← The Dan Buettner Podcast
The Dan Buettner Podcast
New Year Refresh: AI and the Future of Healthcare with Dr. David Agus
01:15:27
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- [00:01]
A
Hiya, Julia Louis Dreyfus here from the Wiser Than Me podcast. Among other things. And I've got a bit of a hot take. Our relationship to our food can feel disconnected. We don't always know how or where our food is grown. And if we throw food scraps in the garbage, we don't think about where it's going. Or at least we try not to. One way that I get back a little of that connection is by using my mill food recycler. Sure, Mill has totally changed my home life in a lot of practical ways. It works automatically. You can fill it for weeks. It never ever smells. But this is also really important. When I use mill, I'm participating in a circular system. All the food I don't eat is helping to grow the food that I do. It makes me feel like I'm part of something bigger. And that feels really, really, really good. And it's all so ridiculously easy. I just drop my scraps in my mill and it transforms them into nutrient rich grounds overnight. I have mine sent to a small farm, but if I wanted to, I could use them in my garden or for my backyard chickens if I wanted backyard chickens. And I don't know, maybe I do now, maybe I don't. Anyway, maybe mill is transforming me too, just a little. If you want to feel more connected or you just want your kitchen to feel less gross, try. Try Mill's risk free trial and just live with it for a while. Go to mill.comweiser for an exclusive offer.
- [01:37]
B
I've written several New York Times bestselling cookbooks on the blue zones and the number one question I get is this. What about when I don't have time to cook? That's why I launched Blue Zones Kitchen Ready to Eat Meals. We've now served over 3 million meals made with the same whole food principles I found in the world's longest lived communities. They're maniacally delicious. Find us in your local freezer aisle or@bluezoneskitchen.com Blue Zones eating even on your busiest days.
- [02:11]
C
Lemonade.
- [02:17]
B
Hello everyone and welcome back to the Dan Buettner podcast. Or perhaps welcome for the very first time. You know I just started this last season and it debuted number one in health and fitness. We got to as high as the top 25 of all podcasts in the world. So as we turn the calendar page into this new year, I want to invite you to join me for a focus and inspiring refresh. We're beginning to bring back some of the most impactful and actionable episodes we've ever produced. I put extra emphasis on actionable because if you're gonna spend time listening to me, I want you to take something back that's tangible, you can put to work in your life and evidence shows us it will add good years to that life. We wanna give you every tool you need to make this the best year yet. We're adding a bonus episode every Tuesday this January. You can expect our brand new interviews and insights on Thursdays. But now you'll get a powerful dose of Blue zone wisdom on Tuesdays too. These re release Tuesday episodes distill proven strategies gleaned from the longest lived people in the blue zones and from world experts throughout the world. All designed to help you build a better life. Not just through theory, but through small manageable steps. So listen every Tuesday and Thursday, take notes and most importantly, let's stop wishing and start doing in 2026.
- [03:45]
C
The world has changed. AI has changed everything. And it's wild. The United States, we spent a good fraction of our healthcare dollars, way over 60% in the last two years of life. I want to get back to dying of old age and to do it with dig here.
- [04:00]
B
You're telling us that our chances of Alzheimer's drop by 50%.
- [04:04]
C
It's pretty dramatic.
- [04:06]
B
So your recommendations. I can't wait to introduce you to our next guest. His name is Dr. David Agus. He's arguably the best doctor in the world. He's been the doctor to Steve Jobs and the Pope and Bill Clinton. He's actually been my doctor as well. But he more importantly runs an institute, the Ellison Medical Institute, which is this vast pool of expertise and AI and this podcast. You're probably going to want to get the transcript and be ready with the highlighter because it's full of such great knowledge, everything from how to pick the right doctor to should you be starting your day with a smoothie? To the newest AI in innovations that are coming, by the way, in the next three years that could actually lengthen your life expectancy by 10 years. So tune in, join us and grab your highlighter. You know, you are the doctor to all these legendary people, Steve Jobs and Larry Ellison and Bill Clinton and the Pope and you know, most illustriously, me lately. And first of all, how, how did that happen? But I guess more to, I think the point of this podcast, because we try to convey what we know to others. So instead of having to hire you as their doctor, they can just listen to this podcast. But what should we be looking for in a doctor if we want to live a long time.
- [05:35]
C
To me, health is a team, and you need a team on it. There's no one right way. Everybody always think, well, should I be doing this or that? It really depends on your value system. So you need a doctor who can have a discussion with you and make the decisions together with you based on your value system. And that's what's critical. Right. It's not a doctor to be a parent to say, hey, do this, and then I'll see you in three months. It's to have a relationship with. And so I'm privileged that, you know, in my life, I've been able to have some amazing people, some of whom are well known, many of whom are not where I can have a relationship with their healthcare. You know, I pinch myself every day that people put their health in my hands. And I said, oh, my gosh, this is amazing that they trust me for this. But we've been doing it for a long time, and like it or not, my. My business is pattern recognition. And so it's seeing all these things and saying, hey, this pattern I recognize here is going to be the outcome or here's gonna be the outcome. I can look on a paper and the statistics say, hey, the outcome will be X. But my gut. And I don't always know why, but my gut is right. Most of the time say, even though the paper says this, I actually think it's gonna be this. So everybody who comes with me with cancer, I look under the microscope at their cancer, and I get a gut. Hey, this is gonna be more aggressive than it says. And that almost no docs do today, which is. And I know it sounds morbid. You're gonna give me weird looks is. But I do autopsies on my patients when they pass away.
- [07:02]
B
Oh, wow.
- [07:03]
C
Because I want to know and I want a feedback loop. I thought that was scar tissue in the lung. That was cancer. Or that was an infection. They had some chest pain. Well, it wasn't a heart attack. It was bad reflux and they had an ulcer. So it enables me to get better and to learn. And while it may sound morbid, every single patient says, yes, I'd like you to. Because I want you to get better for the next person.
- [07:24]
B
Yes. Because you could have been wrong.
- [07:26]
C
And I am wrong many times, and I learned from it.
- [07:29]
B
Yes. And you get slightly righter each time. Well, I mean, I. I was so flattered. I was. I was in Spain and I got sick, and you had. You know, you were the Pope's doctor. And then you, we talked on the phone and, and you were instantly interested and you asked great questions and I could tell you cared. And you called me back and I go, jesus, Pope's doctor is calling me back. And, and I suspect that no matter who you are, you'll get that same sort of inquiry and, and followup from you.
- [08:03]
C
Well, I mean, I think what you were trying to say politely is that you were instantly a pain in the ass.
- [08:07]
B
Yes, yes. So listen, I want everything response I.
- [08:11]
C
Need, I want everything perfect. And I literally am a perfectionist on these things. And I can be a pain in the ass because many times, you know, people say, I don't want to take a medicine, it's a sign of weakness, I don't want to do that. Or, you know, I've got something scheduled tomorrow, so forget the test, I'll do it next week. And I've seen the bad outcomes and so I push where I really believe to make the better outcomes.
- [08:35]
B
You know, I'm working on a book now on the places around the world with the longest health spans. Not blue zones, but places where people live the longest, healthiest lives. And there's a place in Norway, and one of the insights we brought back was that they don't spend a lot of money on specialists. In fact, it's very hard to get a specialist here. We got a specialist for everything there. The focus is on the general practitioner, kind of the country doctor. And I looked at some research and found that one of the most important decisions, health decisions you can make, is picking a doctor who shares your values, who you can have for the long run. Doc, you're the same doctor for 30 years. Why would that be?
- [09:25]
C
Well, I think, listen, there are two parts. One is you want a doctor that can look at the whole, not just the part. So when you go to a specialist, they're looking at your heart, your GI tract, your brain, your lung. I want someone who can look at the whole. Right, because we're not reductionist creatures. We're a complex emergent system. So every time you treat one thing, it's going to affect everything else. So you want someone who's going to look at that big picture then. The second is that you look at yourself every day in the mirror. You get to know yourself. Your doctor has a transaction with you, and it really is a transaction once a year at most. And so in order for them to really get a sense of you, there needs to be that longitudinal follow up, you know, to understand your value systems, how you talk about things. I Have patients that are stoic and never complain. I have patients that complain all the time. And for me to understand what's serious, it really takes that relationship. And then I think the most important is you'll only trust me if you have a relationship with me. If I say to do something, well, you know, I'm better than most. I don't really need to do it. But if there's a level of trust there, then you'll do it. And compliance with that trust is how you get the best outcome.
- [10:37]
B
So get a doctor you can have for the long run and develop trust.
- [10:41]
C
Yeah, stay away from old doctors is.
