The Liz Moody Podcast - Ask The Doctor: Longevity Edition—What To Do NOW To Look and Feel Your Best For As Long As Possible

Episode Date: February 24, 2021

This episode—the Ask The Doctor: Longevity Edition—is all about living our longest, healthiest lives. My guest today is the amazing Dr. Sara Gottfried. Dr. Gottfried is oozing with credentials—she went to MIT and Harvard Medical School and is a NYTimes bestselling author. But what I love about her is her approach to medicine and patients. Her knowledge of science and data is impeccable, but so is her understanding that this is real life. You might want to embrace the wisdom of aging, and you might also wish you had less wrinkles. You might want to eat a perfect diet, but you might have two kids and a job. This episode is jam packed with pragmatic, actionable information to help you feel as good as possible for as long as possible. We talk about: What’s actually happening when you age The number one thing people get wrong about aging The exact changes you should make in your 20s, 30s, 40s, 50s and 60s to live your longest, healthiest life How to eat “intuitively” when you intuition doesn’t work The best type of alcohol for longevity How having kids impacts longevity What the Blue Zones concept gets right about longevity—and what it misses The best type of exercise is best for longevity How to reduce your risk of dementia, even if you have a genetic predisposition to it Hacks to get your cortisol in better shape Hormone supplementation in menopause and perimenopause What to do when your doctors don’t want to give you hormone tests or don’t know to interpret them How intermittent fasting and protein restriction impact longevity What causes wrinkles and gray hair and how to address them The oral and gut microbiome and its impacts on aging You can find more from Dr. Gottfried at saragottfriedmd.com. We’d also both love to hear your thoughts on the episode! Screenshot and tag me—I’m @lizmoody— and she’s @saragottfriedmd. I’d also so love if you’d share with anyone in your life you think could benefit from this episode! PS: Have you snagged my Foodie preset pack? You can get all 8 presets, designed to make your food pics look as good as they taste, at lizmoody.com/presets. PPS: Healthier Together is officially a number one best-seller! You can get your copy on Amazon or at lizmoody.com/cookbook. Please keep sending me your creations on Instagram—they make me so happy! This episode is sponsored by Garden of Life, who just released their insanely delicious Apple Cider Vinegar gummies. I love how supportive they are of my immune system and gut health—if you snag a bottle using my link, it lets the brand know you found them through me, which I massively appreciate and it costs you nothing extra. Link: https://amzn.to/3tJ0iyj This episode is also sponsored by Kyoto Botanicals, the first CBD brand I’ve recommended on this podcast! Right now, I’m loving their Warmth tincture, which has turmeric and cinnamon, and the Warmth balm, which is so helpful for headaches and sore muscles. You can get a whopping 25% off your order (AND they always have free shipping!) by using the code “HEALTHIERTOGETHER” at kyotobotanicals.com. Healthier Together cover art by Zack. Healthier Together music by Alex Ruimy. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello, friends, and welcome back to the Healthier Together podcast. I am your host, Liz Moody, and I am a cookbook author and long-time journalist. I am so excited about today's episode, which is my, I want to say, fifth edition of Ask the Doctor. Basically, I think there is so much amazing work being done in the functional medicine space, but seeing a functional doctor can be tricky depending on where you live and often quite expensive. Enter these episodes.

I basically invite on the absolute best functional doctor. in the world, and then I ask them every single question that we ever wanted to know about a topic. We've got a hormone one, a gut health one, an anxiety one, and I am so excited to share today's, which is all about longevity. My guest today is the amazing Dr. Sarah Gottfried. Dr. Gottfried is oozing with credentials. She went to MIT and Harvard Medical School and is a New York Times best-selling author. But what I love about her is her approach to medicine and patients. Her knowledge of science and data is impeccable, but so is her understanding that this is real life. You might want to embrace the wisdom of aging, and you might also wish that you had less wrinkles.

You might want to eat a perfect diet, but you might also have two kids and a job. This episode is jam-packed with pragmatic, actionable information to help you feel as good as possible for as long as possible. We talk about what people get wrong about aging. The exact changes I ever go through decade by decade that you should make in your 20s of 30s, 40s, 50s, and 60s to live your longest, healthiest life. The best type of alcohol for longevity. What the Blue Zones concept gets right about longevity and what it gets wrong. How to reduce your risk of dementia, even if it runs in your family.

Hacks to get your cortisol in better shape. What causes wrinkles and gray hair and how to address them, including the one supplement that she recommends for both. The oral and gut microbiome and its impacts on aging and so much more. There's so much information in this episode. You can find out more about Dr. Gottfried, including information on her book Younger, which we referenced several times here at sarah Gottfriedmd.com. That's Sarah with no age, Sarah Gottfriedmd.

She's also at Sarah Gottfried MD on Instagram, and I am at Liz Moody. We would both love to hear your thoughts as you listen to the episode. All right. Let's get right into our Ask the Doctor Longevity edition with Dr. Sarah Gottfried. Hi, Dr. Gottfried. Thank you so much for joining me on. the podcast today. My pleasure. I am so excited to just pick your brain about all things longevity. You wrote a brilliant book about the topic younger, which it's such a one-of-a-kind book.

I feel like it's so unique and its approach to it's pro-women, but it's giving women the tools that they need to live their longest health spans, their longest lives possible. And I just think it's such a brilliant work. So I'm excited to get into all things anti-aging. So can you start us off by explaining in brief what aging actually is, like what's happening there? Yeah, the key thing with aging is that ourselves are getting older. And I think what's interesting is that a lot of it is optional. You know, there's definitely this process of aging that occurs such that, you know, when you're 20 versus when you're 80, the amount of reserve you have is much less. But what we want to keep in mind is that there's this accelerated aging that's purely optional.

So when I think about aging, I think about a few things. I think about longevity, which is, you know, trying to make that length of time you have on the planet as long as possible. There's also lifespan, which is the amount of time you have. And then there's health span, which is that period of time that you feel fantastic where you're relatively free of disease. So I think all of those definitions are important when we talk about aging. And what do you think is the biggest thing that people get wrong about aging or the biggest misconception about it? Well, I'd say the biggest thing right now is probably the hormonal piece. You know, a lot of folks, especially after the women's health initiative was published in 2002, a lot of folks feel like, well, you know,

I'm going through perimenopause or I'm going through menopause or antropause. I just have to put up with it. Like it's just kind of a fact of life with getting older. And the truth is, you know, this is another place where we have a lot of options. You know, it's not do I go on hormone therapy? Yes, no, to try to slow down the aging process. It's much broader than that. Like, what are some of the lifestyle drivers that I can utilize to slow down this process? How can I optimize my hormones with nutrition and with the way that I eat, move, think, and supplement? So I would say the hormones are the most important piece that most people get wrong. So what is the relationship with hormones and aging? Are we getting like new hormones?

Are old hormones not functioning in the same way? Is the relationship between them different? Or what's going on there? So there's a lot of different hormones that change at different times in your life. So for instance, when you're, you're in your 20s, the thing that starts to change is testosterone and also the precursor, which is D-H-E-A. So that tends to start to decline in your 20s.

The decline is faster if you're more stressed, if you have more toxic stress. So stress brings up the hormone cortisol, which is so important because you want to have the right amount of cortisol. You don't want it to be too high. You don't want it to be too low. you want it to be just right for you so that you have a level of cortisol that helps you meet your demands, but not so much that you feel overly stressed or that you have too much wear and tear in your body. Too much cortisol is also associated with depression. It's associated with suicide.

And it just breaks down muscle and causes a lot of other issues that can accelerate the aging process. Other hormones that change include estrogen and progesterone, especially in women, that tends to decline in perimenopause. So part of what gets confusing there is that there's two different phases to perimenopause that start in your 40s. So after, you know, sometime between 35 and 40, progesterone starts to go down. And a lot of women notice more anxiety. Maybe they have difficulty with sleep. And then in the second half of perimenopause, estrogen starts to decline. And this is because you're running out of ripe eggs in your ovaries. And when estrogen starts to decline, a lot of women notice more brain fog, hot flashes, night sweats, decreased libido. So those are some of the changes

that occur. Another really important one, Liz, is insulin. And insulin is the hormone that confuses a lot of people, but similar to the other hormones, you want your level to be just right, you know, kind of at that Goldilocks position, where it's not so high that you have what's called a hyperinsulinemia, and that makes you store fat, but it's also not so low that as a result of restricting food as an example, or just not producing enough insulin. So all of these hormones you want to manage as you get older, so that they're not too high, not too low. And then you have this process that's known as senescence that occurs in a lot of your glands. So senescence occurs in the ovaries.

