What is Your Real Age? with Michael Roizen, MD

[00:00:00] Dr. Mike Roizen: Food is a relationship just 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. So, food is a relationship. You should love the food you eat. And it should love your body back.

[00:00:14] Dr, Melinda Ring: This is Next Level Health. I'm your host, Dr. Melinda Ring, Director of the Osher Center for Integrative Health at Northwestern University. On this show, we explore ways to take actionable steps towards optimizing our health with leaders in the integrative, functional, and lifestyle medicine fields who believe in science backed and time tested approaches to well being. Let's take your health to the next level.

 [00:00:42] Dr. Melinda Ring: Today, I'm delighted to welcome Dr. Mike Roizen to the show. I had the honor of co-chairing an annual preventive and integrative medicine conference with Dr. Roizen for years, and I am in awe of his ability to translate complex and cutting edge scientific findings into practical and understandable steps that we can all be taking to push our health to the next level.He is really a trailblazer in lifestyle medicine, more than three decades of research that focuses on aging and longevity. A board certified internist and anesthesiologist, Dr. Roizen was, I believe, the first chief wellness officer ever, at the Cleveland Clinic and Chair of the Wellness Institute. Among his many achievements, he led Cleveland Clinic's Employee Wellness Program, which we'll hopefully dive into a bit today. It's a national model for preventive health care. Dr. Roizen is also a four time number one New York Times bestseller. best selling author, co-founder of the popular Real Age Test, a clinically validated health risk assessment, and host of You the Owner's Manual podcast. Welcome to the show. It is such an honor to have you here.

[00:02:01] Dr. Mike Roizen: Melinda, the honor is mine. Thank you. It's a privilege.

[00:02:04] Dr. Melinda Ring: So let's start by talking about age. And specifically the difference between biological and chronological age. I read that you just had a birthday, so happy birthday. And if you are open to sharing, how, how old are you on your birth certificate versus your real age?

[00:02:26] Dr. Mike Roizen: So I'm 79 calendar years of age and about 57. 6 real age. So real age is the actual age of your body and it can be many years older or younger than your calendar age. And it's based on your risk of the net present value of your health choices and the risk of dying and disability. So when you say someone has the risk of a 57 year old dying, that's less in the next year or ten years than the risk of someone who's 79 if their real age was 79. So my risk of disability and dying based on my health choices, and it's about 158 health choices we didn't know when we started that they were making epigenetic changes. But it's probably based on the fact that most of the changes are that we do, whether it is food or exercise or stress management. Sleep or whatever works through our epigenes to change which of our genes are on or not. And that's what makes our proteins different and makes us younger or older.

[00:03:44] Dr. Melinda Ring: And I remember when this real age concept came out, when you came out with this over 25 years ago, I think we were both at the University of Chicago then, and this was well before people were talking about longevity, which is so hot and mainstream right now. So what was that inspiration for you? What led you to go down that path?

[00:04:07] Dr. Mike Roizen: Well, I wanted to run an ICU when I was a kid and there weren't ICU training programs back when I trained. So I took both internal medicine and anesthesia because I thought the domains of both would fit the ICU. I had that wish at UC San Francisco. I was running an ICU when they asked me to chair, co chair cardiovascular anesthesia. It wasn't because I was so good at it, but it was because the surgeons were difficult to work with. And so I immediately got the data, found out what they wanted, all they cared about was the return to function of their patients. California was unique in that it had kept the outcome data of all cardiovascular and vascular procedures since 1970. This was 1978, so I got the data. And I found out it wasn't heart function, or lung function, or liver function, or kidney function, or brain function. It was your calendar age that made the huge difference. And it was a logarithmic difference, so the 75 year old had three fold the increased risk of dying or disability of a 65 year old nine fold of a 55 year old. And so I said, how do we make people in the two weeks surrounding their surgery, ten years younger. In learning how to do that, you then had to motivate them. And you'd think, oh, just less disability. No, but, but people cared about being younger. So we came up with real age as the metric to motivate them. I then was at the University of Chicago and, you know, I was running executive health as well as anesthesia, critical care and pain management. And I got to care for Gary Becker, who was a Nobel Prize winner, and his Nobel Prize was for the net present value of investments. So I said, how do I do net present value of health choices? And that was what real age was. It was the net, it's the net present value or the integrated value of your health choices. So, if you have salmon today, as opposed to red meat, and you do that consistently for three years, if you will, you're doing it relatively consistently, you're about 1.8 years younger. than someone who's eating red meat instead of salmon.

