Longevity Secrets

But before we do that , maybe let's take a moment and just tell our audience your fascinating story and how you came to be interested in this area fascinating story and how you came to be interested in this area .

But I did that UC San Francisco , did a cosmetics fellowship afterwards and started and completely sold out of the academic world and went and became a cosmetic surgeon for about six , seven years .

Then I became sort of a serial entrepreneur , became an apartment private equity owner essentially , and started other companies , but in the meantime never really kind of lost my nerdiness and love for science and biochemistry , molecular biology and , frankly , all the stuff .

And the next thing , you know , robert , I got divorced and I turned , you know , I was in my mid 40s and I realized I was fat and and and I was out of shape and David Sinclair's books were on the shelf and I was reading those kinds of things and I just completely got electrified and that just brought me completely into this area of longevity and with , you

know , really nothing necessarily monetarily to gain , other than I just love this stuff , I love talking about it , I love writing about it and that's where I'm at now . So I'm using like all my real brain power they got me through med school and surgical residency towards this stuff .

someone from mainstream the healthcare industry , if you will .

We presumably learned about health care , and I mean we learned about medicine and all . But longevity is really really accelerating our knowledge . So , like what really moved you in that space .

Then I went back and I started to , you know , look at some of the Nobel Prize winning work back on Yamanaka factors and that sort of thing , and a lot of it just started to make sense to me and I just started to realize , oh my God , this is something that's really happening , Right ?

You know , sometimes I think about , like , what's happening in this space similar to . You know , there was a show when you and I were kids .

You know the Jetsons , Remember the Jetsons and all those things that seem so crazy , like , you know , people looking and talking on phones , looking at each other , and there was all sorts of technology that's actually real right now , right , yeah . Or you could look at the Internet , for example , and all the things we can do .

No-transcript credit , as well as being a pioneer here because of their vision and saying that here's what aging is and that aging itself is a disease . And , as you and I both know , in medical school we learned , we learned structure and function , how things work when they're normal .

Then we learned pathophysiology , and pathophysiology means what goes wrong , and unless you know what goes wrong with something , you can't treat it . What where David and that research has brought us is understanding the pathophysiology of aging itself . And so if we understand largely now the pathophysiology , the cause of aging itself , then we can actually attack it .

We can actually get to the source of . You know age reversal , age , you know mid , you know slowing age . But I think I would say , as Aubrey DeGray would has argued , that you know , age reversal is just as likely as slowing down age , right . And so then you take a step back and say , well , how long is it going to take ?

I don't know the answer to that . Aubrey obviously says , like what ? 15 years is his latest projection ? 50% chance in the 15 years .

I don't know if it's going to happen for sure in our lifetime , but what I can say is that we already have plenty of low hanging fruit out there things that you've written about that if we follow those things , we could probably fairly I think , with fair confidence say that a lot of people could probably add a decade to their lives if they changed the way

they ate , you know , started to exercise , sleep well , things like basic stuff like that . And for the first time I feel like there's a reason for people to really , really try to do this , because there's a prize here .

If they can live longer , if we can live long enough to get to what Aubrey calls this longevity , escape velocity , then you win the game and at the very least you add , you know , hopefully a decade of really quality , good time to your life . That is very , very doable with what we already have .

Even though they're , you know , they're all in this space , Everybody looks at it kind of differently . How do ?

But we all probably at some time in biology learned about this code called the DNA , that that codes for a bunch of genes . In between there's a whole bunch of letters , actg , and it codes for different proteins that become traits . They pretty much design who we are .

And when I was in college and I was in molecular biology , there was areas in between these individual proteins , like , for example , you would have a code and then you'd have some garbage language ACTGs . That didn't really mean much , we just thought that they were garbage . But they're not garbage , they're actually quite important .

And we now know that as the epigenome they're actually quite important and we now know that as the epigenome right , it is dna that codes . That doesn't code for anything , but that is important in order for the things that do code things to actually come out clearly .

And I think david's information theory theories essentially that what happens is that over time that epigenome , those spaces in between the words . They get changed , chemically altered , uh , by various things , uh , chemical reactions like methylations , for example , unimportant .

The point is that it changes their structure and when that happens , it actually changes the way the actual genes themselves express . They don't come out crisply and clearly , and that phenomena itself ultimately results in aging .

So we have now as I think people down at UCLA even were some of the first people to do this with the epigenetic clocks , right , epigenetic clocks are basically showing how people , how old they are , based on their genome , and the idea is , say , you can give a sample of your blood or whatever , and you can .

You can compare these DNA methylation patterns , these sort of fingerprints on your DNA , by machine learning , artificial intelligence . You can look and say okay , even though I'm 54 years old , my blood sample and my epigenetics matches up with somebody who's 35 years old , right ? Or somebody who matches up who's 75 years old .

