Eric Topol Returns (on longevity)

Summary

Armchair Expert with Dax Shepard: Eric Topol Returns on Longevity

Episode Release Date: May 21, 2025
Host: Dax Shepard
Guest: Dr. Eric Topol
Book Discussed: Super Agers: An Evidence-Based Approach to Longevity by Dr. Eric Topol

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Introduction to Dr. Eric Topol

In this enlightening episode of Armchair Expert, host Dax Shepard welcomes back healthcare innovator Dr. Eric Topol, a renowned cardiologist, scientist, and author. Dr. Topol is the director and founder of the Scripps Research Institute and the author of several influential books, including Deep Medicine and his latest work, Super Agers: An Evidence-Based Approach to Longevity. The episode delves deep into Dr. Topol's insights on longevity, the evolving role of artificial intelligence (AI) in healthcare, and the interplay between lifestyle and genetics in extending human healthspan.

AI's Transformative Role in Healthcare

Dr. Topol and Dax Shepard engage in a spirited discussion about the advancements in AI and its potential to revolutionize medicine. Reflecting on a previous conversation six years prior, Dr. Topol highlights significant strides made in AI's diagnostic capabilities:

Eric Topol [06:21]: "We had six studies that showed that AI compared to a doctor with AI, the AI did better."

Dax humorously remarks on the unexpected outcomes of these studies:

Dax Shepard [06:25]: "Oh, Jesus. So even having the human involved in the system made it worse."

Dr. Topol speculates that the reluctance of medical professionals to integrate AI effectively might be a contributing factor. He emphasizes the necessity of training and adapting to new technologies to harness AI's full potential in disease prevention and management.

Challenges with the Pharmaceutical Industry

A significant portion of the conversation addresses Dr. Topol's courageous stance against pharmaceutical malpractices, particularly his whistleblowing on Merck's suppression of the drug Vioxx, which was linked to increased risks of heart attacks and strokes. Reflecting on the consequences of his actions, Dr. Topol shares:

Eric Topol [09:13]: "We found out they knew about it. They actively were trying to hide this from the public."

Dax commends Dr. Topol's integrity and the lasting impact of his advocacy, lamenting the ongoing issues within the pharmaceutical sector, including the opioid crisis:

Dax Shepard [12:05]: "It correlates beautifully with however much money the drug makes is what exponent it goes up by really how these drug."

Approaches to Longevity: Genetics vs. Lifestyle

In Super Agers, Dr. Topol explores the multifaceted aspects of longevity, emphasizing that genetics play a smaller role than commonly perceived. He recounts studies involving exceptionally healthy individuals, such as Mrs. L.R. and Mr. R.P., who defy typical aging markers. Discussing the heritability of longevity, Dr. Topol notes:

Eric Topol [20:37]: "So you're also seeing that it's really our lifestyle factors and the things that we can do now that our parents, grandparents couldn't do that's making a big difference."

Dax Shepard finds reassurance in the idea that lifestyle choices can significantly influence healthspan, alleviating fears rooted in family medical histories.

Omics and Personalized Medicine

Dr. Topol introduces the concept of "omics"—the comprehensive study of genomes, proteomes, and other biological data—and its role in personalized healthcare. He explains the development of organ-specific biological clocks, which assess the aging process of individual organs:

Eric Topol [57:29]: "So we can do that. Who would have ever thought we can do that?"

This innovative approach allows for tailored preventive measures, targeting specific vulnerabilities in a person's biology to extend their healthy years.

Environmental Toxins and Inflammation

Tackling environmental factors, Dr. Topol underscores the detrimental effects of microplastics, fine particulate air pollution, and "forever chemicals" on human health. He highlights groundbreaking studies linking microplastics in arteries to increased risks of heart attacks:

Eric Topol [50:21]: "They were inflamed to try to protect the body. But in fact, it was incited big time inflammation in an artery that gets in the bloodstream that you wouldn't want."

The discussion emphasizes the urgent need for regulatory measures to mitigate exposure to these pervasive toxins.

Diet, Nutrition, and Lifestyle Factors

A central theme of the episode is the critical impact of diet on longevity. Dr. Topol criticizes the high consumption of ultra-processed foods in the U.S., linking them to various age-related diseases through mechanisms of systemic inflammation. He shares alarming statistics:

Eric Topol [36:31]: "More than 70% of their intake of calories is through ultra processed food or energy. 70% for the adult population. It's horrible."

Conversely, he champions diets rich in plant-based foods and emphasizes the potential of AI-driven personalized nutrition plans to optimize individual health outcomes.

Medical Innovations: Cells, Peptides, and Beyond

Dr. Topol delves into cutting-edge medical advancements, including:

• B Cell Ablation: A breakthrough in treating autoimmune diseases by resetting the immune system, effectively "erasing" the cells responsible for attacking the body's own tissues.

  Eric Topol [54:33]: "These are B cells. B cells are the ones that produce the antibodies."

• Epigenetic Reprogramming: Dr. Topol discusses pioneering research aimed at reversing aging in animal models through partial epigenetic reprogramming, a process that has shown promise but also carries risks such as tumor development.

• Peptide Therapy: While acknowledging the potential benefits of peptides like Tessamorelin for reducing abdominal fat, Dr. Topol urges caution regarding off-label and unproven peptide uses, highlighting the lack of comprehensive studies on their long-term safety and efficacy.

Conclusion: An Optimistic Path Forward

Despite the numerous challenges discussed, Dr. Topol maintains a hopeful outlook. He envisions a future where AI and personalized medicine converge to drastically reduce the prevalence of major age-related diseases, thereby decreasing healthcare costs and enhancing global healthspan.

Eric Topol [53:05]: "The hope is that people will find ways to extend their health span and that's what it's all about."

Dax Shepard echoes this optimism, appreciating Dr. Topol's balanced perspective that recognizes both the potential and the pitfalls of emerging medical technologies.

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Notable Quotes:

• Eric Topol [06:21]: "We had six studies that showed that AI compared to a doctor with AI, the AI did better."
• Dax Shepard [06:25]: "Oh, Jesus. So even having the human involved in the system made it worse."
• Eric Topol [36:31]: "More than 70% of their intake of calories is through ultra processed food or energy."
• Eric Topol [50:21]: "They were inflamed to try to protect the body. But in fact, it was incited big time inflammation in an artery that gets in the bloodstream that you wouldn't want."
• Eric Topol [53:05]: "The hope is that people will find ways to extend their health span and that's what it's all about."

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Final Thoughts:

This episode of Armchair Expert offers a comprehensive exploration of longevity, blending scientific rigor with engaging dialogue. Dr. Eric Topol provides valuable insights into how advancements in AI, personalized medicine, and a deeper understanding of biology can collectively contribute to extending the human healthspan. His candid discussions about the pharmaceutical industry's challenges and the importance of lifestyle choices serve as a compelling call to action for both medical professionals and the general public.

Transcript

[Dax Shepard]

Wondry plus subscribers can listen to Armchair Expert early and ad free right now. Join Wondry plus in the Wondry app or on Apple Podcasts or you can listen for free wherever you get your podcasts. Welcome, welcome, welcome to Armchair Expert Experts on Expert. I'm Mike Shepard and I'm joined by Lily Padman.

[Monica Padman]

Hi.

[Dax Shepard]

Hi. Returning guest from the early. From the bygone era.

[Monica Padman]

That's right.

[Dax Shepard]

And this is. There have been a few guests that have really captured our heart. We just, we fall in love with their spirit.

[Monica Padman]

We do.

[Dax Shepard]

And Eric Topol's like at the top of that list. We think he is the cutest person.

[Monica Padman]

On earth and smart as all heck.

[Dax Shepard]

Outrageously smart. He is a cardiologist, a scientist and author and the director and founder of Scripps Research Institute. His books include Deep Medicine, the Patient Will see you now. That's what we had him on for last time. And now his new book which is out Super Agers An Evidence Based Approach to Longevity. This was a blast.

[Monica Padman]

Yes. And I want to say his approach to longevity is different from a lot of people's approach that we've had on or talk about a lot of optimization. He's actually, I mean he's like with a lot of those people but he has a lot of other opinions. Divergent as well. Yeah.

[Dax Shepard]

And friendly dust ups between Eric and I because I'm on one side of the spectrum. Sure. Please enjoy Dr. Eric Topol. We are supported by Happy Egg.

[Monica Padman]

I love an egg that you can like. The yolk is so bright.

[Dax Shepard]

Yeah. I like a dark orange yolk. When you get that dark orange, you know it's high quality. This restaurant like breakfast place. Yes, yes. So good. I always think there's cheese in the.

[Eric Topol]

Scrambled eggs, but it's just the yolk.

[Dax Shepard]

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[Eric Topol]

I know.

[Dax Shepard]

The irony.

[Eric Topol]

Something wrong with that picture.

[Dax Shepard]

Is that your super cute Bronco out there?

[Eric Topol]

That's my daughter's.

[Dax Shepard]

Oh, I like it.

[Monica Padman]

It is cool. It's a very cool car. It is a bit oj. In a good way? In a good way. No, in a good way, yeah.

[Dax Shepard]

Also I like that there could be a good way.

[Monica Padman]

Well, he was cool before he.

[Eric Topol]

Yeah, Yeah.

[Dax Shepard]

I don't know if you remember, but sales of those Broncos exploded after that. Oh, yeah. You couldn't get your hand hands on a white Bronco.

[Eric Topol]

No kidding.

[Dax Shepard]

Oh, yeah. Ford couldn't make them fast enough.

[Monica Padman]

In accidental marketing, one of the main things you remember is the Bronco.

[Eric Topol]

What was the appeal that you'd be like O.J.

[Dax Shepard]

That'S a great question. I think just seeing a vehicle on display for such a long period of time and I guess it looked formidable and I think young men were like, oh, yeah.

[Monica Padman]

It's like a nice car.

[Dax Shepard]

It's nice. Yeah. Yeah. Someone should do some social science on that.

[Monica Padman]

Malcolm?

[Eric Topol]

Yeah.

[Dax Shepard]

How are you? It's been a while.

[Eric Topol]

I'm well, thanks. Yeah. It's been six years. Pandemic in between.

[Monica Padman]

We sure did.

[Dax Shepard]

Sure. Lots of stuff's happened and you've moved a few times.

[Eric Topol]

I don't know what it was when we first did it. Then you were on Spotify.

[Dax Shepard]

We were independent for three years. Then we were at Spotify for three years and now we're at wondering.

[Eric Topol]

That's great. I was Monica's medical consultant for the show.

[Dax Shepard]

I think primary care physician for a while.

[Monica Padman]

Yeah. I definitely did reach out to you about my weird experience that turned out to be epilepsy.

[Dax Shepard]

Congratulations.

[Eric Topol]

I remember that.

[Monica Padman]

Yeah.

[Eric Topol]

Is it all under control now?

[Monica Padman]

Yeah. I'm on medication and it's all good. But you said it could be.

[Dax Shepard]

Oh, did he? Because it was quite a mystery.

[Monica Padman]

You said it could be seizures, but there really isn't any way to know unless it happens again. Which is correct.

[Dax Shepard]

Can't do it over the phone.

[Eric Topol]

One of the things I really enjoyed was doing some fact checking. You would have somebody else and he would make stuff up.

[Monica Padman]

Yeah.

[Eric Topol]

Is that true?

[Monica Padman]

No, I did.

[Dax Shepard]

Was that other person making stuff up? Me?

[Monica Padman]

Yeah, probably.

[Dax Shepard]

But I hope it's gotten to you over the years. We talk about you quite a bit and we have such a warm spot in our heart for you. That was such a lovely interview the first time.

[Eric Topol]

Thank you.

[Dax Shepard]

So last time you were here promising us that we would be completely without a need of a doctor, our smartphone would be doing all of our stuff, and here we are six years later. And where are we at on that? Before we move on to the show.

[Monica Padman]

We have a phone to pick. We haven't been able to scan our kidneys.

[Eric Topol]

If the medical profession would let things happen, we would. But AI doctor thing has really come a long way. We had an op ed in New York Times recently about how there were six studies that showed that AI compared to a doctor with AI, the AI did better.

[Dax Shepard]

Oh, Jesus. So even having the human involved in the system made it worse.

[Eric Topol]

We don't know if it's because doctors have a bias against using the AI even when they have it, or they haven't learned how to work with it, but to see that it was not predicted at all.

[Dax Shepard]

I bet it's both. Right, Because I do think half of the art of AI is learning how to prompt it. It's such a specific way to communicate, and I've only been dabbling in it and I'm learning as I go how to get a better answer out of it.

[Eric Topol]

Yeah, you're absolutely right. I think the doctors have not yet gotten grounded. That could be the explanation.

[Dax Shepard]

How significant was it?

[Eric Topol]

Well, in these six studies, all of them were pretty substantial. No one in the field really predicted that. They always thought the human plus the AI hybrid would be the best. And one of the biggest things is doctors who have been keyboard slaves, data clerks, are now getting three hours less keyboard time a day because the AI.

[Dax Shepard]

Is just in the room listening and handling all that stuff and making a.

[Eric Topol]

Great audio with a transcript. Follow up appointments, lab tests, prescriptions, pre authorizations, nudging the patient after the visit. What do we talk about? So all these things are happening and it's just a Gift to doctors.

[Dax Shepard]

Nurses could save the career path in a way because every time I interview a doctor and I ask if they would push their children into medicine, almost all of them say no. Very disheartening to see how few doctors want their kids to pursue that.

[Eric Topol]

It is. And it's such a great profession and I can't imagine one that would be more exhilarating. Sense of caring for people. But the work of having to deal with insurance companies and keyboard stuff. And most physicians are managed by bean counter administrators and they basically want them to see more patients or read more scans. And that's interrupting why they went into medicine in the first place. So there's a disenchantment level. The burnout is as high as it's ever been.

[Dax Shepard]

It seems like we need AI to be able to prescribe us medicine and I guess we could have a bucket of that medicine. Non narcotic or whatever things you would not want to be gamed or be dangerous. Where were we at with that? And that's ultimately what you would really want, is you get a thorough examination, ask all the same questions as the doctor would ask you. You take some pictures and then it says, you need this topical ointment. Go pick it up here.

[Eric Topol]

That's coming for the common things like skin conditions, rashes, urinary tract infections, ear infections for children. The US is different. A lot of countries you would get the prescriptions through an AI. Here there's much more protection about the medical need, oversight. I think the next couple years for common things that are not life threatening.

[Dax Shepard]

Right, like one rung above over the counter.

[Eric Topol]

Yeah, exactly.

[Dax Shepard]

That would be incredible. Now, I am curious because in your own history, you famously left the Cleveland Clinic in 05 because you were sounding an alarm that there was this drug Vioxx.

[Eric Topol]

Yeah.

[Dax Shepard]

That was quite detrimental to patients.

