Find that giggle in life

This interview with Dr. Stone was recorded via remote video on November 8th, 2024.

Kevin R Stone MD (00:01) If you’re gonna go exercise in order to build your body strength or your posture or your ability to play a sport better, go ahead and find a fun playmate to do it with, a game out of it, gamify it the way all the kids would on technology. Find ways of making it fun and go play out every day. 

Peter Bowes (00:24) Hello again, welcome to the Live Long and Master Aging podcast. My name is Peter Bowes. This is where we explore the science and stories behind human longevity with the goal of mastering the aging process. Now, as we get older, aches and pains are probably the most common complaint. The mind is willing, but the body isn’t always. Knee pain, hip or back pain that starts when we reach a certain age and means that all of a sudden we feel as if we can’t enjoy the level of exercise that we did when we were younger. Where do we start trying to either prevent or at least mitigate these irksome problems? Let’s talk to Dr Kevin Stone. He is an orthopedic surgeon and founder of the Stone Clinic in San Francisco, beautiful San Francisco here in California, and also the author of Play Forever, How to Recover from Injury and Thrive. Kevin, it’s good to talk to you.

Kevin R Stone MD (01:23) Thank you for having me.

Peter Bowes (01:25) It is a dilemma, isn’t it? As we get older, we want to continue exercising, but we want to continue to be injury free at the same time. And it seems, and I’m a classic example, the two don’t always go together.

Kevin R Stone MD (01:35) You know, they do, it’s interesting what you said in your introduction, which I think we’ll have some fun playing with a little bit, that the mind wants to, but the body won’t comply. And actually what we find more commonly in our athletes who are aging is that the mind tends to go first a little bit, meaning you lose your motivation to really push yourself. You forget how much fun it was to get out and exercise every day. You’ve forgotten that testosterone rush, that energy rush that made you feel young. And what happens is that you tend to just not be quite as motivated as you were when you were younger. And we find if we can work with you and re-stimulate that excitement of exercise, that desire to do more, then we can be very creative about how we work with the various injuries and arthritis that we all have. And our goal, of course, is to have you drop dead age 100, playing the sport you love. And so we want to share that journey with you.

Peter Bowes (02:38) I wonder if that lack of motivation that you describe, is it sometimes out of a fear of not being able to perform knowing that those aches and pains might be sort of lurking in the background?

Kevin R Stone MD (02:50) Sure, and it’s fear, it’s bad advice, it’s just easier not to sometimes as you’re getting older. You think, hey, it’s challenging. And you feel like you deserve the downtime and sort of all those things that happen when you start to get a little bit older and let age define who you are and what your activities are. And our job is to help you not do that.

Peter Bowes (03:18) Well, that’s the classic issue, isn’t it, of age defining people. And of course we have, and maybe there are societal reasons for this, but we have a certain image of what it’s like to be a certain age and we hit 50 and we hit 60 and we feel as if almost we should be behaving in a different way. But as I say, in the background is that urge just to be able to do what we used to be able to do.

Kevin R Stone MD (03:41)  So it is, and so one of the really great things to our older athletes is that they’re much smarter about how they exercise. So let’s step back a little bit a few decades and look at an older athlete, meaning our women athletes are runners, are endurance runners, who are women, very often didn’t start endurance sports until they were 35 or 40, and then progressed into it into their 60s and 70s and even 80s now. So what happened, and what happened I think was, number one, they reached an age of maturity where they could understand their own body, they could work with their body, they understood pain, they understood time on the trail or time in the endurance sport. They became comfortable with what their bodies felt like when they were pushing themselves harder than they may have ever pushed their entire lifetime, other than maybe childbirth, of course. So we learn a lot from our women athletes who took up endurance sports. And it’s true for all of us. As we’re older, we’re smarter about what we can and can’t do. We’re smarter about how we approach our sports. And if you can just keep the motivation to do it, I think you can enter into things that you really didn’t think you could. So one of the things we like to tell people is think about a new sport or a new activity every six months. Not to abandon your old ones, but to just pick up something and try something new every six months, even if it only lasts for a few tries or a month or two. Just keep adding to your repertoire of choices that you have when you roll out of bed in the morning and want to go play.

