Extend Your Healthspan and Lifespan, with Dr. Sandra Kaufmann

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Hello, and welcome to the five Journeys Feel Freaking Amazing podcast. I'm Wendy Trubo. Obviously, Ed's not here today. No star celebrity sighting, obviously. But we have. We have Dr. Kaufman, who is a longevity physician, author, creator of the Kaufman Protocol, and it's the only scientifically rigorous methodology for creating personal longevity programs. Her information is present, presented in two popular books, the Kaufman why We Age and How to Stop it, and Aging Solutions. Sandy, welcome. I'm so excited to have you on the podcast today.

Thank you. I am thrilled to be here.

Let's dive in. I mean, look, longevity is important because the alternative is worse, right?

Well, but you're not.

It's not just longevity. It's healthy longevity. It's really, truly having a health span, not just a long lifespan.

I am so glad you just used those words exactly, because I was just going to say just that whenever I say longevity, people are like, I don't want to be 150 in a wheelchair with a trach, et cetera, et cetera. It's not about that at all. It's about living as well as you can, as long as you can. And that's, I think, what we all want. I mean, who could possibly, you know, poo poo that idea 100%.

So let's talk about. What I really want to understand is why do we age? Like what? Why. What goes on here?

Oh, my gosh. So you just opened the biggest Pandora's box ever. I do E8. So, you know, people who, whenever that you say that, everyone looks at it from different levels. There's the, you know, the social level, there's the what you eat level, there's the exercise level. There's like, you know, theoretical levels. I was a cell biologist before I went to med school. I got a master's in cell biology. I'm an anesthesiologist. So everything I do is cell and organ based. And I deal with a lot of pharmaceuticals and molecular and that sort of thing. So my answer is sort of framed in that way of thinking. So here's. Here's the reasons that you age.

Drumroll.

Okay, here we go. Right, so let me actually, before I say that, a lot of people in my world live by what's called the hallmarks of aging, which is a mishmash of cellular things and some non cellular things, and the list just keeps getting longer and longer, and it's just not very organized. So before even people knew that there was a hallmarks of aging, I decided about 10 years ago that you could clump all of the reasons that cells age into seven big piles, and I call those the seven tenets of aging. So if you think about them sort of like in a very methodological perspective, they're very easy to remember, and they're always in the same order for a reason. And you'll understand that at the end. So reason one, or tenet one, has to do with DNA alterations. DNA go awry for many reasons. Number one is telomeres get shorter. Number two, you get epigenetic modifications, some of which are good, but most of which are bad or detrimental. And then thirdly, we talk about chromatin structure, and there's stuff called heterochromatin and euchromatin. And the ratios of this change over time, which leads to structural changes in your DNA, and thus anomalous things in your DNA get loose and leads to, like, transposons and increased risks of cancer and that sort of thing. So that is tenant one. Anything that can go wrong in your DNA, tenant two has to do with your mitochondria. So this is energy production. And energy production in your mitochondria can fail for roughly seven reasons. And I won't bore you with all of them, but it's structural changes, it's biochemical reasons. It's because we use oxygen in the electron transport chain, and that develops into what we call free radicals, and those are little bombs around your body. You get a. There are endogenous free radical scavengers that fail over time. So that's another one of the reasons you get a shortage of some of the basic ingredients that mitochondria use. The biggest one, of course, is the precursors to NAD are very, very important. Anyone over the age of 40 is generally deficient in NAD. But again, there are many reasons why your mitochondrial fail, and that's all in Tenet 2. Tenet 3 is what I call pathways. And there are many pathways throughout your body that monitor things and then respond accordingly. So the sirtuins fall into this category. Sirtuins monitor how much energy you have, how many nutrients you have, and they dictate what you do. And they, in fact, control all cellular homeostasis. And there are seven mammalian sirtuins, and if anyone's curious, what they are is histone deacetylases, right? So that's a big enzyme, but essentially it turns proteins on and off in your body. And by the time you were 40, these aren't working very well, so you lose cellular homeostasis. So things that go wrong because of this have to do with how you repair your DNA, where you store fat. You know, it's the stereotypical question. Or, you know, everyone says, well, I eat the same thing that I used to and I exercise the same. How come I knew now have a big abdominal ring of fat? Right? That's. Everyone always asks that. And the answer is, you're sirtuin deficient. So your body stores fat differently, which is awesome because it means that there's a reason and we can fix it. But other pathways. So there's the AMP kinase pathway, measures energy, there's the MTOR pathway, and then I've recently thrown the circadian pathways in there because they're extremely complex. And it's not just not sleeping. It has to do with. Roughly 30 to 40% of all of your genes are activated by the same proteins that cause you to fall asleep. So if you're not sleeping, 30 to 40% of your entire genome takes a hit.

