Episode 445: Beyond Normal. The New Science of Enhanced Medicine with Dr. Shai Efrati

In this episode, the brilliant Dr. Shai Efrati enlightens us on a revolutionary concept, enhanced medicine, which goes beyond conventional treatments and focuses on the body’s natural healing abilities. Throughout this episode, you’ll learn what enhanced medicine is, why it is so revolutionary, and how it can change how we see medical attention, treatments, and self-care. You’ll also hear Dr. Efrati’s thoughts on the importance of focusing on root causes, personalized approaches to improve patient care, the multiple benefits of hyperbaric chambers, and much more.

Rob Shallenberger: I’m Rob Shallenberger, and welcome back to all of our Becoming Your Best podcast listeners. I’m so grateful that you’ve joined us today. We have an awesome guest, Dr. Shai Efrati. He is an amazing man, joining us from Tel Aviv, Israel, and has written a book called Beyond Normal. We’re going to dive into that book—why he wrote it, what it’s about, and what it means to you. This is one of those topics that most of us probably don’t know much about, so we’re going to be learning together. They say that knowledge is power. Well, that’s true, but only when we apply that knowledge. However, we can’t apply something if we don’t know it first. This podcast is really going to be devoted, for most of us, to learning something new that we’re not aware of. What we do with that knowledge is going to be up to each one of us. But Dr. Efrati is an amazing man and an expert in this particular field, and we’re going to learn a lot more about it. So, first of all, Dr. Efrati, welcome! We’re so glad you’re able to join us.

Dr. Shai Efrati: Thank you. I’m happy to be here.

Rob Shallenberger: Let’s jump right into this. Give, first of all, all of us a little bit of your background.

Dr. Shai Efrati: So, I’m a physician. I started by specializing in internal medicine and clinical pharmacology, and then nephrology and hypertension. After that, I also specialized in hyperbaric medicine. I’m a professor at Tel Aviv University, in the medical school and the neuroscience school. So, this is my background.

Rob Shallenberger: Well, that sounds awesome, and that really is what led into your book. You just released a new book. Tell us, first of all, about the book Beyond Normal and why you wrote it.

Dr. Shai Efrati: So, actually, in Beyond Normal, we are discussing what I call enhanced medicine. It’s named Beyond Normal because this is the first and most important principle in enhanced medicine. When we talk about standard medicine, we are targeting the “normal,” which is the average for a particular age. If someone is around the average for their age, we typically say that they are okay. However, for 50% of the population, being at the average means they have declined, sometimes even significantly. They can decline by one standard deviation or two. So, this is one problem—going from up to normal. The other problem is if we cannot even reach the normal. For example, if someone is severely injured, and their only biological wish is to move a finger or to blink their eyes or scratch an itch somewhere on their body, that would not be considered a successful treatment goal in standard medicine because it doesn’t bring them back to normal. The basic of enhanced medicine is that we don’t care about the average; we don’t care about what is considered normal for a particular age. The first thing we ask is tell me what your biological wish is, and then I will see if there’s a way to approach or achieve that wish. If there is a way, we will pursue it. If there isn’t, we will tell you upfront that your wish is not something we can accomplish. For example, I wished to be two meters tall, but I figured out at the age of 18 that it wasn’t going to happen. So, I cannot do that. The first principle is to set the expectation: tell me your biological wish. That’s one principle of enhanced medicine. The other principle is based on my journey through medical school and beyond. In medical school, things looked quite easy: you have a book, you memorize it, and there you have the “truth.” If you have a good memory, you feel like the most powerful person in the universe. Everything seems clear—you know everything. When I was a student, it was very simple. I would say, “I will read another book; I will learn this textbook or that textbook.” But now, as a professor, writing and teaching, I know that I don’t know anything. You learn how much you don’t know.