[00:06:34] Dr. Melinda Ring: In 2007, when you became the first Chief Wellness Officer at a major healthcare institution, and you led Cleveland Clinic's Healthy Choice Program, and I know you found that This volunteer, voluntary employee wellness initiative not only improved the lifestyle habits of participants, but also significantly reduced healthcare costs for employees and for the organization. Can you walk us through a little bit how the program was actually structured and what factors made it so successful?

[00:07:05] Dr. Mike Roizen: Sure. The wonderful thing is it came out of Northwestern. So, when I was asked to be the Chief Wellness Officer, there were no guidelines on what you do to decrease employee health care costs. There were a huge number of episodes where they would get people to run or get people to dance or get, do one thing or another. But we, the Cleveland Clinic, is outcome based and Northwestern through the what you would call the Chicago Public Employee Union Studies, they, the Northwestern Preventive Medicine Group, Got the data from the Chicago Water, gas, and Electric company in 1946 after the war ended, those Republican PO unions, and they followed those individuals, largely men, until they died. And what they found was if they got to what we call the six normals, and there was little interpretation of the data, but it was a normal blood pressure, a normal fasting blood sugar, a normal LDL cholesterol, or now apple lipoprotein, BA normal. Waste for Height or Weight for Height Body Mass Index that isn't obese, no cotinine, tobacco end products in the urine, doing a stress management program, seeing a primary care physician who validates that data once a year, and the patient gets a huge enough incentive. When you read the RAND studies that we looked at initially, how much incentive works, it says incentives don't work, except there's a footnote on one of the back pages that says unless they're large. Well, Toby Cosgrove at the Cleveland Clinic said keep going up in the, what you pay them, up to the limits of the law, Obamacare or ACA, PPA law, until we get results. And we found the number, the dollar number in that era, and still. The change in patients, the change in employee behavior, and it wasn't in fact, this, the cardiac surgeons and the environmental service area employees changed at the same number. It wasn't a, it wasn't a difference based on their salary, it was based on the amount of money. And when they did that. And 75 percent now participate, 44 plus percent get to six normals plus two, and when they do that it decreases costs dramatically. We save 190 million. 190 million a year, 1. 5 billion since we started the program. It does, it ramps up over time, but 190 million a year for 101, 000 employees in dependence with roughly we're saving because people don't need medical care. They're healthier. And in fact, our unexpected absentees. Her illness days went down 35 plus percent. Entirely pays for the entire program, but the incentive They get 1, 600 for getting those six normals plus two now. We save another 5, 900. That's how the employees are getting roughly 40 million a year back. So it's a win for them in getting healthier. It's a win for them in more productivity. For them and for us, it's a win for them. In money and no co-pays, et cetera, and it's a win for the Cleveland Clinic in getting more productivity, a healthier workforce, standing for health. Now, I have one more thing to tell you that I didn't, haven't probably told you about, is it actually is projected to decrease their real age by about 15%. So if they were gonna live to be eight 80, they're now going to live an extra 12 years disability free. So huge huge benefit, if you will, in multiple ways and a hundred, 1000 employees. We were able, I was able to do it individually in executive health. When you uh, get to the, the value of the Cleveland Clinic test of this was, we think you can do this on a large scale

[00:11:23] Dr. Melinda Ring: do you think that this program, this trying to get the country to the six plus two, is something that can be scaled by something like the Center for Medicare and Medicaid Services? Is it, is it possible to do?

