The Dr. Hyman Show - Why We Grow Old And How To Age Well

Episode Date: October 31, 2022

This episode is brought to you by Rupa Health, ButcherBox, and InsideTracker. In Western culture, we’ve gained a negative view of aging. But in other cultures around the world, aging is celebrated and embraced. That’s because we define difficult symptoms like aches and pains, cognitive decline, and so many others as “aging” when they’re actually signs of dis-ease that can be prevented and often even reversed. Fortunately, there is much we can do to change the trajectory of aging starting at a young age, or at any age.  In today’s episode, I talk with Dr. David Sinclair, Dr. Frank Lipman, and Dan Buettner about all the ways to age better, from supplements to support mitochondria, to increasing muscle, to cultivating community, and more. Dr. David Sinclair is a professor in the Department of Genetics and codirector of the Paul F. Glenn Center for Biology of Aging Research at Harvard Medical School, where he and his colleagues study longevity, aging, and how to slow its effects. Dr. Frank Lipman is recognized as a vocal pioneer of integrative and Functional Medicine (or what he calls “Good Medicine”). Dr. Lipman is the founder of Eleven Eleven Wellness Center and the Chief Medical Officer at The Well. He is a sought-after international speaker and the bestselling author of six books: How to Be Well, The New Health Rules, Young & Slim for Life, Revive, Total Renewal, and his newest book, The New Rules of Aging Well: A Simple Program for Immune Resilience, Strength, and Vitality.⁣ Dan Buettner is an explorer, National Geographic Fellow, award-winning journalist and producer, and New York Times bestselling author. He discovered the five places in the world—dubbed Blue Zones—where people live the longest, healthiest lives. This episode is brought to you by Rupa Health, ButcherBox, and InsideTracker. Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, and Great Plains. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com. ButcherBox makes it easy to get humanely raised meat and wild-caught sustainable seafood by delivering it right to your doorstep. If you sign up at butcherbox.com/farmacy, ButcherBox will give you two pounds of ground beef FREE in every order for one whole year. InsideTracker is a personalized health and wellness platform like no other. Right now they’re offering my community 20% off at insidetracker.com/drhyman. Full-length episodes of these interviews can be found here: Dr. David Sinclair Dr. Frank Lipman Dan Buettner

Coming up on this episode of The Doctor's Pharmacy. We're in a remarkable time for aging. Now we're in a phase where the question is, what are the right combinations of diet, exercise, food, supplements? Hey everyone, it's Dr. Mark. One of the most important tools I have for helping my patients optimize their health is testing. And that is why I love what Rupa Health is doing. Functional medicine testing can require placing orders with lots of different labs. And it can kind of get really complicated for doctors and their patients to easily access results and keep track of everything. But Rupa Health has totally streamlined that process.

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I'm always being asked how I get enough high-quality protein into my diet and where to find it. With all of the conventionally raised animal products flooding the market, it can be hard to find meat that actually supports your health goals instead of making you further away from them with the use of antibiotics and hormones and an unnatural inflammatory feedlot diet. And that's why I love grass-fed ground beef from ButcherBox. Ground beef is probably the easiest protein out there that can be worked into any type of dish. I love how quickly it can help make up a healthy meal. And when you go to grass-fed, you're getting a great source of omega-3s, vitamins, and minerals too.

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pounds of ground beef for a year. To receive this offer, go to butcherbox.com forward slash pharmacy. That's butcherbox.com forward slash pharmacy, F-A-R-M-A-C-Y, to receive two pounds of ground beef for one whole year. Wow. And now let's get back to this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Feehan, one of the producers of The Doctor's Pharmacy podcast. Did you know that the body has built-in systems to slow and even reverse aging? When you activate these systems, you increase stem cell production, reduce inflammation, increase antioxidant enzymes, build muscle, lose fat, and increase cognitive capacity. Aging is inevitable, but maybe it's time we challenge our thinking on what it means and

how we can age better. In today's episode, we feature three conversations from the doctor's pharmacy on why looking at aging through a new lens is vital for enjoyment of life in our later years. Dr. Hyman speaks with Dr. David Sinclair on advancements in science that show us how we can live longer, with Dr. Frank Lippman on practical tips for aging well, and with Dan Buechner on the importance of friendships and community as we age. Let's dive in. We see increase in inflammation and aging. We see a decrease in mitochondrial function which are these energy cells so we lose energy basically our engine gets the carburetor gets full of

whatever and it doesn't work we see hormonal changes lower testosterone higher cortisol lower growth hormone increased insulin increased blood sugar we see changes in the microbiome that degrade over time we see changes in in our ability to sort of metabolize things and toxins. These are all things that we can understand now with the science we have, which we couldn't even a few decades ago. It's what we've been doing in functional medicine without really understanding that much of the science because it's all emerging. But your work has really started out with looking at the mitochondria as a key to aging and that has sort of led you to some of these other linkages, right? Well, mitochondria, I didn't set out to study mitochondria as a key to aging and that has sort of led you to some of these other linkages right well mitochondria i didn't set out to study mitochondria it's our research pointed

in that direction that they were part of the puzzle we started out when i was with lena you mentioned my former mentor and still friend uh we we started out with the question why do organisms grow old in the first place simple Simple question. Very few people had actually asked it. And so we studied yeast cells from bakers and brewers use it all the time. Why do yeast cells not live forever? And they typically live a week. We actually found out that these genes that you mentioned, sirtuins, are regulators of yeast aging. And we have seven of these genes in our bodies and they do phenomenal things they repair dna help telomeres and one of the things we found they do very well is keep the mitochondria healthy and actually we found what was surprising was how reversible the aging of mitochondria are in

