The Liz Moody Podcast - Want to Live to 100? Start Doing These 3 Things Today

Episode Date: May 7, 2025

Want to live a healthier, longer life? The science of longevity is teaching us how to take steps in our twenties, thirties, and forties, to stay healthier into our old age. In today’s episode, I’m speaking with longevity scientist Dr. Eric Topol about how to reduce inflammation to live a happier, healthier, and longer life.  Many of us will develop chronic diseases as we age, and these diseases can dramatically reduce our quality of life and end our lives early. These diseases are often preventable. Dr. Eric Topol and I discuss the steps you can start taking today to reduce your inflammation for disease prevention and longevity. In this episode, we get into to: Why Should We Want to Live Longer? Assessing Biological Age The Blue Zones Myth Slowing Rapid Aging Reducing Your Inflammation  The Gut Microbiome & Your Immune System GLP-1s and Obesity Can You Be Healthy At Any Size? Diets and Longevity Caffeine and Healthspan  Heart Disease Prevention Why Are Young People Getting Cancer? For more from Dr. Eric Topol, find him on Instagram @EricTopol1 or online at www.drerictopol.com. Subscribe to his Substack, Ground Truths, or purchase his book Super Agers: An Evidence-Based Approach to Longevity.  Ready to uplevel every part of your life? Order Liz’s book 100 Ways to Change Your Life: The Science of Leveling Up Health, Happiness, Relationships & Success now!  To join The Liz Moody Podcast Club Facebook group, go to www.facebook.com/groups/thelizmoodypodcast. Connect with Liz on Instagram @lizmoody or online at www.lizmoody.com. Subscribe to the substack by visiting https://lizmoody.substack.com/welcome. This episode is sponsored by: LMNT: go to DrinkLMNT.com/LizMoody to get a free LMNT sample pack with any order. AG1: visit drinkag1.com/lizmoody and get your FREE welcome kit, Vitamin D, and 5 travel packs today. Pique: go to piquelife.com/LIZMOODY for up to 20% off plus a special gift. Osea: get 10% off your first order at oseamalibu.com with code LIZMOODY10. Maui Nui: head to mauinuivenison.com/LIZ to secure your access to a limited collection of Liz’s favorite nutrient-dense wildly delicious meat cuts and products. Wildgrain: go to Wildgrain.com/LIZMOODY for $30 off the first box - PLUS a free item in every box. The Liz Moody Podcast cover art by Zack. The Liz Moody Podcast music by Alex Ruimy. Formerly the Healthier Together Podcast.  This podcast and website represents the opinions of Liz Moody and her guests to the show. The content here should not be taken as medical advice. The content here is for information purposes only, and because each person is so unique, please consult your healthcare professional for any medical questions. The Liz Moody Podcast Episode 327. Learn more about your ad choices. Visit megaphone.fm/adchoices

Your father had heart disease, you're going to have it kind of thing. No. This is an eminently preventable disease if we pull out all the stops. There's absolutely not a scintilla of evidence for the things he's selling. But now we have the ability with all these layers of data to say you're at risk. It's going to show up at this age unless you take these actions. That's what we can do now. We can never do that before.

The blue zones, unfortunately, are a myth. You talk about certain types of events. vaccine for cancer prevention. Can you touch on that? Yeah, this is really exciting. Hello, friends, and welcome back to the Liz Moody podcast. Today, we're diving deep into the science of longevity. What actually helps us live longer and better? There is so much hype online about anti-aging hacks and miracle supplements and biohacking your way to a longer life. But what does the research really say? This episode is packed with nuance and clarity and actionable steps that go way beyond what a TikTok soundbite or an Instagram reel can offer.

Our guest today is Dr. Eric Topol, a world-renowned cardiologist and one of the top 10 most cited researchers on the planet. He is the founder and director of the Scripps Research Translational Institute, and he is consistently named one of the most influential people in medicine today. His new book is called Super Agers, an evidence-based approach to longevity, and I got to read it before he joined me in our Bay Area studio. It is phenomenal, one of the most information-packed books that I have ever run. He is truly a living legend, and I was absolutely honored to get to have this conversation with him. There's a lot of fascinating insights in this episode. So if you want key

takeaways when you are done listening, head over to lizmoody.substack.com and sign up for our newsletter. Each week, we share the biggest action steps from each episode, plus tons of bonus content like our five-day gut reset, we've got meal plans, we've got an attention restoration challenge, and so much more. Dr. Eric Topo, welcome to the podcast. Great to be with you, Liz. You and I were just talking off-camera. We're going to get into a lot of science in this episode, but I was asking if there's truth

to the idea that tall people don't live as long as short people. Can we start with that? There is something to that in every species, the smallest of the organisms tend to live the longest, and that also applies to humans too. It's not as robust in our species, but it's across the entire animal kingdom. How much would we notice for that? I just want being five foot one and a half sucks.

I mean, it's good on airplanes, but like pretty much everywhere else, I'm like I've got to get my pants hemmed. I can't reach anything on tall shelf. So I just want like a little nugget of something to hang on to it. There's a little nugget there. Yeah. I wouldn't want to put too much on it

because it's at the population level, so it's hard to ascribe it to any individual. Interesting. So interesting. Okay, let's dive in. Your book, Super Ager's is absolutely incredible. It's one of the most comprehensive guides to longevity that I have ever read. And you go deep into the evidence. And we're going to get into a lot of that today. But I'd love to start off with more of a philosophical question, which is as quality of life is decreasing for so many people, why should we want to live longer? Well, that's an important question. Most people, if you ask them, they might not want to live longer, but they want to live healthier. That is, they wouldn't want to live their years with, whether it's dementia or cancer, fighting cancer, or, you know, significant heart disease. It's hard to treat, such as the heart muscle being really weak. So I think that's where we have common ground. And I think that is worth aspiring to, which is what the book is really all about, is how do we eke out a lot more years of healthy living or health span, as it's now referred to. And that's really, I think,

a laudable goal, which is achievable now. Do you think that adding years to one's life is for wealthy people right now, though? Like, is that something that's reserved for the elite class? Well, you would think so if you see all the anti-aging supplements, longevity clinics, these longevity health companies that are pitching all their data fields and sources and testing and whatnot. No, unfortunately, none of that data has been, there's no evidence for it. None of those companies that are selling longevity and health span have any evidence that their products are working, that they do anything. If you're looking at it from that standpoint, you'd say, hmm, this seems like it's, you know,

only for rich people. But what I wrote about in the book is not about that. It's about things that are free or inexpensive that we could use in a very systematic way. And it wouldn't be pitching or selling things. There's no supplements here to sell. It's a very different outline of how we can get to that laudable goal of extending health span. What do you think when those supplement companies say, hey, on a cellular level, were seeing these types of results.

So we're going to extrapolate that that would happen in a human. Yeah, you just can't do that. I mean, a lot of things really, they work really good in a dish, like a petri dish. But to try to extrapolate that doesn't work. And, you know, that applies to people taking all the drugs like rapamycin or the NAD plus supplements and all these sorts of things. Not only do they not necessarily extrapolate to people, sometimes they've been tested, for example, in various animal species.

But they also carry a risk. And that's what I think most people don't acknowledge is, so there's an expense, there's unproven evidence, and there's a risk too. So that's why I believe that any person that's saying they're a longevity researcher who's hawking supplements is someone to really seriously question

because that's not really where evidence lies. And that's what we are going to get into is where is the hard evidence that we can actually promote health span? Do you, are you familiar with Brian Johnson? Yes. What do you think of? I haven't met him, but I've read a lot about him. What do you think of his work?

He's very controversial online. Yeah, well, he's controversial in every respect. Not only because, you know, recent exposés about how he's run his blueprint company. And he's a classic of hawking supplements. He has a longevity mix that's made a lot of people sick. and his chief medical officer recently resigned related to that. A big expose recently in the New York Times and also in Vanity Fair about he as a person. But mostly he is the extreme case.

I think he represents the worst of this, unfortunately, because there's absolutely not a scintilla of evidence for the things he's selling. And of course, there are many people that, the last I saw in the New York Times article, where they had some 40,000 people that are buying his products, which are not just longevity mix. I really question what his mission's all about and his ability or desire to sell that to others. So one of the things that he's doing, he's trying for anybody not familiar with him, he's trying to lower his biological age, and he's testing that.

And then he's saying, I'm the end of one, and then we can take that information and spread it to the masses. I don't know how pure his intentions are, but that's what he says. as his intentions are. Is there any truth to testing your biological age and using that as an indicator that what you're doing is helping with your longevity? Yeah, just to be clear, Liz, you know, I don't have a problem.

