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

by Michael Greger

To help boost this anti-aging pathway, at each meal, consider: reducing consumption of saturated fat (concentrated in meat, dairy, and desserts) increasing consumption of fiber (concentrated in legumes and whole grains) taking each of the following: 2 teaspoons of barberries a dash (1/12 teaspoon) of ground black cumin ¾ cup hibiscus tea mixed with ¼ cup of lemon verbena tea 2 teaspoons of vinegar (though never taken straight; sprinkle on food or dilute it in the tea)

Dietary restriction has been called the “safest way” to stimulate autophagy,245 but that distinction probably belongs to exercise, though it may take sixty minutes or more of moderate to vigorous aerobic exercise (55 to 70 percent VO2 max).246 Again, more details in the video. High-intensity interval training didn’t seem to make a difference,247 and to date, data are insufficient to characterize the autophagy response to resistance exercise.248

Researchers in Italy found that by the time most people reached their sixties and seventies, their spermidine levels had already fallen to about a third of what they measured in middle age. But those living into their nineties and beyond were somehow able to maintain their youthful spermidine levels, presumably by just making more of it internally. However, we could also replenish declining levels externally with a spermidine-rich diet. The researchers suggested foods like soybeans and mushrooms,324 but, as we’ll learn, wheat germ is an even more concentrated natural source.

Okay, but the top sources of spermidine in the population studied were whole wheat, apples, pears, and salad.338

To help boost this anti-aging pathway, on a daily basis, consider: 60 minutes of moderate to vigorous aerobic activity minimizing your intake of french fries and potato chips trying to consume at least 20 mg of spermidine by incorporating foods such as tempeh, mushrooms, peas, and wheat germ into your diet drinking three cups of regular or decaffeinated coffee instituting the recommendations to activate AMPK (see the AMPK chapter) following the recommendations to suppress mTOR (see the mTOR chapter)

To help slow this aging pathway, on a daily basis, consider: consuming quercetin-rich foods, beverages, and seasonings, such as onions, apples, kale, tea, and salt-free capers eating fresh, frozen, or freeze-dried strawberries seasoning meals with pippali (long pepper)

The fact that our epigenetic age is a better predictor of lifespan and several diseases of old age than our chronological age is powerful evidence that DNA methylation is inexorably linked with some fundamental cause of age-related decline.

To help boost this anti-aging pathway, on a daily basis, consider: restricting calories by 12 percent, which would be cutting about 250 calories out of a 2,000-calorie diet (e.g., skipping a piece of pie or cake every day) meeting the 400 µg recommended daily allowance of folate, which could be achieved with about a cup of cooked lentils or edamame, a cup and a half of cooked spinach or asparagus, or two and a half cups of broccoli, for example

Can we have our potatoes and eat them, too, by somehow lowering their glycemic index? There is that cool crystallization trick. By consuming potatoes as chilled potato salad, for instance, it’s possible to get nearly a 40 percent lower glycemic impact. To minimize the glycemic index of potatoes, simply precook them and either eat them cold or reheated in the microwave.804 (I call it the nip-and-nuke method.) The vinegar in that potato salad may even have an additional benefit.

Spices can also be helpful. An Indian curry with 6 g of spices (about one tablespoon) cut the blood sugar response to white rice by 19 percent, compared to no added spices, and 12 g of spices cut the glycemic impact by 32 percent.809 You can also drink your spices.

Since active muscles can siphon off excess blood sugars, exercise timing can complement meal timing. When type 2 diabetics were randomized to a leisurely twenty-minute stroll (about 2 mph) either before or after dinner, researchers found that after-dinner walking can comparatively blunt blood sugar spikes by 30 percent.823

Avoiding the finality of long-term fasting fatality is the impetus behind creating fasting-mimicking diets designed to lower IGF-1 levels by eliminating the key dietary component that drives them up to begin with: animal protein.901

When people switch to a plant-based diet, their IGF-1 levels can drop significantly in less than two weeks.907 However, just adding more plant foods,908 cutting out meat,909,910 or switching to fish may not help.911,912 It’s not all or nothing, though. A study of women carrying the BRCA mutation who are at high risk for breast cancer found that IGF-1 levels could be lessened by simply reducing, but not completely eliminating, animal product consumption across the board.913

Chronic inflammation, also called metabolic inflammation, or meta-inflammation for short, on the other hand, is systemic, persistent, and nonspecific and appears to perpetuate disease.998 It has a low-grade, smoldering quality that can be picked up on blood tests showing abnormally high levels of inflammatory markers like C-reactive protein (CRP).

