Episode 210: 'Lies I Taught in Medical School' and the Role of Medicine in Aging Well w Dr. Robert Lufkin

In this episode of the Aging Well Podcast, hosts Dr. Jeff Armstrong and Corbin sit down with Dr. Robert Lufkin, author of the New York Times bestseller, Lies I Taught in Medical School. Dr. Lufkin discusses outdated medical concepts he once taught and how the medical field has evolved, especially in relation to healthy aging. The conversation covers chronic disease management, the role of nutrition, technology in healthcare, and proactive health measures. Dr. Lufkin shares personal anecdotes about his transformation after being diagnosed with multiple chronic diseases and advocates for lifestyle changes over traditional medication. Join us to discover how to approach aging with the latest science and insights.

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Transcript

0:05

Welcome to the Aging Well Podcast. And in this episode, we are excited to dive into the medical world and explore some fascinating insights with Dr. Robert Lufkin, author of the New York Times bestseller, Lies I Taught in Medical School. We will be discussing some of the outdated medical concepts that Dr. Lufkin once taught. How the medical field has evolved, and what that means for healthy aging. We'll also touch on important topics like chronic disease management, nutrition, the role of technology in healthcare, and how we can all be more proactive in our health as we age. Join us as we explore how to approach aging with the latest science and insights in mind to age well.

jeff_1_11-02-2024_073747: 0:42

Dr. Lufkin, welcome to the Aging Well podcast. Let's just start by having you tell us a little bit about yourself and moreover, what inspired you to write your book? And what were the main lies that you felt compelled to address?

robert-lufkin-md_1_11-02-2024_073747: 0:59

thanks. Thanks, Jeff. Corbin. I'm a fan of your program. So in the work you do. So it's a real honor and pleasure to be with you today here. So my story is I'm actually a little different than some people in this space in that I actually am a medical school professor. So I'm, my book is critical of Western medicine. And I have to admit that I'm part of the problem because I'm in teaching and practicing and doing research and all that stuff. So, the and. I have to say that the book, we're going to talk about, is very critical of the state of Western medicine. But I have to say is I'm a fan of Western medicine. I still am. Last time I checked, I still have my job at a medical school. And but the, Western medicine, In the 20th century, transformed our lives. Those of us who are it basically, it revolutionized public health measures, infectious disease. And it was just, it was the glory days for Western medicine and the pills and the surgeries that were developed were so effective. They truly made the world a better place. And even today, if I get hit by a car out on the street on my bike, I'm going to want Western medicine to handle the acute problems. That is the, you know, I'm the blood transfusion or the get my spleen removed or my fracture set those things. Western medicine, in my opinion, really has no equal to the problem is in the 21st century. now facing a literally literal tsunami of diseases that take up to 80 percent of our health resources, which are called chronic diseases. And although they were present in the 20th century, nowhere near the numbers in the 21st century. And that's what this book is about. And that's what. I've been about, and these diseases go all the way from obesity to diabetes, to hypertension, cardiovascular disease, heart attacks, stroke, cancer, Alzheimer's disease, even mental illness. And the problem is when Western medicine applies the same pills and surgeries that people do. Hey, they work so well in the 20th century when we apply them to chronic diseases, happens. That is, we find that they, the pills and surgery work on the symptoms in most cases, which is good. But in most cases, they don't address the root cause, which is a common cause in my opinion, and the diseases continue to progress all those diseases. And. Yes how I got interested in this is sort of minding my own business as a medical school professor where I not only teach, but like I said, I, I also get to practice medicine and I also did research. Over the years, my lab has received literally millions of dollars in grants from drug companies and device makers and even the federal government to do research. I published hundreds of peer reviewed papers. So, I'm really in the system there. What happened to COVID 19? that caused me to change. I'd like to say, Hey, I just want to make the world a better place, but no, it was actually, I I came down with four of these chronic diseases myself, suddenly out of the blue. at the time I, I had young two girls that weren't even in, in middle school yet. And there's still, yeah, there's still in high school. at the time I came down with these four diseases, I went to my doctor and they prescribed a prescription. pill for each one of those diseases. And I said, Hey, you know, I've been hearing about lifestyle and stuff. What about that? Will that work? And they go, nah, that really doesn't work. You're going to be on these pills for the rest of your life. So get used to it. And at that point I was very concerned because I knew you. That potentially wasn't going to end well. And it forced me to take a deep dive and reexamine my own beliefs and the beliefs of many of my colleagues. And I realized that these pills and surgeries We're great for the symptoms, but they didn't actually control the root cause. And the root cause was something very different. It was basically metabolic disease that the pills and surgery really don't work on, but there's a way to fix our metabolic disease. That's, in my opinion, at the of all the, these chronic diseases. And that is through changing our lifestyle, fairly simple, but significant changes I was able to make in my lifestyle and long story short, I, next time I went back to my doctor after, a few months, they couldn't believe it. They thought the labs were broken. Basically I reversed all four chronic diseases and got off all medications through these lifestyle approaches. And now I've made it my mission to help. Others kind of take back their health and learn from what I've learned and hopefully not make the same mistakes that I made in this process.

