Health Matters 2023: How 21st Century Science Is Improving How We Age

foreign welcome to health matters and what a beautiful day it is so thanks for being here my name is Jeff traum I'm a local resident and I'm a member of Stanford medicine's Community Council I'd also also like to welcome hundreds of folks who are joining us online live stream and they're all over the world today before we get started I wanted to remind everybody here and online that you may submit questions via a QR code that's on your program if you're online you'll see the QR code on your screen and we'll have a live q a after Dr ketta's remarks so today it's my pleasure to introduce Dr Deborah Cotto a geriatrician co-director of Stanford center and longevity and chief of geriatric research in the Department of Medicine she will share some of her groundbreaking work and the work occurring at the Stanford center of longevity and discuss what we can do today to remain Physically Active and mentally Sharp reduce stress improve sleep and enhance our nutrition all factors essential to healthy aging so please join me in welcoming Dr Deborah Cotto good morning well that's a huge charge to accomplish in the next 20 or 30 minutes but we'll do my best and I also want to give a shout out hi Mom and Dad so it's a pleasure to be here and today I'd like to start by asking you all a question do you consider age aging to be a disease so um Dr Laura Carstensen and uh the founder of the Stanford longevity Center and I co-teach a course to the Stanford students and this is exactly the question that I asked them at the beginning of the course and maybe no surprise while there is a majority consensus it's not complete so um why could aging be considered a disease well um with aging if you get to be old enough there is an increased risk for the onset of multiple chronic diseases so scientists have postulated that if we could understand the underlying biological underpinnings of why we age perhaps we could identify an upstream Target that we could development treatments for that could potentially halt or even reverse aging on the other hand why should aging not be considered a disease well at least in humans it is a universal process so that would mean by definition we all have a disease also the word disease has negative connotations and um if we consider aging a disease then it I think it really just serves to increase our implicit and explicit biases we have towards older people now in 2010 the first baby boomers started reaching the age of 65. and billions of dollars are spent annually to try to address this what they consider a problem actually um and uh in whether it's in science or supplements you can buy online or various gadgets to help uh Stave off aging or getting old um it's been interesting so I'm a geriatrician by training and my patients sometimes ask me well doctor what what supplements can I take to perhaps help my brain or my bones or my cart or my joints what supplements should I take and I will say that in most cases my answer is very simple none okay I've been fortunate enough to be in this field for over 30 years now so I've kind of seen the vicissitudes of people who come in and they really believe that they've they found they found the thing they found what you need and they've shown that if you give whatever this treatment to say worms mice even primates this can extend lifespan and this has resulted with the government now not regulating supplements that there are a lot of those things online that you can go out and purchase spending easily sixty dollars a month and um to their credit these scientists often do what they believe in right but I will say that of all those things that I've watched over the years none of those scientists are known for their extreme longevity I'm just saying okay and unfortunately some of them most of them have passed before the age of 80 which isn't even considered very old right now so it is an issue so if not supplements what can help us now so I'm gonna die digress a little bit because I think in order to um to really think about longevity and the best science for longevity in uh the century we have to consider that okay now children are born and can expect to maybe live a hundred years so if you go online and this slide is courtesy of my colleague geriatrician famous writer Dr Louise Aronson you'll get a chart like this basically which shows the lifespan from zero to a hundred and what you see is we have great language for infants toddlers children's tweens teenagers late adolescents young adults then adults where you know hopefully maybe you decide to have a family hopefully you're gainfully employed and then I don't know retirement age just let's just pick an age out of a hat 65 and then all you see is a wheelchair okay uh and unfortunately there's a lot of information missing right once you turn it's even 60 in this chart uh there's there's a lack of information there's not even there's not even a language really that is used and I think if we're really thinking about longevity and the science of longevity we need to pay attention to we have to develop a language we have to develop an idea that actually science has shown Us