How Not to Age: The Scientific Approach to Getting Healthier as You Get Older

by Michael Greger

Don’t cook with salt or add it to food. The food may taste a little bland when you first start skipping the salt, but, within just two to four weeks, the salt-taste receptors in your mouth become much more sensitive so the flavor of your food improves. After two weeks, you may actually prefer the taste of less salty food.2171 Play around with pepper, lime, onions, basil, garlic, tomatoes, thyme, sweet peppers, parsley, celery, chili powder, lemon, rosemary, smoked paprika, curry, and coriander to find new, deeper flavors to enjoy.

Potassium chloride is “generally regarded as safe” by the Food and Drug Administration (FDA).2193 The reason healthy people don’t have to worry about getting too much potassium is that our kidneys just pee out the excess.2194 However, people with known kidney disease, diabetes (since diabetes can lead to kidney damage), severe heart failure, or adrenal insufficiency, and those on medications that impair potassium excretion need to be careful.

The largest lifespan gains would be made by eating more legumes, then whole grains and nuts,

Tied as the second healthiest beverages were tea and coffee, preferably without sweetener or creamer. And the top-ranked drink? Water.2221

a daily recommendation for drinking four to seven cups of water for women

The Healthiest Type of Milk There is a constellation of new choices in the dairy case these days, with milks made from everything from almonds to oats,2259 so much so that major dairy corporations are going out of business.2260 Of all the options, soymilk is probably the healthiest.

I covered hibiscus tea in the AMPK chapter and chamomile in the Glycation and Inflammation chapters. Rooibos, also known as red tea or redbush tea, is another notable herbal tea that may have anti-aging properties.

I review optimal tea brewing techniques in see.nf/red. Red tea should ideally be simmered2284 for at least five minutes.2285 Brew black tea for four minutes,2286 green tea for three minutes at 85oC (185oF),2287 and white tea for seven minutes at 98oC (208oF).

Surprisingly, bags are better than bulk, because the leaves in tea bags are much more finely chopped, allowing for greater extraction.

Those in the olive oil group and especially the nut group, however, did have significantly fewer strokes.

sweet potatoes have been shown to exert both acute and chronic anti-inflammatory effects

It turns out that non-soy beans, including lentils, lima beans, navy beans, and pinto beans, can drop bad cholesterol levels as effectively as soy protein—an eight-point drop in LDL cholesterol,2578 compared to five (mg/dL) for soy.2579 But, if you separate out the studies, natural soy products, such as soymilk and soybeans, really do seem to pull ahead, leading to an average eleven-point drop in LDL

To describe nutrients that may not necessarily be essential for life but may be required for long-term health,2602 famed biochemist Professor Emeritus Bruce Ames coined the term “longevity vitamin” and identified ergothioneine as a likely candidate.2603 Of more than a hundred compounds measured in the bloodstreams of thousands of individuals, the one most associated with the lowest rates of disease and death was ergothioneine,2604 thought to function as a potent intramitochondrial antioxidant.2605 I review what it can do and the best way to get it in see.nf/ergo. In short, mushrooms and tempeh—a fungi-fermented soybean cake—are the only concentrated dietary sources.2606 Porcinis lead the pack, with about three times more ergothioneine than oyster and shiitake mushrooms, which in turn have about three times more than the typical white, cremini, or portobello varieties.2607 Ergothioneine may explain why mushroom consumption is associated with a lower risk of dying prematurely from all causes put together.2608

Of course, to be effective, a reishi mushroom supplement presumably needs to actually contain reishi mushrooms. No thanks to the 1994 Dietary Supplement Health and Education Act, the supplement manufacturers themselves—as opposed to the FDA—are responsible for the safety and integrity of their own products.2626 You can imagine how well that has gone. Out of nineteen reishi supplements tested, none contained actual reishi.

compared to placebo, a quarter teaspoon of garlic powder can dramatically improve artery function2631 and slow the progression of atherosclerosis.2632 Garlic can also significantly lower cholesterol2633 and blood pressure.

those fancy Kyolic aged garlic extract supplements? They’re up to thirty times more expensive and don’t seem to work at all.

For thousands of years, ginger has been used to treat disease in China and India.2641 In India, in fact, it’s known as maha-aushadhi, “the great medicine.” Of course, Indian and Chinese systems of medicine have both also prescribed mercury,2642 so there are limits to what we can glean from “traditional use.” That’s why we have science.

When ginger is dried, fresh ginger’s main pungent compound 6-gingerol is converted into 6-shogaol2659 (from the Japanese word for ginger), which may be even more potent.

When people were fed just a pinch of turmeric a day, DNA damage rates were cut by 55 percent.

out to find an adequate dose for this age bracket, and it seems most need at least 650 mcg to 1,030 mcg a day, so I recommend 1,000 mcg of cyanocobalamin a day for everyone after age sixty-five, ideally as a chewable, sublingual, or liquid supplement.2849 Absorption is boosted when B12 mixes with saliva, because we secrete a B12-binding protein

Sleeping pills are a nonstarter.

