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Dr. Michael Roizen is an extraordinarily well-read, well-researched, and experienced physician in the field of longevity medicine. He dates his first interest in the field back to 1979 as head of an intensive care unit, when he recognized that patients who were biologically younger dramatically reduced their risk for post-operative disease and death. Since then, he has worked tirelessly in many ways to help individuals get physically and mentally younger, improving the lives of patients and documenting millions of dollars of savings per year in employee healthcare costs at Cleveland Clinic. In our conversation he shares his lifestyle-forward approach, one that sits well alongside the Younger You program. Tune in to find out the importance of “posse, purpose, play, and locus of control,” how you can be your own genetic engineer, his take on emerging anti-aging interventions, and much more. As Dr. Roizen reminds us, it’s never too late to start: “until you’re six feet under, it ain’t too late to do this.” -DrKF
How to Be Your Own Genetic Engineer, Save Money and Live Longer, with Dr. Michael Roizen
For over four decades, Dr. Roizen has been bringing longevity medicine principles to improve patient care and outcomes wherever he has worked. Impressively, his approach has been implemented broadly within the Cleveland Clinic internal organization where it has demonstrated an increased average healthspan of 15 percent (equivalent to around 12 years), reduced healthcare costs for employees, AND saved a massive $190 million per year on employee healthcare costs for the company, without changing the benefit design. Those principles are now honed into a structured framework that anyone can access, including a full 180 actions that you can take to slow the aging of your body and brain.
In this episode of New Frontiers, learn about:
- The economics of addressing aging – savings for individuals, companies, and even solving the issues of Medicare trust funds and social security funds running low over the next decade
- The major factors we know slow aging
- Why stress is the greatest ager, and how managing stress is one of the most important things you can learn to stay younger
- Having three major life events in any one year increases your risk of dying and disability in that year to the equivalent of being 32 years older
- Posse, purpose, play, and locus of control – the best ways to manage stress
- Nutrition – food choices and timing – is the second most influential aging factor, followed by physical activity, avoiding harmful activities (such as vaping, smoking) and taking safety precautions (wearing a seatbelt, helmet, etc.), sleep, and supplements/small molecules
- Roizen’s Real Age predictor for death and cardiovascular disease risk
- Roizen’s distillation of the state of emerging anti-aging interventions, including:
- Bumex (Bumetanide) – a $4/month older diuretic pill that antagonizes APOE e4 gene expression and is being studied for Alzheimer’s disease prevention
- Metformin – ongoing research is needed to answer the question of risk vs benefit and the potential “wearing out” of its effects
- Rapamycin – ongoing research needed to determine appropriate dosing
- Pluripotent stem cells – still cost prohibitive but also promising in human trials
- Yamanaka factors – still in animal studies and will likely face challenges in translating to humans. Researchers continue to work on countering cancer concerns
- CRISPR – promising results reducing the risk from genes such as those associated with Alzheimer’s disease. Will likely remain very targeted to specific organs/diseases, and fairly expensive
- What you can do to reduce your rate of aging, even before any one of these emerging areas of research is ready for prime time
Dr. Kara Fitzgerald Hi everybody, welcome to New Frontiers in Functional Medicine where we are interviewing the best minds in functional medicine and beyond. And of course, today is no exception. Before I introduce my next amazing guest I just want to give a shout out to our sponsors, Biotics Research and Rupa, two wonderful, wonderful companies in the functional medicine space who are keeping our podcast going strong. Much gratitude to Biotics and Rupa.
So today on our podcast, I am so happy to be joined by Dr. Michael Roizen. He is the Emeritus Chief of Wellness Officer at Cleveland Clinic. He’s professor at Cleveland Clinic Lerner College of Medicine at Case Western Reserve. He’s the author of four number one New York Times bestsellers and he’s written more than 190 peer-reviewed scientific articles. He’s been recognized with many awards, including the Paul G. Rodgers Award from the National Library of Medicine for Best Medical Communicator. He lives in my hometown, Cleveland, Ohio. Dr. Roizen, welcome to New Frontiers.
Dr. Michael Roizen: So when did you leave Cleveland?
Dr. Kara Fitzgerald Well my family is still there, so I’m back quite a bit, but I am in Connecticut now.
Dr. Michael Roizen: You better come. Where in Connecticut? You got to come and visit.
Dr. Kara Fitzgerald Oh, I do all the time. Yeah, I will absolutely, absolutely, come and visit you. My family all goes to the Cleveland Clinic Center for Functional Medicine. It’s a pretty amazing place. You guys are cutting the edge.
Dr. Michael Roizen: Right. I did help and I did actually recruit Mark Hyman here, whatever it was, a number of years ago to replace me. But he decided not to go into the full wellness sphere and stay in functional medicine. And so that didn’t pan out. But he has left a tremendous mark here.
Dr. Kara Fitzgerald Yeah, yeah. Medicine has changed in Cleveland. It’s really extraordinary, not that we want to digress here too much, but having most of my family there, the quality of care that they’re getting from Cleveland Clinic, even outside of the functional medicine center, seems to be a little bit more expanded than other places. Would you say that’s true?
Dr. Michael Roizen: The amazing thing, the reason I’m dressed like this and have a free thing is I had a procedure here. My rotator cuff was repaired 12 days ago now. And I can tell you, I came here in 2004 as Chair of Anesthesia Critical Care, Pain Management and Executive Health, and we started a pain service, an acute pain service. I really benefited from that because they put in a regional anesthetic pump on my brachial plexus that left me pain free for six days after rotator cuff surgery.
