Live Longer & Reverse Aging, with Dr. Kara Fitzgerald

The more that you're practicing a habit, the more that it's going to spread to generations of cells and be more far reaching. But it's nice to also see that one good habit can make a difference. So even if you're having your first meditation, which we know is like total monkey mind and crazy, you're actually doing your body good just for the effort, which I think is kind of cool.

If you want to live like you matter, ditch the pills, look great, and feel freaking amazing, you're in the right place. I'm Dr. Wendy Trubo.

I'm Dr. Ed Levitan. Welcome to the Five Journeys podcast where.

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Hi, and welcome back to another episode of the Five Journeys podcast, Live like youe Matter. I'm Dr. Wendy Trubo. This is Dr. Edward Levitan, and our guest today is Kara Fitzgerald. So hold onto your seats because she's amazing. So, Kara Fitzgerald, N.D. if MCP, is the first ever recipient of the Emerging Leadership Award from the Personalized Lifestyle Medicine Institute in recognition of her work on DNA methylation as a leading voice in the intersection of nutrition, epigenetics and aging. Her work has been featured in media outlets such as Prevention, Fast Co. And MSN, Everyday Health, and many more. Receiving her doctorate from National University of Natural Medicine, she's on the faculty at the Institute of Functional Medicine, IFM and is an IFM certified practitioner with a clinical practice in Newtown, Connecticut. Welcome, Kara. I didn't ask you, should we call you Dr. Fitzgerald? How do you want to be addressed?

You can call me Kara. That's fine.

Awesome. I'm Wendy, this is Ed.

So I'm really excited because your book is awesome and younger you.

So you found that eight weeks of intervention noticeably, significantly reversed the biological age.

So how do you get younger? Everybody wants to know.

We're always trying to translate science into how we might apply this clinically. We're always in the process of translating and how we might use it. We're early adopters in functional medicine, I think. And so there's this whole conversation that I began to perceive from the literature through the lens of functional medicine, that really, when you go into the literature and you're looking at DNA methylation and lifestyle factors, imbalanced methylation is happening in cancer, in all of the chronic diseases, actually infectious, acute diseases, you can also see gene expression really get wonky. So methylation may be absent where it should be. Happening on the gene and it may be in excess. So in thinking about DNA methylation, if there are a lot of methyl groups, and in the scientific literature, that's denoted by a red, you can see a red lollipop, that's the methyl group. And on a promoter region of a gene, if there are quite a few red lollipops, that inhibits transcription from happening, so that gene is not able to be turned on. You can just visualize all these red lollipops. They literally block transcription, that transcription factor from getting in there and turning the gene on. Conversely, if there are a few methyl groups, that gene can be turned on and expressed. And so in disease states, imbalance is happening. So it's not a simple case of let's throw some folate at this person, let's throw some B12 at this person, let's give them extra choline. It's not that simple because that's pushing methylation forward, that's adding red lollipops. The question has to be, where are those red lollipops going? You know, yes, you may want more, but you don't want them turning off a protective gene, an anti inflammatory gene, a tumor suppressor gene. So if you look at exercise, or if you look at sleep, or if you look at the research on meditation or the absence. So if you look in the research on stress or the lack of exercise, you see how influential it is favorably or not on gene expression and specifically DNA methylation. So it seemed to me we had these extraordinary tools to build something out that could support healthy DNA methylation very much through a functional lens. And we started to do it in 2016. Then the question was, are we really changing gene expression? Are we moving DNA methylation here? We were seeing nice changes with our patients in clinical practice. So we were able to do a full randomized control trial. We were able to hire a clinical research center, actually, at my alma mater out in Portland, Oregon, to run a randomized control pilot study. And that was extraordinary. Now, at that time, there was zero evidence that we could change, that we could reverse biological age. So we measure biological age looking at DNA methylation. So I was confident we were favorably changing epigenetics. I wasn't holding my breath that we were going to move biological age, but I knew that the clocks that measured biological age, looking at these patterns of DNA, well, there was one clock at that time we could look at. So it was a part. The other very interesting reality is that when you look at gene expression, when you look at these patterns of DNA methylation in chronic diseases like cancer, as I mentioned, but cardiovascular disease, diabetes, et cetera, all of these diseases that happen in the aging journey, they look like aging. So the changes, the predictable patterns of aging that enable us to have a biological clock kind of overlap with some of the diseases of aging. Isn't that amazing?

