个性化长寿策略的重要性
@Elwin ：我认为制定个性化的策略远胜于采用通用的策略。每个人的情况都不同，适合一个人的方法可能不适合另一个人。因此，通过测试来制定个性化的策略至关重要。
@Miriam ：我非常赞同Elwin的观点。虽然有些通用的长寿建议，但真正有效的策略需要根据个人的具体情况进行调整。这包括考虑个人的基因、生活方式、健康状况等因素，以确保所采取的措施能够最大限度地发挥其益处。
我与Miriam医生最近进行了一次关于长寿的深入探讨。第一部分，我们主要关注导致过早衰老或降低寿命的根本原因，并强调了测试的重要性。制定个性化策略远胜于采用通用的策略。 每个人的情况都千差万别，一种方法对一个人有效，对另一个人可能毫无作用。因此，基于测试结果制定个性化策略至关重要。
尽管如此，在实际操作中，我发现很多长寿建议，即使并非放之四海而皆准，也至少适用于大多数人。因此，在本期节目中，我们与Miriam医生一起探讨了她最推荐的长寿策略。下半部分，我们将针对一些更高级的策略，例如雷帕霉素、生长激素等，进行深入分析，并探讨其有效性、成本效益以及潜在副作用。我们不会过多关注外貌，而是更关注如何提升健康寿命，让人感觉更年轻，活得更长久。
Miriam医生在亚洲的经历让她对长寿策略产生了浓厚的兴趣。她观察到，即使是上了年纪的亚洲人，也往往保持着较长的健康寿命，这引发了她对西方社会长寿策略的思考。她认为长寿不仅仅是外表年轻，更重要的是保持身体机能的平衡，包括力量、平衡感和认知功能。
Miriam医生推荐的长寿策略结合了生活方式调整和营养补充剂，以及一些新兴疗法，例如外泌体、PRP和雷帕霉素。
一些几乎人人适用的基础策略：
更高级的策略（将在后续文章中详细探讨）：
结论：
长寿策略并非一概而论，个性化方案至关重要。通过结合基因检测、生活方式调整和精准的营养补充与干预，我们可以最大限度地提升健康寿命，延缓衰老进程。 后续文章将深入探讨更高级的长寿策略，敬请期待。
延长健康寿命的目标与方法
@Miriam ：我们的目标是延长健康寿命，不仅仅是延长生物学上的寿命，更重要的是预防器官老化，保持活力和认知功能。我所采用的方法结合了生活方式策略、被低估的草药和补充剂，以及新兴疗法。对我来说，长寿的真正意义在于维持平衡，包括身体的平衡、力量和脑功能的平衡。 @Elwin ：我完全同意Miriam的观点。长寿不仅仅是活得更久，更重要的是活得更健康、更有活力。通过结合生活方式的调整和适当的补充剂，我们可以最大限度地延长我们的健康寿命，并保持高质量的生活。
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与Miriam医生合作的这次播客，我们深入探讨了如何延长健康寿命，而非仅仅延长生物学年龄。这不仅仅关乎活得更久，更关乎活得更健康、更有活力，并预防器官老化，保持旺盛的精力和敏锐的认知能力。
Miriam医生是一位功能医学专家，她的方法独具特色，巧妙地融合了多种策略：
总而言之，Miriam医生的方法强调了个性化和整体性。她认为，延长健康寿命需要一个多方面、持续性的策略，结合生活方式的调整、营养补充和适当的干预措施，才能达到最佳效果。 这并非一蹴而就，而是一个需要持续努力和调整的过程。 我们也将在后续的播客中继续探讨更多先进的长寿策略，敬请期待。
长寿的基础策略：营养、激素与血糖控制
@Miriam ：我认为促进长寿的基础策略包括：增强免疫功能的营养素，缓解衰老和压力的激素，以及控制血糖的物质。这些策略看似简单，但却是构建健康长寿的基础。例如，锌和维生素D对于维持免疫功能至关重要，而DHEA则有助于对抗压力和延缓衰老。同时，控制血糖水平对于预防慢性疾病和延长寿命也至关重要。这些基础策略为我们进一步探索更高级的长寿方法奠定了坚实的基础。
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我与Miriam医生最近进行了一次关于长寿的深入探讨，从基础策略到更高级的抗衰老干预措施，都进行了细致的分析。她强调，虽然个性化策略至关重要，但许多长寿建议具有普遍适用性，至少对大多数人有效。
Miriam医生认为，促进长寿的基础策略包括三个关键方面：
这些基础策略并非相互独立，而是相互关联、协同作用的。 她强调，建立良好的生活习惯，例如充足的睡眠、规律的运动和减轻压力，对于长寿同样至关重要。
在基础策略之上，Miriam医生还探讨了一些更高级的长寿干预措施，例如：
Miriam医生强调，这些高级策略需要在专业人士的指导下谨慎使用，并根据个人情况进行调整。
总而言之，Miriam医生强调长寿并非单一策略所能实现，而是一个需要个性化方案和持续努力的过程。从夯实基础的营养补充和生活习惯调整，到谨慎尝试更高级的干预措施，都需要在专业人士的指导下进行，并根据自身情况不断调整和优化。 只有这样，才能在追求长寿的道路上走得更稳、更远。
胸腺在免疫系统和长寿中的关键作用
@Miriam ：胸腺是免疫系统发育和维持的重要场所，它产生并成熟免疫细胞。保持胸腺健康对身体识别和响应病原体、异常细胞至关重要，有助于预防感染、癌症和炎症。胸腺退化是导致老年人更易受感染、神经退行性疾病和自身免疫性疾病影响的原因之一。胸腺退化还会导致体内积累衰老免疫细胞，产生大量炎症细胞因子。虽然胸腺萎缩不可完全逆转，但我们可以减缓这一过程。
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我最近与Miriam医生进行了一次关于长寿的深入访谈，她是一位功能医学专家，拥有丰富的临床经验。我们探讨了多种延缓衰老的策略，其中一个核心观点是：保持胸腺健康至关重要。
Miriam医生指出，胸腺是免疫系统发育和维持的重要场所，它负责产生并成熟免疫细胞。一个健康的胸腺，能够帮助身体有效识别并响应各种病原体和异常细胞，从而预防感染、癌症和炎症——这些都是加速衰老的重要因素。
随着年龄增长，胸腺会逐渐萎缩，这种现象被称为胸腺退化。胸腺退化的后果不容忽视：它会削弱免疫功能，使老年人更容易遭受感染、神经退行性疾病（如阿尔茨海默病）以及自身免疫性疾病的困扰。更重要的是，胸腺退化还会导致衰老免疫细胞在体内积累，这些“僵尸细胞”会释放大量炎症细胞因子，进一步加剧衰老进程。
虽然我们无法完全逆转胸腺萎缩，但Miriam医生强调，我们可以通过一些方法来减缓这一过程，从而维护免疫系统，延缓衰老。她提到的方法包括补充特定的营养素，例如维生素D、维生素K2、纳豆激酶和锌等。这些营养素对免疫功能、激素平衡以及血糖控制都至关重要，能够协同作用，支持胸腺健康。
Miriam医生还特别强调了锌的重要性。她指出，锌是许多体内生化反应的辅因子，对免疫健康和激素平衡至关重要，甚至参与衰老细胞的清除。她偏好使用锌的某些特定形式，例如锌吡啶甲酸盐，并建议根据个体情况调整剂量，同时关注锌与其他矿物质（如铜）之间的平衡。
总而言之，Miriam医生的观点为我们对抗衰老提供了新的视角：关注胸腺健康，维护免疫系统，是延缓衰老，提升健康寿命的关键策略之一。 通过补充必要的营养素，并采取积极的生活方式干预，我们可以有效减缓胸腺萎缩，从而为健康长寿奠定坚实的基础。 这并非仅仅是关于“活得更久”，更是关于“活得更好”。
维生素D、K2、锌：长寿的基础补充剂
@Miriam ：我认为多数人需要补充维生素D，即使在阳光充足的地区。冬季建议每日至少服用5000单位维生素D，对于水平极低的人，甚至可高达10000单位。我喜欢将维生素D与MK7形式的维生素K2搭配使用，并将MK7、纳豆激酶作为长寿补充剂。锌是多种身体反应的辅助因子，对免疫和激素健康至关重要，对长寿也很重要。我通常建议成年人服用约30毫克锌，我喜欢使用吡啶甲酸锌。锌可能会耗尽铜，但通过食物通常可以平衡。减少铁作为一种长寿策略是有效的，特别是当铁水平高时。
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作为一名功能医学医生，我致力于帮助人们延长健康寿命，而非仅仅延长寿命。在与Owen Orngson的访谈中，我分享了一些我认为对大多数人都有效的长寿策略，这些策略并非放之四海而皆准，但至少适用于大多数人。
维生素D和K2：免疫与骨骼健康的基石
我认为多数人需要补充维生素D，即使在阳光充足的地区。许多人难以从阳光中充分吸收维生素D。冬季，我通常建议每日至少服用5000单位维生素D，对于维生素D水平极低，甚至可能存在维生素D受体问题的个体，剂量可高达10000单位。 值得注意的是，维生素D是脂溶性维生素，肠道功能不佳者可能难以吸收，因此需要先改善肠道健康。
我喜欢将维生素D与MK7形式的维生素K2搭配使用。MK7和纳豆激酶也是我推荐的长寿补充剂，至今我尚未观察到其明显的负面作用。
锌：免疫平衡与激素健康的关键
锌是许多身体反应的辅助因子，对免疫健康和激素平衡至关重要，对长寿也大有裨益。我通常建议成年人每日服用约30毫克的锌，并偏好使用吡啶甲酸锌，因为它吸收效果好。高剂量锌用于治疗情绪障碍，并能有效降低氧化应激。
需要注意的是，高剂量锌可能导致铜的流失。然而，根据我的临床经验，大多数人的饮食中铜的含量高于锌，因此通常能够保持平衡。必要时，我会补充少量铜以维持平衡。
铁：适量摄入，避免过量
减少铁的摄入量作为长寿策略是有效的，尤其是在铁水平过高的情况下。 然而，对于经期出血较多的女性或铁水平较低的个体，则不应刻意减少铁的摄入。 在铁水平稳定的情况下，如果个体有铁蓄积的倾向，我会考虑使用螯合剂来降低铁水平。
其他重要补充
除了以上几种营养素，我还经常建议我的客户关注其他影响长寿的因素，例如：
总而言之，延长健康寿命是一个复杂的过程，需要个性化的策略。 以上只是一些我常用的，并认为对大多数人有效的策略。 建议在补充任何营养素之前咨询医生，并进行必要的检测以确定自身的需求。 只有在医生的指导下，才能制定最适合您的长寿计划。
二甲双胍与黄连素：血糖控制与长寿
@Miriam ：二甲双胍传统上用于降低血糖和胰岛素，但现在知道高胰岛素会促进炎症和衰老。二甲双胍通过抑制肝脏从非碳水化合物来源产生葡萄糖来降低血糖。大剂量服用二甲双胍可能会消耗体内的其他营养素，其副作用包括胃肠道问题，这可能会影响肠道微生物群和营养吸收。黄连素激活AMPK，降低血糖水平，有助于治疗脂肪肝和糖尿病，并作为抗炎剂。黄连素的副作用通常比二甲双胍轻微。我更喜欢黄连素，因为草药中的化合物协同作用，可能比完全分离的化合物效果更好。如果长期服用黄连素以降低胰岛素水平，则需要更均衡的配方。 Miriam：在我的实践中，我看到的一个大问题是没有Akkermansia。Akkermansia在分解粘液方面起着重要作用，粘液是肠道屏障的重要组成部分。Akkermansia能够将益生元转化为短链脂肪酸，这对健康的肠道屏障至关重要。Akkermansia调节血糖水平并减少脂肪积累，水平低会增加患2型糖尿病和其他代谢疾病的风险。
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我最近与功能医学专家Miriam医生进行了一次深入的访谈，探讨了长寿策略。访谈中，我们详细讨论了多种方法，其中关于二甲双胍和黄连素的比较，以及肠道菌群Akkermansia的重要性尤为引人注目。
Miriam医生指出，二甲双胍传统上用于降低血糖和胰岛素，而高胰岛素水平会促进炎症和衰老。二甲双胍的作用机制是抑制肝脏从非碳水化合物来源产生葡萄糖。然而，大剂量服用二甲双胍可能会导致其他营养素的消耗，并伴随胃肠道问题等副作用，这些问题反过来会影响肠道微生物群和营养吸收。
相比之下，Miriam医生更倾向于使用黄连素。黄连素同样能够激活AMPK，降低血糖水平，并有助于治疗脂肪肝和糖尿病，同时还具有抗炎作用。重要的是，黄连素的副作用通常比二甲双胍更轻微。 她解释说，这可能是因为草药中的化合物并非完全分离，而是协同作用，从而产生比单一化合物更佳的效果。当然，如果长期服用黄连素以降低胰岛素水平，则需要搭配更均衡的配方以避免潜在的营养缺乏。
另一个关键点在于肠道菌群Akkermansia。Miriam医生在临床实践中发现，许多人缺乏Akkermansia，这是一种对肠道健康至关重要的细菌。 Akkermansia在分解粘液方面起着关键作用，而粘液是肠道屏障的重要组成部分。它能够将益生元转化为短链脂肪酸，这些脂肪酸对维持健康的肠道屏障至关重要，进而影响免疫平衡和炎症水平。此外，Akkermansia还能够调节血糖水平并减少脂肪积累。Akkermansia水平低与2型糖尿病和其他代谢疾病的风险增加密切相关。
总而言之，在选择长寿策略时，需要综合考虑个体差异和潜在风险。虽然二甲双胍在降低血糖方面有效，但其副作用不容忽视。黄连素作为一种更温和的替代品，值得关注。同时，关注肠道菌群Akkermansia的平衡，对于维持整体健康和长寿也至关重要。 个性化方案，结合生活方式调整和营养补充，才是实现长寿目标的关键。
DHEA在长寿中的作用与应用
@Miriam ：DHEA是我最喜欢的长寿干预措施之一，它是一种由肾上腺产生的激素，有助于对抗皮质醇。DHEA是雌激素和睾酮的前体激素。改善激素代谢，仍然可以考虑DHEA。我通常不使用特别高剂量的DHEA，我会重新测试。身体脂肪水平会影响DHEA向雌激素的转化。如果睾酮或雌激素水平过高，不应直接补充DHEA，而应先解决其他问题。对于男性，我通常从20到25毫克开始，而对于女性，我从10毫克开始。对于那些睾酮水平高或服用DHEA后出现痤疮等症状的人，我会使用7-酮DHEA。 Miriam：在长寿领域，我们正在替代随着年龄增长而下降的激素，并将激素下降视为衰老的迹象。如果你压力很大，DHEA水平可能很低，需要采取措施。女性在更年期前寿命更长，但更年期后，心血管疾病的保护作用消失，激素下降是其中一个因素。
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DHEA，全称脱氢表雄酮，是我最喜欢的长寿干预措施之一。它由肾上腺产生，扮演着对抗皮质醇（压力荷尔蒙）的重要角色，维持身体平衡。 DHEA同时也是雌激素和睾酮的前体激素，这使得它的应用需要谨慎考量。
我的临床经验表明，单纯关注DHEA数值是不够的。我们需要全面评估个体的激素代谢状况。即使激素代谢存在问题，在改善代谢后，仍然可以考虑补充DHEA，以帮助恢复身体的自然平衡。
