Live Longer & Reverse Aging, with Dr. Kara Fitzgerald @Drkarafitzgerald

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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 on to your seats because she's amazing. So. Kara Fitzgerald, ND I of 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 Company, 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?

Like, how do you want to be addressed? But you can call me Kara. That's fine.

Awesome. I'm Wendy.

This is Ed.

Yeah, we're. We're Cash. We don't go. So I'm really excited because your book is awesome, and we're just talking offline that it came out January. Right, you said. Yeah. So younger you. So how do you get younger? Everybody wants to know.

Wait, hold on. How'd you get into this?

Oh, come on.

I wanted to know how to get into it.

You have to set the stage. How'd you even get interested in. I can't stand the term anti aging because it implies you're not aging. What you really want is aging gracefully and without the chronic illness and disease. So how'd you get into all of this?

Well, you know what? It's. It's a little bit of a long story. It's an interesting story to me, so I like to share it. But I give you, you know, carte blanche to just shut me down, interrupt me, especially if I get a little bit too. Too arcane. You can ask me to define stuff or, you know, whatever we need to do, because I can get into the rabbit hole. I. And so the revelation for me was really diving in and tussling with the literature on epigenetics, on gene expression. On what. On the variables that turn genes on and turn genes off. And that happened in around.

So, Kara, I already have a question. What caused you to get interested in that?

Yeah, so as a. Yeah, that's a good question. So as a physician practicing functional medicine, You 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 I'm. And I have a background in laboratory science. I'm just kind of a geek at heart. I'm paying attention to what's going on in science. And a lot of papers were coming across my desk on epigenetics and particularly in relation to cancer. So most of the science out there is looking at gene expression in cancer and how the tumor microenvironment takes over gene expression from us and turns on genes to promote its own survival, turns off genes that would inhibit its growth. And it does this. One of the key ways it does this is through something called DNA methylation. And I'm suspecting you're both physicians, you've thought about methylation. You periodically measure homocysteine. You. Yeah. So you're thinking about it with your patients.

Methylation. We love epigenetics. Our audience, we've talked about it almost every episode.

So all the time, okay, we love it.

So in all the way back from, you know, my time as a postdoc in a clinical laboratory, we were measuring, you know, the methylation cycle. We were looking at the various analytes involved in making S adenosylmethionine, the universal methyl donor. And so just to the very beginning of my career, I was thinking about methylation moving into epigenetics, because at the time, you know, epigenetics was kind of a distant science. But again, Flash forward to 2013, looking at DNA methylation in the tumor microenvironment. It's not a simple let's make more methylation, let's put push methylation forward. Imbalanced methylation is happening in cancer in all of the chronic diseases. Actually, in Covid, you can see this. So in 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 loll 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 there's this whole conversation that I began to perceive from the literature through the lens of functional medicine that really kind of stopped me in my tracks. And that was my entry into this and being in a clinic where we are very nutrition centric. So we've got this biochemical background, but we're also nutrition cent. It occurred to me that we could build something out. We could build a dietary pattern that did two things. One, it supported methylation, so it supported with B12 and folate, et cetera, from nutrients. But it also gave the second class of nutrients, which was a huge aha for me to get into it, that seemed to be able to direct where those red lollipops were going to. Furthermore, when you go into the literature and you're looking at DNA methylation and lifestyle factors, these guys are as potent as anything in the methylation cycle. 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. We wrote up an ebook and we sold it sort of on our website. It was directed towards other physicians. It was written, you know, it was written in professional language. Colleagues were interested. I gave a presentation at the Institute for Functional Medicine. I actually lectured on it in Ireland and you know, really kind of around the world. Our little tribe of clinicians were interested in this. Then the question was, are we really changing gene expression? Are we moving DNA methylation here? You can't write a lab slip and send somebody off to quest and evaluate that, especially back then, like you couldn't. So this was all hypothetical. We were of course hoping we were building best evidence Et cetera. We were seeing nice changes with our patients in clinical practice. Miracles of miracles. Brent Eck, the CEO of MetaGenics, has been a big supporter of our work. And he and I were talking about this actually at IFM in San Diego, the ifmaic, our annual mothership in San Diego. And I want to say it was like 2017, and he agreed to fund us. So we were able to do a full randomized control try. 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, I want to just layer onto this. 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. That's how it's done, and we'll talk about it more. But there was no evidence that that could change in humans at the time we started our study. That didn't come out till 2019, when we were just crunch. We were at the end of our study, pre publication that the first trial in humans was published. 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 those, 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, 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 aging isn't that amazing? And so it was logical that we would want to look at biological aging. So I didn't jump into this as, you know, an anti aging expert. I'm a, you know, I'm kind of a workhorse functional medicine doctor, a little on the geeky side. And that's how we got into it. And of course, our first finding was, you know, something that stopped us in our tracks and got a lot of attention around the world. I mean, I'm a little bit of a behind the scenes geek. You know, I'm a little bit shy. It was extraordinary for us to see that we had reversed biological age in eight weeks using a diet and lifestyle intervention. And by three years we had reversed as compared to our control group. So you can imagine how extraordinary it was for us as well as the larger scientific community. But the world itself came knocking on our door and then now we have this book. Yeah, so let me stop there. I know that was a, that's a big story. But it's interesting, isn't it?

