Learn How to LIVE LONGER - with Sergey Young | The Empowering Neurologist EP. 129

Every piece of science and technology that we are trying to use now, it just helps us to bring affordable and accessible version of healthcare to the world.

Who wants to live to be age 200 years? What a question. Is that something we should aspire to? Is it something even conceivable? I'm Dr. David Perlmutter. Welcome to The Empowering Neurologist. We're going to explore this whole notion of longevity today. We'll be talking with my good friend Sergey Young. He's the author of a new book, The Science and Technology of Growing Young, and it's, it's a fascinating review about where we are today and what the future may hold in terms of the promise of not only extending our lifespans but extending our health spans as well. Let me tell you a little bit more about Sergey. Sergey Young is a longevity investor and visionary, and his mission is to extend the healthy lifespans of a billion people. He's the founder of the $100 million Longevity Vision Fund, which is one of the few funds specializing exclusively in longevity and helping to accelerate longevity breakthroughs. And we'll certainly talk about some of those today. He's the development sponsor of Age Reversal XPRIZE, a global initiative designed to cure aging And age-related diseases. He is on the financial advisory board of the UK's All-Party Parliamentary Group for Longevity, which is helping to shape a national life extension strategy. He is an investor with experience spanning over 20 years, which includes managing a $2 billion private equity fund. His goal, as stated, is to live to be age 200 years. And to find an affordable way for everyone else to do the same. He indicates that we're on the brink of a longevity revolution with new scientific discoveries and exciting technological advances now making it possible to actually reverse aging and treat previously incurable diseases. We're going to learn an awful lot from Sergey today that's in his book and why we should consider reading this book. Let's get to our interview now. Well, hello, Sergey. Welcome again to the program. How are you doing?

Hi, David. I'm very happy. Thank you.

I'm glad to hear that. And you're in New York City?

Yes, I am. I'm doing quite a lot of media appearances and discussions in— well, obviously presenting upcoming book.

Right. And we're going to jump in. In the introduction, I talked about your new book. I'm very, very excited for you about this book. And I just wanna let our viewers know that longevity and healthspan, these are all exciting topics. And I'll just say at the onset, Sergey, you did an incredible job in pulling together so much information. How do we define aging? What are these new technologies? What are future technologies going to look like? Should we even be dabbling in this area? What are the implications of extending our lifespans by 10 years, by 50 years, up to 200 years? There's a lot to talk about here. So let's first begin by, as you began the book, talking about what got you interested in this whole notion of longevity.

Great. I think for majority of us, our interest to health and longevity starts with the wake-up call. I had 2. One was the story of my father who got lung cancer back in 2005. He survived, but the quality of his life never recovered. So physically, the man shrunk by one-third. So that's that was the first wake-up call. And the second, my cholesterol story, and it's it's probably familiar for a lot of people from our audience. High cholesterol level, Sergey, you need to take statins till the rest of your life. And then the question has always been: What's the alternative? Apparently, alternative was so exciting, changing my lifestyle completely. Doing physical exercising, be more plant-based, more plant-based and healthy variation of diet, a bit of supplements like omega-3 as well. So I've done this change in the course of 6 months, achieved exactly the same results in comparison what if I would be taking statins. And I was so happy, I just, I felt excited that I can bring so much change in this field.

Well, I would say that there's been so much emphasis on the cholesterol level as being such an important marker related to cardiovascular disease. And I think to be fair, I'm just gonna go on record as saying that was a bit overdone. Yeah. I mean, we know that this, the prognostic ability of the total cholesterol, for example, is really minimal at best. And all this attention to pave the way for widespread usage of statins, I think is To be kind about it, a bit misguided. You said you took omega-3s, but in the book I think you said you took as many as— and we don't need to go through them all, but I think you said 43 supplements each day.

Yeah. So, I mean, a lot of things in life go in waves. So it was— I was writing this when I was in the peak of my obsession with supplements. Right now I'm more moderate with this. So it's omega-3, like odorless garlic to train and support my heart and vessel system, uh, like some typical things, simple things like seaweeds as well. But all in all, I think it was super helpful for me just to go through this experience to realize that this whole kind of high cholesterol thing is— it was a little bit overrated. Yeah. Oh my God. Yeah. In

fact, that's the understatement on this podcast, but yeah, we'll leave it at that. Let's just be clear, because I think there may be some misunderstanding. What is longevity? I mean, what is this goal that you have, and how do you define it?

