Anti-Aging Expert: "STOP These 3 Habits After 40+! – They Predict Early Death" | Rose Anne Kenny

Dr. Rangan Chatterjee 0:00 Let's say if someone's in midlife, in their 40s or 50s, and you were gonna say one or two things for them to focus on, what would you say?

Rose Anne Kenny 0:10 I'll give the- my top three, and the first one I'd start with would be friendship, and to culture friendship, how important that is. Maybe we can take a step back. You mentioned there that 80% is in our control, and isn't that wonderful?

Dr. Rangan Chatterjee 0:23 Yeah.

Rose Anne Kenny 0:23 'Cause everybody assumes it's genes. You know, aging is about your genes, and your j- you're, you are stuck, more or less, at the moment anyway, with whatever genes you've got. But that isn't the case. Genes only contribute to 20% of the aging process. 80% is within our control, so that's fantastic. And then what are the things that we know are in our control that influence the process, that influence that 80%? And so if my top three would be, as I said, friendship, having good friendships. Um, it's not about quantity, but it's very much about the quality of relationships, qual- quality of friendships, and we can come back to how that works later on. I, I'm, and I'm sorry to say the next two, because the la- once I said this on radio in Ireland, and the interviewer said to me, "Oh, my God, not those old chestnuts again."

Dr. Rangan Chatterjee 1:10 [laughs]

Rose Anne Kenny 1:10 But I have to mention diet and I have to say exercise, because they are very important, and they are something that certainly definitely makes a difference. And then if I were to include a fourth, I'd say stress. How, you know, th- th- stress is so bad for us, so anything that we can do to attenuate stress processes or attenuate stress itself is important-

Dr. Rangan Chatterjee 1:33 Yeah

Rose Anne Kenny 1:33 ... for the aging process.

Dr. Rangan Chatterjee 1:35 Yeah, brilliant. So friendships.

Rose Anne Kenny 1:37 Mm-hmm.

Dr. Rangan Chatterjee 1:37 Well, let's broaden that out.

Rose Anne Kenny 1:38 Mm.

Dr. Rangan Chatterjee 1:38 I guess relationships-

Rose Anne Kenny 1:39 Yeah

Dr. Rangan Chatterjee 1:40 ... the food we're eating-

Rose Anne Kenny 1:41 Yeah

Dr. Rangan Chatterjee 1:42 ... how much we're moving our bodies-

Rose Anne Kenny 1:44 Yeah

Dr. Rangan Chatterjee 1:45 ... and how much stress we're being exposed to. We're gonna get into all of those in detail.

Rose Anne Kenny 1:50 Yeah.

Dr. Rangan Chatterjee 1:51 But as you say, a lot of us who are health-conscious these days have heard some of these messages, right?

Rose Anne Kenny 1:58 Yes.

Dr. Rangan Chatterjee 1:58 You have been publishing papers for years. You've been treating patients for years. You teach medical students. You've got a lot of experience, and I think everyone comes to the aging conversation at different times in their lives, right? So you've mentioned your top three there, but I'm, I'm interested, how would you frame it differently depending on the age of someone who's coming to see you? So for example, if someone is a, I don't know, a 40-year-old female, for example, how would you change that messaging slightly to be super relevant for them?

Rose Anne Kenny 2:36 Good question. So 40-year-old female, uh, will be coming into menopause, so to be preparing for that, I would say that's the first thing. We can talk a little bit about that. Um, it doesn't change what I'm saying about friendship, but it's sometimes much more difficult, because there are an awful lot of other pressures on someone's life.

Dr. Rangan Chatterjee 2:55 Mm.

Rose Anne Kenny 2:56 So they don't have the time to be culturing friendships, et- et cetera. So but to use some mechanism for retaining friendship is very important. You know, when you're picking up kids from school and having to do the housework piece and your work piece, that makes your life much more difficult in the context of diet, in the context of exercise. I can absolutely say that I almost came to a full stop when I was in that period of my life with my children and with my professional life, et cetera. All of the things [laughs] that I'm going to be talking to you now about, and the, and your audience, and sharing as being important for manipulating the aging process were almost at a full stop, because I wasn't able to do everything, and I focused on those other things. But I think to, uh d- not to... It's not all or nothing, so at least to try and do some of-

Dr. Rangan Chatterjee 3:46 Yeah

Rose Anne Kenny 3:46 ... the things we know are beneficial.

Dr. Rangan Chatterjee 3:47 I mean, on that, that's really interesting. At this stage in your life now-

Rose Anne Kenny 3:52 Yeah

Dr. Rangan Chatterjee 3:52 ... with all the experience that-

Rose Anne Kenny 3:53 Yeah

Dr. Rangan Chatterjee 3:53 ... you've got-

Rose Anne Kenny 3:54 Yeah

Dr. Rangan Chatterjee 3:54 ... with the knowledge you now have-

Rose Anne Kenny 3:56 Yeah

Dr. Rangan Chatterjee 3:57 ... if we rewind back to your 40s, had you known what you know now, do you think you would've been able to make different choices? Would you have made different choices back then?

Rose Anne Kenny 4:09 Oh, that's such a great question. At a personal level, I probably wouldn't, 'cause I adore my work, and obviously I love my family. But I, I wa- I, uh... In order to really focus on, on factors we just talked about, you really need to pull back from one or t'other, and I would not have done that. At a personal level, I wouldn't have done it. However, I didn't know as much as I know now, and now that I know [laughs] as much as I know, I'm working really hard on it-

Dr. Rangan Chatterjee 4:38 Yeah

Rose Anne Kenny 4:38 ... to be honest.

Dr. Rangan Chatterjee 4:38 Well, that, that, that thing-

Rose Anne Kenny 4:39 Yeah

Dr. Rangan Chatterjee 4:39 ... about work and, and purpose, of course, is something you, you've written a chapter on, which we're definitely gonna talk about. So I get the messaging for a 40-year-old. Um, if I was 70 years old talking to you, saying, "Hey, listen, what can I do?" how would your messaging change for a, let's say, a 70-year-old?

