Anti-Aging Routine: The Unknown Supplements No One Is Talking About | Dr. Kaufmann

Doctor Sandra Kaufman, one of the smartest longevity docs. Why on earth would you drink Diet Coke?

Because it's delicious and it's refreshing.

I feel so dirty. I'm sitting in a room with someone who doesn't drink coffee.

No, I don't.

Would you take stem cells?

I don't like the idea of someone else's DNA being in my body. I take birth control.

Take birth control. Have you not seen the studies about what that does for your risk of cancer and all these other things?

But you have to understand why it causes cancer.

Oh, my God. You're like the worst longevity doctor ever. What is the number one medication that can be used for longevity that no one's ever heard of? You're listening to the Human Upgrade with Dave Asprey. This episode is recorded live in the studios here in Austin. And a good friend has flown in specifically for this episode. We're both heading to the American Academy of Anti Aging Medicine tomorrow. This is a very weird longevity doctor. I'm just gonna have to say that. And that is one of the highest compliments that I could pay someone. Dr. Sandra Kaufman, or Sandy, as she's known by her friends and colleagues, is a former chief of pediatric anesthesia and a longevity expert and an author and one of the smartest longevity docs I've ever had the pleasure of becoming friends with. We've hung out multiple times, and this crazy person, I'm just gonna have to say this will order the Diet Coke, the Fritos, the cupcakes, and all of the crap that would knock me on my face if I ate it. And she's healthy, lean, her brain works perfectly well. And when I first met her, I thought, this is the worst longevity doctor I know because she doesn't know how to fucking eat. I just have to say that F bomb and all, but I'm like, why would you do that? And she looks at me and she goes, because I like it. And I'm an anesthesiologist, and I know all the pathways, so I'm just going to block them all so I can do whatever the heck I want. And I'm like, this is a fascinating person. And as I got to know her work and just the structured thinking of longevity, I have never had a conversation with Sandy where I didn't walk away reconsidering something, thinking about something. This is going to trigger you or at least has a good chance of triggering you, unless you've done all of your work on being untriggerable. If not, wait for my next book, but she's going to talk about how to do things that you and I both know are not healthy and get away with it. And what is the definition of biohacking? Change the environment around you and inside of you so you have full control of your own biology. If you want the ability to occasionally or maybe even every day eat junk food and either not pay the price or maybe pay a much smaller price, which is what I still think she's doing, she's going to disagree with me. Then she's going to teach you something, or if something's not working, you're going to learn about some of the seven pillars of aging. In her book. How many pillars do you have?

Seven tenants.

Seven tenants. A guy had seven pillars. Some people say there's nine. Um, and so it'll be a similar conversation to things you've heard before if you've taken my longevity course and things like that. Uh, but she's gonna tell you, here's the natural stuff, here's the pharmaceutical stuff that blocked each of these pathways, and the lifestyle stuff. So she's more pharmaceutically oriented than I am. But if you're one of those. One of those people who says, I'm never using a pharmaceutical because they're bad, that's like saying, I'm never using a gun because they're bad. Even if you wanted to eat an animal that was hunted with a Right. So what Sandy knows is the pathways of aging. And she's like an encyclopedia. And all of the tools, pharmaceutical or not, with no bias whatsoever, they give you full control of those pathways. This is a radical look. It is fascinating. And she has no opposition to natural supplements. She's like, give me the right tool for the job. I have no bias. And that is one of the things I respect the most. So, Sandy, I'm so happy you came to Austin for the show.

I am delighted to be here. I have to say, that was the best introduction ever. I love being called weird by you because such the compliment.

It also takes one to know more.

When we first met, we had the best conversation ever. We looked at each other, we had a fantastic discussion argument. Many people gathered around just listening to our repartee. You even joined me on stage where it continued. And we've always just had the best conversation.

We haven't. And you're just endlessly curious. And you, you have this mindset of taking control in a way that's. It's very unique, especially for a physician. And I think for people who aren't in the field of Medicine. And to be clear, guys, I'm not. I just like to pretend like I am on the Internet, I guess. You know, I. I'm not a doctor. I'm very clear about that. And I have great respect for the training. The doctors who really have deep knowledge are anesthesiologists and pediatric anesthesiologists. That's the toughest thing because kids metabolisms are different. So you're at the very top of your game at that. And I think that's led you to be so relentless. Do you think that's right?

No, I think that's absolutely right. In the adult world, we have lots of medications and one size fits nobody. As we say in pediatrics, everything is absolutely titratable to the child's size, their bmi, to what they have. So I've taken that into information with pharmaceuticals as well as natural stuff and sort of taken it and directed it toward the world of longevity.

Okay. When we first hung out, I was kind enough to share a 1mg nicotine dose with you. Nicotine is a longevity drug in my book. You didn't like it very much. What happened biologically?

Biologically, that's an excellent question. So medically, I became tachycardic, diaphoretic, and I vomited my guts out. It was delightful. I did was so appreciative.

I did hold your hair up for you. I felt bad.

You did? I was vomiting in a garbage can. And he very, very kindly, yes, I felt bad, yes. Got me a garbage can, held my hair back, walked me to my room, and then he proceeded to do it again a year later.

You have to try it twice to know if it works.

Yeah, it's a terrible drug.

So I have been with probably 5,000 people who tried pharmaceutical nicotine for the first time. As a nootropic and a longevity molecule for the drug, you had the most severe reaction of anyone I've ever seen. Is that because you're on all these other drugs? And cupcakes.

I love how you got the cupcake thing in there. No, I have no idea. I don't take a lot of nicotine. I never have. I think I'm just not accustomed to it. So my receptors has just never seen him. I mean, God knows my liver seen enough drugs, but just not that one.

How's your liver?

It is fantastic.

How do you measure your liver?

Well, there's the standard liver enzymes, which of which they are absolutely fine, but I upregulate the mitochondria of my liver every day. So I can only assume that it's top notch.

Do you ever do like a liver screen for fibrosis?

I've had full body MRIs and CTs and you can generally see it. Answer is, I have nothing.

Got it. I just did an episode on liver health and they use basically an AI powered thumping test that looks for fibrosis and they said I had a 10 year old's liver, the healthiest results they'd ever seen. So I would say biohacking works on that, of course. Okay. What is the worst pharmaceutical that people take that makes them old without knowing it?

Oh my God. That's an excellent question. There's so many of them.

Right.

I wouldn't even know where to start. The problem is people take medications to cure one problem when they're clearly precipitating others. And if I say anything as a physician, they're going to say, oh my God, I shouldn't take X despite what my physician told me because I could die of something else. Obviously the chemotherapies are terrible.

Yeah.

On the other hand, it's better than dying of cancer.

Yeah. There are times when for a certain kind of tumor, this kind of chemo is very well proven to work and I don't have any issue with that. I wouldn't want to do chemo first line, unless I knew a kind of cancer head and that it would respond that. You can test for that, right?

No, absolutely. But there are, there are a lot of things that are just absolutely horrible for you.

So I'm thinking look, look for more common things.

Look for more common things.

Things that 25 million plus people take daily.

If you're trying to come up with something specific, I don't know what your aim is.

No, I'm just thinking. Well, I mean, there's statins, there's Tylenol, there's ibuprofen, there's cold medicine, there's very commonly prescribed foods that are not good for longevity.

So a lot of it is dose related.

Okay.

For example, Tylenol at a low dose is fantastic. Right. It's not an anti inflammatory per se, but it does do a lot of things in the central nervous system that are actually good in very low dose.

How low is a low dose?

Like five per kilo. I speak in pediatric terms. Right. But standard adult dose, which is about a thousand milligrams. Well over time. Yeah. It's very bad for your liver.

Yeah. And probably some other things like your kidneys also take a big hit.

Well, everything gets metabolized differently. Right.

Okay.

Tylenol gets metabolized in the liver specifically, not really in the kidney.

I thought it also had some metabolite that also like post liver, I could be wrong about it.

So can tabolites in the liver. And then those metabolites obviously have to get excreted. So if you have a bit of a kidney problem, then the excretion is going to go down. It's going to sit in your body a little longer. And that can be problematic. Like everything is stages to sort of metabolize and get rid of it. But you mentioned statins. And again, statins have a place.

They totally do.

If you are, you know, suffering from extreme dyslipidemia, they're very useful. On the other hand, absolutely. Longevity, it's not really their strong suit. They do actually help with stem cells, so it does have a plus. On the other hand, they're extremely harmful in other ways. But there are many ways to skin a cat and there are other pharmaceuticals that get rid of cholesterol rather than decreasing the production of it. So there's many ways to get around statins.

Is cholesterol bad for you?

Too much is bad for you. Too little is bad for you. You need the right amount.

Why is too much bad for you?

Too much is bad for you because it clogs things. It tends to be very. It gets oxidized. It just sits places where it shouldn't sit. It accumulates. On the other hand, not enough means you don't have the building blocks to make standard things in life. So you need the middle amount.

Since plaque and arteries isn't cholesterol, where does it accumulate?

Accumulates in your cells.

Inside your cells.

Okay. Inside your cells, absolutely.

So this is intracellular junk, basically.

Absolutely.

Got it. Okay. And at what levels of total cholesterol do you get worried from a longevity perspective?

It depends on the person and. Absolutely. And it's so funny. I look at international levels all the time and they're so different from country to country. So I don't like to cite numbers. I like medium to low, medium to low.

Okay. And my perspective is I don't really care unless it's above 300ish or something. As long as your LP, PLA2, your homocysteine and your CRP are low, there's no evidence of clogging of the arteries, and Your cholesterol's is 275. Your HDL is high, triglycerides are low. Who cares?

Because it's a. So atherosclerosis is multifactorial it's high lipids, it's oxidative stress, and it's inflammation. Right. So if you only have one of those components, it's not so terrible. If you have two, it's not so great. If you have three, you're going to die. Right. So it unto itself is not terrible unless you pair it with other things. And I will tell you that anyone over 40 has high levels of oxidative stress unless. Unless they're us.