So people always say, “You’re not going to be able to sleep. It’s going to be horrible. You’re going to go on pain pills, et cetera, for…” I haven’t taken anything more than that plus baby aspirin, the usual doses, morning and night for the last 12 days. Slept like a baby, so to speak. And other than looking weird and looking like I belong on Saturday Night Live as a skit, everything’s been great. And I’ve got to say thank you to the pain service as well as a wonderful surgeon.
So they put in these little plugs, they’re fiber screws. And they’re strong enough, they have 13 of them in, he said each one of them, he could pick me up by any one of them. That’s how solid the repairs are now.
Dr. Kara Fitzgerald That’s extraordinary. Well geez, I’m really glad that you’re here with me after that intense procedure and that you’re doing so well. Anyway, I do feel like my family’s in good hands out there.
So you’re talking about longevity these days. Your new book is out now. I think it was released last month, Great Age Reboot. And you cover a lot… Thank you, good. I have the PDF so I can’t hold up the hard copy, so thanks for doing that. I mean well, A, you’ve come into a space of many longevity books. In fact, I just showed you mine back there, Younger You, based on our research. Mark Hyman of course is releasing one soon and Tony Robbins did recently with Peter Diamandis. And here you are, jumping into this space. I mean, I think that you’re…
Dr. Michael Roizen: I’m not jumping into it, I started this space in 1997 with RealAge.
Dr. Kara Fitzgerald Yeah, that’s right. And you know what? I was going to back up and say that, but you’re right. Wrong choice of words. So talk to me about, you’re coming back into this, or maybe you’ve been in this all… Just tell me about why you decided to release this book.
Dr. Michael Roizen: No, believe it or not this started in 1979 when I was asked to chair Anesthesia Critical Care for Cardiovascular Anesthesia at UCSF. I wanted all my life to run an ICU, so I trained in both anesthesia and internal medicine because there weren’t ICU training programs in that era. And what we found when I started to… I was running an ICU in 1979 and they asked me to co-chair Cardiovascular Anesthesia, not because I was so great but because the surgeons were difficult. But all they cared about was outcome of their patients, how fast they return to function, how few disabilities and derangements. And when we looked at the data, we had the data from all of California from 1970 on, it turned out that the leading cause of disability wasn’t heart function or brain function or liver or kidney function, but it was their age.
And so I said, “How do we make patients 20 years younger in the perioperative period?” 20 years, every 10 years was a threefold increase in disability and death risk. So a 75 year old undergoing aortic valve had a ninefold increase in risk compared to a 55 year old. So if I could make a 75 year old 55 I could radically change the risk. And in learning how to do that, and we did, we had to get a metric to motivate patients and that was RealAge. So your RealAge can be… We said 60 would be the new 40. It’s come to pass. We now think 90 will be the new 40.
Dr. Kara Fitzgerald Well let me just, and I want you to talk about that, 90 will be the new 40. I’m putting a pin in this, we will absolutely circle back. But you can’t leave us with the provocative comment that you did make 75 55 back in the seventies without mentioning what you did. And that was the-
Dr. Michael Roizen: Well In the eighties, in the eighties.
Dr. Kara Fitzgerald Okay. And that was the foundation of the RealAge tool.
Dr. Michael Roizen: Right. And RealAge still exists. It’s a free website on Sharecare. It still is the most accurate predictor, more accurate than any biomarker, even than methylation markers, at death risk and cardiovascular disease risk, based on the data that accumulated on the first 19 million people, UC San Diego, that took the test. UC San Diego looked at the death risk index, Social Security Death Index independent of us. And it was a more accurate predictor than any biomarker at that time.
Now it hasn’t been updated, meaning the program’s been updated but the studies haven’t been updated since about 2010. But in any case, it was more accurate than any other predictor of both cardiac and overall mortality risk. Based on their study the receiver operant curves, as you know, were better than any other. And it’s still a free test, but we did it based on… There were about 51 major and 157 things that people could do to change their rate of aging. This was really slowing aging.
Where we’re going now is that you’re going to be able to reverse aging, we think. A lot of that is based on your and other people’s work on that. And obviously there are 14 areas of research into the mechanism of aging that have all made… At least two animal models reverted back either individual organs or total body to a younger self. So it’s not just slowing aging, it’s reverting it back now. But in any case, there were 50… Some major ones, about 51. Those included things like managing your blood pressure. We knew 115/76 is the ideal for aging. It’s been the ideal since the early 1940s when that was radically studied. We know about, if you will, a lower blood sugar level. We’ve known about getting your apolipoprotein B or your LDL cholesterol to a level below 70. And that’s just three of the… And I don’t want to go through all of them, but we’ve known there are four components of physical activity that make a difference to how long and well you age.
We know that stress is the major one and that, posse, purpose, play and locus of control are the major things determining whether stress ages you or not, or whether stressful events, we’ll all have them, age you or not. We know about food choices, portion size and timing of eating. We know about avoiding unforced errors such as smoking and vaping and not wearing a helmet when you go skiing, et cetera. We know about sleep and the 33 things that change your rate of brain aging, and we know about supplements and small molecules.
So those are the six major things. And when you look at them, just like brain aging is 33, there turned out to be… There’re about in that era, if you look at all the small ones such as the individual vitamins by themselves, there’re about 151 things that change the rate of brain aging in men, 157 in women. And so you can motivate people to do that. We’ve done that at the Cleveland Clinic, as you probably know. We do that with our employee health and save compared to our competitors and compared to our own trend line, 38% or $190 million a year without changing the benefit design of our employee health plan. So this can be done with humans as well, and we’ve shown that you can do it.
Dr. Kara Fitzgerald So circling back to your original cohort back when you were in ICU and in California, so basically you reverted these 75 year olds, or you were able to look at the data and see people who were 75 who had the numbers of 55 survived much better. Their outcome was much improved. And then this was the impetus for creating the RealAge or the-
Dr. Michael Roizen: Exactly. It started with patients undergoing cardiovascular surgery and how do we lower their risk?
