The Health Curve

Longevity Medicine: Hacks, Hype, and What Actually Works - with Hillary Lin, MD at Stanford and Elevate X Health

• Dr. Jason Arora • Season 1 • Episode 1

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In our first episode, we explore the rapidly growing field of Longevity Medicine—a proactive approach to health that goes beyond the traditional 'sick care' system. Longevity Medicine focuses on extending both healthspan (living in good health for longer) and lifespan (living longer), while emphasizing disease prevention.

We break down the different components of longevity medicine, separating the science from hype, and discuss how anyone—regardless of their starting point—can navigate their own longevity journey.

Joining us is Hilary Lin MD, a Stanford-trained longevity physician and serial entrepreneur. Dr. Lin is the Founder of Livora Health and Co-Founder & CEO of Elevate X Health, two companies at the forefront of longevity medicine. She is also an Aspen Health Fellow and an Advisor to Stanford Alumni Startups NY and Cornell BioVenture eLab.


SPEAKER_01:

Hello, and welcome to The Health Curve. I'm your host, Jason Arora. In our first episode, we're going to be talking about longevity medicine, a proactive approach to health and disease that is rapidly changing the way we think about aging. Longevity can be broken down into lifespan, which is simply how long we live for, and healthspan, which is how long we live for in good health. The longevity medicine field includes all sorts of things for patients and consumers, from health monitoring and testing, to drugs, therapies, and supplements, to lifestyle services, longevity clinics, and much, much more. It's very exciting because this is really all about disease prevention rather than just treatment. But as with any exciting new field that is expanding quickly, the longevity space is rife with misinformation and false claims. There are so many things out there, and it's getting extremely difficult to navigate for both patients and consumers. So in this episode, we're going to break down the different components of longevity medicine, we're going to separate the science from the hype, and we're going to discuss how anyone, regardless of their starting point, can navigate their own longevity journey. Joining us is Dr. Hilary Lin, a Stanford-trained longevity physician and serial entrepreneur. Hilary, thank you so much for joining us.

SPEAKER_00:

Thank you so much for having me. I'm very excited about this topic, so glad to chat about it today.

SPEAKER_01:

We're very lucky to have you. You know, when I talk to people about longevity, I guess the place to start is like, what is it? Because people talk about longevity. People talk about wellness. There is more of a medical definition for this. And there's more of a kind of common sort of dictionary definition of this. So for our audience, what are we talking about?

SPEAKER_00:

Yeah. And I don't blame you. It's so confusing. Like when you say, what is longevity medicine? Because honestly, it's an evolving definition. And in the mainstream, people are seeing examples from like the Brian Johnsons of the world, which is a bit more biohacker, tech bro oriented. And then we've got the very popular book Outlived by Dr. Peter Attia, which is very popular amongst the evidence-based medicine crowd. And then we have the history of anti-aging and rejuvenation, which is a little bit more focused on things like aesthetics and and performance, for example, in the athlete world. So it's just very, very confusing to everybody. But for our discussion today, I particularly focus on the aspect of longevity that is extension of health span. So as a quick foundational definition of what that is, we all know what lifespan is, which is the number of years we exist alive on this earth. And health span is just the number of years we spend being healthy. So By definition, healthspan is can only be as long as lifespan, but often it is a lot shorter. So like folks in our parents generation, for example, are often spending one or two decades after they're no longer perfectly healthy. Just sort of, you know, unfortunately, dying slowly is the outcome. So I don't know. I think it's an important definition to get out there when we talk about longevity medicine. I find sadly that when I talk to a lot of average folks about longevity, they're so confused and they don't even want to address the discussion because they've just seen far too many examples of that poor end of life story in their families and the people around them. And a lot of times I can feel like it's too late to like to make a significant change. Like if you're somebody's already chronically ill, it can feel really hard to turn that around. But I'm an eternal optimist. And the very most important step you take is the next step you take. And so I think there is always time to shift things in terms of one's health.

SPEAKER_01:

I feel like over the last few years in particular, it's become a common interest topic given we've had documentaries, but people are getting more frustrated with healthcare. It's just become a topic that most people want to know more about. Maybe we start with one that's come up a lot, which is what is the difference between longevity and wellness?

SPEAKER_00:

You know, our traditional medical system, especially in places like the U.S., we have a sick care system where we're treating disease and treating folks once they get sick. There's like a little token mention of preventive health, but it's only three percent of the health care budget, so it's barely anything. And there's the argument that if you treat for wellness instead, then you'll achieve true health rather than just chasing after bandaging these sicknesses that we develop because we're not well. So I completely agree with that. And it's a really great framework. Treat someone for wellness long before they have something that is a problem on their labs or a symptom that they have to deal with.

