New Insights on Medical Science and Longevity: Dr. Michael Roizen

Today we host Dr. Mike Roizen, emeritus chief wellness officer at the Cleveland Clinic and bestselling author. His new app, the Longevity Playbook, is changing the game by democratizing health knowledge.

It is always great to talk to Dr. Mike and learn about the latest and greatest news from the frontiers of the medical science world. I got to hear about everything from the complexities of stem cell treatment to protein restriction to changing testosterone levels to the latest data on genetic control switches and the potential of gene editing to cure heart failure.

We also took time to address some of the controversies in health and wellness, like the proper way to take aspirin to avoid bleeding, and the recent FDA approval of colchicine. Curious about the role of curcumin in reducing dementia risk? Or the function of nitric oxide in our blood vessels? We’ve got you covered. For more on Dr. Mike Roizen, check out the links below:

Today’s Sponsors

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Timeline Nutrition — our favorite supplement for cell support and mitochondrial function. Listeners receive 10% off your first order of Mitopure with code AGEIST at TimelineNutrition.com/ageist. 

LMNT Electrolytes — our favorite electrolytes for optimal hydration. Listeners receive a free 8-serving sample pack with their purchase at DrinkLMNT.com/AGEIST.

Connect with Dr. Roizen
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Transcript:

David: 0:18

Welcome to SuperAge. My name is David Stewart. I am the founder of Agist and your host on the SuperAge show. We talk about how to live healthier, how to live longer and how to be happier and who doesn’t want that? Today’s show is brought to you by InsideTracker, the dashboard to your inner health. Go to insidetracker. com/a geist save 20% on all their products. Today’s show is also brought to you by Element LMNT, my favorite electrolyte mix. It’s what I put in my water in the morning and it’s what I put in my water at the gym. Go to drinklmnt. com/a geist and receive a free eight serving sample pack with any purchase. Today’s show is also brought to you by Timeline Nutrition with their breakthrough product, mitopure, the first clinically tested urolithin A supplement which is showing tremendous results for mitochondrial health. Go com/ timelinenutrition. com/a geist. Use the code AGEIST at checkout and save 10% off your first order of Mitopure. Welcome to episode 145 of the SuperAge podcast. This will be dropping on August, the 3rd 2023. This week we are back in Park City, Utah, and, as you may be able to tell, my voice is not doing so great today. I’ve got some sort of a sinus thing and I thought maybe we shouldn’t do this podcast today. But hey, the show must go on. So today, on the show we have, we’re really honored to have Dr Mike Roizen back again. I believe this is his third appearance on the SuperAge podcast. Mike is a tremendous source of information and knowledge. He’s the emeritus chief wellness officer at the Cleveland Clinic. He’s a professor at the Cleveland Clinic College of Medicine at Case Western. He’s done a number of bestselling books. He’s written 190 peer reviewed scientific articles. Mike is a great guy and he’s a science nerd. He’s also a tremendous communicator. So we’re going to have Mike on and we’re going to go through a few of the sort of controversial things that are out there in the world of health and wellness today and see if we’re going to have Mike unpack those for us. Mike also has a new app out called the Longevity Playbook. I have it on my phone. It’s a great resource and I’m really happy that he’s put this together. Additionally, mike put out a book a couple of years ago that I use as reference all the time. It’s called the Great Age Reboot. A lot of tremendous information out there. I find Mike to be just a real inspiration to me and a great source of medical and science information that’s not really clouded by a lot of the hyperbola that’s out there that one can have access to in the world of Twitter and such. We’re going to get with Mike after just a quick word from our sponsors. The first sponsor of today’s show is Timeline Nutrition with their breakthrough product, mitopure. We all know how important mitochondrial energy is, and especially maintaining muscle and strength as we age. Urolithin A, which is found in mitopure, has been clinically proven to increase muscle strength and endurance with no other changes in lifestyle. Urolithin A is essentially upgrading your body’s cellular power grid, giving your body the energy it needs to optimize. I’ve been using mitopure for a few months now and what I can tell you is there is a noticeable change in the way my muscles re-energize after I use them. What that means is, say, I’m involved in some intense activity in the gym or maybe some sporting activity. Normally, the next time I did it I would be kind of tired, I would be sort of gassed out. That doesn’t seem to happen with this, and all I can imagine is because my mitochondrial grid has essentially been upgraded. It’s not just my muscles that are getting upgraded, it’s all the other cells in my body, because they’re all powered by mitochondria. Go to timelinenutrition. com/ ageist. Use the code AGEIST at checkout and save 10% off your first order of mitopure. The show is also brought to you by LMNT spelled L-M-N-T, my favorite electrolyte mix. One of the great findings that I learned last year was the importance of electrolytes in my water, especially sodium. Of course, if you have hypertension or you’re prehypertensive, this is something you want to pay attention to. But for most of us we’re probably lacking electrolytes. And my favorite one is LMNT and guess what? They just launched grapefruit. I’m actually drinking an element grapefruit right now and that’s awesome. Go to drinklmnt. com ageist, get a free eight-serving sample pack. That’s D-R-I-N-K-L-M-N-T. com/ ageist and get a free eight-serving sample pack with your next purchase. Quick reminder that, right after my conversation with Dr Mike Roizen, we’re going to do just try this a little fortune cookie tip to help you live a little better, a little healthier, with a little more joy in your life. We’ll get to that right after my conversation with Dr Mike Roizen.

Dr. Michael Roizen: 5:18

Mike, how are you doing today? I’m doing great, Dave, and it’s great to see you. I realize this is audio, but getting to see you is a thrill and you look healthy, happy and young.

David: 5:34

Thank you so much. It’s great to have you on here, as always. We always learn so much when you come on. Tell me a little bit about what you’re up to with Longevity Playbook.

