Speaker 1:
Coming up on this episode of The Doctor’s Farmacy,
Dan Buettner:
Your immediate social circle, those four or five people who you spend the most time with have a profound impact on your health. Building that immediate social circle, that three or four friends who care about you on a bad day, that’s about the most powerful lasting thing you can do.
Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman and that’s Farmacy with an F, a place for conversations that matter. And if you care about living well and living long, listen up because we have as our guest today, Dan Buettner, who’s a good friend of mine an inspiration for me and many others who’s pioneered the idea of the blue zones, which are the five areas in the world where people live the longest and figured out why. He was an Explorer. He worked with National Geographic. He’s a fellow there, he’s an award winning journalist and producer in New York Times best-selling author. And his work is not just about going and exposing and uncovering the secrets of the blue zones but he’s taken the knowledge that he’s gotten from those blue zones and he’s applied it in America and increasingly hopefully around the world, with partnering with governments, large employers, health insurance companies to actually implement these same principles of the blue zones in their communities and their workplaces and their universities.
Dr. Mark Hyman:
And those initiatives are applying those lessons and seeing profound changes in health outcomes and reductions in healthcare costs. By using this model, he’s I think shifting what’s happening in the environment for these people, he’s helping shift public policies, social networks and it’s probably affected up to five million Americans, which is pretty amazing. His work is just fantastic. His new book which is just out, The Blue Zones Challenge is a four week plan for a longer, better life. And it’s a guide for four weeks and with a year long follow up to sustain it to jumpstart your journey to health and happiness, less stress and a longer life. And I’m very interested in that because I am 62 and I want to live a long life and a healthy life. And another fun tidbit and I got to talk to Dan about this, he holds the Guinness World Record in distance cycling, which is no small fete. And I’m going to ask how you saved your butt on that one but anyway, welcome to the podcast.
Dan Buettner:
Good to see you, Mark.
Dr. Mark Hyman:
Said, Dan I talked to you earlier in the summer and we were just chit chatting about this and that. And we did an Instagram is like well, I’m like, “Hey, I’m going to Sardinia.” And yeah, I’m like, “I’d love to check out the blue zones.” Is like, “Yeah, you should check out this friend of mine there who takes people on these tours.” And Dan, I went and it just blew my socks off and it was one of the most special trips I’ve ever taken. So thank you for that. And I began to understand the power of your work and how these people live and watching them and interviewing them. And I met with this woman, [Julia 00:02:57], she’s like, “I’m 100 and three months.” Like, “I’m five and three quarters.” She’s like, “I’m 100 and three months.” And I said, “What’s your secret?” She says, “Never getting married.” I’m like, “Okay.” I think that’s actually true, women live longer if they’re unmarried but men don’t but that’s [inaudible 00:03:19].
Dan Buettner:
Being married, gives you a longevity bump no matter what, anywhere two to four years. But women are better for men than men are for women, but it’s still better for both to be in relationship.
Dr. Mark Hyman:
Yeah. It’s so true. So I think a lot of us think of aging as we see it, right? We see aging in this culture and we see decrepitude, frailty, disease, a loss of the ability to do the things you love. And your work has really challenged that notion that being normal aging. And I mean, I was in Sardinia and I met with this guy [Pietro 00:04:04]. I don’t even really know him but he was a shepherd who was like 95 years old, bold, upright, clear eyed, tons of energy. And I’m like, “Well, how are you doing?” He was like, “Well, I’m great. I just stopped doing my shepherding last year but every day we walked five miles. I ate all the food that we made and created here on the land for ourselves. I had my friends and community,” and he was sitting there chit chatting with his friends on the bench who were like his younger friends who I think were in their 70s or 80s.
Dr. Mark Hyman:
But he was like 95 years old and he sat there and sang me this beautiful song. I don’t know what it meant in Italian. And I’m like, “God, this guy is so vibrant.” And 95 years old and he’s not bent over. He’s not frail, he’s strong, he’s vibrant. And I’m like, geez, this is a very different way of growing older. So when you came across these cultures, how did you distinguish the things that they were doing differently from what we’re doing in America and in the Western world that leads to all this disease and decrepitude and frailty as we get older?
Dan Buettner:
Well, the first step was working with demographers to verify that these indeed are places where people are living longer because just because you see a bunch of old people doesn’t mean [crosstalk 00:05:26].
Dr. Mark Hyman:
I’m 175 but where’s my birth certificate?
Dan Buettner:
Florida’s full of old people but it’s… So I did it under the ages of National Geographic and we hired demographers, [Michelle Pullon 00:05:40] and [Johnny Pass 00:05:43] locally. And then once you identify these places, we went looking for the common denominator. So I was writing for National Geographic and I was approaching it like a mystery, a medical mystery. And you know enough about these longevity hotspots. It’s not one silver bullet. The friends you were making in Sardinia were living a long time not because they were taking a supplement or eating a super food once in a while, it’s this mutually supporting world of factors and I’m sure you experienced, part of the reason you were so moved by it wasn’t because they’re eating some magical diet.
Dan Buettner:
It’s this prestige of having very strong families, a very strong community. These people have a very strong sense of purpose. They live in environments where they’re nudged into movement all the time. Most of them by the way are Christian, Catholic. They have a strong faith. I don’t know if you wandered into a church on Sunday but they’re packed in the blue zone generally. And all these things, if you look at all these factors and you look at the academic literature under them, you can see in every case that these things favor longevity. So it’s not a silver bullet, it’s a silver buckshot. It’s this cluster of small things. And by the way, you see the same, I know you’re going to go to Costa Rica. And I think you’ve been to a few of the other blue zones or maybe you’re going, but you’ll start to see the same pattern in all places that are producing statistically long lived places. And you just can’t ignore it.
Dr. Mark Hyman:
Yeah. Well, you talk about this sort of buckshot approach and you break it down to these blue zones power nine of the world’s healthiest, longest lived people, the nine lifestyle habits that actually help determine their longevity. Can you break those down for us?
Dan Buettner:
Sure. Well, I’ll bet you 100 dollars you didn’t see one CrossFit or one stationary bike or peloton in the blue zone.
Dr. Mark Hyman:
They were all doing Vinyasa power yoga. What do you mean? Come on.
Dan Buettner:
[crosstalk 00:07:54] square.
Dr. Mark Hyman:
It was soul cycle in every corner.