He wants to do these things himself and do all sorts of tests. It's promoting it to other people when it's unproven. Now, we've made huge progress in the science of aging in recent years. And one of those is to be able to determine the biologic age of someone,

which is different than their chronologic actual age. There are many different tests for that. The one that is most frequently validated and used is so-called epigenetic tests are methylation side groups of our DNA. And that, you can say if you had that test and then subsequently had it again and it changed and it was less than your actual age, well, you're doing something good, right? There are many other tests besides the epigenetic.

They're under the umbrella of molecular clocks. And this is really an outgrowth of understanding the science of aging. So it's not just the methyl groups, there's the RNA, there's various proteins, the immune system, all sorts of ways that we can say, hmm, you're aging faster or slower, your chronologic age. So that's a good thing. In general, these tests alone, I question their value. But when they're in a multi-layered way, when you have various tests to understand your aging process in you, that's where I think we are going to make some headway.

So if anybody listening is like, wait, I want to know my biological age. Is there anything you'd recommend to them or not at this moment in time? Well, I think the emerging thing that's even more exciting than the overall body, biologic age, because it's hard to do something about that in some respects, and it's some uncertainty. But the organ clock, so-called proteomic or a group of proteins, this is really an exciting area. So recently, the group at Stanford led by Tony Wiss-Core, and now multiple other groups have confirmed that if you have from a single vial of blood, small vial blood, you can get up to 11,000 proteins from your plasma. And then they can be separated to eight different organ systems, heart, brain, kidney liver, and one is also the immune system.

That can tell you not only is, you know, how you're aging, but which organ is out of kilter. And is that available to the masses? Not yet, but it will be. Right around the corner. It's right around the corner. And multiple groups now are working to get this out, you know, for wide-scale use at an inexpensive, hopefully less than $100 or even considered less than that. This isn't like a Theranos thing, though. No, no, no, no.

You're like a little bit of blood and we can do all these tests. No, no, this is a tube of blood, not a nano lid, whatever that was. Although I was like on board with the idea. I would love to have just a prick of blood. No, the idea was attractive. It actually may get realized, but it's many years later with, you know, people that are doing it in a rigorous way. What's exciting about the organ clock is it's not just telling a person their body is

kind of rusting out or aging more quickly, but it's pinpointing a particular organ. and now we also have ways to project the arc of that organ. You know, for example, when is the risk of Alzheimer's going to be cropping up or when the risk of cancer is going to become a real concern. So we're getting to a point of being able to pinpoint the person, the organ, the timing, ways to intervene, ways to go under tight surveillance. That's what's really exciting. And that's different than blocking the body-wide aging.

We're basically working on age-related diseases, the big three. cancer, heart, and neurodegenerative, mainly Alzheimer's and Parkinson's. If we can work on those big three with all these layers of data, learning from the science of aging, this gives us a remarkable opportunity. And we're going to get into all of the big three in this episode. I'd like to know first, though, what do you think of the blue zones? The blue zones, unfortunately, are a myth. Recently, it's been exposed by multiple groups whereby a lot of the people in the blue zones,

they really weren't as old as they said they were. The birth certificates were unavailable, or when they did track them down, they weren't that old. It encapsulates some of the really important lifestyle factors, but we shouldn't believe there are these magical places where if you go there, you're going to be in a blue zone and live healthier, longer. It certainly captivated a lot of people's imagination and interest,

but if we look back, there's been really a lot of lack of proof that they exist, in fact. Okay, research has shown recently that we undergo two periods of rapid aging during our lifespan around ages 44 and ages 60. What is happening from a mechanism of action perspective in those periods? And is there anything that we can do to optimize or prevent or stave those periods off? Yeah, so Liz, you're bringing up that whole protein proteomic clock thing again.

So that same, whether it's 6,000 or up to 11,000 proteins. They've been used to determine there's actually three times. The study you're mentioning from Stanford didn't include people old enough to see the third peak. But there's three proteomic peaks at the ages you mentioned and also in the 70s. It turns out aging is not like a linear process that we just waste away that we are in this degenerative vote throughout our life. There's a few peaks overall in people at these different ages. and that's really interesting. That's a part of that science of aging.

We're learning through the body's proteins. In any given person, we don't know when those peaks are, because we haven't been doing these at scale in hundreds of thousands of people, but at least we know now that there's something going on at a cohort levels that this process, it kind of goes into a burst of aging. We also know that life stresses contribute,

of course, mental health to age, And, you know, there's a whole interplay with the whole aging process with our environment, too. I mean, unfortunately, the things that we are confronted now, a much heavier burden of hazardous things like microplastic, nanoplastics, forever chemicals, and air pollution, particulate matter. These things influence our aging process as well. Yes, there appear to be three peaks. It's confirmed now by a couple of very reputable groups. but it doesn't really give us the insight right there at an individual level what we're going to do about that.

The main thing we want to do is find out who is at risk for accelerate aging, when, what organ, that sort of thing. And that's where the protein revolution, when you get 11,000 proteins from a person, I mean, you need AI to analyze that. But it gives you incredible insights like the one you were just bringing up. That's interesting. And I want to be clear, when you say the protein revolution, you mean these protein, because we're going to talk about diet later, and there's another protein revolution happening online, and I'm not sure you're as in favor of that one. Probably not.

What I'm talking about is high throughput proteomics, which is from the plasma portion of the blood, and basically getting those to link with each of the major organ systems in the body and comparing the age of their organ versus the person's actual age. and that's what gives us the indicator, you know, like a yellow flashing light. We really want to zoom in on heart disease risk for this person. Now, remember, what's so important most people don't realize is it takes 20 years for these three big age-related diseases to actually manifest. So we have a long runway to work with, which we're not using.

But going back to those protein peaks of the kind of burst of aging, if we could start early before the second peak, and we have 20 years to get all over this and prevent the disease from happening, that gives us enormous opportunity. You also ran your own research where you studied 1,400 people who were aging healthfully to see why they were thriving as they aged, and you thought that it might be their genes initially, but you found that was not the case. So can you share what was the case? Yeah, this is really important and kind of really changed my whole view because, you know, for my whole career, I've really been into genetics and

genomics, the sequencing of the genome, and it took seven years to bring together 1,400 of these people we called the Welderly. And that is they were in their late 80s average. They had never been sick, no chronic disease. So to find them is not so easy because they're kind of a rarefied group. And what we did then, which is, of course, more commonplace now, is to do whole genome sequence on all of them to see when we got through all 1400, whether there's some particular their gene variants that accounted for their very remarkable kind of Teflon-coated existence from the standpoint of not having one of these major diseases. And we found very little, which was striking.

Now, each of these people had their theories when you talk to them. Why did you get to, you know, age 98 and you were completely healthy? And, you know, some of them still smoked cigarettes, even up to two packs a day. You say, well, this is incredible. But they would come up with things like, you know, I eat hostess Twinkies or who knows what. You know, everybody had their own theories. The Twinkies last forever. So maybe they make us last forever too.

Very good point. Very good point, Liz. Anyway, we didn't find much. We reported in the journal's cell. We're very surprised, frankly, that this size of a population, which is unique, there hasn't really been a healthy aging cohort assembled. Most of them are for just lifespan. We have to think, and of course, the patient.

who I highlighted in the book, Mrs. L.R., who's 98, never been sick. All her relatives died at a young age, her brothers, her sisters, her parents, also her husband who died at age 97. So there's a lot more to this than the genes. They may account for a small part, but the real key thing is for, I have a terrible history genetically. I shouldn't even be here by now if, you know, my genes were the determinant. But it turns out it's much less important for healthy aging than we have previously estimated.

So people that have a bad family history, they shouldn't be worried near as much because it isn't programmed in their DNA by any means. Which is so, so empowering. Were there any commonalities amongst the welderly or on the flip side, the group that you called the elderly? Yeah, it turns out, you know, their polygenic risk score, which is looking at these common diseases, like heart disease, various cancers, risk of Alzheimer's, they weren't that different. That is, they had almost the same burden that the people who were the elderly who had these diseases, sometimes multiple diseases, chronic diseases. So that, again, reinforced, hey, you know what, folks, this is not a genetic story.

This is much different than that. That's not just our genes. And that's why, you know, things like what we've been talking about, the proteins, the side change of the DNA, the environmental exposures, they're going to play out to be much more important when we start to get into the determinants of health span. You say that the root cause of chronic disease is the immune system. Can you explain what that means in the simplest terms possible? These three killers, these three major age-related diseases, that is, they are much more frequently to occur as we have advanced age.

