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In these countries, our most common and major diseases were universally rare, like heart disease. In the african population of Uganda, for example, coronary artery disease was almost non existent. If you look at age matched heart attack rates in Uganda versus St. Louis. Out of 632 outops in Uganda, one myocardial infarctions and it was evidence of a healed myocardial infarction. So it wasn't even the cause of death. Yet. Out of 632 autopsies in Missouri, same age and gender distribution, 136 myocardial infarction. So 100 times the rate of leading killer. In fact, they were so blown away when back did another 800 autopsies, you've gotten instilled just that one small healed infarct. Out of 1427 patients, less than one in 1000. Whereas here in the United States, heart disease is an epidemic.

Welcome to passion struck. Hi, I'm your host, John R. Miles, and on the show we decipher the secrets, tips, and guidance of the world's most inspiring people and turned their wisdom into practical advice for you and those around you. Our mission is to help you unlock the power of intentionality so that you can become the best version of yourself. If you're new to the show, I offer advice and answer listener questions. On Fridays. We have long form interviews the rest of the week with guests ranging from astronauts to authors, CEO's, creators, innovators, scientists, military leaders, visionaries, and athletes. Now let's go out there and become passion struck. Hello everyone, and welcome back to episode 447 of Passion Struck. Consistently ranked by Apple, it's the number one alternative health podcast. A heartfelt thank you to each and.

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The show every week, eager to listen, to learn, and discover new ways to live better, to be better, and most importantly, to make a meaningful impact in the world. I am so excited to announce that my new book, Passion Struck, is a finalist for the Eric Hoffer First Horizon Award for best debut book of the year, and you can find it on Amazon or on the passion struck website.

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You so much for being here, or you simply want to introduce this to a friend or a family member, and we so appreciate it when you do that. We now have episode starter packs, which are collections of our fans favorite episodes that we organize in the convenient playlists that give any new listener a great way to get acclimated to everything we do here on the show. Either head over to Spotify, Spotify or passionstruck.com starterpacks to get started. In case you missed it, earlier this week I interviewed psychologist Emma Sapala and marketing expert Neil Patel. In my interview with Emma, we discussed her roadmap to how you become psychologically sovereign, empowering you to break free from self destructive beliefs and live life to the fullest. Also in this can't miss episode with Neil Patel, Neil reveals his secrets on the power of personal branding, mastering audience engagement in the art of storytelling to build a lasting brand. We'll break down how Neil uses his setbacks as springboards and a systematic approach to becoming a powerhouse and personal branding and content creation. I also wanted to say thank you so much for your ratings and reviews. And if you love today's episode or either of those others, we would appreciate you giving it a five star review and sharing it with your friends and families.

I know we and our guests love to see comments from our listeners. Today we embark on a fascinating expedition into the realm of health and longevity, guided by doctor Michael Greger. Michael isn't just a physician, he's a New York Times bestselling author and a tireless advocate for public health. With a resume as impressive as it is extensive, he's graced prestigious platforms from the conference on world affairs to the halls of Congress, enlightening minds and championing the cause of wellness. Today, we're going to discuss his latest masterpiece, how not to age the scientific approach to getting healthier as you get older. This groundbreaking work isn't just another book, it's a roadmap to define the sands of time. Backed by rigorous research and Doctor Greger's unparalleled expertise. This work is so extensive, it took me about three weeks to read it, but it was so well worth my time. From the secrets of centurions to the science of cellular rejuvenation, Doctor Greger unveils the keys to preserving vitality and embracing life to its fullest. Drawing upon the wisdom of the blue zones and the latest in nutritional science, he empowers us with practical strategies to unlock the fountain of youth within.

And here's the kicker. Doctor Greger doesn't just present the evidence, he equips us with practical tools to implement these changes in our lives. Whether it's diY, vitamin C serums, or incorporating quercetin rich foods into our diets, the path to optimal health has never been more accessible. Get ready to be inspired, informed and energized as we learn from the master himself. Thank you for choosing passion struck and choosing me to be your host and guide on your journey to creating an intentional life. Now. Let that journey begin.

I am absolutely honored and thrilled to have the one and only Doctor Michael Greger on passion struck.

So excited to be here.

Doctor Greger, we all have moments, I think, that define us. A defining moment for you was your personal experience with your grandmother's remarkable recovery from age end stage heart disease. Can you share with us a little bit about how her transformation influenced your perspective on the power of lifestyle and interventions and promoting health and longevity?

Absolutely. Yeah. That's how it all started with my grandma. I was just a kid when my grandma was sent home basically in a wheelchair to die. She had this end stage heart disease. So many bypass surgeries, she basically run out of plumbing at some point, confined a wheelchair, crushing chest pain. Her life was over at age 65. Then she wrote about this guy, Nathan Pritikin, one of our early lifestyle medicine pioneers. And what happened next is detailed in Pritikins biography. It talks about Frances Greger, my grandmother. They wheeled her in and she walked out. Though she was given a medical death since at age 65, thanks to a healthy diet, was able to enjoy another 31 years on this planet till age 96, to continue to enjoy our six grandkids, including me. That's why I went into medicine. That's why I went into lifestyle medicine, why I started this website, nutritionfacts.org, comma, why I wrote the book, how not to die, why all the proceeds from all my books are all donated directly to charity. I just want to do for everyone's family what Pritikin did for my family.

Well, I'm going to speak to this a little bit, because on this show I have had a ton of medical professionals. And a notable observation that surfaced regarding all of them is that when they go to medical school, there's a limited emphasis that's placed on nutrition in traditional western medicine. Considering your background as a conventionally trained physician, what prompted your shift to focus on nutrition?

