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Long-Term Health: Connecting the Dots With Dr. Mike Wagner

This week, we dive in with Dr. Mike Wagner, a Stanford-trained anesthesiologist, to examine the balance between longevity and health practices. Dr. Wagner provides insight into the vast and evolving landscape of health, blending the science with his personal and practical commitment to healthspan, as we explore the intersection of medicine and age. Dr. Wagner shares his perspective on living the most enjoyable and healthy life. 

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Key Moments:

“The best drug you can have is exercise, and so I try to stay fit with both aerobic and strength resistance training because I think both are important. You know, as you get older, one of the major causes of death is falling, certainly over the age of 65.”

When it comes to healthspan and longevity, we’re probably never going to have great randomized placebo-controlled studies because simply nobody’s going to pay for that and it would take way too long to start people at 50 and then follow them for 40 or 50 years to see who lives longer; that would be hard.”

“I started statin when I was 35, I’m 49 now, just because I had a strong family history of heart disease and that was most likely going to be the thing that would kill me later in life.”

“I take statins because there are hundreds of different randomized placebo-controlled, well done studies that show a direct correlation: the lower you get your LDL, the less likely you are to have a cardiac event. You know, what we call MACE, or a major adverse cardiac event. So the lower you go the better.”

Transcript

David: 10:15

Let’s give Mike a call right now. Hey Mike, how are you doing today? 

Dr. Mike Wagner: 10:21

Good David, how are you? 

David: 10:23

I’m great, thank you. Thanks for taking the time to join me on the show today. 

Dr. Mike Wagner: 10:27

Yeah, absolutely Nice to finally meet you. I’ve heard a lot about you. I know you had Jen on a few weeks ago. 

David: 10:33

This is slander, mike. We have lawyers that deal with that stuff. You’re practicing anesthesiologist, correct, Is that right? Yep, if you don’t know, what do you do? What does anesthesiologist do? 

Dr. Mike Wagner: 10:46

I mean classically, I think most people associate an anesthesiologist as the man or woman who puts you to sleep for surgery. I feel it was actually grown into a lot of other things. I had two areas of subspecialty cardiac anesthesia, which I stopped doing about six years ago, and acute pain medicine, so helping to manage pain around the time of surgery. Before surgery, during and after. We do things like nerve blocks. It’s an area of subspecialization with anesthesia. Those are my two sub-areas. I said I don’t practice cardiac anesthesia anymore Classically. Yeah, I think most people associated with anesthesiologist or nerve synesthetists the person who puts you to sleep. We monitor you while you’re asleep so your heart rate, blood pressure, your ventilation, oxygenation, these things and then make adjustments as necessary. It depends on the surgery. We have very straightforward surgeries. You were telling me you were having a knee scope. That’s pretty straightforward. You have bigger surgeries where there could be lots of blood loss and fluid shifts and those kind of things. Yeah, it’s basically what we do. It’s like I said, it’s a growing field and a lot of areas of subspecialization as well. 

David: 12:00

When I’ve had MDs on this show, I’m going to say 90% of them were anesthesiologists. I don’t know why that is it wasn’t a while I haven’t orthopedized or a cardiac person, but there’s something about the field of anesthesia that seems to bring in people who are very curious about other things. 

Dr. Mike Wagner: 12:20

Yeah, I think classically, the people who go into it have an interest in physiology and pharmacology. That’s kind of the typical statement of people who are applying to the field. It’s actually interesting. I just got a newsletter the other day. The field itself is becoming a lot more competitive for people. When you’re trying to match for your residency, which is where you train, it’s actually becoming increasingly competitive. More and more people are going into the field. It’s interesting. 

David: 12:46

I heard that the field really took a hit from COVID. 

Dr. Mike Wagner: 12:51

Temporarily I think, and it depends on what kind of practice you were in. Certainly people in private practice you know it’s more eat what you kill kind of mentality that when operate. You know, elective surgery especially just stopped happening, but it wasn’t for a very long period of time. So I think most people recovered pretty quickly. 

David: 13:09

I’m thinking that people who were like working the ventilators. 

Dr. Mike Wagner: 13:12

Oh, you mean, like as far as taking care of the COVID patients? Yeah, yeah. And I think that’s a detail to ICU, because we were basically that’s our wheelhouse. As an anesthesiologist, you know you’re kind of a one person ICU. Yeah. What you’re dealing with so managing people on ventilators, on medications to keep your blood pressure up, what we call vasoactive medications that’s kind of something we’re very comfortable with. So, yeah, there were people who were detailed to the ICU to help care for the patients. 

David: 13:40

For sure, oh well, wait, wait. There’s one thing I want to ask you. Still in the realm of anesthesia. So I’m getting my knee done, so that’s general anesthesia, so I get knocked out. And if I were to request a drug to knock me out, what do I want? 

Dr. Mike Wagner: 13:57

Well, most people get a standard cocktail. You don’t actually have to have general anesthesia. Some people you could do spinal anesthesia. Most people don’t do that in an outpatient center though. But you know the classic. Most people get versed. So you know, known as midazol. So it’s like a oral a valley, but IV, that kind of just takes the edge off and most people don’t remember anything. And then the classic kind of induction routine with medication is then fentanyl. So most people use fentanyl all the time. That kind of just helps get you a little deeper. And then propofol, and then you’re kind of off to sleep. They’ll probably for you you’ll probably get what’s called an LMA, so they probably won’t even end up putting a breathing tube in you and you just kind of breathe on your own. But propofol is a great drug. I mean, people love that. You feel great when you wake up from propofol. So I think you know the drugs you’ll get for that are all pretty good. I don’t think you’d have to worry too much. 

David: 14:53

I mean, I think propofol, that was the Michael Jackson drug right yeah. 

Dr. Mike Wagner: 14:58

You know, and it’s funny, we use it everybody and pretty much every single case gets propofol. So it’s a great drug. It’s fast on, fast off and people feel good on it. It’s generally kind of a euphoric feeling drug when people get it. I like euphoria. Yeah, yeah, no, and it’s interesting because now I think we’re a lot more involved in out of our procedures, so like people have colonoscopies and things like that, the field is really expanded because more people want anesthesia involvement in that, and so we generally are the only people that are allowed to give propofol in a lot of hospitals and so it’s a much more pleasant experience than just having sedation. Okay Well, yeah. So yeah, I think you’ll. I think you’ll be fine. I mean, if you want to remember what fentanyl feels like, you could ask not to give Versailles, but I think you’ll be a good end. 

