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[00:00:00.320 --> 00:00:02.400] Candice Rivera has it all.
[00:00:02.400 --> 00:00:08.880] In just three years, she went from stay-at-home mom to traveling the world, saving lives and making millions.
[00:00:08.880 --> 00:00:13.360] Anyone would think Candice's charm life is about as real as Unicorn.
[00:00:13.360 --> 00:00:16.960] But sometimes the truth is even harder to believe than the lies.
[00:00:17.280 --> 00:00:18.000] Not true.
[00:00:18.000 --> 00:00:19.680] There's so many things not true.
[00:00:19.680 --> 00:00:21.440] You got a great lead.
[00:00:21.760 --> 00:00:28.000] I'm Charlie Webster, and this is Unicorn Girl, an Apple original podcast produced by Seven Hills.
[00:00:28.000 --> 00:00:30.800] Follow and listen on Apple Podcasts.
[00:00:31.440 --> 00:00:33.120] Hey, it's Ryan Reynolds here for Mint Mobile.
[00:00:33.120 --> 00:00:40.320] Now, I was looking for fun ways to tell you that Mint's offer of unlimited premium wireless for $15 a month is back.
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[00:01:00.480 --> 00:01:02.160] See MintMobile.com.
[00:01:05.360 --> 00:01:10.960] You're listening to The Michael Shermer Show.
[00:01:17.040 --> 00:01:19.040] Eric, I don't think you've been on the show.
[00:01:19.280 --> 00:01:26.000] Last time we met was at Caltech for your previous book, The Doctor Was The Patient Will See You Now.
[00:01:26.000 --> 00:01:26.480] Right.
[00:01:26.960 --> 00:01:27.760] That looks a ways back.
[00:01:28.640 --> 00:01:29.600] Yeah, that was a ways back.
[00:01:29.600 --> 00:01:30.960] Well, lots of happened in there.
[00:01:30.960 --> 00:01:32.400] But let me give you a proper introduction here.
[00:01:32.400 --> 00:01:32.640] Dr.
[00:01:32.640 --> 00:01:42.560] Eric Topal is the executive vice president and a professor of molecular medicine at Scripps Research, the largest nonprofit biomedical institute in the United States.
[00:01:42.560 --> 00:01:48.800] He is also founder and director of the Scripps Research Translational Institute and a practicing cardiologist.
[00:01:48.800 --> 00:01:58.800] He is one of the top 10 most cited researchers in medicine, known for his groundbreaking studies on AI in medicine, genomics, and digitized clinical trials.
[00:01:58.800 --> 00:02:05.160] He was named at the Time 100 Health List of the Most Influential People in Health in 2024.
[00:02:05.480 --> 00:02:09.400] And he writes the Substack newsletter Ground Truths, which I've been reading.
[00:02:09.400 --> 00:02:10.280] It's excellent.
[00:02:10.280 --> 00:02:12.040] Ground Truths.
[00:02:12.040 --> 00:02:14.440] And is the author of The Creative Destruction of Medicine.
[00:02:14.440 --> 00:02:15.480] The patient will see you now.
[00:02:15.480 --> 00:02:18.040] And here's the new book: Super Agers.
[00:02:18.040 --> 00:02:18.680] Love it.
[00:02:19.000 --> 00:02:21.160] And an evidence-based approach to longevity.
[00:02:21.160 --> 00:02:23.320] Eric, guess what I did this morning?
[00:02:23.640 --> 00:02:24.360] What's that?
[00:02:24.360 --> 00:02:30.360] I played four sets of tennis with an 84-year-old, an 83-year-old, and an 82-year-old.
[00:02:30.680 --> 00:02:31.480] Fantastic.
[00:02:31.480 --> 00:02:33.080] And I said, you know what you guys are?
[00:02:33.080 --> 00:02:34.200] You're super agers.
[00:02:34.200 --> 00:02:37.320] And I showed them your book, and they're like, oh, okay.
[00:02:38.920 --> 00:02:39.560] That's great.
[00:02:40.120 --> 00:02:42.920] I'm 70, and I was like the kid out there.
[00:02:43.240 --> 00:02:44.840] Well, you and I are the same age.
[00:02:44.840 --> 00:02:45.240] Yeah.
[00:02:45.560 --> 00:02:46.040] I know.
[00:02:46.040 --> 00:02:46.680] It's amazing.
[00:02:46.680 --> 00:02:48.600] Age is really not an excuse anymore.
[00:02:48.600 --> 00:02:54.520] I mean, my, you know, when I was a kid, when we were kids, you know, our parents were like ancient in their 40s.
[00:02:54.520 --> 00:02:57.000] And then, you know, they're probably going to be dead by their 60s.
[00:02:57.000 --> 00:02:59.640] And nobody thinks like that anymore.
[00:02:59.960 --> 00:03:06.280] I think we got a reset going and it's going to get accelerated with more super ages than ever before.
[00:03:06.280 --> 00:03:06.760] Yeah.
[00:03:07.080 --> 00:03:13.000] Well, and yeah, I mean, my other story, I have one of my cycling buddies up here, Ed, is 77.
[00:03:13.000 --> 00:03:14.760] We rode his birthday.
[00:03:14.760 --> 00:03:19.640] We rode his birthday in miles last year, 77 miles.
[00:03:19.640 --> 00:03:20.120] Nice.
[00:03:20.120 --> 00:03:26.280] And I have to say, you know, at the last 10 miles or so, I was just dragging ass and he's just pulling me all the way back.
[00:03:26.280 --> 00:03:27.880] And it's like, oh, my God, I can't.
[00:03:27.880 --> 00:03:29.640] So I can't use age as an excuse.
[00:03:29.640 --> 00:03:30.920] Well, I'm old and slow now.
[00:03:30.920 --> 00:03:33.800] No, Ed's up there, and he's 77.
[00:03:33.800 --> 00:03:35.960] So, so much for that.
[00:03:35.960 --> 00:03:37.480] Yeah, that's great.
[00:03:37.480 --> 00:03:40.680] So, just kind of looking back, you've been in this business for a long time.
[00:03:40.680 --> 00:03:45.000] How has medicine changed over the, say, last 50 years or so that you've been in the game?
[00:03:46.960 --> 00:03:54.960] Well, in many ways, it's still very slow to make major changes in terms of the patient care side.
[00:03:54.960 --> 00:04:01.040] But, you know, things have moved more and more into the digital front from what there's a total analog.
[00:04:01.040 --> 00:04:08.880] There's been erosion of the patient-doctor relationship with much less time given to patient encounters.
[00:04:09.520 --> 00:04:12.080] So, that's a negative thing.
[00:04:13.040 --> 00:04:21.280] And now, I think with AI, we're seeing the potential rescue of that, getting the gift of time back if we really work on it.
[00:04:21.280 --> 00:04:31.280] And then, I think the biggest new frontier is using AI with all these layers of data on each person to prevent the major age-related diseases.
[00:04:31.280 --> 00:04:40.960] That's what I'm really excited about right now: that we're moving into a time in medicine that is unparalleled for the opportunity to actually fulfill the fantasy.
[00:04:40.960 --> 00:04:53.680] It's been a fantasy, Michael, for millennia of preventing diseases rather than aiming to try to treat them better or even the more difficult thing of even finding cures.
[00:04:53.760 --> 00:04:56.080] So, this would be like personalized medicine.
[00:04:56.080 --> 00:04:58.400] Your cancer is unique to you.
[00:04:58.400 --> 00:05:03.680] It's not like anyone else's cancer, even if it's prostate cancer, esophagal cancer, or whatever.
[00:05:04.000 --> 00:05:10.320] Yeah, and the idea is that you know about that before the person even has the first cells of a cancer.
[00:05:10.640 --> 00:05:19.280] And I think we have that capability now because so much of cancer, as we've learned, is the immune system letting its guard down.
[00:05:19.920 --> 00:05:32.600] And so, if we have a person's immune system kept up, not allowed to go to senescence as we get older, the age-related cancers have a real great chance that we can prevent them.
[00:05:32.760 --> 00:05:34.280] Let's talk about what your book is not about.
[00:05:29.520 --> 00:05:46.840] You're not promising people are going to live a thousand years or we're going to hit the singularity and you get to have escape velocity and live 13 months longer for every year that you live and therefore you never die.
[00:05:47.160 --> 00:06:05.640] No, this is not Ray Curse While the Singularity is Nearer or the biohacking of people like Brian Nelson, Johnson Wright, or any of these other kind of quack predatory companies that are trying to promote longevity.
[00:06:05.640 --> 00:06:17.560] No, this is about a different side of this, which is using the advances we've made in the science of aging, but using it to prevent the diseases rather than trying to reverse aging.
[00:06:17.560 --> 00:06:22.760] Because reversing aging is a bold, I hope it will click one of these days.
[00:06:22.760 --> 00:06:28.120] There's lots of different ways we might be able to get there, but we're not even close on that score.
[00:06:28.120 --> 00:06:29.720] Yeah, that's my sense too.
[00:06:29.720 --> 00:06:36.200] You know, we deal with this at Skeptic because this is in that realm, I think, of pseudoscience and quackery, at least some of it.
[00:06:37.000 --> 00:06:47.080] But I have to say, just, you know, anecdotally, when I see these people like Ray and Aubrey DeGrey and some of the other like calorie restriction guys, they don't look healthy to me.
[00:06:47.080 --> 00:06:48.600] They look, I don't know.
[00:06:48.600 --> 00:06:51.960] They look old and like just decrepit and weak.
[00:06:51.960 --> 00:06:53.080] And it's like, I don't know.
[00:06:53.080 --> 00:06:57.320] Even that Brian Johnson guy watched that documentary on him, the Netflix doc on him.
[00:06:57.320 --> 00:06:57.800] Yeah, yeah.
[00:06:57.800 --> 00:06:58.840] You know, and he's going to live.
[00:06:59.000 --> 00:07:02.200] I don't know whether he's going to live forever, but he's, you know, centuries or whatever.
[00:07:02.200 --> 00:07:03.960] And he does all these tests and stuff.
[00:07:03.960 --> 00:07:05.960] He doesn't look healthy to me either.
[00:07:05.960 --> 00:07:06.920] No, no.
[00:07:06.920 --> 00:07:08.920] You're at a good call on that, Michael.
[00:07:08.920 --> 00:07:13.000] Actually, those three people you mentioned, they look far from being healthy.
[00:07:13.000 --> 00:07:21.360] But of course, as you know, it's not just from the outside, but at least what you would see, the optics don't look good.
[00:07:14.840 --> 00:07:21.680] Right.
[00:07:21.920 --> 00:07:37.440] So, really, what you're talking about here is let's get people up into their 80s and 90s, and maybe even the first decade of the hundreds without Alzheimer's and without, you know, cardiovascular disease, or at least no heart attacks.
[00:07:37.440 --> 00:07:40.560] In other words, relatively healthy and strong and feeling good.
[00:07:40.560 --> 00:07:44.240] Like, I want to live life continuously because I feel good.
[00:07:44.560 --> 00:07:52.880] Yeah, so getting these three diseases, our arms are wrapped around them to prevent them, I think, is eminently doable.
[00:07:52.880 --> 00:07:54.800] Cardiovascular, we can do it.
[00:07:54.800 --> 00:07:56.240] We're just not doing it.
[00:07:56.480 --> 00:07:59.760] But also, Alzheimer's and cancer.
[00:08:00.080 --> 00:08:05.440] So, if we do that, that's like 80% of preventing diseases.
[00:08:05.440 --> 00:08:07.120] Those are the big three.
[00:08:07.120 --> 00:08:12.080] And I'm confident that we have a new approach now that can get us there.
[00:08:12.080 --> 00:08:15.040] But, of course, we have to go after it.
[00:08:15.040 --> 00:08:16.320] We got to validate it.
[00:08:16.640 --> 00:08:19.600] It's not just going to happen by accident.
[00:08:19.600 --> 00:08:30.000] Yeah, one of the funny lines I use on some of the Uber longevity people, the transhumanists, the cryonics, the mind uploaders, and the ecstropians.
[00:08:30.000 --> 00:08:31.440] You know, they're against entropy.
[00:08:31.440 --> 00:08:33.200] Yeah, good luck with that.
[00:08:33.760 --> 00:08:36.240] You know, they said, Don't you want to live 500 years, Shermer?
[00:08:36.240 --> 00:08:39.120] I'm like, just get me to 100 without Alzheimer's.
[00:08:39.120 --> 00:08:39.840] Can you do that?
[00:08:40.160 --> 00:08:40.640] No.
[00:08:40.640 --> 00:08:45.440] It's like, well, then, no, I don't want to live 500 years with Alzheimer's.
[00:08:46.640 --> 00:08:50.640] You're making the essential point is that we're really after health span.
[00:08:50.640 --> 00:08:59.520] You know, lifespan, if you're demented or you're so frail and have such a poor quality of life, that isn't worth much.
[00:09:00.120 --> 00:09:07.000] So, what I aspire is that we get to 85 plus and without these three diseases.
[00:09:07.000 --> 00:09:16.360] If we can do that, then we've got the real beginnings of a super ager era of humankind, which would be really exciting.
[00:09:16.360 --> 00:09:17.560] Totally.
[00:09:18.120 --> 00:09:19.640] Why do people age?
[00:09:19.640 --> 00:09:21.480] Just give us kind of the big picture here.
[00:09:21.480 --> 00:09:23.560] Why do I have to get older?
[00:09:23.880 --> 00:09:28.680] Yeah, well, there's a lot of things happening as we get older, unfortunately.
[00:09:28.920 --> 00:09:37.480] I touched on the immune system, and that's one of the biggies because immunosenescence, that is, our immune system just does, it's variable.
[00:09:37.480 --> 00:09:45.560] So, some people, like your tennis friends, they could probably, you know, if they haven't had any major diseases, they may have a really intact immune system.
[00:09:45.560 --> 00:09:48.200] But some, at that age, it's down.
[00:09:48.200 --> 00:09:50.680] It's really, you know, minimal.
[00:09:51.080 --> 00:09:52.600] And that's immunosenescence.
[00:09:52.600 --> 00:09:55.240] The other thing is inflammaging.
[00:09:55.240 --> 00:10:02.280] So, our body tends to be much more promoting body-wide inflammation and brain inflammation.
[00:10:02.280 --> 00:10:04.040] And that's not a good thing.
[00:10:04.600 --> 00:10:12.120] The next is that as we have replication in our cells, we have errors that occur.
[00:10:12.120 --> 00:10:18.120] And these mutations can lead to a clone, which can ultimately lead to a cancer.
[00:10:18.120 --> 00:10:21.800] So, just with age, we have more susceptibility to cancer.
[00:10:22.120 --> 00:10:29.160] And without the immune system being totally intact, that gives cancer kind of a free rein in the body to grow and spread.
[00:10:29.400 --> 00:10:42.200] And then, in response to these misfolded proteins that get into our brain, like amyloid and tau, it isn't so much the proteins, it's the brain inflammatory response that gets us in big trouble.
[00:10:42.200 --> 00:10:44.760] And the same thing is the case with our arteries.
[00:10:44.960 --> 00:10:54.000] As we get older, we tend to have more inflammation in our arteries, reaction to the cholesterol that's getting built up.
[00:10:54.000 --> 00:10:57.360] That can start even in teenagers and people in their 20s.
[00:10:57.360 --> 00:11:07.200] The common thing, though, Michael, is all three of these diseases take 20 years plus to actually get rooted in our body, to symptoms actually become manifest.
[00:11:07.200 --> 00:11:09.760] So we have a long runway to work with.
[00:11:09.760 --> 00:11:12.000] And most people don't appreciate that.
[00:11:12.000 --> 00:11:15.280] And certainly, that gives us a big edge to get ahead of it.
[00:11:15.280 --> 00:11:15.840] Yeah.
[00:11:16.480 --> 00:11:22.000] So, but one thing I was getting at is: you know, why can't, why doesn't my body operate like my nine-year-old?
[00:11:22.000 --> 00:11:23.040] I have a nine-year-old son.
[00:11:23.040 --> 00:11:26.480] And, you know, when he gets a cut, you know, I can almost watch it healing.
[00:11:26.480 --> 00:11:30.160] And when I get a cut, you know, it's weeks before it's healed up.
[00:11:30.160 --> 00:11:41.280] And so it must be a bunch of different systems that are just in my body are just not operating as efficiently or yeah, that's where you bring in the senescent cell story.
[00:11:41.280 --> 00:11:58.720] So in the body, as we get older, we have senescent cells that can either secrete proteins that are very much inflammatory drivers, which is bad, but they also can promote healing, which is good.
[00:11:59.040 --> 00:12:04.080] And so we don't tend to have as much of the healing power as we get older.
[00:12:04.080 --> 00:12:05.680] And that's one of the issues.
[00:12:05.680 --> 00:12:18.800] And that's why these synolytic drugs that try to eradicate our senescent cells from our body may not be good because some of that's our healing cells, not just our so-called secretory, pro-inflammatory cells.
[00:12:18.800 --> 00:12:24.640] But yeah, we don't have that kind of quick reaction like your nine-year-old as we get older.
[00:12:24.640 --> 00:12:31.880] And, you know, actually, some people do throughout their, all the way through their 90s, but most of us, we're gradually losing that.
[00:12:32.120 --> 00:12:39.080] And what we've learned, which is really interesting, we now have these protein clocks, proteomic clocks.
[00:12:39.400 --> 00:12:56.120] And now, when you follow thousands of people at different ages, there's like, instead of aging being a linear story, you just keep eroding gradually, it's actually got three peaks of our aging.
[00:12:56.440 --> 00:13:11.560] And so once you hit that 70-plus peak, that's when you get more prone to pro-inflammatory rather than the healing and anti-inflammatory that we would like to see like what would be in a young, young person.
[00:13:11.880 --> 00:13:16.360] As a medical researcher, could you explain to us how you determine causality?
[00:13:16.360 --> 00:13:19.480] So, for example, we know about confounders.
[00:13:19.480 --> 00:13:28.120] So, you know, coffee causes X, but maybe coffee drinkers do something else that's actually causing the X, and it's just a proxy for that.
[00:13:28.360 --> 00:13:36.360] And so, you talk about a lot of these things about diets and exercise and all these different factors, but how do you know it's that and not something else?
[00:13:36.680 --> 00:13:42.680] Yeah, so there's lots of ways to either establish or intimate causality.
[00:13:42.680 --> 00:14:03.080] The first and kind of best way is a randomized trial where you basically keep everything the same in terms of the people that are going into it, and half of them get the intervention, like you're asking like coffee or diet or whatever, and the other half get the standard or placebo or whatever.
[00:14:03.080 --> 00:14:05.400] We have such trials for diet.
[00:14:05.400 --> 00:14:16.160] We have a number of trials like that for Mediterranean diet, which look very reinforced the benefit of a largely a plant-based food diet.
[00:14:17.280 --> 00:14:19.440] So that's the best evidence.
[00:14:19.440 --> 00:14:24.000] The second one that's great is natural experiments.
[00:14:24.000 --> 00:14:38.640] And these natural experiments, they're perhaps even better than randomized trials because here, just by some type of odd happening, you can get large populations not selected by entry criteria into a randomized trial.
[00:14:38.640 --> 00:14:44.000] And so, for example, there's been three of these recently with shingles vaccine.
[00:14:44.000 --> 00:14:56.560] And just because of your birth date or when they started the new vaccine and the old vaccine, whatever, three of them all come out with about a 20-25% reduction of dementia, mostly Alzheimer's, of course.
[00:14:56.560 --> 00:14:59.520] That was a big revelation, and that's through a natural experiment.
[00:14:59.520 --> 00:15:02.080] And that would really point towards causality.
[00:15:02.080 --> 00:15:10.320] It doesn't tell you that you knocked down the herpes virus, it causes that it causes dementia, it causes shingles.
[00:15:10.320 --> 00:15:18.640] But it does tell you that the vaccine, probably through revving up immunity in older people, is a benefit for these people.
[00:15:18.640 --> 00:15:34.800] Now, the third way we do it, which is what you're getting at, is that you get this huge body of data, oftentimes many, many different studies, so-called observational studies, and you try to adjust for all the confounders.
[00:15:34.800 --> 00:15:40.400] So, you know, is the people that drank coffee, were they had a higher sociodemographic?
[00:15:40.400 --> 00:15:41.760] Were they more educated?
[00:15:41.760 --> 00:15:43.680] Did they were more physically active?
[00:15:43.680 --> 00:15:45.120] Did they eat a better diet?
[00:15:45.120 --> 00:15:46.400] And on and on and on.
[00:15:46.400 --> 00:15:48.560] And so you try to adjust for all these things.
[00:15:48.560 --> 00:15:50.560] You can never adjust for them perfectly.
[00:15:50.560 --> 00:15:51.920] You do the best you can.
[00:15:51.920 --> 00:15:56.560] What you want to do is look at lots of these studies to see if they all point in one direction.
[00:15:56.560 --> 00:16:00.360] That could be due to that they all have the same confounders, right?
[00:16:01.880 --> 00:16:11.160] But most of the time, when you see an effect and it's very consistent in magnitude and direction, that's fairly supportive.
[00:16:11.160 --> 00:16:17.480] Maybe not of causality, but certainly of a strong association, a linkage.
[00:16:17.480 --> 00:16:22.920] Now, the last thing which is really popular is to use Mendelian randomization.
[00:16:22.920 --> 00:16:31.800] So you're not randomizing the intervention, but you're looking at a person's genes and you're randomizing by do they have this allele or not.
[00:16:31.800 --> 00:16:35.560] That's a very powerful tool for causality if it's done properly.
[00:16:35.560 --> 00:16:43.640] And we do have some evidence for some of these lifestyle things with Mendelian randomization.
[00:16:43.640 --> 00:16:46.760] So those are pretty much the four ways you can get to it.
[00:16:46.760 --> 00:16:48.440] Causality is hard.
[00:16:49.000 --> 00:17:01.160] And oftentimes, you know, we're betricks between and betwixt as to, oh, this looks like a really strong association, but is it really this causes that?
[00:17:01.160 --> 00:17:02.520] And that could be tricky.
[00:17:02.520 --> 00:17:11.080] Yeah, because you talk about socioeconomic status as a proxy or predictor of health outcomes, but there's nothing magical about that.
[00:17:11.480 --> 00:17:31.840] There must be more physical direct causes, like you're living in a poor environment where there's not any good healthy supermarkets or restaurants or the air quality is bad or the air pollution and you know and so the water is contaminated with these micro particles plastic particles and all that stuff and on and on and on.
[00:17:31.840 --> 00:17:48.240] So you're using that as a broader predictor yeah you're making your point is a really important one because these studies didn't didn't adjust for things like air quality, microplastics, forever chemicals.
[00:17:48.560 --> 00:17:53.440] So, you know, they make adjustments, but they're not comprehensive.
[00:17:53.440 --> 00:18:03.520] And so that's why making too strong a conclusion based on association doesn't negate that concern about these confounders.
[00:18:03.520 --> 00:18:04.160] Yeah.
[00:18:04.320 --> 00:18:07.760] And I always use as an example of natural experiments the blue zones.
[00:18:07.760 --> 00:18:09.280] I always thought that was, I always liked that.
[00:18:09.280 --> 00:18:16.160] But now somebody's been telling me that maybe the reporting of the age of the people was not that accurate.
[00:18:16.160 --> 00:18:18.720] We might change the name to the myth zone.
[00:18:18.720 --> 00:18:19.600] The myth zone.
[00:18:19.600 --> 00:18:23.680] Because there's nothing to substantiate the claims.
[00:18:23.680 --> 00:18:34.480] When they went ahead and went to these places to get the people's birth certificates, they found out that either they didn't exist or their ages were fabricated.
[00:18:34.480 --> 00:18:39.760] So it looks like there's been a lot of funny business going on with these blue zones.
[00:18:39.760 --> 00:18:45.600] And right now, I'd have to say we don't have any support that they exist.
[00:18:45.600 --> 00:18:52.640] We do know that there are people that have remarkable agelessness, if you will, age very healthy.
[00:18:52.640 --> 00:19:02.000] But whether they're in certain parts of the world is still unclear because these magical places, we don't have data now.
[00:19:03.440 --> 00:19:13.760] When it's been put to thorough interrogation, it comes up really very skeptical, is your term, yes.
[00:19:13.760 --> 00:19:14.400] Yeah.
[00:19:14.400 --> 00:19:17.520] Yeah, that's unfortunate because it was such a nice study.
[00:19:17.520 --> 00:19:18.400] Yeah, yeah.
[00:19:18.400 --> 00:19:22.320] Well, there's been Netflix specials and all these books about it.
[00:19:22.320 --> 00:19:28.640] And, you know, it looked really good, but it was, I think, too good to be true.
[00:19:28.640 --> 00:19:31.000] Of course, they could be right for the wrong reasons.
[00:19:31.160 --> 00:19:39.000] For example, if it turns out that, you know, some people in the blue zone exercised more, had more friends, ate a healthy Mediterranean diet.
[00:19:39.000 --> 00:19:43.000] Well, those are correct, but not for the reasons you think they are.
[00:19:43.320 --> 00:19:44.200] Exactly.
[00:19:44.200 --> 00:19:44.840] Yeah.
[00:19:44.840 --> 00:19:45.240] Yeah.
[00:19:45.240 --> 00:19:46.360] That's a key point.
[00:19:46.360 --> 00:19:46.760] Yeah.
[00:19:46.760 --> 00:19:47.400] Okay.
[00:19:47.400 --> 00:19:47.800] All right.
[00:19:47.800 --> 00:19:49.320] So talk about genetics.
[00:19:49.320 --> 00:19:52.920] So would twin studies be an example of teasing and controlling for that?
[00:19:52.920 --> 00:19:53.160] Yeah.
[00:19:53.160 --> 00:19:54.280] Twin studies are really good.
[00:19:54.280 --> 00:19:56.600] That's kind of like the Mendelian randomization.
[00:19:56.920 --> 00:20:02.440] So when you have identical twins, that's a really good way to take a look at an intervention.
[00:20:02.440 --> 00:20:02.680] Yes.
[00:20:03.000 --> 00:20:03.320] Yeah.
[00:20:03.320 --> 00:20:19.720] And so like in that case, for example, as another, I don't know, teasing apart causality, you write about Alzheimer's and that, you know, many of the patients have the plaques entangles upon autopsy, but there are some who had Alzheimer's who don't have the plaques entangles.
[00:20:19.720 --> 00:20:24.200] And then there are some people that have the plaques entangles that never showed Alzheimer's.
[00:20:24.200 --> 00:20:27.240] So obviously there's other factors going on there.
[00:20:27.560 --> 00:20:28.280] Yes.
[00:20:28.280 --> 00:20:36.760] And this is critical because we try to have the kind of reductionist, simplified approach all the time, and it's never that simple.
[00:20:37.160 --> 00:20:39.400] Our bodies are just not simple.
[00:20:39.400 --> 00:20:42.360] So that's exactly right, as you point out.
[00:20:42.920 --> 00:20:49.880] The issue about uniqueness, even identical twins are unique.
[00:20:49.880 --> 00:20:51.560] Their epigenomes are different.
[00:20:51.560 --> 00:20:54.840] They were born somewhat slightly different times.
[00:20:55.400 --> 00:21:05.160] And so when you do a genome sequence, you may see the same DNA, but there's other layers of their biology that are like their gut microbiome could be very different.
[00:21:05.160 --> 00:21:10.600] So we can't even count on the identical twins as being identical.
[00:21:10.600 --> 00:21:12.040] That's how different we are.
[00:21:12.040 --> 00:21:12.680] Yeah.
[00:21:12.680 --> 00:21:17.120] You know, I've been working on a paper on the role of chance and how lives turn out.
[00:21:17.120 --> 00:21:30.640] And Steve Pinker was pointing out to me that even identical twins, yeah, all the stuff you said, but like one's on top and the other one's on the bottom, or, you know, just the neural connections between individual neurons, they're not going to be the same.
[00:21:30.640 --> 00:21:38.080] It's just there's a lot of randomness at work there, most of which we don't know because scientists can't really deal with randomness very well.
[00:21:38.080 --> 00:21:38.400] Yes.
[00:21:38.400 --> 00:21:39.920] And this is another point.
[00:21:40.480 --> 00:21:56.320] I'm glad you mentioned it because, you know, in the book, I present, the first patient I present is this woman, Lee Ruchall, and she is now 98, but her parents died in their 50s and 60s, as did her brothers.
[00:21:56.640 --> 00:22:07.280] And that's what we found in this welderly study of 1,400 people that were past 85 all the way up to 102 and had never been sick on no medications.
[00:22:07.280 --> 00:22:16.640] They didn't have the classic story of that, oh, all my relatives lived to that ripe old age and they all were healthy as a horse, right?
[00:22:16.640 --> 00:22:19.680] Which I never did understand that expression, healthy as a horse.
[00:22:19.680 --> 00:22:20.160] Yeah, right.
[00:22:20.480 --> 00:22:23.840] You know, it's kind of like sleeps like a baby.
[00:22:23.840 --> 00:22:25.920] I never had a baby that slept well.
[00:22:25.920 --> 00:22:43.360] So anyway, you got this problem here: we tend to think that when you have you're 98 and you've never been sick, that that is some great biological explanation.
[00:22:43.360 --> 00:22:44.880] But it could be luck.
[00:22:44.880 --> 00:22:48.160] It could just be a random, you know, stochastic event.
[00:22:48.160 --> 00:22:50.320] And so that's really kind of our burden.
[00:22:50.320 --> 00:22:59.880] I do think, based on all the data, that if you had to put the big bet on it, it's the immune system that wouldn't show up in the genome sequence because you have to do perturbations.
[00:22:59.680 --> 00:23:03.080] You got to really interrogate the immune system.
[00:23:03.320 --> 00:23:10.920] But the DNA sequence does not reveal why people have healthy aging.
[00:23:10.920 --> 00:23:12.120] It's really fascinating.
[00:23:12.760 --> 00:23:20.440] And we know a few things, but they're tied more to longevity, like APOE4 and a few other things.
[00:23:20.440 --> 00:23:26.280] But by and large, we don't really have the underpinnings of health span.
[00:23:26.520 --> 00:23:31.560] I think we're going to get those, but we sure didn't get them from the whole genome sequence.
[00:23:31.560 --> 00:23:36.280] I remember I did 23andMe back when I was writing for Scientific American so I could write about it.
[00:23:36.280 --> 00:23:38.600] And so I, yeah, I want, I checked the box for everything.
[00:23:38.600 --> 00:23:39.880] I want to know everything.
[00:23:40.200 --> 00:23:41.240] And so it came back.
[00:23:41.240 --> 00:23:46.120] I didn't have the two thing, the two genetic things for Alzheimer's.
[00:23:46.120 --> 00:23:47.160] I thought, oh, oh, great.
[00:23:47.160 --> 00:23:48.440] So I'm not going to get Alzheimer's.
[00:23:48.520 --> 00:23:50.280] They go, no, it doesn't mean that at all.
[00:23:50.280 --> 00:23:51.320] You could very well get it.
[00:23:51.320 --> 00:23:53.320] It just means you're slightly less likely.
[00:23:53.320 --> 00:23:54.920] It's like, oh, okay.
[00:23:54.920 --> 00:23:55.640] Thanks.
[00:23:55.640 --> 00:23:56.040] Yeah.
[00:23:56.680 --> 00:23:57.080] Yeah.
[00:23:57.080 --> 00:24:04.200] So that's actually bringing up the polygenic risk score, which it kind of got its early start with 23andMe.
[00:24:04.200 --> 00:24:20.680] But now through, you know, two decades of work, we now have these nailed down multi-ancestry and with hundreds of variants for each of the common cancers, Alzheimer's, heart disease, you know, atrial fibrillation.
[00:24:20.680 --> 00:24:23.320] So we now have a pretty good predictive tool.
[00:24:23.320 --> 00:24:30.120] The problem, beyond what you just mentioned, Michael, it isn't just that it tells you about some risk.
[00:24:30.120 --> 00:24:31.480] It just says yes or no.
[00:24:31.480 --> 00:24:33.000] It doesn't say when.
[00:24:33.000 --> 00:24:40.360] So if you have a high risk for Alzheimer's, what if it's at age 102 versus 72?
[00:24:40.360 --> 00:24:41.880] You know, big difference.
[00:24:41.880 --> 00:24:45.000] So the difference now is we have ways to get at the age.
[00:24:45.200 --> 00:24:58.640] That's where the AI kicks in, the multimodal AI, and the ability to discriminate an arc of a person where they might likely show up within a year or two range of a disease of interest.
[00:24:58.640 --> 00:25:07.040] By the way, on this idea of lifespan and how people today live twice as long as people did a century or two ago, that's a little misleading, right?
[00:25:07.040 --> 00:25:11.200] Because so many of the calculations like that are done with infant mortality.
[00:25:11.200 --> 00:25:15.840] And if you take that out, I mean, if you make it to age 10, then you're probably going to make it to age 20.
[00:25:15.840 --> 00:25:20.240] And if you make it to age 20, that increases your odds to make it to age 30 and so on.
[00:25:20.240 --> 00:25:26.720] So, I mean, Charles Darwin lived to, I don't think, 80 something, and Alfred Russell Wallace lived to 91.
[00:25:26.720 --> 00:25:34.960] You know, so it's not like nobody lived a long time, but if you get through those hurdles, so your goal is to get more of us over those hurdles.
[00:25:34.960 --> 00:25:36.640] Right, right, exactly.
[00:25:36.640 --> 00:26:00.080] If you can get to 80 or, you know, even 70, I would say, and you have no age-related major diseases, the big three we've been talking about, the chance of you getting to, you know, another decade is much higher, especially, you know, with the things that we know, like if you're practicing all the lifestyle factors that we know about and we've learned more about in recent times.
[00:26:00.240 --> 00:26:08.080] Plus, we're going to have better drugs and ways to screen or put people under surveillance so they don't wind up getting these diseases.
[00:26:08.080 --> 00:26:08.960] That's really the key.
[00:26:08.960 --> 00:26:10.080] So you're absolutely right.
[00:26:10.320 --> 00:26:16.000] We were misled because of the high infant mortality a century ago.
[00:26:16.320 --> 00:26:21.680] So, these ideas that we doubled the lifespan are really an incorrect notion.
[00:26:21.680 --> 00:26:23.120] So, I'm glad you mentioned that.
[00:26:23.120 --> 00:26:23.600] Yeah.
[00:26:23.920 --> 00:26:24.400] All right.
[00:26:24.560 --> 00:26:27.440] My favorite chapter in your book, Lifestyle Plus.
[00:26:27.440 --> 00:26:28.240] All right.
[00:26:28.880 --> 00:26:29.760] Let's get into it.
[00:26:30.280 --> 00:26:44.920] By the way, just parenthetically, you know, when I listen to RFKJ, and there's a lot that we are skeptical about with his anti-vaccine stuff, but a lot of stuff he says does kind of make sense: the toxins in the environment and the crappy diets and the obesity problem.
[00:26:44.920 --> 00:26:46.280] Those are true, right?
[00:26:46.920 --> 00:26:48.360] Yeah, here's my problem.
[00:26:48.360 --> 00:26:58.760] You know, RFK is uniquely positioned now to do some things that he could do to take on big food on the ultra-processed food.
[00:26:58.760 --> 00:27:09.960] He could take on the environment as he has during his career regarding air pollution, the plastics, which is such a mess, the forever chemicals.
[00:27:09.960 --> 00:27:17.800] The problem is, while he may be interested in doing that, the administration otherwise is going in the opposite direction.
[00:27:18.120 --> 00:27:24.280] It's basically making the EPA lose all of its oversight.
[00:27:24.600 --> 00:27:38.600] And so, if anything, it's his potential good efforts will be overridden by basically a jungaloid approach to the environment and a denial of the climate crisis and things like that.
[00:27:38.600 --> 00:27:39.960] So, we have real problems.
[00:27:40.200 --> 00:27:56.280] The right-hand doesn't know the left-hand what they're doing, and it doesn't look promising that Kennedy will execute on the good parts of what he's been, I think, interested in and why he has a big movement, you know, like the Maha Moms.
[00:27:56.280 --> 00:27:59.960] And, you know, there are a lot of people that support him for these things.
[00:27:59.960 --> 00:28:04.040] And no one in the government has taken on big food.
[00:28:04.280 --> 00:28:07.480] It took him a long time even to take on big tobacco.
[00:28:07.480 --> 00:28:11.720] But, you know, are we going to ever see this getting accomplished?
[00:28:11.720 --> 00:28:21.040] So I'm worried that he can't do, you know, execute on the things, the good ideas, the good directions that he is interested in.
[00:28:21.520 --> 00:28:29.360] I didn't have time to back check this statement of his about all the chemicals that European countries do not allow in foods that we do.
[00:28:29.360 --> 00:28:30.720] Is that true?
[00:28:30.720 --> 00:28:32.000] Well, there's certainly some.
[00:28:32.000 --> 00:28:37.360] A lot of these food dyes, they eliminated years ago, and we still haven't.
[00:28:38.160 --> 00:28:44.000] You know, maybe in California, there was some legislation, but it hasn't really done much.
[00:28:44.000 --> 00:28:50.080] So our tolerance for the food industry to basically do whatever they want has been very high.
[00:28:50.080 --> 00:28:56.560] Other countries have been much more into dealing with the ultra-processed food story.
[00:28:56.560 --> 00:28:59.840] We have the highest consumption of that in the world.
[00:29:00.480 --> 00:29:10.880] And we don't have, you know, our labels are totally insufficient for a consumer to know about these alien ingredients that you would never find in your kitchen.
[00:29:10.880 --> 00:29:12.480] You don't even know what the hell they are.
[00:29:12.480 --> 00:29:18.240] And some of them are some of those pro-inflammatory ingredients you could ever imagine.
[00:29:18.240 --> 00:29:27.680] So we've done nothing in this country to get onto the ultra-processed foods, whereas other parts of the world, they've really been all over it.
[00:29:28.000 --> 00:29:33.520] So what would be an example of ultra-processed foods that we should be avoiding?
[00:29:33.840 --> 00:29:46.720] Well, if you look at a package, whether a box or a package of like a snack food, you'll see these things in there that you'll never recognize.
[00:29:46.720 --> 00:29:58.720] Some of these are for texture, you know, like a xanthem gum and all kinds of things like that, so that it will get more rapidly into your gut and you'll get your reward circuit amplified.
[00:29:58.720 --> 00:30:01.080] So you'll want to eat more and more of this stuff.
[00:30:01.320 --> 00:30:12.440] And we know from some classic studies by Kevin Hall before he recently resigned from the NIH that people eating ultra-processed foods eat much more food.
[00:30:12.440 --> 00:30:20.120] So it basically is a reward circuit that keeps getting reinforced.
[00:30:20.120 --> 00:30:24.760] So there's also these things that are preservatives.
[00:30:24.760 --> 00:30:37.960] Like if you ever had anything, let's say in your refrigerator that lasted well belong, well longer than you expected, that's probably because it's got so much damn ultra-processed crap in it, right?
[00:30:38.280 --> 00:30:43.240] So whenever I, first of all, the best thing is that you don't have to look at a list of ingredients.