They all have one very important common thread, and that's the same. That is, they're driven by inflammation, driven by a defective, if you will, immune system. So, for example, in cancer, if the immune system isn't on guard, it gives the chance for a cancer to develop and spread. For heart disease, if we attack our own arteries, this can lead to promote acrosclerosis, hardening of the arteries, and heart disease. And, of course, for the brain, if we have what's called neuroinflammation, basically, you're getting the immune system out of whack attacking proteins in the brain. This accounts for

the neurodegenerative diseases. So we have to do a much better job in regulating our immune system, which we're learning how to do, and suppressing untoward inflammation, which now we know is really this common thread. And we are getting tools now to measure it and to suppress it, which is really quite exciting. Yeah, there's a single test that can show our inflammation levels, right, that you say is hugely important and yet not nearly enough people are getting. Well, I wish we had better tests, but for heart disease especially, the C-reactive protein is very inexpensive and it's one way of being able to say if your body has a high level

of inflammation. We need better tests. Can we just ask our doctor for a C-reactive protein test? You can. You can't. Especially it's used in heart disease. in concert with things like your cholesterol and the LDL bad cholesterol, and soon the LPA, lipoprotein A, will be another routine test

because we're going to soon have drugs to suppress that. You'd like to know that if you're at risk for heart disease, for the reasons that we'll talk about, the real risk, not just the risk of the whole world population, that you don't have any markers that show heightened inflammation. And what do you do if the test comes back with a high-neutral? number, what should we do? Should we freak out? Well, there's lots, no, no, you never want to freak out. No, none of that stuff. The key here is that you use it along with the other tests. For example,

if the LDL, if you are at risk for heart disease, and your LDL is not that low, you go lower. There's lots of ways. We have lots of ways of lower LDL cholesterol. But also, you want to exercise more because that raises HDL, a good cholesterol, and lowers LDL, and it will lower. inflammation. The interesting thing is we have even better tests for Alzheimer's. We have a protein called p-tow 217, which you can also get. And that test tells you your increased risk for Alzheimer's. And if you exercise, it goes down. So exercise, diet, sleep health, all these things help reduce inflammation. If you're chronically a poor sleeper, not getting much deep sleep, that is pro-inflammation for your body. If you eat a diet that's full of unprocessed, ultra-processed food, not ultra-processed foods,

and all sorts of bad stuff, it increases inflammation. So like, for example, if you had a high CRP, one of the first thing you want to look at is your nutrition, also your body weight, if you are overweight. So there's lots of ways you can bring inflammation down if you noted in a simple blood test. You're huge in the tech space. What do you think about like whoop and aura and those types of sleep trackers? Do you think that those are giving accurate measurements of our sleep? I haven't used whoop. I do use aura. Once I was doing a lot of this research, I started saying, well, I better, you know, test this out all myself. I use both the Apple smartwatch and aura to both to see how much they align track sleep. And it's interesting. They provide different data

every night for deep sleep, which is the most important, especially as we get older. We lose our deep sleep proportion. And that's the critical time where the waste, the toxins from our brain are getting drained. And you really want that. You want to get rid all that stuff. So you're crisp each day. It did help me using these tools, Aura and a smart watch, which I hadn't used previously. Because I learned how I could get better deep sleep. I learned about having a ritual, trying to stick with the time of going to sleep and waking up, trying to get longer times of sleep. uninterrupted, quantitatively. If you do track it, it helps you to learn how to get better sleep. And when you do that, it pays off not only on day to day, but also we know sleep has a big influence on

inflammation in the body and on all three of these major age-related diseases. It makes you age faster if you're chronically sleep less or poor sleep health. Could you give us maybe three action steps, things to remove from our lives or add into our lives if we wanted to decrease our inflammation levels and support our immune health? Well, you can't get enough physical activity. I mean, even a little helps. But as a cardiologist, I used to always think that aerobic exercise was the winner, getting aerobic running and brisk walking and bicycle, treadmill, elliptical, whatever, swimming. Anyway, what the data shows is that that's good, but we really need to be. We really need resistance training. It's big. And both of these are very important. You don't really want

one without the other. And so to bring down inflammation and to get these age-related diseases under wraps, exercise as often and as much as you can. Now, it doesn't have to be like Peter, Atia wrote in his book, Outlive, where he exercised four hours a day. Very few people could do that. I mean, what else are you doing in your day? But even an hour, a day, five days a week, with one or both of these two forms of physical activity. It's great. Now, even patients that I have, every one of them, I advise, even if they just go for a walk, 30 minutes, that's going to be great. That helps a lot. And there's nothing about magical, about 10,000 steps. Lots of studies show 4,000, 5, 6,000 steps is great. So for everyone to exercise

more, we're going to see less of a burden of these major diseases. So I'll ask for your other two in a second, but I want to drill in on exercise for a second because you're just like, more is better? Is there no risk of inflammation increasing with over exercise? Let's say if you're running marathons or you're working out for hours a day. Really good point. I'm glad to ask that, Liz. In the book, try to show the graphs that there is this worry about too much exercise and too extreme. And so until we know more, it's probably not to go better to go overboard. I mean, getting some good workouts without, you know, having a near-death experience. Marathons are great, half-marathons, but even then, you know, we've seen recent data that

they can be attacks on the brain, the myelin content of the brain. It's reversible. But, you know, you wonder a bit about that, and especially if you're running a lot of those kind of races and stuff. So I think you don't have to go extreme on this. That's really a message. And there are some gyms, I guess, that promote this extreme stuff. And I think that could be concerning. In your mind, what would one week of ideal exercise for our longevity look like? Well, I try to do that. I try to practice that. Usually six days a week. I'm doing 30 minutes on a bike or a brisk walk or sometimes both of those. And I'm also doing about that same time or maybe a bit longer on resistance training. It's with music, sometimes with television, whatever. So,

So it's not hard. I mean, sometimes I'm tired going in the afternoon when I usually get a chance to do this, but I always feel better when it's done. And I also know it's going to contribute to suppressing inflammation, promoting health span. You start to develop this kind of endorphin fix where you do feel better afterwards. So I've done that most of my life, but the thing that I did in recent years was to really amp up the resistance strength training because I had never really paid attention to that. and the data are really strong about how that's equally important.

And you're a cardiologist by training. What about the zones for your heart health and stuff like that? Should we be aiming for anything specific there? Well, the zone five is that extreme where it's basically just a heart rate determinant. And that's, again, a little silly because everybody has different heart rates and different conditioning. And so to say something's magical when you go over a heart rate of 142 is, you know, Zone 5 is a little crazy.

But, you know, being in Zone 3, three or four is certainly a really good form of exercise. If you can't really talk to a person easily, comfortably, without even measuring heart rate, then you know you're getting a good level of exercise and you're sweating. You know, sweating is a really good indicator that you're getting a good workout. You don't have to profusely sweat with, you know, pouring all over the floor or the ground, whatever, but that's a physiologic indicator that you're taking your body out on the highway and that's good. Can you speak to the reverse side of that? What impact is sitting having on our longevity?

You know, I was a doubting Thomas about the sitting thing, and I would turn off all these notifications about getting off. Guess what? I've turned them all on. I control my life. Yeah. No, the reason is, is that the data for sitting is bad. We're not meant to sit for long periods of time.

So we should get up and walk around every hour. Ideally, I can't do a standing desk when I, you know, work. And even that isn't great because you're not moving around. So movement, as you say, Liz, is really important. The data for sitting are pretty compelling, and I was surprised. I hadn't really, you know, delved into that and really was assured that there's something there, but there is. Why is that, in most brief terms from a mechanism of action perspective?

Yeah, it's a good question, and I don't know if we're sure that. It does promote stiffness. Stiffness throughout our joints and muscles promotes inflammation. So, you know, that may be a reason. is that you're just getting this transient increase of these inflammatory proteins that you don't really want, and it isn't good for you. But we don't really know for sure. Interesting. Okay. That's exercise. We have two more things if we want to support decreasing inflammation levels and supporting our immune system. We talked about sleep. The one we

didn't talk about enough really on nutrition, the ultra-process foods are just awful, and they are very pro-inflammatory. And, you know, we don't have, warnings on labels like they do in other countries. And, you know, in Europe, they're kind of all over this, whereas here we're just very complacent. Nothing's really being done about it. But they're really injurious. And I'm convinced by all the evidence that they promote these three major diseases. And 60% or more of our diet is the average American is from ultra-processed food. How robust is that data? I think it's extraordinary. If you go back to what was incriminating about the tobacco industry. You know, we're seeing similar parallels there where everywhere you look, every

population, every analysis that's been done, the correlation with particularly certain types of ultra-processed foods and the percent and the connection with poor outcomes. In the book, I go over the experience of a colleague named Chris Van Tulligan who wrote the book, Ultra-Process People, which is really a great book to take you through this story here. He's a physician scientist, and he had 30 days of the highest ultra-processed food he could eat. And we know from very careful studies done at the NIH metabolic center, people will eat a lot more compared to a control group without the ultra-processed food addition. But he gained over 20, 25 pounds in a month, and his inflammatory markers went through the roof and his brain scan.

