How Not to Age (Part 2)

Today, we have the second in a two-part series, where I offer some highlights from my latest book, How Not to Age taped in front of a live audience. We pick up our story, with tips on how to keep our vital organs in good working order.        

What can we do to protect our bones bowls.. Bladder..

Tons more about individual foods and beverages in the book. But let’s move on to Part Three, where I get into the nitty gritty. What can we do to protect our bones, bowels, bladder, and circulation? Our hair, hearing, and hormone balance? Immune function, joint health? Our minds and our muscles? Sex life and skin? Our teeth, vision, and finally, our dignity in death? Let me just share a few quick pearls.

For example, did you know that 85 percent of bone-related fracture risk has nothing to do with your bone mineral density? That’s just been drilled into our heads by big pharma and a billion-dollar bone density screening industry. Fractures are primarily due to falling, not osteoporosis. So, it’s the age-related muscle loss and impaired balance that may be breaking most of our bones—which is good news, because there’s something we can do something about it.

Seven randomized controlled trials found that strength and balance training can cut fracture rates nearly in half—and that’s just during the trial. In the five years after this one-year study ended, those who had previously been randomized to the combined strength and balance group, suffered 74 percent fewer fractures. That’s far more effective than osteoporosis drugs like Fosamax that can cause fractures—atypical femoral fractures, in as many as one in 300 users.

They are called “atypical,” because they occur not after a fall or trauma, but just during routine activities, like walking, twisting at the hip, or even just standing still. Thanks to the drug, your femur, your thigh bone, the biggest bone in your body—just cracks in half. Too cruel an irony from a drug that’s supposed to protect your bones.

After bones, I talk about preserving your bowel function in chapter number two. Randomize constipated diabetics to either cookies containing a tablespoon (20 g) a day of ground flaxseeds, or flax-free placebo cookies, for 12 weeks. And not only does the flax improve constipation symptoms, but resulted in an eight-pound weight loss over placebo, 25-point lower blood sugars, an astounding drop in hemoglobin A1c, and 17-point lower LDL cholesterol. All for about 10 cents a day of ground flaxseeds.

For a head-to-head test between flaxseeds and psyllium, sold as Metamucil, a third cookie group was added with 10 grams of psyllium, and the flaxseed beat out the psyllium for constipation relief, weight, blood sugars, and cholesterol—and, is about four times cheaper. Flaxseeds were also directly compared to the prescription laxative lactulose, and worked better as well.

Bladder function! The prevalence of overactive bladder syndrome increases with age, reaching about one in three. No wonder bladder-relaxing drugs are a multibillion-dollar industry, yet may only reduce bathroom breaks by a half a pee a day compared to placebo. But a quarter teaspoon (500 mg) a day of dried cranberry powder worked nearly four times better, about two fewer daily trips to the bathroom over placebo, and that’s without any of the drug’s side effects: dry mouth, constipation, sedation, impaired cognition, rapid heartbeat, urinary retention, and the visual disturbances that lead almost two-thirds to stop taking the drugs––whereas cranberries are just tangy.

Urinary incontinence is a common problem among older adults, particularly women, thanks to childbirth. Systemic menopausal hormone therapy like Premarin actually makes it worse. But local, vaginal estrogen may help. What works five times better than estrogen cream, though? Kegel exercises, pelvic floor exercises, as I detail in the section “Jacked in the Box.”

For men, urinary issues are more an enlarged prostate problem––having to get up multiple times at night, wee hours of the night. Cranberries to the rescue there again. Even just an eighth of a teaspoon (250 mg) a day of powdered cranberries can significantly improve prostate symptoms. You can buy cranberry powder in bulk at a cost of less than a penny per day.

What about saw palmetto, the most common herbal supplement used for prostate symptoms? Based on dozens of randomized, controlled trials involving nearly 5,000 men: no clinical benefits. But pumpkin seeds work.

More than a thousand men with prostate symptoms were randomized to either about a tablespoon (15g) a day of plain pumpkin seed kernels, a proprietary pumpkin seed extract, or placebo. The study was funded by the drug company that made the supplement, but the supplement totally flopped, while the pumpkin seeds themselves worked.

Pumpkin seed oil was pitted against the leading drug for hair loss in women. A little less than a quarter teaspoon (1 ml) applied to the scalp once a day versus a dose of the drug, and they both worked, but the drug worked better. Rosemary oil, however, may be more closely matched.