[Eric Topol]

What was it doing causing heart attacks and strokes. The company Merck was suppressing it because it was a multi billion dollar enterprise. We found out they knew about it. They actively were trying to hide this from the public. I had to do it over again. I'm not sure we would have confronted Merck. But we did and eventually they took the drug off the market.

[Dax Shepard]

In 04, you were victorious in this.

[Eric Topol]

Yeah. In 2001, we'd predicted that it was going to be a real problem. They were denying it for three years. They were basically having people try to take me and others down about sounding the alarm. At the end of the day, they took the drug off. They never were charged criminally, which I think they should have been. They went through all sorts of legal things and they never really paid a price for what they did. And we don't even know how many thousands, hundreds of thousands of people were ill affected by this.

[Dax Shepard]

And your pursuit of that then exposed this other problem that you got immersed in, which was this interconnectivity between the institute you were working at and the pharmaceutical company.

[Eric Topol]

Yeah, that was the real shocker there. So I didn't know what was causing the new CEO to tell me. I couldn't talk to the media. Basically put out a gag order. Normally never an issue about talking to a journalist. We had a 60 Minutes thing. They were going to come to Cleveland Clinic and he ordered them not to come. I had to go to New York. But it got even more intense. And then ultimately I found out that the chairman of the board of trustees was the best friend of the CEO of Merck. That was basically the telltale of why it was such a ferocious suppression of me. And that got into a conflict that was so profound. They certainly needed to get out of there.

[Dax Shepard]

Yeah, we would love to think there's a wall between research and big pharma and even hospitals and big pharma. And this kind of showed that if there's a wall, it's permeable at best.

[Eric Topol]

That's a good way to put it. I would never have predicted it all kept secret for me until it came out. When this first came out in 2001, it was a different CEO. He was very supportive. This is really important for the public. Couldn't understand what was going on.

[Dax Shepard]

And then finally, so, okay, you left in 2005. 20 years later. Do you think this problem is the same? Less or more?

[Eric Topol]

Yeah, it's hard to know for sure, but it doesn't seem like we've done a good job of dealing with the pharma companies in general.

[Dax Shepard]

Did anyone from Purdue go to jail?

[Eric Topol]

No. That's a great example. And that was much bigger than Vioxx. The opioid crisis.

[Dax Shepard]

But you're talking to millions of people.

[Monica Padman]

And publicly everyone knows about it. It's not even like it's hidden.

[Dax Shepard]

There's been nine shows.

[Eric Topol]

Millions have ruined their lives and died. The Sacklers and Purdue. It's just been a money thing. How much money do we have to put this aside and how Purdue did this, all their illegitimate marketing and raising the dose and false claims. It's basically taken the Vioxx thing to the third power.

[Dax Shepard]

It correlates beautifully with however much money the drug makes is what exponent it goes up by really how these drug.

[Eric Topol]

Companies can get away with this stuff and be immune to what any other person would have to face for doing things like this. It's just beyond me.

[Dax Shepard]

So I guess I asked that question in pursuit of wondering, will these big institutions, big insurance, big pharma, the networks, will they try to put up roadblocks for this very democratized access to AI and phone medicine?

[Eric Topol]

There's such perverse incentives in our country as opposed to other countries. Yeah, that may well be a problem. It's much less likely that AI will take full hold here as compared to the uk. Many countries in Europe, even Canada, certainly in China. So, for example, we could see getting rid of hospital beds for the most part, except for like intensive care units or the emergency room operating rooms. But most hospital beds aren't necessary. We could monitor people in their home.

[Dax Shepard]

Yeah, you got beds that are telling you how you sleep and your O2 level. I mean, we're getting there.

[Eric Topol]

Yeah, you can convert a hospital room to an intensive care unit equivalent of monitoring. And American Hospital association isn't going to let that happen.

[Dax Shepard]

Right.

[Eric Topol]

That's just one example of what we could do with AI, because AI would be used there to predict if a person's starting to develop the signs of trouble. And then you would send in a team or you'd bring the person to the hospital. That's the number one cost of our $4 trillion a year. Health care is hospitals. We could make a big dent in that, but we have mal incentives to go in that direction.

[Dax Shepard]

Okay, so I have an unpopular view, especially being a liberal. People love to hold up the UK's National Health System or Canada's. You're looking at what sector it's beneficial to. If you're looking to generally just raise the overall access and health, I think it's very effective. But I think you can't ignore the fact that anyone that needs something for real comes here. That's also true. We are also leading in so many areas. So all of this is built on this highly profitable system. So I think to ignore that aspect. And I have lots of friends that live in England. They're not all wild about it. I have lots of friends in Canada. They're not wild about it. What we get sold on here. Just talk to folks that live there. Not everyone's wild about it. But I think the tipping point would be if those countries did embrace all this and we saw, oh no, you actually want to go there and use that. Because again, the AI is catching the tumor at 78% accuracy and our doctor is getting it at 50. If it becomes superior because the tech is so much better, I think the current argument that holds sway kind of falls apart.

[Eric Topol]

I agree with you. So back in 2018, the UK government asked me to do a review of the NHS. So I spent two years going back and forth. They got me this incredible group of like 50 people. All the disciplines I got to work with. And you may know they are the leaders in the world in genetics, genomics. They have really run circles around any other countries.

[Dax Shepard]

Is that because their access to data?

[Eric Topol]

Yeah, and they just took a lead on this early on that they wanted to make that future a part of their healthcare. They set up this big UK biobank, which is the world standard, has 550,000 participants and they're now doing our future health, which is 5 million. They already have 3 million into that. They're getting everyone sequenced, they're getting newborn sequenced. But when I did this review, what I learned is they want to be the world leader in AI and do just what you said, Dax. They want to be getting the accuracy amped up because they don't have any obstacles. There's no billing, there's no insurance.

[Monica Padman]

Exactly.

[Dax Shepard]

There's no tiers to the system.

[Monica Padman]

Do doctors get paid a lot less there?

[Eric Topol]

Less? Some of them do private practice on the side to supplement their injuries income, but yeah, generally it's less, but it's not real low. The physicians in this country do quite well relative to world standards.

[Dax Shepard]

Okay, so your new book is super. An Evidence Based Approach to Longevity. This is right up my alley as someone who turned 50 this year.

[Eric Topol]

You're just a young puppy.

[Dax Shepard]

Well, that's very kind of you to say, but my most optimistic self doesn't think that I am not minimally halfway over on the ride. And I put a lot of thought and effort into trying to see as much of my kid's life as I can. So I'm really, really interested in this. You start the book with two patients, Mrs. LR and Mr. RP. Why do you start with them and what is interesting about them?

[Eric Topol]

Lee Russell, Mrs. L.R. who is proud to be identified. She was a recent patient and she was really a trigger for me to write the book because she came to see me in a clinic appointment referred. The symptom was that she had some leg edema and didn't know why. Her primary care doctor wanted to know why. And then when I first saw her, I said, well, Mrs. Rusoff, how did you get here today? I drove and she didn't look anything like her age, but her age was real. And then I started realizing her medical history, like there was none. Wow. So she was a prototype of a study we did actually called the Welderly. Actually, my daughter Sarah ran that study. 1,400 people she found with a couple other research nurses over the course of years like her.

[Dax Shepard]

Yeah. It's almost impossible to do, right? To find someone who's 90 who's not had any even. The stat in the book is 95% of people over 60 have one chronic illness and 74% of people have two. By the age of 60, she didn't.

[Monica Padman]

Even have high cholesterol.

[Eric Topol]

No, she had nothing.

[Monica Padman]

Oh, my God.

[Dax Shepard]

She's like a newborn.

[Eric Topol]

She's amazing.

[Dax Shepard]

Did you find her battery pack in her motherboard?

[Eric Topol]

That was why we sequenced those 1400 people. No one had ever done a healthy aging study of genomics to see it's got to be in their genes, right?

[Dax Shepard]

Right.

[Eric Topol]

It wasn't. There's nothing there. Hardly anything that we could find. And that was one of the earliest studies of whole genome sequencing in a big cohort, and to this day, the only study that we know of of healthy aging. Most of these studies looking at lifespan, they'll do sequencing of people 100 years old or 90, 110. But no one has tried to select out a group that were never sick with any chronic disease. So when we didn't find anything that said. Hmm. And so that's why I started to try to understand Lee as to what was accounting for this. And she's an artist, oil painting, has a gallery, she plays with her friends, Rummy Cube every week. She does all these big jigsaw puzzles. So she's really a vibrant lady and fully intact. And then the other patient that I introduced was a patient for 35 plus years, and he was a very different 98, now 99. He had significant heart disease, heart attack, a bypass. I had put stents in when I was back at Cleveland Clinic. And he's also had ablations for atrial fibrillation. By two years ago, when he had Covid and was in the hospital, he never had to get into intensive care unit. And he's just a really resilient person who also got to super aging with only one chronic problem of the age related diseases, heart disease.

[Dax Shepard]

But man, it sounded like a pretty significant bit of heart disease. None of this sounds very mild, not at all.

[Eric Topol]

And that was really a reflection, like a triumph for modern medicine.

[Dax Shepard]

Right. In the 60s, he would have died.

[Eric Topol]

Oh yeah. He is really a segue to where we could prevent his disease now that's what's so exciting. We couldn't have prevented it when he started having all these problems. But we can now between these two patients has kind of run the gamut of why we have this exciting opportunity to become superagers. One route is to be the rare one which is just never get any disease. And the other is, okay, we could prevent these diseases. Now everybody's working on magic potion or pill for aging peptides.

[Dax Shepard]

Oh, we'll get to that, Monica. Don't you worry. That's the last chapter.

[Monica Padman]

Okay, we have a lot to talk about.

[Eric Topol]

But on the other hand we have a whole route we can go to take the big three age related diseases on.

[Dax Shepard]

Well, one thing I found very comforting and I'm leaping ahead a bit, but if I understood this paragraph correctly, we do know some markers for aging, some DNA markers that are good for aging. But you say that even if you were to have all 20 of those, really it's going to be about 12% of the pie that's going to predict your lifespan or health span. I found this deeply comforting because I don't come from a long line of old people.

[Eric Topol]

You and me both.

[Dax Shepard]

Yeah, it's very scary. I think common wisdom growing up was, well, you get good genetics or you don't. I guess I was a little relieved that that maybe at best is only 12% of the story.

[Eric Topol]

You're touching on one of the most important messages because so many people like us have a pretty poor family history and we think all the time we're going to be like our parents. That's not true at all. There's a limited part of that, but for the most part it's really our lifestyle factors and the things that we can do now that our parents, grandparents couldn't do that's making a big difference.

[Dax Shepard]

Now you break it up into five dimensions that help with health span extension. And I guess even though we've talked about it in the past, maybe we'll just delineate the difference between lifespan and health span.

[Eric Topol]

This is a big one. The focus on living longer is of course the wrong one. Most people would agree that if you're demented or you're suffering all sorts of other chronic illnesses, that isn't really worth living longer. But if you can live healthily without a major disease and you're cognitively intact and you're not frail and you're vibrant, that's the goal.

[Dax Shepard]

If you could hike to 85 or be sedentary till 105 from 70 on. Yeah, I think we would all likely pick very active with a little less time.

[Eric Topol]

That's the goal. And I think most people would agree. They would like to have the longest health span that they could. There's too much focus on this longevity with these clinics and all this stuff and not enough on what we really are after.

[Dax Shepard]

This is off topic, but to hear you say demented in the clinical sense, does that fly for you too? You want to be demented? Oh, I never hear it in the actual. You're only saying someone's wacky. Right.

[Monica Padman]

Like a young person or they have a bad idea.

[Dax Shepard]

Crazy.

[Monica Padman]

I do need to know. Have you watched the Pit?

[Dax Shepard]

Oh boy.

[Eric Topol]

I watched one episode and I do want to get back to it. I just haven't had a chance.

[Monica Padman]

It's really good.

[Eric Topol]

That's what I hear.

[Dax Shepard]

If you listen in the show, you'd hear it even more.

[Monica Padman]

I talk about it a lot.

[Dax Shepard]

Every single episode. Okay, so the five dimensions that you break it up into are lifestyle, cells, omics, artificial intelligence, and number five, drugs and vaccines. So I just will say up front, I read Outwiv Peter Attia's book.

[Eric Topol]

Yeah, sure.

[Dax Shepard]

And just loved it, probably because it corroborated my belief in what you should do. But at any rate, lifestyle has got to be the biggest chunk of this, the biggest.

[Eric Topol]

And that's the biggest chapter in the book. And I get into a lot of the nitty gritty that people may not know about. People generally know some of the lifestyle factors, the big ones, diet, exercise, sleep. But. But they don't know that they're at risk for this condition and that they really gotta use these changes in their life to avert, prevent. So the lifestyle factors are definitely, of those five, the big one. But they all have interactions. In Peter's book, he doesn't really mention AI. That has a big role now and in the future. There's really not mention of cells, which is saving people's lives. Now we're learning how we can control our immune system. Dial it up or down. The immune system is kind of the basis of most age related diseases, in fact. And then omics is not just the genes, but it's our proteins. That's where there's been an explosion of new knowledge. Organ clocks we'll talk about, but the gut microbiome. So I think what's different about outlive, which I read and I actually interviewed Peter on my podcast.

[Dax Shepard]

Oh, okay, great.

[Eric Topol]

You know, there are a Lot of good parts of the book, but there's some crazy parts.

[Dax Shepard]

Oh, great. I want you to flag those.

[Eric Topol]

He takes rapamycin. There's no data to support that. It's potentially dangerous. It suppresses your immune system. That's the last thing you really want to do.

[Monica Padman]

I know someone who qualified for the trial for it and they immediately got shingles and it was so bad. Spread through the whole body.

[Eric Topol]

Yeah, no, you don't want to suppress your immune system with unproven longevity or even health spin. He also has everybody getting a total body MRI that can set up all sorts of false rabbit holes.

[Dax Shepard]

So I had an argument with Dr. Mike about this because I've had it and I'm pro. I understand what your concern is, but I do think you can go into it with the right mindset, which is I'm not going to chase down everything. I'm not going to have a bunch of follow up stuff. I'm going to look for a big ass tumor that we're going to monitor and I'm going to go next year and see if that thing's exploding. I mean, I think there is some way to do it, but I understand it does set off all this medical intervention that potentially has more downside.

[Eric Topol]

A perfect example. In the book I talk about a friend of mine who's a physician, writes for the New Yorker, Dhruv Kullar. And he went because he was gonna interview Peter. He has a total body MRI. He's like 40. They find this thing in his prostate. Now he has to get prostate biopsies every six months. And this is crazy. That's not a fun procedure to have to have. And there's nothing wrong with him, but he's become, you know, mentally.

[Dax Shepard]

You gotta be strong mentally to have it is my argument.