SPEAKER_01:

So we've talked about the historical context where There are the sort of anti-aging aspects of it. And, you know, we talk about trying to deal with age-related disease and decline. There are the aesthetic aspects to it. So it's about looking better, being younger for longer from that perspective. How would you break it down into its different components? And then maybe from there, we can start to get into a little bit of what's out there.

SPEAKER_00:

Well, I have this sort of informal saying of what people really want, which is, you know, look good, feel good and then do good. And what I mean by that is most people, no matter what they tell you, they want to look good. And, you know, people are afraid to talk about that with their doctors often. But it's like it's what you see in their behaviors. They they will buy things or do things according to how they how it impacts their looks. And then once they they feel like, OK, we look good enough, then they sort of chase after feeling good. So people want to, you know, feel good. short term and long term. So that's like the battle. It's like, how can you make someone feel good long term in terms of their health? That's more what I call doing good. But a lot of folks are chasing after like the near term feeling good. It's like, OK, I want relief from my insomnia because I'll feel good the next day. But they're not really thinking about it in the decades long perspective or like the food that they eat. They're kind of thinking like I just recorded an episode about the carnivore diet. A lot of people feel good short term from the carnivore diet, but they're not really thinking like 20 years down the road. So that's like that feel good piece. And then like the doing good is what I call like, OK, that's like really long term thinking and planning for your true health, your longevity. And that's really hard for people to grasp because it's such a long time frame that they're talking about. And also like when in my own practice, and I think many of us in longevity practice, going to function this way. There's a bit of this pyramid. So there's an optimization pyramid where at the foundation, there's the proven pillars. So metabolic health optimization and exercise, sleep, nutrition, and social relational health, like having a purpose, mental health. Those are the proven foundation. Unfortunately, or whatever, it is what it is. What gets all the headlines are the emerging areas of longevity. And a lot of people have just, you know, associated those like these emerging less proven areas with longevity medicine. But like in reality, you know, the hormone optimization, senolytics, the peptides, the epigenetic age and regenerative therapies like stem cells, these are actually perhaps less proven. impactful to one's longevity, or it's like you're getting little gains in terms of performance and optimization, or at the very worst, you might actually even be harming a person because it's so unproven. But that's what catches people's eyes. That's what makes the headlines.

SPEAKER_01:

There is that foundational layer that I think, you know, most people, even anecdotally, will say, well, look, if I do those things, I generally feel better, both short and medium term. And also over the long term, if I did it for long enough. Talk about that foundational layer layer first, because I feel like it's the thing that most people can do something about themselves.

SPEAKER_00:

I think what is maybe the perspective shift that most people need to make is we need to do better with these foundational aspects. All of these things we just stated, they're so obvious. We've been talking about these forever, even with traditional conventional approaches to medicine. It's just that we do like a C job on a grading system. Whereas I think in longevity medicine, true longevity medicine, preventive medicine, you want to do an A, an A-plus job. And that's what most people and even doctors don't get. That's where we're talking about, like, let's take metabolic health optimization, for example. If you're using a CG, a continuous glucose monitor, for example, that can help you determine, like, what will make the most difference in terms of smoothing out your glucose and insulin spikes. And then getting those extra advanced biomarker panels for things like, you know, lipoprotein little A, the ApoB, ApoA1, those types of labs are never found on traditional panels because that's like the A plus version of those labs. And for your exercise, it's not just about like, you know, hitting the treadmill or lifting just whatever random weights or doing yoga. It's like, how can you do it with personalization and precision? Like, Take a look at the body composition scans with the DEXA or MRI and, you know, see if we need to work on that visceral fat more. Or is it like muscle that someone's struggling with or even bone density? I mean, like bone density is so important and we don't talk about that nearly enough. And then like the VO2 max testing or like data from wearables that are really interesting, like the VO2 max, as well as the HRV, these are now accessible. And these are like what we need to do as that A plus step, rather than just being okay with like passing with all of these foundational pillars.

