BY PETER BOWES | NOVEMBER 30, 2020 | 06:30 PT

The concept of healthspan – the number of years that we enjoy optimum health – has come a long way, in recent years. In fact, Dr. Nir Barzilai, founding director of the Institute for Aging Research at Albert Einstein College of Medicine, believes we are “ushering in a future where the norm will be for people to be healthy, active and mentally sharp, during the last quarter of their lives.” In his new book, Age Later: Healthspan, Life Span, and the New Science of Longevity, he argues that aging can be “targeted, improved and even cured,” and that it should be thought of as not “as a certainty but as a phenomenon.” In this LLAMA podcast episode, with Peter Bowes, Dr Barzilai, discusses his life’s work studying some of the world’s super agers, people who are enjoying active and productive lives well into their nineties and beyond. 

Recorded: September 21st, 2020 | Read a transcript

Topics covered in this interview include:

• Dr Barzilai’s lifelong interest in longevity and healthspan
• The impact of Covid 19 and why it has highlighted issues surrounding agism. 
• Post-covid and finding the right balance with social interactions. 
• The TAME (Targeting Aging with Metformin) study and wider uses for the anti-diabetic drug, relating to aging, coronavirus and cancer. 
• Should we all be taking metformin? The ethical dilemmas. 
• Why “flexible” biology of aging. 
• What has been learned through the study of 750 centenarians?
• Learning lessons from Frieda – the grandmother of Dr. Barzilai’s wife. 
• Why we should not put off our dreams. 
• The longevity dividend.
• Caloric restriction, fasting and time-restricted eating.
• Getting enough sleep.

Connect with Dr. Barzilai: Website | Book: Age later: Healthspan, life span and the new science of longevity | Institute of Aging | Twitter | 

Earlier LLAMA podcast in with Dr. Barzilai: Researching the genetics of exceptional longevity and drugs that could target aging

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Centenarians: They’re healthy, their life is fabulous, OK? They’re doing things. They’re going places. They’re reading, they’re painting. It’s about the healthspan.

TRANSCRIPT

Peter Bowes: [00:00:00] Hello and welcome again to LLAMA, the Live Long and Master Aging podcast, I’m Peter Bowes. This is where we explore the science and stories behind human longevity. This episode is brought to you by AgeUp, a new financial product that provides guaranteed supplemental income for people who worry about the financial impact of longevity. To find out more, visit Age-Up.com that’s Age-Up.com. Well, this week I’m delighted to welcome back to the podcast, Dr. Nir Barzilai. Dr. Barzilai is the founder of the Institute for Aging Research at the Albert Einstein College of Medicine in New York. Now we met and recorded our first episode, it’s hard to believe, four years ago at TEDMED out in the California desert, it was Episode four. If you want to look back into the archives and have a listen. We covered a lot of ground, including how Nir first became interested in the aging process during his childhood walks with his grandfather in Israel. Well, since we last spoke, he has written his first book, his first book aimed at a consumer audience as opposed to articles for scientific papers Age later, HealthSpan Lifespan and the New Science of Longevity is a fascinating read. Nir Barzilai, welcome again to the Live Long and Master Aging podcast.

Nir Barzilai: [00:01:20] Thank you. It’s a pleasure being with you.

Peter Bowes: [00:01:22] Yes, good to talk to you. And I mentioned four years ago in November 2016, and I know you and I are both interested in the passage of time, the aging process. And for me, one of the least attractive aspects of aging is the fact that time seems to pass really quickly the older we get.

Nir Barzilai: [00:01:39] You know, I think the last half a year has made us aware of many things, right? And actually it’s very intense for me in the sense that covid has shown ageism. Let me repurpose something that Kamala Harris said about otherism. The virus has no eyes, but through what we see, it really attacked the older adults in the United States. OK, if you’re over the age of 80, your 200 fold more likely to die than if you’re at the age of 20. Or another way to say it is that 80 percent of the deaths are people over the age of 70. There’s a terrible ageism in covid that shouldn’t have happened and it might be happen again with vaccination, too. So for me, the awareness of aging and its consequence has been highlighted during these epidemics. While personally it’s been great because not travelling all the time, being in a lot of radiation and hypoxia and being jet lagged and not being on your own bed was something very rejuvenating for me. So it’s it’s a it’s a mixed and spending time with my wife and actually taking care of my health better, exercising more. It was was great.

