Feel Better, Live More with Dr Rangan Chatterjee - The New Science of Living a Longer and Healthier Life with Professor Rose Anne Kenny #400

Episode Date: November 8, 2023

Longevity is a hot topic these days. We’re obsessed with anti-ageing as if getting older should be avoided or even reversed at all costs! Of course, we can’t do that and I’m not sure we’d really want to. But today’s guest brings valuable insights about what we can do, to make sure we age healthily and happily. Professor Rose Anne Kenny is a medical gerontologist, Regius Professor of Physic and Chair of Medical Gerontology at Trinity College Dublin. She’s the Founding Principal Investigator of Ireland’s largest population study of ageing (TILDA) and the author of the international bestseller Age Proof: The New Science of Living a Longer and Healthier Life. In today’s conversation, Professor Kenny reveals that while 20 percent of ageing is genetic and can’t be changed, 80 percent is epigenetic – in other words, we have the power to influence how quickly or how slowly we age. Her number one recommendation is to have good quality friendships and relationships throughout our lives. Then follow a healthy diet, plenty of exercise, and reduce stress. Nothing too surprising, perhaps. But what might surprise you is just how far reaching the effects of these relatively simple measures can be – and how much what you do in your 20s can impact your 80s. We talk about how to avoid metabolic syndrome and why it’s important to know key biological markers throughout life. We discuss the benefits of community, family, volunteering and inter-generational friendships, and the undercurrent of ageism that prevails in society. Loneliness increased threefold during the pandemic, according to the TILDA study, and it’s left some people feeling afraid to reconnect. Yet isolation is known to cause inflammation, suppress immunity and speed ageing. Professor Kenny believes we should flip convenience on its head when it comes to exercise. Instead of taking the easy option which means moving less, we should look at the ‘harder’ options, such as taking the stairs or carrying heavy bags, as convenient ways to build activity and strength training into our lives. She also shares excellent advice on sex and intimacy, sleeping better, laughing more, and finding purpose all around you. This is a wonderful and practical conversation that is going to give you a variety of simple ways to play the long game when it comes to ageing. And the empowering message is that it’s never too early or too late to start. Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts https://apple.co/feelbetterlivemore. For other podcast platforms go to https://fblm.supercast.com. Thanks to our sponsors: https://hunterandgatherfoods.com/livemore https://drinkag1.com/livemore https://naturalmat.co.uk/livemore Show notes https://drchatterjee.com/400 DISCLAIMER: The content in the podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website. Hosted on Acast. See acast.com/privacy for more information.

Everybody assumes aging is about your genes and you are stuck more or less at the moment anyway with whatever genes you've got, but that isn't the case. Genes only contribute to 20% of the aging process. 80% is within our control. Isn't that wonderful? Hey guys, how you doing? Hope you're having a good week so far. My name is Dr. Rangan Chatterjee and this is my podcast, Feel Better, Live More. Longevity seems to have become one of the hottest topics in health. We have seemingly become obsessed with anti-aging, as if getting older should be avoided or even reversed at all costs. And of course, even if we could do that, I'm not sure we'd really want to.

However, with much of society struggling as I get older, I do think it's important to remember that there are lots of simple things that we can do that will massively increase the likelihood that we will age healthily and happily. Professor Roseanne Kenny is a medical gerontologist and Regius Professor of Physic and Chair of Medical Gerontology at Trinity College Dublin. She's also the founding principal investigator of Ireland's largest population study of ageing and the author of the international bestseller, Age Proof, the new science of living a longer and healthier life. In today's conversation, Professor Kenny reveals that whilst 20% of aging is genetic and can't be changed, 80% is epigenetic. In other words,

we have the power to influence how quickly or how slowly we age. Her number one recommendation is having good quality friendships and relationships throughout our lives. Then follows a healthy diet, plenty of exercise and reducing stress. So nothing too surprising perhaps, especially if you are already familiar with my books or this podcast. But what might surprise you is just how far-reaching the effects of these relatively simple measures can be, and how much what you do in your 20s can impact you in your 80s. We cover so many different topics in our conversation, including how best to avoid metabolic syndrome and why it's really important to know key biological markers throughout our life.

We take a deep dive into the benefits of community, family, volunteering, and intergenerational friendships, and discuss the undercurrent of ageism that prevails in society. We also discuss how social isolation is known to cause inflammation, suppress immunity, and speed up the aging process. And we go through the best ways to build activity and strength training into our lives. Professor Kenny also shares some excellent advice on sex and intimacy, sleeping better and laughing more. This really is a wonderful and practical conversation that is going to give you a variety of simple ways to play the long game when it comes to aging. And the empowering message is that it's never too early and it's never too late to start.

One of the central messages in your book is that 80% of our aging biology is within our control. So I thought we'd start with some practical tips, right? A lot of people listen to this show ranging from 20 year olds all the way through to 80 year olds, right? So if I was going to say to you, let's say if someone's in midlife in their 40s or 50s and you were going to say one or two things for them to focus on, what would you say? I'll give my top three. And the first one I'd start with would be friendship and to culture friendship, how important that is. Maybe we can take a step back. You mentioned there that 80% is in our control. And isn't that wonderful? Because everybody assumes it's genes. You know, aging is about your genes and you are stuck more or less

at the moment anyway with whatever genes you've got. But that isn't the case. Genes only contribute to 20% of the aging process. 80% is within our control. So that's fantastic. And then what are the things that we know are in our control that influence the process, that influence that 80%? And so if my top three would be, as I said, friendship, having good friendships. It's not about quantity, but it's very much about the quality of relationships, quality of friendships. And we can come back to how that works later on. And I'm sorry to say the next two, because once I said this on radio in Ireland and the interviewer said to me, oh my God, not those old chestnuts again. But I have to mention diet and I

have to say exercise because they are very important and they are something that certainly definitely makes a difference. And then if I were to include a fourth, I'd say stress. How, you know, stress is so bad for us. So anything that we can do to attenuate stress processes or attenuate stress itself is important for the aging process. Yeah, brilliant. So friendships, well, let's broaden that out, I guess, relationships, the food we're eating, how much we're moving our bodies, and how much stress we're being exposed to. We're going to get into all of those in detail. But as you say,

a lot of us who are health conscious these days have heard some of these messages, right? You have been publishing papers for years. You've been treating patients for years. You teach medical students. You've got a lot of experience. And I think everyone comes to the aging conversation at different times in their lives, right? So you mentioned your top three there, but I'm interested, how would you frame it differently depending on the age of someone who's coming to see you? So for example, if someone is a, I don't know, a 40-year-old female, for example, how would you change that messaging slightly to be super relevant for them? if someone is a, I don't know, a 40-year-old female, for example, how would you change that messaging slightly to be super relevant for them?

Good question. So 40-year-old female will be coming into menopause. So to be preparing for that, I would say that's the first thing. We can talk a little bit about that. It doesn't change what I'm saying about friendship, but it's sometimes much more difficult because there are an awful lot of other pressures on someone's life. So they don't have the time to be culturing friendships, etc. So but to use some mechanism for retaining friendship is very important. You know, when you're picking up kids from school and having to do the housework piece and your work piece that makes your life much more difficult in the context of diet, in the context of exercise. I can absolutely say that I almost came to a full stop when I was in that period of my life with my children and with my professional life, etc. All of the things that I'm going to be talking to you now about and your audience and sharing

as being important for manipulating the aging process, we're almost at a full stop because I wasn't able to do everything. And I focused on those other things. But I think it's not all or nothing. So at least to try and do some of the things we know are beneficial. I mean, on that, that's really interesting. At this stage in your life now, with all the experience that you've got, with the knowledge you now have, if we rewind back to your 40s, had you known what you know now, do you think you would have been able to make different choices? Would you have made different choices back then? That's such a great question.

choices? Would you have made different choices back then? That's such a great question. At a personal level, I probably wouldn't because I adore my work. And obviously, I love my family. But in order to really focus on factors we just talked about, you really need to pull back from one or to other. And I would not have done that. At a personal level. I wouldn't have done it. However, I didn't know as much as I know now. And now that I know as much as I know, I'm working really hard on it, to be honest. Well, that thing about work and purpose, of course, is something you've written a chapter on, which we're definitely going to talk about. So I get the messaging for a 40 year old. If I was 70 years old talking to you saying, hey, listen, what can I do?

How would your messaging change for, let's say, a 70-year-old? Well, then the messaging is very different because generally speaking, we have more time. Although I've met a number of 70-year-olds who say, I've never been busier since they retired. Generally speaking, we have more time. And I think that there's a perception out there, societal perception, that as you get older, you shouldn't be doing as much, you should slow down. We don't expect as much of people. And I would love to see that concept changed because my advice would be do a little bit more every year. I definitely mean that applies to exercise a little bit more,

whatever your movement is that you enjoy, do a bit more each year after 50. But I would also recommend that in the context of food, put a bit more variety into your food every year. Think of something different that you can do, but also creativity and purpose. Change that also every year of your life so that you have something that you want to do new every year. Variety on our plate and in our lives and in our exercise regime are really important. So I would say that applies. Can I say something about the age thing? 20 year olds, this is important for, and that's the age I'd like to see starting to engage in the process. Yeah, I was going to come so far away. Well, I have a great story about that because

I was giving a lecture in Trinity recently, and we have what's called a TEP course, which draws students from non-health-related courses in the university into modules they might be interested in, and aging is one of them. So I had students from geography and law and mechanical engineering, etc. in the audience in front of me. And after the lecture, two young chaps came up and they were from Durham University on an Erasmus, Ben and Dominic. And they said that they were looking for the university to choose for their Erasmus. And they chose Trinity because of the longitudinal study on aging that was being done in Trinity. And I was like, just like you. Wow.

And I said, why? And they said, because we feel it's such an important area. Now, one was in bioengineering and the other was in one of the humanities. And they said, and we're interested in becoming, maybe setting up an SME in this very space, but an SME for 20-year-olds. What's an SME? A small and medium-sized enterprise. innovative business in this space so that they could harness their interest in aging to create a business opportunity for themselves. That's why they chose Trinity, so that they could access Tilda. And when I mentioned Tilda during the lecture, they came up to me afterwards. So I was

really energized by that. And their approach was, what you're talking about suits the middle-aged and older person, but we'd like to reshape it for the 20-year-old. So isn't it amazing? I love that. So I want to talk about Tilda. You mentioned it. And I'll be honest, growing up, my familiarity with that term was to do with a particular make of basmati rice which we would have at home tilde basmati rice I'm sure many people listening will will resonate with that but when you talk about tilde you're not talking about a rice brand are you? I'm talking about the Irish longitudinal study on aging that's where the d comes from there was already the Italian longitudinal study on aging so we had to we had to recreate it we couldn't use the Italian longitudinal study on aging. So we had to recreate it.

We couldn't use the S from study. Let's just understand what that means, right? You say longitudinal. What does longitudinal mean? And I just want a bit of context here. People who've been listening to my show for a while will know, very recently, I had on professors Robert Waldinger and Mark Schultz, who are the director and associate

director of the Harvard Adult Development Study that's been going on now, I think, 85 years or more, right? So they're familiar a little bit with that study and some of the learnings from it. So can you explain what your study is? What does longitudinal mean? And how would certain elements of your study compare to what they're doing in Harvard? Okay, so longitudinal means generally that you have a cohort of people, and in our case in Tilda, it's an Irish population of people aged 50 and older chosen through a randomly selected sample, which means that whatever findings we get, we can generalize to the population. And the same people are studied longitudinally at regular intervals, in our case,

every two years. And the study has been running for 16 years now with a three to four year pilot run in. So every two years we go back to the same people. Now that's what the longitudinal bit is. That allows you to understand the process of aging. So you're looking at the same person now for 12, 16 years as it stands at the moment. You knew what they were like at baseline and then you can actually look at changes in the components. I call it the tapestry of that individual which makes up how they are now. For example, we measure a number of different factors. Of course, we measure genetics, the epigenetics, all of those new biomarkers of aging, the common things like you get in a blood screen, your kidney function, your kidney function,

your electrolytes. I was going to say urea and electrolytes. I'm so used to saying that when I'm ordering them. Your kidney function, your electrolytes, your hemoglobin, et cetera. But we also measure social factors and economic factors. And they're really important to understand who we are biologically. So we measure all of those factors. And for example, at age 50, if we had a man who had that broad assessment, including a very detailed health assessment, who had a stroke 16 years later, we can go back and see, OK, what were the things about that man compared to others in the study, which were probably the risk factors at that time, which led him to be a victim to stroke in 16 years.