Peter Bowes (05:27) That’s an interesting idea. Just before we delve into that in a little bit more depth, Kevin, just tell me a little bit about yourself. And I know you’ve involved in a lot of sports over your life and your career as well. And what really what’s brought you to this point in your life?

Kevin R Stone MD (05:42) So I was a college athlete who tore his meniscus cartilage, that big shock absorber inside all of our knees. And I admired the doctor who took care of me back in college. Unfortunately, he took out my meniscus. And that’s a very common story that I hear from thousands of athletes every year. Hey, doc, I injured my knee in high school or college sports. The doc took out the meniscus, and now I have arthritis 10 or 20 years later. So that episode for myself motivated me to go into orthopedics and specifically to figure out how I could replace the meniscus cartilage in people’s knees, thinking I would make a big contribution to orthopedics if I could figure it out. And so that’s defined my research career. I have a clinic here in San Francisco called the Stone Clinic, and I also have a public nonprofit research foundation. So every time we’re doing something for an athlete, we’re studying the outcome. We’re pushing for the science of how we do this. So specifically, we just published a paper this past month in the Journal of Arthroscopy on meniscus replacement in patients over 50 who were referred for partial or total knee replacement. So what that means is they came in with arthritis in one part of their knee or all of it. We looked at their knee and determined that there was enough joint space remaining that we could put back a new shock absorber rather than do a artificial joint replacement for them. And then we followed those patients and half, about 40% of the patients got about eight years of delay before they went on to the prescribed partial or total joint replacement. And the other group of patients never went on to a joint replacement in the two to 25 year outcome study that we just published. So we know contrary to classic orthopedic thinking, that meniscus is just critical to your joint and you can put new shock absorbers back in older knees and you can encourage people to get back to full sports. Now the flip side of that conversation is that I have many athletes who are older and have already had a partial or total knee or planning to have one and they’ve been told to give up their impact sports or give up their skiing or their singles tennis. And what we’ve learned through robotics because the precision of robotic surgery now and the ability to get rid of the bone cement for these total knees. It’s permitted our patients to go back to full sports and full activities. unfortunately for the folks listening to your show, they no longer have any excuse to give up the fun sports that they really would like to get back to as long as they can get these injuries and arthritis treated properly and really get back in play. So. We’re excited about this space. We’re very actively involved in the research around these therapies. And we encourage your listeners and others to seek out the newest therapy and information that’s going on here. So it’s not just about longevity. It’s really about playing until the day you drop.

Peter Bowes (08:52) I think one of the issues for some people is they probably know and they hear about these new treatments from interviews like this and maybe marveling at what can be done. But it’s making that initial decision to seek some advice. And they might be moving into their 60s and just feeling a little twinge in the knee or the hip and thinking, well, I’ll put up with it for a little bit longer. At what point or what is the best point? Is it never too early to seek advice? See if something can be done quite early before it gets too serious.

Kevin R Stone MD (09:24) So I’m biased, and you always need to know the bias of your surgeon or your physician. I want to see an injury the moment you have it, because if I get fresh tissue to repair, my surgical repair of it, if it needs surgery, or my injection therapy to stimulate your own healing, it’s going to work just that much better. So anytime I can encourage you at the moment you have an injury to get a very accurate diagnosis, is this something that needs care? Is this something that will heal on its own? Is this something that needs an injection or is this something else? it’s really helpful to the surgeon who cares about helping you get back to play. So it’s very tough to know when you really need to go, but here, let’s give a few stories. So doc, I injured my knee. I heard a pop and then my knee swelled. So that combination of three things injured, heard a pop, knee swelled. That’s a 90 % chance of you having torn one of the critical structures inside your knee that will need repair. The other story, the other side of it is, hey doc, I went back to skiing this winter and my knee aches on the chairlift or the front of my knee kind of hurts. Well, that’s very commonly a patellar tendonitis, a little inflammation or pain at the front of the knee because you probably haven’t been training in the skiing related sports activities that you now just jump back into. And very often a little good massage therapy and soft tissue massage and stretching will cause that to heal all on its own. So there’s a nice range of things. I wrote a book called Play Forever, which is on Amazon or here at Stone Clinic. And I try to cover a lot of those topics to help people understand when do you need to see the doc and when can you wait.