[Eric Topol]

The other comeback I'd have for you is if you're worried about cancer, which obviously a lot of people are, there's much better ways to go at it than to get a total body mri. Because if it shows up as a mass on a total body mri, it's gone pretty far along. You can find it in the microscopic, in the blood. If you're at high risk. First you want to know if you're at high risk. Then you get a blood test that says in your plasma there's some tumor DNA. And when you get that sequence and find out where it is, then you could get the mri. And hopefully it doesn't show up on the mri because that means it's pretty far along.

[Dax Shepard]

But Eric, I smoked crack for years. And I smoked cigarettes. Cigarettes for 20 years. Like I needed a good scan. I stand by my scan. Found out I had scoliosis. I was like, oh, that's cool. I had no idea. It's extreme.

[Eric Topol]

Yeah. Well, the other thing about Peter, he makes recommendations for the affluent. Not everybody can go and have a 900 to $2,000 MRI. Sure isn't covered by insurance.

[Dax Shepard]

But that's like saying driving Mercedes are bad because only some people can afford them.

[Eric Topol]

I get that. But you'd like to come up with things where everybody could benefit.

[Dax Shepard]

Yes.

[Eric Topol]

And you know, lifestyle factors. Everyone can benefit. Everybody could sleep better, exercise more, eat the. And that gets me to another thing I have a problem with as far as Peter.

[Dax Shepard]

Okay, great.

[Eric Topol]

A lot of things are good in his book, which has obviously been a big hit. But in the book he advocates of ridiculously high protein in the diet. And I don't know if you adhere to that, but the recommended daily allowance is 0.8 grams per kilogram. And he says one gram per pound.

[Monica Padman]

He does it.

[Eric Topol]

That's way too much. It can be dangerous for your arteries.

[Dax Shepard]

Not the protein itself, but what you're eating to get the protein.

[Eric Topol]

No, the protein itself, particularly if it's from animal derived proteins. It's been shown in the experimental models to test this that if you get past a certain protein level, like the equivalent of one gram per pound, which no one else would recommend except Peter.

[Dax Shepard]

Well, Lane Norton, anyone that's into bodybuilding would. The most important part of those studies is every single keto plant based, all diets, all the meta analysis, if you control for protein, they all work the same. That's really, really relevant and that's just uber consistent.

[Eric Topol]

I actually think you should increase over the allowance, I'd say even up to 1.2, 1.4 per kilo. But we're talking about two to three times the highest. And there's no data to support that it's safe. It's all conjecture. I want hard data. If there's risk, you better balance it with some proof that it's helping people, surely. So those are the sorts of things, they're too extreme. But there's a lot of really good things that he put in the book.

[Dax Shepard]

Well, what we could agree, and the only thing I was going to borrow from the book is he points out we got great with vaccines and we got great with treating with antibiotics a lot of different diseases. What we all now have to deal with is these chronic four disorders, obesity and diabetes, heart disease, cancer and then neuro which are in your book. So these are the four that are gonna most plague us now. We're not gonna die of cholera or some medieval disease anymore. These are the four that we gotta really focus on. And lifestyle is hugely impactful for the Four Horsemen.

[Eric Topol]

I actually say the three age related major diseases, Heart cancer and neurodegenerative. I don't see obesity and diabetes. They're very important, but they feed into the other three. You don't die of obesity, you don't die of diabetes, but they accelerate atherosclerosis, increase the risk for cancer, increase the risk for dementia, Alzheimer's. So I see it differently. What I'm getting at is obesity isn't an age related disease. The three big killers are the age related diseases. The GLP1 drugs, Ozempic and Mounjaro. They have had transformational impact well beyond we ever would have expected. We're going to build on that now. There's a pill that simulates the injectables and just going to get more and more practically accessible, not requiring injections, more potent. And building on that success, which I'm not saying we have the definitive treatment for obesity.

[Dax Shepard]

We have the best we've ever had.

[Eric Topol]

Absolutely. It takes down obesity along with all of its associated conditions and then gets on to things like addiction and who would have thought?

[Dax Shepard]

I know.

[Eric Topol]

So it's now being tested in Alzheimer's. We now know the mechanism. It's not just about weight loss. It's about blocking inflammation in the body and in the brain. The fact that it's being tested in Alzheimer's, in big trials that will get the end of this year or the beginning of next year, I mean.

[Monica Padman]

Yeah. Should we just all be on it?

[Eric Topol]

I pose that question in the book. That someday would this be something that would be maybe not universally used, but very commonly used? Because right now it's the most impressive class of drugs we've ever seen. Because the side effects are short term. They're GI side effects.

[Dax Shepard]

The only one that troubles me is the muscle loss.

[Eric Topol]

Yeah.

[Dax Shepard]

That's the only thing you gotta really be on top of.

[Eric Topol]

Absolutely. So the muscle, muscle loss is a concern. And you know, it's a concern because the drug companies are buying up companies that make drugs to build up muscle. When you lose weight, you also lose muscle mass.

[Dax Shepard]

Yeah.

[Eric Topol]

In all the studies so far, there are some people that are losing more muscle mass and they should correct it for their weight that seems to be blocked. If people do a lot of resistance training, strength training, but there are some that the so called sarcopenic obesity, where they get rid of the obesity but now they're frail. We don't want that.

[Dax Shepard]

Right.

[Eric Topol]

The other thing we don't want is to have to require person to take a drug for the rest of their life. Although.

[Dax Shepard]

Okay, so I was arguing with a friend recently and he said, oh, I don't want to be on that because I hear you might have to take it for the rest of your life. And I said, are you stressed out that you have to drink water every day for the rest of your life or that you got to eat food every day for the rest of your. There's a lot of shit we got. You got to brush your teeth for the rest of your life. I think that's a weird mental hiccup.

[Eric Topol]

Well, I'm glad you brought that up, Dex, because I've had some medical colleagues when I say we got to come up with a weaning plan, they say, does a diabetic have to take insulin? Do you have to take your high blood pressure medicines every day? I say, yeah, but it's a little different because first of all, we haven't had people just with obesity take these drugs for more than four or five years.

[Dax Shepard]

Am I right in that the diabetics have been taking this medicine for 15 or 20 years? It's not as new as people think.

[Eric Topol]

That's right. And in fact, they'd been taking it for 20 years. And the real thing that got off the track there was we kept thinking that they never lost much weight. Diabetics, they lost three pounds, five pounds. So why would you ever study a drug to lose weight when the people didn't lose weight?

[Dax Shepard]

Right?

[Eric Topol]

And then this woman scientist at Novo Nordisk in Denmark says, we gotta study it in people who are obese. And finally they listened to her.

[Dax Shepard]

Right?

[Eric Topol]

And it took 20 years to show that the people who don't have diabetes but are obese, they can lose 20, 30, 50, 60 pounds. And we still don't know today why people with diabetes don't lose much weight. We have no idea why.

[Monica Padman]

I didn't know that if you have diabetes and you're on the drug, you don't minimal amount.

[Eric Topol]

There's lots of theories, but no one knows really why.

[Dax Shepard]

Also, the precarious origin of the medicine having been invented by a company that's primary source of income is insulin production, and the fact that they even allowed this drug that potentially was gonna cannibalize their real business, all of it's very interesting.

[Eric Topol]

It goes back to the Gila monster saliva and you know, all kinds of stuff. Yeah, but big diabetes companies are the principals.

[Dax Shepard]

You could have seen them almost killing this thing because they're like, well, that's just going to destroy our.

[Monica Padman]

They took a gamble that this would be bigger like it is.

[Dax Shepard]

Stay tuned for more Armchair Expert if you dare. We are supported by M M's. What a fun sponsor. M M's. I love M M's.

[Monica Padman]

Me too.

[Dax Shepard]

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[Monica Padman]

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[Dax Shepard]

And it's fun to design these. On the Eminem's website. You can choose up to three colors, so maybe their favorite colors or their school colors.

[Monica Padman]

Cute.

[Dax Shepard]

Then you can add text clip art and even photos to the Eminem's. Put their face on there. Or hey, why not your own face? I would make you Eminem's with the Hermes logo. Wow, that'd be a copyright infringement. But I do it anyway.

[Monica Padman]

Do it and I would for you do a crowd.

[Dax Shepard]

Oh, that's good. Once you have your design ready, you then have a bunch of different packaging options to match the occasion. Like the class of 2025 candy dispenser which arrives with your custom M and Ms. Already inside. It's a totally different cheeky special gift that they're going to remember. Order your custom M M's today. Head to MMS.com and use code DAX for 15 off your first order. That's MMS.com code DAX to receive 15% off your first order. We are supported by Ring. With Ring you can be there from anywhere with doorbells and cameras that help you see more to exciting features that help you know more to the app that lets you connect more. See more at the front door, up high and down low with battery doorbells head to toe video capture it all all day and all night with 24. 7 recording and get smarter alerts that know the difference between a person and a package right in the Ring app. Now I relied on these Ring photos.

[Monica Padman]

Quite a bit for our unfortunate violation.

[Dax Shepard]

Yes, it was so good to have all that.

[Monica Padman]

It's also it just brings peace of mind to know you can check at any time.

[Dax Shepard]

Yes, with Ring you can check in and be there from anywhere. Some features require a subscription and are available only on select Ring devices. Exclusions apply. Learn [e-mail] at 24 I lost my.

[Delta Shepard]

Narrative, or rather it was stolen from me.

[Monica Padman]

And the Monica Lewinsky that my friends and family knew was usurped by false narratives, callous jokes, and politics.

[Delta Shepard]

I would define reclaiming as to take.

[Eric Topol]

Back what was yours.

[Delta Shepard]

Something you possess is lost or stolen, and ultimately you triumph in finding it again.

[Monica Padman]

So I think listeners can expect me to be chatting with folks both recognizable.

[Delta Shepard]

And unrecognizable names about the way that people have navigated roads to triumph.

[Monica Padman]

My hope is that people will finish.

[Delta Shepard]

An episode of Reclaiming and feel like they filled their tank up, they connected.

[Monica Padman]

With the people that I'm talking to.

[Delta Shepard]

And leave with maybe some nuggets that help them feel a little more hopeful.

[Monica Padman]

Follow Reclaiming with Monica Lewinsky on the.

[Delta Shepard]

Wondery app or wherever you get your podcasts.

[Monica Padman]

You can listen to Reclaiming early and ad free right now by joining Wondery.

[Delta Shepard]

Plus in the Wondery app or on Apple Podcasts.

[Dax Shepard]

Okay, so in lifestyle, let's go through some of this stuff. So diet, you're taking a real magnifying glass to a lot of these things that we're already aware of. When we talk about diet, let's talk about ultra processed food and sweeteners a little bit.

[Eric Topol]

The ultra processed foods, the evidence is remarkable that they're toxic. The age related diseases, the big three, they're potentiating all of them. The US is the worst in the world for intake of ultra processed food.

[Dax Shepard]

My kids bring home stuff sometimes and I'm like, how did they even think of this much? Let's construct this product. Yeah, it was like Reese's Pieces cups, popcorn. And I was like, well, you're damn right that's gonna be delicious. But how did they do it?

[Eric Topol]

The kids, more than 70% of their intake of calories is through ultra processed food or energy. 70% for the adult, adult population. It's horrible.

[Dax Shepard]

Yeah.

[Eric Topol]

So we have to do something about this. Nothing really has been done that's different in other countries, particularly in Europe, where there's a lot more awareness. How are we gonna let this go on? Because the companies have figured out what tastes good, where the reward circuits are in the brain and changing the texture, adding these things, alien stuff that they throw in there. It's all programmed to be ingested at the highest level.

[Dax Shepard]

There was a 60 minutes on long ago and the segment was about food additive chemistry. They're basically perfumists really. And they take this group of them to an orange grove in California and they're watching them all take one off the tree and peel and then they're tasting it. And this one scientist says, oh yeah, it's this breaking down all the things. And he said, now we wouldn't design it like this because you'll notice the taste lasts for a really long time. It stays in your mouth for a bit. And we want something that goes away almost immediately after you experience the nice taste so that you want to replace it. And I was like, this is actually nefarious. It's not just I want to make it taste good, I want to make it taste good for a blip. So you have to have more immediately. How are you going to compete with a brain trust like that, figuring out how to make you eat as much as possible?

[Eric Topol]

We're the prey. We have to do something about this because all these foods can be made without all this gunk in there. In the book I bring up about the young people developing cancer now it's a big issue. It's been going up at levels we've never seen.

[Dax Shepard]

Specific types.

[Eric Topol]

Colon cancer is one of the biggest ones. But even breast cancer in women in their 20s and 30s, ridiculous. We never saw this stuff before. Now it's starting to become a big issue.

[Dax Shepard]

What's the mechanism that would be happening?

[Eric Topol]

The big theme in this is inflammation. Ultra processed foods, once it gets through your GI tract, you absorb it. It incites inflammation throughout your body and even the gut to brain, which is how the Glip1 drugs lycozempic works. It also activates the circuits and the brain is the master circuit for the immune system. So basically you've got activation of immune system inflammation. That's not good. And the ultra processed foods are doing that. And so they can convert a person who's pre diabetic to be actually diabetic. It certainly would be considered now clearly a risk factor for cancer, for cognitive deficit, for heart disease. I mean the list is pretty remarkable. How can we keep denying it? Now when I talked to my friend, the FDA commissioner twice, Rob Calob who was onto this, he says, well Eric, the U.S. department of Agriculture is really tough to work with. And then we got big food. We're talking about the pharma industry, big food, try to change their ways, try to challenge them. So we haven't taken them on and we need to.

[Dax Shepard]

By the way, this GLP1, there's so many things that are auxiliary to it. One of them being, you read these articles where these food companies are now worried that people are not going to be eating junk food as much. Yes, they have to have a game Plan in place. So isn't that weird?

[Eric Topol]

What you're bringing up is extraordinary because by understanding these circuits between the gut and the brain axis, the fact that people now want to eat healthier foods while they're on this drug. So they're not only eating less food, drinking less alcohol, but also turning to healthy foods. And so like you said, the food industry, now what do we do?

[Dax Shepard]

It feels too good to be true.

[Monica Padman]

Is that why a couple months ago there was that whole study about alcohol causing cancer? Is that because of the inflammation?

[Eric Topol]

I'm glad you brought that up.

[Monica Padman]

It sticks with me.

[Dax Shepard]

We're both gonna service our own pet projects. Hers is alcohol, mine's weightlifting.

[Eric Topol]

My next substack, Ground Truths is gonna be on this because in the book there's a little bit of that. But there's three new studies, one of which was the Surgeon General, who I did a podcast with. Murthy.

[Monica Padman]

Yeah, Vivek, we've had him on as well.

[Eric Topol]

Before his came out, there was the National Academy of Medicine. And then subsequently was another HHS report. So there's three, and they're all different. First of all, the one that was the most carefully done, the National Academy of Medicine original data. They drill down on everything. They say, hey, you know, moderate drinking can actually save lives and reduce cardiovascular mortality.