Peter Bowes: [00:03:15] Yeah, it’s interesting, isn’t it, how our lifestyles have changed and as you imply, some aspects of those changes are actually for the better and will probably stay with us. I think we’re all going to review how much we travel and how much we need to go to an office or indeed to go to a conference. Perhaps we can achieve much more with this kind of semi lockdown state. Not that we like being locked down, but perhaps we can look again at our overall lifestyles and maybe that will be beneficial for our health.

Nir Barzilai: [00:03:45] Right, that’s not not the only thing we really hope to emerge much better after after these epidemics, but for me, traveling looks very different, in particular when there are so many successful meetings and zooms in and Livestream that you wonder. But but but I have to say, you know, it’s not a total switch.

This doesn’t replace the fact that when we go to meeting, we scientists go, you know, to a restaurant and all of a sudden have this discussion and all of a sudden we have all eureka moments and this, you know, personal relation interactions, wisdom that we share that we cannot do by a simple Zoom is something that’s not going to be totally replaced.

So we have to find the right balance.

Peter Bowes: [00:04:35] And it is interesting you imply this in your first answer, the fact that we are beginning to understand more about this virus and how certain people in society are more vulnerable to it, the elderly, those who are not in full health, people who are obese and have other underlying conditions. And it’s interesting how there is a clear correlation developing between your life’s work, which is focused on on well-being and longevity and what we’re learning about this virus.

Nir Barzilai: [00:05:07] Absolutely, look, we went from hope to promise, we hope, when I came to the science and to be a geroscientist, that’s how we call ourselves now. Now, there were just few of us, and we only have a hypothesis. We didn’t have studies. We didn’t have data. And it took not that much. But, you know, a couple of decades that we’re now at the stage that we showed that there is a promise. Aging is flexible. Aging has a biology. It’s flexible. You can intervene with aging. You can delay aging. You can stop aging in several ways. And in some instances you can reverse aging. And it is the time between we got to this promise and realizing that that we were caught with a covid-19 and it’s very frustrating. So let me give you one example. And we talked about it four years ago. There is this study that is called TAME that has been on hold and it’s going to launch hopefully soon. That was basically the idea was repurposing a drug that’s called metformin and metformin when you give to animals variety of animals, mice and rats and and nematodes and and fish, they all live healthier and longer. And in humans, everybody on Metformin is doing better in every aspect, cardiovascular, Alzheimer, cancers, diabetes than people who are not on metformin. And what happened now? What we know now is that people who were on metformin across the world, we have eight studies like that. People on metformin across the world had less hospitalisation and much less mortality than people who were not on on metformin, OK. Too bad that we were not prepared ahead to say, hey, there is an epidemic. Let’s give the elderly metformin so that we can prevent so much of the death and and everything that’s related to that.

Peter Bowes: [00:07:15] You say the study is called TAME, TAME stands for Targeting Aging with metformin, maybe we could just and I would suggest that anyone listening to this might want to go back and listen to our first episode, because you say we did talk about it then clearly a lot has happened in terms of research since then. Well, let’s just talk about metformin, what it is, and perhaps with aging in mind and focus on aging, what is its potential?