Dr. Michael Roizen: 5:43

Well, the goal of this is to democratize, that is, to make available to everyone me, that is. The goal of Longevity Playbook is to have me in your pocket at all times so that all the knowledge that we talk about is in sconce there, if you will, so that people can do things in a systematic fashion to make their actual age younger. That is, we think that sometime in the next 10 years there is likely to be. There are 14 shots on goal, 14 different areas of aging mechanism research, and we think one of them is likely to break through and be able to turn the average 90 year old into the average 40 old. To prepare for that, so you can be that functional 40 year old, you want to stay as young as possible, have as many things healthy as possible, and that’s what the Longevity Playbook. It curates the data so that you know what is science and what is BS and only and don’t waste time or money on things that aren’t as healthy as some say they should be or as healthful to you as some say they should be.

David: 7:05

I’m a particularly fan of the library function.

Dr. Michael Roizen: 7:08

Yes, so the library goes through. It’s got 180 things in it. They haven’t all been released, but the Scientific Advisory Board has looked at 180 different topics, everything from testosterone and hormone therapy and women, and 51 different supplements. Should you take glutathione or catalase or metformin? And all the way back to blood pressure control and its importance, or in what we think the optimal drugs might be in different races, genders, etc. What the Scientific Advisory Board has not thought, but what the data are. So it’s really to curate the data to make it available to each person as if I’m in your pocket. Yeah, it’s tremendous.

David: 7:55

The way it opens up. There’ll be a couple of paragraphs of the summation, then recommendations and then the actual scientific abstracts. For somebody like me, you read scientific abstracts before you go to bed. You love them, but for me this is going to be a little dense.

Dr. Michael Roizen: 8:11

You’re giving away the fact that I’m a scientific nerd. That’s right. As you know, I have season tickets to the Browns, the Cavs and 10 games to the Guardians or Indians, and during the timeouts I read medicine, which is crazy, right.

David: 8:30

But that’s my fun. Let’s talk a little bit about your thoughts on aging, and we spoke a little bit about these genetic control switches and how these affect the proteins and the things that go wrong there.

Dr. Michael Roizen: 8:45

Right. All genes are protein factories. They manufacture a specific protein or set of proteins or parts of proteins. The things that control whether that gene is manufacturing or not are called epigenetic switches and those switches you control. It turns out in the latest data we generally accepted that by the age of 50, you control 70% of the switches. Well, the most recent data in twin studies, at age 40, you control 93 to 94% in those two twin studies of those switches. So what proteins you make is largely up to you. Now what we know is that when you get a misfolded protein so proteins, if you will they fold on each other in different ways. If you will misfolded protein, that causes a different effect, it hits a receptor. So, for example, heart failure in 25 to 30% of people is caused by a misfolded amyloid protein, different amyloid than the brain. This one’s made by the liver and knocking that gene out with gene editing in, 12 people in Australia literally cured heart failure. They went from the ejection fraction of under 12% and under six months to live. Ejection fraction is the percent of blood in your left heart, in the ventricle, that you eject into the systemic circulation, into the rest of your body when you squeeze the heart, or pump, if you will squeeze the muscle. And they went from that under 12% to over 35% in seven of the 12 people who had heart failure. And instead of having a six-month life expectancy, those seven now have an 18-year life expectancy by knocking that abnormal protein manufacturing system out. Well, the interesting thing is you say, why didn’t the other five get the result? Because they had so much structural change they couldn’t recover their heart. So that’s why the longevity playbook is important. It’s to keep that structural change away. It’s also says that maybe we can control a lot of those switches to turn off or on those proteins, those gene manufacturing functions of the and the subsequent proteins and the subsequent response by our actions. Now what we know that is so dramatic is that if you stress your bone, you jump up and down and cause a little injury to your bone, it turns on the bone repairing system. You turn on the osteoclast that repair your bone, so you get stronger bone. Same thing when you do resistance exercise with your muscles you create a little tear in the muscle. That turns on a muscle repairing system that makes the muscle stronger. Now we’ve just learned in the recent months same thing with the brain when you make the brain function quicker like my having to answer questions from you and bring back information that turns on a brain nerve repairing system called the NPAS4, you don’t have to know it, but it’s a series of proteins that repair your brain. That’s why speed we think speed of processing games are one of the reasons they’re so important. The other, stressing the muscle has, not only repairs the muscle but it turns on a gene that produces a small protein called a risen, which gets to the brain and makes the brain bigger. That’s why physical activity, we think, is so good for memory and for hippocampus. So you get to control by a lot of lifestyle choices how you function. That’s really one of the keys. You’re a better genetic engineer for you than anyone else who went to Caltech or MIT is an engineer for you.

David: 13:11

I think you mentioned 14 shots on goal. What are your top save? Four or five, do you think?

