Hormones and mitochondria drive health aging

Dr. Felice Gersh [00:00] Look at what’s evidence-based and what is efficacious and safe that can help with such things as mitochondrial rejuvenation. Because without having healthy mitochondria, you’re not going to get healthy longevity.

Peter Bowes [00:22] Welcome to the Live Long podcast. I’m Peter Bowes. This is where we explore the science and stories behind human longevity. The goal is to optimize our health span and master the aging process.

TIMELINE [00:35] This episode is a co-production with the Swiss Longevity Biotech Company Timeline. We’re in Las Vegas at A4M, the annual Longevity Fest meeting of the American Academy of Anti-Aging Medicine.

Peter Bowes [00:46] Dr Felice Gersh is a board-certified OBGYN, an integrative medicine physician. She is a globally recognized expert on women’s hormones, the gut microbiome, the circadian rhythm, and healthy aging science. She is the author of several books focusing on women’s health. Her most recent is Menopause, 50 Things You Need to Know. Dr Gersh promotes natural interventions to promote the health of women and men. and believes that in many cases the body can heal itself. Dr. Gersh, it’s great to see you again.

Dr. Felice Gersh [01:22] Well, it’s a joy to be back and have this podcast time with you. It’s been so long.

Peter Bowes [01:27] Well, it’s been so long. We have done several episodes already over the last few years, and they’re all available in the index of our podcast. And I think let’s start with that in mind, that we have been talking, you and I, about longevity, longevity science and healthspan for a number of years now. I’m just curious, what is your assessment of the, if you could call it, the longevity industry, the longevity space and people’s understanding of what that means to us?

Dr. Felice Gersh [01:55] Well I think it’s exploding in terms of its growth. In fact, just here at the conference they have a record number of attendees. Never before have there been so many thousands of people. are a variety of types of people. There are some that are just, you know, routine public people, you know, they’re not in the health field, but they just want to learn. So I really think that the whole concept of healthy aging is really now exploding in terms of its interest and research, but I think there’s so much more that needs to be done. it’s also a little bit gimmicky in some ways and, you know, looking for the device, the magic bullet. Sometimes it’s magical thinking and it’s not really based on a lot of science in terms of what really needs to be accomplished. And evidence-based medicine is sometimes not quite where it should be. That’s why I look and work with companies, organizations, and products that really have foundational science to back them up. it’s not always there.

Peter Bowes [03:01] That’s interesting you should say that. Do you think the gimmicky aspects, they’re clearly negative for the sphere of longevity.To what extent are people believing things that are just simply not true? False promises that whatever gadget can help you live for an extra 10 years or a certain dietary regime or even exercise regime that really doesn’t have any proven science behind it?

Dr. Felice Gersh [03:25] I think people want so much to believe certain things, like certain dietary practices or dosing of certain medications, that that will provide them the answer to being healthy and sometimes they want to not have to work hard. They don’t want to do the right things in terms of go to bed, get adequate sleep, work on stress, eat the right foods. They’re looking for things that will be the solution and I think they’re not looking deep enough. So it’s like the GLP-1 agonist. So there’s like this movement of micro-dosing.

Peter Bowes [04:03] Just explain to me what you’re talking about there.

Dr. Felice Gersh [04:05] Well, in the United States, Right now, 40% of all adults, and it’s a ridiculously high percent even of children, are obese. And something like 70% of the population would be categorized as either overweight or obese. So it’s a phenomenal epidemic. And there’s been these new drugs that have come out on the market. They’re not actually new. The GLP-1 receptor agonist, so glucagon-like peptide receptor agonist. So they’re not actually this peptide, they’re mimics. But these drugs have been on the market for about 20 years for the treatment of diabetes. But it was discovered actually some years ago, but it wasn’t marketed for that purpose, that if you increase the dose substantially, it has some different effects and in a significant percentage of people, it can induce weight loss through some additive mechanisms. But it’s very costly. There’s a lot of side effects. You can say the longevity use of these drugs is very low. The dropout rate is phenomenally high. Even the real world data is that at the end of one year, only maybe a third of the people who started it for weight loss are still on the drugs. So a lot of drop-offs. And there could be a myriad of reasons why that’s happening. So people are looking for, well, how can I use these drugs that keep the price down, the side effects down, so they call it microdosing using maybe half or even as little as a fifth or a tenth of the starting dose. But the pharmaceutical companies actually tested those doses before the drugs came to market because that’s what they do and they’ve published and talked about that the very tiny, tiny doses didn’t work. And yet there’s this magical thinking that if you microdose you’ll have this weight loss and you’ll have these benefits. But the reality is that the placebo effect is so dramatic that yes, there’ll be some people that actually get good effects. And we’ve seen that in many, many pharmaceutical trials. The group that is on the placebo, so that’s like sugar pill, not the real drug, that they have benefits, at least for a while. So that’s part of the magical thinking of not really looking at the science, but wanting so desperately to believe that this is going to work. And then it could be some electrical device that puts out an electrical field and that’s going to protect you from all the surrounding electrical radiation that’s in creates this barrier for you, like where’s the data on things like that?