jeff_1_11-02-2024_073747: 6:10

So in the book you present it as lies and I know maybe some of that is just the eye catching title But you talk about outdated and even kind of misleading medical concepts that you once taught Is it more that they're outdated or do you think that we are somewhat misled in some of these medical concepts based on Pharmaceutical companies having such a grasp over medicine can you give examples of any of the kind of the some of these lies and kind of explain how you Evolved your understanding over time

robert-lufkin-md_1_11-02-2024_073747: 6:44

Yeah. And first of all, just an overview of the of lies and knowledge in science and medicine. The, yeah, the title is sort of clickbait. So it obviously worked. It's a New York Times bestseller. So something's worked, but but it's designed to get people's attention. And I was inspired by one of the greatest physicians of all time, which was Sir William Osler, who lived at the at the end of the 1800s. And he famously made one of the. Most famous quotes about science and medical education when he addressed a graduating class of medical students on the day they were Finishing medical school and becoming doctors. And he famously said, I have a confession to make 50 percent of what we've just taught you is wrong. Unfortunately, we don't know which half that speaks even then, 125 years ago. To the nature of our medical knowledge and science itself, that it's continually evolving, that whatever we think we understand whatever our models of reality are constantly changing. And that's certainly happening with science. And the challenge for all of us is that the advances are coming even faster and faster with the internet and with AI. We're literally undergoing a revolution in our understanding of. of metabolism and how our bodies work. You know, we still have a long way to go, but the idea is we need to constantly rethink and reevaluate our models. And what I found out is that, mine weren't up to date just like many of my colleagues that are still teaching medical school. And there's some widely held beliefs that are, that I feel are incorrect and at the very least incorrect and at worst that are actually harming people. And that's what I talk about in the book, sort of my story. And then I go through each chapter is one of these chronic diseases that we mentioned the beginning and how medicine is getting it wrong. So a couple examples is obesity, right? most people are either overweight or fat. It's like never before in history. It's a problem. And obesity is a gateway drug for all the other, all these other chronic diseases. Now it's not that everybody who is obese gets all those diseases. No, we, And it's not that everybody that's metabolically ill is obese. It varies. So you can be metabolically ill and thin or metabolically ill and obese. But the point is obesity indicates that something is going on at a root level with your metabolism. I mean, I'm, I'm not about fat shaming. I think, you know, body positivity is good. We all should, think well of our bodies. And I think we can love ourselves and we can love others at any weight, regardless of the weight, we cannot be healthy in any weight. And, those are different things, but they coexist. So it's a way of looking at it. So obesity, anyway, the. standard advice for obesity today is exercise more and eat less. You know, a calorie is a calorie. Just eat fewer calories. And that is wrong. It obviously doesn't work, and This advice is still given. That's the mainstream. And we, as you guys know, exercising more exercise has many health benefits. Unfortunately, weight loss is not one of them. You know, it's very hard to lose weight with exercise because. What happens when we exercise, we work up an appetite, right? That increases appetite. And, I can hit Starbucks and have a 500 calories in a muffin. It's going to take me a long time to, exercise off those 500 calories. It just, it doesn't work. And then the second thing that a calorie is just a calorie is. is not really true. And in my opinion, different of the three macronutrients, they have different effects on our body. And only one macronutrient tells us to store fat. when we eat those we gain weight, we gain fat. When we don't eat those, most people will lose weight. And that message I don't think is being communicated as, as much as it should. So that's an example of one of the so called lies that I think are driving this.

corbin-bruton_1_11-02-2024_073747: 11:28

So if we're getting it wrong, and they're lies, how do these outdated concepts impact patient care, especially as we age?

robert-lufkin-md_1_11-02-2024_073747: 11:38

Yeah. I wish I could say they're outdated. They're still, that is still the Orthodox view, of today, my medical schools and other, communities. Trusted sources list this advice for people with obesity. And you raised the question earlier, Jeff, about what are the influences that drive these kind of views. And I think there are, in a situation where our trusted medical institutions are influenced By pernicious financial influences and others that cause them to make recommendations that might not be the best way might not be in the best interest of the patients. For example type two diabetes is another disease that is just exploding in unprecedented numbers. It's, it has to do with problems with insulin metabolism. I know you've talked about this on your show and also but basically it's insulin resistance. Our bodies get resistant to insulin. And if I go in and I develop type two diabetes the recommendations of the American Diabetic Association, which is the leading U. S. and literally worldwide authority on diabetes, to you'll be started on some drugs like metformin and then eventually be on insulin to control the blood sugar levels so we don't die. And the problem is. When we treat type 2 diabetes in this way with insulin, something happens that, in other words, type 2 diabetes becomes a chronic progressive disease. That means it's, it doesn't just stay as elevated blood sugar, but it progresses to vascular damage where The number one cause of surgical amputations today is type two diabetes, lower extremity toes and legs from type two diabetes. The number one cause of kidney failure and dialysis is type two diabetes. The number one cause of retinal blindness in young people is type two diabetes and on. It's a driver for heart disease, cancer. Alzheimer's, mental illness, all these things get worse with diabetes. What are the options then? Well, type 2 diabetes is really a carbohydrate intolerance. In other words, the macronutrient group, carbohydrates, which interesting are non essential. Unlike fat and protein, which we don't eat, those will literally die. There are many human populations or a few examples, at least, that. Carbohydrates drive insulin and that causes insulin resistance, so been known for decades, if not longer, that you can reverse diabetes by just lowering the amount of carbohydrates and literally cutting out carbohydrates in the diet. And when you do that, an interesting thing happens when I control the diabetes, as I said, with insulin, most cases, most of the chronic symptoms continue to progress. It gets worse and worse. On the other hand, when I control type two diabetes with diet. And restricting carbohydrates in over half of patients in controlled studies, they can reverse their diabetes and get off the drugs, reversing the point. They don't need these drugs anymore. And what happens? The diabetes stops being progressive and it doesn't go on and get worse and worse. And. This message isn't being communicated to people enough. In fact, on the American Diabetes Association website, they have recipes that are listed literally that show recipes with added sugar. which is a carbohydrate which will drive type two diabetes. And their recommendation is just to quote, cover it with insulin, which will keep you from dying from the immediate hyperglycemia, the insulin of the hyperglycemia. as we talked about treating with insulin, many of these chronic symptoms will actually allow them to progress. But if you look at the, would the American Diabetes Association even say that, why don't they mention diet? Well, on the same page as the advertisement or as the recipe, There's an advertisement from one of their sponsors, which in this case is DeVita Corporation. What's DeVita Corporation? Well, they're one of the largest companies whose business is renal dialysis and kidney failure. what's the number one cause of renal dialysis? It's the people who put sugar in their food in diets. Like when diabetics follow the advice of the American Diabetic Association, in many cases, they will progress to that. And If they followed food advice and got on a diet, they, they might not need these interventions. And admittedly, lifestyle is challenging. It's much easier to give somebody a pill or even a shot, Hey I'm basically lazy too. I'd rather, if I go to see my doctor with a problem, I'd rather have her or him give me a pill. Then give me a lecture about. You know what I should eat or I need to exercise more or something like that because that lifestyle is changing who I am. It's literally, it's a big deal. I need to buy into it. doctors, I, even though I'm a doctor, I now realize that a doctor doesn't make me healthy. Doctor just makes me less sick. If I want to be healthy. way I do it is through my lifestyle choices and no doctor can make those two for me. I get to choose those every single morning when I wake up. I decide what I eat, when I eat, what I'm going to exercise, sleep, all those things. And it's about empowering the patient. taking agency, taking responsibility, and doing what no pill can do. And that is reverse this metabolic disease and lower my risk for all these diseases that I mentioned. And in some cases, even reversing them.

