7 things longevity doctors do to live longer – with Dr Harpal Bains

Some of the subpopulation that I'm getting are those who seem normal in every single aspect cholesterol is good, triglycerides good, every single thing is good. And suddenly their age is coming back as anything from 5 to 10 years older. And what I find is that a lot of them tend to be women, a lot of them tend to be type A personalities and the level of stress that that causes and the hormonal and all the things that should release because you're a high stress personalities impacting your blood vessels. And now have evidence that your blood vessels are stiff despite the fact that everything about you is okay, including your epigenetic clock. Well how old did you turn at your last birthday? Harpal Bains is a doctor whose focus is on longevity. She says your heart, cells and organs could all be a different age to you. Welcome to age better with me, Lizelle. My mission is to change the conversation around aging because what I've learned through the years of research and personal experience is that decline is not inevitable. Aging well is a journey and I truly want you to discover just how good it can feel to age better than you ever thought possible. Now over 7.6 million people in the UK are living with heart or circulatory disease. So Dr. Harpal Bains says that as one of the leading causes of mortality in the UK, heart disease and vascular aging should be right up there with the top priorities when considering longevity. And she should know Harpal is a very well respected medical doctor specialising in longevity medicine, functional medicine and bioidentical hormones. She's the founder and medical director of Harpal Connect in London where she offers numerous tests that can help us keep an eye on our longevity clocks. So is your body aging faster than might be optimal or are you living in a way that's turning back the clock? And how might diet, exercise, hormone replacement, even microdosing, GLP1 medications all support our organ and brain health? Harpal, welcome back. It's a real pleasure to have you back here on the show. We had such a great chat last year, didn't we? And I've just hinted that our bodies might not be the age that we think we are. So can we just talk through the basics there of chronological age, you know, what it says in our passport versus biological age that is the age potentially that our cells think they are. So it's actually a really, really interesting question because there's a lot of people actually wonder how through these testing can be. And the kind of results we have because we see so many patients who do so many of these apigenetic testing, we see something completely different or I think what the public sees as well. The same person can have a completely different apigenetic age based on let's say, glycation or tell your male length or one of that. And then if you were to do a different type of a test, it would give you a completely different result. So the same person we have found in quite many instances, they actually age differently in different systems. It's actually fascinating because you have someone doing I think glycine age is one of the biggest the better ones out there, but things are, you know, there's new things coming all the time, tell them you're testing is at the moment considered a little bit older school and it's not a secure it anymore. However, that shows you only one part of aging and if the same person were to do a different test and we have seen that including journalists within journalists who go around and and we're getting completely different ages for different systems. It's absolutely fascinating. It's really interesting, you know, I've just finished writing my book, How to Age, which comes out in April, which I'd love you to see actually because I think it will right up your street. And as part of that, I did write about these biological clocks and aging and my publishers wanted me to put in it what my biological ages. Now I'm 62, I'm heading for 63 and I did a glycine age test recently and that said I was 44, you know, I've done other tests that have put me in my 30s and you know, there are others that you know can go lower than that and others that might. So it's sort of it's all over the place isn't it so I think it's you've got to be a little bit careful when people say, oh my biological age is this because it depends doesn't it which test you're using which metric you're going on. Absolutely. And should we start by talking about these different longevity clocks then and what we might want to take note of because I think the point of doing all of this is to actually end up with something that's actionable. And what I liked about the glycine age and all the other kind of tests actually is that it gives you a marker that you can then come back and revisit and see whether you can in fact dial back your age further. Or you know what you're doing in your lifestyle, whether that might even increase it, you know, add years to your life, is that the kind of thing that you're seeing in your clinic. Absolutely. Yeah, absolutely. So as I said, like I think in different countries, you may have different tests available in the UK, I would say glycine age is currently the leading one. The results, it comes out, it can be a little vague at times in some people it's quite clear cut. They tell you like you know, you can see exactly where things are not quite sitting right and it's very clear what you need to do in other people. This has been really interesting for me. There are a few longevity doctors who have done the test and ended up with an age that's way older than there and no one can figure out why not even the glycine age people. That's embarrassing. My self included. Really? And why would that be because presumably you're doing everything right? Nobody