[00:11:38] Dr. Mike Roizen: It's much more possible now than it was, in fact, ten years ago. Ten years ago Portman, who's a Republican, and Wyden, who's a Democrat, had eight, seven other R's and seven other D's supported the bill that was allowing incentives for doing this. The bill didn't get out of committee, presumably because people were afraid the amendments might kill Obamacare or the ACA PPA. So it never got out of committee, but it was, if we had predicted that if the people, if Medicare alone Plus the Department of Defense, the two, two big employers, if you were too big. If you will, insurance participants, not even including the VA or Medicaid, did this at the same participation rates as the Cleveland Clinic had it would have saved, it would save, we did it in advance, the U. S. government about one trillion over the period of 2014 to 2024. In fact, when we've gone back and looked at it, it would have saved about 1. 4 trillion. We now predict that if you do the same thing for the exchanges, Medicare is Medi Cal, the Department of Defense, and the employees of the federal government, it would save about 2. 4 trillion over the next 10 years. It does require a law change. That's why the bill was there, because there is no way of paying incentives of a large enough degree to motivate change. Medicare and Medicaid, government employees, and Department of Defense employees. The exchanges can do it without anything, so we think that the test might be scaling it and seeing what happens with the exchanges but remember, the Cleveland Clinic, like Northwestern's Medical Center, isn't all doctors and nurses. In fact, the majority of employees are transporters and personal service, meaning front desk people and environmental service people and people who are, if you will, in the medium and lower medium income levels and it works for them. So I think it's very scalable. In fact, our, our largest, our, the group that's hardest for us to get. involved at the clinic anyway is our nurses who are giving so much time to other things they don't take care of themselves as well as any other group. 

[00:14:20] Dr. Melinda Ring: I know you're integrative minded like me. Another, another example that came to mind was, you know, when you talk about disease prevention, I know you're good friends, long time friends with Caldwell Esselstyn, And his remarkable program that just through diet and lifestyle can reverse heart disease. You know, those angiograms where you see lumpy, bumpy arteries and then with significant lifestyle change completely reverses so they're clean as a whistle, which is amazing. And I know you're also a fan of, if you need a statin, you should take a statin because those also save lives. So how do you counsel patients? Because again, I think some of this is, we have, people have access to so much information and misinformation that there are patients who are like, well, I heard statins cause dementia. I heard they have this and I'm just not going to take them. What's your approach to

[00:15:24] Dr. Mike Roizen: So our approach is. I don't care how you get to six normals, but you get there. And the sooner you get there, the better. If your values are too abnormal, let's go with a medicine that's relatively safe and has much more benefit than risk. And then once you get there, we can use the lifestyle changes that you've already started to make. And if you overshoot, then we'll cut out the statin, or we'll cut down on, if you will, the diet change, or we'll do something else you want to do. But it is, get to the basic six normals, and then you can reduce the risk. But you know, we've now been putting a lot of people, as you probably have, on colchicine as well. Because the data is pretty overwhelming that that decreases inflammation from if you will, that decreases coronary artery disease as well and stroke and memory loss. change is when you do things to get to the six normals. Whether it is with lifestyle or with medicines, you get a huge benefit that compounds over time.

[00:16:37] Dr. Melinda Ring: just do it quickly.

[00:16:39] Dr. Mike Roizen: Just get there and then and then, and then and then you can reduce it, right? Yeah, no, no, no, it is, I mean, what Essie has done, and what Dean Ornish has done, and what Pritikin did, is they showed that lifestyle makes a difference. We now know that lifestyle makes a difference because it changes the way your epigenes are set and that changes which of your genes are on or not and that changes the proteins you make and the quality of those proteins and that changes how well and long you live. So although we didn't know why and we didn't know why lifestyle worked until really the last five or seven years, we know that it worked and maybe medicines work in the same way. We don't know whether they're as good. As, in fact, we really don't know that they're as good as lifestyle but it's a lot easier to get people to do the medicines to get to the normals if, if you educate them. That's our job as physicians. So I'm going to give you my whole job and I get to work with medical students and residents as well as others. Our whole job as physicians is to motivate patients. Everyone knows that they should have a normal blood pressure. And yet when in both private practice and in the VA system, if I write a prescription and they have to walk two blocks to get a free blood pressure pill, only two thirds will do it. And only one third are taking the medicine after a year. We have failed to motivate patients well enough. And the internet is, in fact, inhibiting us somewhat more with some of the information on it. So, I really work hard with each of my patients at motivating them,

[00:18:42] Dr. Melinda Ring: And I remember you were on the TV show and you were the, you were Dr. Mike, you were the motivator. You were going to patients homes and really, and amazingly really helping people transform their lives. So that's definitely something that I've seen you have a gift for. You mentioned the epigenetics and stress. And of course that's, I think, one of the first places we really saw. Epigenetics and lifestyle come together so closely with, was it Elizabeth Blackburn's work?