animals at least and we're not doing human studies in clinical trials that within just a week of treatment with a molecule that a few molecules that we've tested that enhance the function of sirtuins resveratrol was a famous one we worked on now nad boosters all seem to be able to reverse mitochondrial dysfunction within days and we never knew that aging was that malleable until then yeah well we we see it all the time i see it you know treating patients where they're literally biology can reverse at any time. You see people who are in their 60s who have all these end stage diseases like heart failure and diabetes and severe obesity and

hypertension and kidney failure. And you see these things go away when you start to modify these factors that drive inflammation and blood sugar and mitochondria it's pretty amazing yeah well there have been a few paradigm shifts in the field so when i started out and this is we're talking about the early 1990s the idea was our bodies are like cars we eventually wear out there's not much you can do about it you can slow down the rusting free radicals and that's about it but what we discovered in the 90s thanks to works by cynthia kenyon and lenny garanti and others is is that these genes, sirtuins, and there are some others we can talk about later, I think. But these protective pathways exist.

We didn't know that we had protective pathways. It's as though we've discovered not just that our bodies are better than cars, that we actually have inbuilt repair systems. Yeah, it's like a self-cleaning oven, right? Yeah, and they get lazy if you're lazy. They get lazy if you become obese and don't eat well and if you eat too much. There are other things you can do to kick them into action with how you eat, what you eat.

But also what we found is that you can, they're basically inbuilt survival mechanisms that are very ancient. They're found in yeast cells and plants in our bodies. Probably our microbiome plays a role. And so we can basically make a call to the Pentagon of the body and they can send out the troops without actually damaging the body. You don't have to have a war to get ready for war.

And these protect us against diseases and, in many cases, reverse aspects of aging. Another paradigm shift was that we could delete the the bad cells in the body the senescent cells that accumulate and there are some molecules in in clinical trials as well that might be paradigm shifting how do you delete those well they're called senolytics uh senescent lytics lytic meaning lice the cells kill them yeah and there are molecules that can do that. There are some natural molecules, quercetin, quercetin from onions and apples. Tisatinib is a drug on the market.

We, well actually work at the Mayo Clinic primarily and Judy Campisi out at the Buck Institute found that you can treat animals and delete their senescent cells and they get younger. So you basically like go in and like clean up all the bad cells yeah we call these the zombie cells uh senescent cells zombie cells they they they're they're half dead they sit there they should be dead but they're actually causing havoc they're they're secreting inflammation factors cytokines that cause other cells to senescent to become um potentially cancerous and when you delete them, mice live longer. And what's exciting about that technology, that science, is you can, instead of taking a pill every day,

which is the kind of stuff that I work on, if their stuff works, you can have a treatment once every decade maybe, and that's it. And the treatment is a drug? Is it a supplement? It's like quercetin, you say? Well, you can supplement. There's nothing fully proven in humans yet. there are some early studies from the mayo clinic um just this year the study

in humans came out that was promising from jim kirkland uh but in mice a lot of studies now point to this being a phenomenal way to address aging so you got kind of different pathways you can work on at the same time right you can You can work on killing all the bad aging cells, and you can work on optimizing and revving up your engines, or like tuning up your engine. Well, we're in a remarkable time for aging because we've moved from just understanding what's causing it and how we might intervene to truly understanding what can be done.

And now we're in a phase where the question is, what are the right combinations of diet, exercise, food, supplements, and eventually drugs that are on their way? And so I mentioned two paradigm shifts. There's a third one that maybe we can touch on later. And that's reprogramming cells with an understanding of actually what's controlling the clock of aging and how to wind it back. Because you said this limit of 100 years or 120 is not necessarily a hard stop, that there may be ways of understanding the aging process that we can interrupt that. Well, there are plenty of animals and certainly species across the planet that live longer

than we do. It's not a biological impossibility to live hundreds, actually thousands of years. There's even some corals that live for 10 000 years so it's it's not a fact of life that we have to die at 120 if you remove predators and war and disease species evolve longer lifespans it's happening right now on a japanese island where a lizard was released and it's got no president predators it's breeding slower and living longer that's what happens and give us a few more it doesn't it doesn't actually just it sits there in the sun all day right well you know we we don't have we we you know we don't have to necessarily live at the bottom of the ocean like a greenland

shark or on a rock but what what these organisms show us is that life lifespan is malleable it changes over millions of years sometimes in the course of a few generations as we're seeing with this lizard what is happening that's what i want to figure out what is it about those organisms that we can learn from and instead of letting us evolve by having to wait for us to evolve over millions of years why don't we just accelerate that gene editing or is this going to involve more of these other kinds of therapies i touch on gene editing in the book in my lab where we're using gene therapy to kind of leapfrog uh and really see how powerful our genome can be we're having some remarkable results in mice and truly reversing the clock of aging and seeing what can happen and uh you know maybe maybe i'll tell i'll reveal that later okay it's fascinating i i uh i have

an apo e2 gene and a three which is two is like the ones who can live forever drink smoke and not exercise and live to 120 and then the four is the bad one you get alzheimer's so how do i like change my three out for two can i do that i'm gonna get a double two it'll it'll be possible where we're at with gene therapy is, so there are a couple of drugs on the market that are used for rare diseases because that's usually where new technologies are first used. You know, there are scientists who could probably do this

to themselves if they were crazy right now. Technology is there. Where we're not at, the science doesn't allow us to change every cell in the body right now. Even in a mouse where we've been studying this longer, and my lab does this every few weeks in the lab, the problem is we can infect about 30% of the cells, and it infects and changes the genes in some organs more than others.

