podcasts

Mark Hyman
Oh my god, I’m so happy to be here. Thank you so much for having me.

Kalea Wattles
Well, we’re really excited, and I think we should take this just like the functional medicine timeline and start at the very beginning. You refer to the way that we currently age with this decline in our health status, increased illness, more chronic disease, becoming less independent as abnormal. And I think that’s a real novel concept for a lot of people. We expect this to happen.

Mark Hyman
Yeah.

Kalea Wattles
Can you talk to us a little bit about a normal aging process versus what you would consider to be pathological aging?

Mark Hyman
Yeah, absolutely. This is a great question. I think chronologically getting older is inevitable. There’s nothing we can do about that. The clock marches on, but biological aging is not necessarily inevitable as we certainly see it today in America and around the world. What we see typically now as we age is increasing frailty, chronic disease, and morbidity, and that is not inevitable. There are many places around the world where people live long, vital, healthy lives well into their 90s and 100s and are highly functional, and most of the disease that we see are absent. So if that’s possible in a select population, is it possible for all of us? Because that population, when they move, for example, to America, they get the same disease at the same rate. So these are changes that we see that are not inevitable consequences of aging. There are signs of abnormal aging, and the WHO’s recently classified aging as a disease. That’s kind of a controversial notion, but I agree. I think that the chronic decline in our health, the shrinking of our health span, the increased morbidity, is a result of pathological processes that we can treat. And if we now think about the fundamental problems that go wrong as we get older as treatable, then we can actually create a society where our health span equals our lifespan. Whereas James Fries talked about we can compress morbidity and live healthy, long lives without morbidity and the horrible things that happened towards the end. Typically, we spend the last 20% of our lives in poor health, meaning our health span is 80% of our life, and 20% is not, right? So we may live to be 60 in good health and then live to be a total of 80, and maybe the last 20 years of our life, we’re in poor health and on medications. And the truth is that 80% of people over 65 have one or more chronic illness, and it’s getting worse. So we’re now facing a time when we’re seeing this big divergence of our health span and lifespan, and chronic illness is affecting six out of 10 Americans, four to 10 have more than one chronic illness. And it’s not inevitable. This is just not what we should expect as we get older. Heart disease, diabetes, cancer, dementia, not to mention all this frailty and disability, these are consequences of abnormal processes that actually, by the way, we’ve been talking about in functional medicine for decades. Insulin resistance, inflammation, mitochondrial dysfunction, alterations in the microbiome, oxidative stress. I mean, these are all concepts that we are super familiar with in functional medicine that are being now described as the hallmarks of aging, right? If we could cure all heart disease and cancer from the face of the planet, we might see a live extension of five to seven years. If we optimize the hallmarks and we corrected the dysfunctions in the hallmarks of aging, we might see a 30 or 40-year life extension. If you’re a 30-year-old smoker and you smoke two packs a day, the risk of cancer is less than if you’re a 75-year-old non-smoker because age causes these dysfunctions, but they’re not a one-way street. We can actually reverse biological aging.

Kalea Wattles
Well, I heard you lecture about these hallmarks of aging recently, and I was thinking about our functional medicine matrix, and as you were speaking, I can visualize this in my head thinking if we addressed all of our modifiable lifestyle factors and addressed all of the clinical imbalance areas on the matrix, we’re touching on so many of these areas that you’ve identified as the most important hallmarks of aging.

Mark Hyman
Absolutely. I mean, in my book Young Forever, which just came out, I essentially mapped out the hallmarks, and I said the problem with longevity science is that they have not talked about the root, root cause. So they’re saying the root cause of aging is dysfunction in the hallmarks of aging. But as a functional medicine practitioner, I’m always thinking about, what’s the cause, and then what’s the cause of the cause, right? If the cause, for example, of poor health is our food, well, what’s the cause of our food, right? It’s our food system. What’s the cause of our food system? It’s our food policies. What’s the cause of our food policies? It’s the food industry, right? So you’ve got to keep going upstream, and in the hallmarks of aging, you have to go upstream. What is the cause of the hallmarks of aging? That’s where functional medicine comes in. It’s basically Sidney Baker’s genius idea, which is we’re dying of too much of something or not enough of something, right? We have to get rid of the bad stuff, put in the good stuff. And it’s basically a very simple framework for understanding how to optimize these systems is remove the things that are the impediments to health and add in the things that are optimizing health. And that’s really that simple.

