Ep.07 / Unlocking Longevity: The Science of Living Longer with Dr. Mike Roizen Chief Wellness Officer, The Cleveland Clinic

0:04Hi, today I'm incredibly lucky to be chatting with Dr. Mike Rosen, originally an anesthesiologist and internist and currently the chief wellness officer at the Cleveland Clinic. He's a pioneer in longevity, an award-winning author, has many number one New York Times bestsellers and is famous for developing the real age concept that suggests you have the power to lower your biological real age beyond the number in years. I have to say I've used things like Mike, the Real Edge Test in presentations to talk about health, wellness, etc. So I'm incredibly honored to meet you and have the chance to talk to you.

0:52Natasha, I'm the lucky one and the honored one. So it's reversed. So thank you for letting me be here with you. Amazing. Well, Dr. Mike, thank you so much for your time. There are so many things that I want to ask you. I've written some stuff down to try and keep me on track and I know that I have to really stop myself from just asking tons of personal health care questions. I'm assuming when people meet you they suddenly have all these questions that are about them in particular. I'm going to try and pull up. So I'd love to start with one of the things that I'm so impressed by is that you obviously have a purpose.

1:35You know, your career is focused, purposeful. Can you talk to me about that experience that started it all off that made you realize at nine years old that you wanted to go into healthcare and be a doctor? Yeah, so when I was nine, as you said, I was sicker than what I considered the sickest dog I'd seen and clearly had a fever and was not doing well. A physician, a pediatrician named Dick Fisher, visited our house, gave me a shot, and within six hours I was outside playing again. And I said, geez, I want to do that. Helping people feel better is what I want to do, and that changed my life. So out of sickness came my purpose, if you will.

2:35And then it really changed again when in 1979, I was asked to be the co-chief of cardiovascular anesthesia at UC San Francisco, University of California, San Francisco. I'd wanted to run an ICU in my life, which is why I trained in both anesthesia and internal medicine. There weren't intensive care training programs at that time, so I did both. And I was running a step-down ICU, my perfect purpose, what I wanted to do all my life, and they asked me to do something different. Not because I was so good, but the surgeons were difficult to work with. So I met with them, and all they cared about was return to wellness of the patient, which was an ideal thing, right?

3:28It was how fast the patient got back to work. So it was like my goal. I got the data from California. They kept all the data since 1970 on cardiovascular procedures. and I found it wasn't cardiac function or brain function or kidney function or liver function or lung function, all things which people had hypothesized determine when people returned to work, but it was their age. And so I started on a thing, how do we make people 10 to 20 years younger in the two weeks surrounding their operation? Because it was a threefold difference. That is, a 75-year-old had threefold the risk of a 65-year-old, ninefold the risk of a 55-year-old.

4:15And so I said, how come this stuff isn't known that we get to change our rate of aging? From that came the concept of real age. I moved to the University of Chicago as we had brought trans esophageal echo. I did a whole bunch of crazy, innovative things, right? We moved to, and so I started, there were only three transesophageal echo machines in the United States. We had captured all of them at UCSF, and I got two of them when I went to Chicago as chair. So we started that, and the crazy part of this is I got to care for in executive health. So I was running executive health as well as anesthesia, critical care and pain management at the University of Chicago, a Nobel Prize winner named Gary Becker.

5:17Gary had done the net present value of investments as is how he won the Nobel Prize. I asked him to help me with net present value of health choices from aging. And that's how real age got born scientifically. And so it was a series of, if you will, lucky events that got me to be able to help people stay younger longer. And now with the potential breakthroughs, we don't have any yet, but potential breakthroughs in aging research, not only can you be 20 or 30 years younger than your calendar age, you may be able to reboot to a real younger age. and get another shot at your 30s and 40s. Yeah, I'm going to ask you about that because it's pretty incredible.

6:11I think you were saying now that 90 will be the new 40. Well, 90 could be. Let me go and be careful. So I'm trying to be, you know, I'm a scientific nerd. I apologize. So right now, you can be as much as 30 years younger than your calendar age physiologically at age 75. So a 75-year-old can function as a 45-year-old. To get the extra, that is, can you be 40 when you're 90, we need a scientific breakthrough. There are 14 areas of research into the mechanism of aging, which have been able to do that in at least two animal species. And that's all now in early trials in humans with 14 shots on goal.