David: 15:44

I’m a good end. I always. I’ve only been under, I don’t know, maybe four or five times, and whenever they’re about to like put me under, I always ask them what am I getting? They tell me, and, of course, by the time I wake up, I don’t remember any of it, Right? 

Dr. Mike Wagner: 16:01

right? Yeah, Most people don’t. Like I said, if you get the Versailles beforehand, you probably won’t even remember going. You think you will, but you won’t remember even going back to the operating room. 

David: 16:11

Right, wow, you have an interest, as a lot of us do, in maybe living longer, but living healthier longer. Sure, I want to ask you a little bit about some of the things that you’re looking at, that perhaps you’re using on yourself or that you find promising, or what you’re seeing out there, because one of the things I like about you, mike, is you’re, I think, as I said earlier, like you don’t have a dog in the fight, right, a lot of the people that I have on the show, I mean, god bless them. They’re all really great at what they do, but they tend to, either from a clinical or an academic point of view, they have a thing and you don’t have a thing. So I’m really curious what you’re seeing out there, what’s exciting to you? 

Dr. Mike Wagner: 16:50

Yeah, you know, I think you know the field has really grown and I think, fortunately and unfortunately, with social media and the ubiquity of all this information, it gets more and more confusing, Right? Because, like you said, you have people who kind of have a dog in the fight and they strongly believe in this diet or this supplement or and it’s hard to keep track of everything, and there’s not a lot of, unfortunately for you know, when it comes to health span and longevity, we’re probably never going to have great randomized placebo controlled studies, because it’s simply nobody’s going to pay for that and they take way too long to, you know, start people on 50 and then follow them for 40 or 50 years to see who lives longer, that would be hard. So I kind of you know, as far as you know, what are the things that are likely to kill you when you get older, really, right, and so I look at heart disease as being a big one. So you know we were talking about earlier. I’m on a statin and I think it’s interesting to me that in the general population there’s so many people I meet who are so hesitant to start a statin, even though the evidence has been out for decades and the benefit is so strong. You know, like I said earlier, you can only get so far with diet and exercise and the reality is, if you can drive your LDL or a better Markupian and ApoB down below 70, you’re likely to getting heart diseases pushed back decades, and so there’s great evidence for that. So I, you know, I started a statin when I was 35, I’m 49 now just because I had a strong family history of heart disease and that was most likely going to be the thing that would kill me in later in life. And then you know Peter Atea talks a lot about this you know heart disease, neurodegenerative and cancer are the big three right that are likely going to cause harm later in life. So, you know, I try to look at where’s there good evidence for other things, I think. Unfortunately, there’s a slew of supplements out there and it’s hard to parse what to take. So I try to look at where’s there good evidence of little harm and strong benefit. So I take, you know, things like vitamin D supplement. I take a coenzyme Q10 simply because I’m on a statin and there’s evidence that that can be depleted with statin, and outside of that I don’t take a whole lot, believe it or not, I think you know. I go back to what are the major players here? What’s going to, you know, get you 90% of the way there, and that’s exercise. You know, the best drug you can you have is exercise, and so I try to stay fit with both aerobic and strength resistance training, because I think both are important. You know, as you get older, one of the major causes of death is falling, certainly over the age of 65. So, maintaining strength, balance, doing activities like Nordic scheme, alpine scheme, mountain biking, these kind of things. I think diet once again, you know diet is probably the biggest area of confusion amongst people, simply because there is, you know, you have, people who swear and they watch game changers and they say you know you have to be vegan. Right, and that’s not a strong evidence for being vegan, that’s not even really evidence. You know there’s people who are paleo, gluten free. You know all the no dairy, all this kind of stuff. You know I look at it and say I’m not on a special diet. I try to stay away from processed foods, foods that are, you know, high sugar content, these kind of things. I don’t eliminate anything. I think that’s just too hard. You got to live your life, and so so, exercise, diet, sleep, good quality sleep. You know there’s a lot of like Matt Walker out there and people like that who talk about how you can create a good environment for sleep, and then, like I said, I take a few supplements and that’s really it. So I try to take a practical approach and still want to enjoy my life, and I still like to go drink beer and play golf, and so you know, I’m still going to do that a couple of times a month and, even though I know it’s probably not the best for my health, sometimes needed. 

David: 21:08

I want to back up to the statin thing. Yeah, because this is something I find really puzzling that you know we mentioned Osempic earlier that I’m not a scientist and I’m not a doctor but my personal feeling is for people that are morbidly obese, these sort of drugs are life saving. However, you want to lose 10 pounds to get into bikini, the downsides are just tremendous. People I’ve talked to there seems to be much more acceptance about Osempic than statins, which have decades of safety, and there’s like legions of statin haters. Help me to understand the statin hater. I don’t get it. 

Dr. Mike Wagner: 21:45

Yeah, I think this goes back to what I was saying earlier, where when you have you know this plethora of information out there and all these people on Twitter and Instagram, you’re going to get people who you know that’s how they sell books, right, and they you know they back themselves into this corner of statins, are bad, and they come up with you know all these reasons why that really don’t pan out. And so I try to look at, you know, I look at people like Tom Dayspring or somebody like that, who’s a lipidologist and has really good evidence, doesn’t have necessarily a dog in a fight, he’s not making money and nobody’s making money off statins. And so, yeah, with you know drugs like Osempic. You know the problems like we were talking about earlier. You know, even in the anesthesia world, this is a drug where it puts you at a little higher risk because you don’t empty your stomach and so people can come in and say I haven’t eaten in 14 hours and still have a fair amount of food in their stomach and if that goes up into the lungs what we call aspiration, I can, I can kill you. So in in you. Look at the side effects of Osempic. You know people feel nauseated, they feel distended, diarrhea, all these kinds of sounds awful. But once again, like you said, I think for people who are morbidly obese and you know they just have not been able to lose weight, I think it’s a reasonable thing for the people who want to lose five or 10 pounds and I know plenty of people, or heard of plenty of people, who are doing this and going on that drug Whereas with statins you just have decades of evidence of it, of it working really well to drive your LDL down and that’s going to be the the main cause of atherosclerosis. So yeah, it puzzles me as well. 