Yeah, I mean, doctors have a severe nutrition deficiency in education. Most doctors just never taught about the impact health and nutrition can have on the course of illness. So they graduate without this powerful tool in their medical toolbox. Of course, there's also institutional barriers, time constraints, lack of reimbursement. Generally, doctors simply aren't paid for counseling people on how to take better care of themselves. Of course, look, drug companies also play a role in influencing medical education and practice. You can ask your doctor when the last time they were taken out to dinner by big broccoli. Probably been a while, but from my personal story, I mean, I had seen it with my own eyes. And so I knew the power of lifestyle. And then 1990, the publication of Doctor Dean Ornish's lifestyle heart trial proved it to the world. Published the most prestigious medical journal in the world, showed for the first time that you can open up arteries without drugs, without surgery. Just a plant based diet and lifestyle program improved it with something called quantitative angiography. You actually see the arteries opening up. And we thought heart disease was irreversible. You just got worse than you doubt.

But first, Nathan Pritikin showed that you can reverse heart disease, but he didn't have the kind of proof in black and white, we didn't have that angiography technology, but then Ornis actually proved it. And look, this was 1990. So decades ago, we proved that the number one killer of men and women can be prevented, arrested, and reversed with a plant based diet. Yet hundreds of thousands of people continue to die from this preventable, arrestable, reversible condition. That's why I went into nutrition.

Well, thank you for sharing that. And you have created some incredible best selling books. You mentioned how not to die, how not to diet. I wanted to ask you some questions about those before we go into your latest masterpiece, how not to age. I think the biggest question I want to ask is if someone is here on the podcast today and they're dealing with. With cancer or some type of illness like that, what would be some of the most profound things that they could do right now if they wanted to positively intervene in stopping its growth?

Well, first of all, the good news is that we have tremendous power over our health, destiny, and longevity, and that the vast majority of premature death and disability is preventable with a healthy enough diet and lifestyle. In terms of the single most important thing we could do is really tweaking our diet. According to the Global Burden of Disease study, the largest systematic analysis of risk factors in human history found that the number one cause of death here in the United States is the american diet. Bumping tobacco smoking to number two, cigarettes only kill about a half million Americans every year, whereas our diet kills many more. But that's good news, because the power is then at the end of our four.

Okay. And if one of the types of cancers that is really increasing right now is pancreatic cancer, and it's soon to become number two on the list of taking the most lives from cancer, do you have any insights into what is causing this rise with pancreatic cancer and specifically what you would do to someone who might be diagnosed with this with diet intervention?

Yeah, pancreatic cancer. Cancer. One of our most lethal cancers, though I, it would be hard to imagine it kind of bumping out killer number one, lung cancer, and then cancer killer number two, colorectal cancer, would really kind of far lead the field. But I do have. So if you go to nutritionfacts.org, comma, I do have some videos talking about improving survival with pancreatic cancer with certain dietary interventions. However, by improving survival, we're talking about extending, compared to the control group life by a matter of months, not years. But still, that may be better than some of the kind of chemotherapy regimens we now have on the market, which may not improve quality of life or survival at all.

Okay, well, thank you for that. In how not to age, you ventured into the realm of aging, and there have been a number of books over the past year that have come out that have talked about longevity. There's been lifespan, there's been Doctor Mark Hyman's book, Peter Hayes, Kara Fitzgerald's what sets how not to age apart from those other books in your previous works?

Well, I really wanted to be the most comprehensive anti aging book ever published, covering every possible strategy for slowing the aging process for the longest, healthiest life based on the best available balance of evidence. And so ended up with 13,000 citations. It took me three years. We have a team of 22 people working on it, churning through tens of thousands of papers. So I really wanted it to really cover all the bases, really be kind of the reference book for this. I don't think any other resources really come close to the kind of comprehensive nature. So whether you're interested in targeting some of the aging pathways to actually slow the aging process or just talk about preserving function, whether we're talking about bones, bowels, bladder circulation, hearing, hormone balance, immune function, joint health, mind or muscle, sex life and skin, teeth, vision, etcetera. So some of the more kind of cosmetic areas, you're just worried about your skin, or if you're worried about some of these more critical issues in terms of preventing arrest and reversing chronic disease. And so I really wanted to just cover everything. I don't think any other book has quite done that yet.

Okay. And I just want to set this up for the audience because it's going to be impossible for me to go through nearly everything in your book because when you originally wrote this, I think it was like 20,000 words, and you got it down to 10,000 words. And, or I probably have the statistics.

Wrong order of magnitude off, but yes.

But my point is this is a very comprehensive book, and it's now about 600 pages, and it has some really incredible information, in addition to what's in the book that the reader can go through and link out to as well. But the book is divided into four sections. The slow eleven pathways of aging is the first section. The second section is the optimal aging regimen. Third is preserving function, and fourth is your anti aging eight. So I'm going to approach this interview by kind of going through that pattern, but I'm going to open it up with this question. Doctor Greger, there's a growing trend of older Americans, and I think people in many western civilizations where they're seeking out anti aging interventions, with a significant portion of them investing in products and treatments that are touted by the industry. However, many of these interventions lack scientific backing. Can you share your perspective on this phenomenon and offer any guidance on how a person might navigate this landscape?

Yeah, no, and that's really why I wrote this book, is really to cut through all that noise and nonsense. It reminded me of my last book on weight loss, on how not to diet. Both dieting and anti aging are these multi billion dollar industries. And with so much money in the mix, anyone seeking even basic practical advice in either arena, living lighter or longer, is faced with the just inscrutable barrage of pills and potions. I mean, even as a physician, with the luxury of wading neck deep through the medical literature, it's really been a challenge to tease out facts from far. So, look, if it took me three years to sift through all the signs, I'm afraid the casual observer would just have kind of no chance. But the more difficult it was, the more valuable I realized this resource will eventually be.