It's really interesting. Did you do a follow up study like after the pilot was done? Did someone agree to fund a full on longitudinal? I mean it's so expensive.

Yeah, it's really expensive. Well, let me tell you, at that time, so it's epigenetics and the prices of the tests are changing at a breakneck pace. At that time it was twelve hundred dollars a pop. So it was, yeah, it was an expensive six figure study. I'm just again so, so grateful that I had this chance to do it. Now you can get a test in the research setting, same thing, you know, really measuring the, what they call the methylome. But really, you know, a good chunk of those red lollipops for about $200. So it's gone down considerably. And now we can, as physicians and even consumers can access certain tests. So it has changed. You don't get insurance coverage, you still can't send people to Quest. But I think that that time will also come. So we published our study in April 2021 and we were sort of midway into. We were into Covid. Right? We were in the early. Yeah, no, we were midway into Covid. Covid when we unpacked our data. It's funny, the timeline is around my study and Covid. So it was October 2019 when we were in McGill. We were up in Montreal with Dr. Moshe Seff, who is one of the authors and an advisor for us. And this was when we were starting to see our amazing findings. And then Covid kicked in. We published our study and shortly thereafter I was given the book deal concurrent to the book deal. So just to answer your question around research, we partnered with a company to build an app out to really kind of build a do it yourself turnkey younger you program in an app. I walked in irb. I worked really hard to get IRB so institutional review board approval so that we could continue to study within the app. It's actually been a harder journey. I mean you guys were talking to me off the air about learning how to publish a book and the whole journey of that. Yeah, it is funny. I'm picking myself up and dusting myself off a lot. So as far as continued research, I don't have a nice big massive cohort that I'm going to get to publish on soon. But I do have, I am going to be able to write up some case reports. We've got a handful of folks who've finished and who've adhered well to the program and we're going to publish a couple of case reports once we get this app streamlined. Will. So the IRB is kind of sitting in wait right now. But to your point, I will get back to this.

I have two questions. I have like a thousand questions, but I have two questions that I'll specify down into. One is really nuts and bolts. Can you tell us what your favorite epigenetic consumer driven test is to get to order? You know, the $200 test. What's your favorite one?

So we're working with True Diagnostic now and they.

Is there any other ones? I thought that was the only one.

Nope, 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 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 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, 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 Age is another small test that's. Or True Me. True Me is a, is a small sort of more affordable test. Again, it's proprietary. But I, you know, I also believe that they're, you know, 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, you know, I'm just comfortable and familiar and I like what they're doing. Consumers can order all three.

We're having dueling. I have one more question. Thank you for that. What were the characteristics? I know I'm like, don't say anything. 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?

Like, the dead, those folks? 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 in coherence is horrible, and we know nutrition studies are notoriously. They're just poor quality. My. I locked a nutritionist onto each participant, like, clue, and they followed him around. They, like, tased them. 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 when we.

Looked at it, the accountability here.

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. People were also excited. They knew enough about what the study was, that it was new and kind of radical that they were getting to participate in this. It was the first study of its type.

I know I want to do it, or I'm like, I want to do it.

Great. Let me. I want to say one more thing, though, just because I think it's interesting. 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 have to have my rice or I'll lose too much weight or something. You know, there were 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, you know, 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 know.

I mean, we actually literally just had a staff meeting right before this. And we were 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 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.

Okay, so let's go back to the study, because I have.

I have.

Now you have questions.

Go for it. Go ahead.

So you found that Eight weeks of intervention noticeably, significantly reversed the biological age. And then did people notice a difference in their experience of life? Were you even allowed to ask those questions? Because we had a symptom score.

Yeah, yeah, yeah. So we did, yeah, we used the standard ifmsq, but we also used promis. We used a bunch of validated questionnaires as well. So our study was, I want to talk about eight weeks just as the time, because that's interesting in itself. But in terms of how people felt with bioage reversal, we were looking at healthy people. It took us about a year to get our cohort because we had to screen out people weren't on medications, they were already living pretty well, most of them were exercising, most of them had good dietary habits. So we didn't see remarkable changes with regard to their symptom questionnaires, their quality of life questionnaires. We didn't even see remarkable changes with. We looked at a handful of standard biomarkers, like a standard lipid panel. We looked at a standard chemistry, you know, no, not non significant, not even trends. I would say in quality of life questionnaire we saw a trend towards increased energy, a trend towards less anxiety. So some suggestions, but really nothing much. And I think that that just speaks to how healthy our cohort was.

Did you measure biometrics? Like, did you do a bioimpedance analysis or any look at like what was their muscle quality, quantity, water before and after?