Yeah, so for me, longevity is living longer, but in healthy and happy state.

That's

important. So our definition of longevity, and it's intentionally broad today, in the absence of regulatory context to support investments in healthy, and happy living overall. Whatever increased the average healthspan and lifespan on Earth, for me, is longevity.

Now, you've been quoted as saying that we want to sort of compress the disease span, meaning, you know, we want to reduce the time that we are disabled. And that is, I guess, incorporated in the counter to that, the extension of the healthspan. In other words, keeping us alive, but able to participate in life for as long as possible. Clearly, our lifestyle choices are related, that's for sure. And I know that later on in the book, we get a little bit tech heavy, which I think is fabulous because I think for most of us in the field, it's been that the reason we die earlier is because of the mismatch between our current lifestyle and our genome, an evolutionary environmental mismatch per se. And I remember at the first Longevity XPRIZE meeting, I was chatting with another life extent or longevity expert, Aubrey de Grey, and he was all over the fact that this is going to be a technology issue. And I'm kind of a lifestyle guy. And I remember thinking that, gosh, we are at odds. But then when you realize That the gift that we have with this incredible brain allows the technology, and it seems then to be a natural extension of our human abilities to then take it to the next level, to develop things like AI, to develop the wearable technology that allows all these things to happen. So, I'm hoping we have enough time to explore all these things. But early on in the book, you say, You know, one of the biggest goals is to avoid a premature death if you want to live a long time. That seems like a silly comment, but the way you phrased it in the book, I think, was, was very meaningful.

Yeah. Well, I think what we've done so far, we've been working towards avoiding early death. So if you look at the evolution of lifespan for the last 100 or 120 years, so we've doubled our lifespan, average lifespan on Earth from Probably 35 to 70, 75 years, depending on what number of countries you include into that. And all of this has been done just by making sure we don't die earlier. So at the same time, the maximum lifespan on Earth was somewhere around 120 years, and it's still there. So I— and I do think the things that you just mentioned, David, so like lifestyle interventions and changes and technology interventions and changes goes really in a very complementary way. It's not either or, it's combination of both.

That's a great point. And we have the tools now today, the lifestyle adjustment tools, interventional tools, if you will, to help us keep from dying prematurely and to be around then for the next wave, the longer horizon of the things that you talk about later in the book. There's a term that's called longevity escape velocity. And I know that Ray Kurzweil indicates that that's something we may achieve in the next 10 to 15 years. Can you tell us what that exactly means and why it's important for our discussion?

So I think the importance of longevity escape velocity term is just to show that sometimes the quantity of changes goes into quality of what this change can mean for us. So longevity escape velocity is the point of time in the development of us humans, in the point of time in evolution when within every year of while you're becoming one year older, there's more inventions, scientific and technological breakthroughs to help you to live one year longer. So that's technically longevity escape velocity. So that's almost like Well, philosophically, it's an opportunity to live for as much as you want on this planet. But again, for me, importance is healthspan, the quality of these years, not necessarily the quantity overall. But I think Ray is right. All these science and technological breakthroughs, they are very important. They are in development phase. It's going to be another 10, 20 years. Yeah. Until the moment when we can enjoy, embrace, and use it massively. Before that, we just need to stay on longevity bridge, make sure our lifestyle supports a healthy state of our body and mind. So then in ten or twenty years' time, we can actually enjoy all these beautiful developments.

Well, I'm gonna do my best, and you know. We've known about various parameters or mechanisms that have been described over the years that have been considered to be so fundamental in the aging process. Is it shortening of our telomeres? Is it DNA breakage and lack of DNA repair? Issues with proteostasis, issues with cellular senescence, mitochondrial dysfunction, free radical theory, Denham Harmon. And all of that. So, there have been, you know, quite a few so-called theories of aging over the years. Where are we now?

Well, it's an interesting question there, because we had a review of all major theories of aging in the book, in the initial version of the book. And then finally, we decided, unfortunately for me as an author, To scrap these 40 pages of review. Because the reality is that we're still pretty far from having unified theory of aging at this moment. And that's why the hallmarks of aging that you just mentioned, right, from, you know, DNA damage to shortening of telomeres, and some other things which are happening in our body, I think it's very instrumental in terms of organizing... Yeah. Our work, both in science and in technological development, to fight aging. So, well, that's one comment. The other thing is, I do believe if there's one single theory or one single process in our body which is responsible for aging and us getting disproportionately higher risk of age-related diseases, this would have been invented or solved through Either evolution or through current science. So, and I do believe where we are today is just confirmation that human body and mind is extremely complex matter. And to solve it, we actually need to focus on a number of hallmarks, on a number of technologies, number of interventions for us, in the end, to achieve increasing the healthspan.

