Adding years to your life may be simpler than you think. Let our experts give you the facts about living healthier for longer.
From exercise to supplements, what does it really take to add years to your life? Dr. Laith Jazrawi and Dr. Guillem Lomas of NYU Langone Health go through the evidence and bring you the science behind the secrets to longevity.
Narrator: SiriusXM presents an NYU Langone Orthopedics podcast. Orthopedics is just very important to the population in this country. Its ability to restore patient function. Problems related to cartilage, to someone who has more advanced forms of arthritis. Getting people back to their activities and the things that they like to do. Featuring NYU's experts in the field of orthopedics trying to figure out that problem before it even is a problem. Problems with solutions. Well beyond physical therapy, to conservative pain management, to surgery. The best medical minds now come together. Applying all of our minds to solve these problems. We're here to get people feeling better so they can get back to their lives. And that's really what we try and accomplish. These are the Bone Whisperers.
Dr. Laith Jazrawi: This is Laith Jazrawi, Chief of Sports Medicine here at NYU Langone Medical Center, and I have the pleasure of continuing our Bone Whisperers podcast. And we're here today talking to Dr. Guillem Lomas. He's associate professor here at NYU School of Medicine and also happens to be the team physician for the New Jersey Devils Hockey Club. We're going to talk today about an exciting topic. I think both of us have spoken about it in the ORs multiple times with new data coming out. It's about living longer and better, the hype, reality, and what you can start doing right now to be mobile, mentally alert, and productive into your 90s. If you can live into your 90s - I think that's the first question that a lot of people ask. We see these people who get into their 90s and look very active. We also see people in their 90s that are not so good looking. Guillem. I mean, I guess one of the…
Dr. Guillem Lomas: And by good looking, you mean…
Dr. Laith Jazrawi: Yeah, I mean, yes, great question.
Dr. Guillem Lomas: No, no. Uh, but. Well, no, but it's a great point because do both of those correlate, right? Like, is looking young, looking good - does that denote health underneath? Sort of like a tip of an iceberg denoting, you know, the nine tenths of it are underneath. Or can it be a facade? I mean, and obviously, look, plastic surgeons ply their trade to make people look younger, and that doesn't necessarily change the actual health of their patients. But I think it's a good point because I don't even think we necessarily know that. I mean, maybe young skin and good hair is connected in some way, but maybe, maybe it's not. Maybe what's more important is our cardiovascular system, our endocrine system, all the other systems that help keep us young.
Dr. Laith Jazrawi: I mean, it's a great point. You're talking - a lot of people talk about physiologic age, right? So when we talk about physiologic age, it's hard to understand and there are certain individuals who ask what's your biological age? And physiologic and biological age are thrown back and forth. And people are trying to drive down this biological age. So you have someone, and for the people that are listening to the podcast, you have someone who's 40 that you say, hey, that guy looks really young or he's youthful looking. What does that mean exactly? And a lot of it gets to this biological age, and there's a way to test for this where you're able to assess via certain parameters at the cellular level. And they do this by measuring the telomeres, which is part of the genome, measuring those telomeres on the genes, how long they are. Kind of, you're able to figure out what age biologically the patient is, even though chronologically he could be 40, biologically, maybe 20.
Dr. Guillem Lomas: Yeah. And I think, I mean, you're getting to really the crux of the matter, which is, I think if we pan back a little bit and look at why has this become such really an industry? And I say it's more than that, I mean, it's a nexus for research. There's a lot of attention paid to it. And it gets back to sort of the basic existential question, right? Like, we as humans generally fear death. I mean, unless, you know, we have the misfortune of having, you know, being in a lot of pain, we tend to want to keep doing this for as long as we can, especially if we're healthy. And so you can go back historically just to the beginning of humans, and we were trying to do things to prolong our lives. So this gets to a very sensitive point for a lot of people, and a lot of us are just rendered a little vulnerable here. So the reason I say this is, on the one hand, it's in some ways the most important topic that we take on in medicine, in science and just as a society. But that also makes it very ripe for abuse and charlatanism. And so you have to guard against that because a lot of snake oil salesmen find their way into the conversation. But to get to your point, yeah, I mean, I think we are starting to finally have these quantitative markers. These objective criteria that we can look at and say, hey, this person seems to be “healthier”. They seem to be in better shape biologically. But I guess, you know, it all begins with genetics. And that's something that we don't really have a lot of control over. And I think that's worth mentioning too, because that's probably.
