The Science of Healthy Aging: Living Better, Not Just Longer

This program is a UCTV presentation for educational and non-commercial use only. It is my great pleasure to introduce you to Ellen Hewes. Ellen is one of UCSF's most beloved professors. She hates when I say things like this. She tried to make me promise. to make a very brief introduction to say something like here's Ellen, but I'm going to touch on her a little bit. Ellen had earned a PhD in cell biology, but despite that, when she came to UCSF and she got her PhD and then internal medicine from her. residency kind of fell in love with primary care with the kind of medicine where you connect with other people Ellen Ellen is a great lover I think maybe that's how I would describe her she loves everyone it made her a little nervous there for a Minute Ellen was one of the founders of one of the most prestigious parts of UCSF, the Academy of Medical Educators.

She was also one of the really guiding and instigating forces that led to the development of the Osher Center for Integrative Medicine. She was Osher's first director. She center when she couldn't look around her and find someone else to take care of it, but she finally found Susan Falkman to do that. Susan is now nearing retirement. Ellen was the Osher Center Education Director for many years. Ellen retired herself about a year ago. most of us are still a little grieving, but she agrees to come back from time to time. Ellen is a fabulous speaker, she is getting nervous because I am wasting too much time and she is also my very good friend, so here is Ellen, thank you.

Thank you, thank you very much for coming tonight. This is actually a talk that I've personally gotten the most out of researching, so I'm really excited to be able to share information with you tonight about how to try to live

better

. It's

just

longer

, so let's start with a little history, not

just

the definition of

aging

, but what we are learning from many studies in the medical and scientific literature, from the study of people who successfully From start to work in test tube with genes, a lot of that work is being done here at UCSF, so I'm very excited to be able to share that in this context of how that affects what you and I should and maybe could benefit from.

In terms of

aging

gracefully as we age, the last part of the talk will condense much of the information I've been studying into ten basic recommendations for aging as successfully as possible, so let's start aging despite the anti- Industry aging is actually a non-pathological natural process that affects us all and in the United States our life expectancy is twice that of our grandparents at the beginning of the century, so the average child born today can expect live until the end of 70 years. the longest is in Japan and in fact we are going to say something about some of the lessons we have learned from the Japanese who are so long-lived.

The shortest, unfortunately, is in Africa and Sierra Leone, so you can see there's a pretty big difference. Life expectancy depends on where you are born and one in five Americans will be over 65 by 2030, so the population is definitely aging, so the way we learn about aging is on a couple of levels. different. I think people will naturally want to study that looks at successful societies and there are some unique societies where people tend to live

longer

, healthier lives. There are several centenarian studies being done in this country and around the world that study people who have reached the age of one hundred and what it allows them to do.

To be so successful we're not going to touch on people with accelerated aging or twin studies as much, but those are also some of the information that we learn about how to go through our lives, a lot of the work that we're going to talk about. What we're talking about tonight is based on animals and there are a lot of very interesting studies and, finally, some very interesting work in terms of genes. There may actually be some longevity genes that should be of great interest to anyone who is aging. So where are the societies in which people live the longest? longest and I already mentioned that Japan has one of the oldest and the island of Okinawa is supposedly the best place to be born if you want to live a long and

healthy

life.

Some of you may have seen this. The blue areas read about it. It was actually highlighted on Dateline, I think last week, and someone who wrote a book, went to various places around the world and really looked at what the factors were that allowed people to thrive and be

healthy

. until the 80s, 90s and even a hundred, so Okinawa was one of them. Crete in this country was a place in southern California where there is a large percentage of Seventh-day Adventists. Costa Rica and they also added a few other locations overnight. I will be weaving in information that this researcher has discovered and I mentioned studies on centenarians.

There's one in Baltimore and there they're following over a hundred thousand people who are a hundred years old or older in this country, I mean, and in fact, very old is the level or group of people who age most rapidly now many of these people carry healthy lifestyles about a third of them seem to get through it gracefully they don't suffer from the same chronic illnesses that many people in our families have their children also live longer so there must be something and many of them live healthy lifestyles but some no, so that's the big question: why do you always read sometimes when someone is 108 years old and they say, well, it's that whiskey and that cigarette?

I've been smoking and wait a second, that doesn't fit with everything I've heard about getting to a hundred, so what allows some of these people to live this long? And I think this is what The most exciting scientific finding of the last decade is that there are some model organisms and they have discovered that there are some genes in each of these organisms that seem to affect the lifespan of the organism and that, if you can alter that gene, you can actually increase it. or decrease their life expectancy, so not everyone will become a PhD scientist, but Tetrahymena and yeast are very basic organisms, this worm in the middle is something I will come back to with C elegans and one of the best in the world .

Aging researchers Cynthia Kenyon study the lifespan of these worms and they discovered that there was a genetic pathway that if you altered it, the worms lived twice as long, just a simple gene, a single gene that you already know, that It involves a few things about how insulin works in the body. There are mice flying and this strange looking organism to the right of a naked mole rat that looks like a Halloween figurine to me, so let's back up, what are the theories? Old theories about aging where we just wear out like an old car. We ended up looking like this in the junkyard, our parts wore out, we didn't do the oil change even when we did it right.

I just gave up the ghost, but I think the attrition hypothesis is not the full picture and maybe not. even part of the whole picture, so I'm going to talk briefly about some of the theories about why we age, one of them is the calorie restriction telomeres of oxidative stress for which Liz Blackburn just received the Nobel Prize from UCSF and finally a little bit more specifically about these longevity genes and oxidative stress, so when you buy a multivitamin that has an antioxidant, this helps explain what it is, so in the body we need to be able to convert the foods we eat into energy that our body can use and that is ATP and it happens in these little organelles called mitochondria and in every cell in our body and that's great, we need ATP to live, but as a side effect of this metabolic process there are these types of nasty actors , reactive oxygen and nitrogen species that are not.

They are good and can actually damage DNA and proteins and cause dysfunction of cells, organs and ultimately the body, and that is the dark side of having to be a person who needs energy to live, so What antioxidants are substances that people take to help. counteract the reaction of these reactive oxygen and nitrogen species, so that's something to think about, look at these two monkeys, they're the same age and the one on the left looks pretty, you know, it's reasonable, the one on the right is has allowed him to eat as much monkey food as he wanted in his life, no, you know, you just give them monkey food and they'll eat whatever they want.