I mean, it's amazing in a month, deteriorated in just a month. That's just an end of one, but the studies all confirm these sorts of findings. So ultra-processed foods are a real problem. But there's another thing that is considered a good food protein, but if you have too much of it, it may actually backfire. So this is a really important point that the nutritional allowance for the guidelines in this country are 0.8 grams per kilogram. Let's say you're 80 kilograms. That means you're supposed to take in 64 grams. That is attainable, but that's probably not enough as we older. And in fact, it probably would want to be more like one gram, it's 80, or even 1.2, which is more like 90. And you have to work at getting that much. But too much protein over that

1.2 level can promote inflammation. And it's been shown in models to promote atherosclerosis, too, which is really worrisome. And here you have, you know, Peter Atia and Outlive was recommending one gram per pound. Which just, I mean, a kilogram is usually you're going to be, your weight's going to be about half in kilograms that it will be impound. So you're doubling even the high end of the intake. Exactly. A kilogram is 2.2 pounds. So if you take that same person who's 80 kilograms, that's approximately, you know, 2.2 times out of 180, 180 grams of protein, that's like very hard to get, but also very worrisome for what it can do.

So, you know, there's been multiple studies that incriminate very hundred hundred. protein diets, which I would not recommend. But we definitely, as we age, want to get more protein and keep in mind that kind of 1.0, 1.2 per kilogram, not per pound. And that does mean, you know, revving things up in parts of your diet so that you make sure you're not losing muscle mass, this condition of sarcopenia, which is also, you know, makes potential frail and more prone to falling and just overall not something you want to have in your life. Okay, I want to drill into both the ultra-processed food conversation and the protein conversation. Let's start with ultra-processed foods. Is the negative effects that we're seeing on all three of the aging

culprits, is that because of an impact on our microbiome? Great question. The answer is very likely yes. It turns out the gut microbiome is a principal mediator of our immune system. They connect through the vagal nerve right to our brain, and the brain is kind of a mission control to rev up or reduce our immune system's response, but also the composition of the gut microbiome and the bacteria, especially, that composition and its metabolites of these bacteria, they have a big effect on our immune system and on promoting inflammation. You don't get inflammation without these white cells releasing so-called cytokines and chemokines, these proteins that, you know, bring inflammation to various parts or our whole body. So the gut microbiome is really playing a role.

And it's a role that I don't think many of us envision. Like, for example, telling us that we should eat sugary foods, or being able to take in an organism that's young to take that gut microbiome and infuse that to an old mouse and make the mouse young again. But the gut microbiome is holding a lot of embedded information about how our immune system works. And when we feed our gut, these bad foods, we're definitely stimulating these bad products of these, you know, these chemokines, cytokines, telling the brain, you know, that promoting inflammation in the brain even, and no less the rest of the body. So that appears to be a key mediator, the gut, of how these ultra-processed foods are doing their thing.

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Okay, let's drill into the protein. because so many people online are just massively loading up on protein, and they're preaching the benefits of that. What would you say to somebody who said, I upped my protein, I lost weight, I've never felt better in my body? Well, it's fine to lose weight if you need to lose weight, and it's good to keep up your muscle mass, which is a good diet of protein component.

We'll do that. But the whole idea of everything in moderation, it keeps playing out. like I said, I reviewed the data for the very high protein diet. It's concerning about untoward effects. So as long as it isn't extreme, isn't taking over your diet, the only thing you're eating is protein, there are really good fats, just like it's good to have protein your diet, and there are good healthy carbohydrates that, you know, the so-called ketogenic diet tries to reduce that to next to nil or very low levels, and that may not be so healthy either.

idea of moderation is critical and it applies to every, of the macronutrients, fats, proteins, carbohydrates, it's very important to consider that. We also, though, have an epidemic right now of people who are having negative health effects because they're carrying more fat on their body than their body can perhaps handle. And so it is interesting. A lot of people will say, I can't get the satiety that I need unless I'm up at these really extreme protein levels. It turns out there's a lot of ways to achieve satiety with nutrition.

Perhaps the healthiest way is high fiber diets. It doesn't necessarily mean you have to take in a lot of protein or fat or anything, but that will increase satiety. We're learning a lot about this reward system of the brain, like, for example, the Glyp1 drugs like Ozympic and Mungaro have been completely kind of rebooting how we understand about satiety and, you know, ways we can. teach the brain that, you know, enough, you don't need any more food. Which the ultra-processed foods are teaching the brain the opposite.

You need more and more food, and they're really messing with those natural markers of satiety. Exactly. They're short-circing, you know, these brain circuits. And what's amazing is that the more people are taking Glyp-1 drugs, the less of these unhealthy foods, they're eating. They're eating less. but in particular, they're eating less of the foods that are unhealthy, which is really interesting. And in fact, there's a real threat to the snack industry and a lot of these ultra-processed food product companies. Yeah, but I've heard they're already working on it.

They're like, they're chemically engineering stuff to get around the GLP ones right now. They're working on. I don't know if they've been successful yet, but knowing how much money big food spends to preserve their, you know, trillions of dollars of sales and revenue, I wouldn't be surprised. We've got to be on guard about that because big food in this country is an unchecked industry, which has huge lobbying power with the Department of Agriculture. And this is pretty clear cut that they have engineered the foods using the various means components of ultra-process to make people want to eat more, to be addicted to those foods. And that's the last thing we need. What is your stance on GLP-1s?

I am very impressed with them. I tend to be, you know, anti-pharmaceutical. I've throughout my career taken on the farmer companies multiple times. Yeah, and I, you know, sometimes regretted it. But here, I got to give them a lot of credit. The two companies that have led to charge, Novo Nordus from Denmark and Lilly here in the U.S., are changing the world. And what's really amazing about these, Liz, is that unlike most drugs, the side effects, which in this case, are these gastrointestinal side effects, nausea and homin, constipation, diarrhea, all these sorts of things.

They are present in about 10% of people, but usually after a few weeks they go away. But most drugs, when the side effects go away, so does the efficacy. This is like one of the few drugs, maybe the only major drug class, where the side effects are dissociated from the efficacy. And so these drugs, they do have a problem, though. Now they're very potent, and they reduce inflammation, both the body and the brain. And in fact, the inflammation is reduced even before the weight goes down. And that's why they're being tested for Alzheimer's disease in large trials.

And they have had effects across many other organ systems, not just weight loss, that are not just depending on the amount of weight loss or even that there's any. So they're very exciting drug class, but how to get off of them? that's the problem. Because if you go off, the effects go away. Yeah, you typically will gain the weight back. The problem is right now we have this program for these companies that they like. You know, you're on for life.

And, you know, some of my physician colleagues think it's great. It's like you have high blood pressure. You take your high blood pressure medicines forever or diabetes. I don't agree with that. I think ideally we should use these drugs, maybe get the weight to the optimal weight, and then find another way to keep it off. And I hope we work on that. These companies are not necessarily motivated,

but someone somewhere has to come up with a way that they can be weaned successfully because these are potent drugs. Is the positive impact due to the weight loss or is there a direct effect on inflammation? Direct effect. Okay. Because even before pounds are off,

you're seeing things like C-reactive protein and the protein organ clocks, proteomics, a move substantially. So that's where we didn't get it right, thinking, ascribing everything to weight loss. And the more we learned about inflammation, this common thread, the more we appreciate that there's both the weight loss effect, which, by the way, in your visceral fat, like in your belly, the visceral fat, you'll see, you know, with a protuberant belly, that is what you would consider as a manufacturer of inflammation.

That is, the fat cells have a real propensity to make these chemokines become adipokines, but they're the same thing. They promote inflammation throughout the body. So when you get rid of these cells and this fat mass, that has an effect on reducing inflammation. But what we've learned is, even in people who are not overweight, you can reduce inflammation with these drugs. So it's really striking. It took 20 years to understand the obesity story with these drugs, and only in the last

couple years are we getting a handle on the anti-inflammatory effect of these drugs. There's been a few negative side effects reported outside of the gastrointestinal. Loss of vision was in the news recently, and then also loss of muscle mass. What are your thoughts on the negative side effects? And the fact that we don't have data around this much of the population using these for an extended period of time, do we? Or am I wrong on that? Well, we're getting it now because like 10% of people are taking these drugs one way or another or have taken them.

But we have five-year follow-up in people taking these drugs for obesity, not for diabetes, which looks good. But you're bringing up two concerns. There's a rare form of optic neuropathy that leads to blindness where there are mixed data. One recent report suggested that this could increase that rare serious side effect. and so losing vision, that remains to be seen. I think we're waiting to see these are what's so-called retrospective studies, and it's hard to know whether that risk is there. And it's hard to come up with the mechanism since we've just been talking about

this good effect on inflammation. The weight loss is a different matter. When we lose weight, we lose muscle mass. And so the story there is, are we losing more muscle mass because of these drugs? Than we would otherwise if we were just losing weight. Some people, the answer is yes, for sure. And the companies, again, you know they're worried because they've each acquired another company that makes muscle building drug.

