A MASTERCLASS On Reversing Your Age & Preventing CHRONIC DISEASE | Mark Hyman

Welcome to the Longevity Roadmap docu-series. This is an eight-part docu-series about accelerating your health at any age. It's also about preventing, slowing, and reversing disease. It's about turning back your aging clock at any age. It's about becoming resilient, strong, and youthful. We all deserve a long life filled with energy and vitality. And while we can't control everything, The science of longevity teaches us what makes us age quickly and how to age backwards rather than a disease focused approach. We can follow a health focused approach. Most of us have the same goal. I want to add years to my life and life to my years. I want to live a long, active, engaged and healthy life, or as I like to say, to die young as late as possible. Now, as a doctor on the front lines of treating chronic disease in my patients and the population, I have spent my life learning about how to build a strong, healthy body and a healthy mind. And I teach this to my patients every day. And I apply these principles to myself, my family, I share them with my community. We're in a very strange time. Most of us live longer than any time in history, but most of us spend the last few decades, and sometimes more, with dysfunction and disability and suffering from preventable and reversible ailments on piles of pills. Modern medicine is more advanced than ever, and yet we're sicker than ever. Advances in surgery and medication helps many of us live a longer lifespan. But what about our health span? Your lifespan is how long you live. Your health span is how many years you live a healthy, vibrant life. You want your health span to equal your lifespan. Rather than live the last 10 or 20 years or more of your lives incredibly sick and disabled, like most of us, how about living to 90 or 100 and be able to be fully engaged in life and love and play and work? We're so fixated on living longer, but how about living healthier? Right now, six in 10 Americans suffer from at least one chronic disease, and four in 10 have more than one chronic disease. In a few years, 83 million Americans will have three or more chronic diseases, diseases that rob them of their quality of life, seal years from their life, and are almost entirely preventable. We have more information than ever before, more technology, more therapies, and more illness. And this is how it goes for most of us. Chronic disease, problems like heart disease, diabetes, cancer, dementia, depression, osteoporosis, autoimmune disease and lots more comes on gradually, starting around age 45 or 50. For most of us, we see a slow, steady decline in energy, function, well-being. And then after 60, we often see a steeper decline. And by 70, we've resigned ourselves to poor function, and health, and it only gets worse from there. Pills, doctors, hospitals, procedures, nursing homes are worse. And often diseases of aging start really young in our 30s and 40s and smolder along and manifest in our 50s and beyond.

Now, you can consider the idea of optimal wellness and being your best self and having the greatest health span to really be something that you should be addressing your entire life. But when it really comes to where disease is causing the most damage, where we're seeing the most morbidity or reduction in performance, it's in that zone from 65 to 80. That's the red zone. So the goal of medicine should now be really focusing on how do we shorten that. Of course, if you spoke to a room full of people and you said, okay, everybody, who here wants to live to be 100 years old? You don't see a lot of hands go up right away because most people start thinking, ah, you know, I'm going to be 100 years old and I'm going to be in a nursing home and somebody's going to be feeding me. I'm not going to have a great quality of life. I don't think I'm in for that. But if you say, who wants to live to be 100 years old and you'll only be sick for a week or a day, then I think everybody's going to raise their hands. that's pushing back disease, that's increasing our health span. And that should be the focus of what we're doing in medicine now.

And the problem is that medicine has focused on treating disease, but the new science of longevity based on the principles of functional medicine teach us how to create health, to optimize our health well-being and our function. Unfortunately, today, instead of going on long hikes up the mountain, as we age, most of us take regular pilgrimages to the doctor and the hospital. And then our families and our healthcare system spends massive amounts of money trying to keep us alive for as long as possible while we're suffering. We spend about 90% of our lifelong healthcare dollars in the last two to three years of our lives. And these are long, painful, expensive deaths. What kind of life is that? I propose a different way of living, one in which we take the steps we need to take today to feel better than ever. And in turn, we're going to experience health in our later years. I don't know about you, but I'm training for the Centenarian Olympics, something my friend Peter Attia talks about all the time. How do you become a vibrant, alive, connected, healthy human at 100 years old. Think 10, 20, 30 years from now. What kind of life do you want to live? Do you want to be able to keep up with your kids, your grandkids, and your great grandkids? Do you want to be able to travel, have adventures, walk without pain, be mentally sharp, be focused, be learning your whole life? I want those things and I want them for you too. I want you to be resilient and strong in the face of the global pandemic of disease like the one we're currently facing. I want you to thrive. And I want you to die young, as late as possible. Most doctors learn nothing about health, only about disease. Functional medicine is all about the science of creating health. It teaches us how to optimize the essential functions of our body to create health. Our immune system, our gut microbiome, our hormones, our energy systems, how we make energy in our bodies, our detoxification system, our muscles, and our nutritional status. With my team at the Ultra Wellness Center, we will walk you through the major obstacles that are interfering with extending your health span and your lifespan, and the exciting science of supercharging your health using the principles of functional medicine. Now, if you're not familiar with functional medicine, it's the future of medicine Available now, functional medicine seeks to identify and address the root causes of disease and views the body as one integrated system, not a collection of a whole bunch of independent organs divided up by medical specialties. It treats the whole system, not just the symptoms. It is, as I said, simply the science of how to create a healthy human. And when you create health, often disease goes away as a side effect.

In functional medicine, we recognize that all the different systems in the body are interrelated and are related to each other. We recognize that when somebody has gum disease, that can be a trigger for their heart disease. We recognize that when there's imbalances in the microbiota in our digestive system, that's influencing our metabolism, that's influencing level of inflammation in the body. And we know sometimes that causes, it can be an underlying cause of autoimmune disease. So as opposed to just naming a disease and then sending that person to a specific specialist, we're looking and recognizing how all the different systems in the body are interrelated and then working on that individual person to rebalance the systems in their body.

Simply put, we are medical detectives. We work with our patients to uncover what's going on underneath the disease and dysfunction. Getting the diagnosis of heart disease doesn't tell you everything. Heart disease, diabetes, dementia, these are really just symptoms. They're labels that we give to people who share common symptoms. But knowing the name of the disease doesn't tell you what causes it. For example, diabetes just means you have high blood sugar, but why is it from the starch and sugar in your diet, environmental toxins, or maybe an inflammatory microbiome, or maybe nutritional deficiencies, or maybe all of it. The key to successful aging and to health in general is to find all the underlying causes. So let's find them and let's tackle them. In functional medicine, rather than treating the tens of thousands of diseases all as separate things, we restore balance in the basic functional systems of your body that are all connected. When they're in balance and they're functioning well, you're healthy, and when they're not, you're sick. What we know now is that there seems to be a unified theory of aging, that there are common underlying factors that seem to lead to all these downstream diseases. And the diseases that we see that we think are the causes of death, heart disease, cancer, diabetes, Alzheimer's, These are just downstream consequences of imbalances in our biology that we can do something about. And for different people, depending on their genetics and various factors, it can be expressed as heart disease in one person, cancer in another, diabetes in another, Alzheimer's in another. But if you look at the underlying factors like inflammation and mitochondrial dysfunction, which is your energy factories, your microbiome, and your diet, all these things play a huge role in determining whether or not you get these diseases. So these diseases, for the most part, are preventable if we understand how to follow a lifestyle and a way of being and eating and exercising and sleeping and relationships and connection and meaning and purpose and nutritional status that optimize our exposure. Medicine is undergoing an incredible scientific revolution. A massive paradigm shift. We now know the body isn't just a collection of separate organs and parts, all to be treated separately by different specialists. It is one whole integrated, dynamic, interconnected system. The key is treating the system and removing the things that create imbalance and providing those things that restore balance and optimal function. and this can be done at any age, at any stage of disease. But of course, the sooner you start, the better. Your health status at this moment in time is determined by all the inputs of your life, your diet, exercise, quality of your sleep, stress, your nutritional status, your exposure to toxins and allergens, microbes, your relationships, your beliefs, your thoughts, the meaning and purpose, that you have in life all wash over your genes and determine your health status. We can't change our genes, but we can change how they are expressed. We may have a predisposition to diabetes or dementia, but we're not predestined. All those inputs affect your gene expression for better or for worse. We have the power to influence all of it. If we get rid of those things that impair health and we add in those things that create health, we can live a long, healthy life.

I'll talk about genes and longevity and I always like to tell patients that, you know, your DNA is not your destiny. A lot of people have been taught that your genes are your destiny. So if mom had heart disease, dad had diabetes, that you're gonna get it. And that's not necessarily the way it is. Your genes are more or less a recipe for making proteins and various body chemicals in the body and body parts. Your genes are a little bit like a loaded gun. You can have the genes that make you more predisposed towards inflammation or you can have the genes that make you more predisposed towards oxidative stress and inflammation. A gun that's loaded never kills anyone until you pull the trigger. And a person's lifestyle and environment is the finger that pulls the trigger on your genes. So it's really important to have that mindset that you are not destined by your DNA.

The things that influence our lifespan and health span are often similar, but our lifespan in part is determined by our genetics. There's only so many years humans can live. The maximum life of any human has been reported to be 122 years. Most of us don't get anywhere close to that. But there is a possibility for extending our lifespan as a human species to maybe 120 or even maybe 150 with new technologies and scientific advances. But our health span is determined by things we have control over. 90% of our health status is determined by what we call the exposome. Those are the things that we expose our genes to over our lifetime. Functional medicine is simple. Disease results from imbalances in seven basic functional interconnected systems in your body. The key to health, to optimal aging, to preventing reversing and treating disease is really simple. Remove those things that create imbalance in the body and the systems and add in those things that restore balance, and the body's natural intelligence does the rest. So let's review those basic systems. The first is your gut. The function and the balance of your digestive system and your microbiome, which we now know is a massive driver of health if it's in balance, and a huge contributor to disease if it's not, is the first system we have to look at. The next is your immune system and your inflammatory system. So much of aging is caused by inflammation. In fact, we call it inflammaging. Next is your energy production system, those little factories in your cells that burn food and oxygen and turn it into energy that your body can use. We associate aging with the loss of energy, but Learning how to optimize and heal those energy factories called mitochondria is the key to healthy aging. Next is your waste disposal system, or what we call detoxification or biotransformation, where we transform molecules and get rid of them that are bad. The better we are at eliminating toxins that cause damage to our body and that accelerate disease and aging, the healthier we're going to be. Next is your transport system or your circulation and lymphatic system that keeps things flowing and moving throughout your body. The next one is your communication system, the control tower of your body, your hormones, your neurotransmitters, your brain chemistry, your immune messengers, your chemicals that orchestrate nearly everything in your body and get out of balance if we don't learn how to age well. And finally, your structural system, which is everything from the subcellular membranes in your cells to your musculoskeletal system, your muscles and bones. Dysfunction in any of these systems can lead to disease. They manifest as diseases that we know by their names, but by going deeper to the root causes, by learning how to optimize each of these systems, we can make our health span equal our lifespan. We can add more years to our life, and more life to our years. Now, the major elements that interfere with health span around the world are heart disease, diabetes, cancer, and cognitive decline such as Alzheimer's and dementia, and injury mostly from falling because we ignore our muscle mass and strength as we age. In this docu-series, we're going to explain the functional medicine approach to each of these and much, much more so you can take steps toward accelerating your health journey and even age backwards. Each episode will not only cover the functional medicine approach to disease and disease prevention, but what you can do starting today at home to take charge of your health. And we're going to also share how to work with your doctor to get what you need. We're going to talk about the best tests for heart health, cancer prevention, hormonal health, brain health, and lots more. And we will also discover What functional medicine tests are needed to cover imbalances in those seven systems of your body that are crucial to create health and optimal aging? You will learn how to use food as medicine, functional foods and superfoods that help with DNA repair, that activate our stem cells, that balance your hormones, that nourish our gut microbiome, that boost your detox system, and even supercharge your mitochondria or your energy factories. you're gonna learn about foods that build your muscle and reverse inflammation, enhance your immune system. We're gonna talk about every one of these seven systems of the functional medicine matrix and how you can address each of these starting today.

Inflammation is a part of the immune system's response to an outside insult, be it a bacteria, a virus, or an injury. And we wanna have a robust response to inflammation that allows us to fight off an attack, if you will. However, our body then needs to turn that inflammation off. Inflammaging is when we have low levels of inflammation in the body that are like a smoldering burn, and that predisposes towards more rapid aging. So, it's inflammaging is what we call it. All of the conditions which we commonly see in the office, be they inflammatory arthritis, diabetes, heart disease, neurodegenerative conditions like Alzheimer's, are tied in intimately with inflamaging. And when our immune system does not properly turn off the inflammatory process, sort of like a, it's like the smoke alarm. It's like the smoke alarm goes off and it gets sort of stuck in that loop. That can happen in the body and you have to sort of reset or reboot the immune system.

Well, most diseases that we see that are chronic diseases, that affect six in 10 Americans, that four in 10 Americans have two or more, and that in a few years, 83 million Americans will have three or more, these are all inflammatory diseases. And what we're understanding is this unified theory of aging, inflammation plays a huge role. And that's what we call inflammaging. And it happens because a whole series of factors that we have control over get out of control. We eat an inflammatory diet. We don't exercise, which leads to inflammation. We don't focus on the quality of our sleep, which leads to inflammation. We don't learn how to regulate our stress response. We're all get stressed for sure, I get stressed, but I make sure I meditate every day. and that reduces inflammation. It turns on anti-inflammatory genes. We don't have a nutrient dense diet full of ingredients that help to regulate inflammation, like phytochemicals that are tens of thousands of molecules in the food we eat that are in plant rich foods. We're even finding phytochemicals in grass-fed meat. So we can consume these that help regulate the inflammation in our body. We can change our thoughts. Our thoughts literally drive inflammation. We can change the quality of our relationships. If you're in a toxic relationship, it drives up inflammation. If you're in a loving relationship, it slows down inflammation. If we avoid toxins, we stop the inflammatory trigger from that. And you can't avoid all toxins, but we sure know how to avoid a lot of them, and we also know how to help our bodies detoxify from them. So we have the ability to slow down this inflammatory process and to actually reverse it. And I think this is what we don't think about in medicine. We don't have inflamologists. Functional medicine doctors are inflamologists. We ask the question, why is there inflammation? Not just, oh, how do I treat the downstream effects like heart disease, cancer, diabetes, dementia, autoimmune diseases, and so on? We go, well, why is there inflammation in the first place? Is it something you're eating? Is it a toxin? Is it an allergen? Is it stress? Is it bad relationships? Is it lack of sleep? What is it? And then we navigate to find the cause. And by finding the cause, we literally can unwind the effects of inflammation on aging and literally turn back the clock biologically.

When we talk about aging, or when I talk about aging with my patients, I can't help but talk about something called zombie cells. But before we talk about zombie cells, let's talk about something else, something called apoptosis. Apoptosis is basically programmed suicide of cells in our body. When cells get to a certain point where they've outlived their function, they have a suicide program that says, okay, time's up. you need to go. And they die and they're taken out of the system. Zombie cells are also known as senescent cells. I like to call them zombie cells. That's a lot cooler. The senescent cells, they have damaged DNA. It's damaged by inflammation and oxidation. And they end up in this condition of suspended animation where they're not completely functioning. but they are functioning enough to actually release compounds that will make a toxic environment around them, will actually impact other cells with oxidative stress, inflammation, damage those cells, and worse yet, program them to be zombie or senescent cells. And this process goes on and on and on. And if we took care of every other disease, and we didn't address senescent cells, that process alone would lead to our death, and that's aging. Senescent cells can be any cells. We have different types of cells in our body. We have immune cells, for example. So when immune cells do their job, they rush to a scene of the accident in your body, where there's a foreign invader, and they mop up the mess, clean everything up. but when they're done, they die, most of them. Some of them don't die and they become senescent cells. And these senescent cells begin to impact the immune system. And it's believed that senescent cells and their multiplication in the immune system lead to immune suppression or immune dysregulation that makes people as they age much more susceptible to infectious diseases. Senescent cells can also be found in joints. So if you have an accumulation of these zombie cells, these cells suspended in animation, then they can't lubricate the joint, they can't protect it, and they can't regenerate like chondrocytes in a joint will. And you will have more inflammation in your joints, and that will lead to disability. Senescent cells also can impact mitochondrial function in other cells around them. And mitochondria are those powerhouses that play a very big role in how you function every day and how you age. When your mitochondria aren't functioning appropriately, that actually leads to cell death. It actually can lead to more senescent cells. And that's one of the mechanisms by which senescent cells are able to affect the cells around them and put them in suspended animation. The good news is that there's lots of research being done on how to eliminate senescent cells. And we don't have to go far into our nutritional armamentarium to find something that works. Polyphenols or resveratrol has been shown to actually eliminate senescent cells. Where do you get polyphenols? Well, One of the favorite places people like to get polyphenols is in a glass of red wine. The good news is that there are compounds that can help remove senescent cells. One of them is a polyphenol called fisetin. Fisetin can be found in strawberries and seaweeds, and it's formulated as a supplement. It's actually a potent antioxidant and can support brain health as well, so it might be worth taking. Another compound, actually a pharmaceutical drug used to treat diabetes called metformin has also been studied. And in mice, it's been shown to increase their lifespan by 10%. And the proposed mechanism is that it actually slows the aging process down by limiting the number of senescent cells or zombie cells that form. And finally, there's a compound that comes from the red pepper called piperlongamine. Piperlongamine, it's also been researched and studied and found to be able to limit senescent cells and may extend lifespan. So if you like red peppers, hot peppers, that's a place to go. When we're talking about aging and understanding how senescent cells can impact the immune system, it's interesting to think of that in context of health span and what I mentioned before about as we age, we become more frail. Well, part of that reason, is because of senescent cells. They're actually destroying some of the really important systems in our body. And so as we do age, our immune systems get weaker. With the current crisis, this pandemic of SARS-CoV-2 causing COVID-19 disease, a lot of focus is on the immune system. And we're finding that it's elderly people that are having the most problems with COVID-19 and that's where the rate of death is the highest. They're not dying specifically from the virus. They're dying from the immune response. They have dysregulated immune systems. Younger folks are also struggling. Many have died. And so the question is, if the immune system is just going to get weaker as we get older, well, why are the immune systems of younger people being impacted? And are there other reasons why they might be dying from COVID And there probably are. But we do find that they are also having an abnormal immune response that creates a cascade of events that leads to other physiologic issues that might lead to the demise. But it's the immune system that's the real key here. Immune resilience is something that we all should develop. But it's very hard to in our current lifestyles where people struggle with sleep, people struggle with stress, people struggle with eating the right foods, they're getting way too many sugars in their diet, processed carbohydrates, they're getting toxins in the air, they're getting toxins in their food, they're getting toxins in their cosmetics and clothing. you're gonna hear that refrain a lot during this, you know, as we speak about health because those are the elements that are eroding our health. And every one of those things I just mentioned, dysregulate the immune system. They amp it up, causing autoimmunity so that you're actually gonna start creating antibodies against self. They're going to, they're going to depress it so that you can't respond appropriately to infections that will invade you. And in the case of COVID we have a amplified cytokine response that results in almost the final pathway to death in patients. And that's because their immune systems are not strong, their immune systems are in some way broken. So, when we think about health, now, I think from now on, we're going to start thinking about what do I need to do to improve my immune system?

Now, as soon as I turned 60, longevity and health span became a major focus in my life. I want to show up as my best self. I want to give my highest gifts to the world. To spend every day able to fully be present with my loved ones, to cook, go on adventures, travel, do all the things that make me happy. How I define health is to be able to get up in the morning and do whatever I want. Read a book or write a book, climb a mountain, ride my bike, play tennis with energy and vitality. Now, I know many of you want your version of the same thing. So I'm bringing you all the extraordinary new science of longevity so you can train with me for the centenarian Olympics. I'm already on my way. I check my telomeres, those little end caps at the end of our chromosomes that shrink with age. They tell you your biological age. My chronological age is 60, but my biological age is 39. Now, I'm going to teach you how to do the same and reverse your biological age, and it's not that hard. This is innovative, exciting new information that I have not shared yet. You're going to love it, and you're going to want to share it with everyone you know. The biggest killer in the world is heart disease, but our traditional approach is pretty misguided and addresses the symptoms, not the causes. High blood pressure, high blood sugar, high cholesterol, don't just happen out of the blue. There are signs of imbalance, of underlying dysfunction that can be fixed.

We've all been told, you know, why are we seeing more cardiovascular disease? The number one killer worldwide is cardiovascular disease. And cardiovascular disease is not just about the heart, it's about the whole the whole endothelial system. The heart is the pump that pumps out to the arteries, goes to the small arterioles, then goes to the veins, then goes through the capillaries, and then back through the lymphatic system. And that whole system is intimately tied in with our health. It delivers oxygen, it removes waste. And when we get inflammation in that system or gumming up of the pipes, that's when we get cardiovascular disease.

So our endothelium is one cell layer that lines the inside of our arteries. And this endothelial layer is critical for our health. We want that endothelium working really well, and it needs to be able to relax to allow blood to get to all the different tissues in the body. And we know we can impact the endothelium. If the endothelium is not able to relax, that causes our blood pressure to go up. What we know is we start to see endothelial dysfunction and inability for that endothelium to relax even before, years before somebody actually goes on to have the diagnosis of hypertension. So, you know, it's important for that endothelium to be able to relax. And there's many things we can do that can help with that. We know, for example, that blueberries are amazing 'cause they're rich in these anthocyanins, these phytonutrients, that can contribute to improvement in the endothelium. And we know that when people have what's equivalent to one cup of blueberries twice a day, within four weeks, studies have shown that you can drop systolic blood pressure, that top number on your blood pressure, by as much as a blood pressure medication. There's many things that can be damaging to the endothelium. Oxidative stress, for example, we know can cause damage to that endothelial layer. We definitely know that inflammation is a trigger for damage to that endothelium. We know that that may be coming from the visceral adiposity. When people hold onto too much weight around their belly, that weight around the belly is not just sitting there. It is an active endocrine organ. That means it's secreting inflammatory markers like interleukin-6 and tumor necrosis factor, which goes on and causes inflammation throughout the whole body, We know this because when men gain too much weight around their belly, they have a higher risk for erectile dysfunction. And erectile dysfunction is definitely caused by endothelial dysfunction. So we need that endothelial, those blood vessels to be able to relax. And that's really important for everything from prevention of erectile dysfunction to keeping your blood pressure nice and low. And what we see with research is When men are able to lose the belly fat, they have improvements in erectile dysfunction. We see that all the time.

The one thing that I need to tell everyone out there is that cardiovascular disease is not about cholesterol. Let me repeat that. Cardiovascular disease is not about cholesterol. Cardiovascular disease is about inflammation in the setting of cholesterol. And the standard cholesterol test that a lot of doctors do is, in my opinion, pretty much worthless. You really need to look at a whole host of different things to look at a person's cardiovascular risk. So how are they going to potentially develop heart disease or cardiovascular disease down the road? You don't want to wait till you have blocked arteries in all your veins and you can't walk up a flight of stairs to say, oh, you've got heart disease now.