SPEAKER_01:

So if we stick with that, so the foundational pillars, we've talked historically, you and I write a lot about how can you create personalized longevity protocols for people? And how can we help make that a new paradigm in healthcare. But there is this overarching sort of elephant in the room, which is there are some of us who, if we're in the field like you and I, we know about it, we're working in that space, there's a sliver of the population who will read about it, they'll watch documentaries on it, they'll have their wearables, they can start measuring stuff, and they'll have an internal interest to develop their own longevity routines. Most people are probably just You know, listening to this or thinking about this, and it will be completely alien to them. They'll do their best in their day-to-day lives around sleep and nutrition and, you know, their routines. But essentially, the first port of call is the primary care physician. It's the GP. It's like, okay, you know, I need to get my vaccination done or I need to get my cancer screening done or do my annual wellness check. I get my blood pressure taken, that sort of thing. And so I feel like we're almost... intrinsically reliant on the healthcare system, formulating these protocols for us, because that's what it's meant to do, right? Whether it's meant to treat disease or prevent it, it's meant to do both. All that needs to really come from the professionals who can look at our health and tell us how to improve it and to prevent disease. But where we are in the field right now, in most cases, people are having to try and figure it out for themselves. And those who can will go to a longevity service like your clinic, for example, which do exist. They're springing up more and more. And they can get a longevity physician like you to help them come up with this personalized protocol. So where do we go from here in terms of what most people are relying on with their current healthcare versus having to do this themselves versus now starting to try and find these longevity services that are out there? That's also a a really heterogeneous space of like, there's some good stuff out there, there's some bad stuff out there. How do you navigate how you go after this?

SPEAKER_00:

I think you're right. We're in this transition period because we don't have a trusted, reliable source of longevity medicine and medical care, clinical care. Right now, we're seeing a lot of startups come out and small clinics like my own that are available, but it's, you're right, there's a bit of variation even amongst us in the longevity field. Like there's a different focus, whether it's on all the performative sort of metrics that I mentioned versus, you know, more of an anti-aging focus versus more of like a, I've even seen even amongst startups that are hitting the headlines because they're VC funded, they raise like tens of millions of dollars. there's a different focus. Like, you know, sometimes it's on the fitness aspect. Sometimes it's on an e-commerce aspect, like buying supplements and so forth. So I think at the end of the day, the individual has to just develop their critical thinking skills. I think it's a tough thing to say and a tough thing to ask. I know when I talk to my friends who are all really intelligent folks, they're just like, I just need it to be simple. And that's why they turn to sort of off-the-shelf things because you know, you're already busy with your regular life. How are you going to wrap your heads around medicine yourself? So it's really tough. I think maybe the short answer is to to advocate for yourself, because I think a lot of times we too often are kind of set back because we go to a doctor and they're just like, oh, that's like weird that you're thinking about your heart health, even though you're so young. And I'm like, You know, like I have like a really serious family history where something. So like standing up for yourself is number one, because a lot of more traditional doctors out there are not going to be able to wrap their heads around. And, you know, I always say it's not it's not their fault. It's not anyone's fault. It's because of the system we live in. It just promotes that kind of behavior. It's the reimbursement system. Unfortunately, it's really hard to fight that culture. But the individual, the patient does have to stand up for themselves, look for another doctor, look around, just remember how important health is. And, you know, it's just like I see people shop around like crazy to buy their next computer or like, you know, like decide where to stay for their next vacation. That's like the level of intensity that you want to apply to your health care provider or like wherever you go to get your health care done. And on the other side, which I'm happy to talk about too, I do think that there's a lot that needs to be done on the systems level for changing this culture in healthcare.

SPEAKER_01:

Yeah, I think this is such an important point. And it's almost the hardest bit of this, which is, you know, most people don't think about their health until they have to, until it kind of smacks them in the face and, you know, it slows them down or it happens to them. someone very close to them. And then we fall back in this healthcare system that in the end, and I trained in the UK, I've been in the US for many years now working with the US health system, global health systems. The reality is the entire field is not really set up to give us what we're talking about, to give us an elevated health span and lifespan. The ultimate goal is to do the public health and the primary care and the screening and prevention and also then treat the people who do get sick. But it wasn't designed that way in the first place. It's become this thing that has these conflicting goals. And it's very hard, I think, for consumers or patients to rely on the healthcare that they have to completely own this journey for them. And in the time we've been physicians... I trained about maybe 15, 20 years ago, we were talking about this then that the relationship with our physicians has changed. Previously, it was very autocratic. It was very much like, hey, doc, what do I do? I think now for more than 20, 30 years, it's become this, hey, doc, you're my expert advisor. This is what I want to do or this is what I need to know. Can you help me? And so it's almost like that needs to be pushed even more by physicians I think

SPEAKER_00:

so. And the entire model of medicine has become so warped. Like a hundred years ago, a doctor could sit down and get to know a person and really coach them in a natural way towards a healthier life. And now we have 15 minute windows, which are often overbooked to just like quickly spit out like, okay, like, How's this med doing? Do you have side effects? Let's keep going. See you in six months to a year. So I think it's just a really decrepit system for the amount that we're expected to do. And there needs to be actual, like an upgrade, a renovation of the entire system for true change to happen.

