Cheat Your Age - The Science of Staying Young and Fit - Part 1

In this episode I chat with another of my old mates Aaron Deere. Aaron is the Health and Performance Director at Hooke - a longevity/healthspan focused medical clinic in central London.
Aaron discusses the approach they use at Hooke for improving the longevity of their clients - what are the base line markers which give a good indication or predictor of longer life span or in other words that may help us to continue to function optimally well into our later years.
We touch on cognition, nutrition, fitness and genetics as we begin the discussion about what you can do to now to ensure that you age well.
This podcast episode will be part of an ongoing series with Aaron so stay tuned for more!

Links mentioned in this podcast:
https://www.hooke.london
Firefighter Study 

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Transcript

Keywords

longevity journey, health span, personalized program, comprehensive testing, cognitive assessment, fitness assessment, nutrition consultation, brain health, cardiovascular disease, lipid markers, muscle mass, bone mineral density, inflammatory markers, exercise balance, data-driven approach

Speakers

Peter (51%), Aaron (41%), Speaker 1 (6%), Speaker 2 (2%)

Pete Williams
Welcome everyone to functional medicine bitesized. I've got one of my old mates, as I say if you listen to all of my old podcasts, a lot of the people who are experts in their field tend to be people I know. A lot of them that I've known for quite a long time. So this morning, I'm introducing Aaron Dearie, we're all buddies, aren't we? Chap,

yeah, go back a long way we do,
We do don't we? So and we're going to talk a lot about sort of, sort of the longevity journey today, and I think probably this will be one of a few podcasts, because I've got a few other mates that who are in a similar field, and we'll probably amalgamate into a bigger group in future. But so as I say, I've known Aaron for quite a long time, and Aaron is the health and performance director at Hooke in central London in Mayfair. Pal, do you want to chat to us about I mean, obviously we're talking about longevity this morning, but you want to talk to us about what hooke is, and what it does and what it's trying to trying to do, that's probably a good start.

Aaron Deere
Yeah, sure. So. Hook is a longevity slash health span focused medical clinic that combines all the kind of key aspects of healthspan into one service. So we're talking about medical we're talking about cognitive we're talking about nutrition, fitness and genetics all melded into one product that is built and personalized for every single client. So the journey at Hooke starts with a very, very in depth health investigation. It's about a day and a half of consultations with clinicians along with different tests and screens. So let's

Pete Williams
So let's break that down. I mean what? It's a very comprehensive day and a half. So give us an indication of, obviously, I'm assuming there's quite a robust questionnaire that gets filled in before they come to see you. But let's talk about the day and a half of testing and just give us an indication of some of the stuff that you'll you will do.

Aaron Deere
Yeah sure. So it actually begins even before that day. You know, there's a pre call with one of our GPs to go through the history, understand the goals, and then understand kind of what the client sees as the key area of focus. So then when they come in for their testing, it'll start with some blood work. So we test about 170 different blood markers, you know, across the board, from nutrition markers through to things like heavy metals, through to things like liver function, etc. Then they'll undergo gas exchange RMR testing and body composition testing. And then throughout that first day, they'll have a full medical assessment. They'll do a fitness assessment, which includes vo two Max with gas exchange, nutrition consultation, a cognitive test as well, and then a brain health consultation. So that's kind of normally day one and then day two revolves around screening, so there'll be full body MRI, DEXA scan, CT scan, etc. So it's very, very in depth in terms of what we look at. And

Pete Williams
And look let's be fair, there's only a probably a small margin of the population who can probably afford to come in and get all of that done. But I think the point what I'm trying to get out of today, from a point of view of longevity, is that I'm speaking to someone who and for me, there's always a big difference from a point of view of the people who can read a bit of bit of research and say, take this, take that. And then actually the clinicians at the on the front line who actually have to take all of that longevity research and then start putting it into what looks like some, some kind of personalized program. So once you've got all the data, what is, What is the stuff that you find? And you know, how do you, how do you formalize a program and based on the data that you see?

Aaron Deere
Yeah, so that's the the next step in the process. So we have what's called a multidisciplinary team, where we literally have all the clinicians sat around the table at the same time, so there's nothing disjointed about it. And then we go through all the results from each client, each person kind of puts forward what they see as their key area of focus. And then from that, we establish what the the plan is going to be. So what are the immediate recommendations? What's the longer term, etc. Okay, do we need to do more testing, more screening, based off these results that we've seen? And how are we going to start the program? You know, as you can imagine, we have a very diverse group. You know, we've had cancer diagnosis. That we've picked up, but then we have people that just need lifestyle interventions, with it being kind of programmed exercise and help with nutrition. So, you know, it's about building this personalized program for the person in front of you. And you know, we have a very nomadic population as well that comes to Hooke. So we have to be able to be quite agile and be able to work with personal trainers in Dubai, and then be able to work with physiotherapists in Monaco in order to build these programs for each client.

Pete Williams
So talking about, if we move that with regards to longevity, which I'm assuming most, most a lot of your population group are coming in to use the term health span as well, which I prefer from a point of view of longevity. Because I think what you're trying to say is that, how much can we compress that morbidity curve? You know, how long can we keep you sort of functioning optimally into your old age with very little sort of morbidity, or minimal morbidity risk, and then you pop your clogs, or your health deteriorates, you know, 18 months, and then you're dead. That's the sort of that's the ideal sort of health span, isn't it?

Aaron Deere
Exactly. We're not kind of putting forward a message that we're going to make you live to your 120 or anything. You know, there is no medical interventions at this point in time that we believe will make that happen, but we believe that, you know, with the programs we put together, we can do exactly that. What you described, you know, live well right up to the end of your of your lifespan.
So that leads into the conversation with the wording anti aging. What do you think of that as a term,
anti anti aging? Or is it, you know, healthy aging, because it's inevitable, right? If you're saying that something's going to be anti you're trying to stop it. You know, you are still going to age, you're still going to get older. But there's many ways that you can do that.