Dr. Michael Roizen: 13:17

Well, one of them came out just yesterday reports, so I don’t know if we’ve got a delay in this, but at least on the last day of July in 2023, a report came out from a small pharmaceutical company. I had no vested interest, I didn’t do any of the research, etc. But they had previously shown that giving a TNF-alpha inhibitor, a small molecule they made. By the way, tnf inhibitors are the largest selling drugs in the world. They’re used for rheumatoid arthritis etc. So, and psoriasis etc. Abibii, I think, sells $20 billion worth of Humera, or Humera like drugs. Well, they’re $70,000 a year and no one’s looked at them for aging, if you will, in normal populations, but in mice. This company had looked at a TNF-alpha inhibitor and it literally takes mice that look, that are 100 years old, 100 week old mice, the equivalent of a 100 year old human and make them 40 week old mice. Reverses the aging of their heart, of their muscles, of their brain, of their skin, their hair gets normal, their liver functions more normally, like a younger liver, like a younger brain, like a younger heart. Well, they now have started this in human studies and they did a phase two study, which is a safety and efficacy on the biomarkers of aging and of muscle loss. So we lose muscle as we get older, at least due to some of it is due to inflammation, and what they showed is that all of the markers in this phase two study in humans could be reversed and made normal and they reported no side effects. Now this is an oral report. They haven’t published the peer review paper yet or gone through FDA review, but if this holds, that’s just one of the 14 areas, something that decreases inflammation or infamaging, and we know Colchicine and baby aspirin do it to a degree as well. So that’s one of those areas that looks at how do we stay both younger now and is there going to be a big breakthrough where we take the 100 year old person and make them physiologically a 40 year old person? So some of the others and you and I talked a little bit Centelytics, the harvesting of old cells that make their neighbors old. That’s another one. Why is it that Centelytics make their neighbors old? They release a protein again here we’re coming back to proteins that makes it. Another one is study of drugs that block aging phenomenon. So Bumetamine made Bumetamide. It’s a $4 a month diuretic water pill, so it’s used to get water out of the body. Usually it’s a hypertensive or in heart failure, and it’s largely been replaced by Furocemitolasics and hydrochlorthiaside. It was found is the Gladstone in San Francisco looked at all 1363 drugs that had been approved by the FDA and become generic and they looked at does one of these block the attachment of amyloid and tau in the brain to neurons, which is the start of or is associated with Alzheimer’s disease and many other dementias, including Parkinson’s, in a different set of neurons? And what they found was Bumetamide in animal models and a mouse model of Alzheimer’s disease blocked it. Now mice aren’t men, as your friend quotes, so you have to do it in humans. And they looked at epidemiology of a 1.3 million person database and another 3.8 million person database and they found that it blocked it in 70 and 70. The people were taking this water pill. Compared to other water pills or compared to no water pill, had 70 and 72% less Alzheimer’s disease and less dementia. So now they’re doing human trials with that to say can we with this 4, literally 4 dollars a month water pill stop 70% of dementia? So again, it’s working on a protein to block the actions of that protein, of that amyloid or tau in attaching. So there are 14 of these type of shots on goal. There’s gene editing, there’s stem cell research that is being done very well now in some areas there is. So there are there are literally are 14 different shots on goal. Therapeutic plasma exchange, which is like Sinolytics but a little different in that it gets rid of your old plasma proteins and forces you to make new proteins. Hyperbaric oxygen, which tricks the body into thinking it’s in danger. When it’s done in a novel way, it’s a hermetic hyperbaric. They probably should change the name because it isn’t just hyperbaric oxygen, it’s the tricking of the body to thinking you’re low oxygen when you’re not. That cause forth the repair mechanisms and generates more stem cells and more repair mechanisms. So there are a lot of approaches to saying can we make a hundred year old person a 40 year old person? In other words, can we extend the period of life between that you’re most productive, your 40s to 60s, to being between 40 and 90? And that’s where a lot of the the aging mechanism research is going. So, and we think it is, if you will, that the buildup of abnormal proteins causes us to age, and if we can get mechanisms that either inactivate, destroy or prevent those abnormal proteins from being produced or being effective or even being around, that you can either stop or reverse aging.

David: 20:14

Really I want to go through some of the things that I’ve read about in the longevity playbook and that are in your book, the great age reboot, and just sort of touch on them and see if there’s anything new that we need to know about.

Dr. Michael Roizen: 20:24

So that’s why the longevity? That’s why we did the app and the website and it’s even on iPad as well as the website as well as an app is because the science keeps changing and you want to update. So I told you about stuff from yesterday. On the TNF Alpha inhibitor that’s going to enter phase three studies pretty soon, I assume from the company, and if it does, or if a bigger company buys that company out, we will keep track of it. There’s also a C-TEP inhibitor that produces more apo E1 that blocks Alzheimer’s disease in animals. That result we expect to see in September, october of this year. So another new drug by a different startup pharmaceutical company. But if the C-TEP cholesterol transferase, esterase protein ends up being beneficial, that’s again. That’s a huge moon shot to reversing. I mean. In other words, people care about bones and they care about mobility and they care about memory and this one. We’ve got a number of shots at memory as well as a number of shots at bone that are coming.

David: 21:37

Amazing. Let’s talk about aspirin.

Dr. Michael Roizen: 21:39

So the data on aspirin are pretty clear. It decreases nine cancers between 20 and 40 percent colorectal cancer, colon cancer, rectal cancer, esophageal cancer, breast cancer, etc. Nine cancers between 20 and 40 percent in epidemiology and in some randomized controlled trials. They obviously don’t have enough randomized controlled trials for us to say definitively or that the data would be clear that everyone should be taking a baby aspirin twice a day with half a glass of warm water before and after and maybe bovine colostrum as well. I’ll get to those things as well. But it does increase bleeding, especially if you don’t take it with a half a glass of warm water before and after or with bovine colostrum. Now, half a glass of warm water. 70% of the effects of aspirin are landing on the stomach lining and eroding it, or the intestinal lining directly. If you take it with the water, it dissolves in the water and doesn’t do that. That’s why it’s important to take half a glass of warm water. Warm just means it dissolves quicker. So I have a. Before I take my aspirin I have at least half of a cup of coffee. I know we’re doing this video and I keep thinking I’m doing the effects video, but it’s not. It’s too bad. People aren’t seeing the video. I just drank half a cup of coffee, so coffee is fine for the land and the coffee and dissolve in that. And then bovine colostrum in randomized controlled trials, 2,000 milligrams, decreases by over 80%. The shortening of the villi and what we call the shortening, the bloating and the gastric and intestinal leakage, that is, the shortening of the villi, mean that you can break through and leak from inside the intestine to the rest of the body and that process is totally aborted by bovine colostrum, which is the first. So that’s why I take 2,000 milligrams of that and why I take my aspirin twice a day. Now it will increase bleeding if you do extreme sports and get an accident. If you drive and get an accident and hit your head on something, it will increase that. So there is risk and that’s why finding something like a TNF alpha inhibitor that is even more powerful at decreasing inflammation and doesn’t have the risk may be wonderful. And we’ve now found. Recently the FDA approved colchicine 500 milligrams. It’s much cheaper if you get it as a 600 milligram pill, but 600 milligrams of colchicine or 500 milligrams of colchicine taken daily has been shown to decrease heart attacks and strokes and presumably the dementia associated with that. So maybe when we get a study that compares colchicine, aspirin and its side effects and benefits, we don’t know if colchicine has all the anti-cancer benefits that aspirin has, whether it’s a different effective aspirin than its inflammatory effect it correlates very well with its anti-inflammatory effect, but we don’t know that. But colchicine seems to be more powerful and the TNF alpha inhibitor may be even more powerful. In this way, these next 10 years will be amazing in the amount of data that comes out and that’s why we want to curate it and that’s why we did the longevityplaybookcom app and website and iPad version so that people would know the latest data and what we think the Scientific Advisory Board thinks is the best for each individual, personalized to them. So we’ll have enough data from them and be able to personalize it to them, as you have seen on the longevityplaybook app. But the key point is we’re now in this rapid scientific period where we will learn a lot about how to keep younger longer, keep your functions longer, so that if we do get that, what I call the great age reboot breakthrough the breakthrough where you go from 90 back to 40 and stay in your 40s and 50s for 30 years instead of 10 years at a time that if we do get that, you’ll have all the functions intact, and if you don’t, the worst side effect is you’ll live with a lot less disability, a lot longer.