Kalea Wattles
Is it correct to say that the majority of the hallmarks of aging are modifiable?

Mark Hyman
Absolutely. We might… If you want to go through them briefly, but I think they’re not all created equally. I think there are meta frameworks to think about in terms of the hallmarks. For example, I think the deregulated nutrient sensing is kind of a master hallmark that influences all the other hallmarks. So, for example, the new deregulated nutrient sensing is a kind of a convoluted way of describing it, but it’s basically, how does food affect our biology, right? And so we talk about food is medicine and so forth, food is information, but it’s true that food is regulating so many of these biological pathways that have to do with longevity. And there are four key pathways. I call them longevity switches. Insulin signaling pathway, which we’ve talked about forever through understanding insulin resistance and so forth. We’ve talked about that forever in functional medicine. And that’s a huge one that causes all sorts of age-related problems. And insulin resistance is probably one of the major factors driving all the hallmarks. The second is dysfunctions in mTOR. And mTOR means mammalian target of rapamycin. It’s activated by protein and by carbohydrates. It’s overactivated in our society where we don’t stop eating and we don’t take breaks, we don’t eat… We eat all day and all the way through the evening and then as soon as we wake up. So we don’t really have the period of fasting, even though it’s breakfast. And so mTOR is inhibited when you fast, which allows autophagy, which is a critical part of recycling cleanup. But we also need mTOR activation to build muscle, and we need actual protein with leucine in it to stimulate muscle synthesis. So those have to be probably regulated. And then the other two are sirtuins and AMPK, adenosine monophosphate kinase, which is an enzyme that’s impacted by scarcity. As soon as you see low levels of energy, right, ATP becomes ADP and AMP, you basically detect lower risk energy states, and then the body kicks in activation of AMPK. And then you actually activate all these longevity pathways, and that’s where metformin works. And rapamycin, for example, works on mTOR. And sirtuins are very important and are activated by NAB and by various phytochemicals like resveratrol. And they actually activate DNA repair, inhibit NF kappa B, induce mitochondrial biogenesis, and so forth. So a lot of the phenomena around inflammation, mitochondrial dysfunction, change the microbiome, senescence sells, telomere shortening, epigenetic changes, stem cell exhaustion, protein damage, protein impact, proctostasis, like glycation of proteins, impaired autophagy, these are all affected by our diet. They’re all affected by what we’re eating. So what we’re eating is driving so many of these pathways. Now there are other reasons for inflammation or mitochondrial dysfunction, right? Like toxins or other things. But if you look at the problem of longevity and aging through the lens of functional medicine, you come up with a really clear map of how to deal with it, which is basically using the matrix. And in my book, I talked about the seven core physiological systems that have to be functioning. And when those are not functioning, you get problems with all the hallmarks, and that accelerates aging. So fixing the hallmarks is really about optimizing the matrix.

Kalea Wattles
Yeah, I love it. And one of my favorite terms that we’re using in functional medicine especially is inflammaging. And you talk about inflammaging as one of the hallmarks of aging. So my question is, can we make the case that to support someone’s longevity, we can kind of go inflammation hunting earlier on their timeline, looking at sources of chronic inflammation, periodontal disease, and intestinal hyperpermeability and toxin exposure? I mean, can we make a case for this?

Mark Hyman
Absolutely, absolutely. I mean, essentially in my book, I wrote a chapter called “Dying of Too Much or Dying of Too Little,” right? So it’s all the things you just mentioned. What is our diet? What is our exposure to toxins, our microbiome doing, infections, allergens, stress, poor diet, and what are we not getting that we need to thrive, right? The right whole foods, nutrient levels, balance of hormones, light, air, water, movement, rest, relaxation, sleep, connection, meaning love, purpose, all those things are critical for activating longevity pathways. And so how do you begin to sort of construct a clinical practice where you’re meaning to assess these dysfunctions, identify the problems, and then correct them?