Pete Williams
So it's really interesting, isn't it, because, you know, there are, there are tests out there, and we should probably talk about, I mean, you know, some of the ways that maybe you guys are looking at measures of aging. I mean, what tests do you do? Because, you know, I I don't like the word anti aging, because I think it suggests that you can, and I think there's a lot out there that suggests that, you know, you can be 30 years younger based off a test result. I don't believe that for one minute. I'm I'm in your camp. I think what I'm trying to do is that, you know you're trying to live as healthy a life as possible with minimal sickness. And you know, hopefully you get into your 90s and maybe pop your clogs there, because I don't think we have enough data to say. And look, you know you can read David Sinclair's book about age. You know longevity. You know, Peter Ashley's book about about it as well. But I don't believe that it really exists. But I do think you can slow the rate of aging down so that you're optimizing your health. And I think that's a different thing. Is that, how Hooke see it? Yeah,

Aaron Deere
Yeah exactly. You know, it's about trying to avoid those, you know, key diseases of aging, as long as possible, because, you know, within our physiology, we're moving towards those the older we get, so doing everything we can to reduce the risk of those.


Pete Williams
Aaron, can you jump on that? Because that the key thing again, is that, what are the things are probably going to age you most? And you've just picked up sort of, you know, you know those classic diseases? So can you expand on that? And how you how, as a company, consultancy, the changes that you make, you may make to a patient that comes in on those sides. Okay,
yeah. So, you know, if we think about those four big diseases of aging, so we've got cardiovascular disease, you know, that's a that's a huge one. So, you know, that's a big part of the screening that we're going to do. So we're going to look at blood lipid markers for every single client. We're going to do different screens as well, in order to look at coronary arteries, etc, to really kind of establish where you are now in terms of your cardiovascular disease risk. And then what are the interventions we can put in place to help with that? Now, somebody who's got a family history of cardiovascular disease, you know, that puts another layer on top of it as well. So, you know, we go across the board, we've got, we're doing, we've got potential medical interventions, we've also got nutritional we've got exercise, you know, we know all these will potentially have benefits for reducing cardiovascular disease risk, but it's about understanding the person that's in front of you and what's going to be best fit for them.

Pete Williams
So can we talk about, can we talk. About the test that you might want to look as far as lipids. And again, because I cringe some times at some of the stuff and some of the advice I see given on social media. And whilst that might be okay for one person, it may be not okay for a lot of people, which is why, obviously, what Hooke is doing and what we do is you're personalizing medicine, because that approach may just not work for that individual. So So let's assume that you see a patient who has a quite a strong cardiovascular risk component from hereditary which, to be fair, most people do, because it's the biggest killer. So you're going to see it somewhere in someone's history. What's the process you guys work down from there? And what would be sort of, sort of look at lipids, and you know, what would be your, your your go to test from a point of view of the cardiovascular side.

Yeah So, you know, bad lipids, as you said. So you know, definitely looking at LDL, cholesterol, ApoB, Omega six/three ratios. These are some of the big blood markers that we want to assess. And then you know, when we get on to the screening side, things like CT angiogram, CT, calcium, these are the ones that we want to be able to do to get a really good understanding of where each client currently is in terms of the progression, and that's great.
So let's break that down, because I think this is really key for me. What? So there's a, there's a big argument. Again, you can, you can, depending who you listen, to do suggesting that you know your LDLs can go as high as you want. So what would be your response as a consultancy to that.

Pete Williams
Yeah, that's an interesting one, but we know that that ApoB molecule is going to be carried on that LDL.
So mate, can you just give us a sort of brief, because most people who are listening to this probably don't, probably don't want know what the ApoB protein is, and it is a bit of a player, isn't it, from point of view of view of cardiovascular risk. So, so why don't you, why don't you just gently expand on that without getting too technical,

Aaron Deere
okay, so APO B stands for APO lipoprotein B, and you know, it's a protein complex that's carried on LDL, cholesterol. This is the guy that can lodge itself within artery walls. It's very sticky. And, you know, this is the kind of start point of that atherosclerotic plaque that can develop. So, you know, the more ApoB that you have floating around, the higher chance there is of this process beginning, you know, so therefore, you know, having elevated LDL, cholesterol levels, or high LDL, there's a higher, potentially higher likelihood of this occurring. So, you know, you probably want to go to the kind of root potential cause. And by bringing your LDL down, you reduce the potential risk of that happening
 In my opinion


Pete Williams
I totally agree with you. That doesn't mean to say I haven't seen people with high LDLs and super clean on imaging. But the reality of that is that probably, I suppose LDL and the non HDL component of, when you look at a blood test are, they're slightly red flaggy, aren't they, really, from a point of view of, you know, you hear, and I have to say that this is slightly, sort of, in the I say, I listen to it a lot, in a sort of bio hacking sort of industry that, you know, someone's like, Don't worry about your LDLs. They can go as high as you want, and you're like, that's not really what the literature is telling us. And I would be, I wouldn't be happy with someone with a very high LDL without doing the advanced sort of lipid side of that. So do you guys, once you see someone with a higher LDL, are you testing for the APO B straight away, or are you doing the LDL particle size, particle number and the oxidation aspect of it as well?

Aaron Deere
That's the the APOB is just standard for us as our as our panel. That's kind of like one of our go tos we're going to evaluate and monitor longitudinally as well.
Okay and so the reason why you're going to ApoE is because most of the larger organizations, cardiovascular organizations, are saying, this is the Fundamentally, this is the this is the guy that sort of starts the process of atherosclerosis, ie, it's more sticky, it's more likely to get stuck, and then that's when the trouble starts. And if you've got more of them, then you know you're more likely to increase risk. That doesn't mean to say that you do increase risk, but statistically, you're more likely to have risk. Yeah, so yeah. And then what you guys do, don't you, is you start to go to imaging. So you can talk to me just very briefly about, I mean, like a CT angiogram, almost. Gives you that sort of wonderful picture of are the arteries got any sort of, any blockages, any stenosis, and you're doing that, aren't you?
Yeah exactly every time I see that, that imaging is the coolest thing in the world, right? It looks like this kind of roadmap around the heart. So it's, you know, gives you a very, very clear image and understanding of what's going on with that blood supply.