Well, thank you for that background. And one of the things I wanted to ask you about is I think there's this notion we often hear about, I certainly have heard it throughout my whole life, that people want to end up dying from old age or that person died from old age. However, this concept of dying from old age may not be accurate, as centurions and others typically succumb to specific diseases rather than old age itself. What role do you believe that aging plays as the primary risk factor for the conditions many people face?

Yeah. Based on a study of 42,000 consecutive autopsies, centenarians, those who live over 100, were found to succumb to disease. In 100% of cases, though, most were perceived, even by their physicians, to have been healthy prior to death. Not one, quote, unquote, died of old age. They died from disease, most commonly heart disease. And the one killer of men and women in general, which is, again, great news, because there's diet and lifestyle interventions that can prevent, arrest and reverse it. And so. So that's kind of a critical point to remember, though. Aging is a primary risk factor for many of our leading killers. So, for example, yes, having a high cholesterol can make you 20 times more likely to have a heart attack compared to someone with low cholesterol. A 80 year old has 500 times the risk of having a heart attack compared to a 20 year old. Now, the reason we talk about cholesterol is because it's a modifiable risk factor. But the question I raise in the book is, what if aging was modifiable, too? And then we could slow down the rate of age related diseases across the board. So, for example, even if all cancer was eliminated tomorrow, the average life expectancy of the United States would only go up three years.

Why? Because if you don't die from one age related disease, you just die from another. The only reason you didn't die of a heart attack is because you were killed by cancer, but you were getting ready to die next month from heart disease anyway. So instead of playing whack a molecule by targeting each of these diseases, by slowing aging, we can reduce the risk of heart disease, cancer, stroke, dementia, all these age related diseases in one fail swoop.

I love that approach and how you can deal with all of it, because it's interesting. I've seen statistics where as much as two thirds of the population has one, if not two, underlying conditions by the time most of us reach our fifties, which means that really, 30% to 50% of your life, however you want to look at it, you're dealing with a chronic illness, which to me is sad and it's preventable. What is the most important thing a listener could do today if they wanted to change that perspective in their own life?

I'm glad you bring up that concept of health span. Right. It's not just about adding years to your life, but life to your years. When asked how long people wish to live and offered a choice between the 85, 100 and 2150, or indefinitely, most people, which surprised me about two thirds, said that they'd only want to live to 85. But when that question was reframed, is, how long do you wish to live in guaranteed mental and physical health? Ah. Then all of a sudden, the most popular answer jumped to an unlimited lifespan. Right? That raised this concept of health. Spend the period of life spent in good health, free from chronic disease and disability. I mean, what's the point of living longer if you can't enjoy it vibrantly. Unfortunately, here in the United States, we're living shorter and sicker. Life expectancy peaked in 2014. The United States has basically declined every year since, and that was before COVID kneecapped a couple years off our lifespan. And so we are raising the first generation of Americans to, on average, live shorter lives than their parents is primarily due to the obesity epidemic leading to diabetes and other metabolic issues.

And so this is a critical time to have resources like this podcast to help people really take responsibility for their health. Again, there's tremendous power we can exercise over our health and longevity, but we need to intentionally choose to do it.

Yeah, I love that you said that, because this podcast is really about intentional choices, and it's the micro choices that each of us make in the moments that fill out our day that end up changing our trajectory from either good or bad, from either the health span that you talked about, to one that's filled with disease. So appreciate your perspective on that. So your book meticulously examines eleven pathways of aging, and it offers insights into how these processes can be slowed or disrupted. Can you go through perhaps two of them? And how understanding their mechanisms can inform strategies for promoting longevity?

Yeah, so that's part one of the book where I identify kind of the eleven most promising pathways for slowing the sands of time and engage with practical takeaways for targeting them naturally with diet and lifestyle. So, you know, boosting the anti aging enzymes and hormones AMPK, FGF 21, Sirtuins and telomerase, while suppressing the pro aging enzymes and hormones mTOR and IGF one, decreasing glycation, inflammation, oxidation and senescence, while preserving autophagy autelomeres and slowing the so called epigenetic clock. I know these all are kind of fancy sounding scientific terms, but I really do try to break it down to the easily understandable kind of dual practical takeaways. So, just to take a few. So, autophagy, for example, autophagy is considered the kind of primary system for cleaning the body from the inside out, clearing away accumulated cellular debris that may be contributing to the aging process. And so there's some food components that actually suppress autophagy, suppress this anti aging pathway, like acrylamide, which is a toxin concentrated in potato chips and french fries, which is during the frying process. If you absolutely must have your french fry fix, air frying produces 90% less acrylamide. So that would definitely be the choice.

There are some food components that actually boost autophagy, for example, fluorogenic acid, the primary antioxidant in coffee, which may explain why those drinking three cups of coffee a day have about 13% lower risk of dying from all causes put together compared to those who don't drink any coffee because of this autophagy activating compound in coffee, also in foods, something called spermaidine, which out of thousands of life extending compounds among the small subset with the fewest side effects, spermadine has the largest documented lifespan extension and is found concentrated in beans, legumes of beans, split bees, chickpeas and lentils. Also found concentrated in white button mushrooms, though the most concentrated source on a gram for gram basis, not on per serving basis, is wheat germ, actually. And so I encourage people to add wheat germ to their daily diet to get their spermidine, which is considered an anti aging vitamin because when we're younger, we may be able to eat enough. But as we get older, our levels of spermidine drop as much as 50% by the time we reach our fifties. So we may need to start ensuring we're getting enough in our diet to ensure autophagy into old age.

Two other ways to improve autophagy. One is, is water only fasting. Unfortunately, it takes two to three days to really ramp up autophagy in human beings, and that's really too long to go unsupervised safely. But there's another way to activate autophagy. We can fast or go fast. Exercise induces autophagy, though you have to do it enough. 60 minutes of moderate intensity activity, like brisk walking, can boost autophagy based on muscle biopsies taken before and after, but only 20 minutes fails to move the needle. And so those are some of the takeaways from my autophagy chapter. I don't know if there's any other particular aging pathway you want to dive into, but I'm happy to jump wherever you want to go.