Kalea Wattles
That’s great. It’s proactive. And I think as all of us are thinking about how we age, how our patients age, are there some biomarkers of biological age that you watch out for in routine testing? Or is there a health panel? What should we be looking for?

Mark Hyman
Well, I actually think it’s so important to map biology. And through functional medicine diagnostic tests, we do that looking at function, not just pathology, but there’s some newer tests, biological aging tests, which are basically DNA methylation tests. And a lot of the epigenetic changes that happen are mediated through these things like diet, exercise, stress, toxins, allergens, microbiome, and they all damage our epigenetic sort of marks in a sense. They cause more rapid aging. And that’s why we’re able to measure changes over time when we change the inputs. So Steven Horvath came up with the epigenetic clocks, and we’re now refining those. There’s a lot of companies offering those tests, but they’re still kind of all over the place. But I think we’ll get better at it. And I think we will have a biomarker to look at well, gee, if I do these interventions to my patient, what happens to their biological age care? Kara Fitzgerald did a great study, published it, looked at high functional medicine–type intervention, high fighter nutrient diet and lifestyle changes, and found that in eight weeks, they found a three-year reversal on epigenetic biological age, which I think is really impressive. So I think that’s possible. We’re just sort of at the beginning of what we can do.

Kalea Wattles
We’ve touched on nutrition a little bit, and I know nutrition plays such a vital role in healthy aging, our longevity. You did some studying in the Blue Zone areas. Will you enlighten us a bit about how food plays a role in a healthy aging process?

Mark Hyman
I mean, it is the most important thing, right? So if food is information, if food is medicine, then it’s the most powerful medicine around treatment for longevity. And in the Blue Zones, it was amazing. They basically had really traditional diets. They ate very phytochemical-rich diets. They didn’t eat much starch and sugar at all. They had very… I mean, they didn’t have any processed food as far as I could see. They did have cheese, and they did have animal products, but the animals were goats and sheep, and they were all sort of roaming around eating lots of wild plants. They knew, for example, that if they fed them this plant, that this time of year they would have better taste in the cheese or the milk or the meat. And it was because of the phytochemicals we now know are in the actual animal products, which we didn’t really even know before. So one of the guys, Ed Linto, said, “We flavored the animal before we kill it.” And I was like, what do you mean? He says, “Well, we know that if we feed it acorns and we feed it this and that, the other thing, carob, whatever, it’ll taste better, right?” So basically, it’s from the phytochemicals in the meat. So I think we have to understand that it’s really not complicated. It’s basically dramatically reducing or cutting out starch and sugar from our diet. Alcohol is an occasional treat, if at all. High levels of phytochemical-rich phyto fruits and vegetables, which really work through a process called phyto hormesis, which I talked about in the book. It’s basically the plant defense mechanisms, right, are the phytochemicals, and they activate various pathways, and they look like a hormetic stress to our body that activates healing systems. So for example, fisetinist activates pathways that lead to senolytic processes that kill zombie cells, or quercetin does the same thing or works through activating sirtuins or other pathways. So it’s really interesting to see how these phytochemicals work. I think the other piece is making sure we are giving a timing of eating, that we give a break of 12 to 14 hours between dinner and breakfast. I think also protein is important as we get older, really important. And I think it’s a… We can eat plant protein. So we have to either eat processed plant proteins with added amino acids or we have to eat animal protein, because you just cannot get the amount of protein you need as we get older, and you can’t get the amount of leucine, which you need, which is a rate-limiting step for muscle synthesis. So you need two and a half grams of leucine per serving and about 30 grams of protein, which is very hard. It’s like six cups of brown rice, for example, or two cups of beans to do that. So if you want to be vegan, you can, but you have to actually know what you’re doing, and you have to take supplemental plant protein. And I’ve seen big jacked up body builders who are vegan. I’m like, well, how do you do that? He’s like, well, I take six protein shakes a day from pea protein, and I put in all these amino acids, and I add in branched-chain aminos. And I’m like, okay, that’s not a whole-food diet. So I think you have to be realistic about what happens with anabolic resistance as we get older with the need to build muscle, maintain muscle. So it’s really a critical, particularly important piece of longevity strategy.