Dr. Shai Efrati: So, another major principle in enhanced medicine is that we are not targeting a specific enzyme or a specific receptor. We are targeting a pathway that we want to activate. I’ll try to give a simple example: if you are infected with bacteria, giving you antibiotics is classical medicine; giving a vaccination is enhanced medicine. What do you do with a vaccination? You actually prepare the body or activate the immune system to be ready for the bacteria when it attacks you. This is an example of the difference between enhanced and classical medicine. In enhanced medicine, you want to activate a biological cascade of events that will enable you to reach a certain goal. I’ll give you another example. If you don’t eat, you will die. However, if you practice intermittent fasting, you activate a biological cascade of events that makes your body more resilient and can improve your age-related cognitive decline. If you do extreme exercise, you can break your bones. However, if you are doing intermittent exercise, you will damage your body, but in a way that the body will trigger a cascade of events that enables the body’s repair mechanisms. Another element we use is what we call the hyperoxic-hypoxic paradox. One of the most powerful triggers that activate the body’s regenerative repair mechanism cascade is hypoxia. From an evolutionary perspective, once you experience hypoxia—a lack of oxygen supply—then the body knows that there is damage, and it activates all the repair mechanisms. Stem cells start to proliferate, blood vessels begin to regenerate, and the tissue is repaired. However, hypoxia itself is not healthy. If I were to take a person, hold their breath, or stop their heartbeat, I would cause hypoxia, but they would indeed need the repair mechanisms because there would probably be damage.

Dr. Shai Efrati: So, we thought: what is the body actually sensing? Does the body sense absolute values, or does it sense fluctuations? It happens to be that there are no absolutes in life. We decided we wanted the trigger, but we didn’t want hypoxia. What we do is take the oxygen to a very high level and then do a fast decline back to normal. This decline—from very high back to normal—is interpreted at the cellular level as a lack of oxygen, even though you are not lacking oxygen. This activates the repair mechanisms. In order to do that, we use a unique chamber and a specific protocol. This is what we call the hyperoxic-hypoxic paradox. For the first time in humans, even in the brain, we see the generation of new neurons and blood vessels. It’s not stopping the decline; it’s actually about enhancing physical performance.

Rob Shallenberger: That’s awesome. I just wrote down three separate questions that I want to ask. You’re referencing a hyperbaric chamber, right?

Dr. Shai Efrati: Yes. The chamber enables us to change the environment and oxygen conditions according to a specific protocol that we developed, which triggers the repair mechanism. So, the treatment is not the chamber; it’s the fluctuation.

Rob Shallenberger: So, I have a couple of questions about the hyperbaric chamber. For example, how would that apply to someone in the United States, Australia, or the Philippines? Obviously, you’re in Israel, and you may have a specific protocol or a specific type of chamber. I’ll come back to that question in a minute—how someone in different cities in the United States, for example, could access your particular protocol, if that’s what it is, or things like that. Let me come back to that question. Let’s start with another example. You’re talking about this enhanced medicine approach, which I love, and I think a lot of people are on board with and understand, at least by concept or principle. So, let’s take someone who has been having headaches for a year or two and hasn’t been able to figure out why. Using your approach, if they were to meet with you, walk me through what you would do with that individual.

Dr. Shai Efrati: So, the first stage is not looking at the symptoms but rather seeking out the core of the biology that causes the symptoms. We are not treating the symptoms; we are treating the core. For example, with headaches, there can be many reasons for them. It could be a migraine attack. In migraines, the blood vessels are first dilated and then constricted. When they constrict, certain areas in the brain don’t receive enough oxygen, leading to severe pain. It’s also possible that you have headaches due to a brain injury, such as a concussion, and we can see the damaged tissue. You might have headaches because of temporal arteritis, or it could be because your vision is not accurate. In that case, just by putting on glasses, you could eliminate the headache. So, a headache is not a disease; it’s a symptom. We don’t focus on the symptoms themselves. The symptoms guide us to where we need to investigate further. We would never treat a patient unless we know what the core biological is. The first stage is digging in, seeking out the biological core of the symptoms. If we understand what the biological core is, then we look for a way to repair it. For example, if you come to me with a headache, giving you a drug to reduce the pain—from Paracetamol to morphine—is not an enhanced medicine. That might serve as a bridge until we understand how to help you, but it’s not enhanced medicine. It’s just treating the symptoms. This is what I am doing as part of traditional medicine. Digging in and understanding what the biological core is, and then target that core. That’s enhanced medicine.

