Young Forever: How to Reverse Biological Aging - w/ Dr.Mark Hyman | The Empowering Neurologist EP158

Scientists are figuring out that what we thought of as normal aging is actually abnormal aging. You know, the decline, decrepitude, disease, frailty, disability, all those things that we've come to associate with getting older are consequences of malfunctions or dysfunction in core biological systems in the body that we can actually treat and reverse.

Well, hey everyone, Dr. David Perlmutter here, and I'm very excited about our program today. We'll be interviewing Dr. Mark Hyman. His new book is called Young Forever. Uh, it is the— it is a masterpiece. It is, uh, uh, really, I think, Mark's most incredible book to date. As you know, he is a multiple New York Times bestselling author, uh, Really one of the important practitioners of functional medicine for many, many years, a mentor for me over the years as well, and a very, very close friend that I'm proud to know over many years. So, I'm just very excited to learn what Mark has to say. I want to jump right into the interview, so let's do it. Hello, my friend. How are you?

I'm so good, David. I'm so good. Getting younger every day.

Yeah, I know. And in reading your book, I can see why. You know, this is definitely the topic du jour. And I think that what you made clear early on in the book is that, you know, this has more ramifications than we previously associated with the whole notion of aging and so-called anti-aging. Yeah. You know, as you and I explored over the years, anti-aging ended up being, you know, fillers and various procedures. That made you look better. But I think, you know, what you really do the deep dive into in the book— and I don't want to scare anybody off. In the intro, I talked about that, yeah, there's a lot of deep science, but what you've craft— uh, what you've crafted here is a way to allow us all to leverage that information for a better outcome. So, let's jump right in. Major thesis right off the bat is the notion of aging looked upon as a disease. Kind of a bit of a revolutionary concept. Yeah. Can you unpack that for us?

Yeah. You know, David, it's really exciting for me because, you know, in functional medicine, as we've both been talking about, thinking about, teaching about for decades now, we get that there's underlying processes that go wrong that cause all disease. You know, saying you have Alzheimer's disease doesn't tell you anything about what's really going on about the cause. And what's happening now is that scientists are figuring out that What we thought of as normal aging is actually abnormal aging. The decline, decrepitude, disease, frailty, disability, all those things that we've come to associate with getting older are consequences of malfunctions or dysfunction in core biological systems in the body that we can actually treat and reverse. And that's what's so exciting. And scientists are talking about now the hallmarks of aging. call it the functional medicine matrix, which is essentially you talk about—

As we have for decades. As we have for decades.

So it's kind of reassuring and reinforcing to see these concepts that we've talked about forever are now emerging as the foundation for longevity research, for longevity science, for interventions, understanding that there are these 10 hallmarks of aging, which include things like mitochondrial dysfunction, which you've taught me so much about. Inflammation, again, which you've taught so much about over the years, and I've learned so much from you about microbiome challenges, problems with our epigenetics, our proteins that malfunction, telomeres, all these fundamental things that tend to go wrong, our regulation of nutrients and insulin and glucose and how we regulate protein activation through these various nutrient sensing pathways. These are things that all tend to go awry as we get older and that manifest as disability, disease, decline in function, even without a disease. But that is totally reversible and totally treatable. And that's what's so exciting that we address these hallmarks of aging. We might not be able to get just 5 to 7 years of life extension, which we can, for example, if we eliminated all heart disease and cancer from the face of the planet, the number 1 and 2 killers, if we got rid of them completely, we'd see a 5 to 7-year life extension, which is not very much. If we address the hallmarks of aging, we might see a 30 or 40-year life extension. And for most people, that means living to be 120.