Well, the one on the left was given 1/3 less than the one on the right and is

living

a third longer and this has been something that has been observed in everything from these worms to very small organisms up to the non-primate level. humans and maybe even in humans. Let's see more about this, so the animals that were given 1/3 fewer calories - none of us want to hear this - live longer and not only do they live longer, they live healthier, they don't develop the same age-related diseases as they do. same rate they are less resistant to insulin and this makes sense insulin is the hormone that carries the sugar we get in our body to the cells, the more sugar, the more insulin, and there is something that is not so good about having too much of either of the two and there is a slower decline in functional status, I now need to To be clear that this is not an eating disorder type calorie restriction, this is healthy, balanced nutrition, but it has less quantity, which makes sense , so this is not an anorexic monkey, this is a monkey that was given properly balanced nutrition, but just less of it. or normally I would have eaten during the day and there are a lot of people in the United States who have voluntarily chosen to do this, they are members of something called the Calorie Restriction Society, they have written a book called the Longevity Diet and they are banking on the fact that that this research in younger animals, that is, in other animals, will also be applied to them, so they eat 30 to 40% less calories, in a very balanced way, and there is currently an observational study underway with people of this society. who volunteered because it is very difficult to randomly assign people to this type of program, although there is this study, the calorie study, comprehensive evaluation of the long-term effects of reducing energy intake, which is a two-year study and they actually got the people of New Orleans to agree to follow this lifestyle and the preliminary results are quite remarkable, at least in terms of lower insulin levels and many other things that would be associated with aging.

The full two-year study hasn't been published yet, so we'll have to wait a while for this data to come in, but there are many other levels of evidence to support that we're probably eating too much and we're probably eating too many of the wrong types of foods, so why would we have to wait a while for this data to arrive? This works well, remember I just said that when you eat you have to produce energy and transport it, so maybe there is less oxidative stress for the cells, maybe it also means your body has to produce less insulin, but there is also this new family of proteins, some of which are called sirtuins.

I just want to grab a couple of slides to show you what they are. Sirtuins are products of genes that are activated when someone does not eat as many calories and I have resveratrol in that beautiful glass. of Cabernet there for a reason because resveratrol is a substance that triggers the production of these sirtuin type proteins and when they gave very high doses of resveratrol to chubby mice, I bet you know that the mice that were unhealthy actually started to look more youths. to live longer they started to have fewer metabolic problems associated with obesity, so everyone is thinking, hmm, this could be a really good thing to research and a great thing to consider starting a company and sure enough, that happened.

David Sinclair at Harvard started something called the Masuda khals quest to research resveratrol and resveratrol-like substances that will help trigger these special proteins that seem to be good for obese mice and may be good for many other things, including cancer, obesity , diabetes let alone aging in general and just another big problem. The pharmaceutical company felt that the potential in this field was big enough that they paid a pretty large amount of money in 2008 to buy Souris, so now it's part of this larger conglomerate, so let's talk a little bit about the proteins. a little about genes, let's talk a little about aging at the cellular level.

Any of you have ever been in a laboratory. I have seen petri dishes and I know that when people try to grow fresh cells in a petri dish, in reality unless they undergo a certain type of transformation, they die after a certain period of time and there seems to beabout 50 cell divisions, it seems to be the time when cells can't continue dividing in culture and it was called the hayflick limit again actually Leonard hayflick worked here at UCSF and why that might be good that brings us to the history of the telomeres that I'm sure some of you heard about with the recent award of the Nobel Prize.

Telomeres are like the ends of chromosomes and like genes. they divide and chromosomes have to divide, they tend to wear out a little bit and shorten a little bit with stress or with age, so you want your telomeres to protect the ends of your chromosomes, so again they are DNA protein complexes that stabilize the ends of chromosomes. They get shorter in older people, they get shorter in people with illnesses, and they get shorter in people who are under chronic stress, and they get longer, which is interesting: it can actually be shown that they can get healthier or longer in response to good things. like healthy lifestyles, stress management, so this is going to be an area that I think a lot of people are interested in.

If you're interested in looking at the product, in the next five years you're going to go to your primary care doctor and they're going to have your length calculated. your telomeres and then you'll take a medication or do a lifestyle and a couple of months later, six months later, whatever it may be, they'll check your telomeres again as a measure of how well you're doing and the benefits associated with the health you have, what changes you've made, yeah, oh, sorry. National Academy of Sciences is one of the most prestigious, sorry it was too long to write it, but it's a great article, it's an incredible article, so it was also done here locally with Liz Blackburn in collaboration with Dean Ornish, many of you they know. has done a great job with lifestyle modification, particularly a very low-fat diet, so there were 31 men who had low-grade, low-risk prostate cancer and, as you know, prostate cancer in some Men grow very, very slowly and if you are first diagnosed with a low grade cancer, many men actually choose what we call watchful waiting because having immediate surgery or treatment doesn't always impact their lives in a positive way, so These were 31 men with low risk cancer who were followed by this Ornish lifestyle program that involved exercise low fat diet, reduce stress and some yoga and they did it for three months and then they did it.

Some of you may not be familiar with this, but this kind of green and red glowing image at the top is what's called gene arrays so they could check the genes that were active before the men started the program and after, and what they found in just three months of a lifestyle change. 500 or more genes were turned on or off in a healthy direction, meaning genes that controlled tumor formation, oxidative stress and inflammation, all of which are bad, were downregulated, less active after the program and others that we believe are more health promoting were stimulated, so it was pretty mind-blowing that in three months you could see this guy. of genetic change by simply making a change in lifestyle.

The lower graph also shows the length of the telomeres. We had no idea that telomeres could change in such a short period of time. We don't know if this could happen in a month because the study hasn't done it. It hasn't been done yet, but at least after 3 months the very positive message here is that if you make a change in your lifestyle, you change your genes in a very short period of time, so I just want to finish this part about the basic

science

saying at a conference: I went to Harvard recently, there are probably three, four or five other longevity pathways, not just insulin, not just sirtuin, and there's a sense that maybe each of them communicates with each other, so although they haven't reached the popular press level yet I think we're just at the beginning of a very, very exciting period in

science

that will have a huge impact on how we age, so I think it really will be the tip of the iceberg and this was just one way.

I'd say it's a complicated and exciting process and I don't expect you to do it. I'm not even going to go through all of this, but I think there are a lot of different things that affect how we age on a cellular and organic level and I think we're going to know a lot more in the next five to ten years, so what does it all mean? this for you? What does all this basic science mean to you? And I think the truth is that no one has yet discovered a way to reverse aging. I think everyone would love it, right?

Can't I keep the wisdom I have now and return to the body of that 25-year-old who could do more? Oh wow, that would be wonderful, so we still don't have a way to reverse aging, but some of the data that I will present to you in the next part of the talk says that there is a lot that each of us can do to be healthier. and live

better

, not just longer, so I love that these two quotes contain the concept. to die young as late as possible because you would really like to be functional and active and mentally conscious and then know that my wish would be to get your disease and leave quickly, so that's also the concept of compressed morbidity so that you don't know that you don't have a slow decline of ten years and you really don't have the quality of life you would like?