[00:30:43.240 --> 00:30:45.960] That's great, but obviously it's hard to avoid that.
[00:30:45.960 --> 00:30:50.120] But when you do, it should be like two or three things.
[00:30:50.120 --> 00:30:57.720] Once you start seeing a long list, like a paragraph worth, you almost can guarantee that there's really bad stuff in there.
[00:30:57.720 --> 00:31:03.640] And there's a classification, it's called Nova 4, which is ultra-process.
[00:31:03.640 --> 00:31:11.320] And it lists all the things, you know, all these foreign chemicals, which do not exist in anyone's kitchen.
[00:31:11.320 --> 00:31:11.880] Right.
[00:31:12.440 --> 00:31:17.000] And it does bring back, you know, homemade food, you know, yeah, homemade food.
[00:31:17.880 --> 00:31:27.560] So the things that are often in cans and packages and boxes, you really want to be very careful about ingesting those and buying them in the first place.
[00:31:27.560 --> 00:31:31.400] Do you recommend when you walk into a supermarket, stay on the perimeter?
[00:31:31.720 --> 00:31:32.520] You got it.
[00:31:32.520 --> 00:31:34.760] No, that adage is really important.
[00:31:34.760 --> 00:31:43.240] If you're just buying fresh produce, you know, fresh things and not package, not box, you're going to be okay.
[00:31:43.240 --> 00:31:48.960] You're going to avoid the, I call them UFOs, but you know, it's really ultra-processed.
[00:31:49.120 --> 00:31:54.320] But to me, yeah, yeah, I mean, this stuff should not be in our food.
[00:31:54.320 --> 00:32:04.400] And the fact is, our children, which is one of the things RFK has pointed out, our children are even higher than 70% of their diet is from this stuff.
[00:32:04.880 --> 00:32:11.840] And it is incredibly fostering, that's too nice a word, inflammation.
[00:32:12.240 --> 00:32:23.600] So we see risk of type 2 diabetes, of later in life, Alzheimer's, cancer, you name it, of course, cardiovascular disease prominently.
[00:32:23.600 --> 00:32:25.920] So these are really bad substances.
[00:32:25.920 --> 00:32:29.760] Remember the days, Michael, when trans fats were in all our foods?
[00:32:29.760 --> 00:32:30.320] Oh, yeah.
[00:32:30.640 --> 00:32:34.640] And it took decades before this country got on it.
[00:32:34.640 --> 00:32:40.000] And remember, too, that Europe banned them before us by many, many years.
[00:32:40.000 --> 00:32:45.120] And finally, not that long ago, trans fats were taken out this country.
[00:32:45.120 --> 00:32:48.960] Well, this is the same for the UPFs, but we haven't done it yet.
[00:32:48.960 --> 00:32:56.000] And I don't know what we're waiting for, except the fact that the food industry doesn't really want to change.
[00:32:56.000 --> 00:32:56.880] It's working.
[00:32:56.880 --> 00:32:58.480] They get more food eaten.
[00:32:58.720 --> 00:33:04.240] So in that case, they have lobbyists that simply buy their freedom to do that.
[00:33:04.560 --> 00:33:22.080] You know, it's one thing that's really interesting that I would not have predicted, and we don't know exactly why, but the GLP-1 drugs, Ozempic and Munjaro, not only do they have you eat less, but they have you eat healthier.
[00:33:22.080 --> 00:33:22.720] Yeah, I saw that.
[00:33:22.880 --> 00:33:25.360] Okay, you eat less ultra-processed foods.
[00:33:25.360 --> 00:33:27.120] It's like you were saying, how do we know?
[00:33:27.120 --> 00:33:30.600] Well, if you take these drugs, you're going to wind up avoiding them.
[00:33:30.600 --> 00:33:31.560] We don't know why.
[00:33:31.560 --> 00:33:32.440] We do know.
[00:33:32.520 --> 00:33:36.520] It directs you into the perimeter of the supermarket when you walk in.
[00:33:36.520 --> 00:33:38.760] I don't know why I'm going this way, but I am.
[00:33:39.400 --> 00:33:40.840] It's wild, really.
[00:33:40.840 --> 00:33:47.160] So we know it helps reduce addiction to not just alcohol, gambling, even.
[00:33:47.480 --> 00:33:50.360] It changes reward circuits completely.
[00:33:50.360 --> 00:33:51.960] It's really, really interesting.
[00:33:51.960 --> 00:33:54.520] Maybe it's going to be Ozempic will be the next statin.
[00:33:54.520 --> 00:33:56.840] Like everybody should be on it.
[00:33:57.160 --> 00:33:58.600] You know, it's interesting.
[00:33:59.480 --> 00:34:01.240] There is something to that.
[00:34:01.480 --> 00:34:15.560] If it clicks for Alzheimer's and the two big trials that are ongoing, that'll be a huge step towards that because before anyone loses weight, their inflammation in their body goes markedly reduced, is markedly reduced.
[00:34:15.560 --> 00:34:17.640] And then the brain as well.
[00:34:17.640 --> 00:34:19.000] So we'll see.
[00:34:19.000 --> 00:34:23.720] The first trials will be out in Ozempic, which is a weaker drug than the others.
[00:34:23.720 --> 00:34:40.520] But if that clicks by early next year, when those trials are due, that's going to be the big one for expanding the benefits that we've seen in not just obesity, diabetes, kidney disease, liver disease, heart disease, but that would take it to a whole nother level.
[00:34:40.520 --> 00:34:45.240] I've seen some friends of mine take it and just the weight just sheds right off.
[00:34:45.240 --> 00:34:47.720] And then I know some people that are not really obese at all.
[00:34:47.720 --> 00:34:52.760] They just like really like to lose that last 10 or 15 pounds extra lean.
[00:34:52.760 --> 00:34:57.880] I'm like, oh, maybe I should try that because I got that extra 10 or 15 right there.
[00:34:58.840 --> 00:35:00.120] Well, it works.
[00:35:00.600 --> 00:35:05.160] The trials in Alzheimer's are in thin people, you know, so that's what's really interesting.
[00:35:05.160 --> 00:35:05.640] Right.
[00:35:05.800 --> 00:35:08.360] Or, you know, not overweight or not obese.
[00:35:08.360 --> 00:35:11.800] But, you know, it wouldn't be shocking.
[00:35:12.120 --> 00:35:18.240] It's not just the drugs we have today, but this whole gut hormone story.
[00:35:18.560 --> 00:35:24.960] The gut hormones talk to the brain and they talk to the immune system, and they are powerful.
[00:35:25.200 --> 00:35:32.960] And so it might not just be the ones we have today and the triple receptor that we've already seen or the pills from these that we have today.
[00:35:32.960 --> 00:35:41.440] But now we have like 10 or 12 gut hormones that are getting mimics to add to the mix with combinations.
[00:35:41.440 --> 00:35:46.080] And, you know, when I was in medical school, the only gut hormone we knew was insulin.
[00:35:46.240 --> 00:35:48.320] Now we have a long list.
[00:35:48.320 --> 00:35:50.240] And we're just starting to see the benefits.
[00:35:50.240 --> 00:36:09.040] So I think people don't realize that what we're seeing in recent years, this eureka effect with gut hormones, is just the beginning of a whole nother class of drugs that mimic our natural hormones that were only discovered in recent times.
[00:36:09.040 --> 00:36:14.720] Do we know what the causal link is between these ultra-processed foods and inflammation?
[00:36:16.000 --> 00:36:26.640] Well, we know that they do incite inflammation, but there's debate about what is the kind of molecular mechanism.
[00:36:26.880 --> 00:36:32.720] And of course, as you pointed out, they vary a lot in terms of their structure, the chemical structure.
[00:36:32.720 --> 00:36:36.080] So they may not all be working through one common pathway.
[00:36:36.080 --> 00:36:44.080] But yeah, you see a lot of inflammation, like whenever you see experiments, it's like the plastic story, which is amazing.
[00:36:44.080 --> 00:36:44.640] Unbelievable.
[00:36:44.800 --> 00:36:59.600] The classic story in the plastics is that you get, there was a study done in Italy, multiple centers, and they looked at people having a carotid endarterectomy because of atherosclerosis in that artery, in the neck, that feeds the brain.
[00:36:59.800 --> 00:37:11.400] So 60% of people, when they examine the artery, the sick atherosclerotic artery, 60% had microplastics in the artery.
[00:37:11.400 --> 00:37:15.560] And right around the plastics, you see this vicious inflammation response.
[00:37:15.560 --> 00:37:16.440] Vicious.
[00:37:16.440 --> 00:37:29.080] But more importantly, you follow the people, the 60% who had the plastics and the inflammation versus the 40% of hundreds of people who didn't have plastics in their artery.
[00:37:29.080 --> 00:37:30.440] And guess what?
[00:37:30.440 --> 00:37:38.200] The people with the plastics had four to five-fold increase in heart attacks, strokes, and deaths.
[00:37:38.440 --> 00:37:43.240] So that tells us these plastics are not just, you know, innocent bystanders.
[00:37:43.240 --> 00:37:46.840] They induce inflammation, just like the ultra-processed foods.
[00:37:46.840 --> 00:37:53.800] And they can, you know, hurt a person from the standpoint of heart attacks and strokes.
[00:37:53.800 --> 00:37:58.760] And they've been found in the brain, just like the, in fact, they have more affinity in the brain than the heart.
[00:37:58.760 --> 00:38:04.280] So it's the body's way of attacking a foreign object, much like when I was a kid and I used to get splinters.
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[00:38:57.200 --> 00:39:02.960] And around the splinter, you can see, you know, it's red and hot, and so something like that.
[00:39:02.960 --> 00:39:04.560] But what would that be in the brain?
[00:39:04.560 --> 00:39:09.040] I mean, when you say the brain has inflammation, it's the whole brain is swelling or just pockets?
[00:39:09.760 --> 00:39:16.160] Yeah, so some of these ultra-processed foods can get right through their blood-brain barrier.
[00:39:16.160 --> 00:39:21.120] You know, these are chemicals of very low molecular weight, and we don't really have a way to...
[00:39:21.120 --> 00:39:24.240] So they can get in the brain and directly incite inflammation.
[00:39:24.240 --> 00:39:35.760] The other thing, of course, is they can get the, while they're eating and ingesting, they can get the gut hormones activated that tell the brain, you know, go into inflammation mode, if you will, to simplify things.
[00:39:35.760 --> 00:39:42.400] So, no, there's lots of ways that these drugs can hurt us, these ultra-processed foods can hurt us.
[00:39:42.960 --> 00:39:44.800] And it's a real problem.
[00:39:44.800 --> 00:39:55.760] The plastic story, you know, is a big study that showed we're accumulating more and more in recent times of microplastics up to like a spoon's worth in our brain.
[00:39:55.760 --> 00:40:01.680] And it's associated, go back to that, associated with much higher rates of Alzheimer's and dementia.
[00:40:01.680 --> 00:40:15.200] It doesn't, again, it doesn't, it's not good to have foreign things, whether it's these chemicals in food or plastics or forever chemicals in our body because they tend to be pro-inflammatory.
[00:40:15.200 --> 00:40:20.240] If there's one theme here, it's we don't want untoward inflammation.
[00:40:20.240 --> 00:40:26.720] That gets us, it reduces that health span, healthy aging story quite a bit.
[00:40:26.720 --> 00:40:41.400] And isn't there something about how much food you eat and how often you eat that just the whole metabolism ramping up to process food, which causes, I don't know, not inflammation maybe, but something like the body to overwork.
[00:40:41.400 --> 00:40:49.320] So the low calorie or starvation periods of time allows the body to run cooler, something like that.
[00:40:49.320 --> 00:40:56.200] Yeah, so the intermittent fasting is an interesting, there's lots of schedules, you know, the four to three, five to two.
[00:40:56.200 --> 00:40:57.160] I mean, you name it.
[00:40:57.160 --> 00:41:00.760] The point being is that there's been a lot of studies of that.
[00:41:01.080 --> 00:41:10.040] The data are somewhat mixed, as does it reduce your biological epigenetic age, you know, but it does help lose weight.
[00:41:10.040 --> 00:41:12.680] And to your point, I think is a good one.
[00:41:12.680 --> 00:41:31.640] If you can eat your dinner on the early side and you go all the way to the next morning, you don't eat anything in between, that's probably a very healthy thing for a human because that doesn't put your body, you know, kind of metabolically being challenged, gives it a good, you know, timeout.
[00:41:31.960 --> 00:41:34.280] We still don't have all the data to ice that.
[00:41:34.280 --> 00:41:36.200] It's more speculative.
[00:41:36.440 --> 00:41:45.000] But then we don't know, for example, whether fasting extensively or these intermittent fasting schedules, did they really work?
[00:41:45.000 --> 00:41:47.160] Do they really slow the aging process?
[00:41:47.400 --> 00:41:49.240] It's still up in the air.
[00:41:49.240 --> 00:41:59.320] And there are some, like the scientists at USC, that are strong proponents, but some of these studies just don't have the proof that we need.
[00:41:59.320 --> 00:41:59.880] Yeah.
[00:42:00.120 --> 00:42:00.520] All right.
[00:42:00.520 --> 00:42:01.640] Put you on the spot here.
[00:42:01.640 --> 00:42:04.120] We're recording this around at noon.
[00:42:04.120 --> 00:42:05.560] What did you have for breakfast this morning?
[00:42:05.560 --> 00:42:07.240] What are you going to have for lunch and dinner?
[00:42:07.240 --> 00:42:07.800] Okay.
[00:42:08.120 --> 00:42:08.520] Yeah.
[00:42:08.520 --> 00:42:14.200] So I had yogurt, plain yogurt, nothing else, you know, no additives.
[00:42:14.520 --> 00:42:17.920] I had some strawberries and blueberries in it.
[00:42:18.480 --> 00:42:23.600] And I threw in a little bit of granola as kind of a healthy granola.
[00:42:23.600 --> 00:42:25.280] So that was my breakfast.
[00:42:25.600 --> 00:42:29.680] And then I'll go because I love granola, but a lot of them have a lot of sugar.
[00:42:29.680 --> 00:42:30.080] Right.
[00:42:30.480 --> 00:42:36.960] I purposely get a granola from a local grocery that doesn't.
[00:42:37.440 --> 00:42:40.000] So it has, there's no added sugar.
[00:42:40.000 --> 00:42:43.280] It's just grains, some nuts stuff in there.
[00:42:43.680 --> 00:42:48.800] Some like raisins or cranberries, but not any sugar added.
[00:42:48.800 --> 00:42:49.600] But you're right.
[00:42:49.600 --> 00:42:52.880] You know, like these kind bars, they're not kind.
[00:42:52.880 --> 00:42:53.360] Okay.
[00:42:53.840 --> 00:42:55.360] There's a lot of crap in these things.
[00:42:55.360 --> 00:42:57.920] You got to really be careful what you're eating there.
[00:42:57.920 --> 00:43:01.280] So I don't eat basically anything till dinner.
[00:43:01.280 --> 00:43:10.480] And my dinner will be almost invariably, it's a salad with an oil and vinegar dressing.
[00:43:11.040 --> 00:43:21.120] I'll put in, you know, typically lots of different types of lettuce and tomatoes, carrots, lots of carrots, and salmon if I can.
[00:43:21.120 --> 00:43:26.080] Sometimes it would be just some tuna from a can without water, with water.
[00:43:26.080 --> 00:43:30.240] But usually, you know, add some protein to a salad and that will be my dinner.
[00:43:30.400 --> 00:43:31.600] That's what I had last night.
[00:43:31.600 --> 00:43:33.760] That's probably what I'm going to have tonight.
[00:43:34.080 --> 00:43:42.320] So, yeah, I try to follow a healthy diet, and I don't usually eat after dinner till the next morning.
[00:43:42.320 --> 00:43:43.040] I'll get up.
[00:43:43.360 --> 00:43:47.760] I always have thought if you don't wake up hungry, that's not something wrong.
[00:43:47.760 --> 00:43:49.200] You should be waking up hungry.
[00:43:49.360 --> 00:43:51.760] That's why they call brick fast, right?
[00:43:52.800 --> 00:43:54.480] So, yeah, that's kind of me.
[00:43:54.560 --> 00:44:02.360] Sometimes in the middle of the day, I'll have some nuts or something, a small snack, but a lot of times I don't even do that.
[00:44:02.680 --> 00:44:10.200] That was one of the wilder stories in that Netflix talk about Brian Johnson, where he had his dinner at, I don't know, it was like 11:30 in the morning.
[00:44:10.200 --> 00:44:12.440] That was his last meal for the day.
[00:44:12.840 --> 00:44:15.800] And then they asked about, and then he goes to bed by 8:15.
[00:44:15.800 --> 00:44:17.080] So they asked about his love life.
[00:44:17.080 --> 00:44:18.040] He's a single guy.
[00:44:18.040 --> 00:44:20.040] He's well, it's not so good.
[00:44:20.040 --> 00:44:22.040] Gee, that's a shocker.
[00:44:22.680 --> 00:44:29.880] Oh, it's crazy because he has the exact number of calories, like 2,350, whatever it is.
[00:44:29.880 --> 00:44:33.640] And then he has a penile sensor compared to his son.
[00:44:33.640 --> 00:44:34.280] Right.
[00:44:34.280 --> 00:44:35.640] How many erections each night?
[00:44:35.640 --> 00:44:37.480] I mean, these are crazy things, you know?
[00:44:38.040 --> 00:44:38.440] Yeah.
[00:44:38.760 --> 00:44:40.680] Dude, get a girlfriend.
[00:44:41.320 --> 00:44:41.960] Wow.
[00:44:41.960 --> 00:44:42.520] Wow.
[00:44:43.160 --> 00:44:43.400] Yeah.
[00:44:43.400 --> 00:44:43.640] Yeah.
[00:44:43.640 --> 00:44:44.200] Yeah.
[00:44:44.200 --> 00:44:44.600] Okay.
[00:44:44.600 --> 00:44:47.880] But so that sounds like a great diet for sure.
[00:44:48.120 --> 00:44:49.960] What about oatmeal?
[00:44:50.280 --> 00:44:51.720] I don't eat oatmeal.
[00:44:52.760 --> 00:44:56.120] So oatmeal, people think that's such a healthy thing.
[00:44:56.120 --> 00:44:57.240] Yeah, sounds healthy.
[00:44:57.240 --> 00:45:00.360] But it's basically carbohydrate.
[00:45:00.920 --> 00:45:07.080] And if you wear a glucose sensor, I tried that, you know, for a couple of weeks, a couple of times.
[00:45:07.080 --> 00:45:08.920] It shot up my glucose.
[00:45:08.920 --> 00:45:10.920] You know, so I don't want that.
[00:45:10.920 --> 00:45:12.760] I want to, you know, relatively flat.
[00:45:12.760 --> 00:45:19.800] I'll take a small, like to, you know, from 90 to 120, 130, but I don't like something going to the 170.
[00:45:19.800 --> 00:45:32.280] And so I eliminated the that's I used to have oatmeal and like it, but then I started realizing for me at least, it wasn't helping my glucose regulation.
[00:45:32.280 --> 00:45:33.480] It was a challenge to me.
[00:45:33.480 --> 00:45:37.400] I said, why should I keep going through that if it's a challenge?
[00:45:37.400 --> 00:45:38.040] Yeah.
[00:45:38.040 --> 00:45:43.320] How about all the different peanut butters, almond butter, cashew butter, mixed nut butter, all those?
[00:45:43.320 --> 00:45:44.440] Those are yummy.
[00:45:44.960 --> 00:45:47.120] Yeah, I haven't tried those, Michael.
[00:45:47.120 --> 00:45:47.440] Okay.
[00:45:47.840 --> 00:45:55.600] I buy them at the Bristol Farms here, and I just take a spoon as a snack in between meals if I'm hungry.
[00:45:55.600 --> 00:45:57.680] Well, they have a high amount of protein.
[00:45:57.680 --> 00:46:01.440] They probably would be fine, as long as they're not anything else added to it.
[00:46:03.120 --> 00:46:08.480] Yeah, I mean, peanut butter is good stuff as long as it's not all the junk that's added to it.
[00:46:08.640 --> 00:46:10.880] Yeah, the cheaper stuff has sugar in it.
[00:46:10.880 --> 00:46:12.640] Yeah, like JIF and stuff like that.
[00:46:12.800 --> 00:46:13.520] Yes, exactly.
[00:46:13.520 --> 00:46:20.240] So maybe that, you know, back to the SES factor, because they say that some of those poor communities are food deserts.
[00:46:20.240 --> 00:46:24.560] They don't have a Bristol Farms or a Whole Foods anywhere within driving distance.
[00:46:25.600 --> 00:46:32.240] And the local supermarket doesn't have the, you know, the special peanut butter, almond butter stuff.
[00:46:32.240 --> 00:46:35.280] They just got the Jiffy with the sugar.
[00:46:35.280 --> 00:46:36.000] Exactly.
[00:46:36.000 --> 00:46:38.080] Peter Pan or Jiffy or some of the.
[00:46:38.240 --> 00:46:44.160] So there are some good ones that don't, that just have the nuts and maybe a little salt or whatever.
[00:46:44.160 --> 00:46:45.120] But yeah, you're right.
[00:46:45.120 --> 00:46:48.000] And we do have a big problem with food deserts.
[00:46:48.000 --> 00:46:54.640] And in those deserts, we also have the highest intake of ultra-processed foods and, you know, all kinds of.
[00:46:54.640 --> 00:46:55.840] It's really a problem.
[00:46:55.840 --> 00:47:00.240] When my wife moved here from Germany 11 years ago now, wow.
[00:47:00.560 --> 00:47:04.480] She was shocked by the bread because in Germany, the bread is great.
[00:47:04.480 --> 00:47:08.640] I mean, it's a big loaf of bread is like eight pounds, right?
[00:47:08.960 --> 00:47:10.640] Our bread is just crappy.
[00:47:10.640 --> 00:47:11.440] There's nothing in it.
[00:47:11.440 --> 00:47:12.480] It's fluffy and sugary.
[00:47:12.640 --> 00:47:14.240] She's like, what is this?
[00:47:14.560 --> 00:47:15.120] Yeah.
[00:47:15.120 --> 00:47:16.880] No, it's a big difference.
[00:47:16.880 --> 00:47:23.280] You know, the Europeans, they have a lot of edge on us on a lot of the things that they eat.
[00:47:23.520 --> 00:47:27.440] But their bread, of course, is usually a much higher quality.
[00:47:27.440 --> 00:47:38.360] You can find, it's interesting, you mentioned that, Michael, because there's just down the street from where we live, there's this bakery that does like European-style bread.
[00:47:38.360 --> 00:47:47.480] And like on the weekends, there's lines a quarter mile long to get their bread because they can't get it anywhere else, you know?
[00:47:48.200 --> 00:47:50.600] So it's just, it's good bread.
[00:47:50.600 --> 00:47:53.480] I mean, really good bread is hard to come by.
[00:47:53.720 --> 00:48:00.280] But yeah, I mean, and as long as you're not having an overdose on it, it's certainly, there's these people that say no carbohydrates.
[00:48:00.280 --> 00:48:08.120] Well, that's a little off because, you know, there's nothing wrong with having, you know, small quantities of healthy bread.
[00:48:08.120 --> 00:48:08.760] Yeah.
[00:48:09.080 --> 00:48:14.920] I've had John Mackey on the show a couple of times, and he's a longtime good friend, founder of Whole Foods, and so on.
[00:48:14.920 --> 00:48:16.600] But he, you know, he's the real deal.
[00:48:16.600 --> 00:48:17.960] He really lives that life.
[00:48:17.960 --> 00:48:21.240] He's a vegan, but he's also a capitalist.
[00:48:21.240 --> 00:48:27.400] And, you know, we should be able to have people eat healthy and companies can make money the American way.
[00:48:27.400 --> 00:48:31.560] You know, why can't we do that model everywhere?
[00:48:31.560 --> 00:48:33.560] So there's no more food deserts.
[00:48:33.560 --> 00:48:34.600] I'm with you.
[00:48:34.600 --> 00:48:35.320] We need to.
[00:48:35.320 --> 00:48:55.880] I mean, that's actually one of the things that's going to hold us back from this master plan of how we can eradicate or marketly reduce the toll of the big three age-related diseases are all the health inequities and like you're mentioning, the food deserts and all the things and the environmental burden of toxicity.
[00:48:55.880 --> 00:48:59.240] If we don't pay attention to that, we're not going to get where we need to be.
[00:48:59.240 --> 00:48:59.800] Yeah.
[00:49:00.360 --> 00:49:02.120] Okay, quickie on the diet stuff.
[00:49:02.120 --> 00:49:03.640] Chicken and red meat.
[00:49:03.800 --> 00:49:04.600] What do we know?
[00:49:04.600 --> 00:49:05.080] Yeah.
[00:49:05.080 --> 00:49:06.440] Well, chicken's okay.
[00:49:06.440 --> 00:49:09.080] You know, that's not a problem.
[00:49:09.080 --> 00:49:11.560] Red meat is pro-inflammatory.
[00:49:11.720 --> 00:49:15.000] So it's okay, but you wouldn't want to have it on a frequent basis.
[00:49:16.560 --> 00:49:22.480] So, you know, in the book, I review all the data about that pro-inflammatory side of red meat.
[00:49:22.880 --> 00:49:25.040] And so that's just something to keep in mind.
[00:49:25.040 --> 00:49:27.280] I mean, I don't say, oh, you shouldn't eat it.
[00:49:27.280 --> 00:49:30.160] I haven't had any red meat in over four decades.
[00:49:30.160 --> 00:49:30.800] Wow.
[00:49:30.800 --> 00:49:33.840] But a lot of my patients will say, what about that?
[00:49:33.840 --> 00:49:42.320] I said, you know, it's okay, but I wouldn't, you know, have this more than once, twice a week, because then you're just subjecting yourself to some inflammation.
[00:49:42.400 --> 00:49:43.440] It's unnecessary.
[00:49:43.440 --> 00:49:45.280] You're a pescatarian.
[00:49:45.600 --> 00:49:46.880] Yeah, I'm a pescatarian.
[00:49:46.960 --> 00:49:47.600] Exactly.
[00:49:47.600 --> 00:49:48.080] Right.
[00:49:48.960 --> 00:49:49.840] Yeah, okay.
[00:49:49.840 --> 00:49:50.240] All right.
[00:49:50.240 --> 00:49:50.800] Wait.
[00:49:51.040 --> 00:49:53.360] BMI, is that a viable measure anymore?
[00:49:53.360 --> 00:49:54.000] No, terrible.
[00:49:54.240 --> 00:49:54.640] Okay, terrible.
[00:49:54.800 --> 00:49:55.280] I thought so.
[00:49:55.280 --> 00:49:55.680] Right.
[00:49:55.680 --> 00:49:56.400] It sucks.
[00:49:56.400 --> 00:50:02.080] I mean, you really want to have ideally a waist to hip ratio of some kind.
[00:50:02.720 --> 00:50:05.920] Yeah, you have to measure that properly.
[00:50:05.920 --> 00:50:11.120] But, you know, that BMI is so obsolete and still is used.
[00:50:11.120 --> 00:50:12.560] It's really unfortunate.
[00:50:12.960 --> 00:50:14.240] We have to get over that.
[00:50:14.240 --> 00:50:15.920] Someday, perhaps we will.
[00:50:15.920 --> 00:50:16.400] Yeah.
[00:50:17.680 --> 00:50:19.200] Okay, sleep.
[00:50:19.200 --> 00:50:20.080] Seven hours.
[00:50:21.040 --> 00:50:24.400] Yeah, there's a lot of big things that we've learned about sleep.
[00:50:24.400 --> 00:50:32.800] First of all, I was very surprised when I reviewed all the data in the book that seven hours was the optimal duration of total sleep.
[00:50:32.800 --> 00:50:35.440] I always thought it was eight or more.
[00:50:35.440 --> 00:50:35.920] Right.
[00:50:35.920 --> 00:50:42.880] And in fact, what you'd see in all the curves is that you start getting beyond seven and eight, you start to see detrimental links.
[00:50:42.880 --> 00:50:45.520] Again, associations, not causality.
[00:50:45.520 --> 00:50:47.760] I'm so glad you brought that up early.
[00:50:47.760 --> 00:50:57.040] Now, what we've learned more than that, much more than that, is about how we clear the waste metabolic products from our brain each night.
[00:50:57.040 --> 00:51:03.240] And that's through this channels of glymphatics as opposed to lymphatics, glymphatics.
[00:51:03.320 --> 00:51:12.680] And we learned they basically are getting rid of these waste products every night during our deep sleep.
[00:51:12.680 --> 00:51:18.680] That's the slow wave sleep that's typically early in the night, not necessarily, but usually early.
[00:51:18.680 --> 00:51:23.160] And we want to get as much of that as possible to get all that crap out of our brain, right?
[00:51:23.160 --> 00:51:30.120] Now, turns out as we get older, our deep sleep keeps getting lower and lower.
[00:51:30.440 --> 00:51:37.480] And so when I started tracking my deep sleep, I was aghast because it was down to averaging less than 15 minutes.
[00:51:37.480 --> 00:51:38.680] And I said, this is horrible.
[00:51:38.680 --> 00:51:42.040] I knew I didn't sleep well, but I didn't know it was that bad.
[00:51:42.040 --> 00:51:44.280] So I started really working on that.
[00:51:44.280 --> 00:52:31.520] And, you know, everything I could, every interaction, like when did I eat last and when did I exercise last and what did I eat and very importantly limiting my fluid intake in the evening and maximizing it in the morning and early in the day and just really going really wild with fluids water early because that interrupted sleep during the night I mean if you got it in the middle of the night you're up yeah not not good yeah not good because then you got to start all over again with getting back to sleep right so I've been able to get it up to average more like 45 minutes I'm still working on it I want to get up to an hour I don't know if I'll ever get there I've had a couple of nights like that if we when you're 70 if you can get now women do better than men for sleep.
[00:52:31.520 --> 00:52:45.920] But for a man to get 60 minutes of deep sleep, that's really good and we we have to do this because if you want to prevent Alzheimer's, the other thing I learned, which is big, was the regularity.
[00:52:45.920 --> 00:52:47.760] I was erratic.
[00:52:48.000 --> 00:52:51.360] My wife is a big-time night owl.
[00:52:51.360 --> 00:52:53.440] So sometimes I'd stay up late with her.
[00:52:53.440 --> 00:52:55.760] Now I said, no, no, I'm going to bed early.
[00:52:55.760 --> 00:53:00.960] Not like Brian Johnson, but early for me, more like tennish.
[00:53:01.120 --> 00:53:04.240] The reason being is that sleep regularity is a big deal.
[00:53:04.560 --> 00:53:12.160] It ties into deep sleep, but it also ties into cardiovascular, cancer, and neurodegenerative diseases.
[00:53:12.160 --> 00:53:17.600] So these are the adjustments I made, and I just basically followed where the research has taken us.
[00:53:17.600 --> 00:53:22.320] And it's very, it's impressive that we can be much healthier for sleep.
[00:53:22.320 --> 00:53:29.280] And I think we should all be striving for that because most people are not getting really good sleep or deep sleep.
[00:53:29.600 --> 00:53:30.960] I just as we age.
[00:53:31.680 --> 00:53:33.680] I just get up whenever I wake up.
[00:53:33.680 --> 00:53:36.720] I don't set alarms or anything unless I have an early flight or something.
[00:53:36.720 --> 00:53:39.200] But how do I know how much deep sleep I'm getting?
[00:53:40.080 --> 00:53:43.200] Do you have to have one of those wearables like the Oral Ring or a SmartWatch?
[00:53:44.240 --> 00:53:47.280] An Aural Ring, or there's several other rings now.
[00:53:47.280 --> 00:53:49.600] There's smartwatches do it.
[00:53:49.600 --> 00:53:58.080] And mattresses, a lot of mattresses now have a sensor in them, or that you can get an app that you can have tied to your mattress.
[00:53:58.080 --> 00:54:00.640] So there's three ways to get at it.
[00:54:01.440 --> 00:54:05.760] The ring seems to be a bit more accurate than the smartwatch.
[00:54:05.760 --> 00:54:06.640] I use both.
[00:54:06.880 --> 00:54:08.000] I compare them.
[00:54:08.000 --> 00:54:13.920] And, you know, I interestingly, sometimes they're very concordant and sometimes they're very discrepant.
[00:54:13.920 --> 00:54:19.600] But I think the ring is one that is most helpful for accuracy.
[00:54:19.600 --> 00:54:32.600] And I think it's something if you're if you don't think you're sleeping well and you have concerns about that, it might, we don't have a this is something I emphasize in the book.
[00:54:32.840 --> 00:54:37.960] We can't prove that using sleep trackers changes outcomes.
[00:54:37.960 --> 00:54:54.840] We only can infer that if you are regularly getting you know much better sleep pattern, deep sleep regularity, that that is more likely to be associated, not cause and effect, but more likely with favorable major health outcomes.
[00:54:54.840 --> 00:55:01.400] Yeah, I got to get some of those because I think I sleep well, but I have no idea how much deep sleep time I have.
[00:55:01.400 --> 00:55:10.280] So what you're telling me is that when I wake up at two in the morning and flip open my computer and watch a documentary on Hitler and color, that's probably not the best thing I should do.
[00:55:10.280 --> 00:55:11.080] Not a good idea.
[00:55:11.080 --> 00:55:17.160] Oh, and by the way, everyone should rule out that they don't have sleep apnea because a lot of people don't know that.
[00:55:17.160 --> 00:55:17.560] Okay.
[00:55:17.560 --> 00:55:22.280] Because their partner may be sound asleep and they're stopping to breathing.
[00:55:22.680 --> 00:55:26.600] So ruling that out, you don't have to be obese to have sleep apnea.
[00:55:26.840 --> 00:55:31.240] So that's another good thing to know about from tracking.
[00:55:31.560 --> 00:55:35.400] And now you can get that too from rings and from smartwatches.
[00:55:35.800 --> 00:55:42.840] Anyway, yeah, if you're getting up on a frequent basis during the night, that's probably a reason to track.
[00:55:43.000 --> 00:55:49.240] You don't have to do it long term, but just get a grip on it for a few weeks to see what the pattern is like.
[00:55:49.240 --> 00:55:50.120] Good idea.
[00:55:50.120 --> 00:55:50.520] All right.
[00:55:50.520 --> 00:56:07.560] I loved your chapter section on exercise, of course, because I'm an exercise nut, mostly mostly cardio, but now a lot of my cycling buddies are doing weights because a lot of older cyclists have weak, brittle bones because we don't do enough gravitational pull or stress or whatever.
[00:56:07.560 --> 00:56:09.720] Yeah, I'm really into that too now.
[00:56:10.280 --> 00:56:13.080] I used to only say aerobic.
[00:56:13.080 --> 00:56:17.280] And then my patients would come in and they'd come in all, you know, muscular cut.
[00:56:14.840 --> 00:56:19.680] And I'd say, well, you're doing lifting too much weight.
[00:56:19.920 --> 00:56:26.640] What about a bicycle or a treadmill or long walks, brisk walks, whatever, swimming.
[00:56:26.800 --> 00:56:33.200] Anyway, I've shifted to integrate balance, better posture.
[00:56:33.200 --> 00:56:35.120] These are things that are really important.
[00:56:35.120 --> 00:56:38.880] So our balance, as you know, is so critical.
[00:56:38.880 --> 00:56:47.120] And you can train to have much better balance just by standing on one foot on a foam pad and other ways to get your core.
[00:56:47.120 --> 00:56:55.280] So it isn't just weightlifting, getting your core strength is so critical and it interplays with balance.
[00:56:55.280 --> 00:56:58.400] And then finally, yeah, you want to have beach muscles, that's great.
[00:56:58.400 --> 00:57:06.240] But, you know, getting your upper body, which most of our exercises do nothing, aerobic for our upper body.
[00:57:06.240 --> 00:57:10.240] And then that's where you have to really do some weight strength training.
[00:57:10.240 --> 00:57:12.560] So, yeah, I think it's really important.
[00:57:12.560 --> 00:57:14.800] The data are pretty striking.
[00:57:14.800 --> 00:57:16.480] That's what convinced me.
[00:57:16.480 --> 00:57:24.480] I've been well over a year into it, and I've never been stronger and have better balance in my life, I think, just by training.
[00:57:24.480 --> 00:57:25.520] And everyone can do that.
[00:57:25.520 --> 00:57:34.080] And it's very inexpensive, if not, you know, some bands and standing on some, you know, standing on one foot doesn't cost anything.
[00:57:34.080 --> 00:57:38.480] But if you can do that for a minute or two, you know, you're on the right track.
[00:57:38.480 --> 00:57:44.240] And you can tell if your core is weak by going, you know, sitting in a chair to standing.
[00:57:44.240 --> 00:57:46.640] You know, try to do that 20 times quickly.
[00:57:46.640 --> 00:57:50.320] And if you can't do that, that means your core needs some work.
[00:57:50.320 --> 00:57:50.800] Yeah.
[00:57:51.440 --> 00:57:57.840] So, what this translates to, to use an example, I remember talking to my friend Jared Diamond when he turned 80.
[00:57:57.840 --> 00:58:02.520] He said, the riskiest thing I do today, I'll do today is take a shower.
[00:58:03.160 --> 00:58:12.200] And he had data about, you know, people in their 80s, if they fall, you know, that's where the meltdown starts, the break a hip or something like that.
[00:58:12.200 --> 00:58:16.040] And so, your point is that all of us slip or whatever.
[00:58:16.040 --> 00:58:20.520] If my core is good, my grip is solid, and my balance is pretty good.
[00:58:20.520 --> 00:58:28.680] If I slip like anybody slips, I'm more likely to grab something or catch myself or readjust and not actually hit the ground.
[00:58:28.680 --> 00:58:29.640] Exactly.
[00:58:29.640 --> 00:58:39.960] You know, if you get through the big three, cancer, neurodegenerative, and cardiovascular, but then you fall and have a hip fracture and die from that, that's not good.
[00:58:39.960 --> 00:58:51.640] So it turns out, though, interestingly, these three age-related diseases, these big ones, do really well with better balance, strength, training.
[00:58:51.960 --> 00:59:07.000] You know, the whole idea of exercise, interestingly, even though during the exercise there's a bit of inflammation that is from that, overall, it markedly improves your immune system function and you're much less to be pro-inflammatory in general.
[00:59:07.240 --> 00:59:09.240] So, and it isn't just aerobic.
[00:59:09.240 --> 00:59:14.280] I mean, these other forms of exercise and training do that as well.
[00:59:15.240 --> 00:59:17.800] What's the thinking about grip strength?
[00:59:18.520 --> 00:59:21.560] Why do I care about that and related that as hang time?
[00:59:21.880 --> 00:59:25.160] What difference does it make how long I get hang on a chin-up bar?
[00:59:25.800 --> 00:59:33.480] It's a really good point because that's a great metric that's been used and it's an indicator of healthy aging.
[00:59:33.800 --> 00:59:36.120] It's a, I mean, a marker of it.
[00:59:36.200 --> 00:59:41.640] Turns out it's probably a proxy for your upper body strength.
[00:59:41.880 --> 00:59:47.280] I mean, you're not going to have some really great hand grip strength, and then your upper body is going to be weak.
[00:59:47.280 --> 00:59:49.840] You know, so it's probably that.
[00:59:49.840 --> 00:59:55.120] But, you know, I think it's good to have good hand grip strength.
[00:59:55.120 --> 01:00:04.400] But, you know, it's probably something easy to measure, which coincides with what have you been doing with your arms and your upper body.
[01:00:04.400 --> 01:00:11.840] Because as soon as I, you know, got going on my upper body strength, my hand grip strength shot up, you know, too.
[01:00:11.840 --> 01:00:14.160] And I didn't do, you know, hand grip things.
[01:00:14.160 --> 01:00:17.760] So I think they're very, very much correlated.
[01:00:17.760 --> 01:00:18.160] Yeah.
[01:00:18.480 --> 01:00:22.960] Well, then also body weight, because if you weigh a lot, it's going to be harder to hang.
[01:00:22.960 --> 01:00:23.840] You got it.
[01:00:24.160 --> 01:00:24.560] Yeah.
[01:00:24.560 --> 01:00:27.680] No, hanging is a good type of exercise, you know, on a chin-up thing.
[01:00:27.680 --> 01:00:28.000] Yeah.
[01:00:28.080 --> 01:00:29.040] Really good form of exercise.
[01:00:29.200 --> 01:00:35.520] I did it, I don't know, about a year ago when Peter Atia had Lance Armstrong on his podcast, or might have been vice versa.
[01:00:35.520 --> 01:00:37.280] Everybody has a podcast now.
[01:00:37.280 --> 01:00:38.960] And they were doing hang time comparisons.
[01:0

