Grant Pagdin, M.D.

Dr. Grant Pagdin graduated from UBC medical school in 1988. He served for three years as a Flight Surgeon on an F-18 squadron with the Canadian Air Force, and then settled into family practice in Vernon, BC, and is Canadian board-certified in Family Medicine (CCFP). He also did a fellowship in family medicine (FCFP).

He later specialized in Emergency Medicine and worked for a few years in Upstate New York. Relocating to Kelowna in 2005, his primary interest now is Preventative and Anti-Aging Medicine Services, as well as conducting research in regenerative medicine. He is board certified with the American Academy of Anti-Aging and Regenerative Medicine (ABAARM).

Dr. Pagdin completed a fellowship in Stem Cell Medicine with the University of South Florida in December, 2015. He is also a fellow with the Interventional Orthobiologic Foundation. He received a No Objection Letter from Health Canada to conduct clinic research on the use of stem cells for osteoarthritis in January, 2020.

Dr. Pagdin is also a Clinical Instructor with the UBC medical school and assists in the operating rooms at Kelowna General Hospital. When not working he enjoys cycling, cross-country skiing, slalom water skiing, and playing keyboards in a rock band called “Rex”.

0:00-1:18 – Introduction

• Dr. Grant Pagdin introduced as functional medicine practitioner in regenerative medicine
• Currently running osteoarthritis study with 147 patients
• Multiple joints involved: knee, ankle, hip, shoulder, CMC joint
• Focus on expanding lifespan and improving health span

1:18-2:34 – Guest Introduction & Background

• Dr. Pagdin practices in Kelowna, BC (4 hours north of Vancouver)
• Third largest city in BC with ~200,000 population catchment area
• Practice focuses on:
  • Anti-aging and regenerative medicine
  • Optimal aging and hormone replacement
  • Weight optimization
  • Platelets, peptides, and stem cells

2:34-5:59 – Osteoarthritis Study Details

• Study Design: Treats all peripheral joints (shoulders, elbows, wrists, hips, knees, ankles)
• Regulatory Background:
  • Started stem cell work in 2013 with mentor Dr. Joseph Purita (Boca Raton, FL)
  • 2019: Health Canada moratorium on stem cell work
  • Required clinical trial approval or new drug application
• Study Protocol:
  • Three treatment arms (randomly assigned):
    1. PRP + Lipo aspirate
    2. PRP + Bone marrow aspirate
    3. PRP + Both lipo and bone marrow aspirate
• Results: 147 patients enrolled (out of 240 total), ~2/3 achieving clinically meaningful improvement
• Key Finding: No appreciable difference between treatment groups

5:59-8:35 – Procedure Comparison: Fat vs. Bone Marrow

• Patient Experience: Majority find fat harvesting worse than bone marrow
• Fat Harvesting Process:
  • Infiltrate tumescent fluid, wait 10 minutes
  • Use 2mm aspiration cannula with multiple passes
  • More labor-intensive and tedious
• Bone Marrow Process:
  • Sophisticated trocar allows harvesting from multiple depths
  • Single poke through periosteum
  • 3-4 minute procedure with rotation technique
  • Less invasive overall

8:35-11:18 – Procedural Details & Complications

• Post-procedure neuropathies: Some surface anesthesia around incision sites
• Fat location preference: Post-axial fat (flank/”love handles”) vs. pre-axial
• Volume: ~40cc fat with 120cc tumescent fluid (lidocaine + epinephrine)
• Blood thinners: Avoid 48 hours prior to procedure
• Bruising management: Tensor bandages and ice application

11:18-13:43 – Administration & Follow-up Protocol

• Injection method: Intra-articular, ultrasound-guided
• Additional treatments: PRP for supportive structures and ligaments
• Activity restrictions:
  • Immediate range of motion encouraged
  • Gradual resistance training with Thera bands after 2 weeks
  • Avoid high-impact activities for 6-8 weeks
  • Stem cells survive in joint up to 12 weeks
• Follow-up: PRP “top-up” injections at 4 and 8 weeks

13:43-15:02 – Patient Selection Criteria

• Research eligibility: Kellgren-Lawrence grade 1-3 osteoarthritis
• Excluded from research: Grade 4 (bone-on-bone) patients
• Special cases: Grade 4 patients treated outside research if not surgical candidates
• Age considerations: Bone marrow quality declines with age; prefer lipo aspirate in older patients

15:02-16:13 – Follow-up Results & Longevity

• Primary endpoint: 12 months
• Improvement timeline: Good results by 6 months, better at 12 months
• Optimal recovery window: 6-9 months
• 24-month follow-up: Primarily for safety (Health Canada requirement)
• Long-term results: Benefits maintained at 24 months and beyond
• Retreatment: Some patients from 2016-2018 returning as effects diminish

16:13-20:57 – Joint-Specific Outcomes

• Clinical impression: No major difference between upper vs. lower extremity outcomes
• Challenging joints: Ankles difficult but showing good success
• Best results: First CMC joint (wrist) – “third or fourth most common injection site”
• Volume limitations: Small joints receive modest doses
• Most common treatments:
  1. Knees
  2. Hips
  3. Shoulders
  4. First CMC joints