So I just want to say a few words about the anti-aging industry, there are huge amounts of it and I don't. It's a photo that always appears in United Airlines magazine. No, this is from Dr. Life. I don't know him personally, but he underwent one of these anti-aging programs and looks wonderful as a result. The sad thing is that many of these programs support a healthy lifestyle, but they also do a lot of hormone replacement and their belief is that as these hormones decline as you age, you should simply supplement them and you will be fine.

There really is no data to support these claims from the Fountain of Youth and in fact there may be some dangers associated with replacing some of these hormones, so I just don't want to say that you should have a skeptical attitude when reading some of them. these ads, but there are actually a lot of excellent aging guides available and I think these three are three that I would highly recommend. Andrew Weil wrote this book in 2002 and it is impressive. I read it again to prepare for this talk and in 2002 I was already talking about telomeres and the different types of scientific basis for what I'm going to say and there are also quite a few websites that will help me.

Have any of you tried or gone to what is called real age calm? Well, let me tell you what it is. This was based on some of my Croy's and Dr. Rosen's findings bring together all the things I'm going to talk about: What you do is you sit in front of the computer and it says, okay, what's your blood pressure? What is your weight? How BIG is your waist? Do you know how much you exercise? You get and they put all of this into a formula and they give you what they consider to be your functional age, not your biological age?

Some of you may have seen on Oprah, you know, people have come and said they had this test and they're 50, but they're actually 66 by functional status, and then they get religion and they get into a lifestyle and Now they're 48. I'm serious, whatever it is. I think it's a really good thing that people know that what they do in their life really has an impact on their health and that there are 65-year-olds who function at the level of a 40-year-old because, luckily, they know good style. of life, whatever it is, these are good websites to visit and so one of the other pockets I'm sorry, I'm sorry, is if only dr.

Michael Roizen and if you just look at it under how to stay young, you can get it on Amazon so this is another really positive piece of information that surprised me, which really determines your health because a lot of us feel like, oh, I just got the genes. from mom. I'm going to be fat the rest of my life, there's diabetes in my family, why attention and genes are clearly very important, but in some studies, when you look at what the various contributing genes are, they actually make up about a third of our health and they observe this behavior is more influential forty percent of your health can be attributable to the things you choose to do for your health clearly you want to be in a healthy environment you would like to have social contact we will talk more about that at the end and have good care Medical care would certainly be helpful, but the biggest slice of this pie is behavior, so even though it's a little hard to get off the couch from time to time, it really is in the power of each of us to have good medical care. big impact on our own health and maybe the health of our families, so I just wanted to briefly say why I think changing your lifestyle changes your genes.

Remember we just talked about those prostate cancer patients. Well there's a whole new field called epigenetics and we used to I think you know that the genetic code you know is passed down from generation to generation. What they found is that what we do in our lives impacts our genetic material in a way that depends not only on the sequence but on how the chromatin is packaged. modified and those changes are very, very profound, so again I don't want to spend too much time on it, but now we are understanding, on a test tube level, why it is important to get up and exercise, why eating a healthy diet can have such a profound effect on your genes that as we understand those mechanisms, I hope it's an inspiration and some hope for you, but we don't live very healthy lifestyles.

This was a survey of over 150,000 American adults and only 3% said they could answer yes to each of these things they didn't smoke they were a healthy weight they ate five fruits and vegetables a day and they exercised regularly I mean this should be the basic health prescription that you should continue to receive from your doctor and that you should incorporate into your life and that if only 3 percent of us do it, that is not a very positive finding, so we are not going to focus on all the unhealthy behaviors that you know about, but clearly I need to list them smoking drinking taking drugs risky behaviors are not all good, but I would like to focus on the positive aspects of what you can do for your health, in addition to getting rid of some of these unhealthy behaviors health, so here are my 10 recommendations and Let's just start going from 1 to 10.

Maintain a healthy weight. No one walking down the street or riding the bus will be surprised that two-thirds of us are overweight. A third of us are obese. One-third of a million American adults. It is believed that they die prematurely due to obesity-related diseases and it is not surprising that we have evolved in a time when many of you did not know that there was a McDonald's down the block, so if you did not, if you and their ancestors were not programmed to eat when there was food, to have a really healthy appetite, and to retain those calories as fat.

You and I wouldn't be here today so sometimes people call them thrifty genes and there are certainly some families that don't. I don't have it, my family has it in abundance, you know you eat too much, you lack exercise and there you are, you you're saving, you know, in places you don't want to, and on top of that in the last 10. Between 20 and 30 years old we consume a lot of extra calories than our grandparents and, unfortunately, we need fewer calories as we get older. I mentioned it in another talk. I think it was a year or two ago.

As we age, we naturally lose muscle mass. If you are quite active and muscles are the most metabolically active tissue, then the bad news is that let's say you're 20, I'm just going to make up a number and you need 2000 calories to maintain your weight when you're 30. Maybe you only need 1800 calories. when you're 50 maybe you only need 1700 calories, so you're fighting this kind of battle of needing fewer calories as you get older because you're naturally losing muscle mass, so all of these things together have added up to an epidemic of obesity and Honestly, I think one of the main culprits is portion sizes.

Many of you who saw my large size saw the effects of taking the extra size Big Mac even over a period of one month, so here are some strategies. So let me before I continue with the specific strategies of the Okinawans that in the Blue Zones they say a small affirmation before each meal, it is called the 80% rule and before they sit down and eat a meal at 80% of their capacity , they stop or at least I intend to stop when they're 80% full, you don't know, the kind of Thanksgiving dinner, you know, prepare for them to really be aware and, as a result, and maybe other things culturally, they eat on average a thousand fewer calories per adult than we do. in this country,so yeah, okay, yeah, no, that's not necessarily a very good question, so let me repeat it on calorie restriction.

People who choose to follow it already know that some weight loss is a side effect of doing that type of program, but many of them were not obese and that was not their original intention, they would lose weight and lose excess body fat by following that regimen, but they are doing it with the goal of

living

a longer, healthier life. Well, that's a good question, yes. It would be a little bit more complicated because you would really have to make sure that you have proper, healthy nutrition, a very good balance, so you don't know, going it alone, that you're not getting the essential nutrients, okay, so let me, what are they? some strategies, there are some restaurants in San Francisco that will serve you half a portion, so if I found what I don't remember what it was, but I said, "Okay, would you serve me half and bring the rest in a doggie bag?" I'm the kind of place where I grew up I don't know if you eat, you know everything that's on the plate and it's a nice night.