We recently had the opportunity on the program to interview Dr. David Sinclair. I know you've worked closely with him. Yeah. He's about one of the coolest guys I've ever met. I've only met him virtually, but what a mind he has. He has really leveraged this notion of aging being related to an information challenge that we accumulate alterations in the ability of our DNA to express itself over time by virtue of the changes that take place to our DNA in terms of how it gets methylated, the basis of the so-called Horvath clock. Correct. That these days seems to be pretty front and center in terms of measuring aging and certainly perhaps moving forward, the ability to indicate the effectiveness of various interventions. So it seems like in the book you pretty much settled on this information Or disinformation, as it were, however you want to look at it, theory that relates to how we're able at least to chart aging.

Yeah, David is an amazing man, and obviously it was just literally amazing experience to work and co-invest with him in the pieces of science that is under development in his lab. I do think it's important to realize the other positive effect of us having access to aging clocks, to biological clocks. It's basically a set of biomarkers which, you know, in conjunction, in comprehension, shows your biological age. And for some people, your biological age is actually higher than your calendar age. For some of the people, it's below than that. But I think the importance of that is that right now we can be much more efficient with science, with technology, with development of different interventions. Think about the aging experiment or trial which we had 20 or 30, 40 years ago. You just— you take a statistically representative sample of people at a very old age, and then you just sit down and wait until all of them die. Well, that was unfortunate reality. So your feedback loop for however old the group is would be what, 10 years? 15 years, and that's it. Right now, because of the fact that we can use the biological clocks, you know, I can measure my biomarkers almost every day. It's not an exception, it's not a surprise to hold aging experiment or scientific trials in the course of just 6 or 12 months. So, what we've done through this in the last 2 decades, literally, we compress the feedback loop for so many things that we want to try and test on humans. And that, I think, is one of the biggest efficiency gains that we got from biological clocks as well.

You know, vis-à-vis our discussion about how we stay healthy now until the time comes when there's technology developed that will allow us to really gain a foothold. And I think, again, Dr. Sinclair is at the leading edge of that. The rodent studies he's done utilizing reprogramming techniques, the Yamanaka factors in the eye trauma and glaucoma models. Yeah. The rodent, it's breathtaking. But for now, the idea that we can use our personal data, we have the idea of using wearable devices to determine Our moment-to-moment blood glucose, pulse rate, oximetry, heart rate variability, you name it. That is certainly coming a long way. And how powerful is that? How additive is that to the whole notion of being able to preserve our health and maybe extend our lifespans?

Well, that's very important. And I think it was last week, I've just seen an article that I think it was regulator in UK prohibited the purchase of fax machines for national healthcare systems. Imagine, I don't even know, David, you and me, when was the last time we were actually, we had an opportunity to look at fax machine, but they're still in massive use in our healthcare system. That means that we don't really look at the— medical information is data. And then interestingly enough, the other fact is 1/3 of the data in the world is of medical nature, is healthcare data. So there's just massive opportunity for new technological solutions like, you know, big data processing or artificial intelligence to help us to figure out the importance of that and what are the important implications for all of us. So that's why I'm not a big fan of watches or wearables. But a few years ago, I switched to Fitbit or Apple Watch, like whatever wearable you have now, or Oura Ring that I have on my hand, starts collecting my data. And it's been pretty exciting because I do have my feedback loop, right? If I've been lazy, then I can see it in the end of my day, and then I take my dog and I can go to the forest to take a walk. But on the more medical side, I think even today's wearables, they're not like activity trackers anymore, they're personalized healthcare devices. And I do believe in the next year, 2 or 3, there's a couple of features going to be added there, like continuous glucose monitoring, like our ability to monitor our blood pressure. And with addition of these features, I do believe it's going to be like 90% of the data that you want to measure on ongoing basis and go into more preventative mode. Because just looking at the figures and startups and technologies that we invest through our Longevity Vision Fund, treating disease at early stage in preventative way, it's 10 to 20 times cheaper. than reacting and responding to the massive health crisis. Not only that, it's a cost side, but almost in terms of efficiency side of that, if you have an opportunity to catch cancer at early stage, your recovery rates can be as high as 93% to 100%, depending on cancer type. Well, that's beautiful. While at late stage, I mean, they can be around 20% to 30%. So it's not only the opportunity to decrease the cost of healthcare, it's an opportunity for all of us to sustain and improve the quality of our life.