Prompt 2: Key Takeaways

Now please extract the key takeaways from the transcript content I provided.

Extract the most important key takeaways from this part of the conversation. Use a single sentence statement (the key takeaway) rather than milquetoast descriptions like "the hosts discuss...". 

Limit the key takeaways to a maximum of 3. The key takeaways should be insightful and knowledge-additive. 

IMPORTANT: Return ONLY valid JSON, no explanations or markdown. Ensure:
- All strings are properly quoted and escaped
- No trailing commas
- All braces and brackets are balanced
Format: {"key_takeaways": ["takeaway 1", "takeaway 2"]}

Prompt 3: Segments

Now identify 2-4 distinct topical segments from this part of the conversation.

For each segment, identify:
- Descriptive title (3-6 words)  
- START timestamp when this topic begins (HH:MM:SS format)
- Double check that the timestamp is accurate - a timestamp will NEVER be greater than the total length of the audio
- Most important Key takeaway from that segment. Key takeaway must be specific and knowledge-additive.
- Brief summary of the discussion

IMPORTANT: The timestamp should mark when the topic/segment STARTS, not a range. Look for topic transitions and conversation shifts.

Return ONLY valid JSON. Ensure all strings are properly quoted, no trailing commas:
{
  "segments": [
    {
      "segment_title": "Topic Discussion", 
      "timestamp": "01:15:30",
      "key_takeaway": "main point from this segment",
      "segment_summary": "brief description of what was discussed"
    }
  ]
}

Timestamp format: HH:MM:SS (e.g., 00:05:30, 01:22:45) marking the START of each segment.

Prompt 4: Media Mentions

Now scan the transcript content I provided for ACTUAL mentions of specific media titles:

Find explicit mentions of:
- Books (with specific titles)
- Movies (with specific titles)  
- TV Shows (with specific titles)
- Music/Songs (with specific titles)

DO NOT include:
- Websites, URLs, or web services
- Other podcasts or podcast names

IMPORTANT: 
- Only include items explicitly mentioned by name. Do not invent titles.
- Valid categories are: "Book", "Movie", "TV Show", "Music"
- Include the exact phrase where each item was mentioned
- Find the nearest proximate timestamp where it appears in the conversation
- THE TIMESTAMP OF THE MEDIA MENTION IS IMPORTANT - DO NOT INVENT TIMESTAMPS AND DO NOT MISATTRIBUTE TIMESTAMPS
- Double check that the timestamp is accurate - a timestamp will NEVER be greater than the total length of the audio
- Timestamps are given as ranges, e.g. 01:13:42.520 --> 01:13:46.720. Use the EARLIER of the 2 timestamps in the range.

Return ONLY valid JSON. Ensure all strings are properly quoted and escaped, no trailing commas:
{
  "media_mentions": [
    {
      "title": "Exact Title as Mentioned",
      "category": "Book",
      "author_artist": "N/A",
      "context": "Brief context of why it was mentioned",
      "context_phrase": "The exact sentence or phrase where it was mentioned",
      "timestamp": "estimated time like 01:15:30"
    }
  ]
}

If no media is mentioned, return: {"media_mentions": []}

Prompt 5: Context Setup

You are an expert data extractor tasked with analyzing a podcast transcript. 
I will provide you with part 2 of 2 from a podcast transcript. 
I will then ask you to extract different types of information from this content in subsequent messages. Please confirm you have received and understood the transcript content.