I think we should pause here. I know you're in the list of the seven things, but I think we should pause here because not sleeping is such a tremendous risk factor for everything. If you don't sleep, you don't detox, you don't repair, you don't rest. That's then a risk factor for other sequelae like heart disease, diabetes, Alzheimer's, degenerative disease, autoimmune disease. So you cannot overstate the importance of these pathways. So, okay, go back to you. I just wanted to.

And so what's really interesting about this is the traditional belief is that because you sleep, you put that at the top of the pyramid. All of the other things happen because of it. And what's interesting is that's not the way it happens. There are two proteins that put you to sleep, and there are two proteins that wake you up. And as those get made and made and destroyed and made and destroyed, the overlapping pattern causes you to sleep. But the production of these proteins also trigger gene control, or clock controlled genes. So 30 to 40% of your entire genome is controlled by the clock BMLA proteins. Therefore, sleeping is a symptom of the problem, or it's a part of the problem, but it doesn't dictate it. So if you're not sleeping, you take a sleeping pill, you go, oh, I feel so much better. You don't, because you're not making the proteins that you would have that would have caused you to sleep in the first place.

Okay, so this is like a whole podcast unto itself. And set that aside.

And I love this. But, like, so every tenant is honestly A huge monster podcast. But I recently put that one in there because I took a deep dive into circadian rhythms. And I was like, where do I put it in the tenants? I'm like, oh, my God. Of course. It's a pathway, right? So it's pathways. Okay, next pathway, next. Anyway, so that's those. That's tenet three. Those are the pathways. Tenet four is what I call quality control. So if you think of your cell as a factory, things go wrong and you have to fix them. Right? So in this category are DNA repair mechanisms, protein repair mechanisms, or the process of proteostasis and then autophagy. And these are lumped together simply because you have to fix things. And if you can't fix them, then you recycle them. Right. People always think, well, DNA repair can't possibly be that important. And I point out that you have 10 to the 4th to 10 to the 5th errors in your DNA per cell per day. That is a lot of zeros.

That's ten thousand to a hundred thousand.

Errors every day per cell, per cell, per cell.

And then there's something like 25 billion cells, or I don't even know how many cells are in our body.

Right? Yeah. So you have, because of this, you have five essential DNA repair mechanisms to fix them. So your body's constantly patrolling your DNA, finding the problem, fixing the problem as well as they can. And past the age of 40, these systems just don't work very well. So when you can't repair your DNA, your incidence of disease, decay, death, cancer, all of those things skyrockets, Right. Pretty horrible. Okay, so that is tenant. Where are we? Above 4. So we are on a tenant 5. So 5 is your immune system that then turns into your inflammation system. Right. When you are young, this very complex immune system fights infection. And it's just wonderful, wonderful things for you as you get older. And it does not do that. Right. You are more likely to have infections. You're more likely to get autoimmune diseases because it turns on yourself. You're also more likely to become systemically inflamed because it basically activates all of these inflammatory cytokines and it doesn't know how to turn them off. So there's a whole science of your inflammasome and inflammaging and how to control that. And of course, inflammatory issues precipitate DNA errors and protein errors, leading back to the old disease, to death, you know.

Blah, blah, blah, which stresses the mitochondria and then has the management go Go off. I mean, like, it just feels like you're circling the drain with all of these. That it.

It ab. Absolutely. And I talk about them as if they're separate. But whenever I do a lecture in person, I always start with this diagram that looks like this, like, unbelievably chaotic net of, like, arrows and circles and overlaps because it's all intricately entwined. But the only way to totally kind of understand it is to segregate a piece of it, knowing full well that nothing lives in isolation. Right, Right.

I always say to people, it's like that movie Wall E. You're not eva. You can separate your arms from your head from your body. It's all intertwined. Even though we're carving it out so you can understand it, it really is. It's separate.

Yeah. No good. I gotta love that movie.

All right, so that was, like, five. Or I think that was six.