Dr. Kara Fitzgerald Let me just ask you before, and folks, I’ll put this in the show notes, the website for RealAge. People are going to want to revisit it. I think it’s time we revisit it.
Dr. Michael Roizen: So it is revisited, and on January 3rd the updated program I think will be launched.
Dr. Kara Fitzgerald Awesome.
Dr. Michael Roizen: So we update it periodically. It is free on the Sharecare.com app. Sharecare.com app has RealAge embedded in it. It used to be you could go to realage.com but I think you now have to go to… Sharecare.com owns it.
Dr. Kara Fitzgerald Okay, so we’ll chase it down, we’ll find it. And yeah, a lot of our listeners are going to want to check it out and certainly refer their patients to it. Well bravo you for doing that work.
Dr. Michael Roizen: So that was probably done before you were even born.
Dr. Kara Fitzgerald No, I was a little one, in Cleveland. So you’ve just basically covered the contents of our conversation today in your opening remarks. But yeah, we’re moving into this era of reversal. Your book is kind of an extraordinary survey of where you’ve been and also where we’re going. And I want to talk about some of the strong predictions you’ve made. You said earlier, “90 is the new 40,” and you-
Dr. Michael Roizen: With 80% probability. I don’t want to say it’s a sure thing.
So we had enough data on 60 could be the new 40 that we were literally 100% confident that that could happen. We now have animal models, 14 different areas of research from epigenetic reprogramming to induced tissue regeneration to, if you will… Everything from hormetic hyperbaric oxygen to therapeutic plasma exchange. 14 different areas looking at protein and senolytic rejuvenation, that we’ve said there’s at least an 80% probability with 14 shots on goal. But unlike 60 could be the new 40, these are just beginning to move into human trials now.
So we don’t have quite enough data to say that that you’ll be able to, when you’re 90, revert yourself back to 40. Sometime, maybe by 2050, you’ll go in a car wash as a 90 year old and come out as a 40 year old. But for now it looks like it’s going to be organ to organ, which is why the last third of the book is all those 180… There’re now over 180 choices you can make that slow your rate of aging, that avoid what we call, if you will, tissue damage so severe that you can’t revert from it, so that you will be able to benefit.
Let me give you an example if you will. So we know that about 30% of heart failure is caused by a gene abnormality, largely acquired, that produces an abnormal amyloid that goes to the heart and causes amyloid induced heart failure. Very different from amyloid induced brain, this is amyloid induced heart failure. Well by knocking out that gene in 12 people in Australia, seven of them went from an ejection fraction, from the ability to squeeze blood out of the heart of about under 12% to over 35%, from a life expectancy of under six months to an 18 year life expectancy.
Then you say, “Why didn’t it work in the other five people?” ‘Cause they had such structural damage it essentially became connective tissue, parts of their heart. They couldn’t revert those. So it’s really important, and that’s why the last third of the book is on those 180 changes. The middle third is on the economic and policy changes for both the individual and for society that the economist and the demographer who were the co-authors of the book thought important for us as individuals to make and to consider for society, housing, et cetera. And the first third of the book is on these 14 areas and the whiz-bang science, so that the lay audience gets excited about it.
Dr. Kara Fitzgerald Yeah, that was CRISPR. Wasn’t that the first human trial using CRISPR?
Dr. Michael Roizen: Well it’s not the first human trial using CRISPR. The first one was actually done with type one diabetes in Boston, the second one on sickle cell disease, as far as I know. But it’s the first one that I saw in the elderly, meaning the others had been used in younger people to see if they could knock out, for example, the gene that causes, if you will, sickle cell disease or to knock out the sickle cell hemoglobin producing protein. Or the one that, if you will, they could give… do a reversion. So your pancreas started producing insulin again.
So there have been other trials, there’s now one on PCSK9, knocking that out so you metabolize LDL normally. But I think there are now someplace over 30 gene trials this year going on in the United States for individual genes. But that’s just one of the 14 areas, that is gene editing. But they all focus on one thing. They knock out a protein that is causing disease, or they knock out… They either clear a protein or they knock out something producing it, or like the studies at Gladstone they impede the functioning of an abnormal protein.
Dr. Kara Fitzgerald You know, I don’t want to go down this path too-too far, even though that’s really, really interesting. What do we know about follow up on those heart patients? Are they-
Dr. Michael Roizen: All we know is, that was a New England Journal article published and we know the… I think it was the 12 month, it may have been the 15 month result. I haven’t seen a follow up on those. That appeared… I think it appeared in July of 2022. So even if you consider it three months out of date on publication, ’cause they did update it before publication, we’re only probably at 18 or 24 months on the majority of those people.
Dr. Kara Fitzgerald Yeah. Well that’ll be interesting to watch.
Dr. Michael Roizen: I don’t know the follow up on it.
Dr. Kara Fitzgerald So let’s go back to 60 being the new 40 as 100% probable, and how we achieve that. So let’s talk about what the average listener, or there’s a lot of physicians in our audience, what they can prescribe confidently to their patients now. Like, what can we do today to be 40 at 60?
Dr. Michael Roizen: Yeah, the most important thing to understand is you are a genetic engineer. You self-engineer, whether the epigenes are on or off, in at least 80% of the genes. It may be the latest study is 93% you control of your genes being on or off through your epigenes. But in any case, let me give you the example.