Rose Anne Kenny 4:58 Well, then the messaging is very different, 'cause generally speaking, we have more time, although I've met a number of 70-year-olds who say, "I've never been busier," since they retired. Um, generally speaking, we have more time, and I think that there's a, a perception out there, a societal perception, that as you get older, you shouldn't be doing as much, you should slow down. We don't expect as much of people, and I would love to see that concept changed, because I, my advice would be do a little bit more every year. I definitely mean that applies to exercise. A little bit more ex- whatever your m- movement is that you enjoy, do a bit more each year after 50. But I would also r- um, recommend that in the context of food. Put a, put a bit more variety into your food every year. Think of something different-

Dr. Rangan Chatterjee 5:47 Mm

Rose Anne Kenny 5:47 ... that you can do. But also creativity and purpose. Change that also every year of your life so that you have something that you want to do newEvery year. Variety in our, on our plate and in our lives and in our exercise regime are really important. So I would say that applies. Can I say something about the age thing? 20-year-olds, this is important for, and that's the age I'd like to see starting to engage in the process.

Dr. Rangan Chatterjee 6:12 Yeah. I was gonna come to that.

Rose Anne Kenny 6:13 Yeah.

Dr. Rangan Chatterjee 6:13 And that's so, so far away.

Rose Anne Kenny 6:14 Well, I've a great story about that because I was giving a lecture in Trinity recently, and we've a, what's called a TEP course, which, um, draws students from non-health related courses in the university into a module, uh, modules they might be interested in, and aging is one of them. So I had students from geography and law and mechanical engineering, et cetera, in, in the audience in front of me. And after the lecture, two young chaps came up, and they were from Durham University on an Erasmus, um, Ben and Dominic. And they said that they were looking for the university f- to choose for their Erasmus, and they chose Trinity because of the longitudinal study on aging that was being done in Trinity. And I was like, just like you-

Dr. Rangan Chatterjee 6:59 Wow

Rose Anne Kenny 7:00 ... wow. And, and I said, "Why?" And they said, "Because we feel it's such a, an, an important area." Now, they were not... One, one was in bioengineering, and the other was in w- one of the, um, the humanities. And, and they said, "And we're interested in becoming, maybe setting up an SME in this very space," but an SME for 20-year-olds.

Dr. Rangan Chatterjee 7:21 What's an SME?

Rose Anne Kenny 7:22 A, a, a, a small- and medium-sized enterprise. So like a small business, an innovative business, in this space so that they could harness their, their interest in aging to create a business opportunity for themselves. That's why they chose Trinity, so that they could access TILDA. And when I mentioned TILDA during the lecture, they came up to me afterwards. So, so I was really energized by that. And their approach was, what you're talking about suits the middle-aged and older person, but we'd like to reshape it for the 20-year-old. So then-

Dr. Rangan Chatterjee 7:58 I love that

Rose Anne Kenny 7:58 ... isn't it amazing?

Dr. Rangan Chatterjee 7:59 I love that.

Rose Anne Kenny 8:00 Yes. Yeah.

Dr. Rangan Chatterjee 8:00 So, um, w- I wanna talk about TILDA. Um, you mentioned it.

Rose Anne Kenny 8:04 Mm.

Dr. Rangan Chatterjee 8:05 Uh, and I'll be honest, growing up, my familiarity with that term was to do with-

Rose Anne Kenny 8:10 Right

Dr. Rangan Chatterjee 8:10 ... a particular make of basmati rice, which we would have at home, [laughs] TILDA basmati rice. I'm sure many people listening will, will resonate with that.

Rose Anne Kenny 8:17 Yeah, yeah.

Dr. Rangan Chatterjee 8:17 But when you talk about TILDA-

Rose Anne Kenny 8:19 [laughs]

Dr. Rangan Chatterjee 8:19 ... you're not talking about a rice brand, are you?

Rose Anne Kenny 8:21 No. [laughs] I'm talking about the Irish Longitudinal Study on Ageing. That's where the D comes from. There was already the Italian Longitudinal Study on Ageing, so we had to, uh, we had to recreate it. We couldn't use the S from study.

Dr. Rangan Chatterjee 8:35 Let's just understand what that means.

Rose Anne Kenny 8:37 Yeah.

Dr. Rangan Chatterjee 8:37 Why... You say longitudinal.

Rose Anne Kenny 8:39 Mm-hmm.

Dr. Rangan Chatterjee 8:40 What does longitudinal mean? And, and I just want a bit of context here. People who've been listening to my show for a while will know very recently I had on Professors, uh, Robert Waldinger and Mark Schulz-

Rose Anne Kenny 8:50 Yeah

Dr. Rangan Chatterjee 8:50 ... who are the director and associate director of the Harvard Adult Development Study that's been going on now-

Rose Anne Kenny 8:55 Yeah

Dr. Rangan Chatterjee 8:55 ... I think 85 years-

Rose Anne Kenny 8:57 Yeah

Dr. Rangan Chatterjee 8:57 ... or more, right? So they're familiar a little bit with that study and some of the learnings from it. So can you explain what your study is? What does longitudinal mean, and how would certain elements of your study compare to what they're doing in Harvard?

Rose Anne Kenny 9:13 Okay. So longitudinal means, generally, that you have a cohort of people, and in our case in TILDA, it's a, an Irish population of people aged 50 and older, chosen through a randomly selected sample, which means that whatever findings we get, we can generalize to the population. And the same people are studied longitudinally at regular intervals, in our case, every two years. And the study has been running for 16 years now, with a three to four-year pilot run-in. So every two years we go back to the same people. Now, that's what longi- the long- longitudinal bit is. That allows you to understand the process of aging. So you're looking at the same person now for 12, 16 years, as it stands at the moment. You knew what they were like at baseline, and then you can actually look at changes in the components, I call it the tapestry of that individual-

Dr. Rangan Chatterjee 10:14 Mm-hmm

Rose Anne Kenny 10:14 ... which makes up how they are now. For example, we, we, we measure a number of different factors. Of course, we measure genetics, the epigenetics, all of those new biomarkers of aging, the common things, like you get in a blood screen, your kidney function, urea, your, your kidney function, your electrolytes. [laughs] I was gonna say urea and electrolytes.

Dr. Rangan Chatterjee 10:36 [laughs]

Rose Anne Kenny 10:36 I'm so used to saying that when I'm ordering them. Your kidney function, your electrolytes, your hemoglobin, et cetera. But we also measure social factors-

Dr. Rangan Chatterjee 10:43 Mm

Rose Anne Kenny 10:44 ... and economic factors, and, and they're really important for... to understand who we are biologically. So we measure all of those factors and, for example, at age 50, if we had a man who, who was, had that broad assessment, including a very detailed health assessment, who had a stroke 16 years later, we can go back and see, okay, what were the things about that man compared to others in the study, which were probably the risk factors at that time, which led him to be a victim-

Dr. Rangan Chatterjee 11:17 Oh, yeah

Rose Anne Kenny 11:17 ... to stroke in 16 years.