So that is. That's five. So six is individual cell needs. So throughout everything else, I pretend that the cell's a cell. And it doesn't matter what cells they are, but it. You know, as it turns out, of course, reality is reality, and different cells need different treatments. So a senescent cell, for example, is something you want to get rid of. We do not need our senescent cells. A stem cell on the other end of the spectrum is something we absolutely need. And we need to baby them and care. Right. And give them everything that they need. In addition, it recognizes the idea that a blood, you know, red cell is different than a liver cell, which is different than a kidney cell, which is different than a brain cell. They all have individual stresses and requirements based on what they do, what they're exposed to, and how long you expect them to live. Right. Red cell turns over every three months. A neuron in your head lives your entire life. So they have different requirements.

Is there anything that unifies them that you can say, okay, here's the common thread that runs through them. All cells need this. And then we stratify it to that next layer of individuality. Is there anything you can talk through there?

Well, the first five categories responds to, like, all of them. Okay, Right. This is where you go, okay. These are these little, you know, nuances that we need to sort of deal with. So every cell has DNA issues. Every cell has mitochondrial issues and pathway issues and blah, blah, blah. This is where we sort of go, you know what? They're not exactly the same. So, for example, inflammatory issues cause your bone cells. So there's osteoclasts and osteoblasts, Right. You're constantly remodeling. So osteoclasts break down your bone. And osteoblast B for build builds more bone. Right. And it turns out that inflammatory issues make you break down bone and block building of new bone. But that's very particular to bone. That's got nothing to do with your kidney or your brain. So that's a very particular thing to look at. And there are agents that specifically cause your osteoblasts to be more active and then you can delay osteoporosis as an example. Let's see. So that's individual cell requirements. And then the last category is what I call waste management. Right. Because if this is a factory, you have to take out the trash. And most of the garbage reproduce is side products of the entire metabolism. And the worst thing are the sugars. And of course sugars. Everyone points to glucose, but glucose is not as bad as some of the other ones, such as fructose or ribose, but they create something called AGEs or advanced glycation Endpoints products. Sorry. And these destroy your tissues? Absolutely destroy your tissues. But there are ways around that, of course. And then the last thing is this stuff called lipofusion, which is like the junk that is left in the back of your cell when your body undergoes autophagy and is recycling bits and pieces. There's always a bit of goo that your doesn't know what to do with. And the cell goes, well, hell, I'm just going to do what everyone does and squash it in the back and just ignore that it's there. Right. So for short lived cells, it's not a big deal. Right. It just leaves with the cell. But for long lived cells, you're stuck with it. So if you look at the neurons of very old people, half of their brain is filled up with this gooey garbage, which of course no cell is going to function very well if you're stuck with gooey garbage. Right. Anyway, so soup to nuts. That is roughly why you age.

There's gotta be things a girl can.

Do, though of course there are. Otherwise why would we be talking about this? Exactly.

Okay, so are you able to stratify it into, here's the low hanging fruit and here's the slightly higher order behavior, more challenging things.

Okay, so I got extraordinarily frustrated, yet excited when I learned about this a decade ago, right. And it would turn out you'd be reading, you know, one of these issues. And of course it was if all of this Stuff got pieced together over the course of like a zillion years. So no one ever said, oh, well here it is. But you'd be reading about a pathway or a problem or this or that, and they'd say, ah, the stereotypical agent to fix this, agent X comma. And you go, ooh, there's an Agent X. And then I would look it up. Well, what does it really do? Right? And it turns out it always has some activity in some of the seven tenants. Some things did one thing, some things did three, some things did all of it. And you're like, oh my God, this is amazing. So at one point I had this huge piece of paper because I'm old fashioned, I use paper. And it had the seven tenants and I had this check minus system in it, like, right, oh, this is useful. Check two checks in this column, a negative in that column and it turned into a numerical system whereby if Agent X did absolutely nothing in your DNA as an example, it got a zero. Nothing. I couldn't find anything. Zero. If it did something in a test tube or a culture or just a really damn good idea, it got a one, right? If there was evidence in a non human mammal model, like a rodent, a horse, a dog, quail, which aren't really mammals, but good non human animal evidence, it got a 2. And if there was solid human evidence, it would get a three. Right?

Makes sense.

It was just my way of keeping track of this stuff. And then I realized now every agent that I looked at had a seven digit rating number, right? Now they have barcodes. So then I realized right, now keep in mind it's not efficacy, it's clinical evidence. I mean, that's what these numbers are, right? But I decided at some point that they're additive. So if you were going to say, I want to take one thing, take something with the highest numbers in each category. If I wanted to take three things, find things whereby when you added the numbers together, the categories at the bottom were all covered.