knows. And so they're like, oh, it must be because of menopause. I was like, no, I've been in on HRT for X number of years. And then I do a different test to measure my cardio age, my arterial stiffness and my results come back as being 20 years younger, which at that point because I'm one of the first few people to do the test at my clinic. In my head, it was normal because I was like, oh, yeah, I'm sure everybody's results are going to be like that. This is the, I don't tell people that it's come back as trying because it's it's actually almost everyone else have tested. I haven't come across a single person who's had it bigger than that than the gap that I've had majority of the fat so many people older like you know, 10 or 20 years even older than what their actual ages are. Some of these people have done the glycine age and their results have come back as younger. So what is it? It's a really tricky one. Is this because then we have these different clocks within us and our cells are aging at different rates. So for example, our brain cells may age at a different rate from our heart cells or our cardiovascular cells or our bladder cells or our skin cells, you know, because from what I understand from my longevity research is that all our cells have their own little longevity clocks within them and they all run on their own circadian rhythms and their own kind of timings. Is that is that why we get this disparity? That's what we think. So I think if you do it in a system wise manner like with the pro-tomic clocks and not which which hasn't come in, I think by the time we hit 20, 29, 20, 30 will be a little bit more there. So the prices are going to be very high initially, but eventually it'll be achievable for the average public of all these tests like the glycine age and the telemeters and all that. It's quite generally because it measures this overall result of what everything is doing. Everything like the cardio age measures your arterial stiffness and that's quite a specific result of everything that's been out there and trust me, I have looked enough looked and I've looked to me. This is the closest thing we have to a pro-tomic clock testing device currently. I mean it isn't that we are not testing for because we are not looking at the protein, but in an indirect manner, it's actually telling me the age of the person. Every time I relate it back to their history or anything else, I find you to be hugely accurate. It's been a huge learning curve for me. Fascinating. So a pro-tomic clock. What exactly is that and how do you test? So at the moment it's research only, it's not available to anyone to do besides in research institute. That one's very interesting because they are measuring protein elements of the different organ systems. So let's say if you drink a lot, you might have the age of your liver would possibly be completely different to say the age of your brain or another part of your body. And this is where anti-aging is actually going towards. I mean the level of precision that we can get is going to be quite precise. At the moment we don't have access to any of that, although the UK Biobank has been doing testing on pro-tomic clocks and I think they had a sample size of 300,000 and the results should be coming out this year and next year, which is super exciting. It's fascinating. Watch this space. Now you talked just now about people coming into your clinic and being tested and then coming back, you know, and being retested and checking to see what's happening with their age. What sort of lifestyle changes are going to support the healthy changes and the potential dialing back then of our biological age. Unfortunately, the usual things I think everyone knows what it is, you know, eating well, eating moderately. I'm not in support of extremes of diets. You know, people who go completely zero guards, completely ketogenic, completely this complete that I feel it should be a moderation. Nobody knows the exact answer when you don't know the exact answer moderation is usually the answer. A moderate diet, I would say plant heavy good quality oils, extremely important, good quality animal proteins and fats. Really, really important enough fiber in your diet. Be careful about lectins. That is something a lot of people don't think about. Elections are the outer covering of any. - Any food that is brown like brown rice brown, there's brown that. Some people find that by eating all of that, they feel like they're doing the right thing, but they actually find that they get more irritated and there is a reason the outer covering, the brown covering is there to get rid of insects. - That's fascinating. - And so it must be irritating our gut. - Wow, so for years we've been taught, haven't we make sure it's brown, brown bread, brown rice, brown flour, all of that. But actually you're saying that because of the lectins, it could actually potentially be a bit more disruptive, a bit more damaging. - Irritating to some people. Yeah, if you already have a little bit of leaky gut, so I personally don't bother. I love white rice, I'm going to keep eating it. 