The Science of Longevity: An Interview with Valter Longo, Ph.D.

What follows is a transcript for the podcast: Science of Longevity: How Anyone Can Reduce Age-Related Decline

Sub-section topics within the interview include the following:

1. Is Longevity Determined by Genetics?
2. Diets for Medical Conditions
3. Preventing Unwanted Weight Loss During Fasting
4. How to do the Fasting-Mimicking Diet
5. How the Fasting-Mimicking Diet Works
6. Benefits of the Fasting-Mimicking Diet: Apoptosis 
7. IGF-1 and Aging
8. To Fast or Not to Fast? Immune System and COVID-19 
9. Clinical Trials Happening in Prof. Longo’s Lab
10. Five Pillars of Longevity
11. What Prof. Valter Longo Eats
12. Effects of Alcohol on Longevity
13. Book Recommendations
14. Further Information on Valter Longo, Ph.D. 

Is Longevity Determined by Genetics?

Dr. Heather Sandison: Welcome to Collective Insights. I'm your host today, Dr. Heather Sandison and I'm joined by Prof. Valter Longo. Thanks so much for being on the show today.

Prof. Valter Longo: Well, thank you for having me.

Dr. Heather Sandison: So I'm wondering, you have been working with longevity and aging for a long time. You've gotten to meet some relatively old individuals. What have you learned from the centenarians that you've met over the years?

Prof. Valter Longo: Well, usually, in most cases, you learn that each one has a different story and each one of the centenarians may have a completely different story from the other one. And they all believe that's it, that is the secret for longevity. But then I think it also becomes very interesting because as you ask questions, for example, Emma Morano in Northern Italy, in Verbania, she got to 117. She was the third oldest person whoever lived on the planet, as far as we know. And I always remember the New York Times talk about the fact that she eat three eggs a day and she ate meat, raw, raw meat actually, about 100 to 150 grams of raw meat everyday.

But as I got to know her, I learned that she has six brothers and sisters. And all of them made it past the age of 90. And one sister made it to 102 so clearly ... and both of the parents, I think made it either to over 90 or or close to it. So that basically told me that there's a genetic component there. Yeah, she can probably eat as many eggs as she wants and she's still going to make it to a very old age. So that's just an example to tell you that when you go to these subjects, you hear stories. But some of the stories are also very important in sort of being compared to the real data of millions of people and in the lab, et cetera, et cetera, which then need to be the real foundation for the decisions we make.

Dr. Heather Sandison: Yeah. So how much is nature versus nurture? You're talking about genetic components and then also lifestyle components. So do you think it's a 50-50 split? Or do you think that one makes more of a difference than the other?

Prof. Valter Longo: Well, there is not much you can do about the genes that you get, for now. And so obviously the idea would be, yeah, for some people, like we just mentioned, it could be a remarkable effect. And we know that in some centenarians' families, like the one I just mentioned. But I met families like that. It's pretty clear that they have a set of genes, most likely, that are super longevity genes. And together they give them a very high chance of making it there.

For everybody else, say over 99, and probably 99.9% of the population, the lifestyle is going to be the big, big changer, game changer. And so yes, so independently, so the inheritability of longevity actually is fairly low in the general population. It's not low in these families, but it is low in the general population. So the lifestyle is what you have to count on and lifestyle can no doubt make a big difference. And now there's pretty much unanimous agreement that it can make a big difference in diseases. But it can also make a big difference on longevity.

Diets for Medical Conditions

Dr. Heather Sandison: So in terms of lifestyle, you have popularized these fasting mimicking diet, or the ProLon diet is what's available to the general public. You also have another diet that's available to cancer patients. Is that right?

Prof. Valter Longo: Yes. So that's actually this year, I like to think of it after 12 years that we've been doing ... or over 12 years of clinical trials, I hope at least that this will be the end of the beginning of fasting and fasting mimicking diet and cancer. We're going to have three trials just on our side and the collaborating groups. The clinical trials, they're going to be published and represent around 300 patients with different cancers. So yeah. So then I hope by the end of 2020, that the oncologist all over the world will have an option to incorporate, integrate the fasting mimicking diet together with the standard of care. And soon enough, I think we're going to approach the FDA to start thinking about, for example, the [inaudible 00:05:11] the term, with specific cancers, possibly breast cancer or prostate cancer and see if there is a track for FDA approval.

Dr. Heather Sandison: So what would that look like? Say if I was undergoing chemo or some other sort of treatment, radiation, for breast cancer, and I wanted to do the fasting mimicking diet in addition to the standard of care. What would that look like for me as a cancer patient?