David: 23:26

Similar to the sort of the diet stuff you sort of enter the religious where just one needs to suspend belief in facts and just like okay, whatever you think. 

Dr. Mike Wagner: 23:36

Right and if you look at it I mean you can look at meta analysis of, you know, hundreds of different randomized placebo control really well done studies and there’s just a direct correlation the lower you get your LDL, the less you are to have a cardiac event. You know what we call MACE, or a major adverse cardiac event. So the lower you go, the better. And there’s also really good evidence in. If you look at people with familial hypercholesterolemia, where they’re born with a genetic defect in the LDL receptor, you know statins are lifesavers. Those people, depending on if they’re Homo or heterozygote, you know they’ll have events in adolescence right Without statins or more aggressive drugs. And I don’t know what more evidence people need. But I mean and I’m getting to the age now where I’ve had two or three people not close friends but in the community or other places who have dropped dead from a cardiac event, and you know it’s. I think people are so worried about Alzheimer’s and cancer, and I get it, but heart disease is still the number one killer, which is crazy. 

David: 24:44

You know those are the big. Well, there are four there’s cardiac, there’s cancer, there’s brain, neurological stuff, and then there’s also accidents. I think accidents is like number four. I don’t know about you, mike, I feel the most dangerous thing I do in any given day is I get in my car Like it’s not ski racing, it’s not, it’s other stuff, like I’m not going to die doing that. 

Dr. Mike Wagner: 25:04

I might break a leg, but a car yeah Well, yeah, I worked down in Salt Lake, so it’s like I’m doing that community quite a bit. 

David: 25:11

Yeah. 

Dr. Mike Wagner: 25:12

But yeah, and it enters my mind, I mean, as my kids get a little bit, they’re not quite driving age yet, but I think about driving down the 80 with those semis. And then I also think about you know, having taken care of people who are long haul truckers and knowing what their baseline health is. It’s a little scary to think about making that drive and to me that’s probably the number one risk in my life. Is making that drive up and down, right. 

David: 25:34

Yeah, I know people. They ask me like, oh, what kind of car should I get? I don’t care what color your car is, I don’t care how fast your car is, any that. I care about one thing Somebody goes across a lane with an SUV and hits you head on. What happens? 

Dr. Mike Wagner: 25:51

This is the only thing I care about. Yeah, yeah. 

David: 25:53

Let’s talk about some of the other things. So wrap a myosin, talk to me about what’s the upside to wrap up. 

Dr. Mike Wagner: 26:01

Yeah. So it’s something I actually started taking and I felt weird about it, right, because I felt like I was going down the rabbit hole of, like, what am I doing here? But the more I read and I’m not, as you can tell, I don’t take about a ton of supplements. I think that’s a field where you know once again, you have to find what works for you. I tend to be somebody where I take something and I just I don’t feel a difference. You know, when you read about people taking this, maybe some of it is placebo, in fact I don’t know where they take a certain supplement and it’s like, oh, I slept so better, I have so much more energy, or I think more clearly, none of that’s really worked for me. So, Rappamycin, you know I started, I looked at, if you ever I don’t know if people have delved into the ITP or the interventions testing program studies where they will test molecules on a mouse model and they do it at three different labs simultaneously, and that was one when you look at it, and most of the molecules they’ve tested don’t work Things like metformin, stuff like that and it’s a mouse model, so it’s not human. But generally it’s a good place to start, and Rappamycin just shows a huge benefit in both male and female mice. If you look at it it’s shown a benefit in it’s done in a few human trials. So it was done in Australia and New Zealand and people were getting the influenza vaccine. They had a much more robust response to the vaccine, less likely to get influenza, so it was very immunomodulating in a good way and, more importantly, what they’ve shown is just no side effects. So I think it got this reputation, certainly when I was training, as it’s a drug given to people who have kidney transplants as an immunosuppressant, but that’s in a dose that’s dose daily, so you take it every day and it has immunosuppressant. But when you’re given once weekly or once every 10 days a little higher dose, it actually has the opposite effect. It actually is an immunomodulator that enhances your immune system and it’s shown like once again across four different animal species, to prolong life, so increased lifespan and health span as well. So once again it was one of those things where I could never find any evidence of it causing harm, which was the most important thing, and every study I’ve looked at it’s shown a benefit, and a really strong benefit compared to everything else that’s out there the hard part with it. So I’ve been on it for about a year. Is you really you don’t feel any different, right? The one thing? Actually, I’ve been on it longer than that. I started it in 21, december of 2021. And it was interesting with COVID. Everybody in my family got COVID and this who knows right, this is just anecdotal but I never got it. I never got sick and I haven’t. I’ve been on it for about, I guess, two years. I’ve never got sick, and so it’s an interesting side note, because everybody in my family they’re all healthy, but I didn’t get it, so who knows right? 

David: 29:01

So with something like that, how do you determine dosage and frequency? 

Dr. Mike Wagner: 29:06

Yeah, it’s kind of all over the map. Most people that I’ve read about in the studies and even in the ITP stuff it’s once a week. Some people do once every 10 days, but most are doing once a week and the idea is you get this kind of two to three days of the mTORC1 inhibition, but then you’re allowed some time for that to recover and you’re not doing it high enough dosage to inhibit mTORC2. And so I do six milligrams and that seems to be about once again. I’ve read a lot of different studies. People are anywhere from five to eight to 10, some around there, and so I kind of settled somewhere in the middle and I haven’t had some people. So you can get Aptis, ulcers and things like that, but I have not gotten any of those. And so the hard part about all this, as you won’t know, is there’s no biomarker right. So it’s hard to know what to follow. And the problem I have with this is I’ve had no side effects. I’ve tolerated it just fine. Well, I shouldn’t say that. The one side effect, like we were talking about earlier, is my LDL went up, which is known to happen. So I’ve kind of adjusted my dose and my stat to see where that will go. But that is the one thing I have noticed is, my LDL went up, and that’s been known to happen with Rapa Mycin Is how long do I continue this for? That’s the question in the back of my mind. I don’t know, I haven’t, but for now I’ll keep going, but I don’t know how to address that later on. 