我通常不建议使用过高的DHEA剂量。我通常会从较低剂量开始，例如男性20-25毫克，女性10毫克，并根据个体情况和随访检测结果进行调整。 定期复查血液检测结果至关重要，这能帮助我们及时了解DHEA的实际效果，并根据需要调整剂量。
身体脂肪水平会显著影响DHEA向雌激素的转化。高体脂率的个体，DHEA更容易转化为雌激素，这需要我们格外注意。 如果个体已经存在高睾酮或高雌激素的情况，例如多囊卵巢综合征（PCOS）患者，我不建议直接补充DHEA。 此时，更应该优先解决潜在的激素失衡问题，例如改善胰岛素抵抗，然后再考虑是否需要补充DHEA。
在长寿领域，我们关注的是健康寿命的延长，而非仅仅是外貌的年轻化。 随着年龄增长，许多激素水平会自然下降，而我们将这种下降视为衰老的一个标志。 补充DHEA，正是为了弥补这种自然下降，帮助维持身体的年轻态。
压力是导致DHEA水平下降的重要因素。 长期处于高压状态下的人，即使年轻，也可能拥有与老年人相似的低DHEA水平。 因此，积极管理压力，改善生活方式，对于维持正常的DHEA水平至关重要。
女性在更年期前通常拥有比男性更长的寿命，这与她们相对稳定的激素水平有关。然而，更年期后，女性失去了一些保护她们免受心血管疾病侵害的激素优势，心血管疾病发病率反而上升。 激素水平的下降被认为是导致这一现象的重要因素之一。 因此，对于女性而言，关注更年期后的激素平衡，对于维护健康至关重要。
总而言之，DHEA的补充并非一概而论，需要根据个体情况进行个性化评估和调整。 在专业医生的指导下，合理使用DHEA，可以帮助我们更好地对抗衰老，延长健康寿命。
生长激素与雷帕霉素：平衡生长与衰老
@Miriam ：该研究使用了每天约1毫克的生长激素，为期一年。一方面，我们希望保持肌肉质量和良好的细胞修复，生长激素在这方面起着重要作用。另一方面，为了防止衰老，我们希望减缓身体的进程，以避免产生炎症细胞因子的过程。现在，长寿社区的提倡者实际上将生长激素与雷帕霉素交替使用，以减轻影响。生长激素有助于细胞再生、肌肉保护、减少脂肪和骨密度。生长激素会促进那些易患某些癌症或已经有癌细胞的人的癌细胞生长。在开始使用生长激素之前，需要仔细评估激素排毒情况。 Miriam：从成本和副作用的角度来看，我非常喜欢Ipamorelin CJSA 1295。对于那些激素排毒不良风险较高的人，我更喜欢使用肽类而不是生长激素本身。肽类药物产生阴性副作用的风险较低。可以通过高强度训练、力量训练和充足睡眠来刺激生长激素释放。
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我最近与Miriam医生进行了一次关于长寿策略的深入探讨，其中关于生长激素的部分尤其引人注目。她分享了其在临床实践中的经验，以及对生长激素在长寿策略中作用的独到见解。
Miriam医生指出，一项研究使用了每天约1毫克的生长激素，持续一年。这项研究的结果显示了生长激素的双面性。一方面，生长激素对于维持肌肉质量和促进细胞修复至关重要；另一方面，为了对抗衰老，我们也需要减缓身体的某些进程，避免过度刺激导致炎症细胞因子的产生。
因此，她认为，将生长激素与雷帕霉素交替使用是一种更平衡的策略。生长激素带来的益处包括促进细胞再生、保护肌肉、减少脂肪和增强骨密度。然而，她也强调了生长激素的潜在风险：它可能促进那些易患某些癌症或已存在癌细胞的人的癌细胞生长。因此，在考虑使用生长激素之前，必须仔细评估个体的激素排毒能力。
在谈到生长激素的替代方案时，Miriam医生表示，她更倾向于使用生长激素促进肽类，例如Ipamorelin和CJC-1295。从成本和副作用的角度来看，这些肽类药物更具优势，并且在那些激素排毒能力可能较弱的人群中，风险也更低。此外，她还提到，高强度训练、力量训练和充足的睡眠也能有效刺激生长激素的自然释放。
总而言之，Miriam医生认为生长激素在长寿策略中扮演着复杂的角色。其益处与风险并存，需要谨慎评估个体情况，并结合其他策略，例如雷帕霉素的交替使用，才能最大限度地发挥其益处，并降低潜在风险。 她更推荐使用更安全、更经济的生长激素促进肽类作为替代方案。
睡眠与褪黑素在长寿中的作用
@Miriam ：优化睡眠对于长寿至关重要。从激素的角度来看，我也喜欢使用褪黑素。我对褪黑素的看法基本上是积极的。使用高剂量褪黑素治疗免疫抑制患者的研究表明其安全性。嗜睡可能是身体需要更多褪黑素的信号。在健康风险方面，可以安全地增加到至少24毫克，看看第二天是否感觉不那么困倦。我的一些患者在40甚至50年前就开始服用褪黑素，我没有看到任何问题。理想情况下，应该在睡前30分钟到一个小时服用褪黑素。如果你的排毒途径不佳，褪黑素可能效果不佳，你应该优化排毒途径和DNA甲基化途径。我喜欢使用脂质体形式和液体的褪黑素。
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睡眠优化对长寿至关重要。从激素调节的角度出发，我经常建议患者使用褪黑素。基于我的临床经验，我对褪黑素的疗效持积极态度。
高剂量褪黑素的安全性
一些研究，例如使用高剂量褪黑素（例如200毫克）治疗接受化疗的免疫抑制患者的研究，证明了其安全性。 这让我对褪黑素的安全性更有信心。
嗜睡？或许你需要更多褪黑素
许多人服用褪黑素后第二天感到嗜睡。有趣的是，有些人认为这其实是身体需要更多褪黑素的信号。我自己也尝试过这种方法，发现增加剂量到10毫克以上后，第二天嗜睡的情况有所缓解。当然，如果服用褪黑素后感到嗜睡，务必注意安全，避免驾驶或从事需要高度警觉的工作。但在健康风险方面，我认为可以安全地将剂量增加到至少24毫克，观察第二天是否感觉不那么困倦。
长期服用褪黑素的观察
我有一些患者在40甚至50年前就开始服用褪黑素，至今未发现任何不良反应，这进一步支持了我的观点。
服用时间与排毒效率
理想情况下，褪黑素应该在睡前30分钟到1小时服用，这样才能在入睡前达到最佳血药浓度。 然而，如果你的身体排毒途径（例如肝脏解毒功能）或DNA甲基化途径效率低下，褪黑素的吸收和利用率可能会降低，从而影响其效果。因此，优化这些途径至关重要。
褪黑素的剂型选择
就剂型而言，我更倾向于使用脂质体形式和液体的褪黑素，因为它们通常比胶囊更容易吸收。
总结
褪黑素在促进睡眠和潜在的长寿方面具有积极作用。 然而，个体差异很大，剂量和服用时间需要根据个人情况调整。 重要的是，要关注自身的身体反应，并结合优化排毒和甲基化途径等整体策略，才能最大限度地发挥褪黑素的益处。 如有任何疑问，请咨询专业医疗人士。
卡路里限制与禁食：长寿策略的个性化
@Miriam ：每个人都可以采用某种程度的卡路里限制，但卡路里限制的类型需要个性化。激素失衡的人可能难以进行长时间的卡路里限制或禁食。寿命最长的人通常身体处于低代谢状态，这意味着低卡路里和低。蓝区的人通常饮食中蛋氨酸含量较低。我喜欢将医学科学与人类学相结合，看看长寿的人做了什么。冲绳人总是吃到八分饱。我通常支持过夜禁食，大约12到16个小时，但我不太喜欢一整天的禁食。如果你试图在禁食的同时工作，由于皮质醇水平已经很高，禁食会使问题变得更糟。日本人计划饮食的方式不同，他们能够摄入更少的卡路里。
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Miriam 医生指出，每个人都可以采用某种程度的卡路里限制，但这需要个性化。激素失衡，特别是皮质醇水平异常的人，可能难以进行长时间的卡路里限制或禁食。 她认为，寿命最长的人通常身体处于低代谢状态，这与低卡路里摄入和低能量消耗密切相关。
研究蓝区居民的饮食习惯，可以发现一个共同点：他们通常摄入的蛋氨酸较少。 这与一些长寿研究的结论相符。我个人也认同将医学科学与人类学研究相结合，从长寿人群的实际生活方式中寻找答案。例如，冲绳人长期以来就遵循“八分饱”的饮食习惯，这是一种自然的卡路里限制方式。
在卡路里限制的实践方面，我更倾向于支持过夜禁食，时间大约在12到16小时之间。然而，我不建议进行一整天的禁食，尤其是在需要保持日常工作和生活的情况下。因为现代人的压力水平普遍较高，皮质醇水平往往已经很高，而禁食可能会进一步加剧这种情况，导致身体承受更大的压力。
与单纯的卡路里限制相比，日本人通过不同的饮食计划方式，能够在摄入看似较多食物的情况下，实际控制卡路里摄入量，这值得我们学习。 总而言之，卡路里限制并非一刀切，需要根据个体情况进行调整，并结合其他健康生活方式，才能真正促进长寿。
慢性压力对长寿的负面影响与应对策略
@Miriam ：慢性压力可能是对长寿最不利的因素。积极测量肾上腺的压力水平是证明压力对你的生活有不良影响的最佳策略之一。男性通常不认为自己有压力，但肾上腺测试显示皮质醇水平很高，DHEA水平很低。需要从饮食、睡眠、人际关系和工作等方面采取360度的方法来降低压力。有很多研究支持冥想等实践对长寿的作用。每个人都必须有某种形式的冥想、祈祷或反思时间。如果你无法坐下来呼吸五分钟，并且不会感到烦躁，那么你需要解决这个问题。运动，但不要太剧烈，可以帮助释放肾上腺素。
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Miriam医生，一位功能医学专家，在长寿研究领域拥有丰富的经验。她指出，慢性压力可能是对长寿最不利的因素。 许多人，特别是男性，往往忽视压力的影响，认为自己并不感到压力。然而，这并不意味着他们的身体没有承受压力。 Miriam医生强调，积极测量肾上腺的压力水平，是判断压力是否对生活造成不良影响的最佳策略之一。高皮质醇和低DHEA水平往往预示着身体处于慢性压力状态，即使个体主观感受不到压力。
为了有效地管理压力，Miriam医生建议采取全面的360度方法，涵盖饮食、睡眠、人际关系和工作等各个方面。她特别提到，有很多研究支持冥想等实践对长寿的作用。 她认为，每个人都应该拥有某种形式的冥想、祈祷或反思时间，即使只是短短的五分钟。 如果连坐下来平静呼吸五分钟都感到困难，这本身就是一个需要解决的问题，暗示着个体可能处于高度压力状态。
此外，适度的运动，而非剧烈运动，也可以帮助释放肾上腺素，缓解压力。 Miriam医生建议，找到适合自己的压力管理方法，并坚持实践。 她强调，这并非一蹴而就，而是一个需要持续努力的过程。 通过平衡压力，我们可以更好地维护身心健康，为长寿奠定坚实的基础。
雷帕霉素：起源、作用与应用
@Miriam ：雷帕霉素来自复活节岛上分离出的一种细菌。研究人员发现复活节岛的居民皮肤上有更多的这种细菌，这似乎对伤口愈合有保护作用。雷帕霉素可以抑制对癌症至关重要的途径。我们不想将你的免疫系统抑制到那种程度。对于那些患有自身免疫性疾病的人，或者我们认为炎症可以由你自己的免疫系统刺激的人，我们可能会抑制免疫系统。雷帕霉素已经扩大了每种生物的寿命。他们正在尝试使用雷帕霉素进行为期两年的犬类长寿研究。雷帕霉素每周服用一次，三个月开，三个月关。雷帕霉素可以开启自噬，帮助清除那些退化的细胞器和蛋白质，以及那些我们不希望存在的衰老细胞。雷帕霉素甚至可以帮助治疗长期COVID、情绪以及炎症性神经退行性疾病。
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我最近与功能医学专家Miriam医生进行了一次深入的访谈，探讨了长寿策略。其中，她特别提到了雷帕霉素（Rapamycin）这种化合物，它的来源和作用机制都相当引人入胜。
Miriam医生指出，雷帕霉素并非人工合成，而是来自复活节岛上分离出的一种细菌。研究人员发现，复活节岛的原住民皮肤上存在这种细菌的比例更高，这与他们更快的伤口愈合能力似乎存在关联。更重要的是，雷帕霉素能够抑制对癌症生长和扩散至关重要的细胞途径，这为其在抗衰老领域的应用提供了理论基础。
然而，需要注意的是，雷帕霉素作为药物时，其剂量远高于用于抗衰老的剂量。高剂量雷帕霉素会显著抑制免疫系统，这在器官移植手术后用于防止排异反应时是必要的。但对于普通人群，我们并不希望过度抑制免疫系统。Miriam医生强调，雷帕霉素在抗衰老领域的应用，更侧重于调节免疫系统，而非完全抑制。对于自身免疫性疾病患者，或炎症反应过度活跃的人群，适度调节免疫系统或许能带来益处。
雷帕霉素的广泛作用已在多种生物体中得到证实，它显著延长了实验动物的寿命。目前，甚至有研究团队正在进行为期两年的犬类长寿研究，以进一步评估雷帕霉素对犬类寿命的影响。
在实际应用中，Miriam医生建议采用“三个月开，三个月关”的周期性服用方案，每周仅服用一次。这种低剂量、周期性服用的策略，旨在最大限度地发挥雷帕霉素的益处，同时降低潜在的副作用。
雷帕霉素的主要作用机制在于开启自噬作用 (autophagy)。自噬是细胞内的一种“自我清洁”机制，它能够清除受损的细胞器、错误折叠的蛋白质以及衰老细胞（senescent cells），这些都是导致衰老和疾病的重要因素。通过促进自噬，雷帕霉素有助于维持细胞的健康和功能，从而延缓衰老进程。
除了延缓衰老，研究还表明雷帕霉素可能对多种疾病具有潜在的治疗作用，包括长期COVID、情绪障碍以及炎症性神经退行性疾病。这进一步凸显了雷帕霉素在抗衰老和疾病治疗领域的巨大潜力。
总而言之，雷帕霉素这种源自复活节岛的化合物，以其独特的机制和广泛的益处，为长寿研究和抗衰老策略提供了新的方向。然而，任何补充剂或药物的应用都应在专业医生的指导下进行，以确保安全性和有效性。 切勿自行尝试，尤其涉及到免疫系统调节的药物。
雷帕霉素的剂量与周期
@Miriam ：我只是被教导要这样给药。你想要激活那个回收过程。也许你只是想让你的身体有时间休息，然后再做一次。在不使用雷帕霉素的三个月里，你可以使用生长激素或生长激素类似物。这样你就可以平衡生长激素的生长和增殖，以及雷帕霉素对身体的减缓。我使用更多的肽类。我确实开生长激素，但通常因为它是每天使用的，你通常必须自己注射。我同时使用生长激素促进肽类和雷帕霉素。我总是循环使用雷帕霉素。
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我经常被问及雷帕霉素（Rapamycin）和生长激素的联合使用，以及如何优化其疗效。 这篇文章将分享我个人的临床经验和对这两种疗法的看法。