Prof. Valter Longo: So to you, it looks like a box. And so, and that's exactly how we wanted to do it. And I donate everything from this whole operation to the charity and the research. So I am not doing the box for financial reasons. But I thought it very important to standardize it. And so in the box there's going to be two, most likely two, options based on the clinical trials. One is going to be four days, one is going to be five days. And in the four day one, if it's chemo it's going to be three days before chemo, one after, that the patient will eat the food in the box and nothing else. And if it's a five day, then it's going to be four plus one. So four days before and one after. It's mostly a vegan diet. It's a low protein, high fat, 100% vegan. And it has a fasting mimicking properties.

What it means is that it causes same or very similar changes to the water-only fasting while the patient is allowed to eat. And the reason for the FMD, for all FMDs actually, was that when we first did the first trial over 10 years ago at USC, and it was a water only fasting and chemotherapy. And none of the patient wanted to do it. And the oncologists were very worried about it, or at least most of them were worried about it. We were having a difficult time recruiting patients. And then we went to the National Cancer Institute and basically asked for funds to develop a fasting mimicking diet. And thanks to them and other funds, we did it. And so now it's available for lots of different applications, not just cancer.

Dr. Heather Sandison: So FMD is the fasting mimicking diet. And for cancer it would look like a box showing up. You would do it three days before chemo, one day after. And what if I'm just a normal person, healthy, a patient of mine who's say in their 50s. As a doctor, if I wanted my patient to be on one of these diets, what would that look like for them? And how would it be different if it was a cancer patient?

Prof. Valter Longo: Yeah, so we published a trial on 100 subjects 2 years ago, normal subjects. And so they did, in that trial, we tested 71 of them actually. It was a crossover, randomized crossover trial. 71 of them did the diet, three cycles of the diet. And this is five days. It's 1100 calories on day one. And then it goes down to 800 calories. And so yeah, that's what lots of people are now doing. Particularly those who have high cholesterol, high blood pressure or high fasting glucose, high CRP, high triglycerides. All those markers are going down or going down a lot depending on the patient, but significantly going down in those that start with elevated levels of them.

And now we've just done another trial. It's not published yet, but let's just say that it was very supportive of the first trial. So that's good news. I now have another 80-patient randomized trial confirming essentially almost everything they showed in the first trial. So that's for normal people.

Lots of doctors are now starting to look at this as an option, when possible, to not place patients on drugs. And so I think that whenever that is an option, that's something that they can consider. A cancer patient, thus far, of course because there's a diagnosed disease and the FDA regulates on this, the doctor oncologists have not officially been able to recommend it. Starting off with after these three trials, when they're published, I think they're most likely going to have the option, there's going to be discussions with the various government offices. But hopefully this will be made available to all the patients and oncologists that want to do it. It'll always have to be through the oncologist, but hopefully the oncologists will be on board to allow patients with all kinds of therapies, by the way. This was tested mostly on chemotherapy, but now also in combination with hormone therapy, immunotherapy, et cetera, et cetera. So the idea, at least in the animal studies, is that everything is looking very ... it's looking like an enhancement, having an enhancement effect in combination with lots of different therapies.

Preventing Unwanted Weight Loss During Fasting

Dr. Heather Sandison: So in a cancer patient, there's this concern about weight loss, right? Kikexia is one of these end-stage markers, representations or manifestations of cancer where people lose a lot of weight. And of course with calorie restriction, weight loss is something that you would expect. So how do you square that circle?

Prof. Valter Longo: Yeah, I mean, I try to stay, I mean we've been trying to stay away from these genetic words like fasting, calorie restriction. And so the way we handle that with cancer patients, and now I think we're probably close to 500 patients that have been tested with many different cancers, many different therapies. So this is why we want to standardize it.

We want to move away from generic words are almost for sure going to hurt the patients. Let's say you do extended calorie restriction. Of course you're going to be kikexic. We know this. You're going to lose muscle mass. And so eventually, and potentially you're going to be immunosuppressed or certainly immune system is going to be affected. It could be in some ways positives, some ways negatives.

But the FMDs, the fasting mimicking diet are different. That's why they're short and and so in the clinical trials, for example, in Italy with breast cancer women, what we did, we had a video where they could do exercise and then they did the fasting mimicking diet. And then they did this little exercise. And the kikexia was not an issue. It's rarely an issue. So I would say out of 500 patients, maybe ... and I'm just throwing out the number, but it comes from the discussion with the oncologist and looking at the data. But I would say out of 500 patients, the people that had a severe problem with weight loss and not being able to regain it, there are going to be no more than 20 I would say.