Normally, around bedtime, there is a drop in our core body temperature,3038 which seems to be one of our cues that it’s time to sleep, but late-night munchies may interfere with that. In that case, wouldn’t taking a hot shower be counterproductive? No. The moment you step out of the bath, the rapid decline in your skin temperature can enhance that natural nighttime drop and actually improve your sleep.3039 Just soaking your feet in a warm bath may help you fall asleep about fifteen minutes faster.

Footbaths have been called a “safe, simple, and non-pharmacological method to improve sleep quality.”3041 A meta-analysis of trials found that enjoying a warm shower, footbath, or full-body bath for just ten minutes one to two hours before bedtime can help people fall asleep more quickly and sleep better.

A quarter teaspoon of ground lettuce seeds beat out placebo in a double-blind trial for improving sleep quality.

When stressed, the majority of people not only eat more3078 but they tend to gravitate toward foods high in calories, fat, and sugar.

Once you control for these secondary mediators, the significant link between stress and mortality does appear to disappear.

I was reading about the potential mechanisms by which our animal companions might improve our survival after a heart attack when I ran across a passage about a “profound” cardiovascular response when petting dogs or horses. “This response usually takes the form of a significant reduction in the heart rate and blood pressure.” I could totally see that. But then the next sentence made me do a double take: “Unfortunately, we have no information about the physiological responses of the person doing the petting.”3104 The researchers were talking about the heart rate and blood pressure of the animals!

In just a dozen years, expert panels shifted from suggesting widespread calcium supplementation to prevent osteoporosis3150 to telling patients “do not supplement,”3151 the suggestion still in effect for most people today.3152 I detail what happened in my video see.nf/calciumsafety. In short, calcium supplements appear to raise the risk of heart attacks and strokes3153 by leading to unnaturally large, rapid, and sustained calcium levels in the blood3154 that increase the risks of abnormal clotting.

Basically, evidence suggests that dietary calcium intake is not something most people need to worry about,3157 given our body’s ability to absorb more and excrete less at lower intakes.3158 Don’t push it too far, though. Once you get down to just a few hundred milligrams per day, you can suffer significantly more bone loss.

In individuals sixty-five or older, the greater the estimated ratio between acid-forming foods and alkaline-forming foods, the greater the risk of hip fracture.3193 (To see which foods are which, see the figure here.) To prove cause and effect, two-year randomized, double-blind, placebo-controlled trials were performed in which three added servings of fruits and vegetables3194 or the equivalent of six failed to have an effect, but nine daily servings of fruits’ and vegetables’ worth3195 of an alkaline-forming compound (potassium citrate) was able to successfully increase bone volume and density.3196 This shows that buffering the dietary acid load of a typical Western diet with enough fruits and vegetables may help prevent bone loss.

Inflammation and oxidative stress may also play a role in osteoporosis. The intake of pro-inflammatory foods3197 and an elevation of inflammatory markers in the blood, such as C-reactive protein, are both associated with osteoporotic fractures,3198 and postmenopausal women with osteoporosis tend to harbor greater signs of oxidative damage and fewer antioxidants in their blood.3199 These are two more reasons why a higher intake of fruits and vegetables is associated with lower fracture risk.3200 Vitamin C is a third. The consumption of vitamin C–rich foods is associated with lower risk of bone loss, osteoporosis, and hip fracture3201—a 5 percent lower hip fracture risk for every 50 mg of vitamin C a day, which is about the amount in one orange.

The bottom line is that five or six prunes a day may help preserve bone density.3204

Basically, onions can lead to an improvement in a marker of bone loss in people,3205 but the study didn’t last long enough to see if this translated into tangible bone benefits. However, a clinical trial on the other vegetable put to the test did.

almonds may be able to help prevent bone loss but not build bones,3218 whereas the opposite was found for prunes—so a combo prune-and-almond trail mix may be in order.

the group drinking two glasses of soymilk a day ended up with more bone than when they started.

Soymilk also appears to have the additional benefits of reducing risk of breast3227 and prostate3228 cancers, improving gut health,3229 and decreasing inflammation3230 and free radical DNA damage compared to rice milk or dairy milk.3231 It can also improve insulin resistance3232 and help with stroke rehabilitation, improving walking speed, exercise endurance, grip strength, and muscle functionality,3233 as well as lower blood pressure better than dairy milk.3234 Soymilk can even lower your LDL cholesterol as much as 25 percent after just twenty-one days.3235 Nutritionally, soymilk is considered the best choice for replacing dairy milk in the human diet.