Kalea Wattles
Well, nutrition certainly plays an important role, but even beyond nutrition, I’ve heard you talk in the Blue Zones, you saw this sense of community also, togetherness, belonging, connectedness. Will you talk to us a little bit about the mental, emotional, spiritual component here with mental health and loneliness and trauma?

Mark Hyman
I mean, listen, being socially isolated and being lonely is equivalent of smoking two packs of cigarettes a day. Our surgeon general, Vivek Murthy, who’s on my podcast Doctor’s Farmacy, wrote a book called Together about the importance of addressing social isolation disconnection. In the Blue Zones, it was probably one of the most important things where they had such a tight-knit community, there was really no social isolation at all. Everybody was part of the fabric of that society. They celebrated together, they played together, they worked together, they helped each other, they talked, they relaxed, they enjoyed life. They really had a savoring of life, which we don’t do in rushing around. So that’s such an important piece. I saw recently a study where they looked at, you think, oh, in animals, you can do controlled studies because you have controlled environments. And they did a controlled study on rabbits where they basically gave them exactly the same atherosclerosis-promoting diet and exactly the same environment, except for one thing. One of the groups had the rabbits taken out of the cage and cuddled and played with by the researchers and the other ones didn’t. And there was dramatically more atherosclerosis in the ones that were socially isolated, even though they had exactly the same activity level, diet, and everything else. So it just underscores the importance. So we know, for example, cuddling improve your epigenetic expression. So there’s a lot of ways to improve your health, better diet and more cuddles.

Kalea Wattles
All right, more cuddling on the treatment plan. Noted. We’re taking a little tour of our modifiable lifestyle factors here. We’ve talked about nutrition, just covered some relationships. What about exercise? Is there a specific type of exercise? What is the role for intentional movement in supporting our longevity?

Mark Hyman
Well, exercise is interesting, because as I began to kind of research exercise through the lens of longevity, I was sort of shocked to understand how many of these hallmarks of aging are influenced by exercise. Obviously, our mitochondria, our microbiome, our inflammation, our nutrient-sensing pathways, all those four longevity switches, senescent cells, epigenetic changes, telomeres, all proteins, all positively benefited by exercise. So if there was like one single intervention that was somewhat more powerful than anything, it would be exercise, and resistance exercise in particular. So I was really impressed with how the science was sort of reflecting what we all know, but looking at it through the lens of not just how this affects diabetes, but how it affects all these really interesting sort of new discoveries around the hallmarks of aging.

Kalea Wattles
And how about as we kind of make our way through these modifiable lifestyle factors, we’ve talked about different stressors, but what about specifically psychological stress, and what do we need to be aware of in terms of our healthy aging and longevity?

Mark Hyman
I mean, that is the biggest factor. I mean, we talked a little bit about it with the social connection and social isolation and the need to build sort of a community. I think people focus on their diet. I think people focus on exercise and sleep, but I don’t… Even meditation. But I don’t think people focus enough on fostering, cultivating, building, nurturing their social community, their friends, their family, and making a big effort to invest time and energy into building those relationships that make it more of a difference than you can possibly imagine on your health. So I think whether it’s a Zoom meeting once a week with your friends who you have around the country or whether it’s an in-person hang or whether it’s just simple. It doesn’t even have to be complicated, you know? I mean, I think the more you can be seen, understood, and gotten, I think the better it is for your health and immune system. But even just being part of a bowling club or a knitting group is enhancing longevity.

Kalea Wattles
I think it’s so easy to deprioritize that social connection time because we can’t see a clear benefit where we know we need to get our work done and our laundry done and get kids to their sporting events. But I think the more we talk about the health benefits and implications of social connectedness and time with friends, I’m hoping we see this cultural shift where we start to prioritize that. And it sounds like that’s your hope too.