What were the characteristics of the people who took really well to the program and maintained it? What was it about them that they maintained it? Because that, I think, is that's where the rubber meets the road of, like, how do you actually make true, lasting lifestyle change that sticks with you over the years and reverses your biological age? What were those people? What did they do? What was that like? What was it about them? What did they do?

Well, listen, let me tell you that I was like, this is my one chance I get to do clinical research. Now I'm being really, truly funded to do something. We're not screwing this up. And of course, you know, in like, diet and lifestyle interventions, adherence is horrible. I mean, I think that's where this question is coming from. We know adherence is horrible, and we know nutrition studies are notoriously. They're just poor quality. I locked a nutritionist onto each participant, like, clue, and they followed them around. They, like, tased them. If. No, I know that's actually. That's not really true, but not fully true.

Right.

Like, I have one chance to do that. What we did, I think what made an extraordinary difference is that our nutritionists worked with the study participants. And so it was built into the study protocol that they needed. They were required to meet with a nutritionist at least once a week, more if they wanted. They were required for once a week for the first month, and then less than that. I think every other week or something like that. We built into the IRB and they ended up. They ended up really maintaining those relationships. And I want to say something interesting about it.

So that piece was essential, the accountability.

Yes. And when we look at our adherence data, they're impeccable. I mean, I would like to just publish on that to demonstrate this. The structure worked. Our nutritionists weren't allowed to do sort of motivational interviewing. The kind of coaching, the kind of connection that we have in clinic where, you know, you're. You know, you're really cheerleading them. We had to have. They had a dry IRB approved script, like you can imagine. Do you have any questions? You know, did you. That's. It had to be to go through irb. It was dry and boring, and yet it still worked. That point of Contact still worked. So most of our study participants were sufficiently adherent for us to get significant findings. There was a little bit of, you know, some guy absolutely refused to give up his X amount of beers each week. It wasn't terrible. Another guy was like, I'm not getting, you know, I'm. I have to have my rice or I'll lose too much weight or something. There are a few exceptions, but really, for the most part, people did well.

I think what's so poignant about that is we so underestimate the impact of accountability. Even when the accountability isn't motivational or kind or warm. It's just not that they were unkind, but they're just dry. So it makes a huge difference to know I'm going to be talking about this with someone in a week. So I got to stay on the street.

And we actually literally just had a staff meeting right before this. And we're talking about that. Exactly that. Because in our practice, we want people to see our nutritionist because it's not necessarily to learn about nutrition, that's part of it, but it's also to have accountability, to have knowledge is not always power. It's always about just getting people accountable, having somebody that you know you're going to be talking to. So it's so important. So it's great.

Yeah. In fact, what we've done in our practice, and we still get pushback from new patients, we've built nutrition hours into the structure. So if you work with a physician here, you have to, by extension, work with a nutritionist. And plenty of people will say, I know how to do it. I've already done it. Blah, blah, blah, blah. No, we've just learned over the years how important it is.

Yeah. Ours is probably 80 to 90% of our people. We're not 100%, but I think the.

Response to that also is like, if you know what you're doing, then you stopped growing and developing, and it's time to get you in with nutrition so that you can open up again, like, go back into discovery and go back into questioning and not knowing it.

All right. Yeah. And I don't think, and I may be mistaken, but I don't think we've ever had a patient come back and say that was a bad use of time. You know, I knew. I knew everything that the nutritionist told me ever. I think they're always really, you know, grateful for that support, as regardless of their, you know, their training or education.

Can we switch over to stress and talk about the impact it has on our biological age, our clock, does it do things to DNA? What does it all do?