Yep. Unless you're doing something about it. Okay. Why on earth would you drink Diet Coke?

Because it's delicious and it's refreshing and.

It'S addictive as all hell.

It's totally addictive. So I will tell you a story, and this is absolutely ridiculous. Ridiculous. My father, when I was in high school, drank, like, 13 to 14 cups of coffee a day, and he happened to get renal cell carcinoma. And he decided that despite all medical information, because he is an endocrinologist, but despite that, he decided that he'd gotten cancer from coffee, which we all know now is absolutely absurd. I'm talking to the coffee king. However, he said, if you don't ever drink a cup of coffee or if you get through med school without coffee, I will buy you the car of your choice.

Wow.

So I didn't. I've never had a cup of coffee. The irony is that I never got a car either.

I feel so dirty. I'm sitting in a room with someone who doesn't drink coffee.

Drink coffee. I didn't. No, I don't.

You're a longevity doctor. I'm so. I'm so sad.

I know. I take a lot. I eat a lot of chlorogenic acid. Does that. Does that help?

You could just take it straight from the source.

I do. It's called a bottle. It says chlorogenic acid. But I had to drink something that kept me up, so that's what I did. It's okay. I take osteoblastic activators. My enzymes are fine, my bones are fine.

I'm not worried about the phosphoric acid.

Everything is fine.

I totally believe you. Because you measure the stuff. You're hardcore about this. What do you do to protect your brain from excitatory neurotoxicity from the artificial sweeteners?

So I optimize my brain like I optimize anyone's brain, to be perfectly honest. I worry about free radical scavenging. I worry about glycation, stress. I worry about, you know, hippocampal plasticity. All of the standard brain concerns. And I take many things that get through my blood brain barrier to address those issues.

None of those, though, have to do with excess levels of aspartate though, right?

Not really. On the other hand, if your metabolism is good and your mitochondria are good, you're going to process any true toxin and you're going to get rid of it.

And you don't worry about it turning into formaldehyde in the bottle when you drink it. Why not?

You're ruining my bad habit. I, you know, I've looked at all of these things. Clearly life is a risk benefit ratio. I've decided to take the risk.

Okay. In other words, you choose danger.

I do.

See? And guys, everything you do has a risk. And you can say, it was worth it for me. And this is one of the things I just absolutely love about Sandy's way of thinking. It's like, I wanted to do it. My body can handle it. And you could say, well, that's not wise. Except she knows what she's doing. She's an adult. And I totally support her right to drink Diet Coke. For me, I'm going to save the hits my biology is going to take for things that I like more than Diet Coke. But if Diet Coke brought me extreme joy, I would do the same thing. Except for me, I turn to an idiot when I drink it, so I probably shouldn't.

Well, I'm sorry you can't control your Diet Coke. I'm so sorry. But, but what was really interesting about it, and I actually go out of my way to tell people that I do drink Diet Coke and eat cupcakes because a lot of longevity folks are out there portraying themselves as absolutely perfect. And I think for the general population, that is scary. It's intimidating. And they get turned off. They're like, I can't do that. So when clients come to me, I want them to be themselves and I want to optimize themselves. I have a lovely woman, she's from Russia. She loves to vape. As many times if I told her that it's bad for her, she's not giving it up. So we have designed a program to minimize for vaping. I have other women, they will not give up their wine. So we just design programs, you know, for. For everyone's downfall. Because the idea of longevity is you don't have to be perfect. Accept what you can do, accept what you can't do. And that's what. What it is.

My idea of hell would be spending eight hours a day on longevity because I have to live 50% longer just to be. Just to break even because I didn't get to go do fun stuff during all that time. And I also would like to sometimes have smoke all I drink like twice a year. I'm just about a non drinker, but if it's really good sake with my sushi, I'm going to do it. And I know how to block all this stuff in it. I've done multiple episodes about it. Do you drink?

Yeah, I drink a little. Yeah, it's the same sort of thing. If it's good alcohol and you're in good company, have some. Because you, because you don't. You can't be miserable in life. It's about living.

I know some people are pretty good at being miserable.

Oh, I know lots of people.

There's this one guy who says you can't extend human life at all, but if you just exercise for two hours a day, maybe you'll be healthy when you die at a normal age. And he says he's in the longevity. I'm like, that's so weird. Like, that's my idea of hell.

Everyone has their perspective. Yeah, that doesn't sound like fun either. I mean, granted I love exercise, but I don't have time for two hours a day.

Right. And mostly when you exercise, you're bouldering. Right. Like you're going out and climbing rocks. So you're getting.

I do climb a lot of rocks. Yes.

Do you ever climb a building?

I have climbed a building.

That's cool.

Yes. It's really fun.

Yeah, you're built for that. I'm. I'm way too heavy. My, my bone density there.

Yeah, you're just horribly obese. It'd be embarrassing, actually. Yes.

Plus, you ever try putting a size 16 foot into a crevice? Probably.

Clearly not.

No, it's like, that's not a crevice. That's like. It doesn't fit, so. The world's made for small people, I tell you. All right, where do you want to go next? So many fun things to ask and so many educational things. What are the seven. Wait, what do you call them? You don't call them.

I call them tenants.

Okay, there we go. In your work around longevity, what are the seven tenets of aging?

Okay, so the seven tenets. So you have to understand that when I did this, the hallmarks were some weird paper that no one had ever read and no one had ever heard of. I glanced at them and I said, well, that's an interesting list, but it's kind of crappy. So I thought, I'm just going to make one that's better. And it does come from the perspective that I was a cell biologist before I went to med school, so I didn't sort of make all of this up. Right. I mean, it comes from legit study.

You also have a degree in plant physiology or something weird like that?

I do. It's cell biology and plant physiology. I do. Which is amazing. At cocktail parties, when people ask you like, you know, anyway, whatever, what are the tenants? That's a good question. So I organized it by sort of big headings with subheadings. And I think it's better than the hallmarks, only in that you can put in subheadings so you sort of maintain the same structure as an example. So tenant one is DNA alterations. In this category, we've got telomere issues, we've got epigenetic issues. And the new thing that I've sort of jumped into is heterochromatin versus euchromatin distribution. Right. And if I just said, oh, randomly, oh, this is really interesting, where do I put it? It would just be like the 77th hallmark. But no, I have a home for it because it goes into DNA alterations. Right. Two is issues with your mitochondria. Mitochondria fail for six or seven reasons, depending on how you count them. Right. Has to do with mitochondrial permeability, pores. Has to do with NAD deficiency, failure of your mitochondrial or the electron transport chain. You know, the list goes on and on. Endogenous, free radical scavenging, et cetera. So that's three is what I call pathways. And there are probably hundreds of different longevity pathways, but I like to consider the top three. And then I added a fourth. So these are your sirtuins, this is your AMP kinase pathway, your MTOR pathway, and I've recently put the circadian pathway in them because it's just absolutely crucial to longevity. That's three. Then four is what I call quality control. And this has to do with the idea that if your cell is like a little factory, you're making some widgets and you have to check your widgets because things don't always go as planned. So this is DNA repair mechanisms, of which there. 5 and this is prettyostasis systems and all the heat shock proteins and that sort of thing fall into that category as well as recycling when your widgets just aren't working out. So that's autophagy as well. 5 is your immune system that turns into your inflammatory system over time. Quite important. Six is what I Call individual cell needs. So this is where you want to take care of your stem cells, maybe eradicate your senescent cells and understand that bone cells different than a neuron, which is different than a red cell. And then the last category is waste management, because obviously when you have a little factory, there's just stuff that causes problems. So this is going to be glycation issues mostly, and then lipofusion accumulation. Okay, so in a nutshell, that's pretty much why you age.

Got it. One thing that's really cool is you've bucketed these things. The seven pillars that I had have some similarities, and I did my best on those. You have some pathways in your work that I didn't get into. We both have a really strong interest in circadian issues. You know, TrueDark is one of the first modern circadian glasses companies. In fact, I think it's the first modern one. And I've been researching that for 10 plus years. And it's been a major part of my longevity. Things to learn how to go to sleep at 10:30 instead of 2:00am, which was my default for the first 40 years of my life. Just I would always go to sleep at 2. And now I've been able to reset that. And you do see benefits from it. What are the circadian pathways of aging?

So, interestingly enough, I love this one of my favorite topics. So you go to sleep and wake up because you make two proteins that go to sleep. Two proteins wake you up. So you go to sleep with BMOL 1 and clock. They're made in the nucleus. They go to the cytoplasm, they heterodimerize, and then they go back in. That triggers cryptochrome and period. Right. Those are the ones that again go to the cytoplasm, they heterodimerize, they go back in and they turn off the other. So it's on, off, on, off. That is a vacillatory pattern which is then affected by two things, Reverb alpha and ROR alpha. And it turns out that all of these things become sort of kabunk with aging or with disease. And you can actually make all of those things go back to sort of homeopathic levels, which is fantastic. And a lot of people know how to do some of it, but not all of it. And the one that most people don't look at is the ROR alpha, which increases the vacillatory amplitude. And you can do that with something called nobilitin. And I love that one because that's a Drug? No, it comes from orange peel.

Okay, so is it. I don't think you can buy nobilitin directly. What is. How do you spell it?

N O, B, I, E, L, I, T, E, N. Interesting.

I do use an orange peel extract, but it's not that one I'm trying to remember.

Well, it's in orange peel extract, so it might actually be a component of it. But you can separately bind a bilitin.

And you take this at what time for sleep?

Uh, actually, I'm working on that because we know that it affects the RoR alpha pathway, but no one's actually tried to figure out, like, when the best time to upregulate that is. So I'm a bit of an experiment right now. I've been taking it in the morning. We'll see what happens. Um, but I ain't gotta tell you, I'm sleeping like a rock.

What happens when your ROR Alpha pathway increases?