Peter Bowes [06:55] And all of this really falls into your general way of thinking about health, about treatment of conditions, and that you prefer a holistic approach, and you emphasize an approach that is non-toxic, in other words, that it is not going to do any harm. And I think what you’re explaining there falls right into that, that there is potential for negative, perhaps more so than there is for positive.

Dr. Felice Gersh [07:20] Absolutely. I always say I’m a very simple thinker. Okay, so if you’re going to be healthy and have a vibrant life in your 90s, then I look at it, well, what can you do to make your body about, you know, somewhat comparable to what it was, say, in your 30s? Well, what do you need? You need to have the foundational hormones that would be somewhat similar as much as possible to what a healthy, fertile person would have in their 30s. I the 20s is maybe pushing it, so I’ll say 30s. And then you have to have the right food. I mean, it’s just all whole lifestyle. Now, if someone has an illness because we live in a world which, you know, I call it, unfortunately, poison world. We have so many environmental toxicants with pollutions, chemicals in our food, in our water, in our air, and so on which are really challenging to the body in so many ways. So you can actually do everything right. You can, you know, like, and still have medical problems. So I, and people are born often genetically altered, we’ll say, we call it epigenetically modified to make them more prone to obesity. So we know that there are, everyone’s not dealt the same deck of cards or hands. So definitely we can do everything right and still have a lot of challenges with our health. But if you do everything right, you are increasing your medical probability that in your 90s, you can have a really active, wonderful life, somewhat comparable to what you had in your 30s. But there’s no one drug or device that’s going to do that. And so there’s like a whole group of people in the anti-aging world that are looking for a pharmaceutical and they’re looking at metformin and rapamycin and these different drugs, that that’s going to solve all their problems. And maybe I’m too jaundiced being around for so many years that I’ve seen many blockbuster, not as big as the GLP-1 receptor agonist, but other blockbuster drugs that fell by the wayside. They were even taken off the market because they had harmful side effects or they didn’t really work as they thought. So I just think we have to go back to basics and sort of simplify our approach to aging using lifestyle, making sure hormones are right, and also using some targeted supplements, recognizing that no one’s diet is perfect and we have these altered gut microbiomes that also are influencing how we even use our food for the purpose of maintaining and optimizing health.

Peter Bowes [10:07] And you mentioned the 90s and 30s, and we often hear this phrase, the 90s are the new 60s or 30s, or whatever the correlation is. Do you think, to some extent—and lot of people use that kind of language— but are people being sold a false promise? Maybe we should be saying, the 80s are the new 80s. You can feel better and stronger and livelier in your 80s than maybe people did decades ago, but to compare the 80s with the 60s or the 40s. Is it a little delusional?

Dr. Felice Gersh [10:40] Well, I think that we have to be realistic, as you’re saying, that we know that a large percentage of people don’t even live to see 90. That is true. But I guess partly my view is somewhat affected by my own family. I lost my dear aunt last year, and she was 97. And she was still driving her car. She was brilliant. She could talk about any subject. She went to shows and she went to museum exhibits. She was cultured, knew. And my dad got to 98. My mom was in her mid 90s. I guess I’ve, and my mother-in-law was one month shy of 102. So, okay. And I worked with them and I, you know, I was part of their health team, sort of behind the scenes a bit, sometimes not always so behind the scenes. And you know, these are people who lived independently. They were doing like normal things. And I live near a very large community in Southern California that used to be called Leisure World. Now it’s Laguna Woods. And some of the people there are my patients. And so I am seeing maybe a bit of a skewed population of people who are living long and living a full life. So I guess I know that it can be done. And yes, this is definitely optimistic, but it’s a goal. Okay, I mean, so you have a goal. Now I’m not saying in the hundreds, I’m saying that you can have a reasonably normal life in the 90s. I’ve seen it so many times. I know it is doable and we strive for that. you know, certainly people who have had a very poor quality of health and poor lifestyle choices for a whole myriad of reasons and they’re say in their mid 50s now and they’re very, very unhealthy, realistically it would be challenging to have a great life in your 90s. But that doesn’t mean that we can’t do a lot of turnaround. I believe people can really change at any stage of life and do so much better.

