The Secret Sauce to Anti-aging & Longevity Medicine with Dr. Ahvie Herskowitz

Hi, my name is Dr. Ahvie Herskowitz, and today I wanted to focus a talk, almost like a fireside chat, on a subject that is interesting to most of us and, and that is longevity medicine or anti-aging medicine. And I wanted to separate the hype from the appropriate expectations we should have from it.

But particularly today, this morning when I woke up, I read an article, I think it was in the, Wall Street Journal,about another of the billionaires that was investing heavily in anti-aging technology of the company he was supporting. Because there’s a group of us, including myself, that would like to extend our life and extend it in a healthy fashion. But it focused on a lot of the hype around this. So, it focused on many different aspects of science, and I wanted to make sure that everyone understands that my perspective is coming from a molecular background, treating very ill patients for now almost 40 years that has a background in immunology and molecular biology and molecular immunobiology.

So, coming from that perspective, the science that’s present now over particularly the last 20 years is outstanding. When I opened Anatara Medicine, the current place that I founded about 14 years ago, I wanted it to become a scientifically based organization that was treating patients. And I looked around for and used whatever, I think it was indeed at the time, used that platform to look for PhDs with experience in mitochondrial disorders and related research, because we already knew then that both some combination of inflammation and mitochondrial function played a role in aging. We didn’t know much more than that.

And there were zero takers on that. Yeah, at that time, 14 years ago. Today, there are literally hundreds of PhDs throughout the world working in this field because the companies want them to focus on it. So, while we know what we know, and I’ll throughout this talk, I’ll focus on the science that is real and is important to understand.

I do want to have an overlying concept about some of the dangers that the whole field is now progressing rapidly towards because we’re a commercial society and commercial entities are going to take advantage of our fascination with aging. So, what’s the negative side effect of this? Well, the negative is, you tell the public that things are generally okay and all you need to do is wait for a magic pill that’ll happen sometime in the future, we know it’s not happening imminently, but maybe 10, 15 years from now, we’ll have a magic pill for you to take that will reverse aging. Now, that doesn’t sound fantastically impossible, and some people feel it’s probable. At the same time, what do you then do with that information? Well, you continue with life as you see it as you see fit, or you continue with your life the way it is. And that’s the danger.

The opposite is true, I think, and that is that we’ve reached a point in time where our lifestyles are to the point where they’re killing us. So, we’re at a point where our lifestyles are so negatively impacting on our overall ability to repair the injury that we’re experiencing during the daytime, that by the time we wake up the next morning, it’s always a net negative.

So, we don’t have enough energetic, enough for the pathways that are needed to repair all the damage that we’re doing during the day. So, it takes our emphasis off of that. Some people call that, I call it “the terrain”. And you’ve heard our future president talk about removing, draining, the swamp. Well, that type of concept, I think, is a perfect way to think about the injuries that industrialization and modernization of modern life has produced on us.

So, if you take your eye off of that, then you can continue with the same bad things that are continuing to injure ourselves. And so, when you take care of patients today, as we do every day here, which is a wide berth of patients, anywhere from truly ill people with life threatening conditions all the way over to athletes and folks that want to optimize, you realize that we all have certain similarities.

The similarities are we all have to live in this world, and those of us that are taking better care of ourselves, of course, should be healthier and more likely they are. And those of us that are really ill have to change very rapidly or else we’re not going to do well. But what we’re seeing is the expression of things that are possibly even irreversible at this point.

So, when we first started learning genomics, which gained prominence around 20 years or so ago, we realized that there were certain pathways that were more important for aging than others. So, some of them intuitively are things that regulate the way we handle glucose, the way we handle blood sugar, the way our body really is handling overall metabolism. That’s the way to think about glucose, the way we handle inflammation, the way we handle cells cycling throughout life and death, the way we can deal with cells that are going to hibernate, going into a state of hibernation and senescence, so to speak. And so, they’re going to sleep not being very productive and then ultimately mutating and becoming cancer cells over time.

And so certain pathways are more important than others. Now after, I gave a master class on anti-aging medicine abroad to a cluster of Asian doctors. There were around 25 of these genes that are more selective for aging than others. So, we are all exposed to that. But only 1 in 5,000 of us have the magic sauce, genetically, that will more likely or not allow us to live to 100, even though we may not live a healthy lifestyle necessarily, because we have so many compensatory pathways that are there for us.

So that’s the one thing about the human body that’s very clear and it’s unbelievably complex, networking of layers upon layers of communication networks, but there are multiple pathways for each of the tasks. But some of us only have two, some of us may have ten pathways in the same, regulating the same set of metabolic functions.

