 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 second in a two-part series where I offer some highlights from my latest book, How Not to Age, taped in front of a live audience. We pick up our story with tips on how to keep our vital organs in good working order. What can we do to protect our bones, bowels, bladder and circulation, our hair, hearing and hormone balance, immune function, joint health, our minds, our muscles, sex life and skin, our teeth, vision, and finally, our dignity and death. Let me just share a few quick pearls. For example, did you know that 85% of bone-related fracture risk has nothing to do with bone mineral density? That's just been drilled into our heads by big farm and a billion dollar bone density screening industry. Fractures are primarily due to falling, not osteoporosis. So it's the age-related muscle loss and impaired balance that may be breaking most of our bones, which is good news because there's something we can do about it. Seven randomized controlled trials, strength and balance training cut fracture rates nearly in half, and that's just during the trial. In the five years after this one-year study ended, those who had previously been randomized to the combined strength and balance group suffered 74% fewer fractures. That's far more effective than osteoporosis drugs like Phosomax that can cause fractures, atypical femoral fractures and as many as 1 in 300 uses. They're called atypical because they occur not after a fall or trauma, but just during routine activities like walking, twisting at the hip, or just standing still. Thanks to the drug, your femur, your thigh bone, the biggest bone in your body just cracks in half. Too cruel an irony from a drug that's supposed to protect your bones. After bones, I talk about preserving your bowel function in chapter number two. Randomized constipated diabetics to either cookies containing a tablespoon, a day of ground flax seeds, or flax-free placebo cookies for 12 weeks, and not only does the flax improve constipation symptoms, but resulted in 8-pound weight loss over placebo, 25-point lower blood sugars, an astounding drop in hemoglobin A1c, and 17-point lower LDL cholesterol, all for about 10 cents a day of ground flax seeds. For a head-to-head test between flax seeds and psyllium, sold as metamucil, a third cookie group was added, about 10 grams of psyllium, and the flax seed beat out the psyllium for constipation relief, weight, blood sugars, and cholesterol, and is about four times cheaper. Flax seeds were also directly compared to the prescription laxative lactulose, and worked better as well. Bladder function. Prevalence of overactive bladder syndrome increases with age, reaching about one in three. No wonder bladder-relaxing drugs are a multi-billion dollar industry, yet may only reduce bathroom breaks by about half a pee a day compared to placebo. But a quarter teaspoon a day of dried cranberry powder worked nearly four times better, about two fewer daily trip to the bathroom over placebo, and that's without any of the drug side effects, dry mouth constipation sedation-impaired cognition, rapid heartbeat, urinary retention, and the urinary and the visual disturbance that lead almost two-thirds to stop taking the drugs, whereas cranberries are just tangy. Urinary incontinence is a common problem among older adults, particularly women, thanks to childbirth. Systemic menopausal hormone therapy like premarin actually makes it worse, but local vaginal estrogen may help. What works five times better than estrogen cream, though, kegel exercises, pelvic floor exercises, as I detail in the section jacked in the box. For men, urinary issues are more an enlarged prostate problem, having to get up multiple times a night, wee hours of the night. Cranberries to the rescue there again, even just a eighth of a teaspoon a day of powdered cranberries can significantly improve prostate symptoms. You can buy cranberry powder in bulk at a cost of less than a penny per day. What about sol-palmetto, the most common herbal supplement used for prostate symptoms, based on dozens of randomized controlled trials involving nearly 5,000 men? No clinical benefits, but pumpkin seeds work. More than a thousand men with prostate symptoms were randomized to either about a tablespoon a day of plain pumpkin seed kernels, a proprietary pumpkin seed extract or placebo. The study was funded by the drug company that made the supplement, but the supplement totally flopped while the pumpkin seeds themselves worked. Pumpkin seed oil was pitted against the leading drug for hair loss in women. A little less than a quarter teaspoon applied to the scalp once a day versus a dose of the drug, and they both worked, but the drug worked better. But rosemary oil, however, may be more closely matched. 100 balding men were randomized to twice a day minoxidil like Rogaine versus a rosemary lotion. It took six months, but significant comparable improvements in hair counts in both groups with no significant difference between the two. The rosemary lotion appeared to work as well as the drug. If you want to give it a DIY try, you can pre-mix about 10 drops of rosemary essential oil to each fluid ounce of your favorite lotion and rub a quarter teaspoon on your scalp twice a day. Cost-wise, that much rosemary oil would come out to be about a penny per week. Let's move on from hair highlights to hormones. I touched upon how menopausal hormone therapy can increase the risk of urinary incontinence, but that's not all. If 1,000 post-menopausal women, women take the standard hormone regimen for 10 years, you'd not only expect 876 extra cases of urinary incontinence that they would not have gotten otherwise, but nine more cases of invasive breast cancer. Eight more cases of heart disease, probably 22 more cases of dementia, 21 more cases of gallbladder disease, nine more strokes, and 21 more blood clots, though not a single partridge nor pear tree. However, hormone therapy is highly effective in decreasing menopausal hot flashes. Is there any way to keep cool without the clots in cancer? In the U.S., menopausal hot flashes are considered inevitable, but there isn't even a word for hot flash in Japanese, and this may be due to their greater consumption of soy foods, but you don't really know until you put it to the test. Harvard Center of Excellence in Women's Health funded a randomized crossover trial of a half a cup of unsalted soy nuts a day and achieved about a 40 to 45 percent reduction in hot flashes within two weeks compared to the control group. Given that a plant-based diet may also be effective for managing menopausal symptoms, researchers decided to combine the two of plant-based diet plus whole soybeans. In fact, two randomized control trials found that plant-based nutrition with a daily half cup of cooked whole soybeans can reduce the number of serious hot flashes by 84 to 88 percent within 12 weeks. Overall, most randomized to the plant-based bean group ended up free of moderate to severe hot flashes compared to about 95 percent sill suffering in the control group. Lots of other things can help whole fennel seeds powdered into capsules to pit them against placebo in a double-blind trial significantly improve menopausal symptoms at a dose of about a teaspoon a day. Fenugreek may also help at a dose of one and a half teaspoons a day, though not as much as hormones but without the side effects. Though fenugreek can make your pee smell like maple syrup, sounds like a bonus. The nice thing about studying spices is you can entire servings can be stuffed into a pill to pit them against placebo. A quarter teaspoon of black cumin powder a day led to significant improvements in memory and other tests of cognition within nine weeks compared to placebo. Black sesame seeds less than a teaspoon a day of ground black sesame seeds stuffed into capsules against placebo drove down systolic blood pressures by about eight points within a month. If sustained that alone could decrease the risk of stroke by about a quarter. What else can we powder? Strawberries, osteoarthritis patients were randomized to two ounces of freeze dried strawberry powder versus a fake strawberry flavored and colored placebo powder and compared to placebo the real strawberries significantly decreased constant pain intermittent pain and total knee pain and improved disability and overall quality of life. Osteoarthritis is the most frequent cause of physical disability among older adults yet how do we treat it? Acetaminophen Tylenol is considered the first line pain killer but guess what it doesn't work. I mean it works just not much better than a sugar pill but at least it's not going to make things worse. Like other things we doctors have cooked up like steroid injections which actively worsen joint deterioration and offer no greater pain relief than placebos or arthroscopic surgery which may end up tripling our risk of ending up having to get a total knee replacement. I mean so you know even if the strawberry study is some total fluke what's the worst that can happen? Tastier smoothies? And listen to the quarter of a teaspoon of ground ginger a day can beat out placebo for joint pain. Researchers conclude ginger therefore is recommended as a safe drug for these patients but by drug they just mean a couple pinches of the ground ginger you can buy at any store. There was even a study on topical ginger at least when applied to the scrotum paper thin slices of ginger applied over the inflamed testicles and the researchers were on the ball healing nearly three times faster than the control room. There have been more than a hundred randomized controlled trials on ginger shown to help with nausea and vomiting and everything from COVID to PMS, heavy periods, painful periods, migraine headaches, multiple sclerosis, and the list goes on. Bottom line mounting evidence suggests ginger can promote healthy aging. What about garlic clinically proven to protect against those who want to suck your blood? Literally a hundred marines were randomized to a clove a day or a placebo and those on garlic had significantly fewer tick bites though sadly garlic does not appear to help against other blood suckers. So far I've touched on preserving your bones, bowels, bladder, hair, hormones, and joints but preserving your mind is the largest chapter in the book because dementia is one of the most pressing public health problems and most feared condition of later life. There's a common misconception that we have no control over whether we develop dementia but the good news is that although Alzheimer's may be incurable at least it is preventable. There's an emerging consensus that what's good for our hearts is also good for our heads. Clog with cholesterol, closing off arteries, clamping down blood flow. What kind of brain arteries do you want in your head? Too much cholesterol in our blood is unanimously recognized to be a risk factor for the development of Alzheimer's disease. Those with a total cholesterol of 225 or more may have nearly 25 times the odds of ending up with amyloid plaques that plaques in their brain 10 to 15 years later. Cholesterol explains how the Alzheimer's gene apoE4 ravages the brain. After all, apoE is the primary cholesterol carrier inside the brain. LDL cholesterol in those with low kind of bad gene variants of apoE averages 40 points higher but switch people to a diet lower in animal fat and that cholesterol difference can be effectively smoothed out so diet can trump genetics. This may explain the so-called Nigerian paradox where they have among the highest rates of the Alzheimer's gene but some of the lowest rates of Alzheimer's disease. How is that possible? Genes load the gun but lifestyle pulls the trigger. The paradox may be explained by their low cholesterol levels probably because of their diet's low in animal fat. Human beings may have evolved to maintain an LDL cholesterol level of around 25 but the average in the western world is approximately 120. No wonder heart disease is the leading cause of death in high income countries and dementia is killer number two. That helps to explain why the so-called Alzheimer's gene is the single most important gene when it comes to longevity too which is good news because even if we've been dealt some bad genetic cards we still may be able to reshuffle the deck with diet. So in terms of dietary guidelines for the prevention of Alzheimer's we should center our diets around vegetables, legumes, fruits and whole grains. In other words the dietary pillar of lifestyle, medicine, whole food, plant-based nutrition or even simpler plants plants and more plants any plants in particular. Note that the director of Loma Linda's Alzheimer's prevention program single up berries and greens eating strawberries and spinach can mitigate age-related cognitive decline in rats but what about in people? When the cognition of hundreds of twins was followed over a decade consuming the berry pigments in less than a quarter cup of blueberries a day or about a cup of strawberries was associated with slowed cognitive aging by about four years and nearly all the randomized controlled trials on blueberries and cognitive performance found improvements in at least one brain domain perhaps because blueberry consumption can improve blood flow to certain critical regions of the brain. Now the one study that flopped mixed the berries with milk and we know that the addition of milk can prevent the artery protective effects of tea and prevents the bump in antioxidants that you'd normally get eating dark chocolate and impairs the absorption of the autophagy activating compounds in coffee. What about mixing berries and cream? The antioxidant activity of blueberries is not just impaired by milk researchers found that the total antioxidant capacity of our bloodstream measured in two different ways shoots up within an hour of eating a cup and a half of blueberries with water and remains elevated five hours later with milk and maybe we'd expect like less of a bump but in fact they ended up worse than when they started after eating a whole bowl of blueberries they ended up with less antioxidant capacity in their body because they ate the blueberries with milk. One reason greens may be referred to as an anti Alzheimer's plant is because dark green leafy vegetables can also improve blood flow in the brain and interventional trials randomized older adults to the greens pigments found in a cup of days worth of cooked kale and see significant improvements in complex attention cognitive flexibility and those randomized even just half a cup of kale's worth of the cruciferous compound sulforaphane got significant improvements in processing speed and working memory. Here's the rate of cognitive decline in elderly men and women eating a serving a day of green leafies compared to those only eating greens about once every 10 days. Are you sitting down? The rates of decline among those who consumed one to two servings of greens a day was equivalent to being 11 years younger so now are you sitting down to a big salad? Greens come up in chapter after chapter what's the recommendation for preventing age related macular degeneration are leading cause of blindness or even treating it in its earliest stages consume a diet high in green leafy vegetables. We're talking two to three servings a day so at least greens at every lunch and supper with bonus points for sneaking them into breakfast and like a green smoothie in fact blending greens can triple the bioavailability of a key vision protecting nutrients. The main reason greens make it into my anti-aging eight though is because of the nitrates and the serving two of cooked greens can slow our metabolic rate for the same reason that a little shot of beet juice can help freedivers hold their breath longer because it improves the efficiency of our mitochondria little power plants and ourselves allowing us to effectively extract more energy from each breath. Another dietary intervention that is a similar effect on slowing metabolism is calorie restriction right the candle that burns half as bright burns twice as long but instead of starving all the time you can just eat a big salad. What else can greens do? The Harvard nurses health study the consumption of leafy greens appeared to protect against the development of frailty and when put to the test in a randomized double-blind placebo controlled trial the equivalent of two-thirds of a cup of spinach led to a significant boost in muscle strength muscle quality and muscle mass in older men and women. A single cup of cooked greens worth of vegetable nitrates significantly boosted maximal power and velocity in quads so much it was functionally equivalent to acutely reversing the effects of several decades of aging a single cup of cooked greens. Of course when most people think about maintaining muscle mass into old age they don't think spinach they think protein but if you put together all the randomized controlled trials of adding extra protein to the diets of older men and women you find no evidence that adding protein increases muscle mass restraint. Okay yeah but what if you have sarcopenia excessive age related muscle loss right surely then protein helps right no no significant effect on physical performance or muscle strength what does work exercise when it comes to age related muscle mass it's use it or lose it maybe exercise plus protein no protein supplementation does not significantly augment the effects of strength training in older adults in fact one of my anti-aging eight is protein restriction why do longevity experts like valter longo recommend people cut down on protein to live long here's what luigi fontana wrote in his book he's the director of another leading longevity research center excess protein may not mass your muscles but it will accelerate aging how do you boost the pro longevity hormone fgf-21 dietary protein restriction how do you suppress the age accelerating enzyme igf-1 you do it through dietary protein restriction how do you suppress the so-called motor of aging m-tor dietary protein restriction in fact protein restriction was the only intervention i could find that could slow down all 11 of the aging pathways which is good news because it's easier to cut back on protein than to cut back on everything walk around starving all the time and it may even be easier than that most or all of the life extending benefits of protein restriction maybe due to just restricting particular amino acids like methionine in that case you could even keep your protein intake the same but just swap sources from animal proteins like meat to plant-based sources like beans so in humans methionine restriction can be achieved using a predominantly plant-based diet which makes methionine restriction feasible as a life extension strategy of course drug companies look at this same data and think what pharmaceuticals can we develop to mimic these dietary interventions anything else that can maintain muscle mass other than greens and machines how about cocoa beans older men and women are randomized to a single tablespoon of regular cocoa powder a day experience the significant improvement in muscle strains muscle mass and all four measures of physical performance and no the study was not funded by hershey's unfortunately the tastiest cocoa did not work as well the control groups here were just given the same amount of highly dutched cocoa alkalized cocoa where some of the bitter compounds removed during the dutching process are the very flavonoids responsible for the benefits but natural cocoa is so good it can improve walking performance in those with peripheral artery disease not only by improving blood flow but as muscle biopsies showed by improving mitochondrial activity this is consistent with improved mitochondrial structure as well in biopsies taken from people's quads though this study was actually funded by hershey's what else can cocoa do increase the circulation within our skin boosting at 70% within two hours after less than a tablespoon do that every day and within three months you end up with significantly improved skin thickness density and hydration but no change in wrinkles however keep it up for six months and you do see an improvement in wrinkles a significant decrease in wrinkle depth along with an improvement in skin elasticity within 12 weeks all by making your life a little more chocolatey by just adding some natural cocoa powder to your daily diet i uh put it in my oatmeal with uh you know some canned water packed tart cherries for a chocolate covered cherry sensation what else can we do for our skin well there certainly are other antioxidant anti-inflammatory glycotexin free foods so when patients inquire about a diet that might contribute to younger looking skin right evidence supports a recommendation to follow a whole food plant-based diet but the most important thing to prevent skin aging is avoid the sun exposure to sunlight may account for 90% of visible skin aging that's why dermatologists agree there's nothing more important to slow the signs of aging than to protect your skin from the sun the gold standard is considered to be the use of sunscreens in the daytime and so-called retinoids at night they're talking about a prescription only form of topical vitamin a also known as all-trans retinoic acid or tritinoin sold as retin A that has been widely proven to improve skin performance the only skin appearance the only problem is that it may kill you topical tritinoin therapy and all-cause mortality randomized control trial had to be stopped early because significantly more people were dying in the retinoic acid group compared to the placebo cream group when applied topically one day percent is absorbed into the bloodstream could it be killing people well while the debate continues as to whether the increase in deaths was just some statistical fluke or real biological effect tritinoin continues to be banned in europe for cosmetic purposes so what can we use topical niacinamide also known as nicotinamide is described as one of the best studied anti-aging skin cream ingredients which is not saying much but it has been shown to reduce yellowing wrinkling blotchiness and dark spots in aging facial skin for example significantly reducing crow's feet wrinkles around the eyes this was a split face study in which 64 percent of the niacinamide side eye wrinkles had moderate or market improvement compared to zero percent of the placebo side eyes topical vitamin c also similar improvements over placebo and wrinkles salinus and skin tone or firmness unfortunately vitamin c is unstable in creams turning an unsightly brown when it oxidizes limiting its shelf life so instead what the skin industry does skin care industry they use the stable vitamin c esters or derivatives but there's no evidence that these compounds have comparable effects likely because they're poorly absorbed oh excuse me and only minimally convert to the active form but the good news is you can make your own the 10 solution using that study retails for ridiculous 127 an ounce but you can make a diy solution more than 2 000 times cheaper by simply buying a scorpic acid in bulk and mixing three grams into 30 grams of water at a cost of about a nickel per ounce drip a few drops into the palm of your hand and use your fingertips to apply it over your face neck upper chest just don't get it in your eyes and look you can do the same thing with niacinamide which can be even more ridiculously priced but you can buy it in bulk as well at a 5000 discount all right i can go on and on certainly the book does but let me close out by going back to the basics from the anti-aging journal rejuvenation research finally a regimen to extend human life expectancy was it some exotic new stem cell treatment or gene therapy no it was a reference to this Harvard analysis more than 100 000 men and women were followed for decades and even just basic lifestyle behaviors appeared to translate to 12 to 14 extra years um for the average 50 year old even at age 50 we may be able to add an extra dozen years to our lifespan even at age 70 there could still be 10 extra years on the table and if you clean up your life before 50 nearly 18 years maybe up for grabs based on the simple common sense behaviors that's the kind of life extension extrapolating from uh some of these lab animal experiments but after decades of research and hundreds of millions of dollars later efforts to translate these results into humans have largely been in vain yet here we are with human data suggesting dramatic life extension is available to all of us right here right now the the the the trillion dollar pill that anti-aging biotech has been promising us is here it just effectively has to be administered in the produce aisle and the gym and turning back the clock not with a drug or a delorean but just by eating and living more healthfully a mid-life shift between the ages of 45 and 64 to even the barest of minimums the barest of minimums so what are we talking about at least five servings of fruits and vegetables day walking even just 20 minutes a day maintaining healthy weight and not smoking can result in substantial reduction in mortality even in the immediate future right we're talking a 40 lower risk of dying in the subsequent four years the researchers conclude that making the necessary changes to adhere to a healthy lifestyle is extremely worthwhile and middle age is certainly not too late to act you hold the power we would love it if you could share with us your stories about reinventing your health through evidence based nutrition go to nutrition facts dot org slash testimonials we may be able 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 of your local public library of course all the proceeds of the sales of all my books goes directly to charity nutrition facts dot 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 size 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 my grandmother whose own life was saved with evidence-based nutrition