Exclusive Dr. Hyman+ Functional Medicine Deep Dive: Nutrition And Optimal Aging

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Hello, this is Dr. Chris Todamo from the University of Maryland School of Medicine Center for Integrative Medicine. and the Institute for Functional Medicine, where I serve as a senior research advisor. And excited to talk about this topic of nutrition and optimal aging. As you can see in the title, this is geared to be something that you can indeed master. It's very practical. I will go deep with the science and underlying mechanisms of how I think you can optimize aging through nutrition. But ultimately, this is going to come down to tools and strategies and perspectives that you can utilize in your own lives. And everybody's got a slightly different take on this subject, but I think you'll find this encouraging in that there is much that you can do. And I'm going to go ahead and minimize my picture here so we can better see the screen. Just to give a little bit of an overview of where we're going to go with this. So we'll start just on how I came into this topic and then get into this really useful, I'd say construct of the hallmarks of aging. And we'll even look at the hallmarks of health more generally that I think you'll find helpful when you think about your everyday lifestyles, exposures and so on, and what you might be able to do about that. Then we'll just, to make sure everybody's on the same page, give an overview on what we mean by nutrients because I'm going to be talking quite a bit about how nutrient demands change with aging, which is the next sort of area of focus due to both physiological reasons but also a wide variety of other factors, lifestyles, social lives, medications are big, we'll talk about that. Get into another theory, the triage theory from Bruce Ames that some of you may have heard about. and then look at tying it back to those hallmarks of aging and what are some specific foods and nutrients that can help out in that respect. All right, and then really, I gotta dive deep on a few key areas, the first of which is protein and some of the controversy in that area that I hope to provide some clarity on. Then look at a bunch of other nutrients whose demands change with age for a variety of reasons. And then those that are sort of on the cutting edge, in particular, are going to look at creatine and NAD+ precursors, which I think are really exciting, and then kind of tie it all together. All right, so how did I come to this topic? Well, I did my doctoral work on hip fracture patients and looking at how nutritional factors influenced their recovery. so I looked at vitamin E, the carotenoids and antioxidant nutrients, and how basically those that were more replete in these nutrients, those that had levels that were higher than others tended to fare better. They had less inflammation, they recovered more quickly, they had better physical function. And I think this is really interesting, but this is kind of the medical reactionary model. You know, once somebody has had some kind of illness, or chronic injury or so on. And that's important. But what I have found to be more important as time has gone along is actually going back to my roots. So these are some pictures of my grandfather lived to be over 100 years of age. And it's a picture of him on the left where he was a Fortune 500 CEO. So lived a really fast-paced lifestyle, really busy with his work and family and so on. But he was a real believer in lifestyle. so nutrition and physical activity and so on. That picture in the middle, he's probably 95, and the one on the right, he's playing basketball at 98. So I was influenced by this alongside, you know, what I'd done with people who, you know, were maybe not functioning as well with advanced age. And, you know, I've always found the supercentenarians to be of great interest. The paper that you see on the left is those that are over 113 years of age. there's many of them. This paper focused on those that were very well documented with birth records and so on. You know, we know that the longest, you know, lived person was 122 year old woman who actually was not particularly, I would say, most of us say, had the most healthy lifestyle. Also, maybe not the most functional. Granted, 122, what do you expect? But I think what has motivated me the most is probably the images on the right of those who are highly functioning and thriving deep into life. And we're gonna look at factors that should help you reach that to the best of your circumstances. And these are the papers that I mentioned earlier that are quite interesting, the hallmarks of aging. There was a 2013 original version of this, and this was expanded in 2023. Dr. Hyman has spoken of these at some length, and we're going to get into the details on each of the different hallmarks of aging and specific foods and nutrients you can utilize to capitalize on them. But you see them here, they're grouped into different categories of primary, antagonistic, and integrative Primary is kind of the furthest upstream and the integrative ones are the furthest downstream, though very important certainly. And again, we're going to look at each of these in detail, define what they are and define some foods and nutrients and more generally nutritional approaches that may help you optimize these different domains of aging. And this has also been looked at across the lifespan. So the same group had