 Maintaining youthful physiology as we age. All right. Good morning. I'm here to talk to you about a disease. And this disease is responsible for the deaths of 100,000 people each day. And I know all of you in here are going, wow, that's pretty impressive. Now, I'm also going to tell you there is no cure for this disease. So now you look at it and you say, wow, that's kind of sad. And I'm also going to tell you that every single one of you in this room has it. And what we're talking about is aging. Aging is a disease. There's no getting around that. It is a disease that is the gradual accumulation of debris, of trash, of errors in our metabolism. From the time we're born, this disease process is initiated. And as of right now, we don't have a cure for it. But those cures are coming. There are animals or there's life on this earth that doesn't have aging processes. If you look at certain plants, certain plants can live endlessly and they have an equal chance of dying each year from disease and other things, but they do not have this debris built up from metabolism. They don't have stem cell shutdown because of damage to the underlying DNA. And there are actually organisms in the hydro kingdom. They call the immortal jellyfish. They can actually reverse age. And the only way they die is through predation. But it's not to say that aging and death is an inevitable consequence of life. It's not the case. And the person I like to reference is Aubrey DeGray. And aging sucks. Nobody wants to get old. And this aging gracefully, not for me. You know, take a look at this. I mean, who do you know that wants to get Alzheimer's disease or wants to get cancer or arthritis or any of the other aspects of aging? Nobody wants that. Why are you guys here today? You guys aren't here because you want to get on the cover of GQ or something like that. You guys are here because you want to optimize your life, to enjoy life to its fullest for as long as you can. You know, we're in this vehicle that's carrying our consciousness for this lifetime. And we don't get another shot at it. So what we want to do is optimize this as best we can. These are two mustangs, same model year. But look what can happen over time. This Mustang has had a pretty rough life, okay? But imagine if you were given a car at the age of 16 and you were told you will never have another vehicle your entire lifetime. How well are you going to take care of that vehicle? And what we don't realize is, you know, we have people in this audience that are in their 20s and they're still in that immortality phase of life. You know, nothing can happen to me. I can't do any damage right now. But guess what? That damage is going on from day one. I wish I'd known this 20 years ago. I wish I'd been aware of the fact that everything that I'm doing is contributing to my demise at some point or my quality of life at some point. I mean, the only way to avoid this is to die young. And that's not a good option. So you're not going to take this car and put in cheap gas because it's cheap. You know, you're not going to get another shot at this. So, you know, you're going to pull up and get that premium gas for sure. You're going to take it in for checkups. Make sure everything's optimized and working perfect. You're not going to let your buddy borrow your car, okay? That's just not going to happen. So look at it this way. The human body is like a computer that's constantly surfing the Internet. It never gets turned off. It never gets a break. So you're constantly accumulating unused programs, cookies, programming errors, overloaded cash, fragmentation, viruses, constantly building up. What happens to the computer when that happens? Slows down. Slows down big time. It also doesn't work right. Suddenly you're getting errors in programs that won't run. That is the human body. That's the nature of aging. So, how do we fix it? That's what this is about today. Fixing this problem. Well, we could slow things down, but what happens? We become less vital. And we just get to be old longer. I mean, nobody wants to be old longer. That's not the answer. The answer is actually to reverse the aging process. This is not science fiction. This is reality right now. There is research being done on the actual reversal of the aging process. Talking about taking an 80-year-old and recreating a 25-year-old physiology in appearance and inside. This is coming. 25 years from now, it's going to be something that's mainstream. That's how fast it's coming. Technology is growing. And I'm going to talk to you about some of the steps that they're finding for this. But this is not something that we can say, well, let's just slow the aging process. We create more problems slowing it than we do reversing it. If we slow the processes, we do. We slow ourselves down. We become less vital. I mean, our DNA shuts off genes because there's errors in them. Turning them back on isn't going to correct the underlying errors. What we have to do is get to the base damage and fix that. So I'm going to take you through a couple of the steps of this. So to create human body 2.0, we need to wipe the cache, clean the viruses, defragment the disk, and update the programs in hardware. So this could be the new 80. You guys laugh, but it's coming. I'm telling you. One of the processes is cellular loss. Cellular loss occurs as cells go into senescence, as cells go through apoptosis and die. But we have stem cell technology out there right now that is replacing cells. You read about this in the news every day. So this is one of the top ones going on right now. Mitochondrial DNA mutations. DNA and mitochondria do not have protection like our cell membrane or our nuclear membranes. And where do you produce all your free radicals in the mitochondria? So the DNA is constantly