Dr. Laith Jazrawi: I think you hit probably the most important element of living a long life. If you want to live longer, you could just look at your history, your parents, how long did they live? If they lived into their 90s, you can be pretty much assured that you have a chance to live to your 90s. Now, if you add things like smoking, you're obese, you're not exercising - these are all things that may change how long you live. But probably not by much. A lot of the data out there that even some of these people who were destined to live to 90 and you hear all these stories, hey, I had my grandmother, she lived to 90, she smoked every day. Maybe she could have lived longer, maybe she could have lived, but how much longer? And I think a lot of the data is coming out that could be five, 10 years longer. It's not going to be 20 years longer. The question is, when we get into the people, whether you call them octogenarians, and I think the term is centenarian, they get to be 100 years old. What's unique about those individuals and how do they get to that point? Are they taking all these medications? A lot of them are not, because a lot of this newer data has come out more recently. But the question is, if you have a patient that comes in that starts to broach this topic with you, what's the first thing you tell them? Like, what's the most important thing to you for someone? Okay, I want to live longer. What would be, and I have in my mind what I would tell that individual as the number one thing that will enable them to live longer - what is that for you? What would you tell your patient?
Dr. Guillem Lomas: Well, I would look at it and you know, you and I both take care of athletes and I would look at it a little bit like a sport where - just pick your sport, I don't care what it is. Basketball. And someone comes in and says, I want to be a really good basketball player and I know how to do a 360 degree dunk. You're probably going to sit them down and say, that's amazing, but the first thing you need to do is learn the fundamentals, right? Get the fundamentals of the game down. That's the cherry on top. Like doing this amazing move is at the end of the road. But first you gotta get fit, you gotta learn how to pass, you gotta learn the tactics, et cetera. And I think it's the same thing with health and longevity. All of this stuff we hear about, all of the supplements, all the medications, they all take a second row to the fundamentals. And these are the things that I wish I practiced what I preach - I don't always. They're tough just because they're habits, they're things that you have to do every day. So a lot of this is very basic. Exercise. We know exercise is a cure all. If there was ever a cure all, it's that. And it doesn't mean you have to run 100 meter sprints every day or do anaerobic threshold workouts, but you have to move. So it could be a step count, if you're into that, it can be exercise, more intensive exercise. There's something about heart rate variability that seems to keep us young. So the second point I would say is don't do the same thing every day, so exercise, but mix it up a little bit. So that would be the number one thing. Shouldn't even say number one - part of the fundamentals. Get enough sleep. You know, that's the one thing in our society we pay the shortest shrift due. “Aaah, sleep when you're dead, it's fine”. And it turns out it probably is one of the most important things that we can do to decrease inflammation in our bodies. De-stress our bodies just as far as recovery goes, it's so important. And then nutrition, right. You were just talking about weight issues in people. So we know that as we get heavier, it tends to be more of a pro inflammatory state. We know that because like even in our world in orthopedics, people who are obese have a higher rate of finger arthritis. Like the little joints in their fingers get more arthritis even though they don't bear any weight. So we know that something's happening systemically. There's cytokines, there's chemicals floating around our body that induce or accelerate arthritis. So we've just talked about the things that we do every single day, right? Nutrition, sleep and exercise and activity. So I mean that right there - if you do your best to optimize those three parameters, you've probably hit that 80, 90% level in terms of how you can live longer.