David: 26:54

I want to circle back to aspirin, and you mentioned bleeding events. So someone is going to have surgery, for instance me. I’m having my knee cleaned out in three weeks. I currently take 81 milligrams in the morning and the evening, but we don’t want to stop that hard right, because then we get a rebound effect. Is there a taper that you advise people to do on aspirin? You do get a rebound effect.

Dr. Michael Roizen: 27:15

But the data and as you know I ran Cleveland Clinic’s anesthesia, the ROG intensive care unit and pain therapy they were their institutes, they’re so big. I mean we had 166 ORs, 184,000 operations when I last did that. But anyway, the 44,000 ICU days, 110,000 pain therapy patients, so those were big units and what we record, what we data aspirin stops the aggregation of platelets. When the aspirin is present it binds to the platelets that is created. You create new platelets every seven day. Every day you create 1 seventh of your platelets. You need about 1 seventh of your platelets to have normal clotting. For eye surgery, where it’s very meticulous and you want absolute clotting, we say stop it for at least four days. For knee and plastic surgery, maybe four days as well. But for knee surgery there’s a lot of you don’t mind if there’s a little extra blood around the knee. We have it stopped for three days, which means you get two days new of platelets. You want to be extra careful? You do it four days. You want to be really careful, you do it for seven days. But in any case it’s its anti-platelet effect that you’re worried about. Now what do we do? So we have not come to this decision yet, but my guess is that we would start a culture scene or something that has an anti-inflammatory effect, maybe the day before you stop the aspirin, so to continue the anti-inflammatory effect. So the rebound is in the anti-inflammatory effect and the increased clotting. You don’t see the increased clotting rebound if you stop it three days in advance, because four days’ worth of your platelets are still inhibited and will be inhibited until those platelets die and get replaced by new platelets. So as long as you’ll start it two days after surgery, you’ll be fine. So stop three days before start again two days after. To be extra careful, stop four days before, start two days after.

David: 29:49

And are physicians prescribing culture scene.

Dr. Michael Roizen: 29:54

Well, I am. I’ve been doing it for about a month now since the data came out pretty clearly, so at least, yes, we are, the clinic wellness group is I don’t, and our executive health group is, and I assume our cardiology group is. I haven’t looked at the number of prescriptions, but my guess is it’s going up dramatically.

David: 30:21

Let’s move on to something I find really puzzling, which is protein intake, and you see all kinds of numbers out there, and sometimes it’s a gram of protein per ideal body weight, that is a, I mean, 170 pounds. That’s a lot of protein. Is there data on this or are people just making this up?

Dr. Michael Roizen: 30:47

There is epidemiologic data. There isn’t good randomized controlled studies, and let me go through why. I go off of protein for five days a month, low protein, and do a gram of protein per pound the rest of the time, and it’s tough. So, for example, I will have, if you crazily, 10 egg white omelet, which gives you about 65 grams of protein if you will, but I’m still half right, and then I’ll have a couple salmon burgers on that day, which is 30 grams of protein. So I’ll get there, but it is tough. But what protein does is it stimulates growth and repair, and one of the things that happens as we get older is we don’t repair things as well and we don’t regrow things. So you need that protein and that’s why, when you’re younger, you presumably don’t need it. Now, what’s the downside of that protein? Well, it stimulates cancer growth too. Right, it’s stimulating growth of everything. But five days a month if you go off of it. This is Walter Longo’s randomized controlled studies. Going to low protein, I’m in my let’s see Sunday, monday, tuesday this is a Tuesday, so I’m in my third day of low protein this week and I just five days a month. I circle the five days. I’m home that I can do it. I’m not going out to dinner, I’m not going out to a ball game, I’m not doing anything where I’m going to be tempted to have more protein, but I’ll have go over here and get it. I have a thermos which, if you look in the thermos, I’m going to try and show you, dave, I don’t know if you can see it. I can’t turn it. I don’t know if you can. What is that, mike? It’s a tomato soup. Okay, it’s a very low protein. It’s tomatoes. It’s 36 ounces of diced tomatoes, 36 ounces of water, 12 ounces of corn niblets, 12 ounces of water, onions and spices to taste. And so, if you will, 48 ounces of water, 36 ounces of diced tomatoes, 12 ounces of corn niblets. It’s the original recipe Walter Longo, at least in my understanding, used in the original studies Very inexpensive, tastes good, 17 portions a day and you’re 750 calories or less. So the data was 750 calories or less. Low simple carbs, low protein, obviously virtually very little protein in that. And it turns off M-tor. It gets you to be in autophagy where you recycle your proteins. So hopefully you take all the bad proteins, all the cancer-forming cells that your immune system has been knocking out, get recycled rather than get to regrow into normal cancer cells, if you will. And so that’s the data that Longo showed extended lifespan in mice without any real problem, meaning five days of this a month, every month. I’ve been doing it for now in six years a little over six years since the data first came out in graduate students and it’s been replicated now in 35 to 40-year-olds, 55 to 60-year-olds, 65 to 70-year-olds and now 75 to 80-year-olds, where it extends lifespan considerably.

David: 34:51

So Mike, I want to circle back to. This Is the mechanism here the protein restriction or calorie restriction.