'Cause the joy factor counters forever a lot. - I also remember seeing one of the biohackers talk about the amount of arsenic in brown rice. - Oh yes. - And white rice having a lot less. And I looked into it and sure enough, when I looked up the data, it was there. So I now have a cupboard full of white rice actually, which is something I never thought I would have. - It's really interesting. So I just say that all of these things moderation is key. Don't swing too much either way. I think this is kind of why the Mediterranean diet is actually so popular because it is a really moderate diet. If you think about it, it's got a little bit of everything. They're not too strict on almost anything. And then put in the joy factor. If you have a lot of joy in your life, if you exercise moderately, that's another one. Oh my God, all my patients who have a higher age, almost always are all exercises, almost always. It's crazy. - What about sleep? Presumably sleep is a massive component too for biological aging. - Huge. - And the moment you hit a certain age, as you know, with the moment your progesterone levels go down your melatonin, your endogenous progesterone and melatonin levels go down, your sleep is going to be impacted. So it's one of the few things, hormone replacement therapy is one of the core components of I would say longevity. - Oh yeah, because of sleep. There was certainly my experience. I haven't had a hot flush in my life. And yet, it was my lack of sleep, my waking up at four in the morning that sent me running to the GP at the age of 51, I think. And from the first moment I put on that, I got a good night's sleep. I was one of the fortunate ones for me. It worked firstly. I mean, I know a lot of people can do tweaking, can't it? And I know that you do the bioidentical or the body identical hormones. And that's another really interesting area, isn't it? Because hormones we tend to think of, oh, it's just estrogen. But actually there's huge variation, isn't there? In the way that natural body identical or bioidentical hormones work compared to the synthetic form that we would normally find in something like the contraceptive pill. - Yeah. So a lot of people also get quite confused about the terminologies, like in a wire, some people calling it body and some people calling it bio. So these are just terminologies. I've actually got a list on my website. And I think under the menopause page we're explaining the different in great detail. What's the difference by your identical and body identical? Body identical generally refers to the generic big pharma made products, which means you are going to get exactly the same dose in every single pill. You will unfortunately also get an element of fillers. And this is the thing which some patients, majority of people can handle it and it's fine. But there's a small number of patients who cannot handle the fillers and the dyes. I mean, you have to ask yourself, why is a pill white in color? Is that natural to the pill? Usually the answer is no. How did it turn white? Why is it bright pink? There is a reason there. So that's not really natural. And then of course it has to last for a long time. I think the US Navy did an investigation to see how long after the last date with these things last and the answer was about 15, 20 years after the efficacy decreased by about maybe two to five percent. And that's it for majority of the medications that they tested. So these things are still good. But in order for it to be good for that long, it needs a level of preservatives as well. And so you have some patients who are sensitive to all of that, majority are okay. And for those patients, this is where bioidentical comes in. And you have a lot of conventional doctors saying that it's rubbish, it's bullshit. And I think that's really unfair because first of all, for a pharmacy to be able to get the qualifications to even be able to produce these things, you should see the paperwork they have to go through. It's hideously expensive, extremely expensive for them to go through the whole process of being able just to get themselves regulated enough. So these are highly regulated pharmacies. No doubt some parts of the world in the US, I know that there have been incidents where they've then gone and checked and some things have been up to scratch. In our experience, we work with UK compounding pharmacy. We also work with German compounding pharmacy. I must say, a prefer the German one. - Oh really? - They've been doing it for way longer. So their expertise is way more. But the UK, once they're catching up extremely quickly, they are now much better than what they used to be. Quality control is way better. And the best part is you get a vegetable capsule, you get a home when you get a touch of olive oil. If that's what you prefer, you can choose pick another oil if you want to. That's it, very clean, very pure. It does mean it's going to cost more. That's for sure. The other thing is that it's not going to last as long. It's going to last you maybe six months because it's fresh. And the other benefit, and for me, this is the biggest one, is that you can combine quite a few different ones in one single magic cap. So for me, every night, I take my Eastern Progesterone Melatonin, all three in one magical capsule. I guess the issue, for a lot of mainstream medics, is they would say, well, it's not regulated. So the pharmacies themselves might be. But in terms of efficacy, getting progesterone, for example, into the system to protect the uterus, we need to know there's a certain level. And the cost factor is real. I think what really concerns me, actually, when we talk about HRT, I mean, it's good that body identical or bioidentical is more mainstream. It's crazy, isn't it? When you think about our HRT hormones in midlife are body or bioidentical for the most part, unless we're having something like the old-fashioned premerent tablet. And yet, our daughters and the younger people around us are having to have synthetic contraception, which, as we know, is far riskier. And yet, women can easily get contraception from a GP without any really long in-depth conversation. And yet, for many women struggling to get even just basic HRT from their NHSGP, it's such a battle. You must see that in your clinic with people who come to you in desperation, having been turned away. It's not as bad now. I would say about five years ago it was really, really bad. Ten years ago, it was. Now it's not as bad. Because the GP's are getting trained. And they're being told that all the old studies that, it's going to