No, I love that. That's so fascinating, isn't it? I think we can all really get our heads around that, that if this happens, instead of just looking at what were the blood tests on admission or six months before your GP, before you got the stroke, I think there's a growing recognition that these chronic diseases, they don't just happen overnight. The process that's driving them is going on in the body for 10, 20, sometimes maybe 30 years. So I can see the power there that you can go back and go, hey, what was going on when you were 50? And so what are some of those key learnings that you've found so far? Oh, there's a host of them.

Okay, so we've published nearly 600 papers from the study to date. And not only us, we make sure that the data is publicly archived after it's been cleaned and we've done analytics on it to make sure that it's kosher. And then it's publicly archived in Ireland, but also in Michigan so that it's available to universities worldwide. This is a great asset for us because that means that you get researchers all over the world tapping into your data source. So let's say, what have we published so far? So it depends. We carve it into three big domains, social, economic, and health. From the health, in the health domain, we found that things, this won't be a surprise, metabolic syndrome is very common. It starts

early. Metabolic syndrome is where you have a mix of obesity, central obesity, particularly high blood pressure, early diabetic markers and abnormal lipids in the blood. That cocktail makes you much more at risk for cardiovascular events later on. And does that cocktail speed up the rate at which you age? Yes, absolutely it does. And can we just, Rosanna, if you don't mind, just pause here for a second, because I think we talk about aging a lot,

where it's becoming more and more a part of the vernacular, I think. You're certainly in my world, the people I communicate with are very health conscious. We're hearing a lot about anti-aging these days. What exactly is going on when we age? Because then I think it'd be helpful if we understand that, then we can understand, well, metabolic syndrome, which is so common now, how is that influencing those kind of parameters of aging? Okay. So just imagine you have, you know, this very famous image of an iceberg and a threshold, a line going through the iceberg, that's the sea level.

And we can see the iceberg at the top, that's your older person. And below that, there's a whole lot of stuff. And below that is the process which has been accumulating for years and years and years of all of the biological biomarkers, we'll talk about those, influenced by the social and economic factors, which eventually lead, in the case we're talking about now, to health diseases or disorders, to a health outcome. So all of that's been going on for many years, as you've said, and then it creeps above the threshold and we get a heart attack or stroke or dementia or whatever. So aging is actually really the manifestation of disorders or diseases that we're very familiar with and multiple diseases because having multiple diseases is not uncommon as we get

older. An average of four to five is common. But the process that we're trying to understand are the earlier stages where it isn't a disease as such, but it will ultimately evolve into one or other disease if something isn't done about it and checked. And that's what we're most interested in. So if we come back to metabolic syndrome, what we're looking at is early physiological changes in blood pressure, that's the hypertension, and in the lipids, in fat lipids, triglycerides, cholesterol, et cetera, and in your waist-hip ratio or obesity markers, and early diabetes, just creeping haemoglobin A1c and then how they evolve into a disease state. So it might be that you then develop type 2 diabetes, full blast, or kidney disease as a result of atherosclerosis or a heart attack, etc. But it's the early combination of

those. And metabolic syndrome itself is very common in Ireland. 40% of people over the age of 50 have it. It's remarkably common. 40%. Do you know what that figure is in the UK? Oh, very similar. Yeah. Our data is almost a duplicate. And generally America tends to be a little bit worse than us, doesn't it? They're fatter and generally sicker than in Ireland and the UK, actually. So if someone listening to this wants to take action on that, to go, okay, you've said a few things there about metabolic syndrome. What can I do now at home? What would you advise?

Would you advise them to measure these things, go and see a healthcare professional, find out if they have it? How would you advise people to tackle that? So I would definitely say we should all know our blood pressure and we should know it every single year after the age of 40. Know what your blood pressure is and know what your seated blood pressure and your standing blood pressure is. Because as we get older, we're more likely to get a drop in blood pressure standing and that actually has to be managed a little bit differently. So know your blood pressure seated and standing every year. Know your lipid profile. And it's not just about cholesterol. It is about triglycerides and HDL, LDL ratios, et cetera. So know your lipid profile

every year and know your hemoglobin A1c. Hemoglobin A1c is a very good marker for diabetes, obviously, but pending diabetes and pre-diabetes. And it actually is an indicator of what your glucose has been doing over the last two to three months. So that's why it's such a good marker. It doesn't shift up and down with a food intake, etc. So at least those three things we should all know. Yeah. So what I like about that, there's a lot of talk about anti-aging now and some of the testing that has been spoken about is not widely available to everyone yet, right? I agree. Whereas the three things you just mentioned, blood pressure, a blood lipid panel, and an HbA1c measurement from your blood is pretty commonly available certainly in the UK those things are freely available on the NHS right in the National

Health Service so they're very accessible things and so if we just go into those a minute let's take HbA1c okay two to three month average measurement of our blood sugar yeah so one of my frustrations with i guess the way the practice of medicine has evolved over the years is that it's become very black or white and much of the time we interpret things in a very black or white fashion it's either normal or it's pre-diabetic, or it's diabetic, right? Type 2 diabetes I'm talking about. So, you know, if your HbA1c is 6.5 or above, we say type 2 diabetes. If it's between 6 and 6.5, we say that's pre-diabetes. But if it's 5.9 or 5.8 or 5.7, it will often be reported as normal. So I'd love you, with all your knowledge, to expand on what do you like to see with an HbA1c? You know, of course you want it normal,

but are you off the school of thought where lower is better? So when I started off as a junior doctor with respect to blood pressure, we were treating blood pressure, systolic pressure, if it was more than 160. No way. Yes. And now we're looking at 120. Hold on.

So when you qualified, it was 160 you were treating. When I qualified, I'm pretty sure it was 140 was the threshold to actually treat. And now we're down to 120. And that's because massive randomized control trials have been

done to explore this. So it's the same with all of these. We're talking about biomarkers. Everything we're talking about now are biomarkers. All a biomarker is, is a marker of your biological status. So all of the biomarkers that we use, we use thresholds because that's where the information is at that particular time. And obviously it's much easier to apply at a population level. For individuals, it varies. And you know the way there's a distribution at a population level. And of course, people lie outside of a normal distribution, many. And we're learning that that same change with respect to blood pressure is applying to a number of other biomarkers. And lower and lower and lower thresholds are being applied.

So if a patient came to see you and their HbA1c comes back at 5.9, so technically it's not yet in the pre-diabetic range, what do you say to them? I advise them. I give them lifestyle modification advice. You say, look, it's not yet pre-diabetic, but if we don't do something or if you don't do something, this may very quickly end up at pre-diabetes. And that's what we've shown in the study, that it very likely will evolve into pre-diabetes even two and three years later. So get a grip of it now when it's reversible. And grip is easy. Grip is low sugar, you know, manage your diet and lose a bit of weight. The grip for that one is very easy. There's some pretty good data now, I think, showing that

all-cause mortality is, it goes up as your average blood sugar goes up. So if we compare, let's say an HbA1c of 5.9, again, technically normal, with an HbA1c of 5.4, I've seen some good data showing that actually your mortality goes up as that goes up, right? But we're still calling 5.9 normal, which I don't think we should be anymore. And you mentioned something there, which I think is really worth expanding on, at a population level versus an individual level, right? I'm not sure everyone fully understands that concept, right? And I think it's an important one, because a lot of the time, the guidelines we're being given that doctors are applying are things that maybe, let's say, the NHS have been deemed, overall, for these 60 plus million people that exist in the country we can afford to actually manage this percentage of people if we have crossed this

threshold right so on a population level it works but individually you may miss out right how would you frame it so no I think you framed that incredibly well. So if you're near the threshold of something, those thresholds have been derived by averages, just to understand that. And so it's a cutoff based on averages. But each side of the average, there is a distribution. And we don't make recommendations based on the lower pieces of

that distribution or the lower levels of that distribution. We make it where that cutoff occurred because that's the only way we can apply things at a large scale within a health service. So therefore, when you're dealing with an individual patient, I try to deal with the individual. I give them the evidence. I say, look, this is what's, these are what the recommendations are. In my opinion, I'm knowing you, I see these, these potential risk factors. And I actually think if I were you, I would get a handle on these risk factors now when you've plenty of time. It's coming back to the 20 year olds again, there's lovely data on blood pressure to show that if you have a slightly higher blood pressure, even in your 20s, you're on a higher blood pressure trajectory for the rest of your life. Whereas the lower blood pressure group within that population distribution in your 20s are less inclined to have the higher trajectory. Those graphs are fascinating. The whole thing's fascinating. This idea that you mentioned with your TILDA study,

that you can go back. This is for people above the age of 50. Someone has a stroke, let's say, in their late 60s. If they're in your study, you can go back and go, hey, what was going on here? That's incredibly helpful. And I'm really excited to see how this data set builds over the years and what else we're going to learn

but that's 50 and above as you just mentioned with the blood pressure there we can go even further back we can actually recognise in our 20s we might be able to pick up stuff in our 20s that indicates what's going to happen when we're 60 70, 80 so just to finish off on that piece,

we started off talking about the advice you would give to a female in their 40s. Then we moved on to the advice that you would give someone potentially in their 70s, recognizing that everyone's an individual and everyone needs slightly different advice. But stereotypically, advice. But stereotypically, if there was a 20-year-old sitting in front of you saying, oh, aging, you know, that's miles away in the future, right? Why do I need to be bothered about that? Or what would you say to a 20-year-old that might make a difference in terms of what they do? So I would sit them down and I'd show them a great graph from the Dunedin study, which I'll share with you now. Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show.

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It's a thousand babies born in the same year, studied longitudinally, and they're now in their 50s. And in the Dunedin study, they looked at their whole cohort of a thousand when they were all aged 38. And at this stage of the study, they had the ability to measure their biological aging, their epigenetic clocks. Okay. So they were able to actually look at their biological clock. And of course, everybody was the same age, had the same chronological clock. In other words, number of candles on their birthday cake. And remarkably, they showed that some people aged 38 were behaving biologically like 28-year-olds, but some aged 38 were behaving biologically like 48-year-olds.