Dr. Michael Roizen: 34:59

It may be both, so we don’t know the answer to that question. But obviously if you’re doing calorie restriction, you’re doing protein restriction because most people won’t in their calories, just eat protein. But the goal is. So what we know is that as you get older, you need more protein to repair and maintain muscle mass and bone tissue lean muscle mass and lean bone and bones. So that’s why you do the increased protein after the age of 60 or so, maybe 50 or so we don’t have good data on when to do it. Why you want to go without protein is to recycle damaged and old cells rather than let them propagate and cause problems. So that’s why I think that the alternation so I’m a big fan of Walter Longo’s work, of the longevity playbook there are probably 180, I think, two choices you can make that are rational. Now, some of those choices avoiding catalase, glutathione and SOD as supplements I don’t account that as avoiding all the things that are bad for you I count as one choice. But in any case, there are 180 choices. You can make 182 choices you can make that keep you younger now, and I do almost all of them crazily, not because I’m obsessed by them, but because I’ve just built up those habits over the years. I am obsessed by that five days a month because that does require you planning and sacrificing. Almost all the other things are pretty easy to do you mentioned stem cells and it’s sort of a large topic.

David: 36:50

I know there are people people I know who go to Mexico and get stem cell allegedly umbilical cord, spin out the stem cells and they get these massive doses. There’s also platelet-rich plasma, right PRP, which is sort of similar to that. My understanding is the FDA in the US there’s a lot of restrictions on stem cell stuff but there’s there restrictions on it because it isn’t proven In most stem cells.

Dr. Michael Roizen: 37:18

You’ll get 500 to 800 stem cells. That’s useless, except you get the exosomes, the factors with it that come with PRP, that seem to be able to call forth your own stem cells to that area. So let me go through some of the process. Why do you get to a hospital fast after you’ve got a heart attack or stroke? One is to open up blood supply and that saves some cells around there, but it also lets the dying cells send out these messages. We call them exosomes. They’re the insides, their growth factors, inside stem cells and inside other cells that call forth your own stem cells to repair this. How did we learn this? Well, this was actually in 2004. A male heart got put into a female person. That female then had a heart attack. Subsequent to that, after they opened up her blood vessels and restored it, she re-grew and restored her heart function. When they looked at the cells that had done that, they were female stem cells. They were her own stem cells in that male heart. She was a female and you can tell female versus male by looking at the chromosome and see X, y, and she had the female markers and that’s what they were. So they call forth your own stem cells. That’s what we think PRP platelet-rich plasma exosomes do. We’re not sure of that at all and the data are very either. Randomized control data show some people get benefit, most don’t. There isn’t a lot of difference between a saline injection and a PRP injection, except some people definitely get a benefit. It just isn’t statistically a great enough number to make it statistically valid. Now what about stem cells in Mexico? It’s probably a fraud. What about stem cells in Panama? That’s actually two places of setup in Panama that are very legitimate and in Japan they’re doing very legitimate studies. Japan has interpreted the intention or the right to treat part of the International Patent Treaty differently than the US has. In the US, if you find a treatment that works in one person and it’s in a phase three study and you file a right to treat, you have to go through with each person the full process of getting that at the FDA a long legal process. In Japan, once it’s in phase three trial and once one person has filed it, everyone gets the right to treat. So they have done a large stem cell. It takes 30 to 50 million stem cells to repair something. So when you’re doing a heart, when you’re trying to repair the heart and someone’s got a heart attack, you’ve got to inject 30 to 50 million stem cells. No one in the US does it. I don’t think anyone in Mexico does it, to my knowledge. In Panama they’re doing it, in Japan they’re doing it. So you’ve got to grow them in culture, which means taking a biopsy from you and growing it in culture. Or, as they’re doing in Japan, they knock out the immunogenicity, the HLA markers on your and a stem cell and can mass produce trillions and trillions and then give them to everyone without getting fear of rejection. So, stem cells in the US, well, maybe, if given with exosomes, you’re getting the benefit of the exosomes PRP, maybe you’re getting the benefit of the exosomes we aren’t sure. Yet the rest of the world? It’s a wallet biopsy. If you got enough money, they’re going to take it from you, and in Panama and Japan it seems to be in three or four specific places, a legitimate attempt to get you those 20 to 30 to 50 million stem cells done right.

David: 41:52

Continuing in the realm of controversy Metformin.

Dr. Michael Roizen: 41:56

So Metformin has a number of benefits that were shown in one study. Let’s go. What Metformin does is it lowers your blood glucose by facilitating the transfer of glucose, sugar, from your bloodstream into your cells. So sugar in your bloodstream gets on your proteins, causes them to malfunction Again the protein problem. So hemoglobin A1C, which we measure in type 2 diabetes and goes up from the normal 5.6% or less to 5, maybe even 10 or 15% to 10%, let’s go. And what that does is it inhibits that hemoglobin from releasing oxygen normally. So you get ulcers, you get ischemic, you get lack of oxygen changes in your kidney and your heart and your brain. That’s what type 2 diabetes is. And Metformin facilitates getting the glucose out of the blood and into your cells. And in a large epidemiologic study published, I think, 2013, they showed that people on Metformin diabetics on Metformin lived longer than diabetics on other type 2 diabetic drugs and lived longer than non-diabetics. And that fit with some of our biases that sugar in the bloodstream is bad. So people thought and near Bezoral is one of the proponents of this that maybe we should all be taking metformin 500 milligrams in the morning, 1000 in the evening. It does have some stomach side effects, meaning you get some gastric upset, you can get constipation or diarrhea, you can get nausea with it, but assuming you don’t get that and you’re not on other things that lower your blood glucose, it won’t lower your glucose so much as to cause low blood sugar in the vast majority of cases and maybe has this longevity effect. Well, a repeat study in 2018 in the Netherlands, looking at the same type of data, epidemiologically found no benefit and no extension of lifespan from metformin compared to other anti-diabetics, and no benefit compared to people without diabetes who live longer than diabetics. So one there’s some controversy there. The second thing is that metformin, the longer you give it, the less it helps in reversing type 2 diabetes. So if we’re going to develop insulin resistance as we get older, which is what often happens, then you want metformin available, and if you’ve been using it for 20 years before that, it doesn’t reverse it as well. And third is it seems to not have or to knock out the effective exercise as a benefit for decreasing your rate of aging, decreasing aging biomarkers and increasing a lot of other parameters, so in variables. So the point is we don’t know if metformin has any benefit or, in fact, is harmful as you get older, and so I. The scientific advisory board of the longevity playbook says that if you’re exercising, if you exercise with any regularity, probably not to take metformin. You don’t have type 2 diabetes but have it as a risk in your family to not take it till you get pre diabetes and in general it may not have a longevity benefit. But definitely if you exercise regularly or if you have a risk in your family not to do it until it shows up in you.