Peter Bowes (11:14) And what about the dilemma that I know a lot of runners in particular have and sometimes told, look, you can’t keep running at the pace and the distance especially that you’ve been used to, especially marathon runners. know for myself, I run a lot of marathons and then started running in triathlons because there was a little bit less of the running and more of the biking and swimming. It just felt easier on the body. But is that something we need to consider as we grow older that perhaps too much running isn’t necessarily going to be good for us?

Kevin R Stone MD (11:44) So you just said it perfectly. It’s really about volume. And so if you’re a runner and love to run, if you can modulate your volume by introducing swimming, biking, weight training, other things into your training program so that when you go to run, you’re running with good mechanics and good pleasure and just optimizing your time on the road or on the trail rather than just going and running. It’s so easy to…roll out of bed in the morning and throw on the running shoes and go. But if you can roll out of bed in the morning and mix up your, those workouts. I’m a big fan of pool running. so years ago, I, we have a pool and just go side to side in that pool. do 20 laps each day and I can, and I try to do those 20 laps a little bit faster each time with the good running form, high sprinter form. And what that does is it gives me all the running mechanics without the impact of the road. And that’s a great way to mix up your running activities and enjoy the sport. Another good way when you want to be on the road but not having so much impact is there’s a device called an elliptical. It’s like an elliptical machine, but it goes on the road on wheels. That’s another, most of my runners find that as close to running as they can imagine without actually running. So your point about shifting from marathons to tries is such a good one. Think about all the various ways that you can also shift your running and impact activities. So we don’t want you to give them up, particularly because as you age, women more than men lose bone mass and lose muscle mass. And impact exercise is by far the best way to build bone mass and build muscle mass. And so it’s very important that you don’t give up these impact sports. You just find smart ways to do them.

Peter Bowes (13:36) Exactly, because frailty in its various forms is probably one of our biggest enemies as we grow older if we don’t have that bone mass and that muscle mass especially. That frailty happens and then just in the everyday activity that we’re getting involved in we could trip, could fall over and we can’t stabilise ourselves and there so many good reasons behind what you’re saying there.

Kevin R Stone MD (13:59) So let’s talk about that last point you just mentioned, know, tripping and falling over, because it’s clearly one of the big fears of our aging athletes, and clearly for very good reason. If you break your hip as an older athlete from a fall, it really does shorten your lifetime and your life enjoyment. So what does that do to? And it’s due in part due to loss of balance and something we call proprioception. So your ability to know where your body is in space, your ability to land from a jump or a fall and have balance as you do so. And so one of the really important things to mix up, especially if you’re a runner in your running program, is proprioception and balance exercises. So the least expensive way to do that is to just throw your pillow on the floor and do a one leg, like a stork stance on top of that pillow. You’d be surprised how unbalanced that is and how much you have to use all the little muscles in your feet and your lower leg to maintain your balance. And then try to do that with your eyes closed and it becomes even much more difficult. More fun ways to do it are to get out on a stand up paddle board, so a surfboard that you’re standing on or the paddle. A million little balance exercises happen each time you do that. And there are a ton of other exercises with trampolines and unstable boards that you can do, but think about making it fun because we’ve learned over the years if it’s fun, you’ll do it and if it’s not, you probably won’t.

Peter Bowes (15:21) Yeah, exactly. And just going back to the idea of maybe doing a little bit less running, taking up triathlons, including the swimming and the biking. We’re all different. And of course, what isn’t right necessarily good for one person isn’t going to be the right kind of attitude for another person. And we hear stories, we see stories of 90 year olds who are still running with the same sort of aggressive attitude as they did when they were 60 or even 30. They’re probably the outliers. But it is a good point, think, isn’t it? That we are all individual. That’s probably why we should all get individual advice.