Dr. Laith Jazrawi: I agree 100%. They're basics. We have control of this stuff. And I think you hit it right on the nail. It's the stuff - I'll even start out even more basic. Getting a good night's sleep. That's been shown on multiple studies that that is key. And whether it's the numbers tends to be eight hours. The people throw this eight hour number. You can sleep at eight, wake up at four, whatever your clock is. But as long as you're getting those hours and getting that deep REM sleep, that's key. And look, patients with sleep apnea or other sleep disorders, I think that's worth a workup. Figure out your sleep patterns before you start taking more supplements. I think that is number one. Number two, you talked about diet and I think we can get into that more. But eating a healthy diet and how you define what a healthy diet is - avoiding meals with high saturated fats. And ultimately the data is pretty consistent that if you get over to a vegetarian or even a vegan diet that's probably the healthiest diet. And uh, as much as, uh, look, I'm not a vegan, I'm not a vegetarian, but we know that the data is pretty convincing that if you eat that stuff, you'll have lower rates of heart issues and other medical conditions that are associated with non vegan or non vegetarian diets.
Dr. Guillem Lomas: You know, that's a great point. And it sort of gets back to what we talked about at the beginning of the episode when we were talking about judging a book by its cover, right? So there are diets that will make you lose weight. And uh, the other thing that it's probably a little bit outside of our purview as orthopedic surgeons, but you know, the new GLP1 agonists, which are incredibly effective at losing weight. But ultimately the question is, are they healthy? So are some of these diets healthy? So we know, for example, there are, and these have now been popularized, but you know, carb free diets, so just fat and protein and they're pretty effective at weight loss. And part of the reason is likely just you end up eating fewer calories when you're on those diets. They make you have kind of a bit of a low level of nausea and so ultimately just eat fewer calories. You know, carbs have this effect which when you eat them, you kind of want to eat more. But the question is, do they make you healthier? Like for a short period of time you can see results. But is that something that you can carry out long term? And to your point, most of the research says no, that on a long term basis, like if you have to get ready for some, for the Met Gala or something and you really need to lose weight, I mean, maybe you try one of these diets, but in the end that's what they are. They're just sort of these fad diets. They're very difficult to maintain on a long term basis. And all of the studies come back to about the same thing that you said. A balanced diet and generally less saturated fat, meaning less meat. And I'm like you, I love meat. I mean, I could eat steaks every single day of my life. But there's another point that's interesting. I notice this as I've gotten older and I wonder if you notice it too. I don't digest meat as well as I get older. And to me that's also a sign that my body is telling me, this isn't that good for you. And I don't know if you found that, like if I have a big steak dinner, I mean, I'm sweating that night, like I'm not falling asleep until 2 or 3am it's ugh.
Dr. Laith Jazrawi: No, no, I agree. No, no. I'm looking at you thinking, you know, I just had a steak the other night. Uh, it's often with a glass of wine. So we could argue whether alcohol is good and we'll get into that. But yeah, I completely agree. The idea is that there's a high energy required to metabolize that meat and I think that takes a toll on your body. And we know the cancer risks that are associated with saturated fats and meats. But the answer is I agree - diet plays a major role. Getting back to the idea of losing weight. Well, losing weight and getting from obesity into a normal weight, however you do it, whether you do it, as some people would say with these Atkins diets, which is an unhealthy long term approach to it, but it does drop the weight if you stick with it. And that tends to get you out of this metabolic syndrome, which for the people listening is this obesity that leads to insulin resistance, that leads to packing on the fat. When you eat something, it gets right to fat. These GLP1 agonists, they limit the amount of calories you take in, you start losing weight, they affect this cycle of this metabolic syndrome and kind of slow it down. So the answer to the question of does it help with longevity? Probably hasn't been shown yet, but it probably impacts longevity. Even though when you lose weight in your face you get that sunken look, that hollow look, you probably look older, those patients.