A 20-year distribution in their biological ageing, although they were all the same chronological age. That's an amazing study. And so the practical take-home for someone in their 20s is what? So the practical take-home is this process starts really early on. Now, you know, the trite thing to say it probably starts in the womb, but for an individual that doesn't help. But the process does start in your 20s and you can do damage in your 20s. When they looked back on the 38-year-olds who had the almost 50-year-old biological aging through the clocks, the factors which drove that accelerated aging were adverse

childhood events, you know, traumatic experiences in childhood, depression in childhood, or depression in a household, divorce in a household, or bad behaviors early on in life, like smoking and alcohol in the participants' lives. If we just talk about these ACEs for a minute, these adverse childhood experiences, this is something that I've covered on the show many times through the lens of trauma with people like Dr. Gabor Massey, Dr. Bessel van der Koog, recently with a chap called Dr. Russell Kennedy on anxiety. And we're seeing very clearly for many years now, data on adverse childhood experiences on how, you know, difficult childhoods, trauma, divorces, you know, abuse, the impacts of those things

play out in your adult risk of disease, illness, autoimmune disease, all kinds of things, right? But you're saying it also plays out these emotional factors, or what we consider emotional factors, that also plays out in terms of how quickly we're aging. Well, you see, because how quickly you're aging is what's driving those diseases later on in life. That's my point. The aging process, all it is, is the precursor to having one of those diseases. And the pace of that aging process, all that means is that you'll have one of those illnesses earlier. That's what aging is. Professor David Sinclair, who I spoke to maybe two or three years ago on this podcast,

who I spoke to maybe two or three years ago on this podcast, he makes the case in his book that we should consider aging a disease. What's your perspective on that? Well, I don't entirely agree with that, although I can see that there's some overlap in concepts. There isn't a diagnosis for aging as such. It's a very multifactorial process. It's something that we all will experience in one way or another. It doesn't necessarily lead to a disease outcome that we recognize. that. But also as a doctor and knowing busy ED departments, et cetera, I wouldn't like people to think of aging for which we've no cure at the moment is a disease. And when somebody comes in that they attribute something to aging and we can't do anything about it, I think that patients would lose out. Yeah, I think the point everyone's trying to make is that the aging process underpins all kinds of diseases that we get later on in life, heart disease, stroke, dementia, cancer, whatever it might be. And so if we can slow down the aging process, we also reduce the risk or at

least delay the onset of many of these diseases. I think most scientists study aging would agree with that. But I think there's a wider point here for me, which I've been thinking a lot about recently, that does appear to now be, I wouldn't call it an obsession necessarily, but the term anti-aging is something that really has got the zeitgeist now, right? People are very excited about anti-aging, reversing aging, all these kinds of things. Are we missing something about the human experience? Are we trying to defy something that is fundamentally a part of humanity? You know, we're born, we live for a separate time, and then we die. I know you know all the biology and the blood markers, and you've done all the science of aging,

but from a philosophical point of view, what's your perspective on that? That's a, it's a great question. First of all, factually, quality of life gets better as we get older. That's the first thing to say. And this has been shown by many, many studies. In our own study in Tilda, aged 50 upwards, quality of life continued to improve year on year until late 70s. And the factor which actually impacted then on positive quality of life was physical ill health. That was the biggest factor that impacted on quality of life was physical ill health. That was the biggest factor that impacted on quality of life. But the measures that we were using for quality of life,

very good tool, didn't get to the same level in the 80 year olds as it was in 50 until people were 84. So in other words, it went up and it slowly came down and it was only at age 84 that your quality of life was the same at 50. So once you've hit 50, on average, your quality of life gets better and doesn't get down to that level until you're 84. So you have 34 years of good times. Maybe longer because the only factors that were influencing beneficial quality of life, this is on average now, this is at a population level, were physical disability. So not being able to do what you were previously able to do because of arthritis or another physical illness. So is that the point for you? I think that's the point from your book is it's not necessarily

about trying to live to 150, right? The message I get from your work is that it's just about how do you make sure you've got that quality of life until you do drop down dead? Yes, yes, yeah. And living independently and having a good quality of life. They should be our two metrics for happy lifespan. So on that then, what are some of the myths that are currently being propagated, would you say, around aging? There's all kinds of talk about living to 150 or 120, 130. Well, first of all, are there any myths out there that you'd like to share a different perspective on? And I guess related to that, how old do you think it is possible for a human to live in good health? Well, for the latter question, I would answer to Jeanne Calment, who I wrote about in the book. We know, therefore, 126 is feasible, right?

Is that what she lived to? Yeah, she lived to 126. So that's feasible. I think it was 126 or 122. So we know that that can happen. That's the first thing to say. The second thing is that actually longevity is attenuating at the moment. The curve has started to slow down and flatten out in the UK since 2012 and in the US. Now, the attributable reasons for that are disparities in socioeconomic status.

That's what most of the researchers in this area would now agree in the UK. And in the US, a dominant feature driving that is younger deaths due to opiates. longer deaths due to opiates. Wow. So that wonderful linear association between years and lifespan that we've talked about for the last couple of decades seems to be slowing down. So up until 2012, our longevity was going up. In a linear fashion, 2.2 years every 10 years since the 1800s. So each generation was living longer. Every generation was living longer. Every parent wants a better life for their kids than they had. And I guess you could say a longer life potentially.

So that was happening. But in 2012, the graph started to change. It started to slow down. And particularly noticeable actually in the UK. It hasn't slowed that much in Ireland of interest, but we're behind you in terms of the numbers of people over the percentage of the population over 65 that may have influenced it slightly.

But it hasn't, yeah, but in the UK, particularly in the US and some European countries, not Northern European countries of interest. So the biggest driver for that is social disparities. I mean, Rangan, when did we ever talk about food banks? You know, I mean, it's, you know, and now they're daily, part of daily practice throughout the country. So, you know, we never thought we'd see that. A nurse

had to go to a food bank to get food. So that's the level of disparity we're seeing in society. And I know you've studied this as part of the TILDA study. Yes, we have. And I know many researchers around the world have also studied this. But when we think about socioeconomic status, we think about income, we think about poverty, what exactly is that doing on a cellular level? How is that affecting the aging process? I have a colleague, Cahal McCrory, who's actually studying this very thing across the live course and showing the biological, the epigenetic, the clock changes that we're seeing

associated with socioeconomic divides. So you've got five different groups, say quintiles of socioeconomic status, and those who are in the lower, the worst socioeconomic status have much accelerated biological clocks. And because of the richness of the data we're collecting, I'm able to say to you today that that is the case independent of anything else which might be driving accelerated aging. Yeah, I mean, it's absolutely fascinating. Let's just contrast then the lady, I think, Jean-Louise Calamon, who you wrote about in the book, the French lady who went past 120. You've written about her in quite a bit of detail, which is, it was just so fascinating reading about her story.

She had a privileged life and probably all of the components that we have got control of with respect to the aging process, she illustrated throughout her life. That's what I liked about her life. Very positive attitude. Yeah, I wrote this down. You put in, I mean, as I say, I love your book. I think it's jam-packed full of really practical information. At the time of writing, the record holder for longevity for the human species at 122 years and 164 days as a French woman, Jean-Louis Calment. And, you know, there's many paragraphs on her, but this one I wrote down, and I think this really speaks to what we're talking about

with socioeconomic status, which is, Jeanne never had to work. She employed servants and led a leisurely lifestyle with an upper society, pursuing hobbies such as fencing, cycling, tennis, swimming, roller skating, playing the piano and making music with friends. In the summer with her husband, she would mountaineer. She enjoyed an idyllic, relatively stress-free and fun-filled life. Now, you can interpret that two ways. You can either

interpret that and go, okay, wow, that has shown us what is possible. And I can see that the various elements that you write about in your book, a lot of them are, you know, are there within her story. Or that can be incredibly off-putting to people and go, yeah, all right for her. My life is completely different to that. No wonder I'm struggling. So how do you make sense of that? Well, I mean, you're a doctor. I'm a doctor.

You sit down in front of somebody. You talk to them about ways of alleviating stress. But you know that they're finding it hard to make ends meet. And it's a terrible problem. So you've just exemplified that issue. I struggle with that. I mean, I know what the facts are. I know what works at a biological level. So now we're going into how important this is at a sociological level, at a societal level.

How can we change society to enable all of the things that we know will work? And frankly, everything we're talking about here that individuals can modify, they don't cost money by and large, but you need not to be stressed about how to feed the kids throughout the week at the same time. So one of the things that we've learned from our research, certainly, is education, education, education. That education drives better quality of life, less stress, and higher income in later life, if you can achieve that in younger years.

So at a societal level, one of the things that we certainly can do is protect education for everybody and ensure education for everybody. So that's one thing. And then I think we need to be mindful of how closely those societal issues are linked to health. And it's only going to cost us long term in the health service if we don't address them well you know that's the real frustration about this whole topic and area is that we're just kicking the can down the road each government coming in is just trying to win the next election right and they're not thinking about 30 years 40 years down the line because they'll be long gone they won't be in power power by then. And it's a real problem because it's not rocket science to figure out if you

feed your population well, if you provide for them, you make it easier for people, actually people are going to be healthier. They're going to live better. They're going to put less strain on the health service later on in life. But no one's kind of doing that. But one thing I will say, and I think your book really speaks to this, a lot of the things that people can do to slow down aging are free of charge, right? They are. And I, like you, have worked in areas where people are struggling to make ends meet. And even within that, you know, I can't change the poverty. But if you can really connect with that patient and help them understand how, you know,

10 minutes of meditation or prioritizing 20 minutes with your kids or your partner each day, or it is worth on that Saturday afternoon going and nurturing your relationship with your friends and your family, whatever it might be. Those things make a biological difference. So I guess I'm trying to say is that, yes, we want to change society. We want politicians to get involved

and societies to be more equal, less disparity between rich and poor, all those sort of things. But we still, even in an unequal society, yes, it's challenging, but we can help people make better choices, can't we? And we have to take control of this ourselves. And you've written about this. No matter what, even breathing exercises, anything which will enable de-stressing is very important. And that only takes a few minutes a couple of times a day. The other thing I think that we can take control of is community, ensuring community, engaging community, being more engaged in our communities, volunteering. So volunteering will help others who are stressed. And most of the volunteering is now done by people who are coming into their third, fourth, you know, wave of life. And 70% or something is the figure. And they,

they get so much benefit from volunteering. Mental health problems are significantly less. Quality of life is more, is better. And disability is less. We've shown this objectively in people who volunteer. And that's not because they were well enough to volunteer. That's longitudinally people who do it are less likely to get those negative outcomes. So volunteering is really good and volunteering gives back to the community. And volunteering may well help to buffer some of the challenges that we've just outlined. I want to talk about attitudes, our attitude towards life. Because if I continue what you wrote about Jean-Louis Calamon,

you write that she did actually move into a nursing home, I think it was after a fall, aged 110. But again, some really interesting things there, that even though she was in a nursing home, Calamore initially followed a rigorous daily routine. She was woken at 6.45am, started the day with a long prayer at her window. She thanked God for being alive and for the beautiful day that was starting, underscoring her positive attitudes and outlook. Then she sits on her armchair and does gymnastics wearing her stereo headset, right? So this is

fascinating. I've got this wonderful image of this 110-year-old lady basically practicing gratitude every morning, right? And we've touched on gratitude several times on this podcast over the years. There's really good research on gratitude. It seems as though she naturally had this positive attitude. From what you know, from what you've studied, how important is attitude to the aging process? Hugely important. That's what I would say. Probably, you know, the most important thing that now it's hard to change your attitude. I mean, attitude is very much about being an optimist or a pessimist, you know, but knowing it's important, people might be able to put more

time and effort into creating a positive attitude or being positive or less negative about things. And we talk about resilience in the science of aging and what makes some people resilient and others not. And how you perceive yourself aging and your attitude towards your own aging and towards others is a major factor. Again, in the TILDA study, we have shown, we've measured perceptions of aging or aging attitudes at baseline and obviously follow up. And people who saw themselves as 20 years younger than their age, as I do, actually were physically fitter and mentally, cognitively better, independent of all of the other factors we were able to adjust for 10 years hence. So it matters. So the phrase you are as young as you feel actually has

scientific validity yes it's biologically embedded i mean that is yeah it's just fascinating that you know i i think a lot about i guess what might be considered the more softer aspects of health, right? Attitude, our perception, these kinds of things. But really, they're not so soft when you start studying them. There's actually hard data on them. I spoke a few months ago with someone called Professor Anise Mukherjee. She's, you know, very, very experienced consultant endocrinologist, a women's hormone expert. And in the conversation, which is all about women's hormones and the menopause, I shared with her some research that I came across showing that in societies where they perceive aging as a good thing, they associate it with wisdom in life experience, people report less menopausal

symptoms. Right. So I'm very keen to say, I'm not saying that menopausal symptoms don't exist, nothing like that. I'm well aware that they cause huge amounts of problems for many, many women. But it's fascinating to me that when we have a perception in society that actually aging is a good thing, people report less symptoms. And I think that sort of fits with what you're talking about. So perceptions are internal, okay? They come from ourselves, our personality type, if you like, and factors that have influenced us through our lifespan, through the life course, which make us. But also from society, then that's a really good point that you've raised.