And the importance of that is that those epigenetic ages actually correlate extremely well with death . In other words , if a person's you know 54 and their epigenetic age is 74 , they're likely to die soon rather than later , right ? Of course that's scary stuff , unless ? Why would you even want to know that if you couldn't do something about it .

And that's where things get really exciting , because we know we can do things about it .

We can actually do things , whether it's through diet modification , through potentially some medications I know you've talked about rapamycin , things like that that can actually result in reversal of epigenetic age and to me that's where the whole thing completely becomes super exciting , right , because what's the point of learning about aging and longevity if you can't do

anything about it ? Right , then you might as well just go all in and just blow it up , go out with a bang .

It instead is programmed by our lifestyle . And that's the exciting thing , that , the like you say , the food we choose , we choose and everything else we get to change our epigenome . And so what , what have you ? What are you most excited about in that area as far as opportunities for improving our epigenome , slowing down or reversing our biological age ?

is a disorder that ultimately sort of lies on the spectrum between somebody who's completely healthy and somebody who is a diabetic , and it is essentially an inability to properly store and use , you know , calories the right way , causes a lot of inflammation in the body , causes a lot of other health related problems , increases the risk of heart disease disease ,

increases the risk of cancers and visceral fat .

Um , so I think that that's probably , um , you know , between that and exercise are probably , in my view , the biggest hammers that we have , right , and they're so simple , um , to deal with .

But it's just like , you know , you look at something like you , look at something like , uh , you look at something like exercise , which I think is , you know , obviously a huge thing for me .

It's been , you know , I lost 20 pounds of of fat and gained 10 pounds of muscle and , um , you know , I can bench press more now at age 50 than I could at age 20 , you know , uh , you know it's you can make huge differences in your life . And if people knew , like , how much benefit you can get from exercise .

You know , people often want to just take pills , right , but there's a . If you , if you put all the benefits of exercise in a pill , everybody would want to take it and they'd pay a lot of money for it . It's free . So , so I think those are the biggest things , obviously , you know there's there's other things that I think that may not be as obvious .

I mean , I've talked a lot about sleep . You know , as a former surgical resident yeah , and you too , probably in residency , I mean we never thought about sleep . I mean , back in the day it was at least on the surgical side . It was a sign of weakness to you know , to actually admit that you were tired and sleepy .

You know , and I was a neurosurgery resident before they had the so-called 80-hour work week , which was supposed to be like much better . I did like 100 , 110 , 120 hours a weekend .

You know , drilling through skulls , you know , in the emergency department , well , after being up for 36 hours , I mean that sounds dangerous for patients , but in reality there's all sorts of literature , as you know , on not only on a night shift working but on , you know , lack of the appropriate kinds of sleep that might link to increases risks of Alzheimer's

disease and all sorts of things . So I think I think sleep's a big one . I think hormones are actually hormones are massively underrated Testosterone , for example . I don't know what your take on it is , but what I've been really interested in is , first of all , the testosterone levels of men have decreased so much since the 1950s .

They're now , in young men , 30% below where they were in the 1950s , which is just remarkable to me . And I don't I don't , I had no , no , exactly why that is probably food . It's probably some other things going on too . Maybe kids aren't playing outside as much or whatever , but that relates very much .

Actually , if you look at the data , it actually has a . There's a tremendous correlation between that and metabolic syndrome , right ? So you know , I was just talking to a urologist friend of mine and you know they only treat low T in men if they call it symptomatic . And I said well , what do you call symptomatic ? That's the tricky part , right .

Like if you have a guy who comes in and he's worried about erectile dysfunction yeah , that that's kind of obvious , right . But what about a ? What about somebody who's got a bunch of visceral fat ? Right , and do you call that symptomatic ? It certainly could be right .

So one of the things that I like to think about is , like , if somebody's got a lot of visceral fat and you know , like if somebody's got a lot of visceral fat and you know a man who's got a lot of visceral fat and is tired , other things make sure you get your testosterone checked out , because there's actually a pretty significant correlation between low t and

metabolic syndrome , right . So again , there's just so many things like that where they don't teach us this stuff in medical school , right . I mean , you just have to . You have to keep up with the data you have to look at .

You know , you have to look at some of these things and make the correlations yourself and try to look at them for you and your patients .

What do you think are the important choices we can make in our nutrition to help program our epigenome to a more favorable biological age and all that ?

Basically what it's doing is , if you get these big spikes in blood sugar , that blood sugar effectively starts to bind to proteins that you need . We measure that . One way we measure that slime is the way it binds hemoglobin and hemoglobin . We call that hemoglobin A1C , and those A1C levels effectively are a marker of how much our proteins are getting slimed .

And so trying to keep as steady and not elevated blood sugar levels is , I think , in my opinion , is probably the single most important thing that you could do for longevity . Do you agree with that ? I'm curious if that's your take .