首先，关于雷帕霉素的剂量，我通常建议每周服用4-6毫克，剂量较低。这种低剂量疗法，在我看来，副作用相对较小，我观察到的主要副作用是口腔溃疡，以及少数患者出现血糖和胆固醇升高的情况。 重要的是，我并没有观察到患者因雷帕霉素而更容易感染。 许多人将雷帕霉素服用后出现的长时间流鼻涕等症状误认为是感染加重，实际上这更多的是病毒感染后的炎症反应，而非活跃感染本身。雷帕霉素能够有效减轻这种炎症反应。
至于雷帕霉素的服用周期，我通常建议“三个月服用，三个月停用”的循环模式。我只是被教导要这样给药。 我的理论是，你想要激活细胞自噬（autophagy）的回收过程，而这个过程也可能消耗部分抗氧化剂。因此，让身体有时间休息，然后再进行下一轮疗程，可能更有利于整体的健康。
关于生长激素，我更倾向于使用生长激素促进肽类（例如Ipamorelin和CJC-1295），而非直接使用生长激素。原因在于：肽类成本更低，副作用也更小。例如，生长激素有时会升高皮质醇水平，而肽类则较少出现这种情况。 在不使用雷帕霉素的三个月里，你可以使用生长激素或生长激素类似物。这样你就可以平衡生长和增殖（生长激素的作用）与身体的减缓（雷帕霉素的作用）。 我个人并不总是要求患者在使用雷帕霉素期间停止使用生长激素，但我会建议在雷帕霉素停药期间使用生长激素或其类似物。
总而言之，雷帕霉素和生长激素的联合应用需要个性化方案，并密切监测患者的反应。 我的临床经验表明，低剂量、周期性服用雷帕霉素，并结合生长激素促进肽类，是一种相对安全且有效的策略，可以帮助改善炎症、促进细胞再生，并延缓衰老。 但任何疗法都并非万能，需要根据个体情况进行调整和评估。
GLP-1激动剂：益处与风险
@Miriam ：我见过一些非常不健康的人，减轻他们的体重和降低他们的胰岛素水平可以成为他们应用更好生活方式的催化剂。我们必须警惕这种有效的东西可能会有一些副作用。我们要减轻那些副作用，或者尝试促进那些被GLP-1损害的器官的健康。例如，胰腺功能，我们看到胰腺炎的发病率在服用GLP-1激动剂的人群中大幅上升。我不会盲目地给予GLP-1，而不关心支持。即使是每周50到100微克也行。还有一些天然的GLP-1激动剂。一种叫做americate的化合物，据信来自啤酒花植物，也有助于增加内源性GLP-1的产生。某些细菌，如Akkermansia和其他一些菌株，也有助于增加内源性GLP-1的产生。
在探索长寿策略的过程中，我接触到许多不同寻常的案例。其中，GLP-1激动剂（如司美格鲁肽）的应用给我留下了深刻的印象，但也引发了我的谨慎思考。
我见过一些非常不健康的个体，通过减轻体重和降低胰岛素水平，他们的健康状况得到了显著改善，这成为了他们积极改变生活方式的催化剂。GLP-1激动剂在这方面展现出了令人瞩目的疗效。然而，我们必须警惕：如此有效的药物，其副作用也值得关注。
我的临床经验表明，我们需要谨慎对待GLP-1激动剂的长期应用和高剂量使用。 一些患者在使用高剂量GLP-1激动剂后出现了胰腺炎等问题，这警示我们必须关注其对器官健康的影响，特别是胰腺功能。因此，我不会盲目地推荐GLP-1激动剂，而是会仔细评估患者的整体健康状况，并提供必要的支持性治疗。
我通常建议从低剂量开始，例如每周50到100微克，这远低于临床常用的剂量。 这并非意味着否定GLP-1激动剂的价值，而是强调了个体化治疗的重要性。 我们需要根据患者的具体情况，调整剂量和治疗方案。
值得一提的是，也存在一些天然的GLP-1激动剂。例如，来自啤酒花植物的americate化合物，以及某些肠道菌群（如Akkermansia）都能促进内源性GLP-1的产生。 在使用GLP-1激动剂之前，我会先评估患者的肠道健康状况，并采取措施改善肠道菌群平衡，这有助于减少副作用，并提高治疗效果。
总而言之，GLP-1激动剂在辅助改善代谢健康方面展现出潜力，但其应用需要谨慎。 低剂量、个体化治疗以及必要的支持性措施，是安全有效地利用GLP-1激动剂的关键。 我们应该将它视为一种辅助工具，而非万能的解决方案，并始终关注患者的整体健康状况。
Edit:2025.03.01
本章探讨了广泛适用的长寿建议，重点关注基本营养素和激素支持。它强调了胸腺健康的重要性，以及锌、维生素D和维生素K2在免疫功能和抗衰老中的作用。
本节深入探讨了锌的重要性、它与铜和铁的相互作用，以及它在长寿策略中的作用。它还讨论了二甲双胍和黄连素作为血糖调节剂的作用，以及Akkermansia菌的重要性。
本节重点介绍了Akkermansia，这是一种对肠道屏障健康、营养分解和血糖调节至关重要的肠道细菌。讨论还涵盖了Akkermansia补充的挑战及其在预防代谢疾病中的重要性。
本章探讨了二甲双胍和黄连素在长寿中的优缺点。它强调了黄连素因其副作用较轻而更受青睐，并可能与其他植物化合物产生协同效应。
本节讨论了DHEA（脱氢表雄酮）的作用，它在对抗皮质醇中的作用，以及它作为长寿干预措施的使用。它解决了关于DHEA转化为雌激素和睾酮的担忧，并建议了适当的剂量策略。
本章解决了关于激素替代疗法的常见担忧，特别是关于DHEA的担忧。它强调了激素替代疗法在对抗年龄相关衰退、提高生活质量和寿命方面的重要性。
本节探讨了生长激素在长寿中的作用，解决了关于癌症风险的担忧，并探讨了生长激素释放肽和MK-677等替代方案。讨论强调了每种方法的优点和缺点。
本章讨论了褪黑激素在长寿、睡眠优化和解毒中的作用。它解决了关于激素抑制和嗜睡的担忧，并提供了优化褪黑激素使用的策略。
本节探讨了长寿的卡路里限制策略，强调了个性化方法的重要性，并避免极端禁食的负面影响。它强调了正念饮食和社交联系的重要性。
本章强调了慢性压力对长寿的有害影响。它讨论了通过冥想和运动等压力管理技术来改善整体健康和降低肾上腺素水平的重要性。
本节探讨了雷帕霉素的起源及其低剂量用于长寿的用途。它讨论了其作用机制、潜在副作用和最佳剂量策略。
本章探讨了通过平衡雷帕霉素与生长激素或其类似物来实现长寿的策略。它讨论了循环使用雷帕霉素的理由，并建议使用生长激素释放肽作为生长激素的更安全替代方案。
本节探讨了使用GLP-1激动剂（如索马鲁肽）进行减肥和长寿的用途。它警告不要使用高剂量，并强调了营养支持和缓解潜在副作用的重要性。
衰老的成因及评估方法
@Dr. Miriam McKitsky : 我专注于健康寿命的研究,因为东亚人的衰老方式启发了我。我认为长寿不等于健康,更重要的是拥有更长的健康和青春活力。我将加速衰老的原因归纳为遗传因素、表观遗传因素、慢性压力、病原体、污染物和昼夜节律紊乱等。 慢性压力是加速衰老的主要因素之一,皮质醇等激素虽然在应激反应中发挥作用,但也具有破坏性。长期高水平的皮质醇和肾上腺素会破坏肌肉、肠道屏障,导致血糖升高和炎症。 衰老的标志包括基因组不稳定性(DNA损伤和突变积累)、端粒磨损(端粒随着细胞分裂而缩短)、表观遗传改变(影响基因表达)、蛋白质稳态丧失(蛋白质错误折叠和积累)、巨自噬作用受损(细胞清除受损细胞器和蛋白质的能力下降)、营养物质感知失调(身体调节营养物质感知和代谢的途径出现紊乱)、线粒体功能障碍(线粒体产生能量减少,产生更多活性氧和自由基)、细胞衰老(细胞停止分裂但仍保持代谢活性)、干细胞衰竭(干细胞分化和自我更新能力下降)和慢性炎症(促进斑块积聚、内皮细胞损伤和各种疾病的发生)。肠道菌群失调也会影响消化吸收、免疫功能和毒素产生,从而影响衰老。 除了上述因素外,脱氢表雄酮(DHEA)和三碘甲状腺原氨酸(T3)等激素水平也能反映衰老速度。
@Elwynn Robinson : 我认为间歇性压力可能是有益的,因为它能增强身体的适应能力,但长期高水平的压力则有害。评估衰老速度的关键指标包括炎症标志物(如高敏C反应蛋白、铁蛋白)、空腹胰岛素、糖化血红蛋白、同型半胱氨酸、谷氨酰转肽酶、白蛋白、血沉、平均血小板体积、脂质过氧化物等。甲状腺功能检查有助于评估新陈代谢、免疫功能和排毒能力。此外,胱抑素C可以评估肾脏功能,而瘦素则反映了饱腹感和能量平衡。 生物年龄测试可以更精确地预测寿命,但结果需要结合其他指标综合考虑。线粒体健康指数测试可以评估线粒体的功能,而糖基化年龄测试则可以评估免疫系统的年龄。 我认为个性化医疗是未来的方向,应该根据个人的检测结果制定个性化的长寿方案,而不是依赖于通用的建议。
我一直对健康寿命的研究充满热情，这源于我在东亚的经历。在那里，我观察到老年人的健康状况与西方国家存在显著差异，他们即使到了高龄，依然保持着较高的生活质量和身体机能。这让我意识到，长寿本身并非目标，更重要的是拥有更长的健康寿命——保持青春活力，远离慢性疾病。
我将加速衰老的原因归纳为以下几个关键因素：遗传因素、表观遗传因素、慢性压力、病原体、环境污染以及昼夜节律紊乱。其中，慢性压力尤为重要。皮质醇等应激激素虽然在紧急情况下至关重要，但长期高水平的皮质醇和肾上腺素会对身体造成损害，例如肌肉损伤、肠道通透性增加、血糖升高以及炎症反应加剧。
衰老的九大标志
基于对现有研究的理解，我将衰老的标志总结为以下九个方面：
此外，肠道菌群失调也会影响营养吸收、免疫功能和毒素产生，从而加速衰老。 一些激素水平，例如脱氢表雄酮(DHEA)和三碘甲状腺原氨酸(T3)，也能够反映衰老速度。
个性化抗衰老策略：精准检测，精准干预
我并不认为存在放之四海而皆准的抗衰老方案。相反，我认为个性化医疗才是未来方向。 评估衰老速度，需要进行一系列精准的检测，而非仅仅依赖于主观感受或单一指标。我推荐以下关键指标的检测：
除了常规血液检测，我还推荐更深入的检测，例如：
通过这些检测，我们可以更精准地了解个体的衰老速度和潜在风险因素，从而制定个性化的抗衰老方案。 切勿盲目跟风，而应根据自身情况，选择合适的干预措施。 记住，健康长寿并非一蹴而就，而是一个需要长期坚持和精细管理的过程。
Edit:2025.03.01
Timestamps/Annotations: 00:00:00 RP Longevity Part 2 Teaser Trailer 00:01:35 Personalized strategy benefits and intro to Dr. Miriam 00:05:40 These are some things almost everyone can do to promote longevity 00:07:17 Why is the thymus important for longevity? 00:10:43 Simple strategies to help with longevity (Vitamin D3, K2 Nattokinase, Zinc and it’s interaction with other minerals) 00:18:25 Metformin, Akkermansia 00:30:00 Why Dr. Miriam prefers Berberine over metformin 00:32:14 DHEA 00:38:44 Why would I mess with my hormones? 00:42:13 Growth Hormone, Rapamyacin 00:50:05 Melatonin 00:57:20 Calorie restriction 01:07:46 Chronic stress is the worst thing for longevity 01:15:01 Rapamyacin 01:27:33 Rapamyacin and balancing it with growth hormone 01:29:50 GLP1s 01:40:07 Part 3 to come/ Where to find Dr. Miriam
00:00
Hey, it's Owen Orngson here, your host for today of the Rejuvenate podcast, founder of Genetic Insights and author of the Rejuvenate Blueprint. And I'm delighted today to be joined again by Dr. Miriam Mikitsky, normally shorn to Dr. Miriam, who is our resident MD and functional medicine doctor and expert and lots of other stuff.
00:19
We had Dr. Miriam on recently to talk about longevity. And in the first episode, we talked about the kind of the causes or like the root issues when it comes to what would cause premature aging or reduce longevity. And we talked about testing and we emphasized how, you know,
00:41
It's much better to come up with a personalized strategy based on testing rather than only doing a very general strategy. However…
00:50
As Dr. Miriam and I both know very well, even though you do need to customize your strategy for every person because every person is different and what's good for one person is not good for another person. However, it is also true to say that a lot of the time as a practitioner, you are just repeating yourself over and over again because there is a lot of adaptability.