Yeah. So we can. I just. I should distinguish people bring this to my attention. Sometimes I think it's worth distinguishing between short bursts of stress like the experience of exercise or anticipation or the energy you might have before an exam that you've worked really hard for and then it's done. That kind of stress actually can be strengthening for us. Certainly the stress of exercise is extremely helpful. It just turns on really important physiologic processes in the body that are strengthening. But yes, the chronic stress that we experience here in our world, the stress of working too much, of not having downtime, raising families with tight budget, moving through Covid, the COVID isolation, et cetera, et cetera, the stress experience is profoundly pro aging that. I mean, it really is. In the book I call it, I say it's gasoline on the fire of aging. And it might be the biggest variable. You know, we're ready to fight the tiger, but we're sitting in our, you know, in our desk chairs, not moving, and we're fighting the tiger all day long. You know, it's not that short burst experience with some recovery in there, fighting the tiger or climbing the tree. So stress really is toxic. This chronic stress exposure is just toxic on the body. It just really breaks it down. The clock that we used, which is the kind of the flagship, the first clock, or Beth 2013 multi tissue clock, a full 25% of it is influenced by glucocorticoids. So it's influenced by the stress response.

I want to stop you for one second. 25%, that's like people talk about, I have good genes, I eat well, but like 25%, that's huge. Sorry, I'm sorry to interrupt, but I just like, I just want to like, just pause on that because that's like.

Yeah, yeah, that was my experience, you know, of sort of internalizing that information is it's bigger than any other variable in influencing gene expression. So on the hierarchy of what's aging us most, where is stress number one? Is it at the top? I mean, it's a huge player and we don't take it seriously. Again, just thinking about our practice, when do people say, oh, yes, okay, I'm going to really de stress. In my clinical experience, it's always the end of the line. We've done all the diet and various biomedical interventions, we've corrected their lab data, et cetera. We've done all of this sort of mechanistics, functional work and they're not quite where they want to be. And even though we've had the stress conversation since day one, I'm thinking about being in Fairfield county, where a lot of my patients will commute by train to New York City. I mean, it's changed. It's definitely changed post Covid, but there's. And there are a lot of women in my practice and they're raising families and they're doing something high powered in the city. And it's really, it's this relentless, relentless push. And it's only after everything else is corrected and they're not quite where they want to be that I find a willingness to dialogue about the stress, experience it, but it can take a while. And I have to. You know, I would be lying if I didn't say that I went through some version of that myself and still struggle for sure with, you know, running my own business and being a clinician and raising a kid, et cetera. So it's a huge, huge issue and it really needs to be appreciated on how physiologically toxic it is. And you know what? We can total life stress. The epigenetic imprint that can happen with, that can be handed down. I mean, you can pick up PTSD on the epigenome from previous generations. I mean, certainly during pregnancy, early infancy, when imprinting is just massively happening, when those epigenetic changes are just big and active.

So now you've added guilt to the mother's.

Seriously, I'm like, oh my God, I.

Was such a stressful.

That's great. Thanks.

Except guys, you're right, you're in there. I mean, your epigenetic imprints on the DNA and sperm will absolutely influence. In fact, we can put you under in the guilt column. Like if you over, if you ate not even necessarily overate, but sufficient or robust amounts of food in pre adolescence. Pre adolescence, boys, in boys, not in girls, has lasting health outcomes on multiple generations. How you were eating when you were 10.

This is, this is the Sweden. EPI is Sweden and the epidemiological people. God, I listened to that on NPR for like two hours and I was riveted. And it was just amazing because the, because what was so amazing to me was that the two generations down, if your grandparents had feast at puberty, you died six years earlier.

Your granddads, not moms.

Okay, so your granddad, two generations, you died six years earlier or you live 25 years longer if they went through famine when, when they went through puberty.

Fascinating.

So it's not all my mother's fault.

Wasn't like a 30 year spread. No, you can't blame your mom.

Yeah, yeah, yeah, yeah. You got to look at it and then, you know, we can just see, you know, PTSD and total life. Like we can see psychic experiences will be translated into biochemical marks and those can be handed down as well. Yeah, it's pretty extraordinary.

What's a girl to do? I think we need to like, I'm always interested in what are the practical tools that will alter someone's trajectory.

