The Dr. Hyman Show - Exclusive Dr. Hyman+ Functional Medicine Deep Dive: Nutrition And Optimal Aging

Episode Date: August 1, 2023

Hey podcast community, Dr. Mark here. My team and I are so excited to offer you a 7 Day Free trial of the Dr. Hyman+ subscription for Apple Podcast. For 7 days, you get access to all this and more entirely for free!  It's so easy to sign up. Just go click the Try Free button on the Doctor’s Farmacy Podcast page in Apple Podcast.  In this teaser episode, you’ll hear a preview of our latest Dr. Hyman+ Functional Medicine Deep Dive on nutrition and optimal aging with Dr. Chris D'Adamo. To learn more about the Institute of Functional Medicine, sign up for IFM’s newsletter: https://www.ifm.org/about/free-newsletter/. Want to hear the full episode? Subscribe now. With your 7 day free trial to Apple Podcast, you’ll gain access to audio versions of: - Ad-Free Doctor’s Farmacy Podcast episodes - Exclusive monthly Functional Medicine Deep Dives - Monthly Ask Mark Anything Episodes  - Bonus audio content exclusive to Dr. Hyman+ Trying to decide if the Dr. Hyman+ subscription for Apple Podcast is right for you?  Email my team at [e-mail] with any questions you have.   Please note, Dr. Hyman+ subscription for Apple Podcast only includes Dr. Hyman+ in audio content. Sign up for the Institute of Functional Medicine (IFM) newsletter: https://www.ifm.org/about/free-newsletter/ Explore IFM membership options: https://discover.ifm.org/ifm-membership Listen to the Institute of Functional Medicine podcast, Pathways to Well-Being: https://info.ifm.org/podcasts

Hey podcast community, Dr. Mark here. I'm so excited to offer you a seven-day free trial of my revolutionary new platform called Dr. Hyman Plus. For seven days you get special access to all the private content included in Dr. Hyman Plus entirely free. It's so easy to sign up. Just go to Apple Podcast on your phone and click try free button on the Doctors Pharmacy podcast. You'll get exclusive access to ad-free Doctors Pharmacy podcast episodes and functional medicine deep dives where a practitioner dives into topics like heart health, muscle health, insulin resistance, and more to help you understand the root cause of specific ailments and walk you through the steps to improve your health today. You'll also get access to all my Ask Mark Anything Q&As where

I answer the community's biggest health and wellness questions. Because I'm so sure you're going to love this platform, I'm offering you free access to all of this content for seven days and a teaser of my brand new functional medicine deep dive episode, diving deep into one of the most important topics in health. Head on over to the Doctors Pharmacy podcast on Apple podcast and sign up for your free trial right now. Okay, here we go. Hello, this is Dr. Chris Adamo from the University of Maryland School of Medicine Center for Integrative Medicine and the Institute for Functional Medicine, where I serve as a scene research advisor. I'm excited to talk about this topic of nutrition and optimal aging.

As you can see in the title, this is geared to be something that you can indeed master. It's very practical. I will go deep with the science and underlying mechanisms of how I think you can optimize aging through nutrition. But ultimately, this is going to come down to tools and strategies and perspectives that you can utilize in your own lives. And everybody's got a slightly different take on this subject. But I think you'll find this encouraging in that there is much that you can do. And I'm going to go ahead and minimize my picture here so we can better see the screen. So just to give a little bit of an overview of where we're going to go with this. So we'll start just on how I came into this topic and then get into this really useful, I'd say, construct of the hallmarks of aging. And we even

look at the hallmarks of health more generally that I think you'll find helpful when you think about your everyday lifestyles, exposures, and so on, and what you might be able to do about that. Then we'll just, to make sure everybody's on the same page, give an overview on what we mean by nutrients, because I'm going to be talking quite a bit about how nutrient demands change with aging, which is the next sort of area of focus, you know, due to both physiological reasons, but also a wide variety of other factors, you know, lifestyles, social lives, medications are big. We'll talk about that. Get into another theory, the triage theory from Bruce Ames that some of you may have heard about, and then look at tying it back to those hallmarks of aging and what are some