What is cholesterol? What's it doing in our body? And how is it involved in heart disease? Well, cholesterol is not water soluble. so it can't move around our body freely. It needs to be carried around. So it's carried around by proteins, they're called lipoproteins. So when you go to the doctor, everybody by now gets their lipid profile done at least once a year, and they hear the terms total cholesterol, they get LDL, which is your bad cholesterol, or HDL is your good cholesterol. Those are lipoproteins. So there's low-density lipoprotein, which is LDL, which is considered a bad protein, a bad lipoprotein. And then there's HDL, which is a high-density lipoprotein, which is considered good. LDL carries cholesterol from your liver to parts of your body where the cholesterol is needed to do its work. HDL, the good cholesterol, carries cholesterol from the periphery of your body and cells that have used it back to the liver for disposal. That's LDL, that's HDL's job. That's why it's a good cholesterol. It carries cholesterol away once it's been used and gets rid of it. So where does the problem arise? And why is LDL the bad guy? And it's quite, and honestly, it's not the bad guy. and we're going to talk about that in a second. The problem with cholesterol is that it has an affinity for inflammation. And if the endothelial lining of the blood vessel wall and any part of your body is inflamed, that creates an opening in that protective lining. The endothelial lining is the inner lining of a blood vessel. The blood vessel is like a pipe that's carrying water in your house. Well, your blood vessel carries blood throughout your body. The critical places those blood vessels have to be the healthiest are in your heart and in your brain. If you have inflammation in the inner lining, it's almost like rust in a pipe. If you have rust on that endothelial lining, that's inflammation. and cholesterol, particularly LDL, has an affinity for that inflammation. And it will attach to the inflamed blood vessel wall and it will actually enter in underneath that lining and begin to collect. And that's when it becomes a problem. When that happens, the immune system recognizes the cholesterol as a foreigner. and creates an inflammatory response. And it sends these immune cells called macrophages to the site and they begin to gobble up the cholesterol. And when they get big enough, they die and they form these things called foam cells. And then these foam cells initiate an even more potent immune response. And that goes on day after day, month after month, year after year. First, it's on a microscopic level, but then is that what we call plaque begins to grow underneath the endothelial lining. It pushes into the blood vessel wall. And that begins to occlude the blood flow. And when that happens to the blood vessels that feed the heart, then you start to experience what we call ischemic heart disease. Your first symptoms may be fatigue, chest pain with exercise, chest pain when you're under stress. What we experience is the most devastating outcome of having that plaque forming is when it gets big enough that it cracks. And when it cracks, it causes a blood clot. And that blood clot will fill up the remaining space in the blood vessel. And that is a heart attack. And those, can be lethal. And if they're not, they can create a great deal of disability for patients. That's why cholesterol has gotten a bad rap because it's the last bank robber running from the bank and that's the one that got seen. But that's not the problem. The problem is what happened first and that's the inflammation. So what causes inflammation? Lots of things. We're going to go back to lifestyle. And one of the most important things that causes inflammation are carbohydrates, particularly refined carbohydrates and sugars. And in the last 50 years, when we were living under the dogma of cholesterol is bad, our food industry started making low-fat foods. And to make low-fat foods tasty, you needed that sugar. you needed to add salt and you also need to add fat. And the fat that was being used, which was thought to be safe, were vegetable fats, but they were highly processed. And when you highly process vegetable fats, they become inflammatory. So now you have sugar, you have inflammatory oils that are now coursing through our bloodstream, creating inflammation. that's the critical piece.

There are things that you can do to preempt heart disease. One of the big things that we're finding out is that the gut microbiome and leaky gut and also the oral microbiome are intimately tied in with cardiovascular disease. So if you have leaky mouth, leaky gut, you've got bacteria that are floating around your system, your immune system then reacts to these organisms and then potentially can cause inflammation that then being expressed itself in the vasculature, it's in the brain, you're getting problems with memory, problems with brain fog, problems with shortness of breath, all of those things contribute to heart disease. The use of statins in primary prevention, meaning that if a person does not have any known heart disease, the number needed to treat, you have to treat about 500 people to prevent one heart attack. So statins for primary prevention really have no role in my opinion. Unfortunately, because of standard of care and protocols, et cetera, and also how we sort of look at heart disease, a lot of people are unnecessarily being put on statin medications. And these medications do have their role. If you have a person who has had heart disease or has had heart surgery or stents, there is good evidence that taking statins prevent secondary heart attacks and decrease risk for stroke and further heart attacks. But for primary prevention, which is what they're being used primarily for, they really are dangerous medications. There's lots of side effects. Patients can develop muscle disease. I think about one in 10 people will develop muscle injury. That's related to the fact that statins are actually poisonous to mitochondria. And then also they increase a person's risk for insulin resistance and diabetes. So again, statins really, in my opinion, should not be used for primary preventive heart for heart disease. I have had patients who have come to me with a history of heart disease and never have they had their microbiome in the gut looked at. Never had they had any type of testing done for increased intestinal permeability, which leads to metabolic endotoxemia, which is those gram-negative bacteria floating around in your blood. And then I also had some patients who've had heart disease that never had their oral microbiome looked at. The oral microbiome is really important. Lots of regular doctors don't even think about it. Even functional medicine doctors may not think about the oral microbiome because they're not dentists. And a lot of dentists actually don't think that the mouth is connected to the heart. So there are tests that you can do that look at the oral microbiome. And interestingly, various specific organisms are more tied in with cardiovascular disease. Also, autoimmune conditions like rheumatoid arthritis and potentially even intestinal cancers. So CoQ10 is the body's natural antioxidant. Our body produces CoQ10. And statin medications are actually called HMG CoA reductase inhibitors. That stands for hydroxymethyl CoA reductase inhibitors. And when this enzyme is blocked in the synthesis of cholesterol, you also block the production of CoQ10. CoQ10 is vital in the body for its antioxidant functions, and it's also vital because it also helps with mitochondrial function. So if a patient does need a statin medication, pretty much any patient should also concomitantly be on coenzyme Q10. You can also make an argument as people get older, their production or natural production of CoQ10 can drop, and you can actually measure CoQ10 levels. but optimizing CoQ10 in patients over 50 is a good idea, but especially if patients are already on statins.

High cholesterol is not a statin deficiency. In fact, some studies aggressively treating high blood sugar, high cholesterol, and high blood pressure with medication to prevent disease in pre-diabetics actually made them worse. Don't get me wrong, medication is often life-saving and critical when needed, but we're missing a big piece of the puzzle. medications cover over the symptoms instead of addressing the underlying biology. And in the case of heart disease, that's inflammation, insulin resistance, oxidative stress, which is rusting and free radicals, hormonal imbalances and toxins, and lots more. Bad diets, lack of exercise, stress, environmental toxins, nutritional deficiencies, those are the things that lead to high cholesterol, high blood pressure, high blood sugar, and of course, heart disease. In fact, over 90% of all heart disease can be prevented with a few simple habits: staying your ideal body weight, exercising, not smoking, sleeping well, and eating a whole foods, nutrient-dense, plant-rich diet. Not a plant-based diet, a plant-rich diet, or what I like to call the Pegan diet. But you may say, well, high blood pressure, diabetes, heart disease, they run in my family. Here's what the science tells us about genetic risk. Your genes load the gun, but the environment pulls the trigger. Your genes determine your predisposition, but not your destiny. In fact, 90% of chronic disease and unhealthy aging is caused by something called our exposome, not our genome. The exposome is the sum total of all our life inputs into our biology. Our diet, first and foremost, that's most important. Our activity, stress, sleep, our relationships, our connections, meaning, purpose, toxins, microbes from outside and also in your gut, allergens, and lots more. The good news is we have control over almost all of it. Heart disease is a leading cause of death in the United States and also around the world. About 647,000 Americans die from heart disease every year. That's one in four deaths in America. Now, what most people and lots of doctors don't realize, is that two-thirds of heart disease is caused not by fat or cholesterol, but by sugar and starch in our diet, causing a condition that's known as insulin resistance. In fact, the central feature of almost all age-related disease, whether it's heart disease or cancer or diabetes or dementia, even muscle loss and what we call sarcopenia, and even hormonal imbalances is something called insulin resistance. And that happens when we consume boatloads of starch like flour, bread, pasta, rice, and refined grains and sugar. In fact, we eat an average of about 152 pounds of sugar per person and 133 pounds of flour per person every year. This makes up about 60% of our calories and it's killing us and it's making us age very, very fast. Now, the good news is that everything we discuss in this docu-series is focused on getting to the root causes of aging and none is more powerful than insulin resistance. And it is something we can completely reverse. Now, years ago, I remember one of the top cardiologists at Harvard saying that if you found a group of a hundred year olds, With clean arteries, they would have one thing in common. They would be insulin sensitive, meaning that they could perfectly regulate their blood sugar with very little insulin. And this, my friends, is the key secret of healthy aging. But the bad news, my friends, is that today in America, only 12% of Americans are metabolically healthy, meaning they are not insulin resistant. They are insulin sensitive like those 100 year olds with clean arteries. This is shocking. It should be headline news. That means that 88% of people are metabolically unhealthy, including the 75% of Americans that are overweight and get this, between 20 and 40% of normal weight people who are over fat, even if they're not overweight. What I like to call skinny fat, they are equally at risk of heart disease and aging and all the other complications that we see as people get older. Now, abnormal cholesterol, high blood pressure and high blood sugar are all signs of not being metabolically healthy. This is even more important in the age of COVID-19 because the biggest risk factors for serious disease and death with COVID-19 are being overweight, obese, or suffering from an age-related chronic disease. And these are all signs of being metabolically unhealthy. And this is also why we see such an alarming rate of heart disease.

What's amazing about these particles is that we can really influence them with our lifestyle. So we can make our small dense LDLs get bigger and fluffier. We can make our LDL cholesterol become less Atherogenic. We can make your LDL particles be less concerning in terms of causing plaque production in your body. And one of the best ways that we do that is by decreasing somebody's insulin resistance in their body, by pulling away the simple sugars, by removing the refined and processed foods. We can see the LDL particles get bigger and fluffier in size. And that's a wonderful thing we can measure. We measure it all the time with this NMR lipoprotein profile test. It's a really interesting test that tells us about the size of your LDL particles. Are they small and dense and therefore more at risk for causing heart disease and plaque, or are they big and fluffy and less of a risk for your health? So it's good if your cholesterol, if your LDL-C is a little bit high, you wanna ask your physician, Let's do some more testing. Let's look at the particle sizes of those LDL cholesterol. I wanna see, do I have the small dense or do I have the big fluffy? If you have the big fluffy particles, they're less concerning. And if you have the small dense ones, you know it's time to say, I've gotta make a change in my lifestyle. I've gotta make some changes in my diet, my exercise program, and my sleep. I've gotta work to make these LDL particles bigger in size. 'Cause many times we can. Sometimes when somebody's LDL cholesterol comes back very elevated, then it triggers us to look a little bit deeper. There is a subset of our population. It's about one in every 250 people who have something that's called familial hypercholesterolemia. And they have a genetic variation that prevents their body from getting rid of their LDL cholesterol as easily. So for that subset of patients, we might see their total cholesterol be almost 300 or higher. We'll see their LDL cholesterol be greater than 190. That's very high. That's not very common, but if you have those numbers that are higher like that, you want to ask that question, okay, you know, what's going on? Do I have familial hypercholesterolemia? Because we know that people who have this genetic variation have a much higher risk of heart disease. They have a 20 times increased risk of heart disease, and it happens at a much younger age. So they might start to develop heart disease in their 30s or 40s, as opposed to in their 60s or 70s or 80s. So if you have a family history of early heart disease, which means less than 55 for a man or less than 65 for a woman, so if you have aunts or uncles or parents or brothers who've had a heart attack at a young age, or if you have any signs of really high cholesterol, so your LDL being greater than 190, maybe you've got some cholesterol deposits around your eye called xanthelasmAs. You can often see those just by looking in the mirror. You'll see some bumps under the skin around your eye. And if your LDL cholesterol is more toward over 190 or your total cholesterol toward 300, and you have a strong family history of heart disease, Many times in these situations, though lifestyle is critically important and can decrease your risk of heart disease, but these are the patients that we take lowering their cholesterol much more seriously. And these are the patients that really may benefit from medication to lower their cholesterol. Plant sterols are the components of our plants that prevent the reabsorption of cholesterol from the gut. So plant sterols will bind to cholesterol within your intestines and prevent it from getting reabsorbed into your body. then the plant sterols will take the cholesterol out in your stool. As a result, they can lower cholesterol. We know that 2 grams of plant sterols a day can lower LDL cholesterol by 10%. You can take plant sterols as a supplement, but you can also get them from lots of your food. Foods such as your beans, legumes, and nuts and seeds are naturally rich in these plant sterols. When somebody has a very high LDL cholesterol and we're having a hard time getting it down with changes in diet, or we really focus on making sure they're getting a balance of their protein in their body. So not just relying on the animal sources of protein, but pulling in more vegetable sources of protein. This is where you can really get benefit from your beans and legumes and your nuts and seeds. They can help with providing your body with these plant sterols that help with lowering cholesterol. Vitamin B3 is also known as niacin, and niacin can have a positive impact on your cholesterol. It can lower triglycerides and lower LDL cholesterol and raise up the HDL cholesterol. Niacin though, you really want to work with a provider when you're trying niacin as a supplement because you want to get a slow release niacin to help with some of the hot flashes it can cause or hot flushes in the body. and too much too fast may not make you feel so good. So work with a provider if you're going to try niacin to help with improving your cholesterol levels. Fish oil can really help with lowering LDL cholesterol and lowering triglycerides and raising up that HDL cholesterol. Fish oil is phenomenal for so many aspects of our health, but definitely has a good impact in terms of risk of heart disease. The VITAL trial showed that if people are eating less than one and a half servings of fish in a week, then if they take one gram of fish oil per day, they can decrease their risk of having a heart attack. For people eating a lot of fish, fatty fish, especially in a week, they might not need the added fish oil. They may be getting enough from their fish, especially the wild-caught salmon, sardines, those are great sources of your fish oil. You may wonder, should I take some extra fish oil? The people we definitely use fish oil supplements for are people with a high triglyceride, level and low HDL cholesterol. Because fish oil can help with lowering those high triglycerides and increasing that good HDL cholesterol. Two to four grams of fish oil a day has been shown to have a real positive impact on improving your cholesterol levels. Look for a good source of fish oil, one that's a good quality. And I always say keep your fish oil in the fridge. There's other sources of omega-3s like ground flaxseed that are great to add into your diet as well. Ground flaxseed is a great source of fiber and is also really rich in omega-3 fats that can improve your cholesterol profile. One ounce of nuts five times a week can have a really positive impact on your cholesterol. It also has been shown to decrease risk of heart disease, to lower inflammation in the body. So nuts are a wonderful thing to add into your daily routine. So what is one ounce of nuts? That's like equal to 24 almonds or 15 walnut halves or 15 pecan halves, and you wanna keep your nuts fresh. So what I always recommend, I get them, I get raw nuts and I keep them in my freezer, and that keeps them really fresh, prevents them from oxidizing. That's the best way to get those nuts into your daily diet. One of the number one causes of heart disease is insulin resistance. So it's important to understand what insulin resistance is. Every time you eat a meal, your body's blood sugar increases after that meal. And then the body responds by producing insulin. Insulin is that hormone that takes the food and gets it into the cells so you can use it for energy. Unfortunately, what can happen as we get older, or if we're not taking good care of ourselves, or if we're eating too many refined and processed foods, and we've even shown that some toxins can cause this as well, we can develop what's called insulin resistance. and that means that after our meal, our body has to produce a lot more insulin to get the food into our cells. So when somebody has insulin resistance, their insulin levels are actually high. They're much higher than they should be, but the body is not listening to that insulin as well. And so even though you're making a lot of insulin, the food, the nutrients aren't getting into the cells as well as they could. As a result, that high level of insulin causes us to gain weight around the belly, which is that really inflammatory visceral adiposity. High levels of insulin have been associated with heart disease, they've been associated with stroke, they have been associated with many types of cancer, including breast, prostate, and lung cancer. And they've been associated with dementia. So what we wanna really focus on, keeping our insulin sensitive, keeping our insulin in that normal range. you can ask your doctor to check a fasting insulin level. And most research has said less than 12 is considered normal for fasting insulin. We are a little stricter and we like to see that fasting insulin closer to five. And when I start to see somebody getting towards seven, nine, 10, definitely over 12, that's considered insulin resistance or pre-diabetes. Another word that's been used is metabolic syndrome. And so high fasting insulin is one sign that you have metabolic syndrome or insulin resistance. There's other signs as well. So if you're gaining too much weight around that belly, if your waist to hip ratio for a woman is greater than 0.8 or for a man greater than 0.9, that's a sign that you're gaining too much weight around the middle. And that's also a sign that you may have some insulin resistance or metabolic syndrome. If your blood pressure is starting to increase, that's also a clue that there may be a problem. And if your good cholesterol, that HDL cholesterol, is too low, if it's less than 50 for women or less than 40 for men, that's a sign that there's a problem with insulin resistance. If your triglycerides are too high, that's also a signal. And finally, if your blood sugar is starting to get too high. So we can look at fasting blood sugar. We know if it's greater than 100, you're at risk for insulin resistance or Metabolic Syndrome. If somebody's greater than 125, they have type 2 diabetes, and that's what happens when you're greater than 125. But what we're learning is that when you're pre-diabetic, in those years before actually getting diabetes, when your blood sugar is starting to go up and you have all those other markers of insulin resistance, that high insulin, the weight gain around the belly, the low good cholesterol, the high triglycerides, the elevated blood pressure. We know that in those years, even before you get diabetes, your risk for all of the diseases that come along with insulin resistance like cancer and heart disease and stroke are increased as well. So you don't want to just wait until your blood sugar starts to get too high. It's really important many times in conventional medicine Doctors don't have enough time with patients or enough tests are not done. And many times this is missed. I see it missed all the time. Patients, their blood sugar will be slightly high or starting to creep up and they don't realize how important it is to act at this time because this is the time where you can really reverse the prediabetes. You can reverse the insulin resistance and prevent all of these diseases from occurring.

So there are several markers of inflammation that we look at. One's called a CRP, one calls it homocysteine. And I say, I certainly can't make a decision or help you make a decision about whether you should come off your statin or take a statin unless I know how much inflammation you have in your body. So that will be two tests that I will get if they are not part of their profile. Then I will perform something called a nuclear magnetic resonance lipid profile. That is when we are able to look at the actual molecular structure of the lipoproteins that go through your bloodstream and determine which ones you have. And when we do that, we're able to find other lipoproteins, and they've been researched, and they've been found to actually be more important markers of heart disease or risk for heart disease than LDL, total cholesterol and low HDL. One of them is called your low density lipoprotein particle number and one's called your low density lipoprotein size. The low density lipoprotein particle number is really a measurement of how many LDLs you actually have. Not just the total, but how many individual LDL molecules do you have? The LDL size is how big are those LDLs? So it's not just a total LDL, now we're getting more granular. How many of them do you have and how big are they? And what we found is, is that the really small, dense LDLs, they're like missiles. they can penetrate in the endothelial lining where there's inflammation and build up very quickly. So you want larger LDL molecules because the big fluffy ones put you at lower risk for heart disease. And if you have big fluffy LDLs, that's going to be a favorable measurement and is going to be one step towards, your LDL may be high, But they're big and fluffy, and you have lots of them, and you have few of them. You want a low LDL particle number. The fewer particles you have, and the bigger they are, the lower risk you are. So if you have that profile, that's one reason why you might not need to be on a statin, because it doesn't matter that the LDL is high. You have small ones, and you have fewer of them. You have big ones and you have fewer of them. Okay. Then there's another marker. It's HDL size. You want your HDLs to be big. So even if you have a mildly low or low HDL, if we look at the size and they're big, that's really good because HDLs are like, we know what they do. They collect cholesterol and they take it to the liver for it to be disposed of. If you have small HDLs, then that's like having small dumb trucks. And they can't really pack on a lot of cholesterol. And they're not very efficient at collecting it and driving it to the liver and getting rid of it. But if you've got really big dumb trucks, really big HDLs, they can collect more cholesterol, carry it to the liver and have it removed. So your HDL size is also important. And finally, there's a really interesting marker that's gaining a lot of ground as being an important marker for heart disease. And it's called Lp(a) or LpA. So LpA is very much genetically programmed. So 90% of the people that have this LpA, they have a gene for it. And there's some thought that this may have conferred for that population of people a lower risk of dying from injury because it helps blood clot. So evolutionarily, it may have had a value at some point. But now, because of the diets that we have and a lifestyle we have, that what used to be an evolutionary advantage may now be a disadvantage when it comes to heart disease. So Lp actually expresses itself very quickly. So by the time you're two years old, it's fully expressed and you're making a lot of Lp. By the time you're five, you're making a lot of this lipoprotein A. And what it basically is, is an LDL with an additional lipoprotein called apoA. It's fully expressed by age five to your adult level. So you're living with this really high LP little A if you're inclined to do that genetically for most of your lifetime. Knowing that value, we understand about that is that it increases your risk for heart disease fourfold, but nobody screens for it. And so I will screen for an LP little A. because if that is, you know, really high number, even if everything else being equal, you're sort of on the borderline with your numbers.

A.

High Lp is gonna really concern me and I'm going to really wanna work at changing your lifestyle and using that as leverage to have you do it. So what I've just talked about, are different ways of looking at cholesterol. And I told you it's inflammation, but I just got done telling you that there are important cholesterol markers that we need to look at that increase your risk for heart disease. It's both. Inflammation is the genesis and cause of heart disease in that it creates an environment for cholesterol to create those plaques that create the those blockages that create the diseases and the, that cause heart attacks and strokes. So when it comes down to it, we need to be aware of those things that will in our life that will create inflammation. And we also need to be aware that our doctors need to measure it appropriately. So when you come to me as a functional medicine doctor, I'm gonna look at, not just your total cholesterol and your LDL and your HDL, but the markers that identify risk more sensitively, as I've explained, those are LDL particle number, LDL particle size, Lp(a) as your cholesterol markers. On the other side, and more importantly, is do you have inflammation going on in your body right now? And two of the really important markers that need to be included in your cardiovascular risk assessment when we're looking at our physiologic markers are CRP and homocysteine, because both of those are linked to increased risk for heart disease because they are markers for inflammation.