A hundred balding men were randomized to twice a day minoxidil like Rogaine, versus a rosemary lotion. It took six months, but significant comparable improvement in hair counts in both groups, with no significant difference between the two.

The rosemary lotion appeared to work as well as the drug. If you want to give it a DIY try, you can premix about 10 drops of rosemary essential oil to each fluid ounce (30 ml) of your favorite lotion and rub a quarter teaspoon (1.23 ml) into your scalp twice a day. Cost-wise, that much rosemary oil would come out to be about a penny per week.

Let’s move on from hair highlights to hormones. I touched upon how menopausal hormone therapy can increase the risk of urinary incontinence, but that’s not all. If a thousand postmenopausal women take the standard hormone regimen for ten years, you’d not only expect 876 extra cases of urinary incontinence that they would not have gotten otherwise, but nine more cases of invasive breast cancer, eight more cases of heart disease, probably 22 more cases of dementia, 21 more cases of gallbladder disease, nine more strokes, and 21 more blood clots—though not a single partridge nor pear tree. However, hormone therapy is highly effective in decreasing menopausal hot flashes. Is there any way to keep cool without the clots and cancer?

In the U.S., menopausal hot flashes are considered inevitable, but there isn’t even a word for hot flash in Japanese. This may be due to their greater consumption of soy foods. But you don’t really know until you put it to the test. Harvard’s Center of Excellence in Women’s Health funded a randomized, crossover trial of a half a cup (118 ml) of unsalted soy nuts a day, and achieved about a 40 to 45 percent reduction in hot flashes within two weeks compared to the control group.

Given that a plant-based diet may also be effective for managing menopausal symptoms, researchers decided to combine the two: a plant-based diet plus whole soybeans. In fact, two randomized controlled trials found that plant-based nutrition with a daily half-cup (86 g) of cooked whole soybeans can reduce the number of serious hot flashes by 84 to 88 percent within t12 weeks. Overall, most randomized to the plant-based bean group ended up free of moderate-to-severe hot flashes, compared to about 95 percent still suffering in the control group.

Lots of other things can help. Whole fennel seeds, powdered into capsules to pit them against placebo in a double-blind trial significantly improved menopausal symptoms at a dose of just a teaspoon (2g) a day. Fenugreek may also help at a dose of one and a half teaspoons (6g) a day, though not as much as hormones, but without the side effects––though fenugreek can make your pee smell like maple syrup; sounds like a bonus!

The nice thing about studying spices is that entire servings can be stuffed into a pill, to pit them against placebo. A quarter teaspoon (1g) of black cumin powder a day led to significant improvements in memory and other tests of cognition within nine weeks compared to placebo. Black sesame seeds—less than a teaspoon (2.52g) a day of ground black sesame seeds—stuffed into capsules, against placebo, drove down systolic blood pressures by eight points within a month. If sustained, that alone could decrease the risk of stroke by about a quarter.

What else can we powder? Strawberries! Osteoarthritis patients were randomized to two ounces (50g) of freeze-dried strawberry powder versus a fake, strawberry-flavored and colored placebo powder, and, compared to placebo, the real strawberries significantly decreased constant pain, intermittent pain, and total knee pain––and improved disability and overall quality of life.

Osteoarthritis is the most frequent cause of physical disability among older adults. Yet how do we treat it? Acetaminophen, Tylenol, is considered the first-line pain killer, but guess what: it doesn’t work. I mean, it works, just not much better than a sugar pill. But at least it’s not going to make matters worse, like other things we doctors have cooked up, like steroid injections, which actively worsen joint deterioration and offer no greater pain relief than placebos. Or arthroscopic surgery, which may end up tripling our risk of ending up having to get a total full knee replacement. I mean so, even if the strawberry study is some total fluke, what’s the worst that can happen? Tastier smoothies?

And less than a quarter of a teaspoon (~1.25ml) of ground ginger a day can beat out placebo for joint pain. Researchers conclude ginger, “therefore, is recommended as a safe drug for these patients.” But by “drug,” they just mean a couple pinches of the ground ginger you can buy at any store. There was even a study on topical ginger—at least, when applied to the scrotum. Paper-thin slices of ginger applied over the inflamed testicles, and the researchers were, on the ball, healing nearly three times faster than the control group.

There have been more than a hundred randomized, controlled trials on ginger, shown to help with nausea and vomiting, and everything from COVID to PMS. Heavy periods, painful periods, migraine headaches, multiple sclerosis, and the list goes on. Bottom line: “Mounting evidence suggests ginger can promote healthy aging.”