in studies that we've done of older persons that this is the most variable time in life the most heterogeneous time and yet we don't really understand it we have this image of someone I guess in a wheelchair and this is kind of reflected in our our medical profession so as you can see down on the bottom part of that slide usually pediatricians are the doctors who are trained to take care of children up to about the age of 20. and then Internal Medicine doctors are they're about 120 000 of them I'm primary care who are taking care of the General Health of an adult maybe up to this age of 65 and geriatricians are then specially trained to take care of adults beyond the age of 65 in their older years and you can see that while they're 120 000 Internal Medicine doctors they're less than 5 000 or 6 000 now about 5500 in 2023 practicing geriatrics across the country and Jeff who introduced me had asked me when we were preparing for this well how many how many patients is that per doctor so I decided to look it up and based on the data I could get online maybe 1700 patients per pediatrician 2700 patients per internal medicine doctor and almost 12 000 per one geriatrician and that's likely um underestimate if you take 65 and how fast we're crossing that threshold of getting in to be into our older years or perhaps the last third of Our Lives um I do not I want to give a shout out to family practice doctors they're actually trained to take care of patients across the Spectrum from zero all the way up until one passes away but um jury because they have so much to take care of unless they get specialized training in the treatment of the older adult often they don't get the the pearls that we need and why is that well it turns out in medical school across the country generally and this is from when I was in training you get six weeks of intensive pediatric training exposure I've been querying the Stanford Medical sin residents as they've come through since I came here in 2021 and it's very variable and most medical schools I would say don't have a standardized mandatory geriatric education and here at Stanford just in 2021 we now have four hours of mandatory geriatric education in the first year um and for Internal Medicine residents here they get two weeks of exposure in their first year but those two weeks of exposure to what we do can be jeopardized meaning if someone else gets sick or they um whatever happens they get pulled and they don't get they don't get any geriatric exposure uh for to see what geriatricians and do and why they're special so clearly we have a problem we don't have enough so Mary tinnetti a fellow geriatrician from Yale in 2017 started with the Institute of Health Care Improvement and the John a Hartford Foundation to say we need to do something we're having a crisis in health care we don't have enough of us and the population is getting older every day so they came up with the concept of let's try to develop what we call age friendly Health Systems we need age-friendly health care and what does that mean we got to try to make it simple because it's not simple but anyway we're going to do focus on four things and then we call them the four M's one what matters to Mobility because without Mobility people are less likely to be independent and a lot of people if you ask what matters to them they really would like to be independently living if possible three mentation are they able to do things and carry out their activities of what they have done all their lives how how is their memory functioning Etc and then lastly the fourth m is medications because as we age we tend to accumulate pills and there are multiple studies that suggest that the more medications you take the less healthy you might might be become it's not it's not a great a marker of longevity so um I'm going to now move on to some of the exciting science and I just chose um two areas which I've been working since arriving to Stanford and um you can imagine that gosh in the 21st century we are sending spaceships out into space deep space and in um we have self-driving cars so what about ankle Rockets um or has they're called scientifically um ankle exoskeletons so collaborating with my colleague here a professor of mechanical engineering Professor Steve Collins who's the director of the Stanford biomechanronics laboratory there is a booth out there if you want to go see this later on today but he has been very interested in this topic of aiding walking with these anko exoskeletons and he started with younger adults and athletes and showed and has just published in nature this year that these can be used and result in new work walking about 40 percent faster and requiring 40 percent less energy so that was really intriguing to me when I learned of his work because a lot of my patients do complain about fatigue and we know that in multiple large studies that we tend to lose get slower as as we age and that um wake a walking speed is a predictor of important Health outcomes It's associated with being if you walk faster you're probably likely to survive longer for example so um right now um for the past two years we did it to try to apply his technology in older adults