give you all breast cancer and blood clots and this and that. A lot of it has been debunked, which is good for us. At least we now know that it's not. But a lot of GP's, a lot of doctors are still really scared, because if you've been fed that for years and years, if you have spent 20 years of your life telling someone that this thing is going to give you, may give you breast cancer, the moment you heat say 55, I'm not going to give it to you anymore. Because I'm too scared, I'll give you breast cancer. And maybe you can give it a few years. You're right. Now that poor GP is, yeah, is potentially going to sit there. It's scary. A lot of persuading, because ultimately it's their name, isn't it, on the bottom of the prescription? Absolutely. So one organ that I really want to spend some time talking about with you is the heart. Talking about how we can tell the age of our heart, cardio age testing. How does that work? And what can that reveal about our health that we might not otherwise know? So just to give a little bit of context, when we were setting up a longevity service, as I said, we have already been doing longevity over the years. And then about three years ago, I decided, I don't want it just to be longevity, to be part of hormones, or I want to set up a dedicated thing. And in order to set up a dedicated thing, my first question is always what kills you the fastest. And let's figure out how to solve that. That's the easiest way to put it. Otherwise, it gets too muddled and mixed up. That's so much going on. So number one, cardiovascular health. Right. What do we have for cardiovascular health? How to look around? OK, you've got the usual cholesterol. That's what the GP tests for. If you start having a little bit of problems, they try to solve the cholesterol issue. They then try to give you, maybe if you have a little bit more symptoms, they give you the 24 hour blood pressure monitoring device, then they do an ECG on a well person, which pretty much doesn't tell you anything, unless they accidentally stumble upon an arrhythmia, which-- there's a utility there. But ECG is the most useful when you're actually having an event. Otherwise, it gives you a little bit of information, really not enough. And then you leave this person alone, until they have an event, and after they have an event, they then go to the cardiologist, who then does a whole bunch of different things for them. That's an in-between space that's completely forgotten. Like, if I were one of them, what am I going to do to help myself? A lot of people have now heard about the statin debate, and it's a bit like, do I really want to go down that route? I'm not very sure. Let me think about this. And then they end up not knowing what to do blood pressure. The interesting thing in my experience is I find that a lot of people don't take blood pressure seriously. And that really surprised me. They're like, oh, yeah, it's just slightly high. It's just like three to five points higher, never mind. Oh, it's only 10 points higher, never mind. So the general tendency is to feel that way, to think that way. And what this device that I, in the end, decided to invest in, it's a French device that we have, it has blown my mind. It has made people go from not taking things seriously for years and years and years to completely changing their lifestyle. I've never seen anything like it. So what is this? And what's it doing? And is that focusing on blood pressure, then? So it's focusing on this thing called pulse wave velocity. So in a very simplistic way, it measures how quickly, how its wave goes from point A to point B. So, if the wave goes really quickly, it means your blood vessels are quite stiff. And stiff in a blood vessel is not a good thing. We don't want a stiff blood vessel. What would cause a blood vessel to become stiff? Inflammation, calcification, arthrosclerosis, all the bad things. If it's then your blood vessels, it's going to make it stiff. And if it's stiff, your results, it's a fast result. I mean, you're going from point A to point B really quickly. In a good quality blood vessel, it's going to take its time because it's a wave, right? So, it goes and hits one wall, it then goes hit. And there's a nice and this signy method of flowing that it. And that's a good thing. You want that. You like that. And so, can you see how this extremely simple test is hugely, hugely accurate? So accurate to the point that it is the gold standard in most European countries, which does it as a standard within their GP services in Japan. It's a gold standard. Most of Asia, South Asia, China as well, I think it is the gold standard. In the UK, it isn't. In fact, I recently heard a few cardiologists talk about it in terms of, yeah, you know, it doesn't change anything. How does it not change anything? I now have evidence that your blood vessels are stiff, despite the fact that everything about you is okay, including your epigenetic clock, it's not so bad. We've done quite a few on people who just had babies that's super interesting. The cardio age goes up, I think, with all the stress of a brand new baby, with all the hormonal disruption and everything else. If they have had interventions to get a baby, like IEF and the rest of it, even worse. Just as an example, can you reverse it? I believe you can to an extent, but when it's 20 years or 15 years more than the reversal, maybe you can get five, seven years if you're really lucky 10 years, but until you have massive changes in lifestyle, I can't see how that's going to happen. So if you have a patient who comes to you and you discover that that person has stiff blood vessels, what do you recommend that they do then to soften them up again? So a few things will first of all look to see what could potentially cause. Some of the subpopulation that I'm getting are those who seem