Dan Buettner:
So the big insight here is we’ve been sold the idea that exercise is going to be the answer and then we ignore the rest of our environment. And fewer than 15% of Americans get the minimum amount of physical activity, which is only 150 minutes a week of 22 minutes a day of walking. So in blue zones, they’re getting it. And power nine is we call move naturally. So they live in environments where every time they go to work or a friend’s house or to their garden and occasions of walk, they have a garden, their houses aren’t full of mechanical conveniences. So it’s thinking about physical activity in terms of shaping your environment so you’re nudged into moving unconsciously as opposed to, I got to remember on Tuesdays at 9:30 to 10:30, I have my soul cycle and then half the time you don’t make it. It doesn’t make up for the 12 hours you’re sitting at your desk.
Dan Buettner:
Number two, they have sacred daily rituals that help reverse the inflammation of everyday living. And you’re a real doctor, you know how corrosive chronic inflammation comes. So they’re having dinner with their family. They’re going to church. They’re meeting in the village. At Okinawa, they have ancestor federation, they take a nap. These are all things we know reverse that inflammation that comes with the human condition.
Dr. Mark Hyman:
So love is anti-inflammatory.
Dan Buettner:
As our buddy Dean Ornish will tell you, yes. One of the greatest prescriptions you can get is a love prescription from that special somebody. But they have a strong sense of purpose and it’s different from place to place. In Sardinia, they’re almost a fanatic zeal for the family. People don’t search for their purpose in their career, some sort of financial success. They search for it in, they have it right at home with their loved ones. The diet’s changed a lot. I know the diet that you observed is going to be different than the diet but there’s been at least three dietary changes in the blue zone. It was pretty unhealthy before 1960, they were eating mostly bread and cheese, it was the majority of their dietary intake believe it and those shepherds your body but it all [crosstalk 00:10:21].
Dr. Mark Hyman:
It was Grano Capelli which is an ancient grain. And the cheese was from these sheep and goats that were eating all these wild plants that were full of phytochemicals.
Dan Buettner:
Yeah. [crosstalk 00:10:34]. I think you remember peperino. Yeah, very fermented product so it’s good for your gut and so forth.
Dr. Mark Hyman:
There was that cheese with all the worms in it that’s supposed to be like a natural Viagra, I didn’t have.
Dan Buettner:
Yeah. Which is like outlawed. So if you look, I wrote another book called Blue Zones Solution but it’s also distilled in this Blue Zones Challenge. If you want to know what 100 year old, to live to be 100, you have to know what you’re eating as a little kid and an adult and when you’re retired. So we did that exercise. We gathered all the available dietary surveys done in all blue zones over the last 80 years. I did it with Walter Willett from Harvard. So we tried to put some academic rigor.
Dan Buettner:
And if you average that 100 years, they’re eating mostly a peasant diet, whole food, plant-based. Mostly they’re eating grains. You saw a lot of that in Sardinia. They’re eating a ton of greens, nuts, not so much in Sardinia but tubers like sweet potatoes. And then beans, beans are big. They do eat meat but traditionally only five times per month, it’s celebratory food in Sardinia after church on Sunday or a wedding, they just didn’t have the money even the refrigeration till about 1980 in lot of these villages and I don’t know if you noticed that almost nobody ate fish. You can look at the ocean.
Dr. Mark Hyman:
Yeah. There wasn’t much fish. I was like, “An island, it’s an island. Where’s the fish?”
Dan Buettner:
Because traditionally, they had to walk down that hill which was 15 miles away. They didn’t have a car and they had to catch a fish. And then by the time they had brought it back, it stunk. So they didn’t develop a fish eating culture which shock some people. And then water, coffee, tea and wine. And as you know, the wine in the blue zone there, that Cannonau, very high in polyphenols, home made.
Dr. Mark Hyman:
Drank my share of that. I drank my share that wine. Like lunch I’m like, “God, I can’t drink wine at lunch. It’s just like, I’m wasted. I want to just take a nap.”
Dan Buettner:
I know. [crosstalk 00:13:00]. Yeah. My own personal approach is I never drank until five but then I make up for it.
Dr. Mark Hyman:
That’s good. Yeah. It was quite a debauchery in there.
Dan Buettner:
Yeah. The last three things they tend to put their family first, old people in Sardinia are not warehoused in retirement homes. They stay with the family. I’m sure you have felt that, where by the way they work. So instead of sitting around watching reruns and leave it to beaver, they’re making the wine and running the garden and taking care of the kids and doing the cooking. And that transmission of wisdom favors the health and mortality of younger generations. They tend to belong to a faith in all blue zones, variety of different faith and their social circles tend to be healthy. So their unconscious decisions about what they eat and what they do are somewhat governed by their social connections. And that’s a really big idea because it’s very hard to remember. Your Doctor’s Farmacy is a great place for information but once you know the information then how do you put it to work for long enough so you don’t develop a chronic disease. And that’s really the 10,000 dollar question.
Dr. Mark Hyman:
So Dan, what’s really remarkable about your work is that it points to something that most of us don’t think about when it comes to health, which is the reason these people were able to exercise and eat whole foods and have community and have the meaning and purpose they have was because it was automatic. It was the default in their environment.
Dan Buettner:
That’s right.
Dr. Mark Hyman:
The easy choice was the healthy choice. In America, the easy choice is the bad choice. It’s all the processed food. I mean, good luck trying to drive through America and find a healthy place to eat. It’s very tough out there. It’s hunting and gathering in the desert. And so the idea of creating an environment for yourself that actually makes the healthy choices that default and easy choices is a really critical part of your work. And it’s what you did in the original study you did in, I think Minnesota in this small community. And it was fascinating when you change for example, and then they’ve done this in other countries. Now they maybe model after your work where they’ve changed what’s at the checkout counters in grocery stores, they change the size of the plates. You change the size of the plates instead of like a big plate, they have like a 10 ounce plate. You changed basic things that they put in walkways, they just made the environment easier to default into the right things. And that’s something we don’t really think about. And it’s such a key part of your work.
Dan Buettner:
Yeah. We’ve kind of let our living environment to be completely toxic that 97 of 100 decisions are bad decisions. It’s very hard to walk places in many cities because they’re driving communities. And I made a business by helping cities change their environment so it’s a healthy swarm of defaults of good defaults. And the whole idea behind this Blue Zones Challenge is to distill it down for individuals. So I have about 30 evidence based ways where you could set up your kitchen, your home life, your work life and your social life. So the unconscious decisions, the 80 to 90% of the decisions we actually make in a day, food decisions for example are unconscious so that those are engineered to be better. So you don’t have to try to remember to do the right things, which is almost impossible to do.