I have had a glass of red wine. Oh, that extra piece of bread looks great and I'm done. I'm eating more than I need so I know from the start that if I get half of a main course I'll probably feel full, so dividing main courses is a great idea into smaller plates, this is fascinating as I already know. you know if you've ever been to buffets and you get this little thing and you think they're being cheap, they're not, they're helping you with your health, if you go from an 8 inch plate, you know, a 10 inch plate to a 8 inches, you eat 1/3 less when you're not told ahead of time that this is a calorie restriction experiment, so at the buffet you get the small plate, you feel like you know you're filling it up, you can go back for seconds, but instinctively many. people will eat less so there have been a couple of experiments where they literally integrated families and just replaced the size of the plate and that made a difference in terms of weight loss and then these final things are for people who don't really they can bear it. aI understand that the portions are actually quite noticeable and if you only used this plate counterclockwise for a week, you would be surprised what a portion of meat really is.

It's like this tiny little thing in a cup. The difference between this and the plates that are simply marked with "You know, don't put any more protein than this," means that you can still pile a lot of food on those other plates. This will show you because it is like a little cup that fascinates the things that help people. Well, we're not going to have time to go into great detail about each of them, but I just want to scratch the surface, so there's no need to think about working out. 60% of us don't exercise regularly. 25% of us are addicted to television and we burn 800. fewer calories a day than our grandparents at the beginning of the century and that is quite surprising, given that half a kilo of fat is equivalent to 3600 calories, many days eating 800 more calories will not be necessary or nothing more in the combination of eating and not exercising, so everyone probably knows that the minimum national recommendation for moving every day is about 30 minutes of moderate-intensity exercise.

Let me translate it for you, most of the time people say it's brisk walking, so it's not walking, you know, like going down. at the mall you have to walk 3 to 4 miles per hour, so if any of you remember Stan Alive from the Bee Gees, I'm NOT going to subject you to my version of staying alive, but that's a hundred beats per minute and that's the rhythm. you should walk for your width, a brisk walk of moderate intensity, so high, you know, so it's not strolling, so this is the minimum you should do and the problem is that everyone has stress 24/7 week how the hell do you get to the gym to do this and a lot of us just don't have the luxury of getting there so the key thing I see is that you have to integrate it into your life and be creative about it.

Park further away, take the stairs and get off at an early stop. walk on breaks. In fact, when I semi-retired I had the option of continuing to pay for a very expensive parking permit that would take me only to an office or I could pay 1/3 of that and park ten blocks away on a big hill, well, I chose because I'm cheap and I also knew that if I didn't have it, if I didn't have it built in, now I guarantee you I have to walk 10 blocks down and 10 blocks back to my car every time I go. at work I just knew that if I didn't do it, maybe I wouldn't take as many steps trying to exercise with friends if that's something that helps you work with a personal trainer if the resources are there, I set a goal when I turned 60 I decided I wanted to go on a really long backpacking trip, so all year long, whenever I felt like a couch potato, I knew I would feel horrible on the trail if I didn't get out and exercise.

And indeed I finished. On this long backpacking trip I became addicted to television, so you know, I discovered that the only way to stay constantly motivated is to plan a long backpacking trip every summer and no, I'm serious, that's what works. if it's walking, you know, a half marathon with your kids or doing the AIDS walk or doing something, if setting a goal helps you do it and getting a pedometer for those of you or a data-driven device is great, They're available. At a pretty affordable price, the recommendation is 10,000 steps a day, and when they put pedometers on people they found that they actually walked an extra mile, the equivalent of 2,000 steps a day, and they actually lost a little bit of weight, so everything what you can do to achieve it. exercise a positive integrated part of your life, the better and it's never too late.

This was a study of almost 8,000 really old older women and they looked at them for 12 years. Without a doubt, those who were really active and stayed active had excellent results, those who were couch potatoes. and didn't get off the couch did the worst, they had a higher level of mortality, but anyone who then got inspired and who hadn't been active but then switched to active mode had the same mortality as people who had been active. their whole lives and unfortunately people who had been quite active but then became less so they had the same mortality as people who had just never exercised so this is use it or lose it but the good message here It's never too late. stay mentally active, so the whole theory used to be that your brain optimizes around the age of 25-27 and it's downhill from there, it doesn't create any more neurons, there are no more bad connections and the data is really different, now we know. that you can create new neurons and it's like anything, you have to exercise it to help that process happen, so learning something new, picking up a new musical instrument that you wish you had studied, you know, when you were younger, playing video games, knowing, stay as part of your bridge group anything that keeps you doing Sudoku doing the crossword puzzle anything that keeps you mentally active and I just want to share with you this was a fabulous woman I met when I was backpacking last summer Lynne is 75 and read this talk and she's been living it, she's been very active her whole life, she actually had breast cancer and was on some medications that she found very difficult to manage for another cancer, but that didn't stop her from going out and doing the things she wanted . her favorite thing is backpacking with her husband and at the age of 68 she took up the cello you know I'm going all the way she's just them she said it I'm not that good I'm sure as hell I started it at nine years, but she now has a group she plays with, so that's when I asked her permission to talk about her.

I was very inspired when I met her and told her that you are truly an example of her. to stay active both physically and mentally and in fact there are brain conditioning programs now, if any of you saw them when you were there, if you watch KQED you know that the pledge drives are often prizes or offered if you sign up in a big industry 225 million dollars in 2007 and, in fact, when they put older people in these programs, put them in front of a computer and ask them to do these brain conditioning programs, they get better memory, they process things better, so I think this is another way of saying it.

Staying mentally active is a really important and good thing, so this is not so intuitive. Reduce inflammation. Let me explain how to do it. Inflammation is the process in our body that helps protect us against foreign invaders, infections and injuries. Sometimes it feels bad when you have a swollen joint, but that is your immune system doing its job, but the dark side is that if there is too much inflammation that is not good for your health and this is now called the secret killer and people now You are realizing that inflammation is chronic low-grade inflammation. It is probably one of the fundamental causes of many of the chronic diseases that concern us; certainly heart disease, probably diabetes, Alzheimer's, so there are thoughts about we don't want, we want inflammation to be healthy inflammation, but we don't want it to be. be too much, so let's talk about some strategies to reduce it, we'll talk about the anti-inflammatory diet that some of you may have heard of and flossing, we just talked about exercise and I'm going to end with some stress management so anti and sorry yeah examples what information okay so this, you get cut, it gets infected and it gets red hot, swollen and painful, that's because all the immune cells come to that place to try to fight infection. and unfortunately it causes redness, swelling, heat and pain, so that's a form of inflammation, but every time that happens to me, I mean, obviously you don't want to have an infected cut, but I find that I appreciate you, you know, That's my immune system. system that is working, that makes the descent answer your question yes on one level, so inflammation yes, influential inflammatory processes develop in healthy and sometimes unhealthy ways in all of us and, of course, In fact, in people who cannot generate an inflammatory response.