When it increases, the amplitude is stronger. So you know how you. Everyone is always, like, staring at their oura ring, like, how many minutes of REM and this and that and the other. But the. The degree of depth, the depth of sleep is. Is better when you activate ROR Alpha because it increases the amplitude versus reorb alpha decreases the amplitude. So, like, the pathways just get significantly better.

Okay. And you're doing that in the morning. It's really frustrating to hack your sleep because naturally you want to take everything before you go to bed. Right.

And you can, but it doesn't work that way.

No, no, it doesn't work that way.

And and the other interesting component to this is it's also driven by sirtuins and nad. Right. So NAD sort of drives. Is actually so NAD I love, because it is made in a circadian fashion, and by default it controls circadian rhythms.

It controls. Or it's in.

No, it does, because NAD controls Sirtuins, and Sirtuin 1 and 6 control when the other things are made.

Okay.

Right. So it's all very interconnected. So as you age, your NED drops, your sirtuins drop clock, BMOL drop, cryptochrome drops, Ororo alpha drops. Right. So this is why people can't sleep. And I love going to sleep lectures when people say, oh, turn off the lights, do this, meditate, blah, blah, blah. If you don't have the biochemical processes in place, I don't care what you do, you're not going to sleep.

You'll still get better sleep because of the SCN activation. If you dim the lights. But There's a lot more you can do.

You can. Yeah. I mean, it's just not going to get to the heart of the matter. The heart of the matter is biochemical processes.

Okay, if I remember right, dimming lights does affect bmal, but not the other stuff you just talked about?

That is correct.

Okay. So the good thing is it's free to turn off the lights, and you might spend a little bit of money on supplements or something. Is there a sleep pharmaceutical that you think is safe and effective?

Not one to take in isolation.

What about ghb?

Never tried it.

There's a prescription form of ghb.

I've never tried it.

Oh, my God. You. You should. Because it radically increases growth hormone, and since you're a doctor, you have a permission slip to buy whatever you want.

Oh, I can buy whatever I want, regardless.

Not fair. I want to buy whatever I want.

No, I've just. I've never had trouble sleeping since I optimized my circadian rhythms, so I've never had the need, so I've never done it.

Okay. Makes good sense. Ambien. Good for you. Bad for you.

Oh, it's terrible for you.

Got it. Okay. I think so, too.

Yeah.

I thought you were going to say, well, I take it, and I take seven other pharmaceuticals, and I have Ambien parties or something.

Oh, gosh. No, no, no, no, no, no. Take. Taking. Taking a benzo or a benzo, like medication to sleep is the worst idea ever.

Yeah. Oh, it's. It's gonna. It's gonna do bad things. Why is NAD bad for you?

That's very. So too much NAD is bad for you. Let's rephrase the questions.

Oh, take away all the fun.

Okay, I know. I know. So. So NAD is bad for you if you have too much in a short period of time because it has a very short half Life, somewhere between three to 15 hours because it's circadian. And it breaks down into NAM, which has a negative effect on your parps and your sirtuins, so it becomes metabolically sort of toxic. So you don't want a lot of NAD at one time. So I'm staunchly opposed to the IV therapies.

When I did 20 rounds of IV NAD, it did improve my sleep. It improved my alcohol tolerance dramatically, and this was 10 plus years ago. And I've been taking nicotinamide riboside, or NR, since the first mouse study came out. About 15 years ago, I bought NMN when you could only get it from China, started taking that, and I. I have Noticed that I do get inflammation over time from NAD by itself, and I've had a couple episodes about why. Walk me through the reasons you might take nr, nmn, or straight nad. When, how much? Give me the master, the masterclass on nad.

Perfect. Okay, so as we all know, and you know, and I'm sure your listeners know as well, we need NAD for many things around the body. In the redox reactions, we have nad, but we don't actually break it down. We just sort of shovel some protons around. So that's a break even sort of phenomenon. Right. But we need in our mitochondria for the Krebs cycle, the electron transport chain and glycolysis for other reactions. And we need nad for about 500 enzymatic reactions. In your body, the molecule gets chopped into pieces. And where it gets chopped depends on the process. The big two are sirtuins and the parps. So two ones are necessary because it controls most all cellular homeostasis. PARPs, you've got 17 PARPs, but PARP1 is the most important for DNA repair mechanisms. Therefore, without enough nad, you're going to get cancer and you're going to lose cellular homeostasis. And most people, statistically, by the time you are 40, you are deficient. Okay, now what to take? Very good question. There is an internal cycling system called the salvage pathway. And then of course there's the de novo pathway. The de novo pathway starts from tryptophan. Ten enzymes later you get to nad. It's very expensive. Interestingly enough, however, kidneys prefer the tryptophan pathway. So if you are tryptophan deficient, you can, over many years, you can have chronic kidney failure. And I can guarantee you that no nephrologist is going to identify that as an issue because it's just sort of bizarrely esoteric. Once you have NAD and it gets broken down, the standard thing is that you get nam, NAM then goes to nmn, which then gets rejuvenated, generated to nad. Right. It's sort of like this little triangle pathway. NR gets fed into NMN and then turns into nad. So the question is, so all of these different enzymes that sit around interconverting everything, right? So the key is then what tissues have the enzymes and what tissues have receptors for all of these various components. So it turns out that like your retina prefers nmn, turns out that your muscle prefers nr, and as I said, the kidney prefers tryptophan neurons. However, that's the only cell in your body that has an NAD receptor. On its surface. So if you take straight NAD and take not orally necessarily because bioavailability, that method is not so great. But if you get NAD straight into your body, it does actually go through the blood brain barrier, gets into neurons and it's incredibly good for, for neurons. So my argument is that you need a small dose of all of these things sort of together.

Should you inject NAD into your muscle or subcutaneously?

Subcue.

Okay. And no IVs not necessary.

I don't like the IVs too much too soon.

Okay, got it. So 100 milligrams kind of a dose.

I do not talk about doses because sometimes you're talking about a 40 kilo person and sometimes you're talking about a 200 kilo person. So as a pediatric anesthesiologist, we avoid specific doses in publications or on air because someone will take me very specifically and it won't be the right dose for them.

Can you talk about amount per kilo?

You're gonna bite me into this? I will tell you that. Whatever it says on the bottle, take a third of it.

The bottle of injectable.

No, no, I'm sorry, no. But like if you look at the bottle of NMN or nr, whatever, like it always says, like, like, like.

I don't.

I mean the doses are ridiculous.

I could never feel any effect from NR unless I was doing at least a gram a day.

But you don't need to feel the effect.

I liked it.

That's different story. Heroin feels great too, but you don't Diet Coke, it's a rush.

You're so unapologetic about Diet Coke, it's hilarious.

All right, one of these days, Diet Coke, the coke comes going to call me and go, yes, we want her. Hasn't happened yet. So the answer is it just depends. If you are younger, you need less. If you were older and you're more deficient, then you need more. If you are in a state where you have a chronic medical problem, like my agent has type 1 diabetes and she's chronically inflamed. Her body eats through NAD like there's no tomorrow. She needs higher doses. Okay, Right. And when she does, she can feel it, right? I take the same dose. I don't feel a goddamn thing. So everyone is different. Chronic medical conditions do different things. I think if you're deficient, you have an effect. Or if you're uber high, you feel an effect. I think a homeostatic level you really.

Shouldn'T feel when you take NAD or NMN or nr. Over time and again, David Sinclair has shown these are beneficial for reversing cell aging because of sirtuins. And he's found standard stuff. He's a friend. In fact, I was. I shared a stage with him at Oxford. Him and George Church yesterday, which was really cool. And I actually did it over a panel. It was at the second annual conference on Human Enhancement.

Nice.

Which is super cool.

No, I was just an Oxford for a conference. I couldn't find an NAD conference, actually.

Oh, very cool. So NAD has its place, but there's two other things it does. It feeds NNMT and it feeds CD38. Can you talk about that really quickly?

Oh, absolutely. So we're going to start with CD38 because that is crucially important. So there are NAD ACEs that are surface, generally surface markers. And they get CD38 in particular, gets upregulated in a state of inflammation, eats through the NAD and as a consequence triggers more inflammation. So if you can downregulate CD38, not only do you preserve your NAD levels, you decrease inflammatory response. Right. So there's something called 78C that's made by Smith Galaxy that we can't get even. I can't get it. The natural alternative is apigenin.

Okay. So if you take nad, you should take apigenin. And this is a, a kind of well known longevity supplement. I know quality has it in some of their formulas. I've been taking it every day for years. It's probably a point of pulsing it. Maybe I don't take it every day, but I take it most days.

Well, so. So let's talk about pulsing.

Yep.

I differentiate between supplements and adjuvants.

Okay.

A supplement in my world is something that you are supplementing that you already have in your body.

Okay.

Right. So magnesium, for example, it's a supplement. Fine. Carnosine, it's a supplement. And when you have something in your body intrinsically you have feedback loops to deal with. If you have too much or too little.

Okay.

Adjuvants, things your body doesn't normally see, does not have feedback loops.

Okay.

So apogen, you have no feedback loops for it. You're not going to upregulate some specific enzyme or receptor. It's just not going to happen. So you don't have to pulse adjuvants.

Okay. How would someone know whether their supplement is an adjuvant?

Look it up on Wikipedia. And if it's endogenous to your body, then it's a supplement.

Got it. Okay. And apigenin there's none in the human body.

None.

Okay, that makes it real easy. Why would you use Wikipedia, which isn't.

Entirely useless because it knows really dumb facts. Like the first sentence will be this is found in your body. Like they can't screw up like that. Simple shit.

They can't screw that up. I do know there's a lot of big pharma funding for it and there's a very clear bias Wikipedia. So I'm, I'm not a fan.

Clearly. No true scientific data comes from Wikipedia. But like the very first. So I'm not really a huge proponent. But the very first sentence usually says it's. It's endogenous or it's not.