Kevin R Stone MD (15:53) Yes, but there’s one commonality amongst all of us, and that is that almost everyone loves to play. And so if you can find the fun in each of your sports, each of your activities, in your running, in your tries, in your bike training, in any of it, all of us love to play. And the 100-year-old patient that I have just has a giggle on his face. And a 100-year-old woman that I have, 103 years old. She comes in smiling and everybody in the office smiles when she walks in the door. She’s found that giggle in life. And if you can instill that into all of your activities, sure, times when you’re aching and you’re sore and you’re even injured, it’s hard to put that giggle in there. But if you can, you’ll be surprised how much faster you heal and how much more fun you have.

Peter Bowes (16:44) It’s interesting you phrase it like that, talking about having fun as opposed to exercise or indeed movement or playing sports, just framing it as fun, as enjoyment, I think does give us a different perspective.

Kevin R Stone MD (16:56) So let me also encourage you to get rid of the word workout. Playout. If you’re gonna go exercise in order to build your body strength or your posture or your ability to play a sport better, go ahead and find a fun playmate to do it with, a game out of it, gamify it the way all the kids would on technology. Find ways of making it fun and go play out every day. Take the workout words out of your calendar, because who wants to go work? We wanna go play and we wanna go play all the time, we wanna play forever, which is why I titled the book that way. So I think that’s a real simple way of just having a good reminder, what am I gonna do today? How do I make it fun? Who else can I do it with? And that last point’s very important. We find that all athletes of all ages will do their sport better, will do their training better, will get stronger, will stay healthier when they play with a partner. And so if you can find a playmate, if you can find a coach, if you can find a team, if you can find a group, find anybody that emboldens you to do a little bit more, to do a little bit more often, and to put the joy in it, you’ll do better.

Peter Bowes (18:06)

Yeah, I couldn’t agree more. And we learned this during the pandemic, didn’t we, that the social interaction aspect of just going to the park and walking with people, well, we couldn’t go to the gyms then, but just getting out and being with other individuals, how much we missed it then and how important it is to us now, and not only for physical health, but of course, mental health as well.

Kevin R Stone MD (18:27) for sure.

Kevin R Stone MD (18:28) No question.

Peter Bowes (18:29) So let me ask you, what, based on your decades of work, what are the common misconceptions that people have about getting out there and just moving or taking exercise, if you want to call it exercise, what are the misconceptions that maybe hold people back? And I’m thinking of people who really don’t do very much activity because they have certain ideas about it that it isn’t going to be right for them.

Kevin R Stone MD (18:54) The first one is that you can stay fit a couple of times a week with exercise. We really have learned years ago and encourage all of our patients post-op or here just for fitness training to play every day. Do something every seven days a week. Why? Because if you start out that way, you become addicted to the good testosterone and pheromones and adrenaline and feeling of sweat and all of those wonderful things that seduce us into the love of sport. And then what happens is you miss it if you get a day when you can’t get out there for whatever reasons. So it’s very important early on to do something every day. And if you become addicted to that habit, you’ll find for your lifetime, you’ll always be trying to find a way to go out and play, go out and do something fun that day. If you see it as something I just do once or twice a week or on an appointment basis only. it really is much less effective and really not a long-term way to keep that going. So I’d focus right off the bat on getting rid of the idea that exercise is an appointment. Exercise is really a lifestyle. It’s an addiction. It’s a feeling. It’s all the things that we love about living long and happy. And I think that’s important to do. You wouldn’t skip a day of eating, except unless you’re fasting for some reason. Never skip a day of exercising and playing out. That’s the first most important thing. There are others. Go ahead. The other things are just looking at when you’ve been told you can’t do something. you can’t run because you had this surgery or you had this implant or you had this whatever, or you can’t play tennis because you have this or that. Sit down with your trainer, your physical therapist, your doc, whoever is your best coach and say, listen, I’ve been told I can’t for that reason. But can we be creative and permit me to do it a whole bunch of other ways? And you’d be shocked. mean, whether it’s as simple as shifting hands with a tennis racket to your left arm from your right and learning how to play lefty, whether it’s, you know, pick your way of being creative. But one of the fun things to sport is that there’s almost always another way to do it. And unfortunately in medicine and in counseling, it’s so easy to say, well, don’t go do that anymore and find another way to be happy. That’s not a great way to communicate, I think, and not a great way to look at life. Just look at life as each challenge. There’s probably a creative way for you to accomplish what you want to accomplish. Find the people around who will help you figure that out, because there’s almost always a way.

