Episode 12: The 3 Hallmarks of Aging

Welcome to Inside the Cure with Dr. Charles Moak from Allure Medical. Learn what it takes to cure diseases, not just manage their symptoms. Healthcare isn't going to save itself, so let's jump right in.

I'm Dr. Charles Moak with Allure Medical and I want to go over some things I'm seeing as trends in healthcare and really where we're going as a nation, where we're taking our practice individually. So we have different aspects of a practice. Some of the cosmetic things that help people and feel better on the outside, and there's things we do from a medical standpoint as well that have a big impact on people's circulation. But I want to talk about what you can do to look and feel better on the inside, that is to decrease some effects of aging or identify diseases before it occurs. And we should look at kind of customary health care. Healthcare really, I would say, is more of a disease care. We know how to crudely guess who might have heart disease by doing a cholesterol screening. And there's something called Framingham risk factor to determine who's at risk. And they check your blood pressure and your lipids, such a cholesterol and HDL and kind of guess if medication will help you. But you really don't know if these are me beneficial or if you're going to have a heart attack or not, or maybe there's something really lurking there that you don't know about. So that's one hallmark is heart disease. Cardiovascular disease is leading cause of, of mortality in people. Morbidity, where you get sick and mortality where you die. And cardiovascular disease is made up of many things. The most common one that we think of is a heart attack. But there's also strokes and peripheral vascular disease. That's peripheral vascular disease where your circulation doesn't get down to your legs. People have leg pain we call claudication, high blood pressure, which is pretty much silent and leads to cardiovascular disease and even diabetes ties into it. So that's, that's one hallmark of aging and disease. The second hallmark is cancer. So cancer, you know, we've got screening tests such as a, you know, senior dermatologist and get your family doctor and getting a skin screening to pick up squamous cell cancer, basal cell cancers or melanomas, heaven forbid. And that's pretty good for picking up cancers or even self, self detection, seeing a suspicious lesion. Then there's a mammogram for women at over 50 or over 40, depending on what guidelines we're following. The PSA, the Prostate Specific antigen for detecting prostate cancer. Really not a very good test. It's still being used, but it's really questioned whether or not it impacts saving lives at all. Along with that is a digital rectal exam. That's where a physician puts a finger in the med's rectum and sees if prostate feels abnormal or nodular. These are both crude but effective ways that we screen for prostate cancer now, which is common colonoscopy. There's recommendations that you do either colonoscopy after age 50 or every 10 years, or annual stool screening for blood for trace blood. One of those two choices are considered the gold standard for screening for colon cancer. And that's really, you know about it, but we all know somebody who died or got sick and died from a tumor that really wasn't detected by those methods, such as somebody having a pancreatic cancer, ovarian cancer, uterine cancer, sarcoma, which is a type of musculoskeletal cancer. And these occur as well. One cancer screening I forgot to mention was cervical cancer. And that's where women gets a pap smear to pick up cervical cancer in advance. I want to mix that in with these other tumors. So we have cancers that we might develop and do we know if we're at risk for it and can we pick it up at an earlier stage rather than waiting to the last minute? And that that is possible. We'll talk about that. And the last one is neurocognitive decline. That's probably the biggest, scariest one. Whether or not you would, you know, you wouldn't want to live to be much older than you are predict predicted to do now, if you wind up being demented, having dementia where you wouldn't recognize people, wouldn't be able to communicate, having Alzheimer's or other forms of dementia. So those are the big three. So let's talk about what is happening now to pick these three common hallmarks of aging up at an earlier stage. What kind of intervention can occur to lower the chance of you winding up with this disease or either catching it early and treating it early, or even reversing that risk. So I'm gonna start with cardiovascular disease. Cardiovascular disease, that's a big one. And right now we use again, risk factors and cholesterol level, but doesn't tell you whether or not you're going to have the heart attack or you're going to have the stroke or you're going to have the peripheral vascular disease. It can detect it with some degree of accuracy, but it's really Kind of a shotgun approach, and it's not precise. Well, there's two tests that tell you whether or not you actually are going in that direction very specifically and sensitively. And the one is called the calcium score, the CAT sand, CAT scan calcium score. That's where somebody has a CAT scan of their heart, and they look at the arteries and see whether there's calcium deposits in the arteries. I think that's a good screening test in general, but there's some big problems with it. First off, you can't tell if somebody's getting better, if they're going in the opposite direction. The calcium doesn't change much. It's not as accurate on women or African American people. So it's really accurate for Caucasian men, but not so much for African American hearts or women. So that's something that I'm really not recommending as a primary. There's no reason not to do it as inexpensive, but I wouldn't count on using that. It doesn't have the sensitivity that the study that I'm talking about does, which is the carotid intima media thickness test. And this is a ultrasound. They typically look at the carotid arteries, which are in the neck, and sometimes combine that with the femoral arteries, which are in the groin, to see the thickness of the wall, the thickness of the lining of the wall, as well as the presence or absence of plaques. Plaques are little sticky, hard bumps into the vessel wall. And that is the hallmark of atherosclerosis we found over the last 20 years or so, is that as we get older, our wall thickness of our vessels gets firmer and thicker. As people are firmer or thicker than their peers, they're more likely to have cardiovascular disease than people with thinner walls for their age. So in other words, if somebody is at 60 and the average thickness is 0.7 and you're at a 0.9, your risk is substantially higher of developing cardiovascular disease than somebody that's at a, say, a 0.5. And we can predict that with relative accuracy. Additionally, there's evidence that what's called plaque burden, the amount of hardness of the arteries, there's little lumps on the carotid arteries, predict the development of cardiovascular disease and can track it more accurately. And there's a couple reasons to do this type of screening. One is to see if you have it or not to see if you have developed atherosclerosis or hardening of the arteries. The other one is to do something about it, to reverse it. And that's very important. To understand this, cardiovascular disease can be reversed. Now, a lot of conventional medicine assumes that patients aren't going to do anything to reverse their cardiovascular disease, and they use drugs, and drugs have been shown to some degree to reverse cardiovascular disease. But in addition to taking drugs, lifestyle modification can substantially reduce a person's plaque burden and the thickness of their vessel walls and reverse already present cardiovascular disease if you have it. So the test is done with an ultrasound in an office, and it's a little bit different than the screening ones you might see advertised where they're doing to see if you have a blockage in your carotid artery. If you have a blockage of carotid artery, you're really in trouble. This is a much more sophisticated test that shows you that you're not quite there yet, but you're going to be there. So if you have a heart attack in five years from now, well, today we know that you're going to have one in five years or some degree of accuracy. We could predict that because of the thickness of the wall of your vessels or the presence of plaques. And then we could take intervention to reduce the chance of you ultimately getting a carotid event, I'm sorry, coronary event, which would be a heart attack, or cardiovascular cerebrovascular event, which would be a, a brain event, such as a stroke or peripheral vascular disease. Additionally, we can combine that once we see that people have presence of cardiovascular disease, let's say their wall is thicker, they have more plaque burden than we'd expect at their age, we can do genetic testing to see what drugs may benefit you the best, rather than just trial and error and compare cholesterol changes to what medications that were given. So we really hone in on your genetics and the presence or absence of cardiovascular disease to figure out what's going to give you the most, most benefit. There's programs that have been shown over years to regress cardiovascular disease or thickness of the wall of the vein, I'm sorry, the wall of the artery by one year every year. In other words, eight years after starting an aggressive lifestyle program along with medications to reduce a disease burden, eight years later, they're actually eight years younger than the time they started. So they actually lost 16 years of cardiovascular disease. So if you've been maybe neglecting it and maybe did have some blood pressure not treated, and your cholesterol has not been managed, and you do have some plaques over time, with proper intervention, knowing your genes, knowing what you have, you can actually go back in time and reverse cardiovascular disease. So I think that's just very, very important. The second thing we're talking about is the cancer detection. And I'm all for cancer screening. The psa, I'm not crazy about. I don't. It's not really an accurate enough test. And the government has a healthcare task force. Then 2013 pretty much said that if you tested a thousand men for 10 years, you would save one life from dying of prostate cancer. And you wind up killing one person because they got unnecessary tests and had an untoward event. So it's not the best method, but it's what we have right now. But the other ones, the colon cancer screening, the mammogram, skin checks, cervical, doing the cervical cancer evaluation with a Pap smear, and the other ones your doctor recommends them all for. But we're talking about a whole body mri. So an MRI is a radiologic procedure. It does not use radiation, and it allows us to see inside the body and to see if you have tumors that wouldn't be picked up with conventional means and tumors that people have that are detected when it's too late. Examples would be pancreatic cancer, sarcoma, ovarian cancer. It's because they grew at a very slow pace, but by the time the person was symptomatic, the organs had started failing and they were having symptoms of the failed organs. And it was at this point that the cancer was advanced or spread and the person dies in a few years. But picking it up early, we have a much lower chance of dying from it and a much better survival rate. That's why we do mammograms on women with risk for breast cancer, is that we know if we catch in the earlier stages, the mortality or the death rate goes down. If we do colon cancer screenings, the mortality or the death rate goes down. What happens if you did a full body MRI every few years to see if you had cancer? And this technology is available now, some cities don't really routinely offer it. So we're going to work with local radiology departments to show them how to, how to perform these and how to charge for them. It shouldn't be too expensive, and it doesn't have to be as accurate as an official say, you know, full body MRIs, they actually can do less slices and a faster scan because we're checking for something, just the presence or absence, not the degree, the degree in which it, which where it's invested itself. So, for example, if you picked up a pancreatic cancer on a, on a full body mri, then we go Back and do the study again in much more detail to see where it's spread to how big it is. Exactly. So that's the second hallmark, is picking things up earlier and then you could do intervention. So in the case of cancer, we know certain cancers respond very, very effectively to changes in the diet. So if it's very early cancer, many of these cancers respond to very minimal amounts of chemotherapy or surgery and, and changes in the diet that prevent the cancer from growing. For example, some cancers really do very well on sugar. So using a low sugar diet or using medications such as metformin, reduce the chance of it growing, allow the doctors to take care of it. Some cancers respond very good to a plant based diet. Some cancers respond very well to high dose intravenous vitamin C in addition to standard cancer treatments. So getting it early lets you get way ahead of it. And the last thing I want to talk about is neurocognitive decline. So neurocognitive decline, there's this gene called APOE, and there's a 2, 3 and 4. And the APOE 4 has a higher risk of developing Alzheimer's disease. And there's something called homo or heterozygote. If you're a homozygote, meaning both parents gave you this gene, your chance of getting Alzheimer's disease is way greater than the general population. You'd get it younger. So you'd want to know if you're at risk for that and do things to modify your risk of getting that. But can we measure for the, for the development of Alzheimer's as a dementia? And the answer is we can to some degree. So an MRI of the brain, we measure an organ called the hippocampus. And if the hippocampus is smaller than expected from your age, you're going to be at more risk for dementia. That's one of the earlier findings of Alzheimer's is this particular organ in the brain. Brain shrinks and it continues to shrink as the disease gets more progressive. So if you're in, you know, you get a hippocampus MRI and you're in the, you know, 70, 89 percentile for your age, you're, you're not in any risk for developing dementia in the next few years. But if it's in, you know, below 50%, you might start thinking about what you can do to, you know, grow, grow it back. And there's some specific interventions that can be done to enlarge your hippocampus to a more healthy rate. Specifically, there's a process called when the hippocampus has shrunk is because it's been insulted with inflammation. And some of the cells have gone what's called senescent, where they're no longer dividing. They're kind of getting fat and lazy, and they're not dividing and they're not dying. So the brain does decline, and there's a process called autophagy, where our body clears up those dead cells. And it really only occurs when we're fasting, which is kind of hard to do. But I'll go with this real briefly. If you fast two days a week in a row, your body does a very good job at cleaning up dead debris cells, cleaning them out of your body and your organ. You'll be healthier, your brain will grow. I did a one year experiment on myself where I did an MRI my hippocampus. And it was a certain size in 2018, in January. And for one year, I did fasting on Mondays and Tuesdays. In the first couple months, I helped myself by using the bulletproof coffee formula by Dave Asprey, where you take this. I used a bulletproof brand at the time. It's a type of coconut oil liquid, a clear coconut oil in addition to ghee, which is refined butter in coffee. That's the only thing I ate for two days, and I just have very little of it. I'm not an advocate of using that. I was an advocate of using that to teach myself how to fast two days a week. Then I got kind of used to it. I didn't need it anymore. At the start of this one year journey of my health, I was in the 80th percentile of hippocampus weight for my age. So I was doing pretty good. And the size of my Hippocampus was about 9.25 or something cubic centimeters. And one year later, I went to the same machine. It went up to something like the 99 percentile, and it went from 9 point, say 25 up to 11.5. So it had grown about 20%. And the ventricle, which is the dead space, went down from 1.25 down to 0.25. So it almost was invisible. The brain was solid and it was more like resembling a healthy young person's hippocampus. And I want to keep it there because my mother has Alzheimer's real bad. I'm afraid, afraid of getting that. And I don't have the APOE4 gene, so I'm happy for that. But the concern if your family had something, what can you do to Prevent it. Well, there's also some people might say, well, I'm not going to fast for a year. And I get that. I think we should learn to fast. It's good for us. But there's drugs called fasting mimetics, fasting mimedics, and I'll talk about those in a later podcast. But fasting mimetics are drugs that you take that simulate the biologic effects of fasting. So these are drugs that simulate the biologic effects of fasting, block what's called gero conversion. Gero, like gerontology, conversion of cells that are healthy and replicating, turning into cells that are sort of like zombie like cells. Some people refer to them where they're no longer replicating and they just won't die. And they give off signals called sasp, senolytic associated secretory phenotypes. So sasp, I want to say that real fast, you don't need to remember that term. But these are juices that these cells that are senescent give off to cause other cells to go into the same pathway. And that's really a fundamental hallmark of aging. We used to think aging was all oxidation, oxidation triggers it. But a senolytic cell, cells that causes aging causes their cells to die off, and autophagy occurs when we're fasting. But also, these fasting mimetics do one of two things. They can either simulate or stimulate these senolytic cells to die, or they can block conversion from a active normal cell into a senescent cell. So that these are coming. They're already actually commercially available. There's even a couple, say, you know, vitamin type drugs that aren't, they're not prescription, that have been studied and seem to work for removing senolytic cells. And some common drugs, such as metformin, which is used for diabetes, is being tested right now to see if people live longer on it because it seems to be a fasting mimetic, not through its direct mechanism that we think for, for managing diabetes, some indirect effect of blocking conversion into, into senescence. So those studies are ongoing now, not say run out and get, get metformin. But you're in a. If you look it up, you'll see people are really talking about that a lot now, as well as other drugs that mimic fasting. And fasting is something that's very healthy for our body. So those are three things I'm going to talk about those three things we talked about today. And these are becoming more and more widely available. They won't be covered by your Insurance company, because insurance, they do something, they use some people called actuaries. These are data scientists or statisticians that figure out whether or not things are cost effective. And we'll find is that if we screen everybody for, say, carotid disease, they have thickness of their arteries, and we didn't have a way to motivate them to change their lifestyle. We didn't have the proper people to coach them, and we didn't have the proper understanding what to do. Probably not much is going to happen. And then they insurance companies spend, you know, a couple hundred bucks, three or four hundred bucks on a test that nothing came from it. But when people do this on their own, they're more likely to seek out treatment. And also studies have shown that when patients are given a copy of their arteries and they see plaques in them, they're much more likely to change their lifestyle, such as quitting smoking or taking their blood pressure medicine or eating healthier. So that's really important. So it'll be something that you're going to have to pay for yourself. I think we got to face the fact that if we want our insurance company to pay for everything related to health, they're just not going to. They're not necessarily pay for your gym membership or for the healthier food choices that you're going to make, or for meditating or for getting proper sleep. The cats. I'm sorry, the MRIs of the full body, I think that could be supplemented with a CAT scan of the chest. The chest maybe would be as good or better with a CAT scan, the lungs looking for tumors and an MRI of the abdomen, pelvis, the brain. This would be something that would pick up a significant percentage of early cancers, not all of them. We still have to do conventional screening. And there's some cancers that are bloodborne that you wouldn't really see with an mri. So blood tests may be needed as well and brain imaging to see the status of your hippocampus. And if it's shrinking, then you're going to probably want to really consider doing this fasting exercise. And when you're fasting, doing things such as learning a new subject on those days, doing some deep work. So your brain is what we call plastic brain. Plasticity is where the brain can grow back. And those are the three things that we can think about doing to reduce the chance of us getting something that has a big effect on our health span. And in the future, we'd be talking about what can we do, what's coming in the future that will expand the period of time that we're alive and that we're healthy. When I talk to people about this, like, well, I don't want to be, you know, I saw my grandmother, my grandfather in her 90s. I don't want to live like that. But what happens if you could feel in your 90s or hundreds the way you feel 30 or 40 years earlier, would you be ready to die then? And the answer most of the time is no, I want to keep going. So that's, I think, a key to keeping ourselves healthy because the technology is coming to where we will be able to live a substantially longer period of time and be healthy during it by managing things such as detecting cancer at a much earlier stage, detecting cardiovascular disease at a much earlier age, detecting neurocognitive decline in a much earlier age, and then through testing and genetic testing, figure out what's the best therapies for reversing or stopping halting progression or you know, better yet, reversing. And most of these can be reversed so that we can continue to live and be healthy. And then as drugs come out that are these fasting mimetics and other compounds that cause senolysis or death to senescent cells and block the gero conversion or the aged conversion of cells so that we can actually slide backwards on the age clock, these things are coming. There's a study done in 2019, Dr. Fahey, where he put some middle aged men in their 60s on a protocol of drugs already widely available. Three different drugs for six months and at the end of the year they were younger than when they started the protocol. And these were drugs already have known safety to them. And I'm going to talk about these and others in upcoming podcasts. But right now I want you to realize that the time of us getting younger is not here yet. But the science has proven that we can make animals younger. We can definitely make animals younger. Most of the studies that are that are the closest to humans would be in mice study, but currently our studies in humans and dogs and primates on doing things to anti age the person or the animal or the dog or the mouse and these things are going to be available in the future. I'm not sure when. Obviously there's a lot of startup companies that are really searching for new drugs, but there's also drugs that are already out there and available that can be repurposed to slow down aging or reverse aging in animals and possibly can do the same things in the future. So right now we got to be careful with ourselves and keep as healthy as possible and potentially by screening ourselves more than what our insurance companies are willing to pay for.

Thanks for listening to Inside the Cure with Dr. Charles Moak. See you next time.