So it's very easy to change most cells in the liver, but not so much in the muscle and the brain. And you only get one or two shots at it because an adenovirus, which is what carries the gene therapy, causes an inflammatory response. Right. That's not good. So, you know, I'm not planning on doing that anytime soon. But if I had a rare disease and it was going to kill me, or I was 95 and I had nothing else to lose, maybe I'd consider it. Unbelievable.

So the whole goal here isn't just to extend lifespan, right? It's to extend health span, which is how long vibrant years you have. And there's a lot of thinking that if we extend lifespan, there's going to be a lot of old people who are going to be sick and cost the system money and drain our society. And that's not a great thing. And yet there are others that sort of pointed to research that maybe that's not the case. That if we figured out how to create health, that we can do what we call rectangularize the survival curve. James Freeze wrote about this decades ago where he talked about how people who didn't smoke, who exercise and kept the normal body weight, live longer and were healthier and just didn't get sick. They just basically fell off the cliff and died as opposed to long, slow, painful deaths. They died quickly, painlessly,

and cheaply. Yeah. Well, that's what the science is pointing to. And in my lab, we see that a lot when we intervene with a molecule. We see those mice, they are healthier for longer. And actually, you know, when I talk to people about living longer and I ask, how long do people want to live? A typical answer is, oh, I wouldn't want to live over a hundred because people have seen what a hundred year old looks like. You know, God forbid that we get there. But what changes their minds is what if you could be a hundred and still play tennis and hang out with your great grandkids and still be productive. You don't have to be earning a living. You can be helping the community, nonprofit work. And then everyone

raises their hand pretty much. So it's all about health. And that's the key point. I want everybody to know that I don't know how to extend lifespan without keeping people healthy. In fact, the reason- That's how you do it. That's how we do it. That's the only way we can extend lifespan is to keep animals and eventually people free of disease for longer. And then eventually something gives out fairly quickly, typically. And that's the idea. Someone like my father, who's 80 now and still traveling the world and going out every night and hanging out with friends. Some girlfriend 20 years younger.

Well, yeah, multiple friends who are girls. I don't know if they're girlfriends, but that's a life that I think is well-lived. And if he can keep going and helping my family and his community, which he's doing for another 10 or 20 years, the economics show, and we've modeled this for Australia, we've done some, others have done this for the UK, GDP goes up. It's not that there's a drain at all. In fact, the amount of healthcare, it's 17% of GDP right now in the US. It's only going to keep going up. The reason is we're getting older and sicker. The last 10 years of life can be spent in wheelchairs and not going outside and being spoon fed. I've seen that with my grandmother. So my father's mother at 80

could barely walk. She was in a wheelchair, spent the last 10, 13 years of her life in a state that you wouldn't wish on your enemies. And the expense to keep her alive was ridiculous. My father, on the other hand, he's contributing. Yeah. You know, that's what I talk about in the book is that the future is bright if we can tackle this problem, keep people healthy for longer. The problem is if we don't succeed, we have an issue too. The world's economy is going to be dragged down by all the sick elderly people that are coming along. It's true.

I just read a study the other day that was a macroeconomic analysis of chronic disease. Just the United States, the direct indirect costs over 35 years, it's $95 trillion with a T. That's over $3 trillion a year. And if we figured out how to fix that, we literally have money for everything we need in this country. Infrastructure, free education, forgiveness of student loans, free health care for everybody, raising everybody out of poverty.

I mean, it just would be a game changer, right? Yeah. I couldn't have said it better. One of the things that people challenge me on, they say, why work on aging? Don't we have more important problems? Global warming, species extinction. I'm all for that. I'm the biggest greenie and I was going to be an animal rights activist if it wasn't working on aging. But I think the best way to tackle the problems we have is actually first solve the biggest drain on the planet, which is

taking care of the sick and the elderly. And then, like you said, there's trillions of dollars. If we could just reduce one disease of aging by 10%, it's about $3 trillion over the next decade. We're talking about a lot more than that. And that's money you can use to fix the world. And your thinking is actually the thinking that I think can solve the problem. Because in medicine, most of the thinking that I think can solve the problem because in medicine most of the thinking is focused on disease you're focused on the mechanisms of health well sure I mean it's important to know why people die and we have a list of 14,000 diseases in there well it's now 155,000 yeah but knowing why people yeah fall off a cliff I would argue it's also just as important if not more important to know what drove them to the cliff in the first place. Yeah.

So let's get down and deep a little bit. So the thing you're working on now is similar to what you're working on around resveratrol, which is the active ingredient in red wine. Except, you know, the equivalent amount of dose you'll use, I think, was like 1,500 bottles of red wine. So it's not something people should try at home. Because've because that worked on sirtuins would work on mitochondria but now you're working on a different mechanism which has to do with with increasing the uh function and health um of mitochondria using a compound that helps increase nad now can you explain what nad is a little bit about why mitochondria are important? And before you do, I just want to sort of back up a little and say that all the studies on aging that have shown any benefit to increased lifespan in animals have all been often through calorie

restriction, which means you eat less, like two-thirds, a third less, you live a third longer. And also new things like fasting mimicking diets are being studied and other things related to calorie restriction. Now, that apparently affects the mitochondria. That's how it works. And that's really what you're trying to figure out. How do you get around having to starve yourself all the time? Well, a large part of it is mitochondria. They do other things, which we can touch on.