What about garlic? Clinically proven to protect against those who “vant to suck your blood.” Literally. A hundred Marines were randomized to a clove a day or placebo, and those on garlic had significantly fewer tick bites. Though sadly, garlic does not appear to help against other bloodsuckers.

So far, I’ve touched on preserving your bones, bowels, bladder, hair, hormones, and joints, but preserving your mind is the largest chapter in the book, because dementia is one of the most pressing public health problems, and the most feared condition of later life. There’s a common misconception that we have no control over whether we develop dementia. But the good news is that although Alzheimer’s may be incurable, at least it is preventable.

There is an emerging consensus, that “what is good for our hearts is also good for our heads,” iClogged with cholesterol, closing off our arteries, clamping down on blood flow. What kind of brain arteries do you want in your head?

Too much cholesterol in our blood is unanimously recognized to be a risk factor for the development of Alzheimer’s disease. Those with a total cholesterol of 225 (mg/dL) or more may have nearly 25 times the odds of ending up with amyloid plaques in their brain 10 to 15 years later. Cholesterol explains how the Alzheimer’s gene APOE4 ravages the brain. After all, APOE is the primary cholesterol carrier in the brain.

LDL cholesterol in those with bad gene variants of APOE averages 40 points higher, but switch people to a diet lower in animal fat, and that cholesterol difference can be effectively smoothed out. So, diet can trump genetics.

This may explain the so-called Nigerian paradox, where they have among the highest rates of the Alzheimer’s gene, but some of the lowest rates of Alzheimer’s disease. How is that possible? Genes load the gun, but lifestyle pulls the trigger. The paradox may be explained by their low cholesterol levels, probably because of their diets low in animal fat.

Human beings may have evolved to maintain an LDL cholesterol level of around 25 mg/dL, but the average in the Western world is approximately 120 mg/dL. No wonder heart disease is the leading cause of death in high income countries, and dementia is killer #2. That helps explain why the so-called Alzheimer’s gene is the single most important gene when it comes to longevity, too––which is good news, because even if we’ve been dealt some bad genetic cards, we still may be able to reshuffle the deck with diet.

So, in terms of dietary guidelines for the prevention of Alzheimer’s, we should center our diets around vegetables, legumes, fruits, and whole grains. In other words, the dietary pillar of lifestyle medicine: whole food, plant-based nutrition.

Or even simpler, plants, plants, and more plants. Any plants in particular? Note that the directors of Loma Linda’s Alzheimer’s Prevention Program single out berries and greens. Eating strawberries and spinach can mitigate age-related cognitive decline in rats. But what about in people?

When the cognition of hundreds of twins was followed over a decade, consuming the berry pigments in less than a quarter cup (23g) of blueberries a day, or about a cup (138 g) of strawberries, was associated with slowed cognitive aging by about four years. And nearly all of the randomized controlled trials of blueberries and cognitive performance found improvements in at least one brain domain––perhaps because blueberry consumption can improve blood flow to certain critical regions of the brain.

Now, the one study that flopped mixed the berries with milk. And we know the addition of milk prevents the artery-protective effects of tea, and prevents the bump in antioxidants that you’d normally get eating dark chocolate, and impairs the absorption of the autophagy-activating compounds in coffee. What about mixing berries and cream?

The antioxidant activity of blueberries is not just impaired by milk. Researchers found that the total antioxidant capacity of our bloodstream (measured in two different ways) shoots up within an hour of eating a cup and a half (200g) of blueberries with water and remains elevated five hours later. With milk, maybe one would expect less of a bump? But in fact, they ended up worse than when they started. After eating a whole bowl of blueberries, they ended up with less antioxidant capacity in their body—because they ate the blueberries with milk.

One reason greens may be referred to as an anti-Alzheimer’s plant is because dark green leafy vegetables can also improve blood flow in the brain in interventional trials. Randomize older adults to the greens pigments found in about a cup (12mg) a day’s worth of cooked kale and see significant improvements in complex attention, cognitive flexibility. And those randomized to even just a half cup of kale’s worth of the cruciferous compound sulforaphane got significant improvements in processing speed and working memory.

Here’s the rate of cognitive decline in elderly men and women eating a serving a day of green leafies, compared to those only eating greens about once every ten days. Are you sitting down? “The rates of decline among those who consumed 1 to 2 servings of greens a day was the equivalent to being 11 years younger… .” So, now are you sitting down to a big salad?