another very interesting paper when we looked at the hallmarks of health and actually a fair amount of overlap here. We'll see, you know, one of the areas that I've really taken an interest in is circadian biology. So you see the rhythmic oscillations tapping into that. And when we talk a little bit about time-restricted eating today, that would be one area that clearly applies to light exposure and other domains that we can really utilize to our advantage. But to just frame this topic to make sure we're all on the same page, you know, we talk about nutrients, there's two main classes. There are the macronutrients, protein, carbohydrate, and fat that provide energy for the body, which is most often measured in calories, right? Then you've got just thousands of micronutrients. You get your vitamins and minerals, which we'll talk about, and then you get, you know, non-essential micronutrients that While all of these don't provide energy for the body, they're equally as important. They are needed for survival, the vitamins and minerals, and there's probably others that we just don't know about yet. I'm going to talk about these today. But first, to get into the macronutrients, we have protein, and this is an absolute key for aging. Lots of different sources. There are two main types here. they're your complete proteins, which just mean they contain all nine of the essential amino acids. And those are amino acids that our bodies can't produce endogenously. All right? Now, most animal proteins are complete. Not all of them. Things like collagen, for example, which is very popular and quite useful. We'll talk a little bit about that today, but that's another one that I think is quite useful for aging when it comes to joint and skin health and so on. But it is missing some of the essential amino acids. So you wouldn't want as a primary protein source. Then you have your incomplete proteins, which don't contain all nine of the essential amino acids. So it's missing at least one. And most plant proteins actually are incomplete, though they can be combined to form a complete protein. So most cultures had this figured out when you look at things like rice and beans, for example, where one's missing lysine, the other's missing arginine, you can combine them. So it's probably not as efficient of a way to do it as it is for animal protein, but it is certainly a way to do it. And there's a number of good plant-based proteins, powders on the market today. These are broken down by protease enzymes. You can take those as supplements. as time goes on with age, one of the reasons that our nutrient demands increase is that our digestive enzymes from the pancreas are not as abundant or effective. These have four calories per gram. Then you have carbohydrates, a wide variety of these. These are probably some of the healthier sources. Picture here, no essential carbohydrates. There's the ketogenic diet and you know, approaches that that you can, you know, there's you can survive and in some cases thrive without carbohydrates. Most people do well by having them in a diet. But in the case, there's multiple types. There's sugars, which can be either simple or complex starches, which are complex. And it's an oversimplification to say simple, good or bad, complex, good or bad. We really want to think about the nutrients that are accompanying the carbohydrate and not necessarily whether they're simple or complex. Then you have fibers, which are different. So these are non-starches polysaccharides and you have soluble and insoluble. Soluble fibers are things like inulin and so on that feed your gut bacteria. They can cause GI distress in people, but insoluble are those that pass through you, things like psyllium and so on. And these are broken down to glucose with the exception of fiber, which is not by amylase enzymes. And that's actually it starts in our mouths and our saliva. last of the macronutrients are fat. Many different sources of these. There are two essential fatty acids. One's an omega-3 and one's an omega-6. Most people get more omega-6 than they need and probably not as much omega-3 as they would benefit from. There are multiple different types that are distinguished by their carbon bond structure. So you get saturated fats, which for many years had been sort of demonized as harmful to health. But as more evidence has emerged, it's not that simple. Some saturated fats can be harmful, others can be health-promoting. So again, you want to get them in a whole food source that's got nutrients and just trying to avoid the processed forms, ultra-processed foods in general. monounsaturated fats have one carbon-carbon double bond. So some examples of this would be there's quite a bit of monounsaturated fat in olive oil and macadamia nuts. Polyunsaturated fats have multiple carbon-carbon double bonds. So these are things like cold water fish, sardines, salmon and so on. And nuts, linoleic acid is one that's become kind of controversial. recently that's a, that is a form of polyunsaturated fat that some believe we get too much of. But in any case, these are broken down by lipase enzymes and these contain nine calories per gram. So they're more calorically dense than carbohydrate and fat, which is one of the things that gave rise to the non low fat diets, which, you know, probably weren't the best advice. You know, fat is health promoting when you've got healthy fats. Certain fats, you know, you want to avoid. trans