[Dax Shepard]

That's what we grew up with. One glass of wine's good for your heart.

[Eric Topol]

They were not so stringent, whereas Murthy and the Surgeon General's report and the other one were even a little better. Alcohol's bad for you. The mechanism isn't known, but we do know that in large quantities. That's really the big debate. It's mutagenic Alcohol can cause mutations and mutations can lead to cancer. So that doesn't necessarily have to invoke inflammation. There are countries that now have labels on the bottles of alcohol and wine that this could cause cancer as well.

[Dax Shepard]

As everything else in the store. Yeah, you're just like overwhelmed by it at some point.

[Eric Topol]

We don't really have the data to support that. But Ireland, where there's some heavy drinkers and other places they have put that label. So the cancer story is the one that's of main concern. The only thing that these three reports agree on is the breast cancer risk. The other cancers, esophageal choline is much less definitive. They're fuzzy, they don't agree.

[Dax Shepard]

Now, I loved this cuz I am a abuser of caffeine. So tell us about caffeine and its impact.

[Eric Topol]

This is, I think, the Shocking.

[Dax Shepard]

This is only good news in your book, I think. No, there's more, there's more.

[Eric Topol]

I talk about good foods in there and all about exercise. I'm into that. I think the interesting thing about caffeine is a lot of people have thought, I better not drink too much. It's bad for me. All the data, as I reviewed in the book, show if you're drinking less than four cups a day, not only is that not harmful, but there's lots of benefits.

[Dax Shepard]

Yeah, you need to pick up the pace.

[Monica Padman]

Wow, this is great.

[Eric Topol]

After four cups, for the most part, when you look at all the studies, then you say, hmm, maybe that's not so good. But coffee, we don't know why it's so beneficial.

[Dax Shepard]

Well, it has a huge antioxidant effect.

[Eric Topol]

It has, but, you know, a lot of antioxidants we don't really know. But you have to say, looking at the studies, it's just the opposite of these things like ultra processed foods where the evidence is all going one way. For caffeine and coffee, it's all going the other way. And it's good.

[Dax Shepard]

Where are we at on red meat vs plant based?

[Eric Topol]

Red meat is a problem because it induces inflammation. It's okay to have it on a limited amount, but some people eat a lot of red meat and they ought to reassess that because the correlation with all cause mortality, cancer, cardiovascular, Alzheimer's, it's all there. And so ultra processed foods and red meat track together and then there's the worst, which is the meat and processed.

[Dax Shepard]

Yes. Anytime you study humans, it's just such a messy business.

[Eric Topol]

It is.

[Dax Shepard]

So you go, red meat. Okay, well what's your red meat consumption? Well, if we look closer, it's like, well, red meat consumption is largely, probably happening through hamburger consumption. And now when we eat hamburgers, what else do we eat? People eat french fries with hamburgers. Like how you're parsing out the red meat as opposed to, have we studied anyone who only eats a plate of ground beef? That's a hard person to find.

[Eric Topol]

Nobody's condoning the french fries as a healthy food.

[Dax Shepard]

Right. I'm just saying, how do we parse out?

[Eric Topol]

I think the question is, the red meat is something that, hey, if you have it once a week or a couple times a month, no one's gonna say that's a problem. But if you have a good port three times, four times a week, that's where you start to see, hey, this is going to be inciting inflammation in your body. And we have some inflammation markers. They're not great. We need better ones. Yeah, but that's a way to tell if your diet is off track. So I don't know how many hamburgers you eat.

[Dax Shepard]

You would be so mad at me. I don't want to lose you as a friend.

[Monica Padman]

He doesn't eat hamburgers. But a lot of red meat.

[Dax Shepard]

I eat a lot of red meat. Okay, yeah, yeah, I eat a lot of meat. But also, I'll add, I have psoriatic arthritis. I do not want to be an immune suppressant. I was for years. It took me, me seven years to figure out what was triggering it all. So I have a diet now that works for me and I don't have to be on any medicine and I don't have any symptoms anymore.

[Eric Topol]

Is that a ketogenic diet?

[Dax Shepard]

Well, I can't eat gluten, I can't eat garlic, I can't eat peanuts. A list of things. But what the result ends up being is, yeah, I have a pretty low carbohydrate diet because I can't eat pasta or bread. But I'm not afraid of a potato or some rice.

[Eric Topol]

Yeah, that's all right.

[Dax Shepard]

And my cholesterol right now is great. All my markers and I'm spoiled in that were in a study with Dr. Richard Isaacson for Alzheimer's. So I'm getting a lot of work worked on there. I get a lot of blood panels. Things are good.

[Eric Topol]

That's terrific.

[Dax Shepard]

But I do eat an amount of red meat. That would really break your heart.

[Eric Topol]

Well, that has to be individualized. You present a different circumstance. You have this autoimmune disease. We make these recommendations for everyone, but everybody has a little different story behind it.

[Dax Shepard]

And that's the most exciting part of this chapter, is with the help of AI, for people to actually know what diet they should be on. To me, seems like would be one of the most helpful things.

[Eric Topol]

I totally agree. There was a fascinating study that just came out. Over 105,000 people for 30 years and only 9% of them made it to age 70 with no age related diseases. And so they say, well, what are these 9% eating?

[Dax Shepard]

Yeah.

[Eric Topol]

And basically it was plant based diets, vegetables and fruit. That's the best known diet we have best validated a Mediterranean like diet. But that doesn't mean that's the right diet for everyone. And as you say, using AI, there's some big studies going on right now. Hopefully they won't be derailed at nih. Big investment to see if we can find the Right. Diet for each person because each of us metabolize things differently and we have other coexisting conditions or we're at risk for different things. And so when you have all that data, and that's where you use this multimodal AI, you can really help people to guide them as to what would be best for them.

[Dax Shepard]

Yeah. The notion we'd have a food pyramid for 300 million people is a fucking fantasy.

[Eric Topol]

Yeah. And so then we get out of this mode of you eat too much. This. That's where we are right now. It's crazy. We have to get down to the individual level.

[Dax Shepard]

And I think it's been the great frustration with consumers with the nutritional sciences in general, which is we're wanting them to have a magic bullet for all humans. And of course, that's why they contradict each other all the time. And there's no consensus in that field. It's a very frustrating field to monitor. But it's because we are so individual. And that's really gonna be the answer, probably.

[Eric Topol]

This is such a fundamental part of our life, what we eat. And the fact that we haven't cracked the case yet. We know from glucose sensors that people have a totally different response to having spikes of glucose for the exact same food, exact same time, exact same amount. And so we've seen the same thing with our lipid. And that's what we have to get to the determinants and to give the best counsel to people so they'll know. And it may not be that it's the same diet throughout their whole life. You may be. You need to reassess it at times. But we're going to get there someday. We didn't have the way to deal with all this data. Billions of data points for each person and many different layers of data. Their gut microbiome and their glucose sensors, their diet and their stress, their physical activity, all these data points. Now we can actually analyze that, which is extraordinary.

[Dax Shepard]

And what will that AI model look like that be a combination of it? Having mapped your genome, you're wearing some sensors. It knows what you're eating. How will that come together?

[Eric Topol]

Yeah. So we just did a study, soon to be published. We had a thousand people. We got all those layers of data. They took pictures of everything they ate and had the glucose sensor. We did their genome sequence. Their gut microbiome tracked their physical activity, sleep. And so we could figure out in those people what was driving their abnormal glucose spikes. And also who. Who would wind up being the ones to go risk from Marching on from pre diabetes to actually getting to diabetes. Right. So it can be done now. It requires some pretty sophisticated AI modeling, but it's just going to be done a lot more. This was one of the first studies to really try to get at it. And I do think the interactions between sleep, physical activity, stress, what you eat, all these things are very complex. We as humans can't analyze this stuff.

[Dax Shepard]

We can't even keep track. Even when you ask people to say what they ate, they need help. And also, also, it's a tall order to ask people, like, don't eat carbs. Well, wouldn't it be great if they said, oh, no, no, you can have as many potatoes as you want, stay away from rice, and you're allowed to have this. That's a manageable approach for people. Oh, I think that'll be a breakthrough. Okay, I have to ask because my wife will want to know this. The most environmental toxins, how serious of a concern are these?

[Eric Topol]

I think it's very serious. And the data I review, the big three, the fine particulate, air pollution, you know, less than 2.5. The microplastic nanoplastic story, which is really troublesome. And then the forever chemicals, you could add pesticide to that, of course, but they're really troubling because if you watch all the graphs, they just keep getting higher, higher, higher burden, More plastics, more forever chemicals, worse air quality, even without wildfires. So we're not doing anything about it. Here we are. We have these great new ways to prevent age related diseases. Fantastic. But what are we going to do? As I call lifestyle factors, which is our exposure, exposures to these big three, the plastics one is really compelling because we now have plastics in the brain correlated with dementia.

[Dax Shepard]

Okay, so I need more info on. When I get in these debates with her, I go, I'm not arguing at all that we're not measuring more plastic in the body. Or is this studies where we know the impact?

[Eric Topol]

There's one, it's in the book. Because I'm a cardiologist, it's the one that gets to me. So it was done in Italy. These patients were having what's called a carotid endarterectomy where they took the plaque out of their carotid artery, which can cause a stroke. And so it's an operation. And they analyzed. Did they have microplastics and nanoplastics in their arteries? 70% of them had. And they not only had that, but you could see right around where the plastics had accumulated in the plaque that was where there was really nasty inflammation.

[Dax Shepard]

So the body was rejecting it, was.

[Eric Topol]

Seeing it as alien foreign matter. It was inflamed to try to protect the body. But in fact it was incited big time inflammation in an artery that gets in the bloodstream that you wouldn't want. But that's not all they did then. They followed these people. Did they have more heart attacks and strokes and did they die because of heart attacks? Yes, four and a half fold more than the people who didn't have plastics.

[Dax Shepard]

You're gonna pull out a gun and shoot me? But again, I'm just curious.

[Eric Topol]

Yeah.

[Dax Shepard]

Where would you be getting all these plastics other than you're drinking from a ton of soda? And are we actually seeing the result of massive soda consumption or the plastics in the bottle that the soda that.

[Eric Topol]

We'Re actually even breathing in. But the most of it is coming through what we drink and eat. So plastic bottles. Where is all the water bottles?

[Monica Padman]

Well, yeah, it's not just soda water.

[Dax Shepard]

It's a great counter.

[Eric Topol]

You know what, we have people take their food, put it in plastic to store it and then they're going to heat it up and they put it in the microwave. Talk about a double whammy. The food's stored in the plastic and now we're going to heat it up so all the microplastics can fully embed into the food that we're now going to eat.

[Dax Shepard]

Oh, fuck. I got to change that. Okay.

[Monica Padman]

Plastic.

[Dax Shepard]

I do. I'm the only one in my family. The whole family is like off plastics. I'm like the old man.

[Eric Topol]

Well, it sounds like Kristen is onto it.

[Dax Shepard]

She's on it. I'm the only one that's still drinking out of the plastic water bottle.

[Monica Padman]

I do drink out of plastic water bottles.

[Dax Shepard]

I know. I have these blender cups and I fill them up over and over again with protein shakes and stuff.

[Monica Padman]

Essentia comes in plastic.

[Eric Topol]

But you see the millions of tons of plastics that are accumulating that is non biodegradable. So it just stays with us forever. Now our fish are eating the plankton. It's everywhere. We're not doing enough to work against that. And it's one of those things that's just of compounded problem. It's getting worse all the time.

[Dax Shepard]

I lost that one.

[Eric Topol]

The heart attack study to me was the most compelling of all. And then the recent study about a spoonful of plastics in your brain and how that was associated with a much higher risk of dementia. That didn't feel good either.

[Dax Shepard]

I don't know how someone is two standard deviations above or below the plastic consumption. It comes in your can, that is aluminum, but it's got a plastic line like how on earth is anyone taking in more or less?

[Eric Topol]

So your point is a really important one is at the individual level, how much can you do because it's so pervasive. You can do some, but we also need to take this seriously because there are some solutions in sight. There are ways to combat this that have been published, some really elegant science work. We're just not implementing it. It's like we're just ignoring it all.

[Dax Shepard]

There's so much happening, you get fatigued on all the problems we have. The fires thing happened, right? Big panic in my house and I'm like, it's gonna cut however many years off our life, but it's gonna cut that many years off of every single person we know. In some weird way I go like, yeah, but we won't be uniquely punish. It's everyone, it's everything in an illusion that you can escape it. So maybe I've surrendered.

[Eric Topol]

Despite the fact that we've been talking about some worrisome things, I have overwhelming optimism. And the reason I say that is because, okay, we've got these things that are in the way, but we have a new path to preventing the big three age related diseases. And if we can do that and start to get serious about the burdens that we are facing environmentally, then we win it all at all.

[Dax Shepard]

Yeah, okay, so we nailed the lifestyle portion, we skipped exercise. But I talk enough about that social isolation. We've also had Vivek on a couple times talk about that, that's really relevant. But let's talk about cells and what's coming our way and what's going to help us.

[Eric Topol]

A perfect example since you've had an autoimmune condition.

[Dax Shepard]

Yeah.

[Eric Topol]

No one would have predicted that if lupus systemic sclerosis, you could give them a way to ablate their B cells on their body and then they regenerate and they forget that they ever attacked you. The autoimmune is cured. Who would ever guess that?

[Dax Shepard]

Yeah, you think it's destroyed and you even say there's damage within these organs and you would think that would be permanent.

[Eric Topol]

Yeah. Well, basically you stop any autoimmune attacks because the disease is over. Now if there's already been kidney damage from the lupus or something like that, you may not get reversible effects.

[Dax Shepard]

How does that work? What happens?

[Eric Topol]

This is fascinating. There's so many things in medicine that we don't know for sure. We've talked about a couple of them. When the B cells come back, back, it's like control, alt, delete. When your computer's not working, you just reboot it. Whatever the memory was that was leading to these self attacks, it's now lost.

[Dax Shepard]

And that's what's altering your T cells or suppressing your T cells.

[Eric Topol]

These are B cells.

[Dax Shepard]

B cells. I'm sorry, what are B cells?

[Eric Topol]

B cells are the ones that produce the antibodies. T cells are your cellular immunity that are basically going after cells like the CD8 cells that are cytotoxic that just basically kill the cell. But I wouldn't be surprised because of all the advances that we're seeing in controlling the immune system. System. Dialing it up or down. Dialing it up in cancer, especially to fight the cancer. Dialing it down to get rid of autoimmune diseases. Which is amazing. Yeah. Instead of you having to take a immunosuppression drug all your life to block something like psoriatic arthritis, these drugs like rapamycin, you get more infections. They're risky drugs.

[Dax Shepard]

I didn't want to be on it. I'm trading this for cancer potentially. Or I'm trading this for an infection. And you're having to increase them, which is the nature of them.