specific foods and nutrients that can help out in that respect. All right. And then really I got to dive deep on a few key areas. The first of which is protein and some of the controversy in that area that I hope to provide some clarity on. Then look at a bunch of other nutrients whose demands change with age for a variety of reasons. And then those that are sort of on the cutting edge, in particular, going to look at creatine and NAD plus precursors, which I think are really exciting, and then kind of tie it all together. All right, so how did I come to this topic? Well, I did my doctoral work on hip fracture patients and looking at how nutritional factors influenced their recovery. So I looked at vitamin E, the carotenoids and antioxidant nutrients, and how basically those that were more replete in

these nutrients, those that had levels that were higher than others, tended to fare better. They had less inflammation, they recovered more quickly. They had better physical functioning. And I think this is really interesting. But this is kind of the medical reactionary model. You know, once somebody has had some kind of illness or chronic injury or so on, and that's important. But what I have found to be more important as time has gone along has actually gone back to my roots. So these are some pictures of my grandfather lived to be over 100 years of age. And it's a picture of him on the left where he was a

fortune 500 CEO. So lived a really fast paced lifestyle, really busy with with his work and family and so on. But he was a real believer in lifestyle. So nutrition and physical activity and so on. That picture in the middle, he's probably 95. And the one on the right, he's playing basketball at 98. So I was influenced by this alongside, you know, what I'd done with people who, you know, were maybe not functioning as well with advanced age. And, you know, I've always found the super centenarians to be of great interest. The paper that you see on the left is those that are over 114 years of age. There's many of them. This paper focused on those that were very well documented with birth records and so on. You know, we know that the longest, you know, lived person was 122 year old woman who actually was not particularly, I would say most of us say

had the most healthy lifestyle. Also, maybe not the most functional, granted 122, what do you expect? But I think what has motivated me the most is probably the images on the right of those who are highly functioning and thriving deep into life. And we're going to look at factors that should help you reach that to the best of your circumstances. And these are the papers that I mentioned earlier that are quite interesting, the Hallmarks of Aging. There was a 2013 original version of this, and this was expanded in 2023. Dr. Hyman has spoken of these at some length, and we're going to get into the details on each of the different hallmarks of aging and specific foods and nutrients you can utilize to capitalize on them. To see them here, they're grouped into different categories of

primary, antagonistic, and integrative. Primary is kind of the furthest upstream, and the integrative ones are the furthest downstream, though very important, certainly. And again, we're going to look at each of these in detail, define what they are, and define some foods and nutrients and more generally nutritional approaches that may help you, you know, optimize these different domains of aging. And, you know, this has also been looked at across the lifespan. So the same group had another very interesting paper when looked at the hallmarks of health and actually a fair amount of overlap here. We'll see, you know, one of the areas that I've really taken an interest in is circadian biology. So you see the rhythmic oscillations

tapping into that. And when we talk a little bit about time-restricted eating today, that would be one area though that clearly applies to late exposure and other domains that we can really utilize to our advantage. But to just frame this topic to make sure we're all on the same page, you know, when we talk about nutrients, there's two main classes. There are the macronutrients, protein, carbohydrate, and fat that provide energy for the body, which is most often measured in calories, right? Then you've got thousands of micronutrients, you get your vitamins and minerals, which we'll talk about. And then you get, you know, non-essential micronutrients that while all of these don't provide energy for the body,

they're equally as important. They are needed for survival, the vitamins and minerals. And there's probably others that we just don't know about yet. I'm going to talk about these today. But first, to get into the macronutrients, we have protein. And this is an absolute key for aging. Lots of different sources. There are two main types here. They're your complete proteins, which just mean they contain all nine of the essential amino acids. And those are amino acids that our bodies can't produce endogenously. All right. Now, most animal proteins are complete. Not all of them. Things like collagen, for example, which is very popular and quite useful.

We'll talk a little bit about that today, but that's another one that I think is quite useful for aging when it comes to joint and skin health and so on. But it is missing some of the essential amino acids. So you wouldn't want as a primary protein source. Then you have your incomplete proteins, which don't contain all nine of the essential amino acids. So it's missing at least one. And most plant proteins actually are incomplete, though they can be combined to form a complete protein. So most cultures had this figured out when you look at things like rice and beans, for example, where one's missing lysine, the other's missing arginine, you can combine them.