They probably do 100 things that we're still working on. Let's go back to yeast because I think that's a good framework. When we started in yeast, we didn't know why they were dying. We figured that out. It's mainly genome instability that affects their cell identity and then they die. Discovering the sirtuins was a game changer because what we figured out was there are three levels to aging. There's the base level, which is the things that kill you. DNA damage, telomere shortening, mitochondrial dysfunction. That was pretty much worked out in the 90s. Then there was a level there was this top layer, which is the environment. And when the environment is a little bit harsh, adversity, or even perceived adversity, it kicks these protectors into action. And then they slow down or reverse these causes of aging. So think of it as a hierarchy pyramid.

So what you want to do is start at the top. So how do you trick the body into thinking that it's going to run out of food or that there's some other adversity and we found in yeast cells if you reduce the amount of sugar getting back to sugar they kicked into action the sirtuins um i'll talk about how they did that in a minute and then the yeast cells lived longer they protected the dna they boosted mitochondria and they lived longer wait i just want to pause here. So sugar, you're saying, accelerates aging and restricting sugar actually helps increase longevity in these animals. Well, certainly for yeast and a lot of data on humans that lower sugar is better and fasting blood sugar is lower is better too for longevity. But there are other ways to kick the sirtuins into action.

So there's in humans um intermittent fasting is is easier i find than calorie restriction i tried calorie restriction for a week it was pretty yeah i met a guy once who's i said he's doing calorie restriction and he was a member of the calorie restriction society so what do you have for breakfast i have five pounds of celery and three pounds of tomatoes and i'm like uh no thank you right well eating is one of life's pleasures um but i find uh if for me if if i skip breakfast it's no big deal yeah right so intermittent fasting is basically time restricted eating where you eat within a certain time window of eight hours or or 10 hours right yeah there are plenty of varieties i talk about them in the book there

are some other books that talk about that um You've mentioned this many times on your show. There are some skip a meal protocols that skip two days a week. There are some people, Peter Atiyah is doing skip a week of food. He says after three days, magical things happen, he thinks. I haven't tried that yet, but I'm going to. But yeah, no one knows actually what the optimal amount of fasting is. But what I can tell you is some time of being hungry is good. We can see that in our animals. There's no question. If we give our animals, our mice,

food every other day, they live longer. And in fact, if we gave them resveratrol and the combination of eating every other day, we got some very long lived mice and the combination was great. So that's one of the things I do to myself is have resveratrol and try to be hungry once in a while. Yeah, that's what the Okinawans do. They call it harahachi boo, which is 80% false. So you push yourself away from the table when you're 80% false. There's a lot to that for sure. You know, having a lot of food and glucose in your bloodstream, just not a good thing. So getting back to how to mimic this mimic exercise and diet, you can do it in yeast. You can do it in mice by either taking resveratrol. We showed that was one of the ways to activate sirtuin enzyme that protects the body.

But we have something that's, I think, more interesting now, which is the NAD molecule you mentioned. So NAD, let me tell you what that is. Anyone who's studied biology will have heard of NAD, but probably forgotten about it because it's so boring. Yeah, it's the molecule that nobody really wants to care about. What we discovered is that it isn't just a housekeeping molecule for biochemical reactions. Germans discovered 100 years ago you needed it for life. Without it, we're dead in 30 seconds. But what became interesting was, thanks to Lenny's work when I was in his lab, and then later in my lab, we showed that the NAD levels of an organism

are important for controlling the sirtuin protective enzymes. And as they get lower, they're not as active. And if you can get them higher, either artificially or by exercising or dieting they get kicked into action we get the benefits of calorie restriction and exercise without actually having to do those things and the but they're added i don't that's a good message no i was going to add to that which is but if you add them together is that it well? Well, we just published last year, actually, in the journal Cell, that if you have a mouse and you give it an NAD boosting molecule and you exercise, then they become super mice and they can run beyond.

Okay, that's good. So it's a lot of added value if you eat well and exercise. Oh, definitely. Because I remember reading original studies way back when, and I was like, wow, these mice were eating terrible diets and they were metabolically younger they were fitter and they didn't do any exercise I'm like whoa but then I was like wait a minute it's 1500 bottles of red wine it's not gonna work yeah well in the resveratrol study we did show that you could you could live make a mouse live just as long on a high fat diet um as as a a healthy mouse with resveratrol in the diet.

But I don't want to send the message that that's all you have to do and you'll be fine. No, definitely. There's other things that go wrong, and we're not mice after all. And you feel better if you're healthier anyway, right? So anyway, getting back to the NAD. NAD, yeah. We can raise NAD in everything from a yeast to a human by giving them what are called NAD boosters.

And these are either NAD itself or precursor molecules to allow the body to make NAD. The one that we use a lot in my lab is called NMN, nicotinamide mononucleotide is its real name. And the cells in the body take it up. There's a transporter. They get sucked up into cells and they immediately convert it into NAD. And we can see that there's a spike of NAD produced

after NMN after about two to three hours. And then it eventually goes back down. But what we are seeing, especially in mice, where we can take out tissues, look at tissues and blood, is that that has phenomenal effects on the body's protective mechanisms through largely through the sirtuins and mitochondrial activity. and blood is that that has phenomenal effects on the body's protective mechanisms through

largely through the sirtuins and mitochondrial activity. Hey everyone, it's Dr. Mark. You're unique, which means your health and wellness plans should be unique too. But it can be tough to optimize your health and nutrition programs because it's often difficult to get the data you need. And even if you do get your numbers, you actually have to understand them and then be able to make meaningful action based on them. This is where Inside Trackers comes in. Inside Tracker is a wellness tracker that uses science and technology to deliver ultra-personalized healthcare guidance. They can analyze your blood, your DNA, your

lifestyle habits, and give you actionable recommendations to help you meet your health and wellness goals. They'll tell you what you need to do and why, and you can track your progress and adjust your plan based on real-time feedback from your own body. Since 2009, their science team at Harvard Tufts and MIT have been bringing personalized nutrition and wellness to the world with their powerful evidence-based digital platform. InsideTracker is simple, customizable, and most importantly, it's based on you and your body. If you're curious about getting your own health program dialed in to meet your unique needs, I highly recommend checking out InsideTracker.