fats, hydrogenated oils, and so on. But, you know, when we're talking about a prominent whole food diet, fat can be quite, quite helpful and essential. So speaking of things that are essential, we have our vitamins. So these are micronutrients. We're moving over into the non-calorie containing, non-energy containing nutrients. So there's 13 of them that are carbon containing and are essential to health. You see them listed there. We don't produce these endogenously, so we have to get them through the diet. And one example that I'd like to dial in on a little bit is vitamin K. So K actually stood for the German coagulation, so it allows blood to coagulate normally. But that's when we think of, you know, vitamin K1, think of leafy greens and so on. so if someone's getting surgery, they advise you not to, to, you know, consume many of these because they have anticoagulant effects. What about vitamin K2? I want you to pause here and, and, and think of some sources of this. So not as common in the diet. So things like natto, which is the Japanese fermented soy, Gouda cheese. basically K2 is the product of bacterial fermentation. So this is really important for heart health and also works together with vitamin D and magnesium to get calcium into the bones and out of the circulation. So this is also very important. Moving on to minerals, these are non-carbon containing compounds that are also essential to healthy of your macro and trace. You see them all listed here. you need more of the macro than you do trace. Once again, these have to be obtained through the diet. And calcium is, you know, a mineral that we hear quite a bit about. We typically think about it for bone formation, but it's involved in so many other things. You know, dairy, and if you're going to get dairy, you like to get it grass-fed and maybe even better fermented is probably the greatest source you do get it in other sources like sardines when there's the bones there and some leafy greens. Though interestingly, the leafy greens, you have oxalates that, that empiric calcium absorption. So just something to think about if you're osteo product or osteopenic, just to make sure that you're getting enough calcium on your diet. It'd be ideally the calcium and vitamin D supplement. Maybe even more ideal is some K2 in there. All right, so you've heard about the vitamins and minerals. We're going to talk about these as they pertain to aging. Now let's look at some of the non-essential micronutrients that offer lots of health benefits. So carotenoids, these are, you know, there's hundreds of these colorful pigments that are in, you know, lots of different fruits and vegetables. They're in salmon. That's what gives, you know, a nice wild caught salmon, the deep red color, but, you know, you see them in the, the, you know, alpha-beta carotene in your orange colored, you know, pumpkin and carrots and so on, lycopene and your red colors, lutein and zeaxanthin, your leafy greens and egg yolks on a pasture raised eggs, typically. Then you get flavonoids and polyphenols. And a lot of these health promoting foods that you see here, things like resveratrol, curcumin, EDCG and green tea anthocyanidins that are in berries. These actually have helpful prebiotic properties and can help manage inflammation and have epigenetic effects. They seem to really benefit human health in a variety of ways. And all these were plant foods that you see pictured, but there are many helpful micronutrients and animal foods, choline and egg yolks. It's also in beets, but this is really important with age when it comes to cognitive function. We'll talk about that later as we go along. Then we have, historically maligned though the climate seems to be changing on that a little bit, red meat, where I think we need to think about that in a little more nuanced way. If we look at pasture raised regenerative, ideally sourced red meat's a great source of creatine, which is, I'll talk quite a bit about that today, and carnitine, we're going to talk about Bruce Ames' papers with how important carnitine is in the triage theory of aging and coenzyme Q10, especially important if you're taking a statin. And I'm going to talk about a resource for medication depletions. But these are all really good sources too. And if you happen to be on a plant-based diet, you ought to think about supplementing with these because they're really important for health and aging. And just briefly, I'm gonna talk about the nutritional reference values because when we talk about optimal aging, we need to think well beyond the alphabet soup of what you see and things like the recommended dietary allowances or the RDAs. This is what you see on the food labels. But what you may not know is that this is the amount that's sufficient to meet nutrient requirements to prevent nutrient deficiency diseases. So things like rickets and scurvy, not chronic disease. and this varies by variety of factors, gender and life stages, and certain pregnancy and age. You get tolerable upper intake levels. So these are really conservative, especially if you look at things like vitamin D, you know, what we ought to be getting is, you know, considerably higher a lot of times, certainly than the RDA for optimal health, but they are worthwhile to keep in mind that you can get too much of a good thing when it comes to nutrients. but there has been a lot of discussion and evidence that for many years now that these RDAs are too low when it