corbin-bruton_1_11-02-2024_073747: 17:56

It's interesting that you're bringing this up, especially with the rise of, like, the GL1P shots and the Ozempics. All that is just regulating insulin levels. And before people are prescribed it. I think they should be sitting in on a seminar of how to regulate insulin. You mentioned walking earlier or fiber or whatever. Like, get on board with the exercise portion before you get prescribed and just take this shot. I just, yeah, that's really cool that you're bringing this up right now.

robert-lufkin-md_1_11-02-2024_073747: 18:32

It's a great point. Point Corbin. I mean, I'm all about lifestyle and I think lifestyle needs to be in place before we do anything else or lifestyle should be foundational, but since you mentioned it, the these new peptides, the GLP one agonists and other ones, GIP and soon glucagon. were initially prescribed for obesity. And then, they're also prescribed for type two diabetes. I actually think that these medicines, unlike insulin or even metformin, get at one of the root causes of metabolic health and actually can have tremendous benefits. They do regulate blood sugar, like you said, and insulin effects. also have some other effects were just beginning to learn like on brain inflammation they, you know, they have satiety effects on our gut and gastric emptying and all those things, but they also have effects on our brain so that it. they change our relationship with food. And some people are finding, and this is still anecdotal at this place, but at this point, but it's really intriguing that some people find that they, well, most people find they eat less. I mean, that's the point. But they also, some people find they drink less, you know, drink less alcohol. And other people have, they, they have other less addictive behaviors. So they find they're improving in many ways. And I think know, our understanding of this area is evolving. And I think GLP one agonists ozempic and semiglutide and terzapatide basically are the main ones now should not be used without an exercise program and a diet program, because if you just take these by themselves, sure, you're going to we're all going to eat less. The problem is if we're just eating junk food, like most people are who have metabolic disease and. 80 percent of adults have metabolic disease. If we're just eating junk food and we take these pills or these shots and our appetite goes down and we eat less junk food, we will lose weight. But the problem is we will lose and and we'll just be, we'll be less fat, but we'll still be metabolically unhealthy because we're still eating junk food, just less of it. So we have to change our eating patterns, particular attention to protein and carbohydrates and also do strength training. And. I think these peptides are going to be transformational in metabolic health in ways that we don't even, we don't even realize now that there are some controlled studies with where these, peptides are actually reversing many of the chronic diseases or have positive effects on many of the chronic diseases that we mentioned at the beginning of the program. Alzheimer's disease things like cardiovascular disease, kidney disease, and what could be the common pathway? Well, it seems to be through somehow helping with our metabolic fitness. But to your point, are not the magic bullet. They have to be done in conjunction with lifestyle changes. Again, it's not a matter of just, okay, give me the shot doc. And then I'll, you know, that's all I need. No, we still need to take agency and participate in our health.