Nir Barzilai: [00:07:42] So I just described it, if you give to animals, they live longer and healthier. Right. Erm it’s an anti diabetic drug that actually the history is really interesting because it’s kind of a nutraceutical or it’s derived from a French lilac and it was used in the 1940s and 50s around the world to prevent influenza and also malaria. OK, and there are some studies on that, but it was different times. During this period people noticed that it lowers glucose level in people who have high glucose level. And so the whole field was distracted by its anti diabetic diabetic effect. And it’s been 60 years used to treat diabetes. In fact, it’s the first drug of choice to to you to to treat diabetes. And during this period, there were controlled studies and observational studies that show that every time people are metformin, they’re doing better. The people who are not diabetic will not develop diabeties people with diabetes have less cardiovascular disease compared to other drug in clinical studies. People with on metformin have 30 percent less cancers than other people. There is less Alzheimer if you take metformin. And even in clinical trials, people who got metformin for six months or a year had less deterioration in their memory in their name recall, for example, during this period. But I think the most interesting data came from the UK where people actually looked into pharmacies and selected people who are treated with metformin versus people that are treated by the same doctors and are not treated with metformin. And they simply looked at their mortality and people who were on metformin, which means they were diabetic and which means there were also more obese, which means they were also more sick to begin with, had less mortality than people without diabetes. OK, and by the way, at the same study, which included almost a hundred and eighty thousand people, people who took another drug for diabetes that’s called sulfonylurea, had twice as much mortality as people as control or people people on metformin because because diabetes is killing more than others. So if you take all what I said, there’s so many diseases that are prevented by metformin. There’s mortality that’s prevented by metformin. And we know that metformin hits really the eight hallmarks of the biology of aging. You understand why we want to repurpose this drug and make it available. It’s not going to be the best drug that we have for aging, believe me. But it’s going to take your health, spend two or three years ahead, and that’ll be a good start.

Peter Bowes: [00:10:55] Well, you’re almost building a case for all of us, perhaps on reaching a certain age to be taking metformin, when you consider the the range of benefits that you talk about, not only as it applies to aging, perhaps as a preventative measure. You talk about what if people had been taking metformin before covid came along in terms of how you see the drug being used long term, do you have a vision of how it could be incorporated into the lives of what certain people, everyone? Would there be an age where you might start recommending that people use metformin? How would it fit into our health system?

Nir Barzilai: [00:11:33] Well, you know, I just said how frustrating it is that this was the time to use metformin this is exactly the time to use metformin, it’s an ethical dilemma for me. And I wrote about it. I podcasted about it. OK, and I have to tell you, I gave to member to family members metformin during this time because I really think it’s a drug that is safe, that I’m repurposing every doctor repurposed drug and there’s evidence that it’s helpful. So do I sell it for the rest of us? Do I tell your audience, take metformin and the answer is no, because, look, I’m not only a biologist and a geneticist, I’m an M.D. I actually treat people with diabetes. So I know a lot about metformin. I actually wrote the first paper on mechanism of action on metformin for diabetes 30 years ago when I was a fellow at Yale. And this is the problem. When I went to medical school, the first thing they teach you is do no harm premium. Primum non nocere. OK, makes us conservative immediately. And then they teach us that in medicine there’s no always and there is no never. OK, so you become very conservative and and maybe rightly so, because we are always with medicine. We’re on the cusp of are we killing more or less by what we’re doing? We’re still killing a lot of people with medicine. So, you know, I’m like that. That’s how I grew up. And that’s why I cannot come, you know, with an open face and and say, yeah, everybody takes metformin. But you’re asking how do a vision

Peter Bowes: [00:13:22] Hmm.

Nir Barzilai: [00:13:22] People taking metformin and the TAME study is going to test people who are between 65 and 80 and for a specific reason, because we need a lot of outcomes and those are the people who get all those diseases. So it’s not going to answer to us. What’s the best age to take metformin? OK, I think it will be clear eventually. I think there will be people who would look at it, but I don’t know what’s the best age. In fact, this is true for many other treatments that are out there or potentially out there to treat aging. For example, there is a class of drugs called senolytics that are going to kill the cells that are called senescent cells that are causing us a lot of problems. And those cells are accumulating when we are old, when we are our age now. And we’re both, I think, closer to one hundred than zero. I’m guessing. If we’re at our age, we don’t have that many senescent cells. Young people have much less senescent cells, but old people have a lot of senescence. And so there’s a time where it’s probably going to be more effective. So I think there will be several drugs, several mechanisms. There will be several stages when we can interact with ageing. If you want me to guess, I would say 50 is probably the age that you should be on metformin, but I’m basing it on no data.