Pete Williams
And that sort of gives you a really good indication, doesn't it? Because I had a CT angiogram a couple of years back, and, you know, it's one of the key stages. I mean, the stages that you guys are using is always the stages that I will say to patients about, okay, your lipids looking a bit higher. If you want to make the next step, we probably need to do advanced lipids which would contain the APOB, but if you really, you know, it's almost like what's floating around in the pipes, and how clear are the pipes. Is the way, certainly, I look at the CT angiogram, it's, you know, are those arteries around the heart blocked enough that there's going to be problems? So what would be and what are your experiences? Because, again, I suppose that's why I'm sort of trying to take this back to dietary approaches on that side as well. Whether you would start taking people down if you had a situation where number one lipids were high and scanning didn't look great, would you put them immediately on a low saturated fat diet? Would that be one of the, one of the key interventions that you guys would look at?

Aaron Deere
Well, the first step is a conversation with the client to say, you know, like, look, this is what we've found. We're concerned about this. These are the options that are in front of you in order of how we can address this. Okay, so whether it's pharmacological, whether it's lifestyle, which is nutrition and exercise, the two combined together, and then the pros and cons of each and then explain to every client, because they need to be involved in the decision making process. So where, you know, we're going along this pathway, this road, with them together, we're not sitting there kind of as the authority saying, Look, you need to do this. You know, it has to be a joint approach in doing this.

Pete Williams
And isn't that the key? I mean, this is, as you say, I've been in the game for a long time, and, you know, I think we're doing some really good stuff from a cardiovascular perspective. But what I've learned on that, and I think exactly what you're explaining is, is that you have to create a pathway, and you have to have touch points enough on that pathway that is saying, Here's what we found, and here's what we think the decision making should be, a joint decision making should be now, and then we'll see where we are at a period in time going forward, and then we can continually reassess from that point onwards. I mean, that's essentially what your guys are doing. And it just feels like me that is the sort of complete way to do if you like integrated cardiology, it is. Here's what we found. We've got the imaging, so we're very clear about what the pipes look like. We're very clear about what's floating around and what's what's maybe stuck in the arteries. And here's the strategy, both now and sort of medium term and long term. And here's what we might propose. And some of that proposal for you guys may be pharmacology,

Aaron Deere
yeah, that's right. That'll be, you know, be for the for the relevant situation that will be presented, you know, somebody that had this LDL of six or something, it might be kind of highlighted the risks you have here. And then it'll kind of be their decision, and it might be that, okay, we're going to redo the blood work in three months time so we can actually see, you know, has this had the desired effect. And then we may do redo the imaging again, you know, six months, 12 months down the line as well. So it's always important to have these intervals of reassessment so we can really evaluate the effect of what the intervention has done.

Pete Williams
And isn't, isn't that the beauty? I mean, look, I know that's very exclusive, but the reality of that is, then you can really see for this patient, that that the pharmacology or the dietary aspect as or both have really done the job that you wanted them to do, which I think is super cool. And the beauty of that, again, is that it takes all those arguments out about, well, you should do this, and you should do that, and what do you think about that advice? I mean, there's so much on social media around lipids and diet, and, you know, saturated fats and cholesterol in the diet, etc, it's just a very it's like, this concerns me, because, as I said to you, I've seen too many super, super healthy people with who come in on certain dietary approaches where their lipids are through the roof and they think it's okay because they feel great. Is that a similar picture to what you guys see?

Aaron Deere
No, because most people that coming to us aren't you know, right down one end of the kind of spectrum of being super healthy, like most people have come to us because they want to be healthier. They want to improve. So, you know, we have had a few kind of, I suppose, younger guys that were really kind of trying to optimize where they are now kind of make that five to 10% adjustment. But we have, most people are coming in looking for ways to really improve their current level of health

Pete Williams
So I know we spent probably too much time on a cardiovascular side, and probably we could spend the whole host on that. But when people are coming in from a point of view of the baseline assessment of aging, what are the what are the sort of tests and markers that you guys look at, and I know it's on an individual basis, but are there some key markers that you you start off with, and obviously you're going to trace them over time. But what would be some of the key markers that you're getting an indication of where they are now so that you can build the program for later?

Aaron Deere
Yeah. So you know, these are, these are distributed across kind of different areas as well. So if we look at kind of the fitness side of things, we're going to track things like grip strength, VO2 Max, press ups and balance. Because we know all of these are strongly correlated with health span then if we're


Pete Williams
So I want to go back to the word that you said, because someone slagged me off a couple of weeks back on social media because I did a balance test and they came back with regards to this is only correlated, it's not causal. I'm like, Well, I'm pretty sure I appreciate that. But if your balance is shitty, the chances of you falling as you age is pretty significant. So just talk to us from a point of view of your your your guys view, with regards to the science, with regards to some of these exercise parameters, and, you know, living a long, healthy life,

Aaron Deere
yeah, I mean, so if we kind of break down those key ones, you know, we've got the VO2 Max. I mean, there's more and more research coming out now about the importance of VO2 Max in terms of health span, you know, and longevity. So, you know, in terms of a marker, a health marker, you go a long way to find anything that has a bigger effect on health span, of improving your VO two max. So you know, if you're in the the lowest 25% of vO two Max, and you were to improve that and move up to the 75th percentile, there's some of the research indicates that this is a 50% reduction in mortality risk over a decade, which can equate to almost three years to your lifespan, just by improving your cardiovascular fitness. So show me a supplement or or anything that will give you that bigger amount of benefit.