- [10:42]
B
What I'm trying to say. So you not only learn from patients and autopsies, but you've learned recently from animals. And you have this new book, the Book of Animal Secrets. What do we learn from animals when it comes to longevity?
- [10:57]
C
You know, it's so freaking cool, right? I went on this trip with my family to Africa, and it's wild. Cause you see the way the world was, right? Where animals just roaming free. And we've all been on this earth a million years, humans and animals, and what can we learn from their system to basically for us to adopt or to basically cheat on to learn for our own health. And it's very interesting. So I went to the world's experts on different creatures, and I say, hey, you're the world's ant expert. What can I learn from you? And what's wild is that queen ant, for example, she will live about 40 years. Whereas the worker ant, same genetic. She gives birth to all of them. They'll live six months. So what's the difference in the lifestyle between the queen ant and the worker ant? Well, it turns out the worker ants are all taking risk, right? They go out of the hive. I mean, they go out of the ant colony and they go and they search for food and they make sure they're safe. They get exposed to infectious disease. What's interesting.
- [11:58]
B
And anteaters.
- [11:59]
C
Yes, and anteaters too. If they get sick, they basically will stay outside the colony for two or three days. If they get better, they come back. If they don't, they die. And they've learned that the colony is more important than the individual. And it's an amazing lesson.
- [12:15]
B
What a great piece of insight.
- [12:16]
C
If they get injured, right? This the world's ant expert. I said, what's the wildest lesson you learned? He goes, it was actually horrible. I was driving to my ant colony. I've been studied in Africa, and I was away from my Family and I felt so guilty. And on the way to the ant colony, I got a call from my son and he broke his leg playing soccer. And I was just aghast. And I ran over my colony. I go, what? He goes, I've been studying it for years. And I ran over the colony, he goes, but I made my greatest discovery that when an ant is injured, if there are two or more legs injured, they let them die on the battlefield. But if it's fewer, then they lick the wound, they bring them back and they have about a 93% survival. Wow. In the saliva is some anti infectives and they have a triage system where they put the resources to the ones who will get better. And it was a staggering lesson if you think about it.
- [13:07]
B
Yeah, I suppose there's some lessons in our healthcare system and who you can save and who you probably can't. And what.
- [13:13]
C
Listen, the United States, we spend a good fraction of our healthcare dollars, way over 60% in the last two years of life and we spend almost none in those first three or four or five decades. We need to focus our shift to prevention rather than just treating. In the United States, there's kind of a Magic Age of 83 where if you reach that age in most hospitals, they don't put you on a ventilator, they don't do these crazy heroic things, they let you die. Where the last time you could do this in the United States legally was in the 1960s with a cause of death on a death certificate of being old age. They always want a cause, right?
- [13:51]
B
Yeah, yeah, yeah.
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C
You know, they died of lung cancer, of heart disease, whatever. I want to get back to dying of old age and to do it with dignity.
- [13:59]
B
Well, you know, we, we, we like to think that we can live to 120, but, but the ceiling right now, the capacity of the human machine, if you do everything right, it's probably mid-90s. We. Unless you, you're going to tell us something today we don't already know, but getting past 100 right now, you have to have won the, the, the genetic lottery.
- [14:24]
C
So I totally agree, but I think the world has changed. And six months ago we had this interview. I would say you're right. Kind of the max of our engineering is kind of the mid to late 90s. But AI has changed everything. You know, I made a drug for breast cancer that's now on the market. It took 10 years to make and to show it worked in cells, then seven years to test in humans. In the last six months, I've been able to make four drugs. Wow. And so it's wild, right? I could say, hey, here's the molecule I want to bind to. I want it to bind right here. And I could design something that does. Then I say, here's every other protein in the human body. I don't want it to bind to those. Here's the immune system, how it works and how it recognizes things. I don't want this to be recognized as foreign. And here's the metabolism, genes that want it to last X long in the blood and it can do that. I could build in these constraints and I can make drugs, which means all the dreams of if I could turn this off or on, I want to do it to help us have longer health span. I can now do that. And it's wild. Absolutely wild.
- [15:34]
B
So you're saying the pace of discovery is faster.
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C
The pace of discovery and then also the insight. Right. A group of young people, and it's horrible because they're all 20 year olds and it's just inappropriate that AI is dominated by this generation of kids 20 to 30 years old. But what they did was they took this bag of words, which is electronic health records. Right? That's what they are. I would type in words and. And they converted it to structured data with large language models. And they started to look. And one of the things that popped out, for example, was like the shingles vaccine reduced Alzheimer's by close to 50%.
- [16:11]
B
Wow.
- [16:12]
C
So all of a sudden, for decades and hundreds of billions of dollars, we were wrong. Right. Well, these plaques, they lead to Alzheimer's. They do. But we didn't realize that plaques could have been an immune response to a virus that affects neurons like shingles does. And it yielded the plaque. So you hit that virus before it affects those neurons. What do you know? You could prevent shingles. And there probably will be several other viruses associated. Right now we know 100% of multiple sclerosis is from a virus.
- [16:42]
B
I just want to stop there on one thing, because a lot of people out there don't believe in vaccinations. And they.
- [16:48]
C
I know, it became a religion. It's kind of wild.
- [16:50]
B
And they think about all these sort of bizarre kind of side effects of it. But here you're telling us that if we get the shingles vaccination, which is often recommended to older people. Two shots and I've done them.
- [17:05]
C
I love this. Older people, people over 50. That ain't older. Come on.
- [17:09]
B
I meant older than us even.
- [17:11]
C
Yes.
- [17:12]
B
But not only might we not endure symptoms as Bad as we would if we. If we got shingles again, which often happens in older age, but our chances of Alzheimer's drop by 50%.
- [17:25]
C
It's pretty dramatic, right? This is a vaccine that's already on the market, that's FDA approved for everybody over the age of 50. Yet probably less than 10% of people in the country who are eligible actually get it. Shingles hits a good portion of the US Population in some time. You know, we all have. It's chickenpox come back. We all have chickenpox inside our neurons. And when you get stressed, cortisol goes up, your immune system goes down because it's saving energy for, you know, flight to flee a lion. And then what can happen is that virus can come back and you can get shingles. Well, you block that pretty easily with this vaccine and at the same time, a dramatic effect on Alzheimer's.
- [18:05]
B
So your recommendation is get the shingles vaccine.
- [18:08]
C
My recommendation before this was get the shingles vaccine. Now with this new data, it's damn. Get that shingles vaccine. Yes.
- [18:16]
B
Talk a little bit more about, about animals. Any other insights from your. Your book of animal secrets that you. That really stood out?
- [18:26]
C
You know, there are lots. You know, the elephant, you know, when I first saw the elephant, the guide, you know, whoever, these very wise people who've been in, you know, Africa for years, I looked at him and goes, you know, listen, they're so big with so many cells, they miss, get lots of cancer. He looked at me, goes, elephants never get cancer. I go, how could that be? They're so large. Every time a cell divides, there's a chance for error, and that error can lead to cancer. He goes, but no. And so it turns out a remarkable. Researchers looked at elephants and a gene called p53 that corrects error in the genome, mainly from inflammation. When you and I have one copy of that gene, every elephant on every continent has 20 copies of that gene. So all of a sudden, here's a way that if we can recapitulate, we can prevent cancer. You say, why? Well, elephant females give birth into their late 60s. The dominant male protects the herd until the day he dies. So they couldn't afford to get cancer. By the time we hit our 30s, you know, we've had our children, which is what evolution is protecting for. So there really was no reason to protect us. In fact, if we got knocked off with cancer or heart disease, it left more food and housing for the next generation. So all of a sudden, again, here's some insight. Block inflammation that can lead to this DNA damage. We're not going to amplify P53 just yet without new drugs that don't exist. But we can block that inflammation, which is the root of much of cancer, much of heart disease, and much of Alzheimer's. And there are lots of simple ways to do that in our lifestyle.