SPEAKER_01:

Yeah. And I think this is a key point for listeners to take away is that, you know, you really care about which phone you're going to get or which computer or anything that you buy for yourself. With your health and your healthcare, it's really critical that you advocate for yourself, as you say, and you really pick out what is it that you want from it. If you want to improve your health span and live without disease for longer, lead with that in every physician you speak to. And if they can't support those goals, go find another one because you're the owner of your health journey. I want to keep us moving just because there's a lot to cover, I know. But if we have this foundational layer, which we just talked about, sleep, nutrition, exercise and all that, what comes next? So if someone's able to kind of get a hand along that, get into a good routine, know what works for them. And typically this will come through some personal experimentation. What next do you see people going for?

SPEAKER_00:

Yeah, I briefly mentioned it, but I think it's focusing on some of the more ignored systems. So a big one in longevity is hormones, for example. So this gets a little bit distorted in the headlines. Like it looks like, you know, everybody is on hormone therapy as a result. But I think there's like a bigger field around this. And a lot of things one can do are not just about like slapping on testosterone, which is like a cheat code for a lot of folks to get healthier. But it's about understanding where you are and doing all of the pre-medicine things to support your hormonal system. It's not just your sex hormones. It's like your cortisol. It's your thyroid hormones. It's insulin is a hormone as well. There's a lot of different hormones in your body that we are now approaching more directly. It used to be that only endocrinologists thought about hormones, and endocrinology is not actually traditionally a very quote-unquote sexy field, but now it's become such a huge pillar in longevity-focused, healthspan-focused medicine because it's It's that signaling. It's the messaging system in our entire bodies. So it's like, to make an analogy, it's almost like Wi-Fi. It's like if you want your communication pathways to be operating really well and whatever your internet setup is in your house, we can't live without it, obviously. And then in our bodies, we want all of our signaling to work really well. So hormones are a big deal. Very related to that same topic are peptides. So people think of crazy peptides when they think of peptides. They're like, you know, looking at gray area peptides. But peptides are actually very common. We just don't think of them as being common. Like, you know, all the GLP-1 agonists, those are peptides. Like when we talk about taking collagen peptides, those are peptides. Peptides are everywhere. They're in our skincare. They're in our food. They're in our drugs. They're in some supplement. So they are just interesting because They have a direct message that's being told to specific cells in our body. And you can direct that by choosing what peptides you're injecting or eating or whatever it is. And it can be truly powerful. So it's this idea of programming almost your body in a particular direction towards healthspan optimization. And that can be done, roughly speaking, with things like hormones and peptides.

SPEAKER_01:

Okay. And these are things for which the science has both been around for a while, but also hasn't. There are emerging fields about in the more of the health side of the disease spectrum rather than the disease side, where most of the research is typically done. We'll talk about that in another episode, why that is. We'll get back to this conversation in just a moment. But if you're finding this episode helpful... Here's a quick ask. Take a second to follow or subscribe to the Health Curve podcast wherever you're listening. And if someone in your life would benefit from this episode or any of the others you've heard, please send it their way. All right, let's get back to it. So for many people who go to their primary care physician and want to talk about this, if they haven't got access to a longevity clinic, the primary care physician's got maybe 10 minutes, maybe less to talk to them. Is this still the route for people to go if they want to start getting into this stuff? Say you have someone who's in their early 40s. They're otherwise well as much as they know. They can measure their own blood pressure at home. You can get a decent cough off Amazon or whatever. You can measure your HRV, your your heart rate variability. You can do all your fitness stuff. You can do your labs. You can look at your metabolic health and your iron levels and all that, most of which you should be able to talk to your GP about. But once you get beyond that, then what? How much can your primary care physician really help you in those 10-minute appointments? And what would you encourage people to focus on in those conversations if they haven't got a longevity physician?