Dr. Guillem Lomas: Yeah, there's some evidence that there's more muscle catabolism. So essentially what it's creating is a starvation diet where you just don't feel hungry and you stop eating. And it's so abrupt that the body prefers to metabolize muscle over fat because muscle can be turned into glucose, boom, immediately. Fat has to go through a few different processes to get there. So the body preferentially would take some of the muscle. So that may be one of the reasons. The reality is we don't even know. But I agree with you. Like some weight loss, if you are at an unhealthy weight, some weight loss, however it happens, is better than no weight loss, like you would argue, that's going to help you. Then the question becomes, is there a way to do that in a more sustainable way? Is there a way to do that so you are even healthier than just doing these diets or taking the medications. And I think the answer is yes. But listen, I'm very sympathetic to people who struggle losing weight because the body doesn't like to leave its equilibrium. It finds an equilibrium and it just likes to stay there. And it fights to stay there. So it can be very difficult to try to push yourself one direction or another. And I think that's what you're saying with these medications. It kind of does that - it pushes you past that activation energy. And then that's helpful on so many other levels, on psychological, emotional levels. If you realize, hey, I am losing weight, you then may become more motivated to go to the gym, start an exercise program, because you're getting that positive reinforcement. So I mean, these topics are very complicated and I don't think, you know, in general, it's black and white. There's good and bad to all of these things. And the question is, for the individual, how do we create an optimal recipe, if you will, or like, what's the perfect equation for an individual to get to a point where they're healthy?
Dr. Laith Jazrawi: Yeah. So we came up with a couple of things so far as we're going through this discussion. One, we talked about sleep. Getting your eight hours of sleep in will probably help with you living longer. We talked about exercise, and we can dive down into the type of exercise. There are various experts out there, whether you read Dr. Attia's book about this combination of this high intensity exercise where you get your heart rate to a certain amount and really working on your muscles with some weighted exercise. So there's this idea that, okay, walking is good, starting somewhere, being motion is lotion, doing stuff, but then getting into working your muscles with the idea that he brings up a very good point about getting on the floor and getting up off the floor. We have people who can't do that, and that's probably a bad thing. And that probably impacts your overall longevity too. Where there are certain muscles that you're not functioning, not functioning well, you're not using that, you should be training. And I think with an overall sort of approach to exercise where you're working your muscles, you're getting your heart rate up to that critical threshold where you're panting and you feel it, you feel like your heart's going to bust out of your chest. I think those are good things. That stress on your system probably releases things that are good. And it's been shown that high intensity training combined with some aerobic training has the best overall impact on your health and longevity on those patients.
Dr. Guillem Lomas: Yeah. So, you know, it's interesting because at the US Open this year, they were talking about this nonstop about tennis - best sport for longevity. So a couple studies have come out and they basically looked at people who did different sports and they supposedly try to unbias the study and account for different permutations. But it turns out that of all the sports, they're actually of the top five sports correlated with longevity, two of them were racket sports - it was tennis and squash. And so the question becomes why? You were just talking about high intensity or whatever. And so first of all, there's the potential for the studies to be a little bit flawed, right? Because there could be socioeconomic reasons. Like if you play tennis, maybe you're at a higher socioeconomic level. And yeah, if you got more money, you're probably going to live longer. That's actually been shown and multiple studies have shown that the higher you are in an income bracket, typically the longer you live. So there could be an element of that, but I think it speaks to a few other things. So number one, there are high intensity moments in a tennis match, right? You're running to get the ball and maybe it's a long rally. So get your heart rate up, get panting. Then you're playing for a while. So you're playing for like, you know, an hour plus usually these matches are, you know, hour or two hours. So you're out there for a, uh, fair amount of time. So heart rate's up for a little bit longer. And then the final piece, which I think it's hard to tease apart, but I think plays an important role - it's social. And that's the other thing that we didn't mention. But on top of, you know, the nutrition, the obesity, sleep, all that stuff and exercise, it's this social piece seems to be very important. And when they look at areas of the world where people seem to live longer, one of the things that has been shown, and there's Harvard longevity study too, where they followed Harvard - it's a little antiquated and like, it's all basically males because they started, I think, in the 40s or something - but they follow them every decade. And they find that in terms of life satisfaction and even mortality, it's the ones who have the richest social networks seem to live the longest. And so to that point, I think sports or activities that you do with somebody else does something to the body, it decreases stress. It lets the body, somehow the brain gets to decompress, that then has downstream effects on our hormones, our endocrine system, and then it affects our organs. So it sounds like, you know, one of these things like, it's all in your head, but it's not because your head affects the rest of your body.