No, we didn't, we didn't. Again, these guys were, these guys were healthy. In fact, since we had a bit of a structure around exercise, there were at least a couple guys who had to pull back on what they were doing and drop it down a little bit. And I think if we did bia, we wouldn't have seen a remarkable difference. Now if we looked at type 2 diabetics or pre diabetics, I mean, no question we would expect to see a difference and we might even see a greater bio age change because anybody with a chronic condition and diabetes has been well characterized to be biologically older folks with that diagnosis six to nine years in the literature. So maybe we would see a bigger change. And then with some of those biometrics, I would anticipate we would see a difference. We saw, you know, some of the guys lost weight, some of the guys had to work hard to keep enough calories in to not lose weight. They didn't want, you know, so it wasn't. These were not the questions that we were setting out to answer. I can tell you again, going back to the Aging epigenome. These changes happen in an aging epigenome and in particular the volume turns up in middle age. So this was a healthy middle aged population. Like we really wanted to isolate those changes of aging and specifically in healthy folks. So we could really look and study that and see what we could turn around.

And how big was the cohort? Oh, yeah.

So the, the whole group was 43 and we finished 18 in the study.

And was it only men?

It was only men, yeah. We needed to make that decision because we couldn't afford the numbers. So if we had brought women in, middle aged women between 50 and 72 would have been pre menopausal, Perry and Post. We would have all groups. And for us to be able to tease through the influence of hormones, we, we felt like we would need larger numbers.

Thank you.

I told you women are complicated being women are.

I know I, I have experienced that firsthand. Thank you very much.

I know it's such a, I mean, as a woman, as the, as the PI. And being a woman, I've had to answer this question understandably and a lot I, I can say in the first group that will. The first group to finish. The younger you through the app. The younger you program through the app was. It was all women. And so we'll be publishing on that. And I can say that they did great. We used a slightly different clock, so it's not an apples to apples comparison, but they actually did a little better. Go girl, ladies. Yeah, but it's not, it's not a one to one comparison.

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, 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, you know, really important physiologic processes in the body that are strengthening. But yes, the chronic stress that we experience here in our world, the, the stress of working too much, of not having downtime, you know, 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. I mean it's just, it's just such a. Yeah. 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, Horvath 2013 multi tissue clock, a full 25% of it is influenced by glucocorticoids. So it's influenced by the stress response. There's no other variable.

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. Sorry to interrupt, but I just like, I just want to like, just pause, underline it.

Yeah. Yes. 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 how. Yeah. On the hierarchy of what's aging us most is stress number one, is it @ the top? I mean, it's a huge player and we don't take it seriously. Like 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, you know, 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. This is like this. Why can't I see anything? I don't.

Know. It's a big deal. 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, 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 adolescent. I love this in boys, not in girls. Has lasting health outcomes on multiple generations. So how you were eating when you were.

10. This is the Sweden, is it? Sweden and the epidemiological people. God, I listened to that on NPR.

For. Of.

Years. A couple like two hours and I was.

Riveted. So.

Interesting. 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 grand, your grand, your grand. Your granddad's, not.

Mine. Right. You're two. 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. So it's not all my mother's.

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

Dad. And then, you know, we can just see, you know, PTSD and total. 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. Yeah, well, so we know that we can change gene expression actually relatively quickly. Actually very quickly in some cases. I cited 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. And we can. 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 generations of cells and be more far reaching. So this is certainly one way to kind of frame why habits 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. That's.

Awesome.

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

Difference. Cuddling, tell us about.

Cuddling. I know. 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, is really important in gene expression 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, 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.

Yeah. Lessons from blue.

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

You'Re. Do you have some guidepost.

Kara? So in our study we wanted people to get seven hours and we.

Would just sleep or time in bed. Just to be clear, because people like, I spent seven hours in bed, I'm like, that means you slept for six hours and 15.

Minutes. Yeah, right, right, right. So we wanted seven hours sleep. We wanted, we wanted them to shoot for seven hours sleep. And so we would just provide sleep hygiene tips. And I go, 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 it out. 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 and 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. I'm getting.

Up. Mommy, Mommy.

Mommy. Yeah, totally. So if I, if I wanted to sort of have some indulgent adult, you know, stay up a little bit later at night, I mean, I'm, 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 eye, 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 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 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 think it makes sense. And I don't. Even if you talk to muscle scientists, you know, those muscle builders, 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. But my read on triathlete 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 secretary, IGA get athletes post season. You know, it's like if you want to study.

Yeah. 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 agent. Yeah. So even though it hasn't, it hasn't been studied in the, in the way that we might like to see, there's enough evidence out there to see it. Yeah. And it's. You're. What you're describing is. It makes sense to me, and it's very, it's very interesting. So I don't. I. 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.

Yeah. So I feel like we're just scratching the surface of this conversation and maybe, maybe what we'll do is we'll do part one and part two, but in this part one, what? You know, at the end of this conversation, 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 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 in all of our. All the people who want to work with us. Younger Together. 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 drink your.

Epinutrients. Sounds awesome. It's such a.

Title. Yeah. And then I just want to bring people if they want to, they can come over to drkaren 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. Definitely. Thanks for listening and have a great.

Day. Thank you. It's been.

Amazing. Thanks for being.