So, the genomics is one thing, and we now pretty much understand that it regulates a smaller proportion of what is really going on in terms of how we actually feel day to day. And that’s now called the world of, the epigenetic world, which is our environment, how it interacts with our genome.

And that’s what happened when I read the article. The article talked about a company that’s focused on cell reprogramming. So, they’re using the new language of programming and now doing it biologically. So, saying that I can turn a mature cell, this was given the Nobel Prize to a Japanese scientist a number of years ago, with four factors that could turn a mature cell, an adult cell, into a youthful cell.

So, these can turn you into a pluripotential stem cell. But that’s not great for a human because we don’t want to be turned into a bunch of baby cells, but partially to do that, to deal with the errors that normally happen when you get older. As DNA repairs, it makes errors and it does things and it loses certain fat, loses certain capabilities.

And to insert that capability back and I was thinking about that for a while, saying, well, that’s immensely clever. It’s also immensely complicated because if you’re in the pharmaceutical world, like I have been over the last 40 years and participating in clinical trials and understand the way clinical trials are regulated and how it’s developed over time, we rarely mimic the results in animals.

Humans rarely are predicted by animals, by how animals respond to a certain drug. And that’s because of our unique epigenetics. The rats don’t have to deal with a mother-in-law, and they don’t have to deal with other tasks like job, stress and sleep, and so on. They live a certain very automatic type of lifestyle.

And we live almost the opposite of that. And it’s getting more and more complicated to navigate this lifestyle every year. And over time, the last 50, 60 years its gotten immensely more complicated than before because we see the evidence of that. But the question is why? What is going on? So, we know that, we even have terms for it now.

We have forever chemicals that don’t leave the body. They are so mysterious and unseen. The things that interrupt our hormone levels. They are things that interrupt our ability to respond immunologically to the environment, which contains more and more, you want to call them “poisons”, more and more Round Up, more and more gluten sensitivity is more and more of these things that impact on our ability to act in a way that we’ve always acted over the thousands of years, which creates our DNA, the way it functions well in the world.

So, the potential damage of thinking that there’ll be a magic source for me in X number of years, as long as I don’t have a major problem, is okay when you are thirty or even 40 years of age. But as you get a little bit older than that, it becomes important to understand what you are really setting yourself up for.

Now, if things only work that way, it would be simple, but we’re starting with our exposure to toxicities where it’s becoming ever even in childhood. But certainly, when kids turn college age, we know that from pathology studies of soldiers who get wounded and killed during battle, during action, they already have atherosclerotic heart disease. They already have lipids lining their aortas and so on.

They have symptoms of aging, even at a teenager level. So, we understand that the chronic diseases are probably beginning their very first sort of versions in very young age. So, if you say I’m going to live the way I currently live for another ten or 20 years and wait for the magic pill, then it’s a dangerous position to be in, I believe.

And I think that’s an approach that I would take if I was running a big company, and I would want you to think that. I’d want you to think that you don’t have to change very much of anything, and you can live the way you normally live. And we understand that that is not taught into the society from a young age as to what the components of healthy living are like.

We can’t even have a coherent discussion with our doctors about healthy lifestyles because we don’t learn these things in medical school. We’re outstanding at acute care and emergency care, at surgical care, at imaging – outstanding. But should I eat one banana a day or should I eat a grapefruit? Should I? Is milk good or bad?

Is salt good or bad? How much water? I mean, we have very little information on this and from a coherent source. If you’re asking whether the public health sector has done an outstanding job, yeah, we do that with sanitization, but you can’t even get an answer as to who made up this food pyramid, who made up the food pyramid.

It certainly could just have been an alien force versus someone with an intelligent understanding of human metabolism. So, we’ve produced the heaviest society on earth. We produced a society that I think now 90% of Americans are estimated to have what’s called metabolic syndrome. That means that they are predisposed to generating more lipids in their body than they should, and certainly being resistant to insulin, that means their sugar metabolism isn’t normal.

And then secondarily, getting hypertension. And that is one of the fundamental reasons why the West, including the United States, did so poorly with COVID, because COVID’s method of attaching to the body was through the receptor that is off in 90% of the population. So, if we’re this at a younger age, and it’s progressing forward, and we are aging.

So, when you’re aging, you have less of the very good qualities that you have when you’re younger and you think that everything is going to be okay because you’re going to be given this magical thing, I think that that’s exceptionally naive and it doesn’t seem to make even economic sense. Why? Because all these, all the intellectual property that is being generated by the brilliant minds and scientists that are generated, that are running these companies and producing materials, it’s owned by the company.