- [20:01]
B
Valentine's Day gets lots of attention for grand gestures, but what I've learned from the blue zones is that love lasts longest when it's woven into everyday life. In places where people live the longest, relationships aren't rushed or performative. Couples walk together, they cook together, they sit at the table and actually talk. That steady connection day after day turns out to be one of the strongest predictors of happiness and health. We know when I'm at my lake house in Wisconsin, that's what love looks like to me. A quiet morning walk, a simple meal made together, an evening spent playing cards or sharing stories without anywhere else to be. When I'm traveling, I like knowing my home can still be a place for that kind of connection. Hosting it on Airbnb lets other couples slow down, reconnect, and enjoy the time together in a way that really matters. Hosting fits naturally into my life. It's simple, meaningful, and it keeps those moments of connections going even when I'm away. Your home might be worth more than you think. Find out howmuch@airbnb.com host there's so many questions here, but the question I'm going to go with is this. So you, you were talking about AI being able to produce drugs that, that, that could perhaps cure or prevent breast cancer. And there's sort of one branch of, of longevity in avoiding the diseases that foreshorten our lives. Cardiovascular disease, number one, type 2 diabetes, cancer, dementia. But then there's a sort of fundamental mechanisms of aging that you pointed out. Like every seven years or so, our cells reproduce themselves and there's a doubling of damage. And, you know, by the time you're, you're in your 70s or 80s, you're, you're not only old or older, but you're getting older exponentially faster because you have so much built up damage doubling every seven years. Is there anything that, that shows promise at addressing that fundamental, you know, doubling of damage as we get older?
- [22:23]
C
So there was a remarkable scientist who in the 1950s, published her only paper, and then she left science. Her name was Wanda Ruth Lunsford. And what she did was she took an old rat and a young rat and she put them to sleep and she tied their skin together so Their blood supplies joined. So after about a week or two, what you started to see in the old rat is the gray hairs turn brown again, the heart beat stronger. There were new neurons growing in the brain. She claimed she reversed aging and they kicked her out of science.
- [22:52]
B
Well, it turns out, Frankensteinian it is.
- [22:56]
C
But Wanda's experiment was repeated at Harvard, at UCSF and Stanford several years ago, and it worked. And what people were able to show is that at age 25, our stem cells go to sleep. They're still in our body, but they're sound asleep. So there now are ways of potentially turning them back on. So there's a cream, for example, which you could run on the scalp, rub on the scalp, and your hair grows back its original color. So if I do it on my cheek, no hair grows because there are no hair stem cells here. They're over here. And there's trials in the ear.
- [23:30]
B
Does your hair grow back, too?
- [23:32]
C
Grows back the original color.
- [23:34]
B
How come that isn't, you know, it's.
- [23:36]
C
In clinical trials right now.
- [23:37]
B
Oh, my God.
- [23:38]
C
They're, you know, they're trying to activate stem cells in the elderly that broke their hip and people with Alzheimer's and dementia. And so it's difficult, these proteins. But as with AI now, we could start to make ways of stimulating them and turning it on in various locations, not everywhere, but in where they're needed. So I do think we're going to be at a point that we can actually reverse many of the maladies of aging and what you're calling healthspan, we can enable that. Right? You don't want to live until 115 unless it's quality year. That's right. And so I really think, and this is, you know, I think if we can, all of us stay healthy the next two to three years, we could probably add on 10 to 15 years on our life. For what's happening now with AI, just.
- [24:20]
B
Two to three years. Stay healthy, get on the Blue Zones diet.
- [24:24]
C
Oh, exactly.
- [24:24]
B
I mean, it really is amazing here when the. When the innovation gets here, that can give us the next big leap.
- [24:30]
C
Well, think about it. What the blue zones is, is you had this pattern recognition by going out and saying, hey, this part of the world, somebody does better than here. Why is that? Why is the group of people and you notice these patterns that were different. The beauty of what AI is it takes the human brain and it could see patterns much better than we can, and it could look at vastly more data to see those patterns. So if you were able to find the blue Zones with your brain. You can imagine your brain times a thousand, which is what these GPU clusters are.
- [25:03]
B
Sounds like a dumpster fire times a thousand. You know, you're probably more at the center of these innovations than anybody else. And it's the Ellison Medical Institute, I'm guessing that is sort of your main hub of insight and innovation.
- [25:24]
C
Yeah, so I run the Ellison Medical Institute, which is a standalone institute. It's affiliated with University of Southern California, and we also have an affiliation with our sister organization at University of Oxford, where we have researchers who can apply technology to health and we can push aggressively to try to make sure we can all benefit from this.
- [25:43]
B
Today I was scrolling through all of the. A lot of these institutes you hear about. It's a grand name and there's like three people behind it. And I was scrolling pages and pages of who are all these people who are in this institute?
- [26:00]
C
It's amazing people. You know, it started because I had breakfast with Larry Ellison once, and I said. He said, what's your dream? I said, my dream is to have a place where engineers, mathematicians, physicists can all work together with cancer doctors, biologists, and people looking at longevity in every different field and put their insights together. Because we all think differently. You know, a mathematician approaches a problem. Yeah, different than a physicist. Very different than a biologist. Very different than a doctor. Put them all together to try to make insight on disease. And he said, how much will it cost to build this? I said, I made up a number. He goes, let's do it. And we did it. And we have this institute now. We have remarkable people from all different disciplines working together to try to make a difference in health. Many of them are full time, where they've left, what they did. Murray Gelman, who we talked about briefly before one of the greatest living physicists, discovered the quark in string theory, won the Nobel Prize in 1969 when I was four. He started to work in the last seven years of his life with us on cancer. He used to look at me and say, listen, the problem with your field. I go, what do you mean, my field? He goes, with doctors is you always look at the average. You have to look at the outliers.
- [27:10]
B
Oh, interesting, right?
- [27:11]
C
When you look at the outliers, that's how in physics, we learned all of our rules, right? We think all of the electrons should be here, but there's one over here. Why did that get over here when you look at the outliers? Then he said, listen, you're really fans of data. I go, yeah, data Is everything. He goes, the problem with data is that most of the time it's too much, especially for the human brain. What you need to do is coarse grain things. When you were sick, your mother didn't draw your blood and look at your T cells and measure your cytokines. She went like this. Right. This is a coarse grained measurement of biology.
- [27:44]
B
Yeah. For those of you who can't see, David, he's putting his hand on his forehead to test fever.
- [27:50]
C
No, because it comes from the, you know, photography course Granting.
- [27:52]
B
Right.
- [27:53]
C
You make the lens of a camera blurry and I see the outline. You're a human. If I measure every pore on your face, every hair, every aspect of you, it would take a long time to figure out what it represents.
- [28:03]
B
Yeah.
- [28:03]
C
The climate models look at the shape of the cloud and it tells them the weather. They don't go up and measure 600 variables. That shape of the cloud tells them everything. It's a coarse grained element. So we need to start to coarse grain things in biology and then do our modeling like the physics do. And it kind of changed my view of looking at health and disease. He was amazing.
- [28:25]
B
So you have all of these experts, physicists and mathematicians and physicians. How do you organize them so it's not completely chaos? How do you create collaboration rather than silos, rather than.
- [28:41]
C
We do it. One simple way is that we have the clinic in the middle of the labs.
- [28:46]
B
Oh, interesting.
- [28:47]
C
And so a patient comes in and everybody meets the patients. And so it gets organized around a problem. Right. I don't want to work on something that's going to solve something 10, 20, 30 years out. People should. I believe in basic science, but I'm working on things where I can get an answer next year. We don't have a strategic plan for the next decade. We have a strategic plan for today. And it really goes around solving problems. And so patients come in, you know, their cases, whether it be a cancer, heart disease, Alzheimer's. I want all the research there looking at how we make our decisions and then saying, how can I bring in a technology or some data way where we can actually make that done better?
- [29:29]
B
So can anybody come to the Ellison Medical Institute?
- [29:32]
C
Yeah, I mean, listen, patients come all the time. Obviously there's more demand than supply, which is part of the reason we write books and we talk to people like you is to get word out there about things. But our job is not just to treat disease, it's to change how we treat disease.
- [29:48]
B
And what type of patients can you be most effective with we have a.
- [29:53]
C
Large clinic on preventive medicine and we have a cancer clinic. And so those are the two areas that we really put most of our energy to.
- [30:01]
B
So I, I love hearing prevention. I'm a big fan of prevention. I think it's the.
- [30:05]
C
You're pro prevention? Yes.
- [30:07]
B
I guess that's, I guess the point of this podcast actually. But you know, we spend something like 3% of our 5 trillion dollar healthcare budget on prevention because we have a healthcare system where that actually incense for sickness and then gets paid to mitigate. But you're saying that you help prevent disease. How do you do it in a clinic?
- [30:30]
C
So it's interesting, our healthcare system now, you know, the problem is a lot of times is with prevention, if I do something today, it's going to help you in a decade or two decades.
- [30:38]
B
Right, right.