[00:19:18] Dr. Mike Roizen: Yeah, Blackburn with Elizabeth Eppel the two of them together, but, but it was really Blackburn who was the lead at that time. Eppel was the graduate student, which showed, and again, it was with Dean Ornish's love and posse and passion and play that he developed. And when they looked at it, it changed 256 genes from either on to off or off to on through methylation changes in their epigenes. And it turned those genes that produce inflammatory proteins and those genes that produce anti inflammatory proteins on. Remarkable from just stress management.

[00:20:04] Dr. Melinda Ring: And, and so this idea of the posse, which I think is sort of like we talk about your tribe, the people you connect with. I think the Blue Zones talk a lot about this, so posse, purpose, and play are those three P's. And we know there's a loneliness epidemic. So, how, would you have suggestions, like, you know, you said motivating, what are small steps that you encourage people to do to strengthen that posse and find meaning?

[00:20:32] Dr. Mike Roizen: Key and the posse is when you have someone, as you get older, as we get older, people die who are your friends. And so the key is cultivating a friend network. And so one of the things we do is we have people call, you know, cell phones are every place, right? You have people call three people every Sunday that they hadn't connected with in the prior week. That is their distant friends, their high school buddies. Can be strange as heck, but it is that connection. And so we have them do that. The other thing I give you a really good example. So we have social prescribing at the clinic where if someone is lonely or doesn't have friends, we get them to a volunteer group or we get them to something they did. So we had a very famous artist who grew up in. Cleveland moved to New York. He moved back to take care of his mom. When she died, he had no friends around and didn't feel like doing anything. But he's an artist, right? So, we got him to teach two schools, two after school programs in art, and he's befriended, I'm almost going to cry because he's, he's done this so well, he's befriended these kids, and they've befriended him. And so that's the kind of thing the social prescribing network does, it finds something where the person can feel both purpose and friendship. The key point is that stress management The three keys that are, they're really a four from the Whitehall study. It is posse, purpose, play, and decision making in your life. That is, as long as you have, you know, the, the jobs with the, the worst outcomes from a standpoint of, of longevity in the job are those where you don't have decision making latitude. A bus driver has to do a bus route, doesn't have decision making autonomy, as opposed to a cab driver who can go any route they want. And so the cab driver has, has ends up with a longer life and less, less mental dysfunction than the bus driver, even when they started equal.

[00:23:07] Dr. Melinda Ring: So you have advocated for many, many years the 10, 000 steps, and I know there's been debate, well, do you really need 10, 000? My question in terms of the recommendations, hearkening back to the first Real Age book and then all the you books. Has there been any change in the nutrition guidelines, in the physical activity guidelines? Or are you, is everything still holding true? Because I know you read all of the latest data.

[00:23:41] Dr. Mike Roizen: Yeah. The only thing that isn't true. is a vitamin E question whether it is good for mental health or not. It's probably mixed tocopherols that make the difference. That's a technical issue, but, but for example, 10, 000 steps is still when you look at the data yes, 4, 000 is better than 2, 000 and 8, 000 is better than six and 10 is greater than eight for both mortality and all and brain dysfunction, all cause mortality and for. Mental dysfunction, cognitive dysfunction, 10, 000 is the minimum for maximum benefit. 12, 000, in other words, doesn't get you better benefit from all cause mortality or prevention of any of the diseases. Breast cancer, heart disease, stroke, colon cancer, colon cancer. Or cognitive dysfunction than does 10, 000. So 10, 000 is the right number. You know, it was a Japanese pedometer manufacturer who came up with the 10, 000. But he was, it sounds like he was right. He must've known what he was doing because maybe he had the data, but in any case, 10, 000 is the right number. And then when you. When you look at the, well, that's what the current science shows and it's repeated science. So when we wrote about it, it was about five studies. There's now 23 studies that show that same. If you will, leveling off after 10, 000 for all cause mortality and 13 for brain dysfunction. If you look at physical activity, the second most important has always been resistance exercise. That's especially true for people on the GLP 1 the other thing that really is important is jumping. As jumping, just 20 jumps morning and night, strengthens the hip bone and the bones in your spine and the discs, it lubricates those. So start that early enough so that you can continue it, because those are things that are important in physical activity. We always think of cardio as important, It is, but it actually is less important from a net present value than is resistance activity or is, or is walking.

[00:26:09] Dr. Melinda Ring: As long as I don't have to do burpees. No burpees for me. heh heh. heh. You know, a lot, because everything, everyone now is talking about, you know, being in the zone, the zone two training and all of that, but, but you're feeling that's less important than just getting those 10, 000 steps, doing some strength training and doing your jumps twice a day. You think that's a good basic regimen for people.

[00:26:37] Dr. Mike Roizen: data on Zone 2 and, if you will, Zone 2 being better than any of the other zones for building mitochondrial energy production,

how do I say, isn't as solid as one would like it to be from a standpoint of longevity. In other words, you'd think that if it built energy and mitochondrial energy function for the long term, that it would have outcome data by now showing a greater longevity. And at least to my knowledge, it doesn't yet. That doesn't mean it. I'm data driven. So unfortunately I can't use that, use that as a marker.

[00:27:28] Dr. Melinda Ring: And similarly for nutrition, there's been a lot of different nutrition, you know, recommendations over the years. Any change in those recommendations that you're giving these days?

[00:27:40] Dr. Mike Roizen: Yeah, the data are, you know, the rules, the food rules, we call them the ten commandments of food. Number one is food is a relationship just 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. So, food is a relationship. You should love the food you eat. And it should love your body back. Number two is there are only five food felons that have been well established. That is simple added sugar, added syrups, simple carbs red and processed red meat and fried food. Everything else is. Relatively healthy. And then there are some foods you, you, you want extra of leafy greens, blueberries, coffee, and some foods you want to stay away from, the fish with toxic levels of mercury and some ultra processed foods, et cetera. But in any case, the point is that we now have data Muscle building is important as you get older, and the federal government 0. 36 grams of protein per kilogram of weight is probably not correct anymore. It probably is fine for those between 30 and 50. But once you hit 50, you need to turn on muscle building. And it takes, from the data it looks like it takes four grams of leucine. every four hours to do that. I eat in an eight hour window, which means I need to get my protein at, and I'm, I'm now in the belief of 0. 8 grams per pound. So that's an awful lot. So it's about a hundred, a hundred grams, which means I need 33 grams or 40 grams. So my I have two salmon burgers, which give me 40 grams of protein as my 1130. Breakfast or whatever it is. I would love to shift it upwards, but I can't because of socialization, if you will. And then at 3. 30, I'll usually have pea protein as a supplement or if you will, a group of peas. I love peas or cashews. And then at dinner, it is again it is, whether it's tofu, or whether it is beans, or whether it is salmon, or ocean trout, again, the goal is to get, if you will, every four hours to get four grams of leucine which usually means about 40 grams of regular protein, of full protein.

[00:30:25] Dr. Melinda Ring: So,behind this increased need for protein, especially for people on GLP 1s and after age 50.

[00:30:32] Dr. Mike Roizen: yes. Now, we don't have great outcome data, we have great muscle building data.

[00:30:39] Dr. Melinda Ring: Mm hmm.

[00:30:39] Dr. Mike Roizen: on the theory that muscle is good to have and prevents frailty.

[00:30:44] Dr. Melinda Ring: Okay, so we've talked a lot about lifestyle, stress, movement, nutrition, the big six, all of that. I know that you are also on top of the latest technological options and things that are available like hyperbaric chambers and plasmapheresis and some of these things that I think are maybe somewhere on the border of some evidence but still experimental. I guess My question in terms of these, because they are available, in many cases to people, not, not through insurance, but are there things that based on the data, based on the safety and current efficacy, you think ready for primetime right now versus these are really interesting and we should be keeping an eye on the data for them.

