Democratising longevity with Dr Andrea Maier

[00:00:00] Charlie: My song for this week, actually, I was thinking about…

[00:00:04] Greg: Go on.

[00:00:05] Charlie: Bee Gees, Staying Alive. Whether you're a mother or whether you’re a brother, you're staying alive, staying alive.

[00:00:10] Greg: Is this gonna become a thing where every single episode?

[00:00:12] Charlie: I mean, why would it not?

[00:00:12] Greg: One of us is gonna be providing a terrible rendition of a popular song that's vaguely irrelevant to today's subject?

[00:00:22] Charlie: Excuse me, a terrible rendition. I think the listeners will agree. That was banging. 

[00:00:26] Greg: Listeners, please write in with whether that was banging. 

[00:00:31] Charlie: Was that your northern accent? 

[00:00:33] Greg: That was my terrible, terrible northern accent.

[00:00:36] Charlie: Or that's what I'm bringing to the table. You can bring geriatric research and I'll bring…Songs.

[00:00:47] Charlie: This is the Method, a podcast from Thriva about what health looks like in the real world. 

[00:00:50] Greg: I'm Dr. Greg Potter. I'm a scientist and health and performance consultant.

[00:00:54] Charlie: And I'm Charlie Edmondson. Whilst I love sports, I'm definitely not a science expert. I've got a regular job, and I'm here to remind Greg of what life's actually like when you're not a nerd.

[00:01:08] Greg: How dare you call me a nerd. So on this show, we'll work out some sustainable changes to your routine that will actually make a difference to your health. And to do that, we've got a simple three step method. First, we bring an expert to unpack the science behind one key health question. Second, we provide some tips and habits you can try right now. Then finally, we put the practice to the test. 

[00:01:30] Charlie: Each week we're gonna hear from those who have tried and tested our recommendations to help turn a so-called ideal lifestyle into something that actually works for you.

3. Topic Intro

[00:01:46] Charlie:  Good morning. 

[00:01:47] Greg: How are you? 

[00:01:47] Charlie: Good, thank you. How are you? 

[00:01:50] Greg: I'm alright. Thanks. I'm looking forward to your thoughts on moral philosophy today. 

[00:01:53] Charlie: Oh, God, don't do that because my thoughts are, I have no thoughts. 

[00:01:59] Greg: What should we speak about instead? The effects of crumpet intake on ageing. 

[00:02:05] Charlie: I mean, I hope, imagine if it's just crumpets. I've had the secret sauce the whole time. I'm actually 65. You just can’t- You just can't tell. 

[00:02:16] Greg: But we were speaking about the fact that when people start to age, they selectively lose fat from their face. And that can make them look older and maybe crumpets are good for facial age for that reason. They keep the face nice and plump. 

[00:02:25] Charlie: puffing my face, 

[00:02:26] Greg: crumpet like 

[00:02:26] Charlie: popping my, oh, you saying my face looks like a crumpet. Oh my God. 

[00:02:34] Greg: We are actually speaking about ageing today. 

[00:02:35] Charlie: Yeah. Today we're joined by Dr. Andrea Maier, one of the world's leading experts in ageing and longevity. Andrea is a specialist in geriatrics and internal medicine, a researcher in gerontology, which is the study of ageing. For those who, like me, were unsure of what on earth it meant.

[00:02:53] And the founder of Q Longevity, a global centre, focused on measuring and reversing biological ageing. Have you met Andrea before Greg, or is this your 

[00:02:59] Greg: I haven't. But I have long admired her work and she is this incredibly rare blend of someone who is traditionally trained as a medical doctor, but now is.

[00:03:15] At the bleeding edge of research into science of longevity. And so she both is in the ivory tower, but also I think has her feet on the ground. And today we're gonna be speaking about the whole idea that we need to and want to because we'd benefit from democratizing longevity. Charlie, what have you heard recently about some of the factors that affect ageing?

[00:03:39] Charlie: Um, I would say. Diet, what you eat, what you drink? Alcohol, smoking, drugs

[00:03:45] Greg: good drugs or bad drugs? 

[00:03:47] Charlie: Um, well, depends if we're talking about ageing, getting older, making you look older or feel older or making you younger. 

[00:03:51] Greg: Ah. Based on what you've seen, do you think that living a long, healthy life is something that is accessible to the masses?