I've gone from being a guy who is overweight to now like a guy who lifts a lot of weight and there is there is some value , I think , in optimizing in terms of hypertrophy and muscle hypertrophy and that kind of thing , with I found , at least for me , and some and certainly some data suggesting that performance levels sometimes are affected by going to ketogenic

diets . I also , for me , I'm just strictly follow . You know I follow my hemoglobin A1C so closely , robert , and you know I'm always in like the mid fours right and we know if you're , you know you . I don't know what your typical thing is , but I would say that I would say trying to keep things under five .

Point two is probably probably a very reasonable place to be To me . I think that if you're not , if you're not really struggling with it , I don't think you have to go on a ketogenic diet . Sometimes it's kind of hard to do that for people . I mean , gosh , it's , it's , it's a challenging , it's a challenging diet .

It's one that you have to give up a lot . For me , personally , I try very hard just to avoid simple sugars . I mean , I I'll eat whatever vegetables there are , I'll I'll you know , um , um , I will generally stay away from , I won't drink any fruit juices , but will I eat fruit ? Yeah , berries , mostly that kind of thing .

But what I find is that , as long as and I and I also monitor , you know , continuous glucose monitoring is a big , I think , is a tool that everybody has now you can get a patch that literally can follow what your blood sugar does on a daily basis , um , follow that .

You are typically two weeks at a time and you can , you can , look at various foods that are spiking your blood sugar , right , so , um , yeah , so I , I , I am , I would call myself , uh , I , I think , not at all against the ketogenic diet . In fact , I think it's a good fit for many people , but for me personally , I'm just about limiting carbs .

So people , will be able to go into their Walgreens or CVS and get one , which I think is great news , because people ought to be able to do that on the other dietary side . So we limit carbs . Some people talk about limiting seed oils . What's your take ?

I mean , yeah , I'd much rather , you know , be eating flat out , you know , beef fat than seed seed oils , just because of what goes into creating those things and all of the , the chemicals that are related to it , for sure , um , uh , yeah , I almost don't even mention those things because I almost think it's obvious .

But , yes , yeah , what's your , what your take on that , I assume's the same .

Okay , this is all over the board with some really , really smart people that I respect , by the way , right , if you talk to a guy like Peter Atiyah , for example , who I have a tremendous amount of respect for , he would tell you a gram per pound , that's 220 grams of protein a day for me , right , as who's an active , um , who's ?

Who's a guy who you know exercises quite a bit . That's a lot . It's really hard to get into me , right ? The other thing is um , now , then you on the other end of that , you look at , you look at guys who are like sinclair in the lab , or I think of somebody else that I know . You certainly you've had uh advertisements .

I've heard for uh , for walter long girl's uh company .

Right now walter's been on my show on Sapio podcast and he is on the other end of that , which is basically , you know , he cites the data and says lower protein until you're about after that 65-year-old point , if you haven't gotten cancer , you haven't gotten whatever then what he shows statistically is it goes higher , that you should go higher in protein .

This is completely , quite honestly , and the problem with nutritional information out there in the public is it becomes religion , right ? This is something that , as a science person , as a medical person , I don't know the answer to . Right now .

I am leaning on heavy protein myself , mostly , again , because I'm , you know , interested in hypertrophy and I work out and I lift a lot of weights . But I don't know , walter could very well be right on this , who knows ? And so I'm curious what is your take on it ?

So if I'm a bodybuilder and I want to put on weight and there are good reasons for doing that anyway , you don't want to be frail in older age but on the other hand , people who are training and really doing a lot of bodybuilding have different needs and they may .

Even if you optimize for longevity , you may decrease what you can optimize for performance and vice versa there are even , you know , studies with marathon runners with cardiac fibrosis and ultra marathoners who actually , you know they have very high performance but their longevity , presumably because of heart damage , is shortened .

The challenge , if you look at longevity and Peter will you know . Peter Atiyah will talk about how , listen , you've got um , the biggest predictors of longevity when somebody is older , you know , is lean muscle mass and VO2 max right . So that's his argument for the heavy protein . On that .

Walter , on the other hand , looks at it and he says well , listen , you've got all these populations with high protein diets and they tend to get cancer more . They tend to get these disease processes more . And so , again , more , they tend to get these disease processes more .

And so again , really smart people completely almost polar opposite views on higher protein , and I'm not sure exactly how to interpret it . But I think the important thing is that people actually take these perspectives and think about them and not make them religion . That's probably the biggest thing , in my opinion .

Generally , what I do is in in a person's diet when they , when they lower the carbohydrates , like we've talked about we recommend for longevity , they increase the fats and they keep proteins , whatever they were pretty much normal . Now you know one in addition to the sirtuins that Dave is Dave Sinclair is big about .

