 I hear from lots of people every day who are concerned about how their diet is affecting their health. They need answers based on facts—in other words, from the peer-reviewed medical literature—and that is what I'm here for. Welcome to the Nutrition Facts podcast. I'm your host, Dr. Michael Greger. Today we have the first in a two-part series where I offer some of the highlights from my latest book, How Not to Age, taped in front of a live audience. There may be no such thing as dying from old age. From a study of more than 42,000 consecutive autopsies, centenarians—those who live to be 100— were found to have succumbed to disease in 100% of the cases, though most were perceived even by their physicians to be healthy just prior to death, not one died of old age. They died from disease, most commonly, heart disease. If aging kills via diseases, why wasn't my book How Not to Die all the longevity book anyone needs? In it, I ran through preventing, arresting, or reversing each of our top 15 killers starting with heart disease—not only the number one killer of centenarians, but of men and women across the board and projected to main that way in the decades to come. But is it really? Because the single greatest risk factor for most of our killer diseases is how old you are, one could argue that the leading cause of death is actually aging. The rate of death increases exponentially for age-related diseases such as heart disease, cancer, stroke, dementia. So yes, within the same age brackets, having a high cholesterol can increase your risk of heart disease up to 20-fold, but an 80-year-old may have 500 times the risk of having a heart attack compared to a 20-year-old. Now, the reason we focus on things like cholesterol is because it's a modifiable risk factor. But what if the rate of aging was modifiable too? Instead of our current kind of piecemeal approach focusing on individual diseases, what about slowing down the aging process itself? You know, when I was a nerdy little kid, I wanted to cure cancer when I grew up. But even if all forms of cancer were eliminated, the average life expectancy in the U.S. would only go up about three years. Why? Because dodging cancer would just mean delaying death from a heart attack or stroke. If one age-related ailment doesn't get us, another will. So rather than playing whack-a-mole by tackling each disease separately, slowing down the rate of aging could potentially address all these issues simultaneously. Imagine if there were an intervention. They didn't just reduce your risk of the leading killers, but also arthritis, osteoporosis, sensory impairments. Because risks tend to double every seven years. Like if the average 65-year-old had the health of the 58-year-old, slowing aging by even just seven years could cut everyone's risk of death, frailty, and disability in half. That's why I wrote How Not to Age. The problem is that the anti-aging field is said to be a fertile ground for cons, scams, and get-rich-quick schemes. As a former president of the Gerontological Society wrote, there have been few subjects that have been more misleading to the uncritical and more profitable for the unscrupulous. Not only does the popular literature on the subject harbor a huge amount of misinformation, but most age-researching scientists, widely known to the public, are said to be unscrupulous purveyors of useless nostrums according to the editor-in-chief of the leading gerontology journal. When it comes to something as life and death important as to what to feed ourselves and our families, we should rely not on anecdote, but on evidence. That's why I cite everything to the teeth. How not to die at about 2,000 citations. How not to die at 5,000 citations. How not to age ended up with 13,000 citations. All of which I have hyperlinked for you online to access all the original sources so you can download the studies and read them all yourself. My aim was to cover every possible angle for developing the optimal diet and lifestyle for the longest, healthiest lifespan based on the best available balance of evidence. My inspiration for writing the book was a consensus document, interventions to slow aging in humans compiled by the top researchers in the anti-aging field. Their likes of doctors, Longo, Sinclair, Fontana, they were brought together to identify the most promising strategies to combat aging. They identified a list of essential pathways. For example, drugs that can block the hormone IGF1 or drugs to block the pro-aging enzyme tour. But I realized as I looked through this way, every single one of these pathways could be regulated through diet. That became the first section of the book. The term anti-aging has been much abused in popular culture attached to all manner of unproven products and procedures whereas the term should really be reserved for things that can delay or reverse aging by targeting one of the established aging mechanisms, the so-called hallmarks of aging. The common denominators of the aging process like, for example, the buildup of misfolded proteins that can be disposed of through autophagy. See, at any given time, most of our cells are producing and assembling more than 10,000 distinct proteins, each of which can become misfolded or damaged at any time and require a cleanup in aisle three. But during times of excess nutrition, our body figures why bother? We can just toss it in the corner, make another. Having evolved in the context of scarcity, our body expects to fall on the hard times any day now and can put off spring cleaning until then. These days, those lean times hardly ever come so our cells just continually end up hoarding junk. That's where autophagy comes from. From the Greek words for self-eating, it's a housekeeping process by which defective cellular components are broken down and scrapped for spare parts. This doubles as both kind of salvage operation and quality control, clearing out some of the damaged debris implicated in the aging process while renewing our cells in a sort of cellular reset. As one review put it, the janitor is the undercover boss. Our ancient ancestors often went for several days without food so autophagy was constantly being switched on. But these days, our cells no longer need to kind of clean out the corners for sustenance and so the tainted heaps just pile higher and higher, which isn't good because autophagy is essential for lifespan extension. It's not only necessary but sometimes sufficient for increasing longevity. Self-digestion for lifespan extension. Boosting autophagy alone can boost lifespan at least in mice by an average of 12% and it also boosts health span. Unfortunately, our body's ability to take out the trash declines with age leading to this vicious cycle. Garbage builds up accelerating aging which leads to more garbage buildup. No wonder the drug industry so eager to pharmacologically modulate autophagy to combat aging but we can do it naturally. One way is through fasting. Unfortunately, autophagy doesn't really maximally ramp up until after a day or two of fasting which may be too long to do it unsupervised. Fasting more than 24 hours should probably only be done under medical supervision, ideally in a kind of live-in clinic. In other words, don't try this at home. This is not just legalistic mumbo-jumbo. For example, normally your kidneys dive into sodium conservation mode but should this response break down you could rapidly develop an electrolyte abnormality which might only manifest as nonspecific symptoms like fatigue or dizziness which could be easily dismissed until it's too late. Thankfully, there's another way to activate autophagy. You can fast or go fast. Exercise induces autophagy. As one of the researchers said, I've always known exercise was good for you but when we found out it increases autophagy, I finally got a treadmill. You have to do it enough though. Autophagy is activated after 60 minutes of moderate intensity exercise but only 20 minutes fails to move the needle. What about diet? Any foods to avoid? In 2021, we found out that acrylamide can inhibit autophagy, at least it sells in a petri dish. Acrylamide is a toxin concentrated in french fries and potato chips that's formed during the frying process. The fact that high acrylamide exposure is associated with as much as double the risk of premature death would be consistent with an anti-autophagy effect though diminished life spans among eaters of fatty salty snacks isn't exactly a revelation. You can't know if it's cause and effect until you put it to the tip. Very nice! Before being asked to eat a bag of potato chips every day for a month, study subjects were given weeks of boiled potatoes mixed with the same amount of fat and salt as the chips compared to the fatty salty boiled potatoes. Their C-reactive protein levels shot up 50% on the chips suggesting chronic ingestion of acrylamide-containing products induces a pro-inflammatory state. However, deep frying causes the formation of all matter of undesired foodborne toxicants so we can't be sure it was the acrylamide. As one of the earliest geriatric medicine textbooks presently concluded back in 1849, frying is an abomination. If you just must have your french fry fix, air frying produces about 90% less acrylamide. Anything that can help? Well, you know, starving yourself generates discomfort but there is something that activates autophagy that many people find comforting. Coffee. Human-equivalent dose both regular and decaf rapidly induce autophagy within hours in mice and coffee can extend the lifespan of some rats. But what about people? Well, humans will only have observational research but to date about 20 studies have followed more than 10 million people over time and those drinking 3 cups of coffee a day, 13% lower risk of dying from all causes put together. And decaf appears to be just as protective so it's not the caffeine. Coffee contains more than 1,000 bioactive compounds. The polyphenolchlorogenic acid is the most abundant antioxidant in coffee so researchers started there and indeed was found to enhance autophagy in human cells. More than 100 coffees have been tested and the chlorogenic acid levels vary by more than 30-fold. Interestingly, the major contributor to this wide range is Starbucks with its extremely low chlorogenic acid content thought to be because they roast their beans so dark that they destroy it. Now, freeze-drying is okay and brood has more than espresso. Paper filtered is the best because it traps the cholesterol-raising compounds in coffee perhaps explaining why those drinking filtered coffee had even lower mortality rates than those drinking unfiltered coffee. Any food components that can activate autophagy? Spermedine. The Longevity Elixir Spermedine. Don't be put off by the name. Spermedine and its by-product spermine are actually found throughout the body when it was later independently discovered in the brain and the muscles. They called it neurodine and musculamine until they found out it was all the same compound so naming rights defaulted to the less palatable original. Our body can make it from scratch but we can boost levels by eating Spermedine-rich foods which is good news because Spermedine levels tend to decline with age dropping more than half by the time we reach our 50s. This decline is seen across the biological spectrum with one remarkable exception, naked mole rats also known by their more cuddly nickname Sand Puppy considered to be a non-aging mammal without any visible signs of aging almost no decline in physiological function over decades no typical signs of aging like loss of muscle mass or fertility perhaps in part because they're able to maintain their high levels of spermine something that you also see in human centenarians. To prove cause and effect extra Spermedine was fed to animals and induction of autophagy by Spermedine promotes longevity increasing life fans of mice for example by as much as 25%. In a database of more than a thousand life extending compounds among the small subset with the fewest side effects Spermedine has the largest documented lifespan extension. Longevity can be improved even when started late in life kind of the human equivalent of changing your diet when you're already in your 50s anti-aging effects were found in the heart and kidneys rejuvenating immune function delaying brain aging and improving cognitive function yeah but this was in animals like fruit flies and mice I mean who cares if Spermedine cures flies of senior moments what about in people hundreds of men and women their 40s through 80s were fall for 20 years and after looking at 146 different components of their diets the single most predictive of longevity was Spermedine how much Spermedine they were eating higher Spermedine intake is linked to lower mortality those who consumed the most Spermedine had a reduced risk of death from all major causes which is what we'd expect from an anti-aging compound critically the survival advantage persisted even after controlling for dietary excellence meaning it wasn't just because they're eating healthier foods in general but specifically Spermedine rich foods in particular how big of an effect are we talking while the reduction in mortality risk between getting more than 12 milligrams of Spermedine today compared to getting less than 9 was as if those eating more Spermedine were 5.7 years younger it's as if by eating certain foods they were able to kind of effectively turn back the clock nearly 6 years the findings were so extraordinary the researchers sought to replicate their results in a whole new set of individuals indeed arrived at the same conclusion this led some to propose that Spermedine may be an anti-aging vitamin when we're younger we seem to be able to make enough but as we get older we may need to start ensuring we're getting enough in our diet to maintain autophagy into old age well Spermedine is going to be considered an anti-aging vitamin where is that vitamin found? Beans are said to have the highest natural amounts but I compiled a list of the top Spermedine sources and big pancreas beat up bean burritos for the bronze as a certified dark green leafy snob I was begrudgingly impressed to see lettuce score so high the lettuce is so light 100 grams serving would be about 3 cups of lettuce but even the Spermedine little side salads could certainly really add up in the book I spent a lot of time going through the entire list but the single most concentrated source is wheat germ with 2.5 milligrams Spermedine in just the 7 grams and a tablespoon it's also the cheapest source costing as little as 2 cents per milligram you can't get a lot of pancreas for 2 cents does wheat germ actually do anything? let's randomize people to some dinner rolls and find out randomize double blind pilot in which older adults were secretly slipped some Spermedine in the form of wheat germ baked into dinner rolls versus placebo rolls with wheat bran instead and those with mild dementia improved way beyond all available anti-dimension drug treatments so far admittedly that's not saying much but what's the harm of sprinkling a little wheat germ on your food and the latest Alzheimer's drugs don't appear to work at all all you get for your $56,000 is a dramatically increased risk of swelling or bleeding into your brain when the FDA approved it anyway the head of the American Geriatric Society replied my head just exploded maybe they just got slipped a dose of the drug anyway lots of other clinical Spermedine studies but just to wrap up this section autophagy is considered the primary system for cleaning the body from the inside out and we can boost autophagy with aerobic exercise skipping fries and chips drinking coffee and eating specific foods to reach a target of 20 milligrams of Spermedine a day for similar diet and lifestyle takeaways for each of the other 10 anti-aging pathways but don't have time to touch on them because there's three other major sections to the book part two focuses on the diets and lifestyles of the healthiest and long-lived populations around the world the odds of living to 100 have risen from approximately 1 in 20 million to as high as 1 in 50 why do some people make it and others not it's not just a matter of picking better parents studies following identical twins suggested only about 25% of the variation in lifespan is explained by genetics so what can we do for the majority over which we may have some control the media loves stories of hard-living centenarians who attribute their longevity to some combination of lard, vodka and favorite brand of cigarette but how do the oldest and healthiest really eat and live that's what we have the blue zones for areas of exceptional longevity around the world where there may be 10 times the rate of those reaching those triple digits actually named for a color that a demographer used and a kind of heat map mortality around the globe what lessons can we learn well the blue zones organization distilled findings more than 150 dietary surveys from the world's longest living people to create a set of 10 food guidelines the foundation of the blue zones food guidelines is making your diet at least 95% plant-based avoiding highly processed foods emphasizing beans as the healthiest source of protein water as the best beverage and nuts as the healthiest snack that's the foundation the final five guidelines are go easy on fish eliminate eggs slash sugar reduce dairy and retreat from meat noting that blue zone centenarians only eat about two ounces of meat or less about five times a month historically there have been five recognized blue zones but only one survives and thrives to this day the red, white and blue zone the seven-day Adventists in Loma Linda, California with perhaps the longest life expectancy of any formally studied population in history there are a number of shared blue zones lifestyle characteristics, family coherence avoiding smoking, daily exercise, social engagement but plant-based nutrition appears to be the principal component alone accounting for about half the difference in lifespan no surprise since the number one risk factor for death in the United States is the American diet so unsafe sex, bad sedentary lifestyle, bad alcohol and drugs especially tobacco bad but cigarettes only killing about a half million Americans every year whereas our diet kills many more we are what we eat which is good news because it means we have the power changing from a more typical diet to a more optimized diet starting at age 20 would be expected to increase the lifespan of women 11 years and men by 13 years the largest life expectancy gain would be made by eating more legumes beans, split peas, chickpeas and longevity so if there's one thing we could eat legumes for longevity hummus for health then comes whole grains and nuts and eating less meat now for the few of you who aren't 20 anymore not to worry starting eating healthier at age 60 could still mean adding eight or nine years to your lifespan even starting at late as age 80 could add years changing your health destiny can start tomorrow morning at breakfast and it doesn't take much the NIH AARP studies the largest forward-looking study on diet and health in history based on its 6 million person years of observation replacing just 3% of daily caloric intake from animal protein with plant protein was associated with a 10% decreased risk of overall mortality both men and women just swapping 3% of all the animal protein sources eggs were found to be the worst swapping in 3% of plant protein for egg protein was associated with twice the benefit 20% lower mortality for swapping in a few British beans for breakfast instead Harvard researchers found that when it comes to premature death process meat was the worst followed by eggs in essence they found that tuna salad may be better than egg salad or BLT but a bean burrito beat out the bunch when it came to death from all causes put together plant protein beat out every type of animal protein including dairy, fish and chicken a 3% swap from chicken to chickpeas or fish to falafel was linked to a 6% decreased risk of premature death but does eating healthy actually slow down aging randomize hundreds of women to a diet centered around healthy plant foods or exercise or neither and though the physical activity failed those in the plant based dietary intervention group had a significant slowing of biological aging of course it isn't just about adding years to your life but life to your years an unhealthy aging index was devised to measure functional impairments vitality, mental health, physical health substituting even just 1% of calories from plant protein for animal protein appeared to lead to significant less deficit accumulation and substituting 5% may reduce the risk of dying from the greatest deficit dementia that may help explain why those who don't eat any meat at all may be up to three times less likely to become demented but again it's not all or nothing in fact the worst thing about humanity's diet is neither animal nor vegetable but mineral sodium here are the top 5 fatal flaws of our diet millions of deaths may be attributed every year to knocking enough whole grains not eating enough fruit, not enough nuts and seeds not enough vegetables but the single deadliest ingredient in humanity's diet is something we get too much of and that's salt number one dietary risk factor for death a recent whopping study for example more than a half million people found that those who salted their food at age 50 appeared to have about a two year lower life expectancy compared to those that didn't so just swapping out the salt shaker for some salt free seasonings or salt substitutes could potentially add years to your life how do we know it's cause and effect five kitchens at a veteran's retirement home were randomized into two groups for a few years offering meals salted either with regular salt or unbeknownst to them a 50-50 blend of regular salt sodium chloride with a salt substitute like these potassium chloride the kind of salt was the only difference between the meals and cardiovascular disease death rates plummeted by 40% in the folks getting the reduced sodium blend the new difference in life expectancy between the two groups at age 70 was equivalent to that which would have occurred naturally in 14 years meaning simply switching to even just half potassium salt which you wouldn't even be able to taste the difference of appeared to effectively make people more than a decade younger when it came to the risk of premature death what are the likes of the salt institute have to say about public health recommendations to reduce sodium intake well in testimony before a congressional committee the presumption that healthier diets would cut health care costs was challenged indeed one processed food defender testified health care expenditures increase if lifespan is prolonged I mean if people eat healthier and live longer it could be more expensive noting that if tobacco were banned the increase in expected lifespan would increase the cost of care of old people think how expensive it would be if people started taking care of themselves and didn't conveniently die on time ultra processed foods often packed with added salt, sugar and fat consistently account for more than 50% of our dietary caloric intake more than half of our diet is junk not surprisingly those foods are associated with significantly increased risk of dying prematurely so just cutting back on animal foods isn't enough healthy plant-based diets are associated with significantly lower risk of dying but unhealthy plant-based diets are not in the Harvard cohorts the more you minimize meat, eggs and dairy the lower your risk of death falls but that's only if you're eating healthy plant foods if you instead just pile on the junk like chips and soda you can increase your risk of death overall even if animal product consumption remains low same in the million veteran program study healthy plant foods reduce their risk of death but if your idea of a plant-based diet is fries and a coke you're not doing your body any favors same with the risk of cognitive impairment only healthy plant foods reduce risk the same with dementia and depression the same with frailty healthy plant foods good plant-based junk bad that's why Cornell professor emeritus of biochemistry teeth calling Campbell coined the term whole food plant-based diet as a physician terms like vegetarian, vegan just tell me what you don't eat I mean do you actually eat vegetables? Professor Campbell's physician son and daughter-in-law tried putting a group of vegetarians and vegans on a whole food plant-based diet in eight weeks they lost 10 pounds dropped their LDL cholesterol 15 points in other words vegans may benefit from eating a little more plant-based too now meat is a problem in terms of lifespan eating a burger may cut one's life as short as smoking two cigarettes so if it wouldn't even occur to us to light up before and after lunch maybe we should choose the bean burrito instead there are certainly ways to make meat safer though for example one of the ways whole food plant-based diets can help is by reducing the load of gerontotoxins age accelerating toxins such as advanced glycation and prox also known as glyotoxins or AGEs and acronym intentionally chosen to emphasize their toxic role in age-related disease AGEs occur naturally in animals but dry cooking methods can generate 10 to 100 times more when muscle cells rupture under dry heat highly reactive compounds combined with the blood and body sugars to form AGEs within the meat so even without cutting down on meat you can significantly cut down on glycotoxin intake just by switching up cooking methods the safest ways of cooking meat are moist methods such as boiling, poaching, steaming, stewing when people are randomized to a meal of fried or broiled chicken breast and veggies or the same meal with the same ingredients including the oil but with steamed or boiled chicken breast instead that single high AGE meal with a fried or broiled breast induced a profound impairment of artery function within hours I mean the steamed chicken still impaired artery function but not as much as the fried or broiled so we can eat an age less diet by switching to moist methods for example but you know dietary approaches are said to have zero commercial value and hey, stewed chicken may not be as tasty so why not just take a drug to block AGE absorption every time we eat I mean it does lower your blood levels of AGEs is just activated charcoal like when people are poisoned or for like drug overdoses I'm sure our AGEs would also go down if we chased our chicken with some Ipacac too what about fish unfortunately our oceans have essentially become humanity's sewer everything eventually flows into the sea so the consumption of contaminated seafood has become the main route of human exposure to chemical pollutants yes a variety of foods are affected but the number one source of DDT fish number one source of PCBs fish salmon is the worst when it comes to PCBs followed by canned tuna salmon also has the highest levels of dioxin like compounds so on the one hand fish has long been viewed as a healthy dietary component because of those long chain omega-3s but on the other hand we're so polluting our world that we're now seeing heavy metals pesticide, flame retardants in fish forever chemicals which may explain why despite their omega-3s there's been a failure to consistently observe beneficial effects of fish consumption so if we had a time machine to go back before the industrial revolution that'd be one thing but now we have studies like this where mice fed commercially available farmed salmon fillets with common levels of persistent organic pollutants were found to develop insulin resistance glucose intolerance, abdominal obesity fatty liver, chronic low grade inflammation so even just background levels of pollutants that might be presumed to be safe could completely counteract the potential benefits of the omega-3s in particular leading to metabolic issues now for mercury it's more about brain health hundreds of thousands of babies born with brain damage every year seemingly as a consequence of their mothers consuming mercury contaminated fish during pregnancy with the resulting loss of intelligence estimated to cost billions of dollars of lost productivity every year in the aging literature there are cases like this man with progressive memory loss tentatively diagnosed with Alzheimer's dementia his friends and families assumed he was nearing the end of his life but a detailed history revealed that he had consumed swordfish once or twice a week when the fish was removed from his diet his mercury levels fell and his memory bounced back no more dementia so it seemed he didn't have Alzheimer's after all but rather mercury poisoning from a handful of monthly meals of contaminated fish you can see the same remarkable reversals with hair loss here's a common story perimenopausal woman seeks help for hair loss blood tests indicate elevated mercury levels and no wonder because she had a diet high in tuna but within two months of stopping fish her hair started growing back and eventually her hair re-grew completely so doctors should consider screening for mercury toxicity when they see hair loss since there's something we can do about it instructing patients to reduce fish intake could offer relief of symptoms and uncovered dietary habits that may be a source of heavy metal induced hair loss though admittedly sometimes heavy metal can lead to too much hair what about alcohol? that's from plants? sorry to be Dr. Buzzkill but alcohol appears to be humanity's one leading cause of death and disability the safest level of drinking is none but wait a second what about the famous J-curve where light to moderate drinkers appear to have lower mortality rates than the T-total or zero drinks a day this may just be an artifact of the systemic misclassification of former drinkers as lifelong abstainers this leads to the so-called sick-quitter effect where the reason a person may be a non-drinker is because drinking made them sick thereby making current drinkers look good in comparison it's the same reason studies can find higher mortality among those who quit smoking compared to those who continue to smoke it's not that abstention led to poor health but poor health rather led to abstention when researchers went back and told for the error of misclassifying former drinkers the J-curve disappeared no more apparent benefit to moderate drinking in other words compared to true abstainers the more alcohol the more disease with no apparent protection at low levels of consumption even red wine unfortunately interventional trials show that wine can cause inflammation within hours of consumption both red and white significantly more than just drinking sugar water and you get a surge of fat in your bloodstream that you don't get drinking de-alcoholized red wine the same wine with alcohol taken out what about just taking supplements of the red wine compound resveratrol oh you mean the supplement found to nearly triple the loss of brain tissue compared to placebo no thank you the healthiest beverages are probably water and tea increasing tea consumption 3 cups a day may decrease the risk of premature death from all causes by 24% this applied to both green and black tea though green may have a slight advantage part of this protection may be a lower risk of pneumonia in five randomized controlled trials showing that those randomized to green tea are about a third less likely to come down with the flu for example within just one hour of drinking a single cup of green tea we can significantly cut down on the rate of DNA damage in our cells because green tea significantly boosts the activity of DNA repair enzyme in our body that can fix DNA damage and within a month drinking two small daily cups of green tea will increase the risk of DNA resistance to free radical damage in the first place indicating that green tea has significant genome protective effects or DNA protecting effects stay tuned next week for part two of this how not to age presentation we would love it if you could share with us your stories about reinventing your health through evidence-based nutrition go to nutritionfacts.org slash testimonials to share it on social media to help inspire others if you see any graphs, charts, graphics images or studies mentioned here please go to the nutrition facts podcast landing page there you'll find all the detailed information you need plus links to all the sources we cite for each of these topics my latest book how not to age is out now premiering at number two on the New York Times best solos list check it out at your local public library there's all the proceeds of the sales of all my books goes directly to charity nutritionfacts.org is a non-profit science-based public service where you can sign up for free daily updates on the latest nutrition research with bite-sized videos and articles everything on the website is free there, no ads no corporate sponsorships, no kickbacks strictly non-commercial I'm not selling anything I just put up as a public service as a labor of love as a tribute to a grandmother whose own life was saved with evidence-based nutrition