comes to preventing chronic disease. All right, so these are the RDAs and we see they actually vary by life stage. We see the pregnant and lactating women we see throughout your children and to, you know, older adults and so on. We see that these needs differ and that kind of makes sense, but there's only one food label. So to keep this in mind that the, you know, again, just to emphasize, the RDA is, can help you prevent nutrient deficiencies diseases, but for those of you interested in optimizing, you know, your health span and aging, the best you can. You might need to think a little bit more broadly than this. And the labels, food labels, just so you know, these are based on recommendations for young adult women on a 2,000 calorie diet. So nutrition is not one size fits all. We know that needs vary between people based on all kinds of factors, how active they are, whether they're smoking or not, or, you know, whether gender, weight, all these kinds of things. and we also know that within individuals by stage of life that these vary. And this also applies to, to, you know, the obvious things like age and pregnancy, but, you know, vitamin C, you take enough of it, you get to balatar on, you have diarrhea. That level is very different when someone has a cold and when they don't. So even common things like the common cold, our nutrient needs vary quite a bit with that. and this is really important to older adults who have wide differences in their comorbidities and their health. So why is this? So why with this framework in mind, which I hope you find helpful beyond just aging, but it is going to be useful for this talk, why do our nutrient demands increase with aging? And there are a wide variety of reasons why you see them listed here, some of them, there's even more beyond this. but some nice sort of acronyms, Meals on Wheels and determine. So just to go through this, things to think about, like medication usage, polypharmacy, that really changes our nutrient levels and can increase them in many cases. Issues with swallowing or chewing and so on that can happen, these physiological things, economic issues, challenges shopping, you know, a wide variety of things that you see listed here, social contact, that became especially challenged during COVID So there's a bunch of reasons here. It's not just that we are producing less stomach acid or our digestive enzymes aren't working as well. There's a lot of life and social situations that influence why our nutrient demands change with age. That said, there are indeed some, you know, very physiological reasons why this paper gets into some of those factors in aging that affect bioavailability of nutrients. I mentioned some of these. So some of them are, we just don't absorb as well the nutrients in the small intestine. We don't secrete as much pancreatic enzymes. You know, those ones that I mentioned when I talk about the macronutrients. So your lipases, your proteases, your amylases. Our kidney function can be worse and fat soluble nutrients. Those are the ones I did my doctor work on. Vitamin E and the carotenoids, you know, it's a slower uptake of these things. So there are some physiological reasons, but the authors argue that it's actually really driven by age-related disease and not necessarily age itself. This is one of the things I hope you find empowering. So things like, you know, lower stomach acid, atrophic gastritis effects, about 20% of older adults, but lower stomach acid and pepsin leads to low levels of a bunch of different nutrients. And as we see acid blocking medications, if you happen to be on those, we're gonna see that those are associated with low levels of a variety of key nutrients. And then we get in low protein intake, low amino acids, we get sarcopenia, which is low muscle mass, which is just what you wanna avoid. at all costs when it comes to aging because it's associated with all cause mortality and all kinds of other chronic conditions. There's other age-related diseases that increase nutrient demands, things like diabetes, cancer, and again, sarcopenia. This is one resource to show you a few of them of common medication classes that deplete nutrients. So I want to draw special attention to, to see H2 RAs there. So H2 receptor agonists. And these are acid blocking medications, proton pump inhibitors, PPIs. So these are taken by a bunch of people when they have acid reflux or so on. Look at how many of these nutrients are adversely affected by those. You get diuretics are, you know, a lot of older People take those, we see how those are associated with a whole bunch of different nutrients. So this is something that, you know, we're trying to teach our medical students more and more about this, but it's largely going to be up to you to do this. And, you know, one of the best resources is might event.com if you haven't heard of this, I strongly suggest checking it out. If you're taking any medications, so meprazol, there's one of your acid blocking medications and metformin. So I think this is interesting because it's a common medication, but also one that's used quite often by people who kind of, who are in sort of anti-aging communities. And it's, you know, can be a pretty good medication. We'll talk about that as we go along. We talk about mTOR and AMPK and these kinds of things, but but it does have its issues, one of which is it depletes some, you know, key nutrients for especially for aging B12. That's one of