David: 30:39

I have heard this is not medical advice. This is just us having conversations so like, don’t do anything we’re talking about here without checking with your doctor. I mean, I’ve heard with Rapa anywhere. I know it’s so weird. We’ve been talking about this Like well, I know a guy, it seems so, not based in science, but I know some people are three milligrams once a week and I interviewed someone a little while back and he does 12 milligrams every two weeks because he really wants the spike effect. 

Dr. Mike Wagner: 31:08

Yeah. 

David: 31:09

And then I’ve also, since it’s an immunosuppressant, I’m guessing like, if you feel like a cold coming on or something, you probably shouldn’t take it that week. 

Dr. Mike Wagner: 31:18

Yeah, I probably wouldn’t. If I was feeling like I was sick, I would probably skip it that week. But you know, in the dose we’re talking about, it seems to enhance the immune system. So I don’t know. Yeah, no, and this is the thing it’s like once again. It’s all over the place and we don’t even know what do you take it? I’ve actually tried to see do I take it with food or without? And even that people looked at area under the curve and what’s your? And some people are saying, well, you get a higher spike, but less. It doesn’t last as long as far as your blood levels. Versus, if you take it with food, it’s not as high of a peak but it lasts longer. Maybe that’s better, we don’t know. So I kind of sometimes try to alternate it. You know, taking on empty stomachs, sometimes take it with some food, others. But even when you look at all these supplements that are out there and this is one of my gripes you know if something works for you, great, but it’s just a huge unregulated industry and we don’t know on some of this like, do you take it with food, what type of food? You know how often, what time of day, what are the interactions with other things you’re taking, and that’s the hard part. And you know, if you took all these supplements that people are recommending, you would be on 50 supplements a day. I mean, it’s a little bit crazy. 

David: 32:34

Yeah, with the rapid. Did you notice any effect on your blood glucose or it was just the lipids? 

Dr. Mike Wagner: 32:40

Just the lipids. You know, I get an A1C, which is a reasonable estimator of what your average is, and it’s been pretty steady. It didn’t really change at all. 

David: 32:49

Yeah, and then if we look at, say, some of the other, so we have like the big we’ll call them the big four. So cardiac stuff, the statin seemed like a good idea, Anything that we can do to keep. I’m not a doctor, but my personal view on this is that any amount of accumulation you know it’s like an interest-bearing bank account it’s just gonna accumulate in your arteries and you’re not getting it out. So you know, I went to see my GP here and I had a CT scan and it was a two, I don’t know. My LDL was like 90 or something and he was like, oh, you’re fine, you don’t understand. But I said like listen, like I don’t want two to go to three because I can’t bring three back to two. 

Dr. Mike Wagner: 33:35

So Well, I think that’s the new thinking, right, when you look at the cardiac risk calculator, it’s basically in a 10-year increment, right, where, when you think about it, we’re not really worried about living another 10 years. You wanna live another 30 or 40 years or something like that. And if you look at atherosclerosis, it starts in adolescence. You know, you look at the people with an autopsy is on people who were killed in trauma or accidents or over in military stuff and there’s already buildup of fatty streaks and all these kinds of things. So, like you said, why not treat it aggressive and treat it early and not let this progress? So instead of developing significant coronary disease in your 60s, you’re pushing that back to your 90s or something like that. And so I don’t see a downside into treating it really aggressive and really early. And you know, in some of that, like I said, I did cardiac anesthesia and seen what happens in that operating room when you have bypass surgery or having valves replaced and you definitely wanna stay off the table, right, and so, yeah, treating it really aggressive and really early, I think you could prevent a lot of these cardiac events. And then when you, like I said, when you do the risk calculator. Unfortunately, the most heavily weighted item in that is age. So if you took a 40 year old who’s kind of a train wreck and they have poorly controlled LDL, they may even smoke hypertensive. It’s not even gonna trigger treatment because you’d have to be over I don’t know exactly what it is, but eight or 9% risk and it won’t be there because they’re too young, although they’re already developing heart disease. 

David: 35:17

That’s crazy to me. I just don’t understand that. 

Dr. Mike Wagner: 35:20

I think that mode of thinking is changing, but things are changed slowly. Same thing I have a great internist, but some of it is there’s not a lot of emphasis in primary care in this country. A time thing. It’s a lot of these people it’s all about they’re getting bought out by private equity groups and it’s all about returning money to the shareholders and being more efficient, seeing more throughput, and not necessarily about quality. I think that’s one of the downsides. 

David: 35:53

Let’s go to the next biggie cancer. What are you seeing out there? 

Dr. Mike Wagner: 35:58

Yeah, I think that’s the one that scares most people, because everybody has a story of some seemingly healthy person who comes out of the blue. I think what can you do? I think one, screenings that are appropriate. So they’ve reduced the colonoscopy screening age to 45, which I think is reasonable, but once again it’s amazing to me how many people won’t get it done. So for certain cancers like that, I think there’s pretty good screening things. I think you have to have common sense don’t smoke, drink in moderation or less. And then I think it goes back to the things that are good for your heart and good for your brain Maintain exercise, adequate sleep, managing stress, reasonable diet, not being overweight. We know that obesity is a driver for several types of cancers and I think that’s the best you can do. Sometimes people do have bad luck, but I think if you’re exercising, eating relatively well, not smoking moderate or less drinking, getting and trying to get adequate sleep and getting your screenings when appropriate, I think that’s the best you can do. Yeah, I mean, once again, I think people take supplements and do all these other kind of things. I don’t know how much that adds, but that’s how I look at it. It’s like if you’re controlling what you can control, I think you greatly lower your risk. It doesn’t make it zero, but becomes a more new favor. 

David: 37:27

I had Mike Royzen on a couple of weeks ago, who’s the Chief Wellness Officer at Cleveland Clinic, and we were talking about protein. I mean I asked Mike. I said everybody’s talking about a gram of protein per pound of ideal body weight. So I weigh 168 pounds. 