I think you mentioned in the book that as many as half of the deaths in the world annually are preventable with, if they would've had early diagnosis and intervention. Yeah. And it takes us to an interesting topic that you spent some time exploring, And that is this notion of the liquid biopsy. And it's as if we are learning so much more, there's so much more available to us in terms of various markers of disease. Take us through what that means and what you think the future of that technology might hold.

Yeah, so we use an example of the company called Prenom. They similar to GRAIL and others in terms of the problem that they want to tackle. And The interesting thing is that when you have a massive amount of data that you can derive from your blood sample, there's a number of important conclusions and correlations which is very difficult or impossible to do for human being, however smart we are, even in combination. But if you, if you like take 100,000 different samples with a number of biomarkers, and you ask artificial intelligence network to go through that, it actually starts on this massive scale of data analysis. It's not unusual to find particular interrelations, to find particular conclusions. So combination of a lot of sometimes really counterintuitive factors Can really point out of someone having a risk of colon cancer, and colon cancer is one of my favorite ones because you know even I'm like really longevity enthusiast, but even I I'm always like deferring avoiding colonoscopy, right? And because it's invasive procedure, you know you need to do it two three or every five years depending on the protocol that you're following. Hopefully under sedation as well. And literally what has happened in the last few years, we've seen a number of tests which are helping us to identify early stage of number of cancers without going the ordinary or usual route through pretty expensive procedures. So your liquid biopsy, your blood tests which can point out to, for example, colon cancer. The price point for this is going to be anywhere between $100 and $200. But that's amazing. And it's just very difficult to find colon cancer even at early stage. And so I call up Human Longevity Center in San Diego. This is where I've done my health checkup. I do it on an annual basis and I've done it last Tuesday. And they said, well, Sergey, not a problem. So it's going to be combination of full body MRI and these early cancer diagnostic kits that we're going to use, like Cologuard, the test that I used, it costs $19. And it's almost as efficient as usual procedures that you have in hospitals. But it's, again, it's $19. It's like 3 cups of coffee from Starbucks. And I think the beauty of that, and that's what inspires me a lot, is that Every piece of science and technology that we are trying to use now, it just helps us to bring affordable and accessible version of healthcare to the world. So, I do believe that longevity is going to be a less dividing thing for our society. I do think it's one of the rare opportunities to unify people and give everyone access to, like, the best version of healthcare. That we can provide.

Well, even looking at the genome, the predictive value of that does at times lead to action that can be preemptive. And in the book you talk about Angelina Jolie in terms of she was highly predisposed to breast cancer and underwent a bilateral mastectomy because of that. So this is the type of action that people can take when they see that they're at a significantly high risk for a particular disease, they can act in such a way as with that information to reduce the risk of having that disease manifest. And I think, you know, as it relates to Alzheimer's, for example, we see so many people who are making profound lifestyle changes. Yeah. A, and B, profound lifestyle changes when they think they're carrying, or they have been demonstrated to carry, for example, the APOE4 gene. 4 allele, knowing that their risk for that disease has— Mm-hmm. Is likely increased. And there are those who would argue that, well, why should people have this information? There was a great and interesting, I'll leave it at that, editorial in the Journal of the American Medical Association a couple weeks back that talked about continuous glucose monitoring. And really, I think made the point that by and large, this is really something that should only be used for people who have diabetes. And I think that what I'm hearing from you is that we don't want to get diabetes in the first place. And I can tell you that's true. When you think of all the downstream consequences of type 2 diabetes, you don't want to get it. You don't even be pre-diabetic. And what better way to keep yourself from becoming a diabetic than to know what your blood sugar is doing moment to moment? So, you know, as it relates to that, I think I think that's very empowering and I am so in favor of the notion that consumers now have access to this information. I think you made that as a very strong point in the book that while doctors may be lagging behind in making this information available to their patients, consumers through many of the, much of the information that you provided have access to this right now.