No, I wanted to ask you a further question on autophagy, because when I think about it, it's really your body eating itself.

In fact, that's the greek roots, right self eating, right autophagy.

And I do intermittent fasting every single day. Typically, I fast for 16 hours and I eat during an eight hour window.

Nice.

I was recently listening to a podcast by Peter Attil, and he said that from what he has researched, autophagy does not happen if you are fasting, unless you were fasting, he was saying, for four to five days before it kicks in, which, to me, would be very difficult for me to do on a routine basis. What is your thought on that? And what is your thought overall on intermittent fasting? Right.

Well, so tias right in that it takes days for autophagy to ramp up, although you should be able to get within two to three days. You can see ramping up, but again, even thats too long to go without medical supervision, in my opinion. On the Internet, youll hear autophagy activated within hours of not eating. And so they encourage people to do this kind of time restricted feeding to boost autophagy. But that's those all based on rodent studies. Rodents have much higher metabolism. In fact, a couple days of fasting can be deadly for rodents, and they lose a huge amount of their body mass even just after a day of fasting. And so, but in human beings, when you actually put it to the test, it does take days to ramp up. Thankfully, there's other ways to activate autophagy, like the aerobic exercise, which everybody should be doing anyway, and along with these dietary tweaks. But there are other benefits to on time restricted feeding. In fact, in my book, how not to diet, the largest chapter on accelerating weight loss was indeed intermittent fasting because there's so many different types. Alternate day fasting, five two fasting, 25 five, fasting, mimicking diets, time restricted feeding, et cetera, et cetera.

Really, the bottom line, although I talk about the pros and cons of each, is early time restrictive feeding has a variety of benefits. And so exactly like something you're doing, restricting your daily feeding window to 12 hours or less. Eight's even better. But critically important, it has to be earlier rather than later. If you skip any meal, you're skipping dinner, not breakfast. In general, we should try to squeeze as many calories earlier in the day as possible. Ideally, breakfast or lunch would be the biggest meal of the day. Because of our circadian rhythms. The exact same food eaten in the evening is more fattening than the exact same food. Exact same number of calories eaten in the morning causes more of a blood sugar spike, triglycerides, etcetera. And so if you're going to eat junk, eat it in the morning, your body's just better able to handle it, thanks to this really fascinating field of chronobiology, the effect of our circadian rhythms have on our metabolism.

Okay. And I happen to be researching some other podcasts you were on, and I heard you quote this study that was done about cardiovascular disease, where they were looking at people, I think it was in St. Louis, and they ended up, I think, examining 600 patients who had died and how many of them had cardiovascular disease, and then they looked at the same amount of people in Africa. I think it was Gandha, and I was hoping you might be able to share that, because to me, this illustration was just shocking between how people in Africa are eating and living and how we in the United States are.

Yeah, it really goes back to. Wait a second. Where did Pritikin get this idea of reversing heart disease with this diet centered around whole plant foods? Well, it all goes back to this network of missionary hospitals set up by western doctors in sub saharan Africa, which uncovered one of the most important advances in health, really, according to one of the most prestigious medical figures of the 20th century, Doctor Dennis Burkitt, that the fact that in these countries, our most common and major diseases were universally rare, like heart disease. In the african population of Uganda, for example, coronary artery disease was almost non existent. You said, wait a second, our number one killer, almost non existent. What were they eating? Well, they're eating lots of vegetables and greens or protein almost entirely from plant sources, and they had the cholesterol levels to prove it, very similar to kind of modern plant based eaters. And he said, wait a second, maybe the Africans were just dying early from something else. Never lived long enough to have a heart attack. That's where that St. Louis study comes in. And so if you look at age matched heart attack rates in Uganda versus St.

Louis, out of 632 heart types in Uganda, one myocardial infarctions, and it was. And it was evidence of a healed myocardial infarction. So it wasn't even the cause of death. Yet. Out of 632 autopsies in Missouri, same age and gender distribution, 136 myocardial infarction. So 100 times the rate of our leading killer. In fact, they were so blown away when back did another 800 autopsies, you've gotten instilled just that one small healed infarct. Out of 1427 patients, less than one in a thousand. Whereas here in the United States, a heart disease is an epidemic. In fact, atherosclerosis is a disease that begins in childhood. By age ten, the arteries of nearly all children raised on the standard american diet already have what are called fatty streaks in the arteries, which is the first stage of the disease. These streaks then turn into plaques in our twenties, get worse in their thirties, and then can really start killing us off. In our heart, it's called a heart attack. In our brain, the same disease process can cause a stroke, and so the earlier, the better we can get. To improve our diets, the better. But importantly, it's never too late.

It's never too late to start eating healthier, never too late to stop smoking, to start moving. We really do have the power.

So on this whole line of cardiovascular disease, one of the things that many Americans deal with is high cholesterol levels. And it's interesting because a lot of doctors will tell you to eat steel oats as a way to reduce it. But what are some of the examples that you would tell people to do if they wanted to reduce their cholesterol levels?

Oh, steel cut oats would be great, or even better, uncut oats, which are oat groats. What you have before you cut them through two to three times to get steel cut, contain a lot of soluble fiber, which helps remove cholesterol from the body. The most important thing is to cut down on the three things that increase cholesterol in our bloodstream. One is saturated fat, which found concentrated meat, dairy, and processed junk. Number two, trans fats found in these partially hydrogenated oils, as well as meat and dairy. Dairy. And then three, dietary cholesterol found, concentrated mostly in eggs. The overall meat is the largest single intake in the United States. Just because people eat so much meat. And so that should bring, just reducing those three components that elevate our cholesterol really should bring one's cholesterol down to where we want, which is if you don't have heart disease or diagnose heart disease, we really want a total cholesterol, about 150 ldl or so called bad cholesterol, down around 70. And that really is where the bell curve averages out. Now, because of genetic factors, you still may be high, even if youre cutting down all that junk, in which case you have to add to your diet foods that actively pull cholesterol from your system.