If you're constantly getting negative ageist attitudes from the media or from individuals or whatever, very hard for you to retain a positive attitude and an optimistic attitude when you're being bombarded by, in some cases, subliminal ageism. Now, I think that is changing. I even have seen a change over the last decade. I think it's changing. But unfortunately, during COVID, initially, in the initial stages of COVID,

we encountered so much ageism in the policy approaches, the quick fix approaches. We don't need to go into it now but i mean you know the whole approach to people in nursing homes the whole approach to older people being discharged from hospitals etc i mean a very very ageist approach the whole approach to letting people die on their own and not let their families be with them you know the whole thing was was catastrophic so so and then and the language that was being used by the media at the time, people were being called out because of their age, an 85-year-old woman who had multiple diseases, died, et cetera. Now they stopped that. And I noticed it changed during COVID because of the

backlash. In Ireland, we used a term, which is a terrible term called cocooning. So everybody over the age of 70 was asked to cocoon, which meant that they stayed in their home and didn't engage with anybody. So the subliminal implication of that is you're 70. Society no longer needs you. You aren't of value. It's, you know, you can stay there cocooned, terrible word, and no one will notice the difference at a societal level in terms of your input to society. So it is changing, but, and I was very optimistic and then COVID hit and I saw just this negative attitudes towards aging, just enveloping everybody again.

Yeah, I think it's just worth pausing there a little bit because I really feel strongly that these lockdowns, this social isolation piece has been so toxic for so many people. A couple of sort of points I just mentioned from my perspective. I remember a couple of years ago, maybe after the first or second lockdown I can't remember when once the leisure centre had reopened and I went to go and have a swim I was chatting to the guy at reception

who I hadn't seen for about six months and we were just having a bit of a chit chat and he was just saying people have changed he's like people in their 50s and their 60s and 70s who six months previously he said would come in bright chatting they're now withdrawn they look older they're not saying much right and and this is the impact you know of course there's many things there worry fear anxiety whatever it might. But there's no question that isolating people has had really toxic effects.

There's no question about that. Everything you've said, unfortunately, is factually correct. In the TILDA study, the loneliness increased threefold during COVID. So we were able to track that because it's longitudinal. So we knew what the loneliness parameters were that we were measuring before COVID. And it increased threefold, as did depression increase threefold, independent of anything again. And we know from animal studies, if you put a monkey in a cage on its own, because we're gregarious animals as monkeys are, in a cage on its own, because we're gregarious animals as monkeys are,

in a cage on its own, and then biopsy the lymph node, which is the engine house for inflammation and immunity, you can find that the genes in the lymph node are upregulated for inflammation and downregulated for the factors that protect our immune systems. And it's well known with social isolation, you're more likely to get colds and flus and viruses. So there's biology, but it's the long-term toxic effects because inflammation is probably, if you were to identify one thing that accelerates the aging process

and is culpable for the, are causal for the biological changes, it's inflammation. So I think it, I think that the social isolation has indeed caused biological consequences, which may long-term be toxic, but worse again, people are finding it really hard to reconnect. Now, this isn't only older persons. Younger people have also suffered a lot and continue to suffer. So it's something we have to address as individuals to be aware of it and to reach out as much as possible. I think, you know, humans are creatures of habit. You know, we get used to new normals very, very quickly. we get used to new normals very, very quickly. And I really think we've been deceived by convenience, right? There is a cost to convenience. It is more convenient to meet up with your

friends on Zoom. You don't have to go anywhere. You just, you know, in your kitchen with your coffee, press join, and you feel you're interacting with them. Now, of course, that can have benefits, particularly for people who live far away, but it ain't the same thing. And I also have seen with so many patients and so many friends, they used to go to classes, whatever it might be, yoga, martial arts, singing. But over the last years, they went on to Zoom and they've never returned back. But that convenience, I think long-term can be toxic. And I don't know how we start reminding people. I keep saying it on the show. I want to try to remind people to go, listen, you want to do 10 minutes of yoga every night on YouTube? Great. But still sign up for that weekly class

that you used to go to back in 2019. Because you get so much more from that class bar, the yoga, you get the social engagement. And that is, we have evolved as gregarious animals. We have to do it. Talking about community, in your book, you wrote in detail, was it Rosetta? Rosetta, yeah. And it was truly fascinating. So I wonder if you could talk us through Rosetta and what does that teach us about the power of community and social relationships? This is a great story. And it was probably the start of the link between social

sciences and health. So Rosetta was a town, a small town in northern Italy. And in the 1800s, they needed to emigrate. There wasn't any employment. So, they emigrated to a location in the States, in Pennsylvania in the States. They called it Rosetta, the town in the States. And they replicated an awful lot of their lifestyles in Italy in terms of the infrastructure, the way the town was designed, etc. And then more and more from Rosetta, Italy, emigrated to Rosetta in the USA. And a scientist called Stephen Wolfe, he wasn't a scientist, he was actually a gastroenterologist, but he got interested in epidemiology and he was very interested in the brain-gut response and interaction and network.

So he had a holiday home near it and he gave talks to towns and villages nearby. And one night he was speaking in one of the towns and a GP came up to him, a general practitioner, and said, you know, you're talking about what was the big killer at the time, cardiovascular disease in men in their mid 40s, 50s in the usa he said i'm i'm working in this town it's one of two or three towns i work in nearby and i'm seeing i'm not seeing that i'm seeing people living well into their 65s and beyond this is in the 1900s 1930s and 40s um and and he said i'm definitely seeing something different there than the other towns I'm working in nearby. So Stephen Wolfe didn't just take that as a, you know, he went with medical students the next summer.

They took over the town hall and they did all of the measures we know lead to longevity because in the interim, he checked their death rate books and found that, yes, it was true. They seemed to be living longer in Rosetta and he found no suicides, et cetera. So they went and they installed themselves in the town hall and started doing blood pressure. They took blood tests for blood glucose at the time, et cetera, and they couldn't find anything. Then they looked at diet and they couldn't find anything. And I'm sorry to say, but they actually found that they were eating, you know, quite, quite luscious pizzas regularly. And he looked at everything he could think of. Smoking wasn't more common exercise. There wasn't any difference in all the factors we're talking about. And he was sitting one morning in the town square in Rosetta on a Sunday outside the church. And the

next thing, the church doors opened and everybody piled out of church. But they didn't move from there. They stayed outside the church. And for an hour or two afterwards, they were still there chatting, kids running around, mixing. And he realized that the secret of longevity in Rosetta was Rosetta itself. And then he started to explore their social engagement, their social networks their social infrastructure three generations living in one household for for a town of 2 000 civilians at the time there were 22 different civic societies people were always doing something so that was he then he got other researchers from his university involved who were interested in social

scientists, and they started this whole research field, which is so huge now, of how important sociology is in determining our health. It's just fascinating, and particularly what you said, their diets probably weren't that good because of course we're trying to promote healthy lifestyles but what what does that mean you know if you could live by yourself and hit all your exercise targets and hit a clean organic no sugar diet sleep eight hours a night, right? But you didn't have community. You didn't have connections. You know, who would be better off? And I'm inclined more and more to think that social connections are right at the top of the tree. I actually, I believe that. That's why I started when I made my list at the beginning. You asked me what were the top few things and I said

friendship. You know, that's social connection. that's friendship, that's engagement. And we know ourselves, if you've had a good night out in my case with the girls, with lots of laughter, and you know, there'll be a couple of drinks involved potentially, very likely, the next day you feel so good. And it's been such a good experience. So we know this. It's intuitive. And yet we need to make an effort, particularly since COVID, to build that now back into our daily routine. Yeah. And you come back to your yoga.

That's why it's so much better to go to the yoga class and not do yoga on YouTube on your own all of the time. You write about the blue zones. And, you know, I'm interested, as someone who studies aging, what is it about the blue zones that you like so much? You know, what is it that they can teach us? But what is it that they can't teach us as well? Before we get back to this week's episode, I just wanted to let you know that I am doing my very first National UK Theatre Tour.

I am planning a really special evening where I share how you can break free from the habits that are holding you back and make meaningful changes in your life that truly last. It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really complicated, but it really doesn't need to be. In my live event, I'm going to simplify health, and together we're going to learn the skill of happiness, the secrets to optimal health, how to break free from the habits that are holding you back in your life, and I'm going to teach you how to make changes that actually last. Sound good? All you have to

do is go to drchatterjee.com forward slash tour, and I can't wait to see you there. This episode is also brought to you by the Three Question Journal, the journal that I designed and created in partnership with Intelligent Change. Now, journaling is something that I've been recommending to my patients for years. It can help improve sleep, lead to better decision making and reduce symptoms of anxiety and depression. It's also been shown to decrease emotional stress, make it easier to turn new behaviours into long-term habits and improve our relationships. There are of course many different ways to journal and as with most, it's important that you find the method that works best for you. One method that you may want to consider is the one that I outline

in the three question journal. In it, you will find a really simple and structured way of answering the three most impactful questions I believe that we can all ask ourselves every morning and every evening. Answering these questions will take you less than five minutes, but the practice of answering them regularly will be transformative. Since the journal was published in January, I have received hundreds of messages from people telling me how much it has helped them and how much more in control of their lives they now feel. Now, if you already have a journal or you don't actually want to buy a journal,

that is completely fine. I go through in detail all of the questions within the three-question journal completely free on episode 413 of this podcast. But if you are keen to check it out, all you have to do is go to drchatterjee.com forward slash journal or click on the link in your podcast app. So certainly from the blue zones, a lot that we've already rehearsed with respect to Rosetta is evident in the blue zones. already rehearsed with respect to Rosetta is evident in the Blue Zones.

They're sort of an exaggerated Rosetta in that there's a fantastic community activity. There's a wonderful talk by a social scientist who went to Sardinia and she was engaging with this man who was over 100. He was in his kitchen sitting in the corner and she went to interview him. And she said she didn't get a word in edgeways. There were three generations living in the house. And then the way his kitchen was positioned, it was the road outside the house was right beside the kitchen window. So everybody passing would see he was sitting there and they'd hop in to say hello. Some of them he liked, some of them he didn't like. He engaged with them all, but after they were gone, you know, he would say sometimes, can't stand that man or something.

But her point was she couldn't get a word in edgewaged because there was so much activity in the kitchen. It was like a railway station. And it occurred to her, of course, this is contributing to his longevity. He's constantly being distracted and variety and engaged. So never been left isolated, never been left alone. At no stage was he alone. And for people who've never heard the term blue zones before, perhaps it's worth just giving a top line overview.

There are five blue zones and they're important. They're called blue because when they were first identified by the scientists who originally identified them, they marked the zones with a blue marker. So it's no more exciting than that why they're the blue zones. But they're actually in quite disparate areas of the world. I'll tell you where they are. There's Loma Linda in California. It's an Adventist group. And sorry, just to say that underpinning the blue zones is that they have a disproportionately high number of people living to 100 and beyond with good health. Yeah.