Peter Bowes: [00:14:57] Well, it is fascinating research and you write about it in your book, and clearly this is ongoing research we will watch with a huge amount of interest to see how it develops. I mentioned your book and I mentioned that it’s your first book aimed at a consumer audience. I’m curious why you felt you wanted to write a book aimed at, let’s say, everyday people as opposed to the more detailed scientific writing that you do.

Nir Barzilai: [00:15:22] I’ll repeat my opening sentence.

Aging has a biology, this biology can be targeted, aging is flexible, and we can increase healthspan.

OK, which means rather than think of a do I take cardiovascular disease. Do I get cancer? No, let’s let’s. Aging is driving those diseases. Let’s stop aging. This concept, 99 percent of the people do not know. I would include scientists and physicians. They don’t know that. And I’ll tell you more than that. All the people that are dealing with I don’t want to name names, all the people that are doing with covid, OK, smart people, OK, smart scientists. They don’t know that aging can be targeted because we’re in silos. Right there is the Institute for Immunology and Infectious and stuff like that. And they do that. And there’s the National Institute for Heart and Blood and there’s the National Cancer Institute. Everybody has their own project. They don’t think about aging. And it’s hard to penetrate them. It’s hard to penetrate the market. And we need you guys we need you guys to drive this knowledge because the promise is incredible. We cannot not do it now. So it’s out there. And you know, this book I told you, I’m conservative, right? This book is taking you through some of the examples, examples that were relevant to my research. See that it’s not snake oil. I didn’t wake up in the morning and declared the drug right. There is a process. There is a process of how we as a community understood aging or understood a lot of that or understood enough to start it targeting it for people to know in a simple language that, hey, this is really something. Right. And should be done.

Peter Bowes: [00:17:24] Yeah, so it is about getting a message out and you use the expression Healthspan I use Healthspan a lot. I’m wondering how many in the medical profession do you think acknowledge that such a phrase exists and actually understand what healthspan is as opposed to lifespan?

Nir Barzilai: [00:17:45] So, you know, I believe that I’m the first to use the healthspan and I’m writing it as one word, which, by the way, it’ll tell you you have a spelling mistake. When I started, I was talking about aging. I said, oh, so many people will be interested in aging. No, people are not interested in aging. People think that aging is awful. They rather not think about it. So since my research in my research, I have, for example, one of the things I have, I have 750 centenarians where I’m trying to look for longevity genes. And I said, well, longevity, longevity is positive. OK, so I lose longevity. And what it meant to people basically is why do I need longevity and be sick for more years? OK, they immediately assumed that longevity means we get sick and we live longer. And that’s when I said we have to change the marketing here and use healthspan. And in fact, I sometimes say it and maybe I said it the last time we met, that if there’s a drug that will target aging, will say, you know, this will increase your health span, you’ll get less disease, less this disease and the other disease and all those diseases. And in the advertisement side effects, you might live long.

Not everybody wants to live longer or is has enough resources to live longer. OK, it’s a side effect. I think healthspan is really what we’re trying to achieve here. We’re not immortalists.

We’re not trying to, you know, to do anything dramatic except to increase healthspan.