And thats doctor David Jenkins, the University of Toronto, the guy that invented the glycemic index, very prestigious researcher, developed a so called portfolio diet, developing a portfolio of different foods that pull cholesterol from your body. So its a strictly plant based diet, but adding things like the oats, the soluble fiber foods, oats, slimy foods like oats and eggplant and okra, that kind of stuff, and also adding nuts for these phytosterols and a variety of other foods. So I encourage people to check that out. Now, beyond just dietary intervention, certainly quitting smoking will reduce your risk for cardiovascular disease, aerobic exercise. But the good news, and again, we have tremendous power over our risk of getting and dying from the number one killer. And look, if that's the only thing a plant based diet could do, reverse our risk of the number one killer of men and women, shouldn't that kind of be the default diet proven otherwise? The fact that he's also so effective in preventing, arresting, reversing other leading killers, like type two diabetes and high blood pressure, really seem to make the case for plant based eating simply overwhelming at this point.

Okay, and since we're on the topic of diet, let's talk about the second part of your book. In it, you talk about both the mediterranean diet and the okinawan diet, which are two popular diets that many of the listeners might have tried themselves. What are your thoughts on both of those?

Oh, yeah. Well, so it turns out that based on studies of identical twins, only about 25% of the lifespan differences between individuals is due to genetics. So for what we can do over the majority, which we have some control, we can look to these blue zones, these areas of exceptional longevity around the world, where they may have up to ten times the rate of centenarians, those reaching triple digits. And so two of those, as you mentioned, actually three of those, two in the Mediterranean, one in Okinawa, have been found. So Okinawa Japanese, the second longest living, formerly studied population in the world, the only population living longer than that is actually the red, white, and blue zone, which is in Loma Linda, California. The seven day Adventist, the vegetarian seven day Adventist in Loma Linda, California, which actually lived the longest compared to anybody. And it's actually the only blue zone that survives to this day. Unfortunately, all these other blue zones are really kind of historical artifacts of history. But what they all share in common is that regardless of which of these five blue zones that have been documented, they all center their diets around whole plant foods.

So they're minimizing their intake of meat, dairy, sugar, eggs, salt, process junk, and maximize the intake of fruits, vegetables, whole grains, these legumes, beans, lentils, nuts and seeds, herbs and spices, mushrooms, basically real food that grows out of the ground. These are our healthiest choices.

Evan? Yeah. I actually saw another program where one of your tips of advice would be, before you eat a meal, perhaps start with an apple. Oh, and a glass of water. Evan.

That's in how not to diet. Very cool. Yeah. This negative calorie preloading. And so eating an apple before a meal cuts down kind of average caloric intake by 200 calories. You eat 200 calories less than a meal, you feel just as full eating 200 calories less. And so, look, I mean, an apple may only have 50 calories. Right. So basically if you're eating apple before a meal, the apple has like negative 150 calories, right. It's like drawing calories out of your body. Same thing with eating a low energy density vegetable soup or something. By eating soup before a meal you are going to feel just as full cutting down on calories. You have hundreds of calories sucked out of your body veritably and even just drinking water. So before a meal has been shown you can randomize people to drink water before meals or not and you can get a significant acceleration of weight loss. And there's, that's from a number of different mechanisms but yeah. So negative calorie pre lettering is one of my so called 21 tweaks of all the things that have been shown in randomized controlled trial to accelerate the loss of body fat.

And I love it and I think its really interesting. Im just going to go back to blue zones for a second because you mentioned the diet that they follow. The other thing that I think is pretty remarkable is theres two other things that ive studied that they do. One is the concentration on the importance of relationships and the connections that they have with each other in the blue zone. And the other one that really ties into this is that they have a profound sense of purpose in, when they get out of bed, what they're doing in their life that brings them fulfillment. So it seems like it's this combination of the diet, relationships and having this overwhelming sense of purpose that really helps as well. To increase this age and health span.

They also have regular daily exercise, tend not to smoke. So there's other factors though. Diet appears to be the principal component alone, accounting for half the difference in lifespan between blue zones and the rest of the world. But I'm glad you brought up about social isolation and loneliness, both associated with higher mortality rates. For example, marriage appears to carry a survival benefit, but the apparent detrimental effects of social disconnection and bereavement may be mediated by refraining from substance abuse like alcohol and tobacco. And when people are stressed, when people are lonely, they tend to eat more food, less healthy food, more likely to do illicit substances or alcohol, tobacco. And so that is the, that is much of the, which is kind of good news. Meaning that as long as you're able to maintain your healthy habits, you can be stressed and lonely and kind of maintain without it affecting your lifespan if you're able to maintain those healthy habits. But unfortunately they tend to go together.

Okay. And Doctor Greger, I want to jump to part three of the book called preserving function. And here you cover everything from preserving bones, bowel and bladder function, circulation, hair, hearing, immune system, joints, mind, muscles, sex life, etcetera. I wanted to just hit on a couple of these. So the first one, I think when a lot of people feel like they're aging, I think bone strength is one of the things that comes top of mind. So I was hoping you might be able to talk about how do you preserve your bones.