Rob Shallenberger: Yeah, that actually makes a lot of sense. So, let’s use the same example. Let’s say there’s someone who has been having these headaches for a year or two, and they want to address it. One of the challenges, at least from my perspective in the United States, is that there’s so much information out there. A person is inundated and doesn’t even know where to start. You look on the internet, and you find this, and this, and this, and most doctors, to your point—and in my experience, the majority of doctors—are pretty much wired to treat the symptoms. So, to your point, if you have a headache, they say, “Okay, well, let’s give you this; let’s give you this medicine.” That can be really frustrating for a lot of people because you’re not really getting to the core issue. We’ve experienced this and seen it with different family members. So, one of the questions that I’m already thinking about, and that some people might be asking, including myself, is: you’ve obviously developed a specific approach for this enhanced medicine that most doctors are not aware of or couldn’t do. So, do people— and I’m jumping ahead because this is a question I would normally ask you at the end—do you do coaching? Do you meet with people around the world? Is there a way that people can visit with you specifically? It sounds like you’ve developed a technique and an approach that most people haven’t.

Dr. Shai Efrati: Now, there is a replication of what we’re doing in our center in Israel, which is network. For example, there’s a big center in Florida that is already operating in the US. The Aviv Clinic in Florida is performing exactly that way. If you have a problem and you approach us, the first stage is evaluation, and we are saving anything needed during this process. We dig in. You’ll undergo MRI, functional MRI, DTI, or a SPECT scan if we’re dealing with the brain and headaches. We’ll determine if you had a concussion, when it happened, and if it’s related to your current symptoms. We’ll ask if you had COVID and if your headaches are part of post-COVID symptoms. We’ll assess whether you have vision problems. You’ll undergo a full neuropsychological evaluation and a physical evaluation. Only once it’s clear to us—and we will dig in as deep as possible as needed until we understand the core issue—will we not let you take these analgesics. That’s enhanced medicine. Once we know what the problem is, we will find—or try to find—a way to address it at the core. If we have a program that we know can help you, you’ll stay with us for the duration of the program. However, it won’t be a magic pill. There’s no such thing. It’s like a wound. No one expects a wound to be fully healed in two hours, three hours, or even a couple of days. It takes time. If you have a broken leg, it takes time to heal. This is a repair mechanism; this is regenerative medicine and enhancement. It takes time. So, you usually need to stay with us for a period of time so we can apply the protocol that’s best for you, reevaluate to see if the problem has been resolved, and then you can continue with your life. That’s how it works. We have centers in Florida, and Florida is the education hub for other locations in the US. Once the center is fully active, as it is now, it’s starting to be replicated in other locations in the US. We even have a center in Dubai that is fully active and operating, even in these times. Soon, there will be additional centers in Europe. So, now it’s growing, and people are coming from all over the world.

Rob Shallenberger: I think you’re partly answering my next question here that I wanted to come back to—the hyperbaric chamber. So, with a clinic in Florida, Tel Aviv, etc., could you talk a little bit more about the hyperbaric chamber? Maybe we can stick with the same example—the person with the headache or whatever symptom. They go down this path with you, working on this enhanced approach. What does the hyperbaric chamber do? You started explaining that. And then, I guess, my follow-up question is—let’s take the United States, where the majority of our listeners are, although there are listeners around the world—would someone have to fly to Florida to go to the Aviv Clinic? Or could they find a hyperbaric chamber in their city and follow a specific protocol prescribed by you or the Aviv Clinic? Or do they have to fly to Florida for a specific hyperbaric chamber or protocol? Does that make sense?