SPEAKER_00:

Yeah, maybe the question is prioritization. And, you know, of course, first priority is something that's bothering you now. And unfortunately, that's mostly what people go to their doctors. So I think that's obvious. It's like, you know, that's why I end up like in my more traditional experience, like practicing primary care. It was always like, okay, SSRIs for mental health and, you know, WegoView or Ozempic for like weight loss. It's just like a very simplistic transaction. But maybe the next step of prioritization is looking at your own personal risk. And an easy hack to do that without even knowing what your blood looks like or anything is look at your family members, your closest family members. What are people dying of or what are people suffering from? So not necessarily dying of, which can be confusing because a lot of things go into like the cause of death. But if folks have diabetes or have been obese or had trouble with their memory, even though it's not like true dementia, those are key signals to latch onto and direct your questions and ask for testing in those areas. So advanced biomarker testing is probably one of the easier things you can ask for, although some doctors are still going to push back because, I don't know, it causes more work for them, honestly, to order extra things. But you can ask for like advanced lipid panels. Cardio IQ is a very common one with, you know, NMR is another common panel that a doctor can just look up and just be like, OK, these are all the advanced lipid markers that we can double check, not just LDL and total cholesterol, but like also NMR. all of these like lipoprotein little A, ApoB, ApoA1, so on, so forth, homocysteine. These are all related for metabolic health, making sure you catch it super, super early. So a lot of doctors finally are checking hemoglobin A1C. That wasn't true over a decade ago, which is crazy. It was well-known, but we only added it to panels about a decade ago. And now we're trying to promote detecting fasting insulin because fasting insulin elevates faster than, you know, A1c, it goes out faster than fasting glucose. And so you can detect with greater sensitivity a change in someone's metabolic health that way. So those are just two examples. There's a couple of other things depending on your particular risk factors. Like if you are someone going through menopause or you think you may be, then you might want to talk more. Testing is actually kind of tricky here because It's a big topic, but you can at least discuss and talk more about hormones. Inevitably, women, we lose our ability to make hormones at the same level, sex hormones. And so replacement actually is a core component of longevity health. A lot of traditional doctors are still really scared about it because there's that whole women's health initiative debacle that occurred a couple of decades ago. And people don't understand. I'll save you, for those who are interested, I'll save you all the research. You can look at stuff I've written and talked about before. The long story short is modern sex hormone replacement treatments for women are largely, largely safe. The only one that's still around that has a tiny increase in breast cancer is synthetic progesterone. And interestingly, that's the type that is in all of your birth control. That being said, I still give birth control to anybody who wants and needs it. it's a tiny risk in increasing your breast cancer risk and in most cases worthwhile. But the estrogen is actually not the problem with today's versions of estrogen replacement. You can definitely get that safely. If you are prone to clots, make sure you're getting it through the skin rather than eating it orally. And for men, testosterone is an interesting one and a huge topic, which I'm happy to get into. But definitely there's a big argument for how to approach this topic of hormone replacement.

SPEAKER_01:

Right. And I think what this reflects is as patients and consumers of healthcare services, you have to ask questions. You have to go to your physician, whether it's your primary care physician, your OBGYN, whoever. And once you start to take ownership of this health journey yourself, and that's typically what changes the field. It's people asking for more. It's people asking for something else. And, you know, hopefully the more patients and consumers who do this, the more the healthcare system will start responding to it and the more the field will start to change. Hopefully primary care physicians, you know, sort of the quarterback of the healthcare journey for most people before they go see a specialist, hopefully they'll be enabled to be able to answer these questions more, longer appointments and all that. Okay. So we talked a little bit about the next layer. Once you start, once you take care of the day-to-day lifestyle, And then you start to get a bit more into how is my biological health looking when I start to measure things? What else can I do? How are my hormones looking? That sort of thing. What comes after that? Now, this is kind of advanced class. I think we're getting into now where people are measuring their biomarkers. They're starting to look into their own biology and they may be healthy already, but they're really trying to optimize things. So where does this kind of take us? Let's call it the third big layer where there are probably lots of different things people can do.

SPEAKER_00:

