How And Why We Age

Mark Hyman, MD

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Narrator: Coming up on this episode of The Doctor's Farmacy. Dr. Mark Hyman: Doing more of the same type of medicine that we're doing, treating individual symptoms, individual diseases with drugs that block or interfere, inhibit some pathway is just a losing cause, right? Welcome to The Doctor's Farmacy. I'm Dr. Mark Hyman. That's Farmacy with an F. A place for conversations that matter. And if you've ever wondered how you can reverse your biological age, listen up because I'm going to share with you some exciting tips about what we know about longevity because I just wrote a new book on it called Young Forever out February 21st, 2021. Please go pre-order it right now at youngforeverbook.com. But this conversation I'm going to have with you today is going to help you understand the difference between chronological age, biological age, what the underlying mechanisms of aging are. We call the hallmarks of aging. I'm super excited to share this with you because I think about this all the time now, mostly because I'm getting older, but also because I think it's some of the most exciting research in science and it changes our whole framework of how we need to think about aging, how we need to think about disease. So even though the focus is on longevity, the science of longevity is teaching us so much about disease in general and how the underlying causes of all the disease of aging are really the same. And that by treating those underlying causes, we actually don't have to treat the diseases themselves. We can literally treat the process of biological aging and reverse it at any time. And that is to me so exciting and I've done it myself, so I know it works. So let's do a little one-on-one on aging and jump right in of how and why we age. First, what is the difference between chronological age and biological age? Well, your chronological age is how many years you've been on the planet. I was born in 1959, that's 63 years. That's what I got. I can't change that. But my biological age is the age of my underlying biology, how healthy are my tissues, how healthy are my organs, how health are my biochemical processes. And that is something that we actually can change and we have immense control over and we can control it at any age. So it's really remarkable how powerful our interventions are now to change what we think are inevitable chronic diseases. The whole concept of chronic disease, meaning it's chronic meaning you're always going to have it. It's something you have to live with. You have to manage your disease. I have to manage my diabetes, manage my heart disease, manage my Alzheimer's disease, which is good luck with that. But for most people, there's no roadmap for that. But what I'm going to share with you is that these conditions don't have to be a one-way street. You can actually reverse Alzheimer's, you can reverse diabetes, you can reverse heart disease. And I've seen it over and over in my own practice and many of my colleagues in functional medicine. So our body is a system, it's a network and it's made up of subsystems that are all interacting together. And our biological age is determined by the health of those subsystems and by whether or not they're imbalance or out of balance, whether they're functional or dysfunctional. And that's really why we use the term functional medicine. We want to create optimal function. How do we create an optimally functioning immune system? How do we create optimally balanced hormones? How do we optimize our metabolism and our ability to produce energy? How do we optimize our detox system, our microbiome, our circulatory systems, and even our structural system, what we're made of, our biological structure, our tissues, our organs, our cells? We have the capacity to change those at any time because they're influenced by everything we do. They're not just on this set program of deterioration and disease. They are influenced by what we do. So if we don't take care of ourselves, we're going to activate all the disease programs in our body. But if we activate our longevity switches, which we now understand, I'm going to explain what those are to you. But if we understand our longevity switches, if we learn how to activate healing systems in the body, and the body has its own innate healing system that we now understand. And we're so focused in medicine on treating disease and treating symptoms and medications that interfere with some pathway, instead of going, oh, the body is this amazing system that has its own intelligence, that has its own repair systems, its own rebuilding systems, its own rejuvenation systems that we can activate those. And the most obvious one people are talking about is stem cells. Right. If you cut your skin, how does it heal? If you break a bone, how does it heal? It's not because you take some drug to activate the healing system in your body. It's there. It's innate in you. And so the question is how do we enhance those innate healing systems? How do we stop interfering with them, which is basically what we do with how we live, right? So if we don't understand how our bodies work, and by the way, which one of you out there listening has an owner's manual that came with your body? I don't think you got it at the factory when you were born or the hospital. Right. So we now understand what that owner's manual is. We understand how the body's organize and design and we can actually, like the laws of physics, we can actually understand the laws of biology. So if we don't activate these