 Please welcome Dr. Abrams. So my story briefly, actually, as I tell it, I was studying to be a cancer doctor when suddenly AIDS came out of the blue and we didn't know what it was. We didn't even call it AIDS at the time. We didn't know what to do about it. So I became a champion of alternative therapies at a time when there was no conventional therapy. And then when we got our first conventional therapy, I said, hmm, this isn't very good. So I wrote all the chapters in all the AIDS textbooks about complementary and alternative medicine. And then in 1992, somebody challenged me to study cannabis, marijuana, as a treatment for AIDS wasting syndrome at a time when we didn't have any effective antiviral therapies for people with HIV and AIDS. So I said, OK, I can do that. I went to college in the 60s. So I fought the government for a while and ultimately won and got marijuana and money to do research, which gave me a very strong appreciation of the power of plants as medicine, which took me to the Telluride Mushroom Festival in Telluride, Colorado a month after I did my first ever jury duty and came home and said, I want to go to law school. But in Telluride, I met Andrew Weil. And Andrew described a two-year online distance learning fellowship that you could do with his program at the University of Arizona in integrative medicine. So I said, aha, I don't want to go to law school. I want to do that. And I did, and it changed my life. When I finished, I said, I'm done with HIV AIDS. What I want to do now is integrative oncology, working with people living with and beyond cancer and helping them to integrate these other modalities into their conventional care. I can't really do that at San Francisco General Hospital, where I'm chief, because as I often say for most of my patients, their cancer is the least of their problems. They're homeless. They have substance abuse issues. They have mental health challenges, where they're undocumented. And I can't advise them to eat organic and do yoga because they have much more basic needs. So I moved over, I took another position in this consultative integrative oncology practice at the Osher Center for Integrative Medicine, where I don't treat the patient's cancer, but I treat the person living with cancer. I like to tell them that cancer is like a weed and somebody else is taking care of your weed, and it's my job to work with the garden and make the soil as inhospitable as possible to growth and spread of the weed. And a lot of what I tell my patients really comes from Andrew Weil. Andy wrote the book called Healthy Aging. And he was once asked to give a talk that he couldn't do, and he asked, why don't you give this talk? And I think I did it. And then I decided, well, this is relevant to me in my life too because I am in the process as we all are of aging. So what I'd like to share with you today is what is aging, what is it doing to us, and I'm gonna review Andy's sort of 12 steps of healthy aging from his book of the same name. So aging can be defined, I believe this is the Marian Webster definition, as a state of existence arrived at slowly, or a series of disadvantaging events that normally occur in our bodies over time. Well, not very positive, but let's go to Wikipedia because they're the ones that know everything. So they also call it an accumulation of changes in a person over time. Aging in humans refers to a multi-dimensional process of physical, psychological, and social change. Some dimensions of aging grow and expand over time while others decline. Reaction time, for example, may slow while knowledge of world events and wisdom may expand. Research shows that even late in life potential exists for physical, mental, and social growth and development. So a bit more of a positive spin. But let me just review exactly what happens to our physical selves as we age and this'll be not for the faint of heart, so bear with me. But basically all of our systems age over time. Our skin becomes thinner, 50% of us have gray hair by the age of 50 and most men over 60 are partially bald. Tooth enamel is more prone to cracks. Tell me if you've had that one, yep. Our gums recede and old fillings disintegrate and may fall out. And problems ultimately with our oral structure leads to poor nutrition over time. Our eyes and ears, our lenses become less elastic and after 40, muscles controlling it weaken, causing us to need to get new reading glasses. Cataracts are very common in people over 50 as the proteins in our lens oxidize and become opaque. The walls of our ear become thinner and drier and nerves and sensory cells die and hearing declines 25% between the ages of 60 and 80 and nearly one third over the age of 65 have hearing problems. As somebody who turned back my hearing aids last year, I'm now told that I better go get them again because yeah, I went and the first audiologist said, well, if you don't get hearing aids now, then ultimately you'll be able to amplify the sound but your pathways for interpreting them will have disintegrated. So I went for a second opinion and they said the same thing but that guy made a mistake and he told me if you do this, that's the degree of amplification that you're gonna get from hearing aids. So I saved $6,000 and did this until my husband, Clint Werner, wrote his book, Marijuana Gateway to Health and we became panelists on different speaking engagements and one of the things that I have the most trouble with is hearing questions from the audience and Clint said, honey, if you don't get hearing aids and stop sitting up there looking like this, I'm not gonna get colonoscopy. So I got hearing aids but they only lasted for two weeks because I was rounding at San Francisco General Hospital and I was so proud because nobody noticed them but then I put my stethoscope in my mouth and I called the audiologist and he said I wondered if you use a stethoscope. I said yeah, well just because I'm a cancer doctor I still listen to heart. So I've turned my hearing aids back but we'll see if they come back again. With regards to bones and muscles, a lot of media attention to osteoporosis, both sexes. We think of it as a problem in women but both sexes gradually lose bone density after the age of 50. Our muscles lose size and weight in relation to the rest of the body and with our dwindling muscle mass, the body burns fewer calories increasing our tendency to gain fat. The heart, fatty deposits and scar tissue slowly accumulated in the lining of our blood vessels putting at risk for reducing flow to vital organs, having heart attacks and strokes, blood pressure increases. At age about 55, our lungs become less elastic. So how many of you have noticed as you're just doing some just regular walking or walking with the dog or going up a flight of stairs, you're breathing a little bit more than you used to and that's due to the loss of elasticity and the lungs decrease ability therefore to transport oxygen as well. Our gastric juices and enzymes decrease by age 60 and food moves more slowly through the colon. My mother lets me know this every Sunday when I call her in Milwaukee. Some nutrients are absorbed less readily. Our kidneys become less efficient. Our bladder muscles weaken. One third of seniors experience urinary incontinence and prostate enlargement issues are quite common as many of us are well aware. Reproductive hormones decline after age of 50 leading to the sharp drop in women that is known as menopause and in men trying to define this as a problem for men as well. It's being called andropause as our testosterone drops and these effects of this loss of hormones ranges from mood changes to loss of bone and muscle strains. Menopause causes narrowing of the vagina, thinning and drying of general tissues and painful intercourse which often precipitates loss of interest in sex. Impotence is not a symptom of male aging necessarily but less rigid erection and less forceful ejaculation are. And this of course as it says is a Harvard study that's why it's to the 0.1 digit. Your penis shrinks 19.8% as you get older due to the deficiency of testosterone which again this is an ad for testosterone replacement. I don't know how they did this study or how they were so precise in their measurements but you know that's Harvard. Unfortunately our brain shrinks by 10% between the ages of 30 and 90. The frontal lobe shrinks 30% and the hippocampus 20%. Our neurons become less dense and processing ability may wane but attention and language should not suffer. A nice quote, you may have the same size hard drive but the processing speed is slowing down. So cognitive decline is certainly something that is of concern