So it's probably not as efficient of a way to do it as this formal protein, but it is certainly a way to do it. And there's a number of good plant-based proteins, powders on the market today. These are broken down by protease enzymes. You can take those as supplements. As time goes on with age, one of the reasons that our nutrient demands increase is that our digestive enzymes from the pancreas are not as abundant or effective. These have four calories per gram. And you have carbohydrates, a wide variety of these. These are probably some of the healthier sources, uh, picture here. Um, no essential carbohydrates, um, uh, you know, where there's the ketogenic diet and, and, uh, you know, approaches that, that you can, you know, there's, you can survive and in some cases thrive without carbohydrates. Most people do well by having them in a diet, but, um, in any case,

there's multiple types. There's sugars, um, which can be either simple or complex, starches, which are complex. And it's an oversimplification to say simple, good or bad, complex, good or bad. We really want to think about the nutrients that are accompanying the carbohydrate and not necessarily whether they're simple or complex. Then you have fibers, which are different. So these are non-starches, polysaccharides, and you have soluble and insoluble. Soluble fibers are things like inulin and so on that feed your gut bacteria. They can cause GI distress in people, but

insoluble are those that pass through things like psyllium and so on. And these are broken down to glucose with the exception of fiber, which is not by amylase enzymes. And that's actually, it starts in our mouths and our saliva. Last of the macronutrients are fat. Many different sources of these. There are two essential fatty acids. One's omega-3 and one's an omega-6. Most people get more omega-6 than they need and probably not as much omega-3 as they would benefit from. There are multiple different types that are distinguished by their carbon bond structure. So you get saturated fats, which, you know, for many years had been sort of demonized as, you know, harmful to health.

But as more evidence has emerged, it's not that simple. Some saturated fats can be harmful. Others can be health-promoting. So again, you want to get them in a whole food source that's got nutrients and just trying to avoid the processed forms, ultra-processed foods in general. Monounsaturated fats have one carbon-carbon double bond. So some examples of this would be there's quite a bit of monounsaturated fat in olive oil and macadamia nuts. And polyunsaturated fats have multiple carbon-carbon double bonds. So these are things like cold water fish, sardines, salmon, and so on. And nuts, linoleic acid is one that's become kind of controversial. That is a form of polyunsaturated fat that some believe we get too much of. But in any case, these are broken down by lipase enzymes and these contain nine calories

per gram. So they're more calorically dense than carbohydrate and fat uh which is one of the things that gave rise to the non or low fat diets which um you know probably weren't the best advice you know fat is health promoting when you've got healthy fats certain fats you know you want to avoid trans fats hydrogenated oils and so on but um you know when we're talking about a prone whole food diet that can can be quite helpful and essential. So speaking of things that are essential, we have our vitamins. So these are micronutrients.

So we're moving over into the non-calorie containing, non-energy containing nutrients. So there's 13 of them that are carbon containing and are essential to health. You see them listed there. We don't produce these endogenously. so we have to get them through the diet. And one example that I'd like to dial in on a little bit is vitamin K. So K actually stood for the German coagulation, so it allows blood to coagulate normally. But that's when we think of, you know, vitamin K1.

Think of leafy greens and so on. So if someone's getting surgery, they advise you not to, you know, consume many of these because they have anticoagulant effects. What about vitamin K2? I want you to pause here and think of some sources of this. So not as common in the diet. So things like natto, which is a Japanese fermented soy, Gouda cheese. Basically, K2 is the product of bacterial fermentation. So this is really important for heart health and also works together with vitamin D and magnesium to get calcium into the bones and out of the circulation.

So this is also very important. Moving on to minerals. These are non-carbon containing compounds that are also essential to health. You have your macro and trace. You see them all listed here. You need more of the macro than you do trace. Once again, these have to be obtained through the diet. And calcium is, you know, a mineral that we hear quite a bit about. We typically think about it for bone formation, but it's involved in so many other things. You know, dairy.