They're not doing well at all, so it's kind of important, but not in some circumstances, so I love Michael Pollan. Have any of you read in defense of food? These eight words alone are probably the healthiest recommendations for any kind of nutritional advice, really eat. The food isn't too much, mostly plants, so the real food is something your grandmother would recognize. Something that doesn't come in a package. Something that doesn't have five ingredients you can't pronounce. And probably something sold in the central part of the supermarket. so real food, food that is not completely processed, yes, born in Morley's world, what you are seeing I like, thank you, yes, more leaves, less seeds, so we could, if you want to answer, these are rings, maybe even complex leafy greens and not as many carbs, so I'll talk a little bit more about carbs in a second, so let me tell you what this anti-inflammatory diet is.

Well, pretty much what you're saying is true, so if you want a diet rich in nutrient-rich, plant-based whole foods, you don't want them. having a lot of simple carbs that are like sugar, white flour and we're going to say in a second anyway a little bit more about that, in a second you don't want saturated fat, trans fat, additives and you want a fair amount. of the good, healthy fats, the omega-3 fatty acids, and you really don't want them to be terribly processed, which is why most of you have heard of the glycemic index. Some of you let me explain it to you because actually the glycemic index is very high. a certain unit of a food and then they measure how quickly the sugar and glucose spike in the blood afterwards, that's a measure of blood glucose, a high glycemic index food, so a few other things, like white bread, baked potatoes, pure glucose are high and look at this low. glycemic index yes, plants are most fruits and vegetables, whole grains, not just whole wheat, but also whole grains, brown rice and other very low carbohydrate substances, so why is this important?

Well, when your glucose goes up, you need more insulin and remember what I said about Those Worms They Found, in fact, Cynthia Kenyon just posted literally this week. I was in the library making sure it didn't. Got all the latest data for you tonight. She added two percent glucose to the little worms of hers. Twenty percent shorter lifespan and guess who. I guess who's worth all her work is the one who now follows a complex carbohydrate, mostly plant-based diet. It's Cynthia Kenyon because she has observedthese worms for all these years so you know which one is okay so let's talk because I'm going to We'll talk about the Mediterranean diet in a second so let me tell you white whole grains are so good and the reason why They reduce the glycemic index is because they have all this marking and this coverage so that when the enzymes come to digest them, they come across this coverage that does not allow them to reach the part of the endosperm that is really rich in carbohydrates, so they have a coverage that slows down the way it is distributed in the system, which is why whole grains are still covered by brand have a lower glycemic index than white flour, for example, so what happens when you eat a food with a glycemic index high?

I bet this is not an uncommon experience. Here the reward center lights up in your brain. Oh my goodness, this tasted delicious. eat more, sometimes sometimes you get hungry shortly after because the sugar goes up, you get this kind of buzz and then it goes down and the food industry really knows that David Kessler, who was our former dean, just wrote this great book called The End from overeating. and the food industry adds things like sugar, fat and salt because those are the things that add up that make your reward center light up and literally tonight I found this other study where they gave it to rats after they ate a healthy diet, they gave them junk food. food, do you know how long it took them then they started loving Twinkies and fatty things and within five days they were overeating up to twice as many calories as normally and their reward center shut down, they got so used to the bad diet?

They had to eat more to satisfy the reward center, so they became obese quite quickly. Some of these changes took only five days to occur when they were given the bad diet, and when they were taken off the bad diet, it took weeks before they occurred. back to normal, so our food industry knows that some of us are a little more susceptible to this kind of thing than others, but these are not good actors because they really make our reward centers light up, so one of The diets This has been promoted as a very healthy and healthy alternative, and part of this is also because these are people in Sardinia and Crete who follow a Mediterranean diet and are long-lived.

So what are the aspects of those common characteristics? So, mostly fruits and vegetables, lots of beans. nuts and seeds healthy fats olive oil a little dairy fish and poultry very little red meat a couple of eggs and red wine but if you look at what this pyramid looks like, they are mostly low glycemic index foods and then high in fiber and nutrient-rich foods and let's see what the data is about the Mediterranean diet. It's pretty good. These are observational studies. They just say that we look at people who follow a Mediterranean diet and this is what we see, but 9%. reduction in overall mortality in cardiovascular events in Alzheimer's cancer incidence and mortality a recent study just said a 30% reduction in depression which I don't have time to put on the slide reduction in something called metabolic syndrome which is often the precursor to diabetes and It's really a tasty diet, so I just want to leave the anti-inflammatory diet alone to also recognize that many other cultures have diets that are equally healthy and many aspects of the Asian diet are just as healthy.

There are many aspects of a healthy Hispanic diet, so I'm not saying that the Mediterranean is the only one; It turns out that it's the one we have the most data on and I think it's one where I think the principles of the Mediterranean diet will apply. In other cases, then why am I putting flossing in this lecture? No one likes flossing, which is why it ends up being part of the inflammation picture. Periodontal disease with a lot of chronic inflammation is an independent risk factor for heart problems and stroke, and they believe the connection is because there is ongoing chronic inflammation, people with gum disease are twice as likely to develop diabetes and more than 50 studies and meta-analyses link periodontal disease with an increase in blood markers of inflammation, so flossing is a good thing, one epidemiologist estimated it will add 18 months to your life, so flossing is a good thing.

Well, get enough sleep. We slept about nine hours a night at the beginning of the century, most of us now probably sleep seven, maybe even a little less, and Bill Clinton was a proud sleeper. He only five or six hours a night, but look what that did to him. This is Bill nodding off at a Martin Luther King speech and the subtitle was I Had a Dream. I loved. I loved. So how much sleep do you really need? Well, it's different. For each of us, it's actually the amount you need to feel really rested and alert during the day and if you were given a nice dark room at 3 o'clock, wouldn't you fall asleep on average most of the time?

Time people estimate that most sleep societies estimate that it takes about 8 to 8 and a half. I guess a lot of us in this room don't understand that range, although it's pretty big, 4 to 11 and there was even a study. a special about this English guy during WWII who actually needed like 1 hour of sleep and it was real, but most of the time we think we can figure that out to get our way, but it's probably more genetically determined than we think. what we think. They think, and most sleep specialists feel, that you can't really learn to adapt to sleeping less than your body needs without paying a price, and that price is quite significant.

People who are chronically sleep deprived, this isn't rocket science, don't do as well. at school and at work they have more and more car accidents, they don't do as well on memory tests, interestingly when you have a chronic pain condition and you have chronic insomnia, it's much worse. They've done studies where they've had people in the lab give them a little bit of heat, you know, okay, tell me when it's too bad, okay, and then they deprive them of sleep and they go back and test them with the same stimulus of pain. They have a much lower threshold for feeling pain. pain when they are sleep deprived and unfortunately the pain prevents you from sleeping so it's kind of a bad cycle where aggressive behavior increases at times certainly increases health costs and on either end of the spectrum if sleeps chronically too little or too much.