Dr. Rangan Chatterjee 11:18 No, I love it. That's, that's so fascinating, isn't it? I think we can all really get our heads around that, that if this happens, instead of just looking at what were the blood tests on admission or six months before at your GP before-

Rose Anne Kenny 11:31 Yeah

Dr. Rangan Chatterjee 11:31 ... you got the stroke.

Rose Anne Kenny 11:32 Yeah.

Dr. Rangan Chatterjee 11:34 I think there's a growing recognition that these-Chronic diseases, they don't just happen overnight. The process that's driving them is going on in the body for 10, 20, sometimes maybe 30 years. So I can see the power there that you can go back and go, "Hey, what was going on when you were 50?"

Rose Anne Kenny 11:51 Mm.

Dr. Rangan Chatterjee 11:51 And so what are some of those key learnings that you've found so far?

Rose Anne Kenny 11:56 Oh, there's a host of them.

Dr. Rangan Chatterjee 11:58 [laughs]

Rose Anne Kenny 11:58 Now, okay, so let, let, we've published nearly 600 papers from the study to date, and not only us. We make sure that the data is publicly archived after it's been cleaned and we've done m- you know, an- analytics on it to make sure that it's-

Dr. Rangan Chatterjee 12:11 Wow

Rose Anne Kenny 12:12 ... c- c- yeah, uh, kosher. Um, and then it's publicly archived in Ireland, but also in Michigan, so that it's available to universities worldwide. This is a great asset for us because, um, that means that you get researchers all over the world tapping into your data source. So s- let's see, what have we published so far? So depends, we, we, we, we carve it into three big domains: social, economic, and health. From the health, in the health domain, we found that things, this won't be a, a surprise, metabolic syndrome is very common. It, it starts early. Metabolic syndrome is where you've a mix of obesity, central obesity particularly, h- high blood pressure, early diabetic markers, and abnormal lipids in the blood. That, that cocktail makes you much more at risk for cardiovascular events later on.

Dr. Rangan Chatterjee 13:05 And does it, does that cocktail-

Rose Anne Kenny 13:07 Mm

Dr. Rangan Chatterjee 13:08 ... speed up the rate at which you age?

Rose Anne Kenny 13:11 Yes, absolutely it does.

Dr. Rangan Chatterjee 13:13 A- and can we just-

Rose Anne Kenny 13:13 Yeah

Dr. Rangan Chatterjee 13:14 ... um, Rose Anne, if you don't mind, just pause you for a second-

Rose Anne Kenny 13:16 Yeah

Dr. Rangan Chatterjee 13:16 ... because I think we talk about aging a lot, where it's, it's becoming more and more a part of the vernacular, I think.

Rose Anne Kenny 13:25 Mm.

Dr. Rangan Chatterjee 13:25 You know, certainly in my world-

Rose Anne Kenny 13:27 Mm

Dr. Rangan Chatterjee 13:27 ... the people I communicate with are very health conscious. We're hearing a lot about anti-aging these days. What exactly is going on when we age? Because then I think it'll be helpful if we understand that, then we can understand, well, metabolic syndrome, which is so common now, how is that influencing those kind of parameters of aging?

Rose Anne Kenny 13:47 Okay. So, so just imagine you have, you know this very famous image of an iceberg and a threshold, a line going through the iceberg. That's the sea level, and we can see the iceberg at the top.

Dr. Rangan Chatterjee 14:00 Yeah.

Rose Anne Kenny 14:00 That's your older person. Um, and below that w- there's a whole lot of stuff, and below that is the process which has been accumulating for years and years and years of all of the biological biomarkers, we'll talk about those, influenced by the social and economic factors, which eventually lead, in the case we're talking about now, to, to health diseases or disorders, to a health outcome. So all of that's been going on for many years, as you've said, and then it creeps above the threshold, and we get a heart attack or stroke or n- dementia or whatever. So aging is actually really the manifestation of disorders or diseases that we're very familiar with, and, and, and multiple diseases, 'cause having multiple diseases is not uncommon as we get older.

Dr. Rangan Chatterjee 14:51 Mm.

Rose Anne Kenny 14:51 An average of four to five is common. Um, so but the process that we're trying to understand are the earlier stages where it isn't a disease as such, but it will ultimately evolve into one or other disease-

Dr. Rangan Chatterjee 15:05 Mm

Rose Anne Kenny 15:06 ... um, if something isn't done about it and checked, and that, and that's what we're most interested in. So if we come back to metabolic syndrome, what we're looking at is early physiological changes in blood pressure, that's the hypertension, and in the lipids, in li- fat lipids, triglycerides, cholesterol, et cetera, and in your w- waist-hip ratio or obesity markers, um, and, and early diabetes, just creeping hemoglobin A1C, and, and then how they evolve into a disease state. So it might be that you then develop type 2 diabetes, full blast, or kidney disease as a result of atherosclerosis or a heart attack, et cetera. But it's the early combination of those. And metabolic syndrome itself is very common in Ireland. 40% of people over the age of 50 have it. It's remarkably common.

Dr. Rangan Chatterjee 15:54 40%. Do you know what that figure-

Rose Anne Kenny 15:56 Yeah

Dr. Rangan Chatterjee 15:56 ... is in the UK?

Rose Anne Kenny 15:56 Oh, very similar. Yeah.

Dr. Rangan Chatterjee 15:58 Very similar.

Rose Anne Kenny 15:58 Our, our data is almost a, a, a, a duplicate of what's happening here.

Dr. Rangan Chatterjee 16:01 And, and generally America tends to be a little bit worse than us, doesn't it?

Rose Anne Kenny 16:05 They're, they're, they're, they're fatter and generally sicker-

Dr. Rangan Chatterjee 16:09 Yeah

Rose Anne Kenny 16:09 ... than in Ireland and the UK, actually, yeah.

Dr. Rangan Chatterjee 16:11 So if someone listening to this wants to take action on that, right, to go, "Okay, uh, you've said a few things there about metabolic syndrome-

Rose Anne Kenny 16:20 Yeah

Dr. Rangan Chatterjee 16:20 ... what can I do now at home?" You know, what would you advise? Would you advise them to measure these things, go and see a healthcare professional, you know, find out if they have it? How, how would you advise people to tackle that?

