Tegan Taylor (1:54)

Gosh, I am lucky to still be young enough that this doesn't keep me up at night quite as long as it does for the over 50.

Dr. Norman Swan (2:00)

Wait till that brick wall at the bottom of the hill gets closer. You'll want to push it away a bit.

Tegan Taylor (2:06)

I'm learning so much from you. Maybe I'll never have to worry about it.

Dr. Norman Swan (2:08)

Anyway, that's what we're talking about on today's what's that Rash.

Tegan Taylor (2:11)

The podcast where we answer the health questions that everyone is. And Norman, I did say the health questions that everyone is asking. No one has specifically asked us this question, but we are asking it of ourselves. And I think that there are people who have thought about it before. Today we are talking about a guy called Brian Johnson without any other context. Would you know who I was talking about if I just said his name?

Dr. Norman Swan (2:38)

I would because I've written a book on this sort of topic, so I kind of do know who Brian Johnson is.

Tegan Taylor (2:45)

So if you haven't heard of Brian Johnson, if you haven't also written a book about living younger, longer by Dr. Norman Swan. Brian Johnson's whole movement is called, effectively the Don't Die movement.

Dr. Norman Swan (2:56)

And I've just recently read Mel Brooks autobiography, which is very funny. You know, laugh out loud funny.

Tegan Taylor (3:02)

It'd want to be, given his reputation.

Dr. Norman Swan (3:04)

Yeah. Now he's just turned 99. Anyway, at the end of the book, he's asked the question, how do you explain your remarkable longevity in such good shape? And I think his answer was, I didn't die.

Tegan Taylor (3:16)

Well, I mean, if it works, it works. Right? So, yeah, Brian Johnson's whole movement is called don't die. Basically, in 2021, he announced that he wanted to figure out how to continue traveling through time at the normal speed that is like a year passes by, but that his biological age wouldn't change in that time. And Norman, this is a part of the show where I have to issue a trigger warning to you.

Dr. Norman Swan (3:41)

Yeah.

Tegan Taylor (3:41)

Because we are going to talk about so much longevity stuff today and I know that you are just bursting with information about it and we are going to have to like, breeze past a lot of it. Consider this a bit of a Primer for about 15 future. What's that? Rash episodes.

Dr. Norman Swan (3:54)

Good. Yeah. I'm suitably chastised here. And put back in the box.

Tegan Taylor (3:57)

No, I don't want you to be in a box. I just want you to know that that's true.

Dr. Norman Swan (4:00)

I speak about dying.

Tegan Taylor (4:01)

I see you, I love you. But we are not going to be able to go into anywhere near the amount of death I know you're capable of today. This episode is going to be longer than usual already because we've got a lot to.

Dr. Norman Swan (4:12)

So we're just focusing on Brian Johnson and what he does.

Tegan Taylor (4:15)

Yes. But I do think it would be useful for you to give us a bit of a primer on biological age versus chronological age, because that's really what this whole thing is about.

Dr. Norman Swan (4:23)

Yeah. And he's talking about even reversing it. Not just staying at the same age, he's talking about reversing it. But anyway, we'll come back to that later. So chronological age is your age according to the day that you were born. So if you were born five years ago, you're five years old today. If you were born 50 years ago, you're 50 years old today. But the question is, is your body 50 years? And biological age is the age that your body is at, irrespective of your chronological age. And the nice thing to have would be a gap where your biological age is younger than your chronological age. And this is, if you like, a recipe for living longer. How you measure biological age is, however, controversial.

Tegan Taylor (5:04)

Yes, and we'll get to that as well. I would like to give props to Brian Johnson for, like, the branding exercise that he's on here now. Obviously, he wants to live as healthily as he can for as long as he can. He's conscripting other people to join the cause and that sort of thing. But by calling it Don't Die. Like, literally, if you want to sign up for the mailing list, you put your email in and then the button to, like, submit says join or die. And literally, if every single other human who's ever existed in history up till now is anything to go by, we will all die at some stage. So I suppose he'll be right eventually with all of us.