[Eric Topol]

Yeah. So that's why it's so exciting to see the discovery that we can cure. We never were able to cure autoimmune diseases. And multiple sclerosis is a horrible condition which we now know is rooted with this virus, Epstein Barr virus. And now we know that we can also potentially use this tactic to cure it.

[Dax Shepard]

Yeah. Did they find that Ms. Has this triple whammy? If you've had Epstein Barr and herpes.

[Eric Topol]

You don't have to have herpes. You don't just Epstein Barr will do it. Almost all of us have had Epstein Barr. You have to have a genetic predisposition as well.

[Dax Shepard]

Okay.

[Eric Topol]

And then there's even potentially a third, which would be your microbiome of your gut. But the two principles are requisite Epstein Barr virus exposure and a genetic susceptibility for immune system to go into self attack mode.

[Dax Shepard]

Okay. And it just starts eating your myelin sheath.

[Eric Topol]

Yes. Horrendous condition. The treatments for it, they're not good in terms of completely blocking the progression of the disease. And so we have needed for all these years a much better approach to controlling our immune system. System. And the chapter in the book is dedicated to that because this is one of the really exciting frontiers in medicine right now.

[Dax Shepard]

And where are we at in that? We're in clinical trials.

[Eric Topol]

Every few months is another big breakthrough. We treated these four people with this multiple sclerosis, or what was a few, now is probably 100 plus people that have had cures and yet now studied for three years later and no sign of any comeback of the disease. So it looks really encouraged.

[Dax Shepard]

Yeah. Okay. Omics.

[Eric Topol]

So omics is all this biological layers. It's our DNA, but used to think DNA. That's our whole programming that determines everything. Well, that couldn't be further from the truth. That's just one layer. It's important, but it's not everything by any means. There's rna, there's proteins, then there's the gut microbiome. And the epigenome is the packaging of the DNA. So it's the methyl groups, acetyl groups, histones. These are all things that. How does that DNA get so compressed into this tight structure Epigenome? Those components, they are really important because they are like a regulator of the DNA. And the proteins don't make this one, make this one.

[Dax Shepard]

Right.

[Eric Topol]

So these layers of the omics, we've now learned so much about all of them. One of the biggest ones is we now have clocks for the body. So I could say, Dax, for going to get your proteomic clock, each organ, I can say you're 50, but your heart is 38, your kidney is 52.

[Dax Shepard]

Your liver is 65.

[Eric Topol]

Yeah, we can do that. Who would have ever thought we can do that?

[Dax Shepard]

Yeah.

[Monica Padman]

How?

[Dax Shepard]

I got to say, there's another thing I would get skeptical of is these people parade out of some tests and they're like, I'm 38. And I'm like, I don't know.

[Eric Topol]

I agree with you. Because when it's being sold, they want to give you favorable results.

[Dax Shepard]

Yes.

[Eric Topol]

I don't trust that stuff. I don't trust anybody. Hawking supplements. Who? It says they're a longevity scientist. If you're a good scientist, you don't need to hawk a supplement. If it's done right, the epigenetic clocks the methylation. Steve Horvath is the one who discovered this. Uncanny. That is a body wide clock. So we'll say, okay, this age. Well, there's a gap here because your body wide clock tells us it's this age. Biological fat.

[Monica Padman]

Is it a blood test can be.

[Eric Topol]

Done with blood, but it can be done with saliva.

[Monica Padman]

Oh, wow.

[Eric Topol]

Then the organ clocks. This was discovered by a fellow at Stanford, Tony Wiss Corey, who's a brilliant guy, very humble. He's made these amazing discoveries. This was back at the end of 2023 in nature. And these eight organ clocks now have been validated by many other groups. And that's much more to me important than just your body wide aging. Because I want to know which is the organ that's we need to monitor.

[Monica Padman]

Exactly, exactly.

[Dax Shepard]

We couldn't do that before. Right.

[Eric Topol]

And then we have these proteins like P Tau 217 which says he 20 years before you could ever see mild cognitive deficit. We've got this marker that you're at risk and we're going to get all over it so you never have to worry about that. And that's basically the theme of the three age related diseases. One that they take more than 20 years to set in. So you can't get Alzheimer's or cancer except for very rare types of infection or heart disease. You got to wait 20 years. You have a lot of Runway to work with.

[Monica Padman]

You have.

[Dax Shepard]

Yeah.

[Eric Topol]

The second thing is we talked about, they all have this problem of hyper inflammation, abnormal inflammation, immune system. That's basically the underpinning. And they're all preventable right now. They're preventable overall, like heart disease, 80%, 40 to 50% for cancer and Alzheimer's with lifestyle factors. But when you know who's at risk and you know all these things we can do to go into surveillance and high gear prevention, there's no reason why we can't prevent these diseases fully.

[Dax Shepard]

And then now we get into artificial intelligence.

[Eric Topol]

Yes. When you have all these layers of data, all your omics, all your records, all your behaviors, lifestyles, exposures, you have multimodal AI and it says you're not at high risk for these three age related diseases. Lucky you. Or usually it's one of the three, not three, most people, this is the one you gotta go after and you go into surveillance and prevention mode. And this is where we're gonna tighten up these certain risk factors.

[Dax Shepard]

We're gonna direct our resources and our mindfulness on this.

[Eric Topol]

Yeah. So just like we're talking about with the nutrition. But now for healthspan, we individualize a preventive plan for you now that we know this is your vulnerability. A lot of people fortunately don't have vulnerabilities until a later point in time.

[Dax Shepard]

Do you think a lot of people will be listening and going like, yeah, that all sounds great. Some people are gonna get access to that, but there's no way it's gonna get democratized to a point where I'm ever Gonna be able.

[Eric Topol]

Yeah, well, that goes back to our earlier point. I want it to be for everyone. Because the data that you need to put the layers of data for the AI, the AI software, it's inexpensive. If we are really interested in the health of our population, we would make this available to everyone. If it wasn't an insurance company that only has you for one year before you switch, but if it was a country that the overall population is their responsibility and what they're after. So if we really are into it for that reason, then we would make it available to everyone. Because what is the cost in our society to these big three diseases? That's what eats up all our resources.

[Dax Shepard]

Four trillion.

[Eric Topol]

Yeah. I mean we talked about the hospitals, but it's the people that are in the hospital because they have the cancer or they're in these facilities because they have Alzheimer's and then all the heart disease that we still have. The number one killer still today.

[Dax Shepard]

They say like 80% of your lifetime resources you spend in life. Last couple years of your life.

[Eric Topol]

Yes. And there's these three diseases. If we can prevent them, it's in the national, the world's interest.

[Dax Shepard]

We could spend all that money on defense. Oh my God.

[Monica Padman]

Well, if that'll sell it, sure.

[Eric Topol]

Too much common sense there. I know, but.

[Dax Shepard]

So we talked about GLP1s, the T cell engineering.

[Eric Topol]

That's another part of the cell story. This is really amazing. Now you can take T cells out of the body with crispr. You take the T cells, you genome, you basically are directing them now to go after certain proteins of a person's cancer. It can be curative for leukemia, lymphoma. And now there's been many cures, even in solid tumors, even in tumors that are the worst, like pancreatic, they're sent in as a seek and destroy mission. And by the time they are going to lose their life, they've done a lot of their work.

[Dax Shepard]

How long do they live?

[Eric Topol]

This is weeks. And you're talking about a patient who's cancer uncontrolled. And so basically they're revving up the immune system and so they don't have to do it all themselves. The T cells are connected to the B cells that are connected to the everything natural killer cells, the tumor microenvironment. So basically they are setting the stage for an attack. Then there's the other part of this, which is these antigens, the proteins on the surface of the cancer cells you can make vaccines directed against. So it doesn't have to be cellular you can make a MRNA vaccine using that platform with nanoparticles and then inject that. And that can rev up an immune system as well against a cancer. It's a different way, but we've seen some cures now for kidney cancer and pancreatic cancer with that.

[Dax Shepard]

Are we in an age where we might get a vaccine for every type of cancer at some point?

[Eric Topol]

Well, there's two parts to this story. One is using a vaccine to amp up the immune system system in a person who has cancer, which you can never get enough immune response in someone with cancer. We're learning all the tools, like the engineered T cells, Car T as it's called, or the neoantigen vaccines. But that is different than you're at high risk for this type of cancer. We're gonna give you vaccines so you never get that cancer.

[Dax Shepard]

Yeah, Right. We basically train your T cells to identify this preemptively.

[Eric Topol]

Yeah. So this is a part in the book when I get into what is the missing link right now, because I want to do that. But we don't have a readily available way to check your immune system. There is no such test today. It's available. Basically, you get this cockamamie ratio of your white cells to your lymphocytes, which is not worth much. What we want is a immune system checkup to know, because if your immune system is down, that's when you start to see the vulnerability to cancer, or if it's up, the vulnerability to an autoimmune condition. They're done in academic labs, like, I volunteered to be in the human immuno project, which is run out of Yale. And I also put in the book a big immune test where every autoantibody in my body, every exposure to every virus I've ever had in my life, that's the kind of thing we all should know about. We will someday. We're on the brink of starting to get that to commercial level. As we get to my age. We have this thing called immunosenescence. Right. And some of us, because of aging, our immune system isn't working real well.

[Dax Shepard]

That's all the old people who died in Covid.

[Eric Topol]

Exactly. And so if we knew about those people's immune system, that's how stupid we are today. Right. Because not all old people were susceptible, but the ones who their immune system was compromised. We could have done things to rev that up. We're missing that right now, but in the next few years, it'll be available. I mean, I've already. Already had one of these tests and working on getting the other more comprehensive one. And I just hope that we rev that up, because that's the missing link right now.

[Dax Shepard]

Stay tuned for more armchair expert, if you dare. Every time I have someone equipped to answer this question, I have so much curiosity around. Around senescence.

[Eric Topol]

Okay.

[Dax Shepard]

Because the great mystery to me is if you have this process, mitosis, and it makes an exact replica of itself, why on earth, at some point does it stop making an exact replica of itself? What is the process? And the one thing I heard on NPR one day, it was like an hour long story, and you quote him a ton in your book, is this guy who started erasing layers of the epigenome in mice. And he was erasing so much that initially it would put their body into a state of being like a baby and their organs would grow too big. And then it was learning to dial back how much we erase from this. Because you accumulate garbage and flaws in your epigenome. Yeah.

[Eric Topol]

Yes.

[Dax Shepard]

I know already you don't care about living to 200.

[Eric Topol]

You're right about that.

[Dax Shepard]

I already know you don't care. I am fascinated by that.

[Eric Topol]

I wouldn't mind living at 200 and being healthy. That'd be great. That's unlikely.

[Dax Shepard]

Go ahead, shatter my fantasy. That one seemed really promising.

[Eric Topol]

So Juan Carlos Belmonte, who you're referring to, is a close friend. He used to be at the Salk Institute, which is right next to where I work at Scripps. And then he's more recently at Aalto's lab, and he discovered this, the fancy term partial epigenetic reprogramming. What it really means is he's taking these factors called Yamanaka factors, which can be used. This was a guy in Japan that discovered those to make stem cells. But if you just give an exposure to an animal bred to be prematurely aged.

[Dax Shepard]

Progeria.

[Eric Topol]

Progeria, exactly. Wow.

[Dax Shepard]

I got one wow. Out of them, and I'm going to sleep like a baby tonight. Continue.

[Eric Topol]

If you get the right dose timing of this, you can take that and not just a mouse, but other species, and you can reverse their aging. Yeah. And all the features of their organ now they're. This is amazing.

[Dax Shepard]

I think that's the most amazing thing I've ever heard. It is they took these old mice and they made them young again.

[Eric Topol]

Yeah. Of all the different approaches, the one that is the most striking, there's like 12 shots on goal here. That one is.

[Dax Shepard]

Wow.

[Eric Topol]

But as you'll see when you look closely at the data, there's Two issues. One, it's very finicky. It's kind of like Goldilocks. You got to get it just right, otherwise you get tumor development. Because youth cells that are vibrant and dividing never divide perfectly. We're always accumulating mutations so it's never as identical as you'd like to think. So you can get cancer from this? We've seen teratomas in these animals. Now the problem is their company, you know, is billions of dollars of investment.

[Dax Shepard]

Three billion. You said it right?

[Eric Topol]

There you go. They are supposed to go into clinical trials. Well, how are you gonna inject this to a person who's gonna be the person that wants to get this body Wide Yamanaka factors to see if they can reverse their aging.

[Dax Shepard]

A 96 year old, that either make me young tomorrow or I want to die in a week. That's who you're looking for. I guess.

[Monica Padman]

But that might be too far gone.

[Eric Topol]

Yeah, and then you get a misread that it doesn't work. Good point. So they're going to try it in a knee that is just about to have to undergo a total replacement and see if it makes the knee healthier before they go to a total body.

[Dax Shepard]

Yeah, yeah, yeah, yeah.

[Eric Topol]

This one is potent, but also a bit dicey for. So we're going to see. That's why I say in the book. I used to think all these reverse aging things were never going to be a go. But there's so many different ones.

[Dax Shepard]

It breaks some of our previously held tenets of biology.

[Eric Topol]

Yeah, because used to be. Oh, the mouse lived longer. Well, a lot of things make mice live longer. But when you do this sort of thing, like you said, when you cut.

[Dax Shepard]

Their age in half and you see.

[Eric Topol]

It, all of a sudden they have all this muscle and they're cognitively crisp. As best you can tell when you put a rat in a maze test, I mean, it's fascina.

[Dax Shepard]

Yeah. That's incredible. Eric, you're so impressive.

[Monica Padman]

What about peptides?

[Dax Shepard]

Okay, go ahead. But I wanna make sure we get em outta here in reasonable time.

[Monica Padman]

I promise you.

[Dax Shepard]

Okay, then I'll say how much I adore you and I'm impressed. Go ahead. Peptides.

[Monica Padman]

Should we be taking all these peptides?

[Eric Topol]

No. What peptides?

[Monica Padman]

Thank you.

[Eric Topol]

Which peptides?

[Monica Padman]

Actually, we can be done now because that is exactly.

[Dax Shepard]

Hold on one second though. This will dovetail beautifully into why I would recommend this book to people. Because you are an optimist. But you haven't drank the Kool Aid.

[Monica Padman]

Yeah. I align with you so Far it's.

[Dax Shepard]

A very, very moderate approach with a lot of optimism. And I think this is the book for Monica.

[Monica Padman]

Yeah, I fully align because, okay, here in LA there's a group of friends, Dax being one.

[Dax Shepard]

Several of the peptides are in his book.

[Monica Padman]

Okay. So are dabbling with these injectable peptides. And I feel people are on metformin.

[Dax Shepard]

People are on Samorin, there's a bunch of them.

[Monica Padman]

There's like a beauty one, there's, there's a copper one, there's a brain one.