Rose Anne Kenny 16:31 So I would definitely say we should all know our blood pressure, and we should know it every single year after the age of 40. Know what your blood pressure is, and know what your seated blood pressure and your standing blood pressure is, because we get, as we get older, we're more likely to get a drop in blood pressure standing, and that actually has to be managed a little bit differently. So know your blood pressure seated and standing every year. Know your lipid profile, and it's not just about c- uh, cholesterol. It is about triglycerides and HDL, LDL ratios, et cetera. So know your lipid profile every year, and know your hemoglobin A1C. Hemoglobin A1C is a very good marker for diabetes, obviously, but pending diabetes and pre-diabetes.

Dr. Rangan Chatterjee 17:12 Yeah.

Rose Anne Kenny 17:13 Um, and it actually is, um, an indicator of what your glucose has been doing over the last two to three months. So that's why it's such a good marker. It doesn't shift up and down with the food intake, et cetera. So at least those three things we should all know.

Dr. Rangan Chatterjee 17:27 Yeah. So what I like about that, there's a lot of, um, talk about anti-aging now and, and some of the testing that is being spoken about is not widely available to everyone yet, right?

Rose Anne Kenny 17:41 I agree.

Dr. Rangan Chatterjee 17:42 Whereas the three things you just mentioned, blood pressure-A blood lipid panel and an HbA1c, uh, measurement from your blood is pretty commonly available. Certainly in the UK those things are-

Rose Anne Kenny 17:56 Yes

Dr. Rangan Chatterjee 17:57 ... freely available on the NHS-

Rose Anne Kenny 17:58 Yes

Dr. Rangan Chatterjee 17:59 ... right? From the National Health Service.

Rose Anne Kenny 18:00 Yes.

Dr. Rangan Chatterjee 18:00 So th- they're very accessible things, and so if we just go into those a minute, let's take HbA1c. Okay, two to three-month average m- uh, measurement of our blood sugar.

Rose Anne Kenny 18:12 Yeah.

Dr. Rangan Chatterjee 18:12 So one of my frustrations with, I guess, the way the practice of medicine has evolved over the years is that it's become very black or white, and much of the time we interpret things in a very black-or-white fashion.

Rose Anne Kenny 18:29 Mm-hmm.

Dr. Rangan Chatterjee 18:29 It's either normal or it's pre-diabetic or it's diabetic, right? Type 2 diabetes I'm talking about.

Rose Anne Kenny 18:35 Mm-hmm.

Dr. Rangan Chatterjee 18:35 So, you know, if your HbA1c is 6.5 or above, we say type 2 diabetes. If it's between 6 and 6.5, we say that's pre-diabetes.

Rose Anne Kenny 18:44 Mm-hmm.

Dr. Rangan Chatterjee 18:45 But if it's 5.9 or 5.8-

Rose Anne Kenny 18:47 Mm-hmm

Dr. Rangan Chatterjee 18:47 ... or 5.7-

Rose Anne Kenny 18:49 Mm-hmm

Dr. Rangan Chatterjee 18:49 ... it will often be reported as normal.

Rose Anne Kenny 18:51 Mm.

Dr. Rangan Chatterjee 18:52 So I'd love you, with all your knowledge, to expand on what do you like to see with an HbA1c? You know, of course you want it normal, but are you of the school of thought where lower is better?

Rose Anne Kenny 19:04 So when I started off as a junior doctor with respect to blood pressure, we were treating blood pressure, systolic pressure, if it was more than 160.

Dr. Rangan Chatterjee 19:14 No way.

Rose Anne Kenny 19:14 Now... Yes, and now we're looking at 120.

Dr. Rangan Chatterjee 19:16 Oh, hold on.

Rose Anne Kenny 19:17 It's come up-

Dr. Rangan Chatterjee 19:17 So when you, when you qualified it was 160-

Rose Anne Kenny 19:19 W- yes

Dr. Rangan Chatterjee 19:20 ... you were treating. When I qualified, I'm pretty sure it was 140 was the threshold-

Rose Anne Kenny 19:25 Yeah

Dr. Rangan Chatterjee 19:25 ... to actually treat.

Rose Anne Kenny 19:26 Yeah. And now we're down to 120.

Dr. Rangan Chatterjee 19:28 Yeah.

Rose Anne Kenny 19:28 So, so, so, so... And that's because massive randomized control trials have been done to explore this. So it's the same with all of these. We're talking about biomarkers. Everything we're talking about now are biomarkers. All a biomarker is is a marker of your biological status. So all of the biomarkers that we use, we use thresholds because that's where the information, um, is at that particular time. And obviously it's much easier to apply at a population level. For individuals, it varies, and you know the way there's a distribution in- at a population level, and of course people lie outside of a normal distribution, many. Um, and we- we're- we're learning that that same change with respect to blood pressure is applying to a number of other biomarkers, and lower and lower and lower [laughs] thresholds are being applied.

Dr. Rangan Chatterjee 20:17 So, so, so if a patient came to see you and their HbA1c comes back at 5.9, so technically it's not yet in the pre-diabetic range, what do you say to them?

Rose Anne Kenny 20:28 I advise them. I give them, I give them lifestyle modification advice.

Dr. Rangan Chatterjee 20:31 You say, "Look, it's, it's not yet pre-diabetic, but if we don't do something or if you don't do something-

Rose Anne Kenny 20:39 Yeah

Dr. Rangan Chatterjee 20:40 ... um, this may very quickly end up at pre-diabetes"?

Rose Anne Kenny 20:43 And that's what we've shown in the study, that it very likely will evolve into pre-diabetes, even two and three years later. So g- get a grip of it now when it's reversible.

Dr. Rangan Chatterjee 20:52 Yeah.

Rose Anne Kenny 20:53 And grip is easy. Grip is low sugar, you know, manage your diet and lose a bit of weight. The, the grip for that one is very easy.

Dr. Rangan Chatterjee 20:59 Th- th- there's some pretty good, uh, data now I think showing that all-cause mortality is, it goes up as your average blood sugar goes up.

Rose Anne Kenny 21:09 Yeah.

Dr. Rangan Chatterjee 21:09 So if we compare, let's say, an HbA1c of 5.9-

Rose Anne Kenny 21:12 Mm

Dr. Rangan Chatterjee 21:12 ... again, technically normal, with an HbA1c of 5.4, I've seen some good data showing that-

Rose Anne Kenny 21:17 Yeah

Dr. Rangan Chatterjee 21:17 ... actually your, your mortality goes up as that goes up, right?

