Young Forever: How to Reverse Biological Aging

Scientists are figuring out that what we thought of as normal aging is actually abnormal aging, you know, the decline, decrepitude disease, frailty, disability, all those things that we’ve come to associate with getting older are consequences of malfunctions or dysfunction in core biological systems in the body that we can actually treat and reverse Well, hey everyone, Dr. David Perlmutter here, and I’m very excited about our program. Today we’ll be interviewing Dr. Mark Hyman. His new book is called Young Forever. Uh, it is the ma It is a masterpiece. It is, uh, uh, really, I think mark’s in most incredible book to date. As you know, he is a multiple New York Times bestselling author, uh, uh, really one of the important practitioners of, of functional medicine for many, many years. A mentor for me over the years as well, uh, and a very, very close friend, uh, that I’m, I’m proud to know over many years. So I’m just very excited to learn, uh, what Mark has to say. I want to jump right into the interview, so let’s do it. Hello, my friend. How are you? I’m so good, David. I’m so good getting younger every day. Yeah, I, I know, and in reading your book, I can see why, uh, you know, this is the, definitely the topic du jour, and I think that what you made clear early on in the book is that, you know, this has more ramifications than we previously associated with the whole notion of aging. And so-called Anti-aging, you know, as you and I explored over the years, anti-aging ended up being, you know, fillers and, and various procedures that made you look better. But I think, you know, what you really do the deep dive into in the book, and I don’t wanna scare anybody off, I, in the intro I talked about that, yeah, there’s a lot of deep science, but what you’ve craft, uh, what you’ve crafted here is a way to allow us all to leverage that information for a better outcome. So let’s jump right in. Major thesis right off the bat, is the notion of aging looked upon as a disease, kind of a bit of a revolutionary concept. Can you unpack that for us? Yeah. You know, David, it, it’s really exciting for me because, you know, in functional medicine, as we’ve both been talking about, thinking about teaching, about for decades now, we, we get that there’s underlying processes that go wrong that cause all disease, you know, and saying you have Alzheimer’s disease doesn’t tell you anything about what’s really going on about the cause. And what’s happening now is that scientists are figuring out that what we thought of as normal aging is actually abnormal aging, you know, the decline, decrepitude disease, frailty, disability, all those things that we’ve come to associate with getting older are consequences of malfunctions or dysfunction in core biological systems in the body that we can actually treat and reverse. And that’s what’s so exciting. And scientists are talking about now the hallmarks of aging. You know, we call it the functional medicine matrix, you know, which is essentially we talk about As we have, as we have for decades, For decades. So it’s kind of re it’s kind of reassuring and reinforcing to seed. These concepts that we’ve talked about forever are now emerging as, uh, the foundation for longevity research for longevity science for interventions, understanding that there are these 10 hallmarks of aging, which include things like mitochondrial dysfunction, which you’ve taught me so much about inflammation, again, which you’ve taught so much about over the years, and I’ve learned so much from you about microbiome challenges, problems with our, uh, epigenetics, our proteins that malfunction, telomere. All these fundamental things that tend to go wrong are regulation of nutrients and insulin and glucose, and how we regulate protein activation through these various nutrients sensing pathways. These are things that all tend to go awry as we get older, and that manifests as disability disease decline in function, even without a disease. But that is totally reversible and totally treatable. And that’s what’s so exciting that we, we address these hallmarks of aging. We might not be able to get just five to seven years of life extension, which we can, for example, if we eliminate all heart disease and cancer from the face of the planet, the number one and two killers, if we got rid of them completely, we’d see a five to seven year life extension, which is not very much. If we dress the hallmarks of aging, we might see a 30 or 40 year life extension. And for most people, that means living to be 120. Well, let me take a side road here and then we’ll come back, uh, because there’s this notion of escape velocity, and it’s a bit of, uh, it takes a little bit of working through, but you mentioned it in the book, and, and that is this notion that if we can stay alive and healthy long enough that there’s a sense that the technology will, uh, catch up to us, to a point that will stay alive. I mean, That’s, yeah. I mean, it’s a bit of a sci-fi thing. I’m not sure I wanna live forever. It’s ’cause part of what makes us human is knowing that we’re, we’re gonna die someday, so it makes it more precious. So I’m not, I’m not sure how I feel about this, but scientists are now talking about how discoveries in the longevity field