Peter Bowes [12:49] Yeah, I totally agree with you. And there’s nothing wrong with being aspirational. And I think that psychologically, that is a big benefit to people to be optimistic about what they can achieve in the future. In other words, to think big. I think it helps you get there. I mean, yes, clearly the major pillars of diet and exercise and sleep and social connections are all important. But if you think you can achieve it, sometimes that’s part of the battle.

Dr. Felice Gersh [13:17] Absolutely. That goes back to the placebo effect. It’s so unbelievably powerful what the mind can do, for good or for bad. They’ve had studies where and this is sort of amazing where they took people who had asthma, very significant asthma, and they said, I’m going to give you a medication that is going to create an asthmatic attack, but do not worry. I have the antidote. It’s proven 100% effective. It will immediately clear up your asthma attack. So they had these people, I don’t know how they got these volunteers, but this is real. And they gave them saline spray but they didn’t know it. And they sprayed saline up into their nasal cavities, sprayed up their nose, and they all had an asthma attack. And then they gave them saline and they all resolved. It’s amazing. They’ve had cases, this is documented, terrible, terrible acne, like horrible cystic acne, went through hypnosis and created the mindset through the hypnotic effect that you can heal, that you’re fine, and the acne completely cleared up. So I definitely believe in the power of positive thinking and the mind to control, because we know that through the autonomic nervous system that the brain, through the vagus nerve, can control the afferent and efferent signals going back and forth to the GI tract and through the GI tract and also peripherally through activating or deactivating the inflammatory response of the immune system. And of course, underlying aging, and whoever coined this very good term, it’s very applicable, inflammaging, this chronic low-level state of inflammation can be very much on or off based on your emotions. So you can actually have a big impact on how your immune system is activated or calmed down through the way you think. So you can actually, and they’ve had movies where somebody had a big scare and they suddenly had a heart attack. In fact, these have been reported when they’ll say there was an earthquake and two people died of a heart attack. Nothing fell on them.

Peter Bowes [15:43] It often happens.

Dr. Felice Gersh [15:44] So, and in women, there is a condition known as broken heart syndrome, Takusubo syndrome which is like a heart attack, but it’s not due to arteries like being clogged and nothing like that. It’s when you have an overwhelming enormous push of sympathetic, that’s the stress response of the autonomic nervous system that overwhelms the electrical conduction system of the heart because all interconnected. That’s why if you feel anxiety, you have palpitations. So it overwhelms the heart electrical conduction. You have sort of this altered contraction of the heart and it actually balloons out and it can kill and it’s mostly in women and it’s due to stress. So that’s where mind-body medicine is so powerful for healthy longevity because stress underlies so many problems and we understand the mechanisms now because part of stress is what they call adrenergic activation, adrenergic as in adrenal. And then you activate the adrenal gland which pours out more cortisol and cortisol will do so many harmful things when you have it chronically elevated. So you alter your gut microbiome, you’ll get what’s called leaky gut, which creates more systemic inflammation, which leads to insulin resistance. It just goes down like the rabbit hole of medical complications in terms of health problems, all stemming from stress. I think that simple things like learning how to calm yourself, mind-body practices, positive thinking. And one of the things that I talk to my patients about is laughter yoga. Laughing.

Peter Bowes [17:32] Laughter yoga?

Dr. Felice Gersh [17:33] Yes, there’s actually a Society of Laughter Yoga. Laughing, even when it’s not really spontaneous, it’s like pretend, like a laughter track. Like you’re on a sitcom and you’re just laughing as an audience track. It actually activates the vagal nerve and you have vagal activation you have calmness what they sometimes say rest and digest your inflammation goes down your enteric nervous system which controls motility, you know have so many people have GI problems and like heartburn GERD, constipation or irritable bowel syndrome it improves all of that.

Peter Bowes [18:15] So we should all be laughing more?

Dr. Felice Gersh [18:16] We absolutely and I actually tell my patients get some jokes, I don’t care how corny they are, and at the dinner table, you, your family, or even yourself, you just read out loud the joke, and no matter how corny or whatever, you just laugh and laugh for like two minutes, as loud and hearty laughter as you can, you will feel so much better.