the cornerstones that tends to be low with age and where we tend to need a little bit more in folate acid. You see a bunch of other common medications listed on the bottom there. You see antidepressants, stimulants, statins. So it's worth poking around if you're taking any medications or just to know if to advise anyone And looking specifically at B12, Mitevan will talk about some of the specific studies and grades the evidence based on what you see here, this matrix of how they grade it, A being a systematic review of metagenomic human trials down to NA, which is not enough there, or D is kind of you know, in vivo animal trials, these kinds of things. And these data are generated from a variety of sources. So really nice resource, you know, blogs on, on some of key topics. So definitely check out Might Have Been if you're interested in, in that topic. I suggest we all, you know, be aware of it, at least. So let's talk a little about the triage theory that I mentioned before. This is Bruce Ames who popularized this. He's a very impressive guy. probably kind of would be mid nineties at this point, still, you know, doing work. Basically what this is all about is that nutrients are used in this triage manner where the micronutrients are used to ensure survival. Like it's kind of what's the hierarchy of what's most important. That's gonna be our survival. And then a bunch of other, you know, important roles that they play go by the wayside. So this would include all of these hallmarks of aging that I mentioned before, you know, our mitochondria function or DNA repair, telomeres, senescence, and as such, being low in micronutrients can contribute to age-related disease because they're being triaged away from all these important functions they have because we just don't have enough of them around. And I mentioned before that AIM is really mentions carnitine and alpha-lipoic acid, especially because of their role in mitochondrial health. So, you know, just being aware that you're getting enough carnitine in your diet and alpha-lipoic acid in your diet to ensure optimal function. Of course, there's many others that you see, listen here, let's move this down a little bit. And you can cover some of those bases with the multivitamin. Really, although you ought to be thinking food first and there are some other supplements we'll talk about too. so what are some of the specific strategies? You know, there, there have been some efforts such as the Tufts food pyramid that you see here that lists what, you know, they think to, to be important to, to, for aging and things like increased fluid intake. Absolutely. Increased protein intake. Definitely. And they talk about a couple of key micronutrients. Uh, we've already mentioned B12, calcium and vitamin D. But this is just the tip of the iceberg. There are many, many other important nutritional factors that we're going to discuss today. You know, other minerals, many other vitamins, the non-essential nutrients, and then just thinking about how nutrition impacts the other domains, you know, the equal amounts of calories of something can have very different effects on inflammation. you know, different protein sources have very different bioavailability. And when we eat, you know, this fascinating science and practice of time restricted eating can have an impact as well. Okay, so let's look at some of the hallmarks of aging and foods and nutrients that can help with this. So if you look at the primary, these are like the furthest upstream hallmarks of aging. So one would be genomic instability. And this is basically an imbalance between DNA damage and repair. so what you're going to get in your diet there are dietary antioxidants, probably best obtained through food, you know, things like I showed on that slide with the carotenoids and polyphenols and, you know, alpha lipoic acid and all these, these kinds of foods. And our two activators, which is a switch that controls a whole bunch of, of, of genes. So things like sulforaphane, which is in broccoli sprouts and some supplements, curcumin and turmeric, naringenin, the sirtuin activators. We're going to talk about those plantains. We go along, talk about NAD and alpha-ketoglutarate, which is a supplement which I feel like isn't talked about a whole lot, but it's one that seems to impact a number of these different pathways. Then you get telomeres, and these are kind of the shoe strings in the end of the shoelaces. I'm sorry, the shoe, the ends of the shoelaces that can fade as time goes along. So it's the DNA damage at the end of those chromosomes. So things like Mediterranean diet, Terry patterns, there's not one Mediterranean diet, but the general dietary patterns, you know, getting ample fiber, polyphenols, coffee is a great source of polyphenols, vitamin D and omega-3 fats from your cold water fish and other sources. epigenetic alterations. This is changes in gene expression, epi above gene genetic genome. It's above the genome. And this is where there's a lot of really interesting, interesting things with methyl donors, things like Sammy, trimethylglycine, TMG, great supplement, choline, talked about before in the Agocs, B vitamins, omega-3 fats, then you get H H DAC inhibitors, histone deacetylase inhibitors, things like sulforaphane, EGCG. Quercetin, we heard a lot about that during COVID but quercetin, a good supplement also used for seasonal allergies. And once again, alpha-keto-glutarate. L-tyrosine, proteostasis, another