Dan Buettner:
It always bugs me these politicians who wave their finger at us and say, “It’s your individual responsibility to make healthy choices.” And then they let the environment go to shit where the forest of fast food and junk food and chips and sodas, and now go make healthy choices there rather than address the 900 pound grow in the room, which is we need to be shaping our environment to set Americans up for success in health and not right now, we’re set up for failure.
Dr. Mark Hyman:
Yeah, I mean that’s such an important point. I know people don’t realize it and I think people feel bad about themselves. They blame themselves. We certainly have a fat champion culture. We have the government, we have all the professional health associations, nutrition and dietetic associations all promoting the same message, which is it’s all about calories in calories out, just moderation. Don’t be a pig. Don’t be so lazy and you’ll be fine. And that puts all the responsibility on the individual and absolves the government, absolves corporations, absolves the food companies, the ag companies from actually creating an environment that defaults people into health. And that’s why we have a disease creating culture and it’s why these blue zones don’t because all their defaults are the right defaults.
Dan Buettner:
Right. I start out with The Blue Zone Challenge is if you’re unhealthy and overweight in America, it’s probably not your fault. And people raise, what do you mean? But if you look at the big… In 1980, you and I were both alive in 1980 and 15% of Americans were obese. Now today, 45% of Americans are obese. Now, why is that? Is that because all of a sudden 330 million Americans had this degeneration of moral character? Did they lose their discipline? Do we have the diets better in 1980 than they’re now? Are we less educated? No. No. So what’s changed? Well, there are literally 20 times more fast food restaurants. Over 50% of all retail outlets from the place you get your tires changed to where you pick up your obesity medicine, forces through a gauntlet of sugared snacks and sodas and chips. And we’re by the way, genetically hardwared to crave that food but we can’t escape it. And eventually discipline is going to wear out and we reach for the Snickers or the bag of chips and [inaudible 00:19:12] eat that.
Dr. Mark Hyman:
Yeah. And that was on my whole book, the Food Fix was about this whole idea of a degenerated food environment and agricultural system that’s basically creating toxic food system and that’s what’s really driving all our chronic disease pandemic. And we’ve talked about before in the podcast but it’s really the reason America is so overburdened with COVID cases and deaths far more than every other country in the world, because we are the sickest and the fattest country and that’s because of our diet. And I think it’s just not getting enough air time and press, but I think it’s important to think about.
Dr. Mark Hyman:
What I’d love to sort of hear from you is some of the stories because I think I just had so many eye opening experiences of what it’s like to age differently. And one moment when I was with my guides, we went in this little town and we were driving out of the town and this car was in front of us and it pulled over and parked and signaled to us to pull over. And this older guy got out and he went and sat on the side of the stone wall and just sat there and we’re like, “Okay, well, let’s go over and talk to him.” And I just wanted to talk to all the people there. And so we started talking to him and he just wanted to chat. He saw us there and he just wanted to chat. And it’s like people just don’t do that. And then he took us on a journey of where he was born, which was this village that had been actually abandoned on purpose because it was apparently going to be a mudslide and they moved it a little bit away.
Dr. Mark Hyman:
And so the village was still there and he was born there and he showed us where he was born. And then his farm was still there and his family had, and he took us down. He showed us all these hundreds of fruit trees, all of the chickens and the pigs he was growing and the sheep and all the food he was growing in his gardens. And I’m like, “Who takes care of this?” Like, “Well, I do by myself because no one else wants to do now.” And I’m like, “Wow.”
Dr. Mark Hyman:
And literally Dan, he was running up the hill because it was like on the side of a hill, he was running up the side. I’m trying to catch him and he’s like 85 years old and I’m a pretty fit guy. I’m not like a slouch. And I was like, holy cow, this guy is amazing. And he just loved to do it. And he just gave the food away. He didn’t necessarily need it all himself. It was just this beautiful way of living. And so what are the things that you saw there that were surprising that you took home with you, these stories that actually inspired you to do the work you’re doing and keep going with it?
Dan Buettner:
Well, most of the things that people in the blue zones do to live a long time are also things that make you happy. I did another cover story for National Geographic on happiness. So the fact that they’re so social, that they make time for people, for face to face conversations, long lunches. And they live in villages where they bump into each other in the streets and every day at five o’clock, they pour out into the streets and the little bars and that, and they make time for each other. And that feels good. We are a species that evolve socially connecting. And now we know very clearly that people who are well connected live eight years longer than people who are lonely, for example. And it’s just natural there. You also probably notice that people haven’t imploded in their devices yet. And people do have cell phones there but they’re not on them all the time and they haven’t drank that poisonous Kool-Aid yet.
Dan Buettner:
There are still shepherds. The real longevity phenomena in Sardinia is mostly among the males even though females, but the males are really the longest lived people, longest lived men on earth are right where you visited, Sardinia. So you start looking at their life. And even though it’s Mediterranean, where you went in the blue zones, actually a bronze age culture. This is a group of people who broke away from what is today the boss country, made their way through what is today, South of France Corsica and set up shop 11,000 years ago. So they’re not the same as like Spain and France and the rest of Italy, it’s a bronze age culture.
Dan Buettner:
And most Mediterranean cultures, the men sit at the head of the table and it’s male dominated. But I don’t know if you know in Sardinia, it’s female dominated. So women are running the household and they’re taking care of finances and up fixing the roof. And by the way, they’re the ones that carry the guns. They probably never busted one up, but we saw these women busting out because they’re in charge of civil patrol. So really surprised me that where men live the longest, women are in charge.
Dr. Mark Hyman:
Women are in charge. That’s a good lesson. I think that’s probably a good lesson. If women were in charge, this would be a very different world, 100%.
Dan Buettner:
I think quite honestly, I think we’d all be better off.
Dr. Mark Hyman:
I think you’re right, Dan. I think you’re right.
Dan Buettner:
I’m not just [inaudible 00:24:26]. I mean, I believe it.