Peter Bowes [18:38] Corny jokes, much to the irritation of your partner in life, who has probably heard those jokes 20 times around?

Dr. Felice Gersh [18:44]You just laugh at life sometimes, you know?

Peter Bowes [18:47] Well, look, we’re in Las Vegas and we went to see a comedy show last night.

Dr. Felice Gersh [18:51] Yay!

Peter Bowes [18:52] The team with me, we went to see a comedian and we were all laughing and maybe that’s why I’m feeling good today.

Dr. Felice Gersh [18:57] It’s amazing. So, I mean, that’s why I say I’m a simple thinker. you know, I’m not saying that there isn’t some potential with drugs like rapamycin, even the GLP-1 agonist at, you know, actually therapeutic doses and so on, that they cannot be a participant in terms of the journey into healthy longevity. But people are forgetting the basics. You when they’re looking and they have gadgets and this and that, they want the magic solution. And I’m just saying, just stick with the basics. Like, it’s like if you’re learning a course, don’t start at level five, start at the beginning. And people want to jump to level five for healthy aging without doing all the previous steps. And it’s, that’s not appropriate in my mind.

Peter Bowes [19:42] Well, I always say, look, if you get the basics right, which are what you eat, a sensible diet and you could debate forever what the best diet is, and there probably isn’t a best diet because we’re all different. Exercise, clearly sleep, social connections, which I guess come into laughter and getting together and just feeling happy. Those are the key pillars, and we could probably get 80 or 90% of our longevity aspirations by paying attention just to those key things.

Dr. Felice Gersh [20:09] Well, I have to always add one. And because the vast majority of my patients are women, I do have a heavy focus on what I call foundational. So I think of it as you’re building a house, you start with the foundation. So the foundation is necessary but not sufficient. You can’t live on the foundation, whereas the walls, the ceilings and all the other accouterments of a house. But if you don’t have the hormones. If you lose your hormones and every woman 100% will go through menopause, you cannot meditate, yoga, you can’t do anything. Eat vegetables and get. You know, you may delay menopause a little bit. You’re not going to avoid it. And I one of the things that I work on all the time is educating on the importance of having estrogen in the form of estradiol. That’s the type of estrogen made by the ovaries. And it’s sidekick. I call it progesterone. And not just having them, but having them in the right rhythms and doses because like everything, exercising five minutes a month is not going to give you the same outcome as 30 minutes five days a week. And yet now there’s a proliferation of online telemedicine clinics that are dishing out hormones. And I still think any hormones are better than no hormones, just like any food is better than starvation. But they’re giving tiny doses and they’re giving static everyday progesterone. Not physiologic, not optimal at all, although still more than nothing. And it’s really important to understand that the efficacy, the benefits are in the dose and the rhythm. Just like we have rhythms like, you know, circadian rhythm, lunar rhythm, seasonal rhythms and female hormones are rhythmic. They’re definitely lunar. We need to recognize that there’s variations in levels and rhythms of progesterone, and that these hormones are foundational to healthy aging. Now, you could say rightfully that. Well, what about all the women who live to be 100 and they weren’t on any hormones? Well, they are outliers, number one. Number two, they ate a lot of the if you’re a hundred 100 now, you were born during a different era, like sort of the pre plastic era and the pre processed food, ultra processed food era. And we know that there’s some magic in all kinds of fruits and vegetables, beans, all the legumes, nuts and seeds that are called phytoestrogens. And these phytoestrogens are like nature’s gifts to women and men. But I focus on women. Because they’re very weak, but they can bind to the receptors of estrogen, but they’re not estrogen and creates some similar effects and benefits. This has actually been shown. So I mean that and then they were more active. But they’re still outliers. And many women who do live to be elderly have a lot of medical problems. We talk about this all the time that women live a little bit longer, but they tend to have more chronic diseases. 80% of osteoporotic fractures are women. Women have more joint replacements. Women have equal in terms of cardiovascular disease, and tend to die more from the first heart attack. By age 65, 75% of women have hypertension. So and two and a half times more women have Alzheimer’s than men. Age matched. So women do have a lot of chronic diseases with aging. So a lot of this is related to deficiencies. And it starts, in my opinion, with estrogen deficiency. And then when you don’t have enough estrogen you have changes in your gut microbiome. This is published data. Then you do not have proper digestion. You don’t put out digestive enzymes right. You don’t make stomach acid the same. You have more Gerd after menopause. Women surpass men in acid reflux. So there are all these issues are happening to women that are affecting healthy aging.