David: 46:08

I’m giving you a lot of scientific nerdism and I apologize. Not at all. That’s why we’re here. I’m just curious. You said if someone were to take metformin it’s 500 milligrams in the morning and 1000 in the evening. Why? Why that not 1000 in the morning and 500 in the evening?

Dr. Michael Roizen: 46:26

You know I don’t know the full data on that, but it probably relates to the nausea and the stomach effects and that if you sleep you don’t have that effect with the 1000. So it does. So we normally start people with 500 for 7 to 30 days and then, if they’re fine, you go to 1000, you go to 1000, 500 in the morning, 500 in the evening, and if that’s fine, then you go 500 in the morning, 1000 in the evening. So that’s the normal way, that most that that a lot of us started, for example, for PCOF, or polycystic ovary syndrome, or for type 2 diabetes, curcumin and the liver. So I know curcumin is, when mixed with black pepper, seems to have a very positive effect, but I so what you’ve mentioned is that black pepper is needed for the curcumin to be absorbed into the body, so you’ve taken. You said a very important thing very casually, Dave, and a lot of the problem in the early studies on curcumin being a benefit or not were that we never got absorption until people learned that you needed to put it with peppering.

David: 47:44

And are you seeing any negative effects on liver function from curcumin?

Dr. Michael Roizen: 47:50

You see in. I believe, and I have no good data on this, but remember, it’s a supplement and I believe that some of the adverse effects reported from it on the liver are due to contamination in the way it’s prepared We’ve used. You know the data are best with a supplement that I have no stock in, no vested interest in. It’s sold, I think, at Walmart, called Theracurman. It was developed in Japan. It’s a little more expensive but it’s much pure and we don’t see you do see some adverse effects headaches, problems sleeping in some people who take it Usually. We haven’t seen a significant increase in liver dysfunction with it. So my own belief on curcumin is that it is the contaminants with it, not the actual curcumin. Now I tried to cook with it. I don’t know if you know, curcumin turns everything yellow.

David: 49:15

My wife hates that, by the way.

Dr. Michael Roizen: 49:16

And then the founders are all yellow and then it goes to brown and it’s a atrocious color brown. And so you got to. So I was. I tried to get what is the right amount of curcumin. I can put in the reason being is curcumin has a lot of epidemiologic evidence and some randomized animal data and a little human data that it decreases risk of dementia. People who eat a lot of curcumin Indians have one third the risk of dementia as the United States at the same every other characteristic. So that was the start of this study on curcumin and so I tried this. It is very tough to get the right amount of curcumin, to get the maximum, the appropriate dose of curcumin, by cooking with it in American foods there are cumans in the solution there. Let’s something that’s personally baffled me a little bit Basking a whole bunch of controversial areas.

David: 50:24

That’s why you’re here, mike right the endothelial layer and nitric oxide and how this function seems to decrease with age sort of run us through, so so yeah.

Dr. Michael Roizen: 50:38

So you have a thin inner layer cells lining your blood vessels called the endothelium, and then there’s the muscular, the three layers in most arteries and two layers in your arterioles. But there’s endothelium and the endothelium secretes something called nitric oxide in two different fashions and I’ll come back to that in a second, and that dilates your arteries and allows increased blood flow. So, for example, when I squeeze my hand like this, my endothelium start to release nitric oxide to the blood vessels that go to my hand and that dilates and gives more oxygen to those muscles so they can keep contracting. As opposed to, it doesn’t get to my leg artery, so I don’t dilate the blood vessels there because I’m not exercising my leg. At the same time, you give it to the area you need it. We learned about this with, if you will, the heart and we gave nitroglycerin to dilate heart blood vessels when you were having a heart attack. That’s one of the treatments to dilate the blood vessels of the heart. But it dilates everything. So Viagra and Cialis, etc. Levitra block the metabolism of nitric oxide so it stays in the circulation longer, so erections last longer. The blood flow into the penis last longer in those cases, or into the pulmonary circulation or wherever it’s being used for effectiveness. As we get older, we have two. I said two things One is constituent and the other is inducible. So as we get older we lose the constituent, the amount of nitric oxide that’s always there. We still can induce nitric oxide. So foreplay for erections takes longer as you get older, because you’ve lost your constituent of nitric oxide and you have to induce it if you will. I don’t know if that’s an example I can use, but medicine’s in no embarrassment zone. So we lose that constituent Somehow. We don’t cause our bodies to use it and so we lose that capability. So if you will, there’s a. You know it’s a. Use it or lose it. That’s what happens. You lose the constituent if you’re not dilating that blood vessel often enough. So the more times you have sex as a guy or woman and have an orgasm, the more you will have that constituentive as well as the inducible nitric oxide. Well, that goes for your muscles, your brain, your heart, the whole thing. So we lose that over time. It’s why warm up takes longer in tennis players or golfers or whatever as they get older, cause they have to get the inducible form up to normal speed before that muscle functions normally. So that’s the thought on what’s happening. And yes, leafy green vegetables are a great way of increasing that, as long as you don’t use alcohol mouthwash. So in do you eat the leafy green vegetables, you get the nitric oxide out, it circulates through yourself, very glad, and you absorb it. It’s also why you wanna breathe through your nose, cause the nose has a lot of nitric oxide secreting cells in it and breathing through your nose gets those to dilate the arteries in your lungs and you oxygenate better.