Hip fracture risk goes down as weight goes up. Nearly half of underweight women have osteoporosis, for example, but less than 1 percent of obese women, which makes total sense.3248 Being obese forces your body to make your bones stronger to carry around extra pounds. That’s why weight-bearing exercise is important; it constantly puts stress on your skeleton.

among women sixty-five and older, only 15 percent of low-trauma fractures (meaning from a fall from no more than standing height) are due to osteoporosis.3264 Between the ages of sixty and eighty, hip fracture risk increases thirteenfold in men and women, whereas the age-related decline in bone mineral density accounted only for a twofold increased risk.3265 So, 85 percent of the age-related rise in hip fracture risk has nothing to do with the measured density of your bones. Without a fall, even fragile hips don’t fracture. The primary cause of fractures—including vertebral fractures—are falls.3266 The disparity between men and women in hip fracture rates seems primarily not because men have stronger bones but because women fall more often.3267 Doctors simply asking the question “Do you have impaired balance?” can predict about 40 percent of all hip fractures,3268 which is more than a bone scan diagnosis of osteoporosis can.

The primacy of falls in fracture risk explains a number of apparent osteoporosis paradoxes. For example, despite the fact that about 70 percent of bone mass is determined by your genes,3271 the heritability of hip fractures appears negligible3272 because the propensity to fall is much less inherited.3273 It also explains the poor predictive value of DXA scanning for fractures. Adding bone mineral density measures to a hip risk score based just on age, sex, height, weight, the use of a walking aid, and cigarette smoking status did little to improve its predictive power.3274 A provocative editorial published in the Journal of Internal Medicine titled “Osteoporosis: The Emperor Has No Clothes” suggested it would therefore be safer and more effective to focus on fall prevention rather than pharmaceutical intervention.

exercise is the single intervention most strongly associated with a reduction in falls rate.3281

Today, the primacy of the bowel movement’s importance continues. Some have called for bowel habits, along with heart rate, blood pressure, and breathing rate, to be considered a vital sign of how the body is functioning.3296 Optimal frequency, as derived in see.nf/bms, is probably two or three bowel movements a day. However, the most important criterion for establishing a constipation diagnosis is not frequency3297 but, rather, consideration of the most prevalent symptom: straining.3298 Ideally, bowel movements should be effortless.

The primary role of dietary fiber may be to encapsulate nutrients to deliver them to our gut microbiome. Fiber is the brick that builds the cell walls of plants, and those cell walls act as indigestible physical barriers. So, when you eat structurally intact plant foods, some of the nutrition remains trapped. You can chew all you want, but you’ll still end up with nutrients like starch completely surrounded by fiber, delivering sustenance to your friendly flora. Your good gut flora then get to eat not only the fiber but all the food it’s wrapped around, too. Fiber supplements like psyllium, however, fail to carry any bounty to our bacteria and aren’t even fermentable themselves, so we may miss out on all the auxiliary benefits high-fiber diets give your microbiome.

Ground flaxseeds are an excellent whole-food source of fiber.

the prebiotic effect of mango pulp based on mice microbiome studies,3392 which was confirmed in humans in 2020 when a mango a day for eight weeks was found to significantly increase the abundance of Lactobacillus, the good bacteria in our gut.

With or without incontinence, overactive bladder is defined as urinary urgency, often accompanied by increased urinary frequency. More than one in three women experience an overactive bladder in their lifetime, with an increasing prevalence with advancing age.3441 However, a randomized, double-blind, placebo-controlled trial showed that relief may just be ½ g of dried cranberry powder away. Bladder-relaxing drugs to control symptoms, like tolterodine (Detrol), are a multibillion-dollar industry,3442 yet may only reduce average monthly urinations by sixteen, about one less pee every other day.3443 But, less than a quarter teaspoon of cranberry powder worked nearly four times better, resulting in almost two fewer trips to the bathroom a day. And, that’s without suffering from the drug’s side effects, which may include dry mouth, constipation, sedation, impaired cognitive function, rapid heartbeat, urinary retention, and visual disturbances that lead almost two-thirds of users to discontinue taking it.

Individual foods that have been shown to increase circulating endothelial progenitor cells include berries,3540 onions,3541 and green tea,

Phew! you say, because your bloodwork just came back and your doctor said your cholesterol is “normal.” But, hold on. Having a normal cholesterol level in a society where it’s normal to drop dead of a heart attack isn’t necessarily something to celebrate. With heart disease the top killer of men and women, we definitely don’t want to have normal cholesterol levels. We want to have optimal levels—and not “optimal” by arbitrary laboratory standards but optimal for human health.

When more than a thousand men and women in their forties were scanned, most of those with “normal” LDL levels under 130 had frank atherosclerosis. No atherosclerotic plaques were found only when LDL was down around 50 or 60,3553 which just so happens to be the level most people had before our diets changed to what they are today.

So, average values today are regarded as normal based on a sick society.3555 What we want is a cholesterol level that is normal for the human species, which is considered to be around 30 to 70 mg/dL (or 0.8 to 1.8 mmol/L).

The longer the arteries are exposed to higher LDL levels in the blood, the more cholesterol can accumulate within the artery wall and inflame it.