- [30:39]
C
And then there's nothing to course correct along the way. Right. You know, what you want is something where I can make an intervention, I can look at the data, make a corrector, if you will, and have you get a little bit straighter and then straighter and straighter and get to where I need to. And I really believe now with all the collection of data we're going to do with AI, we're going to be able to do that. And so what we do now is that we do studies. Right. If you're a 60 year old and you have an elevated cholesterol level, the first thing I want to do is I want to look inside your heart arteries and say, is there plaque there? If there's plaque there, I want to get very aggressive to stop it so it doesn't cause a problem. If there's not, I can be less aggressive in how I do things. Right. And by the way, if I show the patient, hey, there's plaque there, they're gonna be compliant. They're gonna, you know, listen to what I say and they're gonna understand why they're doing it. If I say this number is elevated, yeah, I don't really need to take it. And by the way, the day before you come in, you always take your medicine and these cholesterol medicines, they work in a day. So you go, hey, listen, I only took it 20 of the last 30 days. And he said my numbers are great. So next month I'll do 10 days. And you're always doing it the day before. So I'm always patting you on the back, not realizing that 20 days of the month you're not doing it. And so when you realize what's going on with Yourself, when you have that inner knowledge of what's happening, you do the right thing. And so I wear these biometric devices and I'm able to look and say, hey, I got good sleep last night. What did I do during the day? Because I want to recapitulate that tomorrow so I can get a good night's sleep tomorrow. Or I didn't get a good night's sleep. Why? And so I have a feedback loop. And the key is to get that feedback loop sleep.
- [32:18]
B
It's, it's a lot easier to convince a six year old with plaque to do something than it is to convince a 20 year old who's eating cheeseburgers and drinking Coke and, and Doritos and not getting very good sleep because they wake up the next day and they, you know, they feel fine. I think the, the biggest problem with prevention is you have to do it for decades to work and you have to remember to do it or find the discipline or find the, the presence of mind. Do any of the interventions you do, I mean, do you actually catch people when they're still healthy and have a protocol for them so they're not showing up in your office at 60 with plaque in their arteries?
- [33:03]
C
So it's interesting, you know, I don't believe in protocols. I believe in education. So in order to get normative behavior change, you need leadership. And one of the things sorely lacking in our field in health is leadership. If I ask you who the Surgeon General is, nobody really knows. They roll their eyes. Right. And who are health leaders? Health and food are 25% of our economy, yet we have no leadership in those spaces. So one of the Silicon Valley companies had me come in and they say, hey, help us with the diet of our employees. So I did the brilliant stupid thing, which is I had the burgers subsidized by the salad. There was revolt. Everybody was pissed off. I love it. Then a couple weeks later, I did something very simple. As I wrote next to each food, a little thing about the good and the bad. Because there's no perfect food and there's no horrible food, everything has something, with a few exceptions.
- [33:51]
B
You mean Skittles?
- [33:52]
C
Skittles, Doritos, A little bit, but most things. And so just by educating people, not telling them what to do, they actually started to make the right decisions.
- [34:01]
B
I love it.
- [34:02]
C
And so we have to get away from the medicine about do this and do that and just educating of the why.
- [34:08]
B
I love the behavioral economics too, where you, you make the, this healthy salad cheaper and charge a little Bit more for the burger.
- [34:16]
C
Listen, there are countries out there that say, hey listen, you're allowed to skip your colonoscopy, but if you have colon cancer, you pay a $68,000 surcharge before we'll treat you. You're welcome to, what country is that? Singapore. You're welcome to smoke, but will you play a 70 plus thousand dollars surcharge before we'll treat your lung cancer? You know, you have to take ramifications for your behavior. In the United States we say do whatever you want and then the healthcare system will pay for the ramifications of your behavior.
- [34:43]
B
That's such a mistake.
- [34:44]
C
That makes no sense. Right? You know, why should the non smokers be subsidizing the smokers? Why should the people who exercise be subsidizing the people who don't? We all need to take responsibility in that respect. We can get a better outcome. You know, Michael Dell had an amazing thing at Dell. We started to say, hey listen, if you're overweight, I'm going to charge you 2.4 times your health insurance cost because that's what it costs us if you smoke 3X. And then there was a revolt at the company, people got pissed off. Then he changed it and same economics, but he gave a discount to the non smokers and a discount to the people who were not obese. And people didn't object. So it's very interesting. The carrot and the stick. The day you went into the smoking cessation program, your health insurance premium changed.
- [35:28]
B
I love that.
- [35:29]
C
So to realize that we're all in charge of our own outcomes and that society doesn't have an obligation for basically enabling us to do the wrong thing.
- [35:39]
B
So great, great answer. And for smoking and obesity, everybody will agree that smoking is bad for you and being, you know, too overweight is bad for you. But when it comes especially to diet, it gets a little bit gray. I, I, you know, I recently spoke to Dr. Dean Ornish, who is a good friend of mine, and I asked him what is the, the diet of longevity, the diet that will keep your heart healthiest? And he said vegan. Vegan and low oil. So you can't eat any animal products. No ultra processed food. And then a few days later I was talking to Dr. Agustin who wrote the south beach diet. And I said, what is the diet of heart health that'll keep me living the longest? And he said, grass fed beef and eggs. And here are the two top doctor experts in the world, the people who are educating us, telling me polar opposite things. What should we be doing when for when it comes to food, if we want to live the longest, this is the problem, right?
- [36:42]
C
Everybody's selling something, right? I'm selling my ideas. You know, I believe in this. Therefore, unless you do this, you've screwed up. And so the key is to look at the data, right? And almost every single clinical trial done. The Mediterranean diet, which you, you know, or espouse, has one in everything. And it's moderation, right? Anything to an extreme doesn't make a lot of sense. You have to look at what we did during evolution, right? We ate real foods, so not processed foods. Nothing in a blender, nothing with ingredients that stabilize the fat or can enable shelf life. We ate real fresh food, we had good fats, we had our mealtimes regular, right? We would make a kill in the wild and then have the group as a family. We all have family meals and we had the leftover in the morning. We didn't have a kitchen cabinet where we ate food all day. So no grazing. Choose. I'm a two meal a day guy or two meal a day girl and three meal a day stick to it with nothing in between. And every meal needs to have protein and fat as well as carbohydrates. And it's very simple like that. You can be a vegan and be remarkably healthy, but it's tough to get enough protein and fat. You have to be very smart. It's a lot easier to eat a Mediterranean diet, but they both will do it. And with both of them, you can achieve a healthy outcome at the same time, right? Evolution didn't select out for who lived till 110. It selected out for who had good children. So if you want to live till 90s, 100, you have to sometimes tweak. And that tweaking means looking at some blood factors. Is inflammation high? Is LDL that bad, cholesterol high? Is that good, cholesterol too low? And there are ways to change all of them to enable you to prevent disease.
- [38:26]
B
So let's coarse grain diet by asking you what you, what you eat, what, what's you. I mean, you're incredibly sharp and you look great. We know how old you are. What's your, how did, what do you eat every day?
- [38:40]
C
So I'm very simple, right? In the morning, you know, I have, you know, heart healthy eggs. I have, you know, some hard cheese, I have some avocado, you know, and that's what I have along with a cup or two of coffee every morning. Lunch, I have salad with some protein and Dinner, I kind of alternate, you know, a cold water fish, chicken. I have grass fed beef once a week and I have a glass of wine a couple nights a week. I eat nothing in between meals. I try not to snack. I exercise every morning. Alternating between, you know, stretching, pattern recognition, things like tennis, weightlifting occasionally, but really try to do things where I push, stop, push, stop. Which is why tennis is really associated with longevity because it's not pushing, pushing, pushing like you do on your thousand mile bike rides.
- [39:29]
B
They were all downhill. But I'll have to say about your diet. There not a lot of plants in there. You mentioned a salad, but not much fiber other than that.
- [39:38]
C
Oh yeah, I mean, so at dinner it's, you know, again, when I say I have cold water fish, it's a small portion of fish and a very large portion.
- [39:45]
B
You better tell us what cold water fish is.
- [39:47]
C
So you know what's very interesting is that it's the, the oils that enable a fish to live in cold water that have a benefit for us as humans. And so people try to replicate it all the time and sell you a pill. Here's the fish oil. You know, 14 ounce serving of salmon is equivalent to 9 to 11 fish oil capsules. And if you have a beautiful fish, you sell it to the fish, you know, company Santa Monica Seafood in la or who's ever selling the fish. And if you have an ugly looking degraded fish, you give it to the fish oil company company. So eat that real food. So yes, I have, along with that source of protein, I have, you know, whatever is in season or flash frozen vegetables that night.
- [40:26]
B
And the salmon, is it okay to be farmed or is it wild?
- [40:30]
C
You know, it's the oils that allow a fish to live in cold water. And so the problem with most farm salmon is it's done very near the shore where it's warmer waters and it's in confined area. So there's much higher concentrations of nitrogen. So I try to restrict to wild salmon. Even if it's flash frozen, it's a lot better. Better than something fresh that's farm raised.