damaged. We turn over all of the mitochondria in our cells every couple of weeks. And what happens is eventually the new clonal line becomes dysfunctional. The cell goes into senescence and it becomes a zombie cell. In older people, you see a lot of zombie cells in organs that are just non-functioning cells. But these cells actually function. They actually damage the other cells around them. So to protect this, what they're doing is they're actually taking the DNA out of the mitochondria that codes for the 13 proteins and putting it inside the nuclear membrane of the cells so that they will always be able to produce those proteins and always have functional mitochondria that can do the cellular respirations. The division of cells, cancers. Cancer is going to be a thing of the past probably within 10 years. Telomere deletions, so the cells can no longer divide. They will wipe them out and then they'll reseed with stem cells. The hay-flick limit. I don't know if many of you are familiar with that, but at the ends of all of our DNA are little caps. They're like the tips of shoelaces as plastic tips that every time our cells divide, we lose some length on those telomeres and then once we get them short enough, we reach the hay-flick limit where the cells can no longer divide. They become senescent. This is something that is really ramping up right now. You've got supplements over the counter that have actually shown to increase telomerase activity which is an enzyme that adds length to telomeres. So knowing your telomere length can actually predict your age and how much probability you have of dying by a certain age and getting cancers. So fixing the telomeres, definitely in the reality realm right now. Advanced glycation end products. These are cross-links that we accumulate over time where we get sugars sticking to proteins and the proteins fold and stick together and they don't function right anymore. Glycation is like hemoglobin A1C or fructosamine. But when it gets deposited in the skin, you never get rid of these. They're constantly there. That's what causes skin wrinkling. And they do have these new enzymes that they're putting in that break up these permanent dysfunctional proteins. We have junk inside the cell. Now, this one is coming in the next five years. They're already in animal studies with this with plaques, heart disease. The plaques inside the cells in the macrophages are keto-cholesterol. And they've found an enzyme in soil that can break that up. They are doing transgenic enzyme insertions into macrophages that can actually digest those proteins or those keto-cholesteroes. Junk outside the cell, like beta-amyloid, they were actually experimenting with this where they actually gave a vaccine against beta-amyloid so you wouldn't get Alzheimer's. It didn't turn out real well. The people had seizures and everything else. So that route is being readjusted. But the vaccines are a reality in that room. So if you want to kind of figure out where you are, there's clinical biomarkers that we look at in our practice. We do telomere testing. So we test the telomere length. We like life length because it gives us average length and shortest length. And they have a nice database they can compare you to and give you an idea of how old you are if you really want to know. They'll base it on your chronologic age versus your physiologic age. There's immunology assessments. These are shorter-term assessments on progress and going in a positive direction with aging. And this is done out of the pathology laboratory at UCLA. Looking at the natural killer cells. You can see if your health is improving, your natural killer cells should come down. You can look at your cytotoxic T cells and look at the CD4 to 8 ratio. You can look at CD28 positive and negative, CD95 positive and negatives and give an idea of where your health is progressing. Oxidative stress assessments. Micronutrient status. Understanding where you are from a basic micronutrient level. This is very important in the aging process because certain micronutrient depletions can cause background problems with DNA repair. Toxic elements looking at your mercury and your lead and all that. And gut health. I don't have to go into gut health. You guys all know that one. We look at hormonal status. We on a yearly basis monitor cognitive status. We look at bone density and body composition by DEXA scan. And we do stress assessments with HRV and capnography. So what we focus on is a whole new paradigm of medicine which we call human potential medicine. This is a whole shift in the sick care versus well care. This is where we take a person and we say where can you be optimally to maintain youthful longevity? Now the idea is that I want to keep people healthy and alive long enough to take advantage of the technologies when they come. You want a vehicle that is performing like that red Mustang. Life is good when you're there. This is Aubrey de Grey's depiction of how this is going to progress over the years. The red line is right now how we age. And this dotted line at the bottom is the line of frailty. You have to be above that to reach the escape velocity of immortality. What we can do now is if we slow aging it would be this blue line. So we would spend more time in the older age group. But what this break in these lines are is the development of technologies over the next 25 years. As we take advantage of each one we can gradually bring the aging curve up. Now we're not talking about taking someone and saying okay we're going to make you a 25 year old and you're going to remain there. It's always a process of okay let's build up the debris. Let's clean it up. So it's a rewind. You're not going to just stop the aging process. Everybody will continue to age but instead of trying to slow it we allow it to accumulate, intervene and bring it down. So currently what can you do to help get you to this point of taking advantage of the immortality? Nutrition of course is number one. I mean that's what everything has been about here. We talk about migraines. We talk about stress. We talk about back pain. We talk about all of these health conditions but it all comes down to optimizing your health for a healthy lifestyle to minimize the impact. Slow the debris build up. Slow the mutation rates. Fitness. You got to look at these biomarkers and understand where you are, what you can do to optimize those. That is the new process of health care. Hormonal optimization. And I know this gets a lot of backlash in the evolutionary biology community but testosterone and other hormones they work great. You talk about youthful longevity. You know just because it's a natural process of aging does not mean it is a healthy process of aging. So we do a lot of testosterone replacement therapy and we have outstanding results with that from an objective standpoint. Maintaining gut vitality. Understanding where you are from the gut. Of course the nutrition is going to help you to get there but maintaining that, maintaining that is going to be important going forward. And stress optimization. Stress is the biggest impact on your aging process. There's plenty of studies that actually show telomere length shrinking dramatically the more stress you have. I used to be a general vascular surgeon. I did gastric bypass too and did over 3,000 of those operations. The stress that I was under had me at my telomere length 16 years over my chronologic age. I got out of that five years ago almost six years now and I checked my telomere about a year ago and I was down to being 1.5 years over my chronologic age. So that was a big improvement for me with changing lifestyle going into meditation, positive living, optimizing all my biomarkers, getting rid of stress made a huge difference. I mean when I first got my telomeres tested I wouldn't recommend it to anybody. It freaked me out to know that I was going to get cancer, I was going to die young and then my partner Micra here she tests and she's like 20 years younger than her chronologic age and I was like oh man I'm going to have to start looking for her a new partner. It's not appealing to understand that you're old when you test your labs but understanding that I could do something about it made a big difference. I did not know I could do anything at the time but it has made a huge difference for me. Directed supplementation, taking all these supplements is generally not the best route. You need to know what you're taking and why you're taking it when you take them. You know just because so much is good doesn't mean this much more is better. It doesn't work that way. You've got to be in an optimal level of that. Just some specific values that we like to look at in our patients that we kind of use as saying okay well we're getting into a more optimal state keeping that hemoglobin A1C less than 5.3 this tells me that the glycation levels are down. That is great. Fructosamine trying to keep that under 225 also is another glycation marker. Fasting insulin levels less than three. Small dense LDL particle numbers less than 200 if you can get less than 90 females I'd like to get less than 90. That's ideal in that. High specific CRP less than 0.5 ideally 0.1 or less. Muscle we talked about this yesterday if you guys attended the muscle talks yesterday lean mass is really important and we see a lot of problems with lean mass especially in the females. See a lot of females that just do not have enough lean. It's not that they're fat they have too much too little lean. So getting that lean mass up really helps and we use testosterone in the females too and it makes a huge difference in lean mass getting that lean mass up. We'd like to use a 15 as a minimum for a female but an ideal female 16.5 or higher on lean body mass index and that's just basically saying okay well this is your lean mass on dexa scan divided by your height and meter squared. In males 17 is a minimum 18 and a half is kind of ideal but we also have males that get up into the into the low 20s that remain healthy. Vitamin D level is greater than 60. I mean we have a whole list of these but these are ones that you guys can commonly look at and determine if those would work for you. This is something too that I can't emphasize enough but it's living positively. Living positively has the greatest impact on reducing aging in the body. Living a life that you can say this is stellar. If you are writing a biography at the end of your life and it's not a page turner you're doing something wrong. You want to have greatness in your life strive for greatness. That is the key. This was a sign on a bridge when I was speaking at Paleo FX down in Austin this year. I was walking by the bridge and I saw this and I thought oh this is perfect perfect for my talk but this is something that people don't pay enough attention to. Live a positive life enjoy life. That's what we're here for. Like I said our consciousness is occupying this body. I want to have a great body and I want to have a great time while I'm here and I don't want to get old okay. So you can find us. We launched a new website on Monday called ephysiologics.com. You can find us there. That's our hashtag down at the bottom of the screen. If you guys want to contact me that's my contact information. Happy to talk to people. I love sharing this information and you know live long and prosper. I'm here to answer questions for you. You know I focus predominantly on free testosterone but it's also very subjective with each patient. The ideal range for me I like at 1.8 to 3.5 in the free testosterone but that's just kind of a reference value for me. I have some females that do fine at 1.5. I have some females that need a little bit higher dose around four and a half. It just, it varies on their response predominantly. There was a good study in menopause two weeks ago about injectable testosterone in females and they found a very dose dependent response without side effects which was pretty amazing and they were doing doses of up to 25 milligrams a week in the injections so. So looking at applying a lot of these insights outside of lab and on larger scale what would you say would be the top two or three most accessible markers that might be cost effective for you know folks to be monitoring, do it yourself or you know have easy access to. The biohackers, yeah. You can actually, I mean you know life extensions you can go on there and you can get a lot of the aging markers that we mentioned here. You know functional lab work with the stool analysis with the oxidative stress is through Genova Labs. Most physicians have access to that to do functional medicine. But the markers that I talked about the hemoglobin A1C, fasting insulin, CRP and those are great baseline assessments that can tell you how you're progressing over time. Have you seen or tracked other things like heart rate variability or you know other things that are so more accessible? The HRV stuff, I mean absolutely that's like I said we have a health psychologist that works for us in our office and we do a lot of biofeedback, neurofeedback training. And you know each person has a different like sweet spot on the HRV so it's very subjective in that regard. But if you're staying in the range I don't know if you're using the M wave or what you're using but typically I like the M wave and then it'll give you a graph of where you want to be. But the trouble with HRV is if you don't know what your capnography is sometimes you can be falsely lulled into a sense of doing something well. But if you are hypercapnic that HRV is not going to mean a whole lot so you also have to understand the breathing aspect of it as well. What lab do you use for micronutrient testing please? We use Genoval labs typically for that. In a world governed by the second law of thermodynamics isn't this a bit utopian in as much as even if you succeed the universe won't. And less fatuously in a world where billions of people don't even have access to clean water we're talking about a fraction of a fraction of a percent of people who will want to stay along perhaps longer than their children will want them to stay along. I mean this is a very rarefied group of people who will get to choose these miraculous small number of processes that will become available. And also if we think they're miraculous a few years ago perhaps if you'd come here and said there are these new drugs that are going to be coming called statins and you won't believe what they'll be able to do. When I look at some of those developments you're talking about I think statin 2.0 is this really what's going to be the case. Do you have any comments on that sort of thing? Yeah actually if you want to get some really in-depth information on this the SENS Institute strategic engineering for negligible senescence. Aubrey DeGray is the medical director there that they've done a lot of research in that and one of the things that they emphasize is that this is going to stay open source. They want it available for everybody. And they've done population studies theoretical studies from a sociology standpoint and understanding okay well what happens when we reach this level of people living to 150 or 200 years old without aging. You know what's going to happen to society and they've actually mapped that out pretty extensively with the reaction based on past social issues with I mean we've extended life we've doubled life expectancy from early 1900s to now already but you look at it and you find that the breeding rates go down and all this it really you know you look at and you say okay well let's cross that bridge when we get there and I understand that a lot of people don't believe that but you know from an evolutionary biology standpoint do you really think that homo sapien is the endpoint of all this evolution it's not going to be so you know we can intervene in some of this stuff and and my feeling is I want to be around long enough I mean if you don't want to be I'm okay with that I'd love to be but I just wonder what happens if seven billion people would love to be with me what will and maybe I guess we'll see hi great talk given I like the car analogy you only get one car how are you going to treat it and but that actually seems to be in contradiction to you know all the stuff that's coming the cell repair the mitochondrial repair what do you say to people who are like well if that all the stuff is coming I can keep eating my standard American diet stuff will fix me in 30 years you've got to live long enough to reach that technology that's what I'm saying is that this this analogy is this is what you can do now this is what we have available now that you can do okay yeah I mean when we come up to the point where we're we're using this this enzyme as a transgenic insertion into these macrophages you know are we going to create a society that suddenly says oh well I can eat the pizza I can I can do all this and I can have this unhealthy lifestyle but the problem is just because we're correcting that one thing all of those nutritional components are going to contribute to that debris build up to the extracellular the intracellular not only just the plaque itself so you know they may feel more comfortable doing that but they're not going to make it be on that frailty stage to take advantage of the technology when it does come okay thanks all right thank you very much