On promoting healthspan and quality of life (2)

Transcript

I'd love to start with a survey and ask who here in the audience has done some of the things Matt was describing perhaps first uh who here has done a diet recently or participated in a workout regimen to try to get a little bit healthier about collected Your Health Data with something like an aura or a whoop and what about taking a longevity related supplement before okay a few hands so good a good crowd what about dexa scan who's done a dexa scan all right you guys are you guys get get a at least a B+ that's good that that's one thing I would suggest body composition is something a lot of people don't pay much attention to it's it's super important that's one of those sort of Diagnostics that I was talking about that can be really um really useful to

help you know where you're at and get on a a better trajectory I'd love to start this uh Q&A where you started your talk Matt alluding to the fact that we have a lot of people in the room here today trying to perform at the highest level and also thinking about their longevity for for the remainder of their life and wanted to ask you how you think about the tension or the complement between performance and Longevity where is performance the same as optimizing for longevity and where is there a trade-off that that we ought to be cognizant of yeah I mean I I think you know it's pretty clear that that that performance and Longevity are are overlapping but distinct and so certainly especially as you get older right uh optimizing your performance one of the ways to do that is to optimize

your longevity your health span your your biological rate of Aging because as we know in many domains not all in many domains performance goes down with age but certainly also the case that again it depends a little bit on how you define performance right but if you're looking purely at how long can I work how much can I get done in terms of work there is for many many people a point where that becomes counterproductive for your overall health your overall um longevity I'm not telling you anything you don't know but you know obviously stress and we know a lot about the biology now for example directly impacts the biology of aging and in many ways can accelerate your rate of biological aging so you may be paying the price later for what you're doing now to

optimize your performance if you're not taking a more holistic view of your your overall health that makes great sense one of the things you've talked a lot about publicly before is risk versus reward and about how we probably don't make the correct estimation of risk and reward can you tell us your philosophy on how you think about that sure so so and this is sort of related to what we were just talking about I think very few people and it's hard but very few few people think about sort of the long-term consequences of number one what you're doing now and number two and probably more relevant what you're not doing so the specific context where I have spent some time thinking about risk reward is in the context of aging and the risk that goes along with doing nothing so we

know that there are we know there are things we can do now that work again we'll go back to Lifestyle those are the gold standard we know those things work we know there are some things where they might work and I think we may talk about some of these but like supplements we talked about there are some things that might work and those have probabilistic components to them How likely is it that they'll work How likely is it that that they won't work and what are the risks and again particularly with FDA I think this is a really good example FDA I'm sure many people in this room are not fans of FDA but FDA you know doesn't take this view when they're thinking about a medication they are not thinking about especially in the context of of a non-d diseased person what are the

consequences if we don't do anything if you wanted to do a clinical trial for a drug to modify the biology of Aging improve health span prevent disease right that's really hard because FDA does not take the view of what are the consequences of not doing anything they don't weigh that risk and I think we need need to have a conversation about that and people more broadly should think about what's the risk of not doing anything when you're weighing the risk of doing something whether that's taking a medication taking a supplement or anything else so that's mostly the context so then let's talk about some of the things that we might do last year at founder Summit we had a session with Laura Deming and as soon as we opened it up for questions all of the questions were about what supplements we should be taking and about whether or not the risk

was proportional this is not medical advice by the way so I'd love to preempt some of those and do a lightning round where I propose to you an intervention and you can share perhaps on a scale of one to five how you think about the risk and and the reward maybe let's start with RFA something that I know you're a fan of okay so yeah so so this is great first thing I I want to just give a one disclaimer I know I'm supposed to keep this short but but I mean again I think it's important to recognize nothing none of this is proven right I'm sure you guys get that but there's all people just always want to have certainty and when we're talking about things that might affect longevity and health span we don't don't have a lot in humans because these things haven't been tested

