wording. This goes back even to me to like, my first surgeries in medical school when I was like a kid basically. And you're just like, shut your mouth. You know, don't touch anything. Just like be in the operating room.

Dr. Cameron Chesnut [00:52:48]: But I remember at the end of these surgeries being like, there's four garbage cans full.

Ben Greenfield [00:52:53]: It's like the Barbie theme songs.

Dr. Cameron Chesnut [00:52:54]: Fantastic. Yes. Life and plastic. And you're just like, I can't leave all this waste and all this plastic. And then, you know, in my operating is a little more efficient than that. But same story is like, you know, getting into like, okay, hearing this, thinking about most of the plasticizers we're worried about are softening, making things like plastic softer, more pliable, like an IV bag or IV tubing and going, okay, what am I, what am I using?

Ben Greenfield [00:53:15]: Sound like the worst kind, right?

Dr. Cameron Chesnut [00:53:17]: Yeah, like, what am I using? What's in them? How can I get around them? Which this was a deep dive. And I always thank my operating room staff for this because with most places, if I was at a hospital, this, everybody would have quit. Yeah, like, you're just making our job so difficult. We're out of here. Right? But this is again, sharing a mindset in my own private space. Everybody's like, yeah, all right. Oh yeah, this is good, let's do this. And diving into.

Dr. Cameron Chesnut [00:53:37]: Where are the microplastics? Where are our main sources? How do we get rid of them? Throwing away tens of thousands of dollars worth of like pre purchased supplies, being like, okay, now that I can't use these, now that I know what's in them, finding ways around it and, and then also learning that some of the, you know, specific plasticizers we're using in the United States aren't even legal in, in Europe. Right. Or that the US knows that like high doses of these things in kids, like exposure with kids with, you know, to these via IV for a long time is detrimental. But for you and I getting our procedures, it's like, you'll be fine. You know, so you're an adult. Yeah. Right. So I wiped all those things out, which was really huge in learning how to do where, where I was finding them.

Dr. Cameron Chesnut [00:54:19]: Because to be in full disclosure, I found some in my or that I'm like, I wouldn't want, I wouldn't want this.

Ben Greenfield [00:54:24]: And then they're difficult via standard detoxification methods. Whether it's, you know, the bowels, the sweat, you know, when you're looking at the, the Dalton size, you know, being like up to a thousand, like you're going to pass that through a sweat gland.

Dr. Cameron Chesnut [00:54:35]: Right?

Ben Greenfield [00:54:36]: Yeah.

Dr. Cameron Chesnut [00:54:36]: And then you, there's. It's just such a world that once you learn, like, well, what's it really doing anyway? And you know, you're like, no matter what it's doing, it's inhibiting the cellular efficiency, the cellular optimization that I want for healing no matter what. So they've got to go, you know.

Ben Greenfield [00:54:49]: Yeah.

Dr. Cameron Chesnut [00:54:49]: And even if it's a 1% better result for me in the long term, totally worth it in my world. And so these are all these little things and this kind of, it's, you know, funny that I'm talking about plastic surgery and microplastics. It's in every type of surgery, but it just takes a. I think we're, I think we're so far away from that becoming like adopted.

Ben Greenfield [00:55:08]: I think remediation of, of microplastics is going to be a hot topic in the health industry for the next decade. I mean, one of the things I do, as I said on calls with companies who are looking for money and I had a very interesting one a couple days ago, and they're doing bacterial remediation, like looking into bacterial engineering. Interesting bacterial strains that in the gut could cause remediation of plastics via the postbiotic compounds that the bacteria make. And I think that's just the gut.

Dr. Cameron Chesnut [00:55:34]: Right.

Ben Greenfield [00:55:34]: There's a lot of other places that they accumulate because you get lung exposure, you get transdermal exposure. But the gut is a significant source.

Dr. Cameron Chesnut [00:55:40]: Yeah, there is.

Ben Greenfield [00:55:41]: So I think, I think we'll see a lot more people and companies looking into how do we just like engineer this stuff out of the body.

Dr. Cameron Chesnut [00:55:47]: Yeah, that's super. Because that's where my head goes next is like, okay, well now what can we do? Even I'm thinking in this more acute setting of weather healing to eliminate them because it's, you know, you mentioned traditional detoxification. It's hard. I mean, they're. I'm not putting somebody in a sauna day one post surgery, you know, so it's like, okay, what can we do? So that's really.

Ben Greenfield [00:56:06]: Yeah, that's true. You can't do that because of the, the surgical.

Dr. Cameron Chesnut [00:56:09]: Yeah.

Ben Greenfield [00:56:10]: Wounds or whatever you call them everything. Wounds probably is the word you use.

Dr. Cameron Chesnut [00:56:12]: Yeah, I don't use the word wounds, but I mean in the sense of like, you know, it's a hormetic stress that. We don't need a hormetic stress right now. We've got enough other stresses going on.

Ben Greenfield [00:56:21]: Yeah, yeah, yeah. Super interesting. Well, I'm ready to go try this pool workout sauna, folks. BenGreenfieldLife.com CAM 2025 Listen to Cameron's other episodes because I get asked all the time, like, my hair's turning gray or my hair's falling out or my skin's regarding like 75% of the time, like, go listen to my episodes with Cameron Chestnut. Because that I'm being lazy and just sending people to listen to you because I know you're on top of this stuff. So thanks for being a 4P guest.

Dr. Cameron Chesnut [00:56:51]: Yeah. Do you remember when we had your like, hair Jesus looking for a while.

Ben Greenfield [00:56:54]: There you were getting long.

Dr. Cameron Chesnut [00:56:56]: You're growing everything out. That was during your hair growth phase when you did a little experiment and we went kind of nuts on your hair.

Ben Greenfield [00:57:01]: Yeah. And I kind of had to clean up a little bit, but that's right, that was years ago and it worked.

Dr. Cameron Chesnut [00:57:04]: Yeah.

Ben Greenfield [00:57:04]: Yeah. Still, again, we should do that Jesus things.

Dr. Cameron Chesnut [00:57:07]: And we did. We did some laser on your skin. Your skin looks great. Yeah, yeah, yeah.

Ben Greenfield [00:57:10]: Awesome. Love it. Down.

Dr. Cameron Chesnut [00:57:11]: Yeah.

Ben Greenfield [00:57:12]: All right, folks, again, BenGreenfieldLife.com CAM 2025 check out the great Dr. Cameron Chestnut. Thanks for watching. To discover even more tips, tricks, hacks and content to become the most complete, boundless version of you, visit BenGreenfieldLife.com.

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