Pete Williams
Totally agree with you, pal, and for me, probably, and probably be good, because most people probably don't understand what VO2 Max is. So can we break that down? But I totally agree. I mean, it's, it's essentially what my IG, my Instagram sort of thing is all about. It's like, if you get yourself fit, you've got a damn good chance of living pretty, pretty long and healthy life. But Can, can you break down what actually, actually what V02 is measuring, and sort of how that equates into the longevity aspect.

Aaron Deere
So it's basically your maximal ability to utilize energy, sorry, oxygen into the working muscles within the body. So you know, the higher your VO two max score, the more oxygen you can get in, the harder you can work. You know, this is really key, because all of those cellular activities around using things like oxidative phosphorylation, are reliant on oxygen to produce energy. So the more the better you can do that the more efficient you are. And it also gives a good measure of the the health in your cardiovascular system, because that's, you know, a key, a key player, in allowing this all to happen.

Pete Williams
And so, in a sense, what you're doing is creating better power plants within every cell so that they just work more efficiently. Would that be a good way of thinking about it

Aaron Deere
Yeah, exactly. So those mitochondria is, you know, is where that oxidative phosphorylation happens. So, you know, the health of your mitochondria are really important when we when we age, you know, the the more of those we can have, and making sure that they're all functioning optimally will be a key part of the of the strategy,
yeah.

Pete Williams
And it's not just muscle health, is it, of course, because we're seeing the component of mitochondrial efficiency very much being pushed over towards dementia and Alzheimer's risk as well. So VO2 max for sure. And you mentioned hand grip strength?

Aaron Deere
Yeah, grip strength. So. Grip strength is like a proxy measure for full body strength. You know, we're not going to go and get people and put a bar in their back and ask them to do one RM back squats. I mean, for people that aren't experienced in the gym, that's probably a life shortening activity rather than extending one. So, you know, we use grip strength as one of the, one of the, one of the measures. And there's good, there's good research around showing that correlation between high group strength and extended life span

Pete Williams
And again, I just want to reiterate correlation, as opposed to cause. I mean, because I actually find that argument sometimes a bit ridiculous. You know, that people get Yeah, but, you know, I and again, you'll have people going, Yeah, but being strong in your grip isn't, isn't a causative aspect to make you age longer. And you're like, ah for goodness sake, how can you be so backward with regards to that? No, but what you're saying is, the stronger your grip strength, it probably gives you a very good proxy indication of general, overall strength. You know, so
show me. Show me someone who's strong that doesn't have good, grip strength


Aaron Deere
Exactly,
exactly so. And you mentioned, you mentioned a couple of. You mentioned one ot, I can't remember what it was.
Yeah. So press up, press up strength. So, upper body endurance, just a good, good measure, simple measure to be able to test your upper body endurance. And there's, you know, population percentile data around this test as well.

Pete Williams
Oh, because there was, there was the Fireman study. Wasn't that it came up couple of years back that suggested, which showed some very big differences. Was it was 40 push ups, wasn't it? Yeah, I think so. I think it's pretty significant.
Yeah, no. I mean, if it asked me to go and bang out 40 push ups. Now, I could probably do it, but I would be be a it'd be pretty not easy. But again, what I think, what that study showed, is just how significant strength is. So again, so if we try and sort of, because I think everything gets dressed up because everyone wants the magic bullet, but there's nothing more I believe there's anything more significant, Data Wise, than being strong, as strong as you can and as fit as you can, as far as measures of increased likelihood that you're going to live a long and healthy Life.


Aaron Deere
Yeah, exactly. And I'll throw mobility slash flexibility on there. Now, I'm not talking about being able to do a yoga class. I'm talking about being able to get up off the floor unassisted. Yeah, you know, all these things, and it's about kind of creating a strategy of, like, what do I want? What do I want to do when I'm 70/75, what's going to be important to me? Well, I want to be able to sit down on the floor, and I want to be able to get up from there, you know, there, you know. And then I need to have a certain level of strength to do that. I need to have a certain level of mobility to be able to do that. And then, okay, what am I going to do in order to program myself, so to speak, to achieve that further down the line,
which is so important, because that suggests on that. And again, it's a lot of what we work on is that getting people to do exercises and build enough strength and enough flexibility that you literally drill them. How do you get down to the floor and how do you get up? I mean, we're that's some of the exercises that we immediately take on board with anyone over 50, because you pretty quickly see the risk factors with, you know, reduced mobility, reduced strength, you know, particularly upper body, you know. How are you going to get off the floor if you have a fall, you know, and how is that going to save you? So again, these are sort of some of the much more important things that we don't think about.
A key word you just said right there for the fall, right? Because that has the potential to change everything (it does) in your life, right? You fall and you fracture your hip when you're over 65 your morbidity risk goes through the roof. So...
And isn't that interesting, because the morbidity risk of and, you know, with the fall and theneck of femur fracture generally, is, is, is pretty horrific. Um, your life expectancy after that is not good,
So what are the, what are the key components are going to prevent you from falling? Yeah, right. So you've got to be, you got to have good balance, yeah, you know, you've got to be strong, because you're going to grab on to something to help you avoid falling, muscle mass that acts as a physical cushion for you. So you can, you know, all these tie back in.

Pete Williams
So I suppose mate, that leads me into another again and again. What I think we're probably going to have to do more and more with you, because, I mean, everything's just coming into my head. And, you know, we can use Hooke as the example of things. So given that muscle mass is key, and you're going to see people who come in with what you would consider less muscle mass than you would like for their age and sex, and they are maybe trying to do some longevity aspects with regards to calorie restriction. Have you got a problem with that?