and here we have a picture of his um specialized treadmill in um his laboratory and what we see is that that treadmill is not like the one you see at the gym this treadmill moves when you move and you can see a line in between which means that each foot is moving the one side on its own so there is it's uh kind of independently moving and this man is donning on one of these masks to measure his metabolic rate so what we found is in our 10 adults older adults all over the age of 65 we found very similar results in that their gate speed increased and the metabolic efficiency also increased so it required less energy to walk faster but what we found also was what we see in other studies when we bothered to look at older people and the that the results are more variable they weren't as uniform supporting this idea that there's a lot of heterogeneity if you're lucky enough to get to be an older age so we are now have submitted a grant to hopefully expand this study to develop this technology to be able to offer in the future maybe not the too distant future and I actually donned these exoskeleton boots because I really didn't have a great idea of what was going on but I um in one session he said I was a fast learner I walked much faster I didn't put on the mask but it feels kind of like ice skating if you've ever been ice skating it feels weird at first not so comfortable but then after a while you don't even know and you're walking that much faster and it's it's kind of cool all right so um the second area that I'd like to spend time talking about I actually started when I was back in UC San Diego and I'm very fortunate to be a part of a very large study of older men that started back in 2000 they had to be 65 when they entered that study and it was a study for osteoporosis but in 2014 about a thousand of them agreed at their next at the fourth Clinic visit to donate their stool for study and I'm going to share some of the results from those older men because not there's a lot going on in the microviome but not so much in the oldest old and so this is a very unique data that we have and have been able to work with so um why gut microbiome well I think for most people I'm going to put this under the category of what matters like maybe if you're regular with your excrement every day you don't think about it but if you get too much diarrhea that's definitely not good and if you get too much constipation it's not good so and a lot of us have experienced either of those things at one point in our lives so um Professor Knight Rob knight from UC San Diego is a world expert in the microbiome all things microbiome like the microbiome the cheese the microbiome your skin but also the microbiome of your gut and he taught me that um it's estimated that we have about 39 trillion microbial cells on our body and most of those microbial cells exist in our gut it's estimated that humans have about 30 trillion cells so if you counted us as human by the percentages of cells we have we'd be about 43 percent human likewise with the advance of being able to do DNA sequencing we estimate that there are about 20 to 20 000 microbial genes and for humans maybe 2 000 so if we count ourselves as human by the amount of genes we have we would be considered about one percent human um but this is actually not a trivial point in that if um it suggests that if we look at this by genes and how can we change things to live a healthier longer life maybe we can change the microbial genes that exist within us and that would be a lot easier than DNA editing of our own genome so um with increased longevity we have really seen you know you've heard probably in the beginning of the 1900s estimated life was somewhere around 50 expectancy and that's more than you know about close to doubled and why is that why is why why are we living longer well I think we can really credit the the an invention of antibiotics and vaccines and with these two things we've really been able to most of us survive into adulthood but with that industrialization there has been come a microbial crisis so we're not getting so many infections except the pandemic thing so many infections but um uh we have seen an increase in obesity diabetes chronic diseases heart disease cancer Etc and some of those things have been linked to the gut microbiome um so what did we see in these men these men um one of the things I do is bone health so I was very curious to see a lot of my patients who come to see me say well you know doc how much calcium should I take and I know that vitamin D is important to absorb the calcium so my patients actually gave me the idea to ask that question so we we looked at the vitamin D levels in these men and also the active hormone vitamin D so the one you get chipped by your doctor is this storage form and what we found in these men is a storage form a vitamin D that your doctor measures to say you're deficient or sufficient had nothing to do with the microbiome it was a flat line but the active hormone that we know that binds The receptors and the get the vitamin D receptor was very highly correlated with a better gut microbial Health meaning that the there was a wider range and of bacteria