Right now, they're offering my community 20% off at insidetracker.com forward slash Dr. Hyman. That's I-N-S-I-D-E-T-R-A-C-K-E-R.com slash D-R-H-Y-M-A-N. And you'll see the discount code in your cart. I think the other thing that is important and I've noticed for aging is muscle. And I think we have a neglected organ, which is our muscle that we don't pay much attention to.

And this condition that we get as we age, it's inexorable. Like if you don't do something to stop it aggressively, you will lose muscle. So you could be the same weight at 65, then you are at 25, but your body be twice as fat. And it literally looks like a ribeye marble steak, as opposed to a filet mignon, which is what you want for your muscle with no fat rippling through it. That's all related to our diet and the lack of exercise. And so the two things I want you to talk about is the other side of the coin

because protein you need and you want to get enough, but not too much, but it's actually sugar and starch that drive this aging process. And then that combined with muscle strengthening and building as you get older seems to be some of the most important factors. So can you talk about those and how they relate to aging? Sure. Well, sugar and starches are the devil. It's not even a debate. You've got to get as much of that out of your diet as possible.

So you want to eat – the protein is a harder one, how much protein you eat. And I think as you get older, maybe decreasing animal protein, increasing a bit of plant protein, but still keeping those carbohydrates as low as possible or the sugars and the starches. I think the muscle issue is interesting. You know, because I've been doing acupuncture for so long and I really got into the functioning of the muscles. That's not just about building muscle. You want those muscles to work efficiently. And what I see a lot of, especially as we get older and we have injuries, certain muscle groups tighten up. And when certain muscles tighten up and they don't fire, your body compensates and starts using other muscles so let's say you have

a tight hip or you have an ankle problem your your your back muscles have to work more and then you start getting back pains and then maybe it work goes up to your shoulder so not only do you have to improve muscle mass or watch the loss of muscle as you get older, you've got to watch that functioning because as we get older, the muscles tighten and the fascia tightens that thin layer that surrounds the muscles. You know, when you cut open a chicken and there's this fascia around the muscles, that surrounds all our muscles in our body. And that, as an acupuncturist and paying a lot of attention to that

for the last 30 years I've seen becomes a problem especially as we get older and as we injure ourselves and especially as we get older and we injure ourselves we don't tend to to recover as well so it's really important when you do injure yourself to get some body work to get some body work, to get some acupuncture, to get those muscles working efficiently again, and not just letting injuries sit there and not treat them. So I think it's not only building muscle mass and not losing muscle mass, but it's improving the muscle efficiency, and that's keeping those muscles long and limber and watching that the

fascia doesn't tighten. That's a really good point, Frank, because I've had back issues my whole life from back surgery when I was 30 and recently had another back surgery. And now I'm getting treated by this physical therapist who's going into the fascia and rewiring things and then giving me exercise to do that compensate for the inactive muscles that exactly what you're talking about and it's i it's been only like three days of working with this person and i feel like a different human being uh my body feels limber lighter opener it's pretty amazing so i i mean not everybody can access that but it's it's there's ways you can do it yourself with foam rollers and other things to really help.

Okay, so let's talk about something that is… In the book, I talk about foam rolling. I just have to mention foam rolling because I think that is… A lot of people can't afford going to some body worker who does deep tissue work, but foam rolling is sort of the closest you'll get to going to someone who can do that I really I can't stress this enough you know recovering from injuries recuperating don't let those muscles tighten because the way our body works is to compensate and tighten somewhere else or overuse another muscle it's really important to have those muscles working efficiently

it's one area of functional medicine that we didn't really get into in functional medicine. We talked about most of the other organs, but we didn't really talk about the functioning of the musculoskeletal system. I think that is really important. Well, it's definitely one of the no's on the matrix, which is structural, but if we don't get into it enough, I agree. And actually, we're talking about building a whole course on structural modules. So, I think that's very important. Let's talk about something that is a little abstract, but is really central to aging, and that is impacted by our diet, light, by exercise, by environmental toxins.

And it's something called our mitochondria. And we've talked about that on the show a little bit before, but it's really important. So what are mitochondria? Why are they so important in aging and disease? And how do we improve them? Because it seems to be the central feature of aging is the dysfunction and the loss of mitochondria. Dr. Right. So the mitochondria are just the energy powerhouses in the cells, and you have many in all our cells. And as we get older, their number decreases and their function decreases. So optimizing their function and trying to increase their number is one of the most important things you can do for aging. And interestingly enough, most of the things we've been talking about

improve mitochondrial function or increase the number. We'll mention a couple of others we haven't, but it's a low-carbohydrate diet or fats are what the mitochondria thrive on. Fasting is particularly good for mitochondria. Exercise, in particularly high-intensity interval training, is really good for it. Strength training as well. So sleep. A lot of the lifestyle changes, you know, to me the mitochondria are what we in Chinese medicine talk about qi. We talk about the energy and how do you boost qi.