It occurs in the testes and leads to less testosterone, not quite as dramatic as we see with estrogen and progesterone in women, but still significant. I've been reading about senescence a lot. It seems like a lot of the anti-aging medical advancements are focused on senescence and preventing in essence, do you think that we're somewhere close to being able to essentially stop that with medical intervention somehow? Well, that's certainly the goal. I think there's, you know, especially in regenerative medicine, this is a major focus.

I don't think we're quite there yet. I think, you know, some of the tried and true ways of approaching how to slow down inflammation are really what we have as tools right now. So, you know, diet, lifestyle, the way that we think, purpose and meaning, I think those things really taking care of our bodies and figuring out what's right for us. You know, I think an important thing with the aging process is to personalize it. You know, there's some people who are aging faster than others. When I wrote my book, I had this experience with checking one of my biomarkers of aging

and finding that I was aging way too fast. And that's what really motivated me to write this book. But I would say a lot of those techniques that are kind of more on the edge, you know, like stem cell therapy and other regenerative forms of medicine, they're not quite ready for prime time. Okay. So you mentioned a few of these lifestyle things and you mentioned things like your hormones are going to change in these ways as you get older.

Is your idea that with the proper lifestyle intervention, you can stop your hormones from changing in these ways or just that you can mitigate the symptoms of those changes on your body? More of the latter. Okay. So, you know, the idea is that what I find with women, for instance, who are going through perimenopause and menopause is that if you've got these lifestyle issues dialed in, like if you're eating the nutrient dense, mostly a whole food diet, I am food agnostic,

so I don't tend to ascribe to one particular way of eating over another. but if you've got the food dialed in and it's right for you and you've got a minimal amount of chronic inflammation in your body, you know, kind of this frat party that's occurring, that accelerates the aging process. If you've got those in place, it's going to help you with hormonal changes. So it's going to keep that cortisol where you want it to be. It's going to help you with insulin. And by extension, it's going to help you with some of the, the downsol downstream consequences of other hormonal changes like estrogen progesterone and testosterone. Okay. So you let's talk about some of those lifestyle factors. Let's start with somebody

quite young, like maybe somebody who's in their 20s and they're like, I want to have the longest life or health span that I possibly can. What should people start doing at those ages to feel better down the line. Well, I think the key in your 20s is really stress. I think that's the age where we really want to get that cortisol to the coldly ox position. Because if it's, as I said before, if it's too high, like if your cortisol is too high, it's going to make you burn through DHA8 and testosterone before your time. So I would say in your 20s, that's where fine some sort of practice of objectively assessing yourself and kind of tuning in with yourself, whether that's meditation or mindfulness or yoga or whatever your preferences, that's a really

important tool to dial in. Another one is I take care of a lot of women who are in their 20s. And when I was a teenager and also in my 20s, I had food issues. I had a poor relationship to food. and I had periods of, you know, borderline anorexia, not quite meeting criteria, but definitely disordered eating. And I have bulimia, both making myself vomit and also exercise bulimia. And I would say those things harmed me in ways that I didn't understand in my 20s. So I think that's another piece where we want to honor our relationship to food and really find a way to make peace with food and find freedom with food. And it's, you know, it's a really

complex topic. I don't want to suggest that healing from disordered eating is easy. But I think that's such an important piece to pay attention to in your 20s. Can I ask? I know it is obviously a very huge topic, but was there anything that really helped you personally to heal your relationship with food? I wish there was one thing. You know, here's the magic bullet. But I think for most people who've recovered from disordered eating or are recovering, it's a combination of things. You know, for me, it was radical self-acceptance. It was personalizing a food plan that really worked for me.

So, for example, when I started medical school, I was 22, and I went to anatomy lab. and I just could not conceive of dissecting this cadaver and then eating meat. Like I just couldn't put the two together. And so I went vegan. And I stayed vegan for a few years, but it wasn't a good fit for me. Now, there's many folks who make veganism work for them. And I happen to not be able to. So that kind of tuning in introset,

you know, really having a sense for what's right for you, I think is so important. There's also the layer of, I would say, sociocultural constructs, I think becoming more aware of those of some of the tropes that women have, especially about their bodies. I think that's such an important part. And then when I was 40, I had a number of patients who came to see me who were in a 12-step program for food. And I was really amazed at how much healing. that they had.

You know, some of them were bulimic, others were morbidly obese, and they found healing in a 12-step program. So I joined that program for a while, and I had a lot of healing from that as well. So it's, you know, I wish it were one simple solution, but those are some of the things that have helped me. There's one other thing. This is more recent. This is super cool.

So a continuous glucose monitor is one of the ways of really being able to personalize how your body reacts to your food. And so I love, you know, I'm into tech and I really love that some of these technologies that are coming our way with wearables, with sensors like the continuous glucose monitor, can really help us dial in what's best for us. because I probably had a few decades of pre-diabetes and, you know, having glucose that was much higher than it should have been that was accelerating this aging process until I got this continuous glucose monitor that tells me what my glucose is and how I respond to food.

Interesting. Is there something like a name for that or something that people could look up? Sure. There's a lot of different manufacturers of this. particular device. One is called Dexcom, another is called Abbott. I like the direct-to-consumer work that's being done by levels health. So that's a way that you can get a continuous glucose monitor without a doctor's prescription. Awesome. Okay. So I'm in my 30s. So I'm very interested in what I should be doing as a 30-something woman. I haven't decided whether I want to have kids yet. So I'm also curious how like having kids impacts all of these hormonal things. But what should I be doing now to increase my lifespan or longevity?

Yeah. In your 30s, stress is still a factor. Oh, I'm aware. Yeah. It's an understatement. I think the main thing in your 30s is that we find that in terms of your ovaries and the production of estrogen and progesterone, there's a tendency toward estrogen dominance. And what's interesting about that is I see a lot of that in women who are 35 to 40.

But what's interesting about it is that there's some really simple things you can do to prevent or reverse estrogen dominance. And the idea of the definition is that you've got too much estrogen compared to progesterone. So they're meant to be partners. They're like a tango partner. and you don't want one of them to dominate. So what do you do? Fiber. So the average 30-year-old gets about 12 to 14 grams of fiber a day.

I know that's not true for you, Liz, because I watch your feed and I know what you're eating. But you've got to make sure that you're getting the prebiotics that you need to feed those good microbes. And to, you know, your microbes are so intimately involved with your immune system. and they also modulate your estrogen levels. So I think fiber is super important. My general recommendation is to slowly build up to about 35 grams per day and sometimes even more than that. So, you know, our paleo ancestors got somewhere between about 50 and 100 grams of fiber a day,

and we just don't get enough. Do you recommend supplementation with fiber? Do you recommend trying to do that all with vegetables and your diet? Well, I would say food first. So let's get as much as we can from vegetables. But I'm also aware that it's hard to get that much just from food. So I usually have at least one smoothie a day. And that smoothie has supplemental fiber. So I think that, you know, if you're someone who likes smoothies, I think that's a great way to get some of the species diversity. You know, it's not like I want you to eat a pound of broccoli. each day. I want you to have species diversity from fruits and vegetables. And smoothies are a great way to kind of make that easy. And just to get into the nitty gritty because we love that on this podcast, is there a type of fiber that you would lean towards in supplementation form like a flax or an inulin or something like that? I like a mixture of prebiotic fibers. So definitely inulin,

glucomanin. I like cillium too. I think you want to have a mix of soluble and insoluble fiber. You want to, you know, another prebiotic that I'm a big fan of is human milk oligosaccharides, which have been shown to really help with improving gut health. There's, they're basically the type of human milk oligosacrides are found in breast milk. And so they're really helpful at building up the kind of benevolent gut microbes and microbiome. that you want. Okay, so we've got our fiber. We're trying to increase our fiber. Is there anything else we should be doing in our 30s? I assume we're also cumulatively doing all of this. So we are keeping our stress low from our 20s and keeping a healthy relationship with food, adding in some

fiber. Are there any like supplements or other lifestyle factors we should be doing? Yeah, supplements are interesting because I don't think you can out supplement a good, a bad diet. So I think it's really essential that you're getting, you know, the colors of the rainbow. I think that's super important for hormones and for slowing down the aging process. Another, if I had to pick a supplement, I like to, you know, pull supplements and to take no more than eight at a. But if I had to pick one, I would say, if we're targeting inflammation and we want to turn down chronic inflammation, I recommend a combination of omega-3s, usually two to four grams a, depending on your family history, together with specialized pro-resolving mediators. So this is a relatively new discovery. These are

marine derived oils that help you resolve inflammation. So I share that because there's a couple of supplement companies that make these. And there's some work that was done at the Brigham in Boston, looking at how do we resolve inflammation? Like, especially the way I used to be where I had pre-diabetes until I got this continuous glucose monitor, what we know is that if you have this low-level inflammation in your body, inflammation that just doesn't resolve after three to five days, that's definitely accelerating the aging process,

but it also tends not to resolve on its own. So I was taught when I went through medical school 30 years ago that inflammation resolves spontaneously, and it's a passive process. That's not true. So what we now know is that you need to actively resolve inflammation. So I think that combination of supplements of fish oil together with the specialized pro-resolving mediators, also known as SPMs, are really important. And then the third thing, if I could give one more thing in the 30s, is alcohol. So can we talk about that? Yeah, let's talk about alcohol.