01:10
advice for longevity which is if not universally applicable then at least applicable to most people and so in this episode we thought we would go through and talk about uh you know dr miriam's favorite longevity strategies and i will be asking her about uh in the second half of the episode i'll be asking her about any of the things that we haven't already covered in terms of the advanced strategies which you may have you know heard other people talk about um
01:37
to hear from Dr. Miriam from her expertise both as a medical doctor and as someone who works with a lot of people in practice like does this actually work? Is this worth doing? Is this worth the money? Does it cause too many side effects? So we'll get her take on a dozen or so of the
01:54
most commonly recommended advanced longevity anti-aging strategy as well. We're not going to be talking so much about appearance. We already did an episode recently about skin health and stuff like that recently. So this is more longevity as in, you know, feeling younger and lasting longer as opposed to looking younger. So with that long introduction over, welcome Dr. Miriam. Yes, thank you so much for having me. And yes, we're going to be focusing more on
02:22
what we can do to expand your health span and, you know, generally feeling not just living longer biologically with your chronological age, but just, you know,
02:32
preventing the aging of your organs essentially and feeling more energetic and cognitively with it really yes and in the last episode we already talked about why this is a passion of yours um you talked about how people uh you spent time with people especially in asia right where you saw that people even as they were getting quite old they seem to still have a long health span is that right and made you kind of question how we could have more of that
02:56
Um, and in the Western countries, if I remember that correctly. Yes, exactly. And I think, you know, made a good point when you said, oh, we're not talking about appearance. Cause I think that's sort of what people kind of zoom in on when it's longevity. But for me, it's more about like, what can we do to maintain balance, uh, like actual balance. So you're not falling over strength. Um, and, you know, and actually just like brain function. So you're, you know, without the older age and you could just see that.
03:22
the scene they were ahead just even through their lifestyle practices so you know I would say that generally my my hacks are a little bit of a combination of yeah lifestyle strategies that can be applied and to most people in addition to in addition to you know herbs and supplements that I think some of them
03:42
are quite underrated. And then also some of your more newer age therapies like exosomes, PRP, rapamycin, those things. Excellent. All right. So it's an exciting episode. We did a brief kind of rundown before we started recording, but you know, there's a couple of things there. I was like, Oh, I'm not familiar with that. So I'm looking forward to this. And I'm looking forward to hearing, you know, your take as well, you know, about everything. So yeah, let's get into it, Dr. Miriam. So let's start with, as we said, like, what's the endocrine,
04:10
And again, I don't know if you agree with me that there's almost nothing that's universally applicable. Like there's always exceptions, but still what's the advice, the longevity advice that's the closest to universal as possible, right? Like the things that you tell most of your clients, if not all of them, which is, you know, going to help them. It's a tough one. It's such a broad question, but I would say that, yeah,
04:33
You know, basics, there was a study done called the TRIM study where they were looking at what you could do to help with thymus regeneration, immune restoration, and also lowering insulin and lowering blood sugar. And that was one of kind of the first studies where they used, you know, like an epigenetic clock to verify that there's actually going to be a decrease in biological age.
05:01
And they use quite basic things. So there's zinc and vitamin D, DHEA, metformin and growth hormone, and sort of that combination. So I would say…
05:14
More or less, everyone could, you know, can have a strategy where they have some basic nutrients to help with immune function, some hormones that can help with aging and with stress mitigation, and then things that can help with blood sugar. So that would probably be my kind of nutshell.
05:33
what you want to start with. So nothing that actually seems too advanced, but I think, you know, you need a groundwork to work on. Definitely. You know, yeah, excellent. Let's start with that. So let's do one of those at a time then. So if that's okay. In fact, just rewind a second. You talked about the thymus. So can you tell us what the thymus is, why it's important? I don't think we covered that in the previous episode. So tell us what it is, why it's important for longevity and anti-aging. I guess in a nutshell, the thymus is, you know,
06:02
you know, essentially where a lot of your, you know, a lot of your immune system development and maintenance happens. And that's where you, you know, you're producing your immunity cells and where they mature. And so that is very important for your adaptive immunity so that which, you know,
06:21
Again, it's important for your body's ability to recognize and then respond to pathogens in the environment, to abnormal cells. So you really want to make sure that the thymus is healthy to protect against infection, cancer, inflammation, all of which really influence aging and lifespan. And we think that as you age, your thymus actually starts to shrink and disappear and that's
06:51
That's sort of what we call involution of the thymus is one of the reasons why you're then more susceptible to infections, why you might have a higher risk of aging-related conditions like neurodegeneration, cancer, but also autoimmune conditions. And then as that thymus also grows,
07:10
deteriorates, goes away, that is when your body starts to accumulate those senescent immune cells which themselves produce a lot of inflammatory cytokines. And senescent cells we talked about last time, so those are kind of zombie cells or cells which become rigid and basically they are not contributing anything and they're kind of getting in the way. That would be the simplified way of looking at it, I think. So, okay, in the thymus…
07:39
I think I heard this theory before, possibly from a different source than what you were talking about. They talked about the thymus. I think this is actually Russian research. So the thymus and the pineal, as you said, they atrophy very early, right? What age is it that the thymus starts to atrophy, roughly? Is it like 15 or 20 or something? Like by the time you're an adult, it's already… It is quite early. I want to say that…
08:05
It definitely is at its largest in early childhood and puberty. I believe it's kind of in the early 20s that the thymus starts to atrophy. And we think it's sort of almost non-functional by 40 to 50 years of age. So, yeah, so really…
08:25
Kind of something to start thinking about particularly if you're interested in longevity and you happen to be of that younger age group You know that you're already kind of aging just through that process And I heard about it shriveling away a long time ago But I recently read something as well that said that it starts to become more fatty almost like a fatty liver Yeah, you're nodding. So that's correct as well, right? Yes, exactly. Hmm interesting. Okay And so that is reversible. That's your take. I
08:50
to some degree or is it fully reversible what's possible i wouldn't say it's it's um it's fully reversible but uh we certainly can slow that process from happening and and this i mean this trial did show that there was partial regeneration of the thyrus of the thymus with with just these quite simple interventions excellent all right well that's a great starting point let's talk about those simple interventions because that's quite an achievement as you said and it does explain why um
09:17
You know, I mean, it's, God, things are different now. Even when I first started teaching this stuff in 2010, I used to say, you know, when you're a child, you're healthy and you get less healthy as you get older. But of course, there's so many children these days who are born unhealthy because of,
09:30
various factors. But anyway, if you're an older person watching this, you kind of remember back when children used to be healthy and, you know, as you said, the famous not being atrophied plays a significant role in that. So, yeah, what were the strategies, Dr. Miriam? So, I mean, in this study, it was particularly just those actual supplements. Well, let's break them down. Let's go through them one at a time and tell us, you know, which ones you use and what dose and all that kind of stuff. Again, obviously, as
09:59
Personalize is always better, right? But just as a general strategy. So, yeah, I would say vitamin D is something that I think most people need to take, especially even if they live in a sunnier climate. I find most people just really seem to struggle to just absorb the vitamin D from the sun on its own. So I would say…
10:25
Really, you need to have your levels checked. But wintertime, I'm usually telling people to take at least 5,000 units per day. But that can even go up to 10,000 in those where we just see really low levels. And we think they might have a vitamin D receptor problem.
10:43
a snip that maybe just prevents their absorption. I guess also taking a step back from that, we know vitamin D is fat soluble. So if somebody has poor gut function and may struggle with fat absorption, they're also then going to struggle with absorbing vitamin D so that you might have to work your way back there and improve fat absorption. Okay. Um,
11:04
And are you ever concerned that that's too much or like in terms of in reality and testing, do you see, you know, that never becomes excessive at that level? I've only seen it once.
11:14
a couple, like I would say one or two times, and I'm still not convinced it was the vitamin D. Also, I like to pair it with vitamin K2 in the form of MK7. And actually, I would say on that front, the MK7, natokinase, I also sort of use as a longevity supplement. We can probably add that. I don't leave it to the end of the list. Yeah.
11:37
But I think those two in combination, I haven't seen any adverse effects. All right, awesome. What's next? Zinc. So zinc we know is a co-factor for many reactions in the body. So it's important for immune health, hormone health. And then I would say from a longevity point of view, I think we…
12:04
We know just that it's important for so many of these biochemical processes. So even in
12:08
in the clearance of senescent cells, um, probably requires zinc. And, um, and because immune function is so important for longevity, um, you know, we, zinc really helps us keep that immune balance. So, um, that's also something I usually recommend in, um, for most people, I would say for adults, usually around 30 milligrams, which is also quite a high dose. Um, and I like to use zinc picolinate, um, but, uh,
12:38
Again, that's just what I've seen research on. Is there a reason you prefer that to like an amino acid salator type like magnesium glycinate or some of these other…
12:49
I use zinc at quite high doses for people with mood disorders. And that was through the work of William Walsh and the Walsh Institute, where we know that zinc has a profound effect on lowering oxidative stress and pyrols.
13:09
Uh, so he preferred percolonate and he was the one that sort of did that a lot of research onto it. So I just stuck with that one. And I found that, uh, when we would check plasma zinc levels, it seemed to absorb best. Um, I'm not, I find sometimes you can't get percolonate. So I found that zinc, um, zinc bisglycinate, um, is, um, even zinc citrate isn't too balanced, but, uh, I've just
13:35
Yeah, I just always had a preference for the Bacillin A type. Fair enough. Yeah. And so you said 30 milligrams. Are you ever concerned that it's going to deplete copper or…
13:44
I think a lot of our viewers are kind of anti-copper these days, to be honest, but I don't know what your take on copper is. Is that a concern, that it might reduce it too much? Yeah, it's a tough one because I would say Walsh, when I did that training, was also anti-copper. But we know copper can also, with that depletion in copper, we often see depletion in iron levels.
14:04
And so I was seeing that and I mean, usually, you know, biochemically recommending a dose of 15 milligrams of zinc to two milligrams of copper. So if I see that copper fall very low, I will add one or two milligrams. But generally, if we look at the foods people are eating, they're eating foods that are richer in copper than in zinc. So often…
14:25
often I think it balances itself out. 100% yeah. I've been on the fence on this one as well but I'm leaning more and more to like higher and higher zinc to copper ratios and even iron getting low isn't necessarily always bad right? The
14:40
there's a whole anti-aging contingent I've noticed these days who are blaming iron for like aging, uh, especially free iron. And they're saying that, cause obviously it acts as a free radical of his excessive amounts and like it rusts the cells and damage them and stuff like that. Um, I mean, obviously I know there's a medical condition, hemochromatosis, where it's definitely the case, but what's your take on, um,
15:03
you know, reducing iron as a longevity strategy. Do you think there's any validity to that? - I think it's, yes, I definitely think there's validity to that, particularly when the iron is high
15:15
Well, particularly when you have someone where they're not losing iron. So I see, for example, women with hormonal imbalance and let's say they're having heavy periods, they might be losing a lot of blood and therefore have chronically low iron levels. So in that sort of a cohort, you wouldn't necessarily want to deplete their iron stores. But I'd say once you get, once people are sort of in a stable state, especially if they tend to accumulate iron, then I would say that that is one of our strategies.
15:43
I would even go so far as to say that I've used kind of active chelators to try and get that iron down when it hasn't really come down in other strategies, kind of like you do with other heavy metals. So yes, I do believe in that. I would just say there's still a percentage of people that aren't getting that much iron through their diet at all. And also with the work with…
16:07
with the Walsh Institute where we're looking at zinc, copper and mood. I've actually used that work for a lot of children and so you didn't really want young children with low iron levels and like very low ferritin so that was where I had to, I often would add a little bit of copper back in to balance it out and that did seem to correlate with an increase in iron. This goes to show yeah that again you kind of have to personalize a lot of this stuff.
16:34
Yeah, it's funny enough, I just saw someone today, like number one longevity strategy, if you're a man is to, you know, give blood regularly to reduce those iron levels. But crucial caveat, if you're a man, right, as you just said, you know, not a child and not a woman of menstruating age. Anyway, sorry, I went on a tangent there. So back to this kind of standard protocol that you talked about. So we did
16:55
with K2 and nettoquinase. We talked about zinc and its interaction with other minerals. What's next? So we also have metformin. Okay. Yeah, tell us about that. You know, so metformin is a medicine that is to
17:12
traditionally used to lower blood glucose and lower insulin. And of course, it's usually actually the first line for that. So it's probably a medicine you've all heard of. But we now know that actually metformin is… We know that high insulin is aging, promotes inflammation, and
17:41
And therefore, yeah, it can be a very effective strategy for longevity. It's not my favorite one, but it just happened to be in the study. But it was part of that study, right? Okay, yeah. And why is it not your favorite? Well, so just to go back, so we know that it's improving your body's response to insulin and lowering glucose levels. But in that process, the way that it's working is it's kind of suppressing urination.
18:06
your body's, your liver's ability to produce glucose from non-carbohydrate sources. And we, I just find that as some of these medicines at the doses that you're supposed to take them
18:25
in a way, can then deplete other nutrients in the body. So we know that some of the side effects of metformin include GI issues, and that could, of course, affect your microbiome and your ability to absorb nutrients. We also know that it can… Sorry, before we go to the next one, I have had people react to that criticism by saying, well…
18:50
It's because, you know, it's similar-ish to berberine, right? It's because it's killing bad organisms. That's what they say. So would you… And then it increases some of the good ones like akkermansia, which I know we're going to talk about later. So would you agree with that? Or would you say, actually, no, it's not the case. It is killing some good organisms as well and potentially creating a problem? Yeah, I mean, I'd say when I've done the gut microbiome tests on people on metformin, they do tend to be low in…
19:17
of the good bacteria too um and i mean i would say that it does work just in a similar way to um to berberine and neither one is going to be as specific to killing off only the bad bacteria as as they're made out to be i i find that in general um yeah metformin and berberine that are
19:40
They're better at killing off the bad bacteria because you typically have more of them, but you will also just affect the good strains too. And actually, I haven't seen, maybe I just haven't read this study, but I haven't particularly seen anything about metformin particularly increasing acromantia. But
20:02
I don't know if that's something you have read? Yes, that was one of the claims as to why it worked or how it worked is by increasing acomancia. The acomancia actually improved the insulin sensitivity. So that was the theory behind it. Yeah.
20:19
As I said, I don't know if it actually works in practice because I haven't seen as many as you, but I have seen plenty of people who've taken berberine and none of them had high acromantia. So I kind of would go along with you, but that was what the study said. Because I thought in a way it was if you had acromantia, then you were a better candidate for using either berberine or metformin. But then acromantia,
20:47
then if you didn't have it, taking it wouldn't sort of magically cause it to grow back. No, no, not grow back, but like increase levels. I think that was the claim. Because most people have at least a tiny bit, right? Well, I don't know. I would say that's a big problem I see in my practice is no acromantia. And I guess I know we're going to speak about the acromantia probiotics later on.
21:12
Might as well, actually, because that is a big problem I had. And before the acromantia-based probiotics were produced, you know, I was trying to use certain prebiotics that were supposed to help with acromantia, like aronia, modified citrus pectin, some of your antioxidants, and
21:35
Those sorts of strategies. And sometimes we would then actually see some acromantia growth, but not always. And then, you know, kind of the consensus in the field was actually, if you don't have acromantia at all and there's no growth, it's very difficult to suddenly have growth. I'm just looking at the GIFX and the coins of M, 30% of the tests they do have zero acromantia. So…
22:00
But yeah, I guess you're probably seeing the sicker. I was going to say that's probably like my entire K-Ship pool. Yeah, fair enough. I know that mine was almost zero. So I'm one of those people. Okay.