Jeff: 21:59

Oftentimes people complain that one of the limitations of medical school is that they don't get enough nutrition or exercise science training. And, we talk about misconceptions in medicine, but, as an exercise science professor, I address a lot in terms of, the misconceptions that we have taught the lies. I need to write a book about the lies I've taught in exercise science because it's taken me a number of years to evolve from when I got my master's in the early 80s or mid 80s. The general consensus was high carbohydrate diet and a lot of carbohydrate or a lot of cardiovascular exercise. And that was the key to health span, longevity and all that. And I think what we're learning is, as we've done more and more cardio, we've done less and less. weight training. So people are getting atrophy. They're seeing sarcopenia. They're not able to do as much cardio. So their activity levels drop as they age, but then promoting carbohydrates. We've really promoted more inflammation in the blood vessels, and that has led to heart disease. And it hasn't been the fat. It's been the fact that we've been pushing carbohydrates and pushing the wrong kind of exercise that have led people to be. less healthy than they could have been if we had given better instruction. So would you agree with that notion that those misconceptions have also fed into some of the misconceptions that we have taught in medical schools?

robert-lufkin-md_1_11-02-2024_073747: 23:27

Yeah, absolutely. I mean, I think we talk about problems with nutrition teaching in medical school, which is minimal still, even to this day. And on top of that, the nutrition education, nutrition science is basically paid for by the food, the junk food business. My mom was a dietitian go to her conferences and there's McDonald's and Coke sponsoring them. And even today they're, there are problems with that field. And then, Hey, we don't get off the hook. Medical education is funded by the pharmaceutical business. So, we're getting, the rest of our education is getting shrewd back, but back to exercise and exercise physiology. There's very little of that taught in medical school, even today. And that's a crime because you know, in, in aging, sarcopenia is so important and muscle loss is a key metabolic factor and strength training is so important. And it's just like not communicate, well, all sorts of exercise, but in particular, as people age, strength training can be transforming as far as metabolic health.

corbin-bruton_1_11-02-2024_073747: 25:06

So what new approaches should we be adopting to better manage or prevent these conditions?

robert-lufkin-md_1_11-02-2024_073747: 25:12

Great question. One other thing that just blew me away in writing this book was that I like, like many doctors, I used to think of a disease starts really when I diagnose it or another doctor diagnosis it, right? When I walk in and I, I can't. Can't find my keys. I've met brain fog. They go, oops, you've got Alzheimer's and it's diagnosed. Or I go in and oops, you've got type two diabetes or oops, you have heart disease or something. I now believe this is incorrect. And actually the disease doesn't start. When the doctor diagnosis it, in fact, it starts years to decades before, before the medical system, lets you know that you have the disease and that part of that is just the way the medical system set up that you need to set certain thresholds somewhere and of it is just, there's, we have a much better understanding of the way these diseases happen. So what does that mean? That means if I wait until the doctor diagnosis, one of these chronic diseases. And hey, I hate to say it, but you know, me and you guys and most of your audience will statistically, we're all going to die of one of these chronic diseases. At least these are the top five, the ones we listed, heart attack, cancer, Alzheimer's, it's a fairly short list. So statistically, no one gets out alive. So it's in the cards for us at some point. The important thing is we can push it back. We don't need to get it when we're 40, we don't need to get it when we're 70, let's get it when we're a hundred, let's get some good years in. And that's what we're, that's where we're going for. And if we wait until the doctor diagnoses something, we've missed a huge opportunity for prevention. And what does that mean? It means that lifestyle, you shouldn't suddenly. Start lifestyle when, the doctor says, Oh, you've got diabetes or you've got Alzheimer's. You shouldn't, don't do what I did. In fact, you should, we should all start doing this, when we're young or, and because the benefits begin accruing like this from a early age like this. And it's, it's a, it's an opportunity for all of us.

corbin-bruton_1_11-02-2024_073747: 27:31

With words of encouragement, you're all gonna die.

jeff_1_11-02-2024_073747: 27:36

My goal is to die just after exercise or something like that at a hundred, go out, run a marathon or something and then come home and just kind of sit down in the recliner, pop open a beer and just fall asleep and never wake up. That's the way for me to go. Or, maybe I'm bench pressing, 300 pounds, which I still can't do, but benching that at 100 and, the weight drops on me and crushes me. That, that would be the way to go.

robert-lufkin-md_1_11-02-2024_073747: 28:03

Well, that's what's, that's what in the book too. I, one of the, one of the chapters, the second to the last, the penultimate chapter is on longevity and I had no, I no intention of writing a book about longevity, but I, what I realized is these chronic diseases that. Statistically, we die of that are driven by metabolic factors. Once we improve these metabolic factors with our lifestyle, we push those diseases back. They occur later. Our longevity increases and Even more so than our understanding of metabolic disease, there's a revolution in our understanding of lifespan and longevity. And it's just it's not unreasonable that you will live to a hundred or hopefully, long after that. So it's a fascinating time. We're living in and all these factors sort of work together.

jeff_1_11-02-2024_073747: 28:54

Yeah, I think it's somewhat unfortunate that we've been using the term longevity rather than health span because, modern Western medicine can keep us alive a lot longer. But that's not necessarily the path we want to go down. I don't want to be a hundred, but be, have a shelf of 20 different medicines that I'm taking every day. And, in a wheelchair and respirator and all that kind of stuff. I want to be living a productive, vital, life when I'm a hundred years old, it's gotta be worth it. The years. It's like that joke where it's like, well, why are you taking all these, supplements and exercising door stuff? Well, because I want to, live an extra 20 years. It's like, well, what good is living all those 20 years if you're miserable? So you got to be able to enjoy it. And we've seen really rapid advancements in medical technology as you kind of mentioned a little bit earlier. How do you think AI and other technologies are really reshaping how we approach health care and particularly with the aging populations?