Peter Bowes: [00:19:26] I will return to my conversation with Dr. Barzilai in less than a minute. You’re listening to the Live Long and Master Aging podcast. This episode is brought to you by AgeUp, a new product that helps fill in the financial gaps that are often created once you’ve mastered aging and achieved an exceptionally long life. Small monthly payments to AgeUp stuck over time to create a secure income stream for your 90s and beyond. Contributions to AgeUp are shielded from market swings and once payouts begin at age 91 or above, they’re guaranteed to last for Life. AgeUp is backed by MassMutual and sold by Haven Life Insurance Agency. You can find out more at Age-Up.com that’s Age-Up.com. Now let’s get back to Nir Barzilai. We’re talking about his new book, Age Later Health Span Life Span and the New Science of Longevity. So you mentioned that you’re interested in centenarians, very old people, and you write in your book about Frieda, one particular elderly lady that you knew. I was wondering if you could just tell me a little bit more about her and why you wanted to include her in the book.

Nir Barzilai: [00:20:41] First of all, Frieda is the grandmother of my wife, was the grandmother of my wife. When we got married she was in her late 80s and, you know, danced very nice in our wedding. And she was one of those people whose biological and chronological age didn’t seem to go together. She is such a good attitude. She was so youthful. She always did whatever you want her to do, whether it’s to dance or to go out. She was ready for everything.

She had several boyfriends. The prerequisite that they should drive a car.

Which means they were kind of younger than her, mostly when she was hospitalized twice, actually. One is when she was 100 year old and she broke her ankle. And the doctor said, look, you’re 100 year old. You know, you can just sit on a wheelchair and not go through, you know, an operation. And she said, no, no way. And she got the operation, when she was 100 years old, and she was fine for the rest of her life. It was uneventful. She recovered immediately, you know, just uneventful. When she was 102, she had the flu and she was hospitalized. And I was with her. That’s when she died. Within three weeks, she died and the doctor said, OK, what medications are you taking? He was taking her history and she said, I’m not taking any medication. So he said, no, no, no, come on here. You must not have not understood me, you know, in the morning, you know, before you have breakfast. They’re like pills, OK? Drugs, medications that you’re taking. She said, I understood you the first time. I’m not taking anything. And he he wasn’t believing it, but she really symbolized the fact that healthspan can be expended. And really, when we look at 750 centenarians now, it’s not that they live longer. They live healthier, longer. They got diseases 20, 30 years after people should get their diseases. And so health spending lifespan went together, which for me meant their aging was slow. And if they’re aging was slow, what is the genetic mechanism that slows their aging? And that’s the discovery we are doing now. And it’s interesting discovering it’s ongoing discovery.

Peter Bowes: [00:23:07] And free to use an expression that I know struck a chord with with you and your wife, never put off your dreams.

Nir Barzilai: [00:23:15] Right, we were contemplating of of actually getting a house in Cape Cod, which is our happy place for a variety of reason, and, you know, we saw a place that we like. But he was kind of out of our range. And and as it was going OK, as it was going these last three weeks, she tells us, don’t put off your dream and then she dies, OK? And at that day, we had an offer on the house and it was rejected. OK, now my wife and I remember different responses. What she says is, please get me this house. Frieda said, don’t give up your dream. And what I remember her saying is getting me the fucking house now. And so we gave the the offering price and we’re not regretting it. And in fact, we have you know, we are Sweet’N Low for the coffee with the sugar and the sweet and low is a can. That is something that she gave us and that’s what we’re using. So we remember it every time we have coffee we remember Frieda.  

Peter Bowes: [00:24:28] Now, that’s a good memory, isn’t it? Do you think it is the case that people that have a strong purpose in life, perhaps those people with the attitude that they will never give up, are inclined to simply live longer?