Peter Bowes [24:22] And the key to this is amongst those women is awareness of these issues that you’ve just outlined. So how many women do you think have a conversation like this with their doctor? How aware are they of those issues that you’ve described, that they will actually ask their doctor for advice and a plan to move forward through the decades?

Dr. Felice Gersh [24:45] Very few. And here’s the other problem. Right now, only 20% of practicing health care professionals that includes doctors, nurse practitioners, PAs were actually in practice at or prior to the time of the big study, the Women’s Health Initiative, which changed, unfortunately, the whole view of hormones. So they had no education in menopause. They have no knowledge of the time before the lost wisdom of the previous, you know, decades that we’re estrogen was revered in all turned around. So they were not taught anything about hormones. They were not trained in menopausal medicine, so they actually were the opposite. They were trained to fear hormones. To think that estrogen gives you cancer when it actually prevents cancer. It’s like the opposite. It’s like everything is like reversed. And so they often will discourage their patients, even the ones who come and say, you know, I heard that hormones can be beneficial. And then the doctor responds, unfortunately, no, they’re really dangerous for you. They’ll hurt you, they’ll give you cancer and they’ll give you dementia and all these things because they were taught incorrectly in the wake of the Women’s Health Initiative. So what’s happening more and more is really from the ground up rather than from the top down. Because more happily, in that regard, women are saying, I need better care, but the doctors are not getting the education yet. That’s one of my goals, is to educate. That’s one of the reasons I’m here at this conference, is to try to educate the doctors and other health care professionals who have now opened the door and want to come in and enter the world of understanding hormones and aging and all the things that can accelerate benefits as opposed to accelerate aging. So, you know, I’m doing my best. I’m trying to create courses and educate. And because the doctors, they were not educated. So and doctors are very busy, so they don’t have necessarily the time to go and take other courses. They’re just getting through the day, going home and then going back to work the next day. So you have to find ways to educate. And that’s what wonderful things like your podcast that they can listen to as they drive.

Peter Bowes [27:18] I hope so, yes.

Dr. Felice Gersh [27:18] I hope so because it’s so important to have not just the population. The patients ask their doctors, but have the doctors then respond with solutions. And and that’s not that’s still it’s still very challenged right now.

Peter Bowes [27:34] You’re right you’ve hit a nerve there, because that is at the heart of at least part of the problem. And that is communication. And it is explaining issues in a way that, well, doctors within their medical community perhaps need to talk more, but relating the understanding and the latest science to their patients in a way that resonates with individuals and the lifestyle that they’re living. And I don’t see that happening a lot.

Dr. Felice Gersh [27:58] No, it still isn’t. So it’s it sometimes is shocking to me that if you go on PubMed, where you have archived all the peer reviewed, published articles from the world, this is like the best tax dollar spending ever. You can find so many scientific articles about how the body works, whether it’s mitochondria, hormones, the gut. the immune system. There’s all this amazing research and published data, but what’s not happening is all of this research being then translated into clinical care. And there’s actually been…

Peter Bowes [28:41] But more than that, the language of a scientific paper, which is way above what most people can get. It’s not anyone’s fault because we’re not trained in reading scientific literature, but the the missing link is the interpretation of those scientific papers into a language and a dialog that actually means something to ordinary people, to your patients.

Dr. Felice Gersh [29:05] Well, it’s funny you say that because actually, that’s how I define myself. I call myself a synthesizer. I take all the research, and then I try to put it together into a cohesive whole that makes sense to. And then to create clinical action. Because what’s the point of having all this research and knowledge that doesn’t get put together into a usable weapon, you know, product that can actually then help people to live better lives. Because why are you just doing research? Just to publish? I mean, you want to then implement all this knowledge into clinical action, and that’s what I’m trying to do. But it’s really difficult because getting the word out, like you said, communication, having doctors who are in practice understand that there’s been a lot of research since 22 or 3 years ago when the Women’s Health Initiative came out. That explains so much more about how the body works, and they’re not getting that information.

TIMELINE [30:06] This episode is brought to you by timeline, the Swiss longevity biotech company, which is pioneering a new category of clinically validated dietary supplements called mitoceuticals to support healthy aging. Mitopure delivers Urolithin A, which has been shown to enhance cellular energy, muscle strength, and the health of our skin. To find out more, go to the show notes for this episode.