- [40:50]
B
You, you told me. And, but you talk a lot about inflammation and I think it's something that people only vaguely understand. What is it? And, and why is it so important to avoid inflammation? Then finally I would ask you how to avoid it.
- [41:08]
C
So when you start to look, you know, when you skin your elbow, you know, it turns red and it hurts. That's inflammation, right? And that inflammation stays there until it's healed. Well, you can imagine inside your blood Vessels, if inflammation there, right? What happens when you get inflammation in your elbow? You get a scab, you get inflammation inside your blood vessels, it can lead to a scab, too. And that scab can lead to a heart attack, a stroke, and other things. And what we also know is that any organ where there's inflammation, there is extreme cell turnover, and there's a dramatically higher rate of cancer. So people with inflammation of the colon, for example, much higher rates of colon cancer. You smoke and get inflammation in your lungs, you have a much higher rate of lung cancer. People who get burns and inflammation on their skin have higher rates of skin cancer. So what we know is organs with inflammation, a decade or so from now will have much higher rates of cancer. So the key is try to keep our inflammation in check. And so lots of sources of inflammation in our body, whether it be our blood vessels, individual organs, muscles, other things, you want to keep them in check.
- [42:17]
B
So we, we get inflammation from infections, but we also get it from being stressed out. We also get it, by the way, from working out too hard. People don't realize you, you know, you go run 10 miles today, tomorrow, when you feel achy, that's inflammation.
- [42:36]
C
Yeah. And you know, with inflammation, right, Your body takes a lot of energy to repair. And, you know, it's basically, you know, you also, with all those cells turning over, every time that cell turns over is a chance of a mutation and getting cancer or other things. And so you want your body to not have that inflammation and be able to put its energy to really good things and productivity, which we all do. So how do we keep inflammation down? Well, we watch our activities. Right. You don't want to do sports and things that have tremendous inflammation. Right. You get inflammation in the brain. Concussions. You know, football players have rather short life expectancy, one of the shortest of any profession because they keep beating their body up and especially their brain. You want to certainly limit that. You want to make sure that you have a diet that doesn't promote inflammation. You want to make sure that there are inflammation.
- [43:27]
B
Wait, what diet promotes inflammation?
- [43:29]
C
The easiest way to keep inflammation down is to fast in between meals, Right? The hormones that promote inflammation are stress hormones.
- [43:38]
B
You better say, you and I know what fast between meals mean, but what does it mean to somebody listening out there?
- [43:45]
C
So it's kind of wild, right? Everyone says, well, listen, I fast in between meals. I only have healthy food in between meals, I only eat almonds or I only have an apple. But what happens is, if you have.
- [43:55]
B
That apple between every meal, I fast an hour.
- [43:58]
C
If you have that apple in between lunch and dinner today, tomorrow your body's insulin cortisol goes up, which are the stress hormones, and they stay up basically until you eat dinner, where they'll come down again. And that really affects the body. So the key is that when you have your breakfast, you stop and you eat nothing, nada, till lunchtime. Or if you're a two meal a day person until dinner time, both of which are fine. You just got to be regular and saying, I'm a two meal a day person or a three and then stick to it. So nothing in between.
- [44:29]
B
What's the optimal eating pattern in your opinion?
- [44:32]
C
I honestly don't know. Nobody has done a randomized trial. You know, all of the trials looking at intermittent fasting and things like that show no benefit to a standard diet where you're not eating in between meals. The key really is the no snacking. What we do know, for example, is that if ball players change one time zone, so shift their meal by an hour or two, it affects their performance both athletically and also thinking cognitive function.
- [44:58]
B
Wow.
- [44:58]
C
So really try to stick to the same time every day for your meals. Your body strives for regularity. We used to have it by the sun, right. We would eat our dinner every night, you know, when the sun would set. And so there'd be slight changes, but it'd be very slight. Now we just do it whenever we want. While Jim's in town, I'm going to eat late. You know, I got home early and even early today. Try to stick to a regular schedule.
- [45:23]
B
So this business about trying not to eat for 12 or 14 hours between your last meal of the day before and the first meal of today that you're not a big believer in that.
- [45:33]
C
Well, there's no real data that there's a benefit there. There's a real data. If you're going to do it and just, you know, be regular with your meals, that's fine. But if you say, listen, I'm going to have 14 hours between my last meal and my first meal and, and then I'm going to eat for that whole period in between, that makes no sense.
- [45:48]
B
Okay.
- [45:49]
C
He really is that regularity. I don't care how long is in between, as long as it's regular.
- [45:53]
B
Great. I'm going to, I'm going to stand inflammation here for a minute.
- [45:55]
C
Yes.
- [45:56]
B
So we have regularity of meals. How about physical activity? Because for years, you know, the, the marathons and triathlons and, and pumping Iron and CrossFit were the paragon of physical active. What do you think is the optimal physical activity for, let's just say a middle aged healthy person in America.
- [46:21]
C
So, you know, our bodies were designed to move. Our lymphatics that control our immune system have no muscle in their walls. It's actually the rhythmic contraction of the muscles in your legs when you walk that make your body work. So movement during the day is critical. Right? The apple watch, when it taps you on the wrist, you know, an hour saying you haven't gotten up and moved. There's a reason for that. So the first is movement over time, critical for health. Then the second is you want to get your heart rate up, you know, for 15, 20 minutes a day. It doesn't have to be dramatic, right? If you can get it up 50 to 60% higher from where you start, you start at 70, get it to 110, 120. That's great.
- [47:01]
B
So now is that a walker? Is that a sprint?
- [47:03]
C
It's different in everybody, right? I mean, if you're in amazing shape, it may take you a little bit of a sprint. If you're walking every day, you know, don't walk a lot, maybe that walk can do it. And then you don't want to push too much. There's kind of diminishing return after an hour. So what happens in marathon runners?
- [47:20]
B
Diminishing returns after an hour.
- [47:23]
C
Marathon runners have relatively short lives comparatively. They push, push, push. You get compensatory enlargement of the heart. And many times you can get aberrant electrical signaling, cardiac arrhythmias and other things. We all remember Jim Fix, who wrote the book on running and was the paragon of running health, who died of a heart attack at a relatively young age while promoting his New York Times bestselling book on running. And so the key really is, you know what grandma said, moderation and everything. And so we're all different. What gives us joy. But the key also is to do things that make us uncomfortable. Right? You know, everybody says, well, I do this every day. I want you to listen. I do yoga. No offense, I hate yoga, but I do it because it makes me uncomfortable and I'm not good at it. And it works, right? To do things that are difficult and make you uncomfortable is really important on things. If you do something you're really good at all the time and nothing that really challenges you, it's probably not the best. You know, the human brain evolved, so he or she who can make their way in the wild and do hunting and gathering and make their Way back survived. So physical activity and pattern recognition are really critical. That's why running outdoors is so much better than running on a treadmill.
- [48:40]
B
I'm going to challenge you on the uncomfortable piece, and it's probably just semantics, but, you know, if you look at Americans, only 25% of them get even 20 minutes of physical activity. That means three out of four Americans don't even get 20 minutes. Why is that? I think because they don't enjoy it. And it's my philosophy when it comes to physical activity to do something every day that you enjoy. And maybe, you know, building muscle mass a la Peter Attia is. Is better for you, or maybe, you know, this sprint is better for you. But I'd rather have 75% of Americans getting over 20% over 20 minutes of physical activity doing something they love then.
- [49:27]
C
Well, I don't disagree. But remember, enjoyment and being comfortable aren't necessarily the same thing.
- [49:33]
B
Semantics.
- [49:34]
C
Thing to do is to do something by rote. Right. Just to do something by road where your brain is turned off and you're just standing at the wall, you know, going on a treadmill like this.
- [49:43]
B
Yeah, yeah.
- [49:44]
C
I want you to be a little bit more uncomfortable to do things that challenge yourself. Right. When you challenge yourself, you get enjoyment from it. I see it in your face. And you hear from you on this bike ride on.
- [49:55]
B
Yeah.
- [49:55]
C
Climbing this. That gave you enjoyment?
- [49:57]
B
Oh, yeah.
- [49:57]
C
That gave you. Made you uncomfortable while you were doing it, but you felt great after. So I don't think they're mutually exclusive.
- [50:03]
B
And what you call coarse grain, it. What's your daily physical activity routine?