Yeah, I think it's a great opportunity to take back control and responsibility for our health. And in today's world, there's so many health-related choices that we outsource to big food, big pharma, your healthcare provider, and I don't think it's fair. So this is my health, and I'd like to be informed, and I'd like to have an opportunity to have a productive dialogue with my doctor or doctors. That I'm working with. And it just, it feels really beautiful. So I've done this health checkup last Tuesday, but I'm still full of sensors. I just took out my Zeopatch. That's the thing that you wear here to measure your heart performance for 7 days in a row. It stores everything on the chip. You send it to the company, and like, it's just a completely new generation of cholesterol monitors, right? Or I have this continuous glucose monitor here, and I'm going to wear this for 2 weeks. I'd like to see my predisposition to diabetes. I'd like to see how my body reacts to different types of foods or lifestyle choices that I'm making. And, well, I think the nature of humans is like, if you receive constant feedback in a good or in a positive or negative way, we always you know, much more keen to act on that, to make choices. And that's exactly what I want us to do. I want us to be, again, responsible for our health and health choices, be better informed, and establish peer-to-peer discussion and dialogues with doctors.

Sergey, one of the impressions I walked away with at the initial meeting for the Longevity XPRIZE was that they asked for a show of hands, how many in— how many of you guys are taking metformin? And I was surprised. There was about 80%. And I would assume probably very, very small number are diabetic. Yeah. Of the people there. And these are the smartest in the world, arguably, and were actually taking a pharmaceutical intervention. And I think that as you describe in your book, Because of the potential that that might have a role to play in longevity. So let's just take metformin apart a little bit here. Yeah. And talk about where we stand today and what it looks like moving forward.

So I'm much more conservative, David, than the majority of people who are, who kind of made longevity as like super passion in their life. And I do believe that in 5 to 10 years' time, we will have longevity in a pill. We'll have a drug which will help us to fight age-related disease. And there's a number of candidates for that, whether it's rapamycin or metformin, etc. In fact, actually, I'm having dinner today with Nir Barzilai, the man behind TAME trial. And, but I do believe that we need to test metformin in a scientific way to make sure that it does have this impact and influence on our healthy and hopefully happy life extension. So personally, I would not be surprised if by the end of this trial, and near American Federation of Aging Research and many other people are working to make it happen, well, it's going to be at least 5,000 people, it's going to be at least 3 or 4 years, and by the end of that, who knows, probably we'll have metformin as the first longevity drug which is available to us. But so, I'm not taking metformin now. I'm more prudent and conservative in this regard. And I do believe that, you know, I can stick and I can stay on longevity bridge for another 5, 10, 15 years to enjoy metformin, any other longevity drugs, or, you know, all the different technologies and pieces of science which will be available to us today. There's so many interesting facts about metformin. I again do believe, I do believe it's going to be plus two, plus three, plus four years to our healthy life as a result of that. But Nir told me that actually, like for every trial, you need to have placebo and you need to have like an actual substance, metformin. So placebo for TAME trial. was more expensive than metformin itself. It just shows you, I mean, that the cost of this generic drug, which has been here for 50 or 60 years, has been really insignificant in comparison to the effect it can have on our lives.

So for our viewers then, metformin is a drug that is commonly prescribed for diabetics, demonstrating in fact lower rates of certain health-related issues in those diabetics compared to those diabetics not taking Metformin, but also in terms of cardiovascular events, etc., other issues, lower rates of these issues in comparison to non-diabetics obviously not taking Metformin. And now the new trial, if you want to look it up, it's called the TAME, T-A-M-E trial, that's really, I think, going to explore deeply what might metformin be able to do, even if it is 2 to 3 years of life extension or reduced risk of a disease complication. Yeah. So I would say that chronologically, Sergey, I'm certainly further along the continuum than are you, but I have elected, at least as of this moment, to not pursue metformin, though I've been tempted. And there's a herd mentality thing where everybody's doing it. And I haven't done it because when we're taking metformin, obviously our goal is to stimulate this AMP kinase pathway, which I know that I do when I go out and run 4 to 6 miles. So I think I'm getting that AMP kinase pathway stimulated in a good way. But there may come a time when I'm less able to exercise when it may make more sense. And I think what we can expect is that the effectiveness of metformin might well be more along, more noticeable in people who are not in as good a shape, who are suffering from some degree of metabolic syndrome. Yeah. One of the, one or more of the components. So we'll see how that plays out. And we're very excited. Maybe you'll come back and we'll get Neal himself to be on the program and talk to us about that. Beyond that, there are other drugs that people are popularizing, like rapamycin, which, you know, is a far more powerful intervention. Any thoughts on using rapamycin?