they were more diverse in their guts and also particular types of bacteria that went along with a higher level of the active hormone of vitamin D um also with collaborators we looked at um kind of Health and Longevity in these older men and what we found was that the men who were in the top third of their class and they were 84 at this time meaning that they self-reported their health as being good they could walk faster they got around they had much better life space mobility and they were on pure medications those men not only survived longer the gut microbiomes were also healthier meaning more diverse and the last study that just came out this spring we looked at sleep in these men we had armbands that they wore for a week and we looked at their sleep patterns and in fact what we found was a signal where the men who had the most diverse gut microbiome had were also the ones who had better regular sleep they had sleep regularity meaning they were more likely to go to bed at the same time and get up at the same time every morning and we also had a questionnaire that's been validated where they also that would they were better sleepers in general so you might ask which bacteria could these um be they turned out to be the bacteria that metabolize resistant starches into short chain fatty acids and particular butyrate producing bacteria and these bacteria are common across all of the three studies that I just mentioned so that study only included predominantly white older men who are now 88 and we're very excited because those who have survived have come back and given another stool sample so we'll be able to see what how it changes with activity what's going on so we're learning a lot from these men so thank you Mr Rossman across the country but it doesn't address the rest of us who don't happen to be in that age group so there is this American gut project that was started by Rob Knight down in San Diego it's a crowd funded project you pay money and then you get to give them your stool and all these samples and answers are a thousand questionnaires but one of the things that was really important in this slide is courtesy of Rob Knight by the way is that they found that people who reported that they ate 30 more than 30 different plant Foods each week compared to those who could only list 10 or fewer had much healthier gut microbial profiles and so this is a project that you had to see I think you had to be 18 or over and there was no upper age limit so really supported this idea of fresh fruits and vegetables and I kind of joke gosh can you even think of 30 different fruits and vegetables but it is possible because it includes seeds and Grains and legumes so you'd be surprised you couldn't get to 30 it's not that bad um and but um the other thing that they were able to show was what types of bacteria did these people who had the healthier gut microbiomes have um they had the bacteria that produced the short chain fatty acids so I'm going to just return back to that I forgot to ask um about those two women who you saw earlier and you saw the slide and I didn't even reference to them but basically they're both age 74 and I wanted to ask you before do you think that supplements had anything to do with the difference in age span that they they they're the same chronological age and yet they look like they're from different decades so um the one on the uh the one who had all the muscles she actually has been interviewed she's turning 87 next month and she looks pretty much very similar if the picture was up to date she does not use supplements okay but she does eat a healthy diet and she obviously works out with weights in fact she's now she's famous for that um so circling back on also the beginning of what Stanford stands for in medicine we really the dean has really pushed this idea and we're well equipped to um push the envelope for precision medicine um and I when I think about that um what does that mean if or Precision medicine to treat diseases and so diseases is in there but what if aging is not a disease then what does that mean so I've been going around saying I think we should think about it reframe it as Precision Health Precision Health to help us and in geriatrics we don't think about chronological age we really try to think about functional age and we see that heterogeneity in our patients every day so I can cite studies as a researcher but all my geriatricians know that to be the truth so I want to thank you very much for your attention and if you have any questions um I think Jeff oh one thing though I must said a shout out to Jill Stanley and thank um to thanks to all the organizers of Health matters for being here and to all of you for showing up on a beautiful Saturday morning thank you so much thank you thank you Dr Cato you're in the future terrific so we do have a number of questions yeah we do have a number of questions already from the audience and just as a reminder there's a QR code on your program or if you're online it's on your computer screen so I'll go ahead and launch into the questions and and it'd be fun to hear how you put these in the context of your forums to matters Mobility memory medicine okay and uh