Well, let me take a side road here and then we'll come back because there's this notion of escape velocity and it's a bit of— takes a little bit of working through, but you mentioned it in the book. And that is this notion that if we can stay alive and healthy long enough that there's a sense that the technology will catch up to us to a point that we'll stay alive. I mean—

Yeah, I mean, it's a bit of a sci-fi thing. I'm not sure I want to live forever. It is. Because part of what makes us human is knowing that we're going to die someday. So, it makes it more precious. So, I'm not sure how I feel about this, but scientists are now talking about how discoveries in the longevity field are accelerating at such a pace that pretty soon, that for every year you're alive, you might extend your life by a year and a month, let's say, or a year and 6 months or 2 years, so that you actually will never reach the point of death. I'm not sure that's going to happen, but what's really interesting is some of the science around it, which is learning how to reprogram our biology to a younger you through epigenetic reprogramming. And this is done through all kinds of different methodologies, but one of the most exciting, in animal models, I should warn, is the Yamanaka factors, which are These transcription factors discovered by Yamanaka, who was a Japanese scientist, he won the Nobel Prize for it. And essentially, these transcription factors regulate your biology in such a way that it teaches you how to evolve and differentiate into who you are. So how did your embryonic stem cell become a kidney or a brain or a liver or skin? There's a whole program you have for doing that. And at some point, it stops. So that you don't differentiate because you would just keep growing more things. You don't want to do that. But the way that this Yamanaka factor framework works is if you actually can insert these transcription factors into a human, and they've done this in animals, potentially you could turn them on and off at different ways that literally will reprogram your stem cells to a younger you. So let's say you're 50 and you've got gray hair and your joints are hurting and you're erections are not as good and you're losing muscle mass. Well, you could turn on a switch externally that would activate these transcription factors, reprogram you back to 25 years old. Now, that's really kind of exciting, but it's also not quite ready for prime time. They've done it in animals and they've restored, for example, mice who are blind to be able to see again, which is pretty remarkable. But I wouldn't say this is on the horizon for us anytime soon. 10, 15 years, who knows? But— It's not what I'm thinking about. I'm thinking about how do I add more life to my years now and feel more vital and healthy and functional.

Well, you know, you mentioned these so-called hallmarks of aging, and I think we can unpack each of those, giving our viewers tools that can actually target each and every one of those. But for what you just discussed, I would ask our viewers, if you want to learn more about that information, go back to the interview I recently did the second interview with Dr. David Sinclair and learn about that, because this is game-changing, potentially game-changing as it relates ultimately to humans. And as you say, it's a long way from that, but, you know, that he was able to restore vision in rodents that have had their optic nerves crushed, you know, what does that say to us about people who are paralyzed or people who have a progressive degenerative condition like ALS or even Alzheimer's?

Yeah.

That we can revert cells back to an earlier state and a more youthful functionality. But, let's talk about— let's get to what our viewers can do right now and go through those hallmarks of aging beginning with, let's say, DNA damage. Let's talk about how we can activate certain pathways that actually facilitate the repair of our life code, of our DNA.

Yeah, absolutely, David. I just want to, just before I sort of dive into the minutia, that I sort of want to talk at a higher level how so many of the things that we've talked about in functional medicine for years, the fundamental lifestyle factors, you know, how we eat, how we move our bodies, how we manage stress, sleep, are so fundamental to regulating all these hallmarks of aging. And so you don't need fancy things like stem cells or Yamanaka factors or super expensive supplements or anything other than most of the things that we already do, but just doing them differently. And that's a very hopeful message because we actually have, if we know how to apply it, the science of how to activate the long— I call them the longevity switches in our body that will literally reprogram us to a younger biological age. So I'm 63 now. Can you believe that? I was like 30-something when I met you, David. And—

Were we in our 30s? Or I was in my 40s.