I always start with the basics. If someone has a poor lifestyle, if their diet's not great, if they're not exercising, if they're under too much stress, if they're not sleeping, if they're a new problem, maybe something called familial hyperlipidemia, which means you get really high cholesterol. And I have a patient right now who's just following all the advice I'm giving him, and he's doing great. But he's one of those patients that needs a statin, and he's a very significant cholesterol absorber. So we actually can do tests now to see whether you're a cholesterol producer or you're a cholesterol absorber, if you're a hyper absorber. So you absorb all the cholesterol and fat in your diet in a way that's not good for you, or maybe your liver just produces too much of it. And we can use things to help block the absorption of cholesterol, whether it's fiber or other factors, or we can use something to help block the synthesis of cholesterol in the liver, whether they're natural products or medications. So it's very personalized and individualized. There's not one size fits all. But the problem today is if anybody comes in with a cholesterol, an LDL of over 100 or 130, the doctor goes, you need a statin. Sort of one size fits all. And that's just not how to practice medicine. And we know this now. I mean, the medical profession understands this. The National Institute of Health has a whole department of precision medicine and precision health and precision nutrition. So we're understanding that this one size fits all medicine just doesn't make any sense anymore. but it takes a while to get it into practice. And functional medicine is the science of personalized medicine. It's the science of personalized nutrition and personalized health. So everybody's different. I treat everybody differently and I look at what their issues are, what their genetics are, and I push as hard as I can on the things that are the least toxic, the least harmful, with the least side effects, Nobody's going to die from improving the quality of their diet. The opposite is true. But some people may have adverse effects from drugs. So I use them, but I use them as a last resort, not as the first step. There's interesting technology available today that allows us to look at the quality and function of your blood vessels. And that's really cool. So we can see in real time, are they stiff? Are they pliable and soft? or are they hardening? And if your arteries are hardening and stiff, it's not terminal. You can influence that by the quality of your diet, by lifestyle. All the things we've been talking about can change your blood vessels from stiff and hard and at risk for damage to soft and pliable and fluid, which keeps you healthy and free of heart disease. so we look at these tests like, for example, endopat, which is a machine that's non-invasive that looks at the vascular health. How is your blood vessels? Are they good or are they bad? And this endopat test can be done at your doctor's office. Again, many, many don't use this preventive technology, but it's a great way to see. And then you can alter your lifestyle and you can come back a month later and do it again and you'll see the change. And we see that very often. Well, if someone has For blood vessel health, we know so much about how to get your blood vessels working better, which is to eat an anti-inflammatory diet, low starch and sugar, lots of plant rich foods, lots of good quality fats, lots of nuts and seeds, what I call the Pegan diet. It's something I've been talking about forever. It's the quality of our food matters more than the quantity, what you eat, matters more than how much you eat. And so focusing on the quality and upgrading the quality of your diet is so critical. And getting rid of all the junk, getting rid of all the flour and the sugar, doesn't mean you can't ever have it, but it's just not a staple in your diet anymore. Exercise also has enormous benefits on your vascular health, on function. Saunas, who knew? But saunas actually increase your vascular health and can produce better vascular resilience and response. increase something called your heart rate variability, which is a sign of the quality of your heartbeat. Is it good or is it bad? Is it more risky for heart disease or less risky for heart disease? There's meditation, which also can affect your blood pressure and inflammation and oxidative stress and all the things that cause your blood vessels to not be happy. And then there's lots of nutrients out there. Fish oil is a great one. Curcumin is another one. Vitamin D, antioxidants, a whole list of plant-derived compounds we call phytochemicals, and also just nutrients play a huge role in your vascular health. So we design a comprehensive program to upgrade the quality of your vascular system in your blood vessels so you don't get heart disease. You know, with the increasing interest in ketogenic diets, and low carb diets, we're seeing a phenomena that's pretty fascinating, which is the variability in individuals response to different diets. Some people do really well on a lower fat diet, and other people do really well on a higher fat diet. Some people do better with lower starch and sugar, some people have more ability to manage starch and sugar. So I have a good ability to manage starch and sugar, but I've noticed, for example, when I have a high intake of certain types of fat, like saturated fat, my cholesterol goes really high. So there's this phenomena called lean mass hyperresponder, which we're still studying and still learning about, which is people who are fit and healthy, when they jack up certain types of fat in their diet, it doesn't work so well for them. and we can actually do analyses that we do in our clinic here at the Ultra Wellness Center called DNA Diet, where we can see how you respond to fat, how you respond to carbs, and how you respond to different factors that regulate your eating behavior, how you respond to salt taste and various kinds of bitter tastes and what actually you should be eating to maximize your genetic potential. When it comes to heart disease, your diet and your lifestyle the single most important thing. Acting now not only saves you later, but the things you need to do to prevent heart disease make you feel great and younger right now. A very big European study called EPIC found that incorporating four simple behaviors can dramatically reduce your risk of developing heart disease by 90%. So not smoking, exercising three and a half hours a week, eating a healthy diet and maintaining a healthy weight. In fact, researchers in the EPIC study found that adhering to these four behaviors alone seemed to prevent 93% of cases of diabetes, 81% of cases of heart attacks, and 50% of cases of strokes, and also 36% of cases of all cancers. Now, there is no medication on earth that can do that. Of course, there is a role for medication in some patients, for some patients with significant genetic risk, or if they've already had heart disease or a heart attack. But over time, by addressing the root causes, many people can come off these medications. Through lifestyle changes and addressing root causes, I have seen patients lose weight, get off all their medication, normalize their blood sugar, normalize their blood pressure and cholesterol, and even reverse congestive heart failure using functional medicine. Incorporating positive dietary and lifestyle changes can lead to miraculous results. You just have to implement the right strategies. Cancer is scary. I can't think of anyone who hasn't been affected by this disease in some shape or form or way. In my family, my sister and my father both die from cancer. I see so many patients who are recovering from cancer and they don't want it to recur. and I see patients who are worried about their genetic risk for cancer. But there are two parts to cancer, the cancer itself and the host in which the cancer grows. And that, my friends, you can do a lot to influence. I don't want you to feel helpless when it comes to this disease, which so, so many people often feel. When it comes to prevention and even how to improve outcomes from treatment, Functional medicine takes a very specific approach to cancer. Now don't get me wrong, conventional medicine is absolutely necessary. And once you have cancer, an integrated approach of chemo, radiation, and surgery combined with boosting your immune system and making your body an unfriendly place for cancer to grow or come back is really essential. The problem is that most patients Don't get taught how to do the second part. I remember one patient, she had three different cancers. Her doctors just wanted her to do what we call active surveillance, which is just doing scans and tests to see if it comes back. There's nothing active about that. It's passive. Just wait and see and hope it doesn't come back and hopefully we catch it early. And it's terrifying for most people who are looking for some way to prevent it. That is where functional medicine shines, finding the underlying root causes and optimizing your biology, making it an unwelcome place for cancer to grow or come back.

The American Society of Clinical Oncology has estimated that obesity is going to overtake smoking as the number one cause of cancer worldwide. And unfortunately, we are seeing a way increased risk of obesity, an increased rate of obesity, We know that two-thirds of adults and a third of our children are obese. This is a driver for many causes of cancer, not all cancer, but definitely obesity increases inflammation in the body, increases insulin resistance, and is a driver for many types of cancer in the body. We are also seeing an increased rate of colon cancer in our younger population, which is very concerning. And I think that, of course, obesity and toxins and inflammation are triggers for colon cancer as well, but we also know that a shift in our microbiome has an impact on our risk of cancer. And unfortunately, there's a high number of antibiotics in our food supply that may be contributing to this shift in our microbiome. I think that when we're looking at cancer, it's really important that we take a functional medicine approach. We want to look at all the systems in the body and how they're impacting a person's risk of getting cancer. So we really focus on the terrain. It's important to pay attention to the cancer cell, but I think it's also important to pay attention to the terrain in somebody's body. The terrain is like the soil. It's everything surrounding that cancer cell, and it can influence whether a cancer cell is gonna grow and proliferate, or if a cancer cell is not gonna grow and proliferate. So we can have an impact on the terrain in our body. by working to lower inflammation in the body. We know that cancer likes to grow in the face of inflammation. So whenever we work to lower inflammation in the body, we're creating a terrain where cancer is less likely to grow. We know that not all precancerous cells go on to become cancerous cells. In the United Kingdom, they did a study on 40 to 50 year old women. And they noted that over 40% of those young women who died of some other reason, they died of another accident or another disease, over 40% had precancerous cells when they looked in their breast tissue. That's precancer cells like called DCIS or LCIS, the stage zero cancer that we're often treating to prevent it from going into full-blown cancer. So we know that 40% that if those women were able to live longer, that 40% of them would not get an invasive cancer. So what we realize is that we're always producing these pre-cancerous cells in our body and not all of them go on to become invasive cancer. And that's where our lifestyle has a big impact on whether those cells become invasive cancer or not. We know our diet can have a big impact on whether those cells become invasive cancer or not.

The first steps that I take in treating a patient that comes to me is establishing a relationship, especially when a person has cancer, because as you can imagine, it's a very, very vulnerable place to be. It's a very scary and uncertain place to be. And when your doctor or healthcare provider can enter into that space in that place with you and show you empathy, it makes all the difference in the world. That empathy and that compassion actually is part of the healing process. That's where I start. Then the hard work begins. I want to find out everything I can about that patient. I want to know the mood their mother was in the night they were conceived, all the way up to the last symptom they had, the moment they walked into my office. When I get all that information, I'm able to find the triggers that may possibly have started the cascade of events that threw their system out of balance that resulted in a cancer forming. That trigger may be the root cause or maybe one of several causes to their cancer. And that's how we go looking for it. with a really, really strong history. Now, as I gather that information.

I.

Plot it out on something called the Functional Medicine Matrix. That matrix has, it's like a wheel with seven spokes. And I take the symptoms and I put them into the physiologic spokes. So we have one spoke that is the gut and the digestive processes. We have another spoke, which are the immune processes, and another spoke, which is energy, mitochondrial function. We have another one that is toxins, and we have another spoke that is the cardiovascular system and the transport system within the body. We have another spoke that's going to be the hormones and neurotransmitters that communicate throughout the body. And then we have our last spoke, which is the structures. this structures everything from the mitochondrial membrane all the way up to a bone. They're all structures. The symptoms that they have represent some type of imbalance or malfunction in one of those system pieces. Now, all those system pieces are interdependent and integrated, and they're working together to maintain your health. to regulate your health and to actually heal you. And once I've put all that information on that wheel and it's actually on paper, but it's also in my brain and the gears are turning, I can begin to find those root causes that we need to work on. By the time I'm done getting that history using the matrix, I usually have a really good understanding of where we're going to need to go. but I often do still have some of the puzzle pieces missing. And that's where I do some testing. The three most important tests that I do are a complete nutritional analysis, a digestive system microbiome analysis, and a DNA analysis. Why these three tests? We know that oxidation, inflammation, infection, toxins are all part of the chronic illness and cancer cascade. These three tests provide the first really good look under the hood and help me begin to understand physiologically where some of the problems may be. The first test I do is a nutritional analysis. The nutritional analysis that I do looks for 125 nutritional markers. It also looks for biomarkers of metabolic dysregulation, inflammation, oxidation and toxins. The second test I do is a gut digestion microbiome test. Almost every patient that walks into my office has gut issues. The tests that I do will look for markers of inflammation, an imbalance of important bacteria, the presence of infection, and even toxins in the stool. The third test I do is a genetic test. The way I explain it to patients is that we're looking for not mutations, but small variations in your gene blueprint that will possibly predispose you to Physiologic abnormalities that lead to chronic disease and cancers. I can explain it like this. You're a contractor, so you're going to be building bathrooms for all types of people. And so when a person comes to you, you want to be prepared for whatever the budget is. So you have one blueprint for a cheap bathroom. You get a toilet, you get a sink, and you get a light bulb. Then you have a more moderate budget. That person gets a nicer sink, a nicer bathtub, they get a nice fixture, and they get a linen closet. And then you have the really high budget one with the Jacuzzi and the waterfall shower and the marble. They're all different, but they're all labeled bathrooms. And you look at the blueprint and at the top of each blueprint, it's going to say bathroom. But each one of those is going to function differently. It's the same thing with the genes that we're looking for. They're called single nucleotide polymorphisms. They're the gene blueprints that have one mild variance like the variances we saw in those bathrooms that will result in the protein that they make having a different type of function. It might function too fast, it might function too slow, it might not function at all. And if we can identify that, we can then help you change your lifestyle, give you a nutritional plan, and even targeted supplements that account for that variation so that it doesn't have that long-term impact and lead possibly to chronic disease or cancer. So it's a really important test. The tests that I use Looks at five critical physiologic pathways and the possible variations and blueprints that make those pathways work. Those pathways include oxidation, inflammation, methylation, and detoxification. Variances in any one of those can be fairly critical. As an example, there are genes that make proteins that are responsible for detoxifying and removing estrogen. One's called the CYP1A1 and one's called the CMT. If you have single variations in those genes, you're not going to be able to appropriately remove estrogen out of your system once it's done its job and it needs to be removed. Once estrogen has done its job, it's going to be metabolized And some of those intermediate metabolites are actually inflammatory. And if you can't move them out of your system appropriately because you have variations in those two genes, they recycle. And now you have recycling inflammatory estrogen compounds which increase your risk for breast cancer. If we can identify 20, when you're 20 years old, if we can identify that you have those genes and they have those variances, then we can actually give you a lifestyle, a nutrition plan, and targeted supplements that will upregulate the detoxification and removal of estrogen. And instead of worrying about whether you need to get a mammogram or thermography, you've taken care of removing your cancer-causing, you created for yourself a cancer-free zone and you've created instead of a cancer, a cancer-generating zone. And that's what I really worry about. I want to create that type of environment.

Now, what's fascinating is that scientists have been discovering a whole new pathway that may be generating cancer and using diet to treat it. One of the leading cancer doctors in the world, Siddhartha Mukherjee, who wrote the book Emperor of All Maladies, came up to me once at a conference and says, Mark, we've discovered one of the keys to cancer. He said, you, know what it is? I looked at him and I said, yeah, sugar. He's like, how did you know? And I was like, well, yeah, I've been paying attention. He says, we're doing studies on mice and animals where we're reversing, literally reversing, Cancers that don't have good treatments like pancreatic cancer, that's a death sentence. Melanoma, often a death sentence. We're reversing these cancers in animal models using a ketogenic diet. That is a diet that's 70% fat and less than 5% carbohydrate. Turns out that cancer cells love sugar. So insulin promotes the growth of cancer cells. It doesn't just promote the growth of belly fat, It promotes the growth of cancer cells. And cancer cells need carbohydrates and sugar to grow. If you shut off that supply, they can't grow. Humans have sort of like a hybrid car. We have electric and we have gasoline, right? The gasoline, let's say, is the sugar pathway, and the electric, let's say, is the fat pathway. So we can live just on fat. We don't need carbohydrates. There's no essential carbohydrates. But we turn our metabolism from processing carbs to processing fat, and all of a sudden it turns on all these anti-aging mechanisms, these anti-inflammatory mechanisms. They shut down cancer growth. So they're studying this aggressively now in science. And it's really exciting to see this. And there are human trials going on with brain cancer and many of the other cancers. And I have a friend who's a doctor who developed a throat cancer, and he decided to go on a ketogenic diet during his treatment for chemo and radiation. He did better than all the other patients. He had less side effects, he recovered better, he was more resilient, and he's clear of cancer. And it was a 50 50 chance. Now, who knows if it was that, but I bet you a lot of it is. And so I think we have to understand that our diet plays such a huge role. I remember being a a medical student on the oncology ward. And I said to my professor, I said, so, and I was always interested in nutrition. I said, so how much cancer do you think is diet related? And I thought he'd say 10%, 20%. He said 70%. Now, if that's true, that means we have incredible opportunity to reduce the burden of suffering from cancer on our population that we have control over this. And I think people feel helpless. They feel so helpless around cancer. They know, oh, okay, I can exercise, I can eat better, and I can eat a low-fat diet, even though it's not the right thing for heart disease. But people don't know, like, okay, what do I do with cancer? I just, like, go to the doctor, get my pap test, get my colonoscopy, come stick my finger in my butt, check my prostate, do my PSA. Okay, get my mammogram, colonoscopy. But that's not prevention. That's just early detection. And that's okay. We want to detect stuff early and we'll prevent cancers doing that. But how about focusing instead on the tumor or the cancer on the host where the cancer grows? And that is what functional medicine does. That is what the science of rejuvenation does. That's what we have the potential to change.

Cancer cells in general, and I'm sort of generalizing because not every cancer is the same, but there are some cancer cells which are dependent upon glucose metabolism. And glucose metabolism, you can actually metabolize glucose through what's called the anaerobic pathway, which is without oxygen, or you can metabolize it through the mitochondria, which is with oxygen. And cancer cells, for some reason, have this effect called the Warburg Effect. And the Warburg Effect causes the body to produce excess amounts of lactate as a byproduct and they sort of feed on glucose. And what we found is that when some patients do a fasting for a period of diet and go into a ketosis, which is producing ketone bodies, when you're burning your fat, it basically starves off cancer cells and shrinks cancer cells. So that can be a very effective treatment for the immune system in general and also actually treating various types of cancers.

Autophagy means self-eating and that's really a process that happens in our body when we're cleaning out old or damaged cells. And autophagy, we want to be able to do that. So we want to be able to get rid of abnormal or damaged cells all the time. Fasting has been shown to be one great way to help support autophagy in our body. We also know on the other side that excessive eating causes a lot of cancer producing systems in our body. So we know that excessive eating can cause a lot of inflammation in our body, can cause a lot of insulin resistance, and has been associated with a higher rate of cancer. So fasting is a time when you're not eating. So there's been a lot of discussion about fasting and how phenomenal it is for our health. We know that fasting can lower inflammation in the body, it can lower oxidative stress. It's one of the main things that has been shown to help improve longevity when we cut back on the amount of food that we're eating. And so there's been a lot of research about fasting and cancer risk. And there's been studies that show that if somebody doesn't eat for 13 hours at night, for example, so that would mean that they wouldn't eat between 6:00 PM and 7:00 AM, they have a decreased risk of breast cancer. And if they're going through breast cancer treatment, they have a decreased risk of recurrence. So giving the body time to rest, giving the body time to not eat, is actually really important for everything from lowered inflammation to letting our mitochondria heal, to giving the body time to get rid of those older damaged cells. So that's an important thing to incorporate. There's been research also on looking at different forms of fasting, such as the fasting mimicking diet, around cancer treatment. So Valter Longo has done a lot of research and others have done a lot of research around using methods of fasting while giving chemotherapy. And so what typically is recommended for some people undergoing chemotherapy is to cut back on calories for a specific amount of time. And they found that that's helpful for a few different reasons. We know cancer cells like to grow or they feed off of sugar or glucose in the body. They can't adapt as easily as our natural cells in our body. So we can, our healthy cells, can adapt when there's not a lot of sugar around. They can use fat, we can go into ketosis and use fat for energy. but the cancer cells can't adapt as well. So when we cut back on calories, we make those cancer cells more vulnerable. So what Walter Longo and others have done with the fasting-mimicking diet is they've said, okay, if people cut back on calories for three days before chemotherapy and two days afterwards, will that help the chemotherapy be even more effective? And some of the research has shown that, yeah, absolutely. For some people, it may help the chemotherapy be more effective because the cancer cells become more vulnerable, they don't have the food to survive, and our healthy cells are able to adapt to ketosis and survive during that time. So they cut down on calories to 700 to 1100 calories somewhere in there for those three days before and two days after chemotherapy. I think it's very important that if your thinking about implementing some of these changes, you're going through chemotherapy and you wanna implement some of these changes in your diet to see if it helps, you really wanna work with somebody to be safe. Because if you cut back on calories so much and you're losing weight, then that's not healthy. We know that that is not a healthy thing to be doing during chemotherapy for some people. Other people, they cut back on calories, they can still maintain their weight, and they get the benefit of the fasting-mimicking diet, those are the people that would benefit from something like this. But it's a lot of work and it takes some careful planning to make sure you're getting all the nutrients your body needs. And so working with a nutritionist, I think, is really important if you're considering the fasting-mimicking diet.

When it comes to treating cancer and chronic disease, the name of the game is stopping inflammation. And there's no more powerful medicine than what's on your plate. So I always recommend an anti-inflammatory diet. The Mediterranean diet, with its focus on fish, vegetables, whole grains, nuts, seeds, legumes, and olive oil, with meat maybe once a week, good dairy choices, and most importantly, severe limits on sugar and carbohydrates is a great choice for a person who wants to stop inflammation when they're treating their cancer, the chronic disease. Sugar is a potent trigger for inflammation. It also creates obesity. And obesity itself puts you at risk for 13 different cancers. Targeted supplements can be an important part of a nutritional regimen when you're trying to prevent or support somebody who has cancer. Antioxidants can be critical. I'll include vitamin C, CoQ10, and omega-3 fatty acids. For detoxification support, I'll include glutathione, which is a master detoxifying molecule in the body, silymarin, NAC, and for women, to help with estrogen removal, DIM and calcium D-glucarate. Immune support will include mushroom compounds like turkey tail and then some minerals like zinc and selenium, and I'll also include vitamin D. Recently, I've been adding in targeted supplements that can limit tumor growth. Tumors secrete a chemical called vascular endothelial growth factor. This growth factor allows the tumor to develop a blood supply of its own that keeps it growing. Wormwood, also known as Artemisia, is a compound that can suppress VEGF and limit tumor growth by eliminating that angiogenesis or vascular generation or blood supply that the tumor uses to grow.

Black raspberries can make pre-cancer cells in the esophagus and colon less likely to progress into cancerous and invasive cells, which is amazing. So add in some berries and raspberries every day. In addition, green tea has a component called EGCG, epigallocatechin gallate. EGCG has a lot of amazing properties for our health in our body. One of the things it can do is it can cause precancerous cells be less likely to become invasive or cancerous cells. It also has a lot of anti-angiogenic properties in it as well. And that means that it prevents the growth of blood vessels to a cancer cell and prevents them then from growing and metastasizing. So in order for one cancer cell to grow and to spread, it needs to have a process called angiogenesis to occur. And angiogenesis is the process where blood vessels grow and feed that cancer cell. One of the amazing things about green tea is that it has anti-angiogenic properties. That means it prevents the blood vessels from growing and feeding that cancer cell. In addition, green tea also impacts us epigenetically, which is phenomenal. Epigenetics means the expression of our genes. So we can influence the expression of our genes through the foods we choose, which is great. We can make tumor suppressor genes more active. That means that the body has more tumor suppressor genes being expressed when we consume sulforaphane, which is rich in our broccoli. Sulforaphane can impact our epigenetic expression, which means that it can cause more tumor suppressor gene production, which can lower the risk of cancer. We know also green tea can impact our epigenetic expression. Green tea can cause more production of genes that produce glutathione, and glutathione is this master antioxidant and detoxifier for our body. Our risk of cancer is always influenced by both our genetics and our environment. We know that over 90% of cancers are influenced or caused by our environment. So by not smoking, by doing regular exercise, by maintaining a healthy weight, by making the right food choices, we can lower our risk substantially. We know that at least 30% of cancers are caused by a poor diet or this sad diet, that standard American diet. You know, we know we can influence our risk of cancer substantially by the lifestyle choices we make.

So your body has DNA repair enzymes. It has the ability to fix this damage cells to clean up the garbage and we can do that. So for example, if you are looking at your DNA, what causes it to be damaged? Well, it's the usual stuff, right? There's no surprises here. It's your diet. It's the same old crappy, sad diet, the standard American diet of processed food, high sugar and starch and lack of protective nutrients. So it's not only the bad stuff you're eating, it's the lack of the good stuff, what we call protective foods, that activate these mechanisms, whether they're phytochemicals or whether they're right essential fatty acids or whether they're right nutrients like vitamin D, these are designed to repair and heal your system to give you a metabolic tune-up. And then we identify how to eliminate those things in addition to your diet that may be causing a problem. It could be you have a load of heavy metals or a load of chemicals and pesticides or maybe using a ton of makeup or sunblock that has lead in it or phthalates or maybe you're drinking from plastic bottles that have BPA in them and other chemicals that continue to erode your health. So getting rid of all that stuff is really important.

The toxins that we are exposed to on a daily basis are things that we're eating. So if you're eating food and you look on the package and there's something that you can't pronounce, don't eat it. There's lots of chemicals that we put in our mouths every day. so eating a diet that's mostly whole foods, that's not packaged, doesn't have labels on it, is a good way to start. Also, drinking clean water is really, really important. Also, choosing where you want to live. If you go onto the website Environmental Working Group, they have some incredible interactive graphical maps of different places around the country that are exposed to things like the poly fluorinated chemicals similar to the Teflon and Teflon related products. And you can see where these compounds are in the United States. And if you actually overlay some of the areas where there's higher levels of cancer, you'll see that there's an overlapping related to a lot of these toxins. There is an excellent paper called the exposome, which is the sum total of all of the things that we are exposed to as people. and the exposome is related to things in the water, things in the air, things that we are exposed to with chemicals that we might breathe in. Old buildings can potentially have that with mycotoxins, especially moldy buildings, chemicals from paints or glues. That new car smell, which everybody likes, is really probably a-- I always tell people I would never buy a new car because that new car smell is a toxic chemical and you're gonna be smelling that for a good year or two. So not only will you save money buying a used car, but you'll be less toxic. So just being aware of these chemicals that we're exposed to in the air that we breathe, the water that we drink, and the food that we eat. Also, you know, a lot of people do body creams and lotions. You can just, you know, make sure that you're having these personal products which are least toxic things that don't contain.

