A (2:48)

Yeah, so there's many different examples of biohacking you can think about wearables like smartwatches, fitness trackers, continuous glucose monitors. And these are devices that will provide real time feedback on sleep, heart rate, your blood sugar levels. And it's important to understand that the biohack isn't the device itself, but it's how you use that data to change your behavior. And things like intermittent fasting that's actually a great example of a biohack. So for some people, intermittent fasting can improve insulin sensitivity and their metabolic health. But for some people, it can be counterproductive if they get obsessive over it or if they have a history of an eating disorder. And the intermittent fasting can backfire.

B (3:35)

So I guess it's unique to each person.

A (3:37)

And that's the whole thing with biohacking and longevity. It's really a branch of preventative medicine that takes advantage of personalized medicine and precision biomarkers to make medical decisions. So there's a big aspect of biohacking and longevity care that is very individualized and linked to the concept of precision medicine or understanding your own biology.

B (4:02)

So what does the science tell us about all this? What does work?

A (4:06)

So this is where I think the conversation is so interesting, because what really works in terms of the foundational behaviors are the things that people talk about all the time. Sleep, movement, nutrition, stress management, and the quality of our relationships. Biohacking in that sense really refers to the optimization and metrics of all of those. So tracking those, tweaking those, sometimes pushing our biology beyond its natural rhythms.

B (4:35)

Could you describe the longevity pyramid and how we should be thinking about our health and longevity?

A (4:40)

Yeah, sure. So this has actually been described in the literature of longevity medicine, where the foundation of the pyramid is really all of those evidence supported interventions that we know about that I just mentioned. And as you go up the pyramid, you get into the more cutting edge tools that might measure biological age that may help you predict your biological age. And at the way top of the pyramid is probably where you get into those experimental peptides and supplements.

B (5:11)

Yeah, speaking of peptides, you see a lot of discussion about them on social media. How do they relate to this conversation about biohacking?

A (5:18)

Yeah, so there are some therapies in the longevity world that are, you know, proven to reduce the risk of disease, things like metformin and GLP1 receptor agonists. But now there is starting to be this bifurcation in this field where there's what's medically proven like metformin and GLP1s and what is becoming very commercialized and the peptides are falling under this category. And these are proteins and supplements that are marketed to optimizers and biohackers as things that can help with anti aging, longevity and health span. A few of the marketed peptides include things like BPC157, Sermorelin and NAD boosters. And a lot of these lack rigorous human trials. But we have patients asking about them, influencers are talking about them on social media. So they're definitely coming up in clinical practice.

B (6:14)

Maybe we're all trying to be a little younger. Is there anything we can do to change that number?

A (6:18)

Yeah. So the things that we know that can impact your biological age are all of those things at the bottom of the pyramid. And those don't really seem like hacks because they take time and they're not shortcuts. So do we know that optim optimizing sleep will improve your biological age? Yes. Will increasing resistance training and strength training reduce your biological age? Yes. Cutting back on alcohol, managing your stress better, all of these things will help your biological age. But again, there's so many influences that say a 50 year old got their biological age down to 25, that doesn't become their destiny because there are still so many other factors such as genetics, environment. You know, you could get your biological age down to 25, but it's not your destiny.

B (7:08)

So I wonder, in your opinion, what is the difference between a biohack or just trying to live a healthy life?

A (7:12)

That's a great question. So the difference between a biohack and trying to live a healthy life probably comes down to framing and intensity. So living a healthy life focuses on the foundational behaviors that we've mentioned a few times, whereas biohacking often focuses on optimism and metrics. So that's where really the tracking, the tweaking, and something pushing the biology beyond natural rhythms falls. So that's where I would say, as you move up the pyramid that I described, you go from living a healthy life to versions of biohacking as you add intensity and add measurements and metrics to this framework.

B (7:54)

Well, I remember when I was using a fitness watch more and it was telling me kind of not great things about my sleep and it did encourage me to improve my sleep hygiene. So. But then at a certain point to your point, you get a little obsessive about it and I just felt like I was failing every day, so I put the watch away and just tried to do my best.

A (8:09)

Yeah, and I mean, there is such thing as these things causing more stress, which is then completely counterproductive. When obtaining wellness becomes stressful, it's no longer good for your longevity.

B (8:20)

Let's dive into some other biohacks. Cause I feel like some of this almost sounds like science fiction. What are nootropics? Is it just a fancy word for supplements?

A (8:29)

So nootropics, which are Nootropics. Nootropics. N O O T R O P I C S. Substances that are marketed to improve cognition. So these are things that could improve memory, focus, creativity, or even mental stamina.

B (8:46)

Are there any that you think are worthwhile?

A (8:48)

I mean, we all engage in a nootropic every day. Caffeine is one. So caffeine can help you focus, it gives you energy. Another one we're hearing a lot about is L theanine, which is an amino acid and it can be found in green tea matcha. And the reason people like it is it creates what people will say is a calm focus, whereas straight up caffeine might cause anxiety and make you feel overstimulated.

B (9:17)

Another biohack I've heard about, caffeine, and I wondered if it's true or not, is that you should wait a few hours after you wake up before having your first cup of coffee. And because it lets you more naturally wake up. Have you heard that? Is that a myth?

A (9:28)

There are some thoughts that by delaying your first caffeine consumption that you can sync that stimulant effect with your natural cortisol or the natural rise in your stress hormone. It's not really very practical for most people because we have to start our days. We get up, we have our coffee. Like for me, I start patients at 8:30. For me to say that 9 o' clock is my optimal coffee time would be quite difficult, even if perhaps it syncs with my rise in cortisol. So you really have to do what's practical for you. And I have heard that, but I wouldn't say that it's scientifically proven to be a biohack or better for you.