And if you're going to get dairy, you like to get it grass-fed and maybe even better fermented. It's probably the greatest source. You do get it in other sources like sardines when there's the bones there and some leafy greens, though, interestingly, the leafy greens, you have oxalates that impair calcium absorption. So just something to think about if you're osteoporotic or osteopenic, just to make sure that you're getting enough calcium on your diet. It'd be ideally with calcium and vitamin D supplement, maybe even more ideal with some K2 in there. All right, so you've heard about the vitamins and minerals. We're going to talk about these as they pertain to aging. Now let's look at some of the non-essential micronutrients that offer lots of health benefits.

So carotenoids. These are, you know, there's hundreds of these colorful pigments that are in, you know, lots of different fruits and vegetables. They're in salmon. That's what gives, you know, a nice wild-caught salmon the deep red color. But, you know, you see them in the, you know, alpha-amphibian curatine in your orange color, but, you know, you see them in the, you know, alpha beta carotene in your orange colored, you know, pumpkin and carrots and so on, lycopene in your red colors, lutein, zeaxanthin in your leafy greens and egg yolks on a pasture-raised egg site, typically. Then you get flavonoids and

polyphenols, you know, when a lot of these health promoting foods that you see here, things like resveratrol, curcumin, EDCG in green tea, anthocyanidins that are in berries. These actually have helpful prebiotic properties and can help manage inflammation and have epigenetic effects. They seem to really benefit human health in a variety of ways. And all these were plant foods that you see pictured, but there are many helpful micronutrients in animal foods, choline and egg yolks. It's also in beets. But this is really important with age when it comes to cognitive function. We'll talk about that later as we go along. Then we have, you know, historically

maligned, though the climate seems to be changing that a little bit, red meat, where I think we need to think about that a little more nuanced way. You know, if you look at pasture-raised, regenerative, ideally sourced red meat's a great source of source of creatine, which I'll talk quite a bit about that today, and carnitine. We're going to talk about Bruce Ames' papers with how important carnitine is in the triage theory of aging, and coenzyme Q10, especially important if you're taking a statin. And I'm going to talk about a resource for medication depletions. But these are all really good sources too. And if you happen to be on a plant-based diet, you ought to think about supplementing with these because they're

really important for health and aging. And just briefly, I'm going to talk about the nutritional reference values because when we talk about optimal aging, we need to think well beyond the alphabet soup of what you see. And things like the recommended dietary allowances or the RDAs. This is what you see on the food labels. What you may not know is that this is, you know, the amount that's sufficient to meet nutrient requirements to prevent nutrient deficiency diseases.

So things like rickets and scurvy, not chronic disease. And this varies by a variety of factors, gender and life stages, pregnancy and age. They get tolerable upper intake level. So these are really conservative, especially if you look at things like vitamin D. What we ought to be getting is considerably higher a lot of times, certainly than the RDA for optimal health. But they are worthwhile to keep in mind that you can get too much of a good thing when it comes to nutrients. But there has been a lot of, you know, discussion and evidence

that for many years now that these RDAs are too low when it comes to preventing chronic disease. All right. So these are the RDAs. And, you know, we see how they actually vary by life stage. You know, we see the pregnant and lactating women. We see throughout children and to, you know, older adults and so on, we see that these needs differ. And that kind of makes sense. But there's only one food label so to to keep this in mind that the you know just to emphasize the rda is is can help you prevent nutrient deficiency diseases but for those of you interested in optimizing you know um your healthspan and aging um the best you can you might need to think a little bit more broadly than this. And the labels, food labels, just so you know, these are based on recommendations for young adult women on a 2,000 calorie diet. So nutrition is not one size fits all. We know that needs vary between people

based on all kinds of factors, how active they are, whether they're smoking or not, or, you know, whether gender, weight, all these kinds of things. And we also know that within individuals by stage of life that these vary. And this also applies to, you know, obvious things like age and pregnancy, but, you know, vitamin C, you take enough of it, you get to bell tar on some diarrhea. That level is very different when someone has a cold and when they don't. So even common things like the common cold, our nutrient needs vary quite a bit with that. And this is really important to older adults who have wide differences in their comorbidities and their health.