healing systems intentionally, if we just go about our business as usual and eat what we want and don't exercise, of course the diseases of aging will take over, and our bodies will degrade. But if we actually learn the right way to interact with our biology, if we learn how to put in the right information and take out the wrong information, if we learn how to put in the right types of energy and the right inputs, we can literally stop this process of entropy, which is decay that happens as part of everything in life. Right. Everything degrades, everything decays. And of course we will too to some degree. I got gray hair now. I didn't have gray hair before, got a few more wrinkles, probably sun damage. I mean, if I wear sun block all the time and stay out the sun, which I don't really like to do, I wouldn't have so many wrinkles. But the truth is we actually can affect most of these biological processes and actually heal our bodies. We can clean up the damage, we can repair old cells and proteins, we can build new molecules and cells and tissues. We can actually enhance all these functions of life. So what causes the degradation that causes the dysfunction that we see as what we call the hallmarks of aging? The hallmarks of aging are these 10 things. Some people say nine, I see 10 basically we'll go through them. But basically these are the identifying features of aging. And if we got rid of all these phenomena that happen with aging, whether it's stem cell, exhaustion, or inflammation, or mitochondrial changes, or damage to proteins, or impaired nutrient sensing or zombie cell, I mean the list goes on. If we were able to get rid of these things, then people would live to be a 120, a 150, a 180. And they've done this in animal models. I've seen how this works. The problem with aging is we have too much breakdown and not enough buildup. Right. You buy a brand new Toyota Camry, drive it off a lot and you can probably drive it for a 100,000 miles. Never change the oil, never take it in for a tuneup or anything else. It'll be fine. If you got a 1929 Mercedes Roadster, well guess what? That's going to require a lot more care and uptake and maintenance. But it can still run and it can still go and be fine. And I think that's the key. We have to have way more positive inputs as we age and we have way less wiggle room to just goof off and do whatever we want. Stay up all night partying, eat whatever we want, not exercise. I could not exercise for a month when I was 25 and I could still go run five miles. If I did that now I'd be in trouble so. And the body's capable of it, but it needs a little more input. So what are the things that are driving this? And it's a lot of the things that we talk about. It's obviously our diet, which we'll talk in great length about, and which I talk about in my book Young Forever. It's our activity level, it's our stress level, it's our sleep, it's the environmental toxins we're exposed to. It's our microbiome. And so we now actually know how to regulate these things to activate the healing, repair and regeneration that's embedded in our biology. And I don't want you to have to manage disease, I want you to prevent them. I want you to reverse them and I want you to get rid of them. And I've seen this over and over. I've talked about cases on my podcast, but I've reversed so many, so many cases of diabetes. So many people with memory loss have improved. So many people with heart failure have gotten better. So many people with angina and all kinds of really what we think of our endstage diseases get better if you give the body the right conditions. And it's going to transform everything we know about healthcare. It's going to transform everything we know about treating disease. We're not going to have to treat all the diseases separately. We're going to be able to actually create health. And then diseases won't need to be treated individually. And so as scientists are looking at longevity and the longevity sciences really exciting because for years it's been a ignored part of medicine. I mean, doctors just thought aging was inevitable. There's nothing we could do about it. Let's focus on the diseases and all the budget of the National Institute of Health is focused on diseases but not on health. It's certainly not focused on aging and the mechanism of aging, but now there's billions of dollars flowing into it from private investment, from billionaires who care about living forever, which is okay because they give money to research. But what they found is that there are 10 things that seem to go wrong that underlie all disease. And if you focus on these, and from my perspective, it's not enough to just focus on the hallmarks, you've got to focus on the causes of the hallmarks. And that's different about my book, Young Forever is a lot of the books out there on longevity talk about the hallmarks and interventions or drugs or mechanisms that we can interfere with these. But I think if we talk about why these hallmarks occur, we can understand how to interfere at an earlier level on the pathway to these hallmarks and not actually just focus on treating those with the medication or other things which may be needed, but it's not the whole story. So one of the things that are causing the degradation in our bodies as we get older, one of the things that are causing biological aging, well, the first and the most important thing is controlled by what we eat. And scientists talk about this as a disrupted nutrient signaling. So what does that mean? Well, your body is really smart and it's learned how to deal with