How to do the Fasting-Mimicking Diet

Dr. Heather Sandison: Out of 500, that's a very small amount. Okay. So well worth maybe that small risk to get the potential benefit. Now if I have one of my patients, a 50 year old, healthy female, relatively healthy female, and I want to do this diet. You said that you would do three rounds? Is that right? So three rounds of ... can you just break it down for me? What would it look like? Would it taste good? Would I want to eat it?

Prof. Valter Longo: Yes. So I think the doctor, if there is a disease involved or there is a condition involved, the doctor needs to make the decision on how to do it. The trial was three cycles, once a month for three months. And then we measured everything at baseline and then one week after the third cycle. But I think it's perfectly fine to say, "Do it every three months," or, "Do it every four months or do it every two months and let's see what happens."

Especially, let's say somebody has a fasting glucose of 98. So probably moving towards insulin resistance in a year or two they could be diabetic, or prediabetic at least. So that patient could be placed on, let's say once every three months, do the cycle. Let's see what happens. Version A, version B would be, let's say somebody who had a 105. Maybe then that's already a pre diabetic person at three cycles. See they move back and then see at the end of that, and this has happened in the clinical trial. At the end of that, let's say they go from 105 to 90. Then see how long it takes for them to go back to 105 and time the FMD based on that. It might not work on everybody, worked on average in the general group. But it doesn't mean it's going to work for everybody. But I would say it should work with a lot of people. And then it's just a matter of identifying how many times a year they have to do it to stay in the normal range, if they are responsive.

How the Fasting-Mimicking Diet Works

Dr. Heather Sandison: So in my practice, if I see a patient who has prediabetes, then I'm usually recommending some sustainable lifestyle interventions, right? Like reducing your carbs, reducing your sugars, certainly going in the direction of potentially a grain-free diet. But I would say that for my patients, the recommendation is to do that every day. Not for five days, every month or five days three times over the next few months. So does it matter what patients are eating in between the cycles or are you not even factoring that in?

Prof. Valter Longo: No, we're not factoring that in. The idea was based on reality, right? So obviously, let's say half of my book is about what you eat every day. But the reality, when I talk to people, you get maybe, I don't know one, one fourth to one fifth that ... so I've been studying nutritional longevity for 30 years now. And my boss was Roy Walford, and he had been studying nutritional longevity for 50 years. And so we know what we're talking about as far as how do you make somebody live long and nutrition. And I would say it's probably not more than one in four, one in five that will listen.

And we're not talking about any radical ... and I recommend a pescatarian diet. So fairly reasonable. Yes it just has vegan plus fish. But most people could do it with no problems. It's not completely vegan. It's very reasonable. And yet, I would say it's difficult to get people to do that. So yeah, the current recommendation, like in your case, is do this and do that. Most people are not going to do it. And most people that do it ... lots of people that do it, eventually they will turn back to whatever it is they came from. So that's the reality.

And so now we're saying, "Okay, can you do at least five days every three months?" And then you get most people, even the ones that absolutely have not ever observed anything in their life who say, "You know what? If it comes like a medicine, and the doctor tells me, yeah. Don't bother me the rest of the time. I'll do what I do and nobody's going to change me. But I will do that." And that's what we were shooting for. And that's exactly the recommendation in the clinical trial. Don't change anything.

And sure enough, the ones that were probably the vegans and the longevity dieters did not improve their much. Right? So the ones that started perfect, not much we could see. It doesn't mean that it didn't improve, but we couldn't see it. We saw a little bit of decreasing IGF1, we saw a little bit of weight loss. But those were the significant effects on the general population. But when you started high cholesterol, high blood pressure, high triglyceride, pre-diabetic, high CRP, then they responded a lot. So this is suggesting that, yes, the people that don't behave are those that are going to benefit the most from the FMD.

Dr. Heather Sandison: So you make a really great point, that if I make a recommendation there's not going to be that many patients that follow it, especially if it involves changing their well-ingrained habits, like what they shop for at the store, how they cook, or whether or not they eat out. So the box that you're describing that shows up makes it very simple for people to incorporate this into their life. And what you're finding is that it's those people who maybe engage in some of those unhealthy behaviors more often where we have more opportunity for change or a larger delta. That's what you're finding in the research that you're doing, is that if somebody has a relatively good lifestyle then this isn't going to move the needle too much. But if they're indulging quite a bit, then having access to something like the ProLon Diet is really beneficial.