Aaron Deere
So it's addressing what the biggest issue is at the moment, right? So, okay, right. You know, fasting may be beneficial. You know, upregulated autophagy, etc, etc. Is that going to help you right now to live longer, or is putting on a bit more muscle mass going to be the intervention that has the potential to help you the most now? So you know, if you're 55 years old, your ability to put on muscle mass now is much greater than it is when you get to 70. So you know, are we as a strategy, going to look at right? Perhaps we need to try to put one two kilos of muscle mass on you now to improve your your health span potential as you get older, because we know that you're going to have sarcopenic muscle loss. (Can you explain what that is pal) so it's just basically the loss of muscle mass as we age. You know? It comes down to things like loss of activity, reduction in amino acid intake, etc. We just don't have that same elevated rate of muscle protein synthesis that's required to maintain the muscle mass. So, you know, most people begin to lose muscle mass as they age. And you know, we've kind of established how important it is, so it's something we really need to protect, hang on to and maintain as long as we can.

Pete Williams
Yeah, so this discussion that, again, is another thing where I think the longevity influencers, I think get completely wrong. And look, I don't think it's anyone's fault, but I can tell you about four or five patients in the last two years who are number one, calorie restricting and then number two coming in on DEXA scans and asking why they've lost muscle mass. And I'm like, told you that, you know so, so my question is on that is that, are you a group that are more interested in... well, it's a fine balance, obviously you don't want to put too much fat on, but eating enough calories so that you can substantiate and as as an effective as possible intervention to put on more muscle mass over time,


Aaron Deere
yeah. But, I mean, it's case by case as well, right? So we're talking about these under muscled people, so it's not a blanket approach, yeah, yeah. That is a that will be a kind of a big red flag in terms of, you know, an area of focus that you are under muscled. This is what we want to improve, like we were talking about lipid markers. We need to improve those lipid markers and bring them into the optimal ranges. We need to bring your muscle mass into the optimum range. And I suppose another bit, when you said DEXA scan, that we, you know, can add to this is people that are on highly restricted diets, they may not be getting the ample supply of nutrients. And you know, when we're talking about things like calcium and bone mineral density, I mean that is a huge health span intervention that making sure you have ample calcium, ample vitamin D, etc, in order to maintain that bone mineral density as you age. Now, you know osteopenia, osteoporosis, we kind of categorize that, I guess, as a bit of a kind of female issue, more. You would not believe the number of male DEXA scans that I've seen that are osteopenic in middle middle age, and it was kind of the first time that I saw it. Oh, that must be something wrong with the DEXA. And it's just repeated it again, again and again. So I think there may be this kind of silent epidemic going on there with kind of middle aged males that have sub optimal bone mineral density, and they never actually pick it up, because it's not as important to it's not seen as important for males to monitor their bone mineral density like females do.

Pete Williams
Interesting, but it would make complete sense, wouldn't it? And then, of course, the worst thing you can do is probably, you know, because, again, can we talk about because one, I think, one of the key things I see just on the basic nutrient perspective. And you can sort of add your experience here is that with, for most of the patients that I'm dealing with, again, on an individual basis, they probably need more protein than less when they are sort of 50 plus, for many reasons. Is that something that you guys again look at and would probably agree with,

Aaron Deere
yeah, 100% so, you know, we go through the dietary analysis, you know, people might not eat much of breakfast, and then lunch is just kind of something on the go, and then dinner is kind of the big meal. But you know, they might only get 40, grams of protein in that dinner, and they're really kind of under that optimal protein threshold, you know, if we look at the research around it, you know, the the RDA is 0.8 grams per kilo, body weight per day. So, you know, if we just make it an easy calculation, and you weigh 200 kilos, that's 80g, and that's doing nothing. That's sedentary. Yeah, so you layer anything else on top of that. Now you're going to start a resistance training program. If we look at the research on the demand for protein with resistance training, it goes up to about 1.4 to 2.2 so if you're training two three times a week, you can potentially have, you know, double the need of amino acids and dietary protein. So that's got to be a big part of the strategy.

Pete Williams
And is that, because protein, protein signaling, also, as you age, doesn't work as effectively.

Aaron Deere
Yeah, that's, that's one of the, one of the key factors as well. We know that kind of anabolic signaling gets turned down, our key anabolic hormones we know are going to start to drop. You know, we've both passed 40, so we're on the or on the slippery slide at the slope now.

Pete Williams
Unfortunately mate, yeah, I don't know whether you're past 50 yet, but I certainly am. I'm 55 in a couple of weeks. So yeah, the slippery slope. Unfortunately, everything hurts a bit more. And, you know, it's a really, I can't remember where, so someone said it, but they said, they said, you know, once you get past 50, you're going to wake up in the morning, you're going to be stiff and you're going to be sore, and you've got a couple of choices. You can either work with it, knowing quite well that you're always going to be a little bit stiff and sore, and you can just work to continue to get stronger, or you can go the other way and avoid it, and degenerate very quickly. And I think that's about as simple as it gets, because, you know, I've, as you say, I'm 55 in a couple of weeks. And, you know, we laughed about it, didn't we, because one of the key things that me and you have both done is in our younger days, is that we've played a lot of contact sports. The evidence on longevity, regards to contact sports, not fantastic. But I suppose you know being a doing that in your early days comes, comes with some degree of sort of unfortunate aspects of health as you go forward. But it is what it is. And I suppose, as I said to you, I, you know, I look at, I look at all of this from a point of view of you're going to be, you're going to have some degree of of stiffness or soreness or joints that, you know, I've had 50 plus years of wear on them, so they're not going to be perfect. And, you know, you might be a bit sore in the morning, but you've got two choices. You either crack on and you try and get them as strong as possible and as effective as possible, or you leave them alone and they're going to degenerate rather quickly. So you know that there's no there's no sort of, there's no sort of sprinkle of magic dust on I suppose

Aaron Deere
it's that J shaped curve right that exists for most things. And you know, if you do nothing, your your risk rate's going to be much higher. If you do too much of the wrong thing, your risk rates it's finding that optimum area that that's right for you. So you know, for somebody that might start at just three sessions of Zone Two exercise, if someone hasn't been exercising for a while, yeah, for someone else, they might need to do six sessions in a in a week, like go

Pete Williams
Can you go on to that, because obviously there's, you know, obviously the, I think the literature is also very clear about if that you do too much, then that could be quite problematic. And we're talking about exercise here, that quite, could be quite problematic. And what do you How are you guys measuring that with some people?