[Dax Shepard]

Listen how upset he is before he.

[Monica Padman]

I know, I like that you're upset because I feel upset. But I also feel, well, if everyone's doing it and then they're all gonna look 22.

[Eric Topol]

No, that's not gonna help.

[Monica Padman]

Okay.

[Eric Topol]

This is a craze, no basis and potential harm when you don't know for sure. I mean metformin is different. That's a pill that's been around forever and that's not really considered a peptide itself. But these injections, that's what I'm worried about. Because anytime you're injecting something and you don't really know what it's doing, good or bad, there's no evidence that any of these have helped people. This was really the impetus to do the book because there's so much of this stuff out there now. And let's just set the record straight. There's reasons for excitement, but let's not jump the gun. Let's not be taking drugs that could be doing harm. Eventually we're going to get there. There may well be a peptide.

[Dax Shepard]

I'm going to make a counter argument. You guys aren't going to to like it. Many of these peptides, these are off label uses of peptides because they saw different results from studies that weren't even addressing this in the exact same one, the GLP1s which you love, it was not designed for what we're using it for, but we started noticing something like which one? Tessamorelin. This was developed for HIV patients. What did they find when people were on this? They had a reduction of abdominal fat that was just a side effect they found very well studied administered. It's been used for 40 years. It's a very well known peptide and it had this auxiliary effect of reducing abdominal fat. There's a peptide.

[Eric Topol]

So you would inject yourself to get rid of abdominal fat.

[Dax Shepard]

Yeah. Then we could get into how many studies there are that abdominal fat is a huge indicator of future for Horseman stuff. This is the Dr. Isaacson this is a dementia.

[Eric Topol]

I agree about the abdominal fat not being good. I don't know the study that connects the dots between this Tessamorelin and better health outcomes.

[Dax Shepard]

Right.

[Eric Topol]

Also, there's no free lunch with any drug.

[Monica Padman]

That's how I feel.

[Eric Topol]

What is the potential side effect? Let's go back to the GLP1. They were studied in massive clinical trials with placebos for the purpose whether it's diabetes or obesity or heart failure. Where's the study for these peptides that were done for this purpose?

[Dax Shepard]

We'd have to go through each and every one of them, but most of them weren't developed for the thing that's being used.

[Eric Topol]

I'm into repurposing. Viagra wasn't studied to give men erections. It was studied to be a blood pressure drug and it was a bust. But you know what? It worked. And they did trials to prove Latisse.

[Dax Shepard]

This eyelash thing was a glaucoma medicine that they found. Oh, everyone using it has beautiful eyelashes.

[Monica Padman]

But then they did do tests before it became publicly used.

[Dax Shepard]

What you're upset about is that there isn't the data for the off label use. But there is, there is plenty of data for the peptide itself in the other application. In the same way that the GLP one had a ton of data for diabetics before, as you said earlier, they were refusing to study it for obesity.

[Monica Padman]

But then they did. But it could have turned out better.

[Dax Shepard]

But you're at a stage where you're going, we should try it for obesity. And you're going, there's no study for obesity, it's for diabetics. And it's like, now we're post that it turns out, no, that was great for diabetes.

[Eric Topol]

How do you know taking this peptide doesn't interfere with your sleep?

[Dax Shepard]

Well, because I've slept like shit forever. So that's my hunch there.

[Monica Padman]

Point is, they did prove that it was good for obesity.

[Dax Shepard]

I'm just pointing out you have an argument for one thing that you feel solid about, which is GLP1s work for diabetics. It wasn't being studied for obesity. It is very safe and now it turns out it's great for obesity. So we are at a phase with many peptides where the off label use is just now happening and it's already been studied for these other things to be safe. So now we're just at the point where we're gonna evaluate them for the off label use. But you guys are going, no, don't use it for off label. We don't have that study yet. It's a little contradictory to your embracing of the GLP1.

[Eric Topol]

No, but I would say not quite because there were specific studies for the off label. It was specific studies to do a new label, a real label. But I don't summarily dismiss. I haven't seen the data for peptide.

[Dax Shepard]

Tessa Morland. Just one I happen to know was for hiv.

[Eric Topol]

It does a great job reducing abdominal fat. Abdominal fat. And it doesn't do anything else. That's really interesting. I'll review any data set and if it's a really good case for somebody to use it. But overall peptides are being heavily promoted and there's lots of them. And I say where's the data and who are these people that are peddling them?

[Dax Shepard]

So where the data is totally fine. But a pessimism about that the data will prove out to be not real, I don't think is warranted. I think it should be given the same neutral opinion that the GLP ones.

[Monica Padman]

It is a neutral opinion, but they're being used prematurely.

[Eric Topol]

The one thing I say is that the peptides, you'd like to see it all in published, peer reviewed journals. We have a different problem right now. We're in the midst of an anti science world where people want to take the peptides because they're not from big pharma, they're not mainstream medicine. They got to be better than those cockamamie doctors.

[Dax Shepard]

I agree. That's a huge problem.

[Eric Topol]

I worry about that. We've rejected the norm of evidence and we basically are at a time when there's a revolt against mainstream medicine.

[Dax Shepard]

Yeah.

[Eric Topol]

They find that maybe it's deserved. I don't know. But the problem is we're embracing things without what we used to say would be the requisite body of evidence Bitcoin thing.

[Dax Shepard]

It's like, I hate that the government regulates. Okay, well now it's been stolen from you. And what do you want now? You want a regulatory committee to come in and chase down your money and give it back so everything you liked about it you now are a victim of and now you want all the regulation. I totally agree with that mindset of I just want anything that's not. That thing I hate is ridiculous and dangerous.

[Eric Topol]

I'm with you because there may be some hidden jewels in these crypto.

[Dax Shepard]

Yeah, I'm of the opinion that are hidden jewels and I agree with you that they're being overused and without a doctor. Yeah, but there are good doctors who do believe in some of the ones that have now a great off label use that will ultimately, in my opinion, be just like the glp.

[Monica Padman]

I hope. I'd love to take a beauty peptide every day, but I do want it to be tested thoroughly before I do.

[Eric Topol]

I'm staying with Modica on this. Yeah, yeah, yeah, yeah, yeah.

[Dax Shepard]

I've been outnumbered a few times in this, but that's okay. I can handle it. Now my closing statements. You're so impressive. Your body of knowledge is mind blowing. Reading the book and then also just what you can bring off the dome. It's mind blowing and I think you have real integrity and a great heart and I'm really, really delighted you're a voice in this space. I loved getting to meet you the first time and I'm so glad you came back the second time.

[Eric Topol]

Oh, well, I have so much enjoyed our conversation. If there's more fun podcasts out there, I don't know of it.

[Monica Padman]

Oh, that's nice.

[Dax Shepard]

Have you done Rogan yet?

[Eric Topol]

No. I'd be happy to meet with Joe. That would be interesting. But the two of you have amazing chemistry and it's good that you don't agree on a lot of things.

[Dax Shepard]

Oh yeah, nothing.

[Eric Topol]

As a non scientist, I love how you think totally different backgrounds, totally different domains of our work. But you're on it and really appreciate your going through the book so well and asking all the great questions. It's been fun.

[Dax Shepard]

Oh, wonderful. Well, we'll have you back for sure. You're gonna write another book and you'll give us more fun information, keep us.

[Monica Padman]

Updated on all these studies.

[Dax Shepard]

Door is always open. I really encourage people to read your wonderful book, Super Agers An Evidence based approach to Longevity. Again, we got bogged down in the bad stuff. It is a very optimistic book.

[Eric Topol]

The hope is that people will find ways to extend their health span and that's what it's all about. I hope that will work for all of us here.

[Dax Shepard]

Yeah, absolutely. Absolutely. All right, well, thanks for coming.

[Eric Topol]

Thank.

[Dax Shepard]

Stay tuned for the fact check.

[Delta Shepard]

It's where the party's at.

[Dax Shepard]

Okay, you wanna hear the thing that I screen grabbed?

[Monica Padman]

Yeah.

[Dax Shepard]

Okay. This is a callback to our period underwear episode.

[Monica Padman]

Great.

[Dax Shepard]

This is by Tracy3872. I was at the pediatrician with my daughter when she was probably around 4 and my purse fell over and a tampon fell out. She grabbed me it and said, mom, here's the medicine for your butt. Thanks, baby girl.

[Monica Padman]

That's cute. One of the kids in the pot, a boy said, why do. Why do girls only have butts.

[Dax Shepard]

Right, Right. Or front butt.

[Monica Padman]

No, no, I think. I think he thought the whole thing was just a big butt on women.

[Dax Shepard]

And if anything, it's like you have your big butt and then you have a miniature butt up front. Two little butt cheeks. If you really look at it.

[Monica Padman]

God, it's so weird that we're attracted to these parts. They're. They're objectively so ugly.

[Dax Shepard]

Yeah.

[Monica Padman]

Yeah. All of it. Like.

[Dax Shepard]

Yeah.

[Monica Padman]

The boobs, the penis, the butt.

[Dax Shepard]

Even when you're saying it, I'm like, well, no, not that one. You go, the boobs. I'm like, no, no. Everyone knows those are beautiful. And then the. What?

[Monica Padman]

The aliens. The aliens don't think they're beautiful? Probably.

[Dax Shepard]

I mean, I think. I think obviously the penis is the most ridiculous.

[Monica Padman]

Sure.

[Dax Shepard]

Part of the body. The placement's goofy. It looks silly. Yeah.

[Monica Padman]

But the butt is very strange. Like we poop out of there and yet it's like an erogenous area. It's so interesting.

[Dax Shepard]

Yeah. What else? We're both in.

[Monica Padman]

Yeah. I got a new outfit yesterday and I'm wearing it today.

[Dax Shepard]

Fun. It's. The top is like. It looks like the inside of a sweatshirt.

[Monica Padman]

It's a little bit fuzzy.

[Dax Shepard]

It's fuzzy?

[Monica Padman]

Yeah, it's a little bit fuzzy.

[Dax Shepard]

And you're in eyeliner again.

[Monica Padman]

I'm not.

[Dax Shepard]

You're not in eyeliner.

[Monica Padman]

Oh.

[Dax Shepard]

What?

[Monica Padman]

Maybe what you're noticing is different. Do you think I look different today again?

[Dax Shepard]

Yeah, you look like you looked the other day. I mean, now I'm noticing. Yes, the eyes were an extra bit, but yes, it still something a little different.

[Monica Padman]

Okay, Rob, can you guess what it is now?

[Dax Shepard]

Cheek filler.

[Monica Padman]

No, I'm wearing concealer. Under eye concealer.

[Eric Topol]

I would not. I would not have guessed that.

[Dax Shepard]

Okay, okay. Under eye.

[Monica Padman]

That must.

[Dax Shepard]

And lipstick.

[Monica Padman]

Yeah, but I wear lipstick every time.

[Dax Shepard]

Every fucking time I leave the house, I'm in lipstick.

[Monica Padman]

It's kind of. If I only have four seconds, I will just put something on my lips.

[Dax Shepard]

If. Yeah, like if some people do mascara. If you're in triage, you only have time for one application. It's going to be lips for me.

[Monica Padman]

Some people do mascara. That's like their big thing. Like they have to. Or their brows, like have to be done.

[Dax Shepard]

What about COVID up?

[Monica Padman]

I mean, my skin is bad.

[Dax Shepard]

That's got it. That'll trump lips now.

[Monica Padman]

Yes, but because of not my not witch, but my regular human esthetician corrective skincare. Jen.

[Dax Shepard]

Yeah.

[Monica Padman]

I can pretty much go out of the house without any foundation on. But I still like a little lip.

[Dax Shepard]

Sure. A little pop. Remind people what's happening. Yeah. I'm gonna say this with the utmost gratitude. I am so happy I live with all. All women. It's such a blessing. I'm glad I don't live with a bunch of men and boys, but. And I'm blessed to work with you all day.

[Monica Padman]

Thank you.

[Dax Shepard]

But sometimes the spirits blow through town.

[Monica Padman]

Okay, you mean periods.

[Dax Shepard]

I don't mean periods.

[Monica Padman]

Oh, okay.

[Dax Shepard]

Let's hear now. It would be easy to blame, period. And in a few years, I will be able to blame, period. But it's because.

[Monica Padman]

Perry. Menopause.

[Dax Shepard]

No, because. No, no, not. Neither are my daughters.

[Monica Padman]

Oh.

[Dax Shepard]

But sometimes the spirits, just the emotion spirits blow through town. And all the ladies are so emotional. And I, as the guy, I'm like, what has happened? Is it weather? Moon food? Is the well poisoned? What?

[Monica Padman]

I really like that you included Moon astrology.

[Dax Shepard]

You know, I'm clutching at straws because I'm not sure what it is, but it'll just be. We have these days where everyone is very emotional upset or just like, well, shine your emotions.

[Monica Padman]

So can you give an example? Because maybe I can help. Maybe I can tell you what's going on.

[Dax Shepard]

Okay. So. Boy, and I keep really trying to evaluate. When do I have to stop talking about my kids because they're old? I'm not sure. Fuck. It's very hard for me.

[Monica Padman]

This is hard.

[Dax Shepard]

It is. But I'll just say, cause whatever.

[Eric Topol]

Yeah.

[Dax Shepard]

Like, just indiscriminately, you know, D Money's got a zone. Or it's almost maniac. It's like she's laughing really hard, and then all of a sudden she's crying and she's completely upset and there's nothing. She's on a big, big time roller coaster. And then we had. Now Lincoln had her play last night. Right. The sixth graders put on a thing last night for. It's like an art show.

[Monica Padman]

Oh, okay.

[Dax Shepard]

And then they've made these enormous paper machines. Cliche heads. And when I say enormous, they're. They're the size of 10 basketballs, you know, they're huge. And they have to go on stilts on the. Someone wears them. Lincoln was lucky enough to have one. And they're the Greek gods. And then there's a play and a dance.

[Monica Padman]

Cool.

[Dax Shepard]

Really cool. First song they kicked us off with was Seven Nation Army.

[Monica Padman]

I don't know it.

[Dax Shepard]

Oh, yes, you do. Jack White. Is it the White Stripes or just Jack White? It's the White Stripes. Oh, it's the toughest, coolest song. And all these little Catholic schoolgirls are fucking Rocky.

[Monica Padman]

So cool.

[Dax Shepard]

To the most badass song.

[Monica Padman]

So she was on stilts.

[Dax Shepard]

She had like this contraption on to hold the head up. I'll send you a picture. Of course, Pictures and video. You know, D money can't even get through that thing. We gotta go outside a few times. I'm on the verge of going like, hey, everyone had it together for your thing. But I know that's only gonna make things worse.

[Monica Padman]

Yeah.

[Dax Shepard]

I can't really say anything. Then we get home and I don't. Lincoln had that thing on her thing for a very long time. And her legs hurt in a way that. Honestly, it seems like she would have had to have been shot with a shotgun for them to hurt as bad as they did. And again, Growing pains.