Rose Anne Kenny 21:20 Yes, yes.

Dr. Rangan Chatterjee 21:21 But we're still calling 5.9 normal, which I, I don't think we should be anymore. And you mentioned something there which I think is really worth expanding on, at a population level-

Rose Anne Kenny 21:33 Mm

Dr. Rangan Chatterjee 21:33 ... versus an individual level, right? I, I'm not sure everyone fully understands that concept, right? And I think it's an important one because a lot of the time the guidelines we're being given that doctors are applying are things that maybe, let's say in the NHS, have been deemed overall for these 60-plus million people that exist in the country, we can afford to actually manage this percentage of people if we have crossed this threshold, right? So on a population level it works, but individually you may miss out.

Rose Anne Kenny 22:07 Yes.

Dr. Rangan Chatterjee 22:07 Right?

Rose Anne Kenny 22:08 Yes.

Dr. Rangan Chatterjee 22:08 How, how would you frame it for people?

Rose Anne Kenny 22:09 So no, I think you've framed that incredibly well. So I'm, I'm, I'm... If you're near the threshold of something, those thresholds have been derived by averages, just to understand that.

Dr. Rangan Chatterjee 22:21 Mm-hmm.

Rose Anne Kenny 22:21 And so it's a cutoff based on averages. But each side of the average there is a distribution, and, and it's, it's... W- we don't make recommendations based on the lower pieces of that distribution or the lower-

Dr. Rangan Chatterjee 22:35 Mm

Rose Anne Kenny 22:35 ... levels of that distribution. We make it where that cutoff occurred, because that's the only way we can apply things at a lar- large scale within a health service. So therefore, when you're indivi- dealing with an individual patient, I try to ind- deal with the individual. I give them the evidence. I say, "Look, this is what's, these are what the recommendations are. In my opinion, I'm, knowing you, I see these, these potential risk factors-

Dr. Rangan Chatterjee 23:00 Mm

Rose Anne Kenny 23:00 ... and I actually think if I were you, I would get a handle on these risk factors now when you've plenty of time." It's, coming back to the 20-year-olds again, there's lovely data on blood pressure to show that if you've a slightly higher blood pressure, even in your 20s, you're on a higher blood pressure trajectory for the rest of your life, whereas the lower blood pressure group within that population distribution in your 20s are less inclined to have the higher trajectory.

Dr. Rangan Chatterjee 23:28 Yeah, but, but-

Rose Anne Kenny 23:28 Those, those graphs are fascinating

Dr. Rangan Chatterjee 23:29 ... the, the whole thing's fascinating. This, this idea that, you know, mentioned with your TILDA study, that w- you can go back, this is for people above the age of 50, someone has a stroke, let's say, in their late 60s.

Rose Anne Kenny 23:42 Yeah.

Dr. Rangan Chatterjee 23:43 If they're in your study, you can go back and go, "Hey, what was going on here?"

Rose Anne Kenny 23:46 Yes.

Dr. Rangan Chatterjee 23:47 That's incredibly helpful.

Rose Anne Kenny 23:48 Mm.

Dr. Rangan Chatterjee 23:48 And, and I, I'm really excited to see how this data set-

Rose Anne Kenny 23:51 Yeah

Dr. Rangan Chatterjee 23:51 ... builds over the years-

Rose Anne Kenny 23:52 Yes

Dr. Rangan Chatterjee 23:52 ... and what else we're going to learn.

Rose Anne Kenny 23:53 Yeah.

Dr. Rangan Chatterjee 23:54 But that's 50 and above.As you just mentioned with the blood pressure there-

Rose Anne Kenny 23:58 Mm-hmm

Dr. Rangan Chatterjee 23:58 ... we can go even further back. We can actually recognize in our 20s, we can might be, we might be able to pick up stuff in our 20s that indicates what's gonna happen when we're 60-

Rose Anne Kenny 24:09 Yes

Dr. Rangan Chatterjee 24:09 ... 70, 80. So just to finish off on that piece, we started off talking about the advice you would give to a female in their 40s, then we moved on to the advice that you would give someone potentially in their 70s, recognizing that everyone's an individual and everyone, you know, needs slightly different advice. But stereotypically, if there was a 20-year-old sitting in front of you saying, "Oh, aging, you know, that's miles away in the future, right? Why do I need to be bothered about that?" Or what would you say to a 20-year-old that might make a difference in terms of what they do?

Rose Anne Kenny 24:45 So I would sit them down-

Dr. Rangan Chatterjee 24:49 [laughs]

Rose Anne Kenny 24:49 ... and I'd show them a great gla- graph from the Dunedin study, which I'll share with you now. So the Dunedin is a different model longitudinal study to ours. It's 1,000 babies born in the same year, studied longitudinally, and they're now in their 50s. Um, and in the Dunedin study, they looked at their whole cohort of 1,000 when they were all aged 38, and at this stage of the study, they had the ability to measure their biological aging, their epigenetic clocks. Okay? So they were able to actually look at their biological clock, and of course everybody was the same age, had the same chronological clock, in other words, number of candles on their birthday cake. And remarkably, they showed that some people aged 38 were behaving biologically like 28-year-olds. But some aged 38 were behaving biologically like 48-year-olds, a 20-year distribution in their biological aging, although they were all the same chronological age. That's an amazing study.

Dr. Rangan Chatterjee 25:57 And so the practical take-home for someone in their 20s is what?

Rose Anne Kenny 26:01 So the practical take-home is this, this process starts really early on. Now, you know, the, the trite thing to say, it probably [laughs] starts in the womb, but for an individual, that doesn't help. But the process does start, uh, in your 20s, and you can do damage in your 20s. When they looked back on the 38-year-olds who had the almost 50-year-old biological aging through the clocks, the factors which drove that accelerated aging were adverse childhood events.

Dr. Rangan Chatterjee 26:31 Mm-hmm.

Rose Anne Kenny 26:31 You know, traumatic experiences in childhood, depression in childhood, or depression in a household, divorce in a household, or, or bad behaviors early on in the, in lives, like smoking and alcohol in, in, in the participants' lives.