Dr. Norman Swan (5:39)

And so he's very rich. He made his money out of a pay company called Braintree, and he's spending a considerable sum of it on himself to try and live longer.

Tegan Taylor (5:48)

Yeah, so he says he's become the most biologically measured person in history. They basically built an algorithm using all of the science and data which we will get into about how you can optimise human biology to keep your biological age as static or as low as possible for as long as possible. And he has basically developed. Well, he's. He's asked the algorithm to develop a protocol and. And he is adhering to it slavishly. So shall I tell you a little bit about.

Dr. Norman Swan (6:17)

Yeah, tell us about his happy life.

Tegan Taylor (6:19)

His happy, balanced, chill life.

Dr. Norman Swan (6:22)

Cause this is sort of something where you may not live longer, but you'll certainly feel as if you lived longer.

Tegan Taylor (6:27)

So it. So basically, at its core, it's good. It's eat well, it's exercise, it's sleep, et cetera. But he eats the pretty much exact same thing every single day. And also, it's not just about what he's eating, but it's also when he's eating. So he has a smoothie in the morning, he has like a breakfast at breakfast time, and then he kind of has like a lunch at 11:30 in the morning, and then that's it for the Rest of the day. And then alongside these meals, he's also having huge amounts of supplements and some medicines as well.

Dr. Norman Swan (7:00)

So he measures his body composition every day. He does meditation, he fixes up his skin, he treats his hair loss problems with a hair loss drug. And as you say, he's got this routine. And every night he goes to bed at 8:30.

Tegan Taylor (7:15)

He talks about like your professional full time job is sleeping. Like nothing's more important than sleeping in his mind. But he has some health markers that he looks at according to when he's asleep.

Dr. Norman Swan (7:26)

Yes, he is obsessed with nocturnal erections. I mean, according to some reports, he gives his penis electric shocks and he takes Tadalafil, which is Cialis, which is a long acting form. Same family.

Tegan Taylor (7:40)

It's not Viagra, but it's in the same kind of family of drugs as Viagra.

Dr. Norman Swan (7:43)

It's longer acting and he would argue that it either helps his erections or it increases blood flow and maybe improves other parameters of ageing as well.

Tegan Taylor (7:53)

Norman, it feels to me that with the rest of his life being so regimented, there may be very little natural joy that he's getting out of it. So let him have this one thing.

Dr. Norman Swan (8:01)

Yeah, I mean, I don't know when he has sex, if indeed he does have sex. It's just an interesting thing to speculate on. Some people think that sex. There is one study from Britain where, which suggests that sex actually does promote healthy longevity.

Tegan Taylor (8:15)

Okay, well, there's only one way to find out.

Dr. Norman Swan (8:19)

He's certainly electrocuting his penis several times a night and measures his nocturnal erections. I think he's almost reached three hours of a nocturnal erection.

Tegan Taylor (8:27)

That honestly sounds exhausting.

Dr. Norman Swan (8:29)

Yeah. What do women do with all this information? I don't know. Run for the hills, I think.

Tegan Taylor (8:34)

I mean, if you get into a long term relationship with this guy, you're in it for life by the sounds of it, because he's never going to die.

Dr. Norman Swan (8:39)

Yeah. And he's never gonna stop pestering you. He's gotta do something with his nocturnal lyrics.

Tegan Taylor (8:45)

No, but, okay, so there's, so there's, that, there's that sort of stuff. There's the sleep thing. I know that we're gonna talk about biological markers, but the thing that pops into my mind as soon as I read this very regimented regime that he follows is just that there's gotta be a psychological impact to living your whole life so closely, to having such constant measurement, to being basically ruled by an algorithm. He has virtually no agency beyond doing what the algorithm tells him to Do?

Dr. Norman Swan (9:14)

Well, he's got complete agency, he's very wealthy, he could decide to do whatever he wants, but he's chosen to do this. And I think because he feels in control, he might just be in perfectly good shape. It would drive you or I nuts if somebody forced us into this routine. But he's made a choice here and he's got the financial resources to do, in fact, whatever he wants with his life. It's probably worth just going through in detail some of the things that he does so that we can kind of dissect. So he eats a minimally processed diet. So he avoids sugar?

