The Dr. Hyman Show - How to Die Young as Late as Possible with Dr. Michael Roizen

Episode Date: December 26, 2018

Aging without feeling old—isn’t that what we all want? By embracing the right lifestyle practices, it’s possible to get a new lease on life. Emerging research is showing optimal health and graceful aging have just as much to do with when you eat as what you eat. We’ve been hearing a lot in the last couple years about intermittent fasting and time restricted eating, which many folks practice by avoiding meals earlier in the day and breaking their fast with a late lunch or large dinner. My guest on today’s episode of The Doctor’s Farmacy, Dr. Michael Roizen, is here to share why science says late eating is not in our favor and how we can flip the script to make time restricted eating support optimal health. Dr. Roizen is the first Chief of Wellness at the Cleveland Clinic, is board certified in internal medicine, an anti-aging expert, and is the author of many New York Times best sellers. His most recent book, What to Eat When, takes an in-depth look at how planning your meal times more mindfully can dramatically improve your health.

Hello, I'm Dr. Mark Hyman. Welcome to the doctor's pharmacy. That's F-A-R-M-A-C-Y, a place for conversations that matter. And today we have a great conversation with a very good friend of mine, Dr. Michael Roizen, who I've known for quite a long time. I'm going to give you his bio in a minute, but Mike and I first really got close when we were tramping around Washington trying to get health reform done so we would pay for lifestyle treatment for chronic disease. And you even forgot your license one day to get in all those buildings. I did. And somehow was still able to get in.

That's right. It was an amazing time. Well, actually, you were a key part of that because I forgot. I was in a rush to go see the Secretary of State who was helping us get in the right meetings in Washington with the head of the health committees and the Senate and Congress and the Health and Human Services. And I managed to finagle my way on the plane, but I had no money. When I got to Washington, I met you in the airport and you gave me a hundred bucks and I put it back in an envelope after I sent it back

to you. So thank you for that. So Mike and I go way back, and he's been the chief wellness officer at Cleveland Clinic. He was the first chief wellness officer of any major academic medical center, any medical center for that matter, and was really a pioneer in thinking about how we change healthcare and how we change health. His work really is focused around aging and healthy aging. His book, Real Age, was a massive bestseller. He's partnered with Share Care and is doing great work around that i think you've had like i don't know 40 million people fill out the real age questionnaire or something like that it's it's

actually 66 okay i can't keep up i cannot keep up now mike is 72 years young and he looks like he's about 12 which i don't even know how he does it but i want to take what he's doing you too you look very young i'm doing okay uh he's a smart dude I want to take what he's taking. And you too. You look very young. I'm doing okay. He's a smart dude. He went to Williams College, UCSF School of Medicine, residency at Harvard. He's worked with Nobel Prize winners at the National Institute of Health. He's board certified in internal medicine and sociology and really an extraordinary guy who's, I think, published more books than I do, which I don't even know how he does

that, but somehow he does. He's had four number one New York Times bestsellers, nine overall top 10 bestsellers, really a great man. And he's the one who helped me come to Cleveland Clinic. He invited me to come here to try to bring a different way of thinking and replace him because he was trying to go on. And thank you for coming. And I came. It was really a breakthrough. I really, Mike has been a key part of the advancement of what we're doing here in functional medicine. So Mike, welcome to the doctor's pharmacy. It's great to be here.

Thank you. It's always great to be on with you. Yeah. Well, I remember first being on shows with you, with Dr. Oz, when you, before that was the Dr. Oz show, there was the radio show, which you and he did. And I remember being in that studio and it was actually fun. The Oprah radio at that time. That's right.

And the producer, Robin Bersin, is now a good friend of mine. She was just an undergraduate, and then she went to medical school at Columbia, and she invited me to speak on functional medicine there. And now she started a whole company to bring functional medicine to millennials, which is pretty awesome. So it all goes around.

So, Mike, you wrote a new book called What to Eat When, which is not just about what we eat, but when we eat. Right. So most of the books that have come out are about what we eat. And that's important. But what we started doing was asking people when they eat. And as you know, nighttime eating is common. Yes.