robert-lufkin-md_1_11-02-2024_073747: 29:55

Yeah, AI is transformative at a foundational level, and I think still don't we're just at the beginning of it. We're we can't appreciate fully what it's going to be able to do. And it's very, it's a very exciting time, but already it's, it's having effects on the way we can gather information and process information and, if you think about it a doctor can only. Review so much information when I go into a doctor's office, they're only going to, even if my charts a foot thick, they're only going to read the last entry, which somebody else summarized. And, it's all that. But AI has the potential to, as we all know, assimilate mass amounts of information and, read every scientific article on the subject. And, we still have a ways to go before the reasoning and that gets translated into actionable items. And even then there's the situation that we have now is that there are, there are scientific papers that contradict each other and there are differing viewpoints on what's the best diet, what's the best exercise. And, Intelligent, reasonable people can disagree. And, you know, a lot of people disagree with what I'm saying in this book. And I'm not saying they're stupid and I'm not, no, it's that we just, we interpret things differently and, maybe we're both wrong, and the truth will be somewhere in the middle. But that's, yeah, that's the challenge. I think AI is going to be amazing. But as before AI comes along. The idea I touched on before is that all of us as patients becoming the CEO of our own health and taking, taking agency in our lifestyle choices is really transformative because, the doctor right now, even with limited AI, have a limited knowledge of what our medical conditions are. We have the whole memory, at least of our whole lifespan. And we, I know my medical history as a patient much better than any doctor ever will. I mean, I know all about, all my childhood traumas. We've all had traumas in childhood. or macro, I know about little fractures and stuff I've had that aren't even in my medical record. And that information, is valuable and, in determining who I am. And as a patient now, I think we're entering an era where doctors are still important and we, we want to listen closely to their advice, but They're really about pills and surgery and the lifestyle choices. The doctors can't control my lifestyle. Those are choices I have to make myself as a patient, but it's an empowering time because every day, every morning when I get up, like I said, it's a new day and I get to choose what lifestyle I want and how I'm going to be in control of my life.

corbin-bruton_1_11-02-2024_073747: 32:53

Well, do you think there's risk to becoming overly reliant on technology in medicine?

robert-lufkin-md_1_11-02-2024_073747: 33:01

I think, yeah, there's risk relying on technology for sure. And AI, of course, famously has a lot of risks to it. And, but I think, balance the technology has really helped us with things like, Think about medical imaging, CT scans, PET scanning, MR scanning, those sorts of things. Think about medical diagnostics. And now, I've got a continuous glucose monitor on my arm so I can, I'm not diabetic, but I can these are now, by the way For the first time in history, as of about two months ago, they're now available in the United States without a prescription. You can just, you could just go to the either Stella is one of them, Stello or Lingo from Abbott and Dexcom, and you can order them online. Amazon will deliver them to your house, but they're a great way to look at. Look at your glucose metabolism in real time. It's like an engine gauge on your metabolic engine. It's fascinating. But, these biomarkers and things, this type of technology, it's I think in balance, there are much more benefits. Then there has been harm from the technology, but you know, to your point, Corbyn, we have to be very careful about how we apply it for sure.

jeff_1_11-02-2024_073747: 34:18

When your book touches on the importance of preventative medicine, can you talk a little bit about how we should be shifting our healthcare approach from the more reactive, as we talked about earlier, to more preventative, and especially for those who are looking to age well?

robert-lufkin-md_1_11-02-2024_073747: 34:35

Yeah. A couple points. Well, one, we already sort of hit on the point that if I'm going to start my lifestyle healthy, I want to start, Today, however old you are, even if you're 20, start today and do that. I have a friend who's 70 and he goes I'm healthy as anything. I've never had a prescription. My doctor, every time I go in, tells me there's nothing wrong with me. I'm healthy. And I took a look at his markers and yeah, he is healthy, but. His hemoglobin A1C has been tracking up over the years. He has, you know, it's different markers. He's progressing towards all those chronic diseases, but the fact that he hasn't been diagnosed, he thinks he's off the hook. Well, he's not. And the problem with looking at normal ranges on your lab tests, because the normal ranges are developed with normal adults and normal adults. 80 percent of them are metabolically unhealthy. Most are fat, most have hypertension. So you really don't want normal blood values. You need to have optimal values. So you want to look at that. So that's the approach to optimizing things with with lifestyle.

jeff_1_11-02-2024_073747: 35:40

That's been one of the things that I've been really stressing with my students, is I teach classes like in exercise testing and prescription, and I put these normative data up on the screen, It just irritates the hell out of me that like, for example, if I put the normative data for the bench press on there, and if I'm 20 years of age and I can bench my weight, I'm in poor shape or fair shape, but it's 61 now, which is how old I am. If I can bench my body weight, I'm like superhuman. And it's like, I'm done. Thank you. It just implies that as we age, it's okay to be getting worse and worse. And that's norm, normal. And it's like you said, that we're addressing this based on the normative data, but that's not where we should be.