Yeah, some of the takeaways from that chapter. First of all, stomach acid blocking drugs like prevacid, prilosec, people often overuse for acid reflux can increase the risk of bone fractures. I don't think a lot of people know that. So can tobacco and heavy cannabis use associated with increased fracture risk. These bisphosphonate drugs like fosamax, the most commonly prescribed drugs for osteoporosis, may help prevent hip fracture risk in high risk individuals, but come with these rare, serious side effects. So I encourage people to look at the pros and cons and see if the makes sense for you. Calcium supplements actually not recommended for most individuals due to their poor efficacy and poor safety records. We should, however, strive to get 600 milligrams of calcium a day from calcium rich non dairy food sources. And the reason non dairy is because meta analyzes show high milk consumption not only does not appear to protect against hip fracture, but is associated with premature death, probably because of the galactose, which is a breakdown product of lactose. Now, those getting inadequate sun exposure should consider supplementing their diets with 2000 international units of vitamin d a day. The sunshine vitamin prunes, onions, tomatoes and almonds, and large quantities of fruits and vegetables appear to have bone protective effects.

However, alcohol, soda and coffee, though evidently not tea, appear to increase osteoporosis fracture risk. Soy phytoestrogens may be safer than estrogen hormone therapy for preserving bone. You can randomize people, the soy milk or regular milk and see an improvement in bone mineral density compared to the dairy milk group. And finally, though weight bearing exercise can certainly improve bone strength, since most of the osteoporotic fractures are a function of falls, not bone density, fall prevention is the single most important intervention, which is good news because we can actually do something about it. Primarily, a combination of lower limb strength exercises and balance training can significantly reduce the risk of fractures. There's been seven randomized controlled trials showing that. So we really do have tremendous power of whether or not we're going to break your bones and all those deleterious consequences that follow from that.

Okay, well, thank you for that. And I think another important one is preserving your mind, which I think there's been a lot of discussion about Alzheimer's and dementia and its rise. And so I think this is a hot topic for many people.

No, absolutely. In fact, it is the most feared condition of later life and tremendous public health challenges in high income countries. Heart disease killer number one. Dementia is killer number two. But though Alzheimer's may be incurable, at least it is preventable. And that is the good news. Modifiable lifestyle factors outweigh the genetic component of Alzheimer's disease. Alzheimer's is related to the atherosclerotic plaque buildup in the brain. So the same dietary changes that can help with cardiovascular health can also help with cognitive health. In other words, whats good for the heart is good for the head. So normalizing blood pressures, for example, in hypertensive individuals can help prevent cognitive decline. Aerobic exercise can improve brain function in both normal and cognitively impaired individuals. Part of that is by boosting something called brain derived neurotrophic factor, which can also be boosted by meditation, caloric restriction, reducing saturated fat intake, and eating high flavonoid fruits and vegetables. So that's colorful. Fruits and vegetables like beans, berries, greens and rye groats, also high in flavanols. Non vegetarians have about two to three times higher risk of becoming demented. So maybe that's because of the saturated fat or oxidized cholesterol, some of the pollutants like DDT in the diet, that may increase our risk of cognitive dysfunction.

So the best kind of dementia deterring diet would be low in added sugars, low in added salt, low in saturated fat, animal products, processed foods, and high in those whole plant foods, particularly greens, beans and berries, for reducing our risk of dementia.

Okay. And I want to just cover one more that I think a lot of people worry about, and that is their sex life as they get older. So what are your tips there in.

Terms of sex life? Something that I had never heard of before. There's a distinctive body odor of the elderly due to a chemical we start producing as early as age 40 called two non, which, which has this unpleasant, grassy, greasy kind of odor, which is caused by the oxidation of omega seven fats, which are increasingly exuded from our skin as we age. But the good news is we can cut that odor by eating two things. One, mushrooms. Randomized controlled trials have shown mushrooms can help, as well as chlorophyll rich, dark green, leafy vegetables. So in terms of smelling better as we age, which may have to do with romantic life. In terms of function, sexual responses for both women and men are related to blood circulation. So again, dietary and lifestyle changes that are good for the heart, also good for the genitals. And indeed, men and women randomized to healthier diets can experience significant improvement in sexual function. And this may be due to the anti inflammatory effects, the blood vessel dilating compounds in certain fruits and vegetables like watermelons and beets, or lowering the phthalates and BPA exposure that we may find these plastics chemicals that are found a lot of processed foods.

In terms of sexual desire, there's a dangerous and ineffective drug prescribed for women called philceraban, which should be avoided. Similarly, there's not enough safety data to prescribe testosterone for women to warrant FDA approval. However, what has been shown to help improve sexual desire in women, which is one of the main complaints with aging for women and sex life, is lavender and bitter orange. Aromatherapy may help. In terms of supplemental testosterone can help low libido in men, though the risks likely outweigh the benefits. Thankfully, there are safe, natural ways to boost testosterone with diet and lifestyle changes such as. As well as eating less than a teaspoon a day of fenugreek seeds, avoiding obesity, avoiding sleep deprivation and beer. Actually, beer lowers our testosterone levels. The spice saffron can improve sexual impairment caused by these SSRI drugs like Prozac, maca root can improve sexual desire in men and sexual function in women. Ashwagandha another route may improve some aspects of sexual dysfunction, but there's a risk of liver toxicity, so I actually encourage people not to use it. About half of post menopausal women experience something called the genital urinary syndrome of menopause, first line treatment of which are low osmolarity, vaginal moisturizers and lubricants.

And I talk about the few brands that actually fit the bill. In terms of safety, the second line treatments are topical hormones, intervaginal estrogens, DHEA. Vaginal estrogen is safer and more effective than to manage these vaginal symptoms in oral hormones, and oral DHEA doesn't appear to work at all. However, oral fenugreek and topical fennel creams can improve sexual symptoms in postmenopausal women. And finally, in terms of erectile function, smoking cessation, weight loss and physical activity can help with erectile function. Though one type of exercise, prolonged cycling, can actually make it worse. Because you're pressing on that pudendal nerve, men should know about the drugs like Viagra can have both short term and long term adverse effects. And so you want to weigh the pros and cons. And though ginseng doesn't have any effect on female sexual dysfunction, korean red ginseng can significantly improve erectile function in men. I think those are kind of the main takeaways in this sex life chapter.