And if you had the “magic sauce”, it would clearly be one of the biggest breakthroughs of humankind. And if you think you’re going to be the first person getting in line to get it, you’re mistaken because it’s not going to be, you know, this is not something that is going to be widely available. So, let’s step back a little bit and say like what, what is the positive thing about learning about how we get here? I think that is another hour’s worth of, and I’ll do that a little bit later, but what do we know increases lifespan already? We know what the list is that’s been shown over decades to increase life. And how do we know, how you can measure something that you think is going to increase your life, your lifespan?

Well, you better study it for a few decades, otherwise you would never know, because that’s what it takes. It takes multiple, multiple years of analysis in order to understand that. The latest ones that are coming out or whether metformin and DHEA, the precursor for testosterone, are going to increase lifespan. So okay, that’s a 20-year study and it’ll come out and the answer will be yes or no, whatever that answer is.

So, there’s only been five or six things that have been already shown in the literature to increase lifespan. And they make sense. Some of them are modulating your immune system, which means that you have less inflammation. Some of them modulate your metabolic rate, your metabolic system so that you metabolize more efficiently.

Some deal with cellular repair, some deal with cellular senescence, or the idea of going through a life span of birth, life, a cell now, birth, life, and then cell death properly. And then there’s an overall overarching thing of being, since we’re since we’re a biological being, whether we’re acidic or alcoholic. So, things like that. So, what are they?

They’re Hemoglobin A1c (HbA1c), which is the measure of glucose metabolism over six to eight weeks. There’s a vitamin in there which is surprising because it’s hard to believe that a vitamin will be, have such broad effects. But vitamin D is not a vitamin. It’s a hormone that’s involved in hundreds of different pathways and has been shown in multiple different ways, either to increase the lifespan or decrease your rate of risk of Alzheimer’s, decrease your rates of infarction, myocardial infarction or heart attacks, and so the aging, so all-cause mortality is decreased from that.

And then there’s also a measure, the most common measure of inflammation is C-reactive protein (CRP). So, CRP is part of the list. Then there’s what’s my pH in my urine when I wake up in the morning, which costs around $2 to measure and for a hundred strips of these pH strips, if it’s normal within six and a half to seven and a half, you’re going to live longer.

And then there’s measures of what’s called oxidative stress. And the stress is physiological. It’s not mental stress, but if you’re stressed out in that particular way, you’re going to oxidize, oxidizing means like, you will turn to rust and your lipids will turn to oxidized lipids and your membranes will be acting poorly and it’s pro-inflammatory.

So, anything with inflammation and so on. So why? There are only about four or five or six things. So, if you measured those six things, you will, and keep them in a normal tight range, you’ll live longer. But I thought everyone sort of knows now, in the know, knows that everyone knows that pro-inflammatory lifestyle is not good, not healthy, but what happened to that big thing that I said before that sort of guides our energy systems for every single pathway, that’s called the mitochondria. That’s producing the end result, which is our energy source, which is adenosine triphosphate (ATP). How come it’s not there? That’s the number one thing, right? The reason is there’s no measure for it. So, the top thing that we’re, the top of the pyramid, we’re looking for is just not easily measurable.

And so, everyone knows that these things are true. But okay, so what can you learn from that? So, if I keep myself in this tight category, so you think that all the major players involved, all the major hospitals and health maintenance organizations would be measuring all these parameters. And when you go for your annual physical in the best centers, you probably will get measures of all of these things.

But routinely we still couldn’t get people to measure vitamin D levels even in COVID days when we knew that vitamin D levels protected people from bad things to happen to them. So, we don’t have a lot of predictive measures in our databases that say, oh, we now have AI, right? AI, I will help us come up with the best predictors.

Well, there’s no predictive information in our routine bloods that we have, so that’s not going to give it to us. There are many new predictive things that we are all trying to measure and place into AI programs and validate those. But we don’t have them truly in the literature over the past decades. But if you did that, you’d be in a much better condition than if you didn’t.

I was once asked by a minister of Health if I could identify one or two things that they could do on a population basis to help the population be healthier and then reduce overall healthcare costs. I said measure hemoglobin A1C and measure vitamin D, and those are not expensive to do. And then you’d understand putting people into higher risk profiles and lower risk profiles.

One of them is really easy. One of them is just you give them vitamin D and the other one is harder, which means you have to lower their consumption of carbohydrates and glucose. So, then you say you have this, and there’s going to be work that has to be done to analyze further all the other predictors that are not so difficult to find.

They won’t be impossible to find is the point. And you can think about that in a 1, 2, 3 year period. And you could drill down on this. Everyone knows that if you’re exercising, you’re moving, you’re going to do a lot better than if you’re sitting all day doing nothing. And everyone now understands that if your muscle mass is maintained over years, as you get into your sixties, seventies and eighties, you will live longer because you’ll be able to function better, you’ll be able to walk better, and so on.