are accelerating at such a pace that pretty soon, that for every year you’re alive, you might extend your life by a year and a month, let’s say a year and six months or two years. So you actually will never reach the point of death. I’m not sure that’s gonna happen. But what’s really interesting is some of the science around it, which is learning how to reprogram our biology to a younger you through epigenetic reprogramming. And this is done through all kinds of different methodologies, but one of the most exciting in animal models, I should warn, is the Yamanaka factors, which are these transcription factors discovered by, uh, Yamanaka was the Japanese scientist. He won the Nobel Prize for it. And essentially, these transcription factors regulate your biology into such a way that it, it teaches you how to evolve and differentiate into who you are. So how does your embryonic stem cell become a kidney or a brain or a liver or skin? There’s a whole program you have for doing that, and at some point it stops so that you don’t differentiate because you would just keep growing more things. You don’t wanna do that. But the way, uh, that this Yamanaka factor framework works is to, if you actually can insert these transcription factors into a human, and they’ve done this in animals, potentially you could turn them on and off at different ways that literally will reprogram your stem cells to a younger you. So let’s say you’re 50 and you’ve got gray hair and your joints are hurting and your erections are not as good, and you’re, you know, losing muscle mass. Well, you could turn on a switch externally that would activate these transcription factors, reprogram you to back to 25 years old. Now, that’s really kind of exciting, but it’s also not quite ready for prime time. They’ve done it in animals and they’ve restored, for example, mice who were blind to be able to see again, which is pretty remarkable. But I, I wouldn’t say this is on the horizon for us anytime soon, you know, 10, 15 years, who knows? But it’s, it’s not what I’m thinking about. I’m thinking about how do I add more life to my years now and feel more vital and healthy and functional. Well, you know, you mentioned these home, so-called Ho Hallmarks of Aging. And I think we can unpack each of those, giving our viewers tools that can actually target each and every one of those. But for what you just dis uh, discussed, I would ask our viewers, uh, if you wanna learn more about that information, go back to the interview. I recently did the second interview with Dr. David Sinclair and learn about that, because this is game changing, uh, potentially game changing as it relates ultimately to humans. And as you say, it’s a long way from that. But, uh, you know, that he was able to restore vision in, in rodents that have had their optic nerves crushed. You know, what does that say to us about people who are paralyzed or people who have a progressive degenerative condition like a LS or even Alzheimer’s Yeah. That we can revert cells back to a, an earlier state and a more youthful functionality. Uh, but let’s talk about, you know, let’s get to what our viewers can do, uh, right now and go through those hallmarks of aging, uh, beginning with, uh, you know, take your, uh, let’s say DNA damage. Let’s talk about how we can activate certain pathways that actually facilitate the repair of our life code of our DNA. Yeah, absolutely. David, I just wanna, just before I sort of dive into the, the minutia that I, I sort of wanna, like talk at a higher level how so many of the things that we’ve talked about in functional medicine for years, the fundamental lifestyle factors, you know, how we eat, how we move our bodies, how we manage stress, sleep, are so fundamental to regulating all these hallmarks of aging. And so you don’t need fancy things like stem cells or Yamanaka factors or super expensive supplements or anything other than most of the things that we already do, but just doing them differently. And, and then it’s a very hopeful message because we actually have, if we know how to apply it, the science of how to activate the lung, I call ’em the longevity switches in our body that will literally reprogram as to a younger biological age. So I’m 63 now. Can you believe that? I was like 30 something when I met you, David, and, and, uh, uh, where were in our thirties, I in my forties probably. No, right? You’re a little older than me, but not that much. And then I, I literally am 63 chronologically, but I’m biologically 43, meaning on, on a cellular level based on my DNA epigenetic tags, my epigenetic programming. I’m 43 now. That’s possible at any age to go backwards. And so the way you do it is by influencing these factors, uh, these, these, these 10, 10 hallmarks of aging. So you mentioned DNA repair. Well, that’s one of the things that happens to all of us. We have little hits to our DNA, maybe a hundred thousand hits a day. And we have a repair system. And this is really the fundamental thesis of my book, young Forever, which is that we have built in an innate, powerful, regenerative repair, renewal, and rebuilding system. We just have to learn how to activate it. The good news is, it’s not that hard. The bad news is pretty much everything we do in our lives today, what we eat, how we don’t move, stress, lack of sleep, environmental toxins, these do everything to screw up these, these fundamental pathways. But if we actually learned how to, how to actually activate, then we could reverse it. So DNA methyl, DNA epigenetic, sorry, DNA changes happen because we have all these insults of bad diet and stress and toxins and so forth. And so we have to repair them. So we have our repair system, which is turned on by sirtuins. Now, something might have heard about sirtuins and red wine and resveratrol, and it was sort of an old story that was sort of interesting, turned out not to pan out because you have to drink 1500 bottles of red wine in order to get enough resveratrol, and you’re die in the process of liver failure. But the idea is that you, you actually can turn on sirtuins, which activate a DNA repair army to go out throughout your body and find the little Nixon damages to your DNA and repair them. ’cause we, we replicate our DNA for quadrillion times, I think, throughout our lifetime. It’s an insane amount of times that it happens. But, but the good news is we actually have a fixing system. So how do you, how do you do that? Well, there’s a lot of ways, right? Fasting, um, cutting out sugar and starch exercise. And, and one of the interesting compounds that can activate sirtuin is NAD or NAD plus, which is, uh, a compound that’s made by our bodies from niacin, from vitamin B three, but actually is involved in energy production, but also stimulates the sirtuin pathways, which then send out this army of DNA repair. So for example, a lot of people might think, oh, well, I’m gonna take NAD Well, you can’t actually take it unless you inject it subcutaneously or take it intravenously, but you can take it as NMN or nr, uh, and which is sort of derivatives that are precursors to NAD, and then you can, can actually activate these pathways. So David Sinclair’s done a lot of work around this. I think we still are learning more about it and how it works, and people have some concerns about it and cancer risk and this, that, but I think they’re kind of overplayed. I think the FDA has recently ruled that NM NM might be considered a, a drug, even though it’s something that our bodies make. And I’ve, I’ve, I’ve, I’ve prevented it from being sold to supplements or a challenge that supplements sales. Although a lot of companies can still sell, they’re not really enforcing it, but it’s, it’s because basically a pharmaceutical company is developing research trials using this compound and wants to block anybody else from using it or selling it. So it’s a bit political, but I think this is a really exciting compound that I, I think has a lot of promise in the longevity space. So lemme just recapitulate, uh, we like to have our NAD plus levels high, or, and, uh, there are two precursors that are commercially available. Nmn, nicotinamide, mono nucleotide, and NR, which is nicotinamide riboside. You can buy those, they need to be kept refrigerated. And in terms of efficacy, I think the jury is still out. There is some discussion that metastatic disease might be increased, uh, in, uh, conjunction with taking, uh, these supplements. So something we’re keeping our eye on, but I think that you delineated the pathway for DNA repair, which is very, very important, and that we can threaten the functionality of that pathway by becoming more sedentary, not exercising, yeah. Eating the wrong foods. And, you know, it’s the same kind of menu that we’ve talked about for an awful long time. But what I, I think what was so beautiful about your book is you’re connecting dots showing, okay, if you do these things, you’re enhancing this pathway that has been fairly recently discovered. Nothing you and I talked about 20, 30 years ago. Totally. But it, it’s, now we understand it and here’s, you know, eat a good diet, but here’s why. And now we have that, uh, that framework for understanding, uh, let’s move on. Another, uh, thing you talk about that I think you had put in the context of the main differentiation between somebody who’s three and running around all the time, somebody who’s 80 and more sedentary was mitochondrial function and how important mitochondrial function is, uh, to maintaining vitality. Yeah, well, wasn’t between a 3-year-old and a 9-year-old. The three year old’s running around like a, like a chicken with head cut off and a 9-year-old sort of moving super slow. And that’s because of the function and the health and the number of their mitochondria. And I think, you know, David, you, you’ve forever taught me about the mitochondria and how to treat it and how to optimize its function. The, the mitochondria are energy factories, and when they go bad, we lose steam, we lose energy. And it’s totally fixable through doing certain things that optimize our mitochondrial function, which is cutting down in starch and sugar, eliminating eating the good fats, right? Went over that grain brain who wrote that quack book? I don’t know. Anyway, that was a, a seminal book that kind of got so many people to wake up to the idea that it was really a problem. So we, we have to keep our a TP our energy up, and we do it by eating the right foods, which is fats, in fact are really a great source of fuel for the mitochondria. Olive oil, avocados, nuts and seeds. MCTA lot of these are really important for regulating our, our mitochondria. And we, we need to kind of avoid also things that are poisonous to mitochondria, environmental toxins as best we can. Heavy metals through reducing the consumption through not eating all the big fish that we tend to consume. And then exercise is such a critical factor, if you wanna know, what is the reason that people stay functional, healthy for a long time is because they have good functioning muscle and enough of it. And when you get older, you lose muscle and you lose function, you lose mitochondria. And so how do you fix that? You do exercise strength training and, and interval training. So this morning, for example, I did a very intensive workout, just 30 minutes, but using bands and body weight and, you know, intensive cardio. And I was able to sort of jack up the input to my mitochondria to make my body make more of them, to make them more efficient, and to help them work better. And then there’s all kinds of other stuff you can do that I write about in the book, for example, like ULI a, which is from pomegranate, basically a compound that is metabolized by your microbiome. When you consume pomegranate, it turns into ULI A and then that is absorbed and activates your mitochondria to clean up old mitochondria, to build new mitochondria, to build muscle, increase your fitness level. It’s really cool, even without doing any exercise, you see an improvement in fitness similar by having this thing that fixtures your mitochondria. Um, so mitophagy is really important as part of the cleanup process. It does that. And then there’s all the mitochondrial supplements, David, that you, you know, you and I’ve used for years with our patients from coq 10 to pqq to acetylcarnitine and acetylcysteine. Um, and even, even other compounds like ribose and, uh, other, other really powerful things that can help the mitochondria work better and function better. And I use this in my patients with mitochondrial disease, which is pretty much all happen with aging, whether it’s heart failure or brain disorders like Parkinson’s. And, and it, it’s incredibly effective when you see it. You know, you, you mentioned, uh, who have mitochondria, patients who have mitochondrial disease. And years ago in medical school, we were, we learned about mitochondria neuropathies or problems with the mitochondria. And there was a very short list of things like progressive external ophthalm, plegia and current hair syndrome and you know, a few others. And that was really it. That’s all we considered as a related mitochondria. And yet we now embrace the notion of an acquired mitochondriopathy. In other words, how over time we, uh, engage various lifestyle issues that threaten mitochondrial function and manifest as diseases. Things like Alzheimer’s and Parkinson’s in, in my field, for example, are primarily predicated on bioenergetic failure, failure of the mitochondria to be able to provide energy in this case to brain cells. And, uh, you know, so we’ve been deeply involved in targeting the mitochondria and how interesting it is now that we recognize that mitochondria are so, uh, focal as it relates to our understanding of inflammation and how that was revealed to us, uh, in dealing with Covid Ovid 19. Uh, and in dealing with, uh, individuals with long covid that the mitochondria, their function is what helps regulate the immune system. And I think, you know, you certainly made it very clear just now and in the book that take all the supplements you want, but to me it’s buy a new pair of sneakers. It’s really about the exercise that’s the best supplement of all because it’s, you know, you are helping degrade defective mitochondria, we call that mi mitophagy. And then stimulating the growth of new mitochondria, activating this pathway that you explore deeply in the book called the a MP kinase pathway to help regulate blood sugar, to help improve muscle functionality, to help us burn and not store fat. Yep. I mean, These are the keys to the kingdom for crying out. It is, is like, what more do you want? It really is. That was, it’s so interesting, you know, Dave, when I started researching the book and I was like, okay, exercise, we all know exercise is good, but like, how does it work, right? How does it actually work? And yes, we know it makes you fitter and it builds more muscle and all that. And, but what really was shocking to me was the amount of science that showed how certain kinds of exercise will regulate these hallmarks and work through helping our epigenome work, through lengthening our telomeres work, through optimizing our mitochondria, helping our microbiome, reducing inflammation, helping fix our proteins, regulating these nutrient sensing pathways that are so key. And I think this is a meta hallmark, the nutrient sensing pathways, which regulates sirtuins and A MPK and mTOR and insulin signaling, all of which are impacted through exercising, can be optimized. So literally that you have the keys to the kingdom in without really doing anything or having to pay any money, just move your body. It’s quite amazing, You know, and, and I’ll say for, uh, people who are interested in this kind of stuff as you are, and, and I am, uh, over the years we’ve known that the exercise is good for you, leave it at that. But, um, we’ve always wanted to go deeper and try to connect the dots. Well, you say it’s good for us, but why? Right. And now you just talked about certain, uh, signaling pathways including, uh, mTOR, a MP kinase, et cetera. You know, fancy names for people who are interested in this, but we, we have to recognize that muscle, the muscle tissue is an endocrine organ. Yeah. Muscle tissue is secreting chemicals that are going and, uh, throughout the body and influencing the functionality of other tissues. It’s so true. Muscle tissue, when you exercise secrete brain derived neurotrophic factor interleukin six, which is the key regulator of a MP kinase, who knew cathepsin B, for example. So muscle is influencing brain. We’re now talking about the muscle brain connection as if they’re, as if everything isn’t connected to everything else. Uh, muscle when active, uh, controls functionality as you know, of the pancreas, uh, the liver, uh, thyroid and bone and fat metabolism for that. Yeah. For that matter. So to look upon muscle as an endocrine organ and how can you enhance its functionality to create those chemicals that have a positive effect, for example, in the brain, BDNF, growing new brain cells, enhancing the formation of synapses, protecting brain cells, increasing the brain’s vascularity. Mm-Hmm. It’s through production of these chemicals. Another one is VGEF, VEGF, uh, that happen when you exercise. So if you need to know that, if that’s important to you to get you on the treadmill, so be it. If if listening To, I think what you just, what you just said there is so important. I I want to emphasize that in medical school, you and I never talked, took a course on muscle. We learned about the musculoskeletal system. We learned about, you know, or like this bones, we learn about muscles, you know, just for sort of skeletal structure, but not as a dynamic functioning organ in itself. That is probably the primary determinant of your health, particularly as you get older. And like you said, if you lose muscle, you lose function. But you, your immune system is in, in inflamed, your, as you mentioned, your brain isn’t working as well. Your blood sugar isn’t controlled, your sex hormones go down, your growth hormone to repair and renew, everything goes down, your cortisol hormone goes up. So muscle is the currency of longevity. If you wanna live a lung healthy life, then you gotta get on creating and building muscle and making your muscle more efficient. And this is the most important thing you can kind of take home other than what you’re eating around how to actually live a long, healthy life. You made a, a point in the book that, you know, it’s great to build up tissues, it’s great to build up mu muscle, et cetera, but that the, the concept of autophagy, of breaking down, uh, is, is important as well. In other words, uh, getting out the weeds. Yeah. And, uh, clearing out the underbrush. Yeah. And, uh, and frankly, exercise is helping your body do both. So it reminds me of the, the song by the birds Turn, turn, turn, which is actually ba based on the Bible, Ecclesiastes, a time to build up and a time to break down. There you go. That’s, that’s the balance. Um, you, you talk about this notion of our epigenetics and that we can influence these, uh, factors over our genome that are influencing its expression, moment to moment more information for our viewers on the interview with, uh, Dr. Kara Fitzgerald. But again, uh, the regulators of our gene expression are to a, a significant degree under our control. Mm-Hmm. And you describe how we gain control and can really harvest that, uh, knowledge to, for, for our betterment. And this is really the, the sort of leading edge of longevity research is how are all the inputs or the deficiencies, you know, by basically my book, I talk about dying of too much of something, right? Bad food, not enough, you know, too many toxins, too much stress, not enough sleep, so forth. And what you’re dying, uh, too little of, too little of the right nutrients and good food and exercise and so forth. So, so the way those things affect us ultimately is through our epigenome. And, and the epigenome is basically something that sits above your DNA, you’re above your genes, epi means above, and you basically have 20,000 genes. You can’t change those, but you have the ability to change the expression of those genes through the epigenome. So the epigenomes, like the piano player, the genes are like the keys on a piano. There’s 88 keys, but it can produce jazz, ragtime, classical rock, whatever, reggae. And that’s amazing. So the piano player has enormous control over what happens. And the piano player is influenced by what you eat, by exercise, by stress, by sleep, by environmental toxins, by all these other factors. Anything causes inflammation, the microbiome. And so we literally can use the epigenome to measure how someone’s aging. This is Steven Horvath’s work who discovered the epigenetic clock. And by measuring tags on the DNA, we can measure your rate of aging. And it’s a biomarker that we never had before to track any intervention and determine how it’s impacting your biological age. So I’m 63 chronologically, I can’t change that. I was born in 1959, it is what it is, and the clock goes forward unless I go to outer space, whatever. But anyway, that’s another talk. That’s physics. Okay? But the, but the biological clock is malleable. That can be changed and turned backwards. And so the epigenome is highly influenced by all these inputs. And it can also be affected by deficiencies, whether deficiency vitamin D or Omega-3 fats or of sleep, or of exercise or whatever it is, love or meaning, purpose. I mean, you can change your epigenome through cuddling, right? Through cuddling. So I encourage more cuddling, and, and then I’ve seen this in babies and infants. So we, we know we can modify epigenome. And that’s what’s so exciting. And, and a lot of the, the interventions around longevity and lifestyle are impacted through the epigenome. Uh, and that’s, that’s what’s so exciting. But the good news is that when you do the right things, it benefit beneficially affects all of the 10 hallmarks of aging, not just one. Yeah. And, uh, as I I mentioned earlier the work of Dr. Kara Fitzgerald, what did she do to reverse the biological, the Horvath clock in, uh, her study population? She put them on a better lifestyle program, end of story. Yeah. She said, you’re gonna meditate, exercise, here’s your diet, and then followed these people and watched their, uh, epigenetic clock reverse, basically turn back the hands of time. Mm-Hmm. As it didn’t, not as it related to chronological time, but as it related to biological time. Mm-Hmm. They improved. Um, the, I I wanna highlight something about that, that, that you just because you know, there are a lot of studies that show interventions for reversing biological age, like quercetin and datin, which is a chemo drug. There are studies of vitamin D, there are studies of Mediterranean diet and various other interventions. None of them had the impact that Cara study did, because in eight weeks she reversed biological age by three years. And the reason it worked was food is medicine. And just like any other drug, the dose matters and the drug matters. And, and when we say food is medicine, we’re not saying it as some abstract metaphorical concept. We’re saying it literally as a biological phenomena where food translates its signals into real effects in the body in real time. And so it has to be the right food at the right dose at the right time. If I say, I’m gonna give you a milligram of aspirin for your headache, you’re gonna conclude that aspirin won’t cure headaches. Right? If I give you, you know, two, two, uh, maybe stalks of broccoli, and otherwise you’re drinking a six pack of soda, it’s not gonna help. So really, it’s about dialing in the food to be super effective. And that’s what’s really exciting. And, and we didn’t really get into this yet, but a lot of the, the hallmarks that are influenced by phytochemicals, so they’re modified your mitochondria, for example, we talked about this, ULI a and mitochondrial function. Well, this is a plant compound. It’s a derivative of a plant phytochemical modified by your microbiome that literally can improve your fitness level without any exercise and cause your mitochondria to kill all the old ones and make new ones. Well, that’s pretty amazing. That’s a pharmacological effect, but it, you need the right dose. That’s the key. But that is available as a nutritional supplement. We did, yeah. A, a podcast, uh, with the actual scientists who developed, uh, u Lithium. I take it every day. And As you may, yeah. Uh, as you, again, it’s something that is considered perhaps a prebiotic in that it’s modified prior to it becoming, uh, becoming functional Dysbiotic, isn’t it? A prebiotic isn’t a prebiotic, which is something that is Modified by your microbiome, modified by your by gut bacteria. Yeah. Uh, uh, um, so, uh, or, you know, um, yeah. So that’s basically a sense, it’s a, it, the, the gut bacteria modify this chemical or utilize the chemical. Um, I wanna get back to the idea of dose. And I’ve been kind of with that lately because there’s a sweet spot, and I hate the term for obvious reasons, but there is a sweet spot for anything you mention, whether it’s not enough of the aspirin or overdosing on aspirin and eroding your stomach lining. And I, I was thinking about that the other day in the cardiologist’s office as, uh, I was being lectured to. The cardiologist said to me after my battery of tests, um, you were, uh, or maybe still are an intense runner, aren’t you? And I said, yeah, you know, ’cause you know, if some is good, more is better the dose, right? Yeah, yeah, yeah. He said, ’cause my heart rate is really low. And he said, because the upper chambers of your heart are enlarged. And we see that with really aggressive long distance runners. And, um, you know, this may explain why on occasion you go into atrial fibrillation, that would be me. Mm. And, uh, again, you know, many of us, well, I always Knew you had a big heart, David. I have a big heart. Uh, but many of us, you know, kind of buy into the notion if some is good, more is better. And, um, I I’m as guilty as the next person of that. And I, I think a message from, from me moving forward in our outreach will be, you know, find the right spot, find the, the middle of, of the bell curve that’s best, that’s optimal, because again, too much of stuff can be harmful as certainly too little can be. Mm. Mm mm-Hmm. You, uh, you talk about the book, the notion of the importance of personalizing the approach for people and Totally. Why is that important? Look, everybody’s different. And I think, you know, for example, you and I are kind of relatively thin, uh, exercisers and probably what we call lean mass hyper responders. I know I am. So if I eat a lot of saturated fat, it tends to adversely lec affect my cholesterol. Whereas another patient I can put on coconut oil and butter and their cholesterol drops like a stone and they lose 20 pounds. So we are all biologically biochemically in individual and different, and we need to see what works for us. So it’s really important to find out what your own body likes and what it doesn’t like. You know, you can use, for example, example a continuous glucose monitor, and that will tell you how different foods affect you. And that might be very different than how they affect somebody else. Uh, they’ve done studies in Israel, for example, that your blood sugar regulation is controlled by your microbiome. That literally That’s Right. The, the, the, the bacteria in your gut will help affect how a particular food impacts your blood sugar. And it’s different than the person sitting next to you. So we, we are just beginning to understand this field of personalized medicine in individualized medicine. But I do think through increased access to biosensors and, uh, trackers and, and various kinds of ways that we can quantify our own biology, we’re gonna be able, like look much more carefully at our, our unique responses to various kinds of inputs and then determine what works or doesn’t work. But it, the general principles are the same for everybody. Don’t eat crap, eat real food, exercise, get enough sleep and learn how to relax, basically, that those are key. But then within that, it’s, you know, dialing it up a little bit down, depending on what’s going on with you. Well, I, I don’t want to, um, degrade the message of your new book because it’s much more, uh, intense or, um, it’s much more specific than what you just mentioned. Those, those, uh, you know, because everybody’s heard of what you just mentioned, but you’re very, very specific about supplements, their validity, their, uh, their dosages, et cetera. Um, I wanna get back to the notion of aging as a disease, uh, in the context of the idea that 80% of, uh, elderly individuals here in America, uh, have, uh, at least one chronic, uh, disease Yeah. And are suffering from at least one chronic disease. But the role of aging, we, we, we were talking about, well, you’re gonna live a long time, extend your lifespan, hopefully your health span, but the notion of aging as representing a, a major input in terms of why people have chronic diseases. Yeah. Yeah. I mean, I think, I think inflammation is such a big driver. David, you’ve talked about this. I’ve talked about this forever. And you know, I, I see it as sort of a final common pathway for a lot of different things. So in and of itself, it doesn’t occur out of the blue. It’s caused by something, right? It’s caused by too much of something, or not enough of something. Right. It’s caused by too much sugar and starch in your diet and not enough, for example, good fats or too much sedentary lifestyle. Not enough exercise or too much stress. And not enough relaxation. So it’s really easy to begin to understand the biology of inflammation when you look at the causes of inflammation. I always joke as functional medicine doctors where ologists is sort of, you know, that’s our specialty in as if you wanna say that’s Sure, yeah. We’re ologists. ’cause we basically look at the root causes of inflammation, and it depends on what’s going on with that person. Sometimes people, it might be their microbiome or food sensitivity or an infection, like a tick infection, or it could be heavy metals, or it could be stress, or it could be sugar. It could be a lot of different things. Even though there’s a final common insult of inflammation, there’s a lot of ways to get there. And so it’s really about personalizing the approach. And this is really what I talk about in Young Forever in the book, is how do you figure out what’s going on with you? And I have very extensive quizzes that are questions that I ask my patients and my practice we’ve done for 30 years in functional medicine to sort out what’s the cause? Is it your gut? Is it toxins? Is it your diet? Is it too much of stress? What, what’s going on that’s actually causing the inflammation? It’s not about taking aspirin or Advil or steroids or something that’s shut off the inflammation. It’s about figuring out why it’s there in the first place. What’s upstream? You know, uh, there’s a, a discussion in your book. You were walking somewhere with David Sinclair from Harvard, and you asked him a question, and the answer was, it’s sugar. And you put that in bold letters, I believe. Yeah. It was Lenny Guar who, who David worked with. Yeah. But yes, I was, it was a Tibetan medicine conference on longevity at the Menlo Center. Yep. And I was reading this, uh, last night, um, on the, a plane ride coming home from, uh, San Francisco about sugar, sugar. No sooner would I finish the paragraph, then there’s an announcement. What’s the announcement? Is there a doctor on the plane? So, oh no. You know, I get up and I, I get up this and this woman in wrote, whatever it was, doesn’t matter, uh, was looked to me like having a hypoglycemic event. She had, she was, she had, was unconscious, uh, or barely conscious. And, uh, I could, I was able to get her up. And what did I, you know, here I’m giving her sugar, another doctor comes to help me. And she said, oh, Dr. Perlmutter. I said, yeah. She said, I, I’m going to interview for a functional medicine job somewhere. We’ll leave it at that. And I said, well, can you imagine here I’m giving this lady orange juice with two packets of sugar in there? I said, this isn’t exactly from the playbook, but I guess there’s a time and a place for everything. It’s context. Right? Totally. But anyway. Totally. Totally. Yeah. But I enjoyed reading your book on the plane last night, and, uh, I wanna, I wanna end with how you started your book. And you, you started your book by asking for yourself and, and for your reader to identify the why. Why do you want this? And, uh, your answer was, was deep and, uh, and very meaningful. So why, why do you do it? Why are you writing books like this? Well, I, I think, you know, we, we live in an era where we, we, we think of people getting older as sort of extra. They’re, they’re not valuable members of society. They become a drain in society, a cost of society. They don’t add value. But the truth is that, and I see this in you, I’ve seen it in me as we get older, you know, we learn more. We are better at navigating life. We understand how to work through challenges that we all face, how to be better friends, better partners, better con contributors to a greater good that we all can be part of. And, and so often when we, we should be at a stage in our lives, we become elders. We become contributors back to the, to the, the world that made us, we often are sort of kicked aside and, and are worse, we’re made sick by our culture and our food. And we don’t get to experience that, that place of wisdom and longevity that can add back value. And so for me, it’s all about how do I show up better? How do I take all the things I’ve learned in life and and be a contribution to humanity? You know, common said, where are you gonna leave your one grain of spiritual sand on the universal scales of humanity? And so for me, that’s the question is like, how do I leave this earth a little bit better, uh, than when I came And, and how do I love more and show up more and create more good and healing in the world? And not everybody wants to do that. I understand. But I think for me, that’s, that’s my why for everybody. They have to find their why. Whether it’s, you know, wanting to be there with their families and contribute or whatever it is. We all, we all have a lot to give. And, and the economics are also compelling. You know, uh, aside from, from the, the personal contributions and the value that that older people can bring is that if we got a year of healthy life extension, which is not a hard action item on the list a year, we would save $37 trillion a year. That that is more than our entire, uh, GDP by double. And if we were able to get 10 years of life expansion, uh, life extension, that would be 300 and like 60 something trillion dollars. That’s, I don’t even know that that’s this enormous amount of money. I I think that’s more than the GDP of the entire world put together every year. So we really have the capacity to both save money and create a better world by learning how to live better, live longer, and have our health span equal our lifespan. And I think it’s important that as you target aging, you are targeting these very expensive to deal with chronic degenerative conditions that we mentioned earlier, affect 80% of adults. And that’s, that’s where the healthcare dollars are going. So, and, and it’s, you know, I, I’m very, I was very taken that you open the book by asking why. And I think when readers read your book, uh, knowing that, you know, it came from your heart, uh, it’ll have even more meaning. And so, I, I’m not surprised, I’m not surprised to see a book like this come from you at this stage of your life and your wonderful development. And, uh, thank you. I’m proud to know you and love you, and I’m very excited about what the future holds for you. So thanks for being with Us today, being mutual. David, thank you for being you, my friend. I learned so much from you. Okay, I’ll see you, uh, in a couple of days. See you in a few days. Alright. Bye for now, mark. Well, I hope everyone enjoyed that as much as I did. Uh, mark is a wealth of information and really, uh, this heart-centered book, I think is, is going to be an incredible achievement, really, uh, setting the stage for people fully understanding that we are the arbiters of our biological destiny, if you will. That yes, the chronological clock ticks on, but we can dramatically affect the rate at which we age from a biological perspective, how our bodies work, how resistant we are to degenerative conditions that are so pervasive. Really the nuts and bolts of what we can be doing day in and day out to remain, uh, young, uh, in spirit, young, uh, in terms of our physiology and certainly continue to contribute, uh, to society. So, uh, thank you Mark, uh, for that wonderful interview. And thank you, uh, to all of you as well for joining us today. And I’ll be back soon. Bye for now.