and and I think we're all on this path to maybe it's finding uh the Fountain of Youth which is elusive but maybe it's about the journey and how do we translate your studies into practical day-to-day life um so how does sleep impact healthy aging and what are some practical tips for improving the quality of sleep and if you don't mind adding a little bit about the power nap the power nap okay great question well sleep is extremely important and there are a lot of experts here at Stanford who spend a lot of time thinking about this it turns out that circadian rhythms are very important for even our Gene function and and that regularity that I pointed out is probably a marker of health and so so it does impact aging and healthy aging and I guess practical tips that I've learned from some of the talks that I've attended here on sleep by the experts are one sometimes we get worried because we know that oh my gosh I have to be somewhere tomorrow and I'm I'm awake and it's 2 A.M this is terrible I'm just not going to be functioning and then it kind of becomes a cycle that you're not asleep and you should be sleeping because you know it's good for you but in fact what we see with these circadian rhythms that is that all of us if we actually listen to our bodies do have these period kids where our thresholds to fall asleep lower so we tend to fall asleep it just becomes problematic but it's more in the middle of the day but to answer your question about power naps if you have you know you're tired you also need to listen to your body so I think it's okay if you need to take a a short rest and by power nap I'm assuming you mean something like 15 20 30 minutes at most but yes and then the other thing I'd like to say about sleep is one I learned from one of my colleagues is that they you know a lot of people take something like Ambien because they can't sleep right and it says in the bottle and your doctor says you should not be on this medicine for a long time but then you're like if I don't take it then I can't sleep and so it becomes this crazy cycle and what they did is they actually compared in a trial Ambien users versus cognitive behavioral Sleep Therapy and what they found over six months is that both groups improve their sleep so if you took the pill you slept if you participated in the cognitive behavioral therapy program you did better and then they stopped what they were doing because the study was over but they bothered to follow them up at a year and guess what the people who were randomized to the Ambien had recurrent sleep problems but the people who participated in the cognitive behavioral therapy were still having a continued good sleep so those are things I'll say about sleep so behavioral practice matters absolutely so can you talk about other practices that that you suggest oh one thing I forgot to mention in the talk was today we're really fortunate to have experts in nutrition and the gut microbiome and cooking to come here so I will first say diet is important so I put it in the context of the guy got microbiome but I like to tell my patients you know what you put in your mouth your body has to process so you should be thoughtful about what that is and in general we know from multiple studies from blue the blue zones if you haven't heard of those those are areas across the world where people are known for their longevity they tend to eat fresh fruits and vegetables daily and they minimize processed foods so diet is one the next thing is mobility right in the context we really need to be mobile so that old adage use it or lose it is totally true so really using your body on a daily basis not only worried about Mobility but also balance that can get worse with aging and really is challenging yourself in terms of balance so you can avoid the fall all and then the fracture other or other injuries and then fermentation actually thinking keeping our minds clear there are multiple things that we can do there so diet and physical activity are actually important for both of those things and Studies have demonstrated that but also attitude and purpose and getting out doing things happiness and I forgot to mention that I wanted to end by talking about some of my centenarian patients and what are the things that they do and what I've I've learned because I've learned a lot from my patients over the years is that all of them 100 percent have faced some significant adversity throughout their lives a hundred percent and I would say 100 of them are pretty resilient so resilience and attitude not a hundred percent this is what made me think about it is that those who are doing the best in terms of my 95 to 100 plusers are those who have this amazing feeling of optimism they just are optimistic and I'm thinking about a patient who's a vet who came to me because he had a vertebral fracture but then was worried that he had to go see his wife who was in the hospital at the same time and I said well how old is she and he said oh she's 86 and I said wow you've been a cradle robber but actually um he he this was his second wife he lost his first wife to cancer when she was 50. and this other woman had only convinced him to remarry when he was 80.