Yeah, I said, look, I'm a little bit like you, David. So I don't think we need to rush into that today, right? Well, let's just go through science and regulation. Let's go through trials before we use that. And I do believe there's many positive things about the concept of longevity drug, concept of drugs which will help us to avoid or fight age-related diseases. But there's one downside of that. By the moment that we are switching to drug, we kind of tend to take less serious all other lifestyle changes that we need to do. And I do believe And again, as we discussed in the beginning of our dialogue, is that human health is extremely complex. So it's almost— I can almost guarantee you that you would need to have a number of changes in your life and your lifestyle to be healthy, to stay on longevity bridge. So I don't think we're there in terms of the massive use of longevity drugs. But I do think we are here, can do so many different lifestyle changes, right? From physical exercises to diet or managing our cortisol level or our mental health through sleep, meditation, and act of kindness like social realization.

I want to go back to something you just mentioned because I think it's really very important. You said that if we I don't wanna paraphrase, but if we develop this reliance or begin to use these pharmaceutical interventions that we may discount or find less applicability of the lifestyle changes, which are so important. And in thinking it through, that's a bit of messaging today that people are getting. It's pretty much you do whatever the heck you want and we've got a pill for you, whether you wanna eat crap and take metformin to keep your blood sugar down. Yeah. Or recently, don't exercise, hang out around the house, don't read a book, whatever. And when you're finally becoming cognitively impaired, why, here's the brand new Alzheimer's drug, which when you look at the data in terms of what the FDA was able to review to sanction its use, it's pathetic with all— It is. It's true. It's virtually a meaningless drug. And yet it's now gotten approval for $57,000 a year per individual to use. Wow. Anyway, we'll leave it at that. But I think your point is well taken that not to underestimate how important all of these lifestyle interventions are that we've been talking about for so long. You've mentioned yourself, you don't eat a lot, you exercise as regularly as you possibly can, you're managing stress, you're making sure that you sleep, you're wearing an Oura Ring. So these are things that you, I think, would include in the notion of a longevity bridge to allow us to remain as healthy as we can until such time is, as, you know, the technology then takes a step further and then brings to us even more powerful tools.

Exactly. Yeah. Well said. Thank you.

I wanna move on to, before we drop the whole notion of taking pills, There's one last area that we should talk about because you spent several pages talking about the whole notion of NAD, and, you know, we had the opportunity to talk to Dr. Sinclair about that, that NAD is what is needed for this repositioning, or the action rather, the action of the sirtuins in terms of things like DNA repair. So that the, the sirtuins are brought about by things like resveratrol, not that they wouldn't be there naturally, but are activated by resveratrol. But the fuel that they need is supplied by something called NAD+. And in your book, you're discussing the whole idea of the rodent studies showing improvements of endurance, for example, in older rodents, but that we might consider taking an NAD+ precursor like nicotinamide riboside. Right. Or nicotinamide mononucleotide. So maybe just a brief overview of where we are in the whole NAD story.

Yeah, so this whole story about, like, having this separate supplement stream and a drug stream is fascinating. And there's so many things that we can take in the form of supplements or using the food as our cure. Because what has happened, like, so today's world is very binary. So it's either like a drug and then you spend 12 years to develop that. The average drug costs $2.6 billion. Or you can go to the substance which really don't need to be approved by FDA. So you don't really— You don't need to pay for it. Consider them as a drug. So, and I do think what has happened in the last 3 to 5 years, we've developed and we finally have this new category of supplements which are longevity-related. And NMN, for example, or any other form of NAD+ boosters, is a great example of that. So, and it's obviously was number of study— studies how it's that helpful in terms of the age reversal, just looking at your biomarkers. But what I like a lot about NMN, um, every person in, in our longevity field that I spoke, uh, with, they were very positive about NMN. Like Eric Verdin, the head of Buck Institute of Aging Research, uh, David Sinclair, Peter Diamandis told me when he started to take NMN

And he did more push-ups.