- [50:09]
C
So I, you know, I stretch almost every day, so I try to do at least six days of week of stretching. I try to do two to three days a week of aerobics. And because of my schedule, I do, you know, two of them in the house because I don't have time to get out many times during the weekday. So I've got a treadmill or rowing machine and I have weights in the house where I could do those. And on weekends, I try to play tennis and be outdoors. So I try to do something every day. And, you know, I hurt my back last year, so for a couple of months I couldn't do anything. And I will tell you, I got depressed. My brain didn't work well. I didn't feel the same. And it really had an enormous impact on me. And I didn't even realize how exercise was helping me for the day. I'm one of those people with these biometrics. I Know, if I exercise in the morning, I have a great day. If I do in the evening, I don't sleep well. Everybody's different. We're all unique. And so I know I have to do it in the morning. So I get up early, I go to the gym, I turn on cnbc, I watch what's going on in the world, and I could do my programs.
- [51:10]
B
Yeah, that brings up a point about data and individual. You know, when it comes to population, we can give very accurate advice. We can, say, get seven to eight hours of sleep a day, move every single day, and we can, say, eat largely whole foods, unprocessed. But when it comes to individuals, it's a lot harder, isn't it?
- [51:36]
C
You know, I was shocked. I wore one of those continuous glucose monitors.
- [51:39]
B
Yeah.
- [51:39]
C
And, you know, I tell everybody exactly what you just said, but I didn't realize, for example, what raised my sugar in my blood. So it's a little patch you put on your arm. Very soon it's going to be on the watches, so you don't even need it. There's a tiny needle that goes in these patches now, but pretty soon it'll just measure it through the skin. And I started to see when I did this, my sugar went up. When I exercised, it went down. This food made it go up. This food didn't. When I had protein followed by carbs, my sugar was flat. When I had carbs alone, it went up. And it was an amazing feedback loop for me. We're all going to be so much better when we get these feedback loops. That's what excites me about technology now. It's starting to give us these feedback loops. Right. And it's starting to say, hey, you hit your goal today for exercise. You got to sleep a score of 70 today. What did you do differently than yesterday where it was 85? And you have these feedback loops, instantaneous rather than waiting decades.
- [52:36]
B
So. So for people who don't have a lot of money, what are. What are the. What are the feed. What are the. The electronics. They might want to. Everybody might want to think about investing in and keeping track of what.
- [52:49]
C
Listen, I don't keep track of our health. Yeah. I don't even think you need the electronics. I mean, electronics are for the geeky people who like bright, shiny things. Many times it's just keeping a diary, Right. I mean, you know, in all of our phones now, we have the ability of keeping a diary of how we feel. How we feel is probably the most important thing. You know, when it tells me I have a readiness score of 90. I feel good. If it tells me a Radical score is 60, I know I don't feel well. And so how you feel is everything. You know, you look back in history, the greatest doctors, right? Maimonides, you know, who's one of the most remarkable, you know, you know, the amazing Greek doctors. What they would do is they would publish, you know, he had a book of basically every food and how it affected his athletic and his sexual performance. An entire book. When I ate milk products, sexual performance was down. If I eat too much protein, my athletic performance is down. And because he listened to himself, we've now shut off this thing of how do you feel after you do something? There's certain foods, you're not going to feel good afterwards. Well, you probably shouldn't be eating them. There are others where you feel fine afterwards and you don't feel bloated and full. Those are probably better for you in the long run. The human body is amazing like that.
- [54:01]
B
If you were to buy one gadget that you could afford, what would it be for your that would improve your health?
- [54:07]
C
You know, for me, I do the ring because it measures my sleep. It takes about 10 minutes, 15 minutes to charge a week. So the problem with the watch is, you know, you have to charge it every day. So you got to choose. I'm going to wear it at night.
- [54:20]
B
Or I'm going to wear it during the day.
- [54:21]
C
So this is an aura ring, but I'm not advocating for one particular product. The Fitbit is great, the Apple watch, they're all great and we're all a little bit different. But the ring is good for me just because I always forget to charge things. Now I could charge it when I'm in the shower once a week and at night it doesn't bother me when I sleep. And to me, knowing my sleep is.
- [54:40]
B
Important and what, how, how, what have you. Is there an example of the ring told you something about your sleep and you've been able to change it?
- [54:48]
C
I realized that I was having dinner most nights. You know, kind of like at 7 or 8 o', clock, I would get home, I'd answer my emails, I play with the kids or talk to my wife and I would have dinner. And then I kind of realized that when I shifted dinner an hour, hour and a half earlier, I got about 8, 9 points on my sleep improvement. So early eating dinner earlier mattered for me. And then the big one for me also was when I watch Blue Light, right? I always looked at my iPhone check on my Patients, I always say, well, I have patients, I have to look at my iPhone or when I would watch tv, I wouldn't get as much deep sleep. When I now wear the blue light blocking glasses, I get about 15% more deep sleep.
- [55:30]
B
Wow, that's a big deal.
- [55:31]
C
And same thing on my kids. It radically affected them. They don't need glasses, they wear plain ones with the blue light blocking and they get better deep sleep.
- [55:39]
B
You know, that's a takeaway I'm gonna do because I look at screens too and I get crappy deep sleep.
- [55:43]
C
But I've got ones next to my tv. I've got it next to where I read at night and it makes a big impact blocking that blue light. When your brain sees blue light, it says, hey listen, it's daytime, so you could be attacked by something. So don't get deep sleep, it's not safe. So it's a safety mechanism. And so you may get sleep, but it's not going to be deep sleep. Everyone says to me, well, I could drink caffeine at night, I can watch TV and I could sleep fine. But I guarantee you if you restricted the caffeine to before 10am and you wear the blue eyed glasses, you're going to get more deep sleep, which, what's needed for your brain before 10:00am wow, that's early 10, 11:00am yeah, well, it's got a half life in the blood of about eight hours. So half of it is gone eight hours later.
- [56:27]
B
So, so at midnight you probably still have a quarter of the caffeine. There's still your first cup of coffee in your. Let's move from what we can do now to what's just over the horizon. You said two or three years. You, you expect, what are, what are the first interventions that are actually going to improve the fundamental workings of aging? This sort of doubling of, of damage we get, not just keeping us from getting diseases, but actually increasing the capacity of the human machine.
- [57:01]
C
So I mean, I think there are two parts to it, right? I mean, one you alluded to, which is blocking disease, Right. You know, if we can block disease, we're all going to live better and have a longer health plan. But at the same time we have to work on our engineering aspects. Yeah, that's. So that's our artery health, that's our muscle health and that's our bone health. Those are the three kind of buckets. And then you couple with that brain health.
- [57:22]
B
Right.
- [57:22]
C
We've all seen people who have cognitive decline as they get older and they certainly cannot enjoy Life like people whose brain is working in their 90s. So the first is on the cognitive side. It's that deep sleep. Right. Tremendously important. We all know we need that, and we have to get better at doing that. There is a class of drugs now, really the first class of drugs that enable you to go to sleep. When I travel, I take a sleeping pill. I know it's bad, but I take a sleeping pill my first night or two. Well, the first class of drugs, it actually hits your sleep center, not your wake center. Most sleeping pills hit your wake center. And the problem is at night, I mean, hit your sleep center. It's not that you're not tired, right? It's that your wake center keeps going. So if you heat your sleep center, you just get more tired. There's a hangover effect the next day, and it affects your cognitive function. Well, we now have the ability of turning off the wake center. And in a clinical trial of people over 70, it improved cognitive function the next day.
- [58:21]
B
Wow.
- [58:21]
C
So the notion of these drugs affects.
- [58:24]
B
Their sleep, not their wake.
- [58:25]
C
Well, it hits their wake center, enabling them to fall asleep.
- [58:27]
B
Okay.
- [58:28]
C
So it doesn't make them more tired. It just blocks that wake signal. It keeps going. When I travel to London, right, at night, my wake center keeps going because it thinks it's daytime for me. And so when you block that wake center, you can get that deep sleep you need to get cognitive function the next day. And that's tremendously important rather than making us more tired and affecting negatively our cognitive function. So these orexin antagonists, they're called, are out there now, and they're a safer form of a pill to be able to do that. And I think you're gonna see other things that enable us basically to get better rhythms in our brain, which is critical our arteries, right? We now can do that, right? We have the technology. It involves radiation now, so it's a CAT scan. Hopefully very soon it won't involve radiation, but we can look inside the heart arteries and know what's going on to say, hey, you know, every five years, there's something there. I want to intervene before it causes damage and a problem. Right now, imaging, right, is transactional. You want an MRI, it's an hour. This is a $10 million machine, an hour scan. So it's not scalable. We only do it when people are very ill. CAT scanners, while it's quicker, involves radiation, cumulative radiation can increase cancer and other risks. But pretty soon, we're going to be able to do very quick scanning with mri like machines that we can upscale the image. Do you ever go on your iPhone and you go like this to make the image bigger?