Elderly men and women (average age seventy-eight) were randomized to a twice-daily application of 3 mL (about two-thirds of a teaspoon) of an emollient to their skin for a month. Remarkably, not only did the blood levels of inflammatory markers like IL-6 drop significantly compared to elderly controls who didn’t moisturize their skin but they dropped down to levels close to that of younger individuals (average age thirty-two).1023 This suggests that applying skin lotion may be a simple way to dampen systemic inflammation.

ANTI-INFLAMMATORY FOODS In the Dietary Inflammatory Index, the spice turmeric is the single most anti-inflammatory food, followed by ginger and garlic, and tea, green or black, is the most anti-inflammatory beverage. In terms of the most anti-inflammatory food components, the top two are fiber and flavones.1155 Dietary fiber, found in all whole plant foods, is most highly concentrated in whole grains and legumes, such as chickpeas, beans, lentils, and split peas.1156 Flavones are plant compounds concentrated in fruits, herbs, and vegetables,1157 with apples, oranges, parsley, celery, and bell peppers the leading sources in the American diet,1158 while chamomile tea is the most flavone-filled beverage.1159

Our stool is not primarily composed of undigested food. Most of it—about 75 percent—is pure bacteria,1177 more than a trillion per tablespoon.1178 No matter how well we chew intact plant foods, when we eat the way nature intended, we transport an array of starch and other prebiotic nutrients down to our good bacteria, who get fruitful and multiply. Production of short-chain fatty acids increases, and we get to bask in all the anti-inflammatory benefits of butyrate.

The mitochondria of long-lived species simply appear to be more efficient. They often leak fewer electrons, which correlates with less oxidative damage to mitochondrial DNA.1466 (Mitochondria have their own tiny loops of DNA commonly thought to code for just thirteen proteins,1467 separate from the bulk DNA coding of the more than 20,000 genes in the cellular nucleus.1468) Thankfully, mitochondrial efficiency is not some immutable characteristic. We may be able to reduce our mitochondrial free radical production rate through exercising,1469 as well as by making a single dietary tweak—lowering our intake of the amino acid methionine.1470

Cruciferous vegetables so boost our detoxification pathways that heavy broccoli eaters might need to drink more coffee to get the same buzz, as the drug-metabolizing pathway that clears caffeine can get so revved up.1676 The protection veggies from the cabbage family give us can even be demonstrated topically. Rubbing a broccoli extract on your skin before spending time in the sun can decrease the redness of a sunburn by 35 percent by reducing the tissue damage caused by UV rays through Nrf2 activation.1677

However, Buchinger fasting (consuming only a limited selection of juices and vegetable broth) can boost sirtuin activity within five days,1824 as can alternate-day fasting for three weeks,1825 dropping down to 1,000 calories a day for a month,1826 or six months of 25 percent calorie restriction.1827

The most anti-inflammatory food component is fiber.

It seems that just a 10 g increase in fiber per 1,000 calories equates to four fewer years of telomere aging.2046

To help boost this anti-aging pathway, on a daily basis, consider: following the recommendations in the Inflammation and Oxidation chapters eating a high-fiber diet centered around whole plant foods choosing to drink tea or coffee over soda or milk eating cruciferous vegetables supplementing with 800 to 2,000 IU of vitamin D3 a day if your vitamin D blood level is under 20 ng/mL (50 nmol/L)

Here is a chart of interventions that may help slow aging by hacking each of the eleven aging pathways:

A number of simple strategies can help you shake your salt habit.2170 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.2172

The Blue Zones Food Guidelines To follow in the footsteps of people with the longest lifespans and healthspans, consider following the official Blue Zones Food Guidelines2396: 1. “95–100% plant-based” 2. “Go wholly whole” (reduce intake of processed foods) 3. “Daily dose of beans” (one to two servings of beans, chickpeas, lentils, or split peas) 4. “Drink mostly water” 5. “Snack on nuts” 6. “Go easy on fish” 7. “Eliminate eggs” 8. “Slash sugar” 9. “Reduce dairy” 10. “Retreat from meat”