So alcohol, you know, I did my share of drinking in my 30s. I was living in the Bay Area. We've got really good wineries all around. And it wasn't until later that I realized, you know, alcohol is actually a neurotoxin. A very normalized neurotoxin, though. A very normalized neurotoxin. it's you know in the the struggle that I had with food what I found was that when I would drink some of that good work that I'd done toward recovery with food would just go out the window

and I think that's you know we know that decision making is impaired when you drink there's so many reasons to be careful with alcohol but I think the most important ones in your 30s are the neurotoxic effect. In fact, I'd even call it a dementedgen. It accelerates the process of cognitive decline. The fact that it raises your bad estrogens and is associated with a greater risk of breast cancer. So three servings or more per week

is associated with a greater risk of breast cancer, a modest increase. But in your 30s, you want to be thinking about that. And then the last thing is it raises cortisol. So a lot of people drink because they want to relax, they want to chill out. The very thing you think you're getting from alcohol, it's actually taking from you. There's so many other ways that we can hit that pause button or relax or chill out. So I'm not saying, you know, no one should drink ever.

But I think we really have to look at our relationship to alcohol. Do you think that there's a better or worse type of alcohol? like, you know, some people are like the resperatrol in red wine and other people are like, you'd have to drink 400 bottles to get enough resveratrol. So is there a better choice if we are to drink? Yeah, I think the key thing with alcohol, I agree with that statement about resveratrol. Like, you just can't get enough. Yeah. That's not a good reason. And even, you know, there was some data from the Framingham study and from some other studies showing that alcohol is associated with better cardiovascular health and also increased longevity. And those data have been disputed. So, you know,

a lot of what we've been told for the past 20, 30, 40 years is no longer the case in terms of the benefits of alcohol. So are there some better forms of it? Yes. What I recommend if you're going to drink is that you choose something that suits you and that, you know, doesn't give you a hangover the next day. If I drink, which is pretty rare, I usually have a biodynamic wine, typically red because the effect on my blood sugar is better than white wine. If I'm in a pinch, I'll choose organic wine, because we want to be, we want to realize that conventional wine, you know, which is what's on the menu at most restaurants, is associated with a pretty high amount of toxins. And the one that I get especially concerned about besides alcohol is glyphosate.

So I think going organic or biodynamic is a good way to go. There's other folks who talk more about the staying away from sugar, which I would say is generally true as a lifestyle hack. And some folks prefer, you know, tequila or vodka to wine or other forms. forms of alcohol, I think that's more a personal preference. I don't think we have data on longevity. And let's talk about in your 30s, I mean, in your 20s and 40s, too, to a lesser extent, but having kids is a really big topic of conversation. Certainly every time I do an Instagram Q&A, everybody's like, are you guys having kids? When are you having kids? Are you guys going to have kids? And I know that having kids has a huge impact on your hormones and given how much we've

associated the change in hormones with longevity. Does having kids help longevity? Does it hurt longevity? How does it impact it? So I don't know if I can rattle off exactly the effect of having children on longevity. I can tell you, you know, if you look at something like breast cancer, having children in breastfeeding reduces the risk of breast cancer, it also reduces the risk of cardiovascular disease by a certain age. So those things are cardiovascular disease, dementia, Alzheimer's disease, those things improve with having children. So I think overall the effect is beneficial with having children. But you also have to weigh having children with some of the stresses that come with that, right? Because when you have kids, most mothers and fathers are

aware of this, sleep is hugely impacted. And sleep is such an important factor for longevity. So another issue that we don't know the long-term effects of is that when you're pregnant and postpartum, there is this period of time where there's some brain shrinkage. It's not a huge amount, but it's like 2%, in some cases, up to 5%. Why? Well, it's thought to be related to pruning and kind of getting the female brain ready for connecting with the baby. So this is, yeah, it's pretty far out.

this particular data. But it's a very dynamic change. And I think for the most part, it has a positive impact on longevity and health span. The other thing that it does for a lot of us is it ignites purpose and meaning in a very profound way. Now, for women who choose not to have children, I'm not saying you can't find that in other ways. You know, there's, you can mother a mission. You can mother many things. But we know that purpose and meaning is so essential to health span. So, you know, it's hard to say exactly how having kids impacts longevity, but I think those are some of the key concepts, the key threads. You say that we know that purpose and meaning is so essential to have to health span. Can you speak a little bit more to that? Like, what do we know about that?

Yeah, so a lot of the data on purpose and meaning came from the blue zones. So, you know, those work around the world looking at some of the long-lived cultures like in Japan, in Greece, in Italy, around the Mediterranean, Costa Rica. And so what they found, you know, there's this one island in Greece where they call it the island where people forgot to die. And what they know is that there's a little. There's this very close-knit social connection so that people socialize a lot. I don't know what's going on during COVID, but they spend a lot of time together. They share meals. They produce wine together.

This particular island, which is Icaria. I hope I'm pronounced it correctly. I think I've only read it. I haven't said it out loud before. What they know is that it's very hilly and kind of mountainous. And so people climb these mountains and, you know, walk over to each other's houses and work. There's not the concept of retirement. People have the sense of purpose and mission, especially around their social ties.

So throughout the blue zones, they found that people who are pulled forward by really clear vision and a sense of purpose about what their life is about, that's associated with longevity. And what do you think about? I was going to ask you this later. since we're talking about it now, what do you think about the Blue Zones research in general? Like, do you think they talk a lot about eating plant-based foods, having a sense of purpose, incorporating movement into your daily routine? Do you think that research holds up in your mind?

I think it holds up. I think it's the advice that most people ignore. So, you know, it's similar to what we know about nutrition and how we should be eating. It's the advice that most people ignore. So why is it so hard? Why is it so hard to do some of those blue zone things? You know, to get more plants, to use extra virgin olive oil if you're, you know, for instance, in the Mediterranean region, to have the sense of purpose of mission. So I think the data does hold water. It's primarily epidemiologic, meaning that it's population based, you know, looking at these different regions. So what's beneficial for someone who's from this island in Greece or what's beneficial for a woman in Japan or Costa Rica may or may not be beneficial for me.

So you bring up a really good point, which is how do we take this epidemiological data like Blue Zones and actually apply it to the individual? How do we personalize it? And I think the way that you do that is, or at least the way I do it, is with N of one experiments. So, for instance, one of the things that they do a lot on this island in Greece is they drink these diuretic teas. So they have like hundreds of different greens, wild greens that they forage and they make teas out of it. And so when I read about that when I was writing my book Younger, I thought, oh, I want to try that. Let me see what that does. And I tried them. So I got this collection of organic teas from this island. And I started drinking it every night. I even got my family to drink it with me. And I noticed, for instance, that my blood pressure came down. Not significantly, but like five to ten points. So that's the kind of experimentation that I think is helpful. So we've got these general recommendations for blue zones. And if I'm really honest with you, Liz, I think they're a little bit bland. I like to have a lot more specificity.