Peter Bowes (21:28) For those of us who are time challenged, of course many people will use the excuse that I just don’t have enough time in the day or the week to fit in, exercise. I mean, from your example, how do you manage to balance, and you have a very busy life as a doctor, as a surgeon, but how do you manage to balance the time that you need to enjoy and have fun and to play and enjoy the physical activity with the rest of your life, which is equally important in many ways?

Kevin R Stone MD (21:58) Yeah, it’s a question I get asked a lot. I used to answer in a little bit of a flip way that I find a lot of time in every second so I can maximize my output. But that’s actually, I’ve learned as I’ve gotten older and more gray hair, that’s actually not a great answer and it’s not a great way to live either when you’re constantly packing in as much as you can in every second. So I think the first thing you really need to do is sit down with the people around you who are the key in your life, whether that’s family or your colleagues at work or your…whoever matters in your day every day, and say, look, let’s make this a priority, not just for me selfishly, but for everybody around us. And let’s just say every day, the way we take a lunch break, we take an exercise play break. The way we get up in the morning and have breakfast or coffee, before we do that, we do something together or do something on my own or whatever. So I find a way in every day to make that play out time really important. I miss it if I miss it. And I just think once you, you know, it’s the old expression, if you ask a really busy person to help you get something done, they almost always find a way to get it done. If you ask somebody who doesn’t have too much to do, there’s always some reason why it’s gonna be next week that they’ll get it done. So just look at yourself and realize that if you’re busy, you’re probably good at doing a lot of things. And then just think through your priorities.

Peter Bowes (23:20) And in terms of orthopaedic medicine, and you touched on this a little bit at the beginning, but what is exciting you now in terms of the treatments that you can offer people and looking ahead to the future? You mentioned robotic influences on what you do. What’s the most exciting development that you’re looking at?

Kevin R Stone MD (23:42) So there’s three areas that I’m particularly jazzed in. First is that this whole space of stem cells that we’ve all heard so much about and over the last 10 years many of your listeners I’m sure have gone to Mexico or the Caymans or Europe and had stem cells injected into one part of their body or even in the United States had their bone marrow or fat aspirated in cells grown up. And it turns out that while that might have been helpful for some, it really wasn’t very helpful for a lot of people who spent an awful lot of money and time trying to get that to work. And that’s because each of us, young people and old people, all have billions of stem cells within their body. Younger people have more, but you still, as you age, have billions of them. Otherwise, you wouldn’t repair from a cut or an injury. So our job in the research side of this world and clinical side is to figure out to mobilize your billions of stem cells that are already within you to get them to the site of injury or to the site of arthritis or wherever it is that we need to stimulate or repair. And we’re getting better and better at these injections which mobilize your own stem cells. So that’s that one area of regenerative medicine by injection therapy is growing very rapidly. And I have a remarkable number of patients who come in my clinic each year with these horrible looking x-rays that you would think, that has to have a joint replacement. And they say, hey doc, I’m not letting you operate on my knee until that injection you gave me doesn’t work anymore. And it gets me all the way through ski season. So I want it today and I’ll see you next ski season. And I can’t tell you how often I hear that in the clinic. So that one area of injection therapy is very potent. The second area is tissue replacement. So we’ve gotten very good now replacing the meniscus, replacing the ACL, using donor tissues, regrowing the articular cartilage, the bearing surface of people’s joints that we used to think we couldn’t regrow and now we can. So we can’t do that in every joint. There some that are too worn out to do that in, but it’s an active field of research and clinical activity that we do in clinic and other clinics you’re doing around the world. And then the last area that’s super exciting for all of us is the advancement of robotics. So, I’ve been doing orthopedics now for about 35 years. I was doing partial and total knee replacements for almost 20 years before I got a robot. used to think I was pretty good at it. It turns out I was nowhere near as accurate or precise as I could be. Once we did 3D modeling of the knee and had robotic arms to remove only the limited amount of bone that we needed to remove to put a new metal cap on the end of a femur or a tray on top of the tibia. So robotics has gotten so much better made me as a surgeon so much more precise that I can now use total joint replacements that don’t have any cement at all. The body’s own bone grows right into them, and once it’s part of the patient, they can go off and play sports as much as they want. They’re not going to knock it loose. So I think these three areas, injections, tissue replacement, and robotics, are dramatically changing the whole field of orthopedics and empowering people of all ages to be able to continue to play.