Peter Bowes [30:28] So let’s talk about mitochondria, the powerhouse within a cell. Every cell of our body apart from red blood cells. I think there is an increasing understanding of the importance of powerful muscles of energy as we grow older. For lots of different reasons. As you’re getting very old, it can prevent frailty and falling over, which is often a very serious issue as you’re getting into your 70s and 80s. Explain to me mitochondrial health and why you think there is this surge in interest and understanding of how important they are.

Dr. Felice Gersh [31:02] Well, I have actually long been a believer of what is sometimes been called the mitochondrial theory of aging, that basically aging is really just tantamount to losing mitochondrial function. And absolutely, I talk about; What is energy? Well, when we talk about metabolism, that word people understand matters. They may not know what it means, but they know metabolism matters. Everyone wants a good metabolism, right? So what is metabolism? It’s the creation, utilization, storage, distribution of energy. And it’s so critical that as humans, we consume intake energy known as food to match our energetic needs of our body. And of course, that becomes dysregulated in a lot of people for a host of reasons, and they don’t have proper appetite, regulation and so on. That’s all part of the whole energy systems of the body. And then in terms of having the ability to do things like move and think, because like you said, every area of the body needs energy. So if you look at the heart, the heart is working nonstop. You never get a break. When you’re a heart, you know, it has to pump all the time. So it needs humongous amounts of energy. The brain as well. But muscles are the biggest organ that burns glucose, so you need to have a lot of muscle to not develop diabetes. In fact, frailty syndrome is often associated with diabetes, and they’re the most difficult ones to manage.

Peter Bowes [32:39] And that’s often the advice for someone who is pre-diabetic is lift some weights.

Dr. Felice Gersh [32:44] Absolutely. So muscle, if you have a lot of muscle, you have at least the capability of burning glucose and of course fats as well. So but the problem is that if you don’t have the right diet and exercise and hormones, then you’re going to get sarcopenia, which doesn’t get talked about anywhere near enough because there’s no pharmaceutical that you can a prescription drug that is for sarcopenia. And of course everyone knows about bone loss. That’s a very big deal. But the goal is to build bone and maintain bone in the most natural way, not through these kind of some of the pharmaceuticals which they have to stop. Or if you do stop them, you have a lot of problems because you lose massive amounts of bone, because their mechanism is not really consistent with optimal health of the bone. So we want to maintain proper energy for all of these. So you can think because actually if you look at mitochondrial degradation that’s associated with things like heart failure, brain failure which is like dementias and muscle, then you have weakness and then you have lack of balance and strength. So like if you can’t get up from a squat, you’re already in trouble. You can’t if you fall, you can’t get up, you know, and you shouldn’t be able you shouldn’t have to like, use your arms to pull yourself up from a counter, you know, like because you squat down to open the lower drawer. So these are really key things for healthy aging and optimizing health. And they require mitochondria. In addition, mitochondria are about energy. They make energy but they also are more complex. Nothing is as simple as we first thought. So mitochondria also control what’s called the cell cycle. And this is really key because every cell in the body well most I won’t say all some we do have heart muscle that is there from the day we were born. Some of our neurons in our brain are still there from the day we were born. But most of the cells in our body, they have a certain lifespan, and then they die, and then they get replaced from our stem cell pool. That’s why everyone wants stem cells, right? So what controls when a cell dies. And that’s called apoptosis or programed cell suicide. It should die when it’s the right time to die and not too late. Because if you have an old cell that’s becoming very, like decrepit, you know, it’s not working, right? So we call them senescent cells. Some people call them zombie cells.

Peter Bowes [35:28] Zombie cells. Exactly.

Dr. Felice Gersh [35:29] Because these zombie cells that are like dying, but they’re not dead, and they produce a lot of inflammation, and they can develop what are called, like, misfolded proteins. They are not their DNA that they contain become damaged. And they can also turn into cancer cells.

Peter Bowes [35:51] Appropriately named then. So kind of scary.

Dr. Felice Gersh [35:53] They are scary cells. Exactly. So these senescent cells won’t die if you don’t have proper mitochondrial function, because the mitochondria actually like flip the switch that say cell die now. But if not, they just linger and they create so much harm in the body. And one of the things that a lot of people don’t know. I just have to put in a plug for my favorite hormone, estradiol. That estradiol has tremendous effects throughout the mitochondria in terms of the what’s called the electron transport chain, which leads to the production of ATP energy, and also mitophagy, which is like..