- [59:52]
B
Yeah, yeah.
- [59:52]
C
It's not changing a lens. Yeah, right. It's upscaling that. And so that's all done with software. So you can imagine taking a very low resolution 5 minute MRI that does your whole body and we can upscale it so it's got a resolution of the most fancy complex mri. That would have taken hours. You want to do a high resolution MRI of your whole body? That's about a four hour test. The beauty is in the future we can upscale these low resolution ones so in five minutes you can have everything and know what's going on. And so we can start to intervene early. And I think that's going to be critical.
- [60:26]
B
So, you know, David Sinclair had this theory that all of our cells have kind of a backup program. And you were talking earlier on that our cells build up damage. They, on average they reproduce themselves every seven years or so. Every time they reproduce themselves, you have 2x more damage. So in 7 years it's x. In 14 years it's 2x and it's 4, then it's 16, et cetera. Is there anything over the horizon, any drug or genetic intervention that you're starting to see at your institute or elsewhere that that suggests we'll be able to stop that, that fundamental damage, which is really the technical cause of aging?
- [61:08]
C
I don't think we're going to reverse what's going on in cells, but I do think we're going to enable generation of new ce. Right. If I knock you off a bicycle and skin your elbow, your platelets come in and they cause clotting and they also turn on stem cells. So you get new regeneration in skin cells and then a month later it's healed over three months later you don't even see the wound. Right. Because stem cells get turned on there. So you can imagine every organ has those stem cells that are sitting there asleep normally in our mid-20s. And if we can turn them back on to regenerate functional good cells, we're going to be able to be much more functional in our bones, in our muscles, in our heart, in our brain. And I do think that's something that will happen over the next several years, is we're going in an organ specific way, be able to enable stem cells. Most of what's out there now with stem cells is total, 99.9% of that is, is, you know, I just want.
- [62:08]
B
To make a point. Most of what's out there with stem cells is total.
- [62:12]
C
It's 100 is you go anywhere, you have to go to a mall or go to a foreign country for it. You know there's something wrong there. Yes, most of what's going on.
- [62:20]
B
Why is it you hear all kinds of people say yeah my, my knee was wouldn't work and I got stem cells is amazing or my shoulder. Some people do system wide stem cells right.
- [62:31]
C
It's right now we don't have the ability. Shinya Yamanaka won the Nobel Prize for what's called Yamanaka factors where he could take fat cells and make them go into stem cells. And now the first real clinical trials are trying to use them first in the eye and then they'll use them in other organs. But it's still early days. Most of what's out there aren't real stem cells. They don't know what they're doing and they can cause real problems and danger. And that's one of the things, you know, taking, whether it be a vitamin a supplement, a stem cell, many of them, it's not that they're benign. Well, it's not going to cause any harm. I might as well do it just in case. Many of them cause harm, right. Men who take vitamin E in one of the largest studies done have dramatically higher rates of prostate cancer. Smokers and former smokers who take vitamin A and beta carotene, dramatically higher rates of lung cancer and death. And by the way, death is a bad endpoint for a vitamin and a supplement.
- [63:26]
B
Great for marketing.
- [63:28]
C
Many of the supplements out there have heavy metals and other things in them and they're not pure. So you start to look at them, there really is the potential of causing harm. So it's sticking to that real food. It's don't doing these things now that don't have data behind them because again, I want you healthy for three, four years from now when these big breakthroughs are going to happen so you can get them.
- [63:47]
B
Do you, do you take any supplements?
- [63:49]
C
Damn, no.
- [63:50]
B
No, I don't either. I don't believe in it.
- [63:51]
C
No. I take a baby aspirin a day and I take a statin. Those are the two things I take.
- [63:56]
B
And statins are so you don't build up cholesterol.
- [64:00]
C
Yeah, statins are so, you know, they, they lower ldl. But the real mechanism, there's something called the Jupiter study where they take people with normal cholesterol and they gave them one of the statins and it dramatically delayed heart disease. And in this study Also reduced cancer because it blocked inflammation. And aspirin, which will reduce the overall death rate of cancer by 30%, heart disease by 22% and stroke by 17, also reduces inflammation. So you look at those two. Reducing inflammation equals preventing disease.
- [64:33]
B
So should every 30 year old start taking an aspirin and a statin?
- [64:37]
C
It all depends on what your family history. You know, right now most of the studies were done at people over the age of 40 or over the age of 50, but it really depends on individual risk factors and is talking to your doctor about it. You know, if everybody in your family died in their 50s of heart disease or there was significant heart disease in the families and elevated cholesterol, you probably want to be on a statin at a very early age. If people had cancer and colon cancer, you may want to be on an.
- [65:02]
B
Aspirin, which by the way, is almost everybody cancer or cardiovascular disease. But what's the one thing you know about health that you wish every 25 year old understood?
- [65:16]
C
What you do today matters tomorrow. I think, you know, most 25, 30, 40 year olds think they're immune. And once they get, you know, there's an amazing study came out saying the biggest changes in health happen in the 40 years old and around 60 years old. And so when something happens and you realize that you've got potential vulnerability, you start to do things, many times it could be too late. So I want to start to encourage healthy behavior earlier and have people understand that what they do today will matter tomorrow. And it's very hard to do that.
- [65:47]
B
Yeah, especially when it tastes good. You know, this pizza tastes good. Yeah.
- [65:51]
C
And listen, you certainly pizza in moderation is fine. I'm not saying don't eat pizza, don't eat pizza every day and make sure the ingredients are good.
- [65:59]
B
The problem with moderation is very few people know exactly what it means. So I only ate a pizza today, for crying out loud, and it was only one a day. So. So on this podcast we give extra points for vulnerability. So I'm going to ask you, I mean, you're a doctor, what is the, the, the piece of health advice that you break for yourself all the time or that you struggle with that you tell others?
- [66:23]
C
Well, listen, I will tell you that in December of this year I had my first real health crisis is that I had a disc that slipped and I woke up and I couldn't move my left leg or feel it. And I ended up having what we call a microdiscectomy, where they can go in with a little scope and clip off part of the disc to enable there not to be pressure on that nerve and your leg to function again. And when I look back, what did I do wrong? I probably didn't focus on my core like I should have for exercise. Right. Working on the core doesn't feel fun. Right. I like playing tennis. I like doing things that, you know, were more aggressive and made me feel fun, but not focusing on my core. So that really, really hurt me. And that was a big issue. And now I'm doing all that boring core exercise where, you know, really building up this part where I'm pointing to kind of below my neck and, you know, above my waist, really focusing on that, because I know it's going to help me a lot as I go into my next couple of decades.
- [67:23]
B
Great answer. I'm gonna ask you just a few sort of common, healthy tips and ask you to rate them on a scale of 1 to 10, and we can just kind of do them.
- [67:35]
C
One is the worst.
- [67:36]
B
What is the worst? Tennis.
- [67:37]
C
The best. Right.
- [67:38]
B
Okay.
- [67:39]
C
Smoothies. Two or three. Two or three through evolution. Right. We weren't made to absorb everything at once and to have things into a blender. So when you put something in a smoothie, it gets absorbed right away. Insulin peaks through the roof. Right. There's a great example. James Lynn was captain of the British Royal Navy, and he fought the French in the battle of Trafalgar. And back then, the British soldiers, he put limes on their ship. That's why British soldiers were called limes. His soldiers didn't get scurvy. The French did get scurvy because they had no fresh fruits or vegetables on their ships. And then at the end of the war, he said, I'm selling the extract of lime to make money, because he wanted to sell the extract. And once you squeeze a lime, all the vitamin C degrades like that. Wow. And it didn't work. And they called him a fraud. You put something in blender, everything degrades right away. And it get absorbed into its parts, not the whole. And that's not what you want. You want to chew and activate these enzymes. Swallow and have some absorbed here, some absorbed here, some absorbed here. Very different than putting something for convenience sake into a blender.
- [68:42]
B
That is such a huge insight. Because I think most people think I start my day with a smoothie or even a vegetable smoothie, and they think it's good for them.
- [68:51]
C
Same with juicer.
- [68:52]
B
There's that whole juicing crate. Why juice? And take the buck on it.
- [68:56]
C
Right. They sell the machines they sell juices. I mean, buy a juice is 10 bucks. To buy an orange cost 50 cents. You're not going to make bucks. I mean, a lot of bucks selling oranges. You will selling juices.
- [69:07]
B
Note to self, all right, A glass of red wine a day, scale 1.
- [69:12]
C
To 10, probably 8 or 9.