Everyone knows that keeping a certain weight category is important and people know that ultra-processed foods are a real serious problem in society. Why? Because they’re actually not food, they’re just processed chemicals and the seed oils that are used, this is coming from my friend and colleague, Dr. Mercola, who’s written a new book on this, the subject of how these seed oils are producing this proinflammatory state. What do I mean by seed oil?

That’s canola oil, vegetable oil versus the more natural oils like coconut oil and butter and so on. So, we know what is healthy. The question is what will motivate us to get there because everyone knows about it, and yet the society is getting heavier, and even spoiled in this particular way because I think one of the major drivers of it is they know that our medical system is outstanding, so you’ll be saved and they think that that’s normal.

They think that it’s normal part of aging is to have a bypass surgery, is to have, you know, be cognitively a little slower every decade. It’s not normal. That’s not a technique. How do I know this? My earliest knowledge of this which happened after I graduated medical school at Albert Einstein in New York, and I wanted to take one year to do pathology because we had finished medical school in three years during the Vietnamese War, and I wanted to have a job rather than pay for the fourth year.

And I loved it and did the whole residency and chief residency. But when I noticed that I couldn’t tell the difference between an autopsy from a 60-year-old versus an autopsy from a 100-year-old person, when you looked inside, you couldn’t tell the difference. There wasn’t a marker, oh this person died early versus this person died late.

It looked identical. So, what does that mean? How could it look truly, not only to the visual, but on the microscope, on the electron microscope, everything looked identical. Well, that means that the person who died early didn’t have the compensatory mechanisms of the person that died later, because it wasn’t historically evident that the person who died later was healthier.

They stayed healthy until a certain time and then they died from the same causes, and they looked identical. But one was 40 years older than the other person. So, it provides that type of insight that you can believe that the system is imminently flexible if you know how to move this, if you know how to move the buttons and press the right button.

So, this is looking at it like a motor vehicle, like a racing car. You’re not going to be able to race your car without looking at the gauges. Well our gauges, what I’m saying is our gauges are relatively primitive now. They’re getting better. And if you don’t listen to the gauge and you get confounded by saying, oh this is more important than that, and you don’t really know what your own strengths and weaknesses are, then you’re going to be wandering in the desert for 40 years.

So that’s where we all are. We all are in a situation where I don’t feel that the personalized medicine field has come to really do what it can possibly do. It hasn’t been able to reach its maximal potential because the data are relatively poor to personalize, although we know what it is, what needs to be measured.

And then the tools to fix it are not pharmaceutical tools, typically. They’re tools that are in another world, and they’re in the supplement world because if I’m depleted in vitamin D, I need vitamin D. There’s no drug that would supplement that, that would replace that. If I need to eat less sugar, I need to eat less sugar and understand how to do that properly.

And it’s not only with insulin. I don’t want to get it to that point when I’m already damaging myself permanently. So, without knowing what I’m depleted in, without knowing whether my detoxification pathways are actually working, without knowing what the terrain looks like, what my own personal terrain looks like, I can’t fix it. So, this is what I want to focus on in the last few minutes here.

The concept of a terrain. So, we have 70 to 100 trillion cells. We have many more trillions of cells that are viruses and bacteria and fungi. Then we have chemicals that are flowing through like hormones and so on. So multiple communications networks are going on simultaneously. So, this complexity is governed within a system, it’s the body’s system.

It’s not just the heart and a liver and a kidney, it’s an entire system biology working together and it’s working in the space that’s communicating with fluids and blood and interstitial fluids and plasma and lymphatics, and so on. So, this terrain, this fundamental matrix has to be clean. So, when you’re born, it’s clean, when you’re young, it’s clean, and over time it builds up whatever is put into it that it doesn’t get removed at night.

And right now, we’re at the pinnacle of our exposure to more of these toxins than ever in the history of humankind. So that turns back to the bad effects of this anti-aging miracle that will happen. Because if you expect that to save you, you’re betting your life on the wrong horse.

I saw a patient this week who was interesting because I had seen her mother 40 years ago when I was at Johns Hopkins Hospital. And she reminded me, as when she was a child, listening to her mom talk about me, she said, “Oh, there’s a doctor there at Hopkins, that was the first one that treated me like a whole human being”. And this was before I knew anything about integrative medicine, before I knew a thing about functional medicine, before I knew anything about the interaction between inflammation and genomics and detoxification.

I knew that I was dealing with a whole human being. And if you take it forward 40 years, you have what we’ve produced here at Anatara Medicine, which is one of the great holistic centers in the world.