Okay, well, thank you for sharing that. And the fourth section goes into your anti aging eight. And these are things such as nuts, green berries, microrna manipulation, probiotics and probiotics, caloric restriction, et cetera. And I wanted to just go through a few of these. The first one I wanted to talk about, because it's something that much of the audience might not be familiar with, is xenohormosis.

Oh, so interesting, right? So, yeah, xenohomorosis and actually micrornas represent these kind of cross kingdom communication pathways between plants and animals that we may be able to use to our advantage, providing both a reminder and mechanism for the importance of exercise and centering one's diets around these kind of unprocessed plant foods. Hormetic stress is the hormesis is that which doesn't kill you, makes you stronger. Principle. Hormetic stress explains the health and longevity benefits of exercise. So exercise actually causes little micro tears in our muscles, actually causes damage to our body. But in our body's repair, we actually end up better than we started out with. Also can help explain the benefits of caloric restriction, as well as certain foods and beverages like broccoli and green tea. So, for example, green tea, you think of as an antioxidant beverage is actually a pro oxidant beverage, but it has overall antioxidant effects because it ramps up your body's antioxidant of defenses. Same thing with broccoli. Our body sees broccoli as this invading compound and boosts our defenses. We actually end up better off than we would otherwise. The xenohormesis comes in. It's just like antioxidants can be kind of commandeered from plants for our own benefit.

So might these xenohormetic stress compounds like polyphenols, which can actually help effect by modulating this microrna expression. So there's been this kind of failure of kind of isolated phytonutrients and, like, supplements to replicate the benefits of whole plant foods. And that may be due for a variety of things. Maybe people are overdosing in these supplements or the lack of synergistic reactions between the thousands of different compounds and foods that are actually as grown, but there also may be this kind of manipulation of human gene expression by these xenomic rna's, again, a way in which there's this kind of genetic communication between plants and animals, which is a fascinating field. This is something that wasn't even discovered by the time I graduated medical school. Really challenges the central dogma of biology, but really helps explain why. Oh, my God, no wonder these foods are good for you. These foods are bad for you because they actually affect the gene expression within our body.

And I think another one that people might be interested in is the role of prebiotics and probiotics in supporting gut health and longevity.

Oh, yeah. Oh, so fascinating. The problem historically with kneeling down this interaction was because foods that are good for our gut are good for us generally. So when you eat a lot of prebiotics, that which feed our healthy gut flora, where the resistant starch, dietary fiber, where is that found? Oh, my God. Really healthy foods. Right. So eating kidney beans, something. And so. Wait a second. Eating kidney beans helps health, but, yeah, is there a microbiome interaction or not? Well, we didn't know until these fecal transplant studies come along where you can actually transplant the microbiome between people, between animals, and actually prove cause and effect. And so you take mice that are genetically manipulated to have better exercise fitness, and you transplant their microbiomes to other mice, you can actually get an improvement in aerobic capacity, proving that, oh, my God, even our microbiome even plays a role in. In our physical fitness. And so basically, prebiotics like the resistant starch and dietary fiber feed our probiotics, which are the good bacteria themselves, acidophilus bifidobacteria, that make beneficial postbiotics like butyrate and acetate. That's why probiotics are so good for us, because they create these byproducts that are then absorbed through our colon wall, circulate throughout our bloodstream, cross the blood brain barrier, and actually can affect our mental health as well, and decreasing inflammation, boosting our immune function, etcetera.

However, feeding the wrong foods can actually foster the growth of bad bacteria, which create toxic postbiotics like tmao, this trimethylamine oxide. The bottom line is our health is inextricably linked to the health of our microbiome. And these fecal transplant studies prove that a preponderance of health promoting bacteria in the colons of centenarians may not just be kind of a biomarker, but actually an active promoter of healthy aging. You do fecal transplant studies, you feed mice the poop from a centenarian and they actually live longer, proving that, oh my God, there's some longevity benefits of the microbiome. Intestinal dysbiosis, meaning having bad mix of bacteria in the gut may actually accelerate aging via leaky gut. But we can seal up a leaky gut by with the short chain fatty acids, which are produced in response to fiber rich diets, adequate zinc intake, reduced exposure to alcohol and reduce exposure to these nsaid drugs like aspirin and ibuprofen, which can play havoc with our gut lining. And then we can prevent the dysbiosis, this bad mix of bacteria in the first place, by reducing unnecessary exposure to antibiotics, including antibiotic residues in kind of typically industrially produced meat, reduce our intake of excess sulfur containing amino acids like cysteine, methionine, found concentrated in certain foods like dairy, decreasing our intake of certain artificial sweeteners and emulsifiers, which can interfere with our microbiome, as well as maximize your intake of these fermentable carbohydrates, like the fiber and resistant starch which we can't actually digest.

But so it makes it all the way down to our colon and creating this kind of prebiotic bounty for our good gut bugs in terms of decreasing tmao levels, that's reducing our intake of animal products and carnitine supplements. So there's carnitine found in some kind of energy drinks. That's another thing that can create, that can foster the growth of these bad bugs in terms of, well, why feed our good gut bugs? And we can just take good gut bugs by eating probiotic supplements. Unfortunately, they have been generally found to have questionable safety, efficacy and purity on the market. And so it's really the best way to go about it is by eating prebiotics with our good gut bugs eat, and then we can, they can be fruitful and multiply and create an environment by which they can do well. In fact, we have randomized controlled trials where you give people, randomized people the prebiotics or placebo, and can significantly improve muscle strength in frail individuals, significantly improve exhaustion. And so these prebiotics are found in these unprocessed plant foods. And there's other prebiotics which many people haven't heard of, urolithins found concentrated in certain foods like pomegranates, that can help explain the health benefits of a diversity of whole plant foods.