[00:04:06] Charlie: Um, I think there's probably elements that are accessible. I suppose it's, if I, if I think about my perspective, you know, you've got to do that to. Live longer, look after your body, so move more brain, train, do a Sudoku. All the things that I think are probably more readily accessible day to day, just go out.

[00:04:30] Walking obviously is free as soon as you sort of then want to maybe take the next level down. I personally wouldn't really know where to start after googling. There's a company that I kept seeing pop up on my Instagram that does, you know, like a full body scan that you can go and they check everything for you.

[00:04:51] And there was an eight-month waiting list and then I noticed all these influencers were doing it and I thought, oh, this is gonna be pricey. And it was pricey. 

[00:05:01] Greg: Yeah.

[00:05:01] Charlie: So. Yeah, I don't know how accessible. Once you go from the very initial tick box things where then the next step is really 

[00:05:07] Greg: Just on the subject of those scans.

[00:05:10] I think what can happen is that people end up on a wild goose chase and they realise that they're a bit one key when. We're all a bit wonky and they start trying to correct things. 

[00:05:17] Charlie: I've got one, one leg shorter than the other.

[00:05:21] Greg: Most people do. My left leg is substantially longer. Which of yours is longer?

[00:05:26] Charlie: Oh, I think it might be my left leg longer. My right leg. 

[00:05:29] Greg: Uh, team long left leg, 

[00:05:29] Charlie: Team long left leg, that'd be a good quiz name, wouldn't it?

[00:05:32] Greg: It would, I think people with longer left legs live longer. 

[00:05:34] Charlie: That could be my killer question. If you've got a long left leg, are you gonna live longer? I've got one leg shorter than the other. Most people do. Yeah, my left leg is substantially longer. Oh, which of yours is longer?

[00:05:45] Right. Sorry, just to loop back to the democratizing longevity in please, the least nerdy science way possible, could you give me a little overview on what that actually means? 

[00:05:59] Greg: It means trying to help us all live longer, healthier lives, irrespective of how well off we are. And it's something I've been very interested in for quite some time.

[00:06:09] There are big socioeconomic status gradients in how long people live and their risk of various diseases, so people who are less well off. Do have shorter lives, and we see that between countries, but we also see that within countries. And I think alongside that, there are a few people who are taking quite extreme measures.

[00:06:30] They tend to be exceptionally wealthy, middle-aged guys and wealthy people who are doing somewhat speculative things to try and live longer, like injecting themselves with. Blood from younger individuals or even trying to manipulate their genes when as you mentioned, many of the things that we know actually help people be healthy for longer are very low cost or even free and readily accessible.

[00:06:59] And I think one of the problems is that our healthcare system is really a sick care system. And there's a chance for it to be a longevity system. But a common theme is that we need a system that helps prevent problems from happening as opposed to focusing on treating problems that already exist. And if we can do that, that can help ensure that we all have good lives and those aren't just reserved for the ultra wealthy

[00:07:25] Charlie: Prevention is better than cure Greg. Who said that? 

[00:07:28] Greg: Is that a famous singer? Is that just, I think it was a moral philosopher. 

[00:07:33] Charlie: Stop it. Have I just become a philosopher? Oh my God, she's on fire. 

[00:07:37] Greg:  I've always thought of you in that light. 

[00:07:40] Charlie: Not only is she a singer, she's a philosopher. 

[00:07:43]  Greg: Well, should we, should we bring in Andrea? 

[00:07:45] Charlie: Yes. Let's, let's bring in the expert.

4. The Science

[00:07:52] Charlie: So Andrea, I'm curious to know, how did you first get interested in aging and longevity? Was there sort of a specific moment or person that pulled you into this field? 

[00:08:01] Andrea: As an intern in medical studies, I, I wanted to go abroad, so I went to. Harbin, which is in, uh, 300 kilometers north and of Beijing in China, and um, I got to know that you don't have to decline in terms of function while being exposed to a 90-year-old lady who was so flexible in her joints.

[00:08:27] That I imagined, like this cannot be the case. This lady wanted to do Tai Chi with me every morning at 4:00 AM and I'm not a morning person. I'm not a Tai Chi person. So I realised then that 90 year olds, or even 70 year olds are very different. And um, that ageing is just beautiful and can be very successful.