robert-lufkin-md_1_11-02-2024_073747: 36:28

Yeah. And I think that's a, that's such a, such an important point, Jeff, that the concept, if we're going to think about. Long health span or longevity where, you know, you live to 100. Our views of aging have to change. In other words, they're people made a fun of both presidential candidates early in the year because they were both approaching 80 and they say, well, they're a little, you know, they're a little foggy and stuff, but that's normal for an 80 year old. No, it's not, brain fog and memory problems are. are indicative of disease. It's not normal aging. There, there are a hundred year olds that are sharper than I am, and so it's, we need to get that thing. And then furthermore, we have a bias built in our, into our medical system where they're, they now, you know, colon cancer is a problem. It's a huge problem. As are all cancers, they're exploding, but colon cancer, especially in young people it's a problem, but it's also in older people. It's, the risk of cancer for most cancers increases with aging. And there's now a recommendation for the American Cancer Society is you know, you don't need to get a colonoscopy after age 70 or 72, I think it is, or something like that, because, well, the implication is, well, you're not going to live that long. So let's not waste resources on it. But well, if you take that attitude, you won't live that long, and so we need to re rethink our metrics for normal aging and and also develop testing there. There are radiation limits that my backgrounds in medical imaging, that the body can only receive a certain amount of lifetime radiation, right? On the cells. So the radiation doses are based on live in the age 65 because that's what people used to do. But if you live to age 100 or 105, don't want to max out your radiation limits at age 65, which is what most of the recommendations are, so there are many things we need to start thinking about as we realize we're going to have an older population and not a, not an older, frail, feeble, confused population, but a healthy, vibrant, vigorous population full of wise elders that can impart wisdom on this messed up world and hopefully, help us all get out of the mess we're in everywhere in the world.

corbin-bruton_1_11-02-2024_073747: 38:51

Okay. So while we're thinking about that and changing that mindset, what are some practical steps people can take to be more proactive with their health?

robert-lufkin-md_1_11-02-2024_073747: 39:00

Yeah. Take. Take a look at lifestyle and we talk about this in the book. And certainly it, for me, it comes down to four pillars that my lifestyle. And most people agree, these are the key things. Number one. foundational is nutrition because it's the one medicine most people take every single day. So choosing when you eat intermittent fasting is healthy and that's valuable. Snacking is not healthy. And then what you eat as far as macronutrients. For me, it comes down to three things. I, of course, Avoid the carbohydrates like we talked about the refined sugars, the starches, the grain, the flour, rice to industrial seed oils are very pro inflammatory. They're oxidative. So things like canola oil, corn oil, rapeseed oil. I avoid that. those. And then three, I also avoid grains. Because I believe they're, even though I don't have celiac disease or gluten allergy, I believe the proteins and grains drive low grade inflammation in many people. And if that's not, Enough in the United States, at least grains, most grains are typically soaked in a toxic weed killer called glyphosate from Monsanto corporation, which 35 countries around the world have outlawed it because of its risk for health and cancer and other things. And then finally grains have high carbohydrates, but those three things in food and then exercise. You guys have covered that well on your program. Exercises, transformative final, and then sleep also not only quantity, but quality of sleep, and then finally stress and a sense of purpose, mindset. All those things need to be in place. If I fix my nutrition, but I, my sleep is messed up. My metabolism can go away if I have perfect exercise, but I, my nutrition's up, so all those things in lifestyle, in my opinion can be balanced. But, looking at each one it's not that hard. And we start with gradual steps and, I have a friend who does he's wants to do pushups. So he started doing one pushup a day and he did two and then he did three and then he did four. And then you guys know that better than I

jeff_1_11-02-2024_073747: 41:23

Yeah. Yeah, it's baby steps. That's one of my favorite movies is What About Bob? I always use that as an example to talk about, baby steps and the importance in making small changes in our lives to, to get us through it. to that area of growth. And, this concept of lifestyle medicine, I think, is becoming more and more mainstream. And, we've been talking about that. One we did a bonus episode just recently where we talked about this movement with the Make America Healthy Again, which again, could stir up all kinds of political controversy because of, just the acronym being used and kind of where the source is. But I really think that is an important step that we are missing. Not only in medicine or in exercise science, but even politically, culturally, and in our communities where we're not focused on how do, okay, we can say you got to exercise. You got to do these things to get healthier. You got to make the right choices. But if we don't give the access to the right choice. Then we missed the mark completely. What are your thoughts on some of that in terms of what can we do as communities, as a country, as States, whatever it might be in order to help people kind of age more healthfully.

robert-lufkin-md_1_11-02-2024_073747: 42:40

Yeah, no, it's a super point. I mean, make America healthy again. There was another one, half that said make frying oil tallow again, which, which, Go from industrial seed oils back to a stable beef tallow, which is stable at high temperatures and much healthier, in my opinion. But I think these are not political messages. These are health messages that should transcend any political divides. I guess by the time this podcast we'll have a new president elect at one party or the other and whatever it is, but hopefully That, these issues need to rise to the national scene. You know, the, I think the presidential candidates need to be talking about the diabetes epidemic, metabolic health. They need, these need to be on our national conversation and we're starting to see it. Hopefully we'll see more of it. And. I'm optimistic there, there are more and more people, hopefully from both parties. So whoever wins the message, we'll get out there, but yeah, it needs to be in the, on the agenda in the zeitgeist, people need to talk about it.

corbin-bruton_1_11-02-2024_073747: 43:50

are there specific lifestyle changes you would recommend to someone in their fifties or sixties who are trying to maintain or regain their health?

robert-lufkin-md_1_11-02-2024_073747: 43:58

Yeah, I mean, I would recommend all of the four that, that I mentioned, all of those, and like I said you can't, it's not enough just to, you know, perfect your nutrition or perfect your exercise or perfect your sleep or get your stress under control. They're. they're all necessary for that. But fortunately, they work together. You know, people who start sleeping better, have more energy for exercising. People who begin to eat healthier begin to have less stress and it all kind of, they build on each other.