So why is this? So why with this framework in mind, which I hope you find helpful beyond just aging, but it is going to be useful for this, this talk, but why do our nutrient demands increase with aging? And there are a wide variety of reasons why you see them listed here. Some of them, there's even more beyond this, but some nice, you know, sort of acronyms meals on wheels and, and determine. So just to go through this, things to think about, you know, like medication usage, polypharmacy, that really changes our nutrient levels and can increase them in many cases. You know, issues with swallowing or chewing and so on that can

happen, these physiological things, economic issues, you know, challenges shopping, a wide variety of things that you see listed here, social contact, it became especially challenged during COVID. So there's a bunch of reasons here. It's not just that we are producing less stomach acid or our digestive enzymes aren't working as well. There's a lot of life and social situations that influence why our nutrient demands change with age. That said, there are indeed some very physiological reasons why this paper gets into some of those factors in aging that affect bioavailability of nutrients. I mentioned some of these. So some of them are, we just don't absorb as well the nutrients from the small intestine. We don't secrete as much

pancreatic enzymes. You know, there's ones that I mentioned when I talked about the macronutrients. So your lipases, your proteases, your amylases. Our kidney function can be worse. And fat-soluble nutrients, those are the ones I did my doctoral work on, vitamin E and the carotenoids, it's a slower uptake of these things. So there are some physiological reasons. But the authors argue that it's actually really driven by age-related disease and not necessarily age itself. This is one of the things I hope you find empowering. So things like lower stomach acid, atrophic gastritis affects about 20% of older adults, but lower stomach acid and pepsin leads to low levels of a bunch of different nutrients. And as we see acid blocking medications,

if you happen to be on those, we're going to see that those are associated with low levels of a variety of key nutrients. And then when you get in low protein intake, low amino acids, you get sarcopenia, which is low muscle mass, which is just what you want to avoid at all costs when it comes to aging, because it's associated with all-cause mortality and all kinds of other chronic conditions. And there's other age-related diseases that increase nutrient demands, things like diabetes, cognitive decline, cancers, and again, sarcopenia. So this is one resource, and to show you a few of them, of common medication classes that deplete nutrients. So I want to draw special attention to, to see H2RAs there. So H2 receptor agonists, and these are acid blocking

medications, P proton pump inhibitors, KPIs. So these are taken by a bunch of people when they have acid reflux or so on. Look at how many of these nutrients are adversely affected by those. You get diuretics are, you know, a lot of older people take those. We see how those are associated with a whole bunch of different nutrients. So this is something that, you know, we're trying to teach our medical students more and more about this, but it's largely going to be up to you to do this. And, you know, one of the best resources is mitovent.com. If you haven't heard of this, I strongly suggest checking it out. If you're taking any medications, so meprazole is one of your acid blocking medications and metformin. So I think this is interesting because it's a common medication, but also one that's used quite often by people who are in the sort of anti-aging communities. It can be a pretty good medication. We'll talk about that as we go along. We talk about mTOR and AMPK and these kinds of things, but it does have its issues. One of which is it depletes

some key nutrients, especially for aging, B12. That's one of the cornerstones that tends to be low with age and where we tend to need a little bit more in folic acid. You see a bunch of other common medications listed on the bottom there. You see antidepressants, stimulants, statins. So it's worth poking around if you're taking any medications or just to know if to advise anyone. And looking specifically at B12, Mitavin will talk about some of the specific studies and grades the evidence based on, you know, what you see here, this matrix of how they grade it, A being the systematic view of metanostasis of human trials down to NA, which is not enough there, or D is kind of, you know, in vivo animal trials, these kinds of things. And these data are generated from a variety of sources. So really a nice resource, you know, blogs on some of the key topics.