Okay, you can also just go to any AI and say is this substance endogenous in the human body? And get a clear answer.

Right. The key is you can't ask AI if it's a supplement because by standard definitions, anything you can buy in a bottle is a supplement.

Right. Okay. We're gonna go out to dinner with a group of friends tonight. And this is a restaurant that has wild caught grass fed. It's called Dai Dewey here in Austin. And it's sort of like the place you go if you want really good meat. But let's say that I'm gonna eat all of the carbs and whatever weird sugary dessert, like a lot of it and some ice cream and all the crap that I actually, I'm probably not going to eat. But let's assume I'm going to have 200 grams of sugar with my dinner. What is the stack with supplements and with pharmaceuticals that will allow me to have that much sugar without harming my aging?

Well, this is really simple because I'm going to take my little pile of pills and I'll bring an extra one and I will slide it across the table to you and then we'll be fine.

When I drop into hypoglycemic coma and twitch on the floor, I'll bring some extra.

I am glucose. You'll be fine. No, but what's really interesting is most pharmaceuticals, even for hyperglycemia, don't. Can't actually send you into a hypoglycemic state. I mean there are a few that.

Can, but pioglitazone can't.

No, it can't.

I've. I've had it happen.

Oh please.

Okay, I have a CGM on my arm and if, if I take it especially my blood sugar is really high. Cause I just ate a whole bunch of carbs. I'll drop into like, 60 and.

Well, then you're very sensitive because I've been taking P Glitazone for years, and.

You might have pee that's more expensive than mine.

I have the best pee ever. It's. It's impressive. Has a very distinctive order.

I. I think I have the most expensive pee. I don't know if it's the best pee, but. All right, let's. I don't think we're going to actually compare that because that's a little bit much of a TMI thing, but I.

Okay, so what pharmaceuticals are going to take.

Yeah, yeah, we're getting distracted, so. Yeah, like, give me the stack. Okay. I'm. I'm going to do something that I know is bad for me because it's going to be delicious.

All right, so. So first thing you want to do is you want to block breakdown of carbohydrates in your gut.

Okay?

Two enzymes there of notes are alpha amylase and alpha glucosidase.

Okay.

We can block those. The easiest thing is a carbos, or your favorite thing, actually that does it is. Is coffee. So chlorogenic acid is a blocker of both. So that will actually help because if you take too much carbos, you will have horrible gas problems and it may ruin the evening. So maybe a little. I'm a big believer in a little of a lot and not a lot of a little.

And you're probably going to get extra lipopolysaccharides too, because if you have undigested carbs in the gut, the bacteria is going to go nuts and it's going to make your gut biome unhappy. So I'm not a fan of carb blockers just because something's going to eat the carbs if I don't metabolize.

No, no. 100%. 100%. Which is why you want a little bit of a lot, right? So. So you can do that.

So many carbos. Maybe if I don't mind farting.

All right, so what the other thing we're going to do is we're going to take a flozin of flozin.

Okay?

It's a flowsin family. It's canagliflozin, dapagliflozin, empagliflozin. They're constantly coming up with new flozins.

Okay.

This is a sodium glucose reuptake inhibitor.

Okay. I just got some in the mail today, so I'm gonna take.

So you're gonna love this. So the way this works is your. Your kidneys are going to filter out the glucose and normally it would get reabsorbed into your vasculature. But because you are blocking the receptor, you are now going to excrete all the glucose that your body didn't need.

So this is something that should be like in birthday cake icing automatically.

Oh, 100%. 100%.

Maybe they could put it in brightly colored kids sugar bomb breakfast cereals. Ooh, Kellogg's better than red number three.

There you go. Let's see what else can you take for your gluten? So obviously metformin most of people are already on that helps a little bit, not a ton.

I don't like metformin for aging because what it does to mitochondria.

Again a little bit is good.

Okay. Micro do metformin.

I take 500 a day. I don't take the TH000 or the 1500. Some people are up to 2000. I think that's bad. I think 500 a day is the way to go. Clearly it does. Yeah. It doesn't help your mitochondria. B12 deficiency too unit 1, blah blah blah blah. That being said, it does help with the hypoglycemia. You mentioned P Glitazone. That's crucial.

And you do 30 milligrams of that for your body weight. See what I did there? I saved you.

I know. Actually that's not true. I do 15, but I just let you go with it.

Okay. I was saying you were fat.

I've got some love handles.

Did you not?

Okay, let's see. And then, and then the other thing that I do, and this is really silly is I take something called hydralazine. So hydralazine is actually a medication for emergency high blood pressure. So if you were to show up in the emergency room and your pressure was 210 over 100, they may give you hydralazine. It's a very fast acting medication. Blood pressure drops. What I love about it is it's a very potent transglycosylating agent. Meaning that if you have glucose that is recently stuck onto some other protein or lipid or whatever it is, right. It will come along. It's more attractive to the glucose molecule. So the glucose jumps onto the hydrazine molecule and oop. Excrete it right out.

Now this is really important because in, in my longevity book we talk about advanced glycation in products and for listeners. When you have high blood sugar, the sugar sticks to proteins semi permanently and it disables them and it makes free radicals. So this is Bad for you from an aging perspective. And there aren't a lot of things that'll break that bond. But hydralazine, which is a pretty potent drug, will do that well.

So what it is is that there are six steps, non enzymatic steps, to go from a glucose and a protein to an age. The first half of those are reversible, the second half are not.

Okay. So if you have built up ages from high blood sugar for a long period of time, what happens to those?

I'll get to that in a second. So for the first period, if you introduce a more attractive molecule, right, Transglycosylation, that is extremely useful.

It's like a decoy. So the sugar will stick to it.

Exactly. So there are a few amino acids.

That can do it, like carnosine or.

Carnosine is actually a dipeptide. So that. That does it. The hydralazine does it. There's a variety of few things that do it. Aspirin also helps a little bit. Once you have an age and it's floating around, it's extremely hard to get rid of. However, lactoferrin is our friend in this instance, because lactoferrin, if you look at it and you squint really hard, the molecule's in the shape of a barbell and it's supposed to carry two irons on each side, Right? It's lactoferrin, ferrin for the iron. However, what it can do if it's not carrying iron is it creates a little hole for ages. So if you take exogenous lactoferrin, if you measure your lactoferrin, your intern is going to tell you that you're horribly inflamed and that you're in really bad health. But if you do take it and don't tell anyone and no one notices, what it will do is it'll soak up up the ages and then you'll excrete them.

Now, the most common way of getting lactoferrin would probably be colostrum. Right?

Yeah, you can do that or you can just buy lactoferrin.

Okay, yeah, you can do both. And the guys from Armor have been on the show and I do use that pretty frequently. So that was going to show up poorly in labs, though.

Yeah, no, it will. It will make your labs. So I actually interviewed for NASA about a year ago and I'd forgotten that I'm on all of these crazy things. And I'd had my labs tested and I looked at them and I thought, holy shit, if anyone saw this they'd think I was going to die and.

You were going to go to space or.

No, I was going to do one of those things where you like in a capsule, like on the ground for three months to pretend like you're in space. And as it turned out, I think it would have driven me absolutely nuts.

I can't see you being happy in one of those places.

Well, I said, great, I can sit still and I can do some research. And they're like, oh, you can't do anything independent. Like, great, I can exercise. They're like, oh no, you have to do the prescribed whatever. I'm like, yeah. So I'm glad I didn't go. But the funny thing is I did realize that some of my labs were ridiculous. My urine was full of glucose. Obviously I'm like, look like a dying diabetic.

Yeah, because you're peeing.

Your labels are way wacky. Because my HDL, my LDLs are like, I have completely altered them to, to make me happy.

Which means high hdl, low ldl.

But like kind of ridiculously it looks, I look pathological.

What's your hdl?

Actually I don't remember anymore. But it's very high.

Is it above a hundred?

Oh, yeah.

Wow. Okay.

Yeah, of course.

And what did that?

Huh?

What does that.

A series of things.

Okay.

I take 12 pharmaceuticals a day and.

They all like, you're so ridiculous but cool.

They all do like little bits. It's like a puzzle, right? Like, and you like go, oh, I need something for over here. And you find a pharmaceutical that does that. Right. Anyway, so lots of little bits. Point being is I didn't get to NASA, so I came off for a week and they went 99% back to normal and I still had a few that were wacky. So I did what every normal human being would be would to do is. So I had my 18 year old change the labs on the computer. That seemed to be the right thing to do. But the point being is just yes, this will make all of your labs look incredibly wackadoodle.

By the way, a really common vitamin called biotin will break most labs. So if you are doing something like the Axo Health, which is my lab testing company that's part of Upgrade labs or any especially the expensive, you know, thousand dollar immune stuff. Do not take biotin for a substantial period of time before that because your results will be insane and they'll think that you're dying. And it's just because most of them are biotin dependent. This is a really important Thing. If you do lab work, you're going to spend good money on labs. So go off the stuff you don't need beforehand. Okay?

Yeah, Good advice.

All right. So I would not do hydralazine.

Why not?

My blood pressure.

Oh, you've got low blood pressure.

Yeah, like it's, it's healthy because I manage it. But if I don't drink enough salt in my water or, you know, I don't take the herbs that keep my blood pressure perfectly regulated, it would drop it. And for a lot of people now, especially if you had long Covid, you're dealing with toxic mold or anything else like that, if your blood pressure is not average to high, that's probably not a good thing because really low blood pressure can be fatal when you fall over and hit your head. Right. Like that sort of a thing is an issue.

No, that is absolutely true. And I, and I will tell you several things. Number one, it took me a long time to build up the ability to take the hydralazine that I take.

Okay?

I bonded myself out many times. So again, I don't recommend people do that without the help of a physician. But you do need to be careful with low blood pressure because it's not just enough to your brain and you pass out, you're decreasing microcirculation and that can be equally as harmful. And of course, the cure is a phosphodiesterase inhibitor. And I'm sure that you are on that.

