00:00So I want to lead with your experience as a geriatrician, something that you've been trained
00:04in and that was really your primary job for quite a while. And your area of specialty for some time
00:10was frailty. And I think that's such a resonant issue with so many people watching this right now,
00:15not only as something they may be experiencing themselves, but particularly as they watch their
00:19parents get older. We see an entire generation having to care for aging parents. And this issue
00:24of frailty, I think has changed vastly in your time as a geriatrician. Can you tell me a little
00:31bit as you were coming up, what the condition of frailty was really thought of as and what its
00:36causes were? Welcome to The Future You, a new series by Men's Health, where we talk to the
00:41leading experts in health and longevity to help you live longer and stronger. I'm your host,
00:46Rich Dormant. In this episode, we're talking with longevity expert, Dr. Linda Freed about strength
00:51in aging. Well, there's been a huge change, I will say. When I was a young geriatrician,
00:58the chapter in the geriatrics textbook about frailty, I still remember, said frailty is the
01:05raison d'etre of geriatric medicine. It's the central reason for geriatric medical care, which is the
01:12treatment of people in older age as they become frail and the prevention of frailty as well as of its
01:20consequences. And what were we talking about when we were saying frail and frailty? I love it,
01:25because that's the question I asked. Because as I tried to learn that as a dutiful, reasonably young
01:32geriatrician, I realized that we didn't have a standard definition, that people were thinking
01:38about frailty as the same as loss of ability to do the things that you valued in your life,
01:45to accomplish tasks, or extreme old age, or having a bunch of diseases or illnesses. And
01:55when I took care of my patients, it seemed to me there was something else going on that I could see
02:01that these things, other things traveled along with, but didn't seem quite the same as. And so I
02:08actually spent almost a decade trying to figure this out, as putting on my head as a scientist,
02:16as well as a clinician, and came to a realization, which I think stands up to this day. And we did the
02:24science to show it, that frailty actually is a condition, even what clinicians would call a syndrome,
02:32clinical syndrome, that emerges in some people, not everybody, as they get older. And that actually is
02:40a product of your inner biologic systems and physiologic systems no longer working as effectively
02:53as they used to, both in themselves and how they coordinate with other systems. And the coordination
02:59is across systems is particularly important. I mean, if you were not cars, but if we thought of
03:06ourselves as a car, if only we were cars, and how the whole motor runs, and you know that there are lots of
03:13interrelated things going on. And they have to interrelate smoothly for the whole car to go. Well,
03:20we're not cars, but there's some commonalities in that. And frailty arises because of what scientists would
03:30call the interrelated slight and incremental dysregulations of these different systems. What
03:40does that do? It impairs your ability to bounce back. It impairs your ability to replace essential things
03:53like energy when you expend it. I had many patients and study participants who said to me that the thing
04:00that drove them most crazy about getting older was not one or another disease, although those were
04:07often quite problematic, but it was that they couldn't count on having the energy they needed for what
04:14they set out to do in the morning. That's what drove them crazy. And ultimately, what we've learned
04:20is that frailty is a problem of energy. And energy is not replaced with the same alacrity that we count on
04:31when we're younger. Energy is not there to fuel the effective interactions between the different parts
04:38of the system. And it leaves people with decreased bounce back ability and decreased ability to count
04:46on the fact that when you set out to do something, you won't hit an energy wall where you just can't
04:51keep going. Now, you've mentioned that it affects some people, but not others. Is there any understanding
04:57at this point, whether it's genetic or whether it's lifestyle based, who ultimately will have to deal
05:03with these issues related to frailty? So like many things, it's a combination. There are some genetic
05:09components. There are also a lot of lifestyle components. And there are components related to
05:17the physiologic and biologic changes of aging, which are contributed to by both. So it's always useful,
05:26I think, to think about what you could have an effect on. Sure. With or without the genetic. And
05:31again, not just on you, but if you have a parent, say, who's struggling with this. So the two biggest
05:38factors in the development of frailty seem to be that we can readily modify, seem to be inadequate
05:48physical activity and inadequate protein in the diet. Inadequate physical activity is of a particular
05:58kind. So particularly for women who start out with less muscle, lean body mass than men, you don't want
06:07to lose that muscle because it's too easy to get to a point that you're weak. But for both women and men,
06:14you need to maintain your muscle strength. You need to do strength building exercise. That's not,
06:20doesn't mean you have to go out and lift hundred pound weights. You need three and five pound weights.
06:25And this is throughout your life. Throughout your life. But certainly in the second half of life,
06:31you have to maybe start at 50. You have to be, I think, diligent about doing the things that maintain
06:39your strength. I remember a study many years ago, which was quite interesting. That was of women in
06:46their fifties and it showed that women, these women in their fifties who did strength building exercises
06:53then seemed to have the energy to go out and do other stuff too. Whereas women who did aerobic exercises
07:01without the strength building, um, didn't actually take on the world afterwards as, as much too tired.
07:10So yeah, I don't, you know, they didn't explain that in the study, but so we'll both guess.
07:14Yeah. But we need both. And the other is you need a healthful diet, uh, certainly, uh, adequate protein,
07:23which people tend to not get as they get older and very important in combination with, with strength
07:31building exercise to maintain muscle. And I, as somebody who struggles with my protein intake,
07:36I think lots of people do who are mindful of it. How much are we talking here? How much,
07:40you know, if there's a formula or something that we can really aim for to sort of maintain that
07:46adequate level? That's a good question. I don't think I, we have the recommendations yet that,
07:54that match what the science is saying is needed. So I don't have a quick answer, but as much as you can,
08:01eating adequate protein, not to the exclusion of other things, of course, but certainly in two meals a
08:08a day is important. Excellent.