Tegan Taylor (9:46)

Well, except for all of the supplements, but yes, the food that he eats minimally processed.

Dr. Norman Swan (9:50)

So one of the things he's on is metformin, which has changed his regime.

Tegan Taylor (9:54)

That's a diabetes drug.

Dr. Norman Swan (9:55)

Yeah. So there is some evidence that it slows down some of the aspects of biological aging. Interestingly, he's now not taking metformin all the time. He's alternating it. He takes things like collagen, protein, creatine, prebiotic, inulin.

Tegan Taylor (10:12)

These are some of these things we have Talked about on WhatsApp rash before. We've talked about collagen and creatine. Inulin is a fibre, like an indo. It's a prebiotic. It helps promote good gut bacteria. I don't know if you just misspoke, Norman. Metformin. You said it was a supplement. I always thought about it as a drug. What is the difference between a supplement and a drug?

Dr. Norman Swan (10:31)

Well, in fact, metformin is a drug. And in fact, most of these supplements you taking are not really supplements. You're taking them as drugs because you're not taking them in the quantities that you would have them in your food. If indeed some of them are in your food, you're taking them in doses, which are actually drug doses. And as one longevity researcher says, if it's not going to kill you, it's probably not going to work. In other words, you've got to take it in a drug like dose. And if every drug has side effects, for example. So, in fact, they're all drugs and it's misleading to think that they're safe by calling them supplements. And metformin is definitely a drug used to treat diabetes. It just has these interesting side effects on aging processes like Norman, apart from.

Tegan Taylor (11:14)

The regimented nature of this healthy food, we've talked about the evidence before and against some of those supplements before. Sleep, exercise is a huge part of his regime as well. But some of the stuff that he's done is a little more out there. I think the biggest headline grabber of the things that he's tried is he literally injected himself with his son's blood.

Dr. Norman Swan (11:37)

Well, son's plasma.

Tegan Taylor (11:38)

Plasma, yes.

Dr. Norman Swan (11:39)

So that's the fluid around the blood cells.

Tegan Taylor (11:41)

What's the base? I mean, apart from the idea of young blood, is there any scientific basis for this?

Dr. Norman Swan (11:47)

There is a little bit, but it's a confusing area. So initially, the idea scientifically was, if you can call it science, that young people, young animals, have some sort of thing in their blood, which is the elixir of youth. And therefore, if you give the blood of a younger to an older person, they are going to be rejuvenated. And so when you infuse young blood or plasma into an older person, measures of aging do seem to slow down when you do that. But the interesting thing is that when they gave, well, not so much a placebo, a control substance, which was saline, still an infusion, you got the same effect. And it turns out what's going on here is probably a dilution of the toxic substances from senescent cells. These are cells that don't properly die. They hang around, they produce toxic substances which are thought to promote aging and other problems. So this dilution is thought to dilute these toxic substances that come from senescent cells. So what he's moved on to is total plasma exchange, which is a bit like dialysis, where the plasma exchange siphons off these substances.

Tegan Taylor (12:59)

Sorry, his. Does it take out all of the plasma from his whole body and replace it with saline.

Dr. Norman Swan (13:05)

It's like a dialysis machine.

Tegan Taylor (13:06)

It's not saline, actually. Sorry, bear with me. It's albumin or something like that.

Dr. Norman Swan (13:10)

It's replaced with a protein called albumin and immune substances. It's used medically as well for some conditions where you can remove substances like antibodies from the plasma by doing this plasma exchange. Anyway, so he's doing that with no evidence behind it, by the way. Some people believe that maybe it has an effect on demand dementia, but that's controversial.

Tegan Taylor (13:34)

The other big thing that he did was gene therapy.

Dr. Norman Swan (13:38)

So he infused himself with the gene for a substance called follistatin.

Tegan Taylor (13:43)

It makes you musclier or something?

Dr. Norman Swan (13:45)

Yeah, Follistatin opposes. There's a substance called myostatin, which controls muscle growth. So myostatin slows down muscle growth. Follistatin increases muscle growth. So he had gene therapy for the follistatin protein, which in theory could enhance muscle growth. And here's the problem with what he's doing is doing so much. If it works, what's worked and what's.