one. So this is, you may hear about protein misfolding and glycated proteins. So this is where, you know, HVA1Cs and, you know, so things like berberine, which can help manage blood sugar, are great, great supplement. we'll talk a little about this when we talk about mTOR. So foraging and spices and herbs, things like cinnamon and cloves and so on, and just generally cooking your food on lower temperatures. So slow cookers, you know, crock pots are wonderful and not burning them to burning your food to oblivion. And then we get disabled macro autophagy or autophagy. We hear about that a fair amount today. We talk about things like fasting and so on. It's basically just, you know, not able to remove damaged cells or waste. so fasting, time restricted eating, caloric restriction, I tend to think for most people, time restricted eating is easier and I worry about long-term caloric restriction for human beings, but there's the time and place for it. Urolithin A is a really promising supplement. Spermidine is another one and then the NAD+ precursors. Okay, so let's look at some of the antagonistic factors can go along with these. So deregulated nutrient sensing is a big one. So this is just suboptimal alterations and anabolic response, autophagy and inflammation and so on. And one of the best things with this, again, is your spectrum of fasting, time restricted eating and caloric restriction and so on, potentially ketogenic diets, recommend those. Generally not for the long term. Some people do well with them. Some people need to do them. Epileptics, for example. But, but they can be useful in a cyclic way, berberine and just getting enough, enough, you know, nutrients and not eating too much, you know, I get mitochondrial dysfunction. And this is, you know, really a big area of interest these days, which just leads to inflammation and, and poor cellular function. more generally, things like L-carnitine, it's coming up, coenzyme Q10, DKK, a ketogenic diet, all these things can help with mitochondrial function. Cellular senescence. These are the senescent cells or we know often called zombie cells that go around, you know, basically they're not really alive, not really dead all the way, but they cause a bunch of inflammation. So there's some interesting flavonoids like fisetin and quercetin that have been used for this. People take them often in a hit and run fashion, they call it. Then once again, you get this timing, your time restricted eating. There's different ways to do it. I think a fair middle ground for a lot of people, something like eating in an eight hour window. and this will vary based on, on, you know, the menstrual period sometimes for women and other factors. He probably wouldn't want to do a whole lot longer than that with, when, with age, but some people really thrive on it and, and it's going to be somewhat individual and, and varies on what you're eating as well. Okay. And lastly, we're the integrative ones, which are the ones that are kind of a result of the other factors. So stem cell exhaustion. So just the, the, the loss of cellular plasticity, you know, stem cells can kind of become a bunch of different cells. Once again, you know, you get your time restricted eating, you know, fasting and so on and, and potential ketogenic diets, altered intercellular communication, which is just where the, these cells don't, don't, there's not, the signaling pathways aren't working as well. So things like alpha lipoic acid, I mentioned collagen before, you know, again, we think of that for. you know, skin and joint health and some glycosaminoglycan, chondroitin, hyaluronic acid, all those types of things that are working in those systems. Dysbiosis, so, you know, not enough diversity and increasing pathogens. So there are things like fermented foods, probiotics, prebiotics, potentially taking short chain fatty acids, postbiotics. and chronic inflammation, which is kind of like this is just all these other hallmarks together lead to a state of chronic inflammation, which is associated with seemingly everything when it comes to chronic diseases and worsening of acute diseases. So omega-3 fats, your polyphenols, spices and herbs, and so on. The authors conclude with some things that resonate with those of us in functional medicine. that, you know, we want to avoid age accelerating environmental factors. So environmental toxins, my team and I have done some work in this area. Really try to avoid those. Get good air filtration in your homes. Be careful if you live in environments where there's significant air pollution, stress, physical inactivity, you know, and, and all these other factors sometimes which are unavoidable, as I mentioned. and then adopting health promoting lifestyle factors, exercise, sleeping well, socializing, and of course diet, which is the focus today. And then they talk about these relatively nonspecific pleiotropic drugs, not just drugs, these can be supplements, things like NAD+ precursors and berberine and so on. So really, I think an encouraging paper that there's a lot of aging that we can control. and when it comes to diet, there's a lot of different ways to get there. You know, I think this slide demonstrates some of the ways which you don't see here. You don't really see any processed foods and Ultra processed Foods. All right, you see ample protein, you see lots of color, you see carotenoids and, you know, flavonoids abound and good fats. and