Well, I appreciate that whole perspective. And the other thing I like to tell people is through the work of Chris Palmer and others. Now we're also seeing the link between gut health and mental health as well.

Yeah, fascinating. Absolutely fascinating.

Right.

So you can, like the anti inflammatory effects, you can decrease asthma attacks in individuals by feeding their microbiome, and you get this butyrate in the system, which suppresses the excess inflammation. Really remarkable effects. And we used to think our good gut bucks is just about digestive health, right, reducing intestinal inflammation. But now we know that these compounds circulate throughout our body across the blood brain barrier and can have effects really across the board.

Okay. And then I had one last question for you. We talked about coffee a couple times today, and the other thing I wanted to mention was red wine, because these are two things that people love. What's your thoughts on each in their role of promoting longevity? Evan?

Yeah. In my chapters in how not to die on liver disease, depression, and Parkinson's, I talk about the benefits of coffee for the liver, mind, and brain. Coffee drinkers do live longer and have lower cancer rates overall, although not for everyone. Coffee can worsen acid reflux disease, bone loss, and glaucoma. Otherwise, though, coffee is good for you, though, every cup of coffee is a lost opportunity to drink something even healthier, which is a cup of green tea. So three cups of coffee a day, associated with 13% lower risk of all cause mortality. Three cups of tea every day, associated with 24% lower risk. So tea is better, though they work through entirely different mechanisms. The coffee is an autophagy boosting effect, whereas the green tea is this hermetic antioxidant defense strengthening strategy. So presumably both would be kind of additive, and so it's not kind of either or. But you could kind of start out with coffee in the morning, switch over to green tea, and then switch over to decaf or herbal tea later on. I talk about the benefits of honeybush tea. Roy bows chamomile for their various anti aging properties. But then, in terms of alcohol, everyone agrees that heavy drinking, drinking during pregnancy, binge drinking, bad ideas.

But there's been this controversy about moderate drinking. Those who tend to live the longest are not the abstainers who drink zero alcohol, but those who imbibe a few drinks a week. Unfortunately, this appears to be an artifact of the so called sick quitter effect, which arises from the systemic misclassification of former drinkers as if they were lifelong abstainers. It's the same reason sometimes you see higher mortality rates among those who quit smoking compared to those who continue to smoke. Why? Because. Why did they quit smoking? Ah, they got sick. So, of course, no wonder those that aren't smoking. These quitters, these new quitters have even worse health. So it's not that the abstention led to poor health, but rather the poor health led to abstention. So when you go back and control for that sick quitter effect, then unfortunately that so called j curve disappears and, and there's just this kind of dose response increase of more disease with more alcohol with no apparent protection at lower levels of consumption. So according to the global burden of z state, the World Health Organization, the World Heart Federation, the safest level of drinking is sadly none.

Grapes, barley and potatoes, best Eden in their non distilled form and Johnnie Walker, no substance for actual walking.

Well, thank you for sharing that. And where would be the best place the audience can go if they want to learn more about you and your work?

Oh, they can go to nutritionfacts.org where all my work is available free. There are no ads, no corporate sponsorship, strictly not commercial, not selling anything. Just put it up as a public service, as a labor of love, as a tribute to my grandmother.

Well, Doctor Greger, thank you so much for joining us today. It was such an honor to have you.

Im so happy to be here. Looking forward to coming back on after my next book, which will be on cancer.

Oh fantastic. Would love to have you back to discuss that.

I thoroughly enjoyed that interview with Doctor Michael Greger and I wanted to thank Michael Flatiron books and fourtier for the honor and privilege of joining us on todays show. Links to all things Doctor Greger will be in the show notes@passionstruck.com dot please use our website links if you purchase any of the books from the guests that we feature here on the show. Videos are on YouTube at both our main channel at Johnr Miles and our Clips channel at Passionstruck clips. Please go check them out and subscribe and join. Over a quarter of a million other subscribers, advertiser deals and discount codes are in one convenient place@passionstruck.com. Deals please consider supporting those who support the show. If you want to join the Passionstruck challenge, then sign up for our newsletter titled Live intentionally and you can do so by going to passionstruck.com dot. If you want to follow me on the socials where I post daily, you can do so at Johnrmiles or Passion Struck podcast. You're about to hear a preview for a special passion struck podcast interview that I did with astronaut Steve Bowen, a.

True hero from the depths of the.

Ocean to the reaches of outer space. We'll delve into the critical moments and the decisions that propelled Steve's career to another hemisphere. He'll share how he tackled self doubt and the unexpected twists on his path to the stars. From record breaking spacewalks to seeing Earth's fragile beauty, Steve brings a fresh perspective on the highs and the lows of space exploration.

I was literally on top of the space station. We were installing an antenna on top of the space station. And so I kind of clipped myself in and got my hands free and sat back and watched the world pass below me for about 25 minutes or so. And what struck me was the reality that what kind of civilization do we have that allows us, all these countries working together, to put people in space, not just to go to space, but really sort of research and challenge ourselves and to explore and to really improve life on Earth? I grew up carrying buckets of cement for my dad. It was not anything I could conceive of to be sitting on top of the space station, installing an antenna. Sometimes I think we all have to stop and take a look, look around us, look at our environment. Just look at the civilization we have. We're living in. It may seem in such turmoil at any given day that really billions of people are living together and getting along. And that's remarkable. And I don't think we necessarily appreciate those aspects of it. We actually can solve problems when we all work together.

We actually can take care of this incredible planet if we challenge ourselves to understand it and understand how to make it work.

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