Oh, my God. It just feels like we're trying to like, it's one thing to solve another problem. Yeah. Yeah. So I think the way to avoid this problem, if you're taking one of these drugs and you're not taking it, you know, to lose five pounds, you're some celebrity, you know, to look better on the red carpet. We're talking about you need to lose weight for your hell.

and there you want to really make sure you're doing good resistance training, that you go pretty serious on that. And that should prevent the muscle mass loss that would be ascribed to both weight loss and also even the drug. We like to make things as actionable as possible here. If somebody's listening and they've been debating whether or not to take one of these drugs, is there questions they could ask themselves to decide if they'd be a good candidate in your mind? Well, there's a lot of issues, for one, unless you have diabetes or you have heart disease or certain specific criteria, you won't have insurance cover it. So it's a big expense. It's come down.

It used to be closer to $1,000 a month. Now it's like $500 a month. That's a lot. So that's already step number one, you know. The next is, you know, this problem of, okay, I cake it. I'm going to get down to this great weight, my ideal weight. But then what? And so until we have a way to assure that you can get off after a year or two, that's a concern.

My dad's a psychologist, and often he'll work with people who've been put on medication, and while they're on that medication to get to a state where they can benefit more from therapy, he'll work with them on therapy, and then hopefully they can get off medication as quickly as possible and benefit from therapy. Do you think there are lifestyle practices people can put into place while they're on these drugs that will make it more sustainable? Yes, yes, I do. I think, you know, if you start to...

really go after these factors, like we talked about, the sleep, the exercise, not just nutrition, but those components in nutrition, and other things that we'll talk about, like nature walks and social interactions and, you know, various things, you know, basically kind of revamping your whole lifestyle, you know, from top to bottom. The interesting thing is I have so many patients on these Lip-1 drugs. They feel so much better. They have higher levels of energy. They just feel back to themselves. Which answers the question of people would be like, if you're going to do all the lifestyle stuff, why not do it anyway? And it's like, well, it's much harder if you're living in a body that makes it much harder.

Exactly. That's interesting. It's harder to do these workouts when you're carrying a whole lot of extra weight. But what's interesting is people do tend to be motivated. They want to stay there. They want to get off the drug. A lot of people do get off. Sometimes just because of practical reasons, like they can't afford it, you know.

So this is unsettled. You know, these drugs still are relatively new, and we do need better proven ways to wean and sustain their benefits. And hopefully we'll see that over time. So if you have one of these risk factors that you can get it covered by insurance, would you be 100% like go for it? Yes. I think it's worth giving a try.

If you can get these medicines at very low cost, you know. I've never heard somebody say before, this can be a really nice bridge if you're in a place where you cannot implement lifestyle factors, that this can kind of get you to a place where you can. And I think that's a really nice way to think about it. I like the way you put that, Liz. I agree with you. This all begs the question for me.

Is weight unto itself a risk factor in terms of our longevity? Because there's a whole movement of there, you can be healthy at any size, and you should be testing all these individual biomarkers, etc. So is the weight itself a risk factor? Or is it things related to weight that may or may not exist at different body? body sizes or body fat percentages.

Yeah, no, it isn't as simple as weight. It certainly isn't as simple as, you know, BMI, body mass index. Because if you've got a lot of muscle mass, you may have a higher weight, but it may not be nearly as concerning. So it's really about your waist size. The worst part of our fat content, our belly fat. That's an indicator, particularly the waist to hip ratio. But no, weight itself by itself can be very misleading.

A higher weight for an individual who's, you know, very. very muscular is much less of a concern than somebody who's got a lot of, doesn't really have much in the way of muscle mass. What about fat? Well, the fat content, I mean, you don't really know that until you have a dexas scan. And what's really cool about, these dexas scans can be obtained very inexpensively. The one I had, I think, cost it $75 or something like that. And if you're going to go on a program, let's say a Glyp One drug or a lifestyle program, you can get

it again after a six months or a year. And you can see exactly where did the fat come off. What percent, where. It's pretty amazing to watch it. So if you're quantitative with some of the people that might be listening, it's kind of a nice tool. It's an added expense, so I'm not widely recommending it. But if you're interested, getting a dexas scan that has the fat map of your body, where it is, whether it's, as you say, around your organs or outside your organs, this can be really another incentive for you to see directly on a scan what you've achieved. Things that you wouldn't see looking in the mirror, but really are interesting. But if somebody is working out, they're eating well, they have a lot of muscle, and they're carrying a lot of fat on their body, on their frame.

Is that unto itself a risk factor for mortality? Yeah, I don't buy this obesity, overweight, metabolically healthy as being really true. Because It's not as good as the people who aren't having a problem with obesity. It's still a gap there. There's been this term about metabolically healthy despite overweight and obesity. I'm not really keen on that because the data still are a bit fuzzy. It doesn't mean it's good. Carrying around significant amount of fat isn't going to help things because, as I emphasize,

it's pro-inflammatory. And this is that problem with our fat cells, is that they, they make things we don't want them to make. And if you get rid of their mass, there's much less chance of being in this pro-inflammatory situation. Going back to protein. Are there better and worse forms of protein for longevity? If you look at all the studies,

there was a really interesting one just published in the journal Nature Medicine. And it was a remarkable study of 105,000 people followed for 30 years. only 9% of them reached the age of 70 without chronic diseases. And the list of chronic disease was more than the three we're talking about. It was 11 chronic disease. And so they looked at the diets of all these people,

because they had the diets that were kept along these 30 years. And the people that did this 9% that made it without these chronic diseases, what did they eat? Well, they didn't eat a lot of red meat. they ate a plant-based diet for the most part with a good amount of protein but not necessarily derived from red meat. Not that they were vegan or vegetarian, but in the book, I review all the data on red meat, not, you know, just as you were alluding to a good steak.

Yeah, yeah. No. I mean, it's okay to have that once in a while, sure, but they are not healthy. I mean, things like, well, for protein, seafood, particularly. particularly those rich in omega-3, like salmon, chicken breast, these are much healthier forms of protein than to eat, you know, things like nuts. There's a lot of protein and nuts. But when you have a lot of red meat, that's going in the wrong direction. And then you go far in that direction if you're eating a lot of ultra-process meat, the things that are even worse. They're like the

worst offenders of all. That's interesting. I know from a weight loss perspective, a lot of people don't feel like beans and things that have kind of carbs in high amounts in addition to their protein, help them reach their protein goals or help them feel satiated in a way that promotes the weight loss they're trying to achieve, which is why I think in many ways these like bowls of meat and stuff are popular online because it fills people up and it helps them feel like they're hitting their protein goals for their weight loss goals. Yeah, I mean, it does fulfill the protein. It's just that there are better proteins that you could take in.

And like I said, I don't think it's a problem, as long as it's in moderation. I mean, that's something I think is really important. But if you're kind of living on this, if you were to check, if we had the really good inflammation protein markers that we should have, you'd see they're going in the wrong direction. I don't think that we have better ways to take in protein than red meat. And so using those means, I think it's advisable. Okay.

I'm going to say diet types, and I'd like you to give me just like a one sentence evaluation of those diet types in terms of longevity specifically, ketogenic diet. Yeah, I don't think it's a healthy diet because even though it leads to satiety and weight loss, it promotes inflammation. It's a risk for people with heart disease. It might be okay on a short-term basis, and it does have a role in certain conditions like people who have seizures, intractable seizures, it's like the only thing that can help them. It's being explored as an anti-cancer diet. We don't have any data yet that's meaningful for that. So it isn't one I would ever recommend. The Adkins diet was made famous and others that have followed in a suit with that.

I don't think, based on all that we've been discussing, that it would be considered a healthy diet. Carnagore diet. Well, that goes back to the red meat story. And I don't think that that's a good idea either. And so the people who are feeling, I'm on the carnivore diet, I've never felt better. Is it placebo? What do you think is going on there? It's hard to know.

It's hard to know. I mean, maybe they lowered their carbs, and that might be good because we tend to have too high a carb intake diet. But it's hard to know in any given person why they feel better, you know, whether it's a confirmation bias. And maybe they've lost weight, and that's why they feel better. There's lots of different ways to lose weight. So it's impossible to say, but there's nothing to support that from hard evidence.

I do think that many diets that people are like, oh, this is incredible. It's because they are switching to whole foods because of the restriction of the diet. And if they switch to whole foods to your point in another way, they would probably experience similar results. Yeah, I think that's true. And I mean, what I try to do in the book, you know, all these things, you know, caffeine and alcohol and you name it, salt and sugar. but there's nothing to support promoting health span with carnivore or ketogenic or some of these other very popular diets. Wait, I'm going to take a brief sidebar to caffeine because I read this part aloud to my husband.