scarcity, with adversity. And so you have these pathways that sense the amount of food in your diet, the kind of food in your diet. And these pathways are, I call them longevity switches because they're really meta, they're almost more important than all the other sort of longevity hallmarks. They're really above everything because they help us to understand what happens to all these others. So all these other hallmarks are influenced by our diet. And so these four longevity switches that we talked about as part of the dysregulated nutrient sensing are one is insulin signaling. And if you ever listen to any of my stuff, I talk a lot about blood sugar and insulin as a big driver of heart disease, cancer, diabetes, dementia, pretty much all age related diseases, kidney disease, high blood pressure, all of it. So too much sugar and starch, overloads this pathway and cause us to age. Now we need some insulin and we need some good insulin signaling, but when it's too much is when we get in trouble. The other pathway that's important is called mTOR, which I talk a lot in my book. It's basically means mammalian targeted rapamycin, which we may not have time to explain, but I go through in the book. But this pathway detects not only sugar but also protein. And when you look at how the body's designed, it's designed to have alternating periods of kind of recycling and cleanup and repair and rebuilding. Right. So if you want to say kind of remodel your house, you have to bring the demo crew in first and get rid of all the old stuff and kind of clean it up. And then you want to bring in the construction crew. So we have that built into our system. We have the demo team and the construction crew and the demo team has to be allowed to work. Now, what is the demo team in terms of the body is it's this process we call autophagy, which basically means self cannibalism or we eat our cells. So we have a process where we can go up and like little Pacman with these cells we kind of absorb all the old proteins and cells, we chew them up, and then we dissolve them with different enzymes and we kind of break them down in the component parts. So you can take a protein and you can break it down into amino acids. So you can then use those parts to rebuild more tissues and more organs. So it's really important that we have this process. Now, mTOR is overstimulated in our culture because we overstimulate this pathway with too much food, with too much sugar, with too much protein. Not the fact that we're eating too much protein, but that we have too much food coming in on a regular basis. We need breaks. So the way to activate this autophagy is through fasting or through not eating for a period of time. And it can just be 12 hours overnight, or it can be 14 or 16 hours, or it can be a day a week or a few days a month or whatever you want to do. But this is a very important pathway that's a survival pathway. So this is the only thing, by the way, that's been shown to extend life by a third. If you look at animals and you calorie restrict them, you inhibit mTOR and you get a third more life extension. So that means for humans that would be going from 80 to 120 years old, which is not insignificant. So it's important to understand that we need to eat in the right way to control these pathways. The other two are AMPK and sirtuins, which have to do with DNA repair and regulating blood sugar, mitochondria, inflammation. And again, these are nutrient switches that are affected by what we eat and the quality of the food we eating and are also influenced by phytochemicals. And I go into great detail about what these nutrients signaling pathways are, but they're so important because they can be modified by what do we eat, when we eat, how we eat? And it's really important to understand this part of nutrition that's so different from how we normally think about it. So how do we activate these pathways of repair and healing and how do we build more tissue when we need to and more protein. So bringing up people say, oh, we should be vegan and we should not eat protein in order to live long. Well, that doesn't make sense because if you don't eat protein, you can't build muscle. If you don't have muscle, you're going to become frail and elderly and weak and break bones and it's not good. So you want to have time to building and a breakdown. The other nine hallmarks, we'll talk about briefly like DNA damage that happened because of little hits every day. But we have a home repair system to activate. Telomere shortening. Telomeres are the little caps at the end of your chromosomes that keep them together, from unraveling. When they get too short, you die and they're infected by our lifestyle, can be modified. Proteins get damaged as a course of just normal life. Things kind of need to degrade, but we can have more protein damage from various insults. So we can actually modify that. We can do things to actually improve our protein function. We have epigenetic changes. Our epigenome is the control switches on our genes determines which ones are turned on or off. And that's influenced by our lifestyle. We see zombie cells form, these aging cells that actually cause inflammation throughout the body, which is really damaging to all of our tissues and organs. And one of the other key features of the aging and longevity hallmarks are, the hallmarks of aging, I mean is inflammation. Inflammation we've talked a lot about on the podcast. It's one of the key features of almost all age related diseases. Even depression, autism, cancer, heart disease, diabetes. The list goes on. Inflammation is