But that's a real problem and when we got delved into the science and it's really new science we found out that circadian rhythms you know your metabolism goes up and down as the day goes through and it that your metabolism is highest in the morning and lowest in the evening so if you've got a normal blood sugar in the morning by the end of the day you're pre-diabetic yeah and so you in fact produce fat when you eat at the end of the day yeah so what we learned from this new science was that when you eat is really important and you want to eat when the sun is out so if you need a light bulb like these lights to eat you shouldn't be doing it there you go well it's fascinating because it's such a controversial area. I remember when I was at Canyon Ranch,

we were advising people not to eat late at night, and we found that these studies that showed that if you ate 2,000 calories throughout the day, you actually burned more calories and didn't gain weight, whereas if you ate them all at dinner, you would actually gain weight, same calories. Right. So, in fact, there's been a great study from Spain where they took people who were trying to lose weight, women who were trying to lose weight, and they had them eat before 3 p.m.,

their biggest meal. You know, Spain, the biggest meal is at lunchtime. So they ate their biggest meal before 3 p.m. or after 3 p.m. The group that ate before 3 p.m lost 25 more pounds wow over the 16 weeks 25 more huge difference so here's here's a question you know we we hear now a lot about time restricted eating intermittent fasting fasting and making diets uh because that's like basically like skip breakfast right and and what you're saying is that may not be right or well the deal you want to skip is dinner ah so in fact all and in fact one of the parts of the plan is cook at dinner but eat it in the morning so in fact we don't want you to spend extra time

cooking in the morning so a lot of things should be cooked in the evening have dinner for breakfast have dinner for breakfast and breakfast for dinner if you will but how do you reconcile that with the whole intermittent fasting thing well in fact you want to eat you know time restricted period so 10 a.m is when i have breakfast and then i have my biggest meal around 1 30 and then very little salad at 6 30 so it's changed my way of eating you know it used to be i mean this is this you know can i tell you something without anyone hearing it maybe so my wife used to get these great raisin cinnamon breads at one of the local bakeries right and i when she brought it home you know she'd come home at seven with a with the bread

i would go through the entire i would eat the entire loaf by the time i mean you know whatever right as my late evening midnight snack and so she would have to hide it well now she doesn't have to do it she can bring it home and i don't even feel hungry for it yeah so in fact it really when you once you change it changes your hunger pattern too so can you talk more about the research behind this because this thing is you know i think we we know that that you know if you eat before bed your metabolism slows down you gain weight and all the hormones are different right so what what have you learned recently about this emerging science that sort of teaches us that we should be you know not eating late so there's a whole raft of science and some of it is you know in animals mice that

eat during their active period as opposed to just before their inactive period they lose weight compared to it fruit flies they fly better they don't develop heart fruit flies are actually the best model of heart disease we have humans that was a surprise too well in fact there are people who do this full-time obviously and it turns out if you eat more just before your sleep period the fruit flies if they eat 24 hours a day for example they develop heart failure Whereas the ones who eat in the beginning of their active period, for us, 10 a.m., they don't. They end up living 30% longer.

So it is a form of intermittent fasting, if you will. So we have some rules, if you will. What are the rules? One is eat only when the sun is up. Eat more early, less later. I already talked about breakfast for dinner and dinner for breakfast. Stop stereotyping foods. So my favorite breakfast food now is salmon burgers with some sweet potatoes and broccoli,

which really, I love it. And so I usually have a salad with a little salmon on it for dinner. But that's really, I've changed the way I've eaten. And what has that done to you? I was actually thinking about that this morning. I have more energy. I have the energy of someone who's 30 years younger. I know.

It's terrible. You chase them down the hall. But it's terrible. They chase them down the hall. But it is true. But it is, you get more energy and you feel, you know, it's like a new lease on life. You feel really energized. It really, to me, I was a skeptic going into this. I thought, what the heck, I'm just going to, if you will, ruin my schedule, you know, by eating more in the morning and not skipping breakfast. I used to skip breakfast, you know, and would eat lunch and then dinner as an intermittent fast if you will yeah um and if

you will get ketogenic well this gets you ketogenic without having to sacrifice anything you know by eating if you will more in the morning and less in the evening you you when you eat in alignment with your metabolism you gain that tremendous advantage. It's like you cracked the code for health and weight loss. So why does this work in terms of your metabolism? Why is it sort of better to eat in the morning? What is happening from your circadian rhythm and your hormones? What happens is you become insulin resistant during the day so insulin

i i for for for those listening um who aren't docs insulin is like a postman or the fedex delivery man who takes glucose from your blood and puts it into your cells yeah if you have more glucose staying in your blood which is what happens when you eat at night you turn it into triglycerides that's fat but you also denature your proteins or or if you will stick a glucose on your protein so hemoglobin a1c yeah which we measure for diabetes is just a hemoglobin with a sugar in the a1c position which is very inflammatory very inflammatory and if you will it's so it does it with a lot of proteins like the proteins that are the grout proteins holding endothelial cells, holding your blood cells together in your blood vessel, your artery cells.