22:12
So, all right. So we talked about, so acromantia, oh, let's, yeah, let's talk about that for a second then. So yes, you can get that as a, as a probiotic now, right? You can buy it, which was not the case until fairly recently. Is that right? Exactly. So there is, because acromantia to actually produce it as a probiotic, it has to be produced under like zero oxygen conditions. So you can imagine that's hard to do in a, you know, in a lab. And so, you know, really it,
22:41
I'm familiar with Acro Manse, at least potentially from the last four years, but I think it hasn't been around for that long of a period of time. It's not common, right? I think if you look for it on Amazon, there might be zero brands selling it. It's not like Bifido or Lacto where there's millions of versions of it. And in fact, a lot of them…
23:05
Because it's so hard to produce, you would be suspicious of a lot of brands, I think you said when we talked about it, right? So we don't normally do brand shout outs and I don't sell it, but is there any particular… I know I said I got some from Laird Origin. You said that's probably one you would trust.
23:21
I mean, I heard about it through the company Pendulum. They reached out to quite a lot of practitioners. So they're from the US and they've actually, I think apart from just the acromantia and mesenophylla, they've also isolated other practices.
23:40
like beetroot producing bacteria and certain strains that work in conjunction with um with the acromantia but i believe their first product was actually acromantia um and um so that that is the brand that i use uh it's just it can be quite difficult to get a hold of in the uk um where i practice but um that's the one that i i like to use
24:03
Great, okay. And you do practice throughout Europe as well, I know, right? You're allowed to prescribe throughout Europe and you have clients from throughout the world. Actually, I realized about Comancio.
24:13
We didn't tell people why they should care. Let's tell people what Acomancia does. We've talked about how you can buy it and how a lot of people do not have a lot of it. I don't think we talked about it last episode. So we talked about Acomancia. I think I just mentioned that it increased insulin sensitivity, which obviously is a big deal. I think most of our viewers and listeners have heard of insulin resistance and why it's bad. But why else would I want to increase my Acomancia and what's good about them? Yeah.
24:39
you know acromantia um so we know that it's a um a specific bacteria in the gut microbiome that um is actually um quite instrumental for breaking down um and mucus which is a kind of a vital part of the the guts barrier and um and it's essentially able to use kind of as mucus as a food source and it can take um like prebiotics from what you're eating and kind of
25:08
Basically convert that into the short chain fatty acids that make an important part of your gut barrier. And we know that having that healthy gut barrier is essential, not only from a absorption digestion point of view, but also just from an immune balance point of view and reducing inflammation in patients.
25:29
that part of the body. But we know particularly that the acromantia, we think because of its role in helping with nutrient breakdown, also regulates blood glucose levels and reduces fat accumulation. So we've actually, there's been, before even they made the acromantia probiotic, we knew that acromantia, having a low level of acromantia actually predispose you to
25:56
type 2 diabetes and other metabolic conditions. Yeah, very interesting. All right, so there's an important one just as much as bifidobacteria, which I think more people are familiar with, and for anti-aging as well. Okay, right, so that's a big tangent again, but let's go back to your list. So we talked about metformin, and there are a bunch of people in the longevity anti-aging community that do recommend metformin.
26:22
So do we cover all the pros and cons to metformin already? Is there anything you want to add about that? I'm not anti-metformin. I have used it in practice. And also for some patients, it has helped to lower their blood sugar. And we can always…
26:41
give a methyl B12, you know, or something to mitigate the effects on absorption. You know, so, and we do know that there is evidence to suggest that it's a, it activates
26:57
basically the pathway AMPK that is activated during caloric restriction. And also that activation helps to promote glucose uptake. So it still is a good medicine. I just think that it's quite strong and can then, for people who may not be, may
27:17
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28:38
Why do you prefer berberine? Let's put it that way. Or do you? No, I do prefer berberine. I would say that generally I think that often when we look at plants and herbs, sometimes those compounds in the herbs haven't completely been isolated and I think a lot of them do work in synergy. So we think that berberine might be the…
29:07
the component that has the biggest effect, but there might be other synergistic polyphenols that work in combination. So when you're getting berberine, let's say from golden seal or from coptis chinensis, you're going to get some other factors in there. So I think that, yeah.
29:22
There might be some sort of compounded effect there. But yeah, berberine, just like metformin, also activates AMPK and can help to reduce glucose levels. It also just has some studies showing that it can help with fatty liver and diabetes.
29:43
And generally seems to work broadly as an anti-inflammatory agent. There are some side effects associated with it, but I find that those side effects tend to be milder with berberine compared to metformin. So the kind of bloating or loose stool people get, you know,
30:02
tends to be milder. I personally like to use berberine in combination with things like licorice or more warming herbs, ginger, because that, at least in a traditional Chinese medicine sense, that helps to kind of offset those side effects.
30:21
So generally, berberine is also used as an antimicrobial. So if someone is only taking it for a short period of time as an antimicrobial, then I'm happy with them using berberine on its own. But if they're going to be using it longer term for longevity, for lowering insulin, then I want them to have a more balanced formula. All right, so let's go back to the list, your original protocol again. So we've done that form, and what's next? So we have DHEA.
30:51
which is, I'd probably say, one of my favorite longevity interventions. So DHEA is just a hormone that's produced by the adrenal glands, and it is…
31:03
it's helping you sort of counteract cortisol and is a, um, it's kind of known as the longevity hormone. Hmm. Uh, yeah. Okay. Awesome. I know, you know, uh, repeat who, uh, a lot of our viewers are familiar with and a lot of them are a fan of, was a big fan of the HCA. Um, a lot of people and other people I've interviewed as well. A lot of people who recommend the HCA, like, uh,
31:31
Oh yeah, Dr. Platt, for instance, that's another one we had on here, the author of Adrenaline Dominance. A lot of them say you've got to kind of be careful with the dosage because if you have too much, it can convert into estrogen. And I had been reluctant to try it for ages or, sorry, not try it, but to have a high dose for that reason. But I've been doing 50 milligrams for quite a while now because I…
31:53
in my test results i always had high cortisol and low dhea so i was like finally okay i'm just gonna you know that ratio as we talked about the last episode of high cortisol to low dhea is not good it's a you know predictor of early mortality so um and i have a genetic tendency to high cortisol so to a certain degree that's always going to be at least a bit higher than average so it's like all right i'm going to try upping my dhea and actually um i didn't show you this
32:18
Dr. Miriam, but my estrogen actually went down since I started taking the DHA. So it went in the opposite direction. So what do you think about those concerns that you often hear about? Oh, I mustn't take any DHA or I mustn't take anything other than a very small amount. Was it converse to estrogen? I mean, I'm sure it's true sometimes, but when is it true? When should people be concerned about that?
32:42
I would say in clinical practice, so it is a precursor hormone to both estrogen and testosterone. So, I mean, I would say because I generally see more women than men. My concern with DHEA is, for example, women who have PCOS. Conversion to testosterone is the opposite. Yeah, okay. Right. But it's interesting because I find that I'll often see women with PCOS where their DHEA sort of
33:12
a bit borderline. And I'm like, I wonder if prior, you know, like 10 years ago, your DHA was actually much higher and it's now depleting. And so, you know, would we say no to DHA? Particularly not. I think you'd want to improve DHA
33:27
the um you know hormone metabolism and still consider dhea because it's it's a bit of a conundrum that you will sometimes see high dhea in what you will see high dhea women with pcos but they may actually have had a much higher level and their energy levels being better way back might have actually um like yeah so once you once you let's say how do i i'll rephrase this actually um
33:53
If we know that the high testosterone is sort of then kind of retroconverting into DHEA, once you sort out the PCOS, drop the insulin, actually the DHEA can dramatically drop. And we know that that's actually their sort of true DHEA in terms of, you know, that would reflect why they might have low energy, for example. Yeah.
34:14
uh but but sorry just to kind of answer your question from before i don't use particularly high doses of dha um i would say 50 is actually kind of the maximum dose i generally use um and i do find that some people just mop up the dha very quickly so i always like to retest about ideally three months later but sort of three to six months later because i've had
34:38
patients with non-existent DHEA on their first test and then we would start something like 25 and then they would be in the they would be in the kind of hundreds range way over their their um the range they were supposed to be okay so in many cases there's actually no need to do a high dose that's good to know and uh
34:59
I think the level of body fat makes a difference, right? I'm thinking for our male viewers. So if you have, the more body fat you have, the more your body's going to convert that DHEA to estrogen. Is that right? Exactly. And I would also say that, yeah, we have to take into account your body fat percentage, bone density. Also, I think just
35:20
If you're somebody who, like, you have a high level of testosterone, let's say in the PCOS crowd, or estrogen because your, you know, your adipose tissue percentage is too high, then you don't want to just give DHA without addressing those other concerns. So what's a moderate amount? Like you said in that study, you know, it was obviously effective. What kind of amount is a reasonable starting amount?
35:46
For women, I usually give higher doses for men. But I would say for men, I normally start at 20 to 25, whereas with women, I sort of start at 10. But yeah, but they did use 50 milligrams in this trim trial that I discussed. Okay.
36:05
And what about, I think you and I talked before about the seven keto DHEA. You said sometimes you prefer that, right? Yeah. Under what circumstances would you recommend that one instead? So exactly. For those people who have high testosterone levels or who they started to take DHEA and then they noticed that they had
36:30
facial hair, acne, um, you know, implying that there was too much conversion into testosterone. I will sometimes use the seven keto DHEA. Um, and then also if I'm in the seven keto DHEA won't raise your DHEA as quickly. So, um, so actually in those, in those
36:50
patients where I wasn't quite sure their DHEA levels looked okay, but they had the classic sort of symptoms of low DHEA, fatigue, brain fog, low immunity, frequent infections. I would sometimes start the 7-keto DHEA to see if those would improve and then wasn't too worried about the levels rising too high. What about to all the people watching this right now who are of the mentality like, you know, okay, fair enough, taking a supplement, taking zinc or whatever, but
37:19
especially if it's low in my diet, but why would I want to be messing with my hormones, Dr. Miriam? That sounds like a bad idea. I know a lot of people feel that way. Can we just address that in the context of longevity specifically? Of course. I mean, I completely understand where people are coming from and I would never blindly recommend hormones without testing the levels and then making sure we get the levels back to a certain point. But the way that…
37:49
In the longevity community, we are replacing hormones that
37:52
decline as you get older and we see that hormone decline as a sign of aging essentially you're doing the same with DHEA and I would say with DHEA because it's depleted with stress and if you're somebody who is putting a lot of stress on yourself because you're not sleeping well not eating well mentally quite stressed then you may have a low DHEA at you know in your 20s and
38:20
And then, you know, you would almost, you could have that DHEA level of somebody who's in their 80s. At age 20, you'd want to do something about that. Yeah, but it's hard one to answer because I'm generally quite pro-replacing the hormones that are lost. I mean, you know, because we, a lot of the longevity studies have been done on males. And whereas, you know, we know that females actually have what have,
38:48
Better longevity until menopause and then that protection that women have against cardiovascular disease and the lower rates of cardiovascular disease that disappears after menopause, then women actually have higher rates. And we think that hormone decline is one of the factors that precipitates that. Yeah, that's good. I'll give my take on this as well, which is, as you said, with some things, maybe I don't know if we're going to get to thyroid, but
39:16
You could say you could make an argument You know, you should really only take it if you need it But you have to understand that with some things like you said the HCA or like with progesterone and estrogen beyond a certain age for a woman pretty much inevitably It's gonna go lower and it's gonna make you feel worse that it is lower and it is gonna you know reduce your quality of life quite possibly a lifespan and That's natural
39:45
In the sense that that's not a sign of, that's not because you haven't eaten well, because you haven't exercised enough or whatever. It's just what happens to you as a human. And so it's just a choice about, am I going to accept that I am going to decline as I age? Or am I going to actually attempt to cheat a bit and augment myself? And if you're watching an episode of Longevity, I hope you understand that
40:09
you know, what you're trying to do is you're trying to cheat nature to some degree, right? This is not an episode about just having a healthy lifestyle and doing your best while staying within the cycles of nature. This is like, well, actually we're trying to, you know, a little bit reverse the inevitable decline that happens with nature. And so if you're interested in doing that, if you're interested in longevity, if you're interested in anti-aging, then I would encourage you to be open, obviously not indiscriminately and stupidly as Dr. Miriam said, but yeah, I would be open to these things. So now,
40:38
we'll go back to growth hormone which is a little bit more controversial than dhea um i think a while ago in the anti-aging community it was there was a lot of enthusiasm around it but i think i don't know if i've got this exactly right up to moment you can tell me but the last five years or so especially i've seen a lot of like anti-growth hormone sentiment people concerned that it's growing the wrong thing um you know the c word that we don't talk about on youtube but that it can you know
41:06
contribute to that so first of all yeah tell us what the study said and then tell us your take on it yeah so the study was using about one milligram of growth hormone per day and it was this is over the course of one year and I
41:23
It's interesting because in a sense, when we think about longevity, it's like on the one hand, we want to maintain muscle mass and have good muscle repair and good cellular repair and growth hormone plays a big part of that. But I agree that then where you have…
41:46
and you have like insulin like growth factor, it almost then kind of flies in the face of, you know, when you're wanting to prevent aging, you almost want to slow the body down so that you don't have this kind of
42:03
these processes that are generating inflammatory cytokines. So I would say actually what, you know, the longevity community, I think now there are proponents of actually alternating growth hormone with rapamycin to sort of, you know, kind of in a way mitigate that because, and yeah, so that's,
42:24
But I think it is an important, I wouldn't say it's something that I use kind of as a mainstay in my practice, but it just, again, happened to be in the study. But I think in terms of, you know, something that can help with, yeah, cell regeneration, muscle preservation, fat reduction, bone density, I mean, it does have benefits.
42:49
good effects from that point of view. And of course, fat loss and muscle gain, which is why a lot of people use it like in the, you know, celebrities, models, actors, all those kind of people, sports people, right? They like it because of, for those reasons. And although that's aesthetic, it's not only aesthetic, right? Obviously,
43:09
High levels of fat has correlated with all kinds of bad health outcomes. High levels of muscles, as long as it's not excessive, correlates with all kinds of good health outcomes. So there is that to be said for growth hormone as well, right? Yeah. And I would say the cancer risk, I mean, it's…
43:25
I think what the studies have shown is that it can promote the growth of cancer cells in those who are predisposed to certain cancers or potentially already have the cancer cells. You would never want to give birth hormone to somebody who has cancer.