And very few people need to ever come here. And I want to say that because everybody is obsessed with this next section of interventions. But most people have not nearly optimized or even gotten like 70 percent of what they should from those foundational layers. And it makes so much more of a difference than any of this other stuff that we're about to talk about. Like this is like peanuts compared to everything. But it's sexy. So people love talking about it. So things like senolytics and epigenetic reprogramming, stem cells, regenerative therapies, these are highly, highly experimental and we don't actually know the right protocols yet for how to apply them to humans. So I'll just mention a few that are a bit safer because we have some evidence either through observation or some limited studies in like maybe non-human models. So quercetin is a supplement that you can take that's a senolytic. It's found in onions, by the way, so you can just eat a lot of onions. But that's one that has been found in a lot of different studies to be a true senolytic. It can help you clean up those old retired cells that need to go away. And another one is fisetin. That's a little bit harder to get. I'm just mentioning it because quercetin and fisetin come together a lot in studies. You can't buy it as easily. You need to be prescribed it. Dasatinib comes along with that. That's another prescribed thing and actually used in cancer therapy. So it's not to be meddled with. But those are some senolytics that we have a lot of strong evidence around. And quercetin is probably the easiest for somebody to go ahead and just buy off the shelf. Then we have mTOR. So mTOR, the mammalian target of rapamycin, is a pathway, a set of pathways that's heavily associated with aging. And there's a lot of debate out there. If you go out and like search right now, you're going to be so confused. But long story short, you need your mTOR pathways to be activated sometimes and you need them to cool off and rest sometimes. So the times that you want to activate them are when you're like muscle building, you're growing, when you want anabolic effects. And the times that you want to cool down is when you want to do apoptosis or cleanup of your cells. So that's why for a lot of these mTOR-like and some other pathway interventions in longevity, we actually have intermittent cycles of using the therapy. So probably you've heard of rapamycin. If you Google longevity, rapamycin will soon follow because it's like a really popular and somewhat controversial drug that's used in longevity protocols. So rapamycin, very short summary. It was originally used for immunosuppression in transplant patients, but the way it's used in those patients is higher dose and daily. So it's continuous. It turns out if you just use it every so often, like every other day or once a week, we don't actually know the optimal cycle is that you have temporary resting or rest. inhibition of that mTOR pathway which is good because it gives your body the chance to undergo apoptosis or like that cleanup process that I mentioned with your cells you always need to like clean up you know straighten the straighten the chairs the furniture in your cellular house and that's kind of what's going on when you take a break using a drug like that you can have similar effects with fasting I have a lot of hang-ups about fasting protocols because people really go extreme with them but just to mention it's kind of the same process that people are going for And then when we go into like stem cells, that is so experimental that, you know, I'll just briefly mention because people will probably hear about it, but I don't think it's anywhere close to ready for prime time. Stem cells and joints, by the way, are actually safer and more proven, like injuries from sports and things like that and direct injection into a joint. That actually is, from my understanding, very much more practiced and safer. The type of stem cell interventions that I'm a little bit more wary about is when they're injecting it directly into your bloodstream. And you can have a lot of potential problems. I actually had a patient who came to me months after because he developed a DVT, a major clot. Due to a stem cell injection he had done in a he was in Thailand and, you know, had done it at a wellness clinic. And the theory is that stem cells can help you rejuvenate a lot of different processes like prevent heart disease and, you know, improve your brain health and so on, so forth. Immune system. But as we saw in this particular case, there's serious outcomes that can happen. There's clots. There's a theoretic increase in risk of cancer development. And it also depends on the type of clinic and the source of the stem cells you get. So there's a lot of nuance there, but I just wanted to paint the picture that with some of these more experimental interventions, there's a great deal of risk. And that's why I typically never go there for my patients.

SPEAKER_01:

So the three layers we've kind of talked about, the first one, very low risk. Most people can do themselves, try and improve your sleep, your nutrition, your routines, spend time with people, loved ones, get out into nature, all that. you know if you're otherwise healthy or even if you have disease it's going to help you in your health journey and then the when we get into the second layer which is starting to look at advanced biomarkers and things like hormonal dysregulation etc you really need to be doing that with the guidance of a physician and so we're already there i think at level two if you want to call it that and then by the time you get to level three we're actually talking about you know, quite a few of these things are experimental still. It's an emerging field. So don't get into that stuff without the guidance and oversight of a longevity physician that you really trust. Would you say that's fair?

SPEAKER_00:

Oh, yeah, yeah. And, you know, I want to say, like, absolutely, if you are well-guided, you can embark on some of that. Like, if you've figured out everything else and you want to reach for the goal, which is to live till you're 500 or whatever, which I know it sounds... But, um... Anyways, you can with the proper oversight. So just to use that rapamycin example, when rapamycin is really interesting to a lot of longevity folks, right? And so a lot of people want to try it. By the way, it also has some preliminary evidence in some studies that are ongoing for helping to sustain fertility for longer. So that's actually, you know, a lot of people are like, Maybe rapamycin is good, but only when you're like 40, 50 years old, because you're starting to really age then and you want to do something. But the case for females who want to preserve fertility actually is a lot younger, as you can imagine. You want to start in the 30s. This is still in clinical trial, so I'm not saying go out there and do it. But say you wanted to embark on that, as long as you have a doctor who's checking your labs before, during, and after, and really going over Like changes, like is your menstrual cycle changing? Is your mood changing? Is your sleep changing? Like all this stuff. You want to be really careful when you are embarking on some of this more experimental level three stuff.