20:57-23:11 – Study Enrollment & Criteria

• Current status: 147 enrolled, capacity for 240 (considering extension to 360)
• Geographic limitation: Canadian subjects only
• Age range: 19-79 years
• Pain requirements: 3-4/10 ideal (need 2-point improvement for clinical significance)
• Lab requirements: Hemoglobin >100, platelet count >100
• Timeline: Enrolling for next couple years

23:11-25:11 – Exclusion Criteria & Cancer Discussion

• Autoimmune exclusions: Psoriasis, lupus, connective tissue disorders, IBD
• Cancer exclusion: Active cancer patients excluded
• Safety data: Long-term studies show no increased cancer risk with stem cells
• Peptide exception: Stage 4 cancer patients may explore bio-regulatory peptides
• Specific peptides mentioned: Vilon (colon cancer), Epithalon, Thymalin

25:11-29:28 – Research Methodology & Outcomes

• Historical safety studies:
  • Philippe Hernigou (France): 3,500+ patients, 10-year follow-up
  • Chris Centeno/Regenexx: 1,600+ patients, 5-10 year follow-up
• Outcome measures: Functional assessments vs. imaging
• MRI considerations: $1,000 CAD cost made pre/post imaging impractical
• Health Canada approval: Functional outcomes deemed adequate
• Patient benefits: Return to activities like running after years of limitation
• Longevity: 3-5+ year benefits observed

30:21-32:54 – Career Transition

• Background: Family practice → Emergency medicine → Private practice
• System limitations: Public healthcare doesn’t cover preventative health, nutrition, weight loss
• Practice model: 8-10 patients/day vs. 70 in traditional system
• Appointment time: Up to 45 minutes vs. “one question only” in family practice
• Schedule: Procedures Monday/Wednesday, consulting Tuesday/Thursday

32:54-36:55 – Current Practice Focus

• Sports injury PRP: Combined with experimental peptides for enhanced recovery
• Peptide protocols:
  • BPC-157, TB-4 (established)
  • Cartilage peptide (injectable, joint-specific)
  • Growth hormone releasing peptides (CJC-1295 with Ipamorelin)
• “Wolverine stack”: BPC-157 + TB-4 + Cartilage (12-week protocol)
• Monitoring: IGF-1 tracking for clinical response

36:55-42:25 – Stem Cell Mobilization & Stacking

• Discussion of Christian Drapeau’s Stem Regen: Natural supplements to mobilize sequestered bone marrow stem cells
• Clinical observations: Faster healing, better incision appearance
• Mobilization concept: ~120 million cells released into circulation
• Nutritional support protocol:
  • Blueberries, green tea, dark chocolate
  • Glutathione support (cysteine supplementation)
  • Master antioxidant for stem cell performance
• Philosophy: Multiple interventions create synergistic effects

40:32-43:02 – Treatment Stacking Examples

• GLP-1 agonists: Must combine with protein + resistance exercise
• PRP enhancement: Rehab + shockwave + red light therapy + peptides
• Cartilage peptide: Short-chain, Canadian-manufactured injectable
• Delivery methods: Injectable vs. oral bio-regulators
• Clinical experience: Injectable forms more powerful than oral

43:02-50:03 – Hormone Replacement Therapy

• Professional resistance: Neighboring OB/GYNs skeptical of bioidenticals
• Aging process: “Nothing good happens as hormone levels decline”
• Comprehensive approach:
  • Women: Estrogen, progesterone, DHEA, testosterone
  • Men: Testosterone optimization
  • Metabolism support with peptides
• Testing: Micronutrient analysis with specific recommendations
• Recheck protocol: 6-month follow-up micronutrient testing

45:02-50:03 – Hormone Therapy Deep Dive

• Women’s Health Initiative critique:
  • Good study design (15,000-16,000 women)
  • Used oral estrogen (increased VTE risk) + synthetic progestin (Provera)
  • Increased breast cancer from synthetic progestin
  • Increased stroke from oral estrogen
• Modern approach:
  • Transdermal estrogen (bypasses liver, no VTE risk)
  • Bioidentical progesterone (no breast cancer risk)
  • 25 years of bioidentical research available

47:22-50:03 – Testosterone Replacement in Men

• Monitoring requirements:
  1. CBC: Watch for polycythemia (thick blood)
  2. Estrogen levels: Control aromatization with small-dose aromatase inhibitors
  3. Prostate health: No connection between testosterone and prostate cancer
• JAMA study insight: Cardiac events in first 3-6 months due to estrogen, not testosterone
• Prostate cancer myth: More aggressive cancers occur in low-testosterone men
• DHT management: 5-alpha reductase pathway modulation for acne/hair loss/prostate enlargement

50:38-52:27 – Practical Management & Closing

• Polycythemia treatment: Phlebotomy (blood donation) vs. dose modification
• High ferritin: Same phlebotomy approach
• Practice philosophy: Passionate about transforming lives
• Field assessment: Rewarding and needed area of medicine

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