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Welcome, welcome, welcome to Armchair Expert, experts on expert. I'm Mike Shepard and I'm joined by Lily Padman. Hi. Hi. Returning guest from the early, from the bygone era. That's right. And this is, there have been a few guests that have really captured our heart.

It's true. We fall in love with their spirit. We do. And Eric Topol is like at the top of that list. We think he is the cutest person alive. And smart as all heck. Outrageously smart. He is a cardiologist, a scientist, an author, and the director and founder of Scripps Research Institute.

His books include Deep Medicine, The Patient, We'll See You Now. That's what we had him on for last time. And now his new book, which is out, Super Agers, An Evidence-Based Approach to Longevity. This was a blast. Yes, and I want to say his approach to longevity is different from a lot of people's approach that we've had on or talk about a lot of optimization. He's actually, I mean, he's like,

with a lot of those people, but he has a lot of other opinions about it as well. Divergent and friendly dust-ups between Eric and I because I'm on one side of the spectrum. Sure. Please enjoy Dr. Eric Topol. Get into your body's vitals with the Vitals app on Apple Watch.

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He's an armchair expert. He's an armchair expert. He's an armchair expert.

You're promoting longevity. We're giving you liquid death. I know. The irony. There's something wrong with that picture. Is that your super cute Bronco out there? That's my daughter's. Oh, I like it. It is cool. It's a very cool car. It is a bit OJ. No. In a good way. In a good way. Oh, in a good way. Yeah. Also, I like that there could be a good way. Well, he was...

Before he left. Yeah, yeah. I don't know if you remember, but sales of those Broncos exploded after that. Oh, yeah. You couldn't get your hands on a white Bronco. No kidding. Oh, yeah. Ford couldn't make them fast enough. Yeah, it was an accidental marketing. One of the main things you remember is the Bronco. Did you remember?

What was the appeal that you beat like OJ? That's a great question. I think just seeing a vehicle on display for such a long period of time, and I guess it looked formidable. And I think young men were like, oh, yeah, I'm an outlaw. It's like a nice car. It's nice. Yeah, yeah.

Someone should do some social science on that. Malcolm. Yeah. How are you? It's been a while. Well, thanks. Yeah, it's been six years. Pandemic in between. We sure did. Sure. Lots of stuff's happened. And you've moved a few times. I don't know what it was when we first did it. Then you were on Spotify. We were independent for three years. Then we were at Spotify for three years. And now we're at Wondery.

That's great. I was Monica's medical consultant for the show. I've been primary care physician for a while. Yeah. I definitely did reach out to you about my weird experience that turned out to be epilepsy. Congratulations. Yeah, I remember that. Yeah. Is it all under control now? Yeah, I'm on medication and it's all good. But you said it could be.

Oh, did he? Because it was quite a mystery. You said it could be seizures, but there really isn't any way to know unless it happens again, which is correct. Can't do it over the phone. And then it did. One of the things I really enjoyed was doing some fact checking. You would have somebody else and he would make stuff up. Yeah. Is that true? No, it's not true. I did. Was that other person making stuff up me?

Yeah, probably. No, likely. But I hope it's gotten to you over the years. We talk about you quite a bit and we have such a warm spot in our heart for you. That was such a lovely interview the first time. Thank you. So last time you were here promising us that we would be completely without a need of a doctor. Our smartphone would be doing all of our stuff. And here we are six years later. And where are we at on that?

before we move on to... We have a bone to pick. We haven't been able to scan our kidneys. If the medical profession would let things happen, we would, but AI doctor thing has really come a long way. We had an op-ed in New York Times recently about how there were six studies that showed that AI compared to a doctor with AI...

The AI did better. Oh, Jesus. So even having the human involved in the system made it worse? We don't know if it's because doctors have a bias against using the AI even when they have it or they haven't learned how to work with it. But to see that, it was not predicted at all. I bet it's both, right? Because I do think half of the art of AI is learning how to prompt it. It's such a specific way to communicate. And I've only been dabbling in it. And I'm learning as I go how to get a better answer on it.

of it. Yeah, you're absolutely right. I think the doctors have not yet gotten grounded. That could be the explanation. How significant was it? Well, in these six studies, all of them were pretty substantial. No one in the field really predicted that. They always thought the human plus the AI hybrid would be the best. And one of the biggest things is doctors who have been keyboard slaves.

Data clerks are now getting three hours less keyboard time a day. Because the AI is just in the room listening and handling all that stuff. And making a great audio with a transcript, follow-up appointments, lab tests, prescriptions, pre-authorizations, nudging the patient after the visit, what do we talk about? So all these things are happening and it's just a gift to doctors, nurses.

Could save the career path in a way, because every time I interview a doctor and I ask if they would push their children into medicine, almost all of them say no. It's very disheartening to see how few doctors want their kids to pursue that. It is. And it's such a great profession. And I can't imagine one that would be more exhilarating sense of caring for people. But the...

work of having to deal with insurance companies and keyboard stuff. And most physicians are managed by being counter administrators and they basically want them to see more patients or read more scans. And that's interrupting why they went into medicine in the first place. So there's a disenchantment level. The burnout is as high as it's ever been. It seems like we need AI to be able to prescribe us medicine.

And I guess we could have a bucket of that medicine, non-narcotic or whatever things you would not want to be gamed or be dangerous. Where were we at with that? And that's ultimately what you would really want is you get a thorough examination, ask all the same questions as the doctor would ask you. You take some pictures and then it says you need this topical ointment. Go pick it up.

here. That's coming for the common things like skin conditions, rashes, urinary tract infections, ear infections for children. The U.S. is different. A lot of countries, you would get the prescriptions through an AI. Here, there's much more protection about the medical need, oversight. I think the next couple of years for common things that are not life-threatening. Right, like one rung above over the counter. Yeah, exactly. That would be incredible. Now, I am curious because in your own history, you

You famously left the Cleveland Clinic in 05 because you were sounding an alarm that there was this drug, Vioxx. Yeah. That was quite detrimental to patients. What was it doing? Causing heart attacks and strokes. The company, Merck, was suppressing it because it was a multi-billion dollar enterprise. We found out they knew about it.

They actively were trying to hide this from the public. If I had to do it over again, I'm not sure we would have confronted Merck, but we did. And eventually they took the drug off the market in 2004. You were victorious in this. Yeah. In 2001, we'd predicted that it was going to be a real problem.

They were denying it for three years. They were basically having people try to take me and others down about sounding the alarm. At the end of the day, they took the drug off. They never were charged criminally, which I think they should have been. They went through all sorts of legal things and they never really paid a price for what they did.

And we don't even know how many thousands, hundreds of thousands of people were ill affected by this. And your pursuit of that then exposed this other problem that you got immersed in, which was this interconnectivity between the institute you were working at and the pharmaceutical company. Yeah, that was the real shocker there. So I didn't know what was causing the new CEO problem.

to tell me I couldn't talk to the media, basically put out a gag order. Normally, never an issue about talking to a journalist. We had a 60 minutes thing. They were going to come to Cleveland Clinic and he ordered them not to come. I had to go to New York, but it got even more intense. And then ultimately, I found out that the chairman of the board of trustees was the best friend of the CEO of Merck. Oh.

That was basically the telltale of why it was such a ferocious suppression of me. And that got into a conflict that was so profound. I certainly needed to get out of there. Yeah, we would love to think there's a wall between research and science.

Big Pharma and even hospitals and Big Pharma. And this kind of showed that if there's a wall, it's permeable at best. That's a good way to put it. I would never have predicted it. All kept secret for me until it came out. When this first came out in 2001, it was a different CEO. He was very supportive. This is really important for the public.

Couldn't understand what was going on. And then finally. So, okay, you left in 2005. 20 years later, do you think this problem is the same, less, or more? Yeah, it's hard to know for sure, but it doesn't seem like we've done a good job of dealing with

the pharma companies in general. - Did anyone from Purdue go to jail? - No, that's a great example. And that was much bigger than Vioxx, the opioid crisis. - But you're talking to millions of people all told. - And publicly everyone knows about it. It's not even like it's hidden. We all know there's 120 dogs. - You know, millions have ruined their lives and died.

The Sacklers and Purdue, it's just been a money thing. How much money do we have to put this aside? And how Purdue did this, all their illegitimate marketing and raising the dose and false claims, it's basically taken the Vioxx thing to the third power. It correlates beautifully with however much money the drug makes is what exponent it goes up by, really.

How these companies can get away with this stuff and be immune to what any other person would have to face for doing things like this, it's just beyond me. So I guess I asked that question in pursuit of wondering, will these big institutions, big insurance, big pharma, the networks, will they try to put up roadblocks for this pandemic?

very democratized access to AI in phone medicine. There's such perverse incentives in our country as opposed to other countries. Yeah. That may well be a problem. It's much less likely that AI will take full hold here.

as compared to the UK, many countries in Europe, even Canada, certainly in China. So, for example, we could see getting rid of hospital beds for the most part, except for like intensive care units or the emergency room, operating rooms. But most hospital beds aren't necessary. We could...

monitor people in their home. Yeah, you got beds that are telling you how you sleep in your O2 level. I mean, we're getting there. Yeah, you can convert a hospital room into an intensive care unit, equivalent of monitoring. And American Hospital Association isn't going to let that happen. Right. So that's just one example of what we could do with AI because AI would be used there to predict if a person's starting to develop the signs of trouble. And then you would send in a team or you'd bring the person to the hospital. That's the number one cost of our $4 trillion program.

a year health care is hospitals. We could make a big dent in that, but we have mal-incentives to go in that direction. Okay, so I have an unpopular view, especially being a liberal. People love to hold up the,

the UK's national health system or Canada's, you're looking at what sector it's beneficial to. If you're looking to generally just raise the overall access and health, I think it's very effective. But I think you can't ignore the fact that anyone that needs something for real comes here.

That's also true. We are also leading in so many areas. So all of this is built on this highly profitable system. So I think to ignore that aspect, and I have lots of friends that live in England. They're not all wild about it. I have lots of friends in Canada. They're not wild about it. What we get sold on here, just talk to folks that live there. Not everyone's wild about it. But I think the tipping point would be if those countries did embrace all this and

And we saw, oh, no, you actually want to go there and use that because, again, the AI is catching the tumor at 78% accuracy and our doctor is getting it at 50% if it becomes superior because the tech is so much better.

I think the current argument that holds sway kind of falls apart. I agree with you. So back in 2018, the UK government asked me to do a review of the NHS. So I spent two years going back and forth. They got me this incredible group of like 50 people, all the disciplines I got to work with. And you may know they are the leaders in the world in genetics, genomics. They have really run circles around any other countries. Is that because their access to data? Yeah, and they just took a lead on this already.

early on that they wanted to make that future a part of their healthcare. They set up this big UK biobank, which is the world standard, has 550,000 participants. And they're now doing our future health, which is 5 million. They already have 3 million into that.

They're getting everyone sequenced. They're getting newborns sequenced. But when I did this review, what I learned is they want to be the world leader in AI and do just what you said, Dax. They want to be getting the accuracy amped up because they don't have any obstacles. There's no billing.

- Yeah, exactly. - There's no tiers to the system. - Do doctors get paid a lot less there? - Less. Some of them do private practice on the side to supplement their income. But yeah, generally it's less, but it's not real low. The physicians in this country do quite well relative to world standards.

Okay, so your new book is Super Agers, an evidence-based approach to longevity. This is right up my alley as someone who turned 50 this year. You're just a young puppy. Well, that's very kind of you to say, but my most optimistic self doesn't think that I am not minimally halfway over on the ride. And I put a lot of thought and effort into trying to see as much of my kid's life as I can. So I'm really, really interested in this. You start the book,

with two patients, Mrs. LR and Mr. RP. Why do you start with them and what is interesting about them? Lee Russo, Mrs. LR, who is proud to be identified, she was a recent patient and she was really a trigger for me to write the book because she came to see me in a clinic appointment, referred. The symptom was that she had some leg edema.

and didn't know why. Her primary care doctor wanted to know why. And then when I first saw her, I said, well, Mrs. Rousseau, how did you get here today? I drove. Oh!

And she didn't look anything like her age, but her age was real. And then I started realizing her medical history like there was none. Wow. So she was a prototype of a study we did actually called the Welderly. Actually, my daughter, Sarah, ran that study. 1,400 people she found with a couple other research nurses over the course of years like her. Yeah, it's almost impossible to do, right? To find someone who's 90 who's not had any

Even the stat in the book is 95% of people over 60 have one chronic illness and 74% of people have two by the age of 60. But she didn't even have high cholesterol? No, she had nothing. Oh my God. She's like a newborn. She's amazing. Did you find her battery pack and her motherboard? That was why we sequenced those 1400 people. No one had ever done a healthy aging study of genomics to see it's got to be in their genes, right? Right. It wasn't. There's nothing there.

hardly anything that we could find. And that was one of the earliest studies of whole genome sequencing in a big cohort. And to this day, the only study that we know of, of healthy aging. Most of these studies looking at lifespan, they'll do sequencing of people 100 years old or 90, 110. But no one has tried to select out a group that...

We're never sick with any chronic disease. So when we didn't find anything, that said, hmm. And so that's why I started to try to understand Lee as to what was accounting for this. And she's an artist. Oil painting. Has a gallery. She plays with her friends Rummy Cube every week. She does all these big jigsaw puzzles. So she's really a vibrant lady and fully intact. And then the other patient that I introduced is a patient for 35 plus years, and he's

And he was a very different '98, now '99. He had significant heart disease, heart attack, a bypass. I had put stents in when I was back at Cleveland Clinic.

And he's also had ablations for atrial fibrillation. But two years ago, when he had COVID and was in the hospital, he never had to get into intensive care unit. And he's just a really resilient person who also got to super aging with only one chronic problem of the age-related diseases, heart disease. But man, it sounds like a pretty significant bit of heart disease. None of this sounds very mild. Not at all. And that...

that was really a reflection, like a triumph for modern medicine. Right. In the 60s, he would have died. Oh, yeah. He is really a segue to where we could prevent his disease now. That's what's so exciting. We couldn't have prevented it when he started having all these problems, but we can now. Between these two patients has kind of run the gamut of

why we have this exciting opportunity to become super agers. One route is to be the rare one, which is just never get any disease. And the other is, okay, we could prevent these diseases now. Everybody's working on magic potion or pill for aging. Pep.

- Oh, we'll get to that, Monica, don't you worry. That's the last chapter. - Okay, we have a lot to talk about. - But on the other hand, we have a whole route we can go to take the big three age-related diseases on. - Well, one thing I found very comforting and I'm leaping ahead a bit, but if I understood this paragraph correctly,

We do know some markers for aging, some DNA markers that are good for aging. But you say that even if you were to have all 20 of those, really, it's going to be about 12% of the pie that's going to predict your lifespan or healthspan. I found this deeply comforting because I don't come from a long line of old people. You and me both. Yeah, it's very scary. I think common wisdom growing up was, well, you get good genetics or you don't.

I guess I was a little relieved that maybe at best is only 12% of the story. You're touching on one of the most important messages because so many people like us have a pretty poor family history. And we think all the time we're going to be like our parents. That's not true at all. There's a limited part of that. But for the most part, it's really our lifestyle factors,

and the things that we can do now that our parents, grandparents couldn't do. That's making a big difference now. You break it up into five dimensions that help with healthspan extension. And I guess, even though we've talked about it in the past, maybe we'll just delineate the difference between lifespan and healthspan. This is a big one. The focus on living longer,

is of course the wrong one. Most people would agree that if you're demented or you're suffering all sorts of other chronic illnesses, that isn't really worth living longer. But if you can live healthily without a major disease and you're cognitively intact and you're not frail and you're vibrant, that's the goal. If you could hike to 85 or

or be sedentary to 105 from 70 on, yeah, I think we would all likely pick very active with a little less time. That's the goal. And I think most people would agree they would like to have the longest health span that they could. There's too much focus on this longevity with these clinics and all this stuff and not enough on what we really are after.

This is off topic, but to hear you say demented in the clinical sense, did that fly for you too? No, I like it. You want to be demented. I'm like, oh, I never hear it in the actual. You're only saying someone's wacky, right? Like a young person. Or they have a bad idea. Crazy, yeah. I do need to know, have you watched The Pit? Oh, boy.

I've watched one episode and I do want to get back to it. I just haven't had a chance. It's really good. That's what I hear. If you listen to the show, you'd hear it even more. I talk about it a lot. Every single episode. Okay. So the five dimensions that you break it up into are lifestyle, cells, omics, artificial intelligence, and number five, drugs and vaccines. So I just will say up front, I read out

Outlive, Peter Atiyah's book. Yeah, sure. And just loved it, probably because it cooperated my belief in what you should do. But at any rate, lifestyle has got to be the biggest chunk of this book. The biggest. And that's the biggest chapter in the book. And I get into a lot of the nitty gritty that people may not know about. People generally know some of the lifestyle factors, the big ones, diet, exercise, sleep, but they don't know that they're at risk for this condition because

and that they really got to use these changes in their life to avert, prevent. So the lifestyle factors are definitely of those five, the big one, but they all have interactions. In Peter's book, he doesn't really mention AI. That has a big role now and in the future. There's really not mention of cells, which...

is saving people's lives now. We're learning how we can control our immune system, dial it up or down. The immune system is kind of the basis of most age-related diseases, in fact. And then omics is not just the genes, but it's our proteins. That's where there's been an explosion of new knowledge. Organ clocks, we'll talk about the gut microbiome. So I think what's different about outlets

Outlive, which I read and I actually interviewed Peter on my podcast. Oh, okay, great. You know, there were a lot of good parts of the book, but there's some crazy parts. Oh, great. I want you to flag those. He takes rapamycin. There's no data to support that. It's potentially dangerous. It suppresses your immune system. That's the last thing you really want to do. I know someone who qualified for the trial for it and they...

He immediately got shingles and it was so bad, spread through the whole body. Yeah, no, you don't want to suppress your immune system with unproven longevity or even healthspan. He also has everybody getting a total body MRI that can set up all sorts of false rabbit holes.

So I had an argument with Dr. Mike about this because I've had it and I'm pro. I understand what your concern is, but I do think you can go into it with the right mindset, which is I'm not going to chase down everything. I'm not going to have a bunch of follow-up stuff. I'm going to look for a big-ass tumor that we're going to monitor, and I'm going to go next year and see if that thing's exploding.

I mean, I think there is some way to do it, but I understand it does set off all this medical intervention that potentially has more downside. A perfect example in the book, I talk about a friend of mine who's a physician, writes for the New Yorker, Drew Kular. And he went, because he was going to interview Peter, he gets a total body MRI, he's like 40.

They find this thing in his prostate. Now he has to get prostate biopsies every six months. And this is crazy. That's not a fun procedure to have to have. And there's nothing wrong with him, but he's become, you know, mentally. You got to be strong mentally to have it, is my argument. The other comeback I'd have for you

is if you're worried about cancer, which obviously a lot of people are, there's much better ways to go at it than to get a total body MRI. Because if it shows up as a mass on a total body MRI, it's gone pretty far along. You can find it in a microscopic in the blood if you're at high risk. First, you want to know

if you're at high risk, then you get a blood test that says in your plasma there's some tumor DNA and we get that sequence and find out where it is, then you could get the MRI and hopefully it doesn't show up on the MRI because that means it's pretty far along. But Eric, I smoked crack for years. I smoked cigarettes for 20 years. Like I needed a good scan. I stand by my scan.

Found out I had scoliosis. I was like, oh, that's cool. I had no idea. It's extreme. Yeah. Well, the other thing about Peter, he makes recommendations for the affluent. Not everybody can go and have a $900 to $2,000 MRI. It sure isn't covered by insurance. But that's like saying driving Mercedes are bad because only some people can afford them. I get that. But you'd like to come up with things.

where everybody could benefit. And you know, lifestyle factors, everyone can benefit. Everybody could sleep better, exercise more, eat the right foods. And that gets me to another thing I have a problem with as far as Peter. A lot of things are good in his book, which has obviously been a big hit.

But in the book, he advocates a ridiculously high protein in the diet. And I don't know if you adhere to that, but the recommended daily allowance is 0.8 grams per kilogram. And he says one gram per pound. He does it. That's way too much. It can be dangerous for people.

your arteries. Not the protein itself, but what you're eating to get the protein? No, the protein itself, particularly if it's from animal-derived proteins. It's been shown in the experimental models to test this, that if you get past a certain protein level, like the equivalent of one gram per pound, which no one else would recommend except Peter. Well, Lane Norton, anyone that's into bodybuilding would. The most important part of those studies is every single keto plant-based activity

All diets, all the meta-analysis, if you control for protein, they all work the same. That's really, really relevant. And that's just uber consistent. I actually think you should increase over the allowance. I'd say even up to 1.2%.

1.4 per kilo. But we're talking about two to three times the highest. And there's no data to support that it's safe. It's all conjecture. I want hard data. If there's risk, you better balance it with some proof that it's helping people. So those are the sorts of things. They're too extreme. But there's a lot of really good things that he put in the book.

book. Well, what we could agree, and the only thing I was going to borrow from the book is he points out, we got great with vaccines and we got great with treating with antibiotics, a lot of different diseases. What we all now have to deal with is these chronic four disorders, obesity and diabetes, heart disease, cancer, and then neuro, which are in your book. So these are the four that are going to most plague us now. We're not going to die of

or some medieval disease anymore. These are the four that we got to really focus on in lifestyle is

is hugely impactful for the four horsemen. I actually say the three age-related major diseases, heart, cancer, and neurodegenerative, I don't see obesity and diabetes. They're very important, but they feed into the other three. You don't die of obesity. You don't die of diabetes, but they accelerate atherosclerosis, increase the risk for cancer, increase the risk for dementia, Alzheimer's. So I see it differently. What I'm getting at is obesity,

isn't an age-related disease. The three big killers are the age-related diseases. The GLP-1 drugs, Ozempic and Munjaro, they have had transformational impact well beyond we ever would have expected. We're going to build on that. Now there's a pill that simulates the injectables and just going to get more and more practically accessible.

not requiring injections, more potent, and building on that success, which I'm not saying we have the definitive treatment for obesity. We have the best we've ever had. Absolutely. It takes down obesity along with all of its associated conditions and then gets on to things like addiction. And who would have thought? I know. So it's now being tested in Alzheimer's.

We now know the mechanism. It's not just about weight loss. It's about blocking inflammation in the body and in the brain. The fact that it's being tested in Alzheimer's in big trials that we'll get the end of this year or the beginning of next year. I mean, yeah, should we just all be on it? I pose that question in the book, that someday would this be something that would be maybe not universally used, but very commonly used because right now it's the most important.

impressive class of drugs we've ever seen because the side effects are short-term. They're GI side effects. The only one that troubles me is the muscle loss. Yeah. That's the only thing you got to really be on top of. Absolutely. So the muscle loss is a concern and you know it's a concern because the drug companies are buying up companies that make drugs to build up muscle. When you lose weight, you also lose muscle mass. Yeah. And all the studies so far show

There are some people that are losing more muscle mass than they should, corrected for their weight. That seems to be blocked if people do a lot of resistance training, strength training. But there are some that they so-called sarcopenic obesity where they get rid of the obesity, but now they're frail. We don't want that. Right. The other thing we don't want is to have to require a person to take a drug for the rest of their life. Oh,

Although, okay, so I was arguing with a friend recently and he said, oh, I don't want to be on that because I hear you might have to take it for the rest of your life. And I said, are you stressed out that you have to drink water every day for the rest of your life or that you got to eat food every day for the rest of your life? There's a lot of shit we got. You brush your teeth for the rest of your life. I think that's a weird mental hiccup. Well, I'm glad you brought that up, Dex, because I've had some medical colleagues say,

When I say we got to come up with a weaning plan, they say, does a diabetic have to take insulin? Do you have to take your high blood pressure medicines every day? I say, yeah, but it's a little different because...

first of all, we haven't had people just with obesity take these drugs for more than four or five years. Am I right in that the diabetics have been taking this medicine for 15 or 20 years? It's not as new as people think. That's right. And in fact, they'd been taking it for 20 years. And the real thing that got off the track there was we kept thinking that

They never lost much weight. Diabetics, they lost three pounds, five pounds. So why would you ever study a drug to lose weight when the people didn't lose weight? And then this woman scientist at Novo Nordisk in Denmark says, we got to study it in people who are obese. And finally, they listened to her. And it took 20 years to show that the people who don't have diabetes but are obese, they can lose 20, 30, 50, 60 pounds. And we still don't know today.

why people with diabetes don't lose much weight. We have no idea why. I didn't know that. If you have diabetes and you're on the drug, you don't... Minimal amount. There's lots of theories, but no one knows really why. Also, the precarious origin of the medicine having been invented by a company that's

primary source of income is insulin production. And the fact that they even allowed this drug that potentially was going to cannibalize their real business, all of it's very interesting. It goes back to the Gila monster saliva and all kinds of stuff. Yeah, but the big diabetes companies are the principles. You could have seen them almost killing this thing because you're like, well, that's just going to destroy our insulin business. They took a gamble that this would be bigger and it seems like it is. And boy did they win.

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Okay, so in lifestyle, let's go through some of this stuff. So diet, you're taking a real magnifying glass to a lot of these things that we're already aware of. When we talk about diet, let's talk about ultra-processed food and sweeteners a little bit. The ultra-processed foods, the evidence is remarkable that they're toxic. The age-related diseases, the big three, they're potentiating all of them. The U.S. is the worst in the world for intake of ultra-processed food. My kids bring home stuff sometimes. I don't

Like, how did they even think of this? Much less construct this product. Yeah. It was like Reese's Pieces Cups Popcorn. And I was like, well, you're damn right that's going to be delicious. But how did they do it? The kids, more than 70% of their intake of calories is through ultra-processed food or energy. 70% for the adult.

population. It's horrible. So we have to do something about this. Nothing really has been done. That's different in other countries, particularly in Europe, with a lot more awareness. How are we going to let this go on? Because the companies have figured out what tastes good, where the reward circuits are in the brain and changing the texture, adding these things, alien stuff that they throw in there. It's all programmed.

to be ingested at the highest level. - There was a 60 Minutes on long ago, and the segment was about food additive chemists. They're basically perfumists, really. And they take this group of them to an orange grove in California, and they're watching them all take one off the tree and peel it, and then they're tasting it. And this one scientist says, "Oh yeah, it's this," breaking down all the things.

And he said, now we wouldn't design it like this because you'll notice the taste lasts for a really long time. It stays in your mouth for a bit. And we want something that goes away almost immediately after you experience the nice taste so that you want to replace it. And I was like, this is actually nefarious. It's not just I want to make it taste good. I want to make it taste good for a blip. So you have to have more immediately. How are you going to compete with a brain trust like that, figuring out how to make you eat as much as possible?

We're the prey. We have to do something about this because all these foods can be made without all this gunk in there. In the book, I bring up about the young people developing cancer now. It's a big issue. It's been going up at levels we've never seen. Specific types? Colon cancer is one of the biggest ones, but even breast cancer in women in their 20s and 30s.

Ridiculous. We never saw this stuff before. Now it's starting to become a big issue. What's the mechanism that would be happening? The big theme in this is inflammation. Ultra-processed foods, once it gets through your GI tract, you absorb it, it incites inflammation throughout your body. And even the gut to brain, which is how the GLP-1 drugs like Ozempic works, it also activates circuits. And the brain is the master circuit for the immune system. So basically you've got...

activation of immune system inflammation, that's not good. And the ultra-processed foods are doing that. And so they can convert a person who's pre-diabetic to be actually diabetic. It certainly would be considered now clearly a risk factor for cancer, for cognitive deficit, for heart disease. I mean, the list is pretty remarkable. How can we keep denying it? Now, when I talked to my friend, the FDA commissioner twice, Rob Califf,

who was onto this, he says, well, Eric, the U.S. Department of Agriculture is really tough to work with. And then we got Big Food. We're talking about the pharma industry. Big Food, try to change their ways. Try to challenge them. So we haven't taken them on and we need to. By the way, this GLP one, there's so many things that are auxiliary to it. One of them being, you've read these articles where these food companies are now worried that people are not going to be eating junk food as much. Yes. They have to have a game plan in place

So isn't that weird? What you're bringing up is extraordinary because by understanding these circuits between the gut and the brain axis, the fact that people now want to eat healthier foods while they're on this drug. So they're not only eating less food, drinking less alcohol, but also turning to healthy foods. And so, like you said, the food industry, now what do we do?

It's too good to be true. Is that why a couple months ago there was that whole study about alcohol causing cancer? Is that because of the inflammation? I'm glad you brought that up. It sticks with me. We're both going to service our own pet projects. Hers is alcohol, mine's weightlifting.

My next Substack Ground Truths is going to be on this because in the book, there's a little bit of that, but there's three new studies, one of which was the Surgeon General, who I did a podcast with, Murthy. Yeah, the VAC. We've had him on as well. Yeah, we like the VAC. Before his came out, there was the National Academy of Medicine, and then subsequently there was another HHS report. So there's three.

And they're all different. First of all, the one that was the most carefully done, the National Academy of Medicine, original data, they drilled down in everything. They say, hey, you know, moderate drinking can actually save lives and reduce cardiovascular mortality. That's what we grew up with. One glass of wine is good for your heart. They were not so stringent, whereas Murthy and the Surgeon General's report and the other one were even a little better. Alcohol is bad for you. The mechanism isn't known, but we do know that in large quantities,

That's really the big debate. It's mutagenic. Alcohol can cause mutations and mutations can lead to cancer. So that doesn't necessarily have to invoke inflammation. There are countries that now have labels on the bottles of alcohol and wine that this could cause cancer. As well as everything else in the story.

Yeah, exactly. You're just like overwhelmed by it at some point. We don't really have the data to support that, but Ireland, where there's some heavy drinkers and other places, they have put that on label. So the cancer story is the one that's of main concern. The only thing that these three reports agree on is the breast cancer risk. The other cancers...

esophageal, choline is much less definitive. They're fuzzy. They don't agree. Now I loved this because I'm an abuser of caffeine. So tell us about caffeine and its impact. This is, I think, the shocker. There's only good news in your book, I think. No, there's more. There's more. And I talk about good foods in there. You do. And all about exercise. I'm into that. Yeah.

I think the interesting thing about caffeine is a lot of people have thought, I better not drink too much. It's bad for me. All the data, as I reviewed in the book, show if you're drinking less than four cups a day, not only is that not harmful, but there's lots of benefits. Yeah, you need to pick up the pace. Yeah.

Wow, this is great. After four cups, for the most part, when you look at all the studies, then you say, hmm, maybe that's not so good. But coffee, we don't know why it's so beneficial. Well, it has a huge antioxidant effect. It has, but a lot of antioxidants. We don't really know. But you have to say, looking at the studies, it's just the opposite of these things like ultra-processed foods where the evidence is all going one way. For caffeine and coffee, it's all going the other way, and it's good. Where are we at on red meat versus plant-based?

Red meat is a problem because it induces inflammation. It's okay to have it on a limited amount, but some people eat a lot of red meat and they ought to reassess that because the correlation with all-cause mortality, cancer, cardiovascular, Alzheimer's, it's all there. And so ultra-processed foods and red meat track together. And then there's the worst, which is the meat and processed. Yes. Anytime you study humans, it's just such a messy business.

It is. So you go red meat. Okay, well, what's your red meat consumption? Well, if we look closer, it's like, well, red meat consumption is largely probably happening through hamburger consumption. And now when we eat hamburgers, what else do we eat? People eat French fries with hamburgers. Like how you're parsing out the red meat, as opposed to if we studied anyone who only eats a plate of ground beef, that's a hard person to find. Nobody's condoning the French fries as a healthy food. Right, I'm just saying, how do we parse out? I think the question is,

The red meat is something that, hey, if you have it once a week or a couple of times a month, no one's going to say that's a problem. But if you have a good portion three times, four times a week, that's where you start to see, hey, this is going to be inciting inflammation in your body. And we have some inflammation markers. They're not great. We need better ones. But that's a way to tell if your diet is...

off track. So I don't know how many hamburgers you eat. You would be so mad at me. I don't want to lose you as a friend. He doesn't eat hamburgers, but a lot of red meat. I eat a lot of red meat. Oh, okay. I eat a lot of meat. But also I'll add, I have psoriatic arthritis. I do not want to be an immune suppressant. I was for years. It took me seven years to figure out what was triggering it all. So I have a diet now that works for me and I don't have to be on any medicine and I don't have any symptoms anymore.

Is that a ketogenic diet? Well, I can't eat gluten. I can't eat garlic. I can't eat peanuts, a list of things. But what the result ends up being is, yeah, I have a pretty low carbohydrate diet because I can't eat pasta or bread, but I'm not afraid of a potato or some rice. Yeah, well, that's all right. And my cholesterol right now is great. All my markers, and I'm spoiled in that, were in a study with Dr. Richard Isaacson for Alzheimer's. So I'm getting a lot of work done there. I get a lot of blood panels. Things are

That's terrific. But I do eat an amount of red meat that would really break your heart. That has to be individualized. You present a different circumstance. You have this autoimmune disease. We make these recommendations for everyone, but everybody has a little different story behind it. And that's the most exciting part of this chapter is with the help of AI for people to actually know what diet they should be on.

to me seems like would be one of the most helpful things. I totally agree. There was a fascinating study that just came out. Over 105,000 people followed for 30 years and only 9% of them made it to age 70 with no age-related diseases. And so they say, well, what are these 9% eating? Yeah. And basically it was plant-based diets, vegetables and fruit. That's the best known diet we have, best validated, a Mediterranean-like diet. But that doesn't mean that's the right diet for everyone. And as you say, using AI, there's some big speculations

studies going on right now, hopefully they won't be derailed at NIH, big investment, to see if we can find the right diet for each person because each of us metabolize things differently. And we have other coexisting conditions or we're at risk for different things. And so when you have all that data and that's where you use this multimodal AI, you can really help people to guide them as to what would be best for

Yeah, the notion we'd have a food pyramid for 300 million people is a fucking fantasy. Yeah. And so then we get out of this mode of you eat too much this. That's where we are right now. It's crazy. We have to get down to the individual level. And I think it's been the great frustration with consumers with the nutritional sciences in general, which is we're wanting them to have a magic bullet for all humans. And of course, that's why they contradict each other all the time. And there's no consensus in that field. It's a very frustrating phenomenon.

field to monitor. But it's because we are so individual, and that's really going to be the answer probably. This is such a fundamental part of our life, what we eat, and the fact that we haven't cracked the case yet. We know from glucose sensors that people have a totally different response to having spikes of glucose for the exact same food, exact same time, exact same amount. And so we've seen the same thing with our lipid. And that's what we have to get to

the determinants and to give the best counsel to people so they'll know. And it may not be that it's the same diet throughout their whole life. And maybe you need to reassess it at times, but we're going to get there someday. We didn't have the way to deal with all this data. Billions of data points for each person and many different layers of data, their gut microbiome and their glucose sensors, their diet and their stress or physical activity, all these data points. Now we can actually analyze that, which is extraordinary. And what will

that AI model look like? Will that be a combination of it having mapped your genome, you're wearing some sensors, it knows what you're eating? How will that come together? Yeah, so we just did a study soon to be published. We had a thousand people. We got all those layers of data. They took pictures of everything they ate and had the glucose sensor. We did their genome sequence, their gut microbiome, track their physical activity, sleep. And so we could figure out in those people what was driving their abnormal glucose spikes and also who would

wind up being the ones to go at risk from marching on from pre-diabetes to actually getting to diabetes. So it can be done now. It requires some pretty sophisticated AI modeling, but it's just going to be done a lot more. This was one of the first studies to really try to get at it. And I do think the interactions between sleep, physical activity, stress, what you eat, all these things are very complex. We as humans can't

Analyze this stuff. We can't even keep track. No. Even when you ask people to say what they ate, they need help. And also, it's a tall order to ask people, like, don't eat carbs. Well, wouldn't it be great if they said, oh, no, you can have as many potatoes as you want. Stay away from rice and you're allowed to have this. That's a manageable approach for people. Oh, I think that'll be a breakthrough. Okay. I have to ask because my wife will want to know this the most. Environmental toxins. How serious of a concern are these? I think it's very serious.

serious. And the data, I reviewed the big three, the fine particulate air pollution, you know, less than 2.5, the microplastic nanoplastic story, which is really troubling. And then the forever chemicals. You could add pesticides to that, of course, but they're really troubling because if you watch all the graphs, they just keep getting higher, higher, higher burden, more plastics, more forever chemicals, worse air quality, even without wildfires. So

We're not doing anything about it. Here we are, we have these great new ways to prevent age-related diseases. Fantastic. But what are we going to do, as I call it, lifestyle factors, which is our exposures to these big three. The plastics one is really compelling because we now have plastics in the brain correlated with dementia. Okay, so I need more info on it. When I get in these debates with her, I go, I'm not arguing at all that we're not measuring more plastic in the body.

Or is this studies where we know the impact? There's one, it's in the book because I'm a cardiologist. It's the one that gets to me. So it was done in Italy. These patients were having what's called a carotid endarterectomy where they took the plaque out of their carotid artery, which can cause a stroke. And so it's an operation and they analyzed, did they have microplastics and nanoplastics in their arteries? 70% of them had. And they not only had that, but you could see right around where the plastics had accumulated,

In the plaque, that was where there was really nasty inflammation. So the body was rejecting. It was seeing it as alien foreign matter. Right. It was inflamed to try to protect the body. But in fact, it was inciting big time inflammation in an artery that gets in the bloodstream that you wouldn't want. But that's not all they did. Then they followed these people. Did they have more heart attacks and strokes? And did they die because of heart attacks? Yes.

Four and a half fold more than the people who didn't have plastics. You're going to pull out a gun and shoot me. But again, I'm just curious. Yeah. Where would you be getting all these plastics?

other than you're drinking from a ton of soda? And are we actually seeing the result of massive soda consumption or the plastics in the bottle that the soda came in? We're actually even breathing in, but the most of it is coming through what we drink and eat. So plastic bottles, where's all the water bottles? Well, yeah, it's not just soda, water. It's a great counter. You know, what we have, people take their food

put it in plastic to store it, and then they're going to heat it up and they put it in the microwave. Talk about a double whammy. The food's stored in the plastic, and now we're going to heat it up so all the microplastics can fully embed into the food that we're now going to eat. Oh, fuck. I got to change that. Okay. You don't use plastics. I do. I'm the only one in my family. The whole family is like, oh, plastics. I'm like the old man. Well, it sounds like Kristen is onto it. She's on it. I'm the only one that's still drinking out of the plastic water bottles. I do drink out of plastic water.

I know. I have these blender cups and I fill them up over and over again with protein shakes and stuff. The Essentia comes in plastic. When you see the millions of tons of plastics that are accumulating, that is non-biodegradable. So it just stays with us forever. Now our fish are eating the plankton. It's everywhere. We're not doing enough to work against that. And it's one of those things that's this kind of compounded problem. It's getting worse all the time. I lost that one. The heart attack study, to me, was the most compelling of all.

And then the recent study about a spoonful of plastics in your brain and how that was associated with a much higher risk of dementia, that didn't feel good either. I don't know how someone is two standard deviations above or below the plastic consumption. It comes in your can...

That is aluminum, but it's got a plastic line. Like how on earth is anyone taking in more or less? So your point is a really important one is at the individual level, how much can you do? Because it's so pervasive. You can do some, but we also need to take this seriously because there are some solutions in sight. There are ways to combat this that have been published, some really elegant science work. We're just not implementing it. It's like we're just ignoring it all.

There's so much happening. You get fatigued on all the problems we have. The fires thing happened, right? Big panic in my house. And I'm like, it's going to cut however many years off our life, but it's going to cut that many years off of every single person we know. In some weird way, I go like, yeah, but we won't be uniquely punished for this. It's everyone. It's everything. And an illusion that you can escape it. So maybe I've surrendered. Despite the fact that we've been talking about some worrisome things, I have overwhelming optimism.

And the reason I say that is because, okay, we've got these things that are in the way, but we have a new path to preventing the big three age-related diseases. And if we can do that and start to get serious about the burdens that we are facing environmentally, then we win it all. Yeah, okay, so we nailed the lifestyle problem.

We skipped exercise, but I talk enough about that. Social isolation, we've also had Vivek on a couple times talk about that. That's really relevant. But let's talk about cells and what's coming our way and what's going to help us. A perfect example, since you've had an autoimmune condition, no one would have predicted that. Lupus, systemic sclerosis, you could give them a way to ablate their B cells on their body, and then they regenerate and they forget that they ever attacked you. The autoimmune is cured.

Who would ever guess that? Yeah, you think it's destroyed and you even say there's damage within these organs and you would think that would be permanent. Yeah, well, basically you stop any autoimmune attacks because the disease is over. Now, if there's already been kidney damage from the lupus or something like that, you may not get reversible effects. How does that work? What happens? This is fascinating. There's so many things in medicine that we don't know for sure. We've talked about a couple of them. When the B cells come back,

It's like control, alt, delete. When your computer isn't working, you just reboot it. Whatever the memory was that was leading to the self-attacks, it's now lost. And that's with altering your T-cells or suppressing your T-cells? These are B-cells. B-cells. I'm sorry. What are B-cells?

B cells are the ones that produce the antibodies. T cells are your cellular immunity that are basically going after cells, like the CD8 cells that are cytotoxic that just basically kill the cell. But I wouldn't be surprised because of all the advances that we're seeing in controlling the immune system.

dialing it up or down, dialing it up in cancer especially to fight the cancer, dialing it down to get rid of autoimmune diseases, which is amazing. Yeah. Instead of you having to take an immunosuppression drug all your life to block something like psoriatic arthritis, these drugs like rapamycin, you get more infections. They're risky drugs. I didn't want to be on it. I'm trading this for cancer potential or I'm trading this for an infection. And you're having to increase them.

which is the nature of them. Yeah, so that's why it's so exciting to see the discovery that we can cure. We never were able to cure autoimmune disease. Right. And multiple sclerosis is a horrible condition, which we now know is rooted with this virus, Epstein-Barr virus. And now we know that we can also potentially use this tactic to cure it. Did they find that MS has this triple whammy if you've had Epstein-Barr and Epstein?

You don't really have to have herpes. You don't. Just Epstein-Barr will do it. Almost all of us have had Epstein-Barr. You have to have a genetic predisposition as well. Okay. And then there's even potentially a third hit, which would be your microbiome of your gut. But the two principles are requisite Epstein-Barr virus exposure and a genetic susceptibility for immune system to go into self-attack mode. Okay.

And it just starts eating your myelin sheath? Yes. Horrendous condition. The treatments for it, they're not good in terms of completely blocking the progression of the disease. And so we have needed for all these years a much better approach to controlling our immune system. And the chapter in the book is dedicated to that

because this is one of the really exciting frontiers in medicine right now. And where are we at in that? We're in clinical trials. Every few months is another big breakthrough. We treated these four people with this multiple sclerosis or what was a few now is probably 100 plus people that have had cures. And yet they'll study for three years later and no sign of any comeback of the disease. So it looks really encouraging. Yeah. Okay. Okay.

So, all mix is all this biological layers. It's our DNA, but used to think DNA, that's our whole programming that determines everything. Well, that couldn't be further from the truth. That's just one layer. It's important, but it's not everything by any means. There's RNA, there's proteins.

Then there's the gut microbiome. And the epigenome is the packaging of the DNA. So it's the methyl groups, acetyl groups, histones. These are all things that, how does that DNA get so compressed into this tight structure? Epigenome, those components...

They are really important because they are like a regulator of the DNA and the proteins. Don't make this one, make this one. So these layers of the omics, we've now learned so much about all of them. One of the biggest ones is we now have clocks for the body.

So I could say, Dax, we're going to get your proteomic clock, each organ. I can say you're 50, but your heart is 38. Your kidney is 52. Your liver is 65. Yeah. We can do that. Who would have ever thought we can do that? Yeah. How? I got to say, there's another thing I get skeptical of is these people parade out of some tests and they're like, I'm 38. And I'm like, I don't know.

I agree with you because when it's being sold, they want to give you favorable results. Yes. I don't trust that stuff. I don't trust anybody hawking supplements who says they're a longevity scientist. If you're a good scientist, you don't need to hawk a supplement. If it's done right, the epigenetic clocks, the methylation, Steve Horvath is the one who discovered this. Uncanny. That is a body-wide clock. So we'll say...

okay, you're this age. Well, there's a gap here because your body-wide clock tells us it's this age, biological clock. Is it a blood test? Can be done with blood, but it can be done with saliva. Then the organ clocks, this was discovered by a fellow at Stanford, Tony Wiskore, who's a brilliant guy, very humble. He's made these amazing discoveries. This was back at the end of 2023 in nature. And these eight organ clocks now have been validated by many other groups.

And that's much more, to me, important than just your body-wide aging because I want to know which is the organ that's off track. We need to monitor. Exactly. Exactly. We couldn't do that before. Right. And then we have these proteins like PTAU217, which says, hey, 20 years before you could ever see mild cognitive deficit, we've got this marker that you're at risk.

And we're going to get all over it. So you never have to worry about that. And that's basically the theme of the three age-related diseases. One, that they take more than 20 years to set in. So you can't get Alzheimer's or cancer, except for very rare types of cancer. It's not an infection. Or heart disease. You got to wait 20 years. You have a lot of runway to work with. Yeah. The second thing is, we talked about, they all have this problem of hyper-inflammation, abnormal inflammation, immune system that's basically the underpinning.

And they're all preventable. Right now, they're preventable overall, like heart disease, 80%, 40 to 50% for cancer and Alzheimer's with lifestyle factors. But when you know who's at risk and you know these things we can do to go into surveillance and high gear prevention, there's no reason why we can't prevent these diseases fully. And then now we get into artificial intelligence. Yes. When you have all these layers of data, all your omics, all your records...

all your behaviors, lifestyles, exposures. You have multimodal AI, and it says you're not at high risk for these three age-related diseases. Lucky you. Or...

Usually it's one of the three, not three, most people. This is the one you got to go after and you go into surveillance and prevention mode. And this is where we're going to tighten up these certain risk factors. We're going to direct our resources and our mindfulness on this. Yeah. So just like we're talking about with the nutrition, but now for HealthSpan, we individualize a preventive plan for you. Now that we know this is your vulnerability. A lot of people, fortunately, don't have vulnerabilities until a later point in time.

Do you think a lot of people will be listening and going like, yeah, that all sounds great. Some people are going to get access to that, but there's no way it's going to get democratized to a point where I'm ever going to be able to. Yeah, well, that goes back to our earlier point. I want it to be for everyone because democracy,

The data that you need to put the layers of data for the AI, the AI software, it's inexpensive. If we are really interested in the health of our population, we would make this available to everyone. If it wasn't an insurance company that only has you for one year before you switch to

But if it was a country that the overall population is their responsibility and what they're after. So if we really are into it for that reason, then we would make it available to everyone. Because what is the cost in our society to these big three diseases? That's what eats up all our resources. Four trillion? Yeah. I mean, we talk about the hospitals, but it's the people that are in the hospital because they have the cancer or they're in these facilities.

facilities because they have Alzheimer's and then all the heart disease that we still have, the number one killer still today. They say like 80% of your lifetime resources you spend in the last couple years of your life. Yes. And there's these three diseases. If we can prevent them, it's in the national, the world's interest. We could spend all that money on defense. Yeah. There you go.

Oh, my God. Well, if that'll sell it, sure. Too much common sense there, I know. So we talked about GLP-1s. The T-cell engineering... That's another part of the cell story. This is really amazing. Now you can take T-cells out of the body...

With CRISPR, you take the T cells, you genome edit them. You basically are directing them now to go after certain proteins of a person's cancer. It can be curative for leukemia, lymphoma. And now there's been many cures even in solid tumors, even in tumors that are the worst, like pancreatic. They're sent in as a seek and destroy mission.

And by the time they are going to lose their life, they've done a lot of their work. How long do they live? This is weeks. And you're talking about a patient whose cancer is uncontrolled. And so basically, they're revving up the immune system. And so they don't have to do it all themselves. The T cells are connected to the B cells that are connected to the everything. Natural killer cells, the tumor microenvironment. So basically, they are setting the stage for an attack.

Then there's the other part of this, which is these antigens, the proteins on the surface of the cancer cells, you can make vaccines directed against them. So it doesn't have to be cellular. You can make a mRNA vaccine using that platform with nanoparticles and then inject that. And that can rev up an immune system as well against a cancer. It's a different way, but we've seen some cures now for kidney cancer and pancreatic cancer with that.

Are we in an age where we might get a vaccine for every type of cancer at some point? Well, there's two parts to this story. One is using a vaccine to amp up the immune system in a person who has cancer, which you can never get enough immune response in someone with cancer. We're learning all the tools like the engineered T-cells, CAR-T as it's called, or the neoantigen vaccines. But

That is different than you're at high risk for this type of cancer. We're going to give you a vaccine so you never get that cancer. Right. We basically train your...

T-cells to identify this preemptively. Yeah, so this is a part in the book when I get into what is the missing link right now, because I want to do that, but we don't have a readily available way to check your immune system. There is no such test today that's available. Basically, you get this cockamamie ratio of your white cells to your lymphocytes, which is not worth much. What we want is an immune system checkup to know, because if your immune system is down,

That's when you start to see the vulnerability to cancer, or if it's up, the vulnerability to an autoimmune condition. They're done in academic labs. Like I volunteered to be in the Human Immuno Project, which has run out of Yale. And I also put in the book a big immune test where every autoantibody in my body, every exposure to every virus I've ever had in my life,

That's the kind of thing we all should know about. We will someday. We're on the brink of starting to get that to a commercial level as we get to my age. We have this thing called immunosenescence, right? And some of us, because of aging, our immune system isn't working real well. That's all the old people who died in COVID. Exactly. And so...

If we knew about those people's immune system, that's how stupid we are today, right? Because not all people were susceptible. Right. But the ones who their immune system was compromised, we could have done things to rev that up. We're missing that right now, but in the next few years, it'll be available. I mean, I've already had one of these tests and working on getting the other more comprehensive one. And I just hope that we rev that up because that's the missing link right now. Stay tuned for more Armchair Experts.

If you dare.

Every time I have someone equipped to answer this question, I have so much curiosity around senescence. Okay. Because the great mystery to me is if you have this process, mitosis, and it makes an exact replica of itself, why on earth at some point does it stop making an exact replica of itself? What is the process? And the one thing I heard on NPR one day, it was like an hour long story, and you quote him a ton in your book, is that it's a process.

is this guy who started erasing layers of the epigenome in mice. And he was erasing so much that initially it would put their body into a state of being like a baby and their organs would grow too big. And then it was learning to dial back how much we erase from this. Because you accumulate garbage and flaws in your epigenome, yeah? Yes. I know already you don't care about living to 200. You're right about that. I already know you don't care. Same.

I am fascinated by that. I wouldn't mind living at 200 and being healthy. That'd be great. That's unlikely. Go ahead. Shatter my fantasy. That one seemed really promising. So Juan Carlos Belmonte, who you're referring to, is a close friend. He used to be at the Salk Institute, which is right next to where I work as Scripps. And then he's more recently at Altos Labs.

And he discovered this, the fancy term, partial epigenetic reprogramming. What it really means is he's taking these factors called Yamanaka factors, which can be used, this was a guy in Japan that discovered those, to make stem cells. But if you just give an exposure to an animal bred to be prematurely aged... Progeria. Progeria, exactly. Right.

I got one wow out of them and I'm going to sleep like a baby tonight. Continue. If you get the right dose timing of this, you can take that and not just a mouse, but other species and you can reverse their aging. Yeah. And all the features of their organs. Now they're young. This is amazing. I think that's the most amazing thing I've ever heard. It is. They took these old mice and they made them young again. Yeah. Of all the different approaches.

The one that is the most striking, there's like 12 shots on goal here. That one is wow. But as you'll see when you look closely at the data, there's two issues. One, it's very finicky. It's kind of like Goldilocks. You got to get it just right. Otherwise, you get tumor development. Because youth...

Cells that are vibrant and dividing never divide perfectly. We're always accumulating mutations. So it's never as identical as you'd like to think. So you can get cancer from this. We've seen teratomas in these animals. Now, the problem is their company, you know, billions of dollars of investment. Three billion, you said it right. There you go. They are supposed to go into clinical trials.

Well, how are you going to inject this to a person? Who's going to be the person that wants to get this body-wide Yamanaka factors to see if they can reverse their aging? A 96-year-old that's like, either make me young tomorrow or I want to die in a week. That's who you're looking for, I guess.

But that might be too far gone. Yeah. And then you get a misread that it doesn't work. Good point. So they're going to try it in a knee that is just about to have to undergo a total replacement and see if it makes the knee healthier before they go to a total body. Yeah, yeah, yeah, yeah. This one is potent, but also a bit dicey for risk. So we're going to see. That's why I say in the book, I used to think all these reverse aging things were never going to be a go.

but there's so many different ones. It breaks some of our previously held tenets of biology. Yeah, because it used to be, oh, the mouse lived longer. Well, a lot of things make mice live longer. But when you do this sort of thing, like you said... When you cut their age in half...

And you see it. All of a sudden, they have all this muscle and they're cognitively crisp. As best you can tell when you put a rat in a mace test. I mean, it's fascinating. Yeah, that's incredible. Eric, you're so impressive. What about peptides? Okay, go ahead. But I want to make sure we get them out of here in reasonable time. I know, but you promised that. Okay, then I'll save how much I adore you and I'm impressed. Go ahead. Peptides. Should we be taking all these peptides? No.

- What peptides? - Thank you. - Which peptides? - Actually, we can be done now because that is exactly-- - Hold on one second though. This will dovetail beautifully into why I would recommend this book to people. Because you are an optimist.

But you haven't drank the Kool-Aid. Yeah, I align with you so much. It's a very, very moderate approach with a lot of optimism. And I think this is the book for Monica. Yeah, I fully align. Because, okay, here in LA, there's a group of friends, Dax being one. Several of the peptides are in his book. Okay, so are dabbling with these injectable peptides. And I feel that that's very scary. People are on metformin, people are on...

Samorinland. There's a bunch of them. There's like a beauty one. There's a copper one. There's a brain one. This is how upset he is before he finishes the one. I know. I like that you're upset because I feel upset, but I also feel, well, if everyone's doing it, then they're all going to look 22. No, that's not going to happen. Okay. This is a craze. No basis.

and potential harm when you don't know for sure. I mean, metformin is different. That's a pill that's been around forever and that's not really considered a peptide itself. But these injectables, that's what I'm worried about because anytime you're injecting something and you don't really know what it's doing good or bad, there's no evidence that any of these have helped people.

This was really the impetus to do the book because there's so much of this stuff out there now. And let's just set the record straight. There's reasons for excitement, but let's not jump the gun. Let's not be taking drugs that could be doing harm. Eventually, we're going to get there. There may well be a peptide. I'm going to make a counterargument. You guys aren't going to like it. Many of these peptides, these are off-label drugs.

uses of peptides because they saw different results from studies that weren't even addressing this in the exact same one the GLP-1s, which you love. It was not designed for what we're using it for, but we started noticing something. Like which one? Tessamorlin. This was developed for HIV patients. What did they find when people were on this? They had a reduction of abdominal fat. That was just a side effect they found.

Very well studied, administered. It's been used for 40 years. It's a very well-known peptide, and it had this auxiliary effect of reducing abdominal fat. There's a peptide. So you would inject yourself to get rid of abdominal fat? Yeah. Then we could get into how many studies there are that abdominal fat is a huge indicator of future for horseman stuff. This is the Dr. Isaacson. This is a dementia. I agree about the abdominal fat not being good. Yeah. I don't know the study that connects the dots between...

this tesamorelin and better health outcomes. Right. Also, there's no free lunch with any drug. That's how I feel. What is the potential side effect? Let's go back to the GLIP-1. They were studied in massive clinical trials with placebos for the purpose, whether it's diabetes or obesity or heart failure. Where is the study for these peptides?

That we're done for this purpose. We'd have to go through each and every one of them, but most of them weren't developed for the thing that it's being used for. I'm into repurposing. Viagra wasn't studied to give men erections. It was studied to be a blood pressure drug, and it was a bust.

But you know what? It worked. And they did trials to prove. Latisse, this eyelash thing, was a glaucoma medicine that they found, oh, everyone using it has beautiful eyelashes. But then they did do tests before they became publicly used. What you're upset about is that there isn't the data for the off-label use. But there is plenty of data for the peptide itself in the other application.

in the same way that the GLP-1 had a ton of data for diabetics before, as you said earlier, they were refusing to study it for obesity. But then they did. But it could have turned out bad. But you're at a stage where you're going, we should try it for obesity. And you're going, there's no study for obesity. It's for diabetics. And it's like, now we're post that. It turns out, no, that was great for diabetics. How do you know taking this peptide doesn't interfere with your sleep? Well, because I've slept like shit forever. So that's my hunch there. Ha ha ha ha ha.

The point is they did prove that it was good for obesity. I'm just pointing out you have an argument for one thing that you feel solid about, which was GLP-1's work for diabetics. It wasn't being studied for obesity. It is very safe. And now it turns out it's great for obesity.

So we were at a phase with many peptides where the off-label use is just now happening and it's already been studied for these other things to be safe. So now we're just at the point where we're going to evaluate them for the off-label use, but you guys are going, no, don't use it for off-label because we don't have that study yet. It's a little contradictory to your embracing of the GLP-1s. No, but I would say not quite because there were specific studies for the off-label. It was specific studies to do a new label, a real label, but I

don't summarily dismiss, I haven't seen the data for peptide. Tessamorelin, just one I happen to know, is for HIV. It does a great job reducing abdominal fat and doesn't do anything else. That's really interesting. I'll review any data set and if it's a really good case for somebody to use it. But overall...

Peptides are being heavily promoted and there's lots of them. And I say, where's the data? And who are these people that are peddling them? So where the data is totally fine. Yeah. But a pessimism about that the data will prove out to be not real, I don't think is warranted. I think it should be given the same neutral opinion that the GLP ones. It is a neutral opinion, but they're being used prematurely. The one thing I say is that the peptide story, you'd like to see it all in...

published peer-reviewed journals. We have a different problem right now. We're in the midst of an anti-science world where people want to take the peptides because they're not from big pharma. They're not mainstream medicine. They got to be better than those cockamamie doctors. I agree. That's a huge problem. I worry about that. We've rejected the norm of

evidence. And we basically are at a time when there's a revolt against mainstream medicine. Yeah, big pharma. Maybe it's deserved. I don't know. But the problem is we're embracing things without what we used to say would be the requisite body of evidence. It's the Bitcoin thing. It's like, I hate that the government regulates. Okay, well, now it's been stolen from you. And what do you want now? You want a regulatory committee to come in and chase down your money and give it back. So everything you liked about it, you now are a victim of.

And now you want all the regulation. I totally agree with that mindset of I just want anything that's not that thing I hate is ridiculous and dangerous. I'm with you because there may be some hidden jewels in these characters. Yeah, I hope. I'm of the opinion there are hidden jewels. And I agree with you that they're being overused and without a doctor. Yeah. But there are good doctors who...

Do believe in some of the ones that have now a great off-label use that will ultimately, in my opinion, be just like the GLP ones. I hope. I'd love to take a beauty peptide every day, but I do want it to be tested thoroughly before I do. I'm saying with Monica on this one. Yeah, yeah, yeah, yeah, yeah. I've been outnumbered a few times in this, but that's okay. I can handle it.

Now, my closing statements. You're so impressive. Your body of knowledge is mind-blowing. Reading the book and then also just what you can bring off the dome, it's mind-blowing. And I think you have real integrity and a great heart. And I'm really, really delighted you're a voice in this space. I loved getting to meet you the first time, and I'm so glad you came back the second time. Oh.

Well, I have so much enjoyed our conversations. If there's more fun podcasts out there, I don't know. Have you done Rogan yet? No, I'd be happy to meet with Joe. That would be interesting. But the two of you have amazing chemistry and it's good that you don't agree on a lot of stuff. As a non-scientist, I love how you think. Totally different backgrounds, totally different domains.

of our work, but you're on it and really appreciate you're going through the book so well and asking all the great questions. It's been fun. Oh, wonderful. Well, we'll have you back for sure. You're going to write another book and you'll give us more fun information. Keep us updated on all these studies. Door is always open. I really encourage people to read your wonderful book, Super Agers, An Evidence-Based Approach to Longevity.

Again, we got bogged down in the bad stuff. It is a very optimistic book. The hope is that people will find ways to extend their health span. And that's what it's all about. I hope that will work for all of us here. Yeah, absolutely. All right. Well, thanks for coming. Thank you. Stay tuned for the fact check. It's where the party's at. Okay. You want to hear the thing that I screen grabbed? Yeah. Okay.

Okay. This is a callback to our period underwear episode. Great. And this is by Tracy3872. I was at the pediatrician with my daughter when she was probably around four and my purse fell over and a tampon fell out. She grabbed it and said, Mom, here's the medicine for your butt. Thanks, baby girl. That's cute. One of the kids in the pod, a boy, said...

Why do girls only have butt? Right. Or front butt? No. No, I think he thought the whole thing was just a big butt on women. And if anything, it's like you have your big butt and then you have a miniature butt up front. It looks like two little butt cheeks if you really look at it. God, it's so weird that we're attracted to these parts. They're objectively so ugly.

Yeah, yeah. All of it. Like the boobs, the penis, the butt. Even when you're saying it, I'm like, well, no, not that one. You could just go the boobs. I'm like, no, no, everyone knows those are beautiful. And then the what? The aliens. The aliens don't think they're beautiful, probably. I mean, I think obviously the penis is the most ridiculous part of the body. The placement's goofy. It looks silly.

Uh, yeah. But the butt is very strange. Like we poop out of there and yet it's like an erogenous area. It's so interesting. Yeah. Um, what else? We're both in white. Yeah. I got a new outfit yesterday and I'm wearing it today. Fun. It's, um, the top is like

It looks like the inside of a sweatshirt. It's a little bit fuzzy. It's fuzzy. Yeah. Yeah, yeah. It's a little bit fuzzy. And you're in eyeliner again. I'm not. You're not in eyeliner again. Oh. What? Maybe what you're noticing is different. Do you think I look different today again? A little bit? Yeah, you look like you looked the other day. I mean, now I'm noticing, yes, the eyes were an extra bit. But yes, it's still something a little different. Okay, Rob, can you guess what it is now? Cheek filler. No. No.

I'm wearing concealer. Under eye concealer. I would not have guessed that. Okay. Under eye. And lipstick. Yeah, but I wear lipstick every time. Every fucking time I leave the house, I'm in lipstick. It's kind of, if I only have four seconds, I will just put something on my lips.

If, yeah, like. If some people do mascara. If you're in triage, you only have time for one application. Yes. It's going to be lips. For me. Some people do mascara. That's like their big thing. Like they have to, or their brows like have to be done. What about cover up? I mean, if my skin is bad. That's going to, that'll trump lips. Yes. No? Yeah. Yes. But.

Because of not my not witch, but my regular human esthetician, corrective skincare, Jen. Yeah. I can pretty much go out of the house without any foundation on. But I still like a little lip. Sure, a little pop. Remind people what's happening. Yeah. I'm going to say this with...

the utmost gratitude. I am so happy I live with all women. It's such a blessing. I'm glad I don't live with a bunch of men and boys. And I'm blessed to work with you all day. Thank you. But sometimes the spirits blow through.

Okay. You mean periods. I don't mean period. Oh, okay. Let's hear. Now, it would be easy to blame period. And in a few years, I will be able to blame period. Because perimenopause? No, because neither are my daughters. Oh, oh, oh, oh, oh. But sometimes the spirits, just the emotion spirits blow through town. Okay. And all the ladies are so emotional. Mm-hmm.

And I, as the guy, I'm like, what has happened? Is it weather, moon, food? Is the well poisoned? What? I really like that you included moon. Astrology. You know, I'm clutching at straws because I'm not sure what it is, but it'll just be, we have these days where everyone is very emotional. Yeah.

upset or just like, well, can you assign your emotions? So can you give an example? Cause maybe I can help. Maybe I can tell you what's going on. Okay. So, um, boy, and I keep really trying to evaluate when's, when do I have to stop talking about my kids? Cause they're old. No, I'm not sure. Fuck. It's very hard. It is, but I'll just say, cause whatever. Yeah. Like just indiscriminately, you know, D money's got a zone. Um,

Or it's almost maniac. It's like she's laughing really hard and then all of a sudden she's crying and she's completely upset. She's on a roller coaster. She's on a big, big time roller coaster. And then we had, now Lincoln had her play last night, right? The sixth graders put on a thing. Last night? It's like an art show. Oh, okay. And then they've made these enormous papier-mâché heads. And when I say enormous, they're this size...

of 10 basketballs you know they're huge and they have to go on stilts on the someone wears them lincoln was lucky enough to have one and they're the greek gods and then there's a play and a dance cool really cool first song they kicked us off with was seven nation army i don't know it oh yes you do jack white is it the white stripes or just jack white it's the white stripes

Oh, it's the toughest, coolest song. And all these little Catholic schoolgirls are fucking rocking to the most badass song. So she was on stilts? She had like this contraption on to hold the head up. I'll send you a picture. Of course, pictures and video. You know, D-Money can't even get through that thing. We got to go outside a few times. I'm on the verge of going like, hey, everyone had it together for your thing. But I know that's only going to make things worse.

I can't really see anything. Then we get home and I don't... Lincoln had that thing on her thing for a very long time. And her legs hurt in a way that honestly, it seems like she would have had to have been shot with a shotgun for them to hurt as bad as they did. And again, man, groin pain. Yeah, yeah, yeah. All of it's possible, but it's a grand mal meltdown. And I got to carry people upstairs and the other person's already thing. And then sweet Belle's just home from New York and she's frazzled and there's too many suitcases. And I'm just...

And I, the guy perspective is whatever I say is going to make it worse. I can't think of a magic thing. Yeah. That's right. And I need to just accept that people are emotional. And I do that. I'm not trying to talk anyone out of it. Mm-hmm.

But I can see how these patterns emerge, which is just like, I just say less and less and less. And I'm more and more scared to just interact with anybody. Yeah. And so...

I find that like I'm just quiet for like eight hours, which is really funny. Right. And then I go to bed. I'm like, you know, hopefully we'll wake up tomorrow and everyone will just kind of be reset for whatever reason. Yeah. It's just one of the very funny gender gappy things that I think is really interesting. And I don't know what it is. And it's just funny to be the solo male in this situation. Yeah. Yeah.

Gosh, I mean, I think you're right. There's not much to do. Yeah. And you can't take it personally. Which you aren't. That's the great thing is that throughout my life, I generally would make that my, I would be the cause of that. That's my knee jerk. And I think that's why people's emotions are so insufferable to me is that I convince myself it's because of me. I knew it was not because of me, luckily. Right. Right.

So that's a huge load off my shoulders. Because if you can figure out a way that it is your fault, then it really is kind of grueling. Yeah. Now that I experience it, I kind of go back in my head and I think of all these like dads I knew who just were like, I hadn't heard them talk in six or seven years. Yeah. They just stopped talking because they just are afraid they're going to make it worse or whatever. Well, they're just like...

Like, whatever. I think they just learn to not take any of it very seriously. And there might be some chaos happening around. But they just kind of block it out. And they think about something peaceful. Yeah, you know, like, when the hero in the movie is, like, walking away and the explosions are happening. And the cool thing to do is not look at and look over your shoulder. You just got to keep strolling. I think that's a little bit like that. Yeah, I mean, it's a ding, ding, ding to the Nick Kroll episode when I was saying, you know, there's just so many...

dads in chairs at stores. Like, you know, they just go to the store and then they just look for a chair and then they sit there while the girls are out shopping and then they get up when you're ready to leave. Kind of a funny experience being a guy a lot of times, you know? Yeah. Like there's many times where I like, I look at myself and I'm just kind of laughing. I'm like, look at this guy. You're just kind of like wandering from room to room hoping you don't bump into anyone and

Yes. Oh, yeah. And like a little panicked when you do when you're forced to say something. Maybe you're in a transition because you wouldn't have been like that before. Like you, I don't think for a long time would have been OK with people being like emotional. You'd be like, get it together. And I think maybe you're transitioning into understanding that's just not a good option. What also happens is.

And maybe you should just always grant everyone. This is like, they build up, you build up trust with one another and they are demonstrating who they are over a long enough period of time that you can really, you have a lot of data to talk yourself out of it, which is like, I know these kids, they're not wimps. They're not, they're not easily defeated, you know? So it does get easy over time because you start to see the actual character of your kids and you're not as worried as much. Yeah. Yeah. But all to say,

You end up just being really quiet. And I just think that's really funny. I think it's really funny. That's hard. It's hard to be. I see you. It's hard. It's hard to feel like I can't talk or something will erupt. Yeah. Walking on eggshells is not a good feeling. Walking on eggshells. Yeah. But I do. Oh, I had one other thing. Okay.

I also have to be realistic about the trade-offs and the rewards. So the joy of having these girls is like I get to be so affectionate and loving all day long. That's like the apex of it. And so, yeah, you don't get that. You don't get like just the good emotions you want to swim in all day, which I do, and not have the other side of the coin. You should aim for.

For the best version. Now, we're not going to hit it every time. We're not. But if you know, like, gosh, a lot of times I understand that my emotions are causing people to walk on eggshells a lot. Then maybe it's like, I need to try not to. I'm still going to do it. Like, it's not going to be 100%. Yeah. But.

I should try to be better about that. All anyone's looking for in life and what is comforting and get you through all of it is if there's any sense that you're getting even fractionally better and you're committed to getting better, then there's like this ultimate tolerance for it. Yeah, exactly. I think it's when someone's not going to change at all or it's getting worse. Sure. Yeah. And then I do think I will say something. I will say I'm not speaking for all women. Yeah. Go ahead. Or all. Nope. Or all anyone who's emotional. Yeah. Yeah.

But, or in touch with their feelings. Oh, beautiful. Sometimes I'm like, yeah, it's over. Like, we don't, it's fine. It was a bad day. Yeah. And then it's over. And they come and go. Yeah, they come, they go. Yeah. It's over. Like, sometimes as the person who has the,

strong emotions, then it's like, oh, now they're upset because I was upset. It's like, can't it just be done now? Everyone's done. It's done. Yes. Does that make sense? Totally. It totally makes sense. I was having kind of a funny thought, which was when you meet your grandparents, they've already been through this whole thing, right? So you meet them and you kind of think you're meeting the original them. But like, I think about my Papa Bob here.

He was so quiet sometimes. Yeah, yeah, yeah, yeah. And I just kind of thought he was a quiet guy at times. But I now realize, like, I met him way into the game. This is his second time around with kids in the house and the whole thing. So it's like, he, I don't even know, who knows what my grandpa was like at 25. I know, it's true. Yeah, he just learned to be quiet over time. I think that is the trajectory of all men if they're going to succeed. And to be fair, not to upset you. Yeah. But...

Sometimes there's walking on eggshells both ways. With men or me? Just me. I'll say all men. Okay. To be nice. Well, because we're just talking about the people we know. Yeah, yeah. You know.

I have moods. They just, they show themselves. Their phenotype is different. It's just a different version. And I know a lot of guys that's like this. It just tends to, again, we do the same thing. We get quiet. We isolate. Yeah. And then we, what feels like is we abandon or we retreat. Right. That's almost our version of being moody or having big feelings is I'll just, I'll remove myself from everyone. Right. And I will-

Soothe was something that's generally solitary. Like, I don't want to be around everyone when I'm depressed or in a mood. Yeah. I think more, I mean, for all men, it's more like there are areas you can't go. Mm.

Like with, with you, there are some areas you just can't go with you. Sure. And Carly. And I don't, I'm not going to say any of it. Don't trap me. Okay. But anyone in my family, there's like, there's some scary areas with you that feel that do feel a little eggshell-y. Like if we're getting into any of these remote topics, like you really have to be really careful about what you say or like you're gone. Ah.

Uh-huh. Forever. Uh-huh. And so that's funny as a woman. I'm more—like, that is more scary to me than, like, just strong, like, annoying emotions. I think you guys are comfortable around each other having big emotions. And then we're—

And then what's scary to you guys is when we just vanish. Yeah. Yes. Exactly. Yeah. Anyway. Okay. So that's it. That was it. Okay. Well, that's it for this chat. Now let's move into facts. Great. Stay tuned for more Armchair Expert, if you dare.

Oh, I love him. Okay, my update is that he just did Dr. Mike's podcast a few days ago. And Mike said to me, I saw the picture of you and Eric and it's the cutest picture ever. It's very cute. Very, very cute. Oh, my gosh. Yeah, I really wish he was my dad. Oh, wow. I mean, I already have a dad, Tom Hanson. Yeah, sure.

But just look how sweet. We could have so much fun lifting weights together and doing father-son stuff. Yeah. I'm sure he'll...

Come hang out with you anytime if he's around. If he's around. Yeah. He's a busy man. Yeah. Dax and Eric Topol took a picture together. Yeah. He had brought a sleeveless tee because he's been lifting. Yes. Yes. And I said, not only yes, do I want to do that, let me go grab a tank top. Yeah. So I did a little wardrobe change. And his daughter took the picture. Yeah. Really cute.

Well, he's awesome. He definitely is more my speed. Yeah. As far as approaches to longevity and taking...

Not as drastic of measures. And I just like him a lot. I used to reach out to him all the time as he brought up for fact checks. Yes. To help me out. And what happened? Did you just like at some point, did you go like, I got to stop bothering this guy? I think the truth is I started taking fact checking less seriously. Oh, sure. Yeah, that makes sense. Like I was really asking for real, like what from a real expert perspective.

What is this? And now I just mainly rely on the internet. Yeah, yeah. So does everyone else. I mean... Yeah. We've increased our... Laziness? Output. So something's got to give. All right. Here we go. Now...

He talked about Vioxx being pulled from the market, which he was... Spearheaded. Yeah, which is incredible. And there's an NPR on this. Oh, there is? Mm-hmm. It's called Merck Pulls... Oh, it's from 2004. Oh, yeah.

Merck pulls arthritis drug Vioxx from the market. Yeah, so this is when it was happening. Study confirmed earlier concerns that it raises the risk of heart problems, including heart attack and stroke. It was currently being used by 2 million people worldwide and had been used by more than 84 people around the world. 84 million? 84 million, sorry. Only 84. 84 million. So good for him for...

sounding the alarm. I wish I could cite something right now, but I have run across numerous articles that talk about just the overall efficacy of the drugs that are passed by the FDA.

And it's abysmal. I mean, it's truly, truly abysmal. Yeah. We're talking like 20% of people will actually benefit from them. You know, really, really low. I guess when the doctor prescribes me something, I think like, well, this thing works. That's why they're prescribing it. Yeah. And in their defense, no, they're going to try that. It might work. And then if it doesn't work, they're going to try another option. Exactly. And they're just knocking out. But I think the general public thinks medicines do the thing they say they're going to, like 100%. Yeah.

It's not. It's more of a process of elimination. You said that, well, you said that men got AIDS over nine to one. In the 80s. In the 80s. Yeah. I mean, yeah, it's still quite...

vast, the difference. Let me see. In general, this is current though. This current, yeah. I'll admit it changed in the 90s and it got different. It's still pretty... Lopsided. Yeah. In general, men tend to get diagnosed with HIV more frequently than women.

Though this doesn't necessarily mean they're more at risk, whatever. We know that. Okay. In 2022, men accounted for 81% of new HIV diagnoses in the United States compared to 19% for women. It says, whoa, it says, however, women are more susceptible to HIV infection than men.

And male-to-female transmission is more likely than female-to-male. Yeah, that almost doesn't happen. Women's genital tract is more susceptible to HIV than men's. As are men's rectums. So bottoms get it way more than tops get it. Lots of pores in there. Yeah.

Fissures, openings, friction. That makes sense. But then that is why can't women, why are women not like giving it to men via their vagina? Well, because the receiver tends to get it more than the giver. Right. But if like, if I got it from a man and then I had sex with another man, I'd be surprised. It would be harder for you to give it to him because he has far less, uh,

openness on his penis than you have in your vagina. And you have more fissures and openness in your rectum than a penis is going to have. It would only work if a woman's vagina could have sex with the man's butt. Then we would be apples to apples. If men and women had sex anally to vaginally... Can you kind of picture it like...

Well, this is how it seems like making out. Yeah. And a lot of like suction noises and stuff. Like a reverse scissor. Yeah. Yeah. I'd like to try it. I guess the butt though, it'd be really hard because the butt cheeks like to really get in there. To Rob's point, you'd have to really sideways scissor. Yeah. Yeah. Hmm. Hi. Who's that? I don't know. Chris. Mom. Hello. Lincoln.

No, come in. Were you running? Are you okay? Oh. Gosh, it's not always bad. Well, when you come, I don't see you and I hear. I did also think for a second. I'm assuming you've come in crying and someone just assaulted you. Wow, I maybe don't want what I came in here for. I was going to tell you I did my bike ride for the first time this month. I'm very proud of myself. I wanted to hug you.

Okay, I'm happy to give you one. Where did you ride your bike? Yeah, yeah. But then isn't that on me that the only time you guys see me out of breath is when...

It's double whammy. You came in to the podcast space, which you don't do often. No, because I got back from my bike ride. I was so proud of myself. On the verge of tears, I was like, I'm going to go get out. On the verge of tears. In fact, you are about to cry. Seems like maybe we were right the whole time. Where'd you go? I just went in the park.

The hilly park. That's too many. Doing it.

Wow. That's exciting. I want to hug you. Good job, Mom. I haven't ridden my bike ever. You know I don't know how. Look at me. Look at one of these cameras. Come over here and look at that camera. Don't look for crap.

She's already crying. I know. I don't want her to cry more. What's so cute is that you're proud of yourself and you're a little bit crying. Let's normalize this because you don't have to just have like a...

big emotion, big feelings when you're sad at yourself or ashamed of yourself. I truly am so proud of myself because when I do it, I can then get a routine and I just feel better mentally and physically. And I came back and I was like, you did it. That is something to cry about. I feel really good. And then I thought,

Are they done? My second thought was, I don't care. My third thought was, be polite and text Rob. My fourth thought was, I'm too impatient to wait for Rob's response after like...

A nanosecond waiting for him. I was like, well, he's not there. Because you're Delta's mom? Yeah. And then I thought, you know what? No. I mean, I love your podcast, but I love you guys more. I want to see my friends. I don't want to tell them that I'm really proud of myself. Yeah, we're proud of you, too. We're so proud of you. It's hard. Those bike rides are hard. They're so hard. They're kind of the hardest workout. They seem too hard. Right? And it's also hard when you get out, like I said, out of the habit. They feel so unattainable, like unbearable.

It feels like you could have been like, Everest, this bike ride. Yeah. 50-50. Pretty much the same. Yeah. Yeah. But I didn't. I'm so proud. Good job. Because I have to work really late tonight and I wanted energy and the whole, I just went through a whole thing this morning of like, prepare yourself. Nice. You did it. That's where I am, guys. And then I also thought on the way home, I mean, you can cut out this. No, this is great actually because it's for Eric Topol and it's about longevity.

Ding, ding, ding. Doing it for you, Eric. This feels now scripted almost. Scripts. Scripts. Are you going to come on Saturday to the meeting? No, I'm going home to visit my mom. Oh, okay. Tomorrow morning. I'll take notes. Take notes. I did send in my proxy. Who, Birdie? No, it's like the two-year-old that lives across the street. No, the little like form you have to fill out. I filled it out too in case we missed it.

I think that'd be really funny to send a kid as your proxy because one time when you were working, the girls had both of their like teacher school initiation meetings, like beginning of the year where they say like, what to expect in first grade. But it was second and kindergarten. And they were at the same time. And I was like, okay, so I sent Lincoln to the kindergarten Zoom while I did Lincoln's Zoom.

And I said, you got to take notes. I still have the notes. They are absolutely unintelligible. You have to prank us. Oh, my God. They don't make a lick of sense. No. No. There's no way they could in second grade. There's like numbers in the letters, in the words. What was the...

The number that she said endlessly. Do you remember she used to say a number over and over again? And she wrote you a... They used to think 60 was the highest number, but this was a Mother's Day card. You said, back when she was really little, like three maybe. Tell me what you want to say to mom and I'll write it. And she said, Dear Mom, 8...

Four, nine, two, seven, one. It started repeating. One, eight, two, five. It was like probably three or four phone numbers combined. Oh, my God. I don't know, 40 numbers. And then she stopped and pretty elegantly just wrote a Happy Mother's Day card to you. She said,

I love you so much. You're the best mom ever. Happy Mother's Day. But it was a... She had to get those wheels turning. And he wrote it down verbatim. Oh, my God. That's fantastic. We were discussing the play earlier. The two versions of the play. Alice in Wonderland Jr. Alice in Wonderland Jr. We were talking about... Because you're... I don't know if you know, you're a professional actress.

Okay, I've heard. Okay. And so when you watch the play, what happens? Do you think I feel bad for the kids that are very highly committed or do you not? Definitely not feel bad for them. If anything, I'm a little impressed. It's sort of like...

How many disruptors can you have on set while maintaining what you know you're there to do? It's good training. It's really good training because some of those kids are wholly and completely digging in their nose, having side conversations, just truly wandering the stage. But then you have like the girl who played the Queen of Hearts who is giving 110 even during curtain call she's Queen of Hearts. Yes. I

I don't know. And the Cheshire Cat. I'm like, that kid definitely auditions. He's probably been on TV. You know, because we're in LA. The White Rabbit. Oh, White Rabbit. Yeah, yeah. Yeah, yeah. I get excited if they've, this is stupid and I hate this, but I do say it all the time on sex. I think it's so stupid. But when you drop in.

When you really drop in to a character. You know, like I'm here. I've dropped in. But like some of those kids are legit dropping in. They are. And they're feeling it. And pretend is so fun. I don't feel bad for anyone. The complete emotion I have around those plays is that it literally doesn't matter what anyone's doing. It doesn't matter the lines they're saying. It doesn't matter...

if their acting is good or even passable. What matters is that a group of people have come together to play pretend and they're standing on a pedestal in front of other people who have agreed to witness it. And there's something so magical about that. It doesn't matter if they restart the song. It doesn't matter if Delta gets handed a microphone and then yells at the stage manager about what she's supposed to do with it mid-song. So funny.

None of it matters. What matters is the witnessing of it. That's lovely. Do you feel that way about sports? Like if the kids are playing sports, is it the same like, oh, they're just like, it's fun and it's a beautiful thing? Or do you think we do more care?

about the result. Yeah, that's really weird because I think I would answer it differently. I would like you to score a goal. Yeah. I'd like you to work a little harder at this. But I'm not saying that's the right way to be or an evolved way to be. But if I'm being honest, yeah, I'm going to root for you to score a goal whereas...

when I'm sitting in the theater, I'm not rooting for you to hit that note. Whatever you hit is going to be great. I'm so glad you're putting yourself out there. Yeah. And it's probably healthiest to have that. Well, I was telling Delta before the play, the night before, she's like nervous. Yeah.

And I said, you just I just want you to hear from me. What impresses me is putting yourself out there. I do not care if you're good. If you remember your lines, what is admirable is putting yourself out there and you will do that because you'll show up. So there's really nothing to be nervous about from my approval. Yeah, that's for sure. And I'm sincere about that. Yeah, yeah, yeah. Especially at that age. Yeah. Do you feel there's a difference in sports and theater?

I am a double Virgo. What can I say? I do. You're like two months away from learning Gematria. What's that? Do you know that's like...

What's Demetria? It's like maybe a crazy person's calculator where like letters mean numbers and the numbers have significance. And if you spell someone's name and it equals like. Oh, meaning like it's a fringe astrology thing. It's an evolution of astrology. You can like spell your name and like Padman would mean false. And then I'd be like, you're Sim. Oh my God. I can't wait to learn it.

Oh my God, what a challenge. Yes, I think I take everything very seriously. So when I'm watching anything, I mean, I'm mainly just laughing because it was just so funny. But yeah, so I am evaluating it like, oh no, these people care a lot and these people don't. And if I were them, I'd be like, why can't everyone just get their shit together and

do this you know care yeah and I would feel the same way about sports but I think there's not a right there's probably not a right and right wrong way to witness things it's like what what's the perspective the lens you're looking through you are like such a consummate professional and ambitious woman like to the letter of the law in a great way it's like you're the one that like the that that Argent puts in their suits to be like this is a this is a woman who will get stuff done and

And it's how would you be able to drop that whole facade and go and be like, try to act like a preschool teacher when you're watching that? No, you're like, there's. Yeah, I'm like, commit, guys. Yeah. Yeah, I know. I know. But I do think your way of looking at it is the correct way. I do think that. I don't know. I think it's just a way. Yeah, everyone's right. It's a way I would like to be doing it, I guess, is the better way of saying it. Solved. Settled. All right, well.

I love you. Great job. Great job. I'm very proud of you. That's the hardest workout. Yeah. Yeah. I wasn't patient, Rob. Sorry I wasn't quick. Okay, bye. We're almost done. Love you guys. Love you. Okay. Let's just wrap this up super quick. There's a fair amount of evidence to say that

that over 200 grams of protein or an excessive amount can lead to kidney issues and liver issues. What's that from?

Oh, Medical News Today is where this one is from. But there's a few. There's Harvard, one from Harvard Health, one from University of Missouri School of Medicine. I will produce, I will cite the many articles that say it's great for you. Great. 13 pounds, you said there's 13 pounds of microbes in a body. According to this, National Institute of Health, two to six pounds of bacteria in a 200-pound adult.

because of their small size, but there are 39 trillion. All right. Well, that's it for Eric Topol. I love him. We can't wait to do it again. Yeah, he'll be back for sure. With probably more gains. More gains and he'll have aged reversely. I hope he's bigger than me in the next photo. That would be incredible. He's going to have to up his protein intake. Yeah, he's going to have to reverse his position on protein probably. All right. Love you. All right. Love you.

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