Things like parabens and BPA and such. Instead of dividing everything into diseases and labels, the emerging science points to a different way of thinking about diseases. Rather than divide the body into organs, functional medicine approaches disease as a systemic problem. We have to treat the system, not the symptoms, the cause, not the disease. This completely redefines the entire notion of disease. How we label cancer is no longer in alignment with what we know about the origins of cancer. Two people who have the same cancer with the same name, like breast cancer, can have two completely different diseases, which require different treatments. Just because you know the name of the disease doesn't mean you know what's wrong with you or what to do about it. Classifying tumors by body site or organ misses the underlying causes and mechanisms and the pathways involved in that particular cancer. It gives us no information about how it manifested in that given patient. Now, two people with cancers in different parts of the body may have developed the disease for the same reasons. And two people with the same cancer in the same part of the body may have developed it for also different reasons. A patient with prostate cancer and one with colon cancer may in fact have more in common with each other than two patients who have colon cancer. So we need to look under the hood and find out what caused the illness to begin with. Many things can contribute to cancer. Studies show that diet, exercise, our thoughts and feelings, environmental toxins all influence the initiation, the growth, and the progression of cancer. If a nutrient-poor diet, it's also full of sugar, and lack of exercise and chronic stress and petrochemical pollutants and heavy metals can cause cancer, could it be that a nutrient-dense, plant-rich diet full of phytochemicals and physical activity and changing our thoughts and mindset and our reactions to stress and upregulating our detoxification might treat the garden where the cancer grows? In other words, treat the soil, not the plant. It's a foundational principle of regenerative agriculture and of regenerating your health. The good news is we can enhance our immune function and our immune surveillance through dietary and lifestyle changes, as well as specific nutrient and phytonutrient therapies. We can facilitate our body's own detoxification system to promote the elimination of carcinogenic compounds. We can improve our hormone metabolism and reduce the carcinogenic effects of too much insulin from our high sugar and refined carb diet. So here's what I really want you to get. One of the main underlying causes of all age-related diseases is this: insulin resistance, including heart disease, cancer, dementia, which is being called type 3 diabetes now, and of course diabetes, and even something called sarcopenia or muscle loss, which we will dive into in a later episode. This is really a unifying theory of aging. But of course, it's not the only thing. Toxins, infections, and even your microbiome are really important factors in cancer and overall aging. In functional medicine, we don't just address one thing. We address everything. Think of it like a 100,000-mile checkup on your car. Here's a cool example of how this works. There's a powerful new cancer treatment called immunotherapy that activates your own immune system to fight the cancer. And when it works, it's a miracle. But it doesn't work in everyone for various reasons. Now, one reason seems to have to do with your gut health and your microbiome. Turns out there is a very important beneficial bacteria in your gut that regulates your immune function called Akkermansia. It's a fancy name, but it's basically one of the microbes that lives in your gut. If your gut is unhealthy, and you have low level of this good bug, the immunotherapy doesn't work. But if you feed it with polyphenols, which are compounds in plants like from cranberry, pomegranate and green tea, things that likes to eat, it's going to grow and the immunotherapy miraculously will work. So you treat the host, not just the disease, that's the key. Now even if we have cancer risk genes, we can change how those genes are expressed. Our genes are regulated by things in our control, our diet, nutrients, phytonutrients, toxins, stress, infections, and other sources of inflammation. This is all good fertilizer for soil in the garden of our body. The key is learning how to cultivate that garden. The important thing is to figure out what works for you, develop a plan, and to stick with it. Now, as we age, our hormones change and they get out of balance leading to faster aging. Sex hormones go down, stress hormones go up, growth hormones go down, thyroid problems increase, and insulin goes up, all leading to a steady decline in energy, function, and vitality. And it kind of happens slowly, almost imperceptibly, so we barely notice. And one day, we wake up just feeling older. Things that should go up go down, and things that should go down go up. These hormones are all connected in a finely choreographed dynamic dance. And when they're in balance, you feel young and strong and healthy. And when they're out of balance, you feel tired, weak and old. And while it's common for these imbalances to occur, it's not inevitable. And getting your hormones in balance, and in harmony is a key part of aging well. And yeah, it takes a little more work as you get older, but it's doable. To keep your insulin low, for example, you have to really limit starches and sugars as you age, and you have to exercise more. You need to do things like meditate and do yoga to regulate your stress hormones. You need to lift weights and build muscle to keep testosterone and sex drive up. Hormones are the great communicators of your body, and they send signals and instructions everywhere. Your cells talk to each other through different messengers or languages. There is the endocrine language, which is your hormones. There's the immune language, which is your cytokines. And there's the nervous system language, also known as neurotransmitters. Your hormones are produced and controlled by your endocrine glands. These are the conductors or the command and control centers for all your hormonal functions. These glands in your brain are the hypothalamus and the pituitary, and they send signals from your brain to different parts of your body. For example, your stress response goes through your adrenal glands. Your blood sugar balance is through your pancreas. Your thyroid hormone is through your thyroid gland. Your sexual function and behavior is controlled through your reproductive organs like ovaries and testicles. Now, this network of glands sends and receives messages in a finely orchestrated symphony, and they have their effects through the whole body. Now, if we have imbalances in our hormones, we can experience advanced aging. And this looks like difficult and debilitating symptoms during perimenopause and menopause. It looks like a severe drop in testosterone, otherwise known as andropause in men. It can lead to increased belly fat, to fatigue, to low libido or sex drive, and lots more in men and women. And this isn't just something we need to worry about when we're 40 or 50 or 60. Imbalances in our hormones can occur in our 20s and 30s and they cause infertility and weight gain and muscle loss, fatigue, acne, severe PMS, and lots more. In this episode, we're gonna discuss the wide array of hormones that influence everything from our blood sugar, to our mood, to our sex drive, to thyroid health, to stress response, and lots more. So one of the keys to successful aging is to understand your hormones, to understand how they get out of balance and how to get them back in balance. And it's so common to have these problems. One in five women and one in 10 men have low thyroid function, and often it's not treated and diagnosed. In fact, over half of them are not diagnosed, and probably 90% are not optimally treated or balanced. Sex hormones obviously get different as we get older. Men testosterone levels drop. Women also have lower testosterone levels. They go through menopause and estrogen levels and progesterone levels drop, and that affects their well-being and their vitality and their energy, their brain function even. Thyroid often starts to dwindle as we get older because it's influenced by so many things, our diet, toxins, stress, and lots more. And of course, insulin is the most important hormone of aging, which we've talked about in the docu-series, and needs to be aggressively managed so that you keep your insulin levels low and your health high, your belly fat low and your muscle high. As you actually drive the changes around hormones, you see a lot of them have to do with something that we call sarcopenia, which is we lose muscle. And as we lose muscle, our sex hormones get worse, our adrenal hormones start to get worse because when you have low muscle, you have increased stress hormones like cortisol, you get lower growth hormone, which is repair hormone, you get more insulin. So everything is going the wrong direction. And the key to balancing your hormones and they're different for each one, is understanding what causes them to be out of balance and what helps them get back in balance and then systematically tweaking and applying it.

Sarcopenia is the loss of lean muscle mass and strength and agility that occurs with aging. But it doesn't have to. Sarcopenia is a major cause of increased aging and something we really want to work against. We know that when we maintain good, strong lean muscle mass, that helps with our mobility and it helps with keeping our joints stable and strong and without pain. And it helps us so we can get up and down off the floor and play with our grandkids. Maintaining good lean muscle mass is critical for overall health. When we are at rest, let's say we were an astronaut and went into space, or maybe we were just laying in bed because we weren't feeling well, we will lose 1 to 2% of our bone density every month. And of course with less bone density that increases our risk for bone fractures. Lean muscle mass is critically important for your bone density. Your muscles are pulling on your bones all the time and that stimulation, that when your muscles pull on your bones, it stimulates your bones to say, I better absorb more calcium. I've got to get stronger. So keeping your muscles strong is one of the best things we can do to keep our bone density strong.

Diet plays a big role. Exercise is a very important thing, especially resistance training. Managing stress to lower cortisol is important. All these things are important. But diet plays a huge role. And here's what happens as we age. We need more protein in our diet to build muscle. And here's what the science shows. Even if people can get away with it when they're younger, when they're older, they can't. And even studies that show, for example, improvements in health with lower animal protein, when they're younger, when they're older, if they don't have adequate animal protein, they can't build muscle. And here's why. All protein is not equal. Protein from a lentil is not the same as protein from a cow. And the protein from Animal protein has a high level of a very important amino acid called leucine. Now this amino acid is so important because you cannot build adequate muscle unless you eat about 2.5 grams of leucine in a serving of protein and you need about 20 to 30 grams of protein to build muscle after you eat. If you eat, let's say 10 or 15 grams of protein, your body can't turn that very effectively into muscle. That's why you see these guys who are weightlifters, they have this big whey protein shake after they work out because that gets turned into muscle. So you can use these strategies. You don't have to be like a giant bodybuilder, Mr. Universe or Mr. Universe, but you have to use a strategy of strength training with protein intake and the right kind of protein intake to build muscle.

It's so, so important.

So this is a really critical strategy. Muscle building, muscle strength, muscle quality, protein quality are all things we don't pay attention to as we age and they're more important than anything because the reason people end up in nursing homes is not because they have a disease. It's because they can't get up out of bed, they can't get up out of a chair, they can't tie their shoes anymore, they lose function. And I've seen people at 80, 90 years old who are strong and can function at a much higher level. My dad was a 88 years old and I saw him and he was dwindling. He couldn't get up out of a chair anymore. He was struggling with his daily functions of life. He couldn't tie his shoes. I said, Dad, I'm gonna, for your birthday, give you training sessions. Now he's 88 years old already, but I sent him to the gym. I paid for his trainer. He worked out three times a week and it was amazing to see the gains in his strength. I saw the videos that his trainer would send. It was just incredible. And he noticed how much more functional and happy and energetic he was. So we have the potential at any age to impact this. Now, it's important to understand that if you wait too long, it's harder and you may not be able to gain the full amount of muscle. So it's important to start early. I mean, I didn't. I mean, I started when I was 60, but I think I'm making up for it now. And I feel like I'm able to actually gain strength that I never knew I had. I mean, I used to try to do, you know, 10 push-ups at 50 years old, and I could barely do 10 push-ups and then I started, you know, working out a little bit and doing push-ups and that was my strength training. And I could do, like, 30 push-ups but by, you know, 29, I was, like, feeling it. And the other day, I just, like, dropped down and did 30 push-ups it was, like, doing three push-ups I could have kept going simply because I've been training myself to get stronger, and I think as we age is more important than ever.

We know that when we're at rest, if we're sick and we're laying in bed or if we're an astronaut and we go into space, we lose about 1 to 2% of our bone density every month. So staying active and keeping our lean muscles strong is one of the best things we can do both for overall health, for our joint health, for our strength, for our agility, as well as for our bone density. Nutrition is critical for strong bone density as well. And so we're always thinking about things like calcium, magnesium, boron, vitamin D, vitamin K, and a good protein source. All of these nutrients are really critical for building strong bones. So we've heard a lot about calcium over the years, and calcium is important for strong bone density, but we probably don't need to be supplementing with as much calcium as we used to supplement with. When I'm working with somebody who has osteopenia or osteoporosis and we need to make sure they're getting in enough calcium, one of the first things I do or one of my nutritionists does is we add up all of the calcium that they're getting in their diet. So if the recommendation for their age and their bone density is to get 1,200 milligrams of calcium a day, we look to see how much are they getting from food and then subtract that from how much they need and then maybe supplement with the rest. so you don't necessarily need to supplement with all of those 1200 milligrams. And you can get calcium from lots of different foods. People are always focused on dairy, but lots of foods have calcium. Sardines are a wonderful source of calcium. Salmon in a can, also a great source of calcium. All of your green, dark green leafy vegetables, collard greens, broccoli, almonds, all very good sources of calcium. So you don't need to always get it from dairy, or even if you can't tolerate dairy, there's many, many foods that you can get your calcium from. If you do supplement with calcium, I usually go with a calcium citrate and as I said, calculate the amount you need based on how much you are not getting from your food in a day. For men, we don't typically use calcium supplementation unless they really are having problems with digestion, absorption, or a very low bone density. And that's because there's been some association with calcium supplementation and prostate cancer. and even heart disease. So we wanna be careful with overusing calcium supplementation for both men and women. We also wanna make sure that the calcium is going to the bones and it's not going to the arteries, right? We know that if calcium gets deposited around the arteries, it can make the arteries less flexible and there could be more plaque production and increased risk of heart disease. So it's important that the calcium gets directed to where it needs to go. and there's two nutrients that really help the calcium go where it needs to go. The first is vitamin D. Vitamin D is critical for absorption of calcium, so you need to have enough vitamin D to absorb your calcium. We typically want somebody's 25-hydroxy vitamin D level in their blood to be around 50 to 70. That's a good range, especially if we're dealing with bone density issues. So if you have issues with bone density, make sure they're checking your vitamin D level and then supplement as needed. People need anywhere between 500 to 2,000 to sometimes 5,000 or even higher IUs a day of vitamin D to achieve a normal vitamin D level. And everybody is different. So if for you it may be something you want to check periodically to make sure you're getting the right supplementation of vitamin D, And then the second nutrient we're really paying attention to is vitamin K. Vitamin K is a fat-soluble vitamin that helps make sure that the calcium goes to your bones and not to your arteries. And so typically we want about 180 micrograms of vitamin K2 in a supplement. And there are many vitamin D supplements that have that K with it. You can also get, your body will make K2, which is the best form of vitamin K for your bones, in your gut. So it gets converted by some of the bacteria in your gut. So that's actually why changes in the gut microbiota influence vitamin K2 levels. You can get vitamin K2 naturally from things like natto, which is a fermented soy. They eat it a lot in Japan. It's a strong taste. And we also get vitamin K from our leafy green vegetables, collard greens, kale, spinach, broccoli, those are typically vitamin K1 and then the body needs to convert it into vitamin K2. But when you're looking for a supplement, go for the K2 form most of the time. So collagen is a really important nutrient for bone density and we sometimes don't realize how important it is. One of the things we know about collagen is that vitamin C is important for good collagen production. which is important for our skin and our bone density. So we wanna make sure we're getting enough vitamin C. We get vitamin C from our vegetables, our fruits. You know, we're always thinking about citrus fruits, but it's also in many other fruits like kiwi and in many vegetables like your peppers and your broccoli. Vitamin C is really rich in a lot of our citrus and non-citrus fruits and vegetables. Lifestyle has a huge impact on hormone balance. So by focusing on balancing blood sugar, that means getting some protein, good healthy fat, and fiber at every meal. That helps with balancing all the hormones in the body. We know that good exercise, daily exercise, helps with also balancing all the hormones. And managing stress is really important for maintaining good cortisol levels, supporting your adrenal gland, and that is resulting in balancing all the hormones in your body.

So in addition to the rhythmic living and the moderate exercise and things like meditation and yoga that can help balance the stress response, there's often nutrients that are really important to help support adrenal function and stress response. The B vitamins, like vitamin B5, for example, and also herbs like ginseng and Siberian ginseng and rhodiola and all these wonderful herbs that you can take to help support your adrenal response and make you more stress resilient. It's what the astronauts use. when they go in outer space to help them stay more stress resilient. So getting your stress response and balance is a really key part of healthy aging as we get older, particularly for women as they go through menopause. The second thing that happens is often the thyroid gets a little out of balance and the stress hormones make it worse. Diet can make it worse if we're eating gluten, for example, or exposed to environmental toxins. That can disrupt our thyroid. So sometimes people need a little bit of thyroid support and that could be something as simple as cleaning up the diet and reducing inflammatory foods. It could be simple as taking vitamin D and selenium and zinc, which help thyroid function, or iodine, which can come from seaweed, or sometimes they need a little bit of thyroid support. We use bioidentical thyroid hormone just to top them off. And often the numbers that you get when you go to the doctor look normal, but what normal means is it's the average kind of of the population. And if you have a sick population, the range is wrong. In other words, if you are Martian and you landed in America today, 75% of us are overweight. So that would be normal. It's not optimal, but it's normal. So we want optimal thyroid, which is actually something we know how to identify and balance.

The role that thyroid hormones play in aging can be very subtle, and there actually is a condition in medicine which is subclinical hypothyroidism. And what that basically means is that somebody's thyroid is slowing down, and that may manifest itself by an elevated TSH level or thyroid-stimulating hormone, but the patient's thyroid hormone levels are actually okay. And currently, the standard of care is that if somebody is having subclinical hypothyroidism, you just sort of watch them, There is evidence, however, if you look into the medical literature, that keeping the TSH level on the lower end of normal so that you have adequate tissue thyroid function is really the way to go. And also realizes that the way that most people are measured for hypothyroidism is just a screening TSH level. And TSH as a hormone level by itself is really inadequate to look at full thyroid function. So our bodies have TSH. TSH stimulates the thyroid to produce T4. Your body then has to take T4 and convert it into T3. T3 is the active form of thyroid hormone and then your body also produces a compound called reverse T3. So looking at the whole big picture of the thyroid is really, really critical. The other thing that I like to do for looking at thyroid function as a person ages is looking at thyroid antibodies. Thyroid antibodies are a little bit like the check engine light coming on in your body because you can have normal thyroid levels but if you have elevated thyroid antibodies that tells me that the body is attacking the thyroid and if you don't have overt clinical hypothyroidism, you're going to develop it down the road. So I really like to dial in thyroid as patients get older. older, although a lot of young people can actually have thyroid issues too. It's not just from aging, there's other things that can cause that. And then also, it's very important that people realize is that about one out of five people will have problems if they are hypothyroid and they're given standard of care, which is T4 thyroid medication, things like levothyroxine and synthroid. One out of five people have problems converting that T4 into the T3, which is the active form of the thyroid. So 20% of your patients, if you're just giving them a standard therapy, you're checking their TSH, you're giving them T4 levothyroxine, you're gonna be missing the boat and they're gonna be under treated. In that situation, what I typically will do is I'll give patients a form of thyroid, which is a combination of T4 with T3. There are various prescription medications like that, like Nature's Thyroid or NP Thyroid. You can also get thyroid compounded if you need to, or in some cases you can give patients T3 alone. Most patients in my clinical experience feel better when they get a combination of T3 with T4. And the nice thing about that is you can really titrate that according to how they're feeling and also according to how their blood levels are. The other thing, there's also a recent paper that came out in the thyroid literature saying that the optimal level for patients who are being treated with thyroid medication is to get that TSH level down to about 0.03 to 0.3. That's sort of the sweet spot. So really keeping that TSH level on the lower end, that's when people feel the best and that's when people are optimal with thyroid replacement. Iodine is needed for proper thyroid function and then also there's an enzyme in the body called 5 prime diiodinase, which is how the body cleaves off the T4. T4 stands for four iodines and T3 stands for three iodines. So when the thyroid molecule has three iodines, that's the active form of thyroid. So making sure that the patients have enough selenium. Selenium is one of those super micronutrients. There's been a lot of work by Bruce Ames about the multiple effects of selenium. It affects thyroid function. So looking at selenium levels, looking at iodine levels, looking at oxidative stress levels, all of those things play a role in optimizing thyroid function. There are some supplements that people can take to support the thyroid and also making sure that they're not having excess amounts of foods which are goitrogenic. Things like cabbage can be goitrogenic. and can cause thyroid enlargement. There are some rare cases where some patients may take some medications like amiodarone, which can cause thyroid problems or prescription doses of lithium, which can also affect thyroid function, but those are the major things to be looking at. So all of our hormones do naturally decrease and decline as we get older. In women, we call that menopause. In men, there's actually a term called andropause. So not only do women's hormones go down, but men's hormone levels go down. And what I would venture to say is that most people, most women probably don't need hormone replacement as they go through menopause. As long as you have your ovaries, the body is able to make sufficient amounts of hormones. You can measure the hormone levels and when the hormone levels go below the normal range that you would expect for their age, those are when people, would benefit by hormone replacement. Or if you combine that with a patient's symptoms, because everyone's different. You can actually have some people who are having symptoms and their levels are normal and vice versa. So you really have to look at the whole context and the whole big picture as far as what's going on. But definitely, you know, lack of estrogen in women. And estrogen is only one of the hormones that women have. Women have estrogen, they have testosterone, they have progesterone. There's three forms of estrogen. There's E1, E2, E3. We also have DHEA, we have cortisol, and all of these hormones interact together. The master hormone when it comes to the body, in my opinion, is cortisol. So oftentimes when people are having either too much or too little cortisol, when you get their cortisol levels into balance, that's related to your circadian rhythm, which is your sleep-wake cycle. the other hormones will oftentimes tend to balance themselves out. But there are times when men need hormone replacement therapy and women need hormone replacement therapy.

So one of the things that happens to men as they get older is, and often, I see this in 30-year-olds and 40-year-olds now because of our poor diet, is they tend to sort of increase belly fat and they tend to lose muscle. And when you do that, you accelerate what we call andropause, which is androgen is the male hormone and andropause is like male menopause. And it's a real thing and guys feel less focused, less motivated, less energetic, have trouble with sexual function, with sexual desire. They often, if it gets really bad, they get these big bellies, they get high levels of estrogen which is produced in your fat tissue. so they'll get man boobs, they'll lose the hair on their chest, the hair on their legs, and they kind of become more like women, but it's not inevitable. At any age, as a guy, you can reverse that trend and fix your hormones by fixing the thing that causes it to go down. By your testosterone going down, you're gonna have all those symptoms. It's called low T syndrome, and it's a real thing. but I see it mostly in guys who really haven't taken care of their health, who get the belly fat, who eat too much sugar and starch and sugar, because the bigger your belly, the lower the testosterone. The bigger your belly, the more insulin you produce. And when that happens, you get insulin resistance, and that's what causes low testosterone in men. So I see guys who are 40 or 50 who have testosterone levels of 90-year-olds. and that's not necessarily inevitable. So by cleaning up their diet, by strength training, lift heavy weights, that'll increase your testosterone. If you eat good fats, that'll help increase your testosterone. If you get rid of starch and sugar, that'll boost your testosterone. So often through natural strategies, we can help men get rid of all that estrogen, build up their testosterone naturally, and feel more vigorous and energetic and strong again. but again, sometimes men need a little help and that's okay. And using bioidentical testosterone, they're being delivered through shots or gel or even pellets sometimes can really help men with sexual function, sexual desire, building muscle and a knee. So I'm not opposed to hormonal therapy. I just don't think everybody should get it as a knee jerk reaction as part of aging and then we should use a lot of these other strategies to help optimize hormones in the absence of having to get bioidental hormones. But it's not bad if you have to do that. It just should be for the right person at the right dose at the right time.

Typically, a woman goes into menopause between the ages of 45 and 55. And perimenopause are those years before a woman goes into menopause. And that may be six years before they go into menopause. They may be in perimenopause. They may be in perimenopause for 13 years before they go into menopause. Every woman is different. but that perimenopausal time is a time where hormones are more erratic. They're not as regular. You may have cycles in perimenopause where you don't ovulate. So, and when that happens, your progesterone level doesn't go up as it does when you're regularly ovulating before you go into perimenopause. In addition in perimenopause, things shift back and forth all the time. There may be one month where you do ovulate and then the next month where you don't and then your periods can become more erratic. You can have some cycles where progesterone doesn't go up like it should. And as a result, women often feel a lot of symptoms. Sometimes women feel more irritable. They may notice that they have trouble with sleep. They may feel more anxious. They may have a harder time calming down their body. For some women, they get more hot flashes. These are all symptoms that are more common during perimenopause. and we can really help with balancing that in so many different ways. And one of the best ways that we can work to rebalance that is by supporting the adrenal glands. And why is that? Because the adrenal glands make hormones like cortisol. And if the body is under chronic stress and needing to take all of its hormones to make cortisol, then it doesn't have as many of those hormone precursors to make some of the other hormones that the body needs, like progesterone and estrogen. And so what's really important is doing things that help with balancing and supporting the adrenal glands. I think that's one of the best ways that we can help support a woman through those years of perimenopause. When we support the adrenal glands, that supports that transition that can be difficult for some women. And so you can support the adrenal glands with getting good sleep, maybe getting enough B vitamins in your diet, or for some women taking an extra B vitamin complex with methylated folate by doing some stress management techniques. We know that when a woman incorporates some meditation for 15 minutes twice a day, she's less likely to get hot flashes. And if she does get hot flashes, they're not as severe and intense. So there's a lot we can do to support the adrenal glands that support all the hormones in your body. For men, one of the things we focus on the most to help with balancing hormones is maintaining good lean muscle mass. We know that our body fat takes hormones and turns it into estrogen. So when we have more body fat, whether we're a woman or a man, we are converting more of our hormones like testosterone or DHEA and converting it into estrogen. So when our body fat increases, so does our estrogen level. And for women, that can increase risk of breast cancer and uterine cancer. For men, that can increase their risk of insulin resistance, prostate cancer, diabetes. But we also know that that results in men just not feeling as good. They don't have the same level of testosterone. If their body is taking that testosterone, and converting it into estrogen. So one of the best ways we can help improve that is by maintaining good lean muscle mass. So through strength training exercise, through keeping their body fat nice and low, or in the right range, we can help with preventing that conversion into estrogen and keeping the testosterone higher. We know that strength training and exercise stimulates production of testosterone, and we also know that when testosterone is high, we are more likely to have more lean muscle mass. So it all works together. When you hear the term bioidentical hormones, what we're talking about are hormones that are identical to the structure of a hormone in our own body. So there are bioidentical hormones that you can get from a regular pharmacy that are prescription medication, as well as bioidentical hormones that you can get from a compounding pharmacy. So bioidentical hormone just means that it's identical to your own body's hormones. For women, that may be something like estradiol, that's identical to your own body's estradiol that you have floating around. And you, as I said, you can get that from conventional pharmacies as well as compounding pharmacies. Bioidentical hormones are probably healthier hormones for us than a synthetic hormone. And there are many ways you can provide bioidentical hormones. You can give them transdermally, through the skin. You can give them as a pellet under the skin or a troche in the mouth. You can give them vaginally. You can also for testosterone, there are things that look like a deodorant that you can spread on your skin or you can rub it on your skin as well as well as injections of testosterone. When we're thinking about do we need to provide somebody with hormones, it's a very individual decision. we're always weighing the risks and the benefits. And, you know, what's important if you're thinking about hormone therapy is that you want to work with a provider to look at all your individual risks and what are the symptoms that you're struggling with. Can these symptoms be just improved with managing your stress better or changing your diet? Or maybe you need a little hormone to support you through the transition into menopause. for a period of time. We typically work to use the least amount of hormones we need to use for the least amount of time, but every person is an individual here. So it's important that we work with each person as an individual to make sure that they're not getting too much risk from the hormones if they need to use them, and we work to wean them off when they don't need them anymore.