Greens come up in chapter after chapter. What’s the recommendation for preventing age-related macular degeneration, our leading cause of blindness? Or even treating it in its earliest stages? Consume a diet high in green leafy vegetables.

We’re talking two to three servings a day. So, at least greens at every lunch and supper, with bonus points for sneaking them into breakfast in, say, a green smoothie. In fact, blending greens can triple the bioavailability of a key, vision-protecting nutrient.

The main reason greens make it into in my Anti-Aging 8 though, is because of the nitrates in a serving or two of cooked greens can slow our metabolic rate––for the same reason a little shot of beet juice can help free divers hold their breath longer: because it improves the efficiency of our mitochondria, the little power plants in our cells, allowing us to effectively extract more energy from each breath. Another dietary intervention that has a similar effect on slowing metabolism is calorie restriction. The candle that burns half as bright burns twice as long. But instead of starving all the time, you can just eat a big salad.

What else can greens do? In the Harvard Nurses’ Health Study, the consumption of leafy greens appeared to protect against the development of frailty, and when put to the test in a randomized, double-blind, placebo-controlled trial, the equivalent of two-thirds of a cup (158ml) of spinach led to a significant boost in muscle strength, muscle quality, and muscle mass in older men and women. A single cup (240ml) of cooked greens’ worth of vegetable nitrates significantly boosted maximal power and velocity in quads so much it was “functionally equivalent, to acutely reversing the effects of several decades of aging.” A single cup (240ml) of cooked greens!

Of course, when most people think about maintaining muscle mass into old age, they don’t think spinach, they think protein. But if you put together all of the randomized, controlled trials of adding extra protein to the diets of older men and women, you find no evidence that adding protein increases muscle mass or strength. Yeah, but what if you have sarcopenia, excessive age-related muscle loss? Surely then protein helps, right? No. No significant effect on physical performance or muscle strength. What does work? Exercise. When it comes to age-related muscle loss, it’s use it or lose it.

But maybe exercise plus protein? No. Protein supplementation does not significantly augment the effects of strength training in older adults. In fact, one of my Anti-Aging 8 is protein restriction. Why do longevity experts like Valter Longo recommend people cut down on protein to live longer? Here’s what Luigi Fontana wrote in his book. He’s the director of another leading longevity research center. “Excess protein may not mass your muscles, but it will accelerate aging.”

How do you boost the pro-longevity hormone FGF21? Dietary protein restriction. How do you suppress the age-accelerating enzyme IGF-1? You do it through dietary protein restriction. How do you suppress the so-called motor of aging, mTOR? Dietary protein restriction.

In fact, protein restriction was the only intervention I could find that could slow down all 11 of the aging pathways, which is good news, because it’s easier to cut back on protein than it is to cut back on everything and walk around starving all the time.

And, it may even be easier than that. Most or all of the life-extending benefits of protein restriction may be due to just restricting particular amino acids, like methionine. In that case, you could even keep your protein intake the same but just swap sources, from animal proteins like meat to plant-based sources like beans.

So, in humans, methionine restriction can be achieved using a predominately plant-based diet, which makes methionine restriction feasible as a life-extension strategy. Of course, drug companies look at this same data and think: What pharmaceuticals can we develop to mimic these dietary interventions?

Anything else that can maintain muscle mass other than greens and machines? How about cocoa beans! Older men and women randomized to a single tablespoon (22 g) of regular cocoa powder a day experienced a significant improvement in muscle strength, muscle mass, and all four measures of physical performance. And no, the study was not funded by Hershey’s.

Unfortunately, the tastiest cocoa doesn’t work as well. The control groups here were given the same amount of highly Dutched cocoa—alkalized cocoa, where some of the bitter compounds removed in the Dutching process are the very flavonoids responsible for the benefits. But natural cocoa is so good it can improve walking performance in those with peripheral artery disease––not only by improving blood flow, but, as muscle biopsies showed, by improving mitochondrial activity. This is consistent with improved mitochondrial structure, as well in biopsies taken from people’s quads (though this study was actually funded by Hershey’s).

What else can cocoa do? Increase the circulation within our skin, boosting it 70 percent within two hours, after less than a tablespoon. Do that every day, and within three months, you end up with significantly improved skin thickness, density, and hydration, but no change in wrinkles. However, keep it up for six months, and you do see an improvement in wrinkles, a significant decrease of wrinkle depth, along with an improvement in skin elasticity within 12 weeks—all by making your life a little more chocolatey, by just adding some natural cocoa powder to your daily diet. I put it in my oatmeal with some canned water-packed tart cherries for a chocolate-covered cherry sensation.