[Monica Padman]

I don't know.

[Dax Shepard]

All of it's possible, but it's a grand mall meltdown and I gotta carry people upstairs. And the other person's already thing. And oh, sweet Belle's just home from New York and she's frazzled and there's too many suitcases and I'm just. And I. The guy perspective is whatever I say is going to make it worse. I can't think of a magic thing.

[Monica Padman]

Yeah.

[Dax Shepard]

And that's.

[Eric Topol]

Right.

[Dax Shepard]

And I need to just accept that people are emotional. And I do that. I'm not trying to talk anyone out of it. But I can see how these patterns emerge. Which is just like I just say less and less and less. And I'm more and more scared to just interact with anybody.

[Monica Padman]

Yeah.

[Dax Shepard]

And so I find that, like, I'm just quiet for like eight hours. Which is really funny.

[Monica Padman]

Right.

[Dax Shepard]

And then I go to bed and I'm like. You know, well, hopefully we'll wake up tomorrow and everyone will just kind of be reset for whatever reason.

[Monica Padman]

Yeah.

[Dax Shepard]

It's just one of the very fun, funny, gender gappy things that I think is really interesting. And I don't know what it is. And it's just funny to be the solo male in this situation.

[Monica Padman]

Yeah. Gosh. I mean, I think you're right. There's not much to do.

[Dax Shepard]

Yeah.

[Monica Padman]

And you can't take it personally. You aren't.

[Dax Shepard]

That's the great thing is that throughout my life I generally would make that my. I would be the cause of that. That's my knee jerk. And I think that's why people's emotions are so insufferable to me is that I convince myself it's because of me. I knew it was not because of me, luckily.

[Monica Padman]

Right.

[Dax Shepard]

So that's a huge load off my shoulders. Cuz if you can figure out a way that it is your fault, then then it really is kind of grueling. Yeah. Now that I experience it, I like kind of go back in my head and I think of all these like, dads I knew who just were like. I hadn't heard them talk in six or seven years. You just kind of. They just stopped talking because they just are afraid they're gonna make it worse or whatever.

[Monica Padman]

Well, they're just like, like whatever. I, I think they just learn to not take any of it very seriously. And there might be some chaos happening around, but they just kind of block it out and they think about something peaceful.

[Eric Topol]

Yeah.

[Dax Shepard]

You know, like when the hero in the movies, like walking away and the explosions are happening and the cool thing to do is not look at and look over your shoulder. You just got to keep strong rolling. I think that's a little bit like that.

[Monica Padman]

Yeah. I mean, it's a ding, ding, ding to the Nick Kroll episode when I was saying, you know, there's just so many dads in chairs at stores. Like, oh, you know, they just go to the store and then they just look for a chair and then they sit there while the girls are out shopping and then they get up when you're ready to leave.

[Dax Shepard]

Kind of a funny experience being a guy a lot of times, you know.

[Monica Padman]

Yeah.

[Dax Shepard]

Like, there's many times where I like, I'm, I look at myself and I'm just kind of laughing. I'm like, look at this guy. You're just kind of like wandering from room to room hoping you don't bump into anyone. And yes.

[Eric Topol]

Oh, yeah.

[Dax Shepard]

And like a little panicked when you do, when you're forced to say something.

[Monica Padman]

I think maybe you're in a transition because you wouldn't have been like that before. Like, you, I don't think for a long time would have been okay with people being like, emotional. You'd be like, get it together. And I think maybe you're transitioning into understanding that's just not a good option.

[Dax Shepard]

What also happens. And maybe you should just always grant everyone. This is like they build up, you build up trust with one another and they are demonstrating who they are over a long enough period of time that you can really, you have a lot of data to talk yourself out of, which is like, I know these, these kids, they're not wimps. They're not, they're not easily defeated. You know, so it does get easier over time because you, you start to see the actual character of your kids and you're not as worried as much.

[Monica Padman]

Yeah.

[Dax Shepard]

Yeah. But all to say, you end up just being really quiet and I just think that's really funny. I think it's really funny.

[Monica Padman]

That's hard. It's hard to be. I, I, I see you. It's hard, it's hard to feel like I can't talk or something will erupt.

[Dax Shepard]

Yeah.

[Monica Padman]

Walking on eggshells is not a good feeling.

[Dax Shepard]

Walking on eggshells. Yeah.

[Monica Padman]

But I do.

[Dax Shepard]

Oh, I'll add one other thing.

[Monica Padman]

Okay.

[Dax Shepard]

I also have to be realistic about the trade offs and the rewards. So the joy of having these girls is like, I am get to be so affectionate.

[Monica Padman]

Yeah.

[Dax Shepard]

And loving all day long. That's like the apex of it. And so. Yeah. You don't get that. You don't get like the, the just the good emotions. You want to swim in all day. Which I do. And not have the other side of the coin.

[Monica Padman]

You should aim for the best version. Now. We're not going to hit it every time. We're not. But if, you know, like, gosh, a lot of times I understand that my emotions are causing people to walk on eggshells a lot, then maybe it's like I need to try not to. I'm still gonna do it. Like it's not gonna be 100% but I should try to be better about that.

[Dax Shepard]

All anyone's looking for in life and what is comforting and get you through all of it is if there's any sense that you're getting even fractionally better and you're committed to getting better, then there's like this ultimate tolerance for it.

[Monica Padman]

Yeah, exactly.

[Dax Shepard]

I think it's when someone's not going to change at all or it's getting worse.

[Monica Padman]

Sure. Yeah. And then I do think I will say something. I will say, I'm not speaking for all women.

[Dax Shepard]

Yeah, go ahead.

[Monica Padman]

Or all. Nope. Or all. Anyone who's emotional.

[Dax Shepard]

Yeah.

[Monica Padman]

But, or in touch with their feelings.

[Dax Shepard]

Oh, beautiful.

[Monica Padman]

Sometimes I'm like, yeah, it's over. Like we don't, it's fine. It was a bad day.

[Dax Shepard]

Yeah.

[Monica Padman]

And then it's come and go. Yeah. They come, they go. It's over. Over. Like sometimes as the person who has the strong emotions, then it's like, now they're upset because I was upset. It's like, can't it just be done now everyone's done. It's done.

[Dax Shepard]

Yes.

[Monica Padman]

Does that make sense?

[Dax Shepard]

Totally. It totally Makes sense. I was having kind of a funny thought, which was, when you meet your grandparents, they've already been through this whole thing. Right. So you meet them and you kind of think you're me meeting the original them. But, like, I think about my Papa Bob. He was so quiet sometimes.

[Monica Padman]

Yeah, yeah, yeah, yeah, yeah.

[Dax Shepard]

And I just kind of thought he was a quiet guy at times, but I now realize, like, I met him way into the game. This is his second time around with kids in the house and the whole thing. So it's like he. I don't even know. Who knows what my grandpa was like at 25.

[Monica Padman]

I know. It's true.

[Eric Topol]

Yeah.

[Dax Shepard]

He just learned to be quiet over time. I think that is the trajectory of all men if they're going to succeed.

[Monica Padman]

But. And to be fair, not to upset you.

[Dax Shepard]

Yeah.

[Monica Padman]

But sometimes there's walking on eggshells both ways.

[Dax Shepard]

With men or me? Just me.

[Monica Padman]

I'll say all men.

[Dax Shepard]

Okay.

[Monica Padman]

To be nice. Well, because we're just talking about the people we know.

[Dax Shepard]

Yeah. Yeah. You know, I have moved moods. They just. They show themselves. Their phenotype is different. It's just a different version. And I know a lot of guys that's like this. It just tends to. Again, we do the same thing. We get quiet. We isolate.

[Monica Padman]

Yeah.

[Dax Shepard]

And then we. We. What feels like is we abandon or we retreat.

[Monica Padman]

Right.

[Dax Shepard]

That's almost our version of being moody or. Or having big feelings is. I'll just. I'll remove myself from everyone.

[Monica Padman]

Right.

[Dax Shepard]

And I will soothe with something that's generally solitary. Like, I don't want to be around everyone when I'm depressed or in a mood.

[Monica Padman]

Yeah. I think more. I mean, for. For all men, it's more like there are areas you can't go. Like, with. With you. There are some areas you just can't go with you.

[Dax Shepard]

Sure. And Carly and I don't.

[Monica Padman]

I'm not gonna say anything. Don't trap me. Okay. But anyone in my family, there's, like, there's some scary areas with you that feel. That do feel a little eggshelly. Like, if we're getting into any of these remote topics, like, you really have to be really careful about what you say or, like, you're gone, ah, forever. And I. And so that's what's. That's funny. As a woman, I'm more sc. Like, that is more scary to me than, like, just strong, like, annoying emotions.

[Dax Shepard]

You guys are comfortable around each other having big emotions, and then we're. And then what's scared you guys is when we just vanish.

[Monica Padman]

Yeah, exactly.

[Dax Shepard]

Yeah.

[Monica Padman]

Anyway. Okay. So that's it.

[Dax Shepard]

That was it.

[Monica Padman]

Okay, well, that's it for this chat. Now let's move into facts.

[Dax Shepard]

Great. Stay tuned for more Armchair Expert if you dare.

[Eric Topol]

Oh.

[Monica Padman]

Cute.

[Dax Shepard]

Oh, I love him. Okay, my update is that he just did Dr. Mike's podcast a few days ago.

[Monica Padman]

Fun.

[Dax Shepard]

And Mike said to me, I saw the picture of you and Eric and it's the cutest picture ever.

[Monica Padman]

It's very cute. Very, very cute.

[Dax Shepard]

Oh my gosh. Yeah. I really wish he was my dad.

[Monica Padman]

Oh, wow.

[Dax Shepard]

I mean, I already have a dad, Tom Hansen, but yeah, sure. But just look how sweet. We could have so much fun lifting weights together, doing father son stuff.

[Monica Padman]

Yeah, I'm sure he'll come hang out with you anytime. If he's around.

[Dax Shepard]

If he's around. Yeah, he's busy now.

[Monica Padman]

He's in town. Yeah. Jackson, Eric Tople took a picture together.

[Dax Shepard]

Yeah. He had brought a sleeveless tea cuz he's been lifting.

[Monica Padman]

Yes.

[Dax Shepard]

Yes. And I said, you not only. Yes. Do I want to do that? Let me go grab a tank top.

[Monica Padman]

Yeah.

[Dax Shepard]

So I did a little wardrobe change and his daughter took the picture.

[Monica Padman]

Yeah. Really cute. Well, he's awesome. He definitely is more my speed.

[Dax Shepard]

Yeah.

[Monica Padman]

As far as approaches to longevity and taking being not as drastic of measures. And I just like him a lot. I used to reach out to him all the time as he brought up for fact checks.

[Dax Shepard]

Yes.

[Monica Padman]

To help me out.

[Dax Shepard]

And what happened? Did you just like, at some point did you go, like, I gotta stop bothering this guy?

[Monica Padman]

I think the truth is I started taking fact checking less seriously.

[Dax Shepard]

Oh, sure. Yeah, that makes sense.

[Monica Padman]

Like I was really asking for real. Like what? From a real expert. What is this? And now I just mainly rely on the Internet.

[Dax Shepard]

Yeah, yeah, yeah. So does everyone else.

[Monica Padman]

I mean, we've increased our laziness output. So I. Something's got to give. All right, now. Now he talked about Vio being pulled from the market, which he was spearheaded. Yeah. Which is incredible. And there's a NPR on this.

[Dax Shepard]

Oh, there is.

[Monica Padman]

It's called Merk Pulls. Oh, it's from 2004.

[Dax Shepard]

Wow.

[Monica Padman]

Merk pulls arthritis drug Vioxx from the market. Yeah. So this is when it was happening. Study confirmed earlier concerns that it raises the risk of heart problems, including heart attack and stroke. It was currently being used by 2 million people worldwide and had been used by more than 84 people around the world.

[Dax Shepard]

84 million.

[Monica Padman]

84 million. Sorry, only. Only 84. 84 million. So good for him for sounding the alarm.

[Dax Shepard]

I wish I could cite something right now, but I have run across numerous articles that talk about just the overall efficacy of the drugs that are passed by the fda. And it's abysmal. I mean, it's truly, truly abysmal. Yeah, we're talking like 20% of people will actually benefit from them, you know, really, really low. But I guess when the doctor prescribes me something, I think, like, well, this thing works. That's why they're prescribing it.

[Monica Padman]

Yeah.

[Dax Shepard]

And in their defense, no, they're going to try that. It might work. And then if it doesn't work, they're going to try another option.

[Monica Padman]

Exactly.

[Dax Shepard]

And they're just knocking out. But I think the general public thinks medicines do the thing they say they're going to at like 100%.

[Monica Padman]

Yeah. It's more of a process of elimination. You said that. Well, you said that men got AIDS over 9 to 1 in the 80s. In the 80s, yeah. I mean, yeah, it's. It's still quite vast, the difference. Let me see. In general, this is current, though.

[Dax Shepard]

This current. Yeah, it did. I'll admit. It changed in the 90s and it got.

[Monica Padman]

It's still pretty lopsided. Yeah. In general, men tend to get diagnosed with HIV more frequently than women, though this doesn't necessarily mean they're more at risk. Whatever. We know that. Okay. In 2022, men accounted for 81% of new HIV diagnoses in the United States, compared to 19% for women. It says. Whoa. It says, however, women are more susceptible to HIV infection than men, and male to female transmission is more likely than female to male.

[Dax Shepard]

Yeah, that almost doesn't happen.

[Monica Padman]

Women's genital tract is more susceptible to.

[Dax Shepard]

HIV than men's, as are men's rectums. So bottoms get it way more than tops. Get it?

[Monica Padman]

Lots of pores in there.

[Eric Topol]

Yeah.

[Dax Shepard]

Fissures, openings.

[Monica Padman]

Yeah.

[Dax Shepard]

Friction.

[Monica Padman]

That makes sense. But then that is. Why can't women. Why are women not, like, giving it to men via their vagina?

[Dax Shepard]

Well, because the receiver tends to get it more than the giver.

[Monica Padman]

Right. But if, like, if I got it.

[Dax Shepard]

Yeah.

[Monica Padman]

From a man.

[Dax Shepard]

Yep.

[Monica Padman]

And then I had sex with another man.

[Dax Shepard]

Yeah.

[Monica Padman]

I'd be surprised that it would be.

[Dax Shepard]

Harder for you to give it to him because he has far less. Less openness on his penis than you have in your vagina. And you have more fissures and openness in your rectum than a penis is going to have.

[Monica Padman]

It would only work if a woman's vagina could have Sex with the man's butt.

[Dax Shepard]

Then we would be apples to apples if men and women had sex anally to vagina. Vaginally.

[Monica Padman]

Picture it like.