B (10:03)

Okay, I appreciate that. So another term I've heard, and I hope I don't pronounce this one wrong, is nutrigenomics.

A (10:09)

You got it right.

B (10:10)

Okay. And does that have something to do with optimizing how you eat with your genes?

A (10:15)

Yes. So nutrigenomics looks at how genes interact with nutrients and, and how individual genetic differences may influence how we metabolize food. The science here is early but very promising.

B (10:28)

I remember anecdotally hearing a friend years ago talking about how she got a blood test and now she and her husband were changing their diet and I was intrigued. So could you talk a little bit about what that means and how someone might approach this?

A (10:38)

Yeah. So some gene diet interactions are well established, but some commercial tests that exist out there may overstate what they can actually predict. So a really well known gene diet interaction is lactose intolerance. So if you test somebody's genes and you learn that they don't make a lot of the enzyme lactase, meaning that they don't metabolize lactose or milk sugar, well, the intervention is a reduced lactose or lactose free diet and that makes their guts feel better. So that is one of the well known nutrigenomic examples of one that is becoming interesting is there is a version of the APOE gene that if you have a defect in it, your cholesterol may go up more when you consume saturated fat. So those are two examples that we can like really grasp. But there are also many areas of nutrigenomics that aren't well developed yet. So these commercial tests that you can buy off the Internet and test all of your food tolerances or intolerances or genetic predispositions probably aren't quite there yet. But I'd say that the lactose intolerance example is a really good long term example of nutrigenomics.

B (11:59)

Is there any other promising science around this you'd want to speak to?

A (12:02)

Yeah, I think that probably gut microbiome testing falls under this category of understanding our intestinal bacteria and whether the pattern of the bacteria we have in our guts may influence our risk of disease and whether we can alter this. There's a species of bacteria called Akkermansia mucinophilia that is associated with better metabolic health. So people that have a high species of this one bacteria have less diabetes, less obesity. And this is something that has been seen over and over again in metabolically healthy people. But then and also in people who take medicines like metformin, like GLP1s, the percentage of mucinophilia in their guts goes up. So by altering your microbiome, perhaps this is biohacking. You're taking a medicine that is impacting your microbiome in a way that changes the bacteria to look like the gut of somebody that is metabolically healthier is an example of something that falls under this category. So then the question is, can you just take Akkermansia and change your gut? And I think that that's where the science is developing.

B (13:19)

Well, and so between this bacteria and these things in the gut and lactose Intolerance. How can people know more about their genes and genetic predispositions? Like what are legitimate ways to know and what's probably bunk?

A (13:31)

So there's many legitimate ways to know. They just sometimes are not the most accessible. We can get our genome sequenced. We can learn the entire sequence of our DNA in our body. The question is, under what conditions is that covered by insurance? When are you just medically curious and wanting to pay for this? And once you have the answer of your entire genome sequenced, who do you go to to discuss what you find? Because what if you find a genetic abnormality with no known clinical significance, are you going to be someone that's going to worry your whole life or worry your whole family that you could develop an unknown disease? So we have to really understand what the consequences of getting an abnormal result, more likely getting a result of unknown significance. And great, if you get all normal results that you have a completely normal genome, that's great. But, you know, most likely people are going to find abnormalities of unknown significance. And that's true for microbiomics, genomics. There is something now called metabolomics, which looks at metabolic biomarkers or proteomics, the proteins in your body. You can almost measure anything. Now the question is, what are you going to do with that information?

B (14:49)

Yeah, because it sounds like some of that information can feel terrifying. And it always makes you wonder how much is too much information.

A (14:55)

I think we're probably at the point where you can get more information than what you know what to do with clinically and what is actionable.

B (15:03)

Any other shortcuts to increasing one's longevity or health span?

A (15:06)

Shortcuts and biohacks kind of sound like they're the same, but there are no true shortcuts. I don't think you can take anything or supplement if you're not getting the sleep. Addressing your metabolic health, avoiding smoking, managing stress, avoiding social isolation, all of the things that negatively impact what we call cellular health. So these aren't things that just, you know, make you unhealthy looking from the outside. These are things that actually hurt your cells and hurt your mitochondria, which are like the powerhouse of our cells. We want to keep our mitochondria healthy, we want to keep producing energy so our brains and our muscles are functioning in a healthy way. And so in that sense, I'd say there are no true shortcuts. Once you've mastered the foundations, do you want to try to do even better and game that biological clock by trying the perfectly timed caffeine and L theanine and metformin. I think that those are all options if you have a good clinician to guide you through this.

B (16:07)

So it seems like the takeaway is that these are all really long term commitments and daily habits, behavior changes that people can make, not really shortcuts.

A (16:14)

I think the key is that our biology has evolved for rhythms and circadian patterns, not for constant optimization.

B (16:23)

Dr. Kumar, thank you so much for joining us. It was such a pleasure speaking with you about biohacking longevity. I feel like I learned so much to implement.

A (16:31)

This was such a fun conversation. Thank you for having me.

B (16:35)

Our Many thanks to Dr. Rekha Kumar. I'm Courtney Allison. To learn more about Dr. Kumar's work with patients, check out the show Notes. Join us next time on Health Matters when we discuss brain health and the short term and long term impacts of of alcohol on the Brain with Dr. Hugh Cahill. That's in two weeks right here on Health Matters. Health Matters is a production of New York Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests. New York Presbyterian is here to help you stay amazing at every stage of your life. To get the latest episodes of Health Matters, be sure to follow and subscribe on Apple Podcasts, Spotify or wherever you get podcasts.