As a noted anesthesiologist, internist and former chief wellness officer at the Cleveland Clinic, Dr. Roizen has written and co-authored approximately four dozen books on health and wellness, including his 2022 work “The Great Age Reboot: Cracking the Longevity Code for a Younger Tomorrow” in which he discusses the technological and societal changes on the horizon to promote a longer and healthier life.
Since the book was published three years ago, there have been enormous changes in longevity science as well as the rollout of GLP-1 drugs. In this interview, Dr. Roizen reflects on these changes, explaining what advances may work from both a medical and policy framework to foster longevity.
NutraIngredients-USA: What was the overall message the book tried to convey?
Dr. Michael Roizen: We wrote “The Great Age Reboot” to let people know how much control they have over their genes. Secondly, that if they take control, there’s a large chance that they will be able to reverse aging in the future. The science into the mechanism of aging is advancing fast enough that if an individual takes control now, there’s a considerable opportunity that they will be able to stay productive, young and without disability for a lot longer.
That’s what we thought was important based on population demographics from a policy standpoint. If everyone lives 10 years longer and works just five years longer, we solve the entire budget deficit in the U.S. The point is that you don’t have to cut out the important social programs in this process. You do have to encourage people to stay in the workforce longer.
NIU: What can people do to stay healthy longer? You talk about exercise, you talk about diet, but how much time can we really add on to our lives considering technological changes?
MR: It isn’t just diet and exercise. Stress management is actually the most important. It is also physical activity. It is managing what we call the biomarkers of cardiovascular disease, LDL cholesterol, fasting blood sugar or hemoglobin, A1C and waist for height. So the average woman could live to 98, and instead of having 30 years of disability, it would be 15 years of disability, meaning you’re expanding your disability-free lifespan.
NIU: In the book, you talk about calorie restriction as a means of extending life, which was an accidental discovery. Considering that, do you promote calorie restriction as a lifestyle choice that people should make?
MR: No, but we do promote the Valter Longo diet, or the fasting mimicking diet for five days a month.
NIU: In the book you also outline several technological advances. If you had to pick three of the most consequential advances that you mentioned, what would those be?
MR: There’s medication that turns fibrotic senolytic cells into normal cells again, and that [research] was published by the Chinese. My guess is they’re working on it beyond mice species by now. The second one is getting rid of misfolded and damaged proteins with therapeutic plasma exchange. And the third is elongating stem cells. We can get rid of damaged cells, we can get rid of damaged protein. Stem cells are what repair us under the age of 30 and keep us relatively normal under that age. We only get so many duplications of stem cells as we get older. That’s because our telomeres, the ends of our chromosomes, get six base pairs shorter each time they duplicate. When they get too short, they stop duplicating.
NIU: What is one question you haven’t had answered yet but still lingers for you, for researchers, for scientists when it comes to longevity?
MR: What the Cleveland Clinic showed is that if you pay people enough, they will change behavior toward healthy behaviors. When I was chair of wellness at the Clinic, our CEO asked me to help get our more than 100,000 employees and dependents healthy. We set out to pay them if they got to what we call six ‘normals’ plus two. The six normal meant normal blood pressure, normal LDL cholesterol, normal fasting blood sugar. Every other wellness program we looked at had focused on process. How much you walk, are you eating healthy, do you smoke, etc.? Whereas the Cleveland Clinic made its name by being outcome based. How fast does the patient return to function after surgery rather than did the surgery go well?
We set out to motivate our employees. We initially paid them $100 a year, and that didn’t do a thing. It wasn’t until we got to a sizable number, a little over $800, that we changed the percentage of people who participate in the wellness program to get to those ‘normals’. This program saves the Cleveland Clinic $190 million a year. We saved $1.5 billion since we started.
If you implement the same program for the health exchanges and Medicare, we estimate at least $1.4 trillion saved over the next 10 years. I wonder if it is possible to make these changes at the federal level.
Supplement regimen
NIU: Is there a place for supplements in the longevity space when it comes to changing some fundamental systems in the body?
MR: The answer is yes. Wouldn’t it be wonderful if our food choices could provide us with all the nutrition we want? We don’t eat either a variety of foods or the specific foods that help motivate us. As you get older, to keep muscle mass, you need to consume twice as much protein as you do when you’re under the age of 50. It’s very hard to get that from food. Equally and very effective at providing leucine is a pea protein supplement or creatine. Creatine monohydrate also is a very useful supplement for not only improving and keeping muscle mass but improving brain functioning. There are definite roles for supplements. I take half a multivitamin twice a day. The reason for half, twice a day is because you urinate out the water-soluble components in under 16 hours. So in order to keep a relatively stable level, I take half twice a day. I also take coenzyme Q10 because almost everyone should be on a statin. I take 17 supplements, not including protein supplements.
NIU: In the book, you talked about the process of turning white fat into brown fat to help people lose weight. But then that was before the onset of GLP-1 drugs. Is there still a place for this fat conversion process in our new era of weight loss drugs?
MR: There is a drug in development that both suppresses appetite and increases metabolism and doesn’t disproportionately affect muscle. The new drug works by activating brown fat without the side effects of GLP-1s.
NIU: On a different topic, there are exponential changes happening in medical advancements for increasing lifespans, but who in society will be able to capitalize on these changes? Is it just the wealthy?
MR: The GLP-1s in America are used by people who can afford it largely or some people with insurance policies that allow it. However, take Great Britain, for example. The drugs are available to everyone on the National Health Service for $50 a month. The National Health Service actually pays for it. We should be able to do this in America without it being expensive. The first people to use it, whether it’s a GLP-1 drug or any other, may be those who are wealthy, but over time it will be available for everyone.
Let me go back when I first started prescribing atorvastatin. It was $140 a month that the individual had to pay. Insurance companies didn’t cover it initially. Then after three years, insurance companies started covering all but 20%, so the individual had to pay $28. What do they cost now? $4 a month. My belief is that democratization is the ability to spread out these costs and it is happening much faster.