You were like, caffeine actually seems to increase our lifespan, but you seemed a little bit annoyed because we couldn't figure out why specifically. Yeah, it's a great one. Caffeine, coffee in particular, there's a number of studies, a huge number of studies. And what's so striking here is it's something that it's actually taste good for coffee lovers who rely on it is actually almost all the studies. And some of these are exceptionally large and rigorous. They're not randomized, you know, because it's hard to randomize people who love coffee to not have their coffee. But outside of that, they are remarkably consistent of benefit.

Now, we're not talking about lifespan. We're talking about things like health span, reduction of these age-related diseases or appearing much later in life. The mechanism, though, as you point out, Liz, is elusive. We don't know really why. And people say, what about tea and what about uncaffeinated and whatnot? You know, the data kind of goes along. Most of it's with caffeinated coffee.

But the rest of these other hot drinks seem to drag along, perhaps not nearly as well. studied. But up to four cups a day, it looks really good. And the other thing, to dispel the notion that they are a rhythmogenic, that is inducing heart rhythms, the data really go against that, even that's where randomized trials have been helpful. So the lack of side effects and the benefits all sort of point to, hey, you know what, you're okay. When you start to go past four cups of coffee, you start to see the benefits are lacking. Outside of the data, if you had to, you had to, to speculate, would you say, if you just had to guess, would those benefits be there for decaf, particularly if you do processing mechanisms that are like water process, you're not using the

chemical solvents? And would you say they'd be there for tea if you had to guess? It might be. It's hard to know for sure because they're just not as enough. I mean, the studies I was reviewing for regular coffee, like, you know, hundreds of thousands of people and so many, there just aren't as many. And in the studies where they looked at both, it trended in the same direction, maybe not as helpful, but nothing to say that these other drinks were having a negative effect. And that's where I think it's so important is you want to look at the totality of the data. And when you see this much accumulation of data, all pointing in, you know, one direction, that's a good thing. Okay. I just wanted you to say that on camera because I know people really

like to have their coffee habit validated by experts. Okay, going back, the vegan diet. Yeah. Well, the vegan diet is kind of moving in a healthier direction. There is nothing to prove that vegan is better than vegetarian or better than a mainly plant-based food diet. It's healthier than the ones we were talking about earlier. Do you worry about nutrient deficiencies in a vegan diet? Yeah, yeah, this is important.

I mean, in general, we don't really face micronutrient vitamin deficiencies. But when you are in a vegan diet, it's hard to keep up on enough protein and some of the other micronutrients. So that you have to really keep an eye on. Mediterranean diet. This is where all the data is. This goes back to that big study I just reviewed. These people were on what would be considered a Mediterranean-type diet that's rich in foods like olive oil and avocados and, you know, certain types of fats, low in animal fat, high in whole grains and nuts. The main thing that these people ate, again, We're fruits and vegetables, okay?

So plant-based diet, Mediterranean diet, is where we have randomized trials. We have the biggest load of studies, hard evidence that confirm benefit. And it's for all three. It's for cardiovascular, neurodegenerative, and anti-cancer. So this is what the diet, you know, I strongly recommend to all patients. And, of course, to readers of the book, I really try to get into all the data, because the evidence is as good as it gets. We're not going to have randomized trials of, you know, 50,000 people that are on the

carnivore diet and 50,000 people on the Mediterranean diet or anything like that. We have to go with what we have today because probably not going to get anything that's going to change the body of evidence. What about fasting? There's been a lot of talk in the longevity circles amongst many very famous experts about the benefits of fasting. What's your take on that? The data are soft.

They're good for weight loss, but beyond that, it's questionable. There's so many different forms, four to three and this and that. I mean, you know, the real point is if you don't eat late in the evening, you don't have a late meal at night, and you don't eat anything after that, let's say, you know, six, seven, late at eight o'clock, and you don't eat, have snacks and stuff later, and then you don't eat until the morning at breakfast. You're fasting, okay?

The question is, do you get another bonus factor? of going a day without fasting or a significant block of time. It's very soft. I reviewed it in the book, and there's just not much there. It does help some people lose weight and they buy into it. There are some big aficionados that advocate this. Yeah, what do you think about like David Sinclair's work? Yeah, I have a lot of questions about his work.

He's the one that brought up the whole Resveritrol and Sertuin and never got replicated and other things. and he's been very controversial and he was even taken out from his own organization on aging, a study of aging. No, so the fasting thing, we can incorporate that easily just by a daily practice of not eating after dinner or meal and hopefully not doing that too late, which will help our sleep help, by the way, because if you eat too late and then go to sleep, that's not good either. Because your body's trying to process the food instead of doing all the other things

that's supposed to be doing while you're sleeping. Exactly. Okay. When you think about strength and resilience, like your ability to feel energized, to recover well, to stay strong as you get older, what do you think that actually comes from? Most people say working out or good nutrition, and yes, of course that matters. But there is a biological foundation underneath all of that that most people are completely overlooking. I have been diving deep into this lately with the team at timeline and what I've learned has genuinely shifted how I think about my own health. Every single movement that your body makes, every step, every workout, every muscle contraction

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You are a cardiologist. We've talked a lot about how heart disease is the number one killer. It remains the number one killer in the U.S. in men and women. In men and in women. So what do you think we're currently getting right and what do you think we're getting wrong when it comes to talking about heart disease? We touched on one already. Somehow or other, a lot of people think women are exempt and they're not. And people think women die of breast cancer, number one, that's far from it. It's still heart disease. And that's why we don't have suspicion about women when they have symptoms that could be heart disease, but we kind of

discounted, well, it's a woman, you know, and she's not post-menopausal where things get reset to more in risk of men as years go on post-menopausal. So that's one myth, is that somehow women are much less risk, immune, and the misdiagnosis rate among women is just horrible when women present to a clinic or emergency room, urgent care, that kind of thing. The biggest thing about heart disease, if you look at these big three, cardiovascular heart disease is 80% plus preventable. Cancer is 60% preventable. And neurodegenerative disease is 50% preventable. But so the heart disease is number one for preventable in terms of all the data. It's striking. And it goes to those risk factors that we have been talking about, avoidance of high blood pressure,

good glucose regulation, avoidance of diabetes or pre-diabetes, of course not smoking, having lots of physical activity, not having, not being overweight, having low cholesterol, lack of inflammation. These are the things that if you work on those with good sleep and, you know, everything that we've been talking about, good nutrition, your chance of heart disease goes way down. The issue, though, is oftentimes people wake up too late. Remember, something I try to emphasize, it takes 20 years to develop a heart attack or significant atherosclerosis. This gets started in our 20s, 30s. So this healthy lifestyle, we talk about preventable, but that's starting early. It's never too late. I don't want you to think that.

But we have to be cognizant that when you start on these things, knowing your risk, which is what we haven't talked about, knowing the risk is critical. If you know that, then you can tailor your changes, your preventable program accordingly. So that's a lot of the risk. That's I think the biggest myth is that your father had heart disease, you're going to have it kind of thing? No, this is an eminently preventable disease if we pull out all the stops. How can we know our risk? This is the biggest important part of the book, is a blueprint for determining risk precisely, what I call precision medical forecasting.

We haven't been able to do that. Like, for example, we just said, oh, your family history, well, we already discussed. That's not enough. that's weak. Then we could go to, oh, well, polygenic risk score. Well, that isn't very good either by itself. Because if I say, Liz, you have a risk of Alzheimer's disease, and it doesn't say when. And it turns out it's 98, age 98, and you worry your whole life that you're going to have an Alzheimer's, that's no good. But now we have the ability with all these layers of data, organ clocks, the gene sequence, the epigenetic clock, these other molecular clocks. In addition to

all of our records, that is the entire stack, the full stack of data, to say, you know what, you're at risk for these three diseases is that you have a risk for this particular disease because your organ clock is, you know, accelerated and everything else supports that. And it's going to show up at this age unless you take these actions. That's what we can do now. We can never do that before. Okay, so if I'm chilling, listen to this episode, do I go to, to my doctor and say I want this stack of tests or what am I doing?

Yeah. So, unfortunately, we're not at that point yet. It's imminent because, as we talked about earlier, the organ clocks, they're not available yet. You can get an epigenetic, like a so-called Horovath clock. There are companies promoting that, but I find they're too expensive and they shouldn't be done in isolation. You can get polygenic risk scores.

And you think that's worthwhile? When you get the package. When you get it alone, it goes back to, well, you're at risk for breast cancer. Well, the question is when and how much risk. So we can define the top five or 10 percent and give them a trajectory, you know, predict when and then put them under tight surveillance and then, you know, use preventive strategies. That's what's so exciting right now is we're at the cusp. It isn't that you can get it today.