So when you stress a muscle you turn on a gene in that muscle that produces the small protein irisin. Irisin goes through the blood-brain barrier, it’s small enough, and turns on the brain-derived neurotrophic growth factor gene which increases hippocampal size. So one of the keys is doing those four areas in physical activity that have been shown repeatedly to change the rate of aging. And each of them has different genes that turn on. So we know that doing all four components changes at least 50 genes.
But that’s not most important, most important thing you do is learn to manage stress. Most important way is having a posse. So one of the things you can do, when you’re young, when you’re as young as you are, you’ve got friends from school, et cetera, games. So you can call those friends or see them routinely. But having a posse with six people you’re vulnerable to, long ago is the Whitehall studies out of Great Britain in ’50 and ’60, was found to be the most… Posse, purpose and locus of control were found to be the most important thing in what were the public employees of the Whitehall in Great Britain. It turns out that got confirmed with the Beckman studies in the United States, in Alameda County in the 1960s. And it’s recently, I don’t know why they did it again, but recently been confirmed several other groups. So posse, purpose, locus of control. What can you do about that?
So I call eight friends every Saturday and Sunday, that’s when I have enough time to talk. I walk while I talk to them. I’m on a treadmill desk now, but as opposed to getting 10,000 steps from my scientific nerdishness of reading articles, I on the weekends call friends and talk to them and walk while I’m doing it. So I’m getting two benefits, if you will. But keeping your posse actually requires work and is a great way of staying young. Then it is having a purpose, you’re helping me with that obviously ’cause my purpose is to help others know how much control they have in their rate of aging.
The third is locus of control. So in those studies, the British bus drivers didn’t have much control. They had to run the same route and they had to do it with the same degree. But a couple of those guys, the bus drivers were mainly men in that era, changed their cab. They changed the decorations so they had more locus of control. So they looked at that as they controlled their environment and they lived much better. Same confirmed with the Berkman studies. And Oprah asked me, “What’s the worst job to have?” It’s a chicken part plucker, right? ‘Cause you’ve got to do so many chicken parts at Purdue every hour and you’re using a dangerous instrument. So in addition to having no locus of control, no ability to change your environment, you have a dangerous instrument with you. So that’s about the worst job you can have.
But in any case, locus of control, posse and purpose, and then play. You want to have something you play and whether… You may not like walking, but you may like playing with grandkids or you may like gardening. So it’s step-for-step equivalents that gets you there. So there literally are 180 choices, none as much as posse, purpose, play, if you will, and locus of control. So yeah, you can do meditation or guided imagery or progressive muscle, or actually any of the 12 things that we know help you with managing stress. But most important: posse, purpose, play and locus of control.
Dr. Kara Fitzgerald Of course those are all key players in managing stress. It’s interesting, I was telling you a little bit about our research, and we used a biological age clock. We looked at DNA methylation patterns, and a full 25% of that clock is our glucocorticoid response elements. So they respond to stress, which for me was a piece of what convinced me that of the hierarchy of interventions that we can shift, stress has got to really be up there at number one. I have a strong… I’m a nutritionist in a lot of my training and I put a lot of focus on that, but I’m really wondering about the stress experience. Toxic stress, is it greater than nutrition? Yeah.
Dr. Michael Roizen: Yeah it is. If you look at the data, both the association and epidemiologic, and the little bit we have in randomized controlled trials on this, major life events, there’s 16 of them, you’re sued, you get married, you’re forced to move, a parent gets sick, et cetera. Of those 16 major events, if you have three in any one year, the average American has 1.28. If you have three in any one year it makes your risk of dying and disability in that year 32 years older.
Food, from the worst diet, I call it the McDonald’s burger and fried and milkshake diet, to the healthiest diet, a pescatarian or a vegan with salmon and ocean trout thrown in, and egg whites. If you have from the worst of the healthiest diet, it’s about 27 years. So nutrition is very important, but stress is the greatest ager. And stress causes, we think, more, if you will, of the epigenetic changes as you indicated, as you found, as you did the research for, than anything else.
So in fact, stresses is the greatest ager and is also one that is amenable to almost… The most easy one from a standpoint of, friends are an easy thing to nurture and a fun thing to nurture. So of all 180 things, are not about castor oil, they’re about sunshine. You want to do things that you love to do and that love you back. So only eat foods you love but that also love you back. You may love french fries but they’re trying to kill you. So food is like a marriage. You wouldn’t marry someone who’s trying to kill you every day. You shouldn’t eat food that’s trying to kill you every day. Same thing with… So you demonstrated that with stress, that it’s a great way of changing the biomarkers of aging.
Dr. Kara Fitzgerald You know, what’s interesting too, not to circle back to my study, but we’re just about to publish on another group that we looked at. So we looked at adherence this time and it covers a meditation, a diet intervention, we track sleep and a couple other pieces. The meditation component of our program was the at least adhered to. And it was pretty modest, it wasn’t a heavy lift. We wanted them to do 10 minutes of breathing twice a day. But when I hear you say it, it’s almost worth us rethinking how we frame it. Sitting down in meditation is probably anxiety provoking for a lot of people, especially if you’re not versed in it. But having fun, hanging out with your posse, I mean, is there any evidence that that is as potent as a contemplative practice? I mean what do you-
Dr. Michael Roizen: There’s actually evidence that it’s much more potent. Now all of that is epidemiologic evidence, but it’s from the Whitehall studies and the Berkman studies at Alameda County. The thing in both that was most important wasn’t whether they meditated or whether they did… It was, did they have a posse of six people they were vulnerable to once a month? And that could include, didn’t include in every case, their spouse. So some of them were not, if you will, fully vulnerable to their spouse. So six people that you’re vulnerable to once a month was the most potent at decreasing the aging that major life events caused.
Dr. Kara Fitzgerald It’s so important, just really important. Underline, underline, explanation point. I mean, that’s just huge.