SPEAKER_01:

Right. And the thing for people to remember is that, you know, the qualified folks out there are still the gatekeepers to this stuff, rightfully so, because it's complicated. The research is still being done. And obviously, you have to be safe with these things. I really want us to talk about what's real versus what is not. Because as with any shiny emerging field, especially things that can improve how people look and feel and all that, there are a lot of charlatans out there. There's a lot of fraud out there. There's a lot of stuff that's not real. What advice would you give people around this where you have things that you can order off the internet or... you know, that folks who may not be qualified are selling or offering. How do people navigate this growing space of options?

SPEAKER_00:

Yeah, oof, this is really hard because, you know, I have to do such deep research on everything and I'm a doctor. So I think for the first category, the foundational pieces, like you're going to hear a lot of influencer advice about all sorts of ways to optimize your sleep, your exercise, your stress or whatever. Basic message or take a home there is it's everything is 80-20. Like you're going to hear influencers talk about like the exact number of grams of protein you need to like, you know, build muscle or like, you know, how much REM you need to be perfect, you know, memory recall. So all of that optimization is just too much to think about. Like I have people being like, Oh, I want to be in zone two exactly. And, you know, they're testing their lactate levels as they're going. I'm like, OK, sure. But like you could also 80-20 it and I'll bet you'll save a lot of time and stress. So that's the basic message for the foundational stuff around, you know, the exercise, nutrition, sleep, that sort of foundation. Then when you get into the moneymakers for a lot of influencers and Be careful around things that make people money. So first of all, supplements. Supplements are easy for people to access, and that's why a lot of influencers sell them or advocate them, because you don't need to go through a doctor to get them. The supplement industry is largely unregulated, and many of the claims aren't backed by solid science or non-Caucasian populations, especially if you're like me and spend a lot of time indoors. There's like magnesium is hung to light and things like that. Protein, if you aren't able to eat enough. So there's a case for supplements in certain cases, but you just have to be careful. And again, it's kind of that 80-20 rule. If someone's like, trying to sell you something that will give you an edge, most of the time it's not really there. Or if you wanted a true edge, you probably need to do a lot of like deep diving into your personal genome and your biomarkers to see if that particular supplement will make any difference for you. No,

SPEAKER_01:

and this is one of those really fast emerging fields where there are lots of companies offering lots of biomarker testing. And, you know, here are here are some supplements to deal with this biomarker or that biomarker. But the clinical evidence for what to do about a lot of these results is still relatively thin. Is that right?

SPEAKER_00:

Yeah. Actually, not to name names, but I've seen this a lot. People will go out there and they'll get like a 250 biomarker blood test. And then it'll spit out like, oh, here are some recommendations. Because these companies, they're not allowed to give you clinical recommendations. But they can suggest you exercise, food, nutraceutical, and some supplement suggestions legally. And they might suggest, like, take 14 different supplements and so forth. And the problem is, first of all, the problem we discussed, which is that supplements are unregulated and dosing and individuality matters a lot for certain supplements. But actually, this is something a lot of people don't think about. Oftentimes, a prescribed pharmaceutical will do the job better. And I'm not like pro-medication or anything. I actually am a huge minimalist. If I can get a person to the least number of medications and supplements as possible, that's, you know, my ideal scenario. But just for example, I see a lot like people, they'll get these advanced lipid panels and then it'll suggest things like, okay, now take like red yeast rice and, you know, eat a ton of fish oil. In reality, I'm like, we have fantastic medications that will do a thousand times better for you. And they're so safe. Like we've studied them for ages. And even if you're anti-statins, there's kind of this like anti-statin trend going on, I feel like. First of all, I'm not anti-statins. I think they're right for the right person. But there's also like PCSK9 inhibitors. There's ezetimide. There's some new stuff coming around the corner. And these pharmaceuticals are going to be able to do things that no food, exercise or supplement will be able to do for you. So I don't know what it is like. I think it's just marketing. Like a lot of people are more pro supplements than they are like prescribed medications. But it's really just different tools.