Tegan Taylor (14:08)

Not, there's no control.

Dr. Norman Swan (14:10)

So he's doing these massive exercises every week in terms of increasing his muscle bulk. So is that Follistatin or is that just doing strength training? So he claims that his Follistatin levels went up and his muscle mass went up, which may be true, maybe not. But the philosophical thing here is, is it just Jeff Bezos, Brian Johnson and a few others who are going to live forever and so these billionaires are going to be around forever and the rest of us are condemned to.

Tegan Taylor (14:38)

Oh, my gosh, death?

Dr. Norman Swan (14:39)

Oh, my God.

Tegan Taylor (14:40)

This is my exact problem with this.

Dr. Norman Swan (14:41)

Go on.

Tegan Taylor (14:42)

It's just an insane amount of privilege that it takes to do this sort of thing. And what's the point of one person or a small group of people living for longer if it's this labour intensive? If longevity is the goal, like one of his catchphrases is, do what the 25th century would respect this idea of future focused. Do you think the 25th century is going to respect one or three guys living forever or doing things like diplomacy.

Dr. Norman Swan (15:09)

And world peace and controlling climate change? It'd be nice to get to the 22nd century, much less the 25th century. And that's one criticism that they're focusing on stuff that's for individuals. It's not actually the bigger play in terms of humanity and where humanity's going. And it's also about money. So these people who are immensely wealthy, are also creating businesses which charge you money to learn from them and develop patented substances that you might take as supplements. So this is about money as well as individual health span. So I mean, to be fair, they're not talking about longevity for the sake of it. They want to live healthier longer.

Tegan Taylor (15:47)

So part of the way they're spending money out of this is by creating the supplements themselves. And the other part is the testing part of it. So I want to talk about the evidence for how he's actually measuring this rate of aging. There's a. He calls it the Global Rejuvenation Olympics. Naturally, he is number one on the leaderboard. He reckons he has the world's slowest speed of Aging, 0.48, I. E. He ages at half the rate of time, actual time, as it. As it travels. And you can pay to test your own rate of aging for the low, low price of hundreds or thousands of dollars, depending on which package you get.

Dr. Norman Swan (16:29)

Well, there's a simple way of taking your biological age have A look at somebody, if they look old on the outside, they probably are old on the inside. But that's being a bit flip. There have been studies which follow groups of people through life and have done lots of measurements on through life. So they know what happens to your kidney function, what happens to your heart and your lungs. Lungs are a good measure of aging, just how fast, how much air you can breathe, out in a minute, measures like that. So you can measure your kidneys, your lungs, your heart and so on. And there is a deterioration in many aspects of their function through the years. And then they compare that to what's called DNA methylation. So DNA methylation is epigenetics. So it's not mutations of the genes, it's changes, if you like, on the outside structure of the genes. And it's been claimed in the past that there's a steady rate of methylation according to your health or ill health. So methylation goes up, you get more epigenetic effects when you're sicker and when you're aging faster and fewer when you're aging more slowly. And what they've done is overlaid the physical measures of these groups of people. One of them is a group of people who've been followed from birth In Dunedin, about 1000 individuals. So what they show as they get older and compared that to their DNA methylation. So DNA methylation, when it's properly controlled is probably quite an accurate way of measuring your biological age. However, that doesn't account for the commercial environment where you might send your blood off for DNA methylation. And you haven't got a clue how accurate that is, what benchmark they've used. It's complicated. So when it's done properly, it's probably not a bad measure of biological age, but otherwise it could dramatically mislead you. What if it showed that you were raging incredibly rapidly and you were actually doing okay? What sort of conflict would that create?

Tegan Taylor (18:29)

But what difference does it make if you're having a healthy lifestyle? Regardless, it kind of, for all that the Brian Johnsons and his like are trying to control this sort of thing. We don't have a lot of control over this beyond healthy behaviours.

Dr. Norman Swan (18:43)

Right.

Tegan Taylor (18:44)

Like, am I missing something?