But somebody listening, like what, if you were going to tell them, they're freaking out a little bit or they're getting excited or anything like that. Somebody listening, what would you tell them to do today? All the things that we spend a lot of time on that are these modifiable factors in one's lifestyle, they're all worth doing now. The point is they're more likely to get done once you know your personal risk.

So we've never been very good at people doing all these things. Yeah. And when you can say, you know, this and it's only five years away, you know, Yeah, the motivation component. There you go. And the studies have shown that consistently, that people, is a big study in Finland that when they got their genetic risk for heart disease, they took action.

They stopped smoking. Because we always think it's going to be everybody else, but not me. Exactly, exactly. Okay, let's talk about young people getting cancer. The rates are startling. They're rising quickly. What specifically is happening in the environment or their exposures that is contributing to that? and how can we start to prevent it?

Well, the big ones we have already touched on because they're pro-inflammatory and they increase the risk for everyone, whether it's cancer or these other age-related diseases. So they accelerate the likelihood. So ultra-processed foods and young people, particularly like in teens and 20s, they're often 75% of the diet.

And in the U.S. and the U.K. highest in the world. I had a friend of a family who, a fellow who, at least 20, developed colon cancer. And his ultra-processed food intake might have been 90% of his diet. So I do think that's incriminated based on everything I've read and all the data I've reviewed in the book. But the others, you know, we have terrible load of micro and nanoplastics that are pervasive, not just in the air and in water, but also in our body, in our brain, in our blood. in our heart, arteries, in our reproductive organs, and, you know, talk about fertility,

no less talking about the issue of cancer. And they appear to be carcinogenic, microplastics, nanoplastics. We're not doing enough, not nearly enough, to try to degrade these. And then, of course, these fluorinated, the PFS, these irrevocable fluoride to carbon bond chemicals that are everywhere in furniture, in carpet, and carpet, and, you know, all these products, which we've done nothing to get them out of our products. So until we get serious about this, we probably are going to keep seeing this cancer at this crazy ages, because these are people who probably are uniquely sensitive to these hazardous exposures.

So if a young person was listening, or really any person, would you say that mitigating these factors on an individual level would be enough to make a difference if they tried to avoid using plastics to microwave and store their food, and they tried to reduce exposure to ultra-process food, et cetera. Air pollution is the other thing. And that's not just in the outside air, also in your inside house air. That's from like furniture, off-gassing, and things like that. Yeah, yeah. So, you know, there's limits of what individual can do. That's why you'd like to see it be done. Systemically. Everywhere. Exactly. But you sure can avoid putting plastic in a

microwave, it's a double whammy. You're getting the plastics from the Tupperware or whatever, and now the heat is really putting it right high concentration in your food. So, you know, use glass or use, you know, something that isn't plastic in heat. So what about water bottles? Plastic water bottles, they're everywhere. You know, we should be doing something about that. We can do that on an individual basis. And so just being cognizant of the plastic that's so pervasive is one step. The air quality is another. Would you get like an air filter in your home? Yeah. It's a good idea. Absolutely good idea. And especially if you're in the urban areas where the air quality is not great, it may be in a rural area at times when it's in an issue. So paying

attention to the forever chemicals, these are all things that are taking us in the wrong direction. You know, we know they're hazardous. We know they're increasing our risk, but we're not doing anything about it. And unfortunately, for each of us or each family, it's much harder to make a big dent until we collectively do things. A lot of people have a lot of concerns around EMFs, Bluetooth, Wi-Fi increasing cancer risk. Is there any data to support that? I haven't seen anything to support that. I mean, this goes back to cell phones and there's always been a worry, but there hasn't been any data to give any real, what I would consider even soft evidence that's, it's always hard to rule these things out. The studies have their difficulties to interpret,

all the confounding factors, but I don't see a real signal there. You said that 29 million Americans currently take daily aspirin to prevent cardiovascular disease in colon cancer, and that is a bad idea. Can you explain why? Yeah, because the studies that have come out, surprisingly, for most it haven't kept up with this, show that the bleeding risk, significant bleeding, like a GI bleeding that you have to go to the hospital and get transfusions, not a good thing, and even other bleeds that are worse than that, like in the head. They're at the similar level as the benefits, which is small. They're both low, but when you have them kind of canceling each other out, the net effect of benefit is minimal, and especially for older people. So,

So the trials that have been done, you know, that risk of bleeding goes up with aging, as does the risk of, you know, heart attacks and heart disease. So obviously this is out there, it's embedded. It's hard to tell people to stop this baby aspirin or daily aspirin dose, because as you say, tens of millions of people are taking it, but the data don't back it up. And they also, unless you're at risk for colon cancer, the same issue, significant risk, high risk for colon cancer. The same issue now is that the risk of bleeding and the very small benefit. We don't even know how aspirin benefits colon cancer. Does it just help that you have fecal

blood that shows up on a test that brings you to a doctor or to surface sooner? So again, we should rethink the aspirin because it's not as safe and it's certainly not as effective in a net basis as we initially had thought from the early studies that were done decades ago. And then there's also a lot of conversations around vaccine and the public consciousness right now. You talk about certain types of vaccine for cancer prevention. Can you touch on that? Yeah, this is really exciting. There's these so-called neo-anogen vaccines and people with intractable cancer,

pancreatic cancer, kidney so-called renal cell carcinoma. And the renal cell carcinoma, the neo-anogens says that they, basically, finding on your cancer cells, what are the proteins on the surface of those cells that are the target? And then making a vaccine that targets those proteins and giving it to you. And nine out of nine people with intractable cancer had an incredible response. We appear to be cured. And that's after getting, you know, the kitchen sink of drugs and everything else we have to offer them. And the same thing, you know, so two different, very hard to treat cancers. And so these Neo-Irefer anti-aging vaccines, which take a little bit of time to make and they're not cheap to make,

but they could be really important in people who have cancer who didn't have a good response. The biggest thing, though, is the cancer vaccines to prevent cancer. So this is where we have that full stack of data. You're at high risk. But in that stack, we have your immune system. And now we say, oh, your guard is way down. We're going to now give you a cancer vaccine for you. They're going to rev up your chances so that your whole surveillance system in your blood,

in your body goes into high gear. And if we have to, we'll keep it there. We don't want to overcook your immune system so that you start attacking your own cells. So there's a fine line there. But this control over our immune system, which I hope we're a whole chapter in the book about, it's so exciting what we're learning to do, being able to prevent or cure autoimmune diseases that were previously hardly treatable, no less curable. And to be able to use these cancer vaccines to prevent cancer that's a work in progress.

Because we're understanding this really complex immune system better than we ever did before. So lots of promise, and there's one other thing that's really exciting, the shingles vaccine. I wouldn't have guessed this. But recent studies, including a big one this week, showing that the shingles, single's vaccine, a lot of people didn't get it who are over age 50, most. I wasn't very interested in getting it because I heard you get very sick and said, I don't really need that, you know. Anyway, the risk of getting Alzheimer's disease and dementia is significantly reduced.

I do recommend people if they're at high risk for Alzheimer's. It's recommended, of course, broadly, anyone over age 50, particularly as you get older and older, you know, you should contemplate getting it. It's a two-shot thing. It's worth it now that we've seen this added bonus because not necessarily that Alzheimer's is due to the virus, but that immunity built from the vaccine, however it's doing its thing,

is helping to prevent not just shingles, but also dementia. That's really a nice bonus factor. You've mentioned relationships a few times. There's the famous Harvard School of Adult Development, study that shows the importance of relationships in terms of longevity and also enjoying our lives. How would you say the data supports relationships in terms of having our best health span? Yeah, I mean, I think this notion of the different concepts of loneliness and social isolation,

as you know, but it's not good for you. This is one of the other side effects of the pandemic of, you know, living in a cave and being isolated from your friends and family, which had its own toll. And I never was a proponent of lockdown just to make sure clear of that. The data for social isolation is really powerful. That's another problem is if you look at what people do as they get older, they tend to be more isolated. Not just because some of their friends died or something, but that's just, you know, a natural default mode. That's the last thing you want to do. And so, again, in the book, I highlighted these two patients that have made it to 98 and now

99, and they are not necessarily, we call them social butterflies. Mrs. L.R., she likes her solitude to do her puzzles and paint, but she also really enjoys Rummy Cube with her circle of eight women friends and other people in her building, and the same thing with Mr. R.P. You know, he's out there. He's a, you know, very friendly, affable person. That's where you want to be. You don't want to go into that isolation, and I think The data supports the experience in just those two people, which are actually, they're obviously anecdotes. But it's really remarkable how that helps.