What else can we do for our skin? Well, there certainly are other antioxidant, anti-inflammatory, glycotoxin-free foods. So, when patients inquire about a diet that might contribute to younger-looking skin, evidence supports a recommendation to follow a whole food, plant-based diet. But the most important thing to prevent skin aging is avoid the sun. Exposure to sunlight may account for 90 percent of visible skin aging. That’s why dermatologists agree there’s nothing more important to slow the signs of aging than to protect your skin from the sun.

The gold standard is considered to be the use of sunscreens in the daytime, and “retinoids” at night. They’re talking about a prescription-only form of topical vitamin-A, also known as all-trans retinoic acid or tretinoin (sold as Retin-A), that has been widely proven to improve skin appearance. The only problem is that it may kill you.

“Topical Tretinoin Therapy and All-Cause Mortality”: a randomized controlled trial had to be stopped early, because significantly more people were dying in the retinoic acid group, compared to the placebo cream group. When applied topically, one to eight percent is absorbed into the bloodstream. Could it be killing people? While the debate continues as to whether the increase in deaths was just some statistical fluke or a real biological effect, tretinoin continues to be banned in Europe for cosmetic purposes.

So, what can we use? Topical niacinamide, also known as nicotinamide, is described as one of the best-studied anti-aging skin cream ingredients (which is not saying much). But it has been shown to reduce yellowing, wrinkling, blotchiness, and dark spots in aging facial skin––for example, significantly reducing crow’s feet wrinkles around the eyes. This was a split-face study in which 64 percent of the niacinamide-side eye wrinkles had moderate or marked improvement, compared to zero percent of the placebo-side eyes.

Topical vitamin C also offers similar improvements over placebo in wrinkles, sallowness, and skin tone or firmness. Unfortunately, vitamin C is unstable in creams, turning an unsightly brown when it oxidizes, limiting its shelf life. So instead, what the skin care industry does, the skin care industry, they use the stable vitamin C esters or derivatives. But there’s no evidence that these compounds have comparable effects, likely because they’re poorly absorbed and only minimally convert to the active form. But the good news is you can make your own.

The 10 percent solution used in the study retails for a ridiculous $127 an ounce (30ml). But you can make a DIY solution more than two thousand times cheaper by simply buying ascorbic acid in bulk and mixing three grams into 30 grams of water, at a cost of about a nickel per ounce (30ml). Drip a few drops into the palm of your hand and use your fingertips to apply it over your face, neck, and upper chest daily. (Just don’t get it in your eyes.) And look, you can do the same thing with niacinamide, which can be even more ridiculously priced. But you can buy it in bulk as well, at a 5,000 percent discount.

I can go on and on, and certainly the book does. But let me close out by going back to the basics. From the anti-aging journal Rejuvenation Research: “Finally, a regimen to extend human life expectancy.” Was it some exotic new stem cell treatment or gene therapy? No, it was a reference to this Harvard analysis. More than a hundred thousand men and women were followed for decades, and even just a few basic lifestyle behaviors appeared to translate into 12 to 14 extra years for the average 50-year-old. Even at age 50, you may be able to add an extra dozen years to your lifespan. Even at age 70, there could still be about 10 extra years on the table. And if you clean up your life before 50, nearly 18 years may be up for grabs, based on simple common-sense behaviors.

That’s the kind of life-extension extrapolating from some of these lab animal experiments. But after decades of research and hundreds of millions of dollars later, efforts to translate those results into humans have largely been in vain. Yet, here we are with human data suggesting dramatic life extension is available to all of us. Right here, right now. The trillion-dollar pill that anti-aging biotech has been promising us is here. It just effectively has to be administered in the produce aisle and the gym. Turning back the clock, not with a drug or a DeLorean, but just by eating and living more healthfully.

A midlife shift between the ages of 45 and 64 to even the barest of minimums, the barest of minimums. So, what are we talking about? At least five servings of fruits and vegetables a day, walking even just 20 minutes a day, maintaining a healthy weight, and not smoking, can result in a substantial reduction in mortality even in the immediate future. We’re talking a 40 percent lower risk of dying in the subsequent four years. The researchers conclude that making the necessary changes to adhere to a healthy lifestyle is extremely worthwhile, and middle age is certainly not too late to act. You hold the power.