right so it's just important to to recognize all of this comes with a degree of you know uncertainty so rap ay I think in the likelihood that it will benefit a lot of people I would give it a four and in the risk and again this is where other people will disagree with me this is Matt's opinion I actually think rap ay is way lower risk than most people appreciate so I'd say it's probably a two in in the risk category how about metformin uh if you're diabetic a five if you're non-diabetic a two in terms of likelihood of working risk is also pretty low probably a two although actually rep metform and most people probably don't know this is probably has some side effects that are more problematic than rapy like in many men metformin reduces testosterone for those

of you who care about testosterone you might want to know that uh how about NAD plus precursors like nmn or NR I know yeah so I think the population where those are likely to be beneficial for people uh is much smaller than certainly rapy and Metformin across the population the lik hood of benefit is maybe a two or a three and the risk is probably a a one or a two although I will say this may change so for those of you who know about NAD precursors if any of you are taking nicotinoid mononucleotide there's an unpublished paper should come out in the next few months hopefully uh this is in mice and again I should have said that too I'm going off of data for longevity and health Span in mice because that's what we've got in mice in AED mice nicotinate mononucleotide maybe

also nicotinoid riboside preferentially causes kidney damage and the mechanism is well understood so if any of you are taking those if you're young probably not a problem if you're older we don't know if it's a problem but but and I think this is a general sorry I know I'm going on again but this is a really important thing for people to appreciate when it comes to supplements FDA will pull a supplement if they learn that it's dangerous just because it's available on the open market does not mean it's safe so it's really something a lot of people don't appreciate but it's useful to know that just because you can buy it over the counter does doesn't mean it's safe MH so now that we've preempted some of the supplement questions I have a a couple uh interventions behavioral interventions

perhaps for starting with exercise you had some interesting thoughts on this yeah I mean my view is uh maintaining function late in life is really really important so exercise overall good okay in general sure you can push it too far in general very few people are pushing it too far and exercise overall is probably the that and a and and a healthy diet are the two most important things you can do sleep being close uh but I tend to to say you know for this is broadly speaking resistance training or other forms of exercise that build and maintain lean mass are typically underappreciated versus you know cardiovascular training and my reason for saying that is that as we get older uh Frailty sarcopenia loss of muscle

mass is one of the leading causes of injury uh and ultimately mortality and it's underappreciated so if I had to put them in buckets I would emphasize resistance training maintaining lean mass building lean mass when you're younger over cardio training obviously you want both this gets back to why I mentioned dexa specifically because dexa will tell you your bone mineral density your lean mass your fat Mass um resistance training also helps maintain and build bone density as well which obviously is important as we get older and finally a number of us were at the cold plunge this morning and I know enjoyed a competition to see who could stay in the longest perhaps you can tell us your thoughts my thing nice job so again I I would put cold plunges there's

a bunch of stuff that's in the maybe bucket right where you know is it good for you I don't know I mean in terms of like your long-term Health span if if it if it makes you feel good if it feels like you relieve stress if it energizes you it's not probably not going to harm you unless you stay in too long but I wouldn't put it in the sort of you know gold standard class of you know some of these other things where we've got pretty good reason to believe that they're going to be net beneficial in the long run now that we've talked about a couple of the potential interventions I'd love to ask you how you would uh like for us to think about a process for evaluating this sort of stuff moving forward and obviously you spend all of your time focused in the literature here

and have a a great uh ability to discern what is true and what is not but for someone who is interested in competent but not coming from a scientific background what what should the process be that we think about when trying to evaluate uh an intervention for longevity yeah so so for interventions in in particular um it's really hard again this gets back to what I was saying before that there's a bunch of noise out there so I think the the the way again the way I would approach it is I'd go right to the primary literature and try to evaluate it for myself I recognize that's not realistic for people who who aren't deep in this space so I again I would try to identify credible voices and figure out what they think but that's hard too so you know for me personally let's say I let's say

I didn't have the background that I have I would probably honestly I mean it sounds kind of silly I would probably say well what does Peter think about it right again I mentioned Peter AA I think he's very credible I think you know well I don't agree with everything that he says he's very he researches it he's not trying to he doesn't have an a financial stake in selling these things I would also be very skeptical and so I would I would try to look and see you know in the long-term so think about this if somebody says this intervention is going to increase your longevity what's the rationale for that and this is where it's important to separate increasing longevity from health benefits not everything that might have health benefits is going to increase longevity right but if somebody's claiming that

this supplement uh slows aging and increases longevity what's the evidence does it come from Human studies no almost certainly not because we don't have any clinical trials for longevity in humans so it comes from Human studies it comes from epidemiology and and how good is that data sometimes it's better than others how long has this been studied if we don't have 10year epidemiological studies and people you should think about what might the risks be how safe do we know this this to be and then you can be guided by the laboratory studies does it increase lifespan and health Span in mice that experiment should have been done if there's any real evidence that this targets the biology of Aging that's a good place to start so I wish I had an easy answer for you but you could

ask me but please don't please don't email me with you well if anyone has questions now is the perfect time to ask them we'll take a couple of questions on the biology of Aging Benedict yeah um thank you very much very interesting what I'm wondering is you know sort of how this plays in with human psychology the problem is that I think a lot of times I see people you know even if they you know read research papers or they they hear you and and give advice on some supplement so they're then thinking okay I got to take this supplement and even if we knew that it would help the problem is they're ignoring the lifestyle Chang which is just like why aren't we just telling people like move what was it like move

sleep and socialize which is like is 90 like there we actually know that it helps and then you know some sorry stupid supplement like which might help and if you're doing all of these things then maybe you should also do that it just seems so ridiculous how much people and like Bro Science is focusing on you know some yeah some like 0.1% well we know the thing that really helps is just do Sports and like eat well yeah you get it so I I mean I don't have the answer to your question you're right so supplements are supplements right you need to get the foundation in place before those are really going to move the needle the one exception I would say is and this is my view on supplements you should supplement to deficiencies and this is where the Diagnostics

getting a comprehensive blood panel done if you're deficient in vitamin D you should supplement if you're deficient in omega-3 you should supplement okay but I you're right beyond that you got to get the foundation in place look humans are funny animals right how do we actually get people to do that that's hard I think there are some tools that can help I don't know how many how many of you have done continuous glucose monitoring I think that's a really sticky tool and it doesn't work for everyone but I think for behavior modification it's a really sticky tool I've I've got one on and I don't do it all the time but I do it you know once every few months I learned something every time and the first time I did it what I learned is bagels are really bad for me right so I don't e

Bagels anymore so that that can be sort of a behavior modifying sort of tool and I think there are some others out there that are that are like that but I don't have the answers to to how you how you modify human behavior other than to say look it's super it's super hard and there are this is where I think the um you know inequities really come into play right because there are C certainly many people who don't have who don't have access to some of the things that they need to optimize their lifestyle so it's it's hard I I don't I don't I don't know but you're right hey I'm really curious how you think about um the whole AB testing Quantified Self way of trying to optimize your health span lifespan

like for instance Guan with his blog he did a lot of that or Brian Johnson is now taking off quite a bit Yeah so so I I have mixed feelings I think that monitoring and obviously I fall into this Camp I'm wearing a CGM right I do a lot of this sort of data collection um I think that collecting data and evaluating biomarkers and trying to to push your biomarkers in the direction we believe is closer to Optimal Health Better Health makes sense that's what we should be doing I think the challenge is that there are a lot of people who um don't have the background or uh information quite right and they're not willing to do the work and so they start using biomarkers that don't make a ton

of sense or come up with these super complicated you know protocols that it really probably only need to do 20% of what they're doing to get 80 or 90% of the benefit so I think the challenge is again this gets back to the credibility a lot of the people in that space are not particular knowledgeable or credible but I think that approach makes a ton of sense and with that please join me in thanking Matt for being with us today thank you