I have done, I would say I've done a full ups on it, but I've mentioned lots of times that Cialis in low doses is a longevity drug. It's such a very important one. So I take 6 milligrams of Cialis, which is, I think, 10% of the recreational dose. So it's enough that it makes sure that the blood's going to get into my brain. And microcirculation, there's a new technology for improving your performance, improving how your cells work. And it's pretty cool. It's working at the quantum level. Now, I've had all kinds of people send me quantum ballpoint pens and all sorts of nonsense because people abuse the quantum word. But there's convincing evidence that reality is based on quantum systems. We know for a fact that your brain is a quantum system. And there's a few studies that support that and all kinds of science. So it makes sense that you can use quantum stuff to affect biology. Except that sounds like a really hard thing to do. Well, enter my friends at Leela Quantum Tech. They make biohacking tools that actually make waves in scientific circles because you'd almost think they couldn't work, except in dozens of studies. They do work and they've got a range of cool products like necklaces that harmonize the energy around you. I actually brought those in for my employees across all my companies because I think it's worth it. And the Leela quantum block that you can use to charge items with quantum energy in these randomized double blind studies, which is the gold standard. Leela's products improve blood quality and heart rate variability. And heart rate variability is also at the core of biohacking because it's a sign of how well your body recovered. I use my Leela quantum tech pretty much all the time in one form or another, and I can feel the difference. Difference. You can get 10% off your order by going to Leela. Q.com Dave I know it's a big claim to say that something works by quantum and I love it that they back up their claims with real world results. You don't have to believe it works. You can measure it. You've probably heard that mitochondria make the energy in your body that you use to be yourself. And you might have heard that damaged mitochondria are a primary cause of aging. In fact, I wrote a New York Times bestselling book on longevity about how I'm going to live to at least 180 and mitochondria are at the very, very center. And I use something called urolithin A in the form of timeline to support my goal to reach at least 180 years. Remember I said at least 180 years because I think you and I are going to live way longer than anyone expects. And for me, timeline is a part of my strategy because I know that if I have young mitochondria, I will have have the energy of youth for as long as I want it. This is something that is our human birthright. So go to timeline.comdave and get 10 off your first order of mito pure. Are there any other drugs that help microcirculation?

Well, they're all phosphorusterase inhibitors. They just come in different brands, different names, different half lives.

What's your favorite?

What do I take? It's on the tip of my tongue.

You know, I have a, I have a pharmaceutical that increases memory. IO if you know which one that is.

Magnesium threonate.

Oh, oh, that's like pharmaceutical. That's a supplement.

Pharmaceutical.

Which, it's just not in the physician's desk reference. It's aniracetam.

Oh, okay. Yeah, yeah.

I'll actually give you some afterwards.

I will take.

It's super, super cool. It has a relatively short half life, but I've taken it every day for 20 years and people are like, why can you do all this stuff? Well, I might have done some neurofeedback, but I've been on modafinil and I've been on aniracetam for Jason for 20 years now.

Nice.

What about modafinil? Is that a good drug or a bad drug?

Medium.

Medium. Okay. Why do you like it or not like it?

I remember looking at it several years ago and the side effect profile was. And I don't remember what the side.

Effects were, it was pretty small.

But I did say distinctly, remembering that it wasn't for me.

Okay.

And I also remember at the time that it was in conflict with something else that I was taking. So I don't recall the specifics. Apparently. I need more of your drug.

Anim is a funny drug. It's not illegal in the US but it isn't approved in the US which is funny because I do not remember hiring my government to approve what I can and can't take. In fact, they're uniquely crappy at that. Look at what they allow in our food. So, like, I don't care what they say. Fortunately, you have the right to import aniracetam if you want to.

Well, God knows I import many medications, so I think that that will be fine.

What is the number one medication that can be used for longevity that no one's ever heard of?

Cellbacks.

What is cellbacks?

Cellbacks. So speaking of out of country, this has been approved by the FDA in Japan and it's been approved for. It's basically a heat shock protein activator and they use it for drug induced gastritis. It turns out that it goes to the cells in your stomach and it reactivates or upregulates the ability to deal with stress from drugs. But if you take it in slightly higher doses, it reduces the risk of all neurologic diseases because it increases the refolding ability secondary to the heat shock proteins.

So, so sellbacks is basically a sauna in a pill.

Absolutely.

Is it expensive?

It's not cheap, but it's not expensive.

Was it like 100 bucks a month kind of thing?

Yeah, something like that.

Got it.

Yeah.

Wow. That's. What if I take it and then go into a sauna?

No, I've never tried. I don't have time for saunas. I wish I did.

You can actually do things way in the sauna.

That's probably true. I sort of fall asleep. No, but cellbacks, they've done a few studies and I'm really surprised they haven't done more. Well, but if you have mild to moderate Alzheimer's, it actually can help significantly.

Wow.

If you have severe Alzheimer's, it can't fix the damage, it can just prevent more damage. And Alzheimer's is because it's a, it's, it's. You know, most neurologic diseases are protein misfolding diseases so in essence they test for that one. But it helps with most of the neurologic diseases and it's an ounce of prevention. Right. And most people are afraid of that sort of thing.

If someone in my family or a friend had Alzheimer's, I would say nicotine, mct, ketone dials and now cellbacks. And that combination along with probably some toxin binders to get down lipopolysaccharides like an activated charcoal and an increase in glutathione would make them feel way, way better.

Oh yeah, no, without a doubt that's a nice combination. I would add free radical scavenging that gets to the blood brain barrier.

Okay. And this would be what?

Like simple stuff. Stuff. Astaxanthin, delphinidin, simple stuff. I like to combine a fat soluble with a water soluble.

Okay. Astaxanthin is something I've talked about for many years. It's in the eye formulas I take. It's a mitochondrial thing. It's the colored compound from salmon. But what was the next one?

Delphinidin comes from the Mackay berry from Argentina. Delphinidin, extremely potent free radical scavengers. And anthocyanin.

Oh, okay, got it.

So it's just water soluble. I like the idea of mixing my solubilities to make sure I get to all the pieces and parts.

So similar to something like pycnogenal.

Something like that.

Okay, got it. So grape seed and grape skin extract or pycnogenal are similar but not identical. Okay.

Yeah. Generally speaking in the terms of fruits and colors, anything in the dark purple range is going to roughly have the same effect.

Okay. Resveratrol. Good or bad?

Good.

How much?

You know, it's really hard to say because now there are all of these different varieties and formulations. So if it's bioavailable or not bioavailable or if it's in a nanomycel or it's of this. If it's that. It's really hard to say. Generally speaking, I go with 250 a day.

Got it. So you take a relatively high dose?

I do.

Do you like trans resveratrol or resveratrol? You don't care?

I don't care.

Okay. Creatine, good or bad?

I don't take it, but people love it.

Why don't you take creatine?

I take 70 other things, and there's significant overlap. And I just looked at it and I go, well, I do other things that do the same thing, so I just don't take it.

Okay. What drives water into cells that you take the way creatine does?

What drives water into cells? Anything that's osmotically active.

So salt.

Salt will do it? Lots of things do it. Uric acid does it. Like, tons of things are osmotically active.

You don't take uric acid?

No, of course not. In fact, I'm, like, trying to lower my uric acid anyway without a Purinol. But again, that's one of those goofy medications that people don't recognize as a longevity medicine. It's for gout. Yeah, but it also treats hyperuricemia. Right, but by decreasing your uric acid, even if you have normal uric acid levels, it decreases your inflammatory response, decreases risk of autoimmune disease. There's a whole lot of really good allopurinol, huh? Yeah.

Isn't there a downside to having uric acid that's too low?

You want too low. You want medium low.

Okay, got it.

Again, this is all like. You don't want one end or the other, but you want, like, low, medium.

Okay, guys, what I'm going to do after this is on daveasprey.com I will work with my team to put together a cheat sheet that has the correct spelling of all these drugs and what we said so you can do it. And I'm also going to include a link to Sandy's book. What's the name of your book? The Kaufman Protocol, I think.

Yep.

Okay. And it's by Sandra Kaufman. That's her official doctor name. It's very. It's very fancy, but she's really. Sandy, Would you take stem cells in the United States from umbilical cords?

No.

Why not?

I don't like the idea of stem cells. I don't like the idea of someone else's DNA being in my body. I don't like the idea of introducing a cell with potentially immunogenic surface markers into my body as an anesthesiologist in the or, we have spent years making sure that the right person gets the right blood and it's tested in three different systems, et cetera, et cetera. So just taking someone else' cells and injecting them seems extraordinarily dangerous.

I am. I am kind of shocked by the state of stem cells within the United States because people are selling these low cost, you know, $400 a month or $1,000 for some random stem cells drawn from an unknown number of umbilical cords from people with unknown health that can't possibly be tested. And the more of those you get in your body, the higher the risk of an immune reaction. I'm not too worried about going, say, down to Costa Rica. And if it's one carefully tested and very healthy umbilical cord that's culture expanded. Right. And I'm okay to take that risk because it's just one. And if I'm getting a ton of benefit from it, okay, fine. But I would not get stem cells in the US Right now. What I would do, though, is I would get exosomes. Tell me about exosomes.

Oh, you're singing my song. Oh, yeah, yeah. So stem cells. 90% of the efficacy of stem cells is through the release of exosomes. Anyway, stem cells probably last about four to five, maybe six days in your circulation. And in that time, they do release a lot of exosomes, which is why they work. Right. But it is just significantly safer and significantly cheaper just to use the exosomes in this country. You can get them through amniotic fluid, you can get them through cord, you can get them through a placenta. They're traced. We know the health of the mother. We know the health of all of the things that sort of go into it. You can buy them. They are reasonably safe. I don't want to say 100% safe, but I have treated thousands of people. No one has ever had a problem.

I've had about 50 vials of exosomes, maybe 54 last time we hung out.

Yeah, no, it's true. And I. I inject it every month. Iv. I put it in my face, I stick it in my joints. I put them everywhere.