So definitely check out MyDivin if you're interested in that topic. I suggest we all, you know, be aware of it at least. So let's talk a little about the triage theory that I mentioned before. This is Bruce Ames who popularized this. He's a very impressive guy. He's in his mid-90s at this point, still doing work. Basically, what this is all about is that nutrients are used in this triage manner, where the micronutrients are used to ensure survival. Like it's kind of

what's the hierarchy of what's most important. That's going to be our survival. And then a bunch of other, you know, important roles they play go by the wayside. So this would include all of these hallmarks of aging that I mentioned before, you know, our mitochondria function or DNA repair, telomeres, senescence. And as such, being low in micronutrients can contribute to age-related disease because they're being triaged away from all these important functions they have because we just don't have enough of them around. And I mentioned before that Ames really mentions carnitine and alpha lipoic acid, especially because of their role in mitochondrial health.

So, you know, just being aware that you're getting enough carnitine in your diet and alpha lipoic acid in your diet to ensure optimal function. Of course, there's many others that you see. Let's hear some of this down a little bit um uh and you can cover some of those bases with the multivitamin um and really although you ought to be thinking food first and uh there's some other supplements we'll talk about too so what are some of the specific strategies um you know there there have been some um uh efforts such as the tufts food Pyramid that you see here, that lists what they think to be important for aging.

Things like increased food intake, absolutely. Increased protein intake, definitely. And they talk about a couple of key micronutrients we've already mentioned, B12, calcium and vitamin D. But this is just the tip of the iceberg. There are many, many other important nutritional factors that we're going to discuss today. You know, other minerals, many other vitamins, the non-essential nutrients, and then just thinking about how nutrition impacts the other domains, you know, equal amounts of calories of something

can have very different effects on inflammation. You know, different protein sources have very different bioavailability. And when we eat, you know, this fascinating science and practice of time-restricted eating can have an impact as well. Okay, so let's look at some of the hallmarks of aging and foods and nutrients that can help with this. So if you look at the primary the hallmarks of aging and foods and nutrients that can help with

this. So if you look at the primary, these are like the furthest upstream hallmarks of aging. So one would be genomic instability. And this is basically an imbalance between DNA damage and repair. So what you're going to want to get in your diet there are dietary antioxidants, probably best obtained through food, you know, things like I showed on that slide with the carotenoids and polyphenols and, you know, alpha lipoic acid and all these kinds of foods. NRF2 activators, which is a switch that controls a whole bunch of genes. So things like sulforaphane, which is in broccoli sprouts and some supplements, curcumin and turmeric, naringinans, the sirtuin actors, we're going to talk about

those plenty as we go along, talk about NAD, and alpha-ketoglutarate, which is a supplement, which I feel like isn't talked about a whole lot, but it's one that seems to impact a number of these different pathways. Then you get telomeres, and these are kind of the shoe strings in the end of the shoelaces. I'm sorry, the ends of the shoelaces that can fade as time goes along. So it's the DNA damage at the end of those chromosomes. So things like Mediterranean dietary patterns. There's not one Mediterranean diet, but the general dietary patterns, getting ample fiber, polyphenols.

Coffee is a great source of polyphenols. Vitamin D and omega-3 fats from your cold water fish and other sources. Epigenetic alterations. This is changes in gene expression, epi above genetic genome. It's above the genome and this is where there's a lot of really interesting interesting things with methyl donors things like sammy uh trimethylglycine tmg it's a great supplement choline talked about before in the egg oaks b vitamins omega-3 fats then you get h h doc inhibitors histone deacetylase inhibitors things like sulforaphane egcGCG, quercetin. We heard a lot about that during

COVID, but quercetin, a good supplement also used for seasonal allergies. And once again, alpha-ketoglutarate. Loss of proteostasis, another one. So this is, you may hear about protein misfolding and glycated proteins. So this is where, you know, HbA1Cs, you know, so things like berberine, which can help manage blood sugar, a great, great supplement. We'll talk a little about this when we talk about mTOR, sulforaphane, again, spices and herbs, things like cinnamon and cloves and so on, and just generally cooking your food on lower temperatures. So slow cookers, you know, crockpots are wonderful and not burning them to burning your food to oblivion. And then we get disabled macro autophagy or autophagy. We hear about that a fair amount today. We talk about things like fasting and so on. It's basically just, you know, not able to remove damaged cells or waste. So fasting, time-restricted eating, caloric restriction, I tend to think for most