Dr. Mark Hyman:
No, I agree. So I think you touched on something earlier, which is this whole idea of community and loneliness and loneliness is among the biggest risk factors for death and for disease and social isolation. And we know from animal experiments that if you give all the same inputs, food, water, light, whatever to an animal, like a monkey but you don’t give it a mother as opposed to the monkey against the mother, they age rapidly, they look decrepit, their immune systems don’t work. I mean, it’s extraordinary when you see the graphic representation in some of these studies. And I think we see that increasingly here. We’ve all become an individualistic culture. I mean, there’s a lot to be said for self-expression, for autonomy, for self realization, for individualism but not at the expense of connection and community.
Dr. Mark Hyman:
And I think a lot of us have lived our lives going for that holy grail of success in whatever way we define it. And along the way, the debris of our life is the lost friendships, the lack of attention to the people that matter in our life, the lack of being present and connected, and that catches up with us. And that is actually a disease causing phenomena that literally affects our genes, our epigenetics, all of it is driven through our social network. And our social threads that connect us are more important than the genetic threads in determining our longevity and our health. And that really is powerful. So how do you help people and what does the Blue Zones Challenge say about building this especially with COVID and increasing isolation and people going to lock down, it’s just hard.
Dr. Mark Hyman:
I mean, I’m finding one of the biggest challenges for me, which is not a big challenge but I’m really having trouble with the masks. Not because I don’t think they’re necessary or we should be using masks to reduce the spread of viral particles and so forth. But I don’t see people’s faces anymore. I don’t see that human expression. I don’t see smiles. I went to shop and get something the other day and I told the joke to the lady at the cashier and I could see her kind of eyes a little bit but I didn’t know if she laughed. All of that natural juice we get from interacting with humans even that we’re not close with this part of our community is such an important nutrient for our souls, for our health, for our wellbeing. How do we start to bring that back into our culture? What have you found works and what do you help guide people to in the Blue Zones Challenge.
Dan Buettner:
I’m going to an answer that on a macro and a micro level, and they’re both important. So I’m sure you’ve seen this study that the casual social interactions throughout the day, the more you have is a bigger predictor of longevity than diet and exercise. And I mean, just as you’re saying, the interaction with the woman at the grocery store or your postman or your barista, very important. And I argue that that’s very much a function of your environment. Again, if you live in a city like Tampa, where you have to drive everywhere, you just don’t have, you don’t bump into people on the street. You’re not seeing your [inaudible 00:27:34] where if you live in a neighborhood like Boulder, Colorado, or Santa Barbara, or even where I live in Minneapolis or in where I live in Miami, I’m out in the streets all the time. And I just get more FaceTime. And a lot of social answer is a function of being in the presence of other humans. So that’s the macro answer.
Dan Buettner:
The micro answer, which I addressed in Blue Zone Solution, I’m sorry, Blue Zones Challenge, is that your immediate social circle, those four or five people who you spend the most time with have a profound impact on your health. If your three best friends are obese, there’s 150% better chance you’re going to be overweight. Alcohol use, drug use, unhappiness and even loneliness is measurably contagious. That’s actually [Nicholas Kristick’s 00:28:27] work, not mine but it underpins an important observation in the blue zones, especially in places like Okinawa, with this notion of Moai, people pay attention to who they’re spending time with and their immediate friends tend to be eating the same healthy diet. They tend to be walking places. They tend to care about you on a bad day. People you can have meaningful conversations with.
Dan Buettner:
So in the Blue Zones Challenge, this is the time of year people start making resolutions. As we all know, resolutions have a half life of about a week and they’re gone in four weeks. Instead of getting on the new fat diet, I take people through a process of A, identifying the type of people who are going to favor your health and longevity, and B give them a strategy to actually bring them in their circle. Because when it comes to longevity, there’s no short term fix other than not dying. There’s nothing you can do this month or this year even that’s going to really favor your life expectancy in 30 years. So if you want to do things that will help you live longer, you have to think in terms of decades or lifetime, what am I going to do that’s going to constantly influence me to eat better, move more, socialize more, live and express my sense of purpose and building that immediate social circle, that three or four friends who care about you on a bad day, that’s about the most powerful lasting thing you can do.
Dr. Mark Hyman:
Yeah, that’s really important. I think you mentioned and I think we don’t really cultivate that and prioritize that in our culture in our life. And how many people, I think I’ve seen them data on this, but how many people can actually say that they have someone in their life that they can call up and tell anything to? And [crosstalk 00:30:21] secret.
Dan Buettner:
It was Robert Putnam, a Harvard researcher, he wrote Bowling Alone. In Bowling Alone was written in the late 1980s. He calculated that each American have about three good friends or friends you can count on, on a bad day. So I keep bringing this up. And what that means is you’ve just broken up with your partner and you’re crying your eyes out. We all have call back slap buddies who sure will have a free beer with you on a good day. But I mean friends who will listen to you weep and if you need to actually borrow money or you just need to pour your heart out, those are the kind of friends I’m talking about. So with three people in the 1980s, we’re now down to under two friends like that. And I still again, I believe it boils down to this thing.
Dr. Mark Hyman:
More friends on Facebook but no actual friends.
Dan Buettner:
That’s right. No friends like Mark Hyman and Dan Buettner [inaudible 00:31:17].
Dr. Mark Hyman:
It’s true. It’s true. Actually COVID and I went through a divorce and it was rough. And I called my circle together and I have a lot of guys I’ve known for a long time, really close friends. We do men’s work together and we’ve known each other for 30, 40 years and we see each other periodically. So I invited these friends to be part of the circle every week. And we do a Zoom hangout with seven of us who’ve known each other 30, 40 years. And it’s really about being transparent and honest and holding a container for each of us to be seen and heard, supported, loved. Sometimes we give each other advice and we just listen. And I mean, I don’t even know how id I’ve gotten through the last year without it.
Dr. Mark Hyman:
And I feel so blessed. I mean, just so beyond blessed to think about that. And I think part of my early evolution was really understanding the importance of community. And so I’ve spent a lot of time in my own life, cultivating and nurturing and watering those friendships. So after 40 years, I can call them up and go, “Hey, I need you.” And what was amazing was that I thought, “I’m just going through a hard time,” and they’re going to do it for me. But then I was like, “Well, can we do it maybe every other week for an hour?” They’re like, “No, no, let’s do it every week for two hours.” And I’m like-
Dan Buettner:
I love that.
Dr. Mark Hyman:
… “Okay. Okay.” And then they all were so in and I was like, “Wow, we all need this. We all want this.” So I’d encourage you to think about how do you start to cultivate that and find those people and develop those relationships. And it really it’s the medicine that we’re missing in our society.