So we know that we can change gene expression actually relatively quickly. Actually very quickly in some cases. I cite a study in the well and I cited a study in there just showing the exposure to pollution. I mean, it's unfortunate that it was a toxic subject, but changed gene expression in the population in four hours. I mean, there was a rapid shift in gene expression certainly. But we could also see like a single exercise event or a single meditation can favorably change gene expression. But if you imagine, you know, just going through cell replication, so, you know, generations of cells and you know, the DNA is dividing as well, the more that you're practicing a habit, the more that it's going to spread to, you know, generations of cells and be more far reaching. So this is certainly one way to kind of frame why habits are, are good because it has this really lasting and impactful and more broad potential. But it's nice to also see that one good habit can make a difference. So even if you're having your first meditation, which we know is like total monkey mind and crazy, you're actually doing your body good just for the effort, which I think is kind of cool.

Well, just breathing, I mean just parasympathetic breathing is going to make a difference.

Cuddling, tell us about cuddling.

Yeah, well, we didn't. I know, we. Okay, so we couldn't put that in our study. It's kind of a funny thing to joke about. So you guys will cuddle, you guys won't. No cuddling, eight weeks, nothing. So we couldn't exactly control for that. But yes, oxytocin is really important in gene expression and, and the experience of love. So oxytocin being the love hormone is very impactful and anything that's going to support getting that up. So engaging in cuddling, I mean, it can be your kid, it can be your partner, it can be your pets. There's just longevity promoting by a variety of different mechanisms, actually. Longevity promoting effect. So yeah, community, you know, just community and contact and interaction.

So essentially the blue zones. The blue zones is the Trick.

Well, one of the lessons from blue zones. Yeah.

Yes, yeah, absolutely. So getting enough sleep, it's just incredibly impactful on gene expression and longevity. If you are not sleeping, you're. Your aging is accelerated. I mean, it's really as simple as that.

Do you have some guideposts, Kara?

So in our study, we wanted people to get seven hours of sleep or.

Time in bed, just to be clear. Because people are like, I spent seven hours in bed. I'm like, that means you slept for six hours and 15 minutes on average.

Yeah, if you're lucky. Right, right, right. We wanted seven hours sleep. We wanted them to shoot for seven hours sleep. And so we would just provide sleep hygiene tips. And I go through a bunch of hacks in the book because of all of the pieces of the younger you program. Sleep was my weak link and I had to figure, figure it out, you know, and, and all of the basic hacks. I think one of the biggest ones for me, to your point, was getting to bed on time. So I actually had the Runway to get enough hours because I have a set time. I need to get up in, in the morning. All right. But I have a young kid at home who's going to wake me up whether I like it or not.

Mommy, Mommy, Mommy.

Yeah, totally. So if I wanted to sort of have some indulgent adult, you know, stay up a little bit later at night, I mean, I'm not going to get enough sleep. So getting to bed early was huge for me. Sleeping in a cool room, you know, making sure it's dark or using an eye mask or something. But anyway, sleep. So sleep is important. And ideally I'm getting seven hours. Yeah. And I track it. I use an OURA ring. I love tracking it. I love making sure I'm getting sufficient deep sleep and REM and, and you know, making the tweaks to be able to do that. So sleep is huge. Exercise is as longevity promoting. Exercise is just ridiculously potent. I mean, it's extraordinary how beneficial exercise is. It's not just disease preventing and it is disease preventing of really all of the chronic diseases of aging, to my knowledge. It's life extended. It's both.

Is it cardio? Is it strength training, is it interval training, Is it stretching? What's the. Is there one or two things that. Because everybody has that question right and everybody answers it differently. So what's your answer?

I think that in our study we had people do a modest. We did cardio in our study and it was just a minimum of 30 minutes, five days a week perceived exertion, 60 to 80% of max. So it was just a basic, simple prescription. I dug into that a little bit, and that's if people want to do the younger U intensive, that's the ask. The literature suggests that resistance, that they're all good, that resistance, high intensity and cardio are smart. We want to maintain our muscle mass as we age. We want to just, you know, we want to keep a robust muscle mass, so we want to do our resistance for that. But we want all of the benefits of, of a good cardiovascular experience. And if we layer in a little bit of high intensity where we're pushing ourselves, I think it's, I think that collection.