Yeah, push-ups was like, what, 30%, 50% more? And it's all within the month. So I do believe there's a certain great story and effectiveness around this new category of supplements that we have. So that's one side. Well, the other side, I like to collect different views on like the same topic. And I do believe that— I, I don't even remember where, when I find this figure, but like the, the work of supplements and the impact of supplements is by 30 or 40% predetermined by placebo effects. So if you believe, I mean, they working for you, then it means they really working at least for 30 or 40% of the effect. So, and that's the other reason why I like supplements, because And why I take quite a bit of supplements because I do believe they make me healthy, they make me happy, and that's the beauty of that. So even again, it might sound a little bit controversial. So even if you think it's just not working, but it's just the fact that you believe in that and you consume it, you have your positive thoughts, you're rewiring yourself towards healthy and happy living might be helpful as well. So I don't know where this. Placebo effect stops and scientific effect starts. Hopefully it's combination of both, but I do recommend people taking this whole placebo thing or, you know, different kinds of supplements just to feel healthy and happy as well.

I've never wanted to knock the placebo effect. If people feel better, if their pain is reduced, if their cognitive performance seems to be increased, if their endurance seems to improve, taking something and it may be the placebo effect. Even as it relates to an antidepressant, great, they're better, they're feeling better, and it doesn't— to me, it really doesn't matter. But I will say that, you know, I don't notice any dramatic difference when I take my omega-3 high-level DHA with high levels of specialized pro-resolving mediators, when I take, in my case, nicotinamide riboside, vitamin D, quercetin, prebiotic fiber, all of those things. I'm not gonna tell you that I necessarily feel better that day 'cause I did it and I can do more pushups because I did. I've not, I've not noticed that if I don't take it, I feel that much worse. Mm-hmm. But understanding the science about how this stuff and so much more that I take works, I think takes me away from needing to have that visceral confirmation of its efficacy. And, we have the ability to read scientific data and it seems like it makes sense. Having said that, there's really not much going on in humans to indicate powerful effects of these oral NAD precursors. I think we're beginning to understand the pool, the regenerative pool for NAD, the various compartmentalization areas of where it is able to enter, et cetera. I think people have seized upon this to begin protocols of giving NAD intravenously. And I think there's no, as of our conversation today, no real good science to be highly supportive of that as an intervention, in my opinion. Yeah. But I do believe that at least based upon what we see in rodents though, taking a precursor is reasonable. There's been a recent study of An NAD precursor and its effectiveness on insulin functionality in women in terms of muscle glycogen formation, et cetera. So I think there does appear to be validation and not to be understated is when you talk to smart people and you've mentioned some really impressive names, you ask what they're doing, and these are people who are all over the literature. And they are taking these and so many more. It does tend to want you to be part of that herd mentality and not miss out. And again, keep yourself in good shape until the time comes when the next technology comes along. And one of those technologies is sort of this interface between— I don't know if I want to call us being cyborgs, but the way that, for example, we foresee Interfacing computer technology actually with the human brain and other things that you've described. I mean, you know, we're seeing the technology make its way within the body, in the heart, in other areas, but that's, I think, a really exciting thing to look forward to.

It is, yes. And I do think people sometimes are pretty skeptical about the things which are done, for example, by Elon Musk and Neuralink. But every time when I see these pieces of radical technology in the development phase, I always think about people who are in need of that, right? So not everyone in the population, but we still don't know how to fight Alzheimer's and dementia, right? What are the sources of neurodegenerative diseases and what is the most effective treatments against that. So think about people at the very late stage of their life where for these— having this human brain-computer interface will give us an opportunity to improve the quality of their life. Because physically they might be fit, but mentally they would require certain support. So in this case, I would argue that having solution developed and available in the field of human brain artificial intelligence integration might be super helpful and will not sound as controversial as just creating the world of cyborgs.

Well, I mean, we know what we all learned from watching The Terminator and, you know, who knows what the future holds. But, you know, I would say for our listeners, If these sound like outlandish ideas, you know, think about when the Wright brothers went about thinking they're going to fly an airplane. I mean, you know, it was beyond fanciful. I mean, how could you conceive of the idea that we would have a smartphone that allows you to do a video conference with anyone around the world? I mean— things are happening at an ever-increasing rate. And, you know, who knows? And I think it's time to be a little bit more open-minded in recognizing the power of development, you know, certainly in the computer world, the utilization of AI and the doors that that is opening. You end up in your book talking about the morality of immortality, I think, right? That's the chapter. And it brings to our attention this, the whole notion of Is this something we should be doing? If we could extend lifespan to 150 years, is that a good thing? Is that the right thing to do? And beyond that, maybe we can discuss the democratization of this technology.