And is this a one size fits all Sandy?

Oh, no, no, no, no. This is, this is the beauty of it, right? If you have no medical problems, then all the numbers should be roughly the same at the bottom, right? If you have a medical problem or you have a family history of a medical problem, all diseases can be tracked to what the cellular processes are, right? If you are pre diabetic or your family's diabetic, that's waste management, that is a glucose management problem. So you know what you do? You look at my number chart and you go, I'm going to need a lot of agents with threes in the last column. That's easy. Now it's right there. If we have a lot of autoimmune disease, if we have a lot of cardiovascular disease. Cardiovascular disease is a little bit more complex, right, because it's lipid issues, which we can fix. It's oxidative stress, it's glycation and it's inflammation. You know what, more points in those categories. And you're going to reduce relative risk. So you can take it on a generic level or you can specify what you want as an individual and sort of manipulate it to for your own good.

So, Sandy, coming back up step. When you're talking about these things, it sounds like what you're sounds to me. I always joke like I don't know how to read between the lines. You have to spell it out for me. So I'm going to ask you to spell this out for me. Are we talking about medications or is this rating system also applied to lifestyle changes like get to bed earlier, stop drinking alcohol, quit smoking.

No, no, no.

What are the agents you're referring to when you talk about this rating?

So I talk about anything that is a molecule. Okay. Going to bed early is not a molecule.

Okay. So this is supplements or medication. In this, in this realm, it's either supplement, it's.

Right. So that's an interesting question. So your body, your cells respond to molecules because you are made out of molecules, your receptors are molecules. And a molecule has to land, right? This is, this is how the system works. So you can sit there and do yoga all you want. You're not putting, I mean, you are changing your internal molecul molecular system. But in terms of bringing things into your body, they're all molecules. Right? So what's a drug versus a supplement? A supplement is a molecule, right? If it's a single agent, if it's carnosine, if it's, you know, astaxanthin, it is a molecule. If you take a full plant supplement, then it's a whole bunch of molecules thrown in there. What is a drug? It's a molecule. That's all it is.

So you're changing.

The only difference between a drug is that some company has decided to make it in a lab versus maybe we grew it in a cell or maybe it came from nature, but it's exactly the same thing. So what I end up doing is. So I only have released metformin numbers. I have a whole series of drug ratings, but they're not public knowledge because I'm terrified that someone's going to kill themselves trying to do this without, like, a physician's assistance. But all of the non medications except metformin are rated and they're on my website and it's, it's open to anybody.

So when you say non medications, you're talking about supplements.

So I also don't use the word supplements because there's a difference between a supplement and an adjuvant. Right? Word supplement suggests that you are supplementing something that you already have in your body. Okay, okay. So carnosine is my favorite example. It is a dipeptide that we all have in our bodies. Carnosine, as you get older, and if you are a woman, you have less and less and less. So if you supplement your carnosine levels, you do better. Why? It's transglycosylator. So you're lifting glucose off your tissues. And it's also a good. It absorbs acid in your muscles. So as you exercise, you don't get that brutal burn. But we take it because it's a transglycosylating agent. But the point being is you already have levels in your body, so you are supplementing them, right? An adjuvant is something that your body's never seen. You are not a plant. Therefore you do not have an astaxanthin molecule in you. So that is an adjuvant sold as a supplement. But I think it's all this garbage, catchphrase baloney. So supplements and adjuvants, the difference is important because your body, anything you have naturally has feedback loops, right? So if your body makes something, it has a system to determine how much you have to determine, do I need to make more? Do I need to make less? An adjuvant doesn't work that way because you don't have any endogenous levels. So you can take as much astaxanthin as you want and nothing happens. As soon as you take carnosine, you upregulate carnosine ace. So you end up having less than you when what you started with. So it's sort of one of these, like, you know, trying to figure out what it is, how the body responds, and then knows how to deal with it.

Okay, so where I was headed with that was you have this system for things that you take correct.

Let's.

Whether they're supplements, adjuvants, or medications, there's still things you take correct. So everybody is looking for the magic pill. And I've kind of figured out that the Magic pill is like a thousand magic pills. But. But basically, what are the things people can do before they get to things they're putting in their mouth as an extra? Right?

Okay.

Something they're gonna. Before you spend money on something, what can you do to help your aging on tenants that doesn't require you to purchase something?

Okay, so. Well, let me. Let me tell you, I have this thing that I call the longevity pyramid. Okay. And much like the fifth grade food pyramid that we all saw very, very.