7:03When I asked one of the Toronto Raptors, if you will, wingman, where I was up in Toronto last year, if he had 14 shots on goal with only the goalie between him and the goal, what's the chance he would make one? He said 100%. Amazing. I think it's probably only 80 % chance with medical breakthroughs, but I think there is an 80 % chance that we'll be able to literally turn back the clock if you stay young enough until this happens. Amazing. So what are those big 14 areas? Oh, you know, there are, you know, I almost have to get a slide out to go through, but the key ones are epigenetic reprogramming, senolytics, and regrowing your stem cells.

7:55Let me go on that last one first. So we only, we repair ourselves naturally, but we run out of our repair system, which is our stem cells, as we get older. Let me relate that to you. So we have stem cells that are pluripotent. They can turn into anything. Stem cell, we started with a stem cell and it turned into a neural brain. It turned into a heart cell. It turned into a lung cell, a kidney cell, a muscle, et cetera. And so they are pluripotent. They can turn into anything. When you have a heart attack, if you get to a hospital fast enough, they open up your blood flow to that area of the heart, you send out a signal called an exosomic signal, which calls forth your stem cells coming.

8:47And if you've got stem cells, your stem cells come to that area and repair the heart. We learned this when a male heart was transplanted into a female person. She had a heart attack. That is, the male heart had a heart attack. and initially her ejection fraction, the pumping function of her heart, declined from about 60 % to about 30%, even in this transplanted heart. But over six weeks, it regained to 55%. And when they looked, when they did a biopsy of the transplanted heart, they found it wasn't male repair, it wasn't male cells, but it was female cells, her female stem cells that had repaired it.

9:31She had some left. Amazing. We only get about 70 duplications of our stem cells because of a thing on the end of our cells and the end of our chromosomes called a telomere. Yeah. Well, so the telomere gets about six base pairs shorter every duplication. I'm giving you way too much information, but it means that we only get about 70, sometimes as much as 100 duplications of our stem cells. And then we run out of them and we can't repair things as well as we could. So one of the areas is saying, can we regenerate those stem cells without causing a runaway, if you will, cancer or something else and have repair ourselves forever?

10:21And the answer is, at least in rats, mice, and now dogs, it appears you can do that. And one of the companies I've been consulting with seems to have a drug that does that. So there appears to be an ability to have much more repair processes. Same thing happens in the brain. You open up the blood flow to the brain, you can get stem cells there and repair it. Same thing with your knee cartilage, et cetera. Interesting. And the knee doesn't have as much blood flow. So that's just one of the 14 areas. Another is what we call epigenetic reprogramming. So these are why do we get old? Maybe the switches that control our genes change over time.

11:15And in that process, excuse me for looking around, but in that process, if you will, we have epigenes that control our genes. So our genes, when they first did the Human Genome Project, cost$3 billion. And they thought they'd find 300 ,000 genes. They only found 22 ,000 or so. They call the rest of the DNA in your nucleus junk. It turned out eight years later, the ENCODE project found it was epigenes. And the epigenes are much more vulnerable to change than your genes. But they turn out to be switches, like a rheostat on the wall that controls your genes. All genes do is produce proteins. In the latest twin studies, as much as 93 % of your gene protein functioning, manufacture of proteins, can be controlled by your choices in manipulating that, in your changes to your epigenes that you cause by food, stress management, exercise, etc.

12:30I love that you've said that... And so one of the theories... Yeah. I'm going to go on too long here. I apologize. Natasha, but I'm going to finish this one and then you'll get to ask me anything you want. But one of the guys who won an author Nobel Prize, Yamanaka, figured out that there were four genes. If you turn them on, they repair your epigenes back to the way they were when you were much younger. and the problem was that in doing that they got the mice, 20 % of the mice became cancerous within the equivalent of two human years but now six groups including the Google moonshot group called Coleco, one of the aptos groups as well is now figured out that if you only turn on three you don't turn on one of the genes in that that you can reset the epigenes and at least get mice and rats and guinea pigs much younger without developing cancer.

13:44So that's a second of these 14 areas. Amazing. I do love that you kind of talk about everyone being able to kind of be their own gene engineer, everyone having the capability to do things in their everyday to change their outcomes, to be healthier longer. You know, there are so many. That's right. You are the most powerful genetic. You control 93 % of the proteins you produce. We know that from the studies. And And by the way, why is this coming so fast? Because I told you it was about$3 billion to do it, a little over$3 billion to do the Human Genome Project. That same amount of science to get your genome now for the same degree of SNPs is$40.

14:35Yeah. So an 8 ,000-fold reduction in the cost of doing this type of science is why we're getting this exponential growth in it. If it costs$3 billion for one genome, still we'd never get it. But at$40, we're learning a ton about the mechanism of aging. What's your view on things like people that might have the APOE4 gene and linked to Alzheimer's and stuff like that? Do you still believe that people can do things that can prevent Alzheimer's even with that genetic? There are two approaches to that. One is where we will be in five years, which is you'll get a Casper, Cas9, or some other gene editing thing derived from Casper, and literally edit that gene out of your brain, the E4.

15:39Now, the other thought is right now there are 40 things you can do that change your rate of brain aging. Everything from practicing speed of processing games to making sure your blood pressure stays normal to having half a tablespoon of olive oil a day to, you know, They're listening to four, if you will, smelling four different smells a day, etc. But there are 40 things you can do now that slow your rate of brain aging significantly. And we don't have data on all of them put together. But we do have data that look like they may not be quite additive, but are clearly complementary. so that, for example, doing brain games and doing physical activity prevents at least 50 % of your risk.

16:45My guess is with food, brain games, exercise, a few other things, that you can maybe get up to 70 % to 90%, I think maybe 90 % reduction in risk. It doesn't eliminate the risk. So if the risk of someone with E4E4, the worst kind, is 80 % at age 85, you could maybe be down to 8 % at age 85. So I think we have a lot of things you can do to control your genes now. Most important is, you know, we call it the three Ps. It's really four Ps, but it's posse, purpose and play. So posse is having friends that help you manage stress. Purpose, which thank you for letting me share mine, which is helping people be younger, longer.

17:46And play is having fun talking to you is play for me. Amazing. I love how, you know, it's funny and maybe it's too much of a stereotype. but um you know you're a scientist you're a doctor but what I love about how you write and how you communicate is it's you met you make things very simple you come up with ideas like the real age tests that are almost branding ideas like you're a natural storyteller a natural branding concept person actually which is interesting how do you think you've kind of built up this part of your expertise, which isn't always the case with scientists and doctors. No, that's the thing we work very hard on.

18:34So I'm proud that you recognize that. I'll go how we write the books and then I'll tell you the story afterwards. So we write the books by writing the science for chapter one. So we're writing another book now and called You, the Owner's Manual of Solutions to Problem Seniors Face. It's about when do you move into a different home? When do you downsize? If your spouse dies, should you get remarried or just live with someone? You know, it's all when do you give up the keys, etc. So it's all of those things. But we write the first chapter. We've written the first chapter of the, you know, the 30 chapters in it.

19:22We've written that. We now go through at least one chapter a week very meticulously with three of us or sometimes four of us working to make it understandable, readable, fun. And so for at least 10 of the next editions, all we're trying to do is put in humor and analogies that are fun for people and make it simple. So it's really a lot of hard work to do that. Yeah. But that's actually what matters. if all I do is tell the science and no one changes behavior. No one remembers that I stomp on white bread, if you will, on a TV show to show that that's not what we should be doing. Yeah. Or, you know, if you will, or saying that the best use of Coca-Cola is cleaning out your toilet, you know, and show that as a video or analogy in the book.

20:20You know, it just isn't meaningful. So the problem is, if you look at it, is it's pretty easy for me to diagnose if someone has high blood pressure. It's pretty easy for me to prescribe a drug. It's tougher than heck to find the motivation that will get that patient to change behavior. And that's my job as a doctor. I think most of us as physicians have failed that mission. That is, our job isn't just to diagnose and prescribe or to tell people or inform them, but it's to do things that get them to change behavior. And so we spend an awful lot of time. And so I appreciate your recognizing that that's it, because we spend an awful lot of time.

21:10When I see a patient, I have 60 minutes with a patient the first time, and 50 of those minutes are trying to find their motivator, trying to find their motivation. Is it their grandkids? Is it sex? Is it their walking ability? Is it their balance? Is it their memory? But whatever it is, you've got to find it. And then I play on that every time I see the patient to get them to change behavior. That's what we do with our coaching program, too. We try and find your motivator, and we work like heck to play on that to get you to change behavior so that you will live younger longer, if you will. I love the idea of finding the motivation and then building habits to create behavior change and starting small.

22:08What are your top recommendations for things that everybody should be doing? Well, I've said the most important are posse, purpose and play. Got it. And then the next set that people usually want to do is something in the physical activity. But what our usual plan is 25 to 30 things, and we ask people to choose no more than three to start with. Some people will start with hormone. A woman might start with a hormone replacement in aspirin if she's at the start of menopause and having trouble sleeping. A guy may start with a supplement of coenzyme Q10. but many start with step or step equivalents.

22:58That is, one of the most important things that is people feel they're doing something accomplishing is they get a step counter or pedometer or get their phone since they're on every phone and get up to the 10 ,000 step per day level. It was initially derived by a Japanese pedometer manufacturer, I think, to sell pedometers, but maybe he knew the data because 10 ,000 step or step equivalents is the minimum for all-cause mortality and is the minimum for brain dysfunction. After that, you may get fitter or you may get some other benefits, but you don't decrease your risk of brain dysfunction or other things.

23:50We often will go through something simple in addition, like doing one or two minutes of balance exercise. But as I said, the most important is cultivating your posse. Call people who you know. Find friends. And what you want to do is find six friends that you can be vulnerable to and that really are your posse, that really are those people who will support you. So posse and then finding your purpose. And so, Natasha, my purpose, you're helping me so much with my purpose because it is helping people live younger and longer. You mentioned HRT. And as a woman, I have noticed that, you know, the past couple of years, obviously, there's been a swing back towards HRT.

24:44What's your thoughts on the controversy? Look at our book from 1999. We wrote about the benefits of it and the problem with the Women's Health Study. Yeah. So the Women's Health Study really, I think, turned back progress by 15 to 20 years. It was useful in some ways. The progestin used in the most common medicine, PremPro at that time, which was the one used in the Women's Health Initiative antagonizes the effect of estrogen. So we learned that in a big way, and hopefully PremPro is not the choice of most physicians. I still see patients with it, and it's not the right choice because an acetated progestin seems to antagonize, at least scientifically, antagonizes the effect of estrogen, bioidentical or otherwise.

25:43But there's a clear, if you, the risk of HRT is increased clotting. So baby aspirin is an appropriate choice if you, to add to it, if you don't do extreme sports, that is have a risk of bleeding. So all of this should go through your practitioner before you do it. But HRT decreases the risk of fracture of the hip and spine by about 15%. That alone, if that's all it did, it would overwhelm the side effects. Yeah. It also, though, probably when you've added the aspirin, decreases heart attack, decreases stroke, decreases dementia, decreases breast cancer. So I am a strong believer. I just got asked a question for, I'm on a transformative age podcast on Wednesday, and I just got asked a question by a woman who's 70 years old and said her doc wants her to stop because it's been more than 15 years she's been on it.

26:54I believe that when we get the data, it will eventually show that people should be on it, women should be on it for the rest of their life. maybe men on testosterone plus baby aspirin as well if they've got a low testosterone level. So the point is, if you look in the first You, the Owner's Manual book, which is 2005, we looked at the benefit, risk, and aging effects. And I think it makes the average woman about three years younger just by the data. not even including the fracture risk data, which wasn't published by that time. But with the fracture risk data, it makes you about eight years younger.

27:44It's an amazing benefit for that. We don't know how long it lasts. It clearly lasts 15 years. Whether it lasts for the rest of a lifetime, I'm a believer in that. But it is not firmly established scientifically. Why do you think that wellness and longevity, you've obviously been talking about it for many, many years. Why do you think it's suddenly starting to kind of spark people's imagination? It's being covered in more mainstream media. Is it because there are more ways to find out about it or more technologies starting to happen? Well, it's like anything in medicine. It takes a long time in technology, too.

28:31you know, if you will, the URL for the cloud was invented and published in a patent in 1998, but we didn't get Amazon doing it till 2014. What is that, 16 years? Medicine is the same way. And technology is usually faster. But I think the, so one is our tendency to not get it widely distributed. That's happening even faster with social media. Yeah. But I think the other reason is there's a real dichotomy. You see obesity with its consequence of type 2 diabetes and cancer and dementia, heart disease, stroke, memory loss, all of those things occurring. And there are a group of people who don't get it.

29:21And their characteristic are they haven't gained as much weight. And the advent of the GLP-1 and GIP drugs has changed that so that people realize there is a benefit. You know, the problem with blood pressure control, which is probably one of the most important things, probably, you know, in an aging sense, almost twice or maybe three times as important as obesity, is that it doesn't have any symptoms until you're at the end, right? So it isn't outwardly, you know, you're not fat with it. Or you don't have to pee all night with it or have a dialysis catheter in until the end. So my guess is that the obesity-diabetes epidemic has given us an awareness that we can do a lot more about this.

30:26And the GOP-1 and GIP drugs have made it so that this is within the reach of many. And are you... Natasha, are you still in the United Kingdom? No, I'm in New York. So the United Kingdom has done something much better than the US in this. You probably know that. So the National Health Service is now offering anyone who is obese and diabetic the GLP and GIPs free. And they are buying them from the two major manufacturers, I understand, for$40 a month. Wow. They wholesale in the U.S. and your favorite New York, if you will, by$440 and$448. dollars. So we have to, we're paying an awful lot more for something that can really make a difference to people who think about food constantly.

31:28And that's, we have a, you know, the food, the large food manufacturers have figured out how to make it addictive to us. And our brains constantly think about food, a certain group of people. And that's where these drugs are most yeah you know and by the way they help with alcohol use disorders and they help with opiate use disorders as well so um we're now beginning to see and and if they were 40 dollars in america and available to anyone we would expand life expectancy by that alone by six years in the United States. So instead of being 74 or 5 and 79, it would be we'd have a life expectancy that was equal to or better than the best in the world.

32:24So we've got to do something about making these more available. But that's what's going to happen with the aging breakthrough. We think that there's a real chance that one of these medications or drugs or procedures that helps you get younger will cause a breakthrough and be affordable for almost all of us. Yeah, it's super interesting. I mean, there's a lot of different new drugs coming out, like in the kind of peptide world that people are starting to talk about on some of the kind of podcasts on health and stuff. Are there any breakthroughs or companies that you think are doing interesting things?

33:14I work in kind of marketing and innovation, creating new brands and business products. Well, I think a number of them are. So I'm going to quote. So obviously Eli Lilly and Nova Nordisk with the GLP ones and GIPs and there are other companies working on similar analogs to those that will also be very beneficial. There's a drug called HU6, which is Rivas Pharmaceuticals. I have no interest in it, but it increases metabolic rate and builds muscle. So one of the problems with the GLP-1 and GIPs, one of the side effects is if you don't do muscle-building exercise, They decrease your muscle mass disproportionately, and you stop losing weight and start gaining it as muscle is a very calorie-consuming item.

34:07So you need to do with those drugs physical activity in the muscle-building category, which is, I think, a good thing anyway. But HU6 may be a breakthrough in that. As I said, the company that I work with on drug telomere is Telomere Pharmaceuticals, which is the one that seems to have a drug that increases your ability to make stem cells. There is the area of therapeutic plasma exchange, and there are companies starting in that field as well. Lifespan Edge is one of those. And I think Fountain Life also offers it. There is, so there, and we expect, you know, the epigenetic reprogramming, we think, is in human trials, not reported to the U.S.

35:18clinical trial database, but in human trials overseas now. So we should be getting more data on a number of these 14 pretty fast. And each of them is really remarkable, right? I mean, just imagine if you had a$10 a month drug that took you back to, if you were 90, made you functional 40 again. It actually solves the budget deficit as well in the United States. It solves the social security problem. Yeah, aging population. But you've got to stay young enough, that is, you've got to stay healthy enough until it comes through. Because if you've got too much structural change, it's not reversible by any of the techniques.

36:05You can't have, if you will, what we call connective tissue replacing your heart or lung and reverse it. So that doesn't appear to be reversible yet. What about, I understand that there's, I'm sure there's some amazing kind of drug and kind of big pharma innovation going on. With more within the consumer world, we're seeing more and more kind of longevity products, whether that's supplements, like trying to go after Senolytics and things like the Brian Johnson blueprint, trying to, you know, create protocols. Let me go and tell you what we've, as you know, I do a real age calculation on these.