Mark Hyman
Absolutely, absolutely.

Kalea Wattles
Well, kind of on the flip side of all of these challenges to our longevity, in functional medicine, we talk about this concept of hormesis, that exposure to an adaptation to environmental stressors can have health benefits at times. One of these approaches that you’ve touched on is intermittent fasting or exposure to thermal stressors like cryotherapy or contrast hydrotherapy. This is one of the topics at our upcoming Annual International Conference. And I would love just to take a few minutes and get your thoughts on some of these challenges to our homeostasis.

Mark Hyman
Well, yeah, it was interesting. I just did a podcast with Susanna Solberg from Denmark, who is one of the leading researchers in hormesis therapies of hot and cold therapy. And her data is just really impressive showing the benefits to our health in terms of both cold and hot therapy and prolonging life. I mean, just saunas for example, in a Finnish study. The control group was one a week, they did four a week with the treatment group, and they basically found a 40 plus percent reduction in mortality. We see studies using heat therapy, increasing heat shock proteins, which help repair cells and damaged proteins. It increases innate immune system, increases heart variability, increases all these various pathways that enhance longevity. So we were historically having to deal with lots of physiological stresses. And so our bodies are very good at handling them. And what happens when we get stressed, we kick into healing repair mode. And so the basic thesis of the book is that we have an innate healing system and that the healing system has to be activated, and it can be activated by different stresses, exercise of stress, fastings of stress, heat therapies of stress, cold therapies of stress. When you do cold immersion, you increase dopamine, you increase adrenaline, you increase parasympathetic activation after a bit, you increase brown fat, which reduces inflammation, increases metabolism, reduces insulin resistance, and has how many positive benefits. So we have a lot of these incredible therapies that are available to us, whether it’s a cold shower or a hot bath or whether it’s a cold plunge or a sauna, whatever you like. Those are really powerful treatments that can actually help activate so much of your longevity switches. There’s a lot of things that you can do that are part of the toolkit we have as functional medicine doctors.

Kalea Wattles
A lot of tools in this toolbox. I had a mentor when I was in my 20s, and she had summited Mount Everest five times. And she said don’t wear so many coats, it’s good for us to be cold sometimes, it’s good to feel uncomfortable sometimes.

Mark Hyman
Yeah, yeah, exactly. Exactly. That’s right. And I think the whole idea of being uncomfortable is not a bad thing, and I think we get adapted to it. We get adapted to exercise. If you never lift weights and you lift weights, it’s going to be really uncomfortable and sore the next day. If you do it on a regular basis, you won’t. Or if you go in a sauna, it might be uncomfortable at first, and then you get adapted to it. And the same thing with cold therapy. So even though it sounds terrible, it actually can be very enjoyable.

Kalea Wattles
Well, on the topic of all of these different interventions, what would you say is one of the most exciting or innovating or promising new therapies that you’re feeling excited to learn about that has some potential to slow or maybe even reverse aging?

Mark Hyman
Well, I’m going to be speaking at the upcoming annual symposium, the AIC conference, and I’m excited about it. And I’m going to talk about some of these things. I think some of the interventions obviously are around hormetic therapies that I think are powerful. And one of the things we’ve found is that calorie restriction is a powerful hormetic therapy that can cause dramatic life extension, like 30 to 40%. And there are now calorie restriction mimetics, things like rapamycin, which I think are fascinating. How do we start to look at how do we activate these longevity switches and pathways with various interventions? And I’m going to talk quite a bit about that at the AIC, and I think that’s really interesting to me. I think some of these other therapies like hyperbaric oxygen and other hormetic therapy, very interesting. And how it works through increasing the destruction of zombie cells or senolytic cell, senescent cells, or increasing telomere length. So there’s a lot of really cool stuff to me around some of these interventions. I think we’re going to be learning about NAD and how that activates sirtuins and some of the controversy about that. I think there’s some really cool kind of things that are coming on the horizon. There’s also some stuff that’s really far out there, like the Yamanaka factors, which is not ready for prime time, and lots of really interesting advances. But this has been an area of research that’s been mostly neglected, and now there’s billions of dollars pouring into it from researchers, through two researchers who are getting funded by billionaires who don’t want to die. So there is a positive influence of money on this field, which is a good thing.