Transcript section:
-> 00:59:21.560] Why do I care about that and related that as hang time?
[00:59:21.880 --> 00:59:25.160] What difference does it make how long I get hang on a chin-up bar?
[00:59:25.800 --> 00:59:33.480] It's a really good point because that's a great metric that's been used and it's an indicator of healthy aging.
[00:59:33.800 --> 00:59:36.120] It's a, I mean, a marker of it.
[00:59:36.200 --> 00:59:41.640] Turns out it's probably a proxy for your upper body strength.
[00:59:41.880 --> 00:59:47.280] I mean, you're not going to have some really great hand grip strength, and then your upper body is going to be weak.
[00:59:47.280 --> 00:59:49.840] You know, so it's probably that.
[00:59:49.840 --> 00:59:55.120] But, you know, I think it's good to have good hand grip strength.
[00:59:55.120 --> 01:00:04.400] But, you know, it's probably something easy to measure, which coincides with what have you been doing with your arms and your upper body.
[01:00:04.400 --> 01:00:11.840] Because as soon as I, you know, got going on my upper body strength, my hand grip strength shot up, you know, too.
[01:00:11.840 --> 01:00:14.160] And I didn't do, you know, hand grip things.
[01:00:14.160 --> 01:00:17.760] So I think they're very, very much correlated.
[01:00:17.760 --> 01:00:18.160] Yeah.
[01:00:18.480 --> 01:00:22.960] Well, then also body weight, because if you weigh a lot, it's going to be harder to hang.
[01:00:22.960 --> 01:00:23.840] You got it.
[01:00:24.160 --> 01:00:24.560] Yeah.
[01:00:24.560 --> 01:00:27.680] No, hanging is a good type of exercise, you know, on a chin-up thing.
[01:00:27.680 --> 01:00:28.000] Yeah.
[01:00:28.080 --> 01:00:29.040] Really good form of exercise.
[01:00:29.200 --> 01:00:35.520] I did it, I don't know, about a year ago when Peter Atia had Lance Armstrong on his podcast, or might have been vice versa.
[01:00:35.520 --> 01:00:37.280] Everybody has a podcast now.
[01:00:37.280 --> 01:00:38.960] And they were doing hang time comparisons.
[01:00:38.960 --> 01:00:41.040] I think Lance said he made it a minute.
[01:00:41.040 --> 01:00:43.440] So then I tried to see if I could do a minute.
[01:00:43.520 --> 01:00:43.920] I did it.
[01:00:43.920 --> 01:00:45.120] I made it a minute.
[01:00:45.120 --> 01:00:46.000] That's great.
[01:00:46.000 --> 01:00:46.640] Really?
[01:00:46.640 --> 01:00:48.080] So it's harder than you think, though.
[01:00:48.080 --> 01:00:50.080] You're like, oh, I can sit there for five minutes.
[01:00:50.080 --> 01:00:50.560] No.
[01:00:50.560 --> 01:00:52.000] Oh, no, no, no, no, no.
[01:00:52.320 --> 01:00:53.760] That would be very difficult.
[01:00:54.000 --> 01:00:54.960] A minute's good.
[01:00:55.440 --> 01:00:57.120] But you want to do repeats.
[01:00:57.680 --> 01:00:58.080] Oh, right.
[01:00:58.480 --> 01:00:59.600] I didn't try the repeats.
[01:00:59.600 --> 01:01:00.000] Okay.
[01:01:01.360 --> 01:01:01.680] Okay.
[01:01:01.680 --> 01:01:07.760] I was really disturbed by the section in your book on the water bottles that I have here in the office that I use constantly.
[01:01:08.080 --> 01:01:15.680] Are you telling me that these plastic water bottles, just there's like molecules are dissolving away into the water?
[01:01:15.680 --> 01:01:18.400] And why is this legal?
[01:01:18.400 --> 01:01:19.680] I mean, come on.
[01:01:20.000 --> 01:01:26.000] Yeah, it's a double hit because the water we drink now already has microplastics in it.
[01:01:26.400 --> 01:01:34.280] And now sitting and stored in plastic, it's just absorbing some of those micro-nanoplastics right into the water.
[01:01:29.600 --> 01:01:36.840] So we should get rid of plastic water bottles.
[01:01:37.000 --> 01:01:42.600] They're a really big toll of our plastic burden that's accumulating, you know, megatons.
[01:01:42.760 --> 01:01:44.360] It's non-degradable.
[01:01:44.920 --> 01:01:54.360] And we also, there's lots of great ingenious ways to degrade plastics from so it doesn't get into our oceans and lakes and air.
[01:01:54.360 --> 01:01:56.120] We're not doing it.
[01:01:56.920 --> 01:02:01.160] So there's a limit on how much we can do on an individual basis.
[01:02:01.160 --> 01:02:07.320] I mean, for example, you don't want to take your food that's sitting in a plastic container and put it in a microwave.
[01:02:07.320 --> 01:02:10.440] That's taking your plastic ingestion to the fourth hour or something.
[01:02:10.600 --> 01:02:11.400] Oh my God.
[01:02:11.400 --> 01:02:11.880] Okay.
[01:02:11.880 --> 01:02:12.840] And ideally.
[01:02:13.320 --> 01:02:15.240] Yeah, you mentioned popcorn bags.
[01:02:15.240 --> 01:02:17.640] All right, because that's in the microwave.
[01:02:17.640 --> 01:02:18.440] Oh, yeah.
[01:02:18.440 --> 01:02:24.120] So, you know, if you have water, I mean, you're better off.
[01:02:24.120 --> 01:02:26.920] Like, I'm sure you've seen it when you've flown.
[01:02:26.920 --> 01:02:29.320] Sometimes they have water in cartons now.
[01:02:29.320 --> 01:02:29.720] Yes.
[01:02:30.040 --> 01:02:31.080] And that's better.
[01:02:31.080 --> 01:02:31.560] Yeah.
[01:02:31.560 --> 01:02:39.240] And why doesn't all the water, you know, be put in cartons without a layer inside that has plastic?
[01:02:39.240 --> 01:02:43.720] So we can do better, but it means making this a national initiative.
[01:02:43.720 --> 01:02:45.160] And there's been no sign of that.
[01:02:45.160 --> 01:02:50.760] That goes back to that RFK thing: that if he was, you know, bold, he would take this on.
[01:02:50.760 --> 01:02:53.000] But I suspect that's not going to happen.
[01:02:53.000 --> 01:02:55.880] I hope it will, but no signs of it yet.
[01:02:55.880 --> 01:02:56.680] Yeah.
[01:02:57.320 --> 01:02:57.960] Okay.
[01:02:58.520 --> 01:03:02.000] Cardiovascular disease and statins.
[01:03:01.800 --> 01:03:02.560] I'm asking.
[01:03:03.000 --> 01:03:04.200] I'm on a statin.
[01:03:04.200 --> 01:03:09.480] My doc is like, I don't know if you really need a turmeric given how much you exercise and your diet and so on.
[01:03:09.480 --> 01:03:13.480] But, you know, my family history, my dad died at 61 of a cardio, of a heart attack.
[01:03:13.560 --> 01:03:16.320] His dad died at 60-something as a heart attack.
[01:03:16.320 --> 01:03:18.320] And one of his two brothers died of a heart attack.
[01:03:14.920 --> 01:03:21.520] So, you know, I tell this to the doc, they're like, all right, we're putting you on a statin.
[01:03:23.040 --> 01:03:24.640] I don't know what to think.
[01:03:24.960 --> 01:03:28.400] Well, I mean, there's lots of ways to get at this.
[01:03:28.640 --> 01:03:31.280] One way is your LDL cholesterol.
[01:03:31.600 --> 01:03:33.120] That's only one way.
[01:03:33.520 --> 01:03:39.040] Another way is to do a polygenic risk score for coronary disease, which is actually quite good.
[01:03:39.840 --> 01:03:41.680] It's been validated to the hilt.
[01:03:41.920 --> 01:03:50.720] Of all the polygenic risks that you can get for, you know, very low cost from one of these 10 different companies, that one is the most accurate.
[01:03:50.720 --> 01:03:59.920] That'll tell you yes, no, and it may liberate you from your parental lineage, your father and grandfather.
[01:03:59.920 --> 01:04:10.240] It may tell you that you're a low risk, which there's a risk polygenic of all the hundreds of gene variants that cumulatively tell you, do you have a risk weighted?
[01:04:10.480 --> 01:04:12.080] Do you have a risk or not?
[01:04:12.080 --> 01:04:15.280] That is very good to tell about statin responsiveness.
[01:04:15.280 --> 01:04:16.400] Right.
[01:04:17.760 --> 01:04:21.760] Some have advocated getting a calcium scan.
[01:04:21.760 --> 01:04:22.240] I did that.
[01:04:22.240 --> 01:04:23.120] CT scan.
[01:04:23.600 --> 01:04:27.840] And if it's zero, then you know, you're not going to get a lot of bang from a statin.
[01:04:27.840 --> 01:04:29.040] I don't recommend those.
[01:04:29.040 --> 01:04:29.520] CAC.
[01:04:29.520 --> 01:04:40.240] I go CAC, you know, Calcium CT because it gets people go, they go cuckoo, some of them, and they have a high calcium, and it may not even be in their arteries.
[01:04:40.560 --> 01:04:48.400] There is some proportionality of the high calcium score with risk of coronary disease and response to statins.
[01:04:48.400 --> 01:04:58.560] But I try to avoid that because I think the polygenic risk score, which you can get from saliva, is cheaper, is a better one test.
[01:04:58.720 --> 01:05:11.800] Then the other thing is you can look at your other proteins, like your APOB, your HDL, your lipoprotein, little A, LPA, and just get a kind of context.
[01:05:11.800 --> 01:05:13.640] Are you at risk for coronary disease?
[01:05:13.640 --> 01:05:22.360] You can also look at inflammation in your body, like a high-sensitivity CRP or cytostatin and other better inflammatory markers that will have.
[01:05:22.360 --> 01:05:27.000] Basically, not knowing if you have a high LDL cholesterol.
[01:05:27.000 --> 01:05:39.320] You know, I think if you've never had heart disease and your LDL is low, your ApoB is low, it's hard to make a really good case for you to take a statin just because of a family history.
[01:05:39.320 --> 01:05:41.240] Well, I have my LDL is a little high.
[01:05:41.240 --> 01:05:43.960] The HDL is in the right range.
[01:05:43.960 --> 01:05:44.520] I don't know.
[01:05:44.520 --> 01:05:46.200] The average is a little high.
[01:05:46.200 --> 01:05:55.400] I did the cardio score of 103, which is, you know, but it's way lower than my buddy who has half the body weight and he's twice as fast as I am on a bike.
[01:05:55.640 --> 01:05:58.600] Yeah, was that 103 recent?
[01:05:59.240 --> 01:06:00.280] About a year ago.
[01:06:00.280 --> 01:06:01.400] Oh, that's great then.
[01:06:01.400 --> 01:06:03.640] No, I mean, you're at very low risk.
[01:06:03.880 --> 01:06:07.320] Okay, I mean, 103 at age 69, that's fantastic.
[01:06:07.320 --> 01:06:07.640] Yeah.
[01:06:07.640 --> 01:06:08.120] Yeah.
[01:06:08.120 --> 01:06:15.640] Well, but so, but on the causal connection of taking a statin, I mean, there's several links in there, right?
[01:06:16.280 --> 01:06:24.920] Of between having high cholesterol and taking a statin to lower that, particularly the LDL, and then downstream, a cardiac event.
[01:06:25.240 --> 01:06:25.720] Yes.
[01:06:25.720 --> 01:06:42.280] So there is no question that if you are, you know, very high LDL cholesterol, that, you know, we're talking way over, you know, 150 plus, your risk of coronary disease and other astical sclerosis in the body is really high.
[01:06:42.600 --> 01:06:52.160] And so those people are going to either benefit from statin or the combination with azetamide that prevents cholesterol absorption from what you eat.
[01:06:52.160 --> 01:06:54.080] It doesn't get into the bloodstream.
[01:06:54.400 --> 01:06:56.400] It's a well-tolerated medicine.
[01:06:56.400 --> 01:07:02.160] There's also now these monoclonal antibodies against the PCSK9 gene that are really potent.
[01:07:02.160 --> 01:07:03.360] You can add to the mix.
[01:07:03.360 --> 01:07:07.760] So if somebody's really high risk, you can get their LDL down very low.
[01:07:08.080 --> 01:07:10.720] You can get it down to less than 30, 20.
[01:07:11.360 --> 01:07:12.720] It's now possible.
[01:07:12.720 --> 01:07:18.240] And we're getting new drugs to lower LPA, these CETP drugs.
[01:07:18.240 --> 01:07:24.480] So our armamentarium to take over the lipid story and inflammation is really expanding.
[01:07:24.480 --> 01:07:40.800] And that's why cardiovascular is so ripe to prevent because it's so responsive to diet, exercise, sleep, and blood pressure control, prevention of diabetes, prevention of obesity.
[01:07:41.520 --> 01:07:52.800] So if you add on this anti-inflammatory story with the LDL and related, you can get the chance of developing heart disease way, way down.
[01:07:52.800 --> 01:07:56.800] And we're just looking at that right now, and we're not doing enough about that.
[01:07:57.120 --> 01:08:01.520] And it isn't just a statin story because a lot of people can't tolerate statins.
[01:08:01.520 --> 01:08:08.400] And I have many patients that they have such terrible night cramps and muscle spasms.
[01:08:08.400 --> 01:08:13.040] And what's interesting is the data from the trialists keep saying, oh, everybody could take a statin.
[01:08:13.040 --> 01:08:13.920] It's in their head.
[01:08:13.920 --> 01:08:15.120] Well, it's not in their head.
[01:08:15.520 --> 01:08:16.400] A lot of people.
[01:08:16.400 --> 01:08:20.800] And one other thing about statins that's really important that I underscored in the book.
[01:08:20.800 --> 01:08:30.000] Over a decade ago, I wrote a New York Times op-ed about if you take intensive statins, you have a higher risk of developing type 2 diabetes.
[01:08:30.840 --> 01:08:34.120] Now, I got blasted by my cardiology colleague.
[01:08:34.120 --> 01:08:35.240] It's true, though.
[01:08:35.240 --> 01:08:49.160] And all the studies that have come out since then keep reinforcing that if you take a really high dose of a tourvastatin, that used to be lipitor or crustor, your chance of migrating into type 2 diabetes is increased.
[01:08:49.160 --> 01:08:54.440] So you need, your doctor may not care, but you should be checking your glucose.
[01:08:54.520 --> 01:08:56.680] My current doctor doesn't think I really need it.
[01:08:56.680 --> 01:08:58.600] He thinks I'm overthinking it.
[01:08:58.600 --> 01:08:59.160] I don't know.
[01:08:59.400 --> 01:09:01.640] 40 milligrams, I'm taking 40 milligrams.
[01:09:01.640 --> 01:09:05.960] I don't get the cramping, I think, because I don't ride as long as I used to.
[01:09:05.960 --> 01:09:09.240] But what would be a high dose then for that?
[01:09:09.400 --> 01:09:13.320] So 40 milligrams of lipitor or lowvastatin.
[01:09:13.320 --> 01:09:13.800] Oh, okay.
[01:09:13.800 --> 01:09:14.760] That's a mild one.
[01:09:14.760 --> 01:09:16.600] So that dose is not a word.
[01:09:16.600 --> 01:09:23.640] The only time we saw the diabetes was in the high doses of a tourvastatin and resuvastatin, which is crustor.
[01:09:23.640 --> 01:09:24.360] Okay, I see.
[01:09:24.920 --> 01:09:29.800] You're on a very mild statin, so you don't need to worry about that one.
[01:09:29.800 --> 01:09:31.160] Okay, I'm going to quit worrying about it.
[01:09:31.160 --> 01:09:33.080] I'm just going to go have fun.
[01:09:33.960 --> 01:09:35.080] Good idea.
[01:09:35.080 --> 01:09:36.200] That's important.
[01:09:36.520 --> 01:09:37.240] That's important.
[01:09:37.240 --> 01:09:38.680] Yes, well, so let's talk about that.
[01:09:39.320 --> 01:09:48.120] What do we know about having a social life, being married, or having a loving relationship, friends, just all that stuff seems to matter?
[01:09:48.440 --> 01:09:50.840] It's actually a much bigger deal than I expected.
[01:09:50.840 --> 01:09:56.440] When you review all the data, and I go over that, I think it's in the mental health chapter predominantly.
[01:09:56.440 --> 01:09:57.320] It's amazing.
[01:09:57.640 --> 01:10:01.320] It's very powerful to have social interactions.
[01:10:01.320 --> 01:10:03.160] And, you know, we need that.
[01:10:03.640 --> 01:10:05.720] We're a social animal.
[01:10:05.720 --> 01:10:16.960] And if we get older, there's a graph in the book that a lot of people get struck by, which is how we become recluses as we age.
[01:10:17.280 --> 01:10:18.960] And that's not a good thing.
[01:10:14.840 --> 01:10:21.600] As we age, we shouldn't live in a cave.
[01:10:21.920 --> 01:10:29.280] We should be doing whatever we can to have more interactions with other people, friends, family, our network.
[01:10:29.520 --> 01:10:33.680] And if we don't have it, you know, grooming it is important.
[01:10:33.680 --> 01:10:40.000] So this is something that a lot of people would say is social science, but the data are very strong.
[01:10:40.000 --> 01:10:47.280] And it, again, has tried to do all the things to rule out the confounding factors like we've been talking about.
[01:10:47.280 --> 01:10:47.840] Yeah.
[01:10:47.840 --> 01:10:58.240] And is it, do we know that it's more than just having friends and family and people who love you to remind you to go to the doctor and take your vitamins and don't forget to work out and don't eat the cheesecake?
[01:10:59.520 --> 01:11:06.560] Yeah, no, I think it's more about that you get a benefit from not being isolated.
[01:11:06.880 --> 01:11:14.800] The isolating is promoting anxiety, even if you're not aware of it, depression.
[01:11:15.360 --> 01:11:19.520] You know, I think it's not good for your mental health.
[01:11:19.520 --> 01:11:25.040] And we know there's this very intricate interdependence of mental and physical health.
[01:11:25.040 --> 01:11:38.960] So I think this is, you know, really the way we understand social interactions is even if you're having an argument with someone else, you're better off to be with that person than you are to live in a cave.
[01:11:39.120 --> 01:11:49.360] You know, and we, there's so many things that happen as we age, the loneliness, social isolation that are undesirable.
[01:11:49.360 --> 01:11:49.840] Yeah.
[01:11:50.400 --> 01:12:04.280] Okay, neurodegeneration, besides doing all the things you've already said to help attenuate that, any use of doing Sudoku puzzles and playing online chess and crossword puzzles and all that kind of stuff?
[01:12:04.760 --> 01:12:07.560] Do we have any evidence that those make a difference?
[01:12:07.560 --> 01:12:08.920] Unfortunately, not.
[01:12:09.400 --> 01:12:12.040] You know, it can't hurt.
[01:12:12.040 --> 01:12:12.440] It can't hurt.
[01:12:12.680 --> 01:12:15.560] We don't have good evidence that it promotes brain health.
[01:12:15.560 --> 01:12:16.680] We're going to have that.
[01:12:16.680 --> 01:12:21.880] We're going to test that because now we have these brain clocks to tell you your brain age.
[01:12:21.880 --> 01:12:31.000] So that these organ clocks are just extraordinary, whereby it's a discovery that Tony Wiss Corey and his colleagues at Stanford made.
[01:12:31.240 --> 01:12:34.120] It was on the cover of Nature a couple years ago.
[01:12:34.120 --> 01:12:38.360] And what happened was now many groups have replicated this.
[01:12:39.160 --> 01:12:54.920] What you see is that from when you take up to 11,000 proteins from your blood, you can partition them with AI to an immune clock, a brain clock, heart clock, you know, liver, gut, all these different clocks of your body, kidney clocks.
[01:12:54.920 --> 01:13:05.400] And so then you can tell if that clock in your, if that organ or organ system in your body is aging faster than you are or the other organs or system.
[01:13:05.400 --> 01:13:15.320] So we're going to know, this is not, we haven't had a test like this whether pseudocu or you know crosswords helps to promote brain health.
[01:13:15.320 --> 01:13:16.600] We just haven't had a way to do that.
[01:13:16.600 --> 01:13:17.560] Maybe we'll see it.
[01:13:17.560 --> 01:13:23.960] Now, what is important is we have much better markers available today.
[01:13:23.960 --> 01:13:31.240] There's a PTAU217 that I write about in the book, which, of course, there's other of these neural markers.
[01:13:31.240 --> 01:13:32.520] We can get that now.
[01:13:32.520 --> 01:13:35.240] It's been around for two years in the U.S.
[01:13:36.280 --> 01:13:39.480] And it has to be ordered by a physician.
[01:13:39.720 --> 01:13:43.320] And if I wouldn't just say willy-nilly, people should go out and get it.
[01:13:43.320 --> 01:14:02.880] But the reason why it's important is if you're at higher risk, let's say you have Alzheimer's in your family, you have an APOE4 allele, which about 20% of us or more have, you're now at a higher risk zone for Alzheimer, especially, you know, you're 50-ish, let's say, or older.
[01:14:03.040 --> 01:14:05.040] If you want, you can even start earlier.
[01:14:05.040 --> 01:14:07.680] You get a P-TAW 217.
[01:14:07.680 --> 01:14:15.040] And what's been shown in multiple studies is exercise and improved lifestyle brings that down.
[01:14:15.040 --> 01:14:21.760] So this is not only a great marker for telling you 20 years in advance of risk for Alzheimer's, it's so sensitive.
[01:14:21.760 --> 01:14:25.520] It's the earliest pickup of detection of risk.
[01:14:25.840 --> 01:14:28.480] It's as good as a PET scan for tau.
[01:14:28.720 --> 01:14:34.880] It's as good as cerebrospinal fluid from a lumbar puncture without having a needle put in your back.
[01:14:35.280 --> 01:14:42.720] So it's a great blood test, and I only recommend it in people who are at high risk for the reasons I mentioned.
[01:14:42.720 --> 01:14:46.080] And it's a motivating factor like LDL cholesterol.
[01:14:46.080 --> 01:14:49.040] Like you take a statin to bring it down.
[01:14:49.040 --> 01:14:55.040] Well, this is for people to want to improve their lifestyle factors to bring it down as well.
[01:14:55.040 --> 01:14:58.240] And that should help prevent Alzheimer.
[01:14:58.560 --> 01:15:03.280] One of my favorite parts of your book is the 93-year-old guy who took up rowing.
[01:15:03.280 --> 01:15:03.920] Yeah.
[01:15:04.160 --> 01:15:07.840] He was not a lifelong athlete, just decided to take it up, and it still works.
[01:15:07.840 --> 01:15:10.400] So you can do this anytime.
[01:15:10.400 --> 01:15:11.680] This is amazing.
[01:15:11.680 --> 01:15:23.680] I was so inspired by him, as I am by all these people that are in the welderly group as compared to our elderly, which is the vast majority of people as they get older.
[01:15:23.680 --> 01:15:30.600] But this fellow, you know, become a world champion rower just by doing a workout in his garage every day.
[01:15:30.600 --> 01:15:32.120] I mean, it's incredible.
[01:15:32.120 --> 01:15:33.960] So it's never too late to be fit.
[01:15:34.200 --> 01:15:35.160] Never too late.
[01:15:35.160 --> 01:15:36.360] I love that.
[01:15:29.840 --> 01:15:37.080] All right, Eric.
[01:15:37.160 --> 01:15:38.840] I know you have other interviews to get to.
[01:15:38.840 --> 01:15:42.280] Your book just came out and it's being well reviewed, I see.
[01:15:42.280 --> 01:15:44.840] So congratulations on that.
[01:15:44.840 --> 01:15:47.160] Just looking forward to the future.
[01:15:47.400 --> 01:15:51.640] Here, I'll think back to 10 years ago when Christopher Hitchens died of esophagic cancer.
[01:15:51.640 --> 01:16:00.280] And Francis Collins, of all people, said, Let's see if we can get the genome sequence of your particular cancer and see if we could.
[01:16:00.360 --> 01:16:04.360] Well, that didn't work out for Hitch, but that's the kind of future we're looking for, right?
[01:16:04.360 --> 01:16:12.680] That my cancer is different from yours where I started, and that my body's different from anybody else's body, and we can personalize our medicine.
[01:16:12.680 --> 01:16:13.560] Absolutely.
[01:16:13.560 --> 01:16:22.520] But what we have now is a unique opportunity, Michael, where everything's been reactive to try to come up with effective treatments for cancer.
[01:16:22.840 --> 01:16:30.680] We have to, if we're going to talk about moonshots or big audacious goals, we got to prevent cancer.
[01:16:31.080 --> 01:16:39.400] Once we already have, you know, on a scan, like an MRI, billions of cells, and it's cancer, we're pretty far along.
[01:16:39.400 --> 01:16:45.400] We have to get, now that we can pick up microscopic cancer, we can pick up people high risk for cancer.
[01:16:45.400 --> 01:16:48.120] So I'm excited about the prevention side.
[01:16:48.120 --> 01:16:50.680] We're not doing anything about it.
[01:16:50.920 --> 01:16:56.200] We have people going through screening, you know, women with mammograms.
[01:16:56.200 --> 01:17:00.600] 88% of women will never get breast cancer ever in their life.
[01:17:00.920 --> 01:17:02.840] But they are all of them getting a mammogram.
[01:17:02.840 --> 01:17:04.040] Talk about waste.
[01:17:04.040 --> 01:17:07.880] So we're not doing anything smart about this, and we can.
[01:17:07.880 --> 01:17:17.600] And so I hope that in the times, short times ahead, that we'll start to partition risk and prevent these big three diseases.
[01:17:17.840 --> 01:17:26.960] We have an opportunity that is unmatched because of the combination of AI and all the things that we've been learning layers of data in recent years.
[01:17:26.960 --> 01:17:29.520] So it's exciting.
[01:17:29.520 --> 01:17:39.040] Yeah, another example I use in one of my lectures on Bayesian reasoning and signal detection theory is no test is perfect and you're going to get a certain percentage of false positives.
[01:17:39.040 --> 01:17:49.120] So if you're testing, you know, hundreds of millions of women for breast cancer, whatever the percentage, however small the percentage is, that's a lot of patients that are going to be told they have breast cancer and they don't.
[01:17:49.440 --> 01:17:56.160] Over 10 years, people, women start at age 50, over 10 years, 60% along the way will have a false positive.
[01:17:56.160 --> 01:17:56.960] That's incredible.
[01:17:56.960 --> 01:17:58.000] High wow.
[01:17:58.000 --> 01:17:58.480] Wow.
[01:17:58.480 --> 01:17:59.520] I mean, it's just crazy.
[01:17:59.520 --> 01:18:01.920] That's a study of 10,000 women.
[01:18:01.920 --> 01:18:02.400] Wow.
[01:18:02.400 --> 01:18:06.800] So we have to do smarter than, we are smarter than this.
[01:18:06.800 --> 01:18:10.560] We know the ways to fractionate partition risk.
[01:18:10.560 --> 01:18:12.320] We just got to start doing it.
[01:18:12.320 --> 01:18:14.000] And it isn't just by age.
[01:18:14.000 --> 01:18:14.480] Yeah.
[01:18:14.480 --> 01:18:15.440] Yeah, right.
[01:18:15.440 --> 01:18:15.840] All right.
[01:18:15.840 --> 01:18:16.320] Here it is.
[01:18:16.320 --> 01:18:17.440] Again, super agers.
[01:18:17.440 --> 01:18:18.560] You want to be a super ager.
[01:18:18.560 --> 01:18:19.440] I want to be a super.
[01:18:19.520 --> 01:18:21.200] I am a super ager.
[01:18:21.520 --> 01:18:23.440] Well, only when you get to 85.
[01:18:23.440 --> 01:18:24.720] You're not 85 yet.
[01:18:24.720 --> 01:18:25.200] Oh, okay.
[01:18:25.680 --> 01:18:27.600] I'm still a whipper snapper.
[01:18:28.160 --> 01:18:32.320] We're both in the quest, but we want to be a super ager.
[01:18:32.880 --> 01:18:40.560] We want to go 15 more years plus and not have neurodegenerative cancer or cardiovascular.
[01:18:40.560 --> 01:18:44.720] If we do that, then we've got to that super ager status.
[01:18:44.720 --> 01:18:48.320] Well, again, it's an evidence-based approach to longevity.
[01:18:48.560 --> 01:18:49.920] We're not looking for utopia.
[01:18:49.920 --> 01:18:51.360] You're not going to live a thousand years.
[01:18:51.360 --> 01:18:53.280] So don't worry about any of that stuff.
[01:18:53.280 --> 01:18:54.960] Just get me to 100.
[01:18:55.920 --> 01:18:57.360] I'll take 85.
[01:18:57.360 --> 01:18:58.600] Yeah, 85 will be.
[01:18:58.680 --> 01:19:01.240] Yeah, I'll aim for that and keep going as long as I can.
[01:19:01.240 --> 01:19:01.560] Yeah.
[01:19:01.800 --> 01:19:05.240] As you said, the more you get to 85, the more you'll ink out some other great stuff.
[01:19:05.800 --> 01:19:06.680] That's right.
[01:19:06.680 --> 01:19:07.400] All right, Eric.
[01:19:07.400 --> 01:19:09.880] Thanks so much for your work and for your new book.
[01:19:09.880 --> 01:19:10.440] Congratulations.
[01:19:10.600 --> 01:19:11.160] Thank you, Michael.
[01:19:11.240 --> 01:19:12.040] Really was fun.
[01:19:12.040 --> 01:19:12.440] Yeah.
[01:19:12.440 --> 01:19:13.640] Thank you.