SPEAKER_01:

I guess the message to people is, ask, what is the evidence? What is the proof that this works versus not? Because for most people, they won't necessarily understand what a clinical trial is or anything like that. And of course, as we know, clinical trials are not perfect themselves. They are a form of research that offers the best of what we can do after hundreds of years of trying to evolve science and try to understand what works and what doesn't. So with this, If folks are able to ask the right questions to their physicians, start to navigate what they're seeing on social media or whatever, start to cut through the noise, perhaps they find their sort of layering. They're like, okay, layer one, everyone should be trying to manage themselves. Layer two, if they have the luxury of doing, and layer three, if they really have the luxury of doing. When we get to some of the challenges across all three of these layers, now I know it's a big topic, but one of the things that comes up a lot with this, it's about inequality and it's about the fact that only some people have access to layers two and three, especially layer three. There are these vampire billionaires trying to live forever and that's what they're doing, you know. How do we improve human health for the human civilization, human population? And we talked a bit about the foundational layers being the most powerful. So let's focus on those. But what would you say to people who are concerned about longevity and inequality?

SPEAKER_00:

Yeah. I mean, one of the maybe unspoken factors is, as you're alluding to, financial circumstances. And so, I mean, if you're in a situation where where access is truly difficult, having the financial ability to, you know, even start thinking about your health, like we have to recognize that everyone's starting from a different place. And so actually before, if I were not being a doctor, but just being like, you know, stepping way back and being like, okay, what needs to be done for a particular person or population? Sometimes it's getting your finances in order or like even your safety. Like, you know, I'm speaking from the privilege of having a very safe shelter. And I'm like, oh, I don't even think about that. But like maybe the first biggest threat to you is your safety. Like if you live in a place that's not super safe. And so I think we have to recognize that the situation is different for everybody. A lot of the big systemic issues have to be solved with regulation. And I think that's an unpopular thing to talk about because it's so hard to change We can't change like so easily what kind of food a kid has access to in school. Like I grew up going to public school and I would eat two dollar spicy chicken sandwiches every single day for lunch. It's crazy to think about. But and, you know, that's what people are doing to this day. There's very little access to healthy food. balanced meals for kids. And that's when longevity actually has the greatest impact is actually when you're young. And then also education in general, critical thinking. I spoke about this a little earlier, but actually critical thinking is the decline of critical thinking is probably the greatest obstacle to good health. I mean, even as we're talking about for folks who are a bit more privileged and are educated at some level, I think we've lost a bit of this critical thinking for oneself. People tend to want to follow influencers. They want to follow a thought leader because they want to take a shortcut and not have to think for themselves. But I think we do need to emphasize that it's really important to think for yourself according to your personal values and what your goals are for your health. Why are you even doing all of this? Different people are going to have a different protocol and solution for their healthspan and longevity depending on their situation that they're starting with. So I don't know, those are hard problems.

SPEAKER_01:

I think this is critical. It almost falls into two layers. One is to advocate for yourself, understand your journey, your starting point, what you have access to, what you don't, and be encouraged by the fact that the foundational things that most people are able to do something about, no matter how small, actually have the biggest impact. And then The second being that once you start advocating for yourself, that's where system level change comes from when everyone starts doing it. And so as you know, one of the goals of this podcast is really to help people take control of their health journey a little bit more and start advocating for themselves a bit more. So I know we're coming up to time and there's a lot more to talk about, but what would be the key takeaways you would give people based on what we've discussed? If they listen to one podcast episode, on longevity, and hopefully it's this one, but if they do, what would you say these are the things you just need to know and be off on your way and you'll be able to figure a lot of this out yourself?

SPEAKER_00:

Yeah, I think takeaway message is progress over perfection. It's so tempting to try and optimize everything that you can based on what you're hearing on podcasts and so forth. But just taking one step is better than taking no steps at all. So whether it's trying to prioritize your sleep, get seven hours, at least give yourself seven hours to be in bed. You know, that's one step that you can take. And or if it's like taking a deep breath in between your back to back calls, like that's one step. And so really just make one step towards a better health, better longevity. And if you know, and maybe the second message is Anybody can do something. So no matter where you're starting from, if you have access to a fantastic longevity doctor or not, or if you have the financial means or not, there's always something you can do. There's that little 10% step that you can do. Push yourself to do a little bit of something. That's what I would say. Don't be intimidated by all of the info out there.

SPEAKER_01:

So Dr. Hilary Lin, thank you so much. You've been an absolutely wonderful guest. I've learned a ton from this podcast episode and it's been a real privilege.

SPEAKER_00:

Thank you so much for having me. Thank you.