Peter Bowes [36:35] I waiting for that word…

Dr. Felice Gersh [36:36] Okay, here it is. Which is like having mitochondria renew themselves and die when they need to die, and then be be replaced because everything needs to be rejuvenated or replaced.

Peter Bowes [36:48] And just to explain, because we’re throwing lots of these jargony words around, mitophagy there’s autophagy as well, essentially the replacement of cells mitophagy specific to mitochondria.

Dr. Felice Gersh [36:57] Right, right. So it’s like amazing the functions of the body to maintain life and health are just so phenomenal. But one of the things that happens so estradiol works for all those those two things. And then when you create energy you get a metabolic waste product like a byproduct called superoxide, which is two oxygens together, which is really toxic. And if it doesn’t get out of the mitochondria, it will literally kill the mitochondria and damage it. And when you have a lot of damaged mitochondria, that sort of underlies a lot of zombie cells, because the mitochondria no longer they create inflammation. They no longer control the cell cycle control when that cell dies that the mitochondria is inhabiting. So it’s a big, big problem. So you don’t want superoxide to just, you know, pile up in your mitochondria. Well, estradiol works with an enzyme that’s in the mitochondria called manganese superoxide dismutase. This enzyme converts superoxide to hydrogen peroxide. Now, hydrogen peroxide is also poison, but superoxide cannot diffuse out of the mitochondria. It’s imprisoned in the mitochondria, but hydrogen peroxide can literally diffuse out of the mitochondria into the cell because the mitochondria is in the cell. And then elsewhere in the cell, there are enzyme processes that convert the hydrogen peroxide to water. So you have O2 to H2o2 and then to H2O, which is harmless water. Without adequate estradiol, that enzyme will not work properly.

Peter Bowes [38:41] So just summarizing on mitochondria, what can we do to aid the processes you’ve just been talking about? We’ve mentioned resistance training, lifting weights. There are other ways that we can boost our mitochondrial health as well, aren’t there?

Dr. Felice Gersh [38:56] Yes. So of the lifestyle things and don’t even I’m not that you do you like magnify in a very good way the benefits of exercise. But that has actually been shown to be incredibly beneficial. And estradiol and in men testosterone. If men’s testosterone is very low, a lot of the benefits of testosterone actually come both directly from testosterone binding to its own receptors and its conversion in tissues to estradiol. So and so men need to have adequate testosterone as they age as well. And then there are some nutraceuticals that have been shown as well. One of the it’s a very interesting byproduct of the polyphenol ellagic acid, which comes from a number of different fruits. And the one that is the most famous is pomegranates. And in the gut, if you are lucky and have the right gut microbiome, which only a small fraction of people do, you can convert the ellagic acid to its next step, which would be the urolithins and urolithin A has been shown to have very beneficial effects in the mitochondria to help rejuvenate, so I think of it as a mitochondria rejuvenation effect. And so that is really, really key. But most people don’t. Actually have the right gut microbiome. Also, most people aren’t eating a lot of pomegranates to be realistic. So these are…

Peter Bowes [40:22] And you’d have to eat a lot of pomegranates…

Dr. Felice Gersh [40:24] Oh yes. I don’t even know what number, but it would be a lot. Just like they say, like for resveratrol, you’d have to have, you know, pounds and pounds of red grapes and nobody can consume that. So I call this green medicine. I use green medicine quite a lot. So green medicine I distinguish from pharmaceutical medicine which pharmaceutical medicine which can be life saving 100%. It can be amazing, but it’s all made of chemicals to create a product that would never naturally exist in nature or in a human body. And green medicine is coming from natural products that exist in nature that are then made into a concentrated form that wouldn’t exist in nature. It’s like concentrated. So it’s like concentrated natural materials that do actually exist. And one of the things that’s also I really like about what I call my natural medicine or green medicine, is that these are biodegradable and people don’t even talk about this. This drives me crazy. Metformin, which is also promoted for anti-aging, that’s sort of iffy. But and that works with the mitochondria too. You know, it’s like the hormesis thing, if people know like a little bit of damage can create some like rebound healing that sort of some of the, the philosophy of, of metformin is that.

Peter Bowes [41:46] Theree’s a lot of work going on with metformin studies, large studies to really to drill down into how potentially beneficial it is for longevity.