So it's a mix, I think.

Yeah, I really, I think it is. If you talk to muscle scientists, you know, those muscle builder guys that are. We've just been thinking a lot about protein. And so I've been tuning into this and they're going, they're proponents of resistance. But then if you talk to the, you know, the expert who's also, you know, a marathoner, they're going to be.

Pushing cardio ultra triathletes.

And yeah, my read on the literature is that all are important. I will, though. Going back to ultra, we can do too much. I mean, there's not a ton of evidence out there as far as it being pro aging as measured by epigenetics. There's one study that I, that I cited in the, in the book. But we know, anybody who was a competitive athlete knows at the end of the season, you get sick. You know, you can tell that there's this immunosuppressive phenomenon. I mean, I used to compete and I got sinusitis at the end of my season every, every year. And if you want a good group of people who don't have enough secretory iga, get athletes post season.

I had an Olympic athlete as a patient, and it was years after she stopped competing. And we were just starting to untangle the adrenal dysfunction that occurred from pushing through and pushing through and pushing through and just that relentless training that she did.

So I think it's pro aging. So even though it hasn't been studied in the way that we might like to see, there's enough evidence out there to see it. Yeah, and it's your. What you're describing is it makes sense to me and it's very, it's very interesting. So I loved getting to have that moment in my life where I was a competitive athlete. I wouldn't change it for anything. And you know, if I were doing that for a lifetime, I could see that it would wear me down. Yeah.

Can you tell us what your favorite epigenetic consumer driven test is to get to order?

So we're working with trudiagnostic now. There's a handful of other ones. So there's Zymo and they're a good lab. Actually. Zymo is a good lab. It's actually their, Zymo is their research hat. If you look up my DNA age, that's the name of Zymo's kit. So Zymo is a research lab that has created a direct to consumer, a spin off and they're offering a biological age test which it's proprietary, which I think I don't love for research. I want to know what they're doing. But they, but they did base it on the original Horvath clock and they are a very reputable lab. So that's an opportunity and that price point isn't bad, I would say for anybody who does that, who works with Zymo. Just if you get your baseline through them and get your follow up through them. True Me is a small sort of more affordable test. Again, it's proprietary. But I also believe that they're doing their best work. True Diagnostic is using the same array that we used in our study. They're working with Illumina, the company that we used. And so I'm just comfortable and familiar and I like what they're doing and consumers can order all three.

So I feel like we're just scratching the surface of this conversation. And even as a conversationalist, I'm thinking, okay, how do we reach you? How do we follow you? How do we stay engaged with you?

Where do we get some programs?

Yeah, where do people, where do people learn more about what you're up to? What are the top things? And we'll make sure to put them in the show notes.

All things younger you is you can find@youngeryouprogram.com all things younger you. So all of our, you know, we're going to the groups that we're doing. If you want to come in and work with us one on one, you can do that. There's just all, there's cool opportunities. We have an app soon to be launched. We finished our beta testing and so that, that will be there for the do it yourselfers, but we'll be using it across the board and all of our, all the people who want to work with us.

What's that called?

That is called Younger Together. Younger Together and there'll be a cool community feature. So it'll be in an app, but you'll be able to connect with other people. Going back to our conversation on community, we have our cookbook companion cookbook, coming out November 8th, and that is better broths and healing tonics. So it's a way to. To drink your EPI nutrients.

Cool. Sounds awesome.

It is. It's.

It's.

It's such a cool book. And then I just want to bring people if they. If they want to, they can come over to drkara fitzgerald.com which is not just me, it's my entire team. It's our clinic, it's our podcast, it's our blog. And, you know, there's just a ton of content on that website as well.

That's really great.

Awesome.

Thank you. So thanks for listening to another episode of the Five Journeys podcast, Live like youe Matter. Our guest today was Dr. Kara Fitzgerald, and you can find her all about her in the show notes. Thanks for listening and have a great day.

Thank you, Kara. It's been amazing.

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