Dr. Norman Swan (18:45)

Well, he would argue that you're missing something. David Sinclair at Harvard, the Australian expatriate, Australian who works at Harvard, would reckon that you're. You're missing something here. So the argument is that you can't. It's not my argument, but it's their argument that it's hard to imitate the biological processes that slow down aging at sufficient intensity that it's actually going to make a big difference. Now, why I don't. I'll come back to the detail in that, but why I don't agree with that is we're actually living longer in good health than we ever have before. So unless something bad happens to you, a lot of people, particularly if you're middle class and well educated and you've got money in your pocket, you're going to live to your 90s and hit your 90s in pretty good shape. So it's already happening, and that's happening through better diet, more exercise, not smoking and so on. Now, what they are doing, so many of the supplements that they're taking imitate starvation, imitate calorie restriction. And there's evidence from the laboratory that in many animal species, if you restrict calories, lifespan goes up. Not necessarily healthcare, but it's in the laboratory in a sterile environment. Now, there are drugs which will imitate calorie restriction. Rapamycin is one of them. This is a drug that's actually got a lot of side effects. And in fact, it's one that Brian Johnson has given up because he reckons their side effects are not worth the potential benefits. But it affects one of the pathways that David Sinclair has actually done a lot of the pioneering research on, the TOR pathway, which is influenced by what you eat and actually shapes aging processes, slows them down, speeds them up in the body.

Tegan Taylor (20:23)

So my understanding of the research and from what Luigi Fontana has said is basically like as little as you can eat as possible will make you live long.

Dr. Norman Swan (20:33)

Yeah. And if you go to the animal experiments where they reduce calories by as much as 30%, you do get almost the same increase in lifespan and healthy lifespan in these animals.

Tegan Taylor (20:44)

But remember, when you say the same, you mean like a 30% increase.

Dr. Norman Swan (20:47)

So 30% decrease in calories with a 30% increase in lifespan in animal models. It's not proven in humans and it's not proven in real life because your immune system might be affected, you might be more susceptible to infection, all sorts of things may happen which haven't been fully tested. And of course, the whole notion of calorie restriction has all sorts of broader effects on human beings.

Tegan Taylor (21:09)

Well, I think. Are you alluding to the idea of falling into an eating disorder or disordered eating?

Dr. Norman Swan (21:15)

Absolutely.

Tegan Taylor (21:15)

They can be deadly.

Dr. Norman Swan (21:16)

They can indeed. And it's interesting that Brian Johnson reduces by 10%, not 30%, so he's not going really radical there. But here's the Problem. One of them is one that I've just said, which is he's doing so much, you haven't got a clue what's going to work because he is calorie restricted by 10%. He's doing a lot of exercise, and it's likely that if he gets any benefits, those things alone are probably doing it. But then he's taking all this other stuff. There is a problem, and the problem is two things. One is a word called homeostasis, and the other is a word that we've used a lot and increasingly on. What's that Rasch? Pleiotropy.

Tegan Taylor (21:55)

Every time you say pleiotropy, I want to play some sort of noise. I've got my. Got my Mediterranean diet bell right here. I've got my fine particulate air pollution harmonica here. But I still don't have a xylophone. I still don't have a xylophone.

Dr. Norman Swan (22:09)

And the reason for the xylophone is that pleiotropy is two things happening at the same time. So you'd be playing a chord on the xylophone.

Tegan Taylor (22:17)

So basically, I still think the harmonica comes pretty close. So the idea of pleiotropy is a gene that has more than one function.