Dr. Michael Roizen: But the other point you brought up is the key point. That’s why we developed RealAge. That is, how do you motivate people to change their behavior? Now at the Cleveland Clinic, when we started this we had 101,000 employees and dependents. And we found you could do it if the financial incentive was large enough. And Cleveland Clinic saves $190 million a year, the employees get the maximum allowed by law, $30 million back direct and probably another 30 to 50 in copays that they save. But you can do a financial incentive on, if you will, the big six. So…
Dr. Kara Fitzgerald So they get money in their pocket if they take care of themselves, is what you’re saying?
Dr. Michael Roizen: Absolutely.
Dr. Kara Fitzgerald Wow, that’s extraordinary, that’s a huge difference.
Dr. Michael Roizen: And we’ve gone from 6% having what we call six normals plus two to now 44%, and from about 12% voluntarily participating to over 73%, 74%-plus this year, voluntarily participating in the program. And yeah, it’s a large savings for us without a benefit design change, but it’s a huge savings for them in money. But in addition, this year we were just submitting… Literally next Tuesday we will be submitting the article on what it did to their rate of aging, and it decreased their rate of aging by more than 15%. And that’s by, if you will, the RealAge metric as their biomarkers individually…
If you look at, do employee wellness programs work? It’s very hard to find anything more than two years. This is a 10 year study on our now 10,000 employees iand dependents. So you can not only get reduced healthcare costs, 38% compared to our competitors and compared to our own trend line. But the employee saves money and the employee will live, if the prediction is right and they stay with it, the employee will live 15% longer without disability or death. So that’s a huge, I mean, that’s essentially living… 15% on an 80 year life expectancy is 12 years.
Dr. Kara Fitzgerald It’s just incredible. And I want to know specifically what you do, but this just brings to mind… Cleveland Clinic, you’ve been early adopters. As you and I were chatting about, there’s the Cleveland Clinic Center for Functional Medicine, which is published in top tier journals. I think it’s really world recognized and it’s changing… And the work that you’re doing is so extraordinary and you-
Dr. Michael Roizen: Well we got to thank the people from the Institute of Functional Medicine who came in and who really… Mark Hyman who came in and said, “Let’s do a research orientation to see if it makes a difference.” So yes, I’ve got to say one of the things that the Cleveland Clinic has done right is focused on outcomes from the beginning. And so the CEO, Toby Cosgrove, who started both Wellness and brought in Functional Medicine when we encouraged him and Johan to do so, our chief of staff really were really… How do I call it? It is a culture of innovation.
The reason they started recruiting me, I brought transesophageal echo over from Germany to use in the Thoracic Center in Amsterdam in 1979. And the reason they started recruiting me in 1981, I didn’t come till 2004, but the reason they started that recruitment was because they saw that the transesophageal echo was going to make a difference in how we manage patients. So it is a tradition of looking at outcome.
Dr. Kara Fitzgerald Well I’ve seen that you’ve also been challenged. I mean, certainly not everybody in the greater medical community appreciates that you’ve embraced functional medicine.
Dr. Michael Roizen: How do I… Part of having a CEO who is a physician always has been that they’re willing to take risk if they think the benefit to patients in outcome has been greater than the risk. And so that’s why… I mean, we’re the first who’s actually been doing, if you will, all the drug approvals looking at, with quantum computing, their effect on specific gene functioning. Can you repurpose drugs that are generic into that? That again, getting IBM here, looking at vaccines for cancer prevention is now one of the areas. So there is a real culture of, “Let’s do whatever we can to help the patient get better outcome.”
Dr. Kara Fitzgerald Yeah. Well and again, being a Cleveland girl and having my family there, I appreciate it. And I’m also on faculty at the Institute for Functional Medicine, so I know Mark Hyman well and I just, I’m very, very, very pleased and proud of the work that folks are doing there.
Let’s talk a little bit about the other aspects. So the whole community and connection and purpose piece is front and center. We can talk a little bit about diet, I’m curious about supplements. Let’s create the stack of priorities to be 40 when we’re 60. And then I want to save time to talk about turning 90 or 100 back to 30.
Dr. Michael Roizen: So the stack is, as I said, those six things. The second most important, food choices, portion size and timing. And partially because you’re changing the microbiome with what you’re doing, and that affects a whole bunch of things that you wouldn’t expect it to affect. It affects mental functioning, it affects exercise capability, et cetera. So you’re a pro at that, I’m not going to go into that at all ’cause… But it is second in the stack. But remember, the stack isn’t the order in which you should do them, other than stress management. The stack is, what do you like to do that loves you back?
So if you say, “I’m going to do…” One of the co-authors is Albert Rattner, who’s turning 95 by the time this comes out, and totally functionally intact. But he started working with us and changed… He didn’t want to change his food at all. So he started and he didn’t want to do steps, but he loves playing with grandkids, loves playing ping pong. So we got him to do 10,000 step equivalents. He has a great purpose and posse, so that was already intact. But then he decided, “Okay, if I’m feeling this much better from this little physical activity I’m going to actually change food.” And so he’s lost 40 pounds and gotten into… If you look at his pictures from three years ago he looks 20 years older than he does now.
So it’s never too late. Until you’re six feet under it ain’t too late to do this. But pick things you love to do that love you back. Third in that-
Dr. Kara Fitzgerald What about… Yeah, go ahead, go ahead.