Prompt 6: Key Takeaways

Now please extract the key takeaways from the transcript content I provided.

Extract the most important key takeaways from this part of the conversation. Use a single sentence statement (the key takeaway) rather than milquetoast descriptions like "the hosts discuss...". 

Limit the key takeaways to a maximum of 3. The key takeaways should be insightful and knowledge-additive. 

IMPORTANT: Return ONLY valid JSON, no explanations or markdown. Ensure:
- All strings are properly quoted and escaped
- No trailing commas
- All braces and brackets are balanced
Format: {"key_takeaways": ["takeaway 1", "takeaway 2"]}

Prompt 7: Segments

Now identify 2-4 distinct topical segments from this part of the conversation.

For each segment, identify:
- Descriptive title (3-6 words)  
- START timestamp when this topic begins (HH:MM:SS format)
- Double check that the timestamp is accurate - a timestamp will NEVER be greater than the total length of the audio
- Most important Key takeaway from that segment. Key takeaway must be specific and knowledge-additive.
- Brief summary of the discussion

IMPORTANT: The timestamp should mark when the topic/segment STARTS, not a range. Look for topic transitions and conversation shifts.

Return ONLY valid JSON. Ensure all strings are properly quoted, no trailing commas:
{
  "segments": [
    {
      "segment_title": "Topic Discussion", 
      "timestamp": "01:15:30",
      "key_takeaway": "main point from this segment",
      "segment_summary": "brief description of what was discussed"
    }
  ]
}

Timestamp format: HH:MM:SS (e.g., 00:05:30, 01:22:45) marking the START of each segment.

Prompt 8: Media Mentions

Now scan the transcript content I provided for ACTUAL mentions of specific media titles:

Find explicit mentions of:
- Books (with specific titles)
- Movies (with specific titles)  
- TV Shows (with specific titles)
- Music/Songs (with specific titles)

DO NOT include:
- Websites, URLs, or web services
- Other podcasts or podcast names

IMPORTANT: 
- Only include items explicitly mentioned by name. Do not invent titles.
- Valid categories are: "Book", "Movie", "TV Show", "Music"
- Include the exact phrase where each item was mentioned
- Find the nearest proximate timestamp where it appears in the conversation
- THE TIMESTAMP OF THE MEDIA MENTION IS IMPORTANT - DO NOT INVENT TIMESTAMPS AND DO NOT MISATTRIBUTE TIMESTAMPS
- Double check that the timestamp is accurate - a timestamp will NEVER be greater than the total length of the audio
- Timestamps are given as ranges, e.g. 01:13:42.520 --> 01:13:46.720. Use the EARLIER of the 2 timestamps in the range.

Return ONLY valid JSON. Ensure all strings are properly quoted and escaped, no trailing commas:
{
  "media_mentions": [
    {
      "title": "Exact Title as Mentioned",
      "category": "Book",
      "author_artist": "N/A",
      "context": "Brief context of why it was mentioned",
      "context_phrase": "The exact sentence or phrase where it was mentioned",
      "timestamp": "estimated time like 01:15:30"
    }
  ]
}