So we have these general recommendations that are well supported by the evidence, but we have to individualize them to the person. That makes sense. It's one of the things I actually like about your approach to is because I think longevity can be a really hard thing to tackle because you don't see whether it worked for a very long time. And so I feel like what you've done is you've isolated the nuanced parts that lead to dying later or feeling bad later. And then you can say like, how does this impact my cortisol now? How does this impact my blood sugar, my blood pressure, et cetera, now? Which knowing how those impact your

longevity, it gives you, it gives you results in the moment rather than having to wait 50 years and being like, well, did I die? Which I think is nice. I think that's really important. I think that's part of why it's hard for people to wrap their hands around longevity. And so it makes some of these recommendations like a little more, a little less specific than I think they could be. So when you break it down, as you just described, into these individual experiments, it can really be helpful. You know, like, what's a protocol that I could implement today to take my cortisol, that's double what it should be, down to the normal level? And so designing that protocol can really make a difference. Now, it's a proxy for L'span, but it's a really good proxy.

You could do the same thing with insulin level. You could do the same thing with lean body mass. One of the things that happens over the age of 40 is that pretty much everybody, unless you're paying a lot of attention to this, is losing about five pounds of muscle mass each decade. So if you really tackle that and you say, okay, I'm going to maintain my muscle mass or I'm going to increase my muscle mass through my 30s,

through my 40s, that's another little experiment. That doesn't take 50 years. So would like doing strength training be something you'd recommend for people in their 30s and 40s? Definitely. So I would say start as early as possible. I like to get, I got my kids doing some weight training when they were younger. You know, not like CrossFit, but, you know, like. I'm picturing like little two-year-olds with like baby weights.

Yeah, with like a little baby. But it's important to model these things. Like I remember it wasn't just weights. It was also, when my kids were young, I rolled out my yoga mat every single day. And I got on the mat just to kind of to model, I mean, I needed it, but also to model for them this introception, you know, like tuning into what's true for you, which is something that a mat really helps me with. There's something about getting on a mat and focusing on my breath and making sure I'm taking deep abdominal breaths. that really helps me tune into self-care and what I need. And so modeling that as well as weightlifting and, you know, just being active and eating

those different colors of the rainbow each day in the food that you architect, all of those things are really important for kids. So I'd say start as early as possible. I have such an exciting product to share with you today. One of my all-time favorite brands, Garden of Life, just launched Apple Cider Vinegar Gummies. and they are amazing. First of all, they taste so good.

Zach and I have started storing ours on top of the fridge because otherwise we will much on the entire bottle in a single day. But, more importantly, they're great for you. Each gummy contains organic apple cider vinegar with 5% acetic acid, which is the part that's responsible for all of the health benefits. The apple cider vinegar that they use is fully unrefined and fermented, originating from the mother. There's also no gelatin, so all of the vegan members of my H.T. fam can enjoy them too,

and they're certified organic and gluten-free and non-GMO project verified. I love the original ones and the probiotic version, which also has 2 billion CFU of probiotics. You can eat them pretty much any time, but my favorite way to take them is about 30 minutes before meals, especially heavier ones like pasta. I found that it makes the biggest difference in my digestion. They're also super supportive for your immune system. And I know I already mentioned that they taste really good, but they taste really good. really good. I'm almost nervous for you to try them. You are going to be hooked. You can find the

gummies at health food stores near you on Amazon or by using the link in the show notes to visit Garden of Life.com. Grab a bottle or two and come back and tell me what you think. Now, let's get back to the episode. Do you think there's a best type of exercise for longevity? Like I've heard that hit, for instance, can have a negative impact on cortisol levels, but I've also heard like any time you're sweating or moving your body is good. And then you were talking about muscle mass and then I think strength training. And then obviously there's all the yogis who are like 150 and doing their crazy yoga move. So do you have thoughts on that? Yeah. Well, I would say, you know, whatever you love the most is an important place to start. There's some controversy with this

particular topic because if I answer it from a cardiovascular perspective, that's a little bit different than if I answer from a balance and flexibility perspective. But let me take the cardiovascular, you know, kind of cardiometabolic first, because we know that that's the top killer of people. So from a cardiovascular perspective, we believe that the best way of exercising is a combination of cardio aerobics, one-third to two-third strength training. So that combination of the two, one-third, cardiore aerobics, two-thirds strength training is what is best for the heart and for the cardiovascular system. So that probably has the best evidence behind it in terms of cardiovascular longevity.

And cardiovascular disease includes not just heart attacks, but also strokes and, you know, peripheral artery disease, all these other things that people can develop. So let's do a quick question. visual here. If you look at a yogi, you know, my great-grandmother died at age 97, practicing yoga, and she didn't die while she was practicing yoga. She died in her sleep with very little in the way of chronic disease and still able to do some quite pretzely yoga poses. If you compare someone who practices yoga to, say, a marathon runner or an ultra-marathoner, and you just look at the aging process in their bodies,

generally you'll find that the ultramarathoner is aging faster. And there's a few reasons for that. Some of it is oxidative stress, you know, kind of this rust that we develop when we're exercising at a high level. Some of it is, you know, not everyone gets adequate recovery. Some of it is injury and the risk of injury. Some people are genetically more prone to injury than others. So the way I think of it is you got to find what you love so that you can be consistent about it.

And I also think you want to have some variety and balance. So you can't, I don't want people to do hit every day. I think what's ideal is to match it to the person, which is kind of a, it's a horizontal to our whole conversation today. So, you know, for instance, I measure my heart rate variability with my aura ring at night. and I think there's something about the ring. I don't have any financial connection to them, but there's something about the ring that measures the time between your heartbeats very accurately.

So I like the aura. I've been measuring heart rate variability for a lot of years, and I like measuring this. And we could talk about what it is and what it means in just a moment. I think of it mostly as a balance between your sympathetic nervous system, like the on button for your nervous system, versus your parasympathetic nervous system, which is the rest and digest.

So I like to match my exercise each day to my HRV. So if I wake up and my HRV is great and I am fully recovered and I've got a lot of energy, I'm going to go hard. I'm going to do that two-thirds, one-third with strength training, pretty heavy weights together with a third aerobics, which for me is spinning. I really love spinning. If I wake up and my HRV is not so good like it was Wednesday when my latest book, Mander's script was due, what I do is something much more quiet and adaptive, you know,

more like yoga or Pilates or just walking my dog and having, you know, kind of a meditative walk in time with her. And if you're not measuring your heart rate variability, I mean, cool if you can get the rig and all of that, but if you're not doing that, could you sort of tune in to, to the signals your body's giving you, like if you're sore, if you're, it sounds like if you're sore or stressed, definitely lean into the more gentle nourishing exercises. And if you wake up and you feel full of energy, use that to do a more intense exercise. Yeah, I think that's generally true. But it also brings up an important nuance here, which is not everybody is able to tune in.

at some point when I was growing up, I stopped being able to tune in. And there's, you know, different reasons for that. For some people, it's trauma, for, you know, what happened for me was that I decided to go into medicine. And so I, like, gave up my 20s. I had, like, 10 years where you just stopped tuning into your body. You know, you can't go to the bathroom when you need to go. You know, if you're in the middle of saving someone's life, you just keep going. So I'm not great at tuning in.

And not everybody wants to use wearables or sensors. I do it because of wanting to develop this introception, this ability to really tune into what's true. So yes, you could certainly tune in, but I think you have to be honest about whether you can or if you might need some help with that. I love, I think that's such an important thing to note. And it also reminds me of, I think I read an interview with Dan Butner who did, who authored the Blue Zone's research.

And the interviewer was trying to kind of pull out of him like, oh, like, what can we do where we live to bring this Blue Zone magic into our life? And the interviewer was super frustrated because Dan Butner kept being like, well, mostly you need to move to Ikaria or move to Costa Rica because so much of being able to live that life is based on the community, the societal structure, the messaging. that we're internalizing daily and all of that. And I do think it's important to recognize the world that we live in and how hard the world that we live in makes it to do a lot of these things, even if we know that they're good for us. And even if we're actively trying to do them, as you point out, which is I think a lot of people can feel like a failure

when a lot of cards are stacked against them in the first place. That's absolutely true. And it's, you know, not many of us can move to Coast Street. or to Greece. I would love to, but, you know, I've got like two kids and a husband who's got a job in Washington, D.C. So that's not going to work. But on the one hand, yes, it can feel like the deck is stacked against us. On the other hand, we may have more opportunity than we realize to really create an environment that supports us in what we want to do. So whether that's the way that you eat, the way that you shop for groceries, like the choices that you make for

the number of colors that are on your plate for dinner tonight, there are ways that we can set ourselves up for success. And I think it's important to realize that, that it's, on the one hand, there's so many factors conspiring against us, like the pandemic as an example. On the other hand, I really learned, and this was part of my food recovery, I really learned that I was applying a victim mindset to a lot of my environment and to a degree that was much greater than what was true. So I'm not saying, you know, stop being a victim. I'm saying let's get really honest about what you can control versus what you can't. I love that. Okay, let's jump back into decades, aging by the decade.