43:40
who has cancer, I would say even someone who has a strong family history of cancers, of certain hormonal cancers like breast cancer, prostate cancer, you know, you'd have to really look at how they're detoxing their hormones before starting that. So, you know, so I would say that it's,
43:59
you know, you just have to, you can't just blink it, give it to everybody. Okay. And I think we should talk to rapid mice and next, then we can talk about that. As you said, the advanced strategy, but just before we get to that, um, so other problems with growth hormone is it has to be prescribed, which is not an issue for you, but for a lot of our viewers. Um, and then of course it's very expensive, right? Compared to most things. Um,
44:21
And so cheaper alternatives would be growth hormone-promoting peptides like ipamoralin and CJC-1295. I think that in the peptide world, that's often what's recommended. One of them is a growth hormone-releasing peptide and one of them is a growth hormone-releasing hormone. So that combo is the most popular, the most common. There's others as well, tesamoralin and stuff like that.
44:49
And then really that still requires injection. So really bargain basement is just like MK 677, right? Which is just a powder or a capsule that you can take, which is really not very expensive. Um, so what's your take on those alternatives and maybe others I haven't heard of versus, you know, actual growth hormone. Yeah. I mean, I'm my, um, yeah, I would say that, um, from a
45:15
cost perspective and also I would say even from a side effect perspective I'm a big fan of those particularly Ipamorelin CJSA 1295 and you know I think that
45:32
I was going to say rapamycin in my book I think is better. And I wouldn't say that everybody that takes rapamycin has to cycle it with growth hormone. But I would say that, you know, I think, for example, on those who might be at higher risk of poor hormone detox, I prefer for them to use the peptides rather than the growth hormone itself.
45:54
I've seen that there's less risk of those negative side effects, right? Even at an effective dose. Yes, exactly. And we know that, for example, in some people, growth hormone can increase cortisol levels. We don't really tend to see that with the peptides. What about MK-677? Do you have experience with that? It's not something I use so much in my practice. I've heard about it, but…
46:23
Yeah, but not something I'm actually that familiar with. I can tell you my experience. One of the doctors we had on there, I think he said that that's what he likes to use. I took, I think it was a tenth of a dose. I think the normal dose is 50 milligrams, and I took five. And then suddenly, like a few hours later, I had this immense kind of stress. It felt like my blood sugar had crashed more than anything, and I felt ravenously hungry. And I ate loads, and I overate, like it caused a digestive problem. This is about when my digestion was worse.
46:51
And then I read more into it and they said, like, the problem is it spikes the growth hormone and the ghrelin, which is the hunger hormone, which correlates with it at almost random intervals. And obviously I was sensitive to it. I mean, I know
47:09
As I said, a lot of people are taking 50 milligrams or even more, 100 milligrams, 150 milligrams. But that thing about the sudden, unpredictable, random attack almost of low blood sugar and hunger, I found very… And high stress, the high cortisol, I found this in something. So I've tried it once and once only. For people who are a little bit less sensitive maybe and who are eating all day anyway, it might work better for them. And so it is the cheapest option. It doesn't require injecting anything. So…
47:38
It's certainly, I think, defective. It's just that a lot of people don't like the random nature of its effects. Yeah, I would say that I, again, see a lot of patients who are very sensitive to supplements, medications, and have blood sugar issues. And so I almost feel like that would put a lot of people off. Yeah. And I don't have blood sugar issues usually, but yeah, I did with that. So…
48:08
Yeah, that was not great. Okay, so…
48:12
But yeah, so now I guess, have we done enough on growth hormone? Should we go into the rapamycin? Yeah, I mean, I was going to also say, I mean, maybe it's a bit too basic, but obviously you can stimulate your growth hormone release to things like high intensity, the neural training, strength training, getting enough sleep. I would add to that list, I think maybe before we get to rapamycin, we know that you are…
48:39
doing a lot of your detox so like your glymphatic system at night when you sleep so you really want as a part of the longevity to optimize sleep and that's where i'd say from a hormonal perspective i also like to use a melatonin oh yeah tell us about that then because obviously some people are not a fan they're very popular andrew hooverman you know talks uh
49:00
has been saying that he doesn't like it because he feels that it suppresses other hormones. Well, not just he feels, he says this research thing, it suppresses other hormones. But then again, I've seen some people who claim that they're
49:11
you know, healing people of all kinds of things by having really high doses of melatonin, like 100 milligrams or 200 milligrams. So I've seen the whole gamut. I think possibly both things are true. And then there's the whole thing about how there's pernil melatonin, but then there's also intercellular melatonin, right? Which is stimulated more by red light. So there's a whole gamut of stuff about melatonin out there. What's your take on it?
49:34
Yeah, I mean, I would say my views on melatonin are largely positive. I mean, I think now that we have seen studies where people are using super high doses of melatonin, like 200 milligrams in, for example, immunosuppressed people who have been undergoing chemotherapy, and
49:51
I vouch for its safety. I just haven't really seen any kind of adverse effects. What about the next morning drowsiness? I've had a lot of people report that, talk about that. Well, there's, I mean, it's a bit controversial, but some people actually say that that's a sign that your body actually needs more. And I have tried that. And I have had a few people who actually are taking sort of upwards of 20 milligrams and
50:17
have said that it has actually, that drowsiness has gone away. I would say there's actually, there's not much of a harm. There really is no harm in trying to do that. Apart from, of course, you know, if you are drowsy, then you've got to just be sensible about, you know, not getting into a car or like, you know, managing your day. That's sort of more the risk. But in terms of just a health risk, I think you could safely go up to at least
50:43
24 milligrams and see if then you feel less drowsy the next day. It has worked for myself because I used to say the same thing, but I saw that once I took upwards of 10 milligrams, I found that I was not drowsy the next day. Interesting. And what about the criticism that it is messing with other hormones? Do you give any credence to that? I have a few patients actually who started to take melatonin about
51:12
you know, 40, even 50 years ago. So, I mean, older patients of mine who are interested in the research that was done in melatonin back then, I've never seen, I mean, it's not a huge number, of course, but I haven't seen any, there didn't seem to be any issues with melatonin
51:31
you know, like early menopause or things like where their hormones were suppressed in those women. Interesting. Well, Andrew Huberman is talking more about men, I guess. Maybe that's a distinction. He was worrying about lowering testosterone. But then again, a lot of people into longevity are on TRT once they get older anyway. So I guess it was, I don't know, it matters. So yeah, it's interesting to hear that take. As I said, I had seen the research that you're talking about as well, very, very high doses being, you know, curing all kinds of very interesting diseases
51:59
things that were very effective that nothing else is working for. So I actually don't have a strong opinion on this either way. I'm definitely interested in hearing your take and your experience. Okay, so there you go. For someone who likes to experiment, if it makes you feel drowsy and spawning, double the dose and see what happens. But make sure you do it on a weekend or a day when you're not working, right, in case it doesn't work. Interesting. So you said this is a sign that you need more
52:27
Uh, is it like, could it be something else? Could it be like, you're not methylated well or something like that? Like if you, if you feel drowsy the next day, um, cause I, I never feel drowsy next day. If anything for me, it's like when I used to take it, I would have to make sure to go to bed quickly, um,
52:43
Or, you know, just go to bed. Go turn the lights off, everything quickly, because otherwise it would run out. Like, it barely did anything. You know what I mean? Like, that was more my… Or I'd wake up maybe an hour later and I wasn't sleepy anymore. So, like, if anything, maybe I should try diaboling the dose, I guess, because it wasn't very effective. Yeah, the other thing is some people say that…
53:03
people are taking it too soon before they go to bed. Like ideally it should be, you know, 30 minutes to an hour before. And that if you take it right when you're hoping to get to sleep, that can still kind of disrupt the natural circadian rhythm in the sense that you would have wanted that melatonin to increase before you actually do feel sleepy. I don't really think that, um,
53:29
There's a different form you can take. I'm sure if you improve your methylation problems and detox. Not a different form, but is there something else? Is it methylation? Is it something where your body is not breaking it down? So therefore you're still drowsy the next morning is what I was thinking.
53:45
Not that I'm aware of, to be honest. I'm wondering if it's like one of the MAO enzymes or something like that that processes serotonin. I wondered if it might be something to do with them. It certainly could be. I mean, I would say that, you know, you…
53:59
How you absorb melatonin, I mean, I like to use the liposomal forms and the liquids. So certainly you could try a different form. I find that those sometimes work better than the capsules. But I would say if you're not somebody who has optimal detox pathways, then yes, it probably wouldn't be as effective. So you'd want to optimize detoxification pathways, DNA methylation pathways, and, you
54:25
in any way. Okay. I'm also thinking of an experience I had once when I was in a complete mess back in 2020 and, you know, anxious and all these issues, right? That pain issue that I've talked about before and I tried to take a melatonin to calm myself down and
54:41
And it kind of worked, but the next day I was like so woozy and like, whoa, like almost, you know, and I felt full. It's because my body is in such a state, you just wasn't able to process it and detoxify it. And so, whereas I normally, my experience is what I said, like it clears very quickly and I barely does anything. In this case, when my detox bath was completely overloaded,
55:03
Like it was the opposite. Like it was, I was still very strongly affected by it like a long time afterwards. That's what made me think that it could be, um,
55:12
you know, the body's ability to process and detoxify it. That's significant. I mean, I would say with, you know, detoxification where you have the phase one and phase two, the phase one detox actually tends to make a more toxic metabolite. And then often people really struggle with that phase two detox. And so potentially that could have been the issue that, you know, that first breakdown product was, you know, more stimulating, more toxic, right?
55:40
Maybe, yeah. Maybe turn it into DNT. I remember it was pretty tricky at the time. Anyway, sorry. We'll carry on. Okay, so sleep, very, very important. Is there any other kind of more general advice you want to go before we go to the advanced stuff? I mean, calorie restriction. Do we want to talk about that? Yeah, let's talk about that. Anything you want. Yeah. I mean, I would say that that is a strategy that is – I think everyone could employ some element of calorie restriction, but I would say –
56:07
The type of calorie restriction needs to be personalized, you know, and those who, you know, do suffer from hormonal imbalance, high or low cortisol levels might struggle with, you know, your kind of extended calorie restriction or fasting. Okay.
56:26
Okay, so I think everyone's heard of calorie restriction. I know it is pretty much the only longevity intervention that has a lot of evidence behind it. I know a lot of people who are a fan of this show, though, are fans of people like Ray Peet, fans of maybe people like Dr. Jack Cruz. And they talk about, well, certainly Ray Peet talks about how…
56:51
The issue is not that… Well, okay, so a couple of things. First of all, I know he talks about studies where just restricting specific things were just as effective as calorie restriction, specifically if you reduce certain amino acids. I think methionine, tryptophan, and maybe isoleucine, it was just as effective as calorie restriction. And I remember another study he talked about where…
57:13
because a lot of these are my studies, right? Where they just restricted, like they removed all the heavy metals from the food and then they found that
57:22
that giving food completely absent of any heavy metals was just as effective, if not more effective, at restricting the calories. And so the theory behind it is that it's not the food or the calories, it's the stuff that comes with the calories that's the problem. And so obviously, if you're having more calories, then you're having more heavy metals, you're having more tryptophan, you're more methionine, because all of that stuff generally comes with the food. But it's not the calories that are the problem itself, but the things that
57:50
usually will always come with the calories. Yeah, it's a tough one because I mean, I would say that if you think about who lives the longest, it's essentially trying to get your body into a state where it's almost…
58:02
using less energy and is in this kind of low metabolic state which to me would equate lower calories and lower okay well that's a more primary debate then because yes the vp people would say that's not the case that's the that's like that's a mechanistic idea that um that you know the body is like a machine that it only has a certain amount of uh capacity to do things whereas
58:23
If you're increasing in metabolism, you increase the amount of energy available to all the systems in the body. So you don't buy into that. You prefer the idea of reducing the metabolism and reducing the level of energy expenditure and creation. I mean, I just think it's a tough one. I see your point and I do agree.
58:46
I would say that if we look at the blue zones, many of them do eat a naturally low methionine diet. And I wouldn't say that they, I mean, maybe apart from the Seventh Day Adventists in California, I think they don't actively practice a fasting diet.
59:05
you know, like have a fasting practice. But I would say, because I really like mixing kind of the medical science with the more anthropological, like cultural and, you know, seeing how people who actually have long, what do they have lived long, what have they done as a community? And I've just found it quite interesting. I think a lot of that culturally, you know, for example, I think Okinawans have, you know,
59:31
I've always tried to eat until they're 80% full. And a lot of those, I would say, groups, I would say they naturally calorie restrict because they're more active, not really snacking. Well, okay, so we're getting to some points of agreement now because I'm dead against snacking, first of all. I've always told people not to do that. Meals, not snacks, I always say. And second…
59:59
second of all i also agree that overeating or eating until you're full is a bad idea um it overloads the digestive system it's more likely to feed you know bad organisms can create endotoxins and all that kind of stuff so i think even you know red people also agree with all of that so so i think yeah not overdoing it with calories agreed not snacking agreed but actually like
01:00:22
You know, fasting, I think, you know, raises cortisol, it raises a lot of stress chemicals, it kind of puts a stress on various systems in the body. You know, Ray Peet talks about how when you fast, it like raises estrogen, it raises adrenaline, all this kind of stuff, which, you know, potentially is not good. So I think, yeah, I think it's especially the fasting part of calorie restriction that probably…
01:00:43
the percentage of our viewers are against it or against as opposed to, I think no one thinks that you should stuff yourself every meal or a snack between meals. I think everyone into longevity does agree on that point. So, yeah. I mean, I would say that, you know, when I say calorie restriction, I mean, fasting, I generally support more of like an overnight fast and, you know, kind of even sort of like, you know, 12 to 16,
01:01:11
14 hours, maybe going up to 16. But I'm not a fan of day-long fasts or these fasting retreats unless I don't…
01:01:24
unless someone is in an environment where they don't really have to do very much and you think that they could actually be maybe sleeping and then detoxing, that's the kind of environment where maybe I think fasting could have some benefit. But in today's society, if you're trying to fast and also function, I just think with already high cortisol levels, you're going to make that problem worse with fasting. I think that's a great distinction. And I 100% agree that fasting
01:01:53
Because there are some people who heal themselves with fasting, right? We also can't dismiss that evidence. They make themselves healthier by fasting. And I think what you just said is a key determinant, right? How are you fasting? And if you're doing it in a very supportive way,
01:02:08
non-stress-inducing atmosphere and environment, maybe with a bunch of other people who are fasting, that's much more likely to be effective than if you just try and do your normal job or whatever. Because if you're trying to do your normal job and fulfill your normal responsibilities, you may feel great. A lot of people say they feel great, but they feel great because they're flying high on stress chemicals, right? That's the problem. And then eventually they crash. But there is a right way of doing it. So I 100% agree with that. But I will say, you know, it's interesting because I have, yeah,
01:02:35
a few members of my family who are very much into the repeat mindset. And I agree with most of the things he says, I'll say. But I would say calorie restriction is difficult. And I think a lot of people emotionally, when you start talking about calorie restriction, you just get a lot of anger because they themselves struggle with it. And my kind of response to that is always, well,
01:03:00
you know, it is, it's a difficult thing to do. And, you know, for example, if you look at, you know, like how people eat in Japan, for example, you know, they're able to have much less calories because they plan their meals differently, or it looks like it's a bigger portion of food. And I think like there are hacks that can help you with calorie restriction that
01:03:19
that doesn't involve you know sitting and feeling like you're starving which is what i think people associate when they give calorie restriction um but yeah i mean that's i know i'm the opposite boat because for a decade and a half i would only ever have two meals a day so i had intermittent fast all the time just because i had digestive issues so i couldn't eat more than two meals a day and i feel way better eating three meals a day than i do on two meals a day um like it's it's
01:03:46
much, much, much, much better. Um, but I don't need to lose weight. And I will say if I, I always say people, if they want to lose weight and they want to restrict calories for that reason, which a lot of people do. And as you just said, a lot of people should, then it's an,
01:03:58
and I agree with Dr. Jack Cruz on this one, skip that last meal, not the first meal. That's the crucial distinction. Eat within an hour of waking up, but then don't eat for like five or six hours. And I think that's, in my opinion, that's where everyone gets it wrong with this intermittent fasting. They just drink coffee until midday or whatever. And it's like, that's the wrong way of doing it. So I think that's the compromise between, as you say, the two opposite systems is like eat, you know,
01:04:26
not long after waking up to keep your blood sugar balanced and make sure you're not running on stress and all that stuff then don't eat at night and what i just said that's really hard to do because people who are running on stress all day then when they finally calm down at night then suddenly they're hungry and not eating then is really difficult so um but that is the right way of doing intermittent fasting in my opinion if you want to what do you think of that no i agree i think um as you know
01:04:52
the earlier you can eat, the better. I think where it gets tricky is, you know, another thing that we talk about with longevity and hacks for longevity is just the kind of social connection, finding meaning. And often if that revolves around food, then it's very difficult to kind of cut your eating time. And most people then, you know,
01:05:14
really value let's say their dinner because that's the one time they can sort of sit down with their family or eat on a relaxed you know in a relaxed environment so i i generally say like you know ideally if you can eat four hours before bedtime or even earlier i think that's still okay so early dinners are still fine because then you get a little bit of the social connection too um
01:05:36
100%. Yeah. And, you know, if any of you want to eat a large meal, you know, just before you go to sleep, that's totally, you know, that's up to you, of course, but don't think that you are intermittent fasting to be healthy if you are starving yourself all morning and then binging at night. That's not, that's because you want to do it, but it's not helping like health-wise.