Dr. Felice Gersh [41:55] Yes. And of course, I hope it would be a positive. But here’s the problem. Metformin is like a forever chemical. People don’t know that. It does not biodegrade. It goes out of the body exactly as it went into the body as metformin. It goes through the water treatment plants with no change, and it enters into our lakes and rivers. And it’s modifying the genitalia and reproductive functions of wildlife. And this is not a good thing. It’s actually concentrating in estuaries. It’s affecting our environmental ecology systems. And so if everyone is going on metformin, what is that doing to planet Earth? Everyone who’s interested in healthy longevity should be an environmentalist. We live on this planet, you know, and we need to have a healthy planet, and we need to have healthy animals and wildlife, and we need to have healthy plants and everything.

Peter Bowes [42:47] Well, exactly. Healthy plants that we eat as part of this process.

Dr. Felice Gersh [42:51] We can’t be killing our planet. And metformin is not good for planet Earth. I think that that needs to be acknowledged. But other things like urolithin A they’re not going to hurt planet Earth. So this really matters to me. That’s why even like berberine, which is an alkaloid extract from certain plants like Oregon grapefruit and so on, which has some similar effects like metformin. They actually had a study in women with PCOS doing in vitro fertilization, and they compared metformin versus berberine. And in that study, berberine beat out metformin for benefits. So you know, I try if I can, to pick something that’s compatible with optimizing health and for the earth. So you know, that’s the type of thing. So I love you know using fruits vegetable concentrates of their I call them the magic sauce of fruits and vegetables and all plants, the polyphenols. It’s like amazing. And people who go on say a carnivore diet, they’re not getting anywhere near the amounts that they need. So that’s really important. That’s why I love a plant-based diet. And I do think that for most people, that is a best diet. Also the fiber. We know that fiber, fiber, fiber will increase GLP one production, you know, so to manage appetite and weight and so on. So using things like supplements that contain urolithin A are phenomenally beneficial for mitochondria because even when we go on hormones, even when I prescribe hormones, it’s not the same as having a 21 year old set of ovaries. I know that I’m not able to replicate the hormones of a 21-year-old. I’m just doing better. So we need to pull. That’s what I call in my integrative medicine world, a bigger therapeutic toolbox to utilize natural products as well as lifestyle, but also, you know, certain targeted supplements. And I’m always trying to research and look at what’s evidence based and what is efficacious and safe that can help with such things as mitochondrial rejuvenation, because without having healthy mitochondria, you’re not going to get healthy longevity. You’re going to have increased risk for fatigue, heart failure, dementia and cancer. So that, you know, I think we need to really understand the essentials of mitochondrial well-being.

Peter Bowes [45:21] Just in conclusion, Felice. We’ve covered a lot of ground here, lots of different topics. What excites you most about the future in your particular field? The science that you’re hearing about? Maybe something at this conference or a study that’s currently underway. Perhaps it’s artificial intelligence. What excites you about the potential to help people with their longevity as we move forward?

Dr. Felice Gersh [45:46]  Well, actually, it’s very sort of basic is the awareness which goes back to what we actually started with is the phenomenal growth of interest, because we have to begin with interest. And I’m trying to recruit donors to donate money to create studies. But you can’t get money. Like after the Women’s Health Initiative, there was like a real scarcity of studies, and the ones that were done weren’t even done properly because they were done with the same philosophy. So the the groundswell of interest is what I see as the most exciting thing going forward, because with this interest will come research that’s really dedicated to this really critical topic of healthy longevity, because it’s not just about living long as we always talk about it’s living well, and it’s not just living well in your 90s, if you’re going to be living well in your 90s, guess what? You’re living well in your 40s and your 50s, all those other years of life. So it’s healthy life altogether at every decade of life. But without getting more targeted research dollars, in looking at some of the most key things and and really getting the evidence to know how to make the right decisions. We’re just going to be like gambling with like we’re in Las Vegas. Like I’m putting my I’m putting all my money on red and hoping that’s the right answer. But where’s the data? I need data, so I’m most excited about the growing interest in healthy longevity and where that will lead in terms of research dollars and actual data so that I can give the best-informed advice.

Peter Bowes [47:29] I share that excitement. I think the future looks bright and there’s lots, hopefully for you and I to talk about in the future. Felice, it’s always fascinating to talk to you. Thank you very much indeed.

Dr. Felice Gersh [47:39] My pleasure.

DISCLAIMER [47:39] This podcast is for informational, educational and entertainment purposes only. We do not offer medical advice. If you have health concerns of any kind or you are considering adopting a new diet or exercise regime, you should first consult your doctor.