Dr. Mike Wagner: 37:42

That is just so like oh my God, so hard, yeah, it’s so hard to eat that much protein. 

David: 37:46

And what is that doing to me? And Mike’s a pretty level-headed guy and he said, well, yeah, but you kind of need to do that. But I said what’s the downside to that? And he says, well, all that protein. Other things grow with protein too, as in cancer. So what he does is he goes five days a month on a Volter Longos program. It’s like 750 calories. This is basically tomato soup. He eats for five days to cause autophagy, clean out all the mispholic proteins and hopefully that sort of balances things out. I don’t really like either one of those schemes of like that much protein or starving myself for five days. Yeah, it’s hard, yeah. 

Dr. Mike Wagner: 38:28

I mean, the protein thing has been kind of the new trend as well, saying you need these massive amounts. To me, our massive amounts, because I’m going to say 180 pounds, 180 grams of protein a day, is really, really hard. I mean, you have to supplement, right, and I’ll be honest, I’ve tried to get that amount in and I don’t feel great. I feel like I’m bloated, yeah, and I lift weights and things like that, and I just I didn’t like that feeling, the intermittent fasting, whether that it’s kind of the M-torque thing once again, or you’re kind of doing some house cleaning and inhibiting M-torque one in that cellular growth. I kind of feel for me maybe I’m cheating it with rapamycin, right, because I was trying to do the same thing without having to go through the agony of fasting. So I don’t know, yeah, I things I enjoy food too much to go even a week with eating just tomato soup, and once again we don’t. It’s a reasonable theory but we don’t have great evidence that’s necessarily true. And so, like I said, I think maybe the rapamycin helps me there, maybe it doesn’t, I’m not sure. 

David: 39:37

I think I I read an analysis once on caloric restriction and the sort of more primitive the species, the better it works. Yeast worms okay, and as soon as you move, mice, well, yeah okay. Dogs less well, and it’s sort of the higher the evolved organism, the less well it works. Yeah. 

Dr. Mike Wagner: 39:56

Well, it’s interesting if you look at this big study that came out and I don’t know if you’ve ever talked about the sun show the Wisconsin study, which looked at rhesus monkeys, which is interesting because they share about like 93% of our DNA, where a mouse is like 40 or something like that. So they basically took one group and restricted them by 30% and the other group wasn’t allowed to eat, add, live in them, just feed on whatever they wanted. And the headliner was well, the group that was fed 30% less lived longer, significantly longer. What was interesting, there was a parallel study done it at the NIA, national Institute of Aging, where they took the same study and they found no difference. The difference and this is kind of the take home point for me with diet was the ones in the Wisconsin study that the ones that were calorically restricted lived longer, were fed a horrible diet. It was the McDonald’s diets, right, they were fed. It was high fruit dose. It was nothing close to what they would eat in the wild, right. So it makes sense you eat less of really bad food, you’re probably going to live longer. In the NIA study, they were fed a healthy diet, a more wild type diet, and what they found is that further restricting calories when you’re eating a good diet didn’t make any difference in aging. So I thought that was pretty fascinating and that’s been my kind of take home with caloric If you’re eating a good diet and not eating a bunch of junk, is restricting the calories and being kind of miserable. Is it worth it? I don’t know. For me no, but maybe for some people they can tolerate it. It’s a real personal choice. 

David: 41:34

I’ve had Brian Johnson on here and, like Brian’s, I’ve heard about that guy. I love Brian, but I mean he’s an N of one. Other people can’t do that. I’ve had other people on who are they really transformed their bodies, very careful about what they eat and counting their macros and their calories, and for them this is a relaxing like it makes sense to them. 

Dr. Mike Wagner: 42:00

For other people, though, I think I did it once for like two weeks and I was like, oh my God, this is a bother, like yeah, yeah, no, yeah and I think if you have the theoretically, if you take somebody like Brian Johnson, and you have the energy and the time and the money and the resources, yeah, I’m sure you are probably gonna add years to your life. But for me, who I wouldn’t want to with it, for me, who I wouldn’t want to live that way, it just wouldn’t be worth it to me. And I think you have to be able to live what you would join now and live for the now a little bit too. And we all want to age gracefully for sure and have as prolonged a health span as best as possible. But I think you have to be reasonable about it as well. I mean, the experiments like that are fascinating to me, but there’s just no way. 

David: 42:47

Yeah, I like where he’s coming from, I like his point of view, I like why he’s doing this, I like what he’s trying to teach us and I’m glad he’s doing it, because I don’t want to do it. 

Dr. Mike Wagner: 42:56

Yeah, but yeah, it’s one of those things too that you can do all these things and, like you said, you get hit by a bus tomorrow, right, but you’re driving down. There are some things that are uncontrolled. That doesn’t mean you want to just say, screw it, I’m gonna eat McDonald’s every day and see what happens. But at the same time, as I think it has to be that balance, sometimes there’s things unpredictable. You can do everything right and still get cancer. You can still get hit by a car or something like that, and you want to try to lower that risk, for sure, especially you can within reason. But it’s trying to find that balance that works. Like you said, you’re an N of one. What works for you, and that’s in everything. There’s people who bought an exercise and their idea of fun is running ultramarathons. But you could argue, may, actually it’s probably not great for the lifespan. But that’s not me. I can go out and run. I say that it’s lacking a little bit because we have a 50K trail run this Saturday, but that’s not my normal. I’ll go out and run five or seven miles or go mountain biking or do whatever, and that’s enjoyable for me. It’s staying active, staying fit, and that’s probably perfectly fine. For other people it might be a brisk walk or whatever, but I think you have to do what works for you. 

David: 44:09

Yeah, I think that’s right. My feeling on this, Mike, is you sort of need to meet people where they’re at Understanding that I’m pretty regimented in my fitness exercise thing. I like metrics. I do an hour or two hours a day. It’s the sort of thing that I do, but I really love it, Like I just get tremendous enjoyment out of maximizing what my body can do. But that’s me, and I think for a lot of other people it’s like okay, maybe just try and walk a little further today. 