people, time-restricted eating is easier. And I worry about long-term caloric restriction for human beings, but there's the time and place for it. Urolithinase, a really promising supplement, spermidine is another one, and then the NAD plus precursors. Okay, so let's look at some of the antagonistic factors that can go along with these. So deregulated nutrient sensing is a big one. So this is just suboptimal alterations in anabolic response, autophagy, and inflammation, and so on. and one of the best things that this again is your your spectrum of fasting time restricted eating and um caloric restriction and so on potentially ketogenic diets recommend those generally not for the long term some people do well with them some

people need to do them uh epileptics for example but um but they can be useful in a cyclic way uh berberine and just getting enough nutrients and not eating too much. Again, mitochondrial dysfunction, and this is really a big area of interest these days, which just leads to inflammation and poor cellular function more generally. Things like L-carnitine keeps coming up. Coenzyme Q10, PQQ, a ketogenic diet, all these things can help with mitochondrial function. Cellular senescence. These are the senescent cells, or we know often called zombie cells that go around, you know, basically they're not really alive, not really dead all the way,

but they cause a bunch of inflammation. So there's some, um, interesting, um, flavonoids like fisetin and quercetin that have been used, uh, for this. Um, you know, people take them often in a hit and run fashion, they call it. Um, then once again, you get this, this timing, you know, your time restricted eating, um, uh, can I, there's different ways to do it. Um, I think a fair middle ground for a lot of people, something like a eating in an eight hour window. Um, and this will vary based on, on, you know, the menstrual period sometimes for women and, um, other factors. He probably wouldn't want to do a whole lot longer than that with, when, with age, but, uh, some people really thrive on it. And it's going

to be somewhat individual and varies on what you're eating as well. Okay. And lastly, we're the integrative ones, which are the ones that are kind of a result of the other factors. So stem cell exhaustion. So just the loss of cellular plasticity, you know, stem cells can kind of become a bunch of different cells. Once again, you know, you get your time restricted eating, you know, fasting and so on, and, and, and ketogenic diets, altered intercellular communication, which is just where the, these cells don't, don't, there's not, the signaling pathways aren't working as well. So things like alpha lipoic acid, I mentioned collagen before, you know, again, we think of that for, you know, skin and joint health and so on. Glucosamine, chondroitin, hyaluronic acid, all those types of things that are working in those systems.

Dysbiosis, so, you know, not enough diversity and increasing pathogens. So there are things like fermented foods, probiotics, prebiotics, potentially taking short-chain fatty acids, postbiotics, and chronic inflammation, which is kind of like this is just all these other hallmarks together lead to a state of chronic inflammation, which is associated with seemingly everything when it comes to chronic diseases and worsening of acute diseases. So omega-3 fats, your polyphenols, spices and herbs, and so on. The authors conclude with some things that resonate with those of us in functional medicine that we want to avoid age-accelerating environmental factors. So environmental toxins, my team and I have done some work in this area. Really try to avoid those. Get good air filtration in your homes.

Be careful if you live in environments where there's significant air pollution, stress, physical inactivity, you know, and all these other factors, sometimes which are unavoidable, as I mentioned. And then adopting health-promoting lifestyle factors, exercise, sleeping well, socializing, and of course, diet, which is the focus today. And then they talk about these relatively nonspecific pleiotropic drugs, not just drugs, these can be supplements, things like NAD plus precursors and berberine and so on. So really, I think an encouraging paper that there's a lot in aging

that we can control. And when it comes to diet, a lot of different ways to get there. I think this slide demonstrates some of the ways, which you don't see here, you don't really see any processed foods and ultra processed foods. You see ample protein, You see lots of color. You see carotenoids and flavonoids abound and good fats. And again, some form of time-restricted eating. It doesn't need to be extensive, but it'd be a couple hours before bed and maybe a few hours after waking up. Those kinds of things. You just don't want to be eating all the time, all right? And that's what's going to help us sleep, which is fundamental to aging as well. Okay, so let's start with protein because this is an area which I think is of paramount importance. Everyone's got different, slightly different takes on this.