Dan Buettner:
Well, I would argue that that investment is way more important than trying to get on a diet or a supplement or training for a marathon or all these other default.
Dr. Mark Hyman:
I can go eat my Chunky Monkey ice cream now?
Dan Buettner:
[inaudible 00:33:10] a little bit of that but [crosstalk 00:33:13]. But you start after yourself why, you look at the budget of the processed food industry, marketing budget and it’s north of 15 billion dollars a year. Then the beverage association, another 10 billion dollars a year. And then the [crosstalk 00:33:32].
Dr. Mark Hyman:
What’s the broccoli about that? That Broccoli is 100 billion, right? Broccoli advertising.
Dan Buettner:
I think it’s 100 dollars but also [crosstalk 00:33:40].
Dr. Mark Hyman:
Good luck.
Dan Buettner:
The exercise industry, another 120 billion. So we are constantly marketed these ideas of what make us healthy. There’s no money in creating a men’s group. Nobody makes money off of that. Nobody makes money off you knowing your sense of purpose and living it. Nobody makes money off of you putting your family first or investing in relationships beyond just the back and forth commerce of it. So it takes people like you, you have a powerful mouthpiece here to not even normally tell people about it. But I mean, you also know the underpinning science and you’re a doctor, you have MD after your name so people listen to you and it’s powerful.
Dan Buettner:
I also think for 40 years, we’ve looked for the answer of better life in technology. And I think technology can help a little bit but when you look back in places like the blue zones, those people are doing things a certain way that has evolved over 11,000 years. And they’re still at work today in people’s life because they are working and to pay attention to this idea of a guy will stop in the middle of the day and just talk to you, or they eat a certain way. And those practices are around because of a certain social evolution that they’ve worked. And we ought to be paying more attention to that in my opinion.
Dr. Mark Hyman:
Yeah. I think those are really important insights because the idea that loneliness is the biggest killer. I mean, we’re talking about diet, exercise, supplements, longevity, but then this idea of community is just so underappreciated. A friend of Radha Agrawal wrote a book called Belong, which is about how to build community, encourage people to think about getting that book. She’s been on the podcast as well. And I want to move on to talk about the thing that’s icy happening and it was amplified during COVID. But for the last three million years, life expectancy has been going up and it went up pretty dramatically over the last century with the advent of public health and hygiene and sanitation and vaccinations, which was all great and the development of antibiotics and the scourge of infectious disease, which killed a lot of people young.
Dr. Mark Hyman:
And yet now with COVID, this was happening before COVID but we’re seeing data that shows our life expectancy is going down. And with COVID, it went down three years for African American, Hispanic populations. And I think about a year and a half for Caucasian populations but it’s staggering. And yet we have the most advanced medical system in the world. So how do we address this and how do we understand the cause of this decrease in life expectancy? And how do we then sort of ship that around to create a formula for longevity?
Dan Buettner:
Well, by the way, it was dropping even before COVID. Largely because…
Dr. Mark Hyman:
Yeah. That’s what I said. Yeah.
Dan Buettner:
Yeah. Before. And it’s largely because of diabetes, type two diabetes, heart disease, some types of cancer, even dementia, all of which are mostly avoidable if not almost completely avoidable like type two diabetes. And I’m sounded like a broken record here. We have to stop beating the dead horse of individual responsibility and thinking that we’re somehow going to master the discipline and presence of mine for the next 50, 60 years of our life to override this horrible food environment. So it’s going to take the realization that we need to shape the way our food is made, shape the way our streets are designed, the advertising environment, what is permitted.
Dan Buettner:
We realized that people died prematurely because of smoking. And we used three levers to bring smoking down from 50% to in some places 10%. And it’s education. So it’s knowing the truth about cigarettes. We need to tell the truth about processed foods. And I would argue, we way too much meat, cheese, and eggs. We need to secondly, use taxation. There’s this idea of externality that cost you and I about $10,000 a year to pay for obese people. Well, these people aren’t obese because it’s their fault. They’re obese because of what they’re eating. We should be charging the manufacturers of that food driving disease to pay for the externality of their cost.
Dan Buettner:
And then the last one is regulation. When I work with these blue zone cities, one of the solutions I offer them is limit the number of fast food restaurants. We know that if you live in a neighborhood Mark with more than six fast food restaurants in a half a mile radius from your house, you’re 30% more likely to be obese than if there are few than three fast food restaurants. So me the simple answer here is limit the number of fast food restaurants. But nobody, my God, that limits freedoms. But these are freedoms to do unhealthy crap that we shouldn’t be doing.
Dr. Mark Hyman:
My father used to say, my freedom ends where your nose begins. And I think that’s a great metaphor for the consequences of harm that are being caused by people’s actions that should not be free. I mean, you’re right. The Rockefeller Foundation came out with a report that showed essentially it’s three times what we actually spend at the grocery store that’s the real cost of food in terms of its consequences on our health, on the environment, on social justice issues, on just a whole catalog of things. And I [inaudible 00:39:59] check that out and that’s staggering. So it should be three times the cost of the food to pay for all these consequences.
Dan Buettner:
I’ve seen calculations like the cost of a burger, the social cost, the economic cost and the health costs is about $30 a burger. Now if burgers were priced according to the damage they cause, we wouldn’t have this problem because burgers would be a once a week. It’s no problem if somebody… You look in the blue zones, they’re eating five times a month, if we were eating meat, cheese and eggs five times a month or junk food, it’d be no problem. But it’s this bacon for breakfast, baloney sandwich for lunch and a pork chop for dinner. That’s when we start getting into trouble and snacking with packaged foods, which I think you’ve written about the toxicity of all these artificial ingredients.
Dr. Mark Hyman:
For sure. Yeah. So what are the other things that you found that we’re going to go through.
Dan Buettner:
Well, if you live in a neighborhood that allows billboard advertising, the BMI or the obesity rate is about 10% higher than a control neighborhood or the same neighborhood with the same profile that doesn’t allow billboard advertising. The reason is billboard advertising often prompts us hungry, McDonald is right around the corner or to pick up a six pack of Coke. And so when we go into a city, we don’t tell a city that they have to do anything, but we do show them the evidence. So here are some that have worked elsewhere to bring the obesity rate and junk food consumption down, healthy food consumption up, people walking instead of driving, better air quality and then smoking less. And then we ask them to adopt it. Another thing that worked very well for us in Fort Worth, Texas, this is a place where the obesity rate dropped about 6% in the six years [crosstalk 00:42:03].