Nir Barzilai: [00:24:41] You know, it’s very hard to judge and let me give you an example, I met one hundred and four year old guy who was the loveliest guy I ever met. You know, as far as attitude and, you know, all these stories, you know, his daughter in law was great and everybody’s great and everybody’s helping here. And he was very nice. And I’m leaving, you know, I’m leaving him after an hour. I’m going through his house and his son, who’s 80 years old, is there. And I’m telling the son what I’m telling you how great his father is. And he looks in my eyes and he says, you should have seen the son of a bitch when he was my age. He was a terrible person. And then you realize we are thinking that personality is with us when we age. And, yes, you know, probably till our 60s, 70s. But, you know, those guys between 70 and 100 had a lot happening. They retired. They lost a spouse. They moved to another place. They moved to an old age home. And their brain has changed, too. And so what’s important in our study is that we are now following the offspring of centenarians to look at the changes as they age in order to depict what’s real and what’s something that we measure at the end of their life. And we say, oh, that must have been that. And it probably was not. I mean, there are a lot of people with strong will and good attitudes that get cancer when they’re young, too, right? I mean, it’s it’s not it’s a little it’s more complicated than that. And although we have three papers describing this wonderful personality of centenarians, I really am short of saying that anything had to do with their personality throughout their lives. You know, you see somebody at a single point of time, you really don’t know what he is now.

Peter Bowes: [00:26:44] Now, something I often hear from critics of longevity research is that it is in some senses a selfish aspiration to want to live longer than, let’s say, the the average human being of about maybe 80 years old and taking into account employment issues and housing and the climate that perhaps it would be fairer if everyone just lived to that average age without becoming centenarians or super centenarians. No, I actually fundamentally disagree with that as a criticism. But I’m curious to hear what you think.

Nir Barzilai: [00:27:21] First of all, you just underline in different words why I use healthspan, right, rather than lifespan or why

Peter Bowes: [00:27:28] Right.

Nir Barzilai: [00:27:28] Did I say that lifespan is a side effect, unwanted side effect? OK, but you know what bothers me and I hear that, too, what bothers me is if I tell you you’re at risk for heart disease and we can lower your cholesterol and stuff, you wouldn’t have that reaction when I’m telling you I’m going to do something that you don’t get the heart disease, you don’t get cancer, you don’t get Alzheimer. What now? Now we are criminals? You know, I think it’s the same it’s the same thing. And we have to package it in a way that doesn’t frighten people. You know, if they’re healthier, that is one of the things with centenarians and hundred years old, is they’re healthy, their life is fabulous, OK? They’re doing things. They’re going places. They’re reading, they’re painting. They’re you know, so it’s about the health span, OK? And also, another important thing to know, there’s something that’s called longevity dividend. We’re all talking about it and writing about it. And I’ll give you the case from centenarians. I told you that centenarians get diseases much later, but that’s not the cool thing. The cool thing is they’re sick for a very short time. At the end of their lives, I gave the example of Freida three weeks at the end of their life. So this contraction of morbidity, that’s the formal name for that contruction morbidity carries a lot of financing. And in fact, the CDC, we all know what’s the CDC now was looking at the medical expenses in the last two years of life of somebody who dies at over the age of 100, to those who die before. And it’s third the cost. OK, so in fact,

We have data to suggest that being healthy is a great economical program.

And my view is what I want to do is I want to live healthy, healthy, healthy and die. What age? I don’t know, 85. OK, but the longevity dividend of being healthier is immense. OK, there’s there’s there’s no reason not to do it. It’s trillions of dollars that accumulate for for health care cost.

Peter Bowes: [00:29:49] I often try to frame it like this in terms of the longevity dividend, the money that could be saved through people not being sick for so many years, imagine what could be done in terms of medical research with that money, focusing on some of those diseases that affect people perhaps earlier in life. That lifestyle, at least as far as we understand it, has nothing to do with these diseases. I’m thinking of Lou Gehrig’s disease and things that come along, pancreatic cancer, these fatal conditions that come along that don’t really seem to be affected by our diet or our exercise regime.

Nir Barzilai: [00:30:29] Right, and you’ll have leftover money for medical research, for climate change, whatever, whatever you need.

Peter Bowes: [00:30:36] Yeah, exactly, so you’ve done all of this research, you’ve written about it, and you talk about it very eloquently, and I know you’ve been doing a lot of podcasts and interviews to try to get across the messages that you’ve just been talking about. Clearly, you have learned a lot during your scientific career that you are applying to yourself in your own lifestyle. And it’s always fascinating to me to ask people like you how you live your daily life, what do you eat, how much time and focus do you spend on your sleep and your rest and the Zen side of your life to to recuperate. What’s an average day like?