Dr. Michael Roizen: Third in that stack is the four components of physical activity. Any like, step equivalents, resistance, cardio and jumping. The fourth is what we call avoiding unforced errors. That is, not vaping, not smoking, not riding in a car without a seatbelt, not going downhill skiing without a helmet, et cetera. And there are many. One of the simple ones is, do you need to filter your water? You can find out great information based on your water supplier of what toxins are in your water and whether you need to filter it. Same thing goes with the air. Do you live more than seven blocks away from where there’s diesel traffic? So there really are some easy choices. Cleveland it’s really important ’cause your parents probably got exposed to the steel mill junk that was here long before and that helped like-
Dr. Kara Fitzgerald Where my grandfather worked. That’s where he worked.
Dr. Michael Roizen: Yeah, right. And fifth is sleep and brain health. Now the reason it’s fifth is ’cause a lot of those things in brain health and sleep you’ve already gotten from the first four. And then sixth is supplements and small molecules. Stuff such as phosphocreatine, which you think of as a bodybuilder thing. But there’s really good data it improves both cognition and it prevents, if you will, sarcopenia, lack of muscle strength, which is important in avoiding frailty.
Dr. Kara Fitzgerald Yes, yes, yes. Okay, so phosphocreatine is one. What are the other supplements, just out of curiosity? I mean-
Dr. Michael Roizen: Well we’ve been asked to look at 53, or anyone can ask us. It’s a website, greatagereboot.com. We’ve been asked to look at 53, of which there are about 15 that you should talk to your practitioner about. They include everything from magnesium and coenzyme Q 10 and a baby aspirin twice a day with half of a glass of warm water before and afterwards and bovine colostrum, to a multivitamin to, if you will, extra vitamin D. Again, measuring the concentration. Curcumin. So there are 15 that are-
Dr. Kara Fitzgerald You think are standouts.
Dr. Michael Roizen: Well, 15 that have substantial data that in people over the age of 50, men over the age of 40, women over 50 have substantially more benefit than risk. And then it is a matter of saying, “Do I want to take that many? Which ones in which hierarchy do I want to go on?” And so when you say, “What do I do?” I am a bit crazy and other than stress, and I do work hard on friends, and other than sleep in my past and now I work hard on that. But other than stress and sleep, I do almost everything.
Now I can’t do the ones that are just for women like hormone therapy, and my own testosterone level is high enough. I’m not worried about hormone replacement for myself. But that’s one of the things that people should consider. Only 3% of men who are testosterone deficient are getting therapy for it. It is the same as women, especially since the women’s health study was misanalyzed in the early 2000s, women and men have not gotten hormone therapy or the aspirin they should get with it.
So the major risk of hormone therapy for both men and women is increased clotting. So you should always talk to your physician or practitioner about getting baby aspirin twice a day with half a glass of warm water before and afterwards, and maybe bovine colostrum for that. And I think your show is sponsored by Biotics. So a probiotic and prebiotics are important in that as well. And I take a variety ’cause we don’t know quite enough. So I take three different probiotics, one each day for three days. So rotate.
Dr. Kara Fitzgerald Oh, you rotate. Oh wow. That’s cool. Okay, good. So you’re in the thick of it. You must be recommending fish oil, that’s got to be in there. That’s such a workhorse.
Dr. Michael Roizen: Yeah, it is. I recommend… This is interesting. So if you look at the omega-3 index, even though I was eating salmon, I eat a salmon burger almost every day for lunch. And I will have salmon, regular salmon, wild salmon. The salmon burgers are Costco salmon burgers, wild salmon. And I don’t have any interest in either Trident that makes them or Costco. But I have caused a shortage of Costco salmon burgers at times by recommending them so much.
But in any case, even though I was eating those regularly my omega-3 index was only in the medium zone. So I take 900 milligrams of algal omega-3. So algal, the fish don’t make the fish oils, the fish get it from the algae they eat. And so I tend to get 900 milligrams of DHA omega-3, and obviously I get plenty of fish oil from the salmon. And usually I’ll eat ocean trout once a week as well. So despite that, my level is now in the upper range. But when I was just doing the food the interesting thing is, although I was doing it pretty intensely, I was only in the middle range.
Dr. Kara Fitzgerald You know what, I don’t think that that’s uncommon. I mean, I think we have to test and we can get insurance coverage generally to make sure people’s omega index is dialed in. That’s relatively easy to do here in the States. And there’s been research just showing a lot of variability in absorbing supplements. So you would expect that to be the case with food as well. And it’s worth knowing that it’s dialed in, I think.
Dr. Michael Roizen: Well that’s one of the things that functional medicine has taught us a lot. So thank you guys.
Dr. Kara Fitzgerald You’re welcome. So let’s move into some of the next generation things we need to be thinking about, like what’s on the horizon and where are we headed? I mean, 90’s going to be the new 40, which is awesome.
Dr. Michael Roizen: Yeah, there are 14 areas of research into this. I’ve gone over a couple. And people say, “How expensive are they going to be?” Well let me give you… The Gladstone in San Francisco looked at all the drugs approved by the FDA that were generic, same as Cleveland Clinic. They used another quantum computing, same as the Cleveland Clinic did. And the Gladstone found that you could antagonize the APOE e4 gene production of whatever it produces by using a $4 a month water pill, Bumex, bumetanide. That was in a computer study, quantum computing again, by looking at its quaternary structures and the structure of the gene.
They then looked at what happened in mouse models. It ablated dementia from the Alzheimer’s model in the mouse model. They then went and looked at a 1.3 million and another 4.8 million patient database and compared bumetanide to other water pills and the incidence of dementia, 70 and a 72% reduction in dementia using that water pill compared to others. It’s generally not used much ’cause of Lasix, or furosemide.
Dr. Kara Fitzgerald When was this published? Just out of curiosity. That’s pretty impressive.
Dr. Michael Roizen: It was published in, I think it’s April of ’22. So all of these things are… As I think I’ve told you, I’m a medical nerd. My hobby is reading medicine.