01:05:57
Okay, so awesome. Sorry, I went on a bit of a tangent on that, but that's calorie restriction, right? That's what we were talking about. So there's a right way and a wrong way to do it.
01:06:08
And I think we've come to an agreement about all the way. Awesome. Okay. What's next? I guess we could talk about rapamycin. Sorry, that was supposed to be the tangent after the growth. No, no, it's okay. We want to talk about your general advice first. So any other general longevity advice? Let's cover that first. So we talked about sleep. We talked about calorie restriction. Do you want to talk about stress at all? Yeah. I mean, I would say stress is probably, you know, even though they're
01:06:33
even though stress is essential for life, I would say chronic stress is probably the worst thing for longevity. And unfortunately, that is what I think is the most challenging to decrease in your life. But I do find that
01:06:54
actively measuring to see like how stressed are your adrenals is is one of the best strategies to then actually kind of prove that yes stress is actually um having a bad impact on your life because i i would say i'm always surprised like i and i would say it's
01:07:10
When I think about in the male versus the female patients I see, males often will say, well, I don't feel like I'm stressed and I don't think that's a problem. But then we'll look at it on an adrenal test and it'll be like, no, like clearly your cortisol is through the roof, your DHA is very low. You may not feel stressed, but that doesn't mean your body isn't stressed.
01:07:31
Um, so, uh, you know, and that's where I think you kind of have to do a bit of a 360, you know, degree approach with, um, looking at, you know, what you're eating, your sleep, um,
01:07:43
your relationships, your work, if you're actively trying to lower that, you need to balance that out. I agree. And I think among challenges, people are addicted to stress. They enjoy stress because I think, unfortunately, it's a vicious circle. The more depleted you get and the more toxic you get, which a lot of us are, then the more you feel like your two choices in terms of what state you're in is you're either kind of exhausted, depressed, or you're like stressed, right?
01:08:12
And stressed feels like the upgrade. So it's like I either feel bad, which is exhausted, depressed, tired, depleted, or I feel good, which is stimulated, energized, but also, as you just said, stressed, right? High cortisol and all the rest of it. And so it's kind of teaching people more how to go into that third state, which I call ventral vagal, based on the polyvagal theory, where you are both
01:08:38
relaxed but also uh present and engaged and um so not relaxed as in sedated in any way but relaxed uh but also present and mentally sharp and and motivated and all the rest of it and for a lot of people i think that state of being simultaneously relaxed and confident and stuff and at the same time mentally sharp and energized and focused and and motivated is
01:09:06
something they can distantly remember from a long time ago and you know as I said I was in that time when I never felt that way for quite a while and so I know exactly what it's like and so I think helping people get to that is one of the best things you can do for them but it's not easy right a lot of people are very far away from that unfortunately. Agreed I mean I think you know there's so much research to support practices like meditation for longevity and I think I mean
01:09:35
I tell everyone must have some sort of, it doesn't have to be necessarily called meditation, but meditation, prayer, reflective time, like you should be able to sit for five minutes, breathe and will not fall asleep and not go crazy that you have to be doing something. Like I think if you do that experiment and you can't cope, that is a problem that you need to work on.
01:10:00
I think people just have a tendency to walk away from it and just say, well, no, it's not for me. But it's like, no, that's a problem that it's not for you. Like you need to be able to, because that is a sign that you are one of these people with high adrenaline and have to go. And that's just not healthy in the long run. 100%. It's so funny you say that. I'm sure you haven't seen it, but I talked about that before in the episode. That's the best test for whether you're able to be in that third state. So I 100% agree. Yeah, yeah.
01:10:25
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To get your unique genetic health reports, go to geneticinsights.co and use code REJUVENATE to get 20% off today. That's geneticinsights.co using coupon code REJUVENATE to get 20% off today. I think you just have to find a practice that works for you. I mean, I would say that for those sorts of people,
01:12:37
movement, but not too intense. Like, you know, for some people running and, but, you know, to the point where they're just able to clear their head, that can sometimes help with releasing that adrenaline. And then they actually, after that can come and sit calmly for five minutes without, you know, without, you know, not being able to sit still. And so that can be a form of how you get to that point. And, and I say that, I mean, I've certainly can be one of those people too. And, and I've just,
01:13:05
always struggling with meditation, but you know, it's a work in practice, not something you're going to be able to do overnight. But, you know, I think that that's an underestimated tool. Yeah, fantastic. All right. 100% agree.
01:13:19
Anything else you want to talk about in the general advice category? I think I've pretty much covered it. So let's go back to some of these more controversial, maybe considered advanced strategies. So we talked earlier about Growform as part of that basic package that you would sometimes do. And then we talked about how you said that in the longevity community, they'll often balance it with rapamycin. So
01:13:47
So I've come across this, but I'm sure I don't know much about it compared to you. So first of all, if you could tell us all about rifamicin and then we'll go into, you know,
01:13:57
the strategy of balancing it with growth hormone. I've known about rapamycin for a long time because it's actually a medicine that's used to suppress the immune system after organ transplants. So it's been around for a long time, but it's just that we're talking about low-dose rapamycin for longevity purposes. And could we just talk about where it comes from? Because I think that's quite an interesting story. Yeah, so it comes from…
01:14:26
So my understanding is it comes from a particular bacteria, Streptomyces, something from, but they isolated on Easter Island. And they actually, let me just kind of get these details straight. But basically when I know that they, researchers found that people who lived on Easter Island, the natives there had AIDS.
01:14:47
a higher amount of these bacteria on their skin and that actually it seemed to be protective against for wound healing so that these people were actually able to like walk on the beach and they would step on a coral and they seem to have just kind of thicker skin and then when they would get a cut it would they would heal much faster.
01:15:07
And then, of course, then it was researched and found to basically inhibit a pathway that's quite essential for cancer.
01:15:20
growth proliferation. And yeah, so that's kind of, I thought it was quite an interesting story of where it came from because I didn't know that until actually fairly recently. Yeah, I like that. I'm often telling people the line between food supplements and drugs is pretty arbitrary. And I think rapamycin is a good example because there are loads of supplements where
01:15:40
It's just a byproduct created by a bacteria. But then this is a byproduct created by a bacteria, but it's classified as a drug. And of course, it's classified as a drug because, as you say, if you have a very, very high dose of it, which is what they use as a medication, then it suppresses the immune system enough that if you have an organ transplant, your own immune system doesn't fight the organ transplant, right? So that's the drug-like dose. But this is typical of mainstream science and medicine to me that
01:16:07
like they always do like the most ridiculously high dose of something that, you know, can possibly kill you if you take it in the wrong context. But, you know, there's a, you can have a much lower amount of it. And I think we're going to talk about low dose naltrexone as well, right? That's a similar story. So a much lower amount is much less dangerous. And in fact, you know, it could be very beneficial. Okay. So now we've gone into that. Yeah. Tell us what, so the low dose, what were we doing with that? Yeah. I mean, I'll just add to that, that obviously,
01:16:37
you know, someone having an organ transplant, that's something that only like modern medicine could accomplish. And so then the rapamycin serves a great purpose. But obviously, you know, we don't want to suppress your immune system to that degree if you don't have that kind of a scenario. And just explain, why would we want to suppress the immune system at all? I guess maybe we should explain that as a concept.
01:17:00
I mean, where you've had an organ transplant, then… No, sorry, just a normal person. Why would you want to suppress it at all? At all, ever, to any degree. Well, for those who are suffering from autoimmune conditions, or we think that inflammation can just be stimulated by your own immune system,
01:17:20
like revving up the production of a lot of inflammatory molecules. So it's not really, I guess, suppressing it. I like to use the term more modulating so that you have a balance of those cells that are, you know,
01:17:34
who are that are like fighting off toxins and pathogens and those that are kind of regulating the whole picture to make sure that the immune system is not overactive. And that balance is difficult to achieve. And we're certainly seeing that it's getting kind of worse with just the prevalence of autoimmune conditions. Yeah.
01:17:50
Yeah, so the fear is understanding that with our modern lifestyle, with the amount of toxins that we have to cope with, which are novel, maybe it's not as much, maybe it's not much more than our ancestors, that's debatable, but there's certainly thousands of new ones that our body is not used to, right? Or maybe more than that. So with that, the immune system…
01:18:09
like the as you just said the fighting elements of the immune system are like overstimulated and the regulating elements are understimulated but my understanding of reprimand my sense is it did it does suppress both of those like isn't it the case that people who take it even with a low dose they've that like they're more likely to take antibiotics and stuff like that or is that old news is is you know is there a better way of doing it well that's not the case well i
01:18:32
Well, I think, I mean, the low dose that I normally recommend is around sort of like four to six milligrams once per week. So quite low dose. And I've seen with that, I haven't really seen many side effects at all. I think the one thing that's kind of come up has been more like canker sores. And, you know, some people and, you know,
01:19:00
like an increase to glucose and cholesterol, which I can talk about that in a moment, but I haven't really seen that it's had that kind of effect. And I think when people think that they're susceptible to infections, often what they're thinking about, for example, like when they have a cold, when they then have that prolonged runny nose, that's actually more the
01:19:24
the inflammatory post-viral part, not the kind of active infection. And so they sort of mistake that, oh, I'm getting, it's taken me so long to get over this. It's like, you've probably actually fought off the pathogen. You haven't gone into a sort of a septic picture. That means in effect that you're dealing with more of that inflammatory response after the infection. Okay. And so which, which reference,
01:19:49
mycin would then help with, right? Because it reduces that inflammatory response. Okay, interesting. And we know, I mean, I was, we recently kind of attended a talk about rapamycin and just kind of was reminded of a lot of that research that it has essentially expanded the lifespan in every organism it's been tested on. Even most recently, dogs, there was a study on dogs. And now there's actually, sorry, I'm,
01:20:17
I have three dogs, so that kind of always peaks by interest. But actually, they're trying to do a two-year canine longevity study using rapamycin. They're actually looking for people who are willing to have their dogs in parts of that. Interesting.
01:20:37
Yeah. Interesting. I just saw funny enough, a news article the other day about how, uh, dogs are, I think it was golden retrievers. Like their lifespan is reduced by 40% in the last 20, 30, maybe 30 years, something like that. Like, and I think it is the amount of toxins again, um,
01:20:53
is, you know, a primary cause. In the case of dogs, right? Because it's not probably so much, you know, stress and lack of sleep and stuff. It's probably more toxins than anything in the case of cats and dogs. Yeah. And I would say that's actually a good point because you don't think about like how, you know, animals are much lower to the ground. They have, you know,
01:21:14
for paws. And for example, like if they're walking around a lot of glyphosates from, you know, from, uh, you know, from the lawns and from plants, they're much easier. They're able to mop it up much quicker than humans. Well, that's a good point. I was actually thinking more about what's in their food, but, uh, yeah, but that's, that's absolutely true as well. And in the air and the water, I guess it's everywhere. Um, and I know some of the people watching, especially, um, like our anti-
01:21:41
the vitamin a fans who are watching that they're probably listening to this going oh all this is unnecessary all you got to do is uh reduce your toxic input and everything would be great um i just want to remind them that first of all um yeah both dr miriam and i are a big fan of reducing toxicity a lot of when we work people that's exactly what we do focus on so we're we're big on that one as well but this is just like extra stuff you know that
01:22:05
there is a lot of evidence to show. So sure, if you want to increase a dog's lifespan, the first thing to do might be to clean up their diet and their air and their water and all the rest of it, as Dr. Miriam just said, their contact with poisons. But another thing you can do
01:22:20
On top of that is also something like rapamycin potentially, right? It doesn't have to be mutually exclusive. No, exactly. And I think what I like about, what I like about rapamycin is it's just something you take once a week and then you take it three months on, three months off. So it's, you know, it's not that difficult to add into your routine, but we know that essentially that it turns on autophagy and that really helps with getting rid of those degraded
01:22:49
organelles, proteins that are essentially toxic, and it helps you sort of get rid of those senescent cells that we don't want hanging around. But actually, the more that it's studied, the more that we've even seen it helping things like long COVID, mood, as well as your kind of inflammatory neurodegenerative conditions too.