Dr. Rangan Chatterjee 26:46 I- if we just talk about these ACEs for a minute, these-

Rose Anne Kenny 26:47 Mm

Dr. Rangan Chatterjee 26:47 ... adverse childhood experiences, this is something that I've covered on this show many times through the lens of trauma-

Rose Anne Kenny 26:53 Mm

Dr. Rangan Chatterjee 26:53 ... with people like Dr. Gabor Maté, Dr. Bessel van der Kolk, recently with a, a chap called Dr. Russell Kennedy on anxiety, and we're seeing very clearly for many years now data on adverse childhood experiences, on how, you know, difficult childhoods, trauma, divorces-

Rose Anne Kenny 27:12 Mm

Dr. Rangan Chatterjee 27:12 ... um, you know, abuse.

Rose Anne Kenny 27:14 Mm.

Dr. Rangan Chatterjee 27:15 The impacts of those things play out in your adult risk of disease, illness, autoimmune disease-

Rose Anne Kenny 27:23 Yeah

Dr. Rangan Chatterjee 27:23 ... all kinds of things, right?

Rose Anne Kenny 27:25 Yeah.

Dr. Rangan Chatterjee 27:25 But you're saying it also plays out these emotional factors-

Rose Anne Kenny 27:28 Yes

Dr. Rangan Chatterjee 27:28 ... or what we consider emotional factors, that also plays out in terms of how quickly we're aging.

Rose Anne Kenny 27:34 Well, you see, because how quickly you're aging is what's driving those diseases later on in life.

Dr. Rangan Chatterjee 27:38 Mm-hmm.

Rose Anne Kenny 27:38 That's my point. The aging process, all it is, is the precursor to having one of those diseases, and the pace of that aging process, i- is, i- all that is, is, means is that you'll have one of those illnesses earlier. That's what aging is.

Dr. Rangan Chatterjee 27:54 Professor David Sinclair, who I spoke to maybe two or three years ago on this podcast, he makes the case in his book that we should consider aging a disease. What's your perspective on that?

Rose Anne Kenny 28:06 Well, I, I, I don't entirely agree with that, although I can see that there's some overlap in concepts. Um, there isn't a diagnosis for aging-

Dr. Rangan Chatterjee 28:18 Yeah

Rose Anne Kenny 28:18 ... as such. Um, it, it's a very multifactorial process. Um, it's something that we all will experience in one way or another. It doesn't necessarily lead to a disease outcome that we recognize, um, so there are some of the reasons that I wouldn't-

Dr. Rangan Chatterjee 28:34 Yeah

Rose Anne Kenny 28:35 ... agree with that. But also a- as a doctor, and knowing busy ED departments, et cetera, I wouldn't like people to think of aging, whi- for which we've no cure at the moment, is a disease, and when somebody comes in, that they, they attribute something to aging and we can't do anything about it.

Dr. Rangan Chatterjee 28:54 Yeah.

Rose Anne Kenny 28:54 I think that, that patients would lose out.

Dr. Rangan Chatterjee 28:56 Yeah, I think the point everyone's trying to make is that the aging process underpins all kinds of diseases that we get later on in life, heart disease, stroke, dementia, cancer, whatever it might be. And so if we can slow down the aging process, we also reduce the risk or at least delay the onset of many of these diseases. I think-

Rose Anne Kenny 29:21 Yeah

Dr. Rangan Chatterjee 29:21 ... most scientists study aging would agree with that. But I think there's a wider point here for me, which I've been thinking a lot about recently-

Rose Anne Kenny 29:30 Mm

Dr. Rangan Chatterjee 29:30 ... that does appear to now be, I wouldn't call it an obsession necessarily-

Rose Anne Kenny 29:36 Mm

Dr. Rangan Chatterjee 29:36 ... but the term anti-aging is something that really has got the zeitgeist now, right?

Rose Anne Kenny 29:43 Mm.

Dr. Rangan Chatterjee 29:43 People are very excited about anti-aging-

Rose Anne Kenny 29:45 Mm

Dr. Rangan Chatterjee 29:45 ... reversing aging-

Rose Anne Kenny 29:46 Mm

Dr. Rangan Chatterjee 29:46 ... all these kind of things. Are we missing something about the human experience? Are we trying to defy something-

Rose Anne Kenny 29:54 Mm

Dr. Rangan Chatterjee 29:54 ... that is fundamentally a part of humanity? You know, we're, we're born, we live for a set period of time, and then-We die. I'm delighted to announce that AG1, the daily health drink that has been in my own life for over six years now, have updated and improved their formulation based upon the latest science. And to celebrate by giving my audience a very special summer offer. Some of the upgrades include more magnesium, which supports muscle function and improves the ability of your nervous system to relax, and also five strains of bacteria instead of just two to reflect the latest advances in microbiome science. It also contains key nutrients like vitamin C, biotin, niacin, vitamin B6, riboflavin, thiamine, zinc, and folate in bioavailable forms the body can easily and readily utilize, maximizing their potential benefits. Nutrition can often seem really complicated. What diet should we be following? What supplements should we be taking? And I think that's one of the main reasons I really like AG1. They make it really simple for you to be the best version of you. Over 70 ingredients, one scoop once a day for less than a cup of coffee. So if you wanna support your health seven mornings a week, get started with AG1, and right now we have a very special limited time summer offer worth 58 pounds, which is around 80 US dollars. To get

Dr. Rangan Chatterjee 31:25 10 free travel packs instead of the usual five, and an awesome welcome kit containing your shaker, scoop, and canister with your first subscription, go to drinkag1.com/livemore. I know you know all the biology and the, the blood markers, and you've done all the science of aging, but from a philosophical point of view, what's your perspective on that?

Rose Anne Kenny 31:51 That's a ... It's a great question. First of all, factually, quality of life gets better [laughs] as we get older. That's the first thing to say, and this has been shown by many, many studies. I- i- in our own study in, in TILDA, um, aged 50 upwards, quality of life continued to improve year on year until late 70s, and the factor which actually impacted then on positive quality of life was physical ill health. That was the biggest factor-

Dr. Rangan Chatterjee 32:20 Mm-hmm

Rose Anne Kenny 32:20 ... that impacted on quality of life. But the, the m- measures that we were using for quality of life, very good tool, didn't get to the same level in the 80-year-olds as they ... It was in 50 until people's ... was, were, were 84. So in other words, it went up, and it slowly came down, and it was only at age 84 that your quality of life was the same at 50.

Dr. Rangan Chatterjee 32:41 So hold on.

Rose Anne Kenny 32:42 So it gets better.

Dr. Rangan Chatterjee 32:42 So, so once you've hit 50, on average-

Rose Anne Kenny 32:44 It gets better

Dr. Rangan Chatterjee 32:45 ... your quality of life gets better-

Rose Anne Kenny 32:47 Yes

Dr. Rangan Chatterjee 32:47 ... and doesn't get down to that level until you're 84.