Dr. Laith Jazrawi: Sure, that's 100%. They talk about these, and you were alluding to it, these blue zones, these places where people live to be centenarian into their hundreds. And what is unique about them? Social structure, very important. Diets tend to be on the vegetarian to vegan side with less saturated fats, fresh fruits and vegetables. These are things that we're constantly bombarded with here in the United States about what's a healthy diet. But the social aspect is very important. Getting back to the tennis point, in addition to doing the high intensity, there's also moments where there's aerobic, where you're lobbing back and forth, but there's also the muscle use where you're swinging the racket and hitting a ball, where there's a counter force which is helping with the muscle. So I think that all those are - and I could see why tennis could be one of those sports that can add to longevity. The other point you brought up when you talked about the GLP1 inhibitors, Ozempic, things like that - what about calorie restriction? Do those drugs mimic calorie restriction? And can you tell me a little about what your thoughts about calorie restriction and the science behind it, showing that you can live longer if you do these calorie restriction diets?
Dr. Guillem Lomas: Yeah, I mean, that's a tough one because obviously in people who are susceptible to it, you could give them a mental illness. I mean, we know anorexia is a problem. But assuming for most of the population, that's not an issue that, like you said in animal studies, it's the one, but it's the most powerful intervention that prolongs life. Caloric restriction, you restrict calories to mice, they live 10%, 15% longer than their siblings. So we know that it probably has an important effect. You know, the way that I sort of view it, again, kind of like holistically to just start to understand it conceptually, is you were talking about the metabolic effort to digest a piece of meat. And so effort takes calories, it takes energy, it produces waste and byproducts. We have organs that can take care of those. But we know that if overloaded, those organs do start to break down and over time they probably are going to break down anyway just because, you know, our cells just start to get less efficient at replicating. And so the idea of caloric restriction in my mind is you're taxing the body less. You're saying “I'm giving you less stuff to have to deal with” and something about that. And there are some hormones that seem to be released when we're calorically restricted, human growth hormone being one of them that may have this effect just naturally at prolonging life. The downside of it is it's pretty uncomfortable to feel hungry all the time. And we were just talking about that equilibrium, right, that the body likes to get, be at a certain point. So if you start to really lose weight, you may find that your body's fighting to get back to where it was. But I think in principle that is a reasonable approach. And you know, the argument that the medication is going to help you get there I don't think is totally flawed. My concern, I think with a lot of these medications is they've been used in the past for very specific reasons. And again we're talking about medications like Wegovy and Ozempic and that kind of thing. They've been used for diabetics specifically. So I don't know what happens in a person who doesn't have that condition, when they're taken only for weight loss. And so we do have a good track record but again it's in a very specific patient population. So we have to see what happens with long term use of them. And do people get tolerant to them? Do they have to start to increase? There's some evidence that you, after three years you may have to increase the dose. Do we get to a dose that's potentially toxic?
Dr. Laith Jazrawi: They're all great questions. Kind of wrapping up this diet aspect, they talk about intermittent fasting, right. Do you think this is a way to mimic some of the calorie restriction in a short term period? And while it's uncomfortable when you're fasting, is this an easy way to get the benefits of calorie restriction and at the same time being able to at least eat, you know?