Dr. Mike Wagner: 44:36

Yeah, and with that said, I think you have to see what fits in your schedule. I know I get up most mornings I’m working, it’s really early. So you read these people like Gander Huberman, who have really taken off, who has a lot of protocols, and people love that. They really love being in these protocols telling exactly what to do when you do it. That’s for me doesn’t work very well. But getting up and getting early morning sunlight I leave for work at 6 am. So starting basically in a couple of weeks that’s not possible and then I’m inside where it’s fluorescent and sunny every day. That doesn’t work for me. So I think you have to find especially people might be out there working 12, 14-hour days and being able to meditate and get early morning sunlight and lived and then take a nap, and it’s just not possible. So you have to figure out what works for you and your schedule and your lifestyle. 

David: 45:30

I want to bring something up here. I don’t want to slam Huberman. He’s a smart guy. He’s not a clinician and he’s a researcher. There’s a huge difference between the two. So clinicians are people who actually see people and treat people with things and see what’s happening. Researchers read research papers and theorize about what may happen and what could be recommended. Like Matthew Walker great book why we Sleep Love that book. Matthew’s a researcher. He’s not somebody that you go to with a sleep disorder, but our friend Wendy Troxell is. You have a sleep problem, you go see Wendy, she’s going to help you out. Or Michael Bruce, people like that. They’re very different. 

Dr. Mike Wagner: 46:10

Yeah no, and things in theory are totally different. In practice and the translation of those a lot of things that you think are really promising or should work on a physiological mechanism, don’t pan out at all, and so it’s totally different taking care of people in real life versus in a study. Or even some of these studies are really small and some of them, even if they’re very reputable journals and some of them are in animal-based studies, and so that once again, translating that over to humans is fraught with failure in a lot of things we think are really promising and just never pan out Different when you’re a clinician. 

David: 46:51

Where I’m going with this is for yourself. You’re up at six in the morning and you’re in a fluorescent lit, or Having a researcher tell you these are the five things you should do every day just doesn’t make any sense. But if you go to a clinician, the clinician is going to say oh yeah, mike, this is your reality, this is your value system, your ambitions. Okay, let’s see how we can figure out something that works for that. And I think that’s a really big difference, that I think a lot of people who listen to podcasts and read stuff in this space don’t understand the difference between those two things. 

Dr. Mike Wagner: 47:25

No, and you have to take that into account for sure. 

David: 47:28

Yeah, now we’re into like things that bug me. The other thing that bugs me is the difference between correlation and causation, which makes me absolutely berserk. You know, like the Blue Zone stuff. We’re not talking about causation here, we’re just talking about observed correlation. I don’t want to pick on that, but there’s like a ton of that stuff. 

Dr. Mike Wagner: 47:53

And well, look at like game changers right With you know that, but which I watched, that was great, I think. If people I would never if somebody came to you said that I want to be vegan and I can do it, I’d be like, fine, you know, I have no problem, I choose not to. But you know people will use that as their evidence. Right, like that’s not science. No that’s just just correlate, you know, right. But hey, if that’s what works for you and you like it and you’ve lost weight and you’ve seen your exercise improve great. 

David: 48:22

That’s sort of the thing. Does it work for you? The correlation? Then again, we sort of move into the religious belief section and I’m not, I’m not gonna be, like you know, Christianity, Buddhism and any of that. What I’m talking about is, like you know, like the diet stuff or the, the statin people. 

Dr. Mike Wagner: 48:42

Yeah, that’s big. And statin’s, because myopathy, you know, muscle aches and soreness is reported at about 4% and it’s much lower than that probably. But it’s one of those things, right, you, you take a statin, you kind of worked out hard, the next day you slept on your neck or on whatever. We all wake up and have aches and pains. Yeah, but you started a statin, it’s gotta be a statin right? 

David: 49:04

That’s where being a clinician gets really tricky, because they have to parse out. You know, oh, you did this and this and this, but what was the causation of whatever you’re here for? I don’t know? Whatever you did, like you ate asparagus tonight and you’re in here and your gut hurts is that really it? Figuring that stuff out, I think is really something where I give a lot of credit to people who actually parse this out like one to one, and you look at a lot more this than I do. But if you look at data curves, it’s often a bell curve or it’s a distribution of data in some way, and if there’s enough data indicating something, okay, we’re going to recommend this. But there’s probably a huge amount of data that’s like outside of that. It just comes down to a probability thing. And does the person that you’re recommending this to fall within that probability? Are there other circumstances here that would affect that and how do we parse that? I think human biology is so complicated, mike. 

Dr. Mike Wagner: 50:04

I just it is it is Right, it’s unbelievably complicated and there’s a tremendous amount of noise, right, yeah, that’s the hard part. And studying everybody is different and you know, maybe someday in the future we get there where you know you’re able to go in and they can look at your DNA and say this is your diet, this is your exercise, this is how much sleep you need, and maybe someday we’ll get there. We’re not there yet, but maybe that’s the future of medicine where everybody has their DNA analyzed and you can know exactly what works best for you. But you know, right now there’s a lot of noise. I mean you can see that in. You know I don’t want this is such a controversial subject. But when you look at COVID and vaccines, I mean you know talk about correlation and causation. I mean you know people get a vaccine. They have a heart attack, right, you know you still see that. Go on, right, somebody you know the NFL player got hit in the chest and you know, had Commodio Cortis and went into cardiac arrest, which is a known mechanism from trauma. And you know others people are saying it’s the vaccine. So you know it’s a hard thing. But, yeah, there’s a ton of noise in biology. 

David: 51:12

My training was as a mechanical engineer, so physical sciences. If you take a ball and you hold it out at arm length, I can tell you precisely, without any doubt, how long it’s going to take to hit the floor. No one’s going to debate that. That hasn’t changed for hundreds of years. But, like when you get into biology, especially human biology, it’s just changing. Even in the field of anesthesia. 