David: 55:05

Okay. Is this also why, as people get older, their hands get cold?

Dr. Michael Roizen: 55:13

I don’t know the reason for that. You know it may be a sympathetic, parasympathetic balance as we get older. I don’t know the answer to that question, I’m sorry.

David: 55:29

Okay, tmao something. Whenever I talk to people about this, this is one of the most divisive things.

Dr. Michael Roizen: 55:38

It shouldn’t be divisive. It’s pretty clear 13 studies over four continents that it’s been studied in. It did start here at the Cleveland Clinic. Trimethamine is a inflammatory molecule produced by the certain of the bacteria inside you. When you expose it to carnitine and saturated fat at the same time, carnitine pills don’t do it. Saturated fat alone doesn’t do it. The two together do it. The bacteria, by the way, do it to old chicken, old meat, old fish. So the fish-like smell that is fishy is actually trimethamine. So if you eat fish that isn’t fresh-rozen or that isn’t fresh, you will have a TMAO level. Now it isn’t because of bacteria producing it. They produced it in the fish by eating the fish. So you can’t get if you eat a level. If you eat old fish or eat fish that looks like it’s fine but has been gotten to by bacteria, you often will have a TMAO level transiently elevated while you digest that. But it’s not the same as your bacteria producing it. When you eat six ounces of red meat, that carnitine and saturated fat for 80, some percent of us changes the bacteria to produce TMA for two weeks. You then convert that TMAO to TMAO in your liver. Now how do I know that smell? Because we tried. We gave a TMAO blocker that blocked the conversion of TMA to TMAO, thinking, well, you can block the oxidated form, which is the form that’s inflammatory TMAO is an inflammatory TMAO is you block that in humans by blocking the conversion? Well, those graduate students smelled like rotten fish for a week. We hadn’t counted on that. We stopped it after about I think they stopped the study after about four students, graduate students because it’s pretty bad that no one would go around them. They literally smelled like rotten fish because they were meat eaters. That’s who we did it in, obviously to try and block the conversion.

David: 58:17

But Mike, you said in 80% of the people. Is this variable on our gut bacteria? Is that on our biome?

Dr. Michael Roizen: 58:24

Yes, okay, we think, we think that’s the cause. We, and it’s that you’re literally, when you eat, you turn on different genes in your bacteria, just like when you exercise you turn on different genes in your muscles. So what you feed your gut bacteria is is then the gut produce, the bacteria produce waste and that’s what you really absorb. Hate to say it that way, but you’re absorbing the gut bacteria’s waste In any case. The point is that about 80% of 82% depends on different studies, but it’s over 80% of people will produce TMA when they get exposed to carnitine and saturated fat together and that strongly correlates with inflammatory processes such as heart disease, stroke, memory loss and even cancer. So strong, very correlation. And in 13 different study centers, as it’s been. It’s not only Cleveland Clinic and its theaters of Sinai, it’s at three places in England and a couple in the Netherlands and one in Israel and another one in China, et cetera. So it’s in Australia, et cetera. So it’s been done on. This is not unique to America or Americans.

David: 59:58

All right, we’re in the bonus round here.

Dr. Michael Roizen: 1:00:01

So you measure TMAO after you haven’t eaten fish for a day and that’s whether you’re producing it. And if you wanna challenge yourself, you have six ounces of steak two days beforehand and see if you’re producing it and if it’s low, then you’re fine.

David: 1:00:20

Then you don’t have that bacteria and then you’re fine. Yeah, Fascinating okay.

Dr. Michael Roizen: 1:00:24

So then you can be a red meat eater without a problem.

David: 1:00:26

I’m gonna touch on lipids part of vascular disease, number one cause of death worldwide. I believe what are your-.

Dr. Michael Roizen: 1:00:34

Yeah, by the way, in white men over 65,. Do you know what the cause of the leading cause of death last year was In the United States? Covid Hip fracture.

David: 1:00:47

Oh yeah, oh I tell people that and they think I’m crazy.

Dr. Michael Roizen: 1:00:50

Well, it wasn’t hip fracture, it was falls, which includes hip fracture and brain Right. So you need to practice balance and take a learn to fall class and you can go in. I don’t know if you were a a truant in school, but I was, and so I had to stand in the corner, facing into the corner, facing into the corner on one leg, and so you fall into the corner and practicing it, don’t do it on, don’t do anything, I say without checking with your physician first or practitioner first. But that’s how to practice balance and to improve your balance. Just three weeks of that remarkable improvement. It’s right, and take a learn to fall class. But cardiovascular disease, you’re correct. Worldwide, in all genders and all ethnicities, et cetera, when you combine everyone, it’s the leading cause of death. That’s correct.

David: 1:01:42

So what are you looking at in terms of you know, to be LDL? I think a lot of people now look at APOB, maybe. Maybe you’re looking at something else.

Dr. Michael Roizen: 1:01:51

No, we look at. We look at both LDL and APOB and hope that the APOB is less than the LDL, which implies that the, that the cholesterol, is in big molecules and doesn’t get into the wall easily. We shoot for levels under 70. It’s hard to have a heart attack under over 70. If they’ve got an increased LPA, that’s a lipoprotein A, both the genetic and the protein are both called the same thing. If they have an increased LPA, then we worry about valve disease and we shoot for LDL or APOB under 40. And that’s those are the basic mechanism. We used to say 130, 130 because that was pretty damn good. Then we went to 100 and now we’re under 70 for the general population and under 40 for those with increased LPA. We never we used to worry about LPA. Lpa increases, it puts the. It somehow abitly gets the cholesterol to attach to the aortic valve and causes aortic valve disease as well as increase atherosclerosis or disease of the blood vessels that is associated with plaque buildup. And so we measure LPA. You only have to measure it once in a lifetime. But there are three drugs in phase three trial that now will antagonize LPA and so we may shortly have a treatment for that specific to that, as well as lowering cholesterol. When do we start to measure it? If you’ve got an increased LPA, we will measure it in six year olds and see if the six year old, if the family member, has it and start treating them for that so they don’t develop a valve disease. And so if you got an increased LPA, your teenagers should certainly have it, if they haven’t already been tested for it, and start treating that early Now. Right now we have statins, but we’re going to have statins and we have benbedoic acid and we have other thing and Zedia and other things to treat it and we’re going to have, we think, two more very good, low cost options in addition to the PCSK9. Inhibitors are high price now very effective, but we think have much less expensive versions of that lower LDL and Apple B within the near future. I mentioned CTEP inhibitors. That’s one of the choices that we think is coming along.

David: 1:04:52

Wonderful. I just want to say the balance thing. So when we last met you were talking to me about balance stuff and I can now brush my teeth single leg. I do everything I can on one leg and I’m up to now I can do single leg eyes closed, which is really hard. I’m up to 20 seconds on that.

Dr. Michael Roizen: 1:05:08

So that’s the equivalent to your under 40 functioning. So somehow balance correlates with Brain functioning long-term. It isn’t a hundred percent, isn’t a perfect correlation, but somehow balance takes into account it’s. It stresses your brain, which makes it repair its neurons. It may be that increases the that you may turn on that repair gene, npa S4. I don’t know the genes that produce the NPA S4 Prokines, I don’t know what’s going on but it does correlate with that Good to know I have a healthier brain, I guess. Yes, definitely, and so that’s right, and I hope you’ve taken a learn to fall class. The key is yeah, is practicing tucking your your head so, whether you fall backwards, sideways or frontwards, you don’t have a head injury.

David: 1:06:10

That’s right. I studied judo for a while and and which is very good at that you don’t have to do it for life if you do it for Six months or a year, and what they do is you have to stand there with your eyes closed and then the sense they will push you, but you don’t know where it’s coming from. And then you have to you. You either roll backwards, your old, forwards, even in your side, and you just, it just gets wired into your brain.

Dr. Michael Roizen: 1:06:35

How to talk and and you do a practicing on mats.

David: 1:06:38

Oh yeah, absolutely, yeah, yeah oh, it’s very safe and they start you kneeling and you sort of work up to that level. Yeah, mike, pleasure to have you on. Is there anything you want to leave people with today?

Dr. Michael Roizen: 1:06:49

well, you know this is a self-serving statement, but the longevity playbook Dot-com app is like having me in your pocket, so it’s having all the questions and you can ask us questions. We answer questions with videos on the app every week, so you can ask us questions as well as Getting me and getting that advice, just like we gave you. Now on all the subjects. You know, you, you, you covered a bunch of controversial ones. Let’s make it fun, but it is on all the subjects. What? What were the 16 supplements? You should talk to your practitioner about which ones. Don’t bother with what. What were the four exercises that you do for longevity and not? So everything’s there at longevity playbookcom. So that’s the other thing. And, of course, I think our book, the great age reboot, which is really written in in lay language so people have fun reading it is, is also available.

David: 1:07:52

I can solve that book every week for something or other, mike, it’s a tremendous resource. Yeah, thanks, it does have good reference.

Dr. Michael Roizen: 1:07:58

Let’s do it for the scientific nerds. I’m sorry.

David: 1:08:04

Between innings reading scientific papers, you know oh.

Dr. Michael Roizen: 1:08:11

Gosh, then you know, actually one of the things was speeding up the pitching. I haven’t I’m not able to read between pitches anymore. Used to be you could read between pitches. I’m getting a lot less reading done at the Guardian at the baseball games than I used to.

David: 1:08:29

I’m sorry if you Mike, mike, thank you so much. Always a pleasure. Tremendous source of information. Everybody check out his app longevity playbook. I’ve been on my phone. I think it’s a tremendous resource.

Dr. Michael Roizen: 1:08:43

Thank you very much. Take care, mike, you too.

David: 1:08:49

That was really tremendous. Mike is such a good guy. I think mench is a great way to describe Mike just a lovable fellow who likes nothing more than to Nuzzle up with a nice scientific abstract and then tell us what it all means. We’re gonna be leaving links in show notes down below to Mike’s book, the great age reboot, and to his new app, longevity playbook, both of which I highly recommend. We’re gonna get to just try this after a quick word from our sponsor. Today show is also brought to you by inside tracker, the dashboard to your inner health. On June 29th, inside tracker officially added insulin as one of the biomarkers they test. Inside tracker has made great strides this year in adding biomarkers like Apo B, which is critical for heart health, as well as re hormone markers that are especially important for addressing symptoms related to aging. Now Inside tracker has added insulin, which is the key biomarker for sustained energy and an early warning for several chronic diseases. Go to inside tracker comm slice a just save 20% on all their products today. This week on, just try this a Little sleep tip. It seems as though, as our bodies cool at night, it’s one of the signals for us to go to sleep and One of the ways that seems to be very effective to this is you can, of course, either cool your room down. That works Well. I like to sleep at about 64, my wife likes to sleep at 68. So there’s always a little dispute there. You may want to try either taking a hot bath or a hot shower before bed, and it seems as though it’s the the difference between what your body is feeling and the temperature in the room that causes this sleep response to happen. So if your body, the external part of your body, is warmed up and then you go to a cooler room, it’s that decline in the perceived temperature that causes the sleep response. I guess I’ll call it that. I don’t know. I know that’s quite a scientific term, but try that out. Try and hot shower or maybe a warm bath before you get a bed, and that may help you sleep a little better. Thank you all for joining us on the program today. Thanks for bearing with my frog-like voice. I’m hoping next week my normal voice will be back. If you’d like to, in spite of my frog-like voice, leave us a review we would love that or perhaps share this podcast with someone. Dr Mike had some great things to say this week, and I’m sure there’s some people out there that you know that could find this useful. Please subscribe to the podcast and if you have any questions for myself or for Dr Mike, you can contact me directly at David at super age calm. Looking forward to having you with us next week. Everyone have a wonderful week. It’s the middle of the summer. It’s a great time of year. Take care now. Bye.