Okay, so that's what it is. So Limalonda, the other one is in Nicoya in Costa Rica. Then you've Sardinia in Italy. And the blue zone, why Sardinia is a blue zone, is people there disproportionately live longer and healthier than mainland Italy, just beside them. Ikaria in Greece, also an island, and Okinawa in Japan. Now, already you'll think, ooh, they're islands, by and large, not all. They're by the sea, and they're all on elevated heights. So,

they're not at sea level, but they're elevated. Now, the things that they share in common, which scientists now believe have contributed to the exceptional longevity, but healthy longevity, or I've described to you great social engagement and civic engagement, community engagement. But also their diets are pretty much plant based. That's one thing they share in common. I'm not saying that these are exclusively associated with longevity, but certainly factually they share this in common. Secondly, no processed foods, little or no processed foods, low salt, low sugar in their foods. And they never eat to satiation. And actually, I have a scientist friend, Giovanni, who was working in Sardinia for a while, who's really interested in biological clocks.

But he's from mainland Italy. And I asked him, what did you notice different about Sardinia? And he said, they don't deliberately do calorie restriction, but they are calorie restricting, he said, and fasting. They don't deliberately do, you know. How are they doing that? They just don't eat as frequently and they don't fill the plates as much as we do. I mean, I appreciate this is secondhand now. You were chatting to one of your colleagues who was there. But is there any more flesh on the bone there? Like what time were they eating? Did they have smaller plates? Did they finish eating earlier? So they had smaller plates.

Smaller plates. Smaller plates. I think that, by the way, I think it's one of the best hacks you can do to eat less is just have smaller plates. So they have smaller plates. And you perceive you have more. Exactly. Just from that. Yes. Smaller plates, predominantly smaller plates. And very often wouldn't have a full breakfast.

Their meal would be a lunch and an evening meal. But neither of those were too heavy in terms of food intake. And then the other things that they had in common were physical activity, as we understand it, was built into their day. It was never cold exercise, but they did a lot of walking. They walked everywhere when they needed to do something. I saw a video by one of the original scientists

who discovered the blue zones of a woman in her mid-90s chopping firewood. And she had done that every day of her adult life and she went out the back. In her mid-90s. In her mid-90s chopping firewood and she had done that every day of her adult life and she went out the back and in her mid-90s chopping firewood but this was part of her routine like jean-marie calmant it was part of her routine you know what i love about that there's no kind of fitness tracker on her on her wrist she's not going i need to hit this amount of aerobic a week this amount of strength a week she's just chopping woods.

She's getting cardio. She's getting strength. Her VO2 max is going up. And that's the fascinating thing for me about the blue zones. But if we talk about exercise for a minute, clearly physical activity is important, right? And right at the start of this conversation, when I asked you, if someone was in their 70s, what would you say to them if they wanted to say, Professor Kenny, how can I slow down aging? How can I make sure I'm as well as I can be when I'm 80 or 90? One of the things you said was to do more, move more. And I know I've heard you talk about that before, and it's something i've become aware of now i'm in my mid-40s but i'm realizing that actually movement yes i was trying to people at this family do at the weekends i was saying one thing i'm realizing you just cannot get away

with not moving once you stop moving it goes downhill very rapidly. And as you get older, you've got to move more. And so I'm massively increasing now how much I move. And a lot of this is just, it's not anything flash. It's just walking more, just walking an hour a day and then trying to, you know, just trying to build that in more and more. But what I find fascinating, particularly as aging is being spoken about and sold to a lot of us in the health space it's a lot about tracking and hitting various metrics and this will be good for your strength this will be good for your heart this will be good for cardio and what you see in the blue zones is that no one's measuring a damn thing right these guys aren't thinking about oh i need to get my

resistance in i need to get my cardio in what's your perspective on that because that's fascinating that's really really interesting so i don't do any tracking or anything because actually frankly it would stress me um uh i i i think with respect to the blue zones it was built into their natural day so for us how would we do that yes go for a walk. But also when you've to nip down to the shop for groceries, give yourself the extra 10 or 15 minutes to walk down to the shop or get on your bike. I cycle to work all of the time because some days that's my only way of getting any activity into my day. And that is very doable, you know, to there are other opportunities. The other thing about the Blue Zones is they did them in nature.

So there was a lot of nature, the sea, obviously, but also a green nature. And I think we underestimate how good nature feels. There's also, though, purpose to their movement, right? And again, I think really trying to go deeper below physical activity you know as you said at the start right you were in an irish television interview talking about diet and exercise and the tv presenters like oh come on you know it's it's almost boring people have heard it that many times right but we know movement is important and we're well aware that in Western society now, frankly, in all societies, our jobs are sat down. We're sitting in cars, we're sitting on sofas, we're on Zooms.

So it's harder. In the blue zones, I know a lot of them, it's part of life. You have to move to get food. You have to move to get in the garden and pick the vegetables. So it's not as if they've necessarily got more willpower than us. It's built into how they function. But the thing I've been thinking about, Roseanne, is that movement has a purpose to it. Walking to the shops has a purpose to it. Standing on a treadmill, right, or walking on a treadmill, or running on a treadmill, like if you got someone from a tribe, and you put them on a plane and

brought them here, can you imagine what they might think looking at someone in a gym in their lycra on a treadmill going, yeah, but they're not going anywhere right and i guess look i get it i'm not saying there's no purpose to it but it's it's quite interesting that the movement has a purpose that lady in a midnight is chopping wood well that's for a purpose for the fire yeah but we're often doing movement without any purpose we're trying to meet a very dry public health guideline 150 minutes of moderate activity a week. Now I understand we need guidelines, but I just think sometimes they're so dry. They don't have, I don't think they connect with people. But you can flip that. Look at your day and say, okay, if I want to build

walking or cycling into my day, what is it about my day that I can restructure slightly? So it's not, you know, as you, you know, that, that fixed interval, but just a liquid part, a fluid part of my day. I've got some people now in, in the hospital I'm working in who've looked at that and thought, okay, the solution is I'm going to walk X, you know, three quarters of my way to work or whatever I can possibly do. Give myself that little bit more time in the morning and make that happen. I'm going to have face to face meetings with people rather than Zoom people and make myself go to their office. And OK, it'll take more time.

But actually, A, the face to face is good for both of you. You get a much better outcome. I think this face to face interview is betterface is good for both of you. You get a much better outcome. I think this face-to-face interview is better than if we did it by Zoom. But also you're getting your so-called activity built into the day. So we can make a difference. We can walk to school with the kids in the morning.

It is feasible for most of us. And I think we have to look, I just want to acknowledge that some people I know can't walk anymore. They struggle with movement. They might have an illness. They might have an injury. They might be in a wheelchair. So I want to acknowledge that and make sure we're including them within the conversation. And of course, if one is in a wheelchair, let's say you can move your arms, for example,

then there are movements that you can do. In fact, Jean-Louise Calment, as we mentioned, when she was in her nursing home, you know, she did gymnastics every morning while she was sat on her armchair. She would flex and extend her arms and her hands and then her legs, right? Oh, this is interesting. Nurses noted that she moved faster than other residents who were 30 years younger, right? So that's really, really interesting to me. And I don't know how you do this. I have a few kind of personal movement rules, as it were, which I really try and apply.

And I've really tried to apply them even more since I had children. So one of them is I will very, very rarely take a lift or an elevator. Me too. I'm always taking the stairs at the airport. If I do drive to the supermarket, I park the furthest away I can from the entrance rather than the nearest one. And my kids now know. And actually, the great thing is, because the kids keep seeing this and they've seen it for a number of years and they know, like if we go to the local supermarket and we've parked we'll always take the stairs there and back with our bags I think once recently

I'd hurt my foot and I was thinking oh you know should I get the lift I was looking at the lift and I think my I think it was my son said come on daddy we always take the stairs and I thought yeah good yeah I'm taking the stairs yeah and so again trying to flip it to go where can we in our modern urbanized let's say western lives how can we put in practices and rules that become our norm do you know what I mean it's what becomes our norm whenever I get off a plane I'm taking that. I've been sat down. I don't want to take that escalator. And honestly, normally I'm the do, I always take the stairs at work rather than the elevator. And it's six flights up and I feel great after it. And sometimes I do it

two or three times a day and that I'm thinking, well, at least I got that much in. So we can build it into our days. It's a mindset. And you said earlier on convenience and since COVID particularly with Zoom and convenience,

that's all about convenience as well. So it's a different way of looking at convenience and actually flipping it to our benefit. Two things about movement that I'd like your perspective on. One is sarcopenia. The other one is how fast we walk. Can you speak to those two things? Because they're really interesting and super relevant to how we age. So sarcopenia is a fairly new diagnosis, if you like, or disorder that we've become aware of. And it's an infiltration of skeletal muscles. They're the muscles we use for moving. And it's very much age related and much more prevalent than we thought. I mean, in people who don't move much, 70% have this sarcopenia. And what it is, it's fairly toxic to skeletal cells. And actually, sarcopenia is probably underlying what we know of as frailty, because muscles maybe haven't been

moved as much as they were moving, because that's how you prevent sarcopenia, by keeping muscles moving, continuously waking up those muscle cells and muscle tissues to keep functioning. And as we get older, they need to be reminded to keep moving. And is this particularly resistance training, strength training that we're talking about here, or is it just generalized? It's predominantly strength training. It's predominantly strength training. Why is it, do you think, that we need guidance on strength training, which makes people think about the gym, which is off-putting for many people,

yet in the blue zones, from what I understand, the people who are living to 100, 100, 500, 100, aren't really going to the gym. No, but they're doing strength training because she was chopping wood and they're lifting the crails of fish that they carry in from the sea, et cetera. And they're, you know, they're going to the stores and walking back with their bags of whatever they're carrying, et cetera. I mean, strength training is, it can be part of an aerobic exercise part of a walking exercise it doesn't have to be deliberately weight lifting again your analogy of the treadmill was brilliant likewise they came and saw people lifting heavy things while seated on a very strange chair in a gym you know that would have the same probably to keep their back straight and in a certain

positive like what what are you guys doing what the hell is this about so so we can do we can build strength training into our into our daily routine as well we we um just because of the way our society has evolved we're not really doing strength training that much as part of our day we buy the wood in in the local supermarket and then throw it in the boot of the car and drive home, etc. So that's why we have to focus more on strength training. It's been eroded everywhere, like even for those people who engage with online shopping, which is very common these days, right, which is verysaving. But a lot of online shops now, the driver will bring the shopping in and put it in your kitchen, right? Now, I get it. Not everyone does that. Not everyone

has access to that. But it's just another example of how bit by bit, any movement that we did have is just being slowly eroded away. It comes back to the convenience thing. Everything we're doing is about convenience. But in fact, convenience isn't necessarily what's best for us. So... Do you strength train? I do. I do weights. I'm one of those people that they'd be shocked at. When did you start doing weights?

I have always loved the gym. Oh, you start doing weights? I have always loved the gym. Oh, have you? Yeah, I've always loved the gym. So this wasn't, it wasn't that your research taught you things that you thought, wow, I need to get in the gym. No. You were already doing it. I've always liked the gym. So I've always done the gym. Not as frequently during the week when I had younger children, et cetera, but I've pretty much always done the gym. Okay. So what in your behaviours has changed on the back of your research? Right. The reveal moment. Oh, it has. It has. Definitely my diet has changed. Really? Oh, yes. Absolutely. Like I wouldn't dream of having a bar of chocolate now.