Balance is the key to staying healthy, and nowhere is this truer than in the world of hormones. Don't think of your hormones separately. They're all connected parts of a whole that all affect each other. See, hormones are influenced by imbalances in all the foundational key seven systems of your body. They're all connected. And balance or imbalance in those systems means the difference between health and disease, between a vibrant, healthy life or a slow, steady decline. Now, our body is one whole system where everything is linked to everything else. So improving your nutrition, reducing inflammation, fixing your gut, boosting your energy system or mitochondria, optimizing your structural system like your muscles, and getting rid of toxins all support the normalization of hormone function, which then translates into better mood, more focus, healthier aging, and even better sex drive. Balancing your hormones is a process. but with the right steps, you can reverse your biological clock and live younger longer. Today we're going to discuss one of my favorite topics, brain health. Now, when you ask most people what they fear when it comes to aging, pretty much everyone says the same. They're scared of losing their executive function, their ability to think and remember, their ability to focus and stay energized. In short, they're afraid of losing their minds. We can get a new knee, even a new heart or kidney, but we cannot get a new brain. At least not yet. When we talk about healthy aging, we have to discuss brain health. Currently, one in three seniors dies with Alzheimer's or dementia. Over five million Americans are struggling with Alzheimer's, and changes can be found in your brain sometimes 20, 30, or 40 years before a diagnosis of dementia occurs. This means that we have a lot of time to heal our brains before we get into trouble. Most of us know we can prevent heart disease by living a healthier lifestyle, but are you aware that the same is true of our brains? Not many people are talking about how to live a brain-healthy life. Remember that unified theory of aging? The problem of insulin resistance caused by too much starch and sugar? Well, it applies to the brain too. Scientists now refer to Alzheimer's as type 3 diabetes or diabetes of the brain. We know that diabetics have four times the risk of getting dementia, and that even prediabetes can lead to predementia. Researchers are exploring, and I have seen in my own patients, the benefits of diet change in dementia, especially very low carbohydrate ketogenic diets. That's mostly fat and very low carbs. Amazing new studies show that aggressive lifestyle treatment and addressing underlying chronic issues like diabetes, high blood pressure, and nutritional deficiencies can actually slow and even reverse memory loss in people who already have early dementia. And remember, an ounce of prevention is worth a pound of cure. So starting early is really key. My youngest brain patient is nine years old. She's fine now, but has a high risk of dementia, which I'm sure we can prevent by starting early to optimize her health and her brain. Now memory loss is just one of the many challenges we see when it comes to declining brain health. Others include anxiety, depression, personality disorders, eating disorders, addictions, obsessive compulsive disorder, attention deficit disorder, and lots more. Now I believe that our brain is our most important and powerful organ. It's a three pound universe sitting at the top of our body that dictates our choices, that gives you personality, that allows you to fully engage in life. In my last docu-series, Broken Brain, I discussed a key insight that most people still don't seem to understand. And that insight is that your brain is an organ that's connected to everything else happening in your body. Fixing your brain starts with fixing your body. You have to optimize all the inputs and take out all the bad influences or bad information going into the system. I truly believe that the brain is resilient. It can recover and it can heal when given the right conditions. I've seen it over and over in thousands of my patients and the brain science backs this up.

Brain health is a really important topic. It comes up in almost every conversation with my patients and dementia seems to be the fear. Most of all my patients, somewhere in their list of complaints, is going to mention something about memory loss or forgetfulness and they start to worry, is this the beginning of Alzheimer's dementia? Quite honestly, they should worry, but not because they're having some lapses in memory or forgetfulness. But because science is showing us that you can begin the process of developing Alzheimer's dementia 20 to 30 years before you wake up one morning forgetting your wife's name. It's important when you're young to start thinking about your brain health. You might not want to and you might not think you have to because you're young. But as I said before, you need to start thinking about brain health before it's too late and changes begin. but what is happening in your brain when you're 30 and 40? You're maturing. You're probably starting to feel mature and really getting a good grasp of who you are. Well, that's because the brain is still developing, believe it or not. And there are different parts of the brain that are now becoming interconnected. And as those connections occur, you're getting more self-regulation, more self-control, and more awareness of your emotions. At the same time, your brain is still putting down myelin on your neurons. Myelin is an insulation that allows those neurons to fire and move information very fast. And the more myelin you have on your neurons, the faster you're gonna be able to think. And it's still happening at quite a rapid clip. It starts to level off by the time you're in your 40s or middle age. But in your 30s and 40s, you're still laying down a lot of myelin. Interestingly enough, in my practice, I do have a lot of 30 and 40 year olds beginning to complain of slower cognition, some brain fog, and even some memory lapses that they hadn't had before. And I think it has a lot to do with stress. Greater college debt, waiting to get married in your 30s, maybe even starting a family, while you're trying to get a foothold on your career, are a confluence of events that just didn't exist a generation ago. The first place to start in building brain power and avoiding early cognitive decline is building stress resilience. We all have stress. It's everywhere. But it's not meant to be chronic. It's really meant to last for seconds. The bear of the lion jumps out of the weeds. All of a sudden, you start to run. Your adrenal glands have pumped out cortisol, followed by norepinephrine. Now your vision narrows, your heart's pumping faster, your muscles are stronger than they were seconds before. Now you either get eaten or you get an opportunity to pass your genes on to the next generation. But it happens in seconds. When we're under chronic stress with marriages and work and kids and illness, and it's constant, our cortisol levels are going to be elevated. And that elevation in cortisol leads to problems that will result in early cognitive decline. High levels of cortisol actually have a huge impact on the hippocampus. It will cause dysfunction and shrinking of the hippocampus. And that's where you retain and form memories. Elevated levels of cortisol Also, impact the prefrontal cortex, and that's where you do your executive function, organization, and critical thinking. When the cortisol is too high, you're gonna see difficulties in those areas of your brain function. High levels of cortisol will decrease a hormone called clothe. Clothe regulates the aging process. It also provides your brain with resilience against toxins many of which can lead to Alzheimer's dementia. A really important study done at UCLA in 2015 looked at long-term meditators comparing them to those that didn't meditate at all. And they found that long-term meditators, people that had been meditating at least 20 years, had far greater volume of gray matter in their brain. Other studies have shown with just three months of meditation, you see structural changes in the brain that impact function. The corpus callosum, which is the band of neurons that connect the right to left brain, actually gets thicker. That allows for the right left brain to communicate and enhance your creativity. You also see an increase in the size of the hippocampus, that part of the brain that's responsible for retaining memory, consolidating it, and maintaining it. And you also will see a shrinking in the size of the amygdala, It's the amygdala is responsible for regulating fear, anger, and anxiety. So meditation has these great benefits that you can see in a very short period of time.

We do tests at the Ultra Wellness Center that look at the risk factors for people with neurodegenerative conditions like Alzheimer's, people with mood conditions, and people with addiction issues. and what you see in this particular genetic analysis, which we use called DNA Mind, it looks at these markers related to oxidative stress, inflammation, and brain-derived neurotrophic factor, or BDNF. When you have imbalances there and you've inherited these tendencies, it pushes your risk level up for developing neurodegenerative conditions. So it helps you to sort of preempt it. Again, just because you have the genes does not mean you're going to get it, but you may find that you are at much higher risk than your brother or your sister or your friend, and that's really where you get preemptive medicine. The earlier you catch neurodegenerative conditions, the better. It's a little bit sad because sometimes I will see patients here who have been having either Parkinson's symptoms or their Alzheimer's symptoms 10 plus years and then finally they find us here. And it's a lot harder to treat those conditions once they're more advanced because you have more destruction. It's sort of like if a building's on fire and it's been on fire for five hours versus five minutes, you can put out the fire a lot earlier. So, I have seen a lot of patients who have come to me and they're having problems with cognition, you can call it brain fog or forgetting. And when you clean up their diet, get them off of inflammatory foods, sugar, gluten, dairy are the big ones, any of the artificial foods, specifically one of the things I always like to emphasize to my patients is artificial sweeteners. Artificial sweeteners are ubiquitous, they're everywhere, and the artificial sweeteners are supposed to help you lose weight. And I've always tell my patients that I've never seen a person lose weight with diet soda, but I've seen a lot of patients gain weight with diet soda. And these also disrupt the gut microbiome. And then also food additives like food emulsifiers can lead to leaky gut, which in turn can affect the brain. So there's, there's definite things that you can do just, you know, nutritional wise and dietary wise that can prove a, uh, a person's, uh, cognitive function. And I've had some patients who have come into me. One, one in particular comes to mind. it was a woman who I saw, she came in with her husband, and she was told by her doctor that you've got Alzheimer's and get your affairs in order. And when we did a full workup on the patient, she had a whole host of things like Dr. Bredesen was talking. It's like a, you know, Alzheimer's is like a roof with 32 holes in it, and there's all different, you know, things where the water can leak in. So you want to look at all of those things. So we look at you know, heavy metals, we look at the oral microbiome, we look at the oral, the gut microbiome, we look at the genes that the person has, we look at their oxidative stress levels, we look at their glucose levels, we look at their insulin levels, we look at the whole big picture. And when she came in, she was having problems with conversation, she was having sort of a flat mood. And when we addressed all of those conditions, and it took some time, It was like she awoke, you know, the movie Awakenings with Robin Williams. It was like she awakened. It was like her brain woke up. That inflammation, that oxidative stress that was happening to her got turned off, like the gene processes got turned off, and she was back to being her normal self. She was then able to have conversation. She was able to drive her car. She was able to be independent. It was really quite remarkable. workable, and that was all without medication.

We always focus first on those lifestyle factors because they have a huge impact on your memory. We make sure they're getting good restful sleep and getting enough sleep, making sure they're getting those seven to nine hours a day. We make sure they're moving every day. We know exercise is critical for brain health. We know exercise is a great way to build BDNF, the brain-derived neurotrophic factor. so we make sure they're getting some exercise every day and getting some good strength training too to improve insulin levels. We focus on diet of course, because food is medicine. We make sure that they're not getting high levels of sugar, we make sure we're balancing blood sugar, we make sure that they have insulin, good insulin sensitivity, and we make sure that their diet is rich in phytonutrients. We work to manage stress. We know that when we're under stress, our memory doesn't work as well. When our cortisol levels are high, we're not going to remember the answer to that question or that person's name. So having some really good stress management techniques is critical for a well-working memory. And then we make sure they've got good relationships and networks. Make sure that they have good family and friends and interactions in their day. That can have a huge impact on how well somebody's memory works. We then go up into the matrix and look at how all the systems in the body are interrelated. We focus on any sources of inflammation. Sources of inflammation could be anything from your belly fat, too much visceral adiposity that's creating inflammation in the body and hampering memory. And we know that insulin resistance is tied to dementia and increased risk of Alzheimer's disease. And it's one of the major things we can do to reverse memory loss. We can lower and improve insulin sensitivity, and that can help improve everybody's memory. So we look for sources of inflammation like coming from the belly fat. We look for sources of inflammation which could come from underlying infections like chronic infections in the body. Does somebody have chronic Lyme or a chronic viral infection? Or do they have a chronic infection which is an imbalance in the good and bad bacteria in their digestive system? Or are they getting inflammation because of a chronic infection in their mouth? Really important to pay attention to. We always look at the mitochondria and say, what can we do to support the mitochondria? Is somebody taking a statin medication that is damaging their mitochondria's ability to turn their food into energy? So sometimes we look for medications that may be causing damage to the mitochondria or damage to some of the cells in the body. And we also work to support the mitochondria, sometimes with things like CoQ10 or other B vitamins. We of course focus on toxins. Toxins are unfortunately a major driver of memory problems, anything from mercury to lead to plastics and other environmental toxins. And so we work to see are there toxins in somebody's body and what can we do to lower them or help the body's detox system. We make sure that their transport system's working well, that they've got good circulation in the body, that they're able to oxygenate their cells, and then we make sure that their hormones are in good balance. We screen for insulin resistance, and if there is, we work to reverse it. We make sure that their stress hormones are in good balance and their female and male hormones are in good balance. All of those things are important when you're looking to see what somebody's individual risk for dementia is. I can't forget to mention also the B vitamins and B12. We see lots of B12 deficiency and so that's important to look for. So I will often do markers like a methylmalonic acid or homocysteine markers to see if somebody needs more B12 than the average person. And we do see some improvements when we supplement with higher doses of B12 in that situation for somebody's memory.

So, there's a great article that I read years ago in the Journal of the American Medical Association called Shifting Thinking in Dementia. And it's kind of had an interesting line in there which says, you know, we have categorical misclassification with etiologic imprecision. And what that means is we say someone has memory loss, and the reason for the memory loss is they have dementia. That's categorical misclassification. Saying they have dementia doesn't mean anything. It's just the name that we give to people who have memory loss, which is kind of stupid because it doesn't tell you anything about why. And second part of that sentence is etiologic imprecision. Etiology means cause. We're imprecise about the cause. We don't look at the cause. So there's no such thing as dementia. there are dementias and everybody's different and we have to treat each person differently. That is going to be the future of medicine. And we're hearing about it. Precision medicine, precision health. But most of that, sadly, has to do with what we call pharmacogenomics, which is matching the drug to your genes. Great. If the genes that you have make this drug work better with less side effects, It's good to know, but it ain't the answer and it's not what we should be doing, which is true precision health and precision medicine and precision nutrition and personalized nutrition, which is functional medicine. And that is the future. We're not going to call it functional medicine in the future. It's just going to be medicine, right? There are new terms like network medicine, systems medicine. They're all just placeholders because the future is being revealed in the science, and we're seeing it for the first time. It's a massive paradigm shift. It's like Einstein theory of relativity or Newton saying there's gravity. These were big ideas that have just blown people's minds. And they took decades and centuries sometimes to be accepted. Even evolution as a theory, is still challenged 150 years later. We're still people saying, nope, didn't happen. So I think this is where we are in medicine today. And if we are humble, if we are willing to look at the facts, if we're willing to change our paradigm, which is hard to do, we're going to see an acceleration in medicine that is going to lead to increased health, increased well-being and longevity like we've never seen before. And I'm just so excited to be alive in this moment. And I'm glad it happened before I got too old so I can take advantage of it. And that's what this whole docu-series about. It's giving you the knowledge and the tools to see the future today and make the future of medicine available to you right now. Dementogens are things that cause dementia. And we know so much about what damages our brain. They're brain damaging things. and there are some things that are obvious and some things not so obvious. Diet, or inflammatory diet, is the number one cause of dementogens. Processed food, sugar, starch, lack of protective nutrients. That is number one. Lack of certain things like exercise are also dementogens. Exercise is one of the best ways to activate BDNF, which is this miracle growth for your brain. Lack of sleep is a dementogen. At night, your brain has to clean up the garbage. And it's got something that's been recently discovered called the lymphatic system. It's like the lymph system of your brain. And unless you sleep and have good quality sleep, you can't get rid of all the metabolic waste. It's one of the most metabolically active, if not the most metabolically active organ in your body. and it has a lot of waste that's produced as a result of that metabolic activity. Well, the way your body cleans it up is this lymphatic system and it's active at night, which is how you clean up your brain. So sleep is so critical. Stress is a dementogen. We know that when your cortisol level is higher, stress hormone, that it literally shrinks your brain. they've seen tumors in animals that produce cortisol causing shrinkage of the memory center in the brain called the hippocampus. That's what shrinks in dementia. And when they take out the tumor, which lowers the cortisol, the brain grows back. So stress is a dementiogen. Toxins are dementiogens, environmental toxins, heavy metals, mercury, lead. Mercury is one of the most undiagnosed health risks that we have today in America that is almost never tested and almost never treated because we never learn about it in medical school. So, if we didn't learn about it, it doesn't exist. And, I personally had mercury toxicity, which caused my brain to not work very well and made me feel like I was demented. And, that's how I learned so much about it. But, it's all the environmental toxins. But, lead, mercury, are among the worst. And it's also lack of relationships. That's a dementogen. If you don't have social connections, social interactions, that affects your brain and makes it decline. Lack of meaning and purpose also. These are biologically active factors. They're not just emotional or psychological. They literally have biological impact on the structure and the function of your brain and every other part of your body. Certain foods can be dementogens that are allergens like gluten can be a dementogen, dairy can be a dementogen, depending on your personal reactivity. Your gut microbiome, if it's not healthy in there and you've got bad bugs growing, which a lot of people do and you have a leaky gut, that's a dementogen because that inflammation goes throughout your body and causes dementia or loss of brain function. So there are all these various factors that are identifiable, measurable, testable, treatable, that literally can take away all the insults that are causing your brain to decline and causing all sorts of problems. May just be brain fog, it may be depression, it may be ADD, and it may be true dementia or early memory loss. These are all things that we can do something about. I mean, I see so many people saying, you know, I don't want to know if I have the Alzheimer's gene because there's nothing you can do about it. Nonsense. We know now from rigorous research that aggressive lifestyle interventions, personalization and optimization of certain nutrients can actually slow and even reverse the course of dementia. So we're in a whole new era of thinking about this. It's so exciting. and that allows us through the use of the lens of functional medicine to diagnose and to treat these dementiogens.

And there are sometimes other things that.

Are not necessarily our lifestyle like infections. If you get Lyme disease or if you have mold exposure, these can also cause brain damage and they're treatable. Chris Christopherson had dementia, quote unquote, turned out he had Lyme disease. He was given intravenous antibiotics and his dementia went away. and I've seen many patients like this. So we have to really look deep and dig deep and be medical detectives and figure out what are the dementias for each person and how do we get rid of them? And then we need the other part of it, which is how do we restore the brain function? How do we create neurogenesis and neuroplasticity? How do we bring in the things that are reparative, regenerative and healing that actually can help the brain function better?

I spend a lot of time talking about lifestyle factors improving brain function, but there's also a very keen interest in nootropics. Nootropics are compounds that increase brain power and function. Nootropics can also be very beneficial in decreasing inflammation and repairing neurons after trauma. But the main focus for most people using nootropics is they want to enhance their brain function. They want more cognitive ability. They want more memory. They want to be able to organize and be more creative because they see that declining. Again, a lot of that may have to do with stress, but people are looking for that benefit. So nootropics can be very helpful for people who are trying to enhance their cognitive abilities. They're also very helpful in the area of dealing with cognitive decline and dementia. Many of the nootropics can actually show improvements in memory and cognitive function in those disease states. Now, most of us, surprisingly, or not so surprisingly, very commonly use nootropics. One of the most common nootropic is caffeine. You find it in tea and you find it in coffee. Caffeine can be bad for you if you overdo it, but it is a stimulant that has been shown to improve cognitive function, and mental endurance. So the good thing about caffeine is that it gives you access to other neurotransmitters in your brain like acetylcholine. Acetylcholine is really important in memory and learning. So we want to have a lot of acetylcholine. L-theanine is another compound that I use that will enhance the effects of caffeine and limit the caffeine-induced jitteriness. Studies have shown that the combination of caffeine and L-theanine actually can help you improve your ability to multitask. And a safe way to get both caffeine and L-theanine together is to simply drink green tea. A really interesting herbal compound that I use is called Herpazin A. Herpazin A increases the amount of acetylcholine in your brain, which is a neurostimulator and improves cognitive ability. The way Herpes Zoster works is that it blocks the action of something called acetylcholinesterase. Acetylcholinesterase breaks down acetylcholine. So by blocking that enzyme, you allow levels of acetylcholine to rise. This is actually a target for pharmaceutical companies who are trying to treat Alzheimer's because there are lower levels of acetylcholine in the brain of Alzheimer patients. But for an average person, using Herpes Zine can improve cognitive function and speed of task performance. My favorite nootropics are peptide nootropics. So peptides are synthetic proteins that are 50 amino acids or shorter. Peptides are designed to enhance naturally occurring physiologic processes in the body. Specifically in the brain, neuropeptides or zootropic peptides can increase BDNF. And we know that BDNF increases the number of connections between neurons and speeds up transfer of information. These peptides can also increase nerve growth factor in the brain and the periphery and therefore have a role to be played post-trauma or other injuries to the brain. The reason why I like peptides a lot is because they have lasting effects and they can change the neurologic structure of your brain, which differs from the temporary effects that you get by just raising chemicals for a short period of time with herperezine, caffeine, or l-theanine. My favorite of all of the peptide nootropics is Dihexa. Dihexa was developed at the University of Washington The key thing about Dihexa, it can enhance neurogenesis and synaptogenesis at multiple connecting of neurons a thousand times more than brain derived neurotrophic factor or BDNF, which is the natural compound that your brain uses to do that. Dihexa has been shown to improve cognitive function is shown to improve memory and learning. There's a lot of hope and promise in using it for patients who are having cognitive decline and early stages of dementia. Those research studies are being done now. Cerebrolysin, another nootropic peptide that is much more known about than Daxeza. Cerebrolysin has been shown to have really great benefits post-stroke and post-trauma like concussion in the brain. It has a neuroprotective effect that is enhanced by its ability to also raise BDNF and nerve growth factor. It can also, because of the enhancement in nerve growth factor, help with peripheral neuropathies. So these are all of the nootropics. We have natural compounds and then we have synthetic peptides. They're all really effective in helping to protect the brain keep it from aging and enhancing brain performance. I do recommend to all my patients before we start using nootropics that we really dial in the lifestyle measures. We work on sleep, we work on stress reduction and resilience, and we get them exercising. In fact, the first prescription I write for most of my patients that are having anxiety, depression, or memory lapses is one for exercise. I want them exercising at least 20 minutes every day. So remember, if you are going to do nootropics, they are supplements that you can buy, start them slow, titrate them slowly so that you can make sure that you tolerate them, and you don't have any side effects.