Long ago, by the way, you shall be throwing that pyramid out because it sucks.

Oh, it's terrible.

We're throwing it out. We're just using it as a reference.

Oh, I know. It's just, it's. I just remember because I was in the fifth grade, I'm like, really? There's a cupcake at the top. But it was that the idea is good, right? The idea is at the bottom, it's things that you need to do more frequently than the stuff that you do at the top. Right? So I thought, well, this makes sense in longevity. So at the bottom of my period are things that you should do every day, right? The next level up are things that you should do a little less frequently. So I put that in the once a week category. Then there are things in the once a month category and maybe once a year, and then so on and so forth until you keep getting farther and farther into this like, sort of wormhole of longe. So what can you do every day? Exercise is the cheapest thing to do, that everyone should be doing baseline. There is no doubt that none of this works without exercise. People always say, well, aerobic or non aerobic, and you have to do both. Your body responds differently to aerobic versus resistance training, so you don't have to be a weightlifter for it. But in order to maintain bone density and a variety of other things, you need compression and you need to activate your muscles. You also need the cardiovascular activity to keep your lungs healthy, to keep your endothelium of your entire sort of vascular system busy. So exercise, without a doubt is the cheapest thing to do. Of course, diet falls into this category. I am not a nutritionalist in any way, shape or form. I think all these crazy diets that people on are a little bit nuts. People tend to be just absolutely all over the place. I'm a vegan, I'm a this, I'm a that. I believe in moderation. Right. Because diet has its fallback.

There's sort of a bunch of ways to look at that. And I don't mean this to sound preachy, so I'm just going to be straight up.

Go ahead.

So I believe that what you eat makes a profound difference on the function and structure and ability of your body to perform well. And so I was thinking about. Michael Pollan has such a great line. Eat real food, not too much. Right? Like that to me is sort of the epitome. And then however you then make that work in your life, you don't eat meat, you don't eat sugar, you don't eat dairy, you don't eat gluten, whatever you're going to drill down into it. But the basis of that eating plan is that it's real food and you can recognize it. And you don't necessarily need a label to tell you what's in it because you go, oh, I see celery and I see carrots. You can recognize the food, that it looks recognizable. Okay, so we did exercise, we did food. What's next? Things in the pyramid that you don't need to purchase necessarily.

It gets a little harder from that on because I do a lot of light therapy, so it's not something you purchase every day. But red light and infrared therapies, eight minutes a day I think is just fantastic. Clearly there's an upfront purchase, but then once you have it, then it's, you know, it's sort of free. Ish. Some people put peptides into this category, but again, that's something that you have to purchase.

Okay, so maybe we don't have to say not purchase, not purchase, but more like not, not something that you're adding to what you're eating to, to round it out. It's more about a lifestyle behavior.

Well, I will tell you, I'm not a lifestyle coach at all. Everyone, you know, there's a big push for yoga and meditation and all of that sort of thing. That is not my gig. I am, I, I'm a, I'm a bit of a hardcore molecular biologist. So I know all of those things are extremely good for you in terms of biofeedback, et cetera. Oh, you know, here's something that I do do, and this is sort of. Everyone makes fun of me. Well, we live on a golf course. I, I only walk it in bare feet because I am a big believer in energy and grounding and that is utterly free to take off your shoes, unless, of course, you step on something and then you end up in the er. But beyond some crazy disaster, you should absolutely ground on a daily basis.

When you were Talking about the red light therapy and the sauna. What about the. I mean, I'm a huge fan. We have a sauna. You know, instead of going to Italy when I turn 50, we finish the basement and put a sauna in. So I'm a huge fan of it. But what about it?

The heat sauna or the light sauna or both?

Near mid far red light and infrared heat sauna.