Aaron Deere
So, you know, we use some monitoring devices, you know. So we'll use things like oura rings and whoops, and, you know, things like this. And you know, we're not saying that these are the be all and end all, but they're just helping us monitor clients. So, you know, we'll look at things like recovery scores, and we'll look at things like HRV scores. And, you know, we're not saying that everyone has to have an HRV score of 80, but what we're kind of looking at is what's your usual baseline, you know, if you're, if you're a 40 guy, and you drop down to 20, okay, what's been going on? Oh, well, I increased my training volume. You know, I've been, now doing double days in the gym. I've been traveling a lot, and it's like, Well, okay, hang on a minute, like we've seen this drop. So, you know, this is along with your recovery score dropping. So we really need to start to think about how we're programming this. Maybe you're doing a bit too much, you know, you're moving into this overreaching, potentially over training zone, your injury risk is going to go up, etc. So, you know, we get a lot of guys that are data driven, and, you know, you, I mean, you can, you can tell you, yeah, but you can tell me, oh, Aaron, you're doing too much, you know. And oh no, I'm fine. I'm fine, I'm fine. I'll be right. You show me the actual data on it. That'll make me, you know, potentially change my mind. So, you know, they're valuable tools to help kind of give a good measure and then get a message across.

Pete Williams
Yeah, you know what, mate, this is really important point, because I think I'm probably me, and you are one of those people who are more likely to age quickly because they do too much, that's definitely me, and, you know, I'm still and, you know, so it would be interesting to wonder whether you there are certain personality types that you see coming into the clinic who are they're going to age more quickly because they, you know, they've highly motivated, they do a lot of exercise. But the reality is, is they don't blend it into the bigger picture, which is what you're doing. And actually, they need the data to go, okay, shit, I need to take a couple of days here calming down, because I think that's me. I'm pretty sure that, you know, I probably do too much. And the beauty of having the tech, which, and I'm not a techie, I'm completely technophobic, but the tech's like, you know that basically, session was was making your fitness worse, not better, and you're like, Holy fuck. I wonder how many years I've gone through without checking data, you know, and I just hammer it, hammer it, hammer it, and then think I'm getting better. And actually, the data's suggesting that overall, long term, I'm probably getting worse. So the data is really good for that, isn't it? And, you know, there's some, you know, Garmin, Whoop, they're all Oura ring. They're just all, I think, probably one of the, one of the best little interventions I think you can do. Doesn't mean say you have to read it all the time, but I've found tech just incredibly valuable for patients. I mean, you guys must see the same.

Aaron Deere
Yeah, exactly.
And we know kind of what we see like, if we take you for an example, you know, we saw your scores, and I said, Oh, Pete, I need you to take three days off exercising. I need you to get eight hours sleep a night. Don't go to the gym, don't run, don't do anything. I pretty much know how that advice is going to go, you know, not too well. But if I said to you, look, Pete, you know, like your scores have dropped here, I'm a bit worried about this. I want you for the next three days just to do zone two. Okay? I want you to give me 45 minutes, then 50 and then an hour over these next three days. And, you know, I put something else in front of you that, you know, it's still, you know, a challenge somewhat rather than kind of telling you that right is to take time off. And this has kind of been the key bit, is to find, you know, like hide the broccoli, so to speak, you know, right? Okay, we, we still want you to keep exercising, but we want you to tone it down a little bit. And this is how we want you to do it.

Pete Williams
Isn't it interesting pal, because I think about, you know, why do I do it? And I think probably because that's the way you were, you were brought up. But I wonder whether there's a, you know, there's a particularly as you age, there's a loss of you, a loss of identity, because you can't go in the gym and bang out 120 keys on your back, you know, anymore. And it's like, Am I losing my identity, my personality type? Because I've that's always been me. I don't know anything different. So I think there's a component of that for sure, and I think.

Aaron Deere
100%,  so I train Brazilian Jiu Jitsu. I'm a black belt under Lucio Rodriguez, and every time I'm out with an injury. So earlier this year, I tore my PCL, so that was three and a half months on the sideline, and exactly what you said, you know, so much of my identity is tied up into Jiu Jitsu, you know, to everyone else that's out there, nobody knows any different, but for me and that world that I exist in within my academy, you know, and when that's taken away, you feel like you're losing a bit of your identity, a bit of your purpose. And, you know, getting back to training. I mean, obviously, to get back on the mats was, you know, you just relish it, but then you kind of get your identity back at the same time as well. And, you know, everything goes back in order, and you don't have an outlet, you know, for your frustrations, your energy, everything.

Pete Williams
And I think this comes back to, I mean, obviously what you guys are doing, but what we do with patients is that if you don't understand who the patient is, the story behind the story, you might miss a lot of what, why things are going wrong. Because so for me, it's like, as I said to you, you're going to have patients like me, where it's not that they not motivated to do the stuff, they're probably going to overdo the stuff, and that might be related to just the way they view themselves within the world and what's important to them. And again, for me, I absolutely agree. I think my worst fear is that probably loss of physical identity, because I've not, I've never known anything else. So you know that that, and that's a key driver for me, but mate, I still keep doing, oh, I mean, I still cock it up all the time by trying to push stuff that I probably don't need to do. So at some stage. But it's true, though, isn't it? I mean, I mean, you're doing the same. And I think there's a, there's a large group where they're probably aging more quickly than they would like, because they're pushing the boundaries still when they probably don't need to do that.

Aaron Deere
Yeah, and
then afterwards, you know, you might tweak your shoulder.
Oh, mate.
Why did I do that? Why did I do that? You know, I think I'm getting older and smarter, but no, I still make the same mistakes.