And do you inject them in your face or just put them on your face?

Oh, no, I inject them in the face.

You are man's facial injections hurt. I've injected a few things in my face. But, I mean, I. I've done a lot of painful stuff. That is one that's just nasty.

It's not Pleasant. The good news, however, is the. The viscosity of exosomes is very. They're very liquidy. Right. So you can use a very small gauge needle. So in. In medical parlance, we use a 34 gauge. I use a 34 gauge, which is really about as small as they can get. So the puncture doesn't really hurt. Sometimes it's the expansion of the tissue that can hurt, in which case you just use the most concentrated stuff that there is. The other caveat is that depending on what tissue source you have, it can burn. So, for example, cord, by definition, has some hyaluronic acid that comes with it that is acidic. That hurts when you inject it. Therefore, if I'm going to do someone's face with cord, I'll put bicarbonate.

Okay. Which just cuts the acid.

Exactly. So there's ways around all of these.

Things, whatever you're doing. Do you do laser resurfacing or something? Your skin looks better than it did last time I saw you.

Thank you. I have been lasering my face every two months for 20 years.

Wow. What flavor of. What flavor of laser do you use?

You know, it's really funny. Everyone asks that, and the answer is, I don't know. And that sounds really horrible. I befriended a gentleman who has a mobile aesthetic laser company.

Sweet.

And he shows up with whatever lasers are in the back of his truck, and he hands me a set of goggles and he says, this is gonna hurt.

And Sketchy street laser guy?

No, no, no. I love him. He's not sketchy.

I'm totally kidding.

No, I know. So what happens is laser technology turns over so quickly that places don't want to invest in the lasers. So the smarter thing to do is to just hire a company that does buy all of the lasers. Right? So this particular company, they have a gazillion different laser types. Brown spots, red spots, wrinkles, collagen production. Like, all of these various things. So they. They have the newest, the latest, the greatest. And honestly, he shows up at my doorstep with whatever he happens to think that I need.

Cool.

He knows my skin better than I do because he's been zapping me for years. And I just sit there and take it. And some days I look like a pepperoni pizza, and other days I go, huh, that wasn't so bad.

Nice. When you talk about sitting there and taking it. I've had laser treatments, and I don't remember which ones. I've talked about them on some of the shows, but I'm not an expert in topical lasers. I knew more about, like, the deeper healing lasers, but some of those really freaking hurt. And you just, like, take a deep breath and you just accept it. And sometimes you look a little odd the next day. But usually I look all right, and it can make a difference. I'm. It's probably been almost a year since I lasered my face. It's about time to do it again.

I did mine a month and a half ago. I guess I'm overdue. He sent me a text yesterday.

Okay, got it. Having your own laser wrangler, that's. That's next level longevity.

No, no, it's not. It's spackle. It's spackle.

Spackle.

Fixing my skin and zapping off little marks isn't going to change my longevity at all. It's just going to make me look better. And that is speckle.

You know, part of longevity is looking better. The way you see yourself in the mirror matters for longevity. It really does.

You know what's funny? And I. I give myself a hard time because I do do this, and it's moderately silly, but then you go to these conferences and these old dudes that look like they're gonna die, they're telling you, like, how to live better, and you think, I'm not. I'm not doing what they're doing.

Yeah, it's. I get some of that. I mean, I've lost a hundred pounds and I don't know what to do. I have, like. I have skin. Like, a lot of skin, and it's young skin. But, like, what. What do you. Do you. If. Unless I want to get fat again, then I could fill my face up, but then I'd have to buy new pants, and pants are expensive. Like, it doesn't.

That's a big problem. Yeah, I'm sure that's your main concern. Yeah.

How do you increase fat in the face?

That's a tough one. Well, number one, you're gonna have to stop looking at red lights.

That doesn't seem like a good idea. Looking at red lights is pretty good for you.

I know, but I'm telling you, you're melting fat in your face, so that's a bad idea.

You're also increasing collagen, though. That's a tough trade off.

Well, you didn't say collagen. You said fat.

So I could be fat and wrinkly or I could have no wrinkles.

So fat women especially, they don't look like they have that many wrinkles because it's all fat.

It's all Stretched out.

Yeah, no, it is, right. And it's filled with fat anyway, but red light does sort of melt it, so that's. That. That's not helping you at all. Otherwise you're stuck. You got an. Either inject it or, I mean, you can increase collagen production. You can do a variety of things, but fat, that's a toughie.

It is one. So I would like to set the record clear that it took almost 20 minutes for Sandy's sad brain to remember the name of the Cialis, like, drug that she takes for microcirculation. Now that your brain that obviously needs nootropics has caught up with us, what's the name of it?

Pentoxifylane. I would just like to point out that I haven't had my normal amount of Diet Coke today, so I think that perhaps my neural circuitry is not going as well as it should.

So you're suffering from a Diet Coke.

Deficiency, I believe that's correct.

People are going to go nuts when they hear that. Oh, man. All right. Speaking of nootropics, are there any nootropics that you use regularly?

I use something called Mexadol.

Okay, what does it do?

It is a benign B3 derivative.

It's like a Benfotiamine.

Yeah, it's Russian. I love it. The reason I started using it was because it was also blocked age production, of course.

Yeah.

That's huge in my world. I don't. I've tried a variety of them. I've tried cerebralysin. I've tried a variety of them. I kind of like. In surgery, we have a rule like, don't with the pancreas, I have a bit of a rule like, don't fuck too much with the brain. We want to maintain homeostasis without causing it undue stress. So I really have concerns about too many nootropics.

I don't like to mess with straight up stimulus like Adderall or something. I don't even know that that should be a nootropic. But I do find that manipulating the catecholamine system is really important. And a lot of adaptogens that are also nootropics do that. Things like rhodiola.

No, no. Oh, no. I mean, okay, fine. So, yes, I do take rhodiola, which is really interesting, though, because. But I don't take it for that. I take it because it changes the cytochrome system in your mitochondria so that you can adapt to hypoxia better. And as a mountain climber, it's incredibly important.

You need to come into upgrade labs because we have a hypoxic trainer.

I need that because I've been breathing into this. This thing that's. It's like this little funnel deal.

You don't want to do that.

Well, I've been doing it.

I started out years ago. It has aluminum particles in there, a lot of them. It's going to mess up your lungs.

That's probably true. Well, a good friend of mine is a lung expert, so I will go see what he has to say. But I would love to use the hypoxic lab because I think hypoxia is better for you than hyperoxia.

No, I think there's a role for both, isn't there? Like, are you opposed to hyperbarics?

Hyperbarics has its place if you are. If you have traumatic brain injury or you have some sort of microcirculation problem for diabetics, wound healing, capillary problems that when you can't get the normal amount of oxygen to tissues, it has a role for normal longevity. I think it just produces too many free radicals and I don't think it's a great idea.

What about the Israeli studies looking at doing.

They pulsed it, right?

Yeah, you pulse it.

Telomere. Deal. So I've had long conversations with Bill Andrews about this. And our hypothesis is that when you measure telomeres, right, you're measuring them from a. You're drawing blood, right? You're doing a liquid sample and you are looking at whatever cells are in the circulation. And the thought is that by pulsing this, you're actually releasing more cells that are newer into the circulation. Therefore, by average, the telomeres are longer, but they're not actually longer.

Oh, interesting. You just cause some new young cells to come in. Yes, that's fascinating because, I mean, telomere.

Science is really interesting because every cell, if you think about it, Right, you have four telomeres per chromosome and 46 chromosomes. So you're looking at 184ish telomeres per cell. Right. And then depending on where the cell is in the tissue, where the tissue is in the body, there is no way that any one number or two or even decent statistical distribution can tell you what your true telomere lengths are anywhere.

Telomere testing is so sketchy. I've seen people change by 20 years in one week on blood tests. It's not.

It doesn't right you. Because you can't. I mean, the idea and the theory, fantastic. The reality, ridiculous.

Okay. So we're both. We know telomere shortening is the cause of aging. It's just measuring it is really hard to do. Yeah. Correct. I wouldn't rely on that just as my only source of longevity data.

Exactly.

What's your favorite test to measure someone's age?

That's a good question. What I think is funny is the reverse. People come to me with their labs, and the one that gives them the best number is their favorite.

I know, right?

Right. By this one, I'm only 27, and I'm actually 63. That's a really good question. I usually like to take three or four and sort of combine them. I love the epigenetic clocks.

Yeah.

I love glycation scores. I actually have this really cool gizmo gadget that comes from Amsterdam, and you hold it against your skin and it tells you how glycated your skin is.

Ooh, I want one of those.

And I think that is a tremendously powerful tool.

Okay. And of course, your aggressive anti glycation regime is probably really.

It really helps.

Yeah. As a top longevity doctor, do you use bioidentical hormones?

I don't.

Is it because your levels are adequate?

Oh, I take hormones. I take birth control.

Oh, my God. You're like the worst longevity doctor ever. Just kidding. You take birth control?

I do.

Have you not seen the studies about what that does for your risk of cancer and all these other things?

But you have to understand why it causes cancer.

Okay.

Right. So as you get older, right, you have mitochondrial failure, right. Which leads to ovarian failure, which leads to menopause, which leads to the inability to make specific hormones repleting those hormones, which obviously have to do within five years or the hormone receptors get downregulated and then you're screwed. So you clearly need some sort of hormone regulation, Right. If you can come up with a pattern that matches that of a 30 year old, you are creating a homeostatic situation. Right. What you need to do to avoid the cancer stuff is you need to avoid inflammation. Inflammation. You need to avoid free radicals. I mean, there's a list of things that cause DNA damage which leads to cancer. And directly that does not do it. That's an indirect effect that you can block.

That's a blockable thing. They do a bunch of other things to the brain though, too, don't they?

The answer is you need hormones. And the whole bioidentical thing is honestly, they're just hormones.