[Dax Shepard]

Well, this just seems like making out.

[Monica Padman]

Yeah.

[Dax Shepard]

And a lot of like suction noises and stuff. Like a reverse scissor?

[Monica Padman]

Yeah, yeah, sort of.

[Dax Shepard]

I'd like to try it.

[Monica Padman]

I guess the butt though, it'd be really hard cuz the butt cheeks like to really get in there to Rob's point, you'd.

[Dax Shepard]

Have to really sideways scissor.

[Monica Padman]

Yeah.

[Eric Topol]

Yeah.

[Dax Shepard]

Who's that?

[Monica Padman]

I don't know. Chris. Mom? Hello, Lincoln.

[Dax Shepard]

No, come in.

[Monica Padman]

Were you running?

[Eric Topol]

Are you okay?

[Dax Shepard]

Oh, well, when you come, I don't see you and I hear.

[Monica Padman]

I did also think scary.

[Dax Shepard]

I'm assuming you've come in crying and someone just assaulted you.

[Delta Shepard]

Don't want what I came in here for because I was gonna tell you I did my bike ride ride for the first time this month. I'm very proud of myself.

[Monica Padman]

I wanted a hug as a rule.

[Dax Shepard]

Okay, I'm happy to give you.

[Monica Padman]

Where did you ride your bike?

[Delta Shepard]

But then isn't that on me? That the only time you guys see me out of breath is when.

[Dax Shepard]

No, no, it's double whammy. You came in to the podcast space, which you don't do often.

[Delta Shepard]

No, because I got back from my.

[Monica Padman]

Bike ride, I was so proud of.

[Delta Shepard]

Of myself on the verge of tears. I was like, I'm going to go get.

[Monica Padman]

Oh, see? All the verge of tears, in fact.

[Dax Shepard]

And you're.

[Monica Padman]

You are about to cry. Seems like maybe we were right the whole time.

[Dax Shepard]

Concerned with you.

[Monica Padman]

What you. Where'd you go?

[Delta Shepard]

I just went in the park.

[Dax Shepard]

The hilly park.

[Monica Padman]

There's only eight hills.

[Delta Shepard]

Ten if you take the two.

[Monica Padman]

That's too many money.

[Delta Shepard]

Look, it's a lot, but I haven't done it in like almost a month. And I was in a routine because you know, I just copy whatever he does. I'm so disappointed in myself. This whole month, like I just got off the wagon. I was so disappointed in myself.

[Monica Padman]

And then this morning I was like doing it.

[Delta Shepard]

I did it and I come back and I'm just filled with pride. Wow, that's exciting.

[Monica Padman]

Hold on. Good job, Mom. I haven't ridden my bike ever. You know, I don't know how. Ow.

[Dax Shepard]

Look at me. Look. Look at one of these cameras. Come over here and look at one of that camera.

[Delta Shepard]

Don't make her cry.

[Dax Shepard]

She's already crying.

[Monica Padman]

I know. I don't want anymore.

[Dax Shepard]

What's so cute is that you're proud of yourself and you're. And you're a little bit crying.

[Delta Shepard]

Let's normalize this because you can. You don't have to just have a, like a big emotion, big feelings when you're sad at yourself or ashamed of.

[Monica Padman]

Of yourself.

[Delta Shepard]

I truly am so proud of myself because when I do it, I can then get in a routine and I just feel better mentally and physically. And I came back and I was.

[Dax Shepard]

Like, you did it. You did it.

[Monica Padman]

That is something to buy a bit.

[Delta Shepard]

I feel really good. And then I thought, are they done? My second thought was, I don't care. My third thought was be polite and text Rob. My fourth thought was, I'm too impatient to wait for Rob's response. After like a nanosecond of waiting for him, I was like, well, he's not.

[Dax Shepard]

There, cuz you're Delta's mom.

[Delta Shepard]

Yeah. And then I thought, you know what? No, I mean, I love your podcast, but I love you guys more. I want to see my friends and I want to tell them that I'm really proud of myself.

[Dax Shepard]

Yeah, we're proud of you too.

[Monica Padman]

We're so proud of you.

[Dax Shepard]

It's hard. Those bike rides are hard. They're kind of the hardest worker too.

[Monica Padman]

Hard, right?

[Delta Shepard]

And it's also hard when you get out, like I said, out of the habit. They feel so unattainable, like unaccomplishable. It feels like you could have been like Everest. This bike ride.

[Monica Padman]

50. 50. Pretty much the same.

[Delta Shepard]

Yeah.

[Monica Padman]

Yeah.

[Delta Shepard]

But I didn't.

[Dax Shepard]

Good job.

[Delta Shepard]

Cause I have to work really late tonight and I wanted energy and the whole. I just went through a whole thing this morning of like, prepare yourself.

[Dax Shepard]

Nice.

[Monica Padman]

You did it.

[Delta Shepard]

That's where I am, guys. And then I also also thought on the way home, I mean, you can cut all this.

[Dax Shepard]

No, this is great actually. Cuz it's for Eric Topol and it's about longevity.

[Monica Padman]

Ding, ding, ding.

[Delta Shepard]

Doing it for you, Eric.

[Dax Shepard]

This feels now scripted, almost scripts. Scripts.

[Delta Shepard]

I. Are you going to come on Saturday to the meeting?

[Monica Padman]

No, I'm going home to visit my mom.

[Delta Shepard]

Oh, okay.

[Dax Shepard]

Tomorrow morning.

[Delta Shepard]

I'll take notes.

[Monica Padman]

Take notes. I did send in my proxy. Who?

[Delta Shepard]

Birdie?

[Monica Padman]

No, it's like, I wish. No, the little like form you have.

[Dax Shepard]

To fill, I filled it out too, in case we messed up.

[Delta Shepard]

I think that'd be really funny to send a kid as your proxy because one time when you were working, the girls had both of their like teacher school initiation meetings, like beginning of the year where they say like, what to Expect in first grade, but it was second in kindergarten. And I. They were at the same time. And I was like, okay. So I sent Lincoln to the kindergarten zoom. While I did Del Lincoln, zoom. And I said, you got to take notes. I still have the. They are absolutely unintelligible.

[Monica Padman]

You have to frame those. Oh my gosh. They don't make a lick of sense.

[Dax Shepard]

No, no. There's no way they can.

[Delta Shepard]

There's like no words in the letters. In the words.

[Dax Shepard]

What was the number that she said endlessly? Do you remember? She used to say a number over and over again. She wrote you a.

[Delta Shepard]

They used to think 60 was the highest number, but this was a Mother's Day card. You said back when she was really little, like three maybe.

[Dax Shepard]

Tell me what you want to say to mom and I'll write it.

[Delta Shepard]

And she said, Dear Mom, 8, 4, 9, 2, 7, 8. It started repeating 1, 8, 2, 5. It was like a. Probably three or four phone numbers combined. I was like, I don't know, 40 numbers. And then she stopped and pretty elegantly just wrote a Happy Mother's Day card. She said, I love you so much. You're the best mom ever. Happy Mother's Day.

[Dax Shepard]

But it was a.

[Monica Padman]

She had to get those wheels turning.

[Delta Shepard]

And he wrote it down verbatim.

[Monica Padman]

Oh my God, that's fantastic. We were discussing the play earlier, the two versions of the play.

[Delta Shepard]

Alice in Wonderland junior.

[Monica Padman]

Alice in Wonderland junior We were talking about. Because you're. I don't know if you know, you're a professional actress.

[Delta Shepard]

Okay, I've heard.

[Monica Padman]

Okay. And so when you watch the play.

[Delta Shepard]

Uh huh.

[Monica Padman]

What happens? Do you. Well, do you think I feel bad for the kids that are very highly committed, or do you not.

[Delta Shepard]

Definitely not feel bad for them? If anything, I'm a little impressed. It's sort of like, like how many disruptors can you have on set while maintaining what you know, you're there to do?

[Dax Shepard]

It's good training.

[Delta Shepard]

It's really good training because some of those kids are wholly and completely digging in their nose, having side conversations, just truly waving at their parents, truly wandering the stage.

[Monica Padman]

Yeah, yeah, yeah, yeah.

[Delta Shepard]

But then you have like the girl who played the Queen of Hearts.

[Monica Padman]

Yeah.

[Delta Shepard]

Who is giving 110 even during curtain call. She's Queen of Hearts.

[Monica Padman]

Yes. I, I don't think in the Cheshire.

[Dax Shepard]

Cat, I'm like, that kid definitely auditions. He's probably been on tv. You know, there's. Because we're in la, there's white rabbit. Oh, white rabbit.

[Delta Shepard]

Yeah, yeah, yeah, yeah.

[Dax Shepard]

The.

[Delta Shepard]

I get Excited if they've. This is stupid and I hate this, but I do. I do say it all the time on Sex. I think it's so stupid. But when you drop in, when you really drop in to character, you know, like, I'm here. I've dropped in. But, like, some of those kids are legit dropping in and they're feeling it. And pretend is so fun. I don't feel bad for anyone. The complete emotion I have around those plays is that it literally doesn't matter what anyone's doing. It doesn't matter the lines they're saying. It doesn't matter if their acting is good or even passable. What matters is that a group of people have come together to play pretend, and they're standing on a pedestal in front of the other people who have agreed to witness it. And there's something so magical about that. Doesn't matter if they restart the song. It doesn't matter if Delta gets handed a microphone and then yells at the stage manager about what she's supposed to do with it mid song.

[Monica Padman]

Funny.

[Delta Shepard]

None of it matters. What matters is the witnessing of it.

[Monica Padman]

That's. That's lovely. Do you feel that way about sports? It's like, if the kids are playing sports, is it the same? Like, oh, they're just like, it's fun and it's a beautiful thing. Or do you think we do more or care about the result?

[Delta Shepard]

Yeah, that's really weird. Cause I think I would answer it differently. I would like you to score a goal. If I'm watching it, I want you.

[Monica Padman]

To work a little harder at this.

[Delta Shepard]

But I'm not saying that's the right way to be or an evolved way to be. But if I'm being honest, yeah, I'm gonna root for you to score a goal, whereas when I'm sitting in the theater, I'm not rooting for you to hit that note. Whatever you hit's gonna be great. I'm so glad you're putting yourself out there. And it's probably healthiest to have that.

[Dax Shepard]

Well, I was telling Delta before the play, the night before, she's like, ne. And I said, you just. I just want you to hear from me. What impresses me is putting yourself out there. I do not care if you're good, if you remember your lines. What is admirable is putting yourself out there. And you will do that because you'll show up. So there's really nothing to be nervous about from my approval.

[Monica Padman]

Yeah. That's for sure.

[Eric Topol]

And I'm sincere about that.

[Monica Padman]

Yeah, yeah, yeah. Especially at that age.

[Dax Shepard]

Yeah.

[Delta Shepard]

Do you feel there's a difference in sports and theater?

[Monica Padman]

I am a double Virgo. What can I say? I can't. I do.

[Delta Shepard]

You're, like, two months away from learning gematria.

[Monica Padman]

What's that? Do you know?

[Delta Shepard]

That's not the.

[Monica Padman]

Like, what's dematri.

[Delta Shepard]

It's like, maybe a crazy person's calculator, where, like, letters mean numbers, and the numbers have significance, and if you spell someone's name and it equals, like, oh, meaning.

[Dax Shepard]

Like, it's a fringe astrology thing. It's an evolution of us.

[Delta Shepard]

You can, like, spell your name and, like, padman would mean false. And then I'd be like, you're sim. Like, it's. You are cusping into.

[Monica Padman]

I can't wait to learn it.

[Eric Topol]

Oh, my God.

[Monica Padman]

What a challenge. Yes. I think I take everything very seriously. So when I'm watching anything, I mean, I'm mainly just laughing because it was just so funny, but. But, yeah. So I am evaluating it. Like, oh, no, these people care a lot, and these people don't. And if I were them, I'd be like, why can't everyone just get their shit together and do this, you know, Care.

[Delta Shepard]

Yeah.

[Monica Padman]

And I would feel the same way.

[Delta Shepard]

About sports, but I think there's not a right. There's probably not a right and wrong way to witness things. It's like, what's the perspective, the lens you're looking through? You are, like, such a consummate professional and ambitious woman, like, to the letter of the law in a great way. It's like you're the one that. Like, that Argent puts in their suits to be like, this is a woman who will get stuff done. And it's. How would you be able to drop that whole facade and go and be like. Try to act like a preschool teacher when you're watching that. No. You're like, there's.

[Monica Padman]

Yeah. I'm like, commit, guys. Yeah. Yeah, I know. I know. But I do think your way of looking at it is. Is the correct way. I do think. I don't know.

[Dax Shepard]

I think it's just a way.

[Monica Padman]

Yeah.

[Delta Shepard]

Everyone's right.

[Monica Padman]

It's. It's a way. I would like to be doing it, I guess is the better way of saying it.

[Dax Shepard]

Solved. Settled.

[Delta Shepard]

All right, well, I love you.

[Dax Shepard]

Great. Great job. Great job. I'm very proud of you. Those.

[Eric Topol]

That.

[Dax Shepard]

That's the hardest workout.

[Delta Shepard]

Yeah.

[Monica Padman]

Agreed. Yeah. Sorry I wasn't patient, Rob.

[Eric Topol]

Sorry it wasn't qu.

[Monica Padman]

Okay, bye. We're almost done.

[Eric Topol]

Done.

[Monica Padman]

Love you guys. Love you. Okay, let's just wrap this up super quick. There's a fair amount of evidence to say that over 200 grams of protein or an excessive amount can lead to kidney issues and liver issues.

[Dax Shepard]

What's that from?

[Monica Padman]

Oh, medical news today is where this one is from. But there's a few. There's Harvard. One from Harvard. Hi, Health one from University of Missouri School of Medicine.

[Dax Shepard]

I will produce, I will cite the many articles that say it's great for you.

[Monica Padman]

Great. £13. You said there's £13 of microbes in a body. According to this national institute of health, two to six pounds of bacteria in a 200 pound adult because of their small size. But there are 39 trillion. All right, well, that's it for Eric Topol.

[Dax Shepard]

I love them out. We can't wait to do it again.

[Monica Padman]

Yeah, he'll be back for sure.

[Dax Shepard]

With probably more gains.

[Monica Padman]

More gains and he'll have aged reversely.

[Dax Shepard]

I hope he's bigger than me in the next photo. That would be incredible. He's gonna have to help his protein.

[Monica Padman]

Yeah, he's gonna have to reverse his position on protein, probably.

[Dax Shepard]

All right, love you.

[Monica Padman]

All right, love you.

[Dax Shepard]

Follow Armchair Expert on the Wondry app, Amazon Music or wherever you get your podcasts. You can listen to every episode of Armchair Expert early and ad free right now by joining Wondery plus in the Wondry Wondry app or on Apple Podcasts. Before you go, tell us about yourself by completing a short [e-mail] survey.