There’s such a remarkable consistency in the number of heartbeats mammals get in their lifetimes that a group of researchers started to ask a provocative question: Can human life be extended by reducing the average heart rate? For further exploration, see my video see.nf/pulse, but the bottom line does seem to be that a faster heart rate may lead to a faster death rate.2428 We should shoot for an average resting heart rate of no more than sixty-five beats per minute, so a goal of about one heartbeat per second to beat the clock.2429 Every ten-beats-per-minute increase in resting heart rate above about sixty-five beats per minute is associated with a 10 to 20 percent increase in the risk of premature death.2430

Canola oil also lowers LDL cholesterol better than olive oil does,2538 and, unlike olive oil, canola has been shown not to acutely impair artery function.2539

½ cooked then frozen purple sweet potato ¼-inch piece of turmeric root ¾ teaspoon matcha 1 cup unsweetened soymilk 1½ teaspoons ground flaxseed 1½ teaspoons wheat germ ¼ cup frozen cranberries ½ cup frozen strawberries 3 pitted dates ¼ teaspoon pumpkin pie spice Dash of cardamom Scrub one purple sweet potato under running water, then pierce it a few times with a fork. Microwave on high until it is fork-tender. When it is cool enough to be handled, cut it in half and freeze both halves. (You’ll use half for this recipe and the other half next time you’re craving this smoothie.) Place all the ingredients in a blender, and blend until smooth.

One of the reasons may be its lower fat intake. When people were randomized to eat a low-fat plant-based diet, they naturally ate about 600 fewer calories a day compared to those randomized to a high-fat ketogenic diet. This led to a significant loss of body fat and a preservation of lean body mass, the opposite of what was found with the ketogenic dieters, who saw no significant loss in body fat but did experience a reduction of lean body mass as their bodies appeared to cannibalize their own body protein (even though they were eating more protein).

After all, what could be more stressful than living under Nazi occupation? Heart attack rates must have skyrocketed, right? No, studies in Nazi-occupied Norway,3086 Finland, and blockaded Sweden showed the rates plummeting, dropping down to as little as only about one-fourth the preceding rate.3087 Check out see.nf/worldwars to see what happens when meat, eggs, and butter are rationed,3088 and food shortages result in diets dominated by garden produce.3089 In reference to the Nazi occupation of Norway, an editorial in the Journal of the American Medical Association noted, “[S]tress has little or no effect if the diet is poor in animal fat.”3090

Individual foods that have been shown to increase circulating endothelial progenitor cells include berries,3540 onions,3541 and green tea,3542 and a diet centered completely around whole plant foods not only showed a boost in endothelial progenitors but an improvement in endothelial function, along with a drop in LDL cholesterol.3543

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.3554 The majority of the global adult population had LDLs around 50 mg/dL. 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).3556

If you’re using drugs late in life to try to stop the progression of your disease, you have to get your LDL under 70 mg/dL, but in order to reverse a lifetime of bad food choices with drugs, you probably have to get it down to around 55.

Those trying to maximize their intake of antioxidants by eating plant-based must deal with the Achilles’ heel I noted here—the risk of vitamin B12 deficiency for those not actively supplementing their diets with B12 or B12-fortified foods.3771 B12 deficiency is one of the rare reversible causes of hair graying through some unknown mechanism.3772 Thankfully, hair can repigment after B12 repletion.3773 Another reversible cause is hypothyroidism, which can be treated with thyroid hormone replacement.3774

Lower protein intake is associated with higher levels of DHEA,4034 and an interventional trial found that increasing fiber intake actively raised levels,4035 so what about putting them together? Researchers found that after only five days on an egg-free vegetarian diet, levels of DHEA in the blood increased by nearly 20 percent.4036

This may be because testosterone increases with “competitive success,” like winning at sports. While sex “is not usually regarded as a competitive event,” psychology researchers note, “one’s mental state following coitus could nevertheless be something like that of a winner,” as opposed to the mental state after masturbation.

Exercise can ramp up our immune system by so much that we can reduce the number of sick days we have to take by 25 to 50 percent.