[00:08:48] Charlie: Does the 90-year-old woman know how much she influenced you your career?

[00:08:51] Andrea: Absolutely. I told her.

[00:08:53] Charlie: So today the focus of the podcast is on democratizing longevity, so can you just explain for listeners what longevity means?

[00:08:58] Andrea: So longevity just means that you are living longer, but most importantly is that you can do the things you wanna do and you have the assets doing it.

[00:09:18] Uh, when I was a geriatrician or much, much more involved in geriatrics, I was always asking my patients, are you able to walk? Are you able to talk and do you have friends? Because these are, I think, the three key characteristics. Especially at all life, like being able to walk and talk and having friends.

[00:09:36] But it also applies, I think for, for a 20-year-old or a 40-year-old, are you able to communicate? Are you able to go there? Do you have the means and are you surrounded by people who actually care for you and asking you if you're not there? So that's having friends. 

[00:09:58] Greg: Yeah. And my understanding is that in general, in recent decades, lifespan has extended throughout the world, but has health span moved in lockstep with lifespan?

[00:10:06] So are people living longer and healthy for a longer time too? Or at the end of life, are people actually just sick for longer?

[00:10:09] Andrea: Good, good question. It depends on the definitions you're using. It's very easy to define lifespan, uh, because that's the number of years you are here, but health span is very, very difficult.

[00:10:26] There's a huge gap between lifespan and healthspan where you only look at can you function your daily life. It's roughly a gap of 10 years, and that gap is absolutely not closing. I would define a health plan differently. For me, health is if you don't have any chronic diseases. Which are defined by the WHO, by the World Health Organization.

[00:10:48] If you are using that definition, then actually the gap between health spend and lifespan is much, much, uh, bigger, roughly 35 years because in most of the countries with appropriate healthcare systems, individuals at the age of 50. Have the first chronic disease, and then in principle, following my definition, health spend would stop.

[00:11:09] And if you're living until the age of 85, then you have 35, uh, years. And also that gap is really not, not closing. 

[00:11:12] Charlie: So on average, it does seem that wealth seems to translate into extra years on your life. Is that typically, from your opinion, sort of better access to healthcare, different lifestyles or less stress?

[00:11:32] Andrea: Yeah. So first of all, I think we have to acknowledge that there's a huge gap. Dependent on socioeconomic characteristics, it is very often depicted by the income somebody has, but also it starts already the school education you were having because school education leads to very often to income and choices.

[00:11:52] You make income and. School education are associated with lifestyle choices you make or others make for you. Because if you are growing up in a family where you don't eat fruit, uh, chips are less expensive and. You are not exercising that lead, and that determines already how many diseases you're going to have later in life.

[00:12:18] And that determines how long you are living healthily. So the health span, and that also determines how long you're going to live. And there are many, many studies. Showcasing that if you are outside the city centre and you are in less affluent regions, that the life expectancy can be up to 10 years less compared to the ones where people live having more money and better jobs.

[00:12:42] The very prominent example is Newcastle and the UK. If you would enter a bus and you're just driving 10K up north or down south, that you actually would by every kilometer, you would enter a different life expectancy by reducing or improving it by one year. So you asked, is it stress? Mm-hmm. Yes. It can be stress because if you are living in very constrained conditions, yes you are more stressed, might be your cortisol levels are higher.

[00:13:16] Yeah. And do you have the knowledge actually that it might be good to do an and your health screening? Very important. So it really determines what the knowledge level is. And that's also the reason why I think if we had. Talking about ageing, we really have to look at family structures. We have to look at where people live and what they already know to really give the appropriate interventions.

[00:13:36] Greg: So before we get to those interventions, it'll be very interesting to get some of your thoughts about what fundamentally drives ageing. I know that is a contentious subject, but how would you explain what causes ageing at its root? 

[00:13:58] Andrea: Ageing is nothing else than the accumulation of damage. So think about a 5-year-old, the best toy.

[00:14:04] You have that toy if you're using them because you love it, you're using it and it gets scratches and it's just, you see there's wear and tear, and that happens also with our body. So dependent on the lifestyle choices we have, you have more damage or less damage. And of course, you see that on the outer side.