What would we add in in our 40s on top of what we're already doing from our 20s and 30s as we start to enter those hormonal phases of our life? In your 40s, I think blood sugar becomes really paramount. And also, I mean, this is related to blood sugar, the way that you exercise. So, you know, we talked about exercising throughout and all of these things are cumulative. Now you're managing stress and doing these other things. getting the fiber that you need. But in your 40s, because you start to lose muscle mass and because blood sugar starts to climb, it goes up by about 10 points by age 50. And because fat mass tends to

increase, we want to get more mindful about that. And here's why. It's not just for vanity reasons, although that motivates a lot of people. It's because if you're 40 or 45 and you want to, you know, live as long as possible to maybe be like my great-grandmother who danced at my wedding and flirted like with every person in the room, I mean, she was generous. If you want to be like that or, you know, define your why for why you want to help span, you've really got to keep your brain working. effectively. And so managing your blood sugar, managing your lean body mass, and managing your fat mass is going to help you with that. I happen to have dementia in my family. And so I pay a lot of attention to what happens to the female brain as we get older. The male brain doesn't have

the dramatic changes that the female brain has. And they also have, you know, men have about half the risk of Alzheimer's disease that women have. So if you look at all the people with Alzheimer's disease, two-thirds are women, one-third is men. And what happens for a lot of women in the 40s is that as glucose metabolism starts to change in the rest of the body, it also changes in the brain. And so we want to prevent that as much as possible. So about 80% of women over the age of 40s start to have cerebral hypometabolism, meaning that they don't use glucose the way that they once did. This is the work of Lisa Moskodi at Cornell. She's a total badass. I totally recommend her. But what she's found is that 80% of women start to have this slowdown and how the brain uses fuel

starts to falter. So I think the more that you can prevent that, it really will help your brain going forward, the way that you reduce your risk of Alzheimer's disease and lengthen that health span where you can, you know, remember that word on the tabir tongue is primarily in your 40s. The other thing it does is that the average age for menopause is 51 for women. And if you really have your glucose dialed in, if you've got it, you know, I can check with my iPhone what my glucose is any moment. And for the most part, it's a flat line. When you have your glucose dialed in, you're much less likely to have hot flashes, night sweats, difficulty sleeping. Those are some of the things that tend to trigger vasomotor symptoms,

which also are now associated. This is a new finding, are associated with a greater risk of cardiovascular disease later on, like in your 60s and 70s. So the more that you can dial that in with really good habits around exercise, the more that you're paying attention to lean body mass. And I'm not saying, you know, you got to have a thigh gap. That's not what I'm saying at all. What I'm saying is we want to keep the fat that we have, which we need for making hormones and keeping our brain healthy. We want to keep it in a state of benevolence so that it doesn't become the type of angry fat that can accelerate the aging process. So just in a like very pragmatic lifestyle sense, if you're worried about elevated glucose levels, you're worried about your blood sugar,

what lifestyle changes would you make to kind of bring that back into balance? Oh, there's so many things you can do. So I'll give you some basic tips. So we know, you know, for the most part, avoiding refined sugar or limiting refined sugar is incredibly important. When you think of glucose, there's kind of two parts of the equation. There's the input, like what are you eating that's affecting your glucose in your blood? And then there's output. Like, are you making your muscles hungry for glucose so that you can use it up when you have it? So with blood glucose, there are certain foods that are going to stabilize your blood sugar and then there's foods that are going to spike it and make it too spiky. And that's not always obvious. You know,

I know, for instance, if I eat a big piece of chocolate cake, that's going to spike my glucose. It depends on the chocolate cake. I mean, maybe you could do some almond flour and some monk fruit and, like, find a way to not spike my glucose. But for the most part, it spikes my glucose. It makes me way too spiky. If I have an assaye bowl, it spikes my glucose. If I, you know, what I had today for breakfast was I had some duck eggs scrambled with some chopped greens, some onion and some salmon. Blood sugar totally stable. So that has fat in it. It's got carbs. It's a balanced

meal. And it's a way for me to really stabilize my blood sugar. There's also supplements that can help with that are insulin sensitizers, things like fish oil or omega-3s, berberine is another good one, alpha-lipoic acid. There's a long list of supplements that can do it. But this is a place where you know, what I generally recommend is dial in your food first, like get the foundation right. And then if you need it, if you're like me with pre-diabetes, then you add in the supplements. And make sure you got the output dialed in, like the exercise that makes your cells hungry for glucose. And if somebody was in their 20s and they had a family history of dementia or Alzheimer's, would you recommend they start monitoring their blood sugar even younger?

Well, I think it's probably never too early. And what we know is that when we test patients for glucose abnormalities, you know, we screen for diabetes with a fasting glucose or hemoglobin A1C, what we know is that those static tests, which are a quick snapshot, you know, it's basically a needle in the vein for about 10 seconds. They don't tell the whole story. They don't tell you, for instance, about what happens when you eat food because you're fasting when you do those tests. The hemoglobin 81C is a three-month average. It's a little bit more complex than that, but it's a way of averaging, you know, looking at your mean glucose. But we know that those tests tend to miss about 15% of people with pre-diabetes and about 2% with diabetes. So I do think that it's important to be tracking this.

You know, one of the things I talk about in my book Younger is I want you to care about your glucose. and your cortisol, as much as you care about your retirement account. Because it is your retirement account. Yeah. I don't want to have some amazing retirement account at age 75 if I can't remember the needs of my children. Like your glucose and your cortisol really are important drivers here of hellspan so that you can enjoy those future years. Are there any, like, little sort of hacks we've talked about cortisol so much just sort of

lifestyle interventions to get your cortisol into that happy place that we could be doing daily or weekly? Oh, yes. So I'll tell you about my end of one trial. Okay. So when I was 35, I had one kid. I wanted to have another kid. And I went to my doctor because I couldn't lose the weight after I had my baby. And I, you know, all the old things that I used to do just weren't working, like exercise and the way that, you know, my body likes to be fueled. And so I went to my doctor and I was like, you know, I've got PMS, I've got decreased libido, I feel stressed, work is really hard as working in McMedic Medicine at the time. And what do you recommend? And my doctor said, sounds like you should take an antidepressant. And have you thought about a birth control pill? Because what you have might be hormonal. And I was so

frustrated hearing that from him because I felt like I was not depressed. I was definitely stressed, but I was not depressed. And he was trying to mask my symptoms. He wasn't looking at the root cause. So I left his office and I went to the lab and I found that my cortisol level, this was in the morning, was three times what it should have been. So I had this really high cortisol level and that's where I started this end of one experimentation. So at the At that time, I was running. I was running about four miles, four days a week. And my weight was about 25 pounds higher than it is now. And I realized that I needed to stop running. Like, I thought the running was actually accelerating the cortisol. I also realized that I didn't like my job.

And that was probably also raising my cortisol. So I ended up working with a coach and kind of building this bridge to opening my own private practice and, you know, having a work life that suited me much better. But in terms of simple hacks, what I did at the time was I started rodeola. So rodeola is one of those adaptogens that can help lower cortisol. I feel like I keep talking about omega-3s and fish oil because they are insulin sensitizers. They also help with reducing the risk of Alzheimer's disease. Here, once again, two grams of diet. And day has been shown to reduce cortisol. And one other thing I took that I really love is phosphatidyl serine. Phosphotidyl serine. So phosphatil serine at doses of about 400 milligrams

has been shown to reduce cortisol. And the effect is pretty fast. It's one of those supplements. You know, not all supplements do this, but it's one of those supplements was where you take it and inside of an hour, you feel better. Like if you have high cortisol, you're, you're, you're to notice a difference. It's one of those, I had one patient describe it to me in this way. She said, I took that phosphatidal searing and I felt so much better that I like called six girlfriends to let them know. So those are some of the simple hacks for dealing with cortisol. And then of course, meditation, yoga, mindfulness, whatever helps you, whatever mind-body technique. Anything that sort of brings stress down, one can associate with likely, positively impacting cortisol level.

correct? Yeah, you know, I don't think of it so much as bringing stress down. I think of it more as bringing cortisol down by meeting the stress, like matching the stress. So I used to think of it more as, you know, managing the stress or getting my, you know, reducing my stress or removing my stress. And I realized after like 15 years that that wasn't very successful. So I think it's more about dancing with the stress. It's more about like meeting it and and maybe changing the reaction to it. That's interesting. Okay, so we've gone through our 40s. Let's just jump into like 50s and 60s, menopausal years. What can we do then? And then we'll start tackling like individual fun stuff like wrinkles and gray hair. Yeah. Well, so in your 50s and I'm in my 50s, so this is relevant for me.