Dr. Shai Efrati: First of all, it’s a program. It’s not only about the hyperbaric chamber. For example, if you take the Aviv Clinic in Florida, it’s a multidisciplinary team that works together in the same location, all for you. It includes physiologists, physiotherapists, and physicians from multiple disciplines, and technicians. You have the entire multidisciplinary team all working for you based on a program that was determined from your baseline evaluation. So, it can be done in other locations, but usually, the best way to first understand what the problem is, is to come to the Aviv Clinic. You can have everything in one location: any type of MRI, metabolic imaging, neuropsychologists, physiologists—everything in one place. Once we understand what the problem is, you can decide where you want to address it. Unfortunately, just like you said, today, people are looking for quick answers. You type your symptoms into Google or ChatGPT, and you expect an answer in a minute—or less. If it takes a minute, you might even check your computer to see if something’s broken. And then, you get a huge amount of information. However, medicine is not just a simple equation of one plus one equals two. It’s an art. Just like when you need to fix your car, you still need to go to the garage because someone needs to put the tires in the right place, fill them, check them, and so on. It’s not something you can just Google. Someone needs to dig in. So, for better or worse, of course, we use algorithms and all of that, but those are just co-drivers—they’re not the drivers. You still need someone who sits in front of you, listens to you, and gives you the time to listen. For example, one of the principles of enhanced medicine is that the physician has time. They will sit with you and take the time to get to know you, to understand who you are, what the problem is, and where it started. It’s not just, “You have a headache; take this pill.” They’ll ask, “Were you playing football? Did you have a car accident? What happened? Did you have COVID?” You have to spend time. The first rule is to give the physician time. Unfortunately, in the way the general system is running today, physicians don’t have time. They have 10 minutes to speak, write, prescribe, and get you out the door.

Rob Shallenberger: Yeah, that’s true. That’s one of the issues with today’s Western medicine. So, let’s go back to your book Beyond Normal. I think people, including myself, now have an understanding of how to go all in on this approach then I think we have a basic understanding of how to do that. I was just looking at your website, or at least of the Aviv Clinic. But let’s go back to the book. Some people aren’t going to be able to travel to a clinic, so let’s focus on the book Beyond Normal. Why should someone pick up the book and read it? What’s the book going to do for someone—take any random person?

Dr. Shai Efrati: I’ll tell you the reason I wrote the book. For many years, a lot of my colleagues came to me and said, “Shai, you need to write a book. You need to write a book.” And I always replied, “I’m not writing a book. I’m writing scientific articles. People can read the scientific articles.” But a year ago, by mistake, I said, “Okay.” What convinced me was the claim that today, physicians are becoming a bottleneck that prevents the general public, who need relief for their conditions, from getting an appropriate approach. If you have a problem, you go to a physician, and you want to believe that the physician’s interest is aligned with yours. But that’s not always the case. The physician’s interest is often tied to who is paying their salary, who is setting the limitations on how they should practice medicine, what they should prescribe, what they should say, and so on. Their knowledge can also be a bottleneck—if they’ve studied something, then they think you are a part of it. I realized that if we want to make a real change, it’s not enough to write another scientific article or do more research. I needed to speak directly to the end user. And the end user is you—it’s people like you. So when I agreed to write the book, the first question I asked was, “Who is the target audience?” The target audience for this book is what I call the “intelligent layman.” It’s not for someone who is completely stupid, but it’s not for medical professionals either. When I started writing it a year ago, it was a huge challenge because when I wrote a chapter, the editor came back to me and said, “Shai, this isn’t good enough.” I asked, “What do you mean, not good enough?” He said, “It’s not personalized enough. You have to add stories.” I said, “What stories? I’m a scientist.” He said, “No, you have to include stories so people can understand.” And when I added a story, he said, “No, it has to be a personal story.” So, I added personal stories. Now that the book is finished, I feel that I am fully naked. It was challenging, but the challenge was to take the high-end science that we have and bring it up to the table so the clients who need it—the end users—can really understand what we’re doing.

Dr. Shai Efrati: If we want to move forward quickly, we need to speak with the end users and bypass everything on the way. We need to communicate in a way that people can understand. If you’re speaking to someone from France, you can’t speak English to them. You can’t always trust the translator; you need to speak French. So, when I’m speaking to you, I need to communicate in a way that you understand, not in a way that I understand. That was the main motivation for the book—to bring the high-end science of what we have today in medicine, specifically in enhanced medicine, and present it in a way that people can understand. Hopefully, I did a good enough job. It may not be perfect, but good enough is good enough.