If no media is mentioned, return: {"media_mentions": []}

Full Transcript

[00:00:00.320 --> 00:00:02.400] Candice Rivera has it all.
[00:00:02.400 --> 00:00:08.880] In just three years, she went from stay-at-home mom to traveling the world, saving lives and making millions.
[00:00:08.880 --> 00:00:13.360] Anyone would think Candice's charm life is about as real as Unicorn.
[00:00:13.360 --> 00:00:16.960] But sometimes the truth is even harder to believe than the lies.
[00:00:17.280 --> 00:00:18.000] Not true.
[00:00:18.000 --> 00:00:19.680] There's so many things not true.
[00:00:19.680 --> 00:00:21.440] You got a great lead.
[00:00:21.760 --> 00:00:28.000] I'm Charlie Webster, and this is Unicorn Girl, an Apple original podcast produced by Seven Hills.
[00:00:28.000 --> 00:00:30.800] Follow and listen on Apple Podcasts.
[00:00:31.440 --> 00:00:33.120] Hey, it's Ryan Reynolds here for Mint Mobile.
[00:00:33.120 --> 00:00:40.320] Now, I was looking for fun ways to tell you that Mint's offer of unlimited premium wireless for $15 a month is back.
[00:00:40.320 --> 00:00:44.800] So I thought it would be fun if we made $15 bills.
[00:00:44.800 --> 00:00:48.000] But it turns out that's very illegal.
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[00:00:59.680 --> 00:01:00.480] Taxes and fees extra.
[00:01:00.480 --> 00:01:02.160] See MintMobile.com.
[00:01:05.360 --> 00:01:10.960] You're listening to The Michael Shermer Show.
[00:01:17.040 --> 00:01:19.040] Eric, I don't think you've been on the show.
[00:01:19.280 --> 00:01:26.000] Last time we met was at Caltech for your previous book, The Doctor Was The Patient Will See You Now.
[00:01:26.000 --> 00:01:26.480] Right.
[00:01:26.960 --> 00:01:27.760] That looks a ways back.
[00:01:28.640 --> 00:01:29.600] Yeah, that was a ways back.
[00:01:29.600 --> 00:01:30.960] Well, lots of happened in there.
[00:01:30.960 --> 00:01:32.400] But let me give you a proper introduction here.
[00:01:32.400 --> 00:01:32.640] Dr.
[00:01:32.640 --> 00:01:42.560] Eric Topal is the executive vice president and a professor of molecular medicine at Scripps Research, the largest nonprofit biomedical institute in the United States.
[00:01:42.560 --> 00:01:48.800] He is also founder and director of the Scripps Research Translational Institute and a practicing cardiologist.
[00:01:48.800 --> 00:01:58.800] He is one of the top 10 most cited researchers in medicine, known for his groundbreaking studies on AI in medicine, genomics, and digitized clinical trials.
[00:01:58.800 --> 00:02:05.160] He was named at the Time 100 Health List of the Most Influential People in Health in 2024.
[00:02:05.480 --> 00:02:09.400] And he writes the Substack newsletter Ground Truths, which I've been reading.
[00:02:09.400 --> 00:02:10.280] It's excellent.
[00:02:10.280 --> 00:02:12.040] Ground Truths.
[00:02:12.040 --> 00:02:14.440] And is the author of The Creative Destruction of Medicine.
[00:02:14.440 --> 00:02:15.480] The patient will see you now.
[00:02:15.480 --> 00:02:18.040] And here's the new book: Super Agers.
[00:02:18.040 --> 00:02:18.680] Love it.
[00:02:19.000 --> 00:02:21.160] And an evidence-based approach to longevity.
[00:02:21.160 --> 00:02:23.320] Eric, guess what I did this morning?
[00:02:23.640 --> 00:02:24.360] What's that?
[00:02:24.360 --> 00:02:30.360] I played four sets of tennis with an 84-year-old, an 83-year-old, and an 82-year-old.
[00:02:30.680 --> 00:02:31.480] Fantastic.
[00:02:31.480 --> 00:02:33.080] And I said, you know what you guys are?
[00:02:33.080 --> 00:02:34.200] You're super agers.
[00:02:34.200 --> 00:02:37.320] And I showed them your book, and they're like, oh, okay.
[00:02:38.920 --> 00:02:39.560] That's great.
[00:02:40.120 --> 00:02:42.920] I'm 70, and I was like the kid out there.
[00:02:43.240 --> 00:02:44.840] Well, you and I are the same age.
[00:02:44.840 --> 00:02:45.240] Yeah.
[00:02:45.560 --> 00:02:46.040] I know.
[00:02:46.040 --> 00:02:46.680] It's amazing.
[00:02:46.680 --> 00:02:48.600] Age is really not an excuse anymore.
[00:02:48.600 --> 00:02:54.520] I mean, my, you know, when I was a kid, when we were kids, you know, our parents were like ancient in their 40s.
[00:02:54.520 --> 00:02:57.000] And then, you know, they're probably going to be dead by their 60s.
[00:02:57.000 --> 00:02:59.640] And nobody thinks like that anymore.
[00:02:59.960 --> 00:03:06.280] I think we got a reset going and it's going to get accelerated with more super ages than ever before.
[00:03:06.280 --> 00:03:06.760] Yeah.
[00:03:07.080 --> 00:03:13.000] Well, and yeah, I mean, my other story, I have one of my cycling buddies up here, Ed, is 77.
[00:03:13.000 --> 00:03:14.760] We rode his birthday.
[00:03:14.760 --> 00:03:19.640] We rode his birthday in miles last year, 77 miles.
[00:03:19.640 --> 00:03:20.120] Nice.
[00:03:20.120 --> 00:03:26.280] And I have to say, you know, at the last 10 miles or so, I was just dragging ass and he's just pulling me all the way back.
[00:03:26.280 --> 00:03:27.880] And it's like, oh, my God, I can't.
[00:03:27.880 --> 00:03:29.640] So I can't use age as an excuse.
[00:03:29.640 --> 00:03:30.920] Well, I'm old and slow now.
[00:03:30.920 --> 00:03:33.800] No, Ed's up there, and he's 77.
[00:03:33.800 --> 00:03:35.960] So, so much for that.
[00:03:35.960 --> 00:03:37.480] Yeah, that's great.
[00:03:37.480 --> 00:03:40.680] So, just kind of looking back, you've been in this business for a long time.
[00:03:40.680 --> 00:03:45.000] How has medicine changed over the, say, last 50 years or so that you've been in the game?
[00:03:46.960 --> 00:03:54.960] Well, in many ways, it's still very slow to make major changes in terms of the patient care side.
[00:03:54.960 --> 00:04:01.040] But, you know, things have moved more and more into the digital front from what there's a total analog.
[00:04:01.040 --> 00:04:08.880] There's been erosion of the patient-doctor relationship with much less time given to patient encounters.
[00:04:09.520 --> 00:04:12.080] So, that's a negative thing.
[00:04:13.040 --> 00:04:21.280] And now, I think with AI, we're seeing the potential rescue of that, getting the gift of time back if we really work on it.
[00:04:21.280 --> 00:04:31.280] And then, I think the biggest new frontier is using AI with all these layers of data on each person to prevent the major age-related diseases.
[00:04:31.280 --> 00:04:40.960] That's what I'm really excited about right now: that we're moving into a time in medicine that is unparalleled for the opportunity to actually fulfill the fantasy.
[00:04:40.960 --> 00:04:53.680] It's been a fantasy, Michael, for millennia of preventing diseases rather than aiming to try to treat them better or even the more difficult thing of even finding cures.
[00:04:53.760 --> 00:04:56.080] So, this would be like personalized medicine.
[00:04:56.080 --> 00:04:58.400] Your cancer is unique to you.
[00:04:58.400 --> 00:05:03.680] It's not like anyone else's cancer, even if it's prostate cancer, esophagal cancer, or whatever.
[00:05:04.000 --> 00:05:10.320] Yeah, and the idea is that you know about that before the person even has the first cells of a cancer.
[00:05:10.640 --> 00:05:19.280] And I think we have that capability now because so much of cancer, as we've learned, is the immune system letting its guard down.
[00:05:19.920 --> 00:05:32.600] And so, if we have a person's immune system kept up, not allowed to go to senescence as we get older, the age-related cancers have a real great chance that we can prevent them.
[00:05:32.760 --> 00:05:34.280] Let's talk about what your book is not about.
[00:05:29.520 --> 00:05:46.840] You're not promising people are going to live a thousand years or we're going to hit the singularity and you get to have escape velocity and live 13 months longer for every year that you live and therefore you never die.
[00:05:47.160 --> 00:06:05.640] No, this is not Ray Curse While the Singularity is Nearer or the biohacking of people like Brian Nelson, Johnson Wright, or any of these other kind of quack predatory companies that are trying to promote longevity.
[00:06:05.640 --> 00:06:17.560] No, this is about a different side of this, which is using the advances we've made in the science of aging, but using it to prevent the diseases rather than trying to reverse aging.
[00:06:17.560 --> 00:06:22.760] Because reversing aging is a bold, I hope it will click one of these days.
[00:06:22.760 --> 00:06:28.120] There's lots of different ways we might be able to get there, but we're not even close on that score.
[00:06:28.120 --> 00:06:29.720] Yeah, that's my sense too.
[00:06:29.720 --> 00:06:36.200] You know, we deal with this at Skeptic because this is in that realm, I think, of pseudoscience and quackery, at least some of it.
[00:06:37.000 --> 00:06:47.080] But I have to say, just, you know, anecdotally, when I see these people like Ray and Aubrey DeGrey and some of the other like calorie restriction guys, they don't look healthy to me.
[00:06:47.080 --> 00:06:48.600] They look, I don't know.
[00:06:48.600 --> 00:06:51.960] They look old and like just decrepit and weak.
[00:06:51.960 --> 00:06:53.080] And it's like, I don't know.
[00:06:53.080 --> 00:06:57.320] Even that Brian Johnson guy watched that documentary on him, the Netflix doc on him.
[00:06:57.320 --> 00:06:57.800] Yeah, yeah.
[00:06:57.800 --> 00:06:58.840] You know, and he's going to live.
[00:06:59.000 --> 00:07:02.200] I don't know whether he's going to live forever, but he's, you know, centuries or whatever.
[00:07:02.200 --> 00:07:03.960] And he does all these tests and stuff.
[00:07:03.960 --> 00:07:05.960] He doesn't look healthy to me either.
[00:07:05.960 --> 00:07:06.920] No, no.
[00:07:06.920 --> 00:07:08.920] You're at a good call on that, Michael.
[00:07:08.920 --> 00:07:13.000] Actually, those three people you mentioned, they look far from being healthy.
[00:07:13.000 --> 00:07:21.360] But of course, as you know, it's not just from the outside, but at least what you would see, the optics don't look good.
[00:07:14.840 --> 00:07:21.680] Right.
[00:07:21.920 --> 00:07:37.440] So, really, what you're talking about here is let's get people up into their 80s and 90s, and maybe even the first decade of the hundreds without Alzheimer's and without, you know, cardiovascular disease, or at least no heart attacks.
[00:07:37.440 --> 00:07:40.560] In other words, relatively healthy and strong and feeling good.
[00:07:40.560 --> 00:07:44.240] Like, I want to live life continuously because I feel good.
[00:07:44.560 --> 00:07:52.880] Yeah, so getting these three diseases, our arms are wrapped around them to prevent them, I think, is eminently doable.
[00:07:52.880 --> 00:07:54.800] Cardiovascular, we can do it.
[00:07:54.800 --> 00:07:56.240] We're just not doing it.
[00:07:56.480 --> 00:07:59.760] But also, Alzheimer's and cancer.
[00:08:00.080 --> 00:08:05.440] So, if we do that, that's like 80% of preventing diseases.
[00:08:05.440 --> 00:08:07.120] Those are the big three.
[00:08:07.120 --> 00:08:12.080] And I'm confident that we have a new approach now that can get us there.
[00:08:12.080 --> 00:08:15.040] But, of course, we have to go after it.
[00:08:15.040 --> 00:08:16.320] We got to validate it.
[00:08:16.640 --> 00:08:19.600] It's not just going to happen by accident.
[00:08:19.600 --> 00:08:30.000] Yeah, one of the funny lines I use on some of the Uber longevity people, the transhumanists, the cryonics, the mind uploaders, and the ecstropians.
[00:08:30.000 --> 00:08:31.440] You know, they're against entropy.
[00:08:31.440 --> 00:08:33.200] Yeah, good luck with that.
[00:08:33.760 --> 00:08:36.240] You know, they said, Don't you want to live 500 years, Shermer?
[00:08:36.240 --> 00:08:39.120] I'm like, just get me to 100 without Alzheimer's.
[00:08:39.120 --> 00:08:39.840] Can you do that?
[00:08:40.160 --> 00:08:40.640] No.
[00:08:40.640 --> 00:08:45.440] It's like, well, then, no, I don't want to live 500 years with Alzheimer's.
[00:08:46.640 --> 00:08:50.640] You're making the essential point is that we're really after health span.
[00:08:50.640 --> 00:08:59.520] You know, lifespan, if you're demented or you're so frail and have such a poor quality of life, that isn't worth much.
[00:09:00.120 --> 00:09:07.000] So, what I aspire is that we get to 85 plus and without these three diseases.
[00:09:07.000 --> 00:09:16.360] If we can do that, then we've got the real beginnings of a super ager era of humankind, which would be really exciting.
[00:09:16.360 --> 00:09:17.560] Totally.
[00:09:18.120 --> 00:09:19.640] Why do people age?
[00:09:19.640 --> 00:09:21.480] Just give us kind of the big picture here.
[00:09:21.480 --> 00:09:23.560] Why do I have to get older?
[00:09:23.880 --> 00:09:28.680] Yeah, well, there's a lot of things happening as we get older, unfortunately.
[00:09:28.920 --> 00:09:37.480] I touched on the immune system, and that's one of the biggies because immunosenescence, that is, our immune system just does, it's variable.
[00:09:37.480 --> 00:09:45.560] So, some people, like your tennis friends, they could probably, you know, if they haven't had any major diseases, they may have a really intact immune system.
[00:09:45.560 --> 00:09:48.200] But some, at that age, it's down.
[00:09:48.200 --> 00:09:50.680] It's really, you know, minimal.
[00:09:51.080 --> 00:09:52.600] And that's immunosenescence.
[00:09:52.600 --> 00:09:55.240] The other thing is inflammaging.
[00:09:55.240 --> 00:10:02.280] So, our body tends to be much more promoting body-wide inflammation and brain inflammation.
[00:10:02.280 --> 00:10:04.040] And that's not a good thing.
[00:10:04.600 --> 00:10:12.120] The next is that as we have replication in our cells, we have errors that occur.
[00:10:12.120 --> 00:10:18.120] And these mutations can lead to a clone, which can ultimately lead to a cancer.
[00:10:18.120 --> 00:10:21.800] So, just with age, we have more susceptibility to cancer.
[00:10:22.120 --> 00:10:29.160] And without the immune system being totally intact, that gives cancer kind of a free rein in the body to grow and spread.
[00:10:29.400 --> 00:10:42.200] And then, in response to these misfolded proteins that get into our brain, like amyloid and tau, it isn't so much the proteins, it's the brain inflammatory response that gets us in big trouble.
[00:10:42.200 --> 00:10:44.760] And the same thing is the case with our arteries.
[00:10:44.960 --> 00:10:54.000] As we get older, we tend to have more inflammation in our arteries, reaction to the cholesterol that's getting built up.
[00:10:54.000 --> 00:10:57.360] That can start even in teenagers and people in their 20s.
[00:10:57.360 --> 00:11:07.200] The common thing, though, Michael, is all three of these diseases take 20 years plus to actually get rooted in our body, to symptoms actually become manifest.
[00:11:07.200 --> 00:11:09.760] So we have a long runway to work with.
[00:11:09.760 --> 00:11:12.000] And most people don't appreciate that.
[00:11:12.000 --> 00:11:15.280] And certainly, that gives us a big edge to get ahead of it.
[00:11:15.280 --> 00:11:15.840] Yeah.
[00:11:16.480 --> 00:11:22.000] So, but one thing I was getting at is: you know, why can't, why doesn't my body operate like my nine-year-old?
[00:11:22.000 --> 00:11:23.040] I have a nine-year-old son.
[00:11:23.040 --> 00:11:26.480] And, you know, when he gets a cut, you know, I can almost watch it healing.
[00:11:26.480 --> 00:11:30.160] And when I get a cut, you know, it's weeks before it's healed up.
[00:11:30.160 --> 00:11:41.280] And so it must be a bunch of different systems that are just in my body are just not operating as efficiently or yeah, that's where you bring in the senescent cell story.
[00:11:41.280 --> 00:11:58.720] So in the body, as we get older, we have senescent cells that can either secrete proteins that are very much inflammatory drivers, which is bad, but they also can promote healing, which is good.
[00:11:59.040 --> 00:12:04.080] And so we don't tend to have as much of the healing power as we get older.
[00:12:04.080 --> 00:12:05.680] And that's one of the issues.
[00:12:05.680 --> 00:12:18.800] And that's why these synolytic drugs that try to eradicate our senescent cells from our body may not be good because some of that's our healing cells, not just our so-called secretory, pro-inflammatory cells.
[00:12:18.800 --> 00:12:24.640] But yeah, we don't have that kind of quick reaction like your nine-year-old as we get older.
[00:12:24.640 --> 00:12:31.880] And, you know, actually, some people do throughout their, all the way through their 90s, but most of us, we're gradually losing that.
[00:12:32.120 --> 00:12:39.080] And what we've learned, which is really interesting, we now have these protein clocks, proteomic clocks.
[00:12:39.400 --> 00:12:56.120] And now, when you follow thousands of people at different ages, there's like, instead of aging being a linear story, you just keep eroding gradually, it's actually got three peaks of our aging.
[00:12:56.440 --> 00:13:11.560] And so once you hit that 70-plus peak, that's when you get more prone to pro-inflammatory rather than the healing and anti-inflammatory that we would like to see like what would be in a young, young person.
[00:13:11.880 --> 00:13:16.360] As a medical researcher, could you explain to us how you determine causality?
[00:13:16.360 --> 00:13:19.480] So, for example, we know about confounders.
[00:13:19.480 --> 00:13:28.120] So, you know, coffee causes X, but maybe coffee drinkers do something else that's actually causing the X, and it's just a proxy for that.
[00:13:28.360 --> 00:13:36.360] And so, you talk about a lot of these things about diets and exercise and all these different factors, but how do you know it's that and not something else?
[00:13:36.680 --> 00:13:42.680] Yeah, so there's lots of ways to either establish or intimate causality.
[00:13:42.680 --> 00:14:03.080] The first and kind of best way is a randomized trial where you basically keep everything the same in terms of the people that are going into it, and half of them get the intervention, like you're asking like coffee or diet or whatever, and the other half get the standard or placebo or whatever.
[00:14:03.080 --> 00:14:05.400] We have such trials for diet.
[00:14:05.400 --> 00:14:16.160] We have a number of trials like that for Mediterranean diet, which look very reinforced the benefit of a largely a plant-based food diet.
[00:14:17.280 --> 00:14:19.440] So that's the best evidence.
[00:14:19.440 --> 00:14:24.000] The second one that's great is natural experiments.
[00:14:24.000 --> 00:14:38.640] And these natural experiments, they're perhaps even better than randomized trials because here, just by some type of odd happening, you can get large populations not selected by entry criteria into a randomized trial.
[00:14:38.640 --> 00:14:44.000] And so, for example, there's been three of these recently with shingles vaccine.
[00:14:44.000 --> 00:14:56.560] And just because of your birth date or when they started the new vaccine and the old vaccine, whatever, three of them all come out with about a 20-25% reduction of dementia, mostly Alzheimer's, of course.
[00:14:56.560 --> 00:14:59.520] That was a big revelation, and that's through a natural experiment.
[00:14:59.520 --> 00:15:02.080] And that would really point towards causality.
[00:15:02.080 --> 00:15:10.320] It doesn't tell you that you knocked down the herpes virus, it causes that it causes dementia, it causes shingles.
[00:15:10.320 --> 00:15:18.640] But it does tell you that the vaccine, probably through revving up immunity in older people, is a benefit for these people.
[00:15:18.640 --> 00:15:34.800] Now, the third way we do it, which is what you're getting at, is that you get this huge body of data, oftentimes many, many different studies, so-called observational studies, and you try to adjust for all the confounders.
[00:15:34.800 --> 00:15:40.400] So, you know, is the people that drank coffee, were they had a higher sociodemographic?
[00:15:40.400 --> 00:15:41.760] Were they more educated?
[00:15:41.760 --> 00:15:43.680] Did they were more physically active?
[00:15:43.680 --> 00:15:45.120] Did they eat a better diet?
[00:15:45.120 --> 00:15:46.400] And on and on and on.
[00:15:46.400 --> 00:15:48.560] And so you try to adjust for all these things.
[00:15:48.560 --> 00:15:50.560] You can never adjust for them perfectly.
[00:15:50.560 --> 00:15:51.920] You do the best you can.
[00:15:51.920 --> 00:15:56.560] What you want to do is look at lots of these studies to see if they all point in one direction.
[00:15:56.560 --> 00:16:00.360] That could be due to that they all have the same confounders, right?
[00:16:01.880 --> 00:16:11.160] But most of the time, when you see an effect and it's very consistent in magnitude and direction, that's fairly supportive.
[00:16:11.160 --> 00:16:17.480] Maybe not of causality, but certainly of a strong association, a linkage.
[00:16:17.480 --> 00:16:22.920] Now, the last thing which is really popular is to use Mendelian randomization.
[00:16:22.920 --> 00:16:31.800] So you're not randomizing the intervention, but you're looking at a person's genes and you're randomizing by do they have this allele or not.
[00:16:31.800 --> 00:16:35.560] That's a very powerful tool for causality if it's done properly.
[00:16:35.560 --> 00:16:43.640] And we do have some evidence for some of these lifestyle things with Mendelian randomization.
[00:16:43.640 --> 00:16:46.760] So those are pretty much the four ways you can get to it.
[00:16:46.760 --> 00:16:48.440] Causality is hard.
[00:16:49.000 --> 00:17:01.160] And oftentimes, you know, we're betricks between and betwixt as to, oh, this looks like a really strong association, but is it really this causes that?
[00:17:01.160 --> 00:17:02.520] And that could be tricky.
[00:17:02.520 --> 00:17:11.080] Yeah, because you talk about socioeconomic status as a proxy or predictor of health outcomes, but there's nothing magical about that.
[00:17:11.480 --> 00:17:31.840] There must be more physical direct causes, like you're living in a poor environment where there's not any good healthy supermarkets or restaurants or the air quality is bad or the air pollution and you know and so the water is contaminated with these micro particles plastic particles and all that stuff and on and on and on.
[00:17:31.840 --> 00:17:48.240] So you're using that as a broader predictor yeah you're making your point is a really important one because these studies didn't didn't adjust for things like air quality, microplastics, forever chemicals.
[00:17:48.560 --> 00:17:53.440] So, you know, they make adjustments, but they're not comprehensive.
[00:17:53.440 --> 00:18:03.520] And so that's why making too strong a conclusion based on association doesn't negate that concern about these confounders.
[00:18:03.520 --> 00:18:04.160] Yeah.
[00:18:04.320 --> 00:18:07.760] And I always use as an example of natural experiments the blue zones.
[00:18:07.760 --> 00:18:09.280] I always thought that was, I always liked that.
[00:18:09.280 --> 00:18:16.160] But now somebody's been telling me that maybe the reporting of the age of the people was not that accurate.
[00:18:16.160 --> 00:18:18.720] We might change the name to the myth zone.
[00:18:18.720 --> 00:18:19.600] The myth zone.
[00:18:19.600 --> 00:18:23.680] Because there's nothing to substantiate the claims.
[00:18:23.680 --> 00:18:34.480] When they went ahead and went to these places to get the people's birth certificates, they found out that either they didn't exist or their ages were fabricated.
[00:18:34.480 --> 00:18:39.760] So it looks like there's been a lot of funny business going on with these blue zones.
[00:18:39.760 --> 00:18:45.600] And right now, I'd have to say we don't have any support that they exist.
[00:18:45.600 --> 00:18:52.640] We do know that there are people that have remarkable agelessness, if you will, age very healthy.
[00:18:52.640 --> 00:19:02.000] But whether they're in certain parts of the world is still unclear because these magical places, we don't have data now.
[00:19:03.440 --> 00:19:13.760] When it's been put to thorough interrogation, it comes up really very skeptical, is your term, yes.
[00:19:13.760 --> 00:19:14.400] Yeah.
[00:19:14.400 --> 00:19:17.520] Yeah, that's unfortunate because it was such a nice study.
[00:19:17.520 --> 00:19:18.400] Yeah, yeah.
[00:19:18.400 --> 00:19:22.320] Well, there's been Netflix specials and all these books about it.
[00:19:22.320 --> 00:19:28.640] And, you know, it looked really good, but it was, I think, too good to be true.
[00:19:28.640 --> 00:19:31.000] Of course, they could be right for the wrong reasons.
[00:19:31.160 --> 00:19:39.000] For example, if it turns out that, you know, some people in the blue zone exercised more, had more friends, ate a healthy Mediterranean diet.
[00:19:39.000 --> 00:19:43.000] Well, those are correct, but not for the reasons you think they are.
[00:19:43.320 --> 00:19:44.200] Exactly.
[00:19:44.200 --> 00:19:44.840] Yeah.
[00:19:44.840 --> 00:19:45.240] Yeah.
[00:19:45.240 --> 00:19:46.360] That's a key point.
[00:19:46.360 --> 00:19:46.760] Yeah.
[00:19:46.760 --> 00:19:47.400] Okay.
[00:19:47.400 --> 00:19:47.800] All right.
[00:19:47.800 --> 00:19:49.320] So talk about genetics.
[00:19:49.320 --> 00:19:52.920] So would twin studies be an example of teasing and controlling for that?
[00:19:52.920 --> 00:19:53.160] Yeah.
[00:19:53.160 --> 00:19:54.280] Twin studies are really good.
[00:19:54.280 --> 00:19:56.600] That's kind of like the Mendelian randomization.
[00:19:56.920 --> 00:20:02.440] So when you have identical twins, that's a really good way to take a look at an intervention.
[00:20:02.440 --> 00:20:02.680] Yes.
[00:20:03.000 --> 00:20:03.320] Yeah.
[00:20:03.320 --> 00:20:19.720] And so like in that case, for example, as another, I don't know, teasing apart causality, you write about Alzheimer's and that, you know, many of the patients have the plaques entangles upon autopsy, but there are some who had Alzheimer's who don't have the plaques entangles.
[00:20:19.720 --> 00:20:24.200] And then there are some people that have the plaques entangles that never showed Alzheimer's.
[00:20:24.200 --> 00:20:27.240] So obviously there's other factors going on there.
[00:20:27.560 --> 00:20:28.280] Yes.
[00:20:28.280 --> 00:20:36.760] And this is critical because we try to have the kind of reductionist, simplified approach all the time, and it's never that simple.
[00:20:37.160 --> 00:20:39.400] Our bodies are just not simple.
[00:20:39.400 --> 00:20:42.360] So that's exactly right, as you point out.
[00:20:42.920 --> 00:20:49.880] The issue about uniqueness, even identical twins are unique.
[00:20:49.880 --> 00:20:51.560] Their epigenomes are different.
[00:20:51.560 --> 00:20:54.840] They were born somewhat slightly different times.
[00:20:55.400 --> 00:21:05.160] And so when you do a genome sequence, you may see the same DNA, but there's other layers of their biology that are like their gut microbiome could be very different.
[00:21:05.160 --> 00:21:10.600] So we can't even count on the identical twins as being identical.
[00:21:10.600 --> 00:21:12.040] That's how different we are.
[00:21:12.040 --> 00:21:12.680] Yeah.
[00:21:12.680 --> 00:21:17.120] You know, I've been working on a paper on the role of chance and how lives turn out.
[00:21:17.120 --> 00:21:30.640] And Steve Pinker was pointing out to me that even identical twins, yeah, all the stuff you said, but like one's on top and the other one's on the bottom, or, you know, just the neural connections between individual neurons, they're not going to be the same.
[00:21:30.640 --> 00:21:38.080] It's just there's a lot of randomness at work there, most of which we don't know because scientists can't really deal with randomness very well.
[00:21:38.080 --> 00:21:38.400] Yes.
[00:21:38.400 --> 00:21:39.920] And this is another point.
[00:21:40.480 --> 00:21:56.320] I'm glad you mentioned it because, you know, in the book, I present, the first patient I present is this woman, Lee Ruchall, and she is now 98, but her parents died in their 50s and 60s, as did her brothers.
[00:21:56.640 --> 00:22:07.280] And that's what we found in this welderly study of 1,400 people that were past 85 all the way up to 102 and had never been sick on no medications.
[00:22:07.280 --> 00:22:16.640] They didn't have the classic story of that, oh, all my relatives lived to that ripe old age and they all were healthy as a horse, right?
[00:22:16.640 --> 00:22:19.680] Which I never did understand that expression, healthy as a horse.
[00:22:19.680 --> 00:22:20.160] Yeah, right.
[00:22:20.480 --> 00:22:23.840] You know, it's kind of like sleeps like a baby.
[00:22:23.840 --> 00:22:25.920] I never had a baby that slept well.
[00:22:25.920 --> 00:22:43.360] So anyway, you got this problem here: we tend to think that when you have you're 98 and you've never been sick, that that is some great biological explanation.
[00:22:43.360 --> 00:22:44.880] But it could be luck.
[00:22:44.880 --> 00:22:48.160] It could just be a random, you know, stochastic event.
[00:22:48.160 --> 00:22:50.320] And so that's really kind of our burden.
[00:22:50.320 --> 00:22:59.880] I do think, based on all the data, that if you had to put the big bet on it, it's the immune system that wouldn't show up in the genome sequence because you have to do perturbations.
[00:22:59.680 --> 00:23:03.080] You got to really interrogate the immune system.
[00:23:03.320 --> 00:23:10.920] But the DNA sequence does not reveal why people have healthy aging.
[00:23:10.920 --> 00:23:12.120] It's really fascinating.
[00:23:12.760 --> 00:23:20.440] And we know a few things, but they're tied more to longevity, like APOE4 and a few other things.
[00:23:20.440 --> 00:23:26.280] But by and large, we don't really have the underpinnings of health span.
[00:23:26.520 --> 00:23:31.560] I think we're going to get those, but we sure didn't get them from the whole genome sequence.
[00:23:31.560 --> 00:23:36.280] I remember I did 23andMe back when I was writing for Scientific American so I could write about it.
[00:23:36.280 --> 00:23:38.600] And so I, yeah, I want, I checked the box for everything.
[00:23:38.600 --> 00:23:39.880] I want to know everything.
[00:23:40.200 --> 00:23:41.240] And so it came back.
[00:23:41.240 --> 00:23:46.120] I didn't have the two thing, the two genetic things for Alzheimer's.
[00:23:46.120 --> 00:23:47.160] I thought, oh, oh, great.
[00:23:47.160 --> 00:23:48.440] So I'm not going to get Alzheimer's.
[00:23:48.520 --> 00:23:50.280] They go, no, it doesn't mean that at all.
[00:23:50.280 --> 00:23:51.320] You could very well get it.
[00:23:51.320 --> 00:23:53.320] It just means you're slightly less likely.
[00:23:53.320 --> 00:23:54.920] It's like, oh, okay.
[00:23:54.920 --> 00:23:55.640] Thanks.
[00:23:55.640 --> 00:23:56.040] Yeah.
[00:23:56.680 --> 00:23:57.080] Yeah.
[00:23:57.080 --> 00:24:04.200] So that's actually bringing up the polygenic risk score, which it kind of got its early start with 23andMe.
[00:24:04.200 --> 00:24:20.680] But now through, you know, two decades of work, we now have these nailed down multi-ancestry and with hundreds of variants for each of the common cancers, Alzheimer's, heart disease, you know, atrial fibrillation.
[00:24:20.680 --> 00:24:23.320] So we now have a pretty good predictive tool.
[00:24:23.320 --> 00:24:30.120] The problem, beyond what you just mentioned, Michael, it isn't just that it tells you about some risk.
[00:24:30.120 --> 00:24:31.480] It just says yes or no.
[00:24:31.480 --> 00:24:33.000] It doesn't say when.
[00:24:33.000 --> 00:24:40.360] So if you have a high risk for Alzheimer's, what if it's at age 102 versus 72?
[00:24:40.360 --> 00:24:41.880] You know, big difference.
[00:24:41.880 --> 00:24:45.000] So the difference now is we have ways to get at the age.
[00:24:45.200 --> 00:24:58.640] That's where the AI kicks in, the multimodal AI, and the ability to discriminate an arc of a person where they might likely show up within a year or two range of a disease of interest.
[00:24:58.640 --> 00:25:07.040] By the way, on this idea of lifespan and how people today live twice as long as people did a century or two ago, that's a little misleading, right?
[00:25:07.040 --> 00:25:11.200] Because so many of the calculations like that are done with infant mortality.
[00:25:11.200 --> 00:25:15.840] And if you take that out, I mean, if you make it to age 10, then you're probably going to make it to age 20.
[00:25:15.840 --> 00:25:20.240] And if you make it to age 20, that increases your odds to make it to age 30 and so on.
[00:25:20.240 --> 00:25:26.720] So, I mean, Charles Darwin lived to, I don't think, 80 something, and Alfred Russell Wallace lived to 91.
[00:25:26.720 --> 00:25:34.960] You know, so it's not like nobody lived a long time, but if you get through those hurdles, so your goal is to get more of us over those hurdles.
[00:25:34.960 --> 00:25:36.640] Right, right, exactly.
[00:25:36.640 --> 00:26:00.080] If you can get to 80 or, you know, even 70, I would say, and you have no age-related major diseases, the big three we've been talking about, the chance of you getting to, you know, another decade is much higher, especially, you know, with the things that we know, like if you're practicing all the lifestyle factors that we know about and we've learned more about in recent times.
[00:26:00.240 --> 00:26:08.080] Plus, we're going to have better drugs and ways to screen or put people under surveillance so they don't wind up getting these diseases.
[00:26:08.080 --> 00:26:08.960] That's really the key.
[00:26:08.960 --> 00:26:10.080] So you're absolutely right.
[00:26:10.320 --> 00:26:16.000] We were misled because of the high infant mortality a century ago.
[00:26:16.320 --> 00:26:21.680] So, these ideas that we doubled the lifespan are really an incorrect notion.
[00:26:21.680 --> 00:26:23.120] So, I'm glad you mentioned that.
[00:26:23.120 --> 00:26:23.600] Yeah.
[00:26:23.920 --> 00:26:24.400] All right.
[00:26:24.560 --> 00:26:27.440] My favorite chapter in your book, Lifestyle Plus.
[00:26:27.440 --> 00:26:28.240] All right.
[00:26:28.880 --> 00:26:29.760] Let's get into it.
[00:26:30.280 --> 00:26:44.920] By the way, just parenthetically, you know, when I listen to RFKJ, and there's a lot that we are skeptical about with his anti-vaccine stuff, but a lot of stuff he says does kind of make sense: the toxins in the environment and the crappy diets and the obesity problem.