Dr. Kara Fitzgerald That’s amazing.
Dr. Michael Roizen: Crazy. So I apologize. We-
Dr. Kara Fitzgerald No, no, it’s awesome. It’s awesome. It’s great.
Dr. Michael Roizen: We’re season ticket holders to the Cavaliers basketball, and I’ve known every time out ’cause you see once they repeat them game after game and during half time, I may be the only person reading medical journals during timeouts and halftime at the Cavaliers games. But anyway, so I’m a little weird.
But in any case, so that’s now undergoing a randomized controlled trial to see if that works in humans as well. That’s probably a five year study. But that shows you some of the really innovative… It’s a $4 a month pill, now $4 a month. So it is inexpensive as heck. And if you look at the Alzheimer’s drug trial, nobody does… This is five times more effective than the drug that looks like it’s going to get approved that’ll sell for $56,000 a year, and require another $40,000 of MRIs to make sure you don’t have a side effect. This is $4 a month, 48 bucks a year. It won’t break Medicare at all.
Dr. Kara Fitzgerald It’s extraordinary, it’s absolutely extraordinary. Geez, thanks for sharing that. What about rapamycin or metformin? But yeah, go ahead. You were going to-
Dr. Michael Roizen: So there are a whole bunch. So metformin, I’m waiting for the team trial that Nir Barzilai (MD) will do. There’s some significant side effects, especially if you exercise, from metformin. There are large amount of benefits, your audience is probably aware of the increased life expectancy using that compared to other diabetic drugs in type two diabetes, and using that in type two diabetes compared to a control group. But there is question about what happens if you exercise.
So for example, I understand Peter Attia just uses it on days he doesn’t exercise, if there is such a day in the week that he doesn’t exercise ’cause he’s pretty aggressive. But in any case the point is, I think we’re not quite ready for primetime because another risk with that is, if you use it to reverse pre-diabetes or diabetes, it wears out that reversal the longer you’ve used it. So after 15 years of use, if you start at 50, by 65 you won’t get that reversal anymore. And maybe not as much of the hypoglycemic effect too. So I don’t think that’s quite ready for primetime. I hope Nir is right and it’s a great drug, but right now it has undetermined benefits and a little risk.
Dr. Kara Fitzgerald Yeah. And rapamycin, your thoughts there?
Dr. Michael Roizen: You hope that that will work. And we need the trials like the Gladstone is doing with bumetanide and Bumex to look at dose and dosing interval, because we don’t know what the right dose of rapamycin is or how often. Is it six milligrams once a week? Is it three milligrams twice a week? Is it three milligrams once a week? I just wish we had an as much funding on that as we have an anti-cancer drug funding, because if we did we’d have these answers on nutrition and a lot of the anti-aging. There is a lot more funding coming in thanks to both private philanthropy and the national institutes. So hopefully we’ll get there soon before I get to be too old.
Dr. Kara Fitzgerald Yeah. It does seem that the lens has finally turned towards aging, towards longevity. Do you think we need to consider-
Dr. Michael Roizen: Well thanks to your work, I mean, your work has been helpful in that. Thank you.
Dr. Kara Fitzgerald Thanks. Do you think we need to consider aging a disease to be able to get it fully funded?
Dr. Michael Roizen: Well the way both NIH and the FDA have traditionally been organized was by disease classes. So it was the National Institute of Digestive Diseases or the National Heart, Lung, Blood Institute. Or the FDA Study Section on Cardiovascular Disease, or on women’s health or on GI cancers. And that was appropriate. We initially focused on childhood diseases and vaccines and sanitation, that extended life expectancy, then went to chronic disease management. That’s where we are now. We’re going to be moving, I believe, into the mechanism of aging management. And whether aging is considered a disease or whether it’s considered a condition that is reversible I don’t think matters, as long as we get the focus of the regulatory authorities to be able to say that this is a treatable and viable problem.
When you look at the economics of it is, longevity is the cure, not the problem. Our Medicare trust funds run out in something like ’27, our social security 2032 or 2033. But if we work, if we’re going to live 30 years longer and we work 20 years longer, they never run out, at least as far as we can calculate through 2020, 2300. So in fact, longevity, if we do it right, is the cure, not the problem. And we’ve got to get that as a societal focus.
When we went to the CBO and testified in front of Congress on the Cleveland Clinic data on managing chronic disease and reducing cost 38% with the incentive, the CBO said, “We can’t pay anyone over 65, everyone over 65’s a cost to us. There’s no benefit.” We said, “They’ll pay into Social Security and Medicare longer.” They said, “We don’t count that. Nothing above the age of 65 is a benefit or an income stream. Everything’s a cost over 65.” So we’ve really got to change the CBO and the policymaker’s concept. And that goes with the regulatory agencies as well, as you brought up.
Dr. Kara Fitzgerald Yes, yes, yes. And it’s more, obviously, than longevity, it’s health span that has to be commensurate with longevity. And I know that you know that. All right. So on our home stretch here, I just want to ask just what your thoughts are with maybe using CRISPR as an intervention for longevity. What your thoughts are on Yamanaka in primetime in humans, Yamanaka factors. Stem cells, we could start with stem cells ’cause those are available now, I guess I would say pluripotent stem cells and your thoughts on pluripotent stem cells. And then any part-
Dr. Michael Roizen: So according to the data you need 20 to 50 million stem cells injected. Most of the stem cell clinics in the United States inject 500 to 8,000. So it’s a fiction. Now they do inject growth factors with it, which probably are important. But to get that many stem cells you’d need to take them from your bone marrow, grow them in culture for four months or six months and then inject them back. That’s very expensive. So you need to knock out immunogenicity. Mike West, a brilliant aging researcher has done that, knocked out the immunogenicity.