I mean, or anything I try really try hard not to have processed foods. Now I will. I clearly have processed foods that I can't help. But but but generally speaking, my diet has changed an awful lot. I don't eat nearly as much red meat. I eat much more fish and much more vegetables, nuts and seeds, etc. Whereas I wouldn't have done that before. So diet, definitely. I've reached out to friends. I was working really hard, focusing on my family, and I hadn't been engaging as much at all. And I've reached out to groups of people that I went to school with, that I went to college with, and we're now all part of different WhatsApp groups. I'm on four different

WhatsApp groups from my past. Is that still good? WhatsApp groups? It's brilliant because now we're meeting up regularly. So one group meets once a month, another group meets twice a year, whatever. But we're meeting up and it's fantastic. And the thing about meeting up at this stage in your life is, you know, there's no baggage. You have nothing to lose. You're not, you know, it doesn't matter who you are or what you are. You knew this person in a time gone by. You shared an awful lot together.

That's so different from anything you'll engage with with somebody new now. And it's very precious and very rich. It's a fantastic experience. We've a great laugh. There's a lot of sharing. And if somebody in the group isn't well or whatever, they share that and we bolster them in that. So that's been something different. I don't drink as much. So I'm talking about alcohol. Alcohol. So I try not to have, I mean, I don't drink at all at the moment and I have very long

periods when I won't drink at all. And how do you find that? You live in Dublin, right? Yes. How do you find that socially? Much more socially acceptable now than it used to be. When I was going to college, or as a young doctor, we worked hard and we played hard. That was what we did. I find it socially much more acceptable, particularly with the younger people and younger students and doctors that I'm engaging with. The drinking culture is changing definitely now.

They may be using other substances, but there's certainly, I think it's more acceptable now for people not to drink. It was interesting when earlier on in our conversation, you mentioned, you know, what you do in your 20s really can make a difference in terms of how you age. I was thinking back to my days in Edinburgh as a medical student thinking, you know, I'm not sure much of what I was doing back then was helping my aging. But I guess related to that, one of your other core messages is that it's never too late. No, it is never too late. It's never too late to make a change. And I think that's a really important message. Can you just speak to that a little bit? Because people may go, oh yeah, in my 20s this happened, or in my 30s

and 40s I was a carer. I was really, really stressed. We can still make changes, even if we've had maybe some toxic behaviours in the past? So, OK, I'll approach that in two ways. We certainly can make behaviours and there have been changes that make a difference. There have been studies of patients in wheelchairs, for example, who have started strengthening exercise programmes, upper limbs or whatever they can, whatever they can move. And they've had an overall benefit, including a benefit in some of the epigenetic activity by doing that. So that's that cohort. So I use that as an example because people would assume, oh, you know, I think very often that that's not something that you're going to modify, but you can within the context of whatever your disability, you can modify other beneficial aspects, including sarcopenia.

But the second thing is there is a recent study, a randomized control trial, where four different interventions were used. One half of the study just carried on as ever. used. One half of the study just carried on as ever. And the other half of the study, modified diet, did exercise to 60 to 80%. So whatever they could do maximally, they did it to 60 to 80% for 30 minutes, five days a week. Would that be the equivalent of, let's say, a brisk pace walk? A brisk pace walk, so you're too breathless to talk. Got it.

So nothing crazy. Simple stuff. So they modified diet and the diet was very much a microbiome focused diet. So lots of diversity, polyphenols, carotenoids, etc. Probiotics. And the exercise was as we've discussed,

but they also did breathing exercises a few times a day to modify stress and to calm stress. And they also worked with sleep and invoked different measures which would improve sleep. Epigenetic markers were measured at the beginning of the study. That's the biological clocks I was talking about earlier on. And the study lasted for eight weeks and at the end of the study. And remarkably, I think, in the cases which had these changes, these interventions in the eight weeks, everybody complied. That was the first thing. They watched compliance very carefully. Epigenetics showed that their aging clocks had reduced by 3.6 years.

Isn't that amazing? Hold on, hold on. In eight weeks. Okay. In eight weeks, by focusing on small changes in our lifestyle, small changes that are under our control yeah they could change their biological aging by over three years yes in just eight weeks yes that is utterly remarkable

it is now i don't know whether that would be sustained i can't imagine it would because what i'm saying is that there must have been a rapid change over the acute phase while the systems were being rebooted. And then the calibration would kind of stave off. Well, it's a bit like, I don't know, if you are completely untrained, you don't lift weights or anything, right? And then let's say you go to the gym. The first two weeks, you're going to start seeing muscles popping out everywhere. You know, your body is going to start adapting very, very quickly. And then that can often start to plateau,

unless, of course, you're challenging it in different ways. It's that kind of biological principle, really, isn't it? Yes, yes. And there will be further studies to look at it. I mean, they just looked at this eight-week period. But this is the first study to look at it. I mean, they just looked at this eight week period, but this is the first study to look at an intervention in older male adults like this, which has shown a change in the epigenetic clock. So there will be other studies looking longer term, et cetera, et cetera. You know, you mentioned epigenetic clock, right? And if I go back to the start of this conversation where we were discussing that 80% of our aging biology is within our control. So what's going on with the other 20%?

Is it genes? And when you say epigenetics, what do you mean? Okay, great question. So genes are the 20%. Epigenetics are the 80%. So the epigenetics are the dynamic, movable features that are on our genes, which are influenced by the environmental factors we've been talking about, like diet and like exercise and like social engagement, etc. The genes are the fixed DNA, which in animal models we can manipulate and change, but not in humans. So they're the fixed bits. We can't do anything about the genes, but the 80% are epigenetics. So they're methyl groups that are stuck onto the genes that are kind of opening up and closing down and opening up and closing down. kind of opening up and closing down and opening up and closing down. And they're giving signals to the cells to produce this protein, to make this energy in the cell, to get the autophagy going,

which is the truck that gets rid of the toxins that the energy produces from the cell, etc. So the dynamic piece of the process is what we refer to as epigenetics. And we have a way of measuring that, and that measurement gives us biological aging of the cell. In other words, the vitality of the cell. Yeah, really, really interesting. So what we can actually do about it. You know, Roseanne, one of the things I really, really liked in your book was in the introduction. I'm just going to read it to you because I think it is so, so key. I'd never ask a patient their age, but rather base decision-making on an assessment of a person's biological age derived from a traditional physical examination and history. No two 83-year-olds are the same. One can run a marathon and the other is a frail

nursing home resident. So making a clinical treatment judgment is very different for each and not related merely to a number. Now, I think this, I think, sews together quite a few things that we've been talking about today. I think, sews together quite a few things that we've been talking about today. How much our perception of aging influences how we age, how quickly we age. But also, if I think about us two doctors sitting here having a conversation, we can stereotype patients. You know, how do we report, how do we present case histories right to our colleagues okay 58 year old male um you know two children works as an accountant you know stereotypes literally start to influence how our colleagues are going to hear that story

right and i think it's really good for all of us to be aware of our biases, right? Because it's like time, right? This is getting quite philosophical now, but it's like time, right? One hour of time. Yes, we can measure it by a clock, but one hour of watching paint dry and one hour of having, you know, a beautiful conversation with you who's flown over from Dublin to have this conversation with me in my studio, it's a completely different experience. It's the same one hour, but you can't really compare those two one hours because the experience is so different. And in the same way, this whole thing about asking people how old they are, like more and more, I think it's highly

problematic because we're conditioning what we think they should be doing or how much they can do simply from an age. And we all know people in our lives of the same age who are, you know, wildly different, don't we? Yeah. That, your analogy was fantastic there. We're, well, I can only speak to my own profession, and yours is medicine. I think we're really bad at stereotyping. And then that's coupled with how we deal with somebody, how we manage their condition, et cetera,

and how we view their prognosis. Now, I don't have solutions for that. I don't know how we step away from that. I say, when I'm teaching, I say, don't ask people their age. You know, you make a judgment call on your assessment. And that's really important, because that will make the young doctor actually look at how somebody's walking. How often do people actually measure?

And I'm always saying right so what's their walking line that i didn't get them up or you know it was late at night or whatever but we need to watch people's gait make judgment calls on objective measures like that rather than than age but i don't have a solution to that it's just i look i think not everything has a solution for it but i think for me the the take home is just be aware of it. Just be aware of that bias, not only for a doctor, but when I'm interacting with anyone in my community or friends or their parents, you know, don't just assume that because someone is a certain age that they will want to do certain things or, you know, certain things are off limits, for example.

In that context, it's awfully important to ask people about their past. You get a completely different patient in front of you if you find out what their life was like, what they did. I mean, suddenly it's like a black and white drawing becomes full of colour. white drawing becomes full of color yeah when you and it easily it makes it much easier for you to contextualize your engagement with that person and how you're going to treat them well that's one of the joys of our job isn't it yeah that's one of the joys of being a doctor is you you get this really intimate window into your patient's lives. It's deemed okay in the patient-doctor interaction to open up about things that in other settings wouldn't happen. So I would say that's one of the great privileges of being a medical doctor.

You get to experience stuff. But we feel so much better, you feel as an individual, so much better about having shared that with someone. I mean, that's why I am passionate about medicine, because I think that it affords us opportunities of engagement that I don't think a lot of other professions do, but also passionate about slow medicine. And we're losing that. So tests have become much more sophisticated, much more easily accessible. And very often we don't give enough of time for the patient to tell us what they think is going on. They, by and large,

will give us the diagnosis in 90% of cases. I completely agree. So when I was at medical school in the end of the 1990s, we were told by our professors back then that the history is everything. Yes. Right? Or most of it, right? So what the patient tells you. Yes. I've been practicing for over two decades. I passionately believe that if you give patients time and space, they will pretty much tell you almost everything that you need to know. So do I, yeah.

In this era now of, you know, fancy testing, diagnostics, do you still share the same viewpoints? Oh, I believe that, absolutely. And I'm practicing and I get virtually everything I need from spending time. But it is time. And particularly with older patients, you have to be prepared to be patient and give the person time. However, it's harder, I find, to share that approach with some of the younger doctors that I'm dealing with because, you know, there's an adrenaline rush

when you're a young doctor and you want to get the angio done now and see what the vessels look like, you know. So I find it harder and harder to persuade young doctors that honestly, you'll get it from the history because that's not very exciting to them when they've so many other exciting opportunities. You know, I very much am drawn to the human side of medicine. I very much have been drawn to what's the message behind the words of what my patients are saying. Yes. The other thing that we should be encouraging, I think, and it falls out from all of this, is intergenerational transfers of knowledge and sharing. So that if you, as doctors, if you give time to the patient to tell their story, you will learn so much. But in life, younger people spending time or having friends who are older, and likewise, people who are older, having friends who are older and likewise people who are older having friends who are in younger generations that's not common anymore anymore and it was and and i think that's something else that

we can individuals listening to this could make an effort to do because you'll gain from it that's what you see in the blue zones don't you that a lot of this intergenerational absolutely not just where they live how they socialize and interact it's not uncommon from what i understand that's it for a 20 year old to be hanging out with a 70 year old which has huge benefits for both parties yes that's right on the subject of you know continuing what we just said about the kind of things patients open up about when they're talking to their doctor if the environment is, if the clinician is being attentive, for example. You've written an entire chapter on sex and intimacy with respect to aging. Now, this is a topic that is not often spoken about. It's a little bit taboo for many people to talk about this. So my first

question is, were you nervous when writing it? Why, I guess, did you think it was so important to put this chapter in? So I wasn't nervous in writing it because I've had a bit of a journey, as it were, with respect to this topic. And the person who opened my eyes to this is a girl called Stacey Lando, who's a professor of gynecology and aging in Chicago. And she is passionate about this area and started writing maybe 20, two decades ago with respect to sexual activity and aging. So I'd followed her and her work for some period of time and have become very friendly with her actually. And I've been really interested in the area. And what fascinates me about it is it's almost like it's invisible in society. It's not discussed. And

when I became enthusiastic about it at the dinner table, because we always made an effort when the boys were in school to get together and we had an evening meal together, I would say, oh gosh, start talking about something I'd learned about sexuality and aging. And they were right, mom, we're gone now. We've eaten. Thank you. We're leaving the table. I don't want any more. No more. I could just, I think younger generations find it almost impossible to conceive that there would be sexual activity between, you know, older persons. In the TILDA study, 70% of couples are still sexually active. And our mean age now is 68, but that's the data from the first wave of the study. So it's common.