Pete Williams
But the problem with that is that is that those injuries again, they they linger. Much longer now, as you age, you know, and again, regardless of how healthy you are, I mean, for me, from 50s, is that, you know, you pick up an injury and it's a niggle, and it's just the much, much longer than it was when you're in 20s and 30s, because your capacity to recover and rebuild and all that stuff is just not as good. Anyway. That's a really good conversation for for for another time. So look, we're already into the hour. So I think what we're gonna have to do is bring you back on, because we're literally, we're not, not even touch the surface with this. And I think I just want to keep us on. Keep us on because we haven't talked about anabolic pathways, sirtuins, etc, you know, zombie cells, stem cell exhaustion, calorie restriction. We haven't done any of that, which I think, again, we will continue to do. But what I want to be able to do is maybe sort of get, sort of round up the almost like introduction in the next few minutes, from a point of view of we talked about some tests of if someone's coming into you, and what would be some of the tests that are giving you at this current time with the patient, where their markers are? So we've talked about the exercise, and we're pretty clear on those, that those are some of the best things that you can do, most validated in the science from a point of view of blood work maybe you know that people could go and get done and again, we know you're building personalized programs. But are there some specific biomarkers that you guys really want to sort of get an indication of right at the beginning, which are very much associated with increased risk of morbidity?

Aaron Deere
Yeah.
So, I mean, we've already talked about those lipid markers. So another key one that we want to look at is those glycemic markers. Okay, so we want to look at fasting glucose, HBA1c, fasting insulin as well. Because you know that this is the the the antecedents of diabetes we know within these markers. So that's one of those big diseases of aging that we want to do everything we can, to try to avoid because we know that our glycemic function will deteriorate as we get older, you know, then we also want to look at things like liver function, which is a key one, you know, especially you know, people that are on, you know, bad diets, you know, kind of the Western diet, you know, want to really screen for fatty liver disease and things like this as well, and looking at inflammatory markers. So you know, in particular, something like CRP, TNF, alpha, these inflammatory markers to understand what kind of the baseline level currently is. And then if there is an issue, trying to establish, you know, what the root cause of it currently is,

Pete Williams
yeah, and that's not easy to do, is it? I mean, you know, again, but I think what we're trying to sort of summarize up, you know, if there were, if there was, if you were trying to say to people listening to this, if you've got what, couple 100 quid to go out and try and get some biomarkers of current state of health, but also maybe, sort of that level is potentially predictive of, you know, increased risk of having problems going forward. What would be your and we've talked about the exercise, which is probably still, you probably say that's your number one. Would you

Aaron Deere
it's all part of the matrix. But you know, for we know that the potential benefits of exercise, and most people aren't doing enough. So, you know, that is, that is a big part of, you know, most people's assessment and program, and that's
free, isn't it, really, from a point of view of, you know, one of the best ways to live a longer life is get fitter and stronger.

Pete Williams
So job done on that one. But let's assume I've got a couple 100 quid, and I want to sort of spend it on, on blood work, if you like. Or, I mean, I'm assuming blood pressure would be a key metric for you as well.

Aaron Deere
Yeah. So definitely, blood pressure, lung function, FEV test, yeah. You know, we also, as part of the medical we do an ECG. We also do some ultrasounding of key organs as well. So you know, we have all this information to draw from,


Pete Williams
so from a base for so again. So let's just summarize those. What you're talking about is your capacity for your lungs to work effectively, and you could do that with a simple bit of spirometry where you couldn't use so you could do what we call an FEV1, very cheaply, couldn't you?

Aaron Deere
Yeah, exactly. That's, that's exactly what we're doing. So, so


Pete Williams
how, how forceful you can blow out into a piece of, piece of kit that you could buy off the internet for, what, 15 quid, if that, and, and what about blood? So again, just, just to summarize, those blood those blood markers, what would be the key ones that you would be interested in. We talked about the inflammatory markers. We talked about blood sugars. And the interesting thing about and we talked about lipids as well. The interesting thing about those aren't they. They are the ones that increase your risk of number one cardiovascular disease and number two diabetes. So being able to be on top of the two, probably, well, two of the key chronic diseases of aging

Aaron Deere
yeah. And then we, you know, we want to look at your red cells. We want to look at your white cells. We want to look at those liver enzymes. We want to look at kidney function as well. So, you know, it's kind of, I guess, a bit like they were doing an MOT on your car. And kind of tick, tick each bit, you know, that's kind of the key bit that we want. We want to be able to do to make sure all these key organs and systems are working optimally. And you know, if we see a red flag, then dive in deeper from there to try to understand what, what's potentially going on here.


Pete Williams
But then what's got to happen with all of that, isn't it, is that your group has to use that your expertise to be able to say, Okay, so here's what we found, here's where we're at. Here's our sort of, if you like, our ground zero. And here's what we need you to think about short term, medium term and long term. And then you've got to get on it, on with it,

Aaron Deere
yeah, and exactly, and it's showing the potential lifetime risk. I mean, you're 45 and you're here now with these markers, probably in the next five years, 10 years, it's not going to be that detrimental to you. But when we kind of expand this out for you, arriving at 70 or 80, you see that your risk rate of specific disease development increases exponentially, which

Pete Williams
I think is a super important point, because if you're struggling getting up from a for an example, if you're 55 and struggling to you know, you're feeling the stairs, if you like, you know, going, you know you got a house, maybe you've got three floors, and you're feeling the stairs at 55. The reality is, it's 65 you're going to be struggling with the stirs if you don't do something about it. And I'm at 75 you can't get up the stairs. And that's difficult to comprehend, isn't it? Because, you know, we're sort of, we don't think that way. But, I mean, I think that's just sort of a, you know, a super important thing. So, and how do people take that? Because, it is, you know, I suppose the question is, people are motivated? Well, a lot of people are motivated by, suddenly, the date, you know, you've got to do a load of testing for them to go, okay, yeah, I better do something about it. Are they motivated by? Here's what it looks like if you carry on as you are, here's what's probably what you know it's going to look like in 15 years, and it's not. A it's not a pretty picture, yeah. I mean,