I know, right? You're a little older than me, but not that much. And then I literally am 63 chronologically, but I'm biologically 43. Meaning on a cellular level, based on my DNA epigenetic tags, my epigenetic programming, I'm 43. Now, that's possible at any age to go backwards. And so the way you do it is by influencing these factors, these 10 hallmarks of aging. So you mentioned DNA repair. Well, that's one of the things that happens to all of us. We have little hits to our DNA, maybe 100,000 hits a day, and we have a repair system. And this is really the fundamental thesis of my book, Young Forever, which is that we have built in an innate, powerful regenerative repair, renewal, and rebuilding system. We just have to learn how to activate it. The good news is it's not that hard. The bad news is pretty much everything we do in our lives today, what we eat, how we don't move, stress, lack of sleep, environmental toxins, these do everything to screw up these fundamental pathways. But if we actually learned how to actually activate them, we could reverse it. So DNA epigenetic— sorry, DNA changes happen because we have all these insults of bad diet and stress and toxins and so forth. And so we have to repair them. So we have our repair system, which is turned on by sirtuins. Now, some of you might have heard about sirtuins and red wine and resveratrol. And it was sort of an old story that was sort of interesting. Turned out not to pan out because You have to drink 1,500 bottles of red wine in order to get enough resveratrol, and you die in the process of liver failure. But the idea is that you actually can turn on sirtuins, which activate a DNA repair army to go out throughout your body and find the little nicks and damages to your DNA and repair them. Because we replicate our DNA 4 quadrillion times, I think, throughout our lifetime. It's an insane amount of times that it happens. But the good news is we actually have a fixing system. So how do you do that? Well, there's a lot of ways, right? Fasting, cutting out sugar and starch, exercise. And one of the interesting compounds that can activate sirtuins is NAD or NAD+, which is a compound that's made by our bodies from niacin, from vitamin B3, but actually is involved in energy production. But it also stimulates the sirtuin pathways, which then send out this army of DNA repair. So, for example, a lot of people might think, oh, well, I'm going to take NAD. Well, you can't actually take it unless you inject it subcutaneously or take it intravenously, but you can take it as NMN or NR, which is sort of derivatives that are precursors to NAD. And then you can actually activate these pathways. So David Sinclair has done a lot of work around this. I think we still are learning more about it and how it works, and people have some concerns about it and cancer risk and this and that, but I think they're kind of overplayed. Yeah. I think the FDA has recently ruled that NMN might be considered a drug even though it's something that our bodies make and have prevented it from being sold as supplements or challenged its supplement sales. Although a lot of companies can still sell it, they're not really enforcing it, but it's because basically a pharmaceutical company is developing research trials using this compound and wants to block anybody else from using it or selling it. So it's a bit political. But I think this is a really exciting compound that I think has a lot of promise in the longevity space.

So let me just recapitulate. We like to have our NAD+ levels higher. And there are 2 precursors that are commercially available, NMN, nicotinamide mononucleotide, and NR, which is nicotinamide riboside. You can buy those. They need to be kept refrigerated. And in terms of efficacy, I think the jury is still out. There is some discussion that metastatic disease might be increased in conjunction with taking these supplements. So something we're keeping our eye on. But I think that you delineated the pathway for DNA repair, which is very, very important, and that we can threaten the functionality of that pathway by becoming more sedentary, not exercising, eating the wrong foods. And, you know, it's the same kind of menu that we've talked about for an awful long time. But what I think what was so beautiful about your book is you're connecting dots showing, okay, if you do these things, you're enhancing this pathway that has been fairly recently discovered. Nothing you and I talked about 20, 30 years ago.

Totally.

But it's now we understand it. And here's, you know, eat a good diet, but here's why. And now we have that framework for understanding. Let's move on. Another thing you talk about that I think you put it in the context of the main differentiation between somebody who's 3 and running around all the time and somebody who's 80 and more sedentary was mitochondrial function and how important mitochondrial function is to maintaining vitality.