It's becoming more discussed. We're becoming more aware of it at a societal level. We as doctors don't talk to patients enough about it. We don't ask patients, would you like to discuss sexual activity on a regular basis? People, I think, find it hard to discuss it on an individual level. So I had no problem writing about it at all because I'm very enthusiastic about it. And I think it's something that we need to be discussing more. And there are issues with it as people get older. Erectile dysfunction is not uncommon.

Now, erectile dysfunction can occur at any age and probably one in three, as you know from your general practice, men have experienced it at some stage or other. And there's lots and lots of reasons for it. But there are reasons which need to be investigated, even if it's intermittent. And it can be indicative of underlying atherosclerosis, that's thickening of vessels, blood vessels, in older adults. When I say older, people 50 and above. And that needs to be investigated early. You know that iceberg we talked about? That's the process happening down here below the threshold of the iceberg. It can be managed early. I think that's a very important take home for people that

we perhaps haven't spoken about enough on this podcast, which maybe speaks to exactly what you're talking about, about how taboo this topic is. But I think a lot of people, women and men, don't realize that erectile dysfunction could be an early warning sign that you already have thinning of the blood vessels in your heart. Like the blood vessels exist everywhere. You know, if there's a problem with your erections, there could be a problem in your heart. So if you're having it, you really should get that checked out, particularly if you're 40s, 50s, 60s. So that's very important to be aware of. That can be an indicator also of early stage diabetes, et cetera, et cetera. So it needs to be. And then for women, vaginal dryness is a huge issue. So some of the reasons why older people don't take part as frequently in sexual activity is because it's painful or uncomfortable, particularly for women. Now that can be dealt with. So dry mucosal surfaces, we know about dry eyes, dry mouth postmenopausally, but dry vagina, dry vulva is also not uncommon. And it can be

dealt with, with hormone replacement therapy, local hormone therapy and gels. But there's something that we should be discussing with our patients. And I really think as doctors for those age groups, we should just ask about it. Have you any problem with? And if there's a problem, that'll open up the discussion. So how does this relate to ageing, right? So let's say a couple want to be intimate and have sex as they're older. Okay. So that's a desire. But in terms of the biology of ageing, how does sex and intimacy play play a role oh well this is really interesting because actually um it probably decelerates the aging process decelerates yeah it's really good and are you you know to get really granular here yeah are we talking about

the act of sex so intercourse or are we talking about intimacy because intimacy both because yes because it's the neurohumoral consequences of intimacy probably that predominate in terms of decelerating the aging process probably through a attenuating any inflammation at a cellular level neurohumoral couple of fancy words there what What does that mean for that? Neuro is the nerves that are involved, usually autonomic nerves, predominantly sympathetic. So nerves and humoral are the hormones involved,

including oxytocin. And the feel-good hormones we know about, endorphins, dopamine, serotonin, etc. So intimacy helps to slow down the aging process. Intimacy does. Now, the act of aging itself is equivalent to, So intimacy helps to slow down the aging process. Intimacy does. Now, the act of aging itself is equivalent to, I did have the figure in the book,

I think it's something like four minutes on a treadmill, but it mightn't even be that. What's it, sorry? Intimacy. The act of the actual sexual intercourse, the act of sexual intercourse. So the added value of that over and above the neuro-humoral effects of intimacy is exercise. And you can get that another way. So it's probably, probably predominantly the intimacy that is having the beneficial effects. So if we just take the big picture look, one of the things I think has come through from this

conversation, you make it very clear in the introduction in your book that there's no one thing that determines how quick you're going to age or how slow you're going to age. It's a combination of factors, right? There's multiple things. And of course, we all live different lives. So, you know, we can all get there. We can all slow down the aging process, I guess, by doing what we can within the context of our lives. So not everyone is going to be able to do everything. Now, in relation to what we've just been talking about, sex and intimacy, of course, many people will feel that they're not in a relationship, right? Many people may feel that, or they are, let's say, happily married, but both themselves and their partner no longer wish to engage in intercourse, right? So let's just be really

clear what we're saying. We're not saying that that's a bad thing necessarily, are we? You know, what's the message there for people? So the message there for people is, of course, it's individualized. And there are people, there are lots of studies to show that there are people who are not sexually intimate, who have very good quality of life and are happy with that status quo. It's only if whatever your situation is, is causing you worry or stress or unhappiness that it's not good. But if you're getting pleasure from whatever the state, either, you know, being single and not having any sexual intimacy, being in a couple, but not having sexual intimacy or having intermittent sexual intimacy, it's whatever is making you happy. And as long as it's not stressing you and making you unhappy,

that's what's toxic. Let's talk about sleep. What is the relationship between sleep and aging? And I've got to say, one of the things I really, really enjoyed reading about was these four sleep chronotypes. Yes. I reckon I'm a lion. What do you think you are? I'm definitely a lion. Okay. From the description in your book, I'm a lion. In fact, do you want to go through those? I go through them. So there are four types. There are dolphins, lions, bears, and wolves. And the whole point about this is, what's our chronotype? Our chronotype is almost our personality type coupled with our 24-hour circadian rhythm. Now, all of our cells have a 24-hour circadian rhythm.

Now, all of our cells have a 24-hour circadian rhythm, and they're all governed by a central clock in the brain called the suprachiasmic nucleus, SCN. And it basically, every single thing about us is governed by that. So that at nighttime, when it's dark, different rhythms are turned off and different rhythms are turned on. And then in the daytime, different rhythms turned off and on. That's what's important. Now, our chronotypes, which are our sort of personality types coupled with our rhythm, are roughly divided into four groups. There's the dolphins, the lions, the bears and the wolves.

Dolphins struggle to fall asleep, sleep approximately six hours, wake up unrefreshed, may experience anxiety, irritability. They're perfectionists. Lions, medium sleep drive, wake up early, lots of energy, little energy at bedtime. I'm almost supine after nine o'clock in the evening. I'm useless. Optimistic, overachievers, go-getters, health conscious, eat well, take exercise, and they're leaders, right? Maybe we're choosing, maybe we're, anyway. Maybe we like to think of ourselves in this way, but I think. No, I'm pretty much a lion. I think I'm a lion. And then bears, deep sleep at night, rise with the sun, strive to be healthy, team players, hardworking, easy to talk to. And they've good people skills.

And then the wolves, I'm married to a wolf, wake up in a haze, groggy in the morning. I recognize that energy in the evening. So he's much better in the evenings, tend to miss breakfast, come alive after dark, creative, pessimistic, moody, comfortable alone. And they're very often the chronotype which is actually aligned with great creativity. And they're also most likely to be addicted than other sorts of chronotypes. And by that we mean to, my husband is not by the way, but by that we mean to alcohol and drugs or gambling behaviors. They're very often wolves in their chronotype. They're just fun chronotypes.

They've been shown to be scientifically more or less aligned. And what benefit is there for us knowing what we are? So the point is that all of our society is orientated towards the dolphin, the lion and the bear. But the poor old wolf finds it really difficult because they come to life later on in the afternoon and the evening. And about one in five of us, 20 percent, are wolves to comply with the timetable that society sets, i.e. be in school at eight o'clock or nine o'clock in the morning, you know, come home at four o'clock, etc. Go to bed early, get up early in the morning. They struggle with that. That's the first thing. The second thing is our chronotypes are very closely aligned to sleep habits, as you can see

from the description, also to food intake. So it's important that people who have the latter chronotype we described, the wolves, are aware that they're more likely to get health, negative health outcomes from negative lifestyle behaviors. And I'm sorry if that sounds miserable, but it's just that they're more likely to overeat or maybe overdrink. And that's part of their struggle with this imposed clock, which isn't their natural clock. Now, you can turn that around, and that's the good news, by bit by bit bringing the clock that you are comfortable with as a wolf into maybe the bear or lion clock. And by doing that, to do that by going to bed consecutive nights, 15 minutes earlier, but you have to stick to it. You have to be very rigid with yourself

and stick to that until you kind of get more into a natural clock. And that does reset some of the neuro humor we're going to come on to to again changes that are very closely aligned with the circadian rhythm yeah it's really really interesting i think you know knowledge is always a good thing isn't it and at least knowing our tendencies can be helpful they can help us realize why certain things are easier for us you know i'm you know yes i find getting up early a piece of cake yes no problem i love doing it i love getting up i love getting after the day first thing in the morning um whereas not everyone in my immediate environments yes let me put it like that is the same right so in fact you you raised something

really interesting you're a lion and your husband is a wolf yes um is there an issue if our partner is not the same chronotype as us? Do you know what? Once you understand what's going on and you understand that this is a physiological behavioral thing, it makes it so much easier. And I think that each to his own in that context. And as you said, knowledge is very powerful and understanding it makes a huge difference. Yeah. I think it's great i think the thing which you did mention which i just want to highlight is that well first of all society is set up in a certain way which makes it easier for certain chronotypes but one thing i've found

very much so is that yes there may be a genetic kind of template that you find easier but some of that is shiftable you know if you don't expose yourself to light as much in the evening if you bring your eating times earlier if when you see natural daylight in the morning if you can do that first thing you know get up early and expose yourself you can actually i wouldn't necessarily say reset but almost reduce the effects like i know there's some studies i spoke to professor sachin panda about this who's done a lot of the time restricted eating research at the salk institute in california you know he spoke to me about a study where they took people camping without electronic devices

and how it's amazing how so much of what we think our natural bedtime is actually is due to our lifestyles it's due to our light exposure at what time we're eating caffeine at what time we're eating our evening meals whereas if you go camping without electronic light you know you're just exposed in nature to natural light, you're eating earlier. Actually, our bedtimes are often quite different. Our natural bedtimes are often quite different from what we think. Yeah, absolutely. So that nucleus, the superchiasmic nucleus, it is linked directly to the eye and it responds most strongly to exposure to darkness or to light. And remember, it is the mother clock that sets all the other clocks in ourselves.