It's one of those lifestyle factors. I call it lifestyle plus. We don't pay enough attention to that factor of isolation. And the more you can spend with family and friends and neighbors and whatnot to have those interactions, the better. And it will help promote health span. It will help promote better mental health. too. So these are things that all are interrelated. We know loneliness increases our risk of death.

I believe it has like a 50% increase of all-cause mortality or something of that. You can correct me if I'm wrong. What is happening there, though? Like, what's the mechanism of action? Well, the studies vary with the magnitude, but you're right about the direction. It's not good. And it's a scene with the social isolation story. What's happening, you know, again, there's always confounding factors that it's hard to parse them out. We are a species that need to be with other people. There's a chapter on mental health in the book, especially dealing with anxiety and depression.

And so this is what is the problem of being isolated and lonely, is your chance of falling into that trap is so much higher. But when you have these interactions, it's stimulating, it's that human touch that we can never get. get enough of, of just, those interactions are crucial. And I have to tell you, I wasn't the one that was a proponent of all this, because it was kind of, oh, social science, you know, wasn't. But again, just like sitting that we talked about, if you look at all the data, it's there. It's meaningful. And mental health, as you know, for stress and anxiety, it is so interdependent with our physical

health. You can't separate those. We know big stresses promote that aging, promote cancer, promote these age-related diseases. They accelerate aging. And so being anxious, and this is an area that we can do much better by promoting social interactions. Are there any other, like, little sort of outside lifestyle things? Let's say we're already eating really well. We're already trying to avoid microplastics, we're exercising as much as possible, moving our bodies as much as possible, not sitting. What about things like sauna or meditation? Is there data behind any of these other kind of bonus factors?

Yeah, the best data I saw for bonus factor was nature. And actually it prompted me about this whole prescriptions for nature. So just being outdoors and even better, you know, go for a hike outdoors or go for, you know, in the woods or around a lake or pond or something or other. there are a beach if you can get there. Outdoors is just extraordinary, being in touch with nature. The data are really strong and I think are surprising. And that's why, you know, this idea of nature prescriptions for patients. And there's even a nature index now you can go to to look at where you live. What is the index and where are the places you can go?

Can you leave us with just one homework assignment? One thing we could all do as soon as we turn off this podcast if we wanted to increase our health span. Well, I think the key here is, for one, there is a new science of aging that's resetting our ability to, in the future, and even starting now, prevent the big three age-related diseases. While we're waiting for that to be available for everybody, and it needs to be not just for people affluence, but all people. Then we know the things that are part of the story that keep us free of these big three diseases. The common thread we reviewed is inflammation.

How do we keep that at very low levels in our body? We've talked about diet. We've talked about sleep. We've talked about physical activity. And then these other factors that we've been talking about, some of which are under our control. Perhaps some of these environmental ones are not as much, but still we have some control. You can vote too. Yeah. Voting is a pro-health span activity.

There you go. Exactly. You know, we're at a, in many ways, an inflection point in health because we really want to promote health span. Most people, that's really what they would like, is to have a long healthy life, not just a long life. And it isn't in the genes, one of the big messages. It isn't in the genes. And we have an ability to modulate this to a remarkable degree. And so don't fall for these longevity pitches because they're not proven. We have a lot of things that are proven,

you know, exceptionally well. Our problem has been to be able to align those practices, those modifiable lifestyle, various factors with the people who need it and, you know, being able to pinpoint that, that's where that medical forecasting comes into play. So, you know, we're at a point where we know what to do. We're going to know even more what to do, you know, each of us if we choose.

Remember, this whole forecasting thing is optional. You may not want to know that you're at risk for this particular organ or system or, you know, whatever, at this point in your life very accurately. You may not want to, and that's perfectly you're right. But if you get in the know, you're going to be able to do a lot. And I predict over time we're going to make a huge dent in the big three age-related diseases of man. Okay, but one specific action step we can take right now. Like just one thing that you think. Literally one thing that we can turn off this podcast and we can do that will have an effect on our health span.

I'd say exercise is the number one on the list. If you're not doing enough of that and you're not incorporating resistance training with aerobic activity. If there was one thing to do of the package, one of my colleagues who I wrote about in the book, you and Ashley at Stanford, he said, you know, one minute of exercise gives you five minutes more of healthy life. I'm not sure if that's fully objectified, but that principle, the more you exercise, the better, you'll feel better. All the good things will happen. Your inflammation proteins will go down. Your p-tow, 217 of your brain will go down. all the good things happen. As long as you don't overdo it, don't hurt yourself. So yeah,

physical activity is, I put number one on the list. How old are you? I'm 70. Is there anything you're doing that we haven't talked about as an aging expert and a doctor? Like I mentioned earlier, I've gone into resistance training and more physical activity. You know I've done it all my life. I read every label now. If there's the junk in there that's ultra-processed, that I wouldn't get it. I wouldn't touch it as best as I can. Sometimes it's unavoidable. I really put in a very hard campaign to get better sleep because I wasn't a good sleeper.

And now, you know, every day I'm looking at how many minutes or hour plus of deep sleep and trying to get those metrics as optimal as I can. Increase some protein, but not to, you know, crazy levels. everything I've talked about, more time in nature, more social interactions, really careful about plastics more than ever before. All the things we talked about, I've, not just for myself, but for my patients, my family, because the data are really strong. And that's why the subtitle is evidence-based. And we should acknowledge we've got a lot to work with here. And we have an ability to not just prevent, but markedly for stall these.

These are killer condition, no less affecting our quality of life, our health span. So we can do this. That's what's so exciting. Well, you're certainly a wonderful example of what healthy aging can look and sound like. I think a lot of people, I would certainly love to be like you when I'm 70. Well, that's kind. Some days I don't feel that way, but I really appreciate that. That's very kind of you, Liz.

Can you tell us a little bit in your own words about your wonderful, dense, very information-packed book, super agers? Well, the one thing is that we talked about that it's brimming with optimism at a time which you could be considered kind of dark for being excited about public health and our own individual health. Because unlike, I think, some of the ideas we have in our head about that we're doomed, the medical system is, you know, treating the sick, which it is. We have a whole new way go forward. And it's a blueprint for that way. We could do it today if we had the push. And this whole idea about make America healthy again, if they really were interested in, you know, zapping chronic diseases, we have a path here and laid it out. It's all doable. The missing pieces, we can fill that

in. I got at least the beginning of an immunome, as I reported in the last chapter of the book. That should be available for everyone. Ten years ago, it was said in science, one of the top journals in the world, it would be available for everyone for $25. And, you know, here it is 10 years later. But the real key here is that I've never been more optimistic about what we can do about the big three diseases that kill us and maim us, if you will. Let's do this. Let's at an individual, at a family level, let's start early.

I wish I'd had this information that wasn't available, you know, when I was 40 or 50 instead of age 70. But it's exciting that we can do stuff now that we weren't capable of doing before. It's a wonderful book, and there's so many actionable steps in it and also just really a commendable amount of science. I was joking with you before

that you have a thing at the beginning that's like, look, there's going to be a lot of science in here, but I didn't want to do a disservice to the reader to not include this. And I'm really glad you included it, and I'm really glad that you spent the time with us today. I really appreciate it. Thanks for having me,

and what a great conversation. If you found this conversation as eye-opening as I did, or if you have a friend who's constantly Googling how to live longer, how to avoid chronic disease, or optimize their health span, please send them this episode, send it to your parents, send it to your siblings. It could totally shift the way that these people think about aging and what is actually worth focusing on so we can live longer and better together. Make sure that you're following the Liz Moody podcast on Apple Podcasts on Spotify or on YouTube so you do not miss out on a single episode. Following means that new episodes will show up

right in your feed. You will never have to go search for one. You'll never miss out on information that could change your life. And also friendly reminder that you can now watch full video episodes on Spotify and on YouTube too. We are able to keep this show totally free for you, thanks to the amazing brand partners that you heard in this episode. You can support the pod and save money by using the discount codes that we share. There's a full list of them at lizmoody.com slash codes. And if you want practical takeaways from today's episode, like all of the test that Dr. Topel mentioned or a roundup of his best tips, I know there were so much information packed into this episode. So you're going to want to head over to Liz Moody.substack.com. You're going to get all

of that there. You're also going to get exclusive content like challenges, meal plans, and bonus expert interviews. And please come hang out with me on Instagram. I am at Liz Moody. I share tons of behind the scenes of my everyday life. I share the longevity tools that I am personally using. And and I just share in general how I am applying everything that we learn on the podcast to my real life. Okay, I love you. I so appreciate that you chose to spend this time with me. It always blows my mind and I'm just so, so grateful for it. And I will see you on the next episode of the Liz Moody podcast.

Oh, just one more thing. It's the legal language. This podcast is presented solely for educational and entertainment purposes. It is not intended as a substitute for the advice of a physician, a psychotherapist, or any other qualified professional.