You know I I talk a lot about mTOR and you know , and also AMP kinases . In there too there are many . There are many of these interlocking complex longevity mechanisms . But for mtor , certainly it's primarily affected by glucose and , you know , in the carbohydrates . But secondarily there are insulin driven right ?

Is it primarily insulin , insulin , yeah but some branch chain , uh , amino acids do it as well so there's a the ones that yeah smaller from protein , so that that that gives me pause there .

The other thing that that I've been thinking about recently , and I know you , it'd be good to get your take on it If we , if we start when everyone's going to die at age 65 , which it used to be that way , or at least statistically you think about health care and recommendations a certain way , but if you're going to die at 100 or 120 , you want to think

about that second half of your life and , and it changes your perspective , like , for one thing , your risk of cancer continues to go up and increases . You know , a 70 year old non-smoker is more likely to have lung cancer than a 30 year old , four pack a year smoker , just because of that cancer risk .

So cancer , you know , should be considered and I would , you know , I would recommend screening for colon cancer in , you know , into your old age , unlike the , the current recommendations you stop at age 70 or 75 , I think , for colon cancer screening .

about it , uh , and that was a great experience and you know both . You know you've been in . You've been in head and neck , for example , right and as a radiologist , and how how often . You know , like is about the , the cited . We talk about cancer , which is typically what they're picking up on .

We're trying to pick up early cancers but like cerebral aneurysms , right , brain aneurysms . It's supposed to affect like 3% of the population .

I don't know if that was that's been your experience , anecdotally or not , but uh , but you know , when you yeah , I mean when you look at that and you're like 3% of the population most of the time uh , when I was a neurosurgery resident , usually those people with ruptured aneurysms they were like 40 something and they were out for a run and they were in

really great shape and they were comatose and dead the next day I mean , okay , so maybe those aren't huge numbers , but if I'm that person , I want to know and so that's why I do this , you know and yeah , and there's a school of thought that I happen to subscribe to that things like a once in a lifetime screening MR for cerebral aneurysms is part of normal

wellness that you get early in your life Because , like you say , it's a small percentage of getting it but if you're that percentage , your chance of having a bad outcome from it is very , very high .

And you know , I mean as a radiologist , you know how these things work more than me , but , as my understanding is , it's a matter of luck of which slices you got and which one you didn't , and you could very well end up thinking that you're in good shape but not be , and that's dangerous .

So , unfortunately , some of this ends up being like can you afford the alternative ?

And so , in my case , again , being very involved with this and feeling like I can spend money on this , I actually did one of these Clery studies here I think uh , they do them over ucla too , right and and effectively shows like really down to these incredible amounts of detail on on blood vessels , not only showing if there's narrowing or , but also if those

plaques are actually calcified and safe or if they're active plaques and that kind of thing .

So , again , if you have the you know they're not cheap , but if you have the ability to do something like that , that is a great opportunity to potentially not die of cardiovascular disease , which I think I think you and I probably would agree that you know it's a number one cause of death in the United States .

It probably shouldn't even be in the top 10 if you take .

You know the number of different things that we can do about it in terms of diet , in terms of exercise and , frankly , you know pharmaceuticals if need be exercise and , frankly , you know pharmaceuticals if need be so , and there's plenty of things you can do or with , if you do have a problem , to treat it early .

So people shouldn't be dying so often of cardiovascular disease .

Bottom line is , by the way , I have a friend , another physician who got that um , who did , who did do a cleary study and essentially did a few major lifestyle changes and also and I'm not sure you and I agree on the cholesterol issue per se , but he actually suppressed his cholesterol quite a bit using Repatha and one year later went from 80% blockage down to

30 in his LED . Yeah , that is unbelievable .

With Buck Joffrey .

I have also a personal finance podcast going for 10 years , but this one's been around for a couple of years and it's similar to the types of stuff you and I are talking about here , right , and I would say it goes into the about the same amount of detail and , as you and I know , not everybody enjoys this kind of detail , and so I like talking about it .

You know you want to get me excited , start talking about Sirtuins and mTOR and rapamycin and but , but that's not everybody , but we do . But I do believe that this message of of being able to um , to intervene and to take advantage of the low-hanging fruit uh , for the masses , is an important one . So we've been able to um .

We're working on another podcast right now .

I am working on another podcast podcast that's going to be released in a few months and it's me and my co-host is actually a model , an actress , and has nothing to do with medicine , and we are interviewing a lot of really smart people like you , and the goal there is to create an environment where it's not just about education , it's entertainment .

So it's entertainment , education , and most of I think most of the country reacts probably more positively to entertainment than just pure education , and so our goal is to try to spread this message of health and wellness and longevity opportunities , you know , to more people who might not otherwise be interested .

So , yeah , that's the major way to follow and hopefully people get something out of it . I talk about some different things sometimes . I mean , actually this week was just for fun because of my cosmetic background . I did all the science of human attraction . Actually , that's no .