so they had been married they were hiking Partners but he was someone who I found incredibly optimistic he served in World War II was shot up had no skills he said when he came back to the U.S in his early 20s he had no skills accepting you how to kill people and he uh and yet here he is he was just an amazing guy so optimism is key and purpose so he had a purpose so that's just a little quick thank you there's more stuff but from the audience do you have research on measuring biological age or the impact of interventions on biological age yeah so that's a good so bio so as a geriatrician you can see I'm biased I'm talking about functional age but I'm happy to go with the biological age I do have a small study where I was looking at women who had been newly diagnosed with breast cancer and was was concerned about what the impacts of certain types of chemotherapeutic Agents were doing to the rate of Aging so we did we I wanted to look at telomere function but that was not feasible and real it was feasible in the cultures and the mice but not in the humans when we tried to look and also on DNA methylation patterns which have been linked to biological aging on the clock so yes I have research has it really informed practice for today I would say it's a little bit far away from that what do you suggest here's here's one for practice what do you suggest for maintaining sexual health and libido into our later decades what a sexy [Laughter] I'm going to say you can lead a horse to water but you can't make them drink it um I would say um it has to do with desire so I'm thinking about geriatrics patients I had at UC UCLA I had there's one older patient and his wife was my patient too and he's like my God she wants so much sex I don't know what to do Dr Khana was just normal you know so I think it does you know I think it's we don't talk about it enough because I think in Western culture there's kind of this taboo sex but in fact sex is alive and well for those who are older and wanted um but cardiovascular health is also important for that so if we're doing that I I suggest you get out and take a good walk you run you watch a sexy movie uh you think about sex all that will be more likely that you'll engage in it and then you hopefully find an attractive partner too terrific thank you let's go to building muscles what do you think about exercise for building muscles how does that relate to bone density and and then when it comes to replacing joints how does the artificial knee the artificial hip and maybe in the future other artificial joints how do they help us with a healthy long life yeah so the majority of my research up until about 2016 was in musculoskeletal aging and my practice has been an osteoporosis and Metabolic Bone Disease and I'd say for the past four or so years I've really been focusing on the muscle and how important muscle strength and function is for bone health there are a lot of biological similarities in terms of signaling whether it's hormones or growth factors Etc that are common between the muscle and the bone and they're directly opposed so it makes sense that there should be communication also my patients have taught me that if they fracture and they have good muscle they're going to recover from that fracture it's not a downhill spiral necessarily so if one is injured it's really good to seek expert help and oftentimes that would mean seeing your physician a physiatrist a physical therapist and it in particularly if you're older to realize that you can cover from this and I love to use top portion Lynch for those of you who don't know her she's the Guinness Book World Records holder for the oldest yoga teacher at age 93 she made it to 102 but I loved it because there's a picture of her balancing on her wrist like this at age 93 or 5 or something like this something that I cannot do until this day and she said you know I had a wrist fracture I had a hip fracture and all these things so what you need to do is get help to learn how to sometimes our bodies compensate on our own and we'll just say oh we'll just ignore the shoulder enters for instance and not work on it because it hurts you really need to work on it you need to work on that area keeping the injury in mind but also knowing that you can recover from that injury and the joint Replacements work so if you're if your doctor is saying well you know what I've got an x-ray you are bone on bone and you're thinking it hurts to walk 10 feet this is probably the time to think about getting a joint replacement thanks you've mentioned yoga I know there are several yoga sessions with the program today and meditation how what are your feelings on meditation and yoga okay I'm the worst meditator I'm just gonna say but um I think it has a place I think uh being mindful of where you are in space I tell this a lot to my patients that a lot of those Falls that happen are because we're not being Mindful and we're thinking about the next thing so mindfulness is something that really is Paramount when you're meditating meditating I think right it's actually supposed to somehow ignore all those racing thoughts that are going through your head and your standings I don't know it's tough but meditation is is really good and in terms of yoga I personally am a yoga doer and I love it because it allows one to work on balance core strengthening just have to be a little careful because some people get really excited and then they want to be the pretzel in the class and that's when I see injuries maybe men more than women so just this is why you have to be mindful when you're doing your yoga to really listen to your body and do what feels right but if you don't feel safe to stop because if you do get injury it is a setback