Dr. Mark Hyman:
Wow. That’s a lot.
Dan Buettner:
It was huge. It doesn’t sound like a lot but we’re changing about a quarter of a billion dollars a year of healthcare saving. So we manage to help raise enough money to put coolers in bodegas, in food deserts. So we couldn’t build up Whole Foods in the middle of the food desert but we made it easy for these owners to be able to offer fresh foods and vegetables. And they discovered two things. Number one, it wasn’t that hard. And number two, people actually wanted it. These fruits and vegetables sell out and they have a nice profit margin for them because we subsidized it a little bit. So that really worked. Then in the beach cities, we got the city to create an ordinance that prohibited all junk full of trucks. I hate trucks, food trucks, they often have delicious food but it isn’t all that good.
Dan Buettner:
1,000 foot no go zone around schools because they put all this money into creating the school lunch better. But then these trucks would pull up and all the kids from the high school would run out and they go by the pork taco or the quesadilla. So they put that in. So that seemed to work as well. About the best thing you can do, I argue the best investment for a city is what we call a complete streets policy where every new street has to be planned for a bike lane, a wide sidewalk, trees which draws pedestrians, narrower lanes which slow traffic down and then lower speed limits. And turns out that does a bunch of stuff. First of all, the number of deaths and accidents dropped dramatically when you do that. You could save hundreds of children’s life per year in a city of 150,000 by adopting.
Dan Buettner:
Number two, the air quality goes up so the rate of asthma drops and number three, we see level of self-reported physical activity going up by about 20%. Now this is we’re not giving them gym memberships or yoga classes or any of this other stuff that we use. We just build streets for human beings and you do it over time because the street has to be redone every seven years or so. So we don’t come in and say, “Rip up the whole city.” We say, “No, the next time your street wears out, here’s the way to build the street for a human being, not just a car.”
Dr. Mark Hyman:
Well then, what I don’t hear is you’re going there and say, eat this, don’t eat that, run 10 miles, meditate. Do yoga. I don’t hear any of that. I hear a very coherent, brilliant strategy of how to redesign the built environment to support health as a default so people are nudged to do the right thing and they don’t even know that they’re being manipulated in a way, in a good way.
Dan Buettner:
That’s exactly right.
Dr. Mark Hyman:
They don’t know that they’re being gently encouraged to do the right thing or inspired to do the right thing because something’s pretty or nice or good. And so I think this is just such an important conversation because most of the conversation around obesity, around chronic disease makes it personal. It’s your fault. You’ve got yourself into this, you get yourself out of it. Don’t bother me with it. It’s all about personal responsibility, which basically gives the food companies an out. And I hear this all the time. It’s like, it’s the mantra. [Kelly Burnel 00:45:42] talks about this. There’s no good or bad foods. It’s all about calories in, calories out. It’s all about moderation. Yes. If you’re eating the right amount of calories, it doesn’t matter where they come from. If it’s a Snickers bar or a Seven Up, it doesn’t matter.
Dr. Mark Hyman:
And I think this is a message that has gotten so deep into America, that people are so ashamed and so self hating and doubtful about theirselves. They don’t understand this is not their fault, and they don’t understand that the built environment is what determines their experience and that changing that can change everything. And you might not be able to change your city, but you can change your home. Can I tell you something, Dan, some nights I’m like work too hard or I didn’t sleep enough or whatever, I feel like something happened or I’m upset about something. If there was a pin of Chunky Monkey ice cream at my freezer, I would fricking eat it. But if I have to get in the car and drive five miles, I’m not going to go do that.
Dr. Mark Hyman:
So there’s nothing in my house that’s going to get me in trouble. The worst is some dark chocolate with some almonds, that’s my big sin. So we have to think about how do we create our… For example, my living room, I have my workout stuff in one corner where it’s easy and I have my band set up. I have all the gear I need to do it. I have on my counter, my kitchen, my smoothie every morning I make with all these phytochemicals and adaptogens and protein that I have everything. It’s kind of a mess but I like it because it just takes me two seconds to put together. I have my supplements in my little packets I do every week. I just make these easy for myself. When I’m traveling, I don’t just not plan where I’m going. I’m like, “Geez, there’s going to be food on this trip. Well, I don’t know. Let me pack a day’s worth of food in my backpack,” which is not hard if you’re packing nuts and seeds and things that are very nutrient dense approaching the fat.
Dr. Mark Hyman:
So what I encourage people to do is really think about how they create the default environment. And in my book, 10-Day Detox which I wrote long time ago, I really featured you because you were talking back then about how do you change that? And that’s really important to think about and it’s one of the key take homes I’ve gotten from you. So one is really change your environment. And two is cultivate community and friendships as the two most important things almost that you could do.
Dan Buettner:
Well, yeah. So I mean, just to bring it around. Last week, I published the Blue Zones Challenge, which is exactly that. So instead of four weeks of a new diet, it takes you by the hand, through your kitchen and exactly what you’re saying about not bringing the junk food into your house. But most of us are on what I call a seafood diet. We eat food [crosstalk 00:48:23]. So there’s all kinds of little hacks you can do, like taking a toaster off of your counter. People who take toasters off their counter, they weigh six pounds less after two years and people have that prompt. Instead I happen to have here I’m afraid, I have this high quality fruit bowl. And that’s what I see when I walk by.
Dan Buettner:
Do I like potato chips, guilty as charged. Do I like Chunky Monkey, guilty as charged. You won’t find in my fridge. So [crosstalk 00:48:55] I do have a bag of chips here but you know where they’re, they’re around the corner in a drawer at the bottom. So if I’m on a clip on my counter, every time I walk in the kitchen, I understand one or two of them here. [inaudible 00:49:13] I don’t see it. I have four foods. Part of the book, I have four foods we can never bring in your house. And I’d like to see if you agree with me and four foods, you should always have.
Dr. Mark Hyman:
Okay. I want to hear, what are they?
Dan Buettner:
The four foods you should never bring into your house? And by the way, I don’t care if you eat it once in a while, but never bring in your house. Sugar, sweet and sodas. Number one source of refined sugar in American eye. Number two.
Dr. Mark Hyman:
And obesity.