jeff_1_11-02-2024_073747: 44:33

Yeah. I started from teaching a pathophysiology and exercise class. My original pillars were just simply exercise. Eat a healthy diet, maintain healthy body composition, and don't smoke. But we've since added sleep in there, sleep hygiene being so critical to all those factors as well. And then we kind of alluded to it earlier that aspect of community, that social connectedness is also very important as well. And so kind of taking that more biomechanical psychosocial approach to health, as opposed to just simply a biological approach. And as an exercise science major. or professor. I'm actually a bit biased, I think, in my thinking. But as I alluded to earlier, I like to suggest that pre med students, all pre med students should come from an exercise science major. I'm sure there's a lot that would disagree with that, but I feel that, the more traditional biology, chemistry route tends to feed that more reactive and prescriptive mindset among physicians. What changes would you like to see in the way medical students are taught today? Especially when it comes to addressing all of these unique needs of the aging population that we've been talking about.

robert-lufkin-md_1_11-02-2024_073747: 45:46

Well, I think that the understanding of metabolism and its fundamental role, and in my opinion, the ultimate driving role for all these chronic diseases. In other words, disease isn't necessarily a disease of beta amyloid accumulation, which is the prevailing model. Now there is beta amyloid accumulation in most Alzheimer's patients, but it may not be causal. It's likely not causal because we've seen people go on a certain diet. A certain nutritional state that some, not all, can reverse their Alzheimer's disease. Same thing with mental health, and these diseases have a basic metabolic foundation that isn't being emphasized now. Also, the idea that the diseases are linked with a common cause rather than oftentimes medicine, modern medicine for better or worse. And actually for good reasons, it's very specialized. You specialize in one area and you get very detailed and that. Sometimes prevents you from seeing the bigger picture and that this is a big, this is a big picture problem. In other words the solution I think is going to come from understanding metabolic illness and metabolic disease and the effects of lifestyle on it. rather than necessarily dissecting beta amyloid and Alzheimer's disease and coming up with a pill for it, which despite unlimited funding and decades of research Alzheimer's disease have yet, there's yet to be a single pill that does anything significant for it.

corbin-bruton_1_11-02-2024_073747: 47:24

Did you just say people can, some people can reverse Alzheimer's disease?

robert-lufkin-md_1_11-02-2024_073747: 47:30

Yeah. Yeah. In the book we talk about Dale Bredesen's work and the protege of his is Heather Sanderson. And physician Mary Kelly has written about this, but putting people on a ketogenic diet, which is a nutritionally healthy diet, which. happens, you go into a state called ketosis when you're in a very low carbohydrate state. some patients with Alzheimer's disease, not all, but some patients get a beneficial effect from this to the point that their their brain fog can significantly improve. I always, Talk about a quote with Heather Sandison. She's a physician who has a bunch of nursing homes for Alzheimer's patients and she follows Dale's spread as Dale Bredesen's protocol, her nursing homes are a little different for Alzheimer's patients is because the patients actually go home, which is something don't want to do with Alzheimer's disease. Typically, it's a one way street. My mom died of Alzheimer's disease a few years ago, and you know, many of us that experience, but she has had some tremendous successes with reversing Alzheimer's disease, and it actually Just published in New York Times bestselling book on that subject. But one of the things she does in her nursing homes is as a policy, all the diets are low carb diets. So they're ketogenic diets basically. And I go, Heather, you've had success with. with your Alzheimer's patients, remarkable, kudos to you. But how do you know it's the diet? I mean, it could be all sorts of things. She goes, well, you know, it is probably multifactorial, but for some patients, the diet, the ketosis is transformative. And I go, how so? And she goes, well, Mr. Jones, I can tell when he's in ketosis. In other words, when he's following the ketogenic diet, grandchildren will come in and he'll smile and hug them and he knows each of their names and we'll talk to them when he eats some carbohydrates or some junk food goes out of ketosis when they come into the room, he no longer recognizes them and sort of ignores them because it's almost like an on and off switch in the brain. So for some people it can really be dramatic. It's not, you know, to be clear, it's not a cure all for everybody, but for some, it can significantly improve their condition.

corbin-bruton_1_11-02-2024_073747: 49:51

Wow. That's amazing. that is revolutionary. I'm thrilled that there's doctors out there that are actually taking this approach. Do you think the rest of the medical community is open to this kind of reform that you're advocating for all these changes and in funding? focusing on the billers.