again, some form of time restricted eating. It doesn't need to be extensive, but be a couple hours before bed and maybe a few hours after waking up, those kinds of things. You just want to be eating all the time. All right. And that was going to help us sleep, which is fundamental to taping as well. Okay, so let's start with protein because this is an area where, what I, what I think is of paramount importance. Everyone's got different, slightly different takes on this. I think we can all agree on the note. processed foods or limited, limited ultra processed foods. But let's talk about protein. Why is this so important with age? Well, for one, there's a decrease in total body protein with age, and we kind of all see this in most older folks who have decreased skeletal muscle mass. We kind of see this, but subclinically it also causes a problem in the organs, in our immune system, in our blood. So protein is, is essential. that are, were made up of it. And the muscle, the, the, the, the decrease in skeletal muscle is really dramatic. So young adults, you know, anywhere around 40, 50% of total body weight, around age 70 for most people, not, doesn't have to be. And that's, what's good news, is about half of that. So we know that dietary protein, you know, builds and maintains skeletal muscle. So dietary protein gets broken down to amino acids, which then get built in skeletal muscle and high quality protein intake is a key to prevent sarcopenia. And again, we talk about low muscle mass, study after study after study, systematic review and meta-analysis show that this is a predictor of all-cause mortality. All right, so we've talked about the RDAs, some of the shortcomings of them before. The RDAs for protein is 0.8 grams per kilogram a body weight. And that's argued by most to be too low. So research suggests at least one gram per kilogram of body weight. And many argue for even more. There's been some interesting papers with that. And, you know, it's not just the muscle mass. I mean, there's, there's all kinds of issues with insufficient protein that you see listed here. So, you know, things are immune function, wound and fracture healing, skin problems. So we need more. And a lot of times you hear, well, what about kidneys? There really is no good evidence of renal harm for healthy kidneys. If someone has unhealthy kidneys, it's a different consideration. They may not be able to handle as much. And for other select conditions that are not very common. But I want to talk about this. All proteins are not created equally. and there are a number of different sort of measurement scales out there to help us assess the quality of protein. And, you know, typically we think about protein quality, and we think of, you know, just maintaining body protein mass, but there's so much more to it. What are the different amino acids? you know, I talked about collagen before not containing amino acids, and I talked about plant proteins. They don't contain, you know, the full spectrum of, of, of essential amino acids. Then, you know, what, you know, the different amino acids, the, and proteins, they have varying effects on our body composition, on our bone health, on the function of our, of our gastrointestinal system, on cell signaling, glucose homeostasis, satiety, you know, also the other nutrients and antinutrients that accompany those proteins. So it's, we got to think about this a little bit more. broadly, you know, things, antinutrients, you've run with those are, those are things like lectins and trypsin inhibitors, which can oxidize, I mentioned before, which can impair, you know, the absorption of minerals and leach minerals and, you know, make a, we don't digest as well. So we got to think about quantity and quality. And this pdc aas, which is the protein digestibility corrected amino acid score, is one such way. to do that. You see what it's listed, how it's done there. But in brief, animal proteins are more bioavailable than plant proteins. We see some listing here, things like whey protein isolate right at the very top. But we get down to things like wheat and soy and peanuts and these things, legumes in their whole form, are not very bioavailable. So, what we need to think about with this, and again, think about combinations and so on, but leucine is one that again, we talk about the amino acids, we really need to think about this. We hear about branched-chain amino acids, these are critical for maintaining muscle mass or putting muscle mass on with age. It's not like it's just a maintenance. You can put on lean body mass with age, which is going to provide resilience. from the hip fractures and all those types of things, but also help you perform better. We see again, whey protein isolate at the top and things that whey protein, which are not very good, not only that, gluten and these are not particularly available. So things like beans, I mean, beans can be, especially with certain protein powders, can be combined with, you know, other, other plant foods to have, you know, form complete proteins. But if you look at the amino acids again, I suggest you think a little bit about more than just grams, but also start to think about amino acids. And there are just many more and something like beef, for example, doesn't mean you have to eat beef, but you do need to be aware of the amino acids. especially with age. So things to think about here.

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