Your entire body and all the core systems in it interact as a single sophisticated symphony. You're one whole person and all the pieces of your biology and your unique genetic code interact with your environment to determine how sick or well you are in this moment. This means your body and your mind are connected as well. The body and the mind are a single, dynamic, bi-directional system. What you do to one has enormous impact on the other. I've said it before and I'll say it again. What you do to your body, you do to your brain and vice versa. We know our mind can dramatically influence our health. your thoughts, your beliefs, your attitudes, traumas, life experiences directly influence your biology. Your cells are literally listening to your thoughts. And the body directly and powerfully influences the brain. Things like nutritional status, hormone imbalances, food allergies, toxins, digestive immune or metabolic imbalances, all these influence our mood, Behavior, attention, attitude, and memory. We need to honor this bi-directional relationship in order to reclaim our brains and live a life of vitality. The most powerful tool you have to change your health is your fork. Food is not just calories or energy. Food contains information that literally talks to your genes and then turns them on or off and affects their function moment to moment. Food controls your hormones, your immune system, your brain chemistry. It even controls your gut microbiome and your detoxification system. And of course, it controls your structural system because it's what you're made of. You are literally what you eat. So ask yourself, do you want to become a Twinkie or a raspberry? The most exciting thing I've heard in a long time is that the Rockefeller Foundation is supporting a research effort to map out the tens of thousands of molecules in food, things we've never discovered before, and what they actually do using the most advanced technology in artificial intelligence, creating a literal periodic table of medicinal molecules in food. I get excited about that. I don't know about you, but it makes me really happy. It goes way beyond what we think of as food. Of course, protein, fat, carbs, fiber, vitamins, minerals, yeah, that's food. and they dig deep into the realm of food as medicine, exploring the realm of what we call phytonutrients. These are plant-based chemicals that have medicinal properties. When you eat, if you eat a whole foods, plant-rich, nutrient-dense diet, you are literally eating your medicine every single day. Food is the fastest acting and most powerful medicine you can take to change your life. and it works fast, literally in minutes, to regulate almost every single function of your body, for better or worse, depending on what you eat. Yes, we are stuck with the genes we got from Mom and Dad, but here's the headline news: you: have amazing control over how those genes are expressed, and the biggest factor controlling your genes is what you eat, or sometimes what you need that you don't eat. Think of your genes as the software that runs everything in your body, just like your computer software. Your genes only do what you instruct them to do, like with the stroke of your keyboard. The foods you eat are like the keystrokes. They send messages to your genes telling them what to do. They create health or they create disease. We know that poor diet is linked to many preventable lifestyle diseases like type 2 diabetes, many cancers, heart disease, dementia, and lots more. We also know that a real whole foods diet that's rich in these phytochemical dense plants that has clean protein, plenty of fiber, and healthy fats can prevent, treat, and even reverse most chronic diseases. You see, food impacts each node of the functional medicine matrix that we discussed in episode one. It can boost your vascular system, your immune system, your hormones, your detox system, your energy system, your microbiome, and everything in between. And there are specific functional foods and superfoods that assist with things like DNA repair, stem cell activity, and that feed the healthy bugs in your gut. This means that there are foods that can actually fight disease. more importantly, there are foods that literally create health. Let's just take COVID-19 for example. Just one study found that if you have good levels of selenium in your blood, you are three times more likely to be cured of COVID and recover. But if you have low levels, you are five times more likely to die. That's a 500% increased risk of dying. That is massive, and that's just one nutrient. And it's easy to get from a few Brazil nuts, but of course don't have more than two to four a day because you can OD. Now, I don't know about you, but I want to incorporate as many of these disease fighting foods as possible. In this episode of the Longevity Roadmap, my team will walk you through our favorite functional and superfoods that can help you make your health span equal your lifespan. Now, I don't want you to think that you can eat a diet of junk food and just incorporate a few of these superfoods to live longer and healthier. Extending your health span and making your health span equal your lifespan requires a complete lifestyle overhaul. So we're also gonna discuss how to personalize your diet, how to test your nutritional status, how to balance your blood sugar, and lots more. So let's dive in. So the Pegan diet essentially was a goofball joke I made once on a stage with some friends who were fighting or were a Paleo doc and a vegan doc. And I just said, well, if you guys are Paleo and you're vegan, I must be Pegan. But then I thought about it and what are the common principles that most diets, even in the diet wars, have in common? And what I realized was there was far more in common with being Paleo or vegan, which are the extremes, than with the traditional American processed SAD or standard American diet. What are those principles? Well, both agree that we should be eating a plant-rich diet that's full of colorful fruits and vegetables that are incredibly nutrient dense and full of phytochemicals. We should be eating good quality fats like olive oil, avocados, that we should be eating omega-3 fats, which are so essential from us. So we should be eating a diet rich in high quality seafood. that doesn't have heavy metals and mercury. Things like sardines and mackerel and herring and anchovies and things that I love and my wife doesn't love. That we should be eating a diet that's got whole grains and beans, but not whole grain flour. So not whole wheat flour, not even brown rice flour. Those are dangerous, but literally whole grains. And the more weird the grains, the better. Things like black rice, or quinoa or red rice or buckwheat. I mean, buckwheat is an interesting one. There's a form of buckwheat from the Himalayas that is the most powerful superfood on the planet that's anti-inflammatory and regulates all these pathways. And the good quality beans aren't too starchy. So these are the basic principles. And if you're eating animal products, you wanna make sure they're regeneratively raised. There's an incredible body research now showing that grass-fed regeneratively raised animals actually contain phytonutrients, which are plant-based compounds that you wouldn't expect to see in animal food, but that are there because of what the animals are eating. So you're not only what you eat, you're whatever you are eating already ate. So we have an incredible strategy for eating a diet that is rich in all these things and is including all these protective foods and removing all the harmful foods. So getting rid of the starch and sugar, a little bit, it's fine, but we shouldn't be eating flour on a regular basis, whatever it is. We shouldn't be eating a lot of sugar or any form of sugar, artificial sweeteners. Occasionally it's fine, but it's not a staple. It's a treat. And we definitely shouldn't be eating things that aren't food that are in our food, like pesticides, hormones, antibiotics, additives, preservatives, artificial sweeteners, chemicals, like those just snapping our food. And another principle is if we're eating dairy, we should be very smart about what we're eating. Most modern dairy is conventionally grown, is got a lot of hormones and a lot of inflammatory proteins that are because of how we've raised the animals and bred them to produce a certain type of casein, that causes all these consequences of inflammation and gut issues. But if you have, for example, heirloom cows or sheep and goat, you don't get the same level of casein. And if you can tolerate it, those are fine to include in your diet. But for most people, they don't tolerate it so much, and most people are lactose intolerant. So those are the principles of a Pegan diet that we can include in designing our daily meals. So, for example, yesterday, I had shashuka, which is a cheated, but it's a Moroccan dish with red peppers, tomatoes, spices. It's made from whole ingredients, and I put it in a little cast iron pan. I broke some pasta raised eggs in there, and I baked it. So it's like baked eggs, and it was a delicious breakfast, actually. Made something the other day. It was kind of fun. I made cashew waffles because don't really eat waffles very often, but I had a friend over, a little kid, and I made cashew waffles, which is cashews and eggs and almond milk. Pretty simple and it turns into waffles, believe it or not. For lunch, I would often have a salad. So I'll make a nice big salad with tomatoes and olives and avocados and pumpkin seeds. I'll open a can of mackerel or sardines or herring often on the side and eat that with it. that's lunch. I use olive oil, vinegar, salt and pepper, really simple. Dinner is usually some form of high quality protein, so I'll use tempeh or tofu. I'll have grass-fed beef occasionally, pasture raised chicken. I've had fish. For example, I like black cod and salmon and some of these other fish that are low in toxins. I'll make lots of veggies, so I'll literally have the protein as a side dish. and I'll have a mountain of, whether it's stir fried bok choy or broccolini, artichokes. So I'll make two or three side dishes of vegetables and I might have a piece of dark chocolate after dinner. So that's essentially what I eat and it's essentially what is going to help promote longevity. I use a lot of spices, I use a lot of good quality fats, I use a lot of veggies and colorful veggies, and I really try to focus on not the five to nine servings, which is the minimum, right? That's the minimum. And a serving is half a cup. So that would be like two cups of vegetables. I think we should be having eight to 10 cups of vegetables a day. And it's not easy to do, but I like to do it. Sometimes we make a, what we call an Alkalizer Shake in the morning, which is lots of veggies, cucumber, celery, greens, avocados, blend it all up. and my wife likes to take all the vegetables and freeze them. So we have them in packets, and we just throw it in the blender, and then we have this nice cold green smoothie in the morning. There's probably like five cups of vegetables. So there's a lot of ways to sort of hack the process, but getting your veggies and your phytochemicals is so important because so many of the pathways related to aging have to do with including these phytochemical rich compounds, whether it's green tea, or quercetin, which is found in onions, or resveratrols in grapes, or turmeric, which is curcumin, which is in curry, including all these as a regular staple in your diet. And if you do that day after day, day after day, and are consistent, you will see the benefits over the long term in terms of your metabolism, you'll increase your organ reserve, you'll decrease body fat, you'll increase muscle mass, You'll reduce inflammation, you'll increase your antioxidant enzymes, you'll boost your mitochondria, you'll improve your brain chemistry, all the things that we want as we age. So food is the most powerful drug on the planet. It is the place to start, and it works anytime at any age for anybody.

So carbohydrates are a necessary macronutrient for our health and well-being. But as most of you know, there's a wide range of carbohydrates. so on one end may be something like simple sugar or soda. That's a carbohydrate that's really broken down and absorbed really quickly into the body causing insulin spikes which causes inflammation and we all know that's not good for us. And then on the other end that may be something like broccoli, right? It's also a carbohydrate but it's slow to get digested and absorbed into the body and it influences our body in a much different way. So all carbohydrates are not equal as we know, and carbohydrates are really important, necessary food for our health and well-being. We just want to make sure we're making the right choices of carbohydrates. We want to be choosing those healthful carbohydrates. And of course, most of us all know, okay, we want to avoid the simple sugars and we want to eat more of the vegetables. But so what about the in-between part? The in-between part is where people have a lot of confusion many times. and they're like, well, what about bread? And what if it's gluten-free? And what if it's whole grain? And what if it's, what about potatoes? And what about, you know, and what about beans and legumes even? So there's a continuum of carbohydrates. We've got our vegetables and then we've got our beans and legumes. For most people, beans and legumes are a wonderful food that's rich in fiber and is good for us. For some people, they could be too high in carbohydrate. And so we have to think about that. And then we've got the refined and processed carbohydrates, right? We know we wanna eliminate those. We wanna avoid things like cookies and crackers and baked goods most of the time. And even things like breads and pastas, they're not usually very nutrient dense, which means per calorie, they're not giving you all the nutrients your body needs. as much as let's say a sweet potato. So you always want to think about, I want a better carbohydrate option. So my root vegetables are going to give me more vitamins and minerals per calorie than something like pasta or bread would. It doesn't mean for most people they can never eat pasta or bread, but those are better choices, right? So where does somebody fall in terms of how many carbohydrates they can tolerate? You want to just listen to your body. to figure out what's the right amount of carbohydrates for you. First of all, you don't want to just have your meal be all carbohydrate because most, I mean, I don't think I've had any patient who feels good with that, right? Pancakes with syrup and orange juice, all carbohydrates and most of the time people don't feel very good after they eat a meal like that. What is the amount of carbohydrates that your body can tolerate? Monitor how you feel after your meal. What's your energy level like? How is your weight? Are you still gaining weight when you don't want to? If you're still gaining weight when you don't want to, maybe you need to cut further back on carbohydrates. If your digestion doesn't feel good after eating some higher carbohydrate meals, maybe some even the root vegetables or for some people the beans and legumes, they may need to cut back there. So it's very personalized when we determine how many carbohydrates somebody can tolerate. For all of us, we want to eliminate the simple sugars and the refined carbohydrates. And then the amount of whole grains, root vegetables, and beans and legumes somebody can tolerate really does depend on their individual health. So for example, if you've got somebody with a lot of insulin resistance, they've got a high fasting insulin, they've gained a lot of weight around their belly, you're seeing skin tags that may indicate insulin resistance, their hormones are out of balance, their periods are irregular if they're a woman, if they're a man their testosterone is low, right? If we're seeing signs of metabolic syndrome, we typically cut back further on carbohydrates. That helps people feel more satiated and when we increase fat a little bit in their meal, make sure they're getting enough protein and cut back more on the grains, even if they are whole grains. Sometimes people just feel better and they'll get to their goal faster. If your metabolism is really good and if you don't have any signs of metabolic syndrome, you may not have to worry about whole grains and you can enjoy some of those whole grains that are rich in fiber like quinoa and brown rice and even some whole grain breads within your meals and feel really good and satisfied with that. So it really depends on the individual person. The other area we really look at when we're personalizing somebody's diet is we're looking at what are their symptoms? What are they concerned about? What are they complaining about? And we talked about if somebody has that metabolic syndrome or the pre-diabetes picture, we're cutting back more on carbohydrates, leaning more toward vegetables for their carbohydrate source, getting a good source of fat, healthy fat, and protein at every meal. Protein is an essential macronutrient for our health, and we want to make sure we're getting enough. We don't need too much protein, but we also don't want too little protein. So just the right amount is really important for overall health. So about 1 gram per kilogram per day is what's recommended for protein intake. so if you are about 150 pounds or 70 kilograms, you want to be getting 70 grams of protein in your day. What I recommend people do in general is to divide that protein throughout all their meals. They don't want to eat it all at one meal at night. They want to have some protein at each meal of the day. So if you eat three meals, you would want to have 20 to 25 grams of protein at each meal. That really helps with everything from focus and keeping your blood sugar more stable to healing in your body, proteins necessary for your cells to heal, for good collagen production, and for detoxification. As we get older, we need more protein. There's a few reasons for that. One, we tend to eat less calories as we get older, and we don't always digest and absorb our protein as well as we get older. So for patients after the age of 65 maybe or 70, we're recommending more protein in their day. So they need more like 1.2 to 1.5 grams per kilogram per day. So for that 70 kilogram patient, we try to get them up to 105 grams of protein in a day. And that can be hard for some people because they're eating less calories and they're not always reaching for protein-rich foods. In general, I recommend that people balance their protein sources. So you don't want to get all your protein from animal products, but you don't want to get, for some people, if they get all of their protein from vegetable sources, we can see deficiencies over time. So in general, we work on balance. We work on a balance of animal and vegetable protein. So mix it up. Try half the time getting your protein from beans and legumes and nuts and seeds. and the other half of the time getting it from wild caught salmon or sardines or grass fed beef or eggs. Mixing it up so you get some from both animal and plant sources is a great general way to get what your body needs. Sometimes we see people showing signs of protein deficiency because they're not digesting or absorbing their protein well. So if we see things like weak nails or hair loss or lackluster skin or maybe they get bloated after they eat. Maybe they feel really full after they have some animal protein or it just feels very uncomfortable in their stomach. It feels hard for them to break it down. If I see any of these signs, I say, oh, maybe somebody's not digesting or absorbing their protein well. And then we have to ask that question, why? You know, we have to look for things like, antibodies, an autoimmune disorder that can damage the cells in the stomach called the parietal cells that produce acid. And that's a very common cause of having a hard time with breaking down protein and absorbing it. We also look for things like dysbiosis or an imbalance in the good and bad bacteria in the digestive system because if there is that dysbiosis, that can cause more inflammation And then if there's inflammation in the digestive system, your digestive enzymes don't work as well, and you don't digest and absorb your protein as well. So if that's the case, we've got to work to rebalance that gut microbiota. Many times people will benefit from some sort of digestive aid for a period of time, like a digestive enzyme or something to increase stomach acid, like bitters or betaine HCL, for a period of time to help them break down and digest and absorb their protein better. if somebody has more concerns with autoimmune disease, maybe they've got a lot of autoimmune disease going on, they've got a lot of joint pain from rheumatoid arthritis, maybe they've got a lot of digestive issues, maybe they've got a lot of inflammation in their body, many times we'll try some elimination diets. Elimination diets are a great way to clear the playing field, to see if any foods are triggering inflammation in that person's body. To see if any foods are triggering that autoimmune process, to see if any foods are triggering their digestive issues, to see if any foods are triggering fluid retention and weight gain, or headaches, for example, or asthma. So comprehensive elimination diets are a diet where you pull away very commonly eaten foods, as well as you pull away alcohol and caffeine, you pull away gluten and dairy for a period of time, you even pull away corn and soy and red meat sometimes, foods that are very commonly eaten and foods that commonly increase inflammation in people's body. And most people, when they're doing a comprehensive elimination diet, work with somebody to like a nutritionist to see to make sure they're doing it in the right way. But there are some good elimination diet programs out there that you can try on your own as well. And when you remove those foods, you want to remove them for at least three weeks. That can help give you an idea of how much that food is impacting your health. The most important part of an elimination diet is the reintroduction. So when you reintroduce those foods, you want to introduce them one at a time and really get a sense of is that food causing my symptoms? And that's a great way that you can see how much food is impacting your health.

Well, I would say that, you know, any foods that, that nurture the microbiome. So things like fermented foods, sauerkraut, kimchi are also great foods for nurturing the gut microbiome. I would also say that the spices, things like turmeric, which is also a good food for overall immune function. Mushrooms are fantastic. The mushrooms have multiple, multiple health benefits. They actually are very good prebiotics, and they also help to some specific mushrooms can raise natural killer cells. So things like shiitake mushrooms, maitake mushrooms are excellent for the gut microbiome. Quercetin is a phytonutrient. It's found in things like apples and teas. And what we find is that quercetin.

Has.

Multiple benefits and it has a polyphenolic component to it and it also actually helps with the synthesis of the tight junctions. So having quercetin in the diet can actually keep the gut healthy by keeping the tight junctions healthy. So for those who don't really conceptually understand leaky gut, a simple analogy to leaky gut is having a house with a screen in door. And the screen door allows the air to come in, but it keeps the bugs out. And when your screen door has holes in it, the air comes in and the bugs come in. And that's essentially what's happening when your body has increased intestinal permeability, which is really sort of rampant. Every time anybody eats a food that contains gluten, you'll get transient leaky gut. If you overeat fatty foods, and we've all experienced that where, you know, that I call it the post Thanksgiving Day dinner where you get a lot of food, there's a lot of fat, and you get that sluggish sensation. Part of that is that you're getting transient metabolic endotoxemia, and you don't want to have that all the time. And these high fat foods, specifically processed fats, not that fat is bad for you, but it depends on the quantity and the type of fat, those types of things will increase leaky gut. and then also making sure that you're not exposing yourself to things like the non-steroidal medications, things like ibuprofen and naproxen, antibiotics can affect it, proton pump inhibitors can do it, and stress. So all of those things that we can use to protect our gut are really important. And then again, a simple thing to do is have high quercetin in the diet. Oftentimes when I'm treating patients therapeutically, I'll actually use prescription strength or nutraceutical forms of quercetin in powder form, which I'll add to other things to help heal the gut.

Our body is always regenerating itself. We have stem cells in our body that help our cells heal and regenerate after there's been damage or injury. We know that foods like chocolate and tea, they have a lot of components in them that actually can help repair damage to our DNA and help repair damaged cells in our body. We know that purple potatoes, for example, the phytonutrients in them can have a tremendous benefit in terms of helping heal DNA damage in our body. Turmeric is a bright orange root vegetable that's a phenomenal spice that's used in cooking all the time. It's rich in curcumin that has a lot of anti-inflammatory and antioxidant capacity in it. Turmeric is a wonderful spice that can be added to many different foods, We know that when foods have more spices added to them, we see less inflammation after a meal. If you take two the same meals, one that has two tablespoons of spices and one that does not, all other things being equal, the food that had the extra spice in it, people have less inflammation after that meal. They can look at that with markers of inflammation, which is pretty phenomenal. So spices are part of those phytonutrients that have a lot of really healthful benefits. in our body and we want to incorporate more spices into our day all the time. We also know that things like sulforaphane, black tea, coffees even are also really rich in these phytonutrients that can help with DNA repair and stem cell production in the body. So there's a lot of foods that we can eat that can help improve the functioning of our immune system. So we know that oysters are a wonderful food that are rich in zinc. Zinc is really important for overall health, but also for overall functioning of the immune system. We know that people who don't get enough zinc, their immune system does not work as well. They may have follicular onions are rich in thiols. These are sulfur-rich compounds that help support the body's detoxification capacity. So you want to incorporate these garlic and onions into most meals of the day whenever possible.

So the research on stem cells is exploding. And what's exciting is that there are some simple things we can do every day to enhance our stem cells. Things like food. Food is medicine. Fish oil, for example. Curcumin, which is basically coming from turmeric that you make curry with. Green tea. And lots of other plant phytochemicals, these compounds in food that are from colorful fruits and vegetables that help to enhance our health in many ways, including stem cell production. There's a whole field of regenerative medicine out there, and these therapies are not your typical therapies. Drug therapies typically work on one pathway that either help or hurt or interrupt some function to change your biology. That's what drugs do. They also have side effects, and they also are not always so effective. They're marginally effective. But there's a whole set of tools out there that are emerging that are regenerative therapies that do things in a broad way that aren't treating a specific disease or pathway that activate all the healing mechanisms that we need to activate to age well. They reduce inflammation. They increase your antioxidant systems. they increase the function and number of your mitochondria and energy production, they enhance brain repair, they enhance tissue repair and healing, they decrease fat storage, they increase lean muscle mass, they increase cognitive function and brain chemistry. And they do this by a mechanism in the body called hormesis, which is essentially where a stress is induced to then create a healing response. So a little bit of stress on the system creates a healing response. And I'll give you a great example of how this happens in nature. Have you ever had a wild strawberry? A wild strawberry is like this big, but the explosion of taste and flavor is unbelievable. Now, you might get a conventional, commercially raised strawberry, it looks red and beautiful, but kind of tastes like, you know, cardboard with very limited flavor and juiciness and ripeness. When you look at why does that wild strawberry have so much flavor? It's because it's hard to be a wild strawberry. You don't have somebody taking care of you and taking the weeds out and watering you and giving you fertilizer and doing all these things. You have to work hard. And so this stress on the wild strawberry creates a whole series of increased protective compounds called phytochemicals that help that strawberry defend itself from all sorts of injury and danger. Well, we're kind of like the conventional strawberry. We don't have any of these stresses on our system and we don't really respond in this way. And organic food's a little better, regenerative food's great, but wild food is the best. If you want to turn off the genes that create disease, and turn on the genes that lead to health, you have to focus on the quality and the type of food you eat. And one of the best things you can do for your health today is to shift from a nutrient-poor diet to a nutrient-rich diet abundant in plant foods such as fruits, veggies, nuts, seeds, beans, whole grains, and seafood, and even regeneratively raised animal foods, which surprisingly contain good levels of phytonutrients because of the grass they eat. This way of eating improves the expression of hundreds of genes, thousands of genes, that control insulin function and obesity, and they help address almost all chronic diseases. For example, the array of colors in veggies contains 25,000 beneficial chemicals. Our hunter-gather ancestors ate over 800 varieties of plant foods, we don't consume a fraction of that anymore. I always say eat the rainbow. Load up on reds, greens, blues, purples, and yellow foods. Focus on lots of superfoods that we discuss in this episode. Also include healthy fats like olive oil, nuts and seeds, avocados, seafood rich in omega-3 fats, and organic and grass-fed meat and animal food. Eating this way can reduce inflammation, it'll boost your detox system, it'll balance your hormones, it'll improve your brain chemistry, it will enhance your ability to produce energy in your cells, and it will provide lots of antioxidant protection, preventing disease and keeping you younger longer. Now, if knowing all this doesn't make you want to upgrade your diet and upgrade your biology, I don't know what will. We all want to know what it takes to live a long, healthy, happy life. Is it just good genes? Well, that certainly helps as part of the equation, but it's so much more than that. You might have heard of the Blue Zone communities before. The regions around the world with a concentrated amount of centenarians, these people who live to be a hundred and beyond and do it well and vibrantly. So what do these communities have in common? Well, they're able to evade the chronic lifestyle diseases that we've been discussing throughout this docu-series and to live long, healthy, engaged lives. We call this the rectangularization of the survival curve, which is a rectangular shape of the survival curve versus a slow gradual decline as we get older. Instead of a long slow gradual decline into chronic disease and disability and a long slow painful and often expensive death, they live long, vibrant, healthy, active lives and die very old, quickly, painlessly and cheaply, meaning their health span is their lifespan. Which path do you want to take? What's their secret? Oh, my friend Dan Buettner discovered that there are certain common characteristics among Blue Zone communities that can significantly contribute to a longer health span and, of course, lifespan. And these include community, our lifestyle, spirituality and movement. Incorporating key and Powerful practices in each of these areas can create health and neglecting them can create disease. In this episode, we're going to consider all these factors that add up to create an extended health span and a place where your health span equals your lifespan and it's very long.