So if you weaken those, when blood pressure comes down, you get small tears. That's when you put in the LDL cholesterol and get atherosclerosis. So it's really, you know, you've pointed out in a number of your books that insulin is a major factor. The big problem. And you really taught me that way back when, when you were at Canyon Ranch, if you will. So, in fact, when you look at that, it is, we become insulin resistant. We change our insulin.

It's as though there's a clock hanging off your liver. So think of a clock on your liver. And when that clock hits, whatever it is, 7 or 8 p.m., it says, come on in, I'm going to make triglycerides. And when it doesn't, it says, go into the muscle cells, go into the brain cells, be productive. So I look at my image image i have two images i think of one is a light bulb if you if you're eating and you have to eat by a light bulb you shouldn't be eating and the second one is it hard in the winter you have to eat like before four o'clock well only if you're in cleveland if you're at the equator you're gonna do you later right and and um but i've yeah if you're if you're in alaska real problem

but anyway um but pretty much just starve all winter like the bears do so they they they may do it right but in any case and the second image is of a clock hanging off the liver because your insulin levels and your insulin resistance changes as the day goes on. So that's really the science in the book. In addition to, we found a lot of things out about what you eat for certain situations, right? What should you eat on a first date? And what should you eat? Now, you don't have to go on any first dates, right? And no little things that stick in your teeth, right? No chia seeds. But anyway, so the book is filled with 30 scenarios like that.

But the real basis, the real plan is how do you switch from eating at night to eating in the morning so that you can, in fact, eating while the sun is out eating less early more less later more early and in fact um not stereotyping food so you don't have to clean out your pantry you can change by what's in your pantry now so in terms of the whole intermittent fasting craze because it's a big craze now. Everybody's doing it, talking about it. A lot of science about how it actually helps reverse a lot of the aging phenomena, helps with weight loss. And could this be done within that framework?

In other words, could you? Oh, it's got to be done within. I think it should be done within that framework. So you could have like a late breakfast, early dinner, and still be in the intermittent fasting. So you give your body 12 to 16 hours to not eat yeah you want 14 or 15 or 16 hours that you're not eating that's right so it's a good thing walter longo you had him on the on your pharmacy if you will i'm going to i actually i

haven't had him yet oh he's wonderful yeah he i had a schedule but he he did a lot of these studies on intermittent fasting in periodic intermittent fasting fasting mimicking diet he calls it right but it really is calorie restricted five days a month yes and so he really did those studies accidentally but there are a lot of people who've looked at time different studies um and shown that that again um whether it's the spanish study there's a study you know i don't know how um the people at the peter brent brigham get people to go and not look at a clock or tv if you will just netflix for 20 days and they feed them but they get them in a if you will they get a group of people who

who will metabolic ward yeah who will eat whenever they tell them to eat and again they showed that the people ate the same calories if you eat 70 of your calories for breakfast versus 70 for dinner you lose weight when you eat them for breakfast, and you gain weight when it's dinner. Who would do that? And it doesn't depend on, you know, it is the chronobiology. Right. So the whole idea of calories as all being the same doesn't really work, and even when you eat the calories matters more almost, it sounds like. Well, when you eat them really matters. And we were really surprised.

And so we road tested it with a bunch of people. You know, the publisher and the editor are pretty stiff critics, and they rarely read. The editors will read the book for grammar, et cetera, and flow. But they actually went on the diet and lost weight. So we've got friends at National Geographic who are much thinner now. That's good. Now, the whole issue of rhythm is what you're talking about.

Because in biology, most of us and doctors ignore rhythm. And yet we know that people who have sleep cycles that are disrupted through various kinds of night shift work are much higher risk of heart disease and death. We know that a lot of your hormones and biology is driven on a biological clock and yet with a light bulb and with the advent of screens and with our kind of 24-7 life and being engaged we don't actually live in a rhythmic way anymore we don't wake up with the sun and go to bed with the sun we don't eat in a rhythmic way and that's what you're talking about is getting back to a certain rhythm that is essential for health right you got a little place in your brain 20 000 neurons out of whatever it is 10 trillion or 1 trillion neurons in your brain i don't even know but it's a lot of brain cells but they're only 20 000 of them that do the rhythm that do the chronobiology

and that really make it and that really makes a difference to sleep yeah it really makes a difference to health and it and we were surprised it makes a difference to your metabolic rate and whether you develop heart disease whether you develop obesity or what you call diabesity yeah is really um we get diabetic if you will at least pre-diabetic as the day goes on. So you think, I don't want to be a diabetic, don't eat at night. Yeah, I think that's really true. So what does a perfect day look like in terms of an eating plan?

So the perfect day is probably close to what Dr. Croupain does, who is the co-author on this, Mike Croupain, who worked at Consumer Report, was their food guy for a number of years, and now is the medical guy, the chief of medical staff at the Dr. Oz show. He really embodies this. So if you will, he will cook, he's a foodie. So he loves food and he cooks at night. So he will often have for breakfast, and he has it at 10 a.m. much like I do, his avocado toast. So you like avocado toast. It's whole wheat bread, 100% whole grain, and avocado.

And then he'll eat his biggest meal and he'll cook something special for lunch at dinner. But he's developed a whole group of recipes. They're going to be on our website, winway.com. He's developed a whole group of recipes where you cook at night and just can eat in the daytime without even re-thermalizing, without even reheating. But so he does that. And so it's salmon and i'm not sure i like cold salmon burgers they're really good until you try them don't knock it but in fact salmon burger but he doesn't he he cooks a uh walnut crusted salmon or a pecan crusted salmon

at lunch and then he'll eat almost nothing he'll have just a little salad um and some wine at dinner so he loves wine but that's his dinner you know a glass of wine is is his full 20 percent of calories if you will antioxidants so he does like red wine so that will be his dinner and then he'll do it again but he will cook something different every day. I'm very stable. So you ask me, I cook four salmon burgers at dinner. I will eat one at dinner, usually two at breakfast and one at lunch, and then I'll have something vegan at lunch in addition.

So that's a typical. On a weekend, I'll have a at dinner this is crazy right i'll have an egg white veggie omelet at 4 p.m is the last meal so that's the only thing i change on weekends if you will so i love what i you know you've got to love what you eat speaking of your routine you're you're going strong you're 72 you you never stop i don't even know how you do it i know you always have a cup of coffee in your hand. Coffee, if you're a fast metabolizer, makes you younger. Yeah, it's impressive.

So how do you live your life? What's your routine that allows you to stay so vibrant and looking young and barely having any gray hair at 72? Well, the key is having a great partner. So my wife is magnificent, wonderful. And so that's what I consider the key is having a great partner. So my wife is magnificent, wonderful. And so that's what I consider the key is having friends. And I saw a beautiful quote that you gave on an article that was about you and how you want to live to be 100 is you wake up every morning and you kiss your wife.

That's exactly right. First thing. That's a very good thing. So great partner. And that helps me manage stress so i do do six minutes of deep breathing morning and night as my meditation if you will so that's part of my life no no tobacco obviously but then um if you will i i don't go to bed you can look at my pedometer i don't go to bed I don't know if you can catch it on. So Bill is a superb cameraman.

I don't know if he can catch this, but this is yesterday. You see, I just made 10,000. Look at that. This is the day before I just made 10,000. There you go. This is the day before. I don't go to bed without 10,000. But if I'm close, I get 10,000 steps.

And you basically have a desk. I've seen it in your office where you're on a treadmill on the phone on conference calls where you're doing your work it's like the slow treadmill you're just going to walk all right so i can i can uh if you will i i um write at 1.7 miles per hour two degrees i type at 1.8 i read at 1.9 and you can do conference calls at 3.3 miles per hour so I do that routinely so you might be breathing heavy well the the problem on that is is if you're doing that is if you forget you're on the treadmill which if you get an excited part of the conference call and want to you know say something important and you forget you're on the darn thing you get flipped out pretty fast so you gotta have a gotta have a chair at the end of the treadmill to catch you

but so i i get to do my passion during the day which is helping cleveland clinic employees and cleveland clinic patients and cleveland clinic if you will we spread it wide to our communities and other companies get healthy. So I get to do the wellness program. I get to see patients a couple days of the week in executive health and in the premier program, which I love doing. And then I get to spread this and get to do shows like yours, which, you know, it's as good as it gets to be with you here. Well, you really, you really love what you do. And one of the joys of being at the Cleveland Clinic is that the other people are so good.

I had a patient last week who had a rare disease. And believe it or not, there's a guy who's specialized who knew more about that than anybody else in the world. And that's typical. If you find a person with a problem, you can find someone who knows more about that and has dealt with that more than just about anyone else so it's a joy to be here and you know i refer you patients too when they get too complex you get them that's right i i worked at kenny

ranch for years which is a health resort so i used to call myself a resort doctor the doctor of last resort so um one of the things you've done which is remarkable is to come into a place which is one of the best hospitals health care systems in the world but it's focused on acute care like the sickest of the sick and you said wait a minute you know with the leadership of toby cosgrove who's a former ceo that we need to rethink health care and we need to rethink how we're going to deal with our own employees. Because now there's what, 100,000 employees and families as part of Cleveland Clinic that are self-insured. 109,000, but who's counting?

You're always good with the numbers. And the remarkable thing is you took a problem that seemed insoluble, which is dramatically rising healthcare costs within businesses and companies and organizations like Cleveland Clinic. And with very difficult to change behaviors like diet and exercise, smoking, stress, and you implemented a program here, which is really a national example of what can be done around creating wellness in organizations. So can you share a little bit about how that came about and what you did and the results that happened as a result of that? Because I think it's an inspiration.

Well, you couldn't do it without great leadership so toby cosgrove and now tom mahoevich who is into it even more have been the leaders and they kept if you will the financial guys at bay for a while because it took a while for this to show a return on investment. So we knew from the Medicare database studies that we did that if you did five behaviors, you decrease your risk of chronic disease over the rest of your life from age 40 to 50 for the rest of your life by 90%. And since 80% of all medical costs

are due to management of chronic disease, you can really change that. So we went to our employees and Toby said, just pay them, if you will. We're a capitalist society. Pay them to stay healthy as well as make some environmental changes and culture change. So we made the culture change, which is really important. So we're down from 15.4% of people smoke to under 5%. In fact, 43.6% of our employees now have, if you will, what we call six normals.

We changed the behaviors into, if you will, outcome measures that we could measure by, and the employee would go with a piece of paper to the primary care physician and say, where am I on these six normals? And then- Was blood pressure, blood sugar- Blood pressure, blood sugar, or hemoglobin A1C, body mass index, LDL cholesterol, cotinine, which is tobacco end products, and then are they managing asthma? We've learned that managing stress is more important when we've worked with other corporations, so we're bringing that in now. But in fact, if you get those six normals in the nurse's health study,

you decrease chronic disease by 90%. In the Swedish men's study, by 87%. But only 1% of the Swedish men did it, and only 4% of nurses did it. We're at 43.6%, if you will. How did you do that? Well, it wasn't me. It was the employee health plan team, Bruce Rogan and Paul Terpoek and David Power. You guys did something unusual. You actually gave people financial incentives. In other words, they got more money back from their health insurance.

In other words, they didn't have to pay the premium. Well, in the Obamacare, which we, you and I, and Dean Ornish lobbied on together, and we hit 66 senators, you know, Republicans, Democrats. We got everyone, if you will, covered. And the point was that if you have money money if you can reduce your premiums by 30 we're now at 1440 dollars goes back to a family of four if they get six normals they save that they work at cleveland clinic for 30 years it means 200 000 extra retirement wow so it's a huge amount of money if you will it that doesn't even include co-pays and being healthier and not having to take time off etc but in fact more productive more productive in fact yes the whole thing

but we did it by focusing on those six normals normal blood pressure normal ldl cholesterol normal body it isn't even normal body mass. It's just not in the obese range. No cotinine greater than secondhand smoke, et cetera. But you offered smoking cessation programs, weight loss programs, exercise classes, free gym memberships. I mean, there was a lot of things that seemed to be a cost center, but actually ended up saving, what, hundreds of millions of dollars? The CFO will say we have not spent i have to put it in we have not spent 665 million so far 168 million the last year for the 101 000 and that doesn't include the employees

have gotten well over 100 million i calculated around 200 million in reduced premiums in addition so it's a win-win for everybody it's a win-win pays less the organization pays less and and the government if you will we're healthier so we can serve other people with more vigor and in fact it is um you know i'll say one one funny thing when we were writing the uh the book what to eat when um it's hit me we don't serve meals after 3 p.m. in most of our restaurants. We do it perfectly at Wenway.