Dr. Guillem Lomas: Yeah, yeah. I mean again, that's become very popular. You know, my understanding of intermittent fasting is in general what we're doing is we're also creating an environment where you just can't consume as many calories. Like if you don't eat for 16 hours of the day, you physically can't fill your stomach up with, you know, more than a couple thousand calories. So I think it may work through more circuitous mechanisms than doing something hormonally, but that may be part of it too. But yes, I think this gets back to what we're talking about. You know, a specific recipe for a specific person. Not everyone is going to be happy with that. I mean you and I probably intermittently fast on days we're in the OR we probably do that without even thinking about it. Just because it's like, yeah, case, case, case, case. Suddenly it's 10 hours since we had a bite. But you know, if someone's sitting at a desk like starving, 10 hours might be a long time torture to wait for their meal.
Dr. Laith Jazrawi: So, uh, as we're getting through this and you know, look, I think we're getting to somewhere and we'll wrap it up with our, basically, you know, our thoughts about what are the best things. We've done the exercise, we've done the sleep in, we've done some calorie restriction, we're eating vegan, vegetarian now. People ask, our patients ask us, what medications can I take? You know, what are some known medications that can help start to increase longevity? And you know, you had mentioned it before, we spoke about it before - inflammation in the body. And um, I'm a firm believer. And this, I think a lot of this, you know, the question is, does aspirin as an anti inflammatory agent or as an anti these things in the body called platelets which can tend to clump and when the vessels are inflamed, platelets could kind of stick to them and they can lead to heart attacks. Aspirin unclumps those platelets. And for me personally, I take a baby aspirin a day. And I just wanted to know your thoughts on that first medication because that seems to me if you can control a little inflammation, we can potentially live longer.
Dr. Guillem Lomas: Yeah, well I think that to me has been also kind of resolved - inflammation is bad. We know that now. It's a little bit like, you know, when people talk about stress. We're designed to experience a little bit of stress, right? We're designed to have some inflammation, right? So it'd be a pretty boring life if you never got stressed. I mean you go and give talks at international conferences, you stand up at the podium in front of 5,000 people in the crowd. Your heart rate probably went up a little bit, right? Yea probably a little. And that's a good thing because that actually prepares you to deliver a good talk, answer questions. And so it's the same thing with inflammation. I mean it's the body's natural response to a stressor, but when it becomes chronic, then it becomes pathological. And so my short answer is I think all these things have to be borne out by studies. I think, with aspirin it has been shown, you know, small amount of aspirin does seem to have a beneficial effect in terms of cardiovascular health. I think it probably depends on the individual, you know. So, for example, I mean, if we're talking about our own personal medical thing, like I happen to have fairly low platelets just naturally. So they're the low end of normal. And I can tell, like sometimes when I get cut, it takes a little longer for me to bleed. I probably don't need to take aspirin. Because I probably just - we talked about genetics, just how it turned out. I'm like that. So I think it's one of those things where it's case by case. But yeah, that is one of those that I think has been settled that it's probably on the hole for most people, a good supplement to take.
Dr. Laith Jazrawi: I'm going to throw out another drug, a cheap one, wonder drug they call it, given to diabetics to sort of get them and control their metabolism a little bit, but not so much eating less, but being able to control this metabolic pathway, Metformin. And one of the things they found out when giving this drug to type 2 diabetics and it seemed to be able to limit their need for diabetic medication, that these patients were living longer.
Dr. Guillem Lomas: Right.
Dr. Laith Jazrawi: So you had this side effect, a very commonly used drug that you can get some extra years in life. I will add on the flip side, also when using this drug there is a cancer risk as well, which, whether it's how long you have to take it, et cetera. So the question is Metformin, what do you think?