Dr. Norman Swan (22:23)

Or a drug that has more than one function. So it's possible that some of these supplements have what they call antagonistic pleiotropy or negative pleiotropy. So it works positively on one thing, but while you're not noticing it's having a negative effect in another area. And homeostasis is this. We survive well because we are well balanced as human beings. And if our blood pressure goes up, there's a system to bring it down. Unless you've got pathological high blood pressure for every action, there's a counteraction to keep the body in balance. And if you take these supplements, it's likely that what happens is that the body reacts to them. So if you take rapamycin and you shift that tor pathway, the body recognizes that as abnormal and opposes it and pushes back. So in theory, something like rapamycin or one of the rapamycin derivatives, which are safer, should work. And in the laboratory, in animals, they do seem to extend lifespan. But in humans, they don't seem to have that effect because the body pushes back. And what some people are arguing is that maybe there is something to the supplement idea of slowing down the molecular pathways of aging. But if you do it at high dose all the time, your body fights back. And while you might get a Response initially, eventually you stop getting a response. What some people think should happen is you get a cocktail of these substances that in theory should work, and you use a cocktail of them, not just one. So that's, you know, Brian Johnson, to.

Tegan Taylor (23:59)

Be fair, is certainly taking a cocktail.

Dr. Norman Swan (24:02)

So that the body is confused about what it's actually having. And you take them in tiny doses so that you don't push the body too hard, so that it learns to oppose it. And you maybe only take it once a fortnight. So it's like a pulse effect at low dose that slowly shifts the system. But what Johnston and others are doing is high doses of lots of stuff, lots of different things, and they will re interact with each other, the body will react to them and it just may be counterproductive.

Tegan Taylor (24:36)

My hiccup with a lot of these sorts of stories is the sort of ethics of a couple of people getting to live longer or forever or whatever. And so there's a little bit of that in the mix for me. But fundamentally, how much of this is useful to you or me or someone listening? How much of this do we take on board? I don't think many of us are going to upend our entire lives and follow this sort of regime, nor can we afford to. But if there is anything to take from this movement, what is it?

Dr. Norman Swan (25:02)

I don't think there's much to take from Brian Johnson because it's not a randomised trial. He's not even doing a trial. Or another favourite thing to talk about, n of 1 n equals 1 n of 1 trial. In other words, doing it on himself is. He's not doing it in any kind of scientific way, really. He's taking a cocktail. It's all a mishmash of stuff, you know, it's not doing one thing at a time. So the likelihood that he's going to find one magical thing that makes a difference is low, is very low, because there's so much going on. And then if it means that you've got to put electric shocks on your penis and not have sex ever again and sleep eight hours and not have a life, nobody's going to do that. I think there is a bigger ethical question, which we all need to ask, and we do ask reasonably frequently in Australia, is why do some people live longer and healthier than others? And that is socially and economically determined. So if you get the train in Perth going north or south or west, then the life expectancy of people along that line drops almost by station, not quite. But the further out you get, if you get in the train in Melbourne and you go west or even east, actually, further east you go. Once you're beyond the wealthier suburbs, life expectancy drops west in Sydney. And then there's the gap, which is shameful In Australia, the 9 to 11 year life expectancy gap between us and Aboriginal people. And that is socially and economically determined. And so you could actually have people living younger, longer by changing social and economic and educational policy in this country and other countries to narrow that gap. Because it's that gap that causes the bigger gap. It's not health care, it's social and economic. So that's the big ethical question here. Now, maybe some researchers in some of this area will come across something that is worth doing. But in the end, if you eat an unprocessed diet, if you watch your calories so that you're not consuming more calories than you need, and you're having reasonably intense exercise, which is both aerobic and strength based, and you don't smoke, you are going to live younger, longer. Question is, will you live younger and longer as much as Brian Johnson? Well, you might, because who knows what he's taking that might kill him sooner?

Tegan Taylor (27:24)

Well, his whole mission is don't die. Norman, I'm offering you the chance to do a throwdown. Is Brian Johnson going to never die?

Dr. Norman Swan (27:31)

No. As much as I wish him good luck, he's going to die just like the rest of us. The question is when and in what shape and whether he's going to be happy.

Tegan Taylor (27:40)

Exactly. Well, thank you very much for this trip down longevity lane, Norman. I can't believe we actually got through it as efficiently as we did.

Dr. Norman Swan (27:47)

Well, you know, you warned me at the beginning. I kept my mouth shut.

Tegan Taylor (27:50)

It did. Well, if you have a question that you'd like us to answer, or if there's a particular facet of living forever that you would like us to dig into in more detail. The email address is the same that rashavc.net au see you next week. See you then.