I think sleep is maybe the most important thing. It's, you know, we've already got glucose under control. We've already got cortisol under control. And I think sleep is as close to a panacea as we have. So I want for people to build their sleep skills younger than in their 50s, but because so many women in particular really skimp on sleep or they have trouble falling as sleep or they, you know, wake up at 4 a.m. and can't go back to sleep. I think it's really essential that we get sleep dialed in. I think I agree. Like, there's been so much conversation about how

important sleep is, but I actually developed sleep issues because of that. Like when I was working at Mind Body Green and we were talking, I was writing a zillion articles about how you needed to sleep and sleep hygiene. And I was like, got to have my blue light blocking glasses on and take my hot shower and I develop sleep issues for the first time in my life. So do you have any of advice about how to sleep better without getting stressed about not sleeping well enough? Yeah, it's a really good point. I mean, there's so much to pay attention to that it's hard to kind of let the natural process come through. So I think the more that we leave it alone and sort of set ourselves up for the best possible sleep, the better. And I'll give you an example.

When I was studying Ayurveda in my 30s, there's this concept that I really love, which is there's cycles every four hours. And at 10 o'clock, the way I heard it described, this is not, you know, like as accurate as it could be. But at 10 o'clock, there's an angel train. And you want to catch the angel train. So you want to be in bed, like prepared for the best possible sleep at 10 p.m. And I really love that idea because, you know, it doesn't involve blue light blocking glasses. It doesn't involve, you know, shutting down all of your screens an hour before, although that's a good idea. It's just this really simple concept of prepare yourself gently for sleep.

Get it done by 10. and be in bed. So, you know, that's something I really recommend. I think if you've got some of these other things dialed in, like glucose and cortisol, it just makes the process a lot easier. And I think we also have to give ourselves some room to have a night or two that's, you know, not so great. So I think that point that you're making where we can get so fastidious about getting

everything right with sleep that we lose sleep over it. So, you know, it's a great irony. I think we have to when that happens, and it can happen not just with sleep, of course, but with food, with exercise, with so many things, we just want to back off and, like, see what's true for us. And something, you know, something that works for Dave Asprey may not work for me. We've got to, like, figure out what's right for each of us. Well, and a lot of the stuff you hear about, even the stuff that It's been studied, it's been studied on men, which I think is incredibly important to realize is that even the hard data and the real science is often based on men. It's so true.

I mean, that's a really key point. And, you know, another thing in your 50s is that women sleep better if the room is kept at 64 degrees or colder. Oh, I fight with my husband about this. Right? I'm like, I need this to be to sleep well. And he's always trying to turn up our thermostat, like one more degree, one more degree. Yeah, my husband and I have the same thing.

Right. Where he like walks over to the nest when he thinks I'm not looking at anything. I can hear the click, click, click. And I'm like, really? And I can tell. I will sleep less well that evening if it's hot for sure. It's not like I'm doing it for no reason. Yeah, it's one of those challenges.

and compromises, I would say, of partnership. Do men not need it to be that cold? Like, is it women's hormones that we need it to be colder than men need it to be? Or is there something biologically happening? So I don't totally know the answer to that, but I can speculate that the issue for women is that this thermoregulatory zone changes. So when you go through your 40s and you're in your 50s and go through menopause, you can trigger hot flashes and night sweats with, you know, one or two degrees temperature change.

So keeping it cooler allows you to be more likely to stay in that thermo-regulatory zone where you're not triggering hot flashes and night sweats. So men don't really do that. I haven't seen data on temperature in men. I just have a lot of field experience with men saying, oh, no, no, no, that's way too cold for me. What about artificial hormones as you enter perimenopause or menopause? So I'm not a big fan of artificial hormones. I am a fan of bioidentical hormones.

Okay. So for women for whom they're the right fit, I think they can be potentially very lifesaving. So, and it doesn't, you don't have to wait for perimenopause. I actually started my first hormone therapy when I was in my 30s because I discovered, you when my cortisol was three times when it should have been. That kind of got me on this path of looking at not just cortisol, but what's going on with estrogen, thyroid, testosterone, progesterone. And that's where I found that because of my high cortisol, my progesterone was low. So I had too much

estrogen compared to progesterone. I had too much cortisol. And so what I did was to use progesterone to get my estrogen back into balance to reverse that estrogen dominance. So for some women, it can be before your 40s and 50s, but for most women, perimenopause starts in your 40s. It lasts for about two to 10 years. And that's where I like to screen patients for whether they're a good candidate for hormone therapy. They don't have to start it right then, depending on their symptoms, but it's a good time to measure a baseline. In fact, I would say that's especially true in your 30s, like when you're feeling, you know, like a hormonally perfect specimen, like, check your hormones then, like get a baseline. Oh, that's interesting. I think that could be

very helpful because then you know what to go back to. It's a way of personalizing what really worked for you when you were 32 or 34 or 36. So I'm a fan of bioidentical hormones. It's not so much a yes, no question. It's more, are you a good candidate? What's the balance sheet, like the risk benefits and alternatives, and then also what's the right dose? So low dose, like 0.025, 0.0375 milligrams of a patch can be very helpful for women who have night sweats or hot flashes, higher doses like 0.075, 0.05, 0.1 milligrams of a patch are better for depression in perimenopause of menopause. You can also use local hormones, like local estrogen in the vagina, if there's vaginal dynas, vulva vagina. So I'm a fan in patients who are a good candidate. Now, we used to

just kind of give them out to everybody. And, you know, this is another place where women were part of a vast, uncontrolled medical experiment where synthetic hormones, Permanent and Provera, were given to women almost like shoved down their throats for about 59 years before anyone did a randomized trial showing that they're dangerous and provocative. So we have kind of the shameful history when it comes to hormones and women that I think people need to be aware of. And we can't repeat those mistakes. So we've got to figure out, okay, based on your cardiovascular risk, based on your risk of breast cancer, based on your risk of dementia, based on mood and other issues, sleep, we've got to decide, okay, are you a good candidate? And if so, what's the right dose?

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yeah, I got it. But I feel like a big problem a lot of people have is that the doctors they have access to don't think about health in this way. So are there, can you go to just any doctor and ask for a series of tests and are there ones you would recommend or how would you recommend navigating that? Yeah, another great question. I wish there are more doctors who practice this way, who do root cause analysis, who do systems medicine, functional medicine, precision medicine. We're growing, but our numbers are still small. So yes, I think it's worthwhile to start by asking for these panels, you know, to look at glucose and hemoglobin A1C, maybe find out about a continuous glucose monitor, if that sounds like something that might be helpful. To do some other testing, we can talk about

some of the biomarkers that are associated with longevity, things like interleukin 6 is one of the best high sensitivity C-reactive protein. So you can ask for these things. And I've got a panel in my book that you can ask your doctor for. But a lot of doctors will say, and I was told this myself as a physician-patient, hormones fluctuate too much. They're not worth testing. You know, so I'm not going to measure your cortisol or your estradiol or your testosterone-free and bioavailable. I'm not going to test your progesterone because it fluctuates too much. But here's the problem, Liz, for women who are trying to get pregnant and are over the age of 35 and have been trying for six months or are under the age of 35 and have been trying for a year,

we will check every single one of those hormones and more. So we'll look at thyroid, cortisol, estrogen, progesterone, FSH. We'll look at the whole panel. So why is it, that if I'm trying to get pregnant, those hormones are valuable. But if I'm not trying to get pregnant, they fluctuate too much. It just doesn't hold water. Yeah. So I think that we deserve to test these things. If you're a physician or clinician won't order them, I would, you know, have a good conversation with them. If they're not open to it, you may want to consider a different clinician.