Rose Anne Kenny 32:50 Absolutely.

Dr. Rangan Chatterjee 32:50 So you have 34 years of good times.

Rose Anne Kenny 32:54 Maybe longer-

Dr. Rangan Chatterjee 32:55 Maybe longer

Rose Anne Kenny 32:55 ... because the only factors that were influencing beneficial quality of life o- ... This is on average now. This is for at a population level ... were physical disability, so not being able to do what you were previously able to do because of arthritis or another physical illness.

Dr. Rangan Chatterjee 33:09 So is that the point for you? I think that's the point from your book is, is not necessarily about trying to live to 150.

Rose Anne Kenny 33:14 No.

Dr. Rangan Chatterjee 33:15 Right?

Rose Anne Kenny 33:15 Yeah.

Dr. Rangan Chatterjee 33:16 The, the message I get from your work is that it's just about how do you make sure you've got that quality of life until you do drop down dead?

Rose Anne Kenny 33:26 Yes. Yes. Yeah. And, and living independently and having a good quality of life. They, they should be our two metrics, um, for, for happy lifespan.

Dr. Rangan Chatterjee 33:37 So, so on that then, um, what are some of the myths that are currently being propagated, would you say, around aging? There's all kinds of talk about living to 150 or 120, 130. You know?

Rose Anne Kenny 33:52 Yeah.

Dr. Rangan Chatterjee 33:52 What, what's your ta- ... Well, first of all, are there any myths out there that you'd like to share a different perspective on? And I guess related to that, how old do you think it is possible for a human to live in good health?

Rose Anne Kenny 34:06 Well, well, for the latter question, I would answer to Jeanne Calment, who I wrote about in the book, we know therefore 126 is feasible, right?

Dr. Rangan Chatterjee 34:14 Is that what she lived to?

Rose Anne Kenny 34:14 Yeah, she lived to 126, so that's, that's feasible. I think it was 126 or 122. So we know that that can happen. That's the first thing to say. Um, the, the, the, the second thing is that actually longevity is attenuating at the moment. It's, it's ... The, the curve has started to slow down and flatten out in the UK since 2012, and in the US. Now, the attributable reasons for that are disparities in socioeconomic status.

Dr. Rangan Chatterjee 34:42 Mm.

Rose Anne Kenny 34:42 That's what we've ... That's what most of the researchers in this area would now agree in, in the UK. And in the US, a dominant feature driving that is younger deaths due to opioids.

Dr. Rangan Chatterjee 34:56 Wow.

Rose Anne Kenny 34:57 So but, but it ... So w- that wonderful linear association between, um, years and lifespan that we've talked about for the last couple of decades seems to be slowing down.

Dr. Rangan Chatterjee 35:09 So up until 2012-

Rose Anne Kenny 35:11 Yeah

Dr. Rangan Chatterjee 35:12 ... our longevity was going up.

Rose Anne Kenny 35:13 Oh, in a linear fashion, 2.2 years every 10 years since the 1800s.

Dr. Rangan Chatterjee 35:17 So each generation was living longer.

Rose Anne Kenny 35:19 Every generation was living longer.

Dr. Rangan Chatterjee 35:20 You know, and every-

Rose Anne Kenny 35:21 That's right

Dr. Rangan Chatterjee 35:21 ... every parent wants a better life for their kids-

Rose Anne Kenny 35:24 Yes

Dr. Rangan Chatterjee 35:24 ... than they had.

Rose Anne Kenny 35:25 Yeah.

Dr. Rangan Chatterjee 35:25 And I guess you could say a longer life potentially. So that was happening, but in 2012, the graph started to change.

Rose Anne Kenny 35:31 It started to slow down, and, uh, and part- particularly noticeable actually in the UK. It hasn't slowed that much in Ireland of interest, but we're behind you in terms of the numbers of people over-

Dr. Rangan Chatterjee 35:43 Mm

Rose Anne Kenny 35:43 ... you know, the percentage of the population over 65. That may have influenced it slightly. But it hasn't ... Yeah, but in the UK, particularly in the US, and some European countries, not Northern European countries, of interest. So a- and, and the biggest driver for that is, is, is social disparities.

Dr. Rangan Chatterjee 36:02 Wow.

Rose Anne Kenny 36:02 I mean, Rangan, when did we ever talk about food banks?You know. Now, I mean, I m- I mean, I've... It's, it's, you know, and now they're d- daily, part of daily practice throughout the country. So you know, you, we never thought we'd see that. A nurse had to go to a food bank to get food.

Dr. Rangan Chatterjee 36:21 Yeah.

Rose Anne Kenny 36:21 So that's the level of disparity-

Dr. Rangan Chatterjee 36:23 So-

Rose Anne Kenny 36:23 ... we're seeing in society.

Dr. Rangan Chatterjee 36:25 And I know you've studied this as part of the TILDA-

Rose Anne Kenny 36:27 Yes

Dr. Rangan Chatterjee 36:27 ... study.

Rose Anne Kenny 36:27 We have.

Dr. Rangan Chatterjee 36:29 And I, I, I know many researchers around the world have also studied this. But when we think about socioeconomic status, we think about income, we think about poverty-

Rose Anne Kenny 36:41 Mm-hmm

Dr. Rangan Chatterjee 36:42 ... what exactly is that doing on a cellular level? How, how is that affecting the aging process?

Rose Anne Kenny 36:50 Um, I have a colleague, Cathal McCrory, who's actually studying this very thing across the life course, and showing the biological, the epigenetic, the clock changes that we're seeing a- a- a- associated with socioeconomic divides. So you've got five different groups, say, quintiles, of socioeconomic status, and those who are in the lower, the, the worse socioeconomic status, have much accelerated biological clocks. And because of the richness of the data we're collecting, I'm able to say to you today that that is the case independent of anything else which might be driving accelerated aging.

Dr. Rangan Chatterjee 37:28 Yeah, I mean, it's absolutely fascinating. Let's just contrast then, um, the lady, I think Jeanne Louise Calment-

Rose Anne Kenny 37:33 Mm

Dr. Rangan Chatterjee 37:34 ... who you wrote about in the book, the French lady-

Rose Anne Kenny 37:36 Yeah

Dr. Rangan Chatterjee 37:37 ... who went past 120.

Rose Anne Kenny 37:39 Yeah.