Sleep is likely to have higher mortality and I think this is one of the most compelling things and it goes back to a lot of what I was talking about with obesity. There seems to be a very strong connection with obesity during sleep, so subjects who are sleep deprived. Guess what happens. Your appetite increases. You know, when you're in college. I can see it with medical students and residents. You know they're eating, they want to go for the ugly food. They are tired after staying up all night. in their test they looked for fat and sugar and they did a study where they had healthy healthy medical students in a sleep lab and they kind of maintained that they didn't wake them up, but they made sure that they didn't go into a deep sleep for three days and they had sugar levels as bad as some prediabetics after just three days of lack of sleep and one of the reasons this may be happening is that melatonin, the hormone produced in the pineal gland that helps regulate our circadian rhythm.

There may actually be melatonin receptors not only in the brain but also in the pancreas, and the pancreas is the organ that produces insulin, so we are very complicated and very programmed, but most people would say that sleeping well at night it will be really good for your health. and there are some strategies that everyone has heard, some of these are probably in the press and if you have the Olympic sleeper and you don't do any of this, I don't care, these are recommendations for people who really have trouble sleeping, for example, you want Get up and go to sleep at the same time.

Actually, the role of light is really interesting. You don't want to try to fall asleep in a very well-lit room because that will inhibit you. the amount of melatonin, on the other hand, if you are one of those very slow people in the morning, you may want to turn on some light so that will help you wake up and reduce your melatonin levels, certainly caffeine and alcohol They are often not considered good. exercise regularly, they say not before bed. I love to exercise before bed, so again, I generally don't have problems sleeping, so I don't need to follow them that closely.

This is interesting. You don't want to have all the things you want. you're used to liking television, playing the radio, you know, you're a PDA, your cell phone, guess what the average number of devices in a teenager's room is, electronic devices, eight televisions, you know, cell phone, computer oh my gosh so turn them all off and finally trying to do some of this letting go thing and letting go of some of that day talk and then just going to bed when you're sleepy if you're lying in bed and you're wide awake and You say oh my God, what did I not put on my shopping list?

And tomorrow I'll be too tired to go to work. Get up, leave your room, do something until you feel sleepy, and come back. They really want you to associate sleeping in your bed with just being intimate with a partner if that's appropriate or going to sleep well, sorry, oh, I grouped you together. Would you mind if someone was actually paying attention? You're not sleep deprived or at least if you are, you've had some caffeine, that's great. Sorry, there were originally six and I actually added them and didn't change them, so thanks. I'm going to make that five great strategies, so these are some resources, great resources if you're interested in sleep, so let's get there. okay, stress management and I know you've had some fabulous talks over the last few weeks about this.

I'll go over this a little quicker. I love it. It was a very wise patient of mine who said, "You know, I noticed." I can't eliminate stress in my life but what I can do is control how I respond to it so I just want to say that stress is really how you define it and one person's stress is another person's hobby so I guess three of these would put me in a fight or flight reaction and three of them make me happy, but these are all things that could be hobbies or things you wouldn't want to do, so I wouldn't be sitting on this beam, it's not an opportunity.

Get me a skydive, you would have to give me general anesthesia, put me in a tight place, dark place like a cave. Oh no, but I love spiders. I like to talk. In reality, giving a public speech is the main way they create stress in the lab. for most people and I really enjoy doing it and then they also force people to do math problems when they want to stress them out. I'm a bit of a geek and I like to do that, so for me these other three are fine, these three are not and I guess each of you will have a different description of what stresses you out and what doesn't, so you've already had two lectures on this, but again we evolved to be able to respond quickly and effectively to acute situations. stress and if we didn't we wouldn't be here so again the zebra runs away from the tiger or the lion she wants to be able to generate energy now her blood pressure goes up her heart goes up she turns off everything that is not essential including growth reproduction digestion and that's great and guess what ten minutes after the lions left, the zebra is sitting there, relaxing, chewing on the Savannah grass, that's not you and me and the reason I love it.

Robert Sapolsky actually wrote a book why zebras don't understand ulcers is that we activate we have a brain that allows us to keep thinking we are constantly under stress we feel like the tiger or the lion is with us most of the time so we can't buffer this and instead we followed this fight or flight system kicked in for months worrying a little about mortgage relationships and promotions. I'm going to understand that, so what constitutes stress in most people? And I guess this suits you and dr. Moskowitz talked a little bit about this at the last conference, it was 800 industry workers in Finland and they started, they looked at them from the baseline and they didn't have heart disease and they followed them for 25 years and those who had the following things that were perceived as stressful for them they were twice as likely to die from heart disease within 25 years so the things that generally make people go crazy is that I have no control over this situation it's too big it's too much I'm overwhelmed there is also , I can't finish everything they ask me to doand I receive no reward.

No one sees the amount of effort and all the overwork I'm putting in and then I also feel challenged and threatened, and that's it. then if you add social isolation, you get a cocktail that is pretty deadly in terms of how we respond, how we perceive, and how that could lead to a chronic situation. I'm just going to leave out the relaxation response, for me it's the opposite. of this fight or flight calms the body, everything is great, so I want to talk about how you can do this in your life and there are really many paths to this and it really isn't like that, it can be individually something very different for me is walking through a trail in the woods or, you know, on the ridge in Marin County, an important common denominator is slow diaphragmatic breathing, where you just breathe, slow down, and imagine the air going first into your stomach and then into your chest and then out of where and there are many other things.

I'm going to talk a little bit about meditation, but you can imagine a whole range for some, it's music for some, it's prayer, for others it's exercise, so each of us has There are many paths to mobilize this relaxation response and guess what? What, when you do it, the stress genes are deactivated. I mean the gene, the unhealthy genes that were similar to those studied in prostate cancer are turned off. These were 19 guys who actually had experience in some. way to trigger the relaxation response and they had a decrease in gene activity again associated with inflammation, not good programmed cell death and how the body handles these reactive oxygen species, so it's a good thing and most of We intuitively know that meditation is a kind of slowing down.

That's a good path for some people, but now we have neuroimaging that really shows us that yes, that's true. The brain regions that are associated with the ability to pay attention to something, stay focused, and process things are bigger, literally bigger, in experienced people. meditators grow because they are being stimulated and get this, the reward and motivation centers are activated when someone starts meditating, maybe you don't need that junk food diet, maybe you need to learn about a meditative practice and finally, expert meditators They have I've been doing this for years when they put them in the scanner and give them like a loud noise or something else, they don't react as much in their brain scans, so I think meditation is a good path for a lot of people, but not you.

I don't necessarily need to go to a cave in India for 20 years. I just wanted to give you some examples of some things you can buy online that will give you a little bit of fun feedback. These are the stress points you put on them. on your fingers or on your wrist and what it does is it checks the temperature and have you ever noticed that when you're really relaxed your hands get hotter or colder hotter guess what this is you know you just did the relaxation response there's more blood flow to your hands so you can compare the color of the points based on whether or not you have a nice warm hand.

If you're a little more quantitative, you can buy this temperature trainer online and literally with a piece of whiskey. Tape it up and you can see the temperature of your hands and anything you do that helps increase this temperature will give you practice in eliciting this relaxation response. In fact, I'm going to say yes to frozen toes, oh, that's cool, you mean like? when you're really freezing when you have cold feet that's another problem certainly relaxation makes my feet a little warmer but I'm like those of us who haven't been blessed with warm feet this may not extend to the toes of the feet, but being relaxed is.

It's going to be a good thing, it doesn't matter if it makes your toes disappear, it's okay, so I just want to say that reflecting as part of this, besides being simple, this was an incredibly simple experiment, the subjects were just asked to be given a piece of paper and a pencil and said to write for four days in a row for just 20 minutes about a disturbing experience trying to really think about what happened and figure out why it went well or why it didn't go well and what What happened was just taking that time to reflect that they reported less stress, the asthma patients actually physically breathed better, the rheumatoid arthritis patients felt less pain, it's amazing and I think this further justifies the fact that we didn't take the time to simply be calm, we are inundated with everything. this information with the TV there is not a moment except if I am in the High Sierra when I am not accessible through some electronic device and you know that is not necessarily so good, obviously, the serenity prayer accepting things, God, grant me the serenity to accept The things I can't change. the courage to change the things I can and the wisdom to know the difference, this is the work of a life, so I just want to finish this about stress management and say that there are many advantages to thinking about finding the individual path that goes towards the future. to help trigger your relaxation response I must admit that some of these are taught very easily and it is not so easy to sit down and try to meditate every day at the time I have been doing it for years and every time for about the first time . ten minutes the shopping list is there, you know, oh, my butt hurts, I'm going to get it, I'm not going to sit here, you know all that, so if that's part of the human condition, then it's not all easy to do, but many of These things are inexpensive, safe, easy, and will easily complement the other things you are doing for your health.

Well, actually, I'm going to go over this super quick because you got a fabulous lecture from Dr. Moskowitz on positive emotions, so, but this is how I look, I have to say this, look at this guy, I love him, he seems like a nasty soul. and this comes back to the fact that I had a couple of classmates in medical school who weren't nice. I don't like being around them. I can't imagine being a patient of one and now finding out that they are being given justice, maybe it's okay, so they've studied long term and it was Harvard, sorry, they studied some medicine. students and they measured them at the beginning of medical school and found that there are some who are kind of hostile and some who are pretty relaxed, so these students ten years later they were followed up if they had high hostility scores, guess what they had? more cardiovascular disease and these were some of you, maybe you've heard type A behavior, well, Meyer Friedman was here at UCSF and he actually tried to take a group of type A driven executives and tried to change them by randomizing. them to this, you know, stress management and a lot of other things, and in the usual care group, more than a quarter of them had a problem with their heart, all of them had had heart problems before the ones who had just received group counseling were fine.

You know you shouldn't feel like stress didn't work much better, but look at the kind of group that had the actual intervention to try to relax some of this hostility and control their anger that had much less recurrence, so I think it's effective, Dr. Moskowitz talked a lot about positive psychology, this is something interesting to me, like if you know there are people in your family or in your lives who are constitutionally happy, you know the glass overflows all the time and you just say, I want some of that. my family the glass had no water at all, so when I looked at this and discovered that my happiness point set, at least by Sonja Lyubomirsky, who is a great researcher, is programmed at 50%.

I have a lot of work ahead of me. I do, but 10% seems to be the environment and 40% this same 40% over which I have some control, so I can say that I am lucky to have been surrounded by incredibly positive people for whom the glass is not unrealistically overwhelmed and after years of just being around them, I am realizing that there is another way to see life and it is not the power of money, the prestige property, if you are above the poverty line, if you are above more than the poverty line, adding more money in studies has not done it.

It has been shown to increase your happiness. Usually what increases your happiness is everything else. I will give you the rest of the recommendations in a second. If you haven't known that there are two incredible centers in the Bay Area that are studying this whole field and the UC Berkeley Great Good Science Center, I think I referenced that, it's a fabulous group and, when Decker Keltner wrote this tremendously interesting book called Born to Be Good, it's doing a wonderful, wonderful job on how to increase positive affect and the way people go through the world I'm going to go through this very quickly okay stay tuned okay this is it one of the most powerful predictors of good health, so meaningful relationships, whether it's a platonic romantic family, are the most consistent predictor of quality of life, so when you think about it, you know, God forbid, in your bed of death, are you going to say that you know that it was those hundred thousand more dollars that I let you know two years ago that gave meaning to my life?

No, they will probably be the people that you love most deeply in your life and it's huge, so not only is there a positive protective effect when you have those relationships, but unfortunately, if you are isolated and alone, there are some health problems associated with this. , so you have three years of experience. They die seven times more if you're constantly alone and depressed and isolated, and that's even after controlling for it, because you know what your cholesterol is, if you smoke, if you exercise or not, so it's very, very powerful and this is very sad for me.

Honestly, I still don't. I don't believe this data: one in four Americans who were surveyed in 2004 didn't talk to anyone about anything of importance in the previous six months, that's just impressive to me and we have other data from medical students who report that they are a little more isolated. or feel lonely have lower immunity get colds more and social isolation is a risk for recurrence and progression in a seventeen-year study of people with breast cancer, so social connection or lack thereof is very powerful for your health and it may not require much They did a study in Alameda County where they followed people for years and social connection was protective against mortality and social connection was as small as going bowling once a month with your league.

I mean, that's not like you know that great social contact belongs in a book. go to the club, you know, I go to a weekly aquarobics class and I realized that I miss when the women that normally come aren't there and they actually know that I'm not there when I'm not there and it's just kind of It's like a kind of extra connection and even having the person at Starbucks recognize me by name in a study made a difference in someone's happiness. The woman at the gym I go to finally found out who I am because I come in at the same time every day and now she says hey Ellen, well, you know, I just said hi to Veronica, you know, now she's going to make my day, I'll do her yours, you know?