[00:14:23] You see that on your skin. If you see yourself now in the mirror and you saw yourself 20 years ago in the mirror, you absolutely see the differences. At least I see that. Most importantly for us is to understand why we age in the inner side and why do wrinkles matter in the inner side because. It determines my function, so if I have a wrinkled heart, that means that the heart is not able to beat as good as it was doing 20 years ago.

[00:14:56] Hence, my endurance and my capacity to run if the tiger is chasing me will be diminish. So that's on organ level. If we are zooming in, we see that every organ have cells which have to communicate together. And if I'm looking in the cellular level, most of the cells have a nucleus, which means a very tiny thing where our genes are being captured and the genes are nothing else than a book we can read.

[00:15:24] And dependent of which chapter I want to read, I can manipulate my body to do. Certain nice things like walking, talking, uh, memorising things. Beautiful. So we have the genes and the genes need to be copied because if I want another cell, I have to copy this book. And with every copy I make, there will be mistakes in my genes.

[00:15:48] So if I have a book, but that was not very nicely. I captured, I might have a problem because then I'm reading a different story and that different story might lead to diseases like cancer. So we now understand how copying while developing as a child, while growing up, while using the body, while having to maintain our body.

[00:16:17] There are so many mistakes. And the reason why we have diseases is because we are not good at at solving it, and we have beautiful machinery in all our trillions of cells. And they don't talk in the end effectively together. So they build friendships within one organ and then one dies, and the other one is lonely and it's just an orchestra, which is a little bit dysregulated. And that's then. Yeah, called ageing.

[00:16:50] Charlie: It's quite sad to think of your organs losing their friend, being lonely, so I'm obviously aware that everyone goes through periods of stress in their lives and have various life transitions. I'm assuming that does affect how fast we age and has, has an impact on ageing.

[00:17:10] But I'm curious to know, do we all age at the same rate throughout our lives? I mean, to use what I'm aware of. My dogs, for example, I've got two dogs. They apparently age at the same rate for the first four years I think it is, and then they accelerate for the later part of their life. I'm curious whether that's not to translate dogs to humans, but I.

[00:17:34] Andrea: So let's stick with humans. We are developing and we are growing, and uh, at the age of 18 to 20, we really have the maximum of our capacity. So we are physically super good and well, and we try to maintain that until our 25th birthday. And then everything declines, and then the rates and the pace of decline.

[00:17:56] If you're looking at groups of individuals. They are quite stable. It's still a decline until the age of 40, and then from the age of 40 to 60 accelerates, and then at the age of 60 it really goes down. There are lots of hypotheses why we age and and what the relevance is of. Us human beings after reproduction, and I think it's absolutely not solved.

[00:18:21] However, there are huge inter-individual differences, which means if you put 40 year olds in a room and you have 100, the pace of aging how fast the age is very, very different. So some of these 40 year olds can be biologically 35 or even 30, and others can be 45 or 50. Which means that the individual trajectory you are following is very different compared to the group.

[00:18:52] Greg: Before we move on to what people can do to age better, to slow their aging, you spoke about how. We have organs that are ageing over time that suggests that they might not all age at the same rate. And you're speaking there about the pace of ageing. Nowadays, there are lots of tests that supposedly measure pace of ageing, and recently we're seeing some tests that are thought to be organ specific.

[00:19:16] So based on, for example, a blood test. Changes in parameters in the blood might indicate that one organ, like the liver is ageing faster than another pancreas, whatever it might be. So you could say to someone, well, based on this test, we think that your heart is 42, but your lungs are 36. Your brain unfortunately, is 47.

[00:19:37] And some of these tests then have a composite assessment of the whole body. So they might say, well, based on all these different organs, we think your overall biological age is x. Do you think that the best way to go about that is to look at all the organs and then come up with some sort of average, or if there's a weak link in the chain and you've got one organ that's way older than the others, that could ultimately cause someone's life to end early?

[00:20:04] And that suggests that some of these organs specific aging clocks could be really helpful clinically because someone might look fine. They've got good skin age, but actually their heart is really quite dysfunctional. 

[00:20:18] Andrea: Yeah, you are absolutely right. Uh, spot on. And that's of course what we do in clinical practice.

[00:20:23] I'm an internal medicine specialist in geriatrics, and I would never say. You are 90, but you are 70, occurs within individuals. The speed is different, and to make it more complicated, that brain might be biologically older. The kidneys might be younger, so what does that actually mean? The reason could be biologically that I'm just, I just have a very, very bad copy machine in my brain, but the copy machine in my heart is working very well.