robert-lufkin-md_1_11-02-2024_073747: 50:11

Yeah it's happening. You know, this metabolically healthy diet, interestingly, which happens to put people in ketosis along with, other things in lifestyle, the exercise, the stress all and sleep. But the, this metabolically healthy diet seems to affect the diseases across the spectrum. For example, there's another fascinating aspect to this with work by Chris Palmer or Georgia Ede, who are psychiatrists, Harvard trained psychiatrists, who both written great books that have just come out, but they're pioneering a new field called metabolic psychiatry. And the way it got started are the early work, I mean, They're both pioneers in it. Chris is at McLean Hospital outside of Boston at the Harvard hospitals, and he treats patients with severe psychiatric illness like schizoaffective disorders, manic depressive, who are hospitalized with, heavy meds. And what he. What he noticed was that the some of the meds for schizophrenic diseases, some of the medicines were the same medicines that are used for seizures for epilepsy. And he thought, well, that's interesting. You know, some common effects. And then he noticed that one of the most powerful treatments for epilepsy is going into ketosis. In other words, a nutritionally healthy diet. So when he, what he did was he took a few of these patients and he put them in a ketogenic diet and again, not all, but some patients, it was remarkable. In other words the diet had tremendous benefits. beneficial effects. And I, again, same question. I was talking to Chris. I said, Hey Chris, how do you know it's the diet? You know, you're, you know, it could be all sorts of things. And he goes, well, I have an example, Mr. Smith, he had schizoaffective disorder. He was hospitalized on medicines. We put him on a ketogenic diet and now he's off on medicines. He's at home. He's got a job. He's back in society with his kids. And yeah. And I said, but yeah, how do you know it's the diet? He goes, well, he has schizophrenia and those your audience may know that schizophrenia is practically the only disease that has a symptom where patient experiences voices talking to them. That's if somebody says they hear voices, it's schizophrenia almost certainly. And Chris said mr. Jones. He can tell when he's going out of ketosis. In other words, if he has some junk food or if he eats some carbs or something to take him out of ketosis, he says that he knows it right away because Voices start talking to him again and then he just goes back into ketosis and gets back on the diet and the voices go away and everything's fine. So it's really remarkable. And again, this doesn't happen with everybody, but just the fact that it happens with anybody is truly remarkable. So now, centers independently Stanford has reproduced this work and they now have a department of metabolic psychiatry at Stanford. And hopefully many other places are looking at this because if you think about it, eating a metabolically healthy diet is a small thing to ask. And if. Even if it doesn't work in everybody, why shouldn't you try it on everybody before you give them the medicines that go in the hospital and all these other things, the risk is very low. There's very little downside to it.

jeff_1_11-02-2024_073747: 53:42

So should I be worried about that little voice in my head that says don't eat that donut?

robert-lufkin-md_1_11-02-2024_073747: 53:47

The little boy saying, Hey, we're almost out of time. Wrap it up with Dr. Rob.

jeff_1_11-02-2024_073747: 53:54

Well, looking ahead, how do you see the future of health care evolving? Are there trends or innovations you believe are going to have the biggest impact on the aging populations?

robert-lufkin-md_1_11-02-2024_073747: 54:04

Well, the aging population is all about these chronic diseases and these chronic diseases, in my opinion, are all about metabolic health and. Lifestyle is, it is important, but the awareness of importance is going to increase. In addition, I think as we talked about offline a little bit we talked about earlier was these new peptides that are used for obesity and type two diabetes the GLP one and GIP and agonists. it's still the jury's out, but I think my personal belief is they are going to have a transformative effect on metabolic health across the board with Many, if not all of these chronic diseases when they're combined with the lifestyle. So they're sort of lifestyle amplifiers. They're not a replacement for lifestyle. So I think that's going to be, that's going to be huge, but time will tell.

jeff_1_11-02-2024_073747: 54:58

Well, speaking of lifestyle and the question we normally ask of all of our guests is, and you've kind of alluded to a little bit of this, but I'll have you bring it all together in a little summary. What are you doing personally to age well? Well,

robert-lufkin-md_1_11-02-2024_073747: 55:11

Well, I've got two teenage daughters, so that's a lot of stress. Well, I talked about my nutrition, what I'm doing. I think we talked about offline. I just started, to get my exercise more. So I started doing 10, 000 steps a day. Everybody has a step tracker. If you have a smartphone, you have a step tracker. It's built into, you know, either Android or iOS. So it's, you don't have to buy anything. And the great thing about a step tracker is it doesn't lie. You know, most of us misremember when we. or when we think we do anything, but the step tracker is great. So I, I started doing 10, 000 steps and I've just started rowing and doing some other things. My sleep, I'm paying a lot of attention to I I used to get four hours as on call all the time. Now I get eight hours no matter what, because it, I, the evidence is very strong in my opinion that everybody needs about eight hours. If you get much less or much more bad things happen to your body. And then stress. Also, I, look at mindfulness practices being grateful, seeing the love in the world. Envisioning the world as a beautiful place and looking for the best that I can, when I look at the world,

corbin-bruton_1_11-02-2024_073747: 56:24

Dr. Lufkin, it's been a pleasure having you on the Aging Well podcast. Where can our listeners find your book? How can they learn more about Ways to connect with you. Is there a website? Do you have social media?

robert-lufkin-md_1_11-02-2024_073747: 56:38

No, I actually don't have any of those. No, I have I have a web. If you want, if people are curious about my book and they don't want to go to the library or buy it somewhere, you can go to my website and download the first chapter for free, either on audio or PDF. And that's the website is robertlufkinmd. com and download the book. Information there. I am active on social media. My wife says too active, but please reach out to be there to say hi.

jeff_1_11-02-2024_073747: 57:13

we'll put those links in the description notes, but before we wrap up, is there anything we missed? Is there that one key takeaway that you want to leave our listeners with?

robert-lufkin-md_1_11-02-2024_073747: 57:23

Just what kind of what I alluded to before that, that I'm so optimistic. I'm so hopeful that this is a new era as patients, as we all take control of our lifestyle because lifestyle for most of us will be more powerful against these chronic diseases than any pill or surgery that, that doctors can provide. So I think it's an exciting time and I can't wait to see how it goes.

corbin-bruton_1_11-02-2024_073747: 57:50

Well, thank you so much for sharing your insight. I personally hope that most of the medical community can get behind you and you're not just, you're not just igniting a spark, but you're creating an entire flame for people to stand on these four pillars. Create a whole new lifestyle approach instead of just getting that the pill to fix everything. And I am excited. I really think that this is groundbreaking information. I stand behind you. I support you and to all of our listeners out there. Keep aging well.

58:28

Thank you for listening. I hope you benefited from today's podcast. Until next time, keep aging well.