Yeah. Well, it wasn't between a 3-year-old and a 9-year-old. That 3-year-old's running around like a chicken with his head cut off and a 9-year-old sort of moving super slow. And that's because of the function and the health and the number of their mitochondria. And I think, David, you've forever taught me about the mitochondria and how to treat it and how to optimize its function. The mitochondria are energy factories. And when they go bad, we lose steam, we lose energy. And it's totally fixable through doing certain things that optimize our mitochondrial function, which is cutting down on starch and sugar, eliminating, eating the good fats. Who knew? Right? Whatever that Grain Brain, who wrote that quack book? I don't know. Anyway, that was a seminal book that kind of got so many people to wake up to the idea that it was really a problem. So we have to keep our ATP, our energy up, and we do it by eating the right foods, which is fats, in fact, are really a great source of fuel for the mitochondria. Olive oil, avocados, nuts and seeds, MCT oil, a lot of these are really important for regulating our Our mitochondria. And we need to kind of avoid also things that are poisonous to mitochondria, environmental toxins as best we can, heavy metals through reducing the consumption through not eating all the big fish that we tend to consume. And then exercise is such a critical factor. If you want to know what is the reason that people stay functional and healthy for a long time, it's because they have good functioning muscle and enough of it. And when you get older, you lose muscle and you lose function, you lose mitochondria. And so how do you fix that? You do exercise, strength training and interval training. So this morning, for example, I did a very intensive workout, just 30 minutes, but using bands and body weight and intensive cardio. And I was able to sort of jack up the input to my mitochondria to make my body make more of them, to make them more efficient and to help them work better. And then there's all kinds of other stuff you can do that I write about in the book. For example, like urolithin A, which is from pomegranate, basically a compound that is metabolized by your microbiome. When you consume pomegranate, it turns into urolithin A, and then that is absorbed and activates your mitochondria to clean up old mitochondria, to build new mitochondria, to build muscle, increase your fitness level. It's really cool. Even without doing any exercise, you see an improvement in fitness simply by having this thing that fixes your mitochondria. So mitophagy is really important as part of the cleanup process. It does that. And then there's all the mitochondrial supplements, David, that you and I used for years with our patients from CoQ10 to PQQ to acetyl-L-carnitine and acetylcysteine, and even other compounds like D-ribose and other really powerful things that can help the mitochondria work better and function better. And I use this in my patients with mitochondrial disease, which is pretty much all they have with aging, whether it's heart failure or brain disorders like Parkinson's. And, and it's incredibly effective when you see it.

You know, you mentioned, uh, who have mitochondria— patients who have mitochondrial disease. And years ago in medical school, we were— we learned about mitochondriopathies, or problems with the mitochondria, and there was a very short list of things like progressive external ophthalmoplegia and Kearns-Sayre syndrome, and, you know, a few others. And that was really it. That's all we considered as it related to mitochondria. And yet, We now embrace a notion of an acquired mitochondropathy. In other words—

Yeah.

How over time we engage various lifestyle issues that threaten mitochondrial function and manifest as diseases. Things like Alzheimer's and Parkinson's in my field, for example, are primarily predicated on bioenergetic failure, failure of the mitochondria to be able to provide energy, in this case, to brain cells. And, uh, you know, so we've been deeply involved in targeting the mitochondria. And how interesting it is now that we recognize that mitochondria are so, uh, focal as it relates to our understanding of inflammation, and how that was revealed to us, uh, in dealing with COVID-19, uh, and in dealing with individuals with long COVID, that the mitochondria, their function is what helps regulate the immune system. And I think, you know, you certainly made it very clear just now and in the book that take all the supplements you want, uh, but to me, it's buy a new pair of sneakers. It's really about the exercise. That's the best supplement of all because—

It is.

You know, you are helping degrade defective mitochondria. We call that mitophagy. And then stimulating the growth of new mitochondria, activating this pathway that you Explored deeply in the book called the AMP kinase pathway to help regulate blood sugar, to help improve muscle functionality, to help us burn and not store fat. I mean, these are the keys to the kingdom, for crying out loud. What more do you want?

It really is. That was so interesting, you know, Dave, when I started researching the book and I was like, okay, exercise. We all know exercise is good, but like, how does it work? Right? How does it actually work? And yes, we know it makes you fitter and it builds more muscle and all that. But what really was shocking to me was the amount of science that showed how certain kinds of exercise will regulate these hallmarks and work through helping our epigenome, work through lengthening our telomeres, work through optimizing our mitochondria, helping our microbiome, reducing inflammation, helping fix our proteins, regulating these nutrient-sensing pathways that are so key. And I think this is a meta hallmark, the nutrient-sensing pathways, which regulates Sirtuins and AMPK and mTOR and insulin signaling, all of which are impacted through exercise and can be optimized. So literally, you have the keys to the kingdom without really doing anything or having to pay any money. Just move your body. It's quite amazing.

You know, and I'll say for people who are interested in this kind of stuff, as you are and I am, over the years, we've known that exercise is good for you. Leave it at that. But, um, we've always wanted to go deeper and try to connect the dots. Well, you say it's good for us, but why? And now you just talked about certain signaling pathways, including mTOR, AMP kinase, etc. You know, fancy names for people who are interested in this. But we, we have to recognize that muscle— the muscle tissue is an endocrine organ.

Yeah.

Muscle tissue is secreting chemicals that are going throughout the body and influencing the functionality of other tissues. This is so true. Muscle tissue, when you exercise, secretes brain-derived neurotrophic factor, interleukin-6, which is the key regulator of AMP kinase. Who knew? Cathepsin B, for example. So, muscle is influencing brain. We're now talking about the muscle-brain connection, as if everything isn't connected to everything else. Muscle, when active, controls functionality, as you know, of the pancreas. the liver, thyroid, and bone and fat metabolism for that matter. Yeah. So, to look upon muscle as an endocrine organ and how can you enhance its functionality to create those chemicals that have a positive effect, for example, in the brain, BDNF, growing new brain cells, enhancing the formation of synapses, protecting brain cells, increasing the brain's vascularity. It's through production of these chemicals. Another one is VEGF, That happen when you exercise. So if you need to know that, if that's important to you to get you on the treadmill, so be it. If—

well, I mean, I think— I think what you just said there was so important. I want to emphasize that in medical school, you and I never took a course on muscle. We learned about the musculoskeletal system. We learned about, you know, like, bones. We learned about muscles, you know, just for sort of skeletal structure, but not as a dynamic functioning organ in itself. That is probably the primary determinant of your health, particularly as you get older. And like you said, if you lose muscle, you lose function, but your immune system is inflamed. As you mentioned, your brain isn't working as well. Your blood sugar isn't controlled. Your sex hormones go down. Your growth hormone to repair and renew everything goes down. Your cortisol hormone goes up. So muscle is the currency of longevity. If you want to live a long, healthy life, then you got to get on Creating and building muscle and making your muscle more efficient. And this is the most important thing you can kind of take home other than what you're eating around how to actually live a long, healthy life.

You made a point in the book that, you know, it's great to build up tissues, it's great to build up muscle, etc., but that the concept of autophagy, of breaking down, is important as well. In other words, getting out the weeds and clearing out the underbrush.

Yeah.

And, uh, and frankly, exercise is helping your body do both. So, it reminds me of the, the song by The Byrds, Turn, Turn, Turn, which is actually based on the Bible, Ecclesiastes, a time to build up, a time to break down.

There you go.

That's, that's the balance. Um, you, you talk about this notion of our epigenetics and that we can influence these, uh, factors over our genome that are influencing its expression moment to moment. More information for our viewers on the interview with Dr. Kara Fitzgerald. But again, the regulators of our gene expression are, to a significant degree, under our control. And you describe how we gain control and can really harvest that knowledge for our betterment.

Well, this is really the sort of leading edge of longevity research is how are all the inputs Or the deficiencies. Basically, in my book, I talk about dying of too much of something, right? Bad food, not enough, too many toxins, too much stress, not enough sleep, so forth. And what you're dying too little of, too little of the right nutrients and good food and exercise and so forth. So the way those things affect us ultimately is through our epigenome. And the epigenome is basically something that sits above your DNA. You're above your genes. Epi means above. And you basically have 20,000 genes. You can't change those, but you have the ability to change the expression of those genes through the epigenome. So the epigenome's like the piano player. The genes are like the keys on a piano. There's 88 keys, but it can produce jazz, ragtime, classical, rock, whatever, reggae. And that's amazing. So the piano player has enormous control over what happens. And the piano player's influenced by what you eat, by exercise, by stress, by sleep, by environmental toxins. By all these other factors, anything causes inflammation, the microbiome. And so we literally can use the epigenome to measure how someone's aging. This is Steven Horvath's work, who discovered the epigenetic clock. And by measuring tags on the DNA, we can measure your rate of aging. And it's a biomarker that we never had before to track any intervention and determine how it's impacting your biological age. So I'm 63 chronologically. I can't change that. I was born in 1959. It is what it is. And the clock goes forward unless I go to outer space, whatever. But anyway, that's another talk. That's physics. Quick fix. Okay. But the biological clock is malleable. That can be changed and turned backwards. And so the epigenome is highly influenced by all these inputs. And it can also be affected by deficiencies, whether a deficiency of vitamin D or omega-3 fats or of sleep or of exercise or whatever it is, love or meaning, purpose. I mean, you can change your epigenome through cuddling, right? Through cuddling. So I encourage more cuddling. And then they've seen this in babies and infants. So we know we can modify our epigenome, and that's what's so exciting. And a lot of the interventions around longevity and lifestyle are impacted through the epigenome. And that's what's so exciting. But the good news is that when you do the right things, it beneficially affects all of the 10 hallmarks of aging, not just one.

Yeah. And as I mentioned earlier, the work of Dr. Kara Fitzgerald, what did she do to reverse the biological, the Horvath clock in her study population? She put them on a better lifestyle program, end of story. She said, you're going to meditate, exercise, here's your diet, and then followed these people and watched their epigenetic clock reverse, basically turn back the hands of time, not as it related to chronological time, but as it related to biological time, they improved.

I want to highlight something about that that you just mentioned because there are a lot of studies that show interventions for reversing biological age. quercetin and dasatinib, which is a chemo drug. There are studies of vitamin D. There are studies of Mediterranean diet and various other interventions. None of them had the impact that Kara's study did because in 8 weeks, she reversed biological age by 3 years. And the reason it worked was food is medicine. And just like any other drug, the dose matters and the drug matters. And when we say food is medicine, we're not saying it as some abstract metaphorical concept. We're saying it literally as a biological phenomenon where food translates its signals into real effects in the body in real time. And so it has to be the right food at the right dose at the right time. If I say, I'm going to give you a milligram of aspirin for your headache, you're going to conclude that aspirin won't cure headaches, right? If I give you, you know, 2, maybe, stalks of broccoli, and otherwise you're drinking a 6-pack of soda, you're it's not gonna help. So really, it's about dialing in the food to be super effective. And that's what's really exciting. And we didn't really get into this yet, but a lot of the hallmarks are influenced by phytochemicals. So they're modified, your mitochondria. For example, we talked about this urolithin A and mitochondrial function. Well, this is a plant compound. It's a derivative of a plant phytochemical modified by our microbiome. That literally can improve your fitness level without any exercise and cause your mitochondria to kill all the old ones and make new ones. Well, that's pretty amazing. That's a pharmacological effect, but you need the right dose. That's the key.

But that is available as a nutritional supplement. We did a podcast with the actual scientist who developed urolithin A.

I take it every day.

And as you may, yeah. Again, it's something that is considered perhaps a prebiotic in that it's modified prior to it becoming functional.

A postbiotic. Isn't it a postbiotic? Isn't a postbiotic, which is something that's modified by your microbiome—

Well, it's basically modified by gut bacteria. Yeah. So, or, you know, yeah. So, that's basically, in a sense, it's a— gut bacteria modify this chemical or utilize the chemical. Um, I want to get back to the idea of dose, and I've been kind of with that lately because there's a sweet spot. And I hate the term for obvious reasons, but there is a sweet spot for anything you mentioned, whether it's not enough of the aspirin or overdosing on aspirin and eroding your stomach lining. And I, I was thinking about that the other day in the cardiologist's office as I was being lectured to. The cardiologist said to me after my battery of tests, you were, or maybe still are, an intense runner, aren't you? And I said, yeah, you know, because, you know, if some is good, more is better. The dose, right?

Yeah, yeah.

He said, because my heart rate is really low. And he said, because the upper chambers of your heart are enlarged, and we see that with really aggressive long-distance runners. And, you know, this may explain why on occasion you go into atrial fibrillation. That would be me. And again, you know, I always knew you had a big heart,

David.

I have a big heart. But many of us, you know, kind of buy into the notion if some is good, more is better. And I'm as guilty as the next person of that. And I think a message from me moving forward in our outreach will be, you know, find the right spot, find the middle of the bell curve that's best, that's optimal, because again, too much of stuff can be harmful as certainly too little can be. You talk about the book, the notion of the importance of personalizing the approach for people. And why is that important?

Look, everybody's different. And I think, for example, you and I are kind of relatively thin exercisers and probably are what we call lean mass hyperresponders. I know I am. So, If I eat a lot of saturated fat, it tends to adversely affect my cholesterol. Whereas another patient, I can put on coconut oil and butter and their cholesterol drops like a stone and they lose 20 pounds. So we are all biologically, biochemically individual and different, and we need to see what works for us. So it's really important to find out what your own body likes and what it doesn't like. You can use, for example, a continuous glucose monitor, and that will tell you how different foods affect you, and they might be very different than how they affect somebody else. They've done studies in Israel, for example, that your blood sugar regulation is controlled by your microbiome. That literally— That's right. The bacteria in your gut will help affect how a particular food impacts your blood sugar, and it's different than the person sitting next to you. So we are just beginning to understand this field of personalized medicine and individualized medicine. But I do think through increased access to biosensors and trackers and various kinds of ways that we can quantify our own biology, we're going to be able to look much more carefully at our unique responses to various kinds of inputs and then determine what works or doesn't work. But the general principles are the same for everybody. Don't eat crap, eat real food, exercise, get enough sleep, and learn how to relax. Basically, those are key.

Yeah.

But then within that, it's dialing it up a little bit down depending on what's going on with the

Well, I don't want to degrade the message of your new book because it's much more intense, or it's much more specific than what you just mentioned. Those, you know, because everybody's heard of what you just mentioned, but you're very, very specific about supplements, their validity, their dosages, et cetera. I want to get back to the notion of aging as a disease. In the context of the idea that 80% of elderly individuals here in America have at least one chronic disease. Yeah. And are suffering from at least one chronic disease. But the role of aging, we were talking about, well, you're gonna live a long time, extend your lifespan, hopefully your healthspan. But the notion of aging as representing a major input in terms of why people have chronic diseases.

Yeah. Yeah. I mean, I think inflammation is such a big driver, David. You've talked about this. I've talked about this forever. And, you know, I see it as sort of a final common pathway for a lot of different things. So in and of itself, it doesn't occur out of the blue. It's caused by something, right? It's caused by too much of something or not enough of something, right? It's caused by too much sugar and starch in your diet and not enough, for example, good fats or Too much sedentary lifestyle, not enough exercise, or too much stress and not enough relaxation. So it's really easy to begin to understand the biology of inflammation when you look at the causes of inflammation. I always joke, as functional medicine doctors, we're inflammologists. It's sort of, you know, that's our specialty, if you were to say. That's fair. Yeah, we're inflammologists because we basically look at the root causes of inflammation, and it depends on what's going on with that person. Sometimes people, it might be their microbiome or food sensitivity or an infection like a tick infection, or it could be heavy metals, or it could be stress, or it could be sugar. It could be a lot of different things. Even though there's a final common insult of inflammation, there's a lot of ways to get there. And so it's really about personalizing the approach. And this is really what I talk about in Young Forever in the book is how do you figure out what's going on with you? And I have very extensive quizzes that are questions that I ask my patients in my practice. We've done for 30 years in functional medicine to sort out What's the cause? Is it your gut? Is it toxins? Is it your diet? Is it too much stress? What's going on that's actually causing the inflammation? It's not about taking aspirin or Advil or steroids or something to shut off the inflammation. It's about figuring out why it's there in the first place.

What's upstream? You know, there's a discussion in your book. You were walking somewhere with David Sinclair from Harvard. And You asked him a question and the answer was, it's sugar. And you put that in bold letters, I believe.

Yeah, it was Lenny Guarte, who David worked with. Yeah, but yes, I was— it was at a Tibetan medicine conference on longevity at the Menla Center. Yep.