Well, I mean, they're processed differently in the liver and in the body, and they have different effects on receptors?

Yeah. Yes, but no. Right. We know the birth control works.

It works for birth control, but we know it has a lot of side effects too.

Not that many.

Oh my gosh. I've had like 10 experts on who would probably like be red in the face.

They might be my guest. I read through the whole thing and I made my scientific decision and this is what I do for myself. I do not do hormone therapy for other people though. So if you're afraid that I'm like, you know, being toxic to other people.

I'm not trying to convince you to change. I'm just, I want to learn. I'm curious.

My intent on longevity is to preserve the physiology of a 30 year old.

You and I are aligned on that. And you think birth control is going to do that for you?

Yeah, Been working so far.

Okay. I can't argue with that. I've maintained my physiology for listeners. I don't think this is a strong argument that you should go out and get on birth control without looking at what it's going to do for your sensing of mate selection and a lot of the other things. But if you want to go down an advanced longevity track and Montreal stuff Ubu, and I totally support that. I just, I, you know, I've looked a lot at women's hormones and you know, worked on fertility and stuff like that and yikes, there's a lot of dysregulation that can happen and I totally believe just like you do Diet Coke and cupcakes and you're like, okay, these type of things, I'm going to encounter them. And that is like the most powerful. Like I, I've got this perspective I've ever seen. So I, I like that. I'm saying I want the benefits of birth control pills and I, it can deal with whatever potential downside.

I like the cycling. I like that it's a pattern that's really important. I mean, I think that it's the idea, right, because the regular, the hormones that they put us old ladies on, even if they're bioidentical, right. They, they're, they're not in a homeostatic pattern.

That's why I, I've recommended the Wiley protocol for a long time. She's the only person that I know of who regularly does that.

They should vacillate, they should have normal homeostatic patterns. That's why I do it.

Okay, that is a really good argument, especially for people who are in menopause potentially.

Yeah, okay. But I mean, the deal is and women ask me this all the time. So when you are young, 35 to 40, optimize your mitochondria as much as possible. When things start to fail, you gotta pour that sucker on every mitochondrial optimization possible. Because fertility is the canary in the coal mine of longevity. As soon as you hit menopause, that's the first system to go. You know that, that, that everything else is soon to follow, Right? So block it, block it, block it. Avoid menopause, number one. I'm preaching the choir. Clearly, that's not your problem. But if you can put it off as long as possible.

It's a good question.

Then when your hormones do start to fall, don't take mega doses. You just need to take.

Fill it in.

Yes, you fill it in with the same pattern as long as possible, knowing that yes, there are side effects, but they can be fixed and addressed.

Cool. How are your cortisol levels?

Low.

You have low cortisol?

Yeah, I'm great.

You realize low cortisol is four times more deadly than high cortisol, right?

I have low normal cortisol. How's that? How's that? Like I'm not dying or anything. No, but like when you say you have high cortisol, like you're stressed out, right? You say you have normal cortisol level. Again, it's also circadian. So when people go, well, what's your cortisol? Well, what time did you measure it.

And did you work out right before?

What were you thinking about? What was your stress level? This, that, that. The other. All of my hormonal levels are completely within low normal levels.

Low normal levels for your age or low normal levels for a 30 year.

For a 30 year old.

Good. That is beautiful.

Again, everything is based on me wanting to be a 30 year old. Clearly I'm not, but that's the goal.

Okay. When we hit about 35, our bodies, and this happens more in women than men, but it happens to both our bodies make less dhea, they make less pregnant alone and they make less progesterone. And these are things that counter adrenaline and cortisol. Do you supplement any of those?

So that's a good question. So what I do and. Well, so what I do and what I do for other people, slightly different, right? Because I'm a bit of an experimentalist. The first thing I do in terms of longevity is I fix the cell. Okay, you have to see this. A cell can make 10,000 different proteins. And as a cell fails over time, you can pick each one of those 10,000 things and supplement it. Or you can fix the factory that's supposed to make all of them. Yeah, Right. So I start with fixing the factory.

Okay. I start with mitochondria, which powers the factory, but isn't the full factory.

So all of the seven tenets of aging must be addressed. You've got to optimize your sirtuins, your AMP kinase, your nad, your mitochondria, all of them. Fix the factory. Okay, Right.

If you do that, will you have DHEA levels of a young person? Yes, you do. So you make enough DHA in your body all by itself?

If you start young enough, you don't need to do any of that if.

You start young enough? Yes.

Right. If a 30 some year old comes to me as soon as they hit 35, protocol. Right. This is what we're doing. We can stave off menopause, we can stave off making or not having to make all of these additives. Right. The problem is if someone comes to you as a 55 year old, they're like, oh, now it's time. Now you're behind the eight ball. But you put someone on a protocol for nine months, six to nine months generally, and then you test these things and it will tell you that what you have to replete is way less than what you would have before.

So they're, they're getting younger?

Well, they're getting younger, but they're doing way better.

Their cells are getting younger then because they're acting like younger anyway.

Yeah, we're fixing them.

One of the reasons that I started the biohacking movement is that no one 35 and under cares about longevity as the number one thing on their to do list. It's always like number 12 until you hit 45, 50, 55 and oh, and then it's much more expensive. I'm fortunate that in my mid to late twenties I hung out with a bunch of people in their 70s and 80s doing longevity because I had chronic fatigue and all that. So I'm like, how do I talk about longevity in a way that would be attractive to me when I'm 20? Because it's almost free to keep your health when you're young. And it's very expensive to get it back when you're old. So it's a great investment, but it has to be in a language that matters for someone young. And Biohack has really done that. It's global movement and all. And for people who are listening, measure your hormones, like do it one time in your 20s so you know what they should look like when you're 30 and 35 and 40. And you can do that dirt cheap. Now, AXO Health is a way to do it. And there's all kinds of online services like that. Just know what they are so you know what they ought to be. If you could go back in time to yourself when you were 20 and give yourself a couple pieces of longevity advice, what would you say?

Oh, my God. Well, at first I would say there's a thing called longevity. Okay, right. Like I didn't discover this until I was 45. And at that point there were pockets of people that knew things I knew nothing. I never heard of it. It dawned on me sitting in my office one day that this aging shit was gotta go. Like I, I started from scratch. I will figure this out. I had no one to ask, no one to turn to. What I would have loved to have known. A, that it existed. B, what cells were actually doing, when were they gonna crump out? What could I do at the time? I mean, you know, I'm a child of the 80s. We laid out in the sun with baby oil. We ate a shit ton of junk food. We didn't know, but at the same time, we were mega athletes. Like, I exercised every day, studied every day. If I had just knocked out a few of the bad habits, clearly I'd have been better off. And if I knew that aging started at 35 instead of me starting at 45, God, I'd have gained 20 years of my life.

Wow.

Right? I mean, I lost a good 10 years, but I think I am better off at 56 than I was at 45.

Everyone can do that too. And the cool thing is, if someone who's even 25 does some of this stuff, you're not going to do it for longevity. You're going to do it for physical and cognitive performance, for your energy, for your happiness.

But the key is knowing what changes. Because you don't truly start aging until 35. Below that. No, it's true, but like sirtuin deficiency, NAD deficiency, those types of things. But what you are doing is you need to worry about your epigenetics. This is what I tell patients under 35. It's epigenetics and it's cancer reduction risk. That's what you're worried about. And just nutrient homeostasis. Like these people don't have to go and buy a gazillion dollars of all the shit that we have because they don't need it. But they don't. They don't need nad. They don't need resveratrol. They don't, because they're not. You don't have to boost the sirtuin level. That hasn't fallen yet. But. But they are responsible for their epigenetic patterns that start in the 20s and then will continue. You are increasing DNA damage. Right. By being out in the sun. So free radical scavenging is important. Repairing your DNA is important. And if you have any family issues, that's when those things are going to start being important. You know, if you have a family history, everyone's hypertensive, everyone's got coronary disease, et cetera. You address those early. But that's not true longevity. That's just preventative medicine.

48% of people under age 40 have early onset mitochondrial deficiency, according to studies.

Yeah, because they're all obese.

Not all of them, but many of them. Right. So aren't they aging because their mitochondria are already broken?

Depends. Depends how you define aging. That just sounds like disease.

Is aging a disease?

It is, but I mean, in my. In our world, it is. In the medical world, and like, I wore several hats, it's not.

Got it.

A normal, healthy, as we would define healthy human at that age should not have mitochondrial failure.

I certainly did. It sucks. I wouldn't want to go back and do that again.

Right, but then. But that. But you were not healthy.

That's totally true.

I like the fact that we don't agree on anything.

We don't have what?

I said I like the fact that we don't agree on anything.

We agree on tons of things. It's just that when we disagree, it's that I'm right and that's okay. I mean, you'll learn. Yeah. Once you get a little older.

Yeah, that's true. Aren't we the same age?

I'm younger than you.

Oh, okay.

Well, I mean, I'm about 35. On the calendar. I saw it on the calendar on my lab tests.

That's funny.

So that's what I identify as. So you know how you fill out those forms and they tell you, like, you know, what's your. What gender do you identify as? Well, when you get to the age, they don't ask you what age you identify as. And so I think that all of those surveys are ageist. If they don't allow us to just pick whatever age we feel like that day.

That's fair. That's fair.

Doesn't that seem right?

Yeah, that's fair.

Are you feeling triggered? No, I identify as triggered. So.

I'm on lithium. Nothing triggers me.

Let's talk about lithium.

Okay.

Okay. I have talked about lithium orotate as a supplement for mood and for longevity. Well, I think since the first year. I wrote about longevity 15 years ago on my blog. And you're not a fan of ortate compared to a stronger form. Talk to me about lithium.