such a key factor. And the senescent cells, these zombie cells tend to even create more inflammation in the body. We also see mitochondrial dysfunction. Our energy factories get degraded. We don't have that much energy. Our microbiome degrades. Our stem cells get tired. And of course we have this inflammation. So these are really important to understand. They're important to understand the science of how they work. But what's more important to understand is how these things go wrong. Why do we get inflammation? Why are stem cells get more tired? Why is our mitochondria degrading? Why is your microbiome of balance? How do our proteins get damaged? How do our telomere shorten? How do our nutrient sensing pathways become dysregulated? This is super important and this is really where functional medicine comes in because we can influence these hallmarks through simple lifestyle changes and behavior changes. And the science of functional medicine, it's basically simple. It's take out the bad stuff and put in the good stuff. And I say this over and over, but functional medicine may be hard to practice, but it's simple in concept to understand which is the body has to be imbalance. And what causes imbalance is the bad stuff, bad food, stress, toxins, [inaudible 00:17:05] lifestyle, allergens, microbes, all kinds of stuff. And what is the good stuff that we're not getting? The right nutrients, the right amount of quality of food, movement, exercise, sleep, rest, community, purpose, meaning, love, all these are the ingredients for health. So we got to take out the bad stuff, put in the good stuff, and that's really how the body works. And by understanding how to do that on an individual level, because everybody's different, we can address these hallmarks and go upstream to the hallmarks which are upstream to the diseases. So hallmarks are better than talking about diseases, but they're not enough. We have to get beyond that. And the good news is we can take away those negative inputs that harm our biology and drive disease and we can add into things that heal our bodies and activate these longevity switches. And that's really what my book Young Forever is about. It's about teaching you in a practical way how to activate your longevity pathways, what causes them to become dysfunctional and how to get them working right. So it's a beautiful model and it really is very personalized. It's very different. And right now I think these hallmarks are such an exciting area for me to think about as we start to reframe disease. In fact, the World Health Organization now considers aging a disease, that what we see as quote normal aging is really abnormal and their beginning to treat these dysfunctions in a different way. So we need a very different model. And the beautiful thing is that we're understanding how this works across the whole life spectrum, but doing more of the same type of medicine that we're doing, treating individual symptoms, individual diseases with drugs that block or interfere, inhibit some pathway is just a losing cause, right? Yes. Like I said, if we erase cancer and heart disease from the face of the planet, maybe we'd see an extra five to seven years of life extension, not 30 or 40 years, which we can see by addressing the hallmarks of aging. Now, for example, heart disease, Alzheimer's, diabetes, cancer, obesity, depression, even infertility, what do they have in common? Are they really all different diseases? They may manifest as different things, but at the root they're the same problem, which is, for example, insulin resistance. Now, this is something you've heard me talk about a lot, but when you look at longevity, it plays an outsize role. I once heard a lecture from the head of preventive cardiology at Harvard, Dr. Jorge Plutzky, and he said, if you were to take a group of a 100-year-old people with absolutely clean arteries like no plaque, no heart disease, what would they have in common? He said they would be insulin sensitive, meaning they would be able to regulate their blood sugar. They wouldn't have huge spikes in blood sugar or insulin. And it's super important. Now, what's even more frightening is that over 90% of Americans are not insulin sensitive. 93.2% are not. There's have some degree of insulin resistance and poor metabolic health, which is essentially what it means. And the beautiful thing is that most doctors don't diagnosis this, but it's a 100% preventable and a 100% reversible. Even in type two diabetics who are fairly extreme, we can see complete reversal of diabetes. Type two diabetics who've been on insulin for decades can get off of it, can change their biology by changing everything. And what causes this phenomena of insulin resistance, well you've heard me talk about it too much starch and sugar, too much processed food. Things that break down into the highly absorbed, quickly absorbed starch and sugar is bread, pasta, rice, crackers, desserts, sugar sweetened beverages, even potatoes, depending on the kind that cause your body to release extra insulin because your sugar's going high. And it keeps your sugar low, but the insulin goes high, and that creates enormous damage to the tissues. I once asked Lenny Gorte, who was from MIT or Guarente from MIT, who basically was one of the discover of sirtuins, which is this really important pathway for understanding longevity. And he said to me when I asked him what the biggest driver of aging was, he said, sugar. I was like, oh, wow, I thought that'd be some fancy complex scientific idea, but he's like sugar. I met with one of the top leading researchers in