I think we can all agree on the no processed foods or limited ultra processed foods, but let's talk about protein. Why is this so important with age? Well, for one, there's a decrease in total body protein with age. And we kind of all see this in most older folks who have decreased skeletal muscle mass. We kind of see this, but subclinically, it also causes a problem in the organs, in our immune system, in our blood. So protein is essential. We're made up of it. And the decrease in skeletal muscle is really dramatic. So young adults, anywhere around 40, 50% of total body weight around age 70 for most people, not doesn't have to be. And that's, what's good news is about half of that. So, um, we know that dietary protein,

you know, builds and maintains skeletal muscle. So dietary protein gets broken down to amino acids, which then get built into skeletal muscle and high quality protein intake is a key to prevent sarcopenia. and we're going to talk about low muscle mass um study after study after study and systematic reason meta meta analyses show that this is a predictor of all cause mortality all right so we're we've talked about the rda some of the shortcomings of them before um the rDA for protein is 0.8 grams per kilogram of body weight. And that's argued by most to be too low. So research suggests at least one gram per kilogram of body weight. And many argue for even more. There's been some interesting papers

that, and you know, it's not just the muscle mass. I mean, there's all kinds of issues with insufficient protein that you see listed here. So I think that immune function, wound and fracture, healing skin problems. So we need more. And a lot of times you hear, well, what about kidneys? There really is no good evidence of renal harm for healthy kidneys. If someone has unhealthy kidneys it's a different consideration they may not be able to handle as much and for other select conditions that are not very common but i want to talk about this um all proteins are

not created equally and there are a number of different um sort of measurement scales out there to help us assess the quality of protein. And, you know, typically we think about protein quality, you know, we think of, you know, just maintaining body protein mass, but there's so much more to it. What are the differing amino acids? You know, I talked about collagen before not containing amino acids, and I talked about plant proteins. They don't contain, you know, a full spectrum of essential amino acids. Then, you know, what, you know, the different amino acids and proteins, they have varying effects on our body composition, on our bone health, on the function of our gastrointestinal system, on cell signaling, glucose homeostasis, satiety, you know, also the other nutrients and anti-nutrients that

accompany those proteins. So we got to think about this a little bit more broadly. You know, things, anti-nutrients, if you're dealing with those, those are things like lectins and trypsin inhibitors, which can oxalate, I mentioned before, which can impair, you know, the absorption of minerals and leach minerals and, you know, make, we don't digest as well. So we got to think about quantity and quality. And this PDC-AAS, which is the protein digestibility corrected amino acid score is one such way to do that you see what it's listed uh how it's you know uh done there but in brief you know animal proteins are more bioavailable than plant proteins we see some listing here you know things like whey protein isolate right at the

very top but we get down to things like wheat uh and soy um you, and peanuts and these things, legumes in their whole form are not very bioavailable. So what we need to think about with this, you know, we'll think about combinations and so on, but leucine is one that, again, we talk about the amino acids. We really need to think about this. You know, here at Branchine Immunoacids, these are critical for maintaining muscle mass or putting muscle mass on with age. It's not like it's just a maintenance. You know, you can put on lean body mass with age, which is going to provide, you know, resilience from the hip fractures and all those types of things, but also help you perform better. We see it again,

weight protein isolated at the top and things like wheat protein, which are not very good. Not only that, they, you know, gluten, these are not particularly, um, uh, bioavailable. So, um, things like, uh, beans, I mean, beans, um, you know, can be, uh, with, especially with, with, uh, certain protein powders can be combined, um, with, uh, you can be combined with other plant foods to form complete proteins. But if you look at the amino acids, again, I suggest you think a little bit about more than just grams, but also start to think about amino acids. And there are just many more in something like beef, for example. It doesn't mean you have to eat beef, but you do need to be aware of the amino acids, especially with age.

So things to think about here. Well, I hope you enjoyed that teaser of exclusive content that you get every single month with Dr. Hyman Plus. If you want to listen to the full episode and get access to ad-free podcast episodes, plus Ask Mark Anything episodes, plus monthly functional deep dive episodes. I guess that's why we call it Dr. Iman Plus. Then head on over to the doctor's pharmacy on Apple Podcasts and sign up for your seven-day free trial. Hi, everyone. Just a reminder that this podcast is for educational purposes only. This

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