and you have to get back to where you started so avoid the type a yoga next question about alcohol and its effects and this leads to and its contribution to memory loss to mention but maybe there are two different topics alcohol and then we can talk about memory okay alcohol um oh okay I'm just gonna put the disclosure I really enjoy drinking okay so especially with you with the food but I do think the preponderance of uh I'll take from my geriatric patients moderation is good right so um for some people maybe any alcohol is not good but for others it may be good and a lot of the studies of large populations had suggested that you know a glass of wine or two a day over a lifetime is associated with Better Health but there and then getting beyond that there are plenty of studies suggest that with more drinking the risk of cancer in particular for women yes memory decline Alzheimer's could definitely go up breast cancer a lot of things are negative that are associated with alcohol as well so um it's a uh it's it's a personal decision but I will say that I definitely am mindful of not overdoing it and certainly binge drinking is not great and in terms of dementia Alzheimer's are there any real preventive practices such as you know the crossword puzzle or games or or learning just continuous learning yeah very important I think one thing we don't realize about our brains we kind of think of us as getting as we age more restricted in what we do but the brain is a very is a how is a very plus plastic organ it can develop new connections and I think one of the things that I learned from going to chamento Italy in an aging study is they these nice people who are 95 and 100 allowed us to go into the country and measure their brains with MRIs to see and I think the neurologists there as well as the people who are from UC San Diego we all kind of opened our eyes when we saw the brain image of this 99 year old who is still driving in the roads that I wouldn't drive in who was doing came back chairs as his professions still were hobby I guess and his brain looked terrible it looked like there was no brain in his MRI but clearly he was functioning and I think that's what Jerry attritions really appreciate is that we can measure these things though you look like you have terrible degenerative spine disease and you're like oh my god what happened but you can look at that same x-ray in somebody else and they're fine I've never had a day of back pain in my life so the measures are helpful but they're not that's not what's important as we age I think thank you next question is about severely limiting calorie intake and does a strict calorie diet really help with longevity okay I I will say that I was at UCLA with Roy Walford who was one of the earliest proponents of caloric restriction and and did practices on uh to to with this idea that you don't want to have too many oxidative products in your body so and then they did this is the one where the study did come out actually they did primates at the University of Wisconsin one showed no benefit but then I think the later one oh yes the the poor monkey who was caloric restricted did survive a bit longer but I always joked when I equipped to my husband I saw the picture on the New York Times like well that one doesn't look very happy yeah so um I don't know I I think it's a little extreme I can bring up something else though that probably someone's thinking about which is now a lot of people are doing um intermittent fasting and uh that I'd say that's the latest fad right now and I think there's science to back it up particularly in Mouse models and things like that uh the one randomized controlled trial that came out earlier this year that was done in China didn't seem to show a benefit but then again you know I think that's why I talk about heterogeneity in people because we each come from our different circumstances and we have different underlying beliefs so I'm thinking whatever makes someone feel good I don't think it's unhealthy for you but I personally like to eat when I'm hungry but if it makes you feel better and I've had a lot of patients saying oh I lost like 30 pounds by you know cutting out breakfast but breakfast is my favorite meal but you know whatever suits them so you mentioned we're all different people what what's the role of genetics and then if you know your genetics great then what actually so one of my colleagues Tom pearls did do a centenarian study and maybe like a lot of diseases like osteoporosis for example we know is an inherited disease what's the G it's a complex inherited disease so I think it's been great that we can sequence the human genome but it is not your it's not your path of what's necessarily going to happen to you health-wise so we have control yeah I think we we'd love more control but we do have control we have control of our actions and uh they and certainly those can affect outcomes because there's all this whole field of epigenetics right so what genes get expressed and what don't discuss are influenced by our environment and our actions absolutely the next question I think hits the heart the heart of much of your research can my bone health be improved without medication okay so the answer to that is yes it can be improved without medication but does that mean that you shouldn't take medication not necessarily because uh starting in 1995 we've had FDA approved medications that really help people prevent fractures by about 50 but it's never the first thing I talk about with any of the patients who've ever come to see me it always begins with lifestyle what are you eating for breakfast lunch and dinner to the point where some people have actually complained like I don't understand what