#115 | Winning Athletic Longevity | Dr Rick Cohen & Daniel Tawfik of Healthspan

A healthy athlete is a strong athlete, and athletic longevity requires a long life. To achieve our athletic longevity goals, almost all of us resort to the optimistic usage of pills and powders.

One of the major bummers for the older athlete, is that no one knows how to make people younger.  All we can do is slow down the rate of aging.  The healthier we are, the slower we age….meaning the more slowly we progress toward that visit to the pearly gates. 

How can we balance risk and reward, prioritize which interventions to pursue first, how to tell is we are getting a positive or negative result from our interventions including pharmaceuticals and nutritional supplements. These are the questions answered by Daniel and Rick, who also share their thoughts about Rapamycin dosing, cycling interventions to restore beneficial cycles of growth and autophagy, and how Healthspan is delivering a platform to help clients to set proper goals and stay on course over time including taking corrective action when interventions (type and dose) don't deliver results.

Links:

• Healthspan Longevity Medicine website: https://www.gethealthspan.com/
• Episode 96 - Healthspan Longevity Medicine: https://www.wiseathletes.com/podcast/96-what-is-longevity-medicine-w-daniel-tawfik-co-founder-of-healthspan/
• Episode 63 - Boosting Testosterone: https://www.wiseathletes.com/podcast/63-boosting-testosterone-right-with-rick-cohen-md/

Dr Rick Cohen & Daniel Tawfik Bios:

Dr. Rick Cohen, M.D. is a leading authority in the fields of nutrition, sports performance and longevity medicine. He received his undergraduate degree in Biomedical Engineering with honors of distinction from Duke University in Durham, North Carolina and his medical degree from Hahnemann Medical University in Philadelphia, Pennsylvania. Rick is also a leader in the field of male functional hormone health and the author of the book “Be All the Man You Can Be” with over 100k copies sold in the past five years. 

Daniel Tawfik is the founder, developer, and CEO of HealthSpan. Daniel holds a BS degree from UCLA in molecular, cellular, and developmental biology and physics. Daniel did his graduate research at UCLA's Protein Expression Technology Center where he studied neurometabolic disorders.

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Detailed Show Notes

Today we are talking about one particular aspect of acquiring and retaining healthiness:  the chemicals we put into our bodies.  Chemicals include:  pharmaceuticals, botanicals, herbs, spices, concentrated foods, vitamins, minerals.   Today, we are NOT going to talk about specific recommendations for specific chemicals…rather we are going to discuss how to think about using chemicals in a way that is safe and responsible, while also being aggressive if we so choose.

We know a lot about getting and staying healthy. The primary pillars are pretty much the same regardless of the source, and supplements can play a role in all of them.

Ray Kurzweil takes 100 supplements a day (according to an article from 2018). Bryan Johnson is the newest famous person for taking many supplements to recover his youthfulness  … 105 per day, as I understand it.  It’s a slippery slope…get healthy, be stronger, solve your biggest problems…for only $0.30 per day (per supplement).  It’s hard to say no.  Frankly, I think it’s my biggest addiction.

Heck, Americans can’t agree on much but we apparently do agree that pills are good.  Almost everyone take some supplements. Multivitamins…I grew up with the one-a-day brand. Immune system boosters like echinacea. I used to swear by echinacea.  Sleep aids like melatonin are very common. Etc.   

So what’s the problem?  So what if it’s a placebo effect….as long as I get an effect I’m happy.  So who’s complaining?

Okay, here it is:

Whenever I talk to or hear actual scientists talk about supplements and consumption of chemicals chronically, the message is consistently for caution. Don’t push it. Their own lists of supplements is short. 5-8 items. Only the basics. And only for short periods of time.  They say we don’t know enough about how they work or how they combine when we take many things at once. 

This is true for OTC supplements for health (whatever that means) and also for longevity interventions.  The most credible scientists say that taking more than 1 compound for the purpose of longevity is going off the map…that the best in the world don’t know how to predict what will happen.

Polypharmacy is an old medical term for people with multi morbidities taking multiple medications which create unintended and unstudied interactions, possibly creating additional symptoms requiring additional medication. 

My fear is that I and people like me are creating a stew of interactions which eliminates the potential benefits or even creates health problems.  

We need a framework for understanding how to be smart. I still want to be bold, but I don’t want to be stupid.  … in my interventions to improve my health, reduce my rate of aging.  I just don’t want to hurt myself in the meantime.

3 step process to think this through…:

1. what is the landscape to navigate…stuff to avoid
2. protocols to follow to stay on the map….to be smart 
3. how can we tell if we are doing it right…or need to make a change?