Aaron Deere
the, you know, not to stereotype, but the kind of, the more data driven type of personality, you know, if the current risk is quite low, but you can show them the risk in 20 or 30 years, that is the huge motivator. You get someone else, and you show them, you know, an elevated marker now, and it's like, what do I do about it right now? So again, it's that that personality type is really important to understand. You know, what is it that you know is going to make them want to put changes in place? We We are lucky at Hooke, because we get people coming to us that want to do this investigation and then want the information. So, you know, they're here, they're in a place where they're where they're looking for advice, and they want to understand what they can do. So it's very it's a collaborative effort. You know, it's not that it's someone that's in opposition or denial or something, because you've come to seek us out, and you know, you've you've taken the time, you've put your your resources, your time, your energy, into coming and doing this, because you wanted this appraisal, and then you wanted the advice. It's not someone going to their NHS GP that's giving them some kind of news they haven't heard before, and then it's kind of like, well, I'm just going to ignore that.

Pete Williams
Yeah. So that's the and that's the big difference for me, is this question is it's a little bit like taking patients on, you know, anything that I do and anything that your group does is going to need a commitment. Otherwise, it's a bit of waste of money and time. What's a big waste of money and a big waste of time? Because it is what it is. You're going to have to make some changes, and you're gonna have to be motivated to do it, and you're gonna have to be the captain of the ship. Now what we will do is, and what your team will do is, you'll put it all together so you can present the evidence for them to say, Okay, so here's what we think. Let's work out how we're gonna do this over time.

Aaron Deere
Yeah,exactly. We don't have a magic fuel, yeah, but we do have key elements.


Pete Williams
Surely the internet's telling me that if I take x, y and z, I'm going to live to 125 I think so that's where we'll move on to next time. Because what are we now? We're already an hour in, and we've literally scraped the surface, but I think what we've done is given a really nice sort of entrance overview, because we've not talked about the mechanisms, genetic instability, DNA damages as we age, telomere attrition. You guys doing any testing around telomere or or clocks, aging clocks.

Aaron Deere
So we do genetic testing. But we're doing polygenic risk scoring.

Pete Williams
Right, so let's, let's leave that until part 2, because that's what we'll open out. I think we should talk a little bit more about protein metabolism and maintenance and how that dysregulated nutrient sensing pathways with mTOR and AMK, KP. So make sure you're read up, pal for that for next time we come on and we'll, we'll go through all of that in a little bit more detail. But I think what we've done is that we've, we've set the initial scene on here. I think we've given some really great advice. All right, Pal, so look, let's, I'm afraid I'm gonna have to bring you one again for, for for part two, because, as I said to you, it's, it's such a big subject, I think you've got to be careful who you listen to as well. Because, you know, as I said to you, the reason why I wanted to do that with with you and your group in particular, is, not only have you got a good scientific group, number one, you're doing it day in, day out. And so the reality looks very different to what you see on social media. From a point of view, if you just simply take this, you're going to live long. And it's like, Nah, I don't think so. And I think what we've got to do is just give, continue to give people the tips that are really sort of scientifically validated and they can implement with reasonably low cost, because I suppose we are showcasing the sort of the top of the tree from a point of view of you know, where you would get the service. Pleasure mate. Thanks so much. Oh, and just to let everyone know that Aaron is, is, is off surfing, in, in in a couple of weeks, we're not sure whether he's going to come back. We're not sure he's going to be able to survive the surf. Where you going to get mate Indonesia, aren't you on some

Aaron Deere
Yeah,go and go into the Mentawai Islands. So it's a bit of a surf Mecca, but it's, it's an absolute mission to get there.

Pete Williams
Where'd you fly into Singapore,

Aaron Deere
I gotta fly to KL and then I gotta go to flight to a place in Indonesia I've never heard of, and then I've got to get two boats, which is about seven hours, but it's it was a nice reminder that, you know, we have such convenience and everything on tap, but this boat only leaves kind of three days of the week, and if you miss it, then you have to wait a couple more days to go there. And, you know, there's no hospitals, there's no coffee shops, there's nothing. It's just some islands that are about 150 ks off the coast

Pete Williams
And is that because there's a particular wave there?

Aaron Deere
Oh there's a lot of waves. It's, it's a really, very, very famous surf spot that picks up a lot of swell. And, you know, kind of July, August is kind of the peak time. It's, that's way too big for me. That's for, you know, the real mad dogs, but it's a bit calmer in October. So, yeah, I'm really looking forward to it.

Pete Williams
So you still think your knees can handle it?
Yeah, I hope so. We'll find out, I suppose. You know, surfing two, three times a day. You know, by the time I come back, I'm going to definitely be on the other side of that J shape curve, I tell you, yeah, they're probably
They're probably going to need a bit of rest on that one. That one great pleasure, listen. So we'll bring you on again. So just remind me, as I said, you're going to surf and pretty soon. So I'd love to bring you on when you when you come back from that?

Aaron Deere
Yeah, I'll be back. I'll be back end of October. So

Pete Williams
We'll get you on then, and we can continue the chat. And hopefully you've and there's no, are you on coral reefs there?

Aaron Deere
Yeah, yeah it's all reef breaks there. So that's a key bit. I think you're trying to stay away.

Pete Williams
I was gonna say, pal, you want to stay away from those. Otherwise you're gonna have a few few scratches from that for sure,

Aaron Deere
Few tiger stripes. But you know, it's all part of the game.

Pete Williams 
Alright Well, fair effort, okay. All right, both. Well, I hope to see you on the on the other side. All right. Cheers, mate. You.
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