Blue zones are areas in the world where people have the longest longevity. People live the longest and live the healthiest. And so they've been studied really carefully to say, well, why are people so healthy in these blue zones? And it's really fascinating. There's some things that they do in common that helps them have a long, healthy, vibrant life. And one of the first things that we notice is that people in blue zones incorporate exercise into all aspects of their day. You know, they are maybe chopping wood and walking more, going for bike rides. We know that people in blue zones are a part of a community. they have a sense of purpose. We know that the people in blue zones are more likely to eat less, about 20% less calories on average they eat per day. And they eat a much higher amount of plants in their diet, plants that are rich in all those phytonutrients that we know are so good for our health. We know that they have times of regular exercise every day, but also times of rest every day. times for a nap or relaxation, prayer, meditation, rest. And so all of those things can be helpful for helping us live a long, healthy life if we just take some of these examples from people who are living in the Blue Zones.

So these are really obvious things that most of us sort of know and take for granted, but there are some interesting differences. You look at, for example, the Plains Indians, the Lakota and the the group that lived at the turn of the century longer than any other population in the world. These were the buffalo hunters. And all they ate pretty much was buffalo and berries, right? They had the longest lived population in the world, the most number of centenarians, people who lived over 100 of any population. And all they ate was meat, but it was buffalo. And then you have this Seventh Day Adventist who also had very, very long lives from Loma Linda, California. and they were vegetarians. But what they also had was practices that supported health. They didn't smoke, they didn't drink, they had great community and connection. I mean, if you join a bowling club or a knitting club, you're more likely to live longer than someone who's socially isolated. I mean, loneliness is one of the biggest killers. So when you look at these populations, there's a lot of variables. But they have certain things in common. And I think we have to just look at what those are. And they're things that often we've lost sight of and undervalue in our rapidly aggressive, consuming, advancing society. We need to sort of refocus our priorities on what actually matters, which is love, connection, community. And in this time of COVID-19, with social distancing, the paradox is that many of us are actually connecting more with each other, connecting more with those we love, spending more time engaging in relationships that matter. And I think that's a good thing. And I hope we don't go back to the old normal and we find a new normal that maintains that level of connection. Everybody gets excited by the next new flashy thing or the next big supplement or the next big treatment to help solve the problem of aging. But we often overlook some of the most important things that we know already scientifically play such a huge role. And their relationships, community, and even meaning and purpose, which, I mean, how could that be related to longevity? But it really is even optimism. is related to longevity. So, your mindset, your beliefs, your relationships, the quality of your relationships and your community all play an enormous role in determining your health and longevity. And that's why, for example, the Okinawans may have found the secret to longevity. It might be their diet, which I think plays somewhat of a role, but when they're born, They're placed into a group of babies called the Moai. And this is a group of four or five little babies that literally grow up together through every stage of life and stay together all the way through school, marriages, children, careers, you know, and retirement. Well, they don't actually retire. They keep being part of the community all the way through until they die. And so they have this sense of belonging, they have this sense of connection, they have this sense of purpose. And it's an incredible thing to see how that relates to longevity and how the opposite is also true. That if you look at as a risk factor, what's more important than diet, more important than smoking, more important than exercise, it's social isolation. It's social disconnection. It's a loss of sense of connectivity. It's a much bigger risk factor for death than all those other things. So you can do everything right, but if you don't tend to your relationships, if you don't tend to your community, if you don't tend to your spiritual life, to your meaning and purpose for being, for living, it's very tough to live a long, vibrant, healthy life.

Mindset is very, very important because, you know, your thoughts create your reality. You know, if you think something's going to happen, it will happen. And if you think something's not going to happen, it won't happen. So, you know, I call it the placebo effect and the nocebo effect. And there's a wonderful book by Bruce Lipton called the Biology of Belief. If you haven't read it, I highly recommend it. It's one of the books that sort of changed how I look at medicine, I look at my patients, and it's the concept of your thoughts and your beliefs and your mindset affect the expression of your genes. And he was a cellular membrane scientist and geneticist, and what he realized is that our thoughts and our mindset actually affect the expression of our genes. and we're all sort of told that, you know, everything, the brain of the cell is in the DNA. And what he said is that there was an interesting experiment they did. They took cells and they basically took the DNA out of the cell and the cell was happy as a clam and would live for like two or three weeks without all the nucleus, no DNA. So it was running, you know, just happily. The DNA, if you will, is a little bit like recipe book that gives you recipes for proteins in various building blocks. But when the cell does not have the nucleus and not have the DNA, the cell works just fine. Only when it needs to go in there to do a reparative mechanism does it have to then tap into the DNA. And the person's mindset, your having a positive mindset is really, really critical. and there is a concept called the nocebo. So when a doctor says something to a patient and that, you know, you're going to die from this, that literally is like voodoo death. It's that negative mindset is toxic. And placebo is the effect where the doctor gives you a sugar pill and says, this is going to get you better. And lo and behold, it's just a sugar pill and the person does get better. So mindset and beliefs can actually have a positive effect or a negative effect. and it's a question of, you know, is the glass half empty or is the glass half full? Well, the glass is just, it just is. The glass, you know, it depends on how you want to look at it. So, your perspective on things and you can shift your perspective. We, you know, that's one thing is that, you know, cognitive behavioral therapy, people go to therapists, one of the things that a therapist does is allow them to sort of see themselves from another angle, another shift. So, yes, the glass is half empty. Yes, the glass is half full. Yes, the glass is. It's a matter of how you wanna change how you see things and also your emotional connection to whatever it is that you're seeing. Like, right now, we have the COVID crisis going on and you can say, oh my God, I'm gonna die or whatever. Now you can also, that's one perspective. You can also say, you know what, I got more free time on my hands. I'm a little bit less busy. What can I do to do better self-care? what can I do to expand my awareness of nature? You can just spend some quiet time by yourself and just be, get off your Netflix, get off your smartphone, and just look at the world around you. And there are small, subtle things that we can do that give us joy and change our perspective and change our mindset in a day-to-day comings and goings.

One of the biggest signs of less than optimal aging is when I notice that somebody has a decrease in their mobility. Mobility is incredibly important for our health. We want to stay active and mobile and have good lean muscle mass and good flexibility. And when somebody is losing some of that, that is a sign that there may be more aging going on in their body. And it's something important we really want to focus on. One of the tests that I do and most physicians do is the get up and go test. It's a really easy test that you can perform. And what you do is you have a patient start sitting, you have them get up, walk for 10 feet, turn around, and go walk 10 feet back and sit down. That's called the get up and go test. And it's a really good sign of how much mobility somebody has and what is their risk of falling. So we know that when somebody can get up, Go and go and come.

So when you wake up in the morning, you want to set your sleep cycle. And how you do that is by seeing the morning light. When your eyes take in the morning light, the light goes through in that area of where your eyes, the nerves that feed your eyes, to something called the suprachiasmatic nucleus. That nucleus sets your sleep cycle, your circadian rhythm. that biologic rhythm that tells your body what to do, when to do it, and how to do it. That needs to be in place and that gets set the first thing in the morning when you see light. But then during the day, you're going to be inside a lot for most people and that kind of light is too much light. So I always recommend blue blocking glasses because that light that you have when you're inside has blue light which is going to dysregulate the information that the super-keismatic nucleus gets. And that's going to also limit the production of melatonin in your brain. Melatonin is an important hormone that at nighttime tells the body it's time to slow down. It's part of that circadian rhythm. And when that rhythm gets to a certain part of the day, you start increasing your amount of melatonin. And melatonin not only tells your body to go to sleep, It plays a role in your immune system. It can actually help fight viruses and decrease inflammation. So it's really important to set your clock in the morning so that your melatonin gets made before you go to sleep. And then it's really important to have good sleep rituals. So when you're home at night and you're watching TV, you're in front of the screen, you should again be wearing your blue blocking glasses. You want to turn off your screen at least an hour before you go to bed. Because if you think you're going to watch the Walking Dead and then go to bed and fall asleep in 10 minutes, that's not going to happen. So you create a ritual. An hour before, turn off the screen, read a paper book, have a cup of tea, take a warm bath, light the candles, write in your journal, create a ritual because that begins to tell your body, your mind, and your soul it's time to rest. And then you go to sleep. The queen is happy and you're going to get a nice restful sleep. Now, that's a really good ritual for the whole day. But I do want to indicate that there are things that can interrupt sleep. And sleep apnea can be one of them. Sleep apnea, a lot of people think only happens if you're overweight. You have obstructive sleep apnea. However, Sleep apnea can occur to thin people. Believe it or not, I have sleep apnea. And after my brain injury two years ago, I was having an even harder time falling asleep. And then about six months ago, I did a sleep study. I had sleep apnea. And starting to be treated for sleep apnea was the turning, the last real big turning point in me regaining and actually improving my cognitive function over what it was before I had my brain injury. Sleep apnea, if you have it, will impact your immune system. It will depress the production of certain cell lines. Sleep apnea will impact your brain. You won't be able to make enough BDNF and you'll lose cognitive function. So just because I've told you to have a really good sleep pattern and a really good sleep ritual and treat her like a queen. There may be something that's interrupting that process. You may be doing all that right and still not sleeping well. And you may wake up in the morning not refreshed. You may be having daytime sleepiness despite doing all those things right. And if you are, then you should really get checked for sleep apnea. When you get a good night's sleep, you're really going to help your immune system. it will decrease your markers of inflammation and elevated markers of inflammation are associated with decreased immune function and more chronic disease and cancers. A good night's sleep also upregulates something called telomerase. Telomerase will stabilize your DNA and when you have deterioration of telomerase, when you're not getting enough sleep, that can lead to DNA breakdown, aging cells, and cancer.

So there's a whole field of regenerative medicine out there. And these therapies are not your typical therapies. Drug therapies typically work on one pathway that either help or hurt or interrupt some function to change your biology. That's what drugs do. They also have side effects and they also are not always so effective. they're marginally effective. But there's a whole set of tools out there that are emerging that are regenerative therapies that do things in a broad way that aren't treating a specific disease or pathway, that activate all the healing mechanisms that we need to activate to age well. They reduce inflammation. They increase your antioxidant systems. They increase the function and number of your mitochondria and energy production. They enhance brain repair. They enhance tissue repair and healing. They decrease fat storage. They increase lean muscle mass. They increase cognitive function and brain chemistry. And they do this by a mechanism in the body called hormesis, which is essentially where a stress is induced to then create a healing response. We need to do that to our bodies periodically to create these stresses, whether it is these times of restricted eating where we fast or we time restrict eating or we do fasting, mimicking diets or we do ketogenic diets, that's a form of hormesis. Whether we do high intensity interval training, which is where we go really, really fast and stress ourselves and then relax, our weight training where we stress our muscles, whether we do heat therapy, which is we use saunas or cold therapy, which is ice baths, which I do, I do that almost every day. I do a steam and an ice bath almost every day because like it's a stress on the system that creates a healing response, whether it's light therapy, certain light therapies create a stress on the body, but also activate a healing response. But there's some really cool things out there that do the same thing. And one of them is called ozone therapy. Now, ozone therapy sounds scary because ozone, we know about the ozone layer, and we know it's dangerous to breathe in ozone because it'll destroy your lungs, and we know that ozone layer being destroyed causes all kinds of health issues. But there's medical ozone where it's used as a hormetic inducer of healing. In other words, this is a molecule that's very reactive. that is a stress to the body, but it creates a very short-term stress that then teaches the body to be like that wild strawberry and create all these healing responses. So, medical ozone can be used rectally, it can be used intravenously through different techniques, but what it does is it activates all of your antioxidant enzymes that protect you as you age. Right? So you stop rusting. Things like catalase and superoxide dismutase and glutathione peroxidase and glutathione S-transferase. These are our own antioxidants. It's not like having vitamin C or vitamin E. These are so powerful and our body makes them. But as we age, they don't make them so much anymore. And so this activates that. It also activates a pathway called NRF2. this is another one of these master regulators that reduces inflammation, that increases antioxidant systems, that increases brain function. And it can also be activated by things like sulforaphane, which comes from broccoli and curcumin, which is from turmeric and resveratrol, which is from red grapes. But when you do medical ozone, it activates the NRF2 pathway. So it protects you, it's a protective system that is anti-aging. And it also blocks the effect of something called NF-Kappa B. Now, this is a master regulator of your gene expression that controls inflammation. Now, we know inflammation is bad. So when you have this stress of ozone, it inhibits NF-Kappa B, which turns off all the anti-inflammatory genes. So you're literally shutting off the inflammation, you're increasing your antioxidants and your creating all these healing responses in the body. As a result, you're even increasing your own stem cell production with ozone, and you're killing off all the bugs that are living in us that create chronic inflammation. So it's this incredible therapy that has yet to be fully researched, but the early data is just striking. And personally, I found it an incredible therapy to optimize health and longevity, as well as treat so many patients with chronic disease. so I think there's all these really cool hormetic therapies that we can use, whether it's dietary manipulations that allow us to be in a little bit of stress, like a short-term fasting or starvation period, whether it's these certain forms of exercise that put a little stress on us, whether it's hot and cold therapy, light therapy, even hypoxia, which is low oxygen concentrations in the atmosphere, actually do the same thing. And there's a machine that they use in Germany that I've tried, which is so cool where you put on a mask and you breathe oxygen, but the levels slowly go down. So it's like walking up Mount Everest until you're a little bit hungry for oxygen and then you get the oxygen bag and come back down. And you do that repeatedly over a period of 15-20 minutes and that creates this response in the body of a little bit of stress that starts to do all the same things and heal your mitochondria, increase your mitochondria, and ozone is one of those therapies. Exosomes do the same thing. Stem cells could do the same thing. So we're seeing all these therapies that aren't treating a disease, they're treating the system to create a healing response, a regenerative response, a repair response, an age-reversing response. Now exosomes is one of those strategies that I think is going to be found as a key driver of health and longevity. Exosomes are the healing factors that are in the stem cells. We used to think that a stem cell would go somewhere and become another cell. I don't think that's what we're learning happens. Stem cells release all these growth and healing and repair factors, anti-inflammatory factors. So exosomes are all the goodies that are in stem cells that have been taken out without the DNA. So I can't use your stem cells, you can't use my stem cells because we'll get an immune reaction. so you have to use your own. But if you're like 65, like you got 65 year old stem cells, but if you use exosomes, you can get, for example, youthful exosomes that come from placenta, where all the genetic materials taken out and only the healing factors remain, and you can inject those. You can inject them into places that are injured to heal. You can inject them into your blood to have systemic reparative effects. And I found this incredibly helpful. yes, we need more research, we're learning more, but I think this is one of the future therapies that's going to be very critical in helping to enhance, repair and heal ourselves as we age as part of regenerative medicine. So stem cells are important and stem cells are something that we can do something about and that actually are a critical part of aging and some of these other techniques of exosomes and other strategies can be very effective in kind of bypassing some of the costs and also some of the the discomfort and struggle of getting stem cells.

One of the other very exciting areas is peptide therapy. So again, peptides are small amounts of amino acids like beads on a string. And peptides actually act as very powerful signaling molecules in the body. One of the peptides that we all know is insulin. Insulin is a peptide. It's a bunch of amino acids. And we know how powerful that peptide is because when you give it to people, it lowers their blood sugar. And there are certain peptides that are out there that specifically can help with the healing of the body. There's one in particular called BBC-157. There's also peptides that are good for the immune function, thymosin alpha, thymosin beta. And unfortunately right now peptides are actually being in the process of being banned or a lot of the peptides are by the FDA. which is unfortunate because these peptides are actually quite safe and they are helpful for a whole host of symptoms. In fact, there are some peptides that actually been used specifically in patients with neurodegenerative conditions like Alzheimer's or post-stroke patients, one in particular called Cerebrolysin. For those who are listening, I would strongly encourage you to contact your senator and congressman to get the FDA to allow doctors to use peptides. When we look at the use of medications or supplements, we always look at what's called the risk-benefit ratio. How much risk is there and what benefit is there? Peptides, in my opinion, have one of the best risk-benefit ratios of all therapeutics that we can use as physicians, and they're very, very helpful for a host of things, helping with people who have ulcerative colitis, leaky gut, autoimmune conditions, et cetera. So these are things that I, as a physician, would like to have in my black bag. I wouldn't necessarily use them as first line therapy, but for patients who need it, there absolutely can be life saving. And unfortunately, right now, we're in the process of potentially losing a lot of these. So the time is urgent to really, you know, try to contact your local congressmen and senators.

All the things that we've discussed, in this docu-series, our diet, exercise, the right nutrients, getting rid of toxins, fixing our microbiome, reducing inflammation, reducing oxidative stress, these are all essential to helping our mitochondria. But what's really exciting about the science of aging and the science of our mitochondria is we now are understanding how to keep our mitochondria young through some very special tools. special nutrients, things that we can take that literally help upregulate and activate our mitochondria, produce new mitochondria, make them more effective and make them more efficient and make them more functional, which makes us more energetic, which is what we want. And one of the key factors that we've learned about that declines as we age is one of the components of this energy production cycle, called NAD. Now, this energy production cycle, there's a lot of steps, a lot of chemical steps. So you eat, you breathe, goes into the mitochondria, goes down an assembly line, and at the other end comes ATP and a little waste, which is carbon dioxide, which you breathe out, and water, which you pee out, and sometimes free radicals, which are produced, sort of waste which comes out your exhaust. The problem is a lot of those steps require nutrients that decline as we age or we don't get enough of like CoQ10 or B vitamins or other things. And NAD is one of the key steps in that process. There's a tremendous amount of research going on now about how to use this molecule, NAD, to activate our mitochondria, to increase our energy, to reduce the aging process. and to even potentially reverse it. And it can be given orally. There's a lot of companies producing this molecule as a therapeutic agent, as a supplement. There are companies trying to make it into a drug. There are scientists all over the world looking at this molecule as a way of helping slow the aging process and even reversing it. And there's also intravenous applications that are a little more controversial, but they can be very effective. And I've seen these patients of mine, for example, with Parkinson's, which is a the quintessential example of a mitochondrial disease. The reason these patients with Parkinson's shuffle and go really slow, one of the key features is called Bradykinesia, which means slow movement. And why they have muscle dysfunction is because their mitochondria don't work anymore. And giving them NAD, literally I've seen stop tremors and increased function in ways that I was shocked to see. I've been using NAD myself. I've been using it in my patients, and I'm seeing remarkable results in helping to increase the energy production. So it's one of those key steps that we need to have functioning in order for us to age well. And I'm really excited about this NAD research that's going on right now. I think we're going to learn more and more about it, and it's already showing incredible promise as a way of optimizing your energy, of helping to slow and even reverse the aging process. So I'm a big NAD fan.

The etymology of hormesis means to urge on. And hormesis is that when our body is exposed to stressors, small amounts of stressors, and that's a small amount of stressor, it can be a variety of different things. It can be a temperature extreme. It can be going up in temperature. So as we raise our body temperature, that's sort of like a fever, and we actually can produce heat shock proteins, which are actually beneficial for the body. Sauna therapy is fantastic. If you actually look in the literature, epidemiologically, people in Sweden who do saunas on a regular basis are 70% less likely to develop Alzheimer's. Now, who'd think of that? Just exposing yourself to sauna therapy can dramatically decrease your risk for Alzheimer's. That's a simple thing to do. That's not a costly thing to do. And it's also a social, it's a fun thing to do. do. So things that we can do to stimulate that hermetic effect, that sort of the transient stressor, cold therapy is also another thing. I actually do that myself every day when I take a shower. And when you live in New England in the winter, that can get pretty cold. And that shock to the system actually pumps out lots of epinephrine and norepinephrine, which is actually good for the immune system. And there have been studies showing that cold therapy actually helps with immune activation. And there's some very interesting work with Wim Hof and the Wim Hof method, which combines cold exposure along with breathing exercises to dramatically decrease the immune system's response. They actually did some studies with medical students in the hospital where they injected them with gram-negative bacteria. They looked at their at their response. And these were people who were trained with breathing and cold water immersion therapy. And what they found is that these people, their immune system's response was much less dramatic. So they have a sort of a more refined and more intelligent immune response so that their bodies aren't overreacting to something. Again, the immune system is really all about balance. You want to have an immune system that is going to fight something if it's going, that bug or virus is gonna kill you, but at the same time you wanna be able to turn that immune system off. So it's really about a balanced immune system and that is the key thing to understanding. Other things that affect hormesis is phytonutrients. So a lot of those compounds which we have in our diet, things like broccoli, garlic, green tea, these phytochemicals act as hermetic molecules. And what it is is our body senses that these molecules are toxic at low levels. It's sort of like a small amount of poison, if you will. And our bodies will actually start to upregulate our body's own antioxidant systems. So including these sub toxic doses of phytonutrients like garlic, like green tea, like resveratrol actually activate our body's own natural defense mechanism systems. So, that's why the, you know, hermetic effect is really good. And then the other thing which is also really good is exercise. Okay? And, that doesn't mean you have to go to the gym and be there for, you know, two hours a day, five days a week. But, doing short bursts of exercise which is stressing the body, is a really good thing to do. So you're getting your heart rate up to 90 to 100% of your maximum heart rate. You're getting out of breath. That actually stimulates that antioxidant systems in the body. So those are all simple things that you can do that activate the hermetic response in the body.

As a physician, it took me years to understand that health often extends beyond our biological systems. We need to set up our environment to enhance those systems. If you think you're doing everything right, but you're not sleeping well, you feel isolated or lonely, you have a lack of purpose and lack of spiritual connection, you still have work to do. Surprisingly, having meaning and purpose leads to a longer life. You're having so much fun you don't want to die. We cannot ignore all these factors that are as important if not more important than what we eat. The first step to getting healthy is to consider all of these spokes on the wellness wheel. They're foundational pillars of health. We can't just jump into the next best supplement or treatment and expect to get healthy. First do the basics and then consider innovative therapies with the help of a trained practitioner. I hope this episode motivated you to make shifts in your daily life. You have the power to turn your health around starting today. Welcome to the final episode of the Longevity Roadmap Docu Series. Now, as I mentioned, I've been doing everything in my power to boost my health span and my lifespan and feel energetic, focused and full of vitality every single day. Now I want to share everything that I've been doing to stay healthy until the end of my life, which I hope is a long time from now. In this episode, we're going to break down what I believe to be the most critical components of achieving a healthy long life and most of the stuff is stuff that you can start today. We know that most diseases of aging are starting younger and younger. We're seeing type 2 diabetes in two year olds. So we will not only cover what you need to know when you're 50 or 60, but what you can do when you're 20 or 30 or 40. The seeds you plant today will keep you strong and thriving in the future. never too late or too early to start.

When somebody comes into my office and they're looking to optimize aging and optimize their longevity, it really depends on their age group, what we really focus on. So when a patient comes to see me and they're in their 20s or 30s, the most important thing we start working on is getting on a good routine, making sure that they're incorporating all of those aspects of self-care into their life and working on getting on a routine for optimal health. Making sure they've got a good sleep cycle, making sure they're getting enough sleep, making sure that they're not binge drinking. We know that has a huge impact on health and making sure they're not smoking. Those are the things we really focus on when somebody's in their 20s or 30s. When somebody's in their 40s, we really focus on what they're doing for self-care. Often in our 40s, our life is crazy busy. We've got kids, or our parents that we're taking care of, and we need to make sure we're taking care of our self. So we'll talk about what are you doing daily for self-care? We know that exercise can be a great source of self-care, but so can yoga, meditation, stress reduction techniques, and making sure they're getting a good healthy diet. In their 50s, we're all focusing on body fat and body composition. Is there too much weight around the midsection? Are we gaining too much body fat? And so we really focus on making sure we're strengthening lean muscle mass and reversing any signs of insulin resistance. In our 60s, it's all about self-care. You know, are you doing all of those things for self-care every day? Are you getting enough sleep? Are you making the right food choices? Are you eating enough protein? Are you getting your exercise in? Are you doing your strength training to increase your lean muscle mass? And are you doing your meditation and yoga? Are you doing your self-care? And in your 70s and 80s, it's all about movement and exercise. Exercise and movement is one of the best things we can all do every day to improve our health span. And we wanna make sure we're getting in that 150 minutes at least of cardiovascular exercise, the at least two days a week of strength training. And as we get older, strength training is more and more important. And it doesn't always have to be with weights. It can be resistance exercise with your own body weight, as well as a more strenuous yoga practice, and Pilates with a reformer. All of those things can help improve your lean muscle mass. So exercise, exercise, exercise.