All right. So when I go through my seven tenants, I pick a subject and I plow into it. I think, okay, how can we fix this? And one of the really interesting things I ran into several years ago was lithium because great studies, people that have bipolar disease have statistically shorter telomeres. People that are bipolar on lithium for longer than two years have statistically longer telomeres. We don't have any studies of normal people on lithium because normal people don't take lithium. So clearly there's some effect that the lithium is having on telomeres. We don't really exactly know what it is. We know it's free laticral scavenger. We know it competes with magnesium. It does a variety of things. But we also know that populations that live in areas that have more magnesium in the drinking water or the plant source or in any food source, all cause morbidity and mortality goes down.

So more magnesium is good for you.

More lithium is good for you. Magnesium and lithium compete in the body.

Okay, okay.

However, so in some places it's good, in some places it's bad. So you need enough lithium to decrease all cultures morbidity, mortality and increase your telomeres, but not enough where it's going to interfere with your magnesium. Okay, Right. So if as a physician, like a few milligrams of magnesium, you know, ha, whatever. So I thought, well, how much magnesium or how much lithium. Sorry. Are these bipolar folks taking? And a standard bipolar dose starts at 300 milligrams and then it goes up to 600 and then 900. And once you get to 600, the side effects start kicking in because of the issues with magnesium and then a variety of other factors. So I thought, well, okay, if most people can tolerate 300, why are people taking 2 to 3 milligrams? So I decided to take as much as I could while trying to avoid side effects.

And the side effects are depression or.

No, like physiologic stuff, some kidney stuff, risks of a few other diseases, just side effects that we don't want. So I decided on 75 milligrams a day.

Of. Not lithium orotate.

No, no. This is pharmaceutical grade lithium.

And that's just straight Lithium salt.

Yeah.

Okay.

Exactly. It's easily obtainable. It is dirt cheap. It is mood elevating or at least stabilizing. Unlike a lot of antidepressants, people have to be on them for a while and then when they come off of them, they feel like absolute garbage. This has zero on off, you just feel better.

Interesting.

So I'm thinking that your mood is better. You're not making rash decisions. I've just decreased all cause morbidity and mortality. And if I'm on it for longer than two years, years, I can only benefit my telomeres. So I think it's like a win all the way around.

Okay. That is, that is fascinating. Why wouldn't people who can't get drugs the way you can just take orotate, you can just.

The milligrammage is significantly lower.

Yeah, got it. That's intriguing. I'm, I'm interested to try it. The difficulty is that if it changes your affect or your mood, you may not notice it unless it's.

I think people feel it. I think. And I think it's 75 milligrams. And I'm small. Right. So for anyone that's bigger than me, I don't think it's going to do much. A friend of mine takes double that.

Okay.

And he seems to do absolutely just fine. But I think 75 is a good dose. Plus they come in 300 milligram tablets. So it's really hard to, you know, if you half it and then half it, it's reasonable.

Just break it down to quarters and you're good to go. Okay.

Anything smaller than that is just going to be crumbs.

Yeah. Okay. I have a little drug dealer scale, but that would be a lot of work in the morning and I'm not going to deal with that. Okay. It appears that bipolar disorder is at least partially a circadian disruption. I know more than a few people who use the very darkest of the true dark glasses who are saying if I use these at night, my bipolar symptoms go down substantially. Do you know the connections between bipolar and circadian systems?

I actually do not.

Okay. It's, it's interesting. It's probably in PARP or BMAL or something. There's gotta be something going on in there.

I'm sure there is.

Okay.

Yeah. I mean, obviously there's the, the SCN in the back of the brain. Information comes in the retina processes there. I mean, the same patterns are on your SCN that are in every cell of your body in terms of the circadian patterns. Except for testicles, which is really quite interesting. They are not circadian.

Interesting. I did not know that Caesar and.

Thymus are the only cells that do not synchronize.

That's weird.

Well, it's. It's the I guess I'm always ready sort of male mentality.

So I've been regularly tanning my butthole and my balls. Is that a good longevity strategy?

Certainly entertain.

Okay, for the record, guys, there is evidence that sunlight on your scrotum will increase testosterone. Or you could just use red light, which is what I actually do. If I'm in the sun, I'm probably not gonna have my clothes on if it's a place where I can't. So I might get some sun on them, but it's not intentional. And sun on your butthole does nothing except for get you in the New York Post with an article that says, biohacker bro burns bums. And yes, that did happen to me. So that was a joke.

Okay, that's fantastic.

Got it. Just checking all the angles.

I think that's great. I'm glad your scrotum is adequately radiated.

We just had to share about all the longevity things that are possible.

That's fantastic. I'm sorry, I don't have a scrotum for which to challenge that.

Since we're talking about that. This is very important science. A group. A research group went out and took a picture of a thousand scrotums. And then they asked a large ish group of women to rate them on a scale of 1 to 10, with 5 being average, 1 being ugly, and 10 being attractive. No scrotum scored above 5. In other words, they're just not attractive. So I don't think you really want one.

I mean, if I did not realize this. So I was in New York City last weekend, and you know the giant gold bull on Wall Street?

Yeah.

People pose to get their picture taken with the testicles.

That's hilarious.

It was sub zero. It was fucking freezing. And there was a line of at least 50 people waiting to have their pictures taken with a scrotum. I was. I was taken aback. Like, why?

People are funny. You go to the Sedona Whole Foods, in the parking lot, there's a statue of some Viking or something. And underne. There's probably no Viking. It must be a Scottish person because they're swearing a kilt. But you can look underneath it and there's balls and people. Same thing. They have to get a picture.

Are they hairy?

It's made out of bronze, so I don't think so.

Kind of hard to say.

I didn't really feel anything because that.

Might be determinant of like ugly or not.

Never thought about it. But I'm just thinking you don't want one.

I, I don't but thank you though.

Now that we've gone completely off of the important topics, I do want to ask a final question. Men and women are different. These principles of longevity apply to men and women very, very well. What are the three things that women need to know versus men for longevity?

I think the biggest thing is that prior to menopause you have to stick with basically the same principles. Basically. Right. Males and females, sirtuins, nad all of those things are roughly equivalent. Roughly equivalent. As soon as you start having hormonal failure, things change dramatically. And it's extraordinarily important to recognize that and to fix it within a five year time period.

Okay.

Because cardiovascular risk shoots through, osteoporosis shoots through so many interesting like issues. And so we as women have to be monstrously careful. Like I, I, I have people like osteoblastic activation is crucial for women more than men. Inflammatory issues are more crucial for women because inflammatory issues are associated with activation of osteoclasts which break down bone. So that's why we're set up for osteopenia as we get older. That's huge as well. Women live longer, but we live worse. We are with Alzheimer's. We're set up for autoimmune diseases. There's something in us that is just different and we have to address them. So more free radicals stuff for the brain. The things that you listed for the brain. Fantastic. I like to be proactive. Sperminine is huge. Protects the brain, also protects the DNA, reduces risk of autoimmune disease. There are a variety of things that fall into that category, but we definitely have a few things that we just have to be adamantly aware of. And I would love to go back to the men thing and say like what's important for you guys? But I'll say I don't care.

One of the things that lowers all cause mortality is having physical touch from a partner. So I care about the health of the women in my life because I'm really just using them to touch me so I can live longer. Or maybe there's more like oxytocin and intimacy and polarity and all that kind of stuff. I, I think relationships are part of longevity strength.

Of course they are. Of course they are. I don't tend to mention it publicly because some People are fortunate, they have relationships and other people are less fortunate and they don't. And it's kind of not fair to say to people, I'm so sorry you're alone and you're going to die early. That's just not fair. So the answer is, you're absolutely right.

Why is that not fair? It's like, do something about it. Like, I'm so sorry you're obese. Lose some weight. There's a thousand ways to. I'm so sorry I drink Diet Coke. Stop drinking. Like, there's all these things you could do.

That's really funny. That's really funny.

But in all seriousness, it's not like you can't learn relationship skills. It's not like you can't do work on yourself, right? Like, it's, it's possible.

It, it, it is possible. I know a lot of single people that want to remain single. I know a lot of people that are, you know, out of long term relationships. They're not there yet. Be that as it may, it's easy to talk about things you can do for yourself. It's much harder to bring someone else into your mix if you have it. Yes, it's extraordinarily helpful if you don't. It is what it is.

That is very, very true. But that is why I think it makes sense to take care of the men in your life. And men, we can take care of women. Like, it's a team effort here.

That's, that is, that is fair. But for example, I don't spend a lot of time looking up like, Ed. Why? Because it's not my problem.

That's so brutal.

No, it's true. Like, I'll be reading something that says prostate issues and I go, ah, if.

You were with someone who had Ed, it would be your problem.

Problem that clearly be like, dude, here, take my false radio.

Yeah, yeah. Oh my God, that is the funniest thing, Sandy. Every time we get to hang out, it's, I'm like, what is this person putting on her plate? Like, why did she do all this stuff? But you have a very fast and fascinating and well informed mind. And I, I say that you're weird and crazy and so am I. And I very much admire your willingness and ability to say, yeah, that's not ideal. So I blocked it. And then to do what you want to do, like, it just takes a certain amount of, of Actually, I really don't like the word empowerment because it's like, like someone else is giving me power, but it actually just takes a certain amount of power and sovereignty over your biology to do that. And I greatly admire your mindset and all this stuff. And it doesn't matter if we agree on Diet Coke and birth control pills or not. Anyone listening? You have to choose your path. And my job is to bring awesome people on the show and to educate you so you can make better choices. And there's so much knowledge and wisdom here. And so go to Kaufman K A U F m a n n 1 f 2 n protocol.com or just go to daveasprey.com and get the notes for this episode where there'll be lots of links to Sandy's work. You can also pick up your book on Amazon or Books. What's your best book?

The first one is more introductory. The second one has more stuff in it. Three and four are on the way.

Okay, beautiful. And those are on Amazon. Sandra Kaufman is her name on the COVID Thank you so much. I can't wait to go to dinner with you and all of our other health friends and just do some more nerding out on longevity.

This is gonna be great. Thank you so much.

See you next time on the Human Upgrade podcast.