[00:26:44.920 --> 00:26:46.280] Those are true, right?
[00:26:46.920 --> 00:26:48.360] Yeah, here's my problem.
[00:26:48.360 --> 00:26:58.760] You know, RFK is uniquely positioned now to do some things that he could do to take on big food on the ultra-processed food.
[00:26:58.760 --> 00:27:09.960] He could take on the environment as he has during his career regarding air pollution, the plastics, which is such a mess, the forever chemicals.
[00:27:09.960 --> 00:27:17.800] The problem is, while he may be interested in doing that, the administration otherwise is going in the opposite direction.
[00:27:18.120 --> 00:27:24.280] It's basically making the EPA lose all of its oversight.
[00:27:24.600 --> 00:27:38.600] And so, if anything, it's his potential good efforts will be overridden by basically a jungaloid approach to the environment and a denial of the climate crisis and things like that.
[00:27:38.600 --> 00:27:39.960] So, we have real problems.
[00:27:40.200 --> 00:27:56.280] The right-hand doesn't know the left-hand what they're doing, and it doesn't look promising that Kennedy will execute on the good parts of what he's been, I think, interested in and why he has a big movement, you know, like the Maha Moms.
[00:27:56.280 --> 00:27:59.960] And, you know, there are a lot of people that support him for these things.
[00:27:59.960 --> 00:28:04.040] And no one in the government has taken on big food.
[00:28:04.280 --> 00:28:07.480] It took him a long time even to take on big tobacco.
[00:28:07.480 --> 00:28:11.720] But, you know, are we going to ever see this getting accomplished?
[00:28:11.720 --> 00:28:21.040] So I'm worried that he can't do, you know, execute on the things, the good ideas, the good directions that he is interested in.
[00:28:21.520 --> 00:28:29.360] I didn't have time to back check this statement of his about all the chemicals that European countries do not allow in foods that we do.
[00:28:29.360 --> 00:28:30.720] Is that true?
[00:28:30.720 --> 00:28:32.000] Well, there's certainly some.
[00:28:32.000 --> 00:28:37.360] A lot of these food dyes, they eliminated years ago, and we still haven't.
[00:28:38.160 --> 00:28:44.000] You know, maybe in California, there was some legislation, but it hasn't really done much.
[00:28:44.000 --> 00:28:50.080] So our tolerance for the food industry to basically do whatever they want has been very high.
[00:28:50.080 --> 00:28:56.560] Other countries have been much more into dealing with the ultra-processed food story.
[00:28:56.560 --> 00:28:59.840] We have the highest consumption of that in the world.
[00:29:00.480 --> 00:29:10.880] And we don't have, you know, our labels are totally insufficient for a consumer to know about these alien ingredients that you would never find in your kitchen.
[00:29:10.880 --> 00:29:12.480] You don't even know what the hell they are.
[00:29:12.480 --> 00:29:18.240] And some of them are some of those pro-inflammatory ingredients you could ever imagine.
[00:29:18.240 --> 00:29:27.680] So we've done nothing in this country to get onto the ultra-processed foods, whereas other parts of the world, they've really been all over it.
[00:29:28.000 --> 00:29:33.520] So what would be an example of ultra-processed foods that we should be avoiding?
[00:29:33.840 --> 00:29:46.720] Well, if you look at a package, whether a box or a package of like a snack food, you'll see these things in there that you'll never recognize.
[00:29:46.720 --> 00:29:58.720] Some of these are for texture, you know, like a xanthem gum and all kinds of things like that, so that it will get more rapidly into your gut and you'll get your reward circuit amplified.
[00:29:58.720 --> 00:30:01.080] So you'll want to eat more and more of this stuff.
[00:30:01.320 --> 00:30:12.440] And we know from some classic studies by Kevin Hall before he recently resigned from the NIH that people eating ultra-processed foods eat much more food.
[00:30:12.440 --> 00:30:20.120] So it basically is a reward circuit that keeps getting reinforced.
[00:30:20.120 --> 00:30:24.760] So there's also these things that are preservatives.
[00:30:24.760 --> 00:30:37.960] Like if you ever had anything, let's say in your refrigerator that lasted well belong, well longer than you expected, that's probably because it's got so much damn ultra-processed crap in it, right?
[00:30:38.280 --> 00:30:43.240] So whenever I, first of all, the best thing is that you don't have to look at a list of ingredients.
[00:30:43.240 --> 00:30:45.960] That's great, but obviously it's hard to avoid that.
[00:30:45.960 --> 00:30:50.120] But when you do, it should be like two or three things.
[00:30:50.120 --> 00:30:57.720] Once you start seeing a long list, like a paragraph worth, you almost can guarantee that there's really bad stuff in there.
[00:30:57.720 --> 00:31:03.640] And there's a classification, it's called Nova 4, which is ultra-process.
[00:31:03.640 --> 00:31:11.320] And it lists all the things, you know, all these foreign chemicals, which do not exist in anyone's kitchen.
[00:31:11.320 --> 00:31:11.880] Right.
[00:31:12.440 --> 00:31:17.000] And it does bring back, you know, homemade food, you know, yeah, homemade food.
[00:31:17.880 --> 00:31:27.560] So the things that are often in cans and packages and boxes, you really want to be very careful about ingesting those and buying them in the first place.
[00:31:27.560 --> 00:31:31.400] Do you recommend when you walk into a supermarket, stay on the perimeter?
[00:31:31.720 --> 00:31:32.520] You got it.
[00:31:32.520 --> 00:31:34.760] No, that adage is really important.
[00:31:34.760 --> 00:31:43.240] If you're just buying fresh produce, you know, fresh things and not package, not box, you're going to be okay.
[00:31:43.240 --> 00:31:48.960] You're going to avoid the, I call them UFOs, but you know, it's really ultra-processed.
[00:31:49.120 --> 00:31:54.320] But to me, yeah, yeah, I mean, this stuff should not be in our food.
[00:31:54.320 --> 00:32:04.400] And the fact is, our children, which is one of the things RFK has pointed out, our children are even higher than 70% of their diet is from this stuff.
[00:32:04.880 --> 00:32:11.840] And it is incredibly fostering, that's too nice a word, inflammation.
[00:32:12.240 --> 00:32:23.600] So we see risk of type 2 diabetes, of later in life, Alzheimer's, cancer, you name it, of course, cardiovascular disease prominently.
[00:32:23.600 --> 00:32:25.920] So these are really bad substances.
[00:32:25.920 --> 00:32:29.760] Remember the days, Michael, when trans fats were in all our foods?
[00:32:29.760 --> 00:32:30.320] Oh, yeah.
[00:32:30.640 --> 00:32:34.640] And it took decades before this country got on it.
[00:32:34.640 --> 00:32:40.000] And remember, too, that Europe banned them before us by many, many years.
[00:32:40.000 --> 00:32:45.120] And finally, not that long ago, trans fats were taken out this country.
[00:32:45.120 --> 00:32:48.960] Well, this is the same for the UPFs, but we haven't done it yet.
[00:32:48.960 --> 00:32:56.000] And I don't know what we're waiting for, except the fact that the food industry doesn't really want to change.
[00:32:56.000 --> 00:32:56.880] It's working.
[00:32:56.880 --> 00:32:58.480] They get more food eaten.
[00:32:58.720 --> 00:33:04.240] So in that case, they have lobbyists that simply buy their freedom to do that.
[00:33:04.560 --> 00:33:22.080] You know, it's one thing that's really interesting that I would not have predicted, and we don't know exactly why, but the GLP-1 drugs, Ozempic and Munjaro, not only do they have you eat less, but they have you eat healthier.
[00:33:22.080 --> 00:33:22.720] Yeah, I saw that.
[00:33:22.880 --> 00:33:25.360] Okay, you eat less ultra-processed foods.
[00:33:25.360 --> 00:33:27.120] It's like you were saying, how do we know?
[00:33:27.120 --> 00:33:30.600] Well, if you take these drugs, you're going to wind up avoiding them.
[00:33:30.600 --> 00:33:31.560] We don't know why.
[00:33:31.560 --> 00:33:32.440] We do know.
[00:33:32.520 --> 00:33:36.520] It directs you into the perimeter of the supermarket when you walk in.
[00:33:36.520 --> 00:33:38.760] I don't know why I'm going this way, but I am.
[00:33:39.400 --> 00:33:40.840] It's wild, really.
[00:33:40.840 --> 00:33:47.160] So we know it helps reduce addiction to not just alcohol, gambling, even.
[00:33:47.480 --> 00:33:50.360] It changes reward circuits completely.
[00:33:50.360 --> 00:33:51.960] It's really, really interesting.
[00:33:51.960 --> 00:33:54.520] Maybe it's going to be Ozempic will be the next statin.
[00:33:54.520 --> 00:33:56.840] Like everybody should be on it.
[00:33:57.160 --> 00:33:58.600] You know, it's interesting.
[00:33:59.480 --> 00:34:01.240] There is something to that.
[00:34:01.480 --> 00:34:15.560] If it clicks for Alzheimer's and the two big trials that are ongoing, that'll be a huge step towards that because before anyone loses weight, their inflammation in their body goes markedly reduced, is markedly reduced.
[00:34:15.560 --> 00:34:17.640] And then the brain as well.
[00:34:17.640 --> 00:34:19.000] So we'll see.
[00:34:19.000 --> 00:34:23.720] The first trials will be out in Ozempic, which is a weaker drug than the others.
[00:34:23.720 --> 00:34:40.520] But if that clicks by early next year, when those trials are due, that's going to be the big one for expanding the benefits that we've seen in not just obesity, diabetes, kidney disease, liver disease, heart disease, but that would take it to a whole nother level.
[00:34:40.520 --> 00:34:45.240] I've seen some friends of mine take it and just the weight just sheds right off.
[00:34:45.240 --> 00:34:47.720] And then I know some people that are not really obese at all.
[00:34:47.720 --> 00:34:52.760] They just like really like to lose that last 10 or 15 pounds extra lean.
[00:34:52.760 --> 00:34:57.880] I'm like, oh, maybe I should try that because I got that extra 10 or 15 right there.
[00:34:58.840 --> 00:35:00.120] Well, it works.
[00:35:00.600 --> 00:35:05.160] The trials in Alzheimer's are in thin people, you know, so that's what's really interesting.
[00:35:05.160 --> 00:35:05.640] Right.
[00:35:05.800 --> 00:35:08.360] Or, you know, not overweight or not obese.
[00:35:08.360 --> 00:35:11.800] But, you know, it wouldn't be shocking.
[00:35:12.120 --> 00:35:18.240] It's not just the drugs we have today, but this whole gut hormone story.
[00:35:18.560 --> 00:35:24.960] The gut hormones talk to the brain and they talk to the immune system, and they are powerful.
[00:35:25.200 --> 00:35:32.960] And so it might not just be the ones we have today and the triple receptor that we've already seen or the pills from these that we have today.
[00:35:32.960 --> 00:35:41.440] But now we have like 10 or 12 gut hormones that are getting mimics to add to the mix with combinations.
[00:35:41.440 --> 00:35:46.080] And, you know, when I was in medical school, the only gut hormone we knew was insulin.
[00:35:46.240 --> 00:35:48.320] Now we have a long list.
[00:35:48.320 --> 00:35:50.240] And we're just starting to see the benefits.
[00:35:50.240 --> 00:36:09.040] So I think people don't realize that what we're seeing in recent years, this eureka effect with gut hormones, is just the beginning of a whole nother class of drugs that mimic our natural hormones that were only discovered in recent times.
[00:36:09.040 --> 00:36:14.720] Do we know what the causal link is between these ultra-processed foods and inflammation?
[00:36:16.000 --> 00:36:26.640] Well, we know that they do incite inflammation, but there's debate about what is the kind of molecular mechanism.
[00:36:26.880 --> 00:36:32.720] And of course, as you pointed out, they vary a lot in terms of their structure, the chemical structure.
[00:36:32.720 --> 00:36:36.080] So they may not all be working through one common pathway.
[00:36:36.080 --> 00:36:44.080] But yeah, you see a lot of inflammation, like whenever you see experiments, it's like the plastic story, which is amazing.
[00:36:44.080 --> 00:36:44.640] Unbelievable.
[00:36:44.800 --> 00:36:59.600] The classic story in the plastics is that you get, there was a study done in Italy, multiple centers, and they looked at people having a carotid endarterectomy because of atherosclerosis in that artery, in the neck, that feeds the brain.
[00:36:59.800 --> 00:37:11.400] So 60% of people, when they examine the artery, the sick atherosclerotic artery, 60% had microplastics in the artery.
[00:37:11.400 --> 00:37:15.560] And right around the plastics, you see this vicious inflammation response.
[00:37:15.560 --> 00:37:16.440] Vicious.
[00:37:16.440 --> 00:37:29.080] But more importantly, you follow the people, the 60% who had the plastics and the inflammation versus the 40% of hundreds of people who didn't have plastics in their artery.
[00:37:29.080 --> 00:37:30.440] And guess what?
[00:37:30.440 --> 00:37:38.200] The people with the plastics had four to five-fold increase in heart attacks, strokes, and deaths.
[00:37:38.440 --> 00:37:43.240] So that tells us these plastics are not just, you know, innocent bystanders.
[00:37:43.240 --> 00:37:46.840] They induce inflammation, just like the ultra-processed foods.
[00:37:46.840 --> 00:37:53.800] And they can, you know, hurt a person from the standpoint of heart attacks and strokes.
[00:37:53.800 --> 00:37:58.760] And they've been found in the brain, just like the, in fact, they have more affinity in the brain than the heart.
[00:37:58.760 --> 00:38:04.280] So it's the body's way of attacking a foreign object, much like when I was a kid and I used to get splinters.
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[00:38:50.720 --> 00:38:57.200] That's Thrive Cosmetics, C-A-U-S-E-M-E-T-I-C-S dot com slash beauty.
[00:38:57.200 --> 00:39:02.960] And around the splinter, you can see, you know, it's red and hot, and so something like that.
[00:39:02.960 --> 00:39:04.560] But what would that be in the brain?
[00:39:04.560 --> 00:39:09.040] I mean, when you say the brain has inflammation, it's the whole brain is swelling or just pockets?
[00:39:09.760 --> 00:39:16.160] Yeah, so some of these ultra-processed foods can get right through their blood-brain barrier.
[00:39:16.160 --> 00:39:21.120] You know, these are chemicals of very low molecular weight, and we don't really have a way to...
[00:39:21.120 --> 00:39:24.240] So they can get in the brain and directly incite inflammation.
[00:39:24.240 --> 00:39:35.760] The other thing, of course, is they can get the, while they're eating and ingesting, they can get the gut hormones activated that tell the brain, you know, go into inflammation mode, if you will, to simplify things.
[00:39:35.760 --> 00:39:42.400] So, no, there's lots of ways that these drugs can hurt us, these ultra-processed foods can hurt us.
[00:39:42.960 --> 00:39:44.800] And it's a real problem.
[00:39:44.800 --> 00:39:55.760] The plastic story, you know, is a big study that showed we're accumulating more and more in recent times of microplastics up to like a spoon's worth in our brain.
[00:39:55.760 --> 00:40:01.680] And it's associated, go back to that, associated with much higher rates of Alzheimer's and dementia.
[00:40:01.680 --> 00:40:15.200] It doesn't, again, it doesn't, it's not good to have foreign things, whether it's these chemicals in food or plastics or forever chemicals in our body because they tend to be pro-inflammatory.
[00:40:15.200 --> 00:40:20.240] If there's one theme here, it's we don't want untoward inflammation.
[00:40:20.240 --> 00:40:26.720] That gets us, it reduces that health span, healthy aging story quite a bit.
[00:40:26.720 --> 00:40:41.400] And isn't there something about how much food you eat and how often you eat that just the whole metabolism ramping up to process food, which causes, I don't know, not inflammation maybe, but something like the body to overwork.
[00:40:41.400 --> 00:40:49.320] So the low calorie or starvation periods of time allows the body to run cooler, something like that.
[00:40:49.320 --> 00:40:56.200] Yeah, so the intermittent fasting is an interesting, there's lots of schedules, you know, the four to three, five to two.
[00:40:56.200 --> 00:40:57.160] I mean, you name it.
[00:40:57.160 --> 00:41:00.760] The point being is that there's been a lot of studies of that.
[00:41:01.080 --> 00:41:10.040] The data are somewhat mixed, as does it reduce your biological epigenetic age, you know, but it does help lose weight.
[00:41:10.040 --> 00:41:12.680] And to your point, I think is a good one.
[00:41:12.680 --> 00:41:31.640] If you can eat your dinner on the early side and you go all the way to the next morning, you don't eat anything in between, that's probably a very healthy thing for a human because that doesn't put your body, you know, kind of metabolically being challenged, gives it a good, you know, timeout.
[00:41:31.960 --> 00:41:34.280] We still don't have all the data to ice that.
[00:41:34.280 --> 00:41:36.200] It's more speculative.
[00:41:36.440 --> 00:41:45.000] But then we don't know, for example, whether fasting extensively or these intermittent fasting schedules, did they really work?
[00:41:45.000 --> 00:41:47.160] Do they really slow the aging process?
[00:41:47.400 --> 00:41:49.240] It's still up in the air.
[00:41:49.240 --> 00:41:59.320] And there are some, like the scientists at USC, that are strong proponents, but some of these studies just don't have the proof that we need.
[00:41:59.320 --> 00:41:59.880] Yeah.
[00:42:00.120 --> 00:42:00.520] All right.
[00:42:00.520 --> 00:42:01.640] Put you on the spot here.
[00:42:01.640 --> 00:42:04.120] We're recording this around at noon.
[00:42:04.120 --> 00:42:05.560] What did you have for breakfast this morning?
[00:42:05.560 --> 00:42:07.240] What are you going to have for lunch and dinner?
[00:42:07.240 --> 00:42:07.800] Okay.
[00:42:08.120 --> 00:42:08.520] Yeah.
[00:42:08.520 --> 00:42:14.200] So I had yogurt, plain yogurt, nothing else, you know, no additives.
[00:42:14.520 --> 00:42:17.920] I had some strawberries and blueberries in it.
[00:42:18.480 --> 00:42:23.600] And I threw in a little bit of granola as kind of a healthy granola.
[00:42:23.600 --> 00:42:25.280] So that was my breakfast.
[00:42:25.600 --> 00:42:29.680] And then I'll go because I love granola, but a lot of them have a lot of sugar.
[00:42:29.680 --> 00:42:30.080] Right.
[00:42:30.480 --> 00:42:36.960] I purposely get a granola from a local grocery that doesn't.
[00:42:37.440 --> 00:42:40.000] So it has, there's no added sugar.
[00:42:40.000 --> 00:42:43.280] It's just grains, some nuts stuff in there.
[00:42:43.680 --> 00:42:48.800] Some like raisins or cranberries, but not any sugar added.
[00:42:48.800 --> 00:42:49.600] But you're right.
[00:42:49.600 --> 00:42:52.880] You know, like these kind bars, they're not kind.
[00:42:52.880 --> 00:42:53.360] Okay.
[00:42:53.840 --> 00:42:55.360] There's a lot of crap in these things.
[00:42:55.360 --> 00:42:57.920] You got to really be careful what you're eating there.
[00:42:57.920 --> 00:43:01.280] So I don't eat basically anything till dinner.
[00:43:01.280 --> 00:43:10.480] And my dinner will be almost invariably, it's a salad with an oil and vinegar dressing.
[00:43:11.040 --> 00:43:21.120] I'll put in, you know, typically lots of different types of lettuce and tomatoes, carrots, lots of carrots, and salmon if I can.
[00:43:21.120 --> 00:43:26.080] Sometimes it would be just some tuna from a can without water, with water.
[00:43:26.080 --> 00:43:30.240] But usually, you know, add some protein to a salad and that will be my dinner.
[00:43:30.400 --> 00:43:31.600] That's what I had last night.
[00:43:31.600 --> 00:43:33.760] That's probably what I'm going to have tonight.
[00:43:34.080 --> 00:43:42.320] So, yeah, I try to follow a healthy diet, and I don't usually eat after dinner till the next morning.
[00:43:42.320 --> 00:43:43.040] I'll get up.
[00:43:43.360 --> 00:43:47.760] I always have thought if you don't wake up hungry, that's not something wrong.
[00:43:47.760 --> 00:43:49.200] You should be waking up hungry.
[00:43:49.360 --> 00:43:51.760] That's why they call brick fast, right?
[00:43:52.800 --> 00:43:54.480] So, yeah, that's kind of me.
[00:43:54.560 --> 00:44:02.360] Sometimes in the middle of the day, I'll have some nuts or something, a small snack, but a lot of times I don't even do that.
[00:44:02.680 --> 00:44:10.200] That was one of the wilder stories in that Netflix talk about Brian Johnson, where he had his dinner at, I don't know, it was like 11:30 in the morning.
[00:44:10.200 --> 00:44:12.440] That was his last meal for the day.
[00:44:12.840 --> 00:44:15.800] And then they asked about, and then he goes to bed by 8:15.
[00:44:15.800 --> 00:44:17.080] So they asked about his love life.
[00:44:17.080 --> 00:44:18.040] He's a single guy.
[00:44:18.040 --> 00:44:20.040] He's well, it's not so good.
[00:44:20.040 --> 00:44:22.040] Gee, that's a shocker.
[00:44:22.680 --> 00:44:29.880] Oh, it's crazy because he has the exact number of calories, like 2,350, whatever it is.
[00:44:29.880 --> 00:44:33.640] And then he has a penile sensor compared to his son.
[00:44:33.640 --> 00:44:34.280] Right.
[00:44:34.280 --> 00:44:35.640] How many erections each night?
[00:44:35.640 --> 00:44:37.480] I mean, these are crazy things, you know?
[00:44:38.040 --> 00:44:38.440] Yeah.
[00:44:38.760 --> 00:44:40.680] Dude, get a girlfriend.
[00:44:41.320 --> 00:44:41.960] Wow.
[00:44:41.960 --> 00:44:42.520] Wow.
[00:44:43.160 --> 00:44:43.400] Yeah.
[00:44:43.400 --> 00:44:43.640] Yeah.
[00:44:43.640 --> 00:44:44.200] Yeah.
[00:44:44.200 --> 00:44:44.600] Okay.
[00:44:44.600 --> 00:44:47.880] But so that sounds like a great diet for sure.
[00:44:48.120 --> 00:44:49.960] What about oatmeal?
[00:44:50.280 --> 00:44:51.720] I don't eat oatmeal.
[00:44:52.760 --> 00:44:56.120] So oatmeal, people think that's such a healthy thing.
[00:44:56.120 --> 00:44:57.240] Yeah, sounds healthy.
[00:44:57.240 --> 00:45:00.360] But it's basically carbohydrate.
[00:45:00.920 --> 00:45:07.080] And if you wear a glucose sensor, I tried that, you know, for a couple of weeks, a couple of times.
[00:45:07.080 --> 00:45:08.920] It shot up my glucose.
[00:45:08.920 --> 00:45:10.920] You know, so I don't want that.
[00:45:10.920 --> 00:45:12.760] I want to, you know, relatively flat.
[00:45:12.760 --> 00:45:19.800] I'll take a small, like to, you know, from 90 to 120, 130, but I don't like something going to the 170.
[00:45:19.800 --> 00:45:32.280] And so I eliminated the that's I used to have oatmeal and like it, but then I started realizing for me at least, it wasn't helping my glucose regulation.
[00:45:32.280 --> 00:45:33.480] It was a challenge to me.
[00:45:33.480 --> 00:45:37.400] I said, why should I keep going through that if it's a challenge?
[00:45:37.400 --> 00:45:38.040] Yeah.
[00:45:38.040 --> 00:45:43.320] How about all the different peanut butters, almond butter, cashew butter, mixed nut butter, all those?
[00:45:43.320 --> 00:45:44.440] Those are yummy.
[00:45:44.960 --> 00:45:47.120] Yeah, I haven't tried those, Michael.
[00:45:47.120 --> 00:45:47.440] Okay.
[00:45:47.840 --> 00:45:55.600] I buy them at the Bristol Farms here, and I just take a spoon as a snack in between meals if I'm hungry.
[00:45:55.600 --> 00:45:57.680] Well, they have a high amount of protein.
[00:45:57.680 --> 00:46:01.440] They probably would be fine, as long as they're not anything else added to it.
[00:46:03.120 --> 00:46:08.480] Yeah, I mean, peanut butter is good stuff as long as it's not all the junk that's added to it.
[00:46:08.640 --> 00:46:10.880] Yeah, the cheaper stuff has sugar in it.
[00:46:10.880 --> 00:46:12.640] Yeah, like JIF and stuff like that.
[00:46:12.800 --> 00:46:13.520] Yes, exactly.
[00:46:13.520 --> 00:46:20.240] So maybe that, you know, back to the SES factor, because they say that some of those poor communities are food deserts.
[00:46:20.240 --> 00:46:24.560] They don't have a Bristol Farms or a Whole Foods anywhere within driving distance.
[00:46:25.600 --> 00:46:32.240] And the local supermarket doesn't have the, you know, the special peanut butter, almond butter stuff.
[00:46:32.240 --> 00:46:35.280] They just got the Jiffy with the sugar.
[00:46:35.280 --> 00:46:36.000] Exactly.
[00:46:36.000 --> 00:46:38.080] Peter Pan or Jiffy or some of the.
[00:46:38.240 --> 00:46:44.160] So there are some good ones that don't, that just have the nuts and maybe a little salt or whatever.
[00:46:44.160 --> 00:46:45.120] But yeah, you're right.
[00:46:45.120 --> 00:46:48.000] And we do have a big problem with food deserts.
[00:46:48.000 --> 00:46:54.640] And in those deserts, we also have the highest intake of ultra-processed foods and, you know, all kinds of.
[00:46:54.640 --> 00:46:55.840] It's really a problem.
[00:46:55.840 --> 00:47:00.240] When my wife moved here from Germany 11 years ago now, wow.
[00:47:00.560 --> 00:47:04.480] She was shocked by the bread because in Germany, the bread is great.
[00:47:04.480 --> 00:47:08.640] I mean, it's a big loaf of bread is like eight pounds, right?
[00:47:08.960 --> 00:47:10.640] Our bread is just crappy.
[00:47:10.640 --> 00:47:11.440] There's nothing in it.
[00:47:11.440 --> 00:47:12.480] It's fluffy and sugary.
[00:47:12.640 --> 00:47:14.240] She's like, what is this?
[00:47:14.560 --> 00:47:15.120] Yeah.
[00:47:15.120 --> 00:47:16.880] No, it's a big difference.
[00:47:16.880 --> 00:47:23.280] You know, the Europeans, they have a lot of edge on us on a lot of the things that they eat.
[00:47:23.520 --> 00:47:27.440] But their bread, of course, is usually a much higher quality.
[00:47:27.440 --> 00:47:38.360] You can find, it's interesting, you mentioned that, Michael, because there's just down the street from where we live, there's this bakery that does like European-style bread.
[00:47:38.360 --> 00:47:47.480] And like on the weekends, there's lines a quarter mile long to get their bread because they can't get it anywhere else, you know?
[00:47:48.200 --> 00:47:50.600] So it's just, it's good bread.
[00:47:50.600 --> 00:47:53.480] I mean, really good bread is hard to come by.
[00:47:53.720 --> 00:48:00.280] But yeah, I mean, and as long as you're not having an overdose on it, it's certainly, there's these people that say no carbohydrates.
[00:48:00.280 --> 00:48:08.120] Well, that's a little off because, you know, there's nothing wrong with having, you know, small quantities of healthy bread.
[00:48:08.120 --> 00:48:08.760] Yeah.
[00:48:09.080 --> 00:48:14.920] I've had John Mackey on the show a couple of times, and he's a longtime good friend, founder of Whole Foods, and so on.
[00:48:14.920 --> 00:48:16.600] But he, you know, he's the real deal.
[00:48:16.600 --> 00:48:17.960] He really lives that life.
[00:48:17.960 --> 00:48:21.240] He's a vegan, but he's also a capitalist.
[00:48:21.240 --> 00:48:27.400] And, you know, we should be able to have people eat healthy and companies can make money the American way.
[00:48:27.400 --> 00:48:31.560] You know, why can't we do that model everywhere?
[00:48:31.560 --> 00:48:33.560] So there's no more food deserts.
[00:48:33.560 --> 00:48:34.600] I'm with you.
[00:48:34.600 --> 00:48:35.320] We need to.
[00:48:35.320 --> 00:48:55.880] I mean, that's actually one of the things that's going to hold us back from this master plan of how we can eradicate or marketly reduce the toll of the big three age-related diseases are all the health inequities and like you're mentioning, the food deserts and all the things and the environmental burden of toxicity.
[00:48:55.880 --> 00:48:59.240] If we don't pay attention to that, we're not going to get where we need to be.
[00:48:59.240 --> 00:48:59.800] Yeah.
[00:49:00.360 --> 00:49:02.120] Okay, quickie on the diet stuff.
[00:49:02.120 --> 00:49:03.640] Chicken and red meat.
[00:49:03.800 --> 00:49:04.600] What do we know?
[00:49:04.600 --> 00:49:05.080] Yeah.
[00:49:05.080 --> 00:49:06.440] Well, chicken's okay.
[00:49:06.440 --> 00:49:09.080] You know, that's not a problem.
[00:49:09.080 --> 00:49:11.560] Red meat is pro-inflammatory.
[00:49:11.720 --> 00:49:15.000] So it's okay, but you wouldn't want to have it on a frequent basis.
[00:49:16.560 --> 00:49:22.480] So, you know, in the book, I review all the data about that pro-inflammatory side of red meat.
[00:49:22.880 --> 00:49:25.040] And so that's just something to keep in mind.
[00:49:25.040 --> 00:49:27.280] I mean, I don't say, oh, you shouldn't eat it.
[00:49:27.280 --> 00:49:30.160] I haven't had any red meat in over four decades.
[00:49:30.160 --> 00:49:30.800] Wow.
[00:49:30.800 --> 00:49:33.840] But a lot of my patients will say, what about that?
[00:49:33.840 --> 00:49:42.320] I said, you know, it's okay, but I wouldn't, you know, have this more than once, twice a week, because then you're just subjecting yourself to some inflammation.
[00:49:42.400 --> 00:49:43.440] It's unnecessary.
[00:49:43.440 --> 00:49:45.280] You're a pescatarian.
[00:49:45.600 --> 00:49:46.880] Yeah, I'm a pescatarian.
[00:49:46.960 --> 00:49:47.600] Exactly.
[00:49:47.600 --> 00:49:48.080] Right.
[00:49:48.960 --> 00:49:49.840] Yeah, okay.
[00:49:49.840 --> 00:49:50.240] All right.
[00:49:50.240 --> 00:49:50.800] Wait.
[00:49:51.040 --> 00:49:53.360] BMI, is that a viable measure anymore?
[00:49:53.360 --> 00:49:54.000] No, terrible.
[00:49:54.240 --> 00:49:54.640] Okay, terrible.
[00:49:54.800 --> 00:49:55.280] I thought so.
[00:49:55.280 --> 00:49:55.680] Right.
[00:49:55.680 --> 00:49:56.400] It sucks.
[00:49:56.400 --> 00:50:02.080] I mean, you really want to have ideally a waist to hip ratio of some kind.
[00:50:02.720 --> 00:50:05.920] Yeah, you have to measure that properly.
[00:50:05.920 --> 00:50:11.120] But, you know, that BMI is so obsolete and still is used.
[00:50:11.120 --> 00:50:12.560] It's really unfortunate.
[00:50:12.960 --> 00:50:14.240] We have to get over that.
[00:50:14.240 --> 00:50:15.920] Someday, perhaps we will.
[00:50:15.920 --> 00:50:16.400] Yeah.
[00:50:17.680 --> 00:50:19.200] Okay, sleep.
[00:50:19.200 --> 00:50:20.080] Seven hours.
[00:50:21.040 --> 00:50:24.400] Yeah, there's a lot of big things that we've learned about sleep.
[00:50:24.400 --> 00:50:32.800] First of all, I was very surprised when I reviewed all the data in the book that seven hours was the optimal duration of total sleep.
[00:50:32.800 --> 00:50:35.440] I always thought it was eight or more.
[00:50:35.440 --> 00:50:35.920] Right.
[00:50:35.920 --> 00:50:42.880] And in fact, what you'd see in all the curves is that you start getting beyond seven and eight, you start to see detrimental links.
[00:50:42.880 --> 00:50:45.520] Again, associations, not causality.
[00:50:45.520 --> 00:50:47.760] I'm so glad you brought that up early.
[00:50:47.760 --> 00:50:57.040] Now, what we've learned more than that, much more than that, is about how we clear the waste metabolic products from our brain each night.
[00:50:57.040 --> 00:51:03.240] And that's through this channels of glymphatics as opposed to lymphatics, glymphatics.
[00:51:03.320 --> 00:51:12.680] And we learned they basically are getting rid of these waste products every night during our deep sleep.
[00:51:12.680 --> 00:51:18.680] That's the slow wave sleep that's typically early in the night, not necessarily, but usually early.
[00:51:18.680 --> 00:51:23.160] And we want to get as much of that as possible to get all that crap out of our brain, right?
[00:51:23.160 --> 00:51:30.120] Now, turns out as we get older, our deep sleep keeps getting lower and lower.
[00:51:30.440 --> 00:51:37.480] And so when I started tracking my deep sleep, I was aghast because it was down to averaging less than 15 minutes.
[00:51:37.480 --> 00:51:38.680] And I said, this is horrible.
[00:51:38.680 --> 00:51:42.040] I knew I didn't sleep well, but I didn't know it was that bad.
[00:51:42.040 --> 00:51:44.280] So I started really working on that.
[00:51:44.280 --> 00:52:31.520] And, you know, everything I could, every interaction, like when did I eat last and when did I exercise last and what did I eat and very importantly limiting my fluid intake in the evening and maximizing it in the morning and early in the day and just really going really wild with fluids water early because that interrupted sleep during the night I mean if you got it in the middle of the night you're up yeah not not good yeah not good because then you got to start all over again with getting back to sleep right so I've been able to get it up to average more like 45 minutes I'm still working on it I want to get up to an hour I don't know if I'll ever get there I've had a couple of nights like that if we when you're 70 if you can get now women do better than men for sleep.
[00:52:31.520 --> 00:52:45.920] But for a man to get 60 minutes of deep sleep, that's really good and we we have to do this because if you want to prevent Alzheimer's, the other thing I learned, which is big, was the regularity.
[00:52:45.920 --> 00:52:47.760] I was erratic.
[00:52:48.000 --> 00:52:51.360] My wife is a big-time night owl.
[00:52:51.360 --> 00:52:53.440] So sometimes I'd stay up late with her.
[00:52:53.440 --> 00:52:55.760] Now I said, no, no, I'm going to bed early.
[00:52:55.760 --> 00:53:00.960] Not like Brian Johnson, but early for me, more like tennish.
[00:53:01.120 --> 00:53:04.240] The reason being is that sleep regularity is a big deal.
[00:53:04.560 --> 00:53:12.160] It ties into deep sleep, but it also ties into cardiovascular, cancer, and neurodegenerative diseases.
[00:53:12.160 --> 00:53:17.600] So these are the adjustments I made, and I just basically followed where the research has taken us.
[00:53:17.600 --> 00:53:22.320] And it's very, it's impressive that we can be much healthier for sleep.
[00:53:22.320 --> 00:53:29.280] And I think we should all be striving for that because most people are not getting really good sleep or deep sleep.
[00:53:29.600 --> 00:53:30.960] I just as we age.
[00:53:31.680 --> 00:53:33.680] I just get up whenever I wake up.
[00:53:33.680 --> 00:53:36.720] I don't set alarms or anything unless I have an early flight or something.
[00:53:36.720 --> 00:53:39.200] But how do I know how much deep sleep I'm getting?
[00:53:40.080 --> 00:53:43.200] Do you have to have one of those wearables like the Oral Ring or a SmartWatch?
[00:53:44.240 --> 00:53:47.280] An Aural Ring, or there's several other rings now.
[00:53:47.280 --> 00:53:49.600] There's smartwatches do it.