(1) The framework has to consider the landscape to be navigated….here are a few key elements.  Is it true that:

• There are interactions between pharmaceuticals, between pharmaceuticals and over-the-counter supplements, between supplements, between everyday foods and the chemicals.  Interactions database from NIH  https://mor.nlm.nih.gov/RxNav/  
• Chemicals have many effects on the body…on our health.  Even if the chemical does have a desired effect, it is having other effects.  We’ve all heard of "side effects."
• There are other ways to get the effects that most or all chemicals can or are promised to provide:  lifestyle, light therapy, etc.
• Our bodies can build up tolerances to chemicals?  The dosages become less effective over time?
• More does not mean better.  Big, superphysiologic doses are especially risky.  The body is good at getting rid of stuff it doesn’t want, but if you hit it with huge doses ….

Creating imbalances

• zinc vs copper
• Copper vs mag
• Mag vs calcium
• Vit A vs Vit D
• Iron vs zinc

Medications that impede nutritional uptake

• PPI
• Birth control
• Statins — b12, coq10
• Ezetimibe— fish oil
• Antibiotics— gut health
• Mouthwash — NO/nitrates → nitrites
• Fiber - soluble fiber becomes a gel…block absorption?
• NSAIDS – b vitamins

Chemicals that were once thought to be no brainers but no more

• aspirin
• calcium …take with K2
• Electrolytes…not needed for cramps
• High dose multivitamin…more is better
• Vit C

(2) what should we do…what sort of protocols should we use to keep from going off the bleeding edge?  To be bold but smart?

• Get as many therapeutic effects as possible from other mechanism, from non-chemical interventions (diet, exercise, sleep, sunshine, avoiding pollution, red light/NIR, PEMF)
• Don’t take too many chemicals at the same time.  Fewer is better.
• Don’t take chemicals everyday forever:
  • Skip days.  Do supplement fasts
  • Cycle out of supplements periodically to see whether you still need it.  
  • Continuously move toward solving the lifestyle issue that is causing the need for a supplement or medication....and then remove the chemical
• Prioritize effects to get 80% of the benefits from 20% of the chemicals.  Go for the more fundamental issues:  metabolic health
• only do 1 thing at a time for each thing you are trying to accomplish...there are diminishing return effect as well as interference

When selecting and buying and using supplements:

• Research potential interactions: Use reputable sources like drug interaction checkers or consult with your healthcare provider to identify potential interactions between your medications and supplements.

• Choose high-quality supplements: Purchase supplements from reputable manufacturers and choose brands labeled with the NSF International, US Pharmacopeia, Underwriters Laboratory, or Consumer Lab seal. These verify that the product actually contains the ingredients that the label says it does, and that the product doesn't have any potentially harmful ingredients. 
• Other third party websites provide analysis of supplements, like Labdoor.com and Consumerlabs.com. These websites publish lists of the highest quality supplements.

• Stick to the recommended dosages for both medications and supplements. More is not always better, and excessive intake can increase the risk of interactions.
• Time your intake thoughtfully: Some medications and supplements may be taken at specific times of the day to reduce the risk of interactions, and to improve bioavailability (empty stomach, fatty meal, etc.).
• Only take a supplement for the recommended length of time. If you are taking supplements in response to a biomarker level, recheck your biomarker to ensure continued supplementation is needed.  Recommendations often have a “safe for x weeks” indication.
• Store supplements in the appropriate environment. Some supplements need to be refrigerated and others kept away from light. 
• Be aware of nutrient interactions: Some supplements, like calcium and iron, can interfere with the absorption of certain medications.  There are web resources that can help with this.  NIH has one.  Your doctor has access to these resources.
• Stay informed: As new research emerges and your health status changes, stay informed about potential interactions, and adjust your regimen accordingly.

All of this probably sounds like a lot of work.  No one is saying you should take a bunch of supplements.  But if you do, do so as though your life depended upon it.  Because it does.

(3) How can we tell if we are doing it right, or doing it wrong, or need to change what we are doing?

• Only add 1 thing at a time and maintain the same routine to see if the new chemical is having a negative affect.  
• Be vigilant for any unusual symptoms or side effects. If you experience any adverse reactions, consult your healthcare provider immediately.  Stop if you feel off or badly.

• Is "How you Feel" a good guide? What does how you feel include:
  • feel good, happy, optimistic, motivated
  • Feel energetic / not sleepy
  • No Chronic pain
  • No chronic Muscle soreness
  • Clear headed / not foggy
• If you feel bad, that means something.  But can you feel good, and be doing it wrong. Don't trust "I feel good" to measure supplement effectiveness. 
• Monitor your biomarkers (physical, blood, etc.): Ensure your medication and supplement regimen is still appropriate for your needs.  Stop if your biomarkers move in the wrong direction.