Dan Buettner:
And obesity. I didn’t know that. You just taught me that. Number two, processed meats put in the same category. So I’m talking to your lunch mate and your…
Dr. Mark Hyman:
That’s baloney.
Dan Buettner:
I’m full of baloney. No, I’m the anti-baloney. But even [crosstalk 00:50:06].
Dr. Mark Hyman:
What the hell is baloney?
Dan Buettner:
We’re going to have a break [crosstalk 00:50:07].
Dr. Mark Hyman:
Essentially they say that’s baloney. You know what it means when they say that’s baloney, it means it’s not real. So actually baloney isn’t even real food.
Dan Buettner:
Yeah. See, I learn something new every day.
Dr. Mark Hyman:
So no sugars in beverage, no processed meat. What else?
Dan Buettner:
Number three, packaged sweets. So having a sweet once in a while, no problem. Just not having them at home. Just the reason you don’t have Chunky Monkey in your refrigerator. And the fourth one…
Dr. Mark Hyman:
So don’t have foods with added sugar in it. Don’t have foods with added sugar.
Dan Buettner:
Yeah. Mostly processed. If you make a bunch of cookies once in a while, it’s no problem. It’s just the packaged one. They also tend to be full of lots other artificial ingredients. And the other too, salted chips, which are also very highly correlated with obesity maybe not as high as. But why don’t treat yourself once a while, wait till you’re out of your house. Four foods to always have on hand I argue is nuts. I think it’s the best snack. It’s associated with two extra years of life expectancy. I say beans because the cornerstone of every longevity diet in the world is beans. And to invest a little bit of time to learn how to make beans taste delicious. And I’ve written [crosstalk 00:51:21].
Dr. Mark Hyman:
And then not make the mess up your stomach, which is another thing, because that takes a minute too to figure that out.
Dan Buettner:
Yeah. I’m going to talk to you about that. I know you and I have a bit of a bean back and forth but I will tell you…
Dr. Mark Hyman:
I’m about beans. I like beans. I’m not against beans. I just think you have to cook them right. You have to cook them right.
Dan Buettner:
You have to cook them right.
Dr. Mark Hyman:
Otherwise you won’t have any friends and then you have no community and you’re lonely.
Dan Buettner:
You have to make them taste good. By the way, people ask me all the time, how you don’t get gas with beans. And what I say is start slow and start with a couple of teaspoons or tablespoons and work your way up to a couple over the course of a few couple of weeks. What do you say?
Dr. Mark Hyman:
I say couple of things. One, soak them overnight. Two, cook them in a pressure cooker with kombu, which is a big chunk of seaweed. And then when they’re done, rinse them.
Dan Buettner:
There you go.
Dr. Mark Hyman:
So I think that usually gets rid of all the stuff that makes you have too much gas. And again, you need to build up because your microbiome changes in relation to what you eat and you might have more fermenting bugs in there that are not used to seeing the beans and then they’re going to go whoopee, and then they’re going to make [crosstalk 00:52:33] cushion. So I think that you can’t get around. I agree. So those are good. So eat beans, nuts.
Dan Buettner:
100% whole wheat bread because we like to make sandwiches. I think a real peanut butter sandwich is a great food that everybody can afford. Real peanut butter, not jiffy crap and real 100% whole wheat bread. And then finally your favorite fruit. So I don’t necessarily tell people what fruit, I mean, we all know that it’s berries and I would say kiwi fruit are better than bananas and grapes, but still bananas and grapes are better than most of the stuff we’ll rip in a package off.
Dr. Mark Hyman:
Sure. Of course.
Dan Buettner:
The thing is important why I say the food you like, because if you’re not planning on doing it for a long time, don’t waste your time doing it this week or for your new year’s resolution, then going back to the Doritos, it’s not going to do you any favors. So you got to think long term.
Dr. Mark Hyman:
Well, I think I agree you with your list except for one part of your list, I’m just going to push back on that a little bit, which is the whole wheat bread. I would say it depends. So most of the wheat that we eat in this country, I wouldn’t touch with a 10 foot pole because it’s grown in ways that make it problematic, dwarf wheat, which is the predominant wheat. It’s a hybridized version of wheat, not GMO, it’s dwarf wheat, has a super starch called amylopectin. So it raises your blood sugar more than table sugar, even whole wheat bread does that. Two, it’s sprayed with glyphosate often at the end of harvest to desiccate it, allow it to be harvested easily. Three, the hybridization increases all the gluten molecules in it. So there’s way more gluten, which is why we see a 400% increase in celiac disease in the last 50 years.
Dr. Mark Hyman:
And lastly, it’s preserved with calcium propionate, which is a preservative that actually causes neurologic dysfunction, ADD, behavioral issues and even autism in animal models. When I was in Sardinia, because I asked them like, what are you making your pasta from, it’s Grano Capelli, which is this ancient weed that doesn’t have all those problems, grown in ancient ways that are quite different. And I think some of that’s fine. I also think that that if we eat grains and I think the breads that I like, and I would agree if you like want to have bread or a sandwich, that’s okay. The breads that I like are the German vollkornbrot breads. They’re not made with flour. They’re made with the actual soaked grains, like vollkornbrot rye and other grains. You can buy in America, these come with all cell thin packages, rectangle things.
Dr. Mark Hyman:
They’re okay. But I don’t know why someone in America hasn’t figured out how to make these amazing German breads. When you go to Germany, they literally had these meat slicers like in a deli for the baloney that we’re not going to eat. They have meat slicers and they literally cannot cut the bread with a knife. It’s that dense. And so they need a meat slicer to cut the bread. And my joke for bread is if you can stand on it and it doesn’t squish, you can eat it. And then the other thing is I would just make a play for some alternative breads, like in my cookbooks, What the Heck Should I Cook? I have a couple of recipes for basically seed and nut breads, they’re delicious and dense and very flavorful, a hemp bread.
Dr. Mark Hyman:
And then there’s this other company called Lynn’s Life, L-Y-N-N, Lynn’s Life, which actually has created a seed bread that’s basically pumpkin seeds, chia seeds, flax seeds, hemp seeds I think, psyllium seeds, maybe not hemp, psyllium seeds, a little salt, and you take egg whites and you take a little bit of lemon, baking soda and a little almond milk or something and you mix it up and you bake it for an hour and it’s this fluffy light bread. And it has an incredible side effect which it makes your poops amazing. So it’s really awesome. And if you get that [inaudible 00:56:41] for bread. So that’s the only thing I’d push back on but otherwise, 100% agree with everything you said.
