00:00Okay, so we're starting, you know, almost 40 years ago as a young clinician.
00:05Fast forward to today, you're at the forefront of patient care in this field.
00:09When you look back on your career and at those front lines,
00:13what are some of the biggest and most exciting developments that got us here
00:17to not only extending healthspan, but extending lifespan?
00:20Welcome to The Future You, a new series by Men's Health,
00:22where we talk to the leading experts in health and longevity
00:25to help you live longer and stronger.
00:27I'm your host, Rich Dormant.
00:29In this episode, we're talking with longevity expert Dr. Mark Lacks
00:32about glucose, weight loss, and metformin.
00:35Well, we are beginning to understand the basic biology of aging.
00:41And I never would have said this even five or ten years ago,
00:45but I do think in the next decade or two,
00:48you'll go to your internist, your family doctor,
00:51and you might be taking medications.
00:54And I'm going to be very careful about this.
00:56I'm not going to say reverse aging.
00:58But I think that will delay the effects of aging.
01:03The first medication that you might hear about is a drug being tested called metformin,
01:09a drug that's used for diabetes, pennies a pill,
01:13used in Europe for 40 or 50 years.
01:16And it seems to affect many pathways involved in cell aging.
01:23And there's a large randomized trial now in which many people are going to get metformin or a placebo.
01:30And they're looking at things like the onset of chronic diseases,
01:35getting cancer 10 years later or heart disease 10 years later,
01:38but also things like how quickly you walk,
01:41what your cognition is like, what your muscular strength is.
01:44So this is just one of many medications that are in the pipeline.
01:52And people say to me, well, you know, what's the big deal if you delay the onset of, say,
01:56Alzheimer's disease by five years?
01:59Well, first of all, the cost to society.
02:01And if you pass away from something else,
02:06maybe bungee jumping or rollerblading or doing something you like,
02:10you know, that's a better way to go.
02:13Tell me about SGLT2 inhibitors.
02:15Well, you're talking about the drugs that everybody wants to take?
02:19Yeah, well, I mean, I don't know if you saw the Oscar performances.
02:22You know, Jimmy Kimmel looked down at the beautiful audience and said,
02:26you know, I look at this audience and I think, should I ask my doctor,
02:29is Ozempic right for me?
02:33I think there's an extraordinary relationship
02:36that we don't fully understand between weight and aging.
02:42I mean, you see people who are overweight and sometimes you'll see they look much older
02:46than their chronologic age.
02:52And when they lose weight, the opposite happens.
02:55We're starting to untangle the biology of that.
02:59Metformin is a drug that has been used for weight loss, for example.
03:03And look, besides whatever the biochemistry is,
03:05you don't have to be a doctor to know that if you're running
03:08and adding another 40 pounds to those knees that are getting arthritic,
03:14it can't be good.
03:15And then there's the increased risk factor for diabetes
03:18and heart disease and other cancers, those kinds of things.
03:23Were you surprised by the centrality of glucose in this conversation now?
03:29I mean, we mentioned it when we talk about, you know, things like Ozempic.
03:32We talk about it when we talk about Menformin.
03:34It seems like it's a topic on everybody's mind right now
03:37in a way that maybe it hadn't been commonly about 10 years ago.
03:40I think there's glucose is but one marker of, you know,
03:46metabolic changes as we age.
03:48It's a propensity for people, even if their diet is controlled
03:51and they maintain on your body weight towards pre-diabetes or diabetes.
03:57And there, too, the quantified self has really been important.
04:01So we have a Dexcom now.
04:04We have people now without diabetes.
04:06Those are continuous glucose monitors.
04:07Correct.
04:08And so you don't have to stick yourself as you do in a diabetic
04:11when I was training.
04:13And so now people are looking at their glucose
04:16over the entire course of the day, non-diabetics.
04:20And we're starting to learn a bit,
04:22and your readers will be interested in this,
04:23about the order of foods in which we eat them.
04:26So there have been these fascinating studies,
04:29some at my place at Weill Cornell Medicine,
04:32where the same meal is given to an individual for breakfast.
04:38It's a muffin and some scrambled eggs.
04:41And when you give the muffin first and the scrambled eggs afterwards,
04:45there's this extraordinary excursion in glucose.
04:48If you give the protein first and the eggs first,
04:51and then the muffin 10 or 15 minutes later, the carbohydrate,
04:55that excursion is much lower.
04:57And we're learning about the order of foods
04:59and the relationship between diet and aging,
05:02both at the clinical level and at the molecular level,
05:06is just being uncovered.
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