To me the mitochondria are the Western equivalent to qi that's your body's energy and all these changes we talk about actually work with the mitochondria what one of the things we we haven't talked about and which actually are um works seems to work well or stimulate the the mitochondria is this concept called hormesis which is I love that concept what does that mean what does that mean I love that concept so hormesis means sort of what doesn't kill you makes you stronger basically that's perfect definition that's the best definition I've ever heard that's a little bit of stress is actually good for the body you You know, chronic stress we know is a problem and creates all these problems and it won't help you age well.

But a little bit of stress, hormesis is good. And that's what fasting is. Fasting is physical hormesis. It's a stress. So a little bit of mild stress on the body and your body's response to that, and we talked about resilience, but your body's response to that will be, is a positive response which stimulates all these factors that are good for aging. So we talk about fasting, we talk about a little bit of interval training where you

push yourself a little bit more than usual. Going from hot to cold. So even just having an ice cold shower after a hot shower. You know, I love going from a sauna. I've become obsessed with my sauna. Going from my sauna, jumping into some freezing cold water. So, you know, temperature extremes are another way of stimulating hormesis. I love that. I love that. I love going from my steam or sauna right into an ice bath. And that's good for aging. I mean, that's good. That's hormesis. So anything that's a little bit of stress on the body is good. And actually, what's interesting, I remember years ago, Jeff Bland talking about this or

someone at one of the functional medicine conferences um with phytonutrients a lot of the hormesis is really good for plants so plants develop more antioxidants and and um protective phytonutrients to protect themselves from whatever they have to deal with to survive. So spraying them with herbicides and that doesn't actually help them develop these phytonutrients to protect themselves, which actually end up being good for us too. Yeah. The first time I heard about hormesis was years and years ago at one of the functional medicine conferences where someone, I think it was Jeff, who talked about the importance of hormesis on plants and developing, you know, organic versus conventional plants, or even wild plants, even versus organic plants. The wild plants have way more, by hundreds to thousands of times more antioxidant potential, phytonutrient compound, and they also taste better. And what's interesting

is that flavor goes along with phytonutrients. So the flavor profile of a food is directly related to the nutrient density and to the phytochemical content. So if you go to a garden, which I did the other day in a friend of mine's garden, and you pick a really ripe tomato that's just ripened on the vine, you stick it in your mouth, and it's an explosion of taste and flavor and phytochemicals that is so different than these cardboard store-bought tomatoes that don't taste like anything. So that's really the power of the little stresses. And I think the strength training, the hit interval training, the fasting, the phytochemicals, these are all ways to actually improve this.

I want to get into some tweaks that you have in your book that are really, really great. But before I want to talk about this idea called our epigenome and how that plays a role in how our cells age and how we deteriorate. So what is an epigenome? What is its relevance to aging? How do we deal with it? What can we do to help fix it? Right. So this is, you know, once again, one of the basic concepts that's come out of, well, that hasn't come out of functional medicine, but what functional medicine treats. You know, most of our genes we can change or we can manipulate in a way or upregulate or downregulate. So, for instance, you know, I actually just did a whole genetic test.

I've got terrible genes. I knew I had terrible genes. You know, I have the genes. I have the ApoE. I have the gene for Alzheimer's. I have heart disease genes. I mean, my genetic profile is terrible. But whether I get Alzheimer's and heart disease and all these diseases

of aging is determined by how I live my life. So these lifestyle factors, how I sleep, how I think, how kind I am to other people, how optimistic I am, what I eat, how I move my body, all are going to affect most of those other genes or the genes that we can affect to up-regulate or down-regulate to affect our aging. So aging is probably less than 20% genetic. I mean, there's obviously a genetic component where you can't change those genes. I've got those genes. Oh, no, I don't know about those genes, but I've got enough genes that I know that I can change, you know, just because I have the

ApoE4 gene, just because I have some of these heart genes doesn't mean I'm going to get it. Yeah, I probably, I am losing it a little bit. You seem all right. You seem all right, Frank. You're doing okay. My heart may not be as good, but that sort of makes me, you know, want to just be more careful because you can change how you age. You can change, you know, the progression of these diseases. And I think it just all comes back down to these

lifestyle changes that we all have to make and you know sleeping is one of those things that i think is really really important and and you know we don't talk enough about it although more and more people are starting to to realize the importance of sleep um But, you know, how you move, how you sleep, how you think, how you eat, when you eat, all these factors affect this epigenome, these malleable genes that actually can be upregulated or downregulated and affect how well we feel and how we age. I think that's really an important point, Frank, because, Frank, because you mentioned you have these predisposing genes, but they're not predestined.

They're not predestined to get these conditions. And what most people don't realize is that 80% to 90% of our chronic disease issues are not driven by genetics. They're driven by what we call the exposome, what our genes are exposed to and how those genes are expressed. And so if you're exposed to environmental toxins, if your microbiome is not healthy, if your diet is crappy, if you're not exercising, if your mental set,

your mindset is not optimistic and focused and positive, it literally can change the expression of your genes by all these factors. And that's the beautiful thing about functional medicine. It teaches you how to optimize the function and the expression of your genes to improve their functioning and also to reduce the ravages of aging. And I'm very optimistic about you, Frank, because I didn't realize you were 66. I thought you were like 56. I mean, I know you're kind of older than me, but you don't look it. So something's working. And I think for two old dudes, we're doing all right. I'm 60, you're 66.

It's working. And I think that people don't understand that what we see often as aging in America is abnormal aging. Exactly. It's not really how we need to age, that we can age vibrantly and healthfully and be alert and focused and energetic, even right up to the end. And I've seen this in many people. I met this guy who was 95 years old the other day. He had a girlfriend that was 20 years younger than him. She was a young spring chicken at 75.

And he was just running around the room. And I'm like, what's up with you? How do you do this? He says, whatever I'm like, what's up with you? How do you do this? He says, whatever I did yesterday, I just do it today. If I played single sentence yesterday, I do it today. And I think he just kept living his life and not mentally succumb to the idea of aging. And I think you have to be more cautious, careful. You have to be more alert to what you need to do to take care of yourself. But I think, you know, we have so much potential to stop and even reverse the ravages of aging. And I,

you know, I noticed this to myself, you know, I, because of COVID, I was locked at home like everybody else. I'm like, well, I'm not going to not exercise. And I got a Zoom trainer and I really never had done weights before because I was, you know, I was running around on the road. I was, I didn't, I don't like it. I don't like it hurts. It's uncomfortable. I'd rather go for a bike ride, you know, like Dennis. And, and I got, I got serious about it. And within a very short time, I noticed my body started to change. I literally put on 10 pounds of muscle. My, my, it was like, I was an incredible transformation and it was just in a very short time. So I think we have the potential at any age to stop and even reverse these effects.

You know, most of the things that people in the blue zones do to live a long time are also things that make you happy. You know, I did another cover-face conversations, long lunches. And they live in villages where they bump into each other in the streets. And every day at 5 o'clock, they pour out into the streets and the little bars and that. And they make time for each other. And, you know, that feels good. We are a species that evolved socially connecting. And now we know very clearly that people who are well-connected live eight years longer

than people who are lonely, for example. Yeah. And it's just natural there. You also probably notice that people haven't imploded in their devices yet. You know, people do have cell phones there, but they're not on them all the time. And they haven't drank that poisonous Kool-Aid yet. There are still shepherds. The real longevity phenomena in Sardinia is mostly among the males,

even though females live on it. But the males are really the longest, you know, even though females live, but the males are the really the longest lived people, longest lived men on earth are in right where you visit in Sardinia. So you start looking at their life and you know, even though it's Mediterranean, this is where you went in the blue zones, actually a bronze age culture. This is a group of people who broke away from what is today the boss country made their way through what what is today south of france corsica

and set up shop uh you know 11 000 years ago so they're not the same as you know like spain and france and the rest of italy it's a bronze age culture. And most Mediterranean cultures, the men are the – sit at the head of the table when it's male-dominated. But I don't know if you know, in Sardinia, it's female-dominated. So women are running the household, and they're taking care of finances and up-fixing the roof. And, by the way, they're the ones that carry the guns. They probably never busted one up, but we saw these women busting out there because they're in charge of civil patrol.

So, you know, what really surprised me that where men live the longest, women are in charge. Women are in charge. That's a good lesson. I think that's probably a good lesson. If women were in charge, this would be a very different world, 100%. Quite honestly, I think we'd all be better off. I think you're right, Dan. I think you're right. I'm not just pandering. I mean, I believe it. Oh, no. I agree. So I think you touched on something earlier, which is this whole idea

of community and loneliness. And loneliness is among the biggest risk factors for death and for disease and social isolation. And we know from animal experiments that if you give all the same inputs, food, water, light, whatever, to an animal like a monkey, but you don't give it a mother as opposed to the monkey that gets the mother, they age rapidly. They look decrepit. Their immune systems don't work. I mean, it's just extraordinary, like, when you see the graphic representation in some of these studies, and I think we see that increasingly here, we've all become an individualistic culture. I mean, there's a lot to be said for, you know, self-expression, for autonomy, for self-realization, for individualism,

but not at the expense of connection and community. And I think a lot of us have lived our lives, you know, going for that holy grail of success in whatever way you define it. And along the way, the debris of our life is the lost friendships, the lack of attention to the people that matter in our life, the lack of being present and connected. And that catches up with us. And that is actually a disease-causing phenomena that literally affects our genes, our epigenetics. All of it is driven through our social network. And our social threads that connect us

are more important than the genetic threads in determining our longevity and our health. And that really is powerful. So how do you help people? And what does the Blue Zones Challenge say about building this? Because especially with COVID and increasing isolation and people getting locked down, it's just hard. I mean, I'm finding one of the biggest challenges for me, which is not a big challenge, but I'm really having trouble with the masks. Not because I don't think they're necessary or we should be using masks to reduce the spread of viral particles and so forth.

But I don't see people's faces anymore. I don't see that human expression. I don't see smiles. You know, like I went to shop and get something the other day and I told the joke to the lady at the cashier and I could see her kind of eyes a little bit. But, like, I don't know if she laughed. All that natural sort of juice we get from interacting with humans, even that we're not close to this part of our community, is such an important nutrient for our souls, for our health, for our well-being.