cancer, Siddhartha Mukherjee, who actually had been study ketogenic diets and cancer. He wrote The Emperor of All Maladies. He said, Mark, we figured out what causes most cancer. I'm like, what? He's like, sugar. I'm like, yeah, I know, I know. So insulin is essentially being produced at high levels. We can measure insulin. Most doctors don't measure it. It's one of the most important tests to measure. I co-founded a new company called Function Health, which allows you to do self-testing and we actually check insulin on everybody. Go to functionhealth.com to learn more about it. And insulin is a fat storage hormone. Over time, your cells become resistant to the effects of insulin. You need more and more insulin to keep your blood sugar normal. And that creates this whole cascade of problems, including loss of muscle, extra belly fat. You're hungrier, you have sugar cravings, you get more inflammation, you get high blood pressure, you get high triglycerides, low HDL, high bad cholesterol, too many small particles, fatty liver, low sex hormones, low sex drive, depression, memory loss, dementia, extra blood clots, diabetes, heart attack, strokes, dementia, cancer. It's a lot of stuff. So this is all caused by too much starch and sugar. And when you treat all these diseases separately, fertility, depression, cancer, heart disease, you're kind of missing the boat. They're not separate problems. They're really linked to the same root cause. So I really never treat disease. I create health. And as a side effect, things go away. And I'll just give you a quick case example of someone who had a terrible inflammatory disease that was being treated in many different ways by many different doctors. And all of them were basically like the blind men in the all thing, treating all the symptoms but not the cause. So she was about a 50-year-old business coach woman. She had terrible psoriatic arthritis, which is an autoimmune disease where you get joint pain, you get psoriasis, which you know the heartbreak of psoriasis. She had also depression. She was overweight, she was pre-diabetic, she had terrible reflux, irritable bowel syndrome, insomnia, migraines, you name it. She had everything. And she was seen by the best doctors and had the best treatments. And one of the drugs she just took for her autoimmune disease was like 50 grand a year. And she was on the best antidepressant, the best stuff for her irritable bowel, the best drugs for reflux, the best drugs for her autoimmune disease, the best drugs for depression, the best drugs for pre-diabetes. And nothing was really working that well. She was managing the diseases. So what I did was I basically, I gave her, instead of treating all things separately, I treated her core system and I realized that her gut was the source of a lot of inflammation. She had terrible bloating, bacterial overgrowth. She'd taken lots of antibiotics and steroids, probably had yeast overgrowth, we call it SIFO. And I gave her an antifungal and antibiotic to clear out the bad bugs, some probiotics, some vitamin D, some fish oil, put her on elimination diet, got her off inflammatory foods, off of sugar and processed food. And really it was amazing. Within six weeks she came back and all of her symptoms were gone. Her psoriasis was gone, her arthritis was gone, her depression was gone, she'd lost 20 pounds, her reflux was gone, her irritable bowel was gone. Literally everything was gone. I wasn't managing anything and she stopped all her medication. I didn't tell her to which I don't tell people to stop. I said, well, let's just see how you do, then we'll decide. But she stopped everything and she was completely better. So I kind of joked that I'm a holistic doctor, that I take care of people with a whole list of problems. And she had a whole list of problems where were treating separately, and instead of treating all those diseases separately, I got to the root cause. And that's what we can do with aging. So just to recap a little bit, we don't have to accept our current approach to aging, which sees it as an inevitable decline in function. Then decrepitude. We don't have to accept that we need a pill for every disease in medicine. We can treat the root causes using the framework of functional medicine. We can create health from the inside out and we can extend both our health span and our lifespan. Biological age, we can now measure through a test called DNA methylation. I measured mine. I'm 43, although I'm 63 chronologically. We can do that. And this is what I'm going to share with you in the book Young Forever. We don't have to accept it as this inevitable part of our lives where we get frail and decrepit and dysfunctional. We can maintain a high level of function until very old. I plan on surfing until I'm a 100 years old. So I know I don't want to stop. Why should I? And if you maintain your body and your health, you can do. And I think it's an really exciting moment in health. I want to have you all look at your biological age. It's a great way to look at what's going on in your body. And we can change it. It changes over time. If you want to learn more about all this, you learn more about my book, go to youngforeverbook.com. Order it today. I promise you won't be disappointed. I pour my heart and soul into it. I hope you love this health bite on the doctor's Farmacy. Be sure to share with your friends and family on social media and we'll see you next time on The Doctor's Farmacy. Speaker 3: Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner and can help you make changes, especially when it comes to your health.