Dr Kato cares about you know what I eat but um it you know diet matters for bones as well as and as so does activity so um yeah thank you can you comment about nmn and NAD and Longevity oh yeah so um so there's a product out there that you can get by a company I think you can pay 60 a month or if you buy more you could maybe get a discount that uses n m and uh to promote longevity and it's been developed by really famous people Nobel laureates and in fact maybe they're even taking this compound but if you look so this is this works in animal models right but does it work in humans so what what advice do we what um what is the evidence in humans well they studied 120 and randomized them to their basis it's called basis versus placebo and guess what their NAD levels went up in their blood and it was correlated with how much they took so like it works the problem with that is that they also looked at things like metabolism what's your glucose level what was your blood pressure did you walk any faster and there were no differences between the groups and we've seen this a lot in medicine right where we get excited about something so back in the day we used to think about homocysteine as being a big risk factor for heart disease stroke and maybe even cognitive decline and you can lower homocysteine if you take vitamin B vitamins and certainly if you give people vitamins against Placebo their home assisting levels will go down so it worked but you know fast forward another 10 years when they did about 11 randomized controlled trials around the country no world I'm sorry and they saw no benefit in terms of cardiovascular disease or stroke or cancer so we don't measure homocysteine so much anymore and can you talk more about how these the medicine and the interpretation and the practice all goes fads in and out of favor over time you touched on it earlier yeah well as you said Jeff I I don't know I think I've forgotten my talk to talk about about the fact that whether age is a disease has been an age-old question for centuries and we've always been looking for the Fountain of Youth so you know Seneca the Roman philosopher said age is old age is definitely a disease and Plato said no um so I remind me your question again oh just about the fads the fads in medicine and the feds and the way people so so there have been fads over the centuries and um skanski who's from the University of Chicago and and a longevity expert did a very nice job in one of some of his writings talking about the different people who've proported different things that could expand lifespan and um you know unfortunately not the the longest lived one was I think he did live to 98 in the 1400s and he did talk about diet as being important and also like not being over indulgent so if King Henry VII was not the way to go but um yeah so I think that's life life cycles through history you know I think you've already mentioned vitamin D but how can you measure the vitamin D levels and how do they actually correlate with health and aging we're like different lectures okay vitamin D is actually complicated so the one we measure clinically is our bodily storage form that's very stable and I am more and more convinced that it's not a really good marker of very much except in certain extreme cases you know specialized cases um and basically um they keep on moving the question can you go back the question about vitamin D yeah yeah at correlate with health so the level doesn't really correlate with health and aging we've done studies in multiple populations that have been on both sides um so it it in itself but I'd say with the negative trials that have come out and 25 000 people for bone health and everything else there are two areas that are interesting one is in immunity there for the active hormone very important for immune function I do believe that and it is important for bone health if it's really too low we develop rickets for example in soft bones okay we're almost at the end of our time but maybe two quick questions um one if someone is from the audience if someone is on meds it's difficult to exercise how do you start if if you want to live a healthy life how do you get back on track I love this question because sometimes people come in and they're like oh it's all over now I've never I haven't made great decisions and it's just too late but studies actually show that you can make a decision at any time it's your choice and that people can make these changes uh late in light in life and sometimes see the greatest benefits so you probably would go to see a specialist figure out which medications are really necessary which may not be and then to start slow you don't want to just dive in right away but have this attitude that it's possible and begin slowly with each day and say today is a new day and I'm gonna I set a goal that's obtainable and you might surprise yourself so that woman who was the muscle builder she didn't she was not a regular exerciser until in her 50s she lost her sister from her brain aneurysm and that changed her Outlook in life and you can see where she is at 87 now well we have so enjoyed getting to know you listening to you and having you answer these questions so one final question what tip would you have do you have for your children on what to do now to live a nice long healthy life yeah so in geriatrics we say everything is multifactorial but you said tip so I'm going to just say one and I think it applies I I think for what regardless of what age you are um to really think about purpose that that if you have purpose then that is a great guiding force to everything else all right well thank you very much [Music]

2023-06-07 06:27

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