Aside from our muscle, our most neglected organ is our gut. Now, I don't just mean our colon and our small intestine. I mean the incredible ecosystem that is living in us, the holobiont, this incredible symbiotic relationship between us and our microbes that determine almost everything about our health. Now, what happens as we age is that our microbe in our gut degrade. We see a loss of gut function. We see an increase in what we call leaky gut, where the contents of the gut, which should be staying in the gut, except for food, which should get filtered across start to leak through and activate our immune system causing inflammation. And it happens for a lot of reasons. One, our crappy diet that's low in fiber and high in processed food because of drugs that we take like antibiotics and acid blockers. It's because of sometimes natural changes that happen as we age in our gut with our acidity or other factors. And by focusing on your microbiome throughout your life and especially as you age, you can regenerate your health, you can reduce inflammation, you can repair a leaky gut. And the best way to do that is by avoiding the gut-busting things, right? Which is what? Processed food, sugar, starch, artificial chemicals, toxins in your diet. Also drugs that are gut-busting drugs, antibiotics, acid-blocking drugs, which almost everybody takes like Pepcid and Protonix and prilosec and prevacid and nexium and the whole category of those drugs that block your acid production and really destroy your microbiome. Advil, Aleve, those are not good for your gut over a long time. Occasionally it's fine. Steroids, even sex hormones like the pill can mess up your gut. So avoiding those as much as possible. And then designing a gut healthy life. which means upgrading your diet to increase the amount of special kinds of fiber called prebiotics. Now, what are prebiotics? They're fertilizer for the good bugs in your gut. So you want to increase those, which come from all kinds of incredible plant foods like artichokes, asparagus, acacia fibers, konjac root, which is a Japanese root that's used in shirataki noodles that you can make pasta with that have no calories and no carbohydrates. these are all great fertilizers for the good bugs in your gut. You can even take plantain and even things like even rice that you can heat and then cool in the fridge becomes a resistant starch that helps fertilize the good bugs in your gut. And then you want to have probiotic foods, things like sauerkraut and kimchi and tempeh and miso and natto and all these incredible foods, yogurts that are ideally made from sheep or goat can be great sources of probiotic foods. So you want the good bugs you want to add in, you want to fertilize them, and you want to get rid of all the stuff that's damaging your gut. So eating the right diet is so critical to cultivating an inner garden and even including phytochemicals. And this is a big discovery in the last few decades is that not only do you need these fibers and probiotics, but that things like colorful nutrient dense compounds in your food that are in the rainbow foods have enormous benefits on your gut. For example, cranberry, green tea, pomegranate, they fertilize these really important microbes in your gut called Akkermansia. Now, if Akkermansia levels drop down, you're more likely to get autoimmune disease, more likely to get diabetes, more likely to get cancer, and all you need to do is feed them the right stuff and they grow and you reduce your risk of all these things. So there's a lot of strategies around keeping your gut healthy, but it is one of the most important things to learn how to do. And yes, there's a lot to do as you age. You have to reduce inflammation, you have to help your mitochondria, you have to help your gut, you have to help your muscle, you have to help your hormones. It's just the way we're designed. I'm just a messenger. I didn't design this thing, but I'm just telling you what you got to do. And the beautiful thing about it, is that the principles that we're discussing around food and exercise, lifestyle, supplementation, they work on all of these things.

We know that the gut microbiome has a huge impact on our risk of cancer. We know that the gut microbiome can create insulin resistance, which causes inflammation. We know that the gut microbiome is really critical for mobilization of toxins, including our own body's estrogen. And there's much more we're gonna learn about the microbiome in the future, for sure. But paying attention to the gut microbiome, I think, is really important when you're looking at a comprehensive approach to somebody's cancer risk. One of the things we know that the gut microbiome is involved in is in the elimination of toxins and estrogens in the body. And we know that when somebody's estrogen level is high, that that can increase their risk of breast cancer, it can increase their risk of uterine cancer, and for men, it can increase their risk of prostate cancer. So we want to really pay attention to how the body is mobilizing and eliminating this estrogen because it can have an impact on somebody's risk. There's a substance called beta-glucuronidase, and beta-glucuronidase is an enzyme that will unfortunately allow estrogen to get reabsorbed into the body. So glucuronic acid is bound to estrogen in the intestines, and if there's too much beta-glucuronidase, that that will get cleaved, and then estrogen can get reabsorbed into the body, and then people can have signs of estrogen dominance. And we know that that estrogen dominance can be a trigger for growth of breast cancers, it can be a trigger for growth of uterine cancers, it can be a trigger for growth of prostate cancers, and it can also be involved in things like PMS and breast tenderness and irritability, other hormone imbalances. And so we know that when the gut microbiome is out of balance, that's one of the things that can cause this excessive amount of beta-glucuronidase. And we can check for that. We do stool tests all the time that measure level of beta-glucuronidase. And if it's high, then we can use things that can lower it. And we also want to think about the microbiome and what we can do to rebalance it. For example, I had a patient who came to see me and she had just finished treatment for breast cancer and she wanted to do whatever she could to prevent it from coming back. And so we looked at many things in her health. She actually had good levels of insulin sensitivity, which I was really excited about. and she didn't show a lot of inflammation in her body. But she did have some toxins that we needed to work to lower, and she did have this high level of beta-glucuronidase. So what we did is we worked to shift the microbiome using things like good probiotics, using something called calcium D-glucarate, which can help lower the amount of estrogen that gets reabsorbed into the body through that when there's high beta-glucuronidase. And we used prebiotics, which can help feed the good probiotics, so a lot of fiber in her diet. We added in some probiotic supplements, and we even added in some phytonutrients to help feed the microbiome. So we focus on things that help improve the growth of the good bugs in the digestive system. We're so excited about all these phytonutrients and how they have this tremendous ability to feed the good bugs in our gut. We know, for example, that sulforaphane, which comes from your broccoli, and is really rich in, it's this phytonutrient that's high in a lot of your cruciferous vegetables like broccoli and cauliflower, cabbage and kale. Sulforaphane can actually feed the good bugs in your digestive system. So by incorporating more cruciferous vegetables into her daily routine, we helped with feeding all of that good bacteria. We also know that green tea can feed the good bacteria in your gut. And things like pomegranate has ellagic acid, which also feeds the good bacteria in the digestive system. All of these things are important when you're paying attention to somebody's risk of cancer.

So to have a good sense of where you are in the aging process, there's a whole bunch of tests that really help to figure out where you are in that spectrum. Conventional tests and functional medicine tests, which should be really regular tests anyway, but right now they're functional medicine tests. And when you go to your conventional doctor for heart disease, you need to look at things that are readily available that your doctor can order that they might not be used to ordering, but they can really ask for. And the most important one is looking at the quality and type of your cholesterol. This is a test that's not just your typical cholesterol test. It's called NMR or nuclear magnetic resonance testing. You can get it at LabCorp or the Cardio IQ test, which you can get at Quest. These are available. They're not expensive. And they're really important because they tell you about the size of your particles, the number of your particles, the kind of HDL, the kind of triglycerides. Super helpful test. The next test you want to look at is measurements of your blood sugar control, which play a huge role in your risk of heart disease. You want to measure your blood sugar, obviously, and your insulin levels fasting. You want to measure something called hemoglobin A1c, which is your average blood sugar over six weeks. Now, if you really want to get fancy, you can ask for a glucose tolerance test that measures blood sugar and insulin because insulin will start to go up, maybe not fasting, but it might go up after you have a sugar drink. And that's an early telltale sign that your metabolic health is going downhill. So those are really important. You also want to look at your inflammation level, something called cardio CRP. This is a really important test to look at the level of inflammation. You want to look at a few other clues that we use things like Lp or Lp, we call it, which is a genetic marker, but it's determined by your genes, but it also is influenced by your habits. So you can modify that as well. You want to look at your body's clotting and blood thickness, which you can look at through fibrinogen. You also want to look at your indirect measures of how your metabolic health is like your liver function test. which tell you, for example, if you have a fatty liver, which affects 90 million Americans and is caused mostly by sugar and starch, that's another clue. These are really important basic tests. And there's another one that I like, which is called homocysteine. And this is a measure of your B12 and folate and B6 status that also plays a role in your risk of heart disease. And then there's other tests that are a little more fancy that some doctors can do called F2 isoprostanes or oxidized LDL or oxLDL. these are available in conventional labs and they look at the oxidative stress level or free radicals. So can you tell if your cholesterol is going rancid? These are basic blood tests. And then there's some other tests that are really important that are imaging tests. I encourage people to do an ultrasound of their carotid glands, which is these blood vessels in your neck. And if you do an ultrasound, you can see if they've got plaque developing or they develop clogged arteries. You can see that. There's also an important test called a calcium score. It's a very high speed CAT scan, not a lot of radiation that you don't do all the time, but you do once as a screening test. And then you can do it maybe over five or 10 years. And it measures a calcium around your heart. Now, calcium is the body's Band-Aid it goes with his inflammation. And you can see if there's a calcium buildup, and that gives you a pretty good prediction of your risk of heart disease. There is another factor that's super important, super high tech. It's called a tape measure. All you have to do is measure around your belly button and measure around the widest part of your hips and you divide the waist number by the hip number. If your waist is more than 0.8 as a woman or more than 0.9 as a man, if your waist to hip ratio is more than that, then you have what we call a lot of belly fat, and that is an indicator of poor metabolic health. So that's a quick screening test that everybody can do at home with a tape measure. So these are the basic things that I look at. There's more fancy tests like the endopad test, which looks at the vascular health. There's tests of heart rate variability, which you can use your iPhone to measure, essentially looks at the beat to beat variability in your heart and tells you about your overall heart health. Because when you're beets are too homogenous. If it's 72-72-72-72, that's a sign of lack of resilience and flexibility. You want a lot of flexibility and resilience in your health. So your heart rate should be a little bit more complex and variable. Complexity is health. An ecosystem, a rainforest, is incredibly complex and resilient. A cornfield is a monocrop, and you get a corn beetle in there, the whole thing's dead. not very resilient. So you want a lot of complexity in your health. So those are the kinds of things I look at when I look at cardiovascular health. And I take those as a whole to look at what the issues are and what the pictures are. I also look at some genetic tests. We can look at genetic tests that look at your lipid metabolism, your cholesterol metabolism, what you should be eating and not eating, tests to look at your likelihood of clotting and whether you should be taking various kinds of things that help thin your blood, like fish oil or nattokinase or lumbrokinase, which are natural supplements or other things that can help reduce inflammation and clotting in your blood. So those are the kinds of things as a doctor that I can do from a conventional perspective. From a functional medicine perspective, there may be other tests that I want to look at. And I think for the cardiovascular system, it might be looking at more advanced tests to look at inflammation, at whole profiles of inflammatory biomarkers that you can do from various companies that provide these tests. I might look at other things that maybe people aren't thinking about, like absorption and production tests where you look at the amount of cholesterol your liver is producing versus the amount of dietary cholesterol you're absorbing. And then I can customize my treatment along that route. I might look at something called TMAO, which is a microbial metabolite from the gut that may increase inflammation and the risk of heart disease that comes from what you're eating, but also can be because your microbiome is not healthy.

So low-grade inflammation, which we talked about earlier, which is the inflamaging, every time a person is having cheeseburger fries and a Coke, you're going to have low-grade metabolic endotoxemia. And if you're doing this on a regular basis, you're basically flooding your body with these these gram-negative bacteria and the compounds which are associated with them, which stimulates the immune system. And this is ongoing immune activation, and that is the thing that leads to cardiovascular disease, leads to diabetes, leads to neurodegenerative conditions. So they're really intimately tied in with the aging process. And again, it's not just fat, it's really related to the amount of fat and the types of fat, that is really tied in with heart disease. In fact, one of the tests that we do is a test called TMAO, trimethylamine oxide. This is a newer test. What we found is that this particular compound is strongly associated with heart disease. What we find out is that this TMAO molecule is produced in certain individuals, not all individuals, but certain individuals whose gut microbiome is unbalanced or dysbiotic, and if you eat certain foods like eggs and red meat, which contain higher levels of carnitine and choline, you'll produce higher levels of this very reactive compound called TMAO. Now, what we know is that for a long time, heart doctors have told us that red meat and eggs are bad for you because they contain cholesterol. well, that's not necessarily the whole story. In certain individuals with a dysbiotic gut microbiome who then feed them red meat and eggs and you produce this compound that leads to more systemic inflammation. So it's, it's, there's more to it than just cholesterol and just the cholesterol hypothesis.

So I look at a whole series of these parameters. I might look at akkermansia on your stool test because we know that if your akkermansia is low, you might have an increased risk of poor cardiometabolic health. And they might want to say, okay, you should have more cranberry or pomegranate or green tea to help grow the macromancy back. So I use a lot of things that seem a little outside the norm. I might also look at heavy metals because we know that mercury and lead and arsenic are risk factors for poor cardiovascular health outcomes. So I'll look at a lot of things that traditional doctors may not look at, but that are helpful as part of the picture. But in heart disease, the conventional tests often tell you so much that you can get a great picture just from ordinary tests that you can get at any doctor's office. So cancer testing is, at this point in time, pretty much early detection. It's not really true prevention. And they're important. A Pap test for cervical cancer, prostate exam and PSA test for prostate cancer, colonoscopy for colon cancer, a mammogram or breast MRI or thermography for breast cancer, and maybe sometimes even a lung scan for lung cancer. The problem with these tests is that by the time you see something growing on an imaging test, it's often been there for a while and you may catch it in time so that you don't die, which is a good thing. but it really isn't true prevention. What I'm much more interested around cancer is looking at measuring what we call the biological terrain. Rather than the tumor, I'm looking at the soil in which the tumor grows. How do I optimize that to make it an inhospitable place? How do we look at causes of inflammation? how do we analyze nutritional levels and diet? How do we analyze the load of toxins in the body? How do we look at the gut microbiome in ways that we can optimize that to reduce cancer risk? Because we know that problems with the microbiome cause cancer. How do I look at things like insulin and blood sugar, which are related to heart disease but also related to cancer? So I look at all these parameters, nutritional status, metabolic status, toxic load, inflammation and immune function. And how do I optimize those things so that if there are tumors growing, they can't continue to grow? The fact is that every single one of us, all of you listening and watching, all have cancer right now. I do, you do, we all do. But our body has a surveillance system. It has a system of finding and getting rid of those cancerous cells. And you want to tip the balance in favor of your body doing that by finding out what are those things that are carcinogenic, whether it's sugar or whether it's pesticides or whether it's a low vitamin D level or whether it's bad bugs in your gut. How do you fix all that so that cancer doesn't have a place to grow. Hormones are typically not well evaluated by traditional medicine unless things are really bad. So rather than identifying things that are slowly degrading or out of balance or a little dysfunctional, we only treat you if you're way off the spectrum on the biomarker. So if your thyroid is really high, we'll give you something. but we don't usually check your thyroid antibodies. We don't check something called free T3, which can go down as we age because of stress and other factors. So we do a more comprehensive view of traditional tests. We can get T3, T4, TSH, and thyroid antibodies when we're looking at thyroid. For sex hormones, we look at a lot of different things that may not be looked at. We look at, for women, we look at estrogen, progesterone, FSH, LH, those are the pituitary hormones that control your hormones. We look at testosterone in women too, and see what their testosterone levels are. We look at DHEA, which is an adrenal hormone. We might look at pregnenolone. Same thing for men. We look at their estrogen levels. Men have estrogen too. In fact, a lot of men have very high estrogen levels if they're eating a lot of starch and sugar. We look at their free testosterone, their total testosterone. We look at other factors that that may be important like their sex hormone binding globulin. These are all tests that are available through a conventional lab that give you a really good picture of whether their hormones are off or not. We might look at pregnenolone and DHEA in men as well. So we get a really comprehensive picture. Stress hormones are a little more challenging to look at. You can look at DHEA, but we do saliva testing for cortisol, which is actually available conventionally, but many people don't order it. And that looks at your stress hormone level over the course of a day that can help. there are tests looking at melatonin levels for those who aren't sleeping at night. There are tests that look at growth hormone related hormones like IGF-1. So there's a lot of things we can look at to tell you what the balance of hormones are on your sex hormones, on thyroid hormones, on your adrenal hormones that are all playing a role. And of course insulin we've talked a lot about on how to measure that through looking at fasting insulin and even maybe doing a challenge test to look at what happens after you have a sugar load on your insulin. That'll often go up early. So we can get a really good idea of where your hormones are in or out of balance, and then we can target how to fix those things. So for women particularly, it's important to look at estrogens because there is no such thing as estrogen. There are different forms of estrogen, and they vary throughout the lifespan and life cycles for women. But one of the big risks we look at is how are your estrogens metabolized by your body? And often, if you have a high risk of breast cancer or if your estrogens aren't being metabolized properly, there are certain estrogens that promote breast cancer and others that are protective against breast cancer. So we look at ratios, for example, of the metabolites of the hormones like two or 16 estrogens or four estrogens. And we can see, do you need more of the B vitamins to get this pathway going? If you have high levels of two, it's protective. What makes those goes up? That's exercise and isoflavones from whole soy, not GMO soy. Flax seeds, green vegetables like broccoli, so fluorophane, indole-3-carbinol, these are compounds that are basically from the broccoli family that can raise this and actually prevent and even in some studies looking at reversing cervical cancer. And then there's the 16 estrogen, which is often increased because of insulin resistance or lack of exercise or toxins. So we can modify these levels and measure them in the urine in a way that actually help improve the quality of hormones, improve the quality of hormone metabolism, and reduce your risk of cancer and fibroids and bad PMS symptoms and all sorts of things that help to actually give you more health and hormone balance. And it's done through a very sophisticated urine test that looks at all these different metabolites. And it's a really important test we use in functional medicine to help optimize women's hormonal health. Well, if you're having memory problems and you're concerned you have by that family history or maybe you have early onset Alzheimer's, When you go to the doctor, they're going to check a number of things that are pretty standard. They're going to look at your vitamin B12 level, which is probably not the best test to look at your vitamin B12 status. It should be a different test called methylmalonic acid, but they usually do the B12 tests. You would look at homocysteine, which also checks your folate status. They'll look at your thyroid function. They might look to see if you have dementia related to mini strokes. in cardiovascular disease. But for the most part, they'll do a neuro-psychological test, which is a series of questions to test your memory. And they might do an MRI brain scan to see if your brain volume has shrunk or your hippocampus is small. And if they're very fancy, they might do an amyloid scan, which looks at the development of amyloid plaque in your brain, which is associated with Alzheimer's. And that's about it. and they might offer you a few drugs which have very limited benefit or evidence, and they will probably tell you to get your affairs in order. When you go to someone who's expert in understanding brain health and functional medicine approach to brain health, they're going to do a cognoscopy, which we've discussed in earlier episodes, but it looks at a whole array of parameters that are highly relevant in determining whether your brain is going to work well or not, and what you can do to reverse some of these factors that are what we call dementogens. So we look at nutritional status, optimizing your vitamin levels and your mineral levels, vitamin B12, vitamin D, making sure your zinc is good, your omega-3 fats, these are all really important, folate, B12, B6, critical. We look at your dietary patterns and the effects on your metabolic health. Do you have insulin resistance and how do we optimize that? We look at toxin levels, heavy metals using heavy metal challenge tests, looking at urine levels of mercury and lead. We will also look at your microbiome to see if there's inflammatory processes happening there. We can optimize your gut health. We'll look for hidden infections like tick infections, like Lyme or other tick related infections or mold exposure. And we'll look at all these parameters in a very sophisticated way to see what's happening. How are your mitochondria? Are they functioning well or not? What is the level of inflammation in your body? What is causing inflammation? And we'll look at all these molecules and all these parameters and it may be thousand of different analytes compared to just a few dozen or 10 or 12 that a traditional doctor will do. And we'll be able to see through this pattern of these analytes, what's out of balance, how to restore balance and optimize your health. And then it'll give us direction where to go. So we know, oh gee, this person is really low in B12, they need B12 shots. Or this one's really low in vitamin D. Or this one has high copper, low zinc, we have to give lots more zinc. Or this person has high levels of mercury, we better get rid of that. Or this person's gut's a mess, we better fix their gut and optimize their microbiome. Or this person has Lyme disease, we better treat that. and see what happens. So we basically customize and personalize a treatment based on this diagnostic roadmap. Now, it may be a little bit more expensive by the time you get to dementia to do all this stuff, but the cost of Alzheimer's is so great, the human cost, social cost, the economic cost, that doing this work up front is so worth it because you can literally stop slow and even reverse cognitive decline in so many patients. And this is just not my opinion. There's more emerging data on this. Dr. Richard Isaacson from New York, I think he's at Cornell, has done rigorous studies looking at how we can personalize these treatments based on their metabolic type and their vitamin D levels and their homocysteine and their insulin and various aspects that they can customize. And they didn't even do a full cognoscopy and look at all the dementogens. They just did the basics. and saw really amazing changes. So if anybody's listening and they feel like they have family history of dementia or they have family history of Alzheimer's or they're worried about their memory or their brain function, it's important to go deep and to learn about what you can test and what you can do. And this is what we do with the Ultra Wellness Center every single day. We've been doing it for almost a decade and a half or more than a decade and a half and we're seeing how Our science is matching our practice. Rather than having all these discoveries that are happening out there and not being translated into medical practice, that's what we do at the Ultra Wellness Center, is take these discoveries and implement them. And we do it in a way that is safe, that's effective, that actually uses the best of science, and we do an incredible job for so many people. And it's one of the most satisfying things for me as a doctor to be able to do this work and to see the changes in people's lives and to see people get their lives back when often they've been given up on by traditional medicine. So wherever you are in the spectrum of aging, wherever you are in your life, whether you're 20 or 30 or 40 or 50 or 60 or 70 or 90, there's always something to do. I just literally sign up a new patient who's 87 years old who wants to optimize his health. and I will work as hard to help him optimize and maximize his health and increase his health span to equal his lifespan as I would do on someone who's 20. Because I believe in the power of rejuvenation, in the power of regeneration, in the power of functional medicine, and in the science of longevity to give us all healthy, long, vibrant lives and be able to get up in the morning and do whatever it is we'd love to do, whether it's take a walk with our spouse, play with our grandkids, hike a mountain, or just sit and read a book and have the quality of life that we all deserve. And I know this feels like a lot of information, but here's the good news. With a plan and daily action, you can slowly incorporate these habits into your daily life. Soon, they're going to become second nature. Remember, pretty much 90% of what we discussed in this docu-series can be incorporated at home starting today. You don't always need to see a special doctor or use innovative therapies. Sometimes you just need to start with the basics. When we feed our body the right information, real whole foods, when we get our mindset right, positivity is important. When we focus on our purpose, on our spiritual life, on movement, when we double down on proper sleep, and we take out all the bad information going into our systems from processed foods and sugars and negativity and lack of sleep and lack of movement and purpose, we are well on our way to aging backwards. So I want you to think about the reason why you might want to live a long and healthy life. See, understanding why you want to live a long and healthy life is as important as taking the steps. So why is a long healthy, happy life important to you. For me, I want to play with my future grandkids and maybe great grandkids. I want to go on adventures with my wife. I want to keep learning. I mean, there's millions of books I haven't read yet. Once you identify this why, I want you to write it down and why you come back to this intention. Think of it as your guiding light. And the more you focus on this intention, the more motivated you will be to achieve your best health. Now aging is inevitable chronologically, but we don't have to age the way we imagined. I truly believe that we can become the picture of health throughout our lives. I hope you take the lessons that you've learned in this docu-series and you apply them starting today. You deserve to live a life of vitality. Thank you for watching. If you loved that last video you should check out the next one for sure on getting the root cause of all disease. I can count on my hands how.

Many times I sat down and ate.

A meal with my family growing up.

Wow.

All right.

Wow.

This was an incredibly rare occasion.

This is usually, if it wasn't a holiday by the.