Peter Bowes (26:56) And on the robotics side is artificial intelligence coming into play there as well.

Kevin R Stone MD (27:02) No question. There’s no question in my mind that you won’t see a doctor next year where you are not AI enabled, meaning your Siri in your pocket, your voice agent will remind you of all the things you forgot to tell the doctor or some drug reaction you had years ago or something else that was important to you. And the doctor won’t be AI enabled. The doctor will have a Siri like voice agent listening to you when you talk and reminding the doctor of some other drug interaction or therapy that could use or the latest, greatest knowledge about this topic or the other. Why should that doctor be sitting there with only their knowledge in their pocket when they could have the world’s knowledge in their pocket? And so this interaction is evolving very quickly. We’ve been experimenting with different versions of it here in the clinic now for a few years, also on the research side of it, and it’s getting better and better. So expect that next year you’ll be a more potent patient and your doctor can be a more potent doctor as well.

Peter Bowes (28:03) It’s actually quite mind boggling, isn’t it? The speed at which things are moving. I know my doctor is just on a fairly simple level using AI just to listen to the conversation that we’re having and to summarize it. Just the note taking part of a doctor’s job. it goes much broader than that, doesn’t it?

Kevin R Stone MD (28:20) It’s Fantastic.

Peter Bowes (28:22) So moving ahead, and this podcast is about human longevity. It’s about aspiring to a longer HealthSpan, it’s something I talk about all the time, is HealthSpan versus Lifespan, which I know you’re very well aware of. I’m just curious in terms of your own life and a very active life and your attitude towards your own HealthSpan. What is it that you do every day that maybe you didn’t do even just five or 10 years ago, based on the knowledge that you have, that will help you to pursue a better, healthier life for hopefully many decades to come?

Kevin R Stone MD (28:55) I think just the way we spoke earlier about the smarter athlete, I think as you age, getting smarter about reducing your stress, being calmer about the number of things that are on your plate to do that you can’t get to do, or the number of things going on in your life, either within your own body that are stressful or in your family or your friends. And I think just adopting a calmer approach towards these things will most likely decrease your whole inflammatory status, which we’re all very attuned to as a primary common pathway in aging and destroying our health and our enjoyment later in life. So I would tell you, just like the female athlete at age 35 who discovers running for the first time and goes and runs 100-mile events, you at every age can learn from that experience that you can do extraordinary things if you have a calm mind. But if you don’t, any little thing that disrupts the game plan will throw you off your game and disrupt your enjoyment.

Peter Bowes (30:01) Just to dive into that a little bit, in terms of joining the dots between the inflammatory pathway and the calmer, more stress-free lifestyle, I think it’s sometimes going be difficult for some people to actually get that there could be a physical advantage to a different mental attitude.

Kevin R Stone MD (30:22)