Prof. Valter Longo: Yes. I mean at least at the disease level and in what you can observe, right? That it could very well be and most likely, for example, the mice that we study have a very healthy diet or fairly healthy diet. They're not overweight, they don't eat anything bad, but yet we extend the lifespan. We cut the tumors almost in half and we decrease inflammation by almost 50%. So there is probably lots of hidden things that even those that are fairly healthy will eventually get, but it's hard to see in a three month to six month trial. Whereas in those that start with a poor diet, it's much easier to see. We can see the significant effects already cycle two or three. So that's a big difference. The other thing-

Dr. Heather Sandison: So the benefits for a relatively healthy person might be longer term, not three to six months, but maybe three to six years or three to six decades even.

Prof. Valter Longo: Right. Even very healthy people get cancer. Even very healthy people get cardiovascular disease. Maybe not so much diabetes, but yes. So you may not be able to see the effect of, let's say, the diet, where we've shown very clearly in mice, for example, that the diet is equivalent to a cycle of chemo. So you give mice a cycle of chemo or one cycle of FMD, you see the same effect on many, many different types of cancers. So, now let's say you have a precancerous cell or a cancerous cell, if what we see in mice is true for people, you can see how somebody looking very healthy that has just had that first mutation in rats and that starts building the future malignant tumor, yeah, that's possible. And again, we only know it for mice, but certainly we are starting to see evidence for lots of the markers in humans moving in exactly the same way that we see it in mice.

And so we suspect that that very hostile environment will be hostile to autoimmune cells, it would be hostile to insulin-resistant cells, would be a hostile to precancerous cells. So yeah, we think that everybody could benefit. The only thing that I wanted to mention, which is very interesting, is that lots of the people that have a poor diet that we placed on the ProLon FMD, this is the first time they've ever been vegan in their life. And what we observe in the great majority of people is them to say, "You know what? It wasn't so bad to be vegan for five days." And then they almost, I would say over 90% they're influenced by this. So in the long run, by the time they do it two, three, four, five times, now they're starting to convert and they're starting to say, you know what? I don't need to eat both the meat, but also those they ate lots of pasta and bread.

And they tend to say, "I went five days with none of it and I was fine and I felt good." And so there may be also some I think cognitive associations, so like the opposite of fear conditioning, right? So where you basically associate now feeling well and you don't know why you're now looking for the same type of food but your brain is telling you, "Maybe we need to go that way because we were doing much better during those days."

Dr. Heather Sandison: I would say that's exactly what I see in my clinic as well. Whenever I've recommended a cleanse that someone has been able to follow through on, they do. They have this feeling of, they're less inflamed, they're clearer thinking, their sleep gets better, they appreciate losing a little bit of weight typically, and then they associate the experience with feeling better. The other thing that happens is they start to generate the habits of like, "Okay, this is what I shop for. That's what I eat, that's what I don't," And some of that, even if not all of it, they take into their everyday life after the cleanse.

So that's amazing that you're seeing some of those things as well, that people can kind of shift the trajectory, even if it's just a little bit. That can make a lot of difference over a long period of time in their lives. 

Benefits of the Fasting-Mimicking Diet: Apoptosis 

Dr. Heather Sandison: So we are talking about the benefits of fasting mimicking diets. Can you list some others? So potential longevity of reduction in inflammation. And I think what you're describing is the senolytic effect, right? Getting rid of some of these cells that don't serve us. Can you expand on that a bit more?

Prof. Valter Longo: Yes. So we've always known that there is a process called apoptosis, and if you look at apoptosis, it's really a clever system, and apoptosis means program cell death. And so it's a very clever system that during development, but also in cancer, it can kill at least some of the damaged cells and leave alone the good ones. And so it's not surprising then there may be during starvation when the system has to look around for something to kill and to sacrifice, because not everything can stay alive. Why? Because let's say that in our history, ancient history, 50,000 years ago, we would probably regularly undergo a couple of months of no food per year. Maybe during the winter season.

So in those times, obviously the system has to adjust and has to be leaner, has to be smaller, and to do that, going from the summer, let's say, to the winter, it has to start eating itself and by partly by a process called autophagy but probably part by this new process that we are describing, which is eating cells and redistributing cells. And so it would make sense, as it does for apoptosis, that you would select damaged cells first. And now how do you detect damage cells? We don't know, but one possibility would be that everything, for example, if you look at mitochondria, everything is in very, very in a sort of an extraordinary equilibrium. And when that equilibrium is disrupted, electrons leak and these oxidants are generated. Superoxide, hydrogen peroxide.

And so it could be, and we see a lot of evidence for that, that this equilibrium is established in the Sal. And when the equilibrium is distorted, that somehow gives the signal to the cell itself to undergo suicide, but it may be also giving the signal to the immune system, "Go ahead and get rid of me because I'm in trouble." And this is exactly what we see, for example, for breast cancer. Breast cancer cells normally are not detectable by the immune system. Now we treat them with chemo and the starvation and the fasting mimicking diet and the immune system now recognizes them as targets to be destroyed. Very interesting. Now we're starting to show in a multiple system and, and there's others that are starting to do the same. So yeah.

So there seems to be a very sophisticated filtering, search and destroy type of system, probably for the benefit of maintaining the healthy cells, killing the unhealthy. And then what happens is the stem cells get turned on, and of course you don't know when the food is going to come back around. So you kill lots of the cells that are not very useful, and then you turn on, for example, we've shown that in the blood system, you turn out the hematopoietic stem cells and then when food comes back around these hematopoietic stem cells can self-renew, so they expand and they give rise to more white blood cells and leading to improvements in their immune profile, at least in mice. But soon enough, we're going to be publishing this for people.

IGF-1 and Aging

Dr. Heather Sandison: And you mentioned IGF-1, but what's the role of that marker, particularly in relatively healthy patients? What do you notice there?

Prof. Valter Longo: The IGF one I believe is the most important marker for life and death, and in fact soon enough, we're going to publish a meta analysis on IGF one and mortality, but the normal function of IGF-1 is to promote growth and to promote cell division and also to prevent death. So this is why it's a potentially very problematic growth factor. Why is that? Because it can promote the growth of normal cells, put them in a sensitive state, then pre-cancer cells, then cancer cells. And it can also block the cancer cell from dying. And so block apoptosis, and a so it in fact in mice, the mice have record longevity are those that have no growth hormone synthesis or no growth hormone receptor synthesis, meaning that they're lacking either growth hormone or growth hormone receptor, which leads to very low levels of IGF-1.

And so these mice live about 40% longer, but more important than 40% longer, half of them will never develop any disease versus less than 10% for the regular mice. So now you are living 40% longer and you're really eliminating a big part of the diseases in spite of this longer lifespan. So it's really remarkable. And so for the longest time people thought, "Well, it must be just mice. It couldn't possibly be people," until knowing that the sort of dwarf, because these mice are very small. And so we had known that the little [inaudible 00:11:43] were super protective, super, super long lived. The mice were the same, and then we went and looked for people and we found them in Ecuador and we started studying about a hundred of them.

And sure enough, they have very low levels of cancer, just like the mice. And they also are protected from diabetes and recently we published that their brain seems to be having a more youthful profile. So they have very low levels of IGF-1, they also have very low levels of insulin. So growth hormone controls insulin, IGF-1 and Tor, which we think are the three most important factors in accelerating the aging process, or certainly three of the most important ones. And yeah, so that may explain why we see such remarkable effects in all kinds of organisms, but now also in humans.

To Fast or Not to Fast? Immune System and COVID-19 

Dr. Heather Sandison: So that is fascinating. Who wouldn't want that, right? So let's kind of segue into who wouldn't want that in all realistic cases? So there are some people where a calorie restriction diet or else a fasting mimicking diet maybe doesn't make a lot of sense. So what are the potential risks? And where we are here having this conversation on Friday, March 20th, like 12 hours after Gavin Newsome put everyone in California on lockdown because of COVID-19, and so immune function is one of the big things that comes up here, whether we're talking about cancer patients or we're talking about healthy patients. Fasting mimicking is a bit stressful on the system. So can you break down maybe some of the risks that are associated with doing this and if maybe right now in the heat of the COVID-19 crisis, is it a good idea with how much stress people might be under?

Prof. Valter Longo: Yes. So first of all, I think it's very important to move away from these generic words like calorie restriction and from the words like fasting or intermittent fasting. They really don't mean anything. In the medical world it will be very strange if a doctor says, "I'm going to recommend that you have this type of intervention," versus, "I'm going to give you this dose of this drug to take disease out." So we went from a very careful, disciplined intervention to words like fasting or eating. I always say, “saying fasting is like saying eating.” It doesn't mean anything. Eating could be very bad or very good for you, depending on what it is.

So if we're talking about extending the severe restriction of calories, let's say chronic calorie restriction, which means that a normal person with normal weight starts eating all of a sudden 25% less and that person will become very thin. It will be viewed by most doctors as dangerous or becoming anorexic. So that can have, believe it or not, very powerful anti-aging effects, but at the same time can have very scary effects on all kinds of systems and most likely the immune system being one of them. So very few doctors or maybe no doctors recommend that you do this, although the aging field has been studying this, and in fact even put monkeys on this nutrition for 25 years and the effects, at least at the University of Wisconsin, were very good. But you start seeing the difference between age-related disease in the monkeys who were calorie restricted and overall mortality.

So the mortality caused by age related diseases goes down tremendously. They have almost no insulin resistance. They have health of the cancers, they have 20, 30% reduction cardiovascular disease, but then they don't live there much longer, suggesting that are trade-offs. And I've been trying to get an answer and the trade-offs for a long time. I don't have one yet, but there are trade-offs and one of the trade-offs could be very well immunity. Now if you move from that to, let's say a five day fasting mimicking diet that's got 1100 calories and has, on day one 800 calories, and day two, three, four, five, you're in a very, very different domain. So then the question is, what is the benefit? What is the risk during the five days and what is the risk after? So during the five days, if you look at the white blood cells, if you look at the lymphocytes, there is no significant difference.

So then there is a difference, only if you include the people that have inflammatory disease in the group. So they suggest that the small reduction temporarily, it's occurring mostly because of reversal of the lymphocytosis caused by the inflammation and not by even a temporary reduction. So there may be a very slight but not significant reduction in the five days. What you get at least in the mice, I can talk about it in people. We haven't published it yet. We're going to publish it this year. But what you get after in the mice is clearly immune rejuvenation, so the immune system now you see the lymphoid myeloid ratio being improved. So then in view of a viral pandemic, I will caution people to be very careful. Even though we don't see a decrease in white blood cells, we don't see a decrease in lymphocytes temporarily, at least in those that don't have inflammatory issues. We don't know. We don't know. Could I make it better or worse for you during the diet? We don't know.

The only evidence that I've seen is a paper, it was published in [inaudible 00:18:04], the famous journal, a few years ago in mice and assured that several viral infection, if you have a major decrease in glucose, that could, during fasting, that could negatively affect or can help the virus. So then the recommendation that we've been given is if you have any risk, if you're a risk of, let's say a medical professional, but also somebody near somebody that has been infected, probably better not to do any fasting mimicking diet. If you're isolated, maybe you already had the coronavirus and you are very, very low risk, then I will say it's probably okay. Talk to your doctor if you're concerned, and if you do get any symptoms, then stop. So yeah, I will not in any suspicion of symptoms or symptoms for the flu even, not just the coronavirus, stop the diet. Begin eating normally because again, that sugar level could be important.

Is it for the immune system? Is it because it's reducing ketone bodies? We don't know. Nobody knows. That paper specifically talks about sugars being effective by reducing ketone bodies by reducing ketone bodies. But we definitely don't know. First of all we don't know the effects in people and then we don't know the mechanisms. But I would say it'd be good to be cautious and eat normally, at least based on the data we have if you are infected or if you suspect or are a risk of being infected.

Clinical Trials Happening in Prof. Longo’s Lab

Dr. Heather Sandison: There's still a lot to learn in this space. So tell me what is going on in your lab. What are the questions that you are aiming to answer this year in the next?

Prof. Valter Longo: Yeah, so now we have many clinical trials. I think we have 25 clinical trials ongoing right now. And they go from Alzheimer to multiple trials on diabetes type two diabetes type one, multiple sclerosis, inflammatory bowel disease, and then we'll continue to work on this multi-system regeneration, rejuvenation. So how do we maximize this? Can we do this in the brain, for example? Can part of the brain be regenerated, rejuvenated, or is that simply something that is mostly seen in organs that are known to include hyperinflation. So yeah, so those are some of the things we're working on.

We're trying to apply this to many diseases and of course we're now, it's very exciting, after 30 years of work, it's a very exciting next couple of years because now we're seeing everything being tested. So now we have, for example, very soon we just finished a trial and we're going to publish it soon by [inaudible 00:21:15] University is about to finish a trial on diabetes and the fasting mimicking diet. And again, we're going to see three trials on cancer this year. So yeah, very exciting year because we see all of this basic research and translational research now being tested. It's not going to work for everything obviously, but it'll be exciting to see for which disease it works, both at the therapeutic level and also at the preventive level.

Five Pillars of Longevity

Dr. Heather Sandison: So take me through your five pillars of longevity. I really appreciate that you incorporate a systems based approach whenever you think about an intervention. So can you talk through what the things that you want to make sure are incorporated into any view of living longer?

Prof. Valter Longo: Yeah, so I think it's very important that we move away. As you know now lots of people stopped listening to all of us because they feel that there's too many opinions and if you look at it carefully, the people that have really spent our lives doing this generally agree. There is some disagreement, but whenever I go to conferences and you have some of the top people that have dedicated their lives to nutrition and longevity, there is not much of a difference between the different people. And so I think that the five pillars had the job of putting all the data together and say we should have a better system to give recommendations.

It shouldn't be, "Oh, an epidemiological study was just done and it show that the people that eat more carrots live seven years longer, so everybody should eat more carrots," and the person is saying it doesn't really know much about any of this, but they're just giving you this recommendation. I think it should be okay, well let's go look in all the pillars. So the centenarians, do they eat more carrots? In the clinical trials are randomized. If you give people more carrots versus a control, do they do better in six weeks, a year or whatever. And then basic research. What if you put mice on more carrots and you keep them on it for two and a half years? Do they live longer? And that's really a gold standard because it's really pointless if you decrease cancer by 30% and in the process increase cardiovascular disease by 30%. Now you just gave somebody a difficult change that will turn out to have no effect on their health or longevity.

So that's the third pillar and then another pillar is epidemiology. Of course, a very important pillar. So yes, if you look at a population of a million people and those that regularly adjust for all the other factors, if those who eat more carrots happen to live longer, that's a good pillar to keep in mind. Then finally my fifth pillar is complex systems and I wanted to also have a pillar in there that kept in mind the reductionism of a physicist and say, when the other four pillars can not explain, go to a machine like a plane or a car, and look at, let's say oxidation. How does oxidation affect a plane and overuse affects a car. So for example, if people ask you, if you look at the data on an exercise, let's say string of exercise and health and longevity, it's not that clear.

So is it good? Is it not so good? So that's when you may go to the fifth pillar and say, well, what happens if you drive a car for 500 miles a day after 20 years? Most people would agree that's probably not a good idea. You know, there's not going to be a beat up car after. So yeah. So then that pillar, I think looking at systems that are complex, like a car or a plane can help you make a decision even when the data doesn't really, it's very confusing because of course exercise got a lot of benefits. And so then the recommendation is do 150 minutes and yes, you could do 300 minutes a week of exercise, but probably 150 is better because it's got, epidemiologically speaking, the same affects as 300 minutes or close to it. But it doesn't put you at risk of wear and tear.

What Prof. Valter Longo Eats

Dr. Heather Sandison: I see, I see. Balance, it sounds like, is one of the pieces in there. So tell me about your diet. What did you have for breakfast this morning? What do you eat?

Prof. Valter Longo: My breakfast is not my best longevity feature, but I usually have tea and I have two slices of cinnamon raisin bread. Yeah, I'm also my own self experiment so I use a continuous glucose monitor recently to see what it does. Sure enough, I shouldn't probably do it. Should have a better breakfast, but that's my only violation. I like it and doesn't bother me at all. So yeah, I'm okay with it, but I wouldn't recommend it this way. It's fine, but it does cause a insulin sugar spike, a glucose spike and therefore insulin release. So it's probably not a good thing. But then my lunch usually is either no lunch when I, when I gain weight or something that is almost completely a vegetable and olive oil the rest of the time.

And then I usually have a pretty big dinner. My typical dinner is maybe 60 or 70 grams of pasta. And then let's say a lot of chickpeas and lots of vegetables. So it's about a pound of food with only a small part of it, which is pasta. So this is a typical dish that I eat. And this is also very much the typical dish that people used to eat in those very long lived towns. And the interesting thing, if you look at some of the centenarians that used to eat like that when, when food was not that abundant, they still eat like that and they like it. And that's where I really appreciated some of these dishes that I think they taste great even though they're so simple, and to a lot of people they may look not ideal.

So now for example in Italy and all over the world, you see people with these dishes full of pasta, very low nourishment, lots of starches. And in the end you're just hungry all day. Like I do for my bread in the morning, another big spike of insulin. And yeah. So yeah, I think that those are the adjustments I talk about in the book. So eat a lot, don't eat less like the Okinawans do, eat more, but eat more in this way. The calories are going to be less, the stomach is going to be full so you can have a mechanical signal to the brain, but you also have a biochemical signal to the brain. I got everything I need and so I'm okay for the next seven or eight hours and that's what you want. So for example, when I get up in the morning, I'm not hungry and because I think about all those factors.

Effects of Alcohol on Longevity

Dr. Heather Sandison: I'm curious about your opinion about alcohol. In some of these communities of centenarians we see that they consume not a lot, but a little bit of alcohol relatively regularly. What are your views on that?