Okay, so I will, I will. So infrared and red light are really amazing. And I think this is completely cool on a molecular level because what they actually do, and it's two very, very, very specific wavelengths. If you look at your electron transport chain, there are five complexes, right, that move the little electron along to create a gradient. And at the very last one, because you have a gradient of protons, they spin from one side to the other of this lipid bilayer and it causes the last complex, called atpase, to spin. And the faster it spins, the faster you make ATP, right? Red light and infrared light at those very specific frequencies causes it to spin faster. So you are making more energy free of charge. So as a consequence, all of a sudden, your cells are jacked up for six to eight hours, because that's sort of the time components. So you haven't burned any energy. And yet your regenerative ability or your performance ability, whatever tissues you are affecting is significantly better. Okay? That's what the light therapy does. Now, the heat part, here's my I love this cheating business, right? You ask yourself, what does heat therapy do, right? And it activates heat shock proteins. This is why people do it. They don't know why they do it, but this is why they do it. And you have to spend 30 minutes per day at a reasonably high temperature to activate your heat shock proteins. And heat shock proteins are important because they are molecular chaperones and they fall into the protein stabilization business. It's proteostasis, right? The cool thing about that is there's actually a Japanese drug called Cell Beck and it is sold for gastritis. But it is one of the strongest heat shock protein activators that we have. And there actually was a study demonstrating that if, if people were on this drug for their gastritis, they have less incidence of Alzheimer's, because Alzheimer's is a protein misfolding disease, or that's one of the components of it. Therefore, if you can, you know, upregulate your heat shock proteins, you can reduce relative risk of most neurologic diseases, including Alzheimer's. Therefore, you can either sit in the sauna half an hour a day, which is great, feels wonderful. But I don't have that kind of time. I take Celvex.

It was interesting because I was just saying to someone like, I love being in the sauna. The only challenge is when you're in the sauna, then you have to wash your hair so that you wash the toxins that came out of your body. Your head is full of sebaceous glands which are storing the fat. So if you don't wash your hair, then you just reabsorb the toxins. So you have to wash your hair. And it's not the sauna, it's actually the shower and do my hair part that I'm like, oh, I don't feel like dealing.

A lot of work. It's a pain in the butt. It's a pita.

So, okay, so, so we're doing these things. What else is in the pyramid of things? And is it that these things. And maybe we can't untie it, but is it that these things are promoting longevity or that they're reducing illness?

Both. Are you? It's both.

Right, so it's, it can start to untangle them.

Absolutely both. Absolutely both. Because so if you think about it as simple example, let's look at glucose, right? Glucose causes age, age glob onto collagen and other proteins. But they love collagen. And my analogy is always if you take like a cloth tablecloth and if you look at the little fibers, they're cross linking and you can slide them, right? And that's what our skin does, or our bone or the tissue in our heart, anything collagen based, and they slide. As soon as you put an age on there, it's sort of equivalent to a drop of superglue. And then when you slide the fibers, they break, right? So this is why your collagen fails over time, thus your skin droops, thus your bones become fragile, thus you get congestive heart failure without coronary disease, Right? Happens to everyone. It is just more advanced if you are diabetic. Thus the statement that pissed a lot of people off that I said is, I think everyone is pre diabetic because everyone has glucose, therefore everyone has ages and everyone's skin droops over the course of time. If you can prevent that early on, and I have seven steps to blocking age production, you just do better. So you reduce morbidity and mortality. So it's a spectrum. So all of these things do both.

I want to make sure that we're doing justice to your Pyramid. Is there anything else? So we did the sort of.

That's every day. It's every day, every week. I recommend that people get a full body massage. And the reason for that is you. Every time you're massaging muscle, it's. It's basically, it's helping your muscle, right? It's bringing blood flow to your muscle, which is bringing nutrients to your muscle, as well as getting rid of toxins. It's increasing blood flow to the skin. Skin. It's reducing relative stress. All these things are amazing, right? It's fantastic. And when you work out a lot, you kind of hurt. So it's just perfect. So that's once a week, once a month. It gets a little bit more goofy. I believe in IV glutathione. Once a month.

Why only once a month? Why not?

I'll tell you. I'll tell you why. Because glutathione is a naturally occurring substance in your cells. If you take glutathione every day, your feedback loops will tell your body, oh, I already have enough. I'm not going to make it. So you're going to shut down your glutathione production. That is really bad. If you do a high dose once a month, it doesn't do it. And conveniently, I'll already have an IV in once a month because I do IV exosomes every month.

So you get a twofer.

You get a twofer. And I said, and I inject spermidine IV and I inject methylene blue iv. So I just have a good old time once, you know, Saturday morning once a month. And my kitchen looks like, you know, disaster.

But when you're an anesthesiologist and you're. You're in Florida, so those are two sort of very rare things that go together. Because, like, in Boston, we can't. Like, we can't do ozone. We have to go to New Hampshire. Like, there's a. There's a fair number of restrictions for what you can do. So it feels like it's.

It's.

Some of this is dependent where you are in the country, but it sounds awesome. I'd love to have, like, one Saturday a month where I could just do it.

Okay. Well, it's. You know, the nice thing is I don't have to go anywhere to do it. It's my kitchen. Right.

You do it on yourself, of course. Okay, so. So that's once a month.

What Ha.

And then what's the next ring on the pyramid?

So. Oh, so I'm not done. So the other thing that you have to do once a month is eradicate your senescent cells. And it's not there. There's various things that do. So senescent cells are basically any normal cel that morphs from DNA damage into a senescent cell. So people call them zombie cells. I call them grumpy old man cells because they get kind of fat and globby and they just release a whole lot of like negative energy or negative cytokines. And I just picture like some old fat guy whining in the corner and just being a dick. But anyway, because they come from different cell types, you have to get rid of them with different therapies. So once a month, I will rotate. I either do quercetin, I do decentive, I'll do fisetin, I'll do roxithromycin. And then a new one I just ordered is fenofibrate, which is an anti cholesterol medicine that also has been demonstrated to clear out senescent cells. So I rotate those, but I do one of each. That's not true. I do one of them every month so that I rotate them as we go. So that's once a month. As you go higher up the pyramid, this is sort of where money starts getting in there. Then you've got plasmapheresis issues, maybe you've got stem cell infusions, that sort of thing. Then there's a whole lot of other crazy stuff that I'm not a huge believer in. Like I think hyperbaric will kill you. I actually think ozone will kill you. And then at the top of the pyramid, I always put cryogenics, because when the worst comes to worst, the last thing you could possibly do is freeze yourself, because I just think it's funny.

So where would you put a cold plunge?

I don't. I think that's. I mean. Well, that's not true. Probably would be once a week. I don't do it because it sounds miserable, and I've got medications to sort of substitute for that, but it would be in the once a week category. Got it. Okay.

When you're looking at longevity, are there separate things to do to decelerate the aging process, or is it essentially the things that promote longevity also decelerate the aging process?

Of course, all of the things I've listed in the seven tenets, if you can reduce the incidence of any of them, you just decelerated aging. If you can separate each of them just a little bit, then it's synergistic. Right. But you can't just do one. You have to sort of do them all to. To get, you know, biggest bang for your buck.

Okay. When people do these things, aside from, you know, I always say to my patients, look, the absence of a problem is really hard to track, and you can't study yourself, so you don't know what you would have done if you hadn't done or if you did, do you. You don't know the other outcome that happens from the opposite behavior. So when people do these, aside from that, they live and they don't feel badly necessarily. Are there things that they'll notice that they go, oh, oh, oh, that's meaningful?

Oh, 100%. And it depends. Well, so let me address this in several ways. There are a lot of blood tests that will test certain aspects of aging. So you can track it to a certain degree, numerically. Is it completely accurate? No. But you can do a methylation test, you can do a telomere test, you can do a glycation test. You can do a variety of things. So to some degree, it's trackable. But what most people notice is things that they wanted to get rid of in the first place. So, for example, most people in their 40s and 50s start realizing that their vision is going. I can reverse that. Most people complain that they don't have a lot of energy. I can reverse that. Those are the easy stuff. This is, you know, if someone feels amazing and they sleep eight hours a day and they feel perfect and their skin is perfect and they're perfect, they're not going to notice the goddamn thing because they're perfect. Will it help? Yeah, it actually does still help. They just haven't noticed it yet. But definitely, people with defined symptoms are the ones that benefit the most. Okay.

And is there anything I haven't asked you that I should ask you?

I don't know. It's a lot. I don't know. I guess the question would be like, do you want any details? Do people actually want to know what to take or when to take it?

Yes. And the caveat is, talk to a functional medicine doctor. Talk to someone who's skilled in this so that you're not. You know, I don't think people should be taking it without the guidance of cells.

Oh, See, I, I completely and utterly, I disagree. You do absolutely disagree, because a lot of this stuff is entirely benign. I will tell you in the absence of cancer. And cancer is the great caveat. Right. Because if you optimize your cells, you potentially are optimizing cancer cells. As well. But if you put the stigma on there, oh, you got to see your doctor first. No one's going to do it. And anyone over the age of 40 is going to be NAD deficient, just by definition.

Sorry, I wanted. I was more talking about like medications that need a prescription.

Oh, medications are different. Right? Medications are different. And as a consequence, that's why I do not release my rated medication list. Because if anyone saw that I would what I was on, I would look like some sort of pathological, diseased, horrible person. I mean, it's really crazy what I am on, but the non pharmaceutical list is really quite benign and people do extraordinarily well with it.

Okay, yeah, let's talk about those things.

So what I. So the top five things. Because I always get this question so many years ago, I'm like, okay, well, what would the top five be? Biggest bang for your buck. To cover as many categories as possible. And I came up with something that I call the panacea. And the idea is, well, the letters are sort of spelled, started to spell panacea. I'm like, okay, what the hell? We'll call it the panacea. But. So the first one is either pterostilbene or resveratrol. Pterostilbene comes from blueberries. Resveristrol comes from bread, wine or grapes. They're sirtuin activators. By the time you are 40, your Sirtuins are slowing down, you're losing cellular homeostasis. So that is crucial to start with a sirtuin activator. That's the P for pteristobene panacea. PA A is astaxanthin. Astaxanthin is one of the most potent free radical scavengers that we have. It comes from algae. You piss off algae, it turns orange, it makes this lovely goo. The goo is designed to protect its own DNA. And so what does it do for us? It protects our DNA. I give it to my kids because we live in Miami. As a consequence, I have very pale children. I got a blondie and I got a redhead. And they burn when they take their astaxanthin. They don't. Why? Because it blocks DNA damage and it blocks inflammation. So that is very benign and very easy to do. Pan. So N is an NAD precursor. Options are NMN or nr. They're both one enzymatic step different. So it doesn't really matter which one you take. There's IVs, there's patches, there's this, there's that. The Only thing I will warn people about because a lot of people love IV NAD because it sort of gives you a, a buzz, is that NAD is controlled by your circadian rhythms and in effect controls your circadian rhythms. So if you give yourself a big giant dose, you're sort of screwing at your circadian rhythms for a day or two with potential harm. So you want to take it in the morning at a reasonable dose and just do it consistently to maintain your circadian patterns. The next C is curcumin. Curcumin is extraordinarily benign, real curcumin. However, the half life is terrible. It's only about a half an hour. So you need some sort of like revved up, specialized version. And I use something called REV genetics because they put it in nanomycel so you know, it's just sort of stronger. But that is the strongest anti inflammatory that we have. So that, that helps a lot of problems. It also decreases lipofusion accumulation. It's a polyphenol, so it helps with a variety of things. And then lastly is carnosine, as we talked about earlier, transglycosylating agent because we have to throw something in there for glucose. So that would be top five. Anyone? 40 ish. Very little if any worry about any medical problems. So it's extremely benign. And it's an easy place to start with having to, without having to see anybody.

Sure, yeah. You're not going to hurt yourself with those things.

No, you're not. And the funny thing is so many people have done this now that if you type one or two of them into Amazon, the other ones pop up as frequently bought with like, so this is good. I know people are doing it and I don't get paid a penny so I don't actually care. But, but I know that it's working because people send me emails all the time that they've started with this, they love it. Now what do they do.

And where do people find you? Sandy?

I hide in corners so no one can find me on airplanes, right? I am on a lot of airplanes.

You know, we were, we were recently, we've recently flew to Greece and I was like, if something's going to happen, this is kind of flight to have it on because it's long. So I whispered to the stewardess, my husband and I are both physicians and we're seated in these rows. Don't need us. Like don't have anything happen. But if you need us, that's where we are. And wouldn't you know, on both flights we got. Is there a physician please come to the back of the airplane? We're like, are you kidding me? Like, this never happens. But it happened. Okay. Anyway, so where do people find you?

It happens all the time.

I know it never happens when I'm on the plane. Never, Never. I have.

I put IVs into people this last year. I've looked at rashes. It's crazy. People just panic on airplanes. So easiest place to find me is my website. It is kaufmanprotocol.com I have an email address on there, which is kaufman aai mail.com which is. No one's going to remember that, but it is on the email. I answer every email myself. I have no staff and this is not my primary job at the moment. I'm an anesthesiologist, but I answer absolutely every question. It takes me some time to get to it and people get mad, but it is what it is. I answer questions on Instagram. I am Kaufman anti aging. Otherwise, books are on Amazon and I'm on a bazillion podcasts.

Awesome. All right, well, thank you, Cindy. Thank you for being on this because it's very refreshing and you're very clear and it's all, you know. You told me you rambled before I started. I'm like, you have not rambled at all. You really, like, very on to the point. So thank you. Thank you for being on the podcast and to the listeners, thanks for listening to another episode of the Feel Freaking amazing podcast. Have a great day.