- [69:15]
B
Wow.
- [69:16]
C
It's pretty amazing, right? The National Academy of Medicine, one of our most august bodies, published a report in December saying that net net alcohol in moderation has a health benefit rather than a detriment. Some benefit on heart disease, minimal increase in breast cancer, particularly in women. The surgeon general, several months later, literally a couple weeks before he stepped out of office, said, hey, alcohol, we have to put a warning label on. And so if you really look at it. Do you drink coffee?
- [69:46]
B
Yes.
- [69:47]
C
Do you ever have a piece of toast?
- [69:49]
B
Yes.
- [69:50]
C
You put them in a toaster, right, And. Or the coffee bean, and you roast them. That brown is sugars joining together, forming something called acrylamide. Acrylamide has more carcinogenic potential than red dye number three by almost an order of magnitude, has more carcinogenic potential than alcohol, yet we don't outlaw them. And so you have to really look at the whole. And you need to set real criteria. So certainly a glass of wine. We've been doing it for thousands of years, right? Going back to, you know, cultures. It's a 6000. Really?
- [70:22]
B
Yes.
- [70:22]
C
That's wild. If we've been doing it for 6,000 years, I guarantee you it's okay.
- [70:27]
B
Probably not so bad. Yeah. How about protein powders and protein supplements?
- [70:32]
C
Again, I'm not a fan of that. I probably give them a four is, you know, everybody wants a shortcut, right? I need lots of protein. So let me put it into a powder again. Your body was made to, you know, have protein, particular animal protein or plant protein, degrade it and absorb what you need. Once you put it into a powder, it's very different and goes into the bloodstream very quickly and can change things like blood pressure. You can have modulation and changes there. And you also don't absorb in the way your body was meant to. What you need. You get it all mainstreamed, if you will. So the key really is, and I think all of the studies have showed, that it doesn't help much on muscle mass at all and can have some bad health ramifications. Eat real food.
- [71:16]
B
How about a cup of beans a day scale 1 to 10.
- [71:19]
C
9. It's great.
- [71:21]
B
I love it. And. And how about running a marathon?
- [71:30]
C
You know, running a marathon once, probably a 6 or 7. I like it because it gets you into a mindset. It trains you. It means you're a lean body mass running a marathon, you know, a couple times a year. Probably a 2 or 3. Yoga, probably a 9 or 10. Wow. Pilates. Probably a 9 or 10.
- [71:51]
B
We're getting a theme here.
- [71:52]
C
Yeah.
- [71:54]
B
I want to kind of sort of close with. I'd like to talk a little bit about this little health thing I went through with that you were so kind to help. Help me with. I was in. I was in Madrid and I had a lung infection, and I kept bicycling and traveling through it, and I. It somehow spread to my heart, and I had a vasospasm which cut off the blood to my heart. I ended up in the hospital for four days. And I came out and I called you and you were very kind. And what. What was your assessment of what happened to me? I don't know if you remember those conversations.
- [72:38]
C
First of all, I mean, I appreciate you talking about it. I mean, when all of us show our vulnerabilities. Anybody. I mean, it helps others realize that this is not something you have to hide and that we have to focus on areas to prevent things. So when we first spoke, a mutual friend set us up. You and I have known each other for a long time. Just been on the speaking circuit together.
- [72:57]
B
Yeah.
- [72:58]
C
And we've seen Jerry Murdoch.
- [72:59]
B
Wouldn't mind us dropping his name, but no.
- [73:01]
C
Jerry Murdoch, one of the great wine collectors of the world. Speaking of wine, keeping our hearts healthy, put us together. And he really did it out of caring for you. Yeah. And, you know, the first thing was, you know, I wanted to make sure that the acute care, which means the care in that moment was correct. Many times medical care is transactional, particularly if you're in a foreign country. Right. They want to just get you out to go back to the hotel or go back to your home, rather than making sure you're going to be okay a week, two weeks from now, et cetera, because you had to fly several thousand miles back home. So we had to make sure that you were stable and everything was done right so you could travel home safely. And so that was our first major conversation. Then the second one was when you got back to the stage, trying to say, hey, why did this happen? How do we prevent this from happening again? Long term. Right. Nothing is, you know, in the short term a problem. You're remarkably healthy from your lifestyle, but at the same time, with that crazy healthy lifestyle, you're not immune to things. Things. And I Think that's one of the biggest messages is right, the healthiest people in the world will still die of disease.
- [74:06]
B
You know, I had. So you looked at my cholesterol numbers, they were great. I mean, by the common assessment, I had low regular blood pressure. I get physical activity every single day. I eat a whole food plant based diet. I have tons of friends, I have a great sense of purpose. I don't take supplements. I drink a glass of wine a day. I do everything you're supposed to do, but somehow I end up with a heart event. And what message does that give to people who are saying, well, why should I work out if you know, why should I do any of this stuff if Dan Buettner, Mr. Blue Zones get.
- [74:48]
C
Sick, you know, it's very interesting because all of this is we call probabilistic, right? If you have a great cholesterol and your numbers were great, then probabilistically you're lower risk for heart disease. But it's not zero. And so I think what we have to realize that we are all vulnerable. And if we can improve our numbers, there's a benefit to that. And so all of us, even the Dam Buettners of the world, he can get better on things. And so looking at what is my family history and then doing and saying, hey, listen, even though I have all of the good things, maybe I should get a test and see what's inside and to see what's there. If everything is clean, I'm great for the next five years. If it's not, I can intervene. So probabilistic assessments are very, very difficult. If I say your LDL is 65, you go, that's a great number. But that still doesn't mean you're immune from heart disease.
- [75:40]
B
That's good cholesterol.
- [75:41]
C
That's the bad cholesterol. It's 65. If that's low, that's good. But it means you're lower likelihood, but you're not zero. If your hdl, that good one is high, that means again, you're lower likelihood. But it doesn't mean that number is zero. And so I think we all have to realize that we have some vulnerability probabilistically. It tells us when to test on things and when to look, but it doesn't mean you're immune.
- [76:06]
B
So what should I have done differently that might have precluded this event?
- [76:12]
C
Do you have a family? Did anybody have heart disease in your family?
- [76:15]
B
My grandfather had heart disease.
- [76:17]
C
Yeah. And so having somebody in your family with a heart disease, you know, we probably would have looked and done a study to say, hey, is there something going on in your blood vessels? And then is your LDL low enough to prevent it in you? And looking at those numbers. So while your LDL was low, it wasn't tremendously low. And so the way I look at statins is very simple. And I know people get pissed at me and I get hate mailed because of it. If I put you on a statin which will lower your risk of heart disease even with a normal cholesterol, and lower your risk of cancer and you don't know you're on it, I've done a good thing. If you have side effects, then it's probably not a good thing. So there's a risk reward here. Very small percentage of people have side effects, which is muscle aches, you stop it, they go away in a day. So if I could put you on a preventive medicine that will lower risk of things, even if you start off on the lower side, I've done a good thing.
- [77:10]
B
Well, you did a good thing for me and I have enduring. Thanks. And I, I might not have been here, by the way. You advised me to stay in Madrid, which I did for five days. It turns out in my situation, flying could have been fatal. And so I, I guess I kind of owe you my life.
- [77:27]
C
It was interesting because, you know, I was a bit of a pain in the ass and you're like, no, but I have to be at this.
- [77:31]
B
I have to be at this.
- [77:33]
C
And I'm there trying to, you know, be tough and really explain the data to you. And listen, you're one of the smartest people on earth and it still took you a while to understand that. So you can imagine somebody who doesn't even want to hear it. You had an open mind at least and would listen. But this is why we have many issues in medicine. It's very hard to explain things to people.
- [77:55]
B
And when you explain it to them, it's still hard to take that advice if it goes counter to what they want to do. Anything else you want to talk about that we haven't touched on?
- [78:04]
C
No. Listen, I love, and I have to say this, I've always loved what you do, which is pattern recognition on the globe. You're going out there and saying, where's a pattern of, on a health basis, things that are better and why does that pattern happen? And I think it's pretty amazing. Listen, I try to do it on the cancer side, you're doing it on the global side with overall health and we can all learn from that. And I appreciate it.
- [78:28]
B
Well, I appreciate you, David. I think you're one of the best doctors in the world. And I thank you. And thank you for this hour. And thank you for helping everybody listening live longer.
- [78:39]
C
Thank you, Dan. Ha, ha.
- [78:41]
B
Oh, and because not everybody gets this, by the way, what I'm about to give you here is only for the people who open up and are vulnerable. So thank you for telling us about your desk.
- [78:56]
C
Thank you.