Dr. Guillem Lomas: Yeah, I mean, look, exactly. Look at these studies and these studies, you know, compared to us in orthopedics, where unless it's some registry out of Finland or something, I mean, we struggle to get these kinds of numbers together. And in cardiology and endocrinology, they put out studies with 20,000, 30,000 participants. So it's very compelling. And I think again, some people do get side effects from it, so it's a no go. But it is an interesting idea. You're getting at again, homeostasis controlling, getting that glucose at a very stable level. That seems to be really important at decreasing inflammation. Where we see it, and, uh, interestingly, where I kind of find a lot of these, like, inflammatory conditions emerging. Frozen shoulder. So we know when we see patients with frozen shoulder, they're like, well, why did this happen? They get this inflammation in their shoulder. And the one thing that seems to be a consistent trend is there's some kind of underlying inflammation, whether it's an injury, a surgery, or they have diabetes that's a little bit uncontrolled. They're in menopause, so their hormones are a little less stable. Thyroid conditions. So it's almost like a little barometer of what's going on in the body. So for me, that makes sense that, you know, if you take that, you're probably stabilizing your glucose levels and overall that's helping control inflammation.
Dr. Laith Jazrawi: Yeah. So I think dead on. Exactly. And I think it's tough sell. You know, certainly as an orthopedic surgeon, I'm not advising my patients to take Metformin. But if they're type two diabetics and there's an indication where that medication could help them, I think - Why not refer them? Yeah, yeah, refer them to get evaluated for that. Now, to get to a controversial drug, rapamycin. Cancer drug. Oh, look, there's a side effect. These patients are living longer.
Dr. Guillem Lomas: Right.
Dr. Laith Jazrawi: So it seems interesting to me when this came out, and there's this theory that at low doses, this affects sort of the cellular turnover pathway and it affects some of the ability of - I mean, one of the things where we look at how these medication works, there's in our body, there's this homeostasis, like you mentioned, where we gotta get rid of the junk that the body's producing. All these cellular mechanisms, and then we need to replicate our cells because there's this constant change. What happens with aging? The new replication of cells decreases and all these byproducts and junk increase. So you have this junkyard where you're filling up your cells with all this junk. Rapamycin supposedly is able to modulate that pathway and be able to get rid of this junk products a lot quicker and also help with cellular renewal and regeneration. So why not? What do you think?
Dr. Guillem Lomas: Yeah, I think it gets back to what we first discussed, right? Get the fundamentals down. Once those are down, then you can start pushing the envelope with something like rapamycin. I think the evidence is certainly very impressive, both in animal models and with humans as well. It's the one medication that really is touted as this sort of anti aging agent. But again if you do that and don't do the other stuff, you're probably just getting much less of a benefit. So I think, look, for me I probably need to see a little bit more evidence before I would personally start taking it. I think for a lot of people the argument has been settled and they're good on it. But I think a lot of times, like we've seen innumerable times in medicine, something looks really good on paper, looks good in a very tightly controlled study population. And then when it goes into the so called wild, when we started using it just in normal everyday use, we discover unintended consequences. The so called cobra effect.
Dr. Laith Jazrawi: Yeah.
Dr. Guillem Lomas: That uh, you and I have talked about in the past where like yeah the British had issues with cobras. They would pay whatever a rupee this is in India, they would pay a rupee each for a cobra. And what happened is enterprising locals started breeding cobras. Instead of the population getting decimated, it became a massive problem. So the point is we don't know necessarily what happens when this gets out and people start using it that maybe the indications aren't as tight.
Dr. Laith Jazrawi: Yeah. So uh, I agree with you 100%. I'm not quite there utilizing that. And I think ultimately the question and the most important question you have to ask yourself is how many years is this giving you? Where are you going? Is this something where you're going to get 30 years added to your life? 50 years added to your life? The answer is no. If anything the studies have shown you're looking at plus or minus 10 years. Okay. We haven't seen the effect of getting patients and lots of patients who are on these drugs into their hundreds. There's not that many. So the answer is, I think the way I see it is if you go to live to 90, if you have parents that have lived to 90 and they lived an unhealthy lifestyle, let's say they're smokers, they're obese, but they live to their 90s. If you have a healthier lifestyle, exercise, you're not obese, you eat healthy, maybe you can get to 100. I think that's how I see it. Or if your parents died in their 70s from heart disease, let's say, or 60s from heart disease, maybe there's a role where some of the - why did they die at that young of heart disease? Maybe it was diet, maybe it was lack of exercise. Maybe it was, uh, something cholesterol related, some genetic thing where they had a high cholesterol. And we know some of these cholesterol lowering agents, another medication can help reduce issues with cardiac disease from elevated high LDLs. We're really honing in on the specific LDL type, the bad cholesterol. And what does that mean? And I think rather than just get started on a cholesterol lowering agent, whether it's Rovastatin or some of these other statins, to really look critically at your number and talk to a health specialist or physician about where do you want that number? And what medication is right for you?