Kalea Wattles
Lots of emerging research and tools on the horizon. But what would you say, would you be willing to maybe share your top three strategies that someone like all of us with no fancy testing, no tools, three things that we can do every day to support our longevity?

Mark Hyman
Well, I think the first thing is focusing on food, right? And in terms of food, starch and sugar are the killers and accelerators of aging. Having lots of phytochemicals, having enough protein, which is usually about 1.6 grams per kilo. Probably double what the RDA is, which is the minimum amount not to get deficiency with the right amounts of leucine, either supplemented or as part of the food. And then I think resistance training is probably the next thing I would focus on, which is especially as you get older, build more muscle and maintain muscle. And then I would say focus on your social connections and relationships. And lastly, if you can add in a bunch of hormesis, great, hot and cold therapy, whatever you like. So those are my top tips.

Kalea Wattles
Well, on a related note, I know that you walk your talk and you have a biological age that’s a bit lower than your chronological age. So tell us, what does a day in the life of Dr. Mark Hyman look like? What’s your personal longevity protocol? We have to know.

Mark Hyman
Well, my biological age is 43, even though I’m 63, I think I’ve been living a healthy lifestyle my whole life. So that’s probably helped influence that.

Kalea Wattles
That helps.

Mark Hyman
Yeah, I sure try to do the things that I know work. I resistance train, I do yoga, I do cardio. I eat a very low starch, sugar diet, lots of high quality protein I’ve added, regeneratively raised goat whey, I use a few other things that I like, like urolithin A from pomegranate, which improves my autophagy and VO2 max and muscle strength and function. I’ll use extra creatine along with the goat whey for muscle building. I use the adaptogenic mushrooms, and this helps my resilience. I use also NMN product. I use a lot of quercetin. I use HTB Rejuvenate by Big Bold Health as a staple for longevity, because of course the 10 many other factors. So it’s kind of a mix, a cocktail of stuff. I make sure, going out with friends tonight, I make sure I have time with my partner. I make sure I take time with my family. So doing the best I can. Go to hot yoga after this. So hot yoga’s good because hormesis, it’s hot, it’s stretching, it’s cardio, it’s all benefit.

Kalea Wattles
We’re writing it all down. And you mentioned that in June, you’re presenting at The Institute for Functional Medicine’s Annual International Conference. So we’re so excited to hear you speak about the frontiers of longevity. Will you tell us what you’re looking forward to most at AIC? Some people describe it as a family reunion. What are you looking forward to?

Mark Hyman
Yeah, I mean, it’s been a while. I mean, COVID has been rough, and I miss seeing everybody, and so it’s like family, it’s like a part of the community, right? It’s that social community that we have where we recognize each other, we see each other, we’re all on the same path, we’re aligned in our vision, we’re all doing the same work. And that’s worth its weight in gold.

Kalea Wattles
Very good. Well, Dr. Hyman, it’s been such a pleasure to chat with you today. Thank you so much for all of these insights that we can apply to stay young forever. It’s just a joy to speak with you. Thanks so much for your time.

Mark Hyman
Aw, thank you so much. Really appreciate you, Kalea.

Kalea Wattles
IFM’s Annual International Conference returns to an in-person program this June 1-3. Hear from leading researchers and experts in functional medicine, including Dr. Hyman, who will present additional research on aging and longevity. Can attending AIC extend your lifespan and support your longevity? We’ll let you be the judge of that. Come join us this year in Orlando, Florida. Additional details are available at aic.ifm.org.

To join the conversation on this topic, visit IFM’s pages on Facebook and Instagram. For more information about functional medicine, visit IFM.org.

Show Notes:
Dr. Hyman’s latest book, Young Forever, is now available!
Learn more about his podcast, The Doctor’s Farmacy, by following @drmarkhyman on social media.

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