Prof. Valter Longo: Yeah, so my view is the five pillars and if you look at the five pillars you come up with the epidemiology being a strong component, but also what you just mentioned, the centenarians, you come up with five drinks a week, up to five drinks a week, being perfectly fine, seeing minimal effects on longevity. Once you go more than five, you started seeing problems but up to one glass a day of wine, particularly, if anything, it seems to be slightly beneficial as far as a lifespan is concerned.

Book Recommendations

Dr. Heather Sandison: So since a lot of us are quarantined these days, what book has influenced you the most and had the biggest impact on your career? If we're looking at reading lists for this quarantine time, what do you recommend?

Prof. Valter Longo: I mean, certainly Roy Walford, my former mentor. Yes, his books, long time ago, changed my life. I was starting to get high blood pressure, high cholesterol in my late twenties and I thought, I mean I always thought, "There's no way I'm taking drugs," but that was going to start already becoming a reality, having familial hypertension. And so I read his book and of course I was in his lab, so I had almost no choice. But yeah, he was talking about, "Hey, if you change the diet this way, your cholesterol is going to drop and your blood pressure is going to drop," and so yeah, sure enough, that's what I did and I never taken a drug in my life. So I would definitely put that at the top of the-

Dr. Heather Sandison: What as the title of that book?

Prof. Valter Longo: I forget, I think the 120 Year Plan, but if you just look at Roy Walford. Yes, there was one that had 120 years in there I believe.

Dr. Heather Sandison: All right.

Prof. Valter Longo: So there was one of the ones that I had and I read.

Further Information on Valter Longo, Ph.D. 

Dr. Heather Sandison: We'll put it on the list. So you run a foundation. Can you tell us more about the foundation?

Prof. Valter Longo: Yes, the foundation, we started a few years ago with the profits from the book, from the first book. It was, I did very well in Italy and now it's doing very well in the United States. The book is Longevity Diet and so that allowed the establishment of the two foundations called Create Cures. You can find it at createcures.org, and the foundation is basically the idea is to educate on nutrition and longevity. But also we now just opened a clinic in Italy with registered dietitians and nutritionists. Now here we open in a clinic now in Santa Monica with doctors, with actually internal medicine doctors, a dietician animal, and a molecular biologist. And the idea there is to serve as a hub for the sort of integrative medicine strategies that we are taking. So working let's say with oncologist at different hospitals, a cardiologist and, and a rheumatologist, et cetera, et cetera.

And yeah, so the focus now is a little bit on everybody, but eventually I think we want to focus more on the people that are in trouble. So what is your stage four breast cancer or any other cancer? Or what if you have autoimmunity that is in advanced stages? And we want to, obviously based on everything I say, we want to sort of go to the foundation of the disease. Why do you have high cholesterol? Why you have high blood pressure? How can we fix the problem? Why do you have prediabetes? So some of them we already know we can take care of it. So prediabetes, we have a very high efficacy as you probably do, but you know, some others we're still at the beginning. But how can we work with the existing drugs and the existing matters to get the person back to a healthy state?

So I always mentioned for example, celiac disease and now maybe 30 or 40 years ago, lots of doctors were probably laughing when the patient or somebody said, "Oh, but this is caused by food." There was a doctor that had already had described that, but nobody's paying attention. And so now imagine all the drugs that were given to people on celiac disease instead of just removing the gluten. So yeah, so I think that that's the clinic that the job is to say, "Hey, but there is a doctor that has been studying this and has been showing this, so let's see. Is he or she right? Could we eliminate the problem?" And then the foundation, now we do lots of education in schools. And the idea is eventually to have camp summer camps and other camps where we can have the children do sports and also learn about nutrition and healthy nutrition. So maybe they can go home and educate the parents.

Dr. Heather Sandison: Fantastic. What a wonderful goal. So anything else that you want to share with our listeners about where they can find more?

Prof. Valter Longo: Well think you can find more on the longevity diet, my book, almost everything we talked about is in there. And again, all the profits go to, in fact the book belongs to the foundation and then you can go to the website for the foundation, createcures.org, createcures.org and so there's lots of there and obviously we also always looking for donations to continue to do what we do.

Dr. Heather Sandison: We'll make sure all that's in the show notes. So look below and find more. Find links. So Prof. Valter Longo, thank you so much for being with us today. Our love goes out to certainly your family and friends in Italy right now and I'm really praying for resolution of all of this all over the world as quickly as possible. Thank you for doing what you do to contribute to the health and wellbeing of the planet and for being here today, sharing your time with us.

Prof. Valter Longo: Okay. Thank you. I appreciate it. Thank you.

Dr. Heather Sandison: You're welcome.