[00:20:54] And it might be that there is exposure from outside, which actually then makes you much, much older in, for example, the liver. If you're drinking far too much alcohol and you are a binge drinker, not good, makes your liver older. So to make it accessible, we often say you are biologically young or older.

[00:21:15] But of course, that's absolutely not the story. The story is we have to look at all the organ systems. To actually determine how these organs are functioning, and that's the reason why your gp, your family, uh, medicine physician is measuring the blood pressure, is measuring, the glucose, is looking at you.

[00:21:33] We have, as clinicians gut feelings where to look at. To find the weakest links.

[00:21:43] Charlie: So when it comes to biological age, just applying a number wouldn't actually give us a accurate picture of what's going on. Your heart, your lungs, your kidneys, they're all probably ageing at a different rate. So it would be really worth checking in with your GP to figure out what needs most attention. If you may be parted a little bit hard at uni, your liver might need a little bit more TLC.

[00:22:05] That's just one example, isn't it? We all know our own bodies better than anyone else, so now that's clear. Let's move on to the practice section. This is where we talk about practical things that we can use in everyday life to help actually make us feel and function better. 

6. The Practice

[00:22:19] Greg: Andrea, you've done some work with the World Health Organization. They've had a focus on so-called intrinsic capacity, which is basically the sum of all physical and mental capacities. So those include things like cognitive functions, attention, memory, that type of thing, as well as physical capacities. So in that strength and stamina, if we start with physical capacities.

[00:22:46] In research grip strength is often used, but it has its pros and cons. For example, it's easy to test, easy to standardise, but it only test the strength of certain upper body muscles when lower body strength does seem to be more important to avoiding frailty and for people to stay independent. As they get older, the same goes for test of endurance, so in this case, maximal oxygen consumption or VO two max is often used, and that's measured by analysing a person's breathing.

[00:23:21] During a graded endurance test, so a test that gets harder and harder might be running on a treadmill, for instance, and VO two max is an excellent measure of cardio, respiratory fitness of function, of your cardiovascular system and your respiratory system too, but it requires special equipment. There are alternatives, like getting a VO two max estimate from a wearable.

[00:23:44] You can get that from pretty much any wearable nowadays, like a Fitbit or a Garmin or an Apple Watch, so how do you suggest listeners assess their physical capacities? 

[00:24:01] Andrea: So intrinsic capacity is indeed being defined and being used by the WHO, and there's not only intrinsic capacity, but there's also vitality capacity, and now there's also social capacity.

[00:24:08] So at the moment, we are rewriting the chapter of what the capacity is to be social and what that means. But coming back to your question with regards to the physical function. Whatever age you have, you should actually know how good your muscle strengths is and your muscle mass and my view. There are now machines which are very often accessible, for example, in gyms who can measure your fat mass and your muscle mass, and sometimes even how much visceral fat, uh, you have, which gives you a good indication.

[00:24:45] Of how muscled you are, the fear to max. So that means you're going on a treadmill, you're going on a bike, you have a mask on. We are measuring your respiration and we are actually seeing how good your mitochondria work is the best test you can ever do. So if you want to give yourself a present, uh, make sure that you do a fear to max because that's the best predictor for how long you are going to live.

[00:25:09] There are estimates of that fear to max if you have in, uh, smart watches. But these are estimations, and very often they're quite inaccurate. If you don't have a watch and you want to actually see what your respiratory capacity is and your endurance, I would say always start with yourself by recognising where you are at this moment.

[00:25:32] Right? So start with the pushups. How many can you do? Really push yourself to the limit and say, okay. Can I train and can I do more? And that's I think most important. I always say, yes, you can compare yourself to the average, but why don't you want to polish yourself and be optimal? And at all the individuals or a 90-year-old, I wouldn't ask how many pushups can you do?

[00:25:56] But the first thing is, can you stand out out of the chair without using your hands? And it seems to be so easy. But it's really not many at older age cannot stand out out of the chair without using the hands. If somebody can do it, then you are testing the number of seconds you need to stand out of the chair.

[00:26:17] So from sitting to standing five times. So they are very, very easy indicators to see how a person is functioning. And of course, it's even more interesting how much you actually improve. 

[00:26:31] Charlie: So I'm just thinking if you know, we might have 30 year olds, 40 year olds, 50 year olds, 60 year olds listening to this, is there somewhere that people could go to have a look at maybe what the benchmarks are for the different exercises?

[00:26:42] Some publication or any information online that's useful that people could look at and say, right, as a 40-year-old male, I should be able to do X, but as a 60-year-old female, the expectation would be something else. 

[00:26:53] Andrea: Yeah, good question. So we just got a publication out actually giving the reference ranges per country for muscle mass, muscle strengths for other physical characteristics.

[00:27:11] Per age group and per sex. So because very often males are stronger compared to females because of the body composition. So now we have that, and so I would say follow our website, seamless. We'll put the link in the show notes as in when it's available for anyone that obviously does want to dive into that.

[00:27:32] Charlie: Greg's also mentioned the idea of, um, cognitive frailty as something that's sort of a precursor to dementia. Could you just quickly explain what cognitive frailty actually means, and from a listener's point of view, how you would notice it? There's quite a lot of free online tests and things that you can do. Are they useful? Are they worthwhile? 

[00:27:54] Andrea: Yeah, we just talked about muscle training, and if we are talking about muscle training, we can also do cognitive training. So cognitive health should be. Absolutely at the forefront to be tested across the lifespan. So at different ages, at a certain time, we are talking about cognitive frailty.

[00:28:17] If cognition is actually declining and you cannot compensate anymore, which means sometimes you forget things and it's getting worse. Cognitive frailty might be the precursor of Alzheimer's disease, which can occur at the age of 50 or 60, especially it's genetically determined, which means that. You can still train and try to keep up your cognition, but it's more likely compared to individuals who are not cognitively frail, that these individuals will either have mild cognitive impairment in the end or then enter a stage of dementia.

[00:28:58] I would advise everybody to do a cognitive test, which are online available to actually see where you are. Can you memorise things quickly. Can you be accurate enough to memorise them after an hour after two hours? So what I'm meaning is short-term memory. Long-term memory, can you do double tasks? Can you walk and talk and quantifying how good your machinery is later in life?

[00:29:30] Charlie: When you talk about cognitive training, um, brain training, I think about Sudokus, crosswords, are they helpful, useful, or is there other things that people could be doing to train their brain? 

[00:29:46] Andrea: No, absolutely yes. I don't like them, but do them if you like them. Very good. So most importantly is use your brain, and the best way to see how your learning capacity is, is for example, learn a new language.

[00:30:00] So if you don't like the puzzles in the Sudokus as I do. I could challenge myself with learning a new language, or I could play an instrument and learn it, which I do not play yet. And then you actually bring, while playing music, the physical side and the cognitive side together, you actually use your hands.

[00:30:22] You have to think about it and you have to listen. And this cognitive double tasking of doing something manually that helps you to. Keep your brain active. We ourselves did studies, for example, in the choir. It improves the cognitive capacity of individuals. And now we also know that, um, learning new languages is absolutely positive.

[00:30:48] Also, if you're on the gym and you really want to strengthen your muscles, think about if it's, of course safe, uh, do a cognitive double task. So think about memorising things or thinking about listening to a podcast like this one. So hopefully we have lots of podcast listeners at the moment on the treadmill.

[00:31:07] Or you could talk walking while talking is quite difficult at order age. So we often have walking meeting. And we have that not only to expose ourselves to sunlight and going out of the offices, but also because we are training our brain quite differently because we have to walk, we have to talk, we have to look at where others are, and that's hugely important.

7. The Experience

[00:31:37] Charlie: Now we move into the experience section. So we've covered the science and the practical side of things, and now is the reality of actually trying to live this and put this into practice. So we've had some listener questions that we'd love to get your take on. The first one is a voice note. 

[00:31:54] Voice Note: Hi. So what have I discovered? I've lost six stone after being on a zeck, which has made a massive difference to my life, but also it's taken me on the journey. I've found that I have very low to non-existent testosterone. Which has led me down a path of getting, uh, testosterone replacement therapy, which has made a big difference.