Yeah, yeah, this is very important. And when I started to work in longevity field, I arrived to a shocking realization that Depending on the country and the question you ask, like semantics of the question, 60 to 80% of the people don't want to extend their life. And it was shocking for me because I was created with completely different setup, mindset around this. But I do think it's important and we should not ignore that. So what I've discovered that science and technology is here or will be here in the next 5, 10, 15 years. And as I say, we've created the science and technology to extend our life, but we haven't created life that we want to extend. And there's so many ethical considerations that we need to go through. There's so many moral dilemmas that we need to solve for ourselves. Like, if we're all going to be living longer, what will happen to marriage? What's going to be the construct of our life? Would it be several beautiful mini-lives? What about our careers? Like, can we have careers every decade or so in our life? And again, for me, questions are also around inequality. So how are we going to close inequality gap? And I'm actually like very happy that all of the new pieces of technology give us an opportunity to democratize completely access to healthcare. So hopefully in the future when we're all going to have universal basic income, equal access to healthcare, food will not be a problem because food is going to be more plant-based. That means it's cheaper, it's healthier, more accessible. We'll have more opportunities and time to realize our dreams to be like a better version of ourselves. But again, these are all very serious concerns, and I do believe time to discuss that is not in 20 years from now. Today is the time to start this important conversation and to make this choice. And don't delegate this choice to the government or scientific bodies. But I mean, this is our lives we need, and lives of our kids and grandkids. So we need to sort it out ourselves.

And we have to conceptualize aging as a disease in and of itself, give it its own ICD code.

Yeah, yeah, yeah, we have to. So, right now, remember, so when we created Longevity Vision Fund back in 2019, we were one of the few longevity-focused funds in the world. In fact, we were, and we still is, the largest longevity-focused fund in the world. Why is that? This is counterintuitive as well. This is a big theme for all of us, like aging, facing the risks of age-related diseases. And the problem is that we became so detailed, so narrow in our definition of what disease is. So we lost the comprehensive and more integral view of human body and what is happening with that. So that's why you can have permission, you have an economic model to put billions of dollars into fighting one particular disease like cancer. And a lot of good things happening because we fight, we are right in the middle of winning the war against cancer by investing $100 billion every year in research and development against that. But like if you look at longevity or fighting age-related disease, there's only $1 or $2 billion coming into work every year. And this is simply because there's no viable economic model created by regulators which supports your investments in longevity. So that's why it's always either science or people like with altruism who are— who has their own idealistic view of the world. So I do believe we need to accept the fact that aging is very important risk factor, or Aging is disease. Because again, look at the figures, your chances to get diseases like cancer, heart disease, diabetes, neurodegenerative disease increase exponentially with age. And I do think it's important to recognize, and I do think it's important to make this change in our regulation, so then we can consider aging as disease officially or a born risk factor. And it's going to be hundreds of billions of dollars of new money, new funding, which will support the development of science, technology, different interventions, will redefine the whole space and will give us an opportunity to fight disease, not at the time of our life when disease manifests itself, but being really proactive and preventive about this whole thing.

Well, you know, you're walking the talk and you're a very, very good role model and I'm so grateful that You've memorialized all of this information. I think that you've— I'm not gonna ask you to commit to this, but this is the type of book that you need to revisit in 3 to 5 years. I should. I should. This is what did happen. This is the new stuff that hasn't happened yet. This is where CRISPR technology has gone. This is where CAR-T therapy has gone, good or bad. And I'm very, very much looking forward. So I'm gonna ask you, to get together with me 5 years from today. Although, who knows? Always a pleasure. That's why we need to push the longevity thing for older folks like me. And we'll get together. I'm sure we'll see each other before that. But anyway, Sergey, always a great pleasure to spend virtual time with you and, you know, face-to-face time as well. I hope that's really soon.

Thank you very much, David. And to all of our audience, Stay healthy and happy.

Wow, isn't that refreshing? Isn't it really great to see all the cool things that are happening right now, all the things that are kind of in production right now, and at least get a glimpse in terms of what the future may hold in this space? Really incredibly important information, exciting information. Again, the book, The Science and Technology of Growing Young. Wouldn't we all love that? Thank you for joining me today. I'm Dr. David Perlmutter on The Empowered Neurologist, and we will be back soon.