Some people have a team of clinicians, you know, those who are more. functional and root cause-based and those that are more conventional who can help when you have an ankle spring. You can also do some direct-to-consumer testing. Should we talk about that for a moment? Yeah. So there's a lot of labs that will allow you to run some of these tests. An example is Wellnessfx, Wellnessfx.com, and I don't have any financial ties to these groups. But that's a lab that you can order. You can pay for it's a pretty reasonable price and you can go to Quest and get the blood drawn. There's others that I have listed in my book. There's a group that started out of Harvard and Yale. I'm blanking on the name right now. It's something that I tested to look at

like a set of biomarkers that assess your age, your biological age. There's a couple different groups that do that. I could send that to you later. if you have show notes. Yeah, I do have show notes. I'll put them in. So Wellness FX, I think, is probably the best because I like that they get their blood work done through Quest. What about something like intermittent fasting? And how does that impact aging?

It's a good thing. So intermittent fasting, I think, is interesting. It's like one of those trends right now, like a mega trend. And the truth is we've been intermittent fasting for millennia, right? Like the way that our DNA evolved was to eat after the sun comes up, to have a period of, you know, this eat-eat window. And then to have usually a few hours before the sun goes down before where you stop eating. And so those periods of metabolic rest, which for our paleo ancestors was probably somewhere between 14, 16, maybe 18 hours, they're really good for the body. And there's a lot of different reasons for that.

So we know that intermittent fasting definitely prolongs longevity. It's similar to caloric restriction. So maybe we should talk about caloric restriction for a moment because I'm not a fan. And yet pretty much every organism on the planet with caloric restriction extends their lifespan. But I think you have to ask at what cost. You know, the periods of time in my life where I've done caloric restriction, like bordering on an eating disorder, I found were a colossal failure. I pretty much always gained the weight back. It was stressful.

I don't like that state of, you know, constant hunger. I just don't think it's healthy for most of us. So caloric restriction tends to be too stressful. and we also know that only about 2 to 5% of people are successful with it. There was this really interesting experiment in Arizona, the biosphere, where they ended up doing caloric restriction. They had this group of scientists that were trapped inside this ecosystem, and they were trying to be self-sustainable and grow all their own food.

And they ended up not growing as much food as they expected, so they ended up having caloric restriction. And one of the lead scientists was an expert at caloric restriction. And so they came out with having lost a fair amount of muscle mass and also body weight. And the lead scientists ended up dying early. And it was thought that it was related to the stress of this ongoing caloric restriction. So I think we have to be really careful about caloric restriction. I also just think psychically that I want to live as long,

as possible. Like, I want to be around to see what my kids are like and, you know, if they end up deciding to have children with those kids are like, I want to have amazing conversations with my husband until I'm as old as possible. But I also, like, I want those years to be really full and luscious. Choloric restriction doesn't feel full and luscious to me. So as an alternative to caloric restriction, which is, you know, fails 95% of the time, there's this option of intermittent fasting. And intermittent fasting, I think, is a great way to be more tuned into circadian rhythm. And it's in sync with your hormones too, because first thing in the morning, you tend to metabolize carbs better. That's the best time to have carbs. It's where your insulin is higher. Your melatonin is low.

whereas, you know, a few hours before you get to bed, usually, you know, if you catch the angel train by 10, this is by about 7 p.m. Melatonin starts to rise, and so you become more insulin resistant. And so if you have a big meal after the sun goes down, for some of us, we don't respond very well to it. Some of that's genetically determined. Some of it is based on epigenetics and, you know, what's happened to your DNA over time. So I'm a big fan of intermittent fasting. But again, just like with caloric restriction, you don't want it to be too stressful. It can raise cortisol. And the latest research coming out of Harvard as well as USC with Walter Longo is that probably a window of 14 hours is ideal.

So it'd be like eight to eight at night to 10 in the morning and you're done with 14 hours. That's right. So, you know, for some people it's more doable than a 168 protocol where you have an overnight fast of 16 hours. needing window of eight hours. So 14 hours is what a lot of the experts think is the best way to sort of split the difference and compromise. I've heard some stuff about using limiting protein as a way to mimic the same effects of calorie restriction. Can you speak to that? Yeah. Well, there's there's a lot of different ways to do that. And the idea from an aging perspective is that carbs modulate insulin, and that's one of the anti-aging pathways that we can get on.

Protein modulates Tor or m-tore pathway. And there's a gene that's involved in this, but you can either restrict carbs and go down that insulin pathway of slowing down the aging process, or you can restrict protein. So a lot of the work of Volta Longo is looking at this in particular. He develops something called the fasting mimicking diet, which is it has some protein, but it's probably less protein than the average American diet. And what I think is important about protein is that some of us, myself in particular, if I get too much protein, it converts into blood sugar. So it raises my blood sugar through the process of go deogenesis. So a lot of people think that protein's good.

You know, it's going to help me build muscle. It helps to stabilize blood sugar. But if you get too much of it for your own use, then it can convert into higher blood sugar. So last night, for instance, I don't eat meat that often, but I just have my period and I kind of crave it after I have my period. and my husband grilled some grass-fed, grass-finished beef ribs. And I ate some of them last night, probably a little more than I usually do. And when I got up this morning, my blood sugar was okay. It was like fasting blood sugar of 80, but my breath ketones were way in the burning carb range.

And it's because of the amount of protein I had yesterday. So I think it can't be helpful. I mean, this again, it's kind of like the sleep. experience that you had where paying more attention to what I have to dial in with sleep can make it more confusing. I think similar when it comes to what I eat to really accelerate or to slow down the aging process. So I would say this is where you could do an end-of-one experiment and figure out, okay, what's the right amount of protein for me? That's high enough so that I don't lose lean body mass. I don't lose muscle mass. But it's low enough that I'm slowing down the

aging process and I'm also keeping my blood sugar stable. And you would do that by essentially consuming protein and then monitoring your own blood sugar after that to make sure to make sure it's an ideal place. That and also tracking your lean body mass and your fat mass over time. All right. Let's get into gray hair and wrinkles. I found my first gray hair last week. So this this is personal for me. Are gray hair and wrinkles? Are they symptoms of something that you could address at an underlying level? Like, does that mean your telomeres are getting short or autophagy isn't happening the way that it should? Or is that just a natural part of aging? What's actually going on there? I think of it in two ways. One is sort of the normal process of aging and just losing

the pigment in your hair, which is what gray hair is. And I think finding one gray hair in your 30s isn't anything to be worried about. I do have some patients who turned like 100% gray in their 20s or their early 30s. And that's, you know, a sign of something that needs to be paid attention to. In that situation, I'm looking at things like the thyroid, thyroid thyroid function. I'm looking at micronutrients. Are they getting all the micronutrients that they need from their food. There's a lot of different tests you can do for that looking at micronutrients inside cells like the Genova Nutraval or the metabolomics. There's also spectra cells, micronutrients. So I kind of divided into the more pathological that we want to assess root cause for, and then

the more normal aging process, which it sounds like might be more what you experienced. So I don't think it's, you know, this is, it raises a bigger question of how do we befriend aging? Like, how do we find a way to really enjoy getting older and like all the benefits that come with it? And to, you know, kind of find this sense of congruence with what's happening. So if your lifestyle is quite optimized and you're doing it. some of those things that we just talked about, you know, sort of by the decades and you find a gray hair, maybe that's a reason for celebration. Like, maybe you've accomplished something, Liz, in your life that we need to celebrate. So I think in some ways, we may need to flip the way that we look at gray hairs.

One other thing I'll say about gray hairs, since I get asked about this a lot, and I wrote about this and younger is that for some women who have gray hair, it's related, as I said, to micronutrients, but there are specific micronutrients that could be playing a role. And one of my friends, Paul Hawkin, developed, he worked with the scientist to develop a way of really getting the B vitamins to your hair and other nutrients that helped to maintain the pigment. And so his product is one thing to consider, but I wouldn't I wouldn't use it for one gray hair. This is more for women who are in their 40s and 50s and 60s. What's it called?

It's called hair print, hair print. Excellent. Hot tip. Hot tip. So wrinkles. You know, I think of wrinkles in the same way that there's a poem about when I'm an old woman, I will wear purple. And there's a line in there about being seen. and brown. And I really love that line because it's about instead of looking at our skin and

seeing wrinkles, seeing the seams, like the seams that have come from a life well lived. Now, I also understand that many of us look at our face each day and we want to kind of keep that glow. I understand that. And I think out of all the different treatments that are available, my favorite is probably collagen. So we know that a daily dose of collagen over some period of time, I forget what the study was. It was probably four weeks or six weeks or eight weeks. It's associated with improved skin elasticity. So taking collagen internally helps with that estrogen, collagen teamwork that happens in your skin.