normal in every single aspect, cholesterol is good, triglycerides good, every single thing is good. And suddenly their age is coming back as anything from five to 10 years older. And you're like, it's come to a point where like, oh my god, now I've got to break the bad news. And you know it's real results. These are real results. Whereas there are others who you know, they already know their blood pressure is high, they drink a lot. They're doing all the bad things, so it's higher. And that's okay. And surprisingly enough, those people I find that it goes up to 10 years higher, but not a lot more. Which then brings me back to this first subset of patients. And what I find is that a lot of them tend to be women, a lot of them tend to be type A personalities, high stress types. And everything has to be just right in their lives. And the level of stress that that causes and the hormonal and the, all the things that should release because you're a high stress personalities impacting your blood vessels, usually the thing that I tell them because they're already eating right. Everything in their lives right, even their blood pressure is right, but something is showing in this test that I find it mind boggling and I still cannot really see what, but it's picking it up on this test. It's that sensitive. So when I see them, I'm actually telling them I was like the biggest thing you have. A lot of stress in your life right now. I think if nothing else, that's the first thing they really need to look at. I mean, of course it's individual to each person, but usually by the time they come to us, our average patient population group is really self-aware. They eat extremely well. A lot of them eat way better than I do. They don't really drink much. You know, they're already doing everything right. So then you have to look at other things and what's causing it. And it's in where we stress. It's crazy how bad that can be, especially in women who don't do self care. That's fascinating that that cortisol presumably could have an impact on stiffening your blood vessels. And I imagine, you know, protocols like looking at toning the vagus nerve and mindfulness meditation. I mean, in my experience, trying to get a highly stressed, high-powered, high-achieving woman, especially to sit down and do some journaling, you know, good luck with that one, because they're not going to take it seriously, but maybe someone's listening to this and think, "Oh, I stiffen my blood vessels. Maybe I need to do it." Super interesting. Well, we're going to take a break now. When we come back, let's talk not just about the heart itself, but we'll let's really cover things like inflammation. And I'd love to get into this potential idea of microdosing with the GLP ones. Oh, yes, love that topic. Well, welcome back. And it's super interesting to be talking there about the pulse wave velocity, the PVW. And hopefully that is going to make its way into standard practice in our GP clinics soon. But I think we can't really finish that conversation without bringing in the cholesterol question. You touched on the statin debate. I've had blood tests and tested for blood fats, you know, for many, many times, every health clinic I go to, but she seems to want to run the test. And what was interesting for me recently when I was researching my book was having the test for the LPA marker, the LUP protein A, and actually finding that I was quite high in that, which gives me a greater risk of clot. So I thought, well, that's interesting. So I can do things about that. But for me, personally, or somebody with an LPA, a high LPA reading, a statin would potentially be disastrous, would not be the right idea at all. So I think the more we know about these screenings and these blood tests, where do you stand on this debate or discussion? Where I stood six months ago is different to where I stand today. And that is the biggest thing about this. So I, for those who are listening in, who are not aware, there's a big debate on statins where some people think it's the be-all and all, it needs to go as low as possible. And, you know, just try to push it as low, low, low, low, as low as you can. Your LDL. Then L, the LDL, the bad guy, the so-called bad guy. And then there's another subset of people who are like, all that is absolute bullshit. The all-course mortality studies show that it's not true and so on and so forth. So there's a pro statin and the anti-statin. And, of course, when I was in my NHS days, I was pro statin, then I got into functional medicine. I became anti-statin. Right now, I'm a bit on the fence, not quite on the fence. And I'll explain to you who I am. This is interesting. But rather, I think there is a place for statin. I think the understanding of LDL and HDL has changed quite a bit. Unfortunately, not many people have received a memo. Will I change my mind in another six months? Huge possibility. We have a group of doctors within our clinic and we constantly have meetings and the rest of it. It's so interesting to hear a whole bunch of hugely passionate doctors, you know, being able to talk and talking the same language. Super fascinating. So this is one way of thinking about it. First of all, cholesterol is a repair molecule. It's there to regenerate, repair, and build. It does a lot of things. Your body will not make a component which is going to kill you. So cholesterol is there for a reason. It builds. It makes all your hormones. It does all the repair. There's a damage in the cell membrane. That's what it's going to do. That's what it's there for. You then have what people think of as a good guy and the bad guy, except that it's not really good a bad. They simply are carrier proteins. They're just carrying the cholesterol molecules from point A to point B. One way to think about the bad guy, the LDL, is like they are your