[00:32:16] I've also gone down the rabbit hole of peptides due to niggling injuries I've had with being back in the gym. And for personal experience, I can say that I've done really, really well. What would be your thoughts on these peptides like BPC 1 51 TB 500, uh, the copper peptide? But my experience has been quite good with all these. 

[00:32:40] Charlie: Just so we are clear, could you just explain what a peptide is for anyone that's not sure on what a peptide is?

[00:32:45] Andrea: A peptide is a molecular structure which can influence the body. For example, it's either against a high glucose level or to reduce obesity. We have so many peptides because it's just a class. Of molecules. Mm-hmm. And GLP ones are a peptide and it's the best drug at the moment. We have to reverse our body composition and helping us with reducing our weight.

[00:33:19] But every drug very often has side effects. So in a side effect for the GLP ones can be a reduction of muscle mass, for example. While you are losing. The fat mass, you are also losing muscle mass. And while using the muscle mass, you might be at risk to have sarcopenia in the end. So it's good to hear that he actually lost weight.

[00:33:46] Of course, that's the essence. However, I would be very, very concerned about the muscle mass. So when we are prescribing GLP ones, we always combine a risk resistance exercise training to make sure that we are building up the muscle reserve. That not an in 10 or 20 years time, we actually have an incidence of in fall, uh, for example, a fracture and there was losing that benefit of having lost weight.

[00:34:13] Then there are also other peptides which are not yet FDA approved. So, which just can be bought from the market. You either inject it yourself or you go to clinics who can inject it. And there are thousands at the moment, some very, very popular where we don't know what the evidence is in humans. And very often these kind of peptides are coming out of small animal studies and sometimes huge side effects that people actually fall ill and sick.

[00:34:46] While getting treated. So I would be hugely cautious in every peptide, which is not FD approved, and do it only under medical guidance and um, under medical treatment. 

[00:34:59] Greg: One problem here is that a lot of people are acquiring these peptides from the black market, and even with the supplement industry, we know that a lot of the products that people acquire off the shelves.

[00:35:13] Don't necessarily contain what they say they do. So many of the products people are using are potentially contaminated and therefore, even if they were beneficial and shown to be so by well powered, well-controlled, rigorous clinical trials, it doesn't mean that they would be beneficial in that context because they might contain some nasties.

[00:35:34] Charlie, back to you. 

[00:35:37] Charlie: Thank you. So Greg, I need your help on the next question. So the, um, the question is from anonymous and it says, I would love to know the hype about NMN is true and if supplements are necessary as we get older. If so, what form should NAD precursors be taken? 

[00:35:54] Greg: Ide, mono nucleotide and ide Riboside. Yeah, just NMN and NR will suffice.

[00:35:59] Charlie: So yes, they're interested to know what's the hype around these supplements and if they're necessary. 

[00:36:06] Andrea: There is indeed a huge discussion with regards to NED precursors. So NED levels are lower at higher age compared to, uh, younger ages, and NED is needed in mitochondria to make energy.

[00:36:21] That's what we know. N-N-N-N-R can boost NED levels. So therewith, if our NED levels are lower at higher age, why can we just boost them and make us younger again while giving energy to their, with our mitochondria and everything is fixed. Um, this story is just a theory, however. There is a huge potential, and I will give an analogy if we are talking about mitochondria, we are talking about energy and cells and energy and cells.

[00:36:54] You can compare with your power level in your smartphone, what you actually charge your smartphone. If it's 100% charged. So if people are 100% charged, they are putting even more charging material into their body. For example, with NN of NR and in the precursors, it's very likely that it's not going to help, but it helps people who have a problem with the mitochondria.

[00:37:23] So they need to charge. Their mitochondria. So it really depends on how good your physical function is, your mitochondria, to see what kind of supplements you use. So there was, I would say yes. And then overall's a hype for the wellness sector for customers, because customers cannot make their choice if they need element of nr.

[00:37:50] I think we have to bring it into the medical system measuring NED levels, and that's what I do in clinical practice. Seeing how much energy you need. Then subsidise that with the supplements, measuring it again, and also asking, do you feel better? Are you better? And that's, I think, proper care and proper use of supplements, uh, like NMN and NR.

8. Takeaways

[00:38:17] Charlie: So we like to end the episode, Andrea, with just providing listeners with one key takeaway. So if you could provide them with one takeaway or one piece of advice, what would that be? 

[00:38:29] Andrea: If you are falling asleep with the idea that. This was not a good day. It was something else. With your life, we can really, really manipulate the body so beautifully now.

[00:38:42] But you need, and I don't like the word purpose, but you need to be happy with yourself. So think about what did you do and cherish your life because otherwise, why would we charge our car if we never use the car? Why would we do it? Why putting energy in it? Yeah. Oh, love that. I wasn't expecting that, but I really like that answer.

[00:39:07] Charlie: Thanks Andrea. It was lovely to chat to you. Thank you so much for your time. Really appreciate it. 

[00:39:17] Greg: Thanks, Andrea. Lovely to meet you.

[00:39:20] Charlie: You know, I really liked, actually at the very start when she was talking about can you walk, can you talk and do you have friends? I love that. That's. In the category with walking and talking. Yeah. I think it's a, a nice little way to think about it and the positive impact that having friends can have on your life.

[00:39:38] And I think, you know, mentioned, do you have someone that asks, are you okay? Really stuck with me actually. What about you? Was it about wrinkles on your heart? 'Cause that also stuck with me. I was thinking about is my heart wrinkly? 

[00:39:52] Greg: I have quite a few takeaways, so please bear with me. We didn't really speak about the value of certain common health tests, including getting your blood work done and Andrea very recently contributed to an expert consensus statement, which was about biomarkers of ageing.

[00:40:08] In that the panel that was included ultimately collectively arrived at 14 tests that they think are related to ageing. Another subject we didn't get to is the importance of systemic variables. Singapore, which is where Andrea works and lives, I think the life expectancy there is currently about. 84. So it's one of the longest lived societies in the world, and in recent years, the government has invested very heavily in longevity, and that total is 37 billion US dollars.

[00:40:41] Some of that is going into research and development, some's going into longevity clinics, some is going into other initiatives, and Andrea's done lots of work. With Longevity clinics. She's actually founded a private one named Chi, but she's also written about the need to integrate these types of clinics into public hospitals too.

[00:41:01] So overall, if we want to democratize longevity, lots of changes needs take place, and only some of those have come up today, like low-cost interventions, changes to your nutrition and so on. Low cost technologies like wearables, but also. Healthcare systems that try to prevent problems, not just treat diseases once they've occurred.

[00:41:24] And as the population ages, the workforce is going to need to change, we'll need to modify our working lives, but we also need to shift our attitudes in various ways. And a good example of that is getting past ageism, which is still quite pervasive in many countries. Overall, I really hope that we get the chance to come back to some of these subjects in future episodes.

[00:41:58] Charlie: You've been listening to the Method Health in the Real World. A podcast brought to you by Thriva.

[00:42:03] Greg: If you don't know about Thriva, it's a health tracking platform that helps you see exactly where your health is heading, what to work on and how to do it. So they use painless at-home blood testing to show you what's going on in your body.

[00:42:14] The results are analysed by accredited labs and based on the tests, you get personalised guidance from real doctors, not AI ones. People use Thriva like a compass testing every few months to help steer their health to where they'd like it to be. It's a great tool to start feeling more empowered about your health and to get information you need to make progress, even when life is a bit hectic.

[00:42:35] Charlie: Thriva also has some great content out there that can help you get to grips with complex health questions, exactly like what we try to do on this podcast and all of that is free to access. So if you want to learn more, just head over to thriva.co. That's thriva.co. 

[00:42:48] Greg: And of course, if you'd love the show subscribe. Why would you not do that? It takes just a few seconds and you won't regret it. You can also leave us a review or write to us by email to the method@thriva.co. 

[00:43:01] Charlie: Or if you’re like me and Greg and you'd rather send things over by voice note, then we'd love to hear from you. 

[00:43:05] Greg: Special thanks to Thriva team and to Lower Street for helping us bring the show to life content direction by Rich Cousins, Hamish Grierson, Tamar Loach, Vishal Shah, and Katie Yokey, production from Lise Lovati with the help of Sam Datta-Paulin and Daria Lawson. Sound designed by Alex Rose.

[00:43:24] Charlie: We are your hosts. Charlie Edmondson and Greg Potter and we'll see you next time.

[00:43:35] Greg: Professor Maier, do you have a longer left leg? End call. 

[00:43:39]Charlie: Andrea. Andrea, are you there? Andrea?