How do we start to bring that back into our culture? What have you found works, and what do you help guide people to in the Blue Zones Challenge? I'm going to answer that on a macro and a micro level, and they're both important. So I'm sure you've seen this study that the casual social interactions throughout the day, the more you have is a bigger predictor of longevity than diet and exercise. And I mean, just as you're saying, the interaction with the woman at the grocery store, your postman or your barista, very important. And I argue that that's very much a function of your environment. Again, if you live in a city like Tampa, where you have to drive everywhere, you just don't have, you don't bump into people on the street. You're not seeing your

postman except where if you live in a neighborhood like boulder colorado or santa barbara or even where i live in minneapolis or in where i live in miami i'm out in the streets all the time and i had just have get more face time and a lot of social is a function of being in the presence of other humans so that's the macro answer. The micro answer, which I addressed in Blue Zone Challenge, is that your immediate social circle, those four or five people who you spend the most time with, have a profound impact on your health. If your three best friends are obese, there's 150% better chance you're going to be overweight. Alcohol use, drug use, unhappiness, and even loneliness is measurably contagious. That's

actually Nicholas Christakis' work, not mine, but it underpins an important observation in the blue zones, especially in places like Okinawa with this notion of Moai. People pay attention to who they're spending time with, and their immediate friends tend to be eating the same healthy diet. They tend to be walking places. They tend to care about you on a bad day. They tend to be people you can have meaningful conversations with. So in the Blue Zone Challenge, you know, this is the time of year people start making resolutions. As we all know, you know, resolutions have a half-life of about a week.

And they're gone in four weeks. Instead of getting on the new fad diet, I take people through a process of, A, identifying the type of people who are going to favor your health and longevity, and, B, give them a strategy to actually bring them in their circle. And because when it comes to longevity, there's no short-term fix other than not dying. There's nothing you can do this month or this year, even that's going to really favor your life expectancy in 30 years. So if you want to live a long, if you want to do things that will help you live longer, you have to think in terms of decades or lifetime. What am I going to do that's going to constantly influence me to eat better, move more, socialize more, live and express my sense of purpose and building that immediate social circle, that three or four

friends who care about you on a bad day, that's about the most powerful, lasting thing you can do. Yeah, that's really important. I think you mentioned it. I think we don't really cultivate that and prioritize that in our culture, in our life. And how many people, I think I've seen some data on this, but how many people can actually say

that they have someone in their life that they can call up and tell anything to? And those intimate feelings and secrets. It's Robert Putnam, a Harvard researcher. He wrote Bowling Alone. And in Bowling Alone, it was written in the late 1980s. He calculated that we, each American, have about three good friends or friends you can count on on a bad day. I keep bringing this up. What that means is you've just broken up with your partner and you're crying your eyes out. You know, we all have backslap buddies, you know, who sure, I'll have a free beer with you on a good day. But I mean, friends who will listen to you weep.

And, you know, if you need to actually borrow money or you just need to pour your heart out. Well, those are the kinds of friends i'm talking about um so with three people in the 1980s we're now down to under two friends like that and i still again yeah i believe it boils down to this thing um more friends on facebook but no actual friends no friends like mark hyman and Dan Buechner. You know, it's true. It's true. I, I, I find, you know, you know, I actually COVID and, you know, I went through a divorce and it was rough and I, I, I called my circle together and I, you know, I have a lot of guys I've known for a long time, really close friends. We do men's work together. We know each other for 30, 40 years and we see each other periodically. But so I invited these friends to be part of the circle every week.

And we, we do a zoom hangout with seven of us who've known each other 30, 40 years. And it's really about being transparent and honest and holding a container for each of us to be seen and heard, supported, loved. Sometimes we give each other advice and just listen. And I, I mean, I don't even know how I would have gotten through the last year without it. And I feel so blessed. I mean, just so beyond blessed to think about that.

And I think part of my early evolution was really understanding the importance of community. And so I've spent a lot of time in my own life cultivating and nurturing and watering those friendships so you know after 40 years i can call them up and go hey i need you and and what was amazing was that i thought oh you know i'm just going through a hard time and you know they're gonna do it for me but then i was like well can we do it maybe every other week for an hour they're like no no let's do it every week for two hours and i I'm like, okay, okay. And then like, they all were so in and I was like, wow, we all need this. We all want this. So I encourage you to think about how do you start to cultivate that and find those people and

develop those relationships. And it really is the, it's the medicine that we're missing in our society. I would argue that that investment is way more important than trying to get on a diet or a supplement or, you know, training for a marathon or all these other defaults. You know, the thing is… Can I go eat my Chunky Monkey ice cream now? A little bit of that, but you start to ask yourself why. You look at the budget of the processed food industry, marketing budget, and it's north of $15 billion a year. And then the beverage association, another $10 billion a year. What is the broccoli about?

Broccoli is $100 billion, right? Broccoli advertising? I think it's $100 billion, right? Broccoli advertising? I think it's $100. But also the exercise industry, another $120 billion. So we are constantly marketed these ideas of what make us healthy. There's no money in creating a men's group. Nobody makes money off of that.

Nobody makes money off of you knowing your sense of purpose and living it. Nobody makes money off of you putting your family first or investing in relationships beyond just, you know, the back and forth commerce of it. So, you know, it takes people like you with, you know, with know, you have a powerful mouthpiece here to not even normally tell people about it. But, I mean, you also know the underpinning science and you're a doctor. You have MD after your name, so people listen to you. And that's powerful. I also think it's, you know, for 40 years we've looked for the answer of better life in technology. And I think technology can help a little bit. But when you look back in places like the Blue Zones, those people are doing things a certain way that has evolved over 11,000 years.

And they're still at work today in people's life because they are working. And to pay attention to this idea of a guy will stop in the middle of the day and just talk to you, or they feel a certain way. And those practices are around because of a certain social evolution that they've worked. And we ought to be paying more attention to that, in my opinion. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in. Hey, everybody. It's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do

and introduce to you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com

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