delivers. They go and deliver all the stuff. It all the plastic packaging and everything else. And after you finish it, you're dumping all of the plastic packaging and the bit that you don't want to eat anymore outside on the streets. And this is where HDL come in. HDL is actually the guy that he's the garbage truck. He's the garbage truck, but he's a super boosted garbage truck because not only does he take the garbage and throws it away, he also then cleans the whole average scrubs it a little bit makes it all nice. HDL actually have anti-inflammatory properties as well. And that's a really powerful tool. And that's something the bad guy doesn't have that much off. It has a little bit, but really not enough to make it. So here are two carrier proteins. They both do completely different things. And it doesn't mean that one's bad and one's not, but what you infer from it. So if you have a lot of LDL, the so-called bad guy, it means that a few things could be happening. First of all, your body may not be clearing enough of it to get out of the system, which means it's now going to go and give you the cholesterol, right? And which means it's going to help with the repair and everything else. If you have a lot of parts of your body where let's say, let's go back to the blood vessel, you now have a blood vessel. There's a little tear in the blood vessel. And the body goes like, oh my god, help me help me save me. And when this happens, it changes the nature of the blood vessel. It makes it sticky and it makes it kind of like a magnet. It kind of attracts things. And the LDL as it's going past, it's like, oh, okay, fine. It's calling out to me. Let's go there. It's going to go there. It's going to get stuck because it's sticky. And then the endothelial because it's damaged, it holds on to the so-called bad cholesterol and it doesn't let it go. And then it because it doesn't let it go, this guy now starts going like, oh my god, I'm trapped here. What am I going to do? It starts giving out all this damaged signal. It's like, you know, help me help me. What happens? The body goes like, oh my god, it needs help. It goes and it tries to help it out. In the process of helping out, it causes a lot of inflammation. And in the process of all of that, the LDL now becomes oxidized LDL. So LDL is not the bad guys that oxidize LDL, which is now the thing that is going to cause damage. The body But it recognizes LDL, therefore it doesn't attack it, it doesn't do anything to it, it doesn't recognize oxidized LDL. So what it does is because it doesn't recognize it, it thinks it's the enemies, you're now your immune cells going, it starts to attack all this oxidized LDL and makes these things called the foam cells. These are big foamy, fat-filled cells. And that's kind of how the whole thing starts. And then the moment you have foam cells, more attracted. So if your LDL levels are really high, move them, get sticky and go and stick onto it. So it increases your LDL burden. So the argument here is that should I decrease my overall LDL so that not as many become sticky and get stuck there? Does that kind of make sense? Whereas the whole argument is like it's a repair molecule, why should I bother with it? And it has been a huge shift for me in my head where I have gone from it's a repair molecule, why should I bother taking it down to wait a minute. For a primary person like who has never had an incident and overall it's good, I think there isn't a lot of place for it. But the moment you've had an incident or you know that you have an unstable plug, then that's where LDL reduction actually really comes in. So I have gone from studying being very bad to actually there's a place for it. There is a place, but it's always the nuance isn't it? And I think that's also interesting about functional medicine. We are all individual, our epigenetics are different, our DNA is different, you know, our lifestyle is different. And it's about having that personalisation which we're seeing a little bit more of them, it's very slow but it is beginning to get in the mainstream. So really bottom line just to finish off that conversation, are we then saying that it's not the LDL per se, it's the oxidation of it? And if so, how can we in general life reduce our risk by just generally helping to reduce our oxidative stress of LDL? I mean, are there simple things that we can do or should we be eating, you know, having fish oils or is it stress reduction or exercise? You know, what's the key here? Unfortunately, yeah, absolutely the same answer. So you have to ask yourself, go back all the way to the endothelium that's damaged, a blood vessel that's damaged and ask yourself, why are you damaged? One reason, high blood pressure, you've got this high pressure hitting the walls eventually causing damage, smoking can cause it too much of quality food. And environmental toxins is a very big one. Environmental toxins is huge. You know, what are you using to cook? How much lead are you breathing in every day? What's your mercury exposure? All of that makes a huge difference. So you've got all of these things that's going to cause endothelial damage. So the more of those you can take away, the less damage is happening, the less areas are sticky, therefore less LDL is going to get stuck. Then able to do its job as normal, which is what we want. It's really scary, isn't it? When you look at the amount of environmental pollutants that we are exposed to everything from microplastics, people worry about heavy metals in chocolate. You know, I mean, the list goes on and on. Are there simple things that we can do on a daily basis that will help to clear the system when people talk about having lots of soluble plant fiber and that might actually help to pull some of these unwanted materials out of the body? Are there protocols that people talk