[00:53:49.600 --> 00:53:58.080] And mattresses, a lot of mattresses now have a sensor in them, or that you can get an app that you can have tied to your mattress.
[00:53:58.080 --> 00:54:00.640] So there's three ways to get at it.
[00:54:01.440 --> 00:54:05.760] The ring seems to be a bit more accurate than the smartwatch.
[00:54:05.760 --> 00:54:06.640] I use both.
[00:54:06.880 --> 00:54:08.000] I compare them.
[00:54:08.000 --> 00:54:13.920] And, you know, I interestingly, sometimes they're very concordant and sometimes they're very discrepant.
[00:54:13.920 --> 00:54:19.600] But I think the ring is one that is most helpful for accuracy.
[00:54:19.600 --> 00:54:32.600] And I think it's something if you're if you don't think you're sleeping well and you have concerns about that, it might, we don't have a this is something I emphasize in the book.
[00:54:32.840 --> 00:54:37.960] We can't prove that using sleep trackers changes outcomes.
[00:54:37.960 --> 00:54:54.840] We only can infer that if you are regularly getting you know much better sleep pattern, deep sleep regularity, that that is more likely to be associated, not cause and effect, but more likely with favorable major health outcomes.
[00:54:54.840 --> 00:55:01.400] Yeah, I got to get some of those because I think I sleep well, but I have no idea how much deep sleep time I have.
[00:55:01.400 --> 00:55:10.280] So what you're telling me is that when I wake up at two in the morning and flip open my computer and watch a documentary on Hitler and color, that's probably not the best thing I should do.
[00:55:10.280 --> 00:55:11.080] Not a good idea.
[00:55:11.080 --> 00:55:17.160] Oh, and by the way, everyone should rule out that they don't have sleep apnea because a lot of people don't know that.
[00:55:17.160 --> 00:55:17.560] Okay.
[00:55:17.560 --> 00:55:22.280] Because their partner may be sound asleep and they're stopping to breathing.
[00:55:22.680 --> 00:55:26.600] So ruling that out, you don't have to be obese to have sleep apnea.
[00:55:26.840 --> 00:55:31.240] So that's another good thing to know about from tracking.
[00:55:31.560 --> 00:55:35.400] And now you can get that too from rings and from smartwatches.
[00:55:35.800 --> 00:55:42.840] Anyway, yeah, if you're getting up on a frequent basis during the night, that's probably a reason to track.
[00:55:43.000 --> 00:55:49.240] You don't have to do it long term, but just get a grip on it for a few weeks to see what the pattern is like.
[00:55:49.240 --> 00:55:50.120] Good idea.
[00:55:50.120 --> 00:55:50.520] All right.
[00:55:50.520 --> 00:56:07.560] I loved your chapter section on exercise, of course, because I'm an exercise nut, mostly mostly cardio, but now a lot of my cycling buddies are doing weights because a lot of older cyclists have weak, brittle bones because we don't do enough gravitational pull or stress or whatever.
[00:56:07.560 --> 00:56:09.720] Yeah, I'm really into that too now.
[00:56:10.280 --> 00:56:13.080] I used to only say aerobic.
[00:56:13.080 --> 00:56:17.280] And then my patients would come in and they'd come in all, you know, muscular cut.
[00:56:14.840 --> 00:56:19.680] And I'd say, well, you're doing lifting too much weight.
[00:56:19.920 --> 00:56:26.640] What about a bicycle or a treadmill or long walks, brisk walks, whatever, swimming.
[00:56:26.800 --> 00:56:33.200] Anyway, I've shifted to integrate balance, better posture.
[00:56:33.200 --> 00:56:35.120] These are things that are really important.
[00:56:35.120 --> 00:56:38.880] So our balance, as you know, is so critical.
[00:56:38.880 --> 00:56:47.120] And you can train to have much better balance just by standing on one foot on a foam pad and other ways to get your core.
[00:56:47.120 --> 00:56:55.280] So it isn't just weightlifting, getting your core strength is so critical and it interplays with balance.
[00:56:55.280 --> 00:56:58.400] And then finally, yeah, you want to have beach muscles, that's great.
[00:56:58.400 --> 00:57:06.240] But, you know, getting your upper body, which most of our exercises do nothing, aerobic for our upper body.
[00:57:06.240 --> 00:57:10.240] And then that's where you have to really do some weight strength training.
[00:57:10.240 --> 00:57:12.560] So, yeah, I think it's really important.
[00:57:12.560 --> 00:57:14.800] The data are pretty striking.
[00:57:14.800 --> 00:57:16.480] That's what convinced me.
[00:57:16.480 --> 00:57:24.480] I've been well over a year into it, and I've never been stronger and have better balance in my life, I think, just by training.
[00:57:24.480 --> 00:57:25.520] And everyone can do that.
[00:57:25.520 --> 00:57:34.080] And it's very inexpensive, if not, you know, some bands and standing on some, you know, standing on one foot doesn't cost anything.
[00:57:34.080 --> 00:57:38.480] But if you can do that for a minute or two, you know, you're on the right track.
[00:57:38.480 --> 00:57:44.240] And you can tell if your core is weak by going, you know, sitting in a chair to standing.
[00:57:44.240 --> 00:57:46.640] You know, try to do that 20 times quickly.
[00:57:46.640 --> 00:57:50.320] And if you can't do that, that means your core needs some work.
[00:57:50.320 --> 00:57:50.800] Yeah.
[00:57:51.440 --> 00:57:57.840] So, what this translates to, to use an example, I remember talking to my friend Jared Diamond when he turned 80.
[00:57:57.840 --> 00:58:02.520] He said, the riskiest thing I do today, I'll do today is take a shower.
[00:58:03.160 --> 00:58:12.200] And he had data about, you know, people in their 80s, if they fall, you know, that's where the meltdown starts, the break a hip or something like that.
[00:58:12.200 --> 00:58:16.040] And so, your point is that all of us slip or whatever.
[00:58:16.040 --> 00:58:20.520] If my core is good, my grip is solid, and my balance is pretty good.
[00:58:20.520 --> 00:58:28.680] If I slip like anybody slips, I'm more likely to grab something or catch myself or readjust and not actually hit the ground.
[00:58:28.680 --> 00:58:29.640] Exactly.
[00:58:29.640 --> 00:58:39.960] You know, if you get through the big three, cancer, neurodegenerative, and cardiovascular, but then you fall and have a hip fracture and die from that, that's not good.
[00:58:39.960 --> 00:58:51.640] So it turns out, though, interestingly, these three age-related diseases, these big ones, do really well with better balance, strength, training.
[00:58:51.960 --> 00:59:07.000] You know, the whole idea of exercise, interestingly, even though during the exercise there's a bit of inflammation that is from that, overall, it markedly improves your immune system function and you're much less to be pro-inflammatory in general.
[00:59:07.240 --> 00:59:09.240] So, and it isn't just aerobic.
[00:59:09.240 --> 00:59:14.280] I mean, these other forms of exercise and training do that as well.
[00:59:15.240 --> 00:59:17.800] What's the thinking about grip strength?
[00:59:18.520 --> 00:59:21.560] Why do I care about that and related that as hang time?
[00:59:21.880 --> 00:59:25.160] What difference does it make how long I get hang on a chin-up bar?
[00:59:25.800 --> 00:59:33.480] It's a really good point because that's a great metric that's been used and it's an indicator of healthy aging.
[00:59:33.800 --> 00:59:36.120] It's a, I mean, a marker of it.
[00:59:36.200 --> 00:59:41.640] Turns out it's probably a proxy for your upper body strength.
[00:59:41.880 --> 00:59:47.280] I mean, you're not going to have some really great hand grip strength, and then your upper body is going to be weak.
[00:59:47.280 --> 00:59:49.840] You know, so it's probably that.
[00:59:49.840 --> 00:59:55.120] But, you know, I think it's good to have good hand grip strength.
[00:59:55.120 --> 01:00:04.400] But, you know, it's probably something easy to measure, which coincides with what have you been doing with your arms and your upper body.
[01:00:04.400 --> 01:00:11.840] Because as soon as I, you know, got going on my upper body strength, my hand grip strength shot up, you know, too.
[01:00:11.840 --> 01:00:14.160] And I didn't do, you know, hand grip things.
[01:00:14.160 --> 01:00:17.760] So I think they're very, very much correlated.
[01:00:17.760 --> 01:00:18.160] Yeah.
[01:00:18.480 --> 01:00:22.960] Well, then also body weight, because if you weigh a lot, it's going to be harder to hang.
[01:00:22.960 --> 01:00:23.840] You got it.
[01:00:24.160 --> 01:00:24.560] Yeah.
[01:00:24.560 --> 01:00:27.680] No, hanging is a good type of exercise, you know, on a chin-up thing.
[01:00:27.680 --> 01:00:28.000] Yeah.
[01:00:28.080 --> 01:00:29.040] Really good form of exercise.
[01:00:29.200 --> 01:00:35.520] I did it, I don't know, about a year ago when Peter Atia had Lance Armstrong on his podcast, or might have been vice versa.
[01:00:35.520 --> 01:00:37.280] Everybody has a podcast now.
[01:00:37.280 --> 01:00:38.960] And they were doing hang time comparisons.
[01:00:38.960 --> 01:00:41.040] I think Lance said he made it a minute.
[01:00:41.040 --> 01:00:43.440] So then I tried to see if I could do a minute.
[01:00:43.520 --> 01:00:43.920] I did it.
[01:00:43.920 --> 01:00:45.120] I made it a minute.
[01:00:45.120 --> 01:00:46.000] That's great.
[01:00:46.000 --> 01:00:46.640] Really?
[01:00:46.640 --> 01:00:48.080] So it's harder than you think, though.
[01:00:48.080 --> 01:00:50.080] You're like, oh, I can sit there for five minutes.
[01:00:50.080 --> 01:00:50.560] No.
[01:00:50.560 --> 01:00:52.000] Oh, no, no, no, no, no.
[01:00:52.320 --> 01:00:53.760] That would be very difficult.
[01:00:54.000 --> 01:00:54.960] A minute's good.
[01:00:55.440 --> 01:00:57.120] But you want to do repeats.
[01:00:57.680 --> 01:00:58.080] Oh, right.
[01:00:58.480 --> 01:00:59.600] I didn't try the repeats.
[01:00:59.600 --> 01:01:00.000] Okay.
[01:01:01.360 --> 01:01:01.680] Okay.
[01:01:01.680 --> 01:01:07.760] I was really disturbed by the section in your book on the water bottles that I have here in the office that I use constantly.
[01:01:08.080 --> 01:01:15.680] Are you telling me that these plastic water bottles, just there's like molecules are dissolving away into the water?
[01:01:15.680 --> 01:01:18.400] And why is this legal?
[01:01:18.400 --> 01:01:19.680] I mean, come on.
[01:01:20.000 --> 01:01:26.000] Yeah, it's a double hit because the water we drink now already has microplastics in it.
[01:01:26.400 --> 01:01:34.280] And now sitting and stored in plastic, it's just absorbing some of those micro-nanoplastics right into the water.
[01:01:29.600 --> 01:01:36.840] So we should get rid of plastic water bottles.
[01:01:37.000 --> 01:01:42.600] They're a really big toll of our plastic burden that's accumulating, you know, megatons.
[01:01:42.760 --> 01:01:44.360] It's non-degradable.
[01:01:44.920 --> 01:01:54.360] And we also, there's lots of great ingenious ways to degrade plastics from so it doesn't get into our oceans and lakes and air.
[01:01:54.360 --> 01:01:56.120] We're not doing it.
[01:01:56.920 --> 01:02:01.160] So there's a limit on how much we can do on an individual basis.
[01:02:01.160 --> 01:02:07.320] I mean, for example, you don't want to take your food that's sitting in a plastic container and put it in a microwave.
[01:02:07.320 --> 01:02:10.440] That's taking your plastic ingestion to the fourth hour or something.
[01:02:10.600 --> 01:02:11.400] Oh my God.
[01:02:11.400 --> 01:02:11.880] Okay.
[01:02:11.880 --> 01:02:12.840] And ideally.
[01:02:13.320 --> 01:02:15.240] Yeah, you mentioned popcorn bags.
[01:02:15.240 --> 01:02:17.640] All right, because that's in the microwave.
[01:02:17.640 --> 01:02:18.440] Oh, yeah.
[01:02:18.440 --> 01:02:24.120] So, you know, if you have water, I mean, you're better off.
[01:02:24.120 --> 01:02:26.920] Like, I'm sure you've seen it when you've flown.
[01:02:26.920 --> 01:02:29.320] Sometimes they have water in cartons now.
[01:02:29.320 --> 01:02:29.720] Yes.
[01:02:30.040 --> 01:02:31.080] And that's better.
[01:02:31.080 --> 01:02:31.560] Yeah.
[01:02:31.560 --> 01:02:39.240] And why doesn't all the water, you know, be put in cartons without a layer inside that has plastic?
[01:02:39.240 --> 01:02:43.720] So we can do better, but it means making this a national initiative.
[01:02:43.720 --> 01:02:45.160] And there's been no sign of that.
[01:02:45.160 --> 01:02:50.760] That goes back to that RFK thing: that if he was, you know, bold, he would take this on.
[01:02:50.760 --> 01:02:53.000] But I suspect that's not going to happen.
[01:02:53.000 --> 01:02:55.880] I hope it will, but no signs of it yet.
[01:02:55.880 --> 01:02:56.680] Yeah.
[01:02:57.320 --> 01:02:57.960] Okay.
[01:02:58.520 --> 01:03:02.000] Cardiovascular disease and statins.
[01:03:01.800 --> 01:03:02.560] I'm asking.
[01:03:03.000 --> 01:03:04.200] I'm on a statin.
[01:03:04.200 --> 01:03:09.480] My doc is like, I don't know if you really need a turmeric given how much you exercise and your diet and so on.
[01:03:09.480 --> 01:03:13.480] But, you know, my family history, my dad died at 61 of a cardio, of a heart attack.
[01:03:13.560 --> 01:03:16.320] His dad died at 60-something as a heart attack.
[01:03:16.320 --> 01:03:18.320] And one of his two brothers died of a heart attack.
[01:03:14.920 --> 01:03:21.520] So, you know, I tell this to the doc, they're like, all right, we're putting you on a statin.
[01:03:23.040 --> 01:03:24.640] I don't know what to think.
[01:03:24.960 --> 01:03:28.400] Well, I mean, there's lots of ways to get at this.
[01:03:28.640 --> 01:03:31.280] One way is your LDL cholesterol.
[01:03:31.600 --> 01:03:33.120] That's only one way.
[01:03:33.520 --> 01:03:39.040] Another way is to do a polygenic risk score for coronary disease, which is actually quite good.
[01:03:39.840 --> 01:03:41.680] It's been validated to the hilt.
[01:03:41.920 --> 01:03:50.720] Of all the polygenic risks that you can get for, you know, very low cost from one of these 10 different companies, that one is the most accurate.
[01:03:50.720 --> 01:03:59.920] That'll tell you yes, no, and it may liberate you from your parental lineage, your father and grandfather.
[01:03:59.920 --> 01:04:10.240] It may tell you that you're a low risk, which there's a risk polygenic of all the hundreds of gene variants that cumulatively tell you, do you have a risk weighted?
[01:04:10.480 --> 01:04:12.080] Do you have a risk or not?
[01:04:12.080 --> 01:04:15.280] That is very good to tell about statin responsiveness.
[01:04:15.280 --> 01:04:16.400] Right.
[01:04:17.760 --> 01:04:21.760] Some have advocated getting a calcium scan.
[01:04:21.760 --> 01:04:22.240] I did that.
[01:04:22.240 --> 01:04:23.120] CT scan.
[01:04:23.600 --> 01:04:27.840] And if it's zero, then you know, you're not going to get a lot of bang from a statin.
[01:04:27.840 --> 01:04:29.040] I don't recommend those.
[01:04:29.040 --> 01:04:29.520] CAC.
[01:04:29.520 --> 01:04:40.240] I go CAC, you know, Calcium CT because it gets people go, they go cuckoo, some of them, and they have a high calcium, and it may not even be in their arteries.
[01:04:40.560 --> 01:04:48.400] There is some proportionality of the high calcium score with risk of coronary disease and response to statins.
[01:04:48.400 --> 01:04:58.560] But I try to avoid that because I think the polygenic risk score, which you can get from saliva, is cheaper, is a better one test.
[01:04:58.720 --> 01:05:11.800] Then the other thing is you can look at your other proteins, like your APOB, your HDL, your lipoprotein, little A, LPA, and just get a kind of context.
[01:05:11.800 --> 01:05:13.640] Are you at risk for coronary disease?
[01:05:13.640 --> 01:05:22.360] You can also look at inflammation in your body, like a high-sensitivity CRP or cytostatin and other better inflammatory markers that will have.
[01:05:22.360 --> 01:05:27.000] Basically, not knowing if you have a high LDL cholesterol.
[01:05:27.000 --> 01:05:39.320] You know, I think if you've never had heart disease and your LDL is low, your ApoB is low, it's hard to make a really good case for you to take a statin just because of a family history.
[01:05:39.320 --> 01:05:41.240] Well, I have my LDL is a little high.
[01:05:41.240 --> 01:05:43.960] The HDL is in the right range.
[01:05:43.960 --> 01:05:44.520] I don't know.
[01:05:44.520 --> 01:05:46.200] The average is a little high.
[01:05:46.200 --> 01:05:55.400] I did the cardio score of 103, which is, you know, but it's way lower than my buddy who has half the body weight and he's twice as fast as I am on a bike.
[01:05:55.640 --> 01:05:58.600] Yeah, was that 103 recent?
[01:05:59.240 --> 01:06:00.280] About a year ago.
[01:06:00.280 --> 01:06:01.400] Oh, that's great then.
[01:06:01.400 --> 01:06:03.640] No, I mean, you're at very low risk.
[01:06:03.880 --> 01:06:07.320] Okay, I mean, 103 at age 69, that's fantastic.
[01:06:07.320 --> 01:06:07.640] Yeah.
[01:06:07.640 --> 01:06:08.120] Yeah.
[01:06:08.120 --> 01:06:15.640] Well, but so, but on the causal connection of taking a statin, I mean, there's several links in there, right?
[01:06:16.280 --> 01:06:24.920] Of between having high cholesterol and taking a statin to lower that, particularly the LDL, and then downstream, a cardiac event.
[01:06:25.240 --> 01:06:25.720] Yes.
[01:06:25.720 --> 01:06:42.280] So there is no question that if you are, you know, very high LDL cholesterol, that, you know, we're talking way over, you know, 150 plus, your risk of coronary disease and other astical sclerosis in the body is really high.
[01:06:42.600 --> 01:06:52.160] And so those people are going to either benefit from statin or the combination with azetamide that prevents cholesterol absorption from what you eat.
[01:06:52.160 --> 01:06:54.080] It doesn't get into the bloodstream.
[01:06:54.400 --> 01:06:56.400] It's a well-tolerated medicine.
[01:06:56.400 --> 01:07:02.160] There's also now these monoclonal antibodies against the PCSK9 gene that are really potent.
[01:07:02.160 --> 01:07:03.360] You can add to the mix.
[01:07:03.360 --> 01:07:07.760] So if somebody's really high risk, you can get their LDL down very low.
[01:07:08.080 --> 01:07:10.720] You can get it down to less than 30, 20.
[01:07:11.360 --> 01:07:12.720] It's now possible.
[01:07:12.720 --> 01:07:18.240] And we're getting new drugs to lower LPA, these CETP drugs.
[01:07:18.240 --> 01:07:24.480] So our armamentarium to take over the lipid story and inflammation is really expanding.
[01:07:24.480 --> 01:07:40.800] And that's why cardiovascular is so ripe to prevent because it's so responsive to diet, exercise, sleep, and blood pressure control, prevention of diabetes, prevention of obesity.
[01:07:41.520 --> 01:07:52.800] So if you add on this anti-inflammatory story with the LDL and related, you can get the chance of developing heart disease way, way down.
[01:07:52.800 --> 01:07:56.800] And we're just looking at that right now, and we're not doing enough about that.
[01:07:57.120 --> 01:08:01.520] And it isn't just a statin story because a lot of people can't tolerate statins.
[01:08:01.520 --> 01:08:08.400] And I have many patients that they have such terrible night cramps and muscle spasms.
[01:08:08.400 --> 01:08:13.040] And what's interesting is the data from the trialists keep saying, oh, everybody could take a statin.
[01:08:13.040 --> 01:08:13.920] It's in their head.
[01:08:13.920 --> 01:08:15.120] Well, it's not in their head.
[01:08:15.520 --> 01:08:16.400] A lot of people.
[01:08:16.400 --> 01:08:20.800] And one other thing about statins that's really important that I underscored in the book.
[01:08:20.800 --> 01:08:30.000] Over a decade ago, I wrote a New York Times op-ed about if you take intensive statins, you have a higher risk of developing type 2 diabetes.
[01:08:30.840 --> 01:08:34.120] Now, I got blasted by my cardiology colleague.
[01:08:34.120 --> 01:08:35.240] It's true, though.
[01:08:35.240 --> 01:08:49.160] And all the studies that have come out since then keep reinforcing that if you take a really high dose of a tourvastatin, that used to be lipitor or crustor, your chance of migrating into type 2 diabetes is increased.
[01:08:49.160 --> 01:08:54.440] So you need, your doctor may not care, but you should be checking your glucose.
[01:08:54.520 --> 01:08:56.680] My current doctor doesn't think I really need it.
[01:08:56.680 --> 01:08:58.600] He thinks I'm overthinking it.
[01:08:58.600 --> 01:08:59.160] I don't know.
[01:08:59.400 --> 01:09:01.640] 40 milligrams, I'm taking 40 milligrams.
[01:09:01.640 --> 01:09:05.960] I don't get the cramping, I think, because I don't ride as long as I used to.
[01:09:05.960 --> 01:09:09.240] But what would be a high dose then for that?
[01:09:09.400 --> 01:09:13.320] So 40 milligrams of lipitor or lowvastatin.
[01:09:13.320 --> 01:09:13.800] Oh, okay.
[01:09:13.800 --> 01:09:14.760] That's a mild one.
[01:09:14.760 --> 01:09:16.600] So that dose is not a word.
[01:09:16.600 --> 01:09:23.640] The only time we saw the diabetes was in the high doses of a tourvastatin and resuvastatin, which is crustor.
[01:09:23.640 --> 01:09:24.360] Okay, I see.
[01:09:24.920 --> 01:09:29.800] You're on a very mild statin, so you don't need to worry about that one.
[01:09:29.800 --> 01:09:31.160] Okay, I'm going to quit worrying about it.
[01:09:31.160 --> 01:09:33.080] I'm just going to go have fun.
[01:09:33.960 --> 01:09:35.080] Good idea.
[01:09:35.080 --> 01:09:36.200] That's important.
[01:09:36.520 --> 01:09:37.240] That's important.
[01:09:37.240 --> 01:09:38.680] Yes, well, so let's talk about that.
[01:09:39.320 --> 01:09:48.120] What do we know about having a social life, being married, or having a loving relationship, friends, just all that stuff seems to matter?
[01:09:48.440 --> 01:09:50.840] It's actually a much bigger deal than I expected.
[01:09:50.840 --> 01:09:56.440] When you review all the data, and I go over that, I think it's in the mental health chapter predominantly.
[01:09:56.440 --> 01:09:57.320] It's amazing.
[01:09:57.640 --> 01:10:01.320] It's very powerful to have social interactions.
[01:10:01.320 --> 01:10:03.160] And, you know, we need that.
[01:10:03.640 --> 01:10:05.720] We're a social animal.
[01:10:05.720 --> 01:10:16.960] And if we get older, there's a graph in the book that a lot of people get struck by, which is how we become recluses as we age.
[01:10:17.280 --> 01:10:18.960] And that's not a good thing.
[01:10:14.840 --> 01:10:21.600] As we age, we shouldn't live in a cave.
[01:10:21.920 --> 01:10:29.280] We should be doing whatever we can to have more interactions with other people, friends, family, our network.
[01:10:29.520 --> 01:10:33.680] And if we don't have it, you know, grooming it is important.
[01:10:33.680 --> 01:10:40.000] So this is something that a lot of people would say is social science, but the data are very strong.
[01:10:40.000 --> 01:10:47.280] And it, again, has tried to do all the things to rule out the confounding factors like we've been talking about.
[01:10:47.280 --> 01:10:47.840] Yeah.
[01:10:47.840 --> 01:10:58.240] And is it, do we know that it's more than just having friends and family and people who love you to remind you to go to the doctor and take your vitamins and don't forget to work out and don't eat the cheesecake?
[01:10:59.520 --> 01:11:06.560] Yeah, no, I think it's more about that you get a benefit from not being isolated.
[01:11:06.880 --> 01:11:14.800] The isolating is promoting anxiety, even if you're not aware of it, depression.
[01:11:15.360 --> 01:11:19.520] You know, I think it's not good for your mental health.
[01:11:19.520 --> 01:11:25.040] And we know there's this very intricate interdependence of mental and physical health.
[01:11:25.040 --> 01:11:38.960] So I think this is, you know, really the way we understand social interactions is even if you're having an argument with someone else, you're better off to be with that person than you are to live in a cave.
[01:11:39.120 --> 01:11:49.360] You know, and we, there's so many things that happen as we age, the loneliness, social isolation that are undesirable.
[01:11:49.360 --> 01:11:49.840] Yeah.
[01:11:50.400 --> 01:12:04.280] Okay, neurodegeneration, besides doing all the things you've already said to help attenuate that, any use of doing Sudoku puzzles and playing online chess and crossword puzzles and all that kind of stuff?
[01:12:04.760 --> 01:12:07.560] Do we have any evidence that those make a difference?
[01:12:07.560 --> 01:12:08.920] Unfortunately, not.
[01:12:09.400 --> 01:12:12.040] You know, it can't hurt.
[01:12:12.040 --> 01:12:12.440] It can't hurt.
[01:12:12.680 --> 01:12:15.560] We don't have good evidence that it promotes brain health.
[01:12:15.560 --> 01:12:16.680] We're going to have that.
[01:12:16.680 --> 01:12:21.880] We're going to test that because now we have these brain clocks to tell you your brain age.
[01:12:21.880 --> 01:12:31.000] So that these organ clocks are just extraordinary, whereby it's a discovery that Tony Wiss Corey and his colleagues at Stanford made.
[01:12:31.240 --> 01:12:34.120] It was on the cover of Nature a couple years ago.
[01:12:34.120 --> 01:12:38.360] And what happened was now many groups have replicated this.
[01:12:39.160 --> 01:12:54.920] What you see is that from when you take up to 11,000 proteins from your blood, you can partition them with AI to an immune clock, a brain clock, heart clock, you know, liver, gut, all these different clocks of your body, kidney clocks.
[01:12:54.920 --> 01:13:05.400] And so then you can tell if that clock in your, if that organ or organ system in your body is aging faster than you are or the other organs or system.
[01:13:05.400 --> 01:13:15.320] So we're going to know, this is not, we haven't had a test like this whether pseudocu or you know crosswords helps to promote brain health.
[01:13:15.320 --> 01:13:16.600] We just haven't had a way to do that.
[01:13:16.600 --> 01:13:17.560] Maybe we'll see it.
[01:13:17.560 --> 01:13:23.960] Now, what is important is we have much better markers available today.
[01:13:23.960 --> 01:13:31.240] There's a PTAU217 that I write about in the book, which, of course, there's other of these neural markers.
[01:13:31.240 --> 01:13:32.520] We can get that now.
[01:13:32.520 --> 01:13:35.240] It's been around for two years in the U.S.
[01:13:36.280 --> 01:13:39.480] And it has to be ordered by a physician.
[01:13:39.720 --> 01:13:43.320] And if I wouldn't just say willy-nilly, people should go out and get it.
[01:13:43.320 --> 01:14:02.880] But the reason why it's important is if you're at higher risk, let's say you have Alzheimer's in your family, you have an APOE4 allele, which about 20% of us or more have, you're now at a higher risk zone for Alzheimer, especially, you know, you're 50-ish, let's say, or older.
[01:14:03.040 --> 01:14:05.040] If you want, you can even start earlier.
[01:14:05.040 --> 01:14:07.680] You get a P-TAW 217.
[01:14:07.680 --> 01:14:15.040] And what's been shown in multiple studies is exercise and improved lifestyle brings that down.
[01:14:15.040 --> 01:14:21.760] So this is not only a great marker for telling you 20 years in advance of risk for Alzheimer's, it's so sensitive.
[01:14:21.760 --> 01:14:25.520] It's the earliest pickup of detection of risk.
[01:14:25.840 --> 01:14:28.480] It's as good as a PET scan for tau.
[01:14:28.720 --> 01:14:34.880] It's as good as cerebrospinal fluid from a lumbar puncture without having a needle put in your back.
[01:14:35.280 --> 01:14:42.720] So it's a great blood test, and I only recommend it in people who are at high risk for the reasons I mentioned.
[01:14:42.720 --> 01:14:46.080] And it's a motivating factor like LDL cholesterol.
[01:14:46.080 --> 01:14:49.040] Like you take a statin to bring it down.
[01:14:49.040 --> 01:14:55.040] Well, this is for people to want to improve their lifestyle factors to bring it down as well.
[01:14:55.040 --> 01:14:58.240] And that should help prevent Alzheimer.
[01:14:58.560 --> 01:15:03.280] One of my favorite parts of your book is the 93-year-old guy who took up rowing.
[01:15:03.280 --> 01:15:03.920] Yeah.
[01:15:04.160 --> 01:15:07.840] He was not a lifelong athlete, just decided to take it up, and it still works.
[01:15:07.840 --> 01:15:10.400] So you can do this anytime.
[01:15:10.400 --> 01:15:11.680] This is amazing.
[01:15:11.680 --> 01:15:23.680] I was so inspired by him, as I am by all these people that are in the welderly group as compared to our elderly, which is the vast majority of people as they get older.
[01:15:23.680 --> 01:15:30.600] But this fellow, you know, become a world champion rower just by doing a workout in his garage every day.
[01:15:30.600 --> 01:15:32.120] I mean, it's incredible.
[01:15:32.120 --> 01:15:33.960] So it's never too late to be fit.
[01:15:34.200 --> 01:15:35.160] Never too late.
[01:15:35.160 --> 01:15:36.360] I love that.
[01:15:29.840 --> 01:15:37.080] All right, Eric.
[01:15:37.160 --> 01:15:38.840] I know you have other interviews to get to.
[01:15:38.840 --> 01:15:42.280] Your book just came out and it's being well reviewed, I see.
[01:15:42.280 --> 01:15:44.840] So congratulations on that.
[01:15:44.840 --> 01:15:47.160] Just looking forward to the future.
[01:15:47.400 --> 01:15:51.640] Here, I'll think back to 10 years ago when Christopher Hitchens died of esophagic cancer.
[01:15:51.640 --> 01:16:00.280] And Francis Collins, of all people, said, Let's see if we can get the genome sequence of your particular cancer and see if we could.
[01:16:00.360 --> 01:16:04.360] Well, that didn't work out for Hitch, but that's the kind of future we're looking for, right?
[01:16:04.360 --> 01:16:12.680] That my cancer is different from yours where I started, and that my body's different from anybody else's body, and we can personalize our medicine.
[01:16:12.680 --> 01:16:13.560] Absolutely.
[01:16:13.560 --> 01:16:22.520] But what we have now is a unique opportunity, Michael, where everything's been reactive to try to come up with effective treatments for cancer.
[01:16:22.840 --> 01:16:30.680] We have to, if we're going to talk about moonshots or big audacious goals, we got to prevent cancer.
[01:16:31.080 --> 01:16:39.400] Once we already have, you know, on a scan, like an MRI, billions of cells, and it's cancer, we're pretty far along.
[01:16:39.400 --> 01:16:45.400] We have to get, now that we can pick up microscopic cancer, we can pick up people high risk for cancer.
[01:16:45.400 --> 01:16:48.120] So I'm excited about the prevention side.
[01:16:48.120 --> 01:16:50.680] We're not doing anything about it.
[01:16:50.920 --> 01:16:56.200] We have people going through screening, you know, women with mammograms.
[01:16:56.200 --> 01:17:00.600] 88% of women will never get breast cancer ever in their life.
[01:17:00.920 --> 01:17:02.840] But they are all of them getting a mammogram.
[01:17:02.840 --> 01:17:04.040] Talk about waste.
[01:17:04.040 --> 01:17:07.880] So we're not doing anything smart about this, and we can.
[01:17:07.880 --> 01:17:17.600] And so I hope that in the times, short times ahead, that we'll start to partition risk and prevent these big three diseases.
[01:17:17.840 --> 01:17:26.960] We have an opportunity that is unmatched because of the combination of AI and all the things that we've been learning layers of data in recent years.
[01:17:26.960 --> 01:17:29.520] So it's exciting.
[01:17:29.520 --> 01:17:39.040] Yeah, another example I use in one of my lectures on Bayesian reasoning and signal detection theory is no test is perfect and you're going to get a certain percentage of false positives.
[01:17:39.040 --> 01:17:49.120] So if you're testing, you know, hundreds of millions of women for breast cancer, whatever the percentage, however small the percentage is, that's a lot of patients that are going to be told they have breast cancer and they don't.
[01:17:49.440 --> 01:17:56.160] Over 10 years, people, women start at age 50, over 10 years, 60% along the way will have a false positive.
[01:17:56.160 --> 01:17:56.960] That's incredible.
[01:17:56.960 --> 01:17:58.000] High wow.
[01:17:58.000 --> 01:17:58.480] Wow.
[01:17:58.480 --> 01:17:59.520] I mean, it's just crazy.
[01:17:59.520 --> 01:18:01.920] That's a study of 10,000 women.
[01:18:01.920 --> 01:18:02.400] Wow.
[01:18:02.400 --> 01:18:06.800] So we have to do smarter than, we are smarter than this.
[01:18:06.800 --> 01:18:10.560] We know the ways to fractionate partition risk.
[01:18:10.560 --> 01:18:12.320] We just got to start doing it.
[01:18:12.320 --> 01:18:14.000] And it isn't just by age.
[01:18:14.000 --> 01:18:14.480] Yeah.
[01:18:14.480 --> 01:18:15.440] Yeah, right.
[01:18:15.440 --> 01:18:15.840] All right.
[01:18:15.840 --> 01:18:16.320] Here it is.
[01:18:16.320 --> 01:18:17.440] Again, super agers.
[01:18:17.440 --> 01:18:18.560] You want to be a super ager.
[01:18:18.560 --> 01:18:19.440] I want to be a super.
[01:18:19.520 --> 01:18:21.200] I am a super ager.
[01:18:21.520 --> 01:18:23.440] Well, only when you get to 85.
[01:18:23.440 --> 01:18:24.720] You're not 85 yet.
[01:18:24.720 --> 01:18:25.200] Oh, okay.
[01:18:25.680 --> 01:18:27.600] I'm still a whipper snapper.
[01:18:28.160 --> 01:18:32.320] We're both in the quest, but we want to be a super ager.
[01:18:32.880 --> 01:18:40.560] We want to go 15 more years plus and not have neurodegenerative cancer or cardiovascular.
[01:18:40.560 --> 01:18:44.720] If we do that, then we've got to that super ager status.
[01:18:44.720 --> 01:18:48.320] Well, again, it's an evidence-based approach to longevity.
[01:18:48.560 --> 01:18:49.920] We're not looking for utopia.
[01:18:49.920 --> 01:18:51.360] You're not going to live a thousand years.
[01:18:51.360 --> 01:18:53.280] So don't worry about any of that stuff.
[01:18:53.280 --> 01:18:54.960] Just get me to 100.
[01:18:55.920 --> 01:18:57.360] I'll take 85.
[01:18:57.360 --> 01:18:58.600] Yeah, 85 will be.
[01:18:58.680 --> 01:19:01.240] Yeah, I'll aim for that and keep going as long as I can.
[01:19:01.240 --> 01:19:01.560] Yeah.
[01:19:01.800 --> 01:19:05.240] As you said, the more you get to 85, the more you'll ink out some other great stuff.
[01:19:05.800 --> 01:19:06.680] That's right.
[01:19:06.680 --> 01:19:07.400] All right, Eric.
[01:19:07.400 --> 01:19:09.880] Thanks so much for your work and for your new book.
[01:19:09.880 --> 01:19:10.440] Congratulations.
[01:19:10.600 --> 01:19:11.160] Thank you, Michael.
[01:19:11.240 --> 01:19:12.040] Really was fun.
[01:19:12.040 --> 01:19:12.440] Yeah.
[01:19:12.440 --> 01:19:13.640] Thank you.