So the whole story of inflammation is a really complicated, really fun one. You need inflammation. If you have an injury, your body has inflammation, rushing of blood vessels and cells to that site of injury, carrying away of the broken tissue, a laying down of new collagen, a remodeling. That whole process is initiated by the first inflammatory act that occurs with the injury. And it’s true in so many other settings. Unfortunately, inflammation also can become chronic where instead of it resolving and you having natural tissue healing, you have a chronic inflammatory tissue or you have a disease that stimulates inflammation like an arthritis where the joints stay inflamed and swollen and sore. So there’s this wonderful dance between how much anti-inflammatory medications, foods, activities do you do and where is the benefit versus where is the negative part to it. So a good example of that is each of us have millions of cancers that pop up, mutations that pop up within our billions of cells every day in our natural inflammatory system, whether it’s the immune system or otherwise, identifies those, shuts those down, wipes it away, and you never know it. So the question is, if you ramped up your anti-inflammatory skill set, would you potentially permit abnormal things to occur and run wild. And we don’t have any idea yet, but there is some critical balance between anti-inflammatory therapies, diets, vitamins, activities, and the natural healing ability of recognizing an injury or disease. And so we think we’re getting better at that. Many of your listeners who have had any type of cancer where fantastic new immune therapies have come along to target that specific cancer with a specific antibody to wipe it out are very knowledgeable about how this whole system is working to our advantage today. But I can tell you, even in sports injuries and arthritis, tuning up and fine tuning where we permit a degree of inflammation and then where we shut it down is a big part of maintaining a lifespan for all of us. I think from the health point of view though, the mind controls so much of the body’s responses. And to the degree that you can calm your mind, you can use all of your resources in ways that might be extremely helpful.

Peter Bowes (32:59) Yeah, I think that’s really interesting. And how much weight do you put on the other pillars of good health, which I usually describe as being sleep, often putting that number one, because if you don’t get enough sleep, everything else seems to go wrong in your day in terms of exercise, diet, your nutrition, and we’ve touched on this social connections, but it’s a complex jigsaw, if you like, in terms of putting all these pieces together. How much weight do you put on nutrition sleep and as I say the social side of just being alive.

Kevin R Stone MD (33:30) They really go hand in hand. It’s not like you can, not like I can weight them differently for people. think when you’re exercising daily, when you’re eating food as fuel, so you’re eating the right amount to permit you to do the things you want to do, and not anymore, not any less in a sense. When you’ve fine tuned the balance between your food intake and your exercise output, when your muscles feel that little electric feeling of exercise and strength. When you get a chance to exercise each day so that when you go to bed at night, you can calmly go to sleep. When you frame your mind in that calmer mindset, whether that’s using meditation or yoga or other ways of learning how to quiet the busy mind, then sleep becomes so much easier and better for all of us. And so while it would be lovely to say, just work on your sleep hygiene, make sure your setting is great, your partner’s great, the lighting’s great, you haven’t looked at a computer before you went to bed, you’ve given up. That would be wonderful, but if you haven’t exercised that day and you’ve overeaten and you’ve done other things, you’re probably not gonna sleep well anyhow. So I really think that having the story together about how do you as a person take this moment in time and take an inventory of who you are, what you are, what your strengths and weaknesses are physically and mentally, and then say, okay, here’s my training program for my whole body. Here’s how I’m gonna get to where I wanna go, and here’s the other people in my life who can help me get there. Then I think you really have a shot at having a whole body fitness program that we admire.

Peter Bowes (35:10) about your own longevity aspirations? You mentioned those centenarians that come into your office and often with a smile on their face. Do they inspire you?

Kevin R Stone MD (35:20) They do, they’re better than I am. When you ask them, when you ask so many of them how you got to where you are, that little giggle that people have, it’s almost universal. I’ve never really met a grouchy old person older than 100. They just don’t seem to be. I think they didn’t get there. I think they early on created that mindset or adopted or had it or were born with it that permitted them to get to that stage. For me personally, it’s sort of like exercising every day. It’s taking a little inventory, how can I be better? How can I push my science better? How can I push the medical care I gave for patients better? How can I be a better surgeon? But how can I also be a little better athlete? How can I be a better person within myself? How can I be a little calmer? How can I make sure that every moment I appreciate? And when I do that well, I sleep better and life’s going on better and I think the future looks brighter.

Peter Bowes (36:16) I think that’s a great way to end this. Kevin, really inspiring conversation. Thank you. I’m going to put in the show notes for this episode, some links to your practice and your book. And also there’s a transcript of this conversation. But thank you. Inspiring and thought provoking conversation. I appreciate your time. Thank you.

Kevin R Stone MD (36:34) Great to talk to you, Peter.