sometimes about chelation or having certain minerals that will bind with these heavy metals and remove them from the system? What would your favourite protocols be for that? It's so when it comes to things like heavy metal, microplastics and all of that, it's not as simple as what people think. And this is one reason very, very, very few clinics actually do it. Because first of all, when you think of a complete detox protocol, you have to think about all the major detox organ, your skin is of course one, so that's sweat. You've got your kidney, you've got your bladder, these are the main organs of detoxification. Then you have to think about where is this toxin lodged and one very interesting thing that I know we're going to be talking about GLP ones, but that we're seeing right now is too much sudden weight loss. It's actually causing toxin overload in these people and the reason why a lot of them feel absolutely awful is not so much because of the drug itself, but because suddenly all these toxins which are just sitting inertly in their fat is now being dumped into the blood stream and the body doesn't have the capacity to deal with it. It is crazy. So as we release the fat cells through extreme dieting or all the GLP ones which we'll talk about in a sec, then we're also getting released to any of the heavy metals or toxins that have been stored in those fat cells, suddenly going into the system and making us feel dreadful. Absolutely, which is why the weight loss has to be slow, has to be measured, which is why the microdosing, that's a place for it. Okay, let's talk about that then. So when we're talking about GLP ones, presumably we're talking about things like Mangero, Gobi, Ezempik, microdosing, how low a dose are we talking about and how often and what kind of effects would we still be losing weight are people microdosing for other reasons other than weight loss? Oh yeah, so in the US, the number of studies that's currently going on the benefits of these GLP ones on cardiovascular health, Alzheimer's is a very big one, the study that's going, that they're doing in the US. There's a ton of studies that's looking at all of this at a much lower dose, but I think people are so scared about it because, you know, bad new cells, but in good news and they keep talking about pancreatitis and there's that and the eye problems and everything else that the average person gets really scared is that true. Yes, it's true. If you take it to the extreme, you know, anything to its extreme is going to cause a problem too little or too much. The medicine is in the dose and that's just it really. So every time I get asked this question, I'm like, you know, what constitutes this microdosing? I was like, well, think about the beginning dose of anyone, you know, Gobi, Ezempik, think about whatever the beginning dose is, half it or quarter it, that's kind of like a microdose, but for some people, even the starting dose becomes the microdose. And I don't think there's a, I don't think anyone can say definitely what a microdose is for each individual. It really depends on what you're trying to achieve. Someone would still a little bit of wait to lose or they know they have attended these very quickly go up might decide on a higher dose, which maybe technically may not be called microdosing, but in the big scheme of things, you know, no side effects, the joints start to feel better. Less inflammation all around and those are things you can actually feel. So they might be quite happy with that and they might just decide to do two injections a month and that's it. Really? And that even that's good enough. Yeah. So not just the dose, but also less often. Yes, the frequency. So just to put this into the kind of practical terms, if you were saying taking manjaro, say the starting dose is normally I think 2.5 milligrams once a week. So you could start on that or you could have less, you know, 1.5 milligrams, for example, and you could be doing that every other week. So you would get perhaps a little bit of weight loss, maybe, but primarily the reason for doing that would be to lower inflammation, to look after heart health, brain health. You were talking there about new studies looking at Alzheimer's. And why would that be? You know, linking things like brain health and heart health is that due to inflammation? Because, you know, we tend to think of GLP ones as primarily just taking away the appetite and stopping us eating. I mean, what else are they doing? The inflammation reduction is, I think, the biggest benefits because Alzheimer actually is protective in its own way. It's the body's attempt to try to deposit these things to, because there's inflammation going on and it's just that in the end, the thing that is depositing is not desirable. You know, we're never meant to live this long. So that's not the problem as well. Now that we are all the body's ability or all these so-called protective things that the body does actually comes back to haunt us because it's not protecting us anymore. It's actually causing us more problems. So there's an in between here and we have to understand how it works. If you decrease the inflammation, there's not as much to repair. Therefore, there's not as much deposition of all this stuff we do not want in our body, including the blood vessels. Indeed, and of course, these GLP1 ligandists, they are working on a hormonal level, aren't they? It is that hormonal pathway. And we talked about menopause hormones earlier. Generally, though, what do you think about hormones being part of a longevity strategy for midlife women? If we look at things like testosterone, for example, or any other supplementary hormone, are we looking at things like improving our muscle mass and our brain function and our mental well-being, are there many more benefits than simply helping with symptoms of