Rob Shallenberger: So, really, the bottom line is, to summarize the book, it’s focused on an enhanced medicine approach, and it introduces several new areas that most people wouldn’t be familiar with—hyperbaric chambers, for example, would be just one part of it. You talked about things like intermittent fasting and exercise, which are some of the big ones that a lot of people are familiar with, but I’m sure there are others. I haven’t read it yet, but I’m going to. You’ve piqued my curiosity enough that I’m going to read it. This is an area I’m fascinated with—enhanced medicine. I think most people would agree with this, but in my experience, the Western medicine approach is great when you have to go to the emergency room for a broken arm or an accident—wonderful! If there’s an issue with the heart that needs to be resolved right now. But when it comes to solving some of these areas that are a little more mysterious, under the radar, or things like Long COVID, Western medicine often falls short. It’s just the prescribed approach: “Here, let me give you this, and let’s treat that symptom” without really getting to the root cause. So, if I understand correctly, what you’re saying, Dr. Efrati, is that Beyond Normal is really about this enhanced medicine approach that targets why something is happening—whatever fill-in-the-blank is. Is that correct?

Dr. Shai Efrati: Absolutely. So, you have all of these categories in the book: post-COVID, post-concussion or TBI, stroke, dementia, and Alzheimer’s. But there’s also a major element that’s important to me, which is age-related functional decline. You know the phrase, “You’re normal for your age, so you’re okay.” But who wants to be normal for their age? I want to perform—period. I want to perform at my best. I don’t want to be just normal for my age. The book targets all of these issues, explaining the core mechanisms in a way that people can understand, whether they’re scientists or businesspeople. An interesting thing happened with the book: it’s still in the pre-order phase, but during that time, it became number one on Amazon in two categories, which may seem contradictory to some people. One category is sports medicine, and the other is geriatrics. It ranks high in both because enhanced medicine is about enhancing biology. A lot of my treated population just won a few gold medals in the Olympics. On the other hand, geriatrics are also elite athletes. They’re saying, “I’m not going to be normal to my age. I’m going to improve myself. I’m going to push the boundaries.” So it’s the same element for both: not taking the biology for granted but enhancing it.

Rob Shallenberger: That actually makes a lot of sense because there are a couple of different groups of people here. There are people who are going through age-related issues, which I can relate to. At age 49, it’s like the wheels started coming off the bus—my vision started getting worse. What is all this? So I can relate to that. But then you have a whole other segment of the population, which, to your point, is really focused on athletes. For example, how do I become a better athlete? World records are being broken, Olympic records are being broken—people are getting better and faster. That’s a whole separate group. They’re just saying, “How do I take where I’m at today and make it even better?” So, I can see a lot of different people wanting to read this book. You said it’s pre-order only. When is it actually scheduled to be released?

Dr. Shai Efrati: Actually, it’s already released. People can order it, and they will start to get the orders in three weeks from today.

Rob Shallenberger: Perfect. So, by the time this podcast comes out, people can order it, and it’ll be available. Well, we are almost out of time. I can’t believe it’s been just about 30 minutes—amazing! We could keep talking for a lot longer. Let me finish with one question. I always like to ask a question like this towards the end of the podcast, and that is, through all of your life experience—through writing this book, years and decades as a doctor in Israel, all of your life experience and research—what’s one or two of your biggest lessons learned along the way?