Dr. Mike Wagner: 51:35

I see it every day, right so people come in and once again it’s the theoretical to the practical. What is the practice of anesthesia like in real life? And it’s different than what you learn in the textbook. I was very integral in teaching residents for the first nine, 10 years of my career and you know I’d say that there’s the board answer, the theoretical answer, and the real world answer, and they’re very different. So you know you can take somebody to come in and say how much pain medicine does this person need if they’re having a knee replacement? And you know they get the same nerve block, they get the same anesthetic, they get the same surgeon, same type of surgery and some people have no pain. Some people it’s 10 out of 10. They’re taking opiates and painkillers around the clock for weeks and you know you can throw away the people who are chronic pain. Let’s say who you know, you know are going to have more of a pain requirement or have a history of drug abuse For people that you know would probably have higher amounts. But you take people who you know know history of abuse, not on opiates. Same surgery, same surgeon, same anesthesia, it’s all over the map and there’s no predicting it. So it’s just amazing to me every time I see that I’m like you know it’s hard to predict. 

David: 52:50

Yeah, exactly. The other thing we talked about were accidents and cars. Of course, cars are very cars. Are everyone out there? Cars are very, very dangerous. 60,000 people here die in them. 

Dr. Mike Wagner: 53:03

Well, that’s funny because I don’t road bike. I’m not a bike, but I don’t road. And that’s a little bit dangerous, but I don’t road bikes. I’m too afraid to get back. I feel like I can control the narrative a little bit on a mountain bike. 

David: 53:14

Let me just tell you about that sport, which I don’t do anymore because I was just bleeding. To everything I do, I come home bleeding. I don’t need to do this. A good friend of mine crashed his mountain bike for broken ribs, broken collarbone. What they were telling us at the hospital here in Park City is that they have more mountain bike injuries in the summer than they do ski injuries, but the amount of people mountain biking is, oh, it’s like 10% of the amount of people that ski. Sure, we were at dinner and the guy’s wife was like you realize, you’ve had two major accidents in the last two years and you’ve gone out maybe 30 times. So that’s what an 8% chance of you ending up at a hospital. Why are you doing? 

Dr. Mike Wagner: 53:58

this. Well, it’s funny because I do probably the least amount of that. I do a little bit, but I ski a lot more than I mountain bike. I tell my wife that all the time I feel when I ski I’m in control, I can handle about anything. When I’m coming down on the mountain, I like the mountain biking for the climbing, for the fitness, but coming down I feel like I don’t know what’s going to happen, right? So yeah, I don’t do it as much, but it definitely seems to be the riskiest thing I do. 

David: 54:25

I ski, I ski race, I ski fast, but like if I fall down, I’m falling on a surface that’s soft-ish versus a rock. 

Dr. Mike Wagner: 54:36

Yeah, like some of the uniform, right, yeah, exactly, exactly. 

David: 54:41

Back to the accident thing. Falling is like no good. So we know that what we want to prevent falling is a few things. So we want to have good fast-quitch muscles so that if we think we’re about to fall, we can protect a leg or whatever hand out there to stop it, and then, most importantly, balance and proprioception, so that we know where we are in space. Six months ago my PT had me stand on one leg and close my eyes. I think that was like three seconds. I can now do 20. Are you doing things? I think this is particularly something like after 60. Like I didn’t notice this when I was in my 50s, but are you doing anything? 

Dr. Mike Wagner: 55:20

Yeah, I don’t do anything planned. I kind of feel it’s probably a good idea. For sure I don’t have any sort of balance type exercises. I do. I kind of feel that, and probably maybe not true, I don’t know if there’s any evidence, but by skiing and biking and doing all these other kind of things there’s not. I guess there’s a lot of balance and coordination in that you kind of dig it for granted living here where a lot of people can ski really well, but to be able to go down the mountain and maintain that balance and do those things, I think probably is a good thing going forward that a lot of people can’t do or don’t. Do you think about just running in a straight line? You’re probably not getting that, but being on a bike or skiing, or even if it’s Nordic skate skiing or something like that, there’s a lot of balance and coordination in that. By doing that, I feel like maybe I’m checking that box. 

David: 56:21

What I’ve noticed is that as I get older, most of my sense of where I am in space and how I’m moving is visual, versus all the other senses I have in my body. I was with somebody who was an extremely fit athlete and she’s about 70. She’s sort of well known. We were talking about balancing. She can balance on one leg with her eyes open for an eternity. Closes eyes, boom. Can’t do it. How this sort of thing gets one of those things that we can turn Well I know because I’ve gone from three seconds to 20 seconds. It’s humiliating. To train. I like picking up heavy things. It’s really fun. But balancing is something fun about balancing. But it’s so much faster because the brain knows. Once you put in a new circuit there, the brain is like, oh that’s great, that works, we’ll hold on to that, versus muscle building, which takes just months. 

Dr. Mike Wagner: 57:20

Yeah, and I think, as you said, when you start getting into your 60s and stuff like that, I think you need some degree of strength, but you don’t need to be the big bulky muscles for sure. Right, in developing those new neural connections as far as balance and coordination and those kind of things become, I think, of greater importance. For sure, I think when you’re still in your 40s, maybe in your 50s, you’re having the bigger muscles, whatever it looks good. But I think, yeah, I think that importance shifts as you get older and even things like I know I’m not going to be able to do the things I do now, or as well as high of a level when I’m 70. But, once again, still staying active is so important, right, just whether it’s bruise, walking or hiking or whatever it is that you’d like to do, and I think that’s the important thing is what gives you enjoyment. If you’re going out and doing something that you absolutely hate, you’re just not going to stick with it. 

David: 58:14

That’s right, and it goes again to what works for whoever. Maybe you really like dancing. 

Dr. Mike Wagner: 58:19

I love dancing, dancing is awesome, yeah, and that’s great because you get the balance and the strength and coordination and all those kind of things. And there’s some people like I have family members who live in Arizona and it’s so hot, Everybody’s in a gym. And here we take it for granted because I’m rarely in a gym. I do some strength stuff in a gym or at home, but we’re outside all the time year round and that’s not always possible in other places. 

David: 58:44

Yeah, absolutely. But as we wrap up here, mike, what gives you the greatest hope out there? You spent a lot of time reading about all this stuff. What are you seeing out there that’s hopeful? 