menopause? That's actually, our clinic was started out as a hormone clinic, but hormone for longevity because the first message I heard, my background was surgical, so I didn't have to unlearn. A lot, if you are a conventional doctor of your internal medicine doctor, there's a lot to unlearn and you have a lot of barriers. In the surgical field, it meant that I didn't have to unlearn a lot, which is super useful. So when I went to the US to first learn about hormones, but from this different perspective, from this perspective of keeping you as well as possible, you're talking about 13, 15 years ago. That's when I first stumbled upon it. Before thinking. I had never heard such a thing and it's so aligned with what I thought medicine should be. I knew I found my passion at that point. So if you ask me for me, that's number one. It's not even number two. It's number one. It's not hormones. And I keep telling my patients, the symptom reduction is a bonus. That's just a bonus. But really, what I want these hormones for you is what it's going to be able to do for you five years, 10 years, 20 years down the line. And another question I get asked a lot as well is like, you know, I'm 60 now and I never took HRT at all and my GP doesn't want to give it to me. to me, can I start it? Because I've been told that it's too dangerous. I would say I started at any age. Our older patient is 85. She started when she was in the 70s. She loves her life. - Yeah, well, my mother, and I've spoken about this before, and she doesn't mind me sharing this. She went back onto HRT after a big, big break at the age of 80. It was her 80th birthday present, and she's doing super well. And I'm just so grateful. You know, I'm so grateful. I mean, I'm in rage that we've had to live through decades of hormone deprivation, and the inadequacies of female healthcare. And that's a whole other discussion that I could get very soapboxy about that. But at least, thank heavens, we do now have it. And we do have forward thinking people like you as well. How well before we go, what are some of your own personal habits and routines as a longevity doctor? But we could potentially incorporate into our own days. What have you seen the most difference with? - Having a 70% is good enough attitude, I think. I love that, 'cause we can't be perfect. Can we? Oh my gosh. And then we beat ourselves up because we sat on the sofa with a box of dairy milk, you know? Well, hopefully not, 'cause that's for the part. - Yeah, no. - But, you know, something else. - If I'm doing things 70% right, I'm happy. You know, that's good enough. That's good. I'm not going to beat my, and I definitely am going to go out with my friends and have, you know, drink. I'm going to do that. I'm going to go out dancing. I'm going to do things that give me a lot of joy, because honestly, of every single thing I've seen, I think that makes possibly the biggest difference. - Joy. - Joy in life. Yes. - Brilliant. - Having a moderate attitude in life, which then goes into how you eat, how you exercise, and maybe being a little bit more fussy about environmental toxins and actively doing something, like, you know, I've got an apurify at home, changing my cookware to the right things and stuff like that, infrared saw, and else, of course, huge. So, those are the things which I actively do, and planning my supplements every day. I tend to ask myself, okay, what do I want to achieve today? Or what do I want to achieve this week? And I will take my supplements accordingly, because otherwise, you can get carried away. It's just too much. So, it is this, let's just not think too much. Let's just not care too much. Like, you know, take it every day as it comes, and a bit easy going. - Not to overthink, I think, is what you're saying, but to be aware and be very mindful, and keeping in mind that 70/30 balance. - Oh, well, absolutely brilliant chat to you. I'll make sure that we put all the details of how to connect with you in the show notes, and fascinating. Let's continue our conversations. I'm sure our polls will cross at various longevity events, but, you know, it's such a fast moving space, and I have huge respect for you to saying that, you know, you change your mind on certain things, having looked at the data, because that's what all good doctors and scientists should be doing, reviewing, and, you know, assessing, reassessing all the time on current knowledge. So, thank you for being here today. - Thank you so much for having me. - Oh, awful. Thank you so much for your time. Always so great to chat so much there to dig into. And, of course, very timely. Our poll was talking there about the toxic overload, and how really we need to be much more aware of what's going on. And, in fact, this time next week, we will be talking about that very subject, you know, how concerned should we be about these so-called forever chemicals and the toxic load that our bodies are subjected to? Well, we are going to be finding out with a leading global authority on that very subject. And, if you'd like to hear that episode, 24 hours early and add free, then do subscribe to age better with Lizard Plus on Apple podcasts for a very small monthly fee. And, in the meantime, I will be back with another episode answering your questions and details on how to get in touch will be in the show notes. Or, of course, we can always chat on Instagram. The team and I are there at Lizard Wellbeing, and I'm on there too, personally at Lizard Wellbeing. Okay, until the next time, we chat then. Go very well. Goodbye. Age better with Lizard is not medical advice. If you need help with a health concern, please speak to a doctor. This episode is presented by me, Lizard, and is produced by a new chicotate for fresh air production, with thanks to our head of brand, Ellie Smith, and social media manager, Nemi van Gelen.