Nir Barzilai: [00:31:14] Yeah, so I’ll tell you that, but I want to say something in the book, I have a whole chapter on that, OK? And I reluctantly wrote the chapter. And the reason I did write the chapter, I started by saying, look, there are lots of things out there. You know, you get marketing for lots of things, nutraceuticals and drugs, and people are swearing by them. And there’s only one way to know if they work. And that’s doing clinical studies. Clinical studies means you take a bunch of people who want something, want to live healthy, and half of them getting a treatment and half of them are not getting a treatment. And you see what happens to them, not lifespan. That’s too much. But, you know, healthspan, if you don’t have studies like that, they might be promise, but there’s no way you should do that. There are very few things that you can tie together into a healthspan. So I’m calling really the public to know, to read clinical studies and not fall to the side with things that can actually be dangerous. And there are some things, you know, luckily most of the nutraceutical don’t have even what they claim to have. There’s no overview of that. They are not harmful. You know, luckily, the good thing about it is they support the economy. Nothing is wrong with that, OK? You spend money and makes people making money. But if you really want to do it, you need a clinical studies. So for me, there are really two major things that I’m doing. First of all, I’m exercising and I have to just get it over with. Exercise is the most important thing you can do with the environment, OK? By far at every age and every sex exercise is the most important. So let’s take it off. I’m doing it every day. I’m exercising basically every day. I’m not taking a break. Not always the same intensity, but I exercise every day. So let’s take it off the table. The more important thing is the diet, the diet. What we’ve done, and I describe it in the book, is we do caloric restriction. When you do caloric restriction to mice, to rats, you know, you take brothers. Half of them get whatever they want. Half of them get forty percent less food. They live forty percent longer. OK, and we took it to mean that if you have less for breakfast, lunch and dinner, you live longer. But that’s not what we’ve done. We brought all the food in the morning to the rats or mice that are hungry and they finish the food within an hour. Within twenty minutes really. And now they’re fasting for twenty three more hours. When we start feeding them throughout the day, they’re lean because they don’t have enough food. They don’t live longer. OK, so something is in the fasting, OK, not only in the amount of calories and that’s why I’m fasting 16 hours after dinner. I finished dinner yesterday at 8:00. It’s noontime, it’s past noontime actually, and I haven’t had lunch yet, so I’m going to have 17 hours of fasting.

Peter Bowes: [00:34:28] And just for people who I do exactly the same thing, my 16 hours is a little bit earlier than yours, so I try to finish by five or six p.m. in the early evening, late afternoon, which means that I can start eating again the next day by nine or 10 a.m. I just like to shunt things forward, but we all have our own different lifestyles. But I’m curious, since you are right at the end right now of that fasting period for people who haven’t done this, how do you feel? Because people will say, oh, well, I wouldn’t be able to get through the morning. I wouldn’t be able to think. I wouldn’t be able to function.

Nir Barzilai: [00:35:00] So so I’ll tell you, you know, I recognize that not everybody can do it. There are people who say I cannot skip breakfast, my glucose goes down. That’s not true, OK? There’s no way your glucose is going down and maybe people get ketones and they don’t feel well with ketones. And I actually feel when I get ketones, I have a little ketones now. But overall, my energy, my muscle mass, everything else is pretty good. I eat whatever I want. You know, look, if I gave you a diet, a three months diet, you could break any day. OK, but if all you have is an hour or two to go without food, you’re not going to break, you know, because then you can eat whatever you want. And it’s fascinating how much it’s easy for most of us, not for everyone. I realize and I realize that people are sincere. Sometimes they try. For me, it’s you try for a week and then decide if you can do it or not. But not it’s not for everyone. But at least this is the kind of diet that is consistent with the most important observation that we have in aging, that just caloric restriction with fasting, enhanced lifespan and healthspan by a lot. And I feel it, too, from a drug perspective. I’m taking metformin. I was put on metformin by my doctor more than five years ago. I think because I was pre diabetic, I have diabetes in my family. I gained weight. I’m on metformin. I’m not prediabetic anymore, but I’m not stopping the metformin for another. For another reason, my physician is prescribing me the metformin. I also experiment with [00:36:40] some [00:36:40] NMN preparations, which is a nutrient signal that goes down with aging. And if you can replace it, it gives you energy.