So estrogen and collagen kind of keep everything lifted in your skin. It's like the architecture of your skin is the girding. And so taking oral collagen can help with that. Is there any other internal stuff that would help with reducing the appearance of wrinkles? Like vitamin C helps build collagen and skin, doesn't it? It does, yeah. So I think it's crotinoids. I don't have this off the top of my head.

I think I've, I wrote about it in my book, but I don't have it at the tip of my tongue. But something about carotenoids, vitamin C, possibly vitamin A. I'd have to look at it again. Okay, we're running out of time, but the last thing I want to talk about is the microbiome and its impacts on aging. We've talked a lot about societally the microbiome, and there's been a lot of recent research on it. So I've read some interesting stuff, both about the oral microbiome and how it impacts aging and heart health and the gut microbiome. And I would just love to hear your thoughts on microbiome and aging. It's super important.

And, you know, I feel like the next 10 plus years of medicine is going to be all about the microbiome and, like, how we can modulate it. We're not quite there yet. There's a lot of direct-to-consumer testing companies that say we are there and offer a test to, like, tell you what to eat so that you can perfect your microbiome. But in terms of a healthy microbiome and what that looks like person to person, we still don't have a completely clear picture. So what do you do? you separated out the oral microbiome like what's in your mouth versus the rest of your gut and i i think that's a helpful concept we know when it comes to the oral microbiome that flossing twice a day is associated with pretty dramatic increases in longevity what about once i've gotten myself up to one today hey if you went from zero to one props to you thank you i think it's all about progress and

not perfection. So, you know, if you compare zero versus one versus two, one is well ahead of zero. So one step at a time. And two does help in terms of the plaque and, you know, most of us eat two or three times a day. And then brushing, you know, using an electric toothbrush for at least two to three minutes is also associated with greater longevity and better cardiovascular health. So if we look at the microbiome in general that's in the gut, it's hard to separate out the microbiome and its role with the immune system because they're so intricately intertwined. And a big part of slowing down the aging process is your immune system and your immunosum. So there's a lot of different factors that impact immunosinessence. The microbiome is one of them. It's

pretty major. And trying to, you know, reduce the risk of dysbiosis as we get older, reduce the risk of increased intestinal permeability known as leaky gut. So doing things to take care of our microbiome and protect it. There's also the role of hormones, hormones that are regulated by the microbiome, but also hormones that are the effect of hormones on the immune system. So, for instance, estrogen, estradile, has a salutary effect on the immune system. We know this from decades of vaccine data, but also with COVID-19. We know that women tend to do better with COVID-19. They're less likely to have severe disease.

They're less likely to die, you know, like two to three-fold less than men. So there's a number of factors here. When I think of the microbiome, if we talk about estrogen for a moment, there's a subset of bacteria that are involved in either getting you to poop out estrogen once it's used or to keep recirculating it, kind of like mad karma. And those are the bacteria that produce an enzyme called beta-cleronidase. And so we want to be thinking with our microbiome that we want to try to, avoid dysbiosis, like especially with these particular bacteria that produce beta glucagonodase,

because if they keep you recirculating estrogen, that's associated with a greater risk of breast cancer, endometrial cancer, and prostate cancer. So those are a few little threads of how your microbiome, both oral and also in your gut, are related to longevity. And do you think taking care of your microbiome and your hormones as a side effect of that? Is that to you like eating plants, taking probiotics, eating fermented food? What does that actually look like in practice? Well, again, you have to personalize. So if you have someone who's got a pretty healthy gut, where I usually start is with a Mediterranean diet. So this again, you know, kind of harkens to the blue zones. But the Mediterranean diet is the most anti-inflammatory and the most proven

evidence-based diet that we have. So what I do is I start with the Mediterranean diet, and then we adapt it through end-of-one experiments to figure out what's the best diet for you. So Mediterranean is mostly plant-based. It's a lot of fruits and vegetables. And what I find, if I have a patient with autoimmune disease, I had a patient this morning with multiple sclerosis and also Hashimoto's. And with that patient, we're going to, at a patient, we're going to, adapt the Mediterranean diet so that we may avoid grains. We may avoid nightshades so that we're trying to back off on the stimulation of the immune system. So what does it mean to support your microbiome?

I think it means a food-first philosophy. I'm a big fan of fermented foods. I think that's the best way to get probiotics. But for a lot of people, it's not enough. So I like to use prebiotics. I think they're more proven than probiotics. We talked about human milk oligococryds and others, getting sufficient fiber generally.

And I do use probiotics, especially in patients who have gone through a course of antibiotics, you know, to use them for replacement or for one purpose or another. You know, if I have a patient who's got increased intestinal permeability, that's a situation where I'll use some different. supplements to try to improve intestinal permeability. And also, I might give a probiotic that's been associated with improving permeability. Like a targeted strain of bacteria. Targeted strain, exactly. All right, can you just finish us off with maybe one to three sort of weird longevity

things that we haven't talked about yet? Like, I know a doctor who drinks Earl Grey tea with a squeeze of lemon to help with his autophagy. Just kind of like give us a few sort of fun out there things we could incorporate into our lives. Number one is the sauna. So I'm a huge fan of saunas. What we know they do is it's a form of heat stress. It's a form of what's known as hormesis, kind of a positive stress for the body. It's like pushing on the body and getting it to bounce back with even more energy. So saunas, what we know in terms of lunges, is that they improve longevity. They turn on FOX-O-3, which is one of the longevity genes, along with the Sertuins and mTOR.

So what I prescribe is 20 to 30 minutes, four days a week. That's the first hack. Wait, really fast. If we live in Airbnb's and it's COVID and we can't go to a sauna, could we get some of the same effects in a bathtub or no? We don't know. Okay. I hope so because I take a hot bath pretty much every day.

I'm a huge fan of hot baths. But we don't know. And it's also, a lot of the data on saunas comes from Finland. And I have some Finnish relatives. So what I can tell you about saunas is just like in the blue zones. It's not just the heat. That's the benefit. It's also the socializing.

It's like the hanging out with your family and friends and having this time together where there's no distractions. and then maybe you go and jump in a lake, right? You get a little cryotherapy in addition to the heat therapy. So the second hack, this is from my great-grandmother. So she used to start every day with a full glass of warm water with lemon. And before she went to bed, she would have a full glass of water with lemon. And we know that the ash of lemon is a little alkaline.

So you think of it as acidic, but the ash and what it does in the body is alkaline. And, you know, she was born in 1900. She was way ahead of her time in terms of understanding that when you wake up, you're pretty dehydrated, like especially those of us who are mouth breathers. So getting a big old glass of water, having that be the first ritual that you do when you get up, I think is really replenishing for yourselves. adding some women, I think, is a great way to alkalinize because we tend to be somewhat acidifying with the way that we eat and drink. So that's number two. Number three, I'm going to finish with

love and purpose. I just think this is such an essential part. And it includes, you know, if we go back to the gray hair that you discovered or, you know, the wrinkle that I can see in my nasolabial folds here, I think if we have that sense of love and not recrimination as we age, and we're pulled forward by this vision of who we want to be as we continue to evolve, you know, kind of brimming with purpose and with meaning, that's the best hack you could possibly bring to the aging process. I love that. That's a perfect note to end on. If people want more from you, as I'm sure they will, where's the best.

place for them to find you. The best place is probably saragoffreadmd.com. That's the mothership. Awesome. And we've been referencing your wonderful book, Younger, a lot during this episode, and I'll obviously put a link to your website and also to Younger in the show notes. So thank you so much for sharing all of your amazing wisdom with us today. My pleasure. Thanks, Liz. I hope you loved that episode as much as I loved recording it. It was just so jam-packed with information. I got a ton of tips that I'm definitely going to implement. in my own life, and I hope that you did too. If you did love it, I would so appreciate if you would share it with somebody that you think

could also benefit from Dr. Godfrey's immense wisdom. It means the world to me, and it really helps me share the messages of this podcast to grow this podcast fam, and I just love you all for it. Also, if you love these Ask the Doctor episodes, let me know. Another great way to let me know is to leave an iTunes rating a review or a rating and review on any platform that you listen on. I read them all. I love them all.

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