Dr. Shai Efrati: If people ask me, “What is the most powerful tool that we have?” I would say the most powerful tool we have is between our ears. I’ll give you an example. When people ask me, “What is the definition of an old man?” they expect me to say telomere length, senescent cells, or biology. If I were to take those measurements, from this point, you are old. But my definition of an old man is someone who looks backward. If you talk to someone old, they’ll say, “I used to do this. At that age, I did that.” But if you talk to a young man, he’ll always say, “I’m planning on doing this. After I do that, I’ll do this.” I have someone who is highly influential in the US at a very high level, and he’s 81 years old. I was discussing with him, and during the conversation, he said, “You know what my next plan is? I’m working on how we can build houses and infrastructure on the moon. This is where my mind is. I’m going to do it.” He’s 81. So, this guy is not old; he’s young. He’s looking forward. The biology—I’ll fix that. We can help with the biology. But if someone has the perspective of looking backward, no matter what I do with them, they’re lost. So, always look forward. Always plan. If you have this mindset, your biology will do its best to reach the goal. If needed, you can get help from people who understand biology, like me and others, who can push you forward. But if you don’t have this mindset, you’re lost. Nobody can help you.

Rob Shallenberger: That is such great advice. It reminds me of a gentleman I met when we were in Kenya. He was 91 years old, if I remember correctly. We were talking about vision, goals, and pre-week plans—some of the things we do in our company. And he said, “I can’t wait to get started on my vision. I can’t wait to start doing this.” I was just thinking that he’s 91—statistically, there’s not a lot of runway left. But what a great mindset! It was so inspiring. I wrote that down because it’s awesome. It’s really easy, as we get older, to start looking backward. And I love the example of the person you just shared—who I think you said was 81 or whatever age—talking about building infrastructure on the moon. They’re not done with life; they’re not sitting on the porch drinking lemonade. They’re engaged with life.

Dr. Shai Efrati: I’ll tell you, people often think about a big mission, but the mission doesn’t have to be big. You have to make yourself needable. Needable for something. If you are needable, then your biology will do its best to preserve you. If you’re not needable for something, you’re lost. Being needable doesn’t mean going to the moon. Needable could mean that there is someone who waits for you tomorrow to play cards with them.

Rob Shallenberger: I agree with you 100% on that. We’re just releasing the second edition of Do What Matters Most in December, and in looking at other studies, we found that there are numerous predictors of longevity. The top two are, number one, relationships—having quality relationships—and number two, having a purpose. That’s exactly what you’re talking about. I’ll reinforce and agree with you 100%—it doesn’t need to be going to the moon, but there does need to be a purpose of some sort. You need to have a reason for your heart to beat when you get up in the morning. I just love that advice.

Dr. Shai Efrati: I’ll tell you even more than that. When people ask me, “How do I know if I’ve reached my goal?”—this is part of enhanced medicine—you’re asking, “What are you doing?” and so on. And they ask, “How do I know if I’m needable or not?” I say it’s very simple. If there’s a day you don’t get out of bed, and someone is calling you and asking, “Where are you? I need you.” If you have that, you got it

Rob Shallenberger: I actually really like that. That’s cool. I love it. Well, we’ve got to wrap this up. So before we finish, how can people find you? Obviously, the book Beyond Normal is on Amazon. I’m going to order it right now and read it in the next two weeks. I’m excited to read it. By the way, is there an audiobook version out yet?

Dr. Shai Efrati: Yes, there will be an audiobook release as well.

Rob Shallenberger: Great! So, you can get the audiobook or the physical book Beyond Normal. How else can people find you?

Dr. Shai Efrati: They can search for “Aviv Clinic” on Google.

Rob Shallenberger: I just looked that up. If you search for “Aviv Clinic,” it’ll come up pretty easily. It’s really a fascinating website. I’ve been looking through it while we’ve been talking to get a better understanding of what it is, and it looks like an awesome place. I’m curious enough that I’m going to look into this a little bit more—it looks fascinating. Thank you so much for being with us. I appreciate it—a lot of good things for our listeners to think about. This is exactly why we chose to have you on the podcast. I’ll just say as a side note that we probably get, I don’t know, two to five podcast requests a day from people who want to be on the podcast, and the majority of those just aren’t a fit. But when I saw what you were doing, I thought, “This is something people need to be aware of. This is something that could help people and benefit people all over the world,” especially for those who are taking their health seriously—their biology. So, I really appreciate you being here. To all of our Becoming Your Best podcast listeners, we appreciate you. Hope you have a wonderful day and a great rest of your week.