It's true. I went over to the new food emporium, and I was like, I want to have dinner. I'm like, there's nothing left. I'm like. No, they stop at 3 p.m., so it works. But in fact, that wasn't, we didn't know about that at the time. But in fact, so by motivating the employees and giving them programs, we are saving, you know,

if you just replaced our nurses and didn't have to when they're not sick. So we have reduced the what we call unexpected sickness days from 1.07% to 0.77%. That 30, that 0.3%, if all you did because we got so many nurses that would pay for the entire program um we and that says us docs and administrators are useless so all it is is replacing the nurses so in fact um over time the program i mean it's a huge pay for itself and so we've spread it so one of the companies we spread it to is another health care organization that took 11 of their hospitals and didn't do it and 10 that did it they're saving 32 percent in the 10 that did do it they can't actually believe

it's not a no-brainer why isn't this being done all across the country in various organizations how easy was it to to convince those um senators even after we convinced them yeah a bunch wouldn't vote for it even after they said you're right well they were into it i think it just got on the cutting room floor you know so so in fact um there is a great benefit to this for society if we we did this, if Medicare did this for everyone in America, you could pay every Medicare recipient, the same percentages did it for Medicare, 69% participate and 43.7% get normal. You could give every Medicare recipient $2,000 more per year huge amounts more than ten percent of their average take-home for the medicare population and save the government between three and four hundred billion a year so what you're advocating is exactly what we should do um you and i know that if you will

um and uh so as you know i'm science-based. And so that's what this is. It's amazing. The data's there. The data's there. Okay, so knowing everything you know and being in this space for a long time, if you could change something in terms of health, health care, environment, or society, and you were king for a day and you had autocratic power, could do anything you wanted,

what would be the thing or things that you would focus on to make the most difference? I'd focus on getting people voluntarily as we do, giving them big enough incentives. The Rand study on wellness says incentives doesn't work, except there's an asterisk. I think it's on page 36, which says, unless they're large. Well, healthcare costs enough that we can make, you know, instead of causing, if you will, income inequality, if you stop having an increase in medical costs, you all of a sudden make income much more equal because the lower level employees get much more of that benefit, if you will. So in fact, I would say, let's offer large incentives and have a cultural revolution like we had in World War II.

Everyone pitched in in World War II to help the country win. We should, in fact, all pitch in to have everyone stay healthy. And that reduces our budget deficit tremendously. If you do it for, just imagine, veterans and Medicaid as well as Medicare and all the government employees, you have a tremendous budget, if you will, dividend that you can then make society much better. So that's what I would do, and I'd close all the restaurants after 3 p.m so pay people to be well pay people to be well yeah and you you because of medical costs you know we could shut down a number of the cleveland clinic hospitals well we uh we were talking about this in terms of a project we're working on at cleveland clinic and other people around the country of food

pharmacies where you actually give people free food three meals a day two meals a day whatever and you see make the cost go down by 80 percent in diabetics right no no food is so key and both what avoiding the sugar the making you're making sure that you don't have simple carbs added syrup simple if you will sugar sugar yeah and also making sure you eat early enough when you eat is important because you become free diabetic as the day goes on so you're absolutely right you know pharmacy is a great name for a podcast i'm envious as heck it's all right so anyway michael roysen michael roizen from the cleveland clinic former chief wellness officer rabble rouser new book is what to eat when which you should all go check out it's a full of scientific information and great practical guidelines on how to actually

eat according to your metabolism which is what we all need to do and i really hope you've enjoyed this conversation i think it really matters uh if you like this podcast please share with your friends and family on social media if you'd like to leave a comment or review we'd love to hear from you and we will see you next time on the doctor's pharmacy