Dr. Mike Wagner: 58:56

Yeah, I mean, I think, just the general trend, right? I think this stuff, being able to read about this stuff or get information about this 20 years ago, 15, maybe even 10 years ago was almost impossible. Nobody was talking about this. How do we age more gracefully? How do we maximize our health span? So I think, as we get continued research and more and more great scientists and physicians are taking up interest in this field, I think we’re going to get some better answers to some of these questions. Like I said, maybe we get a biomarker someday. That’s accurate. And suggesting what you’re doing really is Because you read about this stuff about chronological age and biological age, and how accurate is that? I don’t know, I don’t buy into any of that. So I think it’s just the general trend that more and more people are taking an interest in this and talking about it, and I think that as long as you can weed through some of the stuff that’s not useful, I think it’s only going to be a benefit in not taking this kind of tertiary care approach, more of a primary care on how do we prevent some of these things from happening? 

David: 1:00:01

Would you consider moving into a parallel field, leaving the OR with anesthesia and moving into something like this yeah, I have a great interest in this. 

Dr. Mike Wagner: 1:00:11

I’m ready to make that move right now, but certainly I think in the next four to five years I would like to transition out of clinical medicine a little bit. I still enjoy what I do but given that opportunity I think I would probably jump at it for sure. 

David: 1:00:30

I guess the difference is with anesthesiology is that you don’t have a great patient relationship. It lasts for about 15 seconds and then they’re unconscious and then your job is to keep them alive. 

Dr. Mike Wagner: 1:00:40

That is true, it’s a short interaction. I’ve kind of branched out and done more of this acute pain management where you get to establish a little bit more of a relationship. But two, I think when you’ve been doing something for a while I don’t want to say you get bored, but it becomes pretty routine. I find this field a lot more interesting right now and challenging, because we weren’t trained in any of this in medical school. None of this existed. I think now it’s starting to become more important and people are taking a lot greater interest in it. If there was an opportunity, if you try, I’d probably jump ship a little bit. 

David: 1:01:17

I think there needs to be more people who are doing that. I guess, is where I’m going with this. 

Dr. Mike Wagner: 1:01:22

The time, the resources. I think that’s the hard part. Once again, I think we’re a system in this country that’s very tertiary, care-based, where the money is really taking care of people who are sick and established disease. If somehow you shift that focus where you’re able to make a living working with the people who want to stave off disease, I think that would be a great place to practice. 

David: 1:01:45

I think that’s right. I think it’s very hard to put this sort of a burden on an internist or your GP. It’s sort of like apples and oranges. It’s sort of a different thing. Mike, thanks so much. 

Dr. Mike Wagner: 1:01:56

Yeah, absolutely. 

David: 1:01:56

I appreciate having you on. We’ll be in touch. I’m a huge fan of your wife and what she’s doing. Jen Wagner. 

Dr. Mike Wagner: 1:02:02

Yeah, this is a whole talk about it. She made the pivot. She’s doing something totally different. I’m proud of her and it’s been a big leap for her. 

David: 1:02:11

Awesome. All right, have a good day out there. I hope you get some time on the bike. Yeah, sounds good. Take care man. Bye-bye, we’ll talk to you later. That was great. I’m glad to have that conversation with Mike. I think it’s really interesting to hear what somebody who’s clearly smart and Stanford-educated medical professional has to say about some of the things that are going on out in the worlds of longevity and wellness and what they’re doing and what we can learn from that we’re going to get with. Just try this in just a moment. After a quick word from one of our sponsors. Today’s show is also brought to you by Inside Tracker. Inside Tracker is the dashboard to your inner health. We talk about this a lot, about metrics. What matters? Biomarkers? The thing is you can’t take actions on things that you don’t know about, and what you don’t know about can hurt you. I use Inside Tracker. I take their ultimate test four times a year. I look at their biomarkers. I see what’s moving from quarter to quarter, so I can see if I’ve made changes in my program and my diet. Is there something that I need to adjust? Their food first, supplement second, recommendations are great. I always share the results with my doctor and if there’s something we need to go over, we do that. Get a dashboard to your inner health. Go to insidetrackercom. Slash agist save 20% on all their products this week on. Just Try this. What’s top of mind for me is fiber. I’ve been traveling a lot recently and one of the things about traveling is it’s hard to get enough fiber. It’s airport food not so much. Why do we need fiber? Fiber, it’s not just about pooping. Pooping is important and pooping regularly and I have good poop, that’s all great Fiber is also. It’s super important for your gut buddies to keep your gut microbiome happy. Getting enough of this stuff can actually be a bit of a project, something that we need to pay attention to. There’s foods, things like legumes, chickpeas, lentils, beans, celery, most green vegetables. Things like this have a lot of fiber in them and that keeps your gut really happy, and happy gut leads to happy brain. I can say if you have an unhappy gut, you’re going to have an unhappy brain. This week, let’s just focus on eating a little more fiber and figuring out what foods you like that you can get enough fiber every week. It’s super easy. Let’s try this. So, guys, thank you so much for joining us on the show today. It is great to have you. I love this village that we’ve built. I love the way you guys stay in touch with us and I’m so appreciative of your time and attention every week. There’s a lot of other things you could be doing right now and you’re listening to this, and that makes me really happy. If there’s somebody else out there who you think could use this podcast, give them a shout and maybe ask them to subscribe. As always, I know it can be somewhat difficult to do, but you guys can do it, and that is, you can leave us a comment, you can leave us a review, up to a five-star review, I hope. I know, depending on where you’re listening to this podcast, if you’re listening on iTunes or Google or Skitcher, you might have to poke around for a couple of minutes to figure out where to do that and how to do that. But hey, we can do it. We’re clever people and we would really appreciate that, so that would be great. Hey, next week we’re going to be talking about skin and the latest in technology around skin care, skin rejuvenation. We have our favorite dermatologist, dr Kelly, coming on. So until then, everyone, have a wonderful week and we’ll see you then. Take care now.

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1 COMMENT

  1. Clinician versus researcher–I have never heard it expressed as well as you did in this podcast, David. I practiced as a clinician(now retired). We work where the rubber meets the road, in other words, the real world. Individuals are not populations. Grateful to you for pointing this out.

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