And I was reading this, uh, last night, um, on the plane ride coming home from San Francisco about sugar, sugar. No sooner did I finish the paragraph Then there's an announcement. What's the announcement? Is there a doctor on the plane? So, you know, I get up and I get up this and this woman in row, whatever it was, doesn't matter, was looked to me like having a hypoglycemic event. She had she was she had was unconscious or barely conscious, and I could I was able to get her up. And what did I? You know, here I'm giving her sugar. Another doctor comes to help me and she said, oh, Dr. Perlmutter. I said, yeah. She said, I'm going to interview for a functional medicine job somewhere. We'll leave it at that. And I said, well, can you imagine here I'm giving this lady orange juice with 2 packets of sugar in there? I said, this isn't exactly from the playbook, but I guess there's a time and a place for everything. It's context, right?

Totally, totally, totally. Yeah. But

anyway, I enjoyed reading your book on the plane last night. I want to end with how you started your book. And you started your book by asking for yourself and for your reader to identify the why. Why do you want this? And your answer was deep and very meaningful. So, why do you do it? Why are you writing books like this?

Well, I think we live in an era where We think of people who are getting older as sort of extra. They're not valuable members of society. They become a drain in society, a cost to society. They don't add value. But the truth is that, and I see this in you, I see it in me, as we get older, we learn more. We are better at navigating life. We understand how to work through challenges that we all face, how to be better friends, better partners, better— contributors to a greater good that we all can be part of. And so often when we should be at a stage in our lives where we become elders, we become contributors back to the world that made us, we often are sort of kicked aside and, or worse, we're made sick by our culture and our food. And we don't get to experience that place of wisdom and longevity that can add back value. And so for me, it's all about how do I show up better? How do I Take all the things that I've learned in life and be a contribution to humanity. Common said, where are you going to leave your one grain of spiritual sand on the universal scales of humanity? And so, for me, that's the question is like, how do I leave this earth a little bit better than when I came? And how do I love more and show up more and create more good and healing in the world? And not everybody wants to do that, I understand. But I think for me, that's my why. For everybody, they have to find their why, whether it's wanting to be there with their families and contribute or whatever it is. We all have a lot to give. And the economics are also compelling aside from the personal contributions and the value that older people can bring is that if we got a year of healthy life extension, which is not a hard action item on the list, a year, we would save $37 trillion a year. That is more than our entire GDP by double. And if we were able to get 10 years of life extension, that would be $360-something trillion. That's— I don't even know. That's just an enormous amount of money. I think that's more than the GDP of the entire world put together every year. So we really have the capacity to both save money and create a better world. by learning how to live better, live longer, and have our healthspan equal our lifespan.

And I think it's important that as you target aging, you are targeting these very expensive to deal with chronic degenerative conditions that we mentioned earlier affect 80% of adults. And that's where the healthcare dollars are going. So, and it's, you know, I was very taken that you opened the book, by asking why. And I think when readers read your book, knowing that it came from your heart, it'll have even more meaning. And so, I'm not surprised. I'm not surprised to see a book like this come from you at this stage of your life and your wonderful development. And I'm proud to know you and love you, and I'm very excited about what the future holds for you. So, thanks for being with us today.

Yeah, the mutual, David. Thank you for being you, my friend. I learned so much from you.

Okay, I'll see you in a couple of days.

See you in a few days.

All right, bye for now, Mark. Well, I hope everyone enjoyed that as much as I did. Mark is a wealth of information, and really, this heart-centered book, I think, is going to be an incredible achievement, really setting the stage for people fully understanding that we are the arbiters of our biological destiny, if you will. That yes, the chronological clock ticks on, but we can dramatically affect the rate at which we age from a biological perspective, how our bodies work, how resistant we are to degenerative conditions that are so pervasive. Really, the nuts and bolts of what we can be doing day in and day out to remain young in spirit, young in terms of our physiology, and certainly continue to contribute Uh, to society. So, uh, thank you, Mark, uh, for that wonderful interview, and thank you to all of you as well for joining us today. And I'll be back soon. Bye for now.