01:23:13
Excellent. And so just the bottom line of this is that inflammation is blamed for a lot of, as a root cause for a lot of issues. Rapamycin is possibly the most effective thing
01:23:24
found at reducing inflammation is that a bottom line of it yes i'd say one of the most studied things that um can help and and this is something you take although again for our purists out there certainly massively reducing your toxin intake and extremely more toxins would also make a big difference to your level of information uh we both agree with that one as well
01:23:46
And since we're having it once a week, I remember Hannah, my wife, trialed this a few years ago. And I think we had one milligram capsules and she was just taking it every day. I think that was the kind of recommendation at the time. So can you tell us why once a week is better than just a smaller amount every day or a smaller amount five days a week? Oh, actually, to be honest, that is just how I was taught to dose it. I mean, I presume that…
01:24:13
You want to activate that recycling process and
01:24:20
And perhaps, you know, you kind of then, that maybe uses up some of your antioxidants as well. So potentially you just want your body to have time to rest and then do it again. That would be my theory because I don't know off the top of my head. What's the amount given to someone if they have, you know, an organ transplant? I probably would have to look that up. I want to say it's about, I mean, it's orders of magnitude higher. I think it's something like,
01:24:50
It might be, I think it's a little bit less than that. I think it's something like 10, 12 milligrams, but yeah, every day. So that's what I was wondering. So you're having a kind of half the amount given to an organ transplant person on one day. So doesn't that mean on the one day you take it that your immune system function is significantly reduced? That's kind of what I was wondering. I wouldn't say that it's, I mean, to be honest, at the moment now,
01:25:15
It's not the immunosuppressive drug that's given. I think that there are potentially better ones, but I have for the perspective of transplant rejection to prevent that. But yeah, it's a good point. Personally, though, I just haven't really seen that happen in practice. I think that if you're…
01:25:41
Yeah, I mean, I haven't just seen that people seem to be more susceptible to infections on the rapamycin dose. So, yeah, I've never really had to look into that, to be honest. Yeah, fair enough. Well, you know, that's what we want you here, not only for your theory knowledge, but for your practical, you know, technical experience. So, yeah, great. Okay.
01:26:01
And then you talked about three months on, three months off. So is that the three months off rapamycin? Is that where you might then do three months on with the growth hormone or growth hormone analogs? Exactly. I mean, you wouldn't necessarily have to do it. I wouldn't say some people actually don't even stop the growth hormone when they're on the rapamycin. I would, though. At least that's how I would dose it in my practice. But yeah.
01:26:28
But yeah, I think that would be a good way to do it so that you balance the growth and the kind of proliferation that you see with the growth hormone and the stimulation IGF-1 versus the kind of slowing down of the body with the rapamycin.
01:26:45
And actually, I don't think we talked about growth hormone. So again, you said you have your longevity clinic, right? Are you giving people actual growth hormone or do you prefer giving them peptides? What do you like to do? I mean, I actually use more peptides. I do prescribe growth hormone. But generally, because it is something that is used daily, you then typically have to…
01:27:10
inject it yourself. And I was a little bit wary about people doing it themselves from a medical liability point of view, but I have, I have instructed people to have had to do it and have used it. But, and, and those, I, I don't necessarily cycle, I actually just use the growth hormone promoting peptides and these, they're up in my soap at the same time.
01:27:34
Okay. But you still do cycle the rapamycin, just not the growth hormone? Yes. I always cycle the rapamycin, yeah.
01:27:41
Very interesting. Okay, fantastic. And both of those are prescription only. Actually, I don't know, do you do growth hormone? I don't think they're available at all in the UK, right? But they are available in the US. Yeah, no, you can. Growth hormone is available from compounding pharmacies. Sure, no, no, the growth hormone peptides, I was saying, in the UK. Okay.
01:28:03
Yes, you can still get it in the UK. You just have to be a bit careful about your sourcing. Okay, awesome. So GOP1s, obviously, is a big thing at the moment.
01:28:18
I think this might be another one for you and I for doing perspective, but that's okay. I'm a little bit more wary of them. So GOP ones are things like semaglutide, and there's some other ones I can't remember how to pronounce. Most of you can tell us. Commonly known as things like Ozempic or Wegovy. Obviously, these are originally diabetes drugs. I think most people have heard of them, but…
01:28:41
that they're so effective at weight loss that they've become very popular. So what's your take on these, Dr. Miriam? Yeah, I would say, I mean, initially I was very skeptical of the GLP-1 agonists and I still am a little bit worried about…
01:29:00
people using them longer term and at the high doses that medical community tends to use. But I, I just, the reason why I am, I think we can't discount them is because I, you know, I've seen people who have just been very unhealthy who, you know, I think as a strategy, getting, getting excess weight off of them and lowering their insulin can be then a catalyst for them applying sort of better lifestyle practices. Yeah.
01:29:28
And so, which I think is just kind of an amazing medical achievement. But I think we have to be wary about how something like that that works so potently is likely going to have some side effects. So, you know, want to then mitigate those side effects or try to promote the organ health that
01:29:50
is being kind of damaged by the GLP-1. For example, like pancreatic function, you know, we're seeing a big uptake in pancreatitis rates, people who are on GLP-1 agonists. But then, you know, they're not really taking anything to support pancreatic health. So I wouldn't want to just blindly give that without care.
01:30:11
the support. What would be an example of something that people would take to support pancreatic health if they're already taking one of these? Like, you know, pancreatin, bitters that help just with bile flow, those sorts of things. Yeah, I want to give my updated one actually quickly because I did an episode on this and I was quite negative about it. I think I have a slightly more nuanced approach. I'm still not taking any, by the way, so it's not to justify my own behavior. But, you know, as I've looked into it, I think there was a certain
01:30:39
of the population. And if I go back to the Korean system that I did an episode on a while ago, I think they're the ones who are stomach dominant. They are people who generally have strong stomach function. They produce a lot of stomach acid. They're hungry a lot and they can easily overeat. And also they have quite fast gastric motility. And I think with someone maybe through genetics, like they just have a bit like over-
01:31:07
active stomach function compared to average and it's very easy for them to overeat and they're hungry a lot and so maybe taking a GLP-1 agonist to bring them back into balance as it were would actually make sense my concern is just when people overdo it and you know they get to the point where every week they you know feel sick and vomiting for several days this just doesn't seem like
01:31:30
And the other problem is a lot of people are not eating a very high nutritious diet. I've done quite a few episodes on this recently, trying to demonstrate to people, you know, how to meet even just your 100% RDA of all the nutrients, let alone you should probably gain more, but at least that from food is not particularly easy.
01:31:48
And so even when people are eating, say, a 2,500-calorie diet and they're trying to eat healthily, I observe that a lot of the time they're not really meeting their nutritional needs. So then when they start taking these GLP-1 agonists, they cut down to maybe a 1,500-calorie diet.
01:32:06
like and they're not careful with this stuff then I think it often it creates more and more nutritional deficiencies and as well as all the other you know potential side effects that you just said have slowed you know digestive motility whether it's pancreatitis or you know maybe SIBO or any of these other things that can happen when
01:32:26
things move too slowly so um so yeah i just wanted to share my take on it i'm not universally against it anymore but my thing would probably be that very low doses like so that certainly not enough that you feel sick when you take them so that's my opinion what's your opinion you did say about lower doses um what what kind of doses do you like to and obviously it depends on the person but
01:32:51
you know, what kind of amounts do you find are appropriate, like for people? I mean, even starting as low as 50 to 100 micrograms a week. Wow, that is very, because the minimum usually is like 250 micrograms, right? With a semi-glutide. Okay, yeah, that makes perfect sense to me. Absolutely. And that's what I think has been recommended in the peptide communities before, you know, I think that they can't.
01:33:17
pharmaceutical ozempic really took off in popularity. So I think it's being
01:33:21
massively overdosed and i and i would say i mean in there are also some some natural glp-1 agonists um you know there's a compound called um americate which i believe is derived from like the hops plant that is also supposed to put you know help to increase endogenous glp-1 production uh we know that certain bacteria acromantia um and a couple of other strains can also help so i i usually will um
01:33:49
sometimes bridge somebody to say okay like you know we know that amaricite that that compound can actually um similar side effects so if you're taking that and you already feel nauseous and had a lot of gi issues then you probably need to do a bit of a gut program first before considering it um you know and um so i wouldn't start it blindly i think you you need it would be more of like a
01:34:16
I wouldn't say a last resort, but I would say when I'm really struggling to get someone's insulin down and they're overweight and that sort of food noise that really disrupts people's
01:34:30
eating habits where they're just constantly thinking about food. They never seem satisfied. If that's the sort of presentation I'm getting, then I think that they can be a fantastic tool, but with a lot of added support for that. That's such an awesome nuance to take, Benna. Yeah, I 100% agree. What about GLP-1 antagonists? I heard Dr. Cruz recently talk about how he believed that there was a conspiracy around this, that
01:34:59
because Blue Light is a strong GOP-1 antagonist according to him, and then a lot of the artificial sweeteners like Aspartame are strong GOP-1 antagonists. So his…
01:35:08
uh, theory is that first of all, they flood, you know, for several decades, they flooded people with Gopro one antagonists. And then they, so it's like they created the problem and then they sell you the cure for the problem, uh, you know, a very high price. And then kind of your, you have to keep taking that for the rest of your life. So I thought that was interesting. Um, you know, with conspiracy, you never know there's really that, you know, level of intention behind it, but you had to see a fairly, um, what's, what's the words like, um,
01:35:37
it wasn't just an idea he had, he'd done a lot of research into it and he, uh, you know, he claimed that this was intentional. Um, so I, I think that's possibly part of it as well to, uh, to consider and look into for people is to reduce the level of antagonists. Yeah, no, no, certainly. I mean, I think a lot of those, um, those strategies like kind of fall into just good, good lifestyle habits. Um, and, um, yeah,
01:36:05
And we also know that some medicines that do block GLP-1 include steroids and things that a lot of patients are on. So I would say that you kind of have to, I think a better strategy would be to first make sure that you're not blocking the GLP-1 from a poor lifestyle, poor diet, and
01:36:32
And then use the GLP-1 agonist as a tool when you're really not making the progress that you want. Another big point there is that obviously a lot of people who are on GLP-1 agonists are losing a lot of weight, but they're also losing a lot of muscle mass. And then, you know, they're not, we don't want to talk about appearance, but they are looking quite gaunt and not exactly the picture of health that you would want. So, you know, I think also from a,
01:37:02
From the peptide community, you'd want to combine the similar glutide with muscle-building peptides. Like growth hormone? Yeah, like growth hormone, for example, and then, of course, things like the iprimirelin. I think that's where some people are using the MK-677 as a kind of something that you would take with a similar glutide.
01:37:27
um but then they seem like they're going in completely opposite directions you know one of them is ravenous hunger one of them's sick at the thought of food so maybe they balance each other out yeah i don't know but i was gonna say if you had a big what sounds like then a spike at a crush it might not be the best strategy i mean i i was sensitive to it but i'm not the only one like this is well known i think in the bodybuilding community that
01:37:50
MK-6, 7, 7, if you take the full dose that they normally recommend, you get ravenously hungry. That is definitely part of it because it's a strong ghrelin agonist, right? The hunger hormone. And I would say that with the semi-glutide, apart from just things that help to, with growth hormone increase, I would also say like looking at things that help with muscle recovery. So things like BPC-157,
01:38:15
And then also that help with, as a tissue regeneration, like thymus and beta-4, those are other peptides that I would, you know, I would generally prefer to use kind of the peptides as a kind of a pack of things that you're taking rather than just one. Okay.
01:38:30
Fantastic. Well, I think we're already at time, Dr. Miriam, and we barely got through half our list of advanced strategies. So I don't know if you're open to it, but maybe we could do another episode where we talk about advanced strategies for people, for advanced longevity strategies, and we can continue this conversation then. Yeah, no, certainly. Because I know we really wanted to talk about the low-dose naltrexone. So why don't we just tease that to people? Yeah.
01:38:53
In the next episode, we'll talk about no-gas no-trexotome. We'll talk about Dr. Miriam's take on mRNA gene therapies. We'll talk about platelets-rich plasma. We'll talk about exosomes, different tools for mitochondrial optimization, senolytic cell detox.
01:39:10
autophagy and mitophagy which we already talked about a bit but we'll talk about some specific compounds and then possibly more that we'll come up with by the time we film that so that's all to look forward to in a future episode um in the meantime um
01:39:23
you know if i wasn't already a client of yours i would feel very excited about the possibility of it having heard all you know the different strategies that um you've outlined and wanting to try them so um for people out there can you tell them how they can find you and uh you know have you helped them with this uh yes so you know i think obviously a lot of the strategies we talked about are more like
01:39:45
things you would incorporate into your life, but obviously things like rapamycin or, um, DHEA, uh, in the, in the UK, DHEA is prescription only. So you should just have to come through a compounding pharmacy. Um, that, you know, if you, I think, um, and yeah, that's definitely something I can help you with if appropriate. Um, and, um, you know, let's say you could always find me at, um,
01:40:10
So my longevity kind of base clinic is called Health Miro. And you can find us on Instagram or on our website. And we do have complimentary and a 20 minute discovery calls. So we can get into a little bit about it. Nobody comes to these like consultations 100% healthy. There's always some area like the thyroid or the adrenals. So it'd be about, you know, what we can do to help plus the longevity aspect.
01:40:38
Yes. And so it's health Miro health N I R O.com, um, health Miro M I R O on Instagram. And, uh, you also have your own practices to say no less longevity focus. That's, uh, McKinsey medical.com. We'll put all of those links in the, uh, uh, description of the episode, both on wherever you're watching Spotify, Apple, or YouTube, it will be there.
01:41:05
If you have any questions, if you're on YouTube, please leave them in the comments. Please subscribe and click the notification bell to be notified when part three of this series is coming up. I didn't know there would be a part three, but I'm happy to do it. And I'm actually happy we have more time to talk about some of these advanced strategies in a separate conversation, Dr. Miriam, because I'm sure there's more that I can learn about this, especially if we talk about it in detail.
01:41:32
Um, so thank you so much for your time today. Again, I want to give the recommendation to, um,
01:41:39
you know, there's very, very few practitioners who are like Dr. Miriam, who have both, you know, that excellent understanding of the mainstream medical system and an excellent understanding of not just, you know, the alternative, but it's a functional medicine. Uh, you also, you know, you've mentioned occasionally about energies and stuff and traditional Chinese medicine, which is something that you're also trained in. I know you have a bunch of other specialty certifications. For instance, I found you because you're, you're certified in the, uh, Wilson's temperature, uh,
01:42:08
syndrome treatment protocol which I did an episode about a while ago so you know she just has an excellent range of different skill sets and knowledge bases and all the rest of it and
01:42:24
And unlike most doctors, is not focused on getting you functional and out of the door, but is actually focused on helping you to optimize, which I guess is probably obvious by now, given what we've talked about in this episode. But still, so yeah, not many doctors like that who are actually genuinely focused on helping you optimize. And if I could just add, someone who genuinely cares about you, who doesn't just see you as another number or another body in the door, but who genuinely cares about your
01:42:51
well-being and you know that you are happy and healthy and all the rest of it so definitely check out dr miriam health n-i-r-o dot com thank you so much for your time today dr miriam thank you all window and thank you for that um recommendation as well i appreciate it
Edit:2025.03.01