Peter Bowes: [00:36:51] Let me just ask you, finally, in closing, I mentioned of all those things we can pay attention to, like diet and exercise. There is that. There is resting. There is recuperating. There’s the Zen. Are you often referred to as the Zen part of your your daily life or your lifestyle?

Nir Barzilai: [00:37:06] Right, so so actually, what I was going to say about sleep and sleep, look, I have now for a few weeks, I have terrible I don’t get my R.E.M. sleep. You know, I have this for whatever it’s worth, the Fitbit. And we don’t know what we’re measuring, really, you know, but I did I did use to have R.E.M. and it’s declining now, I have no idea what to do with it now. So I want to sleep eight hours. But I really am OK if I sleep seven hours and usually sleep less than that and I’m OK, but there’s nothing I can do about it. It doesn’t make sense to take a sleeping pill. I don’t know what increases R.E.M. By the way, NID supposed to increase REM. I thought it did. It doesn’t any more for me. Maybe melatonin, you know, maybe I’ll try melatonin. Sleep is harder to deal with, even if you want it, you know, what do you do? What do you do for you? What do you do spiritually for you? What do you do? How do you recharge? I’m not going to go into that because I’m not specializing in that. My time out I read three books at one time, and this is this is my way of of checking out. And, you know, some of the books, the books vary, but one of them is more philosophical. One of them is more historical. One of them is junk. And and I just use it whenever I feel like and check out. And and I have to tell you another thing. I just took a vacation for the first time in probably a year. You realize all of a sudden that, yeah, I’m working from home, but I’m working more than ever. I’m all in. I’m waking up. I’m there all the time. There’s no boundaries. People are telling you, can we schedule something for eight thirty? You know, it’s like all of a sudden and you find out that you need a vacation even if you’re on covid. And I think that’s important to keep in mind. We need the vacation and we should take it.

Peter Bowes: [00:39:05] Yeah, and we’ve come right back to where we started and just on the point that you made a couple of minutes ago about encouraging people to read the research, I always make the point on this podcast that I’m not I don’t really want my guests to advise people to do anything in particular, because this is a forum to share ideas and share information. But people really need, first of all, to speak to their own medical professionals. They need to speak to their own doctor if there’s an issue and take it from there and do the research. But I think it’s important, and you reflected this during our interview, it is important to expose the ideas and expose the research to as many people so people can begin to understand some of the science that’s happening.

Nir Barzilai: [00:39:44] Well, all I can say, you know, Moses took the children of Israel out of Egypt, but he was stuttering and the people who did the talking with the pharaohs and his brother, Aaron. And thank you for being a brother here, because you’re putting the things I’m saying much clearer. I think I should ask the question and let you talk the next.

Peter Bowes: [00:40:07] Maybe we should do that next time, Dr. Barzilai, another wonderful conversation. It’s great to meet up with you again. Thank you very much indeed.

Nir Barzilai: [00:40:14] Thank you. Thank you.

Peter Bowes: [00:40:16] And a reminder that his book is Age Later Healthspan Lifespan and the New Science of Longevity. Details in the show notes for this episode. You’ll find them at our website, Live Long and Most Aging. We use the acronym LLAMA. So it’s the LLAMA podcast LLAMApodcast.com LLAMApodcast.com. We are a Healthspan Media production.

And if you enjoy what we do, you can rate and review us at Apple podcasts, you can follow us in Social Media @LLAMApodcast and direct message me @PeterBowes.

Always good to hear from you. Many thanks for listening.