to all of us as we age. I just yesterday started thinking about ordering one of those fight off senility supplements because I keep on, I think it's my iPhone just deletes things or puts things in the wrong place but I'm more not, I used to be very precise and I'm becoming a little more forgetful which makes me concerned. So what puts people at risk for cognitive decline? Certainly genetically the ApoE4 gene increases the risk of Alzheimer's disease but other medical problems, hypertension, diabetes and heart disease particularly also put people at greater risk for having dementia in the future. Exposure to lead, smoking, use of alcohol and other substances, lower levels of education, lack of physical activity, lack of social interaction and high levels of stress are all associated with cognitive decline. So how do we avoid cognitive decline? Certainly something that we're all interested in and we're all doing right now by staying intellectually engaged, remaining physically active, being socially active, practicing stress reduction, avoiding tobacco and moderating alcohol, treating those diseases that precipitate cognitive decline, high blood pressure, diabetes, depression and elevated cholesterol and using hearing aids and glasses as needed so that our senses are working to their fullest capacity. I'm just reading a book now, I don't know how many of you saw Zeke Emanuel's piece in Atlantic, Monthly Why I Hope to Die at Age 75. It was pretty stunning. Actually one of my patients pointed it out to me at first, a gentleman who decided that he didn't wanna go through his chemotherapy after radiation and chemotherapy and then surgery for his rectal cancer, he said, I've had enough, I'm 75. I said, what does that have to do with it? I said, it's sort of like baking a cake and not putting the frosting on. And he said, did you read Zeke Emanuel's article? And I said, no, so he sent it to me and I read it that night. I sent him an email, I said, okay, if you don't wanna frost your cake, don't frost it because it was a very powerful article about Zeke Emanuel who's 57, own feelings about aging and not wanting to become disabled and debilitated as he ages. On the other hand, Jimmy Holland is a colleague who's an oncologist, psycho oncologist at Memorial Sloan Kettering in New York. And she wrote a piece, a rebuttal of that in one of our oncology newspapers. And I sent her an email saying, write on, she's 86 and still practicing. And so I sent her this message, applauding her and she said, she's written a book, lighter as we go. And she said in the book, she describes the you-ben, she calls it, in well-being, saying that well-being is at a peak in 20 year olds and declines through the age of 50 and then rises again, 60 through 80. So I've just started reading that book and I'm ending my talk with a quote that I picked up from the book, but she's, one of the chapters talks about aging through the ages and apparently Aristotle was the first to call aging a disease due to the loss of heat. And for 2000 years, people appreciated that aging was a disease over, with people losing heat over time and then later on they added that it was also loss of moisture. So loss of heat and loss of moisture but subsequently as we entered the scientific era, other theories of aging have emerged. One of them being the free radical theory. Oxygen, as you know, lives as two molecules linked together, that's what we breathe, that's how we live but when those oxygen molecules separate, they create so-called free radicals which knock into our DNA causing aging or cancer. Antioxidants take those free radicals out of circulation so they don't do damage. So the free radical theory of aging was as we age, we create more free radicals that cause these changes in our chromosomes which also is part of the somatic mutation theory that as we age, our DNA accumulates mutations that leads to the decline. The currently popular one is the telomere theory. Elizabeth Blackburn, formerly of UCSF, got the Nobel Prize for her identification of telomeres. Telomeres are like in your shoelace, the end piece that keeps your shoelace from unraveling. Telomeres are like that in your DNA and as we age, our telomeres get shorter but if we have a lot of the enzyme telomerase, we can elongate our telomeres so that our aging process is slowed and that's now the current sort of theory of aging that's mostly being adopted. Now this shows how old this is. I haven't seen another update on this but Newsweek did a survey that was published in July of 2001 where 801 Americans, 45 to 65 were interviewed and it was really a survey on aging and the results were published in a special fall, winter edition called Living Longer Living Better and of those, 72% believed that they would live to be 80 and 11% thought that they would live to be 100 and a number of slides are gonna refer to the people that participated in this poll and you can see that over 50% of them felt that their health at the time was excellent or very good. In North America and Europe, the annual death rates among people who are 15 are 0.5% so five per thousand. Among 50 year olds, the rate is 1.5 per hundred and among 105 years old, it's one in two. This rise in mortality as we age is mainly due to heart disease, cancer and stroke but if you eliminate those three diseases, only 15 years would be added to the lifespan which is half the gain achieved during the 20th century itself. So the 20th century saw significant advantages in increasing our life. So what is the goal of healthy aging? Christian Bernard, who's the one who invented heart transplants, if you remember, said die young as late as possible. Andy Weil says, compressed morbidity, lead a long, happy, healthy life and then in the end, go quickly. So let's talk about Andy's program. Andy wrote the book Healthy Aging in 2005 and again, it's not a 12 step program but interestingly there are 12 key points that he emphasizes and the number one point is to eat an anti-inflammatory diet. Last year, the JAMA, the Journal of the American Medical Association published a report on the state of the United States health, 1990 to 2010 and the number one cause of morbidity and mortality in the United States today is now dietary risks. It surpasses tobacco use as the number one cause of morbidity and mortality and it does not include obesity, which is number four and decreased physical activity, which is number five. So dietary risks include eating too much sugar, refined carbohydrates, saturated fat, red meat, eating not enough fruits, vegetables, nuts, polyunsaturated fatty acids, fish, et cetera. Those, there are 14 dietary risks and that is now the number one cause of our health problems in this country. So Andy's anti-inflammatory diet is something that he really made quite popular. Inflammation by the way, let me just mention what that is. If you cut yourself or when you have surgery, when you heal, it gets red, hot, tender and swollen. That's inflammation, it's part of normal healing but when that goes on inside of us without provocation, it leads to degenerative diseases such as dementia, heart disease and cancer and there's much that we can do by what we eat and what we don't eat to impact inflammation and I'll talk about that in just a second. But I do wanna say that the only thing that's ever been really proven to prolong life in animal species is caloric restriction. Every animal species that this has been studied in, when you restrict calories in mammals, they have lower insulin and increased insulin sensitivity. Their body temperature is lower. They have delayed onset of age-associated diseases and slower age-related decline in functional tests. We find it hard to change behavior as human beings and we find it easier to take a pill. So resveratrol, many of you have heard of, is from red grapes and red wine. It mimics caloric restrictions supposedly. I don't think so. I think if you really wanna use that as your method to prolong your life, you should restrict your calories and not depend on a pill. It's sort of our Western pharmaceutical dominated paradigm that everything could be answered by swallowing a pill. So my standard recommendations to my patients and my friends to decrease the risk of cancer and also decrease ongoing inflammation is to increase plant-based foods. I recommend an organic, plant-based, antioxidant-rich, anti-inflammatory whole foods diet. Increasing whole grains, fruits and vegetables, so we should have five to nine servings of fruits and vegetables each day, more vegetables than fruits, with the cruciferous vegetables, those with the flowers growing in the shape of a crucifix, so broccoli, cauliflower, Brussels sprouts, jump to mind, but they're also green leafy cruciferous vegetables, cabbage, kale, very popular, thanks to Hunter Pence, collard greens, arugula, bok choy, all of these contain really potent phytonutrients or plant nutrients that benefit us. Now let me just talk about organic for a moment because the British have done a number of studies saying that organic produce is pretty much the same as conventional produce when it comes to macronutrients. That is fats, proteins, and carbohydrates. They do agree that organically produced produce has more phytonutrients, plant nutrients, that, well, a plant that's grown outdoors organically needs to fight, to protect itself from other plants, birds and insects, and the sunshine. And the only way a plant can protect itself is by making chemicals. Turns out those chemicals that the plant makes are the ones that protect us. So if we're gonna let food be our medicine and medicine be our food, organic is much more potent than conventional. So fruits and vegetables, I think, should be organic. Fruits, I like the berries. In fact, Ruth brought me some blueberries here to snack on. So my dogs love blueberries. They won't go to sleep at night until they get blueberries after dinner. Berries out of season can be frozen. They only lose 10% of their nutritional value, but they must be organic, because they're like little sponges for all those toxins. Animal fats, I think, are not good. I like animal fats coming from deep cold water fish, salmon, black cod, albacortuna, herring, mackerel, sardines. These are fish that are rich in omega-3 fatty acids, which are anti-inflammatory. Other fish and seafood are okay, but those are the ones that are richest in the omega-3s. Poultry, Andy in his book, is a little bit down on chicken and eggs, because he says chicken and eggs are the most pro-inflammatory foods out there, not only because of what we feed chickens so that they make a lot of omega-6 fatty acids, but because they're high in arachnodonic acid, which is the precursor to prostaglandins, the chemical mediators of inflammation. So if you're eating poultry, it must be organic. And if you eat eggs, they should be organic omega-3 eggs. Red meat and dairy, the linear relationship between beef consumption or red meat consumption and colon cancer in women is such that countries that consume the less red meat have the less colon cancer and those that consume the most have the highest rates. Dairy is a little bit controversial. Barbara Kingsolver, in her book, Animal Vegetable Miracle, I think says it best. No other animal drinks another species' milk, but no other animal drives a car or goes to college, so that's not a very good argument. But no other animal drinks milk after they've been weaned and by the age of three or four, we lose the ability to digest the sugars and the proteins in dairy. We make a big deal about fat, low fat, no fat 2%. It's not the fat and if you want a dairy product, butter or ghee is probably a good one. It's the sugars and the proteins and we talk about lactose intolerance as if it's a disease or a disorder when in fact it's the norm and the ability to digest lactose is a genetic mutation on the second chromosome found mainly in Scandinavians who needed to digest reindeer milk in times of freeze. Otherwise, the rest of us are all lactose intolerant, especially Asians, Africans, Jews, Mexicans, Southern Europeans and we don't know until we stop. So then people always ask me, well, what about yogurt? Because yogurt and kefir, the sugars and the proteins have been altered by the bacteria. So again, if you need a dairy product, yogurt or kefir, as long as they're not artificially colored, artificially flavored or have added sugar because sugar is probably the number one no on the list. So refined sugar, white flour, white rice. So brown rice is better than white rice, but if you like white rice, jasmine and basmati are okay because their glycemic index is better. Millet and quinoa are also good grains. Season liberally with ginger, garlic, onions and turmeric. Turmeric is quite popular. How many people take a turmeric supplement in the room? I thought, yeah, in looking at India, which is a huge country, we're trying to figure out how come they have such a low rate of cancer and Alzheimer's. And much of the evidence is suggesting that the consumption of turmeric, which provides color to Indian curry, not much flavor. Most of the flavor comes from cumin, coriander or fennel geek. The turmeric provides the orange yellow color. It's very potent, anti-inflammatory and also has some potential anti-cancer activity. So turmeric is a good spice. The Mediterranean spices are also good, basil, thyme, rosemary and oregano. For beverages, green tea, green tea is second only to cruciferous vegetables in the potency of its cancer risk reducing and anti-inflammatory chemicals. Green tea, tea is a name of the beverage made from the Chinese camellia or the camellia sinensis and it's graded on how oxidized the leaf is before the beverage is brewed. White, green, oolong, black and poo air. And the only two that have the cancer fighting chemicals are white and green. So I recommend, I drink five cups every morning of green tea. Organic Japanese is what I recommend. And if you're drinking alcohol, red wine is the preferred beverage because of the resveratrol and other phytonutrients in red wine. Andy says, use dietary supplements wisely to support the body's defenses and natural healing power. Now, what does that mean? That's sort of an open statement. This is a photo from one of my high school classmates who's a woman who has lupus and thyroid cancer and she's also an artist and she takes pictures of her supplements lined up against her prescription drugs in a cemetery in Boston. So this sort of shows the tension, if you will, between supplements and prescription medications. So what are potentially useful supplements? Well, in general, I believe that we should get most of our vitamins from the foods that we eat. Studies have really suggested that supplementing with particular vitamins, particularly the fat soluble vitamins may in fact be more harmful than good. For example, I used to smoke tobacco in my youth even as I was training to be an oncologist. And studies have demonstrated that beta carotene or vitamin A actually increases the risk of lung cancer in men who smoke cigarettes. Now, I eat a sweet potato every day in the winter and a lot of carrots to the point where people say, what a good tan I have and I show them, I'm not really tan, I'm keratinemic. Because I'll eat my beta carotene, but I won't take a multivitamin because multivitamins are supplementing with vitamin A or beta carotene. Vitamin E, in that original study where it showed that smokers had higher rates of lung cancer, it suggested that men had lower rates of prostate cancer if they supplemented with vitamin E. Well, that study was discounted by a larger study in 30,000 older men. Vitamin E actually increased their risk of prostate cancer. So I'm not a big fan of taking a multivitamin or of supplementing with fat-soluble vitamins except vitamin D. So vitamin D is the one that we get from the sun. And those of us over 50, those of us with darker skin and those of us who are overweight don't make vitamin D as well as we did when we were younger. And we think of vitamin D deficiency with regards to rickets. Nobody's ever seen rickets, you know, those bowed legs on children that we learned about in elementary school, but soft bones, osteoporosis, osteomalacia, depression, immunity. We talk about the flu season. You think that there are viruses waiting off the coast for November? No, we as a herd, when the sun starts going down, lose our immune function because we become vitamin D deficient. Cancer, breast, prostate, colon, and pancreas are associated with low vitamin D levels. And in patients with those cancers, those with lower vitamin D levels don't do as well as those whose vitamin D levels are up. So vitamin D is one that I, D3, is one that I do supplement and recommend and check all my patients for their levels. Now there's an ongoing study looking at supplementing older Americans with vitamin D3, omega-3 fatty acids, both or neither. And that study may ultimately come out the same way as these others, showing that it's harmful. But until those results are out, I am going to take that risk and try to keep my vitamin D level up. And I'm gonna take an omega-3 fatty acid because I'm not eating deep cold water fish every day. Omega-3s are anti-inflammatory, slightly anti-depressant, and they also lubricate the colon. So I told my mother, try four grams, mother, of omega-3 and see what happens. Calcium, because I don't do dairy, calcium I need to get from food, but dairy is really the largest single source of calcium. Green leafy vegetables, tofu, also have some calcium, but a little calcium supplement for people over 50 is not a bad thing. Other things that people may take for arthritis, conroitin, sulfate, and glucosamine, St. John's wort is a little tricky for mild depression because if you take any prescription medications, St. John's wort ramps up, believe it or not, the metabolism of enzymes in the liver that metabolize many prescription medications. So if your doctor's prescribing something and you're taking St. John's wort, you're actually getting a much lower dose of the prescription medication. So only with caution. Valerian is another sort of calming medication, saplometto, men might take for prostate issues, women with menopausal symptoms may benefit from a number of different supplements, evening primrose oil, black cohosh, or red clover. Anybody taking a statin or a statin-like substitute should probably be supplementing with coenzyme Q10 because statins deplete this enzyme, which is important for mitochondria function, the little energy factories in our cells, and this is what leads to muscle problems. So coenzyme Q10 is also good for gums and just energy in general. Ginkgo, for memory, if you can remember to take it, because it's usually three times a day. I like the 10 botanical xiflament, which has turmeric and green tea and a number of other things as an anti-inflammatory agent. And resveratrol, I'm still a little confused as to whether or not I think it has any benefit. I follow a little bit Paracelsus, who was an alchemist who spanned alchemy and medicine in the Renaissance who said there's poison in everything. The difference between a remedy and a poison is the dose. One gram of resveratrol is the amount of resveratrol in 667 bottles of red wine. I don't think we were meant to be able to consume that in one sitting. I mentioned the Telluride Mushroom Festival where Clint took me and I met Andrew Weil and it changed my life. Well, since that time I've become a bit of a fan of medicinal mushrooms. Mushrooms is medicine, you say. Well, you can eat a mushroom and you can die or you can eat a mushroom and have quite a psychedelic experience. So obviously they have biologic activity. The way many mushrooms work is that their cell wall resembles a bacterial cell wall. So when you ingest the mushroom, your body thinks it's being invaded by bacteria and it mounts a non-specific immune response, which is good for us sometimes. Now one thing I do want to say is that all mushrooms need to be cooked. So slicing white button mushrooms and throwing them in a salad is a no because white buttons have a cancer-causing compound, a guarateen very similar to hydrazine, which is in rocket fuel, which is a carcinogen. So all mushrooms need to be cooked. White buttons, they're brown cousins, the crimini and they're giant cousins, the portobello, all need to be cooked. They may have some aromatase inhibitor activity, which is good for women with breast cancer or other estrogen-driven hormones. Better mushrooms are the Asian variants. So shiitake here, mytake, these are immune enhancing. They're edible, they're delicious. For people that can't find them, if you find them dry, by the way, shiitake mushrooms dry are actually more potent because the fluid has been withdrawn from them. But these are, again, immune enhancing and may have some anti-cancer activity. Reishi is the mushroom of immortality. In Chinese, it's called lingzhi. And in addition to having this non-specific immune enhancing activity, the reishi has some chemical compounds that appear to have some direct anti-cancer activity as well. This is lion's mane or Horisium, which is a neuroprotective and good for people with cognitive issues. Also, very delicious mushroom when you can find it, if you know how to cook it. So yeah, so mushrooms have many useful properties. They're antioxidant, as I mentioned, immune enhancing. They may have some anti-viral activity. They're anti-inflammatory, may have some anti-cancer activity, and again, aromatase inhibition. So a very good food as medicine. So the third point in Andrew's program is to use preventive medicine intelligently. That is, know what you're at risk for at your age and screen for it if screening is appropriate. Now, we're in a bit of a funny period with regards to prostate cancer screening and even mammography. Because, again, as an oncologist, it seems to me that we're overdiagnosing some of these malignancies that may not actually wind up causing problems in the life of the person. I mean, many men I see with prostate cancer don't appreciate that 60% of men over 60 have prostate cancer. 80% of men over 80 have prostate cancer. So it's sort of a linear curve. The issue is we're not gonna die from it, we'll die with it. Similarly in Japan, 20% of people at autopsy have thyroid cancer, and thyroid cancer is being slightly overdiagnosed in this country as well. These are things that are probably quite indolent and not necessarily going to cause the demise and often in the case of prostate cancer, some situations with breast cancer cause more problems with their attempt to treat than they would in life if they had not been discovered. So elevated blood pressure, elevated cholesterol, getting appropriate immunizations. That's sort of another hot button topic right now I hear on the radio, but these are all things that we should do to maintain our health. And if we need to take medicines, we should take them. The five costliest classes of drugs, and I just look to see if this has been updated because the data's a bit old, but I couldn't find anything online saying that this information from the federal government has been updated. But cardiovascular drugs, followed by hormones, $24.5 billion, central nervous system drugs include antidepressants, anxiolytics, sleeping pills, et cetera, cholesterol lowering on then, sorry, the psychotherapeutics, which would be the antidepressants and antipsychotics. So that's where our money goes with regards to medicines. That poll that they did in 2001 showed that about 50% of Americans, 55 to 65 are on blood pressure medication, a quarter are on cholesterol lowering medication, 15% on antidepressants. I would suspect that Viagra use is higher now in both men and women than those percentages. And I don't know where hormone replacement therapy would be, but one third of women in 2001 were taking estrogen. Testosterone certainly was a big headliner. Many people thought that this was the fountain of youth and that men, as we aged, if we would replace our testosterone would feel much better. Interestingly, if we thought that it would prolong survival, that's actually not the case. Did you hear about the one about the Unix in Kansas? So actually castration has been shown to prolong survival in men, not testosterone. So it was sort of wishful thinking that testosterone was a fountain of youth hormone. We know that secretion of growth hormone itself falls 12% per decade after middle age. Estrogen drop is abrupt and testosterone gradually declines. DHEA and DHEAS, which are precursors to both testosterone and estrogen, fall progressively after the age of 30, and by 60 they're down to 50% of what they were when we were younger. But studies have shown that neither DHEA nor low dose testosterone replacement in elderly people has any physiologically relevant beneficial effects. And I do worry, even though I just did that rap about prostate cancer, testosterone does increase the risk of prostate cancer and makes prostate cancer more aggressive. That's why our treatment of prostate cancer is basically shutting off and blocking testosterone. Point number four in Andy's 12 point program is get regular physical activity throughout life. How many people here have a program of regular physical activity? So not bad, we're in San Francisco that might account for it. Five domains of fitness that we need to be concerned about are posture, strength, balance, flexibility, and endurance. And all of these are things that we have to grapple with as we age. So this is a little from a book, Age Defying Fitness, How Fit Are You? Are you standing as straight and tall as you once did? Well, I don't know about that. I used to, Clint says, you were never five nine. I went to the doctor, they measured me, they told me I was five six. I walked in, I was taller than my doctor, I asked him how tall he was, he said he was five seven. So I said, well, something's wrong here. But you know, I hear day in and day out when I ask my patients how tall they are that we all lose something one inch or two is walking up a flight of stairs a strain at times. Are you getting up from a chair more slowly? Is it harder to look to the left and right when backing up? Whoa, that one time I sort of backed into the side of the garage and I didn't really even notice it because I was on a conference call anyway. Do you get stiff with prolonged sitting? Is standing on one leg to put on a shoe difficult? Do you trip or lose your balance more easily? Those cracks in the sidewalk, you know, I don't know when they became so dangerous. Does walking or jogging a distance take longer? So these are things to think about and not to make a shy away from being physically active and even just taking a brisk walk. If you're not gonna join the gym and do the treadmill or the elliptical, taking a brisk walk controls weight can be as effective as psychotherapy as an anti-depressant. And lowers your blood pressure and increases HDL cholesterol. Also, just that activity, if even if you're my cancer patients, I'm too tired to exercise, just take a walk because then you increase your endorphins or your endocannabinoids, whichever they are and you actually feel more up and euphoric and then you actually sleep better. So it's a good treatment for fatigue to be physically active. But in that poll of Americans, in 2001, difficult behaviors to adapt, 50% of Americans said exercising enough was the hardest thing for them to do. Giving up tobacco was easier than exercising. So it's, you know, lifestyle modification, if we can't take it as a pill, it's difficult and if it takes time in our busy lives, it's difficult. I try to do the treadmill, even though my joints are screaming that I should do the elliptical, a few times a week, I work out with the trainer and do resistance and I started doing yoga when I turned 60. And I think that yoga, I'll talk about in a second, but it's a very useful exercise. These are one generation ago of our dogs, Byron and Shelly and Sleep, Byron and Shelly. Now we have Dante and Ruby. Rest and sleep is important and especially as we age, there's a bit of a controversy and certainly at our house as to whether you need more or less sleep as you get older. Americans probably used to sleep on average eight to eight and a half hours a day and now probably seven to seven and a half hours a day. People need anywhere from six to nine hours so it's individualized and there are things that we can do to have better sleep. Sleep hygiene, going to bed at a regular time, avoiding alcohol before you go to bed, limiting activity in the bedroom, having appropriate lighting, no eating immediately prior to a meal and then thinking about medications that one might take that interfere with sleep. Brief naps are important and as people get older, they're known for taking brief naps. Melatonin or other botanicals may also be useful. Reuben Nyman wrote a great book called, good, helpful, what is it called? Healing Night or something like that, Reuben Nyman and it's a wonderful book about sleep. The history of sleep makes Thomas Edison into the villain because he gave us perpetual light and talking about how the cycles of night and day we need to sort of recapitulate if we're gonna sleep well so that led me to put dimmer switches in the house and after eight o'clock at night I like everything dim. Clint says, why is it so dim? I keep turning up, he turns them up, I turn them down but the other thing that we need to know is that melatonin which we produce at night to let us know it's nighttime is suppressed by blue. That's why we have a blue sky in the daytime because if you look at that it suppresses your melatonin so you don't fall asleep. So if you're watching television right before you go to sleep, the combination of the light from the television is red is blue and if you're working on your laptop or perhaps even reading from your i-tablet that's also blue light turning off your melatonin making it more difficult for you to fall asleep at night. So something to consider. Some herbs that might work for insomnia. Valerian has the strongest evidence it appears safe. Cava used in the South Pacific. Some people are concerned because it has potential for liver toxicity. I mentioned St. John's wort. Chamomile, probably a good thing, hops. Lavender either as an aromatherapy. Passionflower is also good. There's some particular teas, sleepy time or nighty night that are combinations of valerian, passionflower, lemon balm and hops. All of these are good herbal things. I really get very upset when I see my patients on some of those sleep pills, especially the ones that make people drive without knowing it or go down and eat in the kitchen in the middle of the night. I took one of those when I was flying to Brazil once and my friend on the flight said I try to crawl into the overhead compartment. So learn and practice methods of stress protection. He doesn't say stress reduction. He says stress protection. And so that's, as I mentioned, me. I don't usually dress like that for my yoga class. But yoga, just to digress again, is about strength and balance and flexibility. But it's also meditative because you're moving with your breath and you let go of all those other thoughts that are in your head to follow your breath. I always say that Jewish boys can't meditate. But for me, at the end of yoga, when we've done corpse pose for 10 minutes and the teacher says, come back now. I've gone someplace. So I don't know. For me, yoga is very important in my life. Now stress is something that's devastating. This is from the National Cancer Institute. With all that we know about how stress aggravates cardiovascular disease, promotes viral infections, exacerbates metabolic diseases, halts reproduction, and regulates the normal function of virtually every cell in the body, why would cancer cells somehow be exempt? So stress, bad. Stress is adrenaline or epinephrine, which kills your lymphocytes, the building block cells of the immune system. And stress is cortisol, which is a steroid hormone, which is an immune suppressant. So when I ask my cancer patients to tell me their story, they often evolve a story as if stress caused cancer. Stress in and of itself can't cause cancer. But studies have been done that's shown in rats, for example, with breast cancer, that if they stress a group of these rodents by putting them in a confined space for three hours a day, at the end of the experiment, the stress animals have the same size primary tumor, but increased size and number of metastatic lesions. So stress is not good for cancer or for anybody. So how did those people in 2001, which remember I believe that's before 9-11 because it was July, how did they reduce stress? Watching TV, well, I don't know about you, but I don't. Andy once said, take a break from the news. And that's when I did my fellowship in 2004. I really don't follow news. And my poor mother, who can't sleep in Milwaukee, said, well, mother, you watch that news every night before you go to sleep. You learn about everybody who's been raped and pillaged and burned and robbed for miles. You don't need to know that. I mean, if something needs to come to the level of your consciousness, and TV seems really violent to me. I only watch sports much to the chagrin of Clint. Baseball season is around the corner. I find that that's not as stressful as some of these other things. So 83%. Reading is very good. We're at the library. I'm in a book club. We meet every six weeks. And we only read fiction. Because many of us are doctors. And nonfiction is just not. If you're dealing with what I deal with every day, fiction is very good. So reading is good. And music. I'm felt to be at home. I'm called a blue meanie, because I don't seem to have much appreciation for the same kind of music. So anyway, talk to someone, three quarters. Exercise, sports, walking. I like 50% ignore it, and 37% go shopping. So that's good. Having a drink or a cigarette, probably not a good idea. The number of Americans who now smoke tobacco is less than 20%. So that's a good thing for health in general. Exercise your mind as well as your body. Again, here we are doing something that's hopefully provocative in exercising the mind. I think this is really important. I don't play that game that people do to try to keep their flexibility. I forget what it's called, but maybe I should. But exercising your mind, again, reading, having conversations, taking fellowship, that's why I needed to do my fellowship. This is some of my graduating class in Tucson 12 years ago. I really felt at that time that I wanted to keep my mind active and learn. And when I retire, I'd like to learn Chinese as my next thing to keep myself plastic and moving forward. Maintaining social and intellectual connections as you go through life. There are many people in the room here that are friends and people that I've known for 35 years or 40 years. I don't even know. So I think it's very important for me, maintaining connections with parts of my life that have passed is very grounding for me and keeps me healthy in my aging. Be flexible in mind and body. Learn to adapt to losses. And let go of behaviors no longer appropriate for your age. I think that sounds difficult, but I think we do that. My friend Jerry Jampolsky is going to be 90 tomorrow. Jerry and Diane founded the Centers for Attitudinal Healing. And we went to Jerry's 80th birthday party, which was quite a large event 10 years ago. And he went up on stage and he made a joke. And he said, I just came from a friend's 60th birthday. And I told him, you know, the best thing about being 60, you no longer care what other people think about you. The better thing about being 80, you don't remember. So I think, you know, I always used to be very phobic about what people thought about me. And I just don't, you know, a little bit, but not as much. You know, it doesn't drive my life as much as it used to be. So speaking of Jerry and Diane, when we first started in the AIDS program back in the 80s, dealing with the tremendous amount of loss that we were dealing with as HIV care providers, Paul Volverding, who was the head of the program, asked Jerry and Diane to come do weekly therapy sessions with the staff. And every week they would give us a lesson. And when they came back the next time, we sort of had to discuss how that lesson impacted on our life and how we integrated it into our life. And their number one lesson, they wrote the book, Love is Letting Go of Fear. Number one lesson from Jerry and Diane is choose peace. And that means when I was coming here tonight, there was traffic and was I gonna get here in time and then I couldn't get the phone to ring and I couldn't find a place in the, and I could have gotten myself wound up like that, but I also could just say choose peace. Because this isn't gonna start without me. And you know, eventually I'll be here. So just choose peace and don't let yourself get riled up by things that you don't really have any control over. If you're involved in a tug of war, if you let go of the rope, you are no longer involved in the tug of war. Which doesn't mean just bend over and be passive. It just means choose your battles. And you can escalate on the phone with that machine that says push number this, if you want this, push number, you know, or whatever. And you can get yourself, but again, if you just let go, practice forgiveness. I mean again, that's also very Buddhist and very, very nice. If you practice forgiveness, then that also is one way that you can relax and heal your attitude. When someone comes to you with anger, recognize it as underlying fear and return love. That's really a beautiful one that, you know, that I use a lot when I deal with people who get angry by things that I need to tell them that it's not my fault, it's not their fault, but fear underlies a lot and fear of our own mortality underlies most of our fears. So all of those, I think, are good principles of attitudinal healing from Jerry Jampolsky on the eve of his 90th birthday that have stayed with me over the past, I guess, 26 years. Humor, something I like to use a little bit too, and here's a study of 54,000 Norwegians who we don't really think of as being the most humorous of people, but they filled out a survey on how easy they found humor and its importance and the greater the role that humor played, the greater the chance of survival over the next seven years. So the top quarter of people who found humor important were 35% more likely to be alive than the lower quarter. In 2015, who had a diagnosis of cancer at baseline, a great sense of humor cut their chance of dying by 70%. So the conclusion was that humor works like a shock absorber in a car. And laughter is so important now that there are these laughter yoga as an intervention that we have at the Osher Center because even if you don't find humor in your life, these are little exercises where the instructor teaches you to go ha, ha, he, he, he, and you do this enough times that either the absurdity of it or the infectious nature of the whole group doing these ho, ho, he, he, ho makes you laugh and really you get it behind your ear stuff and you laugh and you smile and at the end of it you feel a bit high. So humor and laughter are important. In this book, Healthy Aging, Andrew Wiles sort of anti those reverse aging or stop aging programs that are out there sold to a lot of people who are gullible enough to believe that they can do that. And Andy says we need to instead embrace aging and think about the benefits of aging and why do we venerate this, I just heard about one of these violins on the news yesterday that I'm not a basketball person so I had to turn on non-sports station yesterday and it really rattled me but I did hear one nice story about some woman who got an old violin but old violins, old trees, old wine, old cheese, these are all things that we venerate, why not old people? We need to think about the benefits of aging, experience, wisdom, the gift of time allows us to be creative and enjoy others' creativity, spending time with family, enjoying nature, freedom and then senior discounts. I just went to Rainbow on the way to pick up something because I do get a senior discount and the guy in front of me was asked to show his ID and he said oh you flatter me and then I got there and I said I'll have my senior discount and he didn't ask, he didn't ask me to show my. What can I do? Microphone they're saying. He didn't ask me to show my ID so I was a little bit disturbed but anyway, senior discounts are a good thing. Do not deny the reality of aging or put energy into trying to stop it, this is the one that I said, use the experience of aging as a stimulus for spiritual awakening and growth. That's, his last recommendation in Andy's book was something that was really new to me and that I've shared with many of my patients. He basically said that we should have a living, not a living will but when you're deceased, you leave physical things to the people that you're leaving behind. Andy said you should write an ethical will and tell the people that are remaining after you what you learned in your life, from your life experience and what you think they would benefit from knowing. So this is something that is probably a worthwhile thing for us to consider doing. He said that it was part of a Jewish tradition, it's not something that I've actually heard of but I know people who have read the book and have actually taken this to heart and have spent time writing their ethical will so that they could share with people who remain what they've learned during their life and how they learned to cope. I think it's a nice thing. He also says, read it from time to time yourself, add to it, revise it. Soon as we can find the time to do it, that might be worth doing. So the bottom line from the Newsweek study, all this research holds a fairly obvious lesson. Life itself is lethal and the things that make it sweet make it more lethal. Chances are that by starving and castrating ourselves, we really could secure some extra years but most of us would gladly trade a lonely decade of stubborn survival for a richer middle age. Our bodies are designed to last only so long but with care and the maintenance they'll live out their warranties in style. So the quote that I got from Jimmy Holland's book was this, we're offered to my choice, I should have no objection to a repetition of the same life from its beginning, only asking the advantages authors have in a second edition to correct some faults of the first. Benjamin Franklin who lived quite a nice life for that period, 84 years old. So I thought that was a good closing thought and with that I wish everybody healthy aging and I'm happy to answer any questions. Thank you for your attention. I have some questions, okay. I have some questions from the audience. Sugar substitute stevia. So Andy Weil always says stevia and, what's it called? Agave nectar are the two best substitutes but now I think has changed with the concern that agave nectar may be actually contaminated with high fructose corn syrup. So if you need a sugar substitute, I think stevia, five cups of green tea is that five tea bags. Yes, I do five different tea bags because I don't do the tea itself because I'm running around in clinics and for those of you that are caffeine averse, what I learned recently, if you brew your bag for two minutes and throw out that first pass of tea and then brew it again, you've eliminated most of the caffeine. So if you have cardiac issues or something and can't do caffeine, that's how to do that. Please, let's see. What is the prospect for a functional cure for AIDS? Not gonna talk about AIDS. I've stopped doing AIDS in 06, so I don't keep up on it, I'm sorry. Lab level for vitamin D3. 30, 30 nanograms per ML is the lower limit. The Institute of Medicine recently changed the limit to 20 because so many Americans are deficient and that's how they decide what's normal. So they looked at the population, it's been over 30 for years, but because so many of us are now deficient because of sunscreens, avoiding sun, the Institute of Medicine put the level down to 20 much to the chagrin of many endocrinologists and other people. So I like people to be 30 to 50. What mushroom is good for cognitive issues? I forget, no, no, it's Lion's Mane or Horisium. The relationship of circadian rhythms and metabolic disorders, I don't really know that. I do know that there is a concern that women who do night shift work are at greater risk to develop breast cancer and it's felt to have something to do with the rhythms being out of whack, particularly the melatonin, yeah. Can you talk about the medical use of cannabis and inflammation? Well, that's a whole another hour presentation, right? So one of my other jobs is studying medicinal cannabis. Cannabis is a very potent medicine. It's probably, I just did something for the guardian today and I thought it was the Bay Guardian but it said their office was in New York so is it, is it the Manchester Guardian or whatever, I don't know. There was a story about extreme runners or people that do extreme marathons using cannabis for their pain, nausea and relaxation. And so I basically spoke about cannabinoids and pain. We have this system in Clint's book, Marijuana, Gateway to Health, How Cannabis Protects Us Against Cancer and Alzheimer's goes into this very well. The cannabinoids, receptors and the endocannabinoids, our body makes our own cannabinoids just like we make our own opiates, the endorphins. We make our own endocannabinoids and they're probably there to help us moderate or modulate our experience of pain. And so the CB1 receptor, which is the second most densely populated receptor in our brain is probably there to help our central processing of brain or of noxious or stimuli. And then cannabis in and of itself is an anti-inflammatory. The plant has many compounds that are anti-inflammatory, including CBD or cannabidiol, which is another cannabinoid like THC that decreases inflammation. So CBD is felt to be anti-inflammatory as well as analgesic against pain, as well as a sedative. So many of my patients who don't want psychoactivity, which comes from THC are seeking blends of cannabis that are high in CBD. So cannabis also seems to have an effect if used topically. I have used on burns, topical ointment called external, external. And it completely took away the pain and stopped blistering. And it was rather amazing. So I think cannabis is a plant that has been around and known as a medicine for 3000 years. And it looks like in our lifetime may eventually come back again to be a medicine. It only hasn't been a medicine in this country for the past 72 years. It was removed from the U.S. Pharmacopoeia in 1942 up until that time physicians could prescribe cannabis to their patients. So I think it seems to be making a comeback. Clint's book, again, suggests having done research, he's spoken to investigators both at Scripps and at Ohio State, who believe that cannabis is one of the most potent disintanglers of the fibrillary bundles that create Alzheimer's. And I think the quote was that at Scripps, they said, well, we're not in a position to recommend an illicit substance as a treatment, but we don't see anything that's more effective in Alzheimer's disease, which led my stepsister to ask if she should bring some to my stepmother at the Hebrew home for the aged and the Bronx. And I said, I don't think so. Betsy, it's not gonna work. Organic eggs versus pasteurized eggs. Again, so the thing about eggs is if you feed the chickens the wrong kind of stuff that chickens don't eat, they make eggs that are very rich in Omega-6 fatty acids, which promote inflammation. But otherwise, chicken and eggs, according to Andy, are very high in this arachnodonic acid regardless of whether they're a pasteur or organic or not. So better to be organic. Do you recommend taking chlorella or spirulina? I usually don't. Maybe because I don't know enough about it. Can you speak about MDs who discourage supplements while patients are in treatment for cancer, hep C, or after liver transplants? Most people I know have been told not to take them. That's because medicine today is really focused. My colleagues at the cancer center, there's the breast specialist, the colon specialist, the pancreas specialist, and they all have a lot to keep up with because there's so much happening, you can't ask them to know about supplements and the potential interaction of supplements and this new cancer therapy. So the default, easiest response is don't take anything. And I think that's unfortunate because it's depriving people of benefit. But that's the easiest thing for all these people to say. Good. Are we taking hand wave questions or just no? Okay, we're not. But I can't hear too well, but if you're gonna. Two questions. Residue for all, if you don't drink wine or alcohol, does Welsh's grape juice work? And also if you're not eating organic eggs, would you just assume not eating them at all? Or is it like strawberries where organic strawberries are best, but conventional okay, or are both conventional? Yeah. Yeah, so the eggs, yeah, I don't know what to say about that, I like nutritionfacts.org, which is a website, Michael Gregor who's at Cornell, puts out a weekly three videos on Sunday morning that you can watch. Michael himself appears to be a militant vegan, so he's sort of against any animal product, but he did have the why egg cancer link suggesting that eggs increase the risk of prostate cancer. I personally don't like women with gynecologic malignancies to eat eggs. Why would you feed eggs to cancer of the eggs? And at first I thought this is something I shouldn't say out loud to people, but I ran it by my Chinese medicine practitioners and they say, oh no, women with gynecologic malignancies should never eat eggs. So I'm not a big fan of eggs, but I know that most of America eats two of them every morning for breakfast. I eat broccoli, tofu, and rice, or mochi, which is pounded rice, puffed up in the oven with almond butter and a sweet potato on top of it. And that's because of our macrobiotic orientation at our house, but I don't think the standard American diet is the diet that we should be consuming. Grape juice is an excellent question, so I follow the American Institute for Cancer Research, World Cancer Research Fund guidelines on reducing the risk of cancer. There are nine of them, and number 10 says, for cancer survivors, follow the nine guidelines above. Number one is to be as lean as possible without being underweight, and number two is to be physically active for 30 minutes each day. And number three is the first that says anything about food, and it simply says avoid sugary drinks. So I was at the microphone in 2007 when they unveiled that. The wording was new. Previously it said avoid energy-dense foods and sugary drinks, but they changed it to put sugary drinks on top. So I went to the microphone, I said there are sugary drinks and there are sugary drinks. You can drink Coca-Cola, God forbid, or Tropicana fruit punch, which is probably glucose and high fructose corn syrup, or you can squeeze three oranges in the morning. And the response from the podium was energetically they're all the same. Because if you eat an orange, the fiber slows down the absorption of sugar into the bloodstream. If you squeeze the sugar away from the fiber, it's like drinking a Coca-Cola. So why is that bad? When the body sees that load of sugar, it responds with insulin, an insulin-like growth factor, both of which promote inflammation, and insulin-like growth factor causes cancer to grow, because it's a growth factor. So grape juice, not attached to the grapes, is gonna have that same issue. Does it mean I don't squeeze three oranges in the morning? I used to do it every day, now I do it twice a week. Men with prostate cancer are told to drink eight ounces of pomegranate juice a day to lower their PSA levels. I worry about all that sugar without fiber. So I'm not sure grape juice may have resveratrol, but I'm not sure that it has the same. And the guideline on alcohol, by the way, is if consumed at all, limit alcohol to one a day for women and two a day for men. So if at all versus two a day seems like a big dichotomy in it. You're drinking alcohol. Yeah, yeah, I know. Red lines and grape juice is not a good substance in it. No, yeah, grape juice is okay. I just wouldn't do it every day. I wouldn't drink grape juice every day. What about oatmeal? Oatmeal? Yeah, oatmeal's fine for me. I take, when I travel, and TSA doesn't like me to go with my rice dream anymore, they think I'm a terrorist, even though I have a, cause usually when I travel, I take muesli and rice dream, but I have a letter from Dr. Loos, my colleague, saying please allow Dr. Abrams to travel with eight ounce beverages, but they always wanna open it. I say, well, no, you can't open it. How am I gonna fly with an open rice dream? Anyway, so now I take instant oatmeal. So when I'm traveling and I can't do my normal breakfast, that's a good option. Yes? You mentioned that collard restriction was the only thing across species that uniformly extends life. You didn't mention there are some studies that said that diet's advanced in both and advanced by different products. You're the same thing as collard restriction as well as intermittent fasting. No, I don't know enough about it. I know that many of my cancer patients are feeling like they should fast before their chemotherapy to make it work better. I think that's a bit strenuous if you're getting chemotherapy and I've cured cancer in the past without having people necessarily fast. So, I think either I've heard more and more about this intermittent caloric restriction over the past few months actually, but I don't know enough about it. I guess intermittent fasting or juice fasting, but I'm not a juice person. Yes, I can hear you probably. Any problems with daily long-term use of melatonin? I don't think we know, I don't think so. I think people do that, but nightly. You mean nightly. I mean, a lot of my cancer patients, there's a cancer doc in Italy who believes that 20 milligrams of melatonin is good for brain, breast, and lung cancer. Personally, when I take my melatonin, I get really intense dreams and they're not always pleasant and then I feel a little groggy and depressed in the morning and I only take it at 1.5 milligrams under my tongue before I go to sleep at night. So, I don't know how people can take 20 milligrams by mouth, but they do and they tell me they ramp up slowly and it's fine. So, I don't think... Is there any caloric imbalance? What's that? I suppose you could, yeah. I don't think there's any contraindication. Yes. Hi, how are you? You're familiar. Okay, yeah. How are you? What's up? I can't hear you. My question is about bottled water. Glass is better than plastic if it's the wrong kind of plastic. Alkaline water? No, the body, a lot of my cancer patients are into this alkaline diet and by alkaline water, the kidneys don't allow us to change the acid-base balance of our blood by what we eat. So, alkaline water is a not necessary expense and I drink bottled water as a source of my calcium. Gerlsteiner, which is a German bottled mineral water, has 10% of your daily requirements in every glass. So, since I don't do dairy, I do do bottled water, but in a glass bottle. Yes. Soy is a good one. Many of my patients with breast cancer particularly are concerned about soy. Soy I think in this country has become very GMO and people are phobic of GMO foods. I don't know enough about that. I did go to a nutrition conference where the speaker was very militantly anti-GMO and showed pictures of dead cattle that had been fed GMO grains. I thought it was very dramatic. I think if you buy organic soy products, they're not GMO. We know that in Asia, Asians eating Asian diets have lower rates of breast and prostate cancer than Asians in America eating in American diets and it's felt to be soy which is a weak plant estrogen that protects against those hormone related malignancies. In this country, studies have been done in women with breast cancer showing that daily consumption of one serving of soy foods actually decreases the risk of recurrence even if the tumor is estrogen receptor positive and that study was confirmed by a large study in China. But when I say soy foods, I mean whole soy. Soy beans, soy milk, tofu, tempeh and miso and not soy cheese, soy turkey and soy hot dogs because those are just heavily processed foods. In the back, I'll try to hear you. They're gonna change the guidelines on consumption of, what are they saying? That it's good. Oh yeah, well I think fat is important and any of these diets which eliminate a food group, protein, fat or carbohydrates are not gonna work. I mean they might work in the short term to help you lose weight but they're not good balance for energy. There are good fats. There are polyunsaturated fatty acids, there are omega threes. There are the deep cold water fish fats from that. We need fat to make hormones, so fat is good and a shooing fat I think is the wrong thing to do but saturated fats such as from red meat, processed meats and dairy products are probably not as good as fats from nuts, fish and others. So I don't know what exactly you're talking about but I think a certain percentage of Dean Ornish who's a lovely guy I think is limited 10% of the calories from fat which did increase telomerase but I don't think it's a palatable diet. I think most of us crave a little bit more fat and so do our hormones. Yes, in the hat. I think especially for my patients who are on chemotherapy which is a very potent antibiotic, I think a probiotic every once in a while is a good thing. I take a probiotic probably twice a week. I think it's okay to sort of stimulate our gut flora with new visitors but I think it's something I wouldn't do every day. I think it's good for leaky gut and for our own immunity and we are commensurate with our bacteria so I think probiotics and pre and probiotic foods as well, fermented foods, pickles, sauerkraut, those are all important for us. Yes. Yeah, so are there any negative side effects for young adults? So what is the young adult? 25 to 40, I think it's okay to use marijuana, isn't it? Everybody, yeah. Yeah. I think under 18 I would be concerned because of plasticity. I mean I always say that I went to Brown University and Stanford University School of Medicine and I'd be a very different person today if I used alcohol as opposed to cannabis as my weekend recreational substance and I was in that age group at that time. So I think younger, in Clint's book, Marijuana Gateway to Health, who should not use cannabis, he says young people under the age of 18. I think if we could go to war and vote, we probably are okay to use cannabis. Yes. Do you know if there's any negative effects of taking anticoagulant or blood-hitting drugs for long periods of time? Well, I'm not gonna do personal health issues, I'm sorry. Yeah, if you need them, you need to take them, yes. What is? Salt. Salt? We are salt. No, it's not inflammatory. There is a guideline, number seven says avoid heavily salted foods and that's mainly because this is an international guideline and people in developing nations where they use salt to preserve food have a higher rate of cancer of the esophagus and stomach because of heavily salted foods but what we use in this country, it's a good thing. Yeah, yes. I'd like to know if you think that people that cure their cancer through either macrobiotic diet, the gersen therapy or any other kind of diet? No. You don't believe that? I don't believe that. I mean, I think there are cases of spontaneous healing and in the literature, macrobiotics is a bit tough to adhere to forever but it is, I think it also is a bit of a starvation diet in a way. The gersen diet, too much negative flow of coffee enemas, I don't think we should be pushing contents from our colon into our bloodstream. Too many supplements, too many juices. Yeah, I don't think so, yes. Yeah. If we have more rest, no, I don't think because sleep is all about those rhythms, the alpha, beta and whatever and you need that to sort of replenish so it's a good thought. In fact, they say the opposite. If you're having trouble sleeping, you should get out of bed and do something else so maybe it'll help you fall back to sleep. Am I getting the ax? You are getting the ax. Okay, good. And I wanna say thank you very much. Yes.