So if we are retuning it, if you like, by exposure to light first thing in the morning and then darkness at night, that will help greatly because that clock is what's attuned to your chronotypes. I cite a very famous Irish Gaelic footballer actually in his 90s. And when I was chatting to him one day, I asked him about his day and he gets up first thing in the morning and he goes outside and takes the air. He just goes outside every single morning and gets some real natural light. Natural light is very important. Then the corollary of that is to help with sleep, make sure your room is really dark. Because that's how our biology is responding. It's basic stuff that I think needs re-emphasizing time and time again, because we hear this stuff all the

time, right? But if hearing it once meant that we would change our behavior, well, I wouldn't have a podcast. You know, I wouldn't be writing books. You may write your book. It's like, if we just heard it once, your diet and movement is important, and we did it, there would be no need for us to keep talking about these messages around the world. So I'm going to put a challenge to you now, right? So the other big thing is blue light

that's really bad for that suprachiasmic nucleus. And certainly I am guilty of this at night. I'll just check for one minute my email or my text messages just before I go to bed, right, before I go to sleep. And then an hour later, you're still trawling through something. You have just exposed your poor old nucleus to all of that blue light immediately before it's supposed to switch off all your systems and allow

the systems which kick in to get rid of toxins in the brain to kick in. Blue light is really bad. And we should try to abstain from it for about an hour before going to bed. I mean, we've evolved with familiarity with yellow light, fires, et fires etc and yellow light bulbs until very recently blue light is very new to to us the wavelength of blue light is not good for that nucleus in terms of the circadian rhythms so if possible we should try to and that's something else i've changed that behavior is not looking at anything on a computer or on my phone for about an hour before I go to bed. Yeah, I mean, it's something that's so difficult for people to do. They're so addicted to these devices. You know, I went to a meeting in Barcelona recently,

a cardiology meeting. I was leaving very early in the morning, like 4.30, leaving the house in the taxi, almost at Dublin airport. And I thought, oh gosh, my phone. I've forgotten my phone. There's no way I could go back for it. I had my laptop. So for four days, I had no phone. I was wearing one of those Garmin devices as part of an experiment that one of my research students was doing. And my mean heart rate went down from 74 during the day to 66 because I had no phone. And I was able to, in the evenings after the meeting, go home and log on to my emails and do it. But I was in control. I was making the choices there. I didn't have any tanging or pinging or light alerts in the background. And that just shows how much, I didn't realize it

before this, but how much impact that was having on my cardiovascular system. That is absolutely incredible. I'd love to see that done on a wider trial because I just don't think we realize the insidious nature, the way being on the entire time has crept in where it is now the norm for so many of us. For me, one of the most powerful things I can do for my health, if and when I remember to do it, and I've got to say at the moment, I've been really good with it, is I charge my phone in my kitchen. So I live in a house. I leave it downstairs. It doesn't enter my bedroom. Yeah.

So by not entering my bedroom, it's automatically, you know, the friction there to actually go and get it is huge. It's just not going to happen. Whereas if it's there, it is very hard for people to resist. And of course, when people say it's my alarm clock, it's always like, you know,

alarm clocks, you can get for about a fiver on Amazon, you know, it's all wherever, you know, your secondhand charity shop, whatever it might be, right? You can get them. I'm always looking with patience in myself for what are the kind of one-time behaviours, the kind of upstream behaviours I can do that automatically downstream change things. And I think not bringing your phone into your bedroom, if you can, is such a powerful way of doing that, where you're not going to be looking at blue light, you're not going to be looking at your email, you're not going to be getting caught up on Twitter and something. But of course, people find it hard to do. And I also want to acknowledge that some people need to be on call for certain things. Sick family members, whatever it might be. The way I tackle that, because that

is something that is real in my life, is I have a landline and I've got a mobile. And now I know a lot of people these days don't have landlines anymore. I do, and only immediate family have my landline number. So therefore I can put my mobile phone off and I know if someone in my immediate family needs me, there's an emergency, they can get me. Yes. And so again, I don't want to say that's for everyone. I share that in case there's anything in there

that's helpful for someone. But these are small things that make a massive difference. They're tiny things, but it's awfully hard to do. I panicked when I realized I didn't have the phone. And by the end of the four days, I kind of thought, do I really have to pick up my phone again? And within 24 hours, I was right back there. And I really noticed at this time, the pinging and the background constancy of it and the expectations by others that I was available. You know, it's almost, it's a terrible pressure that we're putting on ourselves.

When we talk about the biology of aging and slowing it down, what exactly does sleep do? Sleep is very important. I'm tentative about saying this because if people are poor sleepers and you emphasize how important sleep is, you know, one thing you don't want to do is make people more anxious about the fact that they're not sleeping. So when we're talking about this, we'll also talk about solutions, hopefully, that might help people. Sleep is very important. Seven to nine hours sleep is what is recommended as we get older. Now, our clocks, our biological clocks, not our biological clocks, our chronotropic clocks change as we get older. So we don't sleep as much with age. So that might be an issue. But sleep is the time when our bodies get a chance to get

rid of all the toxins. It's a time when our brain gets a chance to consolidate the memories we've learned during the day and to store them in long term memory. It's a recharging period. It was thought that our brains were dormant or almost dead during sleep. But then once we had EEG, we realized that actually it's the most active period for our brains in the 24-hour cycle. It's working really hard to get rid of toxins, to be refreshed and ready for the next day. And people who have shorter sleep are more likely to get cognitive impairment and dementia in the longitudinal studies. And they're more likely to have inflammatory consequences like

poor immune responses to viruses or indeed cardiovascular disease. So sleep is very, very important. So, you know, like it's always hard with sleep, isn't it? As you say, there will be people with young families, young children who are struggling. And often they can hear that and go, oh man, you know, I'm sleep deprived. I'm knackered. What can I do? You know, I'm going to speed up the rate at which my biological clock ages. And I think we have to acknowledge that. We have to recognize that it is tough. It's really tough for adults, for many adults now who don't have help around them. Or night shift workers. I mean, you know, people who have to work at night. I mean,

the evidence that night shift is not good for your health is quite strong. But we have to have workforces who work at night. We've worked at night for a significant proportion of our lives. So what are your top tips then for people? So what can we do about it? Exercise during the day helps, okay, but not immediately before you go to bed because what exercise does is it triggers your whole autonomic nervous system. It gets it all lively and active and awake and it's going to be awake when you're going to bed. So try and have a chilling period for a period of time, maybe an hour before you go to bed. Read a book or do something to de-stress. Meditate if possible. Make sure the room is dark. We've said that before. Some people find a hot bath or a hot shower

helps before sleep. There are foods which are not good and there are foods which help. So any foods which contain tyramine, tyramine is a precursor to noradrenaline. Noradrenaline is one of the transmitters involved in the sympathetic system, and that's the fight or flight system. So any foods which contain tyramine will keep you awake at night. And what are those foods? They are the like blue cheeses, dark cheeses, preserved meats, bolognese sauce, anything with additives in it like that, they're not good. Foods which contain tryptophan, which is one of the proteins evolved with serotonin, which is a relaxing, if you like, compound, are good. And that would be foods such as cottage cheese, almonds, the teas we know about, and believe it or not, fatty fish like salmon.

There's a great study in 95 men in each cohort where they ate salmon before going to bed three times a week versus a group who just ate the same equivalent of protein but taking different meats with it and the salmon eaters their sleep improved over a period significantly over a short period of time so omega oils they help um so that's essentially saying for that particular group that was studied, eating fish in preference to meat, if people are choosing to consume animal protein, you're saying fish seems to be better in terms of promoting good sleep as opposed to meat in the evening. Yeah. And I've given a whole list. It's

quite a large list of things. And the other thing to be aware of is foods that are high in fiber may impact on sleep at night because they just require more activity from the gut to break down the foods. So there are things for people to be aware of. And if there are some technologies now which are emerging, and you've probably discussed this on your show before, which may help some people and they're worth trying. Pink noise, white noise, what they do is they influence the rhythm of the brain waves during sleep, the non-rapid eye movement waves and the rapid eye movement waves and may help. And there are also technologies which actually marry the noise with the different slow waves, which is what you want to get more slow wave activity, which may be of

benefit. They've been shown to be of benefit in some studies and not of benefit in other studies. So my own take on that is this could be very individualized, but definitely I think worth trying. And for those people who are in that stage of life where, let's say, they're struggling, for example, young parents, young kids, they're not sleeping particularly well at the moment. In terms of a message of hope for them, let's say you go through three or four years of sleep deprivation whilst your kids are young. It's certainly something that I did, my wife did, right? How detrimental is that? Or is it just one of those things that happens in life at a particular time, but as soon as you are able to, and if you can get back on track with your sleep, then like from an aging perspective,

is that okay? Well, first of all, the vast majority of people do get back on track to whatever their normal sleep rhythm is. That's the first thing. And secondly, there's very little evidence that that period of time has a negative impact, particularly on longer term consequences and the aging process. I think a lot of the core messaging in your book and from your research is that it's not about the one-off things. It's about what are you doing 80 you know, 80% of the time,

by and large, you know, month after month, year after year. Is that a fair reflection? No, that's a very fair reflection. It's about consistency. And it's the long game, you know, particularly if you start the game early. Yeah. I've got to say, we've been chatting for a long time and there's so much more to talk about. You really have written a wonderful book, Age Proof. It's so succinct. It's full of science and research, but it's also very, very practical. So I can see why it's proven so popular with people. I did want to cover this. I'm not sure we got a time to go into it in detail, but there's one chapter on purpose and laughter, which is really interesting.

Any kind of top line thoughts on those two things you want to share? Well, first of all, laughter is really important. And we know this intuitively because we feel good after, but it releases a whole lot of neurohormones, which are very important for us. And that's actually used therapeutically now. I'll just cite one study, which I find amazing, is that people who had had a heart attack, who were exposed to laughter therapy, were 48% less likely to get a recurrence of a heart attack. Now that's a massive figure. So that's the benefit. So just carry that moment and know that laughter matters. Laughter is a way of us to bond socially. So it's all tied up with this whole social engagement.

Yeah, it plays into what you said about friendships before. Like if I think about hanging out with my best mates, what do we do? Well, we do lots, but one thing we're always doing is laughing when we're together, right? So, you know, again, that speaks to everything that they're not all in isolation. They all, all of these behaviours. Absolutely, interact. And you know, again, that speaks to everything that they're not all in isolation. They all, all of these behaviours. Absolutely, interact. And you know, kids laugh 400 times a day. There are studies to show this. Toddlers laugh 400 times a day.

But we laugh so much less as we get older. So let's introduce laughter as part of it. So laughter really is the best medicine. And then purpose. Purpose is terribly important. And actually, my message about that is anything can have purpose. You know, making a shopping list and go down to the shop to get the stuff, that's purpose. You can create purpose in your day. We need to feel purpose. If we feel we have no purpose or

almost unwanted or unnecessary, and we come back to this whole concept of social isolation of people over 70 and cocooning people over a certain age, if we feel we have nothing to contribute, we have no purpose, that's really bad for us from a physiological perspective. Yeah, one of the things in that chapter I particularly liked, and it's something you just echoed now, is that you can find purpose in anything. It really makes me think of what we were saying about attitude. Yeah. Right. Like, you know, going to get the shopping can be seen as a chore.

Oh man, I've got to go and get the shopping now or whatever it might be. But you can actively reframe that, you know, maybe a bit of gratitude, maybe a bit of, oh wow, I get to go and actually get the food now that feeds my family or feeds me and my partner or whatever it might be. And I know it sounds very soft and very simple. I honestly believe that you can train yourself to have this attitude. You can train yourself to look at the positive side of everything, even washing the dishes. And purpose is tied into control. And we need to be in control. There are lots and lots of

studies showing that in an employment hierarchy those who are in control that is one of the most important contributors to good health in those individuals compared to those who maybe are often in the bottom of the of the hierarchical chain and have no control they have to do what they're told etc so purpose is part Purpose, if you can reframe it, gives you control over your life. It is your purpose and you're framing what your purpose is. Therefore, you're in control. And that's really good for us biologically. Yeah, I love that. I've got to say, I've so enjoyed our conversation. I enjoyed meeting you a few months ago at the book festival and speaking with you and having all our panel discussions. I've really enjoyed reading the book. Just to finish off,

what would your top tips be for people to say, Professor, I want to slow down the rate at which I age. What can I do? I would say build an even stronger friendship group. Keep moving and move a little bit more every year, not less, more every year, and be cautious about your diet. Love it. Thanks for coming on the show. Really hope you enjoyed that conversation. Do think about one thing that you can take away and apply into your own life. And also have a think about one thing from this conversation that you can teach to somebody else. Remember, when you teach someone, it not only helps them, it also helps you learn and retain the information. Now before you go, just wanted to

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