How to Solve Aging in America

We have to ask ourselves if we can call ourselves the greatest nation in the world while 70%, nearly 3 out of 4 adults, are overweight or obese, while we spend about 18% of our GDP on healthcare, more than any other nation, and yet we rank 55th in life expectancy. Our children are getting type 2 diabetes at unheard of rates. This is not just a health crisis, it is a cultural crisis. Obesity is not inevitable. It is not an act of God. It is something that can be prevented. It is a choice that has been compounded by bad habits over time. It is reinforced by a culture that does not foster good decision-making and self-discipline.

And we have created a culture where these difficult truths have become personal attacks, where physicians are afraid to talk about a patient's weight because it's too taboo. If we can't have a conversation about obesity, how can we ever solve the obesity crisis? Obesity is associated with 13 different types of cancers. It takes between 3 to 10 years off of life expectancy. It damages DNA, causes double-stranded breaks to DNA, which is the precursor to oncogenic mutations. And it fundamentally accelerates the aging process. And yet it is the principal difference between our nation and the longest-lived nations. We are overfed but undernourished. So about, I would say, 60% of daily total calories consumed by the average American come from ultra-processed foods.

These foods are caloric-rich, they are nutrient-poor, they do not increase satiety, so people do not get satiated, they continue to overeat, they gain weight. They're cheaper than whole foods, so people are economically incentivized to eat unhealthy. And they activate the dopamine reward pathways in our brain, causing addiction. So this trifecta of no satiety, low cost, and addiction really kind of spiral us into this process of poor health outcomes and runaway healthcare costs. And it's not— overconsumption of calories is actually not the only problem. We are also micronutrient deficient. So the food we eat is supposed to provide us with essential vitamins and minerals that run our entire metabolism. Omega-3, so about 80 to 90% of Americans have low omega-3 levels.

We now know that low omega-3 levels have the same mortality risk as smoking. Vitamin D deficiency, easily corrected. Vitamin D gets converted into a steroid hormone that basically runs about 5% of our protein-encoding human genome, everything from immune function to brain function to cancer. Very important, easily corrected. Magnesium, about half the country does not get enough magnesium from their diet. Magnesium is essential for over 300 enzymes in the body, including repairing damage to our DNA. DNA damage is happening every day. It's not something you can see in the mirror. It's not something that you're going to know about on a day-to-day basis, but it is what promotes cancer. So decades later, it rears its ugly head. But the real problem is simpler.

We actually need to start thinking about physical inactivity as a disease. We now know that it carries the same mortality risk as smoking, cardiovascular disease, and type 2 diabetes. Yet, when the average American reaches age 50, they lose about 10% of their peak muscle mass. By the time they reach age 70, they're losing about 40% of their peak muscle mass. And this isn't just about looking strong. It's about physical independence. It's about survival. So So higher muscle mass is associated with a 30% lower all-cause mortality. Grip strength is actually a better predictor of cardiovascular-related mortality, the number one killer in the United States, than high blood pressure. And yet nobody talks about it. And strength is also associated with a 42% lower dementia risk.

And yet we think of resistance training as an add-on, as a luxury. It is not. It is a fundamental pillar of aging. It increases muscle mass, muscle strength, and bone mineral density. So fractures are a death sentence. Between 20% to 60% of Americans that have a hip fracture die within a year. And yet resistance training can lower fracture risk by 30% to 40%. This is preventable. We have the information. We have the data. We need to take action. And resistance training, exercise, getting the right foods are the most important things that we can do to prevent disease and make a difference in our country. So thank you. Dr. Patrick, our healthcare system is broken. It's reactive, not preventative.

How do we get more longevity-focused care into mainstream medicine, and what's standing in the way? Well, I think that the most important thing that we can do right now for longevity medicine is actually move more. And I think that the federal exercise guidelines are sort of out of date, to be honest. We don't focus at all on resistance training. It says 2 days a week. What does that mean? I mean, to be honest, people might just start doing some bicep curls and, I mean, there's not information there. You need to give people specific information, actionable information. I think resistance training, okay, well, you can do, you know, 15-minute— 7 or 8 15-minute workouts throughout the week and that's as good as doing 3 45-minute workouts in terms of gaining muscle mass and strength.

So, giving some more specifics in terms of, like, types of exercise, also compound lifts. Like, you want to basically make people be physically independent. So, you don't want bicep curls. You want people to be doing squats, or you want them to be doing, you know, rows, or, you know, deadlifts, things that are multi-joint, right? I also think exercise snacks is a big one. So, there's nothing in the guidelines about how people can get exercise benefits by doing these short bursts of physical activity. Tons of research coming out on this. I mean, we're talking— a recent study just showed that doing 10 bodyweight squats every 45 minutes over a 7.5-hour workweek was better at improving blood sugar regulation than a 30-minute walk. I mean, that's like 2.5 minutes a day.

There's also tons of evidence coming out on these unstructured exercise snacks, and that's also something that can be recommended. So these are the kind of things that you take the stairs instead of the elevator, or you walk briskly instead of, you know, taking a car to work, you know, to work. And there have been studies showing that people wearing these accelerometers are able to reduce their cancer mortality by 40%, their cardiovascular-related mortality by 50% if they're doing 9 minutes a day of these unstructured— sorry, these, yeah, unstructured snacks where they're just basically taking advantage of everyday, you know, situations to get physically active. It doesn't cost money to do bodyweight squats. You don't have to have a gym membership.

So, I think that's one important way that I think information can be improved and more targeted. And I think that's one of the questions I have for, you know, Dr. Patrick. We've known about this for quite some time, right? I mean, the food pyramid was a marketing— there's nothing scientific about that. It was a marketing deal. We've gone to seed oils. Again, the problem we have as a consumer is Again, you have all the books out there, you have all these different theories. Who do you believe? It's a very confusing thing unless you just go completely simple, all whole foods, no ultra-processed food, try and approach it that way. But Dr. Patrick, just kind of comment on that.

Well, I do think that going whole foods and trying to reduce your ultra-processed foods as much as possible is is the way to go. And I think we have a lot more information now than we did, you know, 30, 40 years ago. We know that these ultra-processed foods are not causing satiety. That is— we know that they're, you know, activating these addictive reward pathways in our brain. So I think that information is a little more in-depth. But I also think that some of the information on like, why do we eat? Okay, if we have nutrition in primary and secondary school, Definitely medical school, you're right. I mean, one class in nutrition, it's absurd, right?

I mean, if we can start educating at an early age children why they eat, what are they supposed to get from their food, why do you want to eat leafy greens? Magnesium's there. What does magnesium do? What happens if you don't get magnesium? What is cancer? You know, this— there's even some data out of Japan. They have that program in Japan where they have in primary schools nutrition education, and they've shown longitudinal studies that people that were, you know, educated with nutrition in childhood are much more likely to eat healthy, nutritious later in life.