I run through all the studies in the video, but basically, zinc lozenges appear to shorten colds by about three days,4639 with significant reductions in nasal discharge (by 34 percent), nasal congestion (by 37 percent), hoarseness (by 43 percent), and cough (by 46 percent).4640 The best way to take zinc for the common cold is lozenges containing around 10 to 15 mg of zinc taken every two waking hours for a few days, starting immediately upon symptom onset as either zinc acetate or zinc gluconate4641 without binders such as citric acid, tartaric acid, glycine, sorbitol, or mannitol.4642

Those with a total cholesterol of 225 mg/dL or higher have up to twenty-five times the odds of ending up with amyloid plaques in their brains ten to fifteen years later (compared to 224 mg/dL or less).5009 Too much cholesterol in our blood is now universally recognized to be a risk factor for the development of Alzheimer’s disease.5010

It would seem that our psychological expectations are able to trump any actual physiological effects.

Fenugreek seeds are also hormonally active, as I document in see.nf/fenugreek. Men randomized to capsules containing fenugreek got significant gains in body composition and upper (bench press) and lower (leg press) strength compared to placebo,5946 along with a significant boost in total blood testosterone5947 and a doubling of the frequency of morning erections.5948 And the only side effect? It can make your sweat and pee smell like maple syrup.5949 (Sounds like a bonus!)

A half dozen studies have found that the spice saffron beat out placebo or rivaled medications like Prozac in the treatment of depression.6073 It may be the red pigment, crocin, since that alone (in a dose equivalent to about a half teaspoon of saffron a day) beat out placebo as an adjunct treatment, significantly decreasing symptoms of depression, symptoms of anxiety, and general psychological distress.6074

There are antiseptic mouthwashes with chemicals like chlorhexidine, which is considered to be the “gold standard” anti-plaque agent, but as I show in see.nf/mouthwash, there is a cheaper, safer, better option: using green tea as a mouthwash,6471 with or without added amla.6472

Goji berries may cost about twenty dollars per pound in natural foods stores, but they’re even cheaper than raisins in Asian supermarkets, where you can buy them as “Lycium” berries. I encourage you to swap out raisins for goji berries—in your breakfast oatmeal, as a snack, in muffins, and anywhere else. As one review concluded, goji berries offer a “‘whole food’ dietary supplement for the maintenance of retinal health as well as for prevention and/or delay in progression of retinal diseases commonly seen in clinical practice.”

Top Ten Common Food Sources of Nitrates 1. Arugula 2. Rhubarb 3. Cilantro 4. Butter Leaf Lettuce 5. Spring Greens (e.g., Mesclun Mix) 6. Basil 7. Beet Greens 8. Oak Leaf Lettuce 9. Swiss Chard 10. Beets

Nitrate supplementation can significantly increase exercise tolerance6831 and performance,6832 not only because it enables our body to extract more energy from oxygen6833 but because it helps to dilate our arteries so they can deliver more oxygenated blood to our muscles6834 and even directly improves muscle function (contractility) through an unknown mechanism.6835 Nitrate-rich diets have been associated with improved muscle strength and physical function, leading researchers to conclude that “vegetables may be an effective way to limit any age-associated declines in muscle function.” Causality, however, can’t be inferred due to the cross-sectional nature of the data.6836

The healthiest way to get your nitrate fix is to eat a big salad every day. People randomized to eat a green leafy salad with arugula and spinach lowered their blood pressures within hours, compared to eating a greens-free salad of cucumber, green beans, and cherry tomatoes.

Berries appear to reduce all-cause mortality risk as much as green leafy vegetables.6880 Greens are the healthiest vegetables, and berries the healthiest fruits—in part due to their respective plant pigments.

The one food group with more antioxidant power than berries is spices. Herbs and spices have been used in meat preservation to reduce rancidity for thousands of years.6897 Researchers prepared a spice mix composed of about a teaspoon of paprika, one and a half teaspoons of oregano, a half teaspoon of garlic powder, a half teaspoon of ginger, and about a quarter teaspoon each of black pepper, cloves, cinnamon, and rosemary to a half pound of ground beef. Compared to the burgers without the spice mix, the spiced burgers cut the MDA flowing through the subjects’ systems approximately in half (as measured in their urine).6898 Just adding about a half teaspoon of turmeric to a half pound of ground beef can cut its MDA content by around 20 percent. Although black pepper alone doesn’t seem to help, combining the turmeric with even just an eighth of a teaspoon of black pepper appears to double turmeric’s effect.6899