And every time I leave now she says goodbye, Ellen and me. I feel like wow, I think I'll come here more often, so these last two are really important, so Indy and I grouped them together, but they're not, they're different. Engage in activities that have meaning for you and connect you. with something beyond you, many of you are aware that Victor Frankel wrote Frankel wrote this incredible book called Man's Search for Meaning, which was a lot about survival during the Holocaust period and I love his quote, life has a meaning until the last breath. possibility of realizing that values ​​exist until the last moment and people who have a sense of why to live can endure almost any how, so there are two sides to this, so you can choose to fill your life with things that are not so important or you can choose to fill it with activities that have meaning, so that's one part of it, but you can also add meaning to all the other things that you do that you may not find very inspiring, and we are also an incredibly generous American Society.

Giving and volunteering more than almost any other society in the world and a recent study by one of my former medical students. He looked. You know he studied veterinarians. You don't think of vets as great volunteers, but some of them did and those. that lived longer and supported greater life satisfaction and people are actually happier when they give. They've done experiments where they give people $15 or $20 and tell them to spend it on themselves or give it as gifts and then see how happy they are. two days later and the people who gave it are much happier, so I think they know that when we think about other people and reach out, it's a verypositive for our health and finally connecting with what is bigger than yourselves for many of you in this audience it can be a spiritual presence God or whatever, but it doesn't have to be, it can be nature, it can be a cause, It can be anything that feels bigger than yours, you know your specific life and when people make that sense. of connection, they often enjoy greater health and happiness and one of them.

I just wanted to review the literature on spirituality. Most of the time they measure this by church attendance or mosque attendance or whatever, but clearly people who go to church regularly. or have some regular spiritual practice or be healthier. More than 50 peer-reviewed studies show that regular religious attendance is associated with better health. Yes, I'll let you read the rest. Okay, so this is the end. I just want you to realize that. We've been through a lot, simpler lifestyle things. I hope some of the other things we've talked about make you think a little about the changes you'd like to make in your life. to improve your sense of well-being and maybe even that you're going to live longer and better, so I wanted to say just to recap, we talked a lot at the beginning about the new science of aging and I hope that wasn't the case.

You also know it's complicated, but I'm really excited because I think you're going to hear more about how this basic science supports these other 10 recommendations. We talked about how diet, you know, lifestyle really impacts health and the best news of all for me. is that if you make these changes you will see effects on your health much faster than we ever thought and I don't want you to forget the powerful role of connection with the people you love, positive outlook and meaning. on your well-being, so I really hope you take five seconds to sit down and quietly think about what change you'd like to make this week based on some of the things we've talked about.

Just take five seconds. and sometimes telling a loved one what you've decided to do helps make that happen, so maybe you can share it with whoever you want later this week and finally I hope you better appreciate that there are some real benefits now. I'm serious, you know that old Stradivarius violins get better with age, just like cheese and wine. The redwoods are a lot you know they're wonderful and you still know I'm almost 65 so I'm getting my senior discount soon so I just want to say how grateful I am that they've been a great audience.

I will be happy to answer any questions. Ask. Yes, back, yes, ooh, very good question. The longer you know, the longer we live physically, you know? what's going to happen to the incidence of dementia and that's why staying mentally acts so all the things that I recommended in terms of lifestyle for the heart and for diabetes are good for the brain, but you're absolutely right, The National Institutes of Health has a whole Institute on Aging and they are really interested, not just from an economic point of view, that we are going to need a lot of additional nursing care if people develop dementia and start to live between ninety and one hundred years, that's why I'm so excited about the conference.

I think there are ways you can prevent it, slow it down, or reduce your chances of getting it if you follow even some of the advice here, but that's something to think about in terms. said: stay mentally active, but all the other lifestyle things, exercise, healthy diet, all of that will also affect your ability to stay as cognitively clear as possible, but great question, yeah, okay, guess what kind of grain they eat? , I bet, so I'm sure your question was what. In populations or societies where they eat only this whole grain and do not get fat, first of all, they run in the savanna, so most of them are much more physically active, but probably what happens with whole grain is that it is not that moment of high glycemic index, you know, the load of sugar in the system is not refined, it's the whole food has a lot to do with it, yeah, in the pink, uh-huh, no, I'm, so they're both choosing in the back and then.

We'll do it for you, yes, when you put things in the blender, that reduces its fiber. Oh, great question, so what kind of things are you thinking about throwing in the blender? Yes, yes, probably momentarily, but that will also happen in your digestive system. with the digestive acids, but that just means I don't think it's going to break it down so much that, especially if you drink it or whatever right after, it's going to be a problem because if you have like the whole apple that you'll have all that fiber even if you juice it. , if you eat the juice and the pulp and everything else, you get the whole apple, you just get it in liquid form and that should be fine, okay?

I had a question there are 10,000 varieties in her ball are they healthy oh you just you just and yeah so she's right she said you have you're looking for yeah there's nothing oh great okay so you said all week so let me, yes, first of all. Have you read about how Cocoa Puffs are now heart healthy? Sorry I have nothing to do with Cocoa Puffs but there should be better labeling but if you see whole wheat it's not the same as whole wheat so actually in a product you would want to see the seeds you actually want to see something where it comes from, but you have to say whole grains would be a place to start, but I agree with you, it's like they're all brown, oh look, and some of that is just added molasses.

You know that it is not necessarily the fiber and you will know it because if you really eat a whole food that is very rich in fiber your system will tell you in a positive way you will know that your digestion and your elimination have improved it is difficult it is very difficult to read food labels yes , yeah, yeah, okay, those of us who train for backpacking trips or follow you, you know all the rest yeah, hey, yeah, you came, yeah, okay, so she was saying those people, and I imagine you're Speaking for yourself, we follow a lot of these healthy lifestyle things and go backpacking with our little ones.

Yes, yes, and you can finish, so it depends on how you perceive this. I imagine two people training for an Ironman marathon, you know, an Ironman competition, and one of them is really stressed and the other sees it as a joyful possibility, so what is it really? What matters is not so much the behavior, although you can certainly exercise compulsively and that is not good, you will literally tear your muscles or hurt yourself, but rather your inner landscape and can you approach it in this very elegant Aikido way and say what? marvelous? opportunity versus oh my gosh.

You know, I couldn't run today because of the rain. That makes sense? So I think if you can dampen that kind of driving a little bit, a little trip is great, you know, if medical students If you were to do a personality inventory of most medical students and law students and so on, we're very goal oriented, you know you have to be to get to this stage, the problem is can you turn the volume down enough that it's not unhealthy for you, so I like to let you know that there are times when I need to turn up the volume. volume if I have a bad deadline, but if I can't get it down again, that's when I become you all know the things that are It's not good for my health, so I know it's late.

Doesn't anyone know you have a this? It's awful. Does anyone have a PDA or something? You can check the result of the World Series. I made the Phillies. I mean, I'm fine anyway, thanks. For your attention I will be happy to answer your questions