[00:31:43] Dr. Mike Roizen: Yeah, so I think the data, and I'll go on, the basic data is how do we protect our brain. So, it's brains and mobility that matter to people and that. look like they're important for long term outcome. So it's joints, mobility, and, and your brain power. So for brains, it is the six, you know, the six normals is normal blood pressure, normal LDL, et cetera. We've gone over that, but it is stress management. The next thing that is ready for prime time is speed of processing games. Demonstrated in multiple randomized controlled trials to decrease dementia risk hugely. Just 18 hours of practice over 10 years in the speed of processing games decreases dementia by more than 30%. Maybe by as much as 50%. When you then go to the next level of things we think that in early dementia, getting rid of misfolded proteins is important. Shown in the AMBAR studies and in some studies that the Buck Institute has just published with Dobriya Kiprov and the convoys that aphoresis, a therapeutic plasma of aphoresis. is appropriate for that group of people that is early dementia. And we, the hyperbaric oxygen in the way that the Aviv Clinic does it. So I'm mentioning a name, but it's very tough to do. It is you're there for three months five days a week you have a hyperbaric oxygen it appears to increase stem cell production for, which helps you with repairs but they go through and they do everything at the same time. They teach you nutrition, they go through physical activity, they go through speed of processing games, they go through friendship and social prescribing. So I, we don't know. Is it really the hyperbaric or is it the full three months immersion into a healthy program? Dean Ornish's program, which did lifestyle for this, seems to do about the same thing. Not quite as good as the data on stem cell production. The other thing is that I think it's really ready for prime time and it's pretty easy to do. I've been doing it for nine years now. It is the Longo fasting mimicking diet. All that is, is 750, is a thousand calories the first day, 750 the next four days, it's five consecutive days. Low protein, low fat, and then you go back on your normal diet, low protein, low carb, sorry, and then you go back on your normal diet, the that in the data is really good at reversing aging biomarkers. So if I'm going to say, now, people always ask me about supplements, there's 17 that have more benefit than risk, but if you include all 17 in someone who's eating a relatively normal diet. It's about a three year effect. It's no place near as great as the best diet from the worst 27 year effect, stress management, 32 year effect, a physical activity, a 10 year effect, if you will. So the big six are the big six because they are that important.

[00:35:25] Dr. Melinda Ring: I know you've given so many pearls. We've got the, the six, we've got the 10, 000 steps. We've got the, we should be upping our protein. We need to be doing strength training and adding in some jumps, which is not my thing, but I'm going to start doing it today.  Is there one piece of wisdom that you want to share to help people live their healthier, more vibrant lives and. improve their real age.

[00:35:52] Dr. Mike Roizen: falling is a key risk as you get older. The largest cause of death in 2022 of Caucasian men over the age of 65 was falls. It wasn't heart disease or stroke or cancer. It was falls. So practice balance. but standing on one leg. In just one leg for a minute a day on each leg in three weeks, your balance will get dramatically bigger, better. And the other thing is since you're in a snow area when the snow falls, practice falling into the thick snow, starting on your knees or go to a ski slope and learn how to fall. So tuck and roll is a key way of preventing brain and hip injury.

[00:36:44] Dr. Melinda Ring: Alright, well, Mike, thank you so much for sharing your time, your incredible insights, and really your lifelong work in helping people take charge of their health. For listeners who want to learn more, I highly recommend checking out my book. of Dr. Roizen's books, but also his You, the Owner's Manual podcast. The Real Age Test. Do it for yourself. See what you need to do. Oh, the Great Age Reboot. Go to Italy with him. Go to, uh, go to Italy and see how to eat, and live properly with Dr. Roizen. And thank you again, Mike. It's just such a pleasure to reconnect with you.

[00:37:28] Dr. Mike Roizen: Melinda, the privilege is mine, thank you.

[00:37:30] Dr, Melinda Ring: Thank you for joining me on this episode of Next Level Health. I hope you found some inspiration and practical insights to enhance your wellness journey. Don't forget to leave a comment on YouTube or review on Apple Podcasts. I'd love to hear your thoughts and suggestions for future topics or speakers. Be sure to follow Next Level Health with me, Dr. Melinda Ring, as we continue exploring the path to healthier, happier lives, together.