Dan Buettner:
How about Ezekiel bread?
Dr. Mark Hyman:
Are those better? For sure. Very dense, right? Very much like they’re soak, they’re made from the whole grains. Because if you pulverize whole wheat, even if it’s whole wheat, it’s still got a high surface area. So it’s got a much high glycemic index. And then most wholly breads in this country are not really, they’re made with high fructose corn syrup and they’re made with all kinds of weird things then they’re all these extra ingredients.
Dan Buettner:
How about making your… I make this and I learned this recipe in Sardinia. I actually snuck some of the culture back here, but I make a sourdough bread where it’s half whole wheat, half bread or flour. But when you use that lactobacillus and you leaven it with the bacteria or the yeast, most of the gluten is metabolized. Like 90%, 95% [crosstalk 00:57:47].
Dr. Mark Hyman:
I would agree. I’ll agree. Like Dan Barber is a chef and he’s created this company called Row 7 Seeds, which is to bring flavor back into food. And flavor is a result of the nutritional quality of the food of the phytochemicals in the food and the nutritional density of the food. So he’s doing it from a culinary perspective, but it’s also the same thing that correlates with a health perspective. So phytochemicals equal flavor, equal medicine. And I think there’s a lot of ancient grains that we should be bringing back to use. For example, Himalayan Tartary buckwheat, we made buckwheat pancakes and make incredible foods from this ancient grain that’s got more phytochemicals than any super food on the planet.
Dr. Mark Hyman:
So there are ways of choosing grains. For example, ligands in ancient rye are very helpful and help turn on genes that reverse diabetes. And so I think if you can get ancient strains of wheat, there’s einkorn wheat, there’s Kernza wheat, which is actually a newer developed wheat but it’s actually quite good in terms of it’s properties, is also great for putting roots in the ground and restoring soil. So I would say, be creative about your bread and your options there and stay away from the pulverized white flour, even whole wheat breads in America because they’re usually crap.
Dan Buettner:
How about ones you make yourself, do you start with whole wheat flour?
Dr. Mark Hyman:
Yeah, for sure. But where you get your flour from. Because if it’s whole wheat hour from dwarf wheat, that’s the problem. What’s the strain of wheat. It’s what’s the breed of wheat. And I think that’s really important because you start with the seed, the seed determines everything. And so yes, certain forms of wheat are fine. There’s the ancient wheats out there that when you look at the, what are that, the long Amber Fields Of Grain or whatever that’s in one of our songs in America. I mean, that was this tall billowing wheat fields. Now we have like these really shrimpy little wheat, which is great for growing tons of starch in a very short time, in a harsher environments. And they’re more drought resilient and they’re better for a lot of reasons but they have this downside. So I’d be careful of that.
Dan Buettner:
Shrimpy wheat. [crosstalk 00:59:53].
Dr. Mark Hyman:
Yeah. So Dan, I want you to take us through as we close the Blue Zones Challenge. What are the key elements of the The Blue Zones Challenge: A 4-Week Plan for a Longer Better Life, it’s available now on Amazon, everywhere you get your books, check it out for sure. I learned a lot from it but tell us in a nutshell, what are the take homes that are provided in that four week guide to give you a reboot on your health?
Dan Buettner:
Yeah. So instead of trying to change your behavior, which we do at the beginning of every new year and it fails by February, I ask you to change your environment. So over the course of the four weeks, I take you through your kitchen, your bedroom, the rest of your house, your workplace, your social network and we give you evidence based ways to set up your life, thereby engineering your unconscious choices. And the other thing we ask you to do during that four weeks is to go as cold turkey, to try a whole food plant-based diet and to get the processed foods out of your diet for just four weeks and see how you feel. And we just had 1100 people from the Adventist health system, employees do the Blue Zone Challenge.
Dan Buettner:
And this isn’t a weight loss program but they report it clearer skin. They reported losing 4.4 pounds. There’s a big focus on how you connect socially. So I take people through your mid age, how do you make friends in America? So we take them through the process of identifying the right friends and making those friends and committing to it. And it’s a different way to think about your health journey but it’s distilled right from what both you and I experienced in Sardinia. And I’ve had 11 years of putting these ideas to work in cities, and this is sort of my opus in trying to distill it for individuals and yes.
Dr. Mark Hyman:
Well, that is so brilliant. That is so brilliant, Dan. I can’t thank you enough for doing that because I’ve always said that it’s our social networks that determine our health and what I mean by that is our social environment and our built environment. And we are trying to fix people one by one by one, but we’re talking about a cultural shift to create a more loving, connected society that makes it easier to be healthy. And you’re doing that on an individual basis in people’s homes but the beauty of what you’re doing is it actually spills over because then people will do that in their work environments, they’ll do that with their families. They’ll tell their friends and I hope you’re going to create a revolution with this book. And I encourage everybody to get it.
Dr. Mark Hyman:
It’s really a roadmap to thinking about creating health in a different way than typical books. Even the ones that I’ve written, which is change your diet, do this, do that, take the supplement, it’s like, wow, let’s make it easy to be healthy. And let’s change the things that make you able to make the healthy choice as opposed to the unhealthy choice. And it’s a really beautiful book. So everybody get a copy of it. I just love your work. I think you’ve been a real inspiration for so many people and so many people think about aging and longevity. You were really one of the first to start to talk about it and thank you for that. And I’m so excited. My next book is actually going to be on longevity from a functional medicine perspective. It’s a little bit different angle but I’m really excited about it and thanks for all that you do, Dan.
Dan Buettner:
Well, Thank you, Mark. And now I want to thank you but also your audience for taking this time and I had the big chunk of their day. I’m very good at answering questions. If anybody has questions, I’m at Dan Buettner. I answer them personally and thank you for your work Mark, you’re an ongoing inspiration. And I hope we actually get some real face time in 2022.
Dr. Mark Hyman:
I know, I know. Soon. Okay. And make sure everybody go to bluezones.com to learn more about Dan, bluezones.com and make sure you get the book, The Blue Zones Challenge: A 4-Week Plan for a Longer Better Life. We hope you’ve loved this podcast. If you love that, you want to share it with somebody, we’d love you to share it with your friends and family. Leave a comment, leave a review. We’d love to get to know what you think about the podcast. Subscribe to [inaudible 01:03:59] podcast and we’ll see you next week on The Doctor’s Farmacy.