So in Japan there are trials for ischemic heart disease. It’s for ischemic heart disease induced heart failure, of injecting 30 to 40 million stem cells at a time that are immunogenicity incompetent. And so I don’t know where that’ll come. I’m hopeful, but we’re probably four to 10 years away from that. Panama, there are some centers doing it in Panama in that way. The problem is there’s a very large expense, so it’s not available to the masses. And second problem with it done in Panama is we don’t have outcome data from them. So as you can tell, I’m Cleveland Clinic, we’re outcome driven. Without outcome data you can’t believe it.
Dr. Kara Fitzgerald Yeah, I hear you. I know, I know in Columbia they’re doing pluripotent stem cells. Man, my eyes are open to it but I think you bring up some very reasonable cautions. CRISPR, Yamanaka?
Dr. Michael Roizen: So yeah, the Yamanaka factors are the four factors that Dr. Yamanaka, who was in Japan, now is at the Gladstone in San Francisco, came up with that reboot the epigenes back to your original set. The problem with that in the mice models was that about 30% of the mice two years later develop infinite growth of some of the cells, meaning cancer. They have revised that to knock out c-Myc so it’s only three genes that they’re turning on. When you turn on those three genes in three institutions, a private firm near UC Davis, at Harvard MIT and one in Switzerland, and now reproduced at both Hopkins and by Calico, the Google moonshot for aging, they’ve shown that turning on those three genes does revert the animal from the equivalent of 107 week old mouse to a 40 week old mouse, the equivalent of about 104 human years to about 34 or 35 human years, without the cancers growing at least in the first 30 weeks of that.
I haven’t seen anything in the last 15 weeks to know whether it’s a full year or not, but a full if you will… So we think that that is a very promising… It’s been done in three animal species now. Not only mice and rats but also in dogs, male beagles. And so we think that that may be one that gets the home run. But again, translating animal data to humans is fraught with problems. So that’s why we think with 14 shots on goal there’s an 80% chance, but it ain’t 100%.
As far as CRISPR-Cas9 and varieties, just imagine if you can turn an e4 into an e2 gene, instead of 20% dementia for women at age 90 going up to 60% if you have e4 it would go down to 10%, or in men, 10% down to 5%. And that’s actually occurring, meaning the experiments of that are now being undertaken. So we believe that that’s going to be a one organ by one organ, or one gene by one gene. Fairly expensive. It’s not expensive in ingredients, it’s $5 worth of CRISPR-Cas9 for a whole body. But because of the difficult regulatory and careful scientific… And harvesting the genes, et cetera, and knowing what it is, it’s very expensive. But that’s occurring now.
So where we are is I am going to continue to read, and sometime in the next 10 years I’m hoping one of the 14 shots on goal is done by Messi and gets to the back of the goal and we all can get rebooted.
Dr. Kara Fitzgerald Woo-hoo. Well Dr. Roizen, it was really great to talk with you today on New Frontiers. I’m so glad you joined me, this was an awesome conversation. I appreciate your command on the literature. This was a tour-de-force conversation. Thank you.
Dr. Michael Roizen: My privilege. Thank you. You’re great. You’ve been a great interviewer and a great leader in the field, so thank you for Younger You.
Dr. Kara Fitzgerald Thanks. As always, thank you for listening to New Frontiers in Functional Medicine, where our sponsors help bring the very best minds in functional medicine, and today is no exception. Not everyone can be a sponsor on my platform, and I so appreciate the good work, relentless research, and generous support from my friends at Rupa Health, Biotics and Integrative Therapeutics. These are brands I know and trust in my own clinic and can confidently recommend to you. Visit them at RupaHealth.com, BioticsResearch.com and IntregrativePro.com, and please, tell them you learned about them on New Frontiers.
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Dr. Roizen served as Cleveland Clinic’s first Chief Wellness Officer from 2007 to 2019 and founding Chair of its Wellness Institute. The Clinic’s Wellness Programs helped the clinic not spend over 1.250 billion dollars for its 101,000 employees and dependents over 11 years compared with national averages and help over 43.6% of participants achieve 6 normals+2® for health. Compared to national averages, they reduced their rate of aging and time of disability onset and was associated with over a 30% decrease in sick time.
He is a Phi Beta Kappa graduate of Williams, AOA from UCSF School of Medicine, and now serves fifty percent time as Cleveland Clinic as Chief Wellness Officer Emeritus, and is a Professor, Learner College of Medicine of the Cleveland Clinic at Case Western Reserve University.
Dr. Roizen is a recipient of an Emmy, an Elle, and the Paul Rogers best medical communicator award from the National Library of Medicine. He has nine top 10 and four #1 NY Times’ Bestsellers. He initiated and developed the RealAge concept to motivate behavior change. That started the concept that 60 could be the new 40. He now believes that soon, 90 will be the new 40 — and how to prepare is described in his most recent book and app, The Great Age Reboot and Reboot Your Age app, which may be useful for employers to help motivate employees to sustainable health promoting behavior change.
Dr. Roizen’s free RealAge test
Dr. Roizen’s Great Age Reboot program
Can an Old Diuretic Drug Disarm APOE4, Prevent Alzheimer’s?
Very disappointed in Dr Roizen’s comments regarding stem cells. Regenexx pioneered orthopedic bone marrow treatment and has published half the research. He mentions Panama but ignores Regenexx with their advanced labs, research, training institute and patient registry. More and more self funded benefit plans are adding Regenexx as an employee benefit. Fiction? Hardly. I sense a Cleveland Clinic “not invented here” bias. Perhaps you should interview Dr Chris Centeno.