Dr. Guillem Lomas: Yeah, well, the other thing, and you know, it's interesting because of course it's natural - we just started going down the rabbit hole, right? We said fundamentals and then all these like, accoutrements started coming out and it's really endless, right? I mean, we could talk about things that are even more conventional, like vitamin D, but certainly all these other medications, resveratrol, there's all sorts of stuff. But it really does come down to what we said, right? Ultimately, it's the fundamentals. It's hard to even look back because even the environment could have affected. Like if you had parents who lived next to a coal plant or something, where, you know, there's no question that 30, 40, 50 years ago, the regulations were a lot different and a lot more lax. I mean, some people were living next to factories where they were just spewing junk out into the air and the local population had no idea. So I think all these are great to think about. But one little caveat is if you become obsessed with this, right, with longevity. And again, this is the most sensitive topic for humans because it is totally existential. Literally there's an element of stress that can develop where if you're really so worried about it, you just start to think about all the different ways that you could hurt yourself or help yourself. And there certainly can be this almost paradoxical amount of stress that actually takes away more than all of these supplements, all of these lifestyle changes can give. And because if this is another thing that has been shown, you know, the less stressed you are, and this is where the social part of things I think really helps, where you have a community where you can kind of like talk about stuff and de stress. But that is something that you want to limit as much as possible. So to some extent it's like, I think you just have to find a comfortable routine, habits that you can actually maintain. And that's probably the best you can do. Everything else is going to push you, like you said, a couple years, plus, minus. But the best thing that you can do is do the things we know that help and try to do them in a very sustainable way. And then after that, yeah, if you have time and it's not a big deal, yeah, throw some medication in there, talk with your Internet, see what they say. They think you're a good candidate for it, but that's at least my approach is. I just try to be a little holistic because you can just go nuts with all this stuff. And especially now online social media. We talked about the snake oil aspect of it. You could just go crazy, right? Everyone's got that secret thing that they don't want you to know about that they're hawking. And most of it is B.S.
Dr. Laith Jazrawi: Right. I completely agree. And as we wrap up the podcast, I think the three things you can control are diet, exercise, and sleep. So those three things.
Dr. Guillem Lomas: And social. I would say that's the fourth one. Just don't be a loner.
Dr. Laith Jazrawi: Right. Well, that was great. Again, wrapping up our discussion on longevity with Dr. Guillem Lomas, associate professor here at NYU School of Medicine and team physician for the New Jersey Devils. And this is Laith Jazrawi, chief of sports medicine here at NYU. Thank you for listening to his podcast on living longer.
Narrator: The Bone Whisperers is a co production of NYU Langone Health and SiriusXM. The podcast is produced by Scott Uhing. Sound design by Sam Doyle. SiriusXM's executive producer is Beth Ameen, and senior operations manager is Emily Anton. Narration and additional sound design by Michael Luce. Don't miss a single episode of the Bone Whisperers and subscribe for free wherever you listen to podcasts. To hear more from the world-renowned doctors at NYU Langone Health, tune in to Doctor Radio on SiriusXM on channel 110 or listen anytime on the SiriusXM app. For the Bone Whisperers podcast, I'm Michael Luce. Join us next time for the latest advances in orthopedics on the Bone Whisperers.