Dr. Rangan Chatterjee 37:39 You, you've written about her in quite a bit of detail-

Rose Anne Kenny 37:41 Yes

Dr. Rangan Chatterjee 37:42 ... um, which is, it was just so fascinating reading about her story.

Rose Anne Kenny 37:46 She had a, a privileged life, um, and probably all of the components that we have got control of with respect to the aging process, she illustrated throughout her life. That's what I liked about her life. Um, very positive attitude.

Dr. Rangan Chatterjee 38:05 Yeah. I w- I wrote this down. Um, you p- you put in... I mean, it's, uh, as I say, I love your book. I think it's jam-packed full of really practical information. Um, at the time of writing, the record-holder for longevity for the human species at 122 years and 164-

Rose Anne Kenny 38:21 Oh, wow

Dr. Rangan Chatterjee 38:21 ... days is a French woman, Jeanne Louise Calment. And you know, there's many paragraphs on her, but this one I, I wrote down, and I think this really speaks to what we're talking about with socioeconomic-

Rose Anne Kenny 38:33 Yeah

Dr. Rangan Chatterjee 38:33 ... status, which is, "Jeanne never had to work."

Rose Anne Kenny 38:37 Mm-hmm.

Dr. Rangan Chatterjee 38:37 "She employed servants and led a leisurely lifestyle within upper society, pursuing hobbies such as fencing, cycling, tennis, swimming, roller skating, playing the piano, and making music with friends. In the summer with her husband, she would mountaineer. She enjoyed an idyllic, relatively stress-free-

Rose Anne Kenny 38:55 Mm

Dr. Rangan Chatterjee 38:55 ... and fun-filled life." Now, you can interpret that two ways. You can either interpret that and go, "Okay, wow, that has shown us what is possible," and I can see-

Rose Anne Kenny 39:07 Mm

Dr. Rangan Chatterjee 39:07 ... that the various elements that you write about in your book, a lot of them are, you know, are there within her story. Or, that can be incredibly off-putting to people and go, "Yeah, all right for her," you know. "My life is completely different to that. No wonder-

Rose Anne Kenny 39:22 Mm

Dr. Rangan Chatterjee 39:22 ... I'm struggling."

Rose Anne Kenny 39:23 Mm.

Dr. Rangan Chatterjee 39:24 So, so how do you make sense of that?

Rose Anne Kenny 39:25 Well, well, I, well, I mean, you're a doctor. I'm a doctor. You know, you sit down in front of somebody, you talk to them about ways of alleviating stress, but you know that they're finding it hard to make ends meet.

Dr. Rangan Chatterjee 39:36 Yeah.

Rose Anne Kenny 39:37 You know, I mean, and, and it's, it's, it's a terrible problem. Um, it, it's, uh, so you've just exemplified [laughs] that issue. I struggle with that. I mean, eh, uh, I know what the facts are. I know what works at a biological level. So now we're going into how m- how important this is as, at a sociological level, at a societal level. How can we change society to, to enable all of the things that we know will work? And frankly, everything we're, we're talking about here that individuals can modify, they don't cost money, by and large, but they, you need not to be stressed about how to feed the kids-

Dr. Rangan Chatterjee 40:14 Mm

Rose Anne Kenny 40:14 ... throughout the week at the same time. So one of the things that we've, we've, uh, learned from our research certainly is education, education, education. That education drives better, um, quality of life, less stress, and, um, more, higher income in later life if, if, if you can achieve that-

Dr. Rangan Chatterjee 40:37 Mm-hmm

Rose Anne Kenny 40:37 ... in younger years. So at a societal level, one of the things that we certainly can do is protect education for everybody, and ensure education for everybody. Um, so that's one thing. And then I, I think we need to be mindful of how closely those societal issues are linked to health, and it's only going to cost us long-term in the health service if we don't address them.

Dr. Rangan Chatterjee 40:59 Well, you know, that's the real frustration about this whole topic and area, is that we're just kicking the can down the road-

Rose Anne Kenny 41:08 Mm-hmm

Dr. Rangan Chatterjee 41:08 ... and each government coming in is just trying to win the next election, right?

Rose Anne Kenny 41:13 Mm-hmm.

Dr. Rangan Chatterjee 41:13 And they're not thinking about 30 years, 40 years down the line, 'cause they'll be long gone. They won't be in power, [laughs] you know, by then. And it's a real problem-

Rose Anne Kenny 41:20 Mm

Dr. Rangan Chatterjee 41:21 ... because it's not rocket science to figure out-

Rose Anne Kenny 41:24 Mm

Dr. Rangan Chatterjee 41:24 ... if you feed your population well, if you-

Rose Anne Kenny 41:27 Mm

Dr. Rangan Chatterjee 41:27 ... um, provide for them, you make it easier for people, actually, people are gonna be healthier.

Rose Anne Kenny 41:33 Mm-hmm.

Dr. Rangan Chatterjee 41:33 They're gonna live better. They're gonna put less strain-

Rose Anne Kenny 41:36 Mm-hmm

Dr. Rangan Chatterjee 41:37 ... on the health service later on in life. But no one's kinda doing that. But, but one thing I will say-

Rose Anne Kenny 41:42 Yeah

Dr. Rangan Chatterjee 41:42 ... uh, and I think your book really speaks to this, a lot of the things that people can do to slow down aging are free of charge, right? They, they, they are.

Rose Anne Kenny 41:51 Mm-hmm.

Dr. Rangan Chatterjee 41:51 And I, like you, have worked in areas where people are struggling to make ends meet, and even within that, you know, I can't change the poverty. Um, but if you can really connect with that patient and help them understand how, you know, 10 minutes of meditation, or prioritizing 20 minutes with your kids or your partner each day, or-

Rose Anne Kenny 42:14 Mm

Dr. Rangan Chatterjee 42:14 ... it is worth on that Saturday afternoon going and nurturing your relationship with your friends and your family, whatever it might be.

Rose Anne Kenny 42:20 Mm-hmm.

Dr. Rangan Chatterjee 42:21 Those things make a biological difference. So I guess I'm trying to say is that-Yes, we wanna change society. We want, uh, politicians to get involved and societies to, to be more equal, less disparity between rich and poor, all those sort of things. But we still, even in an unequal society, yes, it's challenging, but we can help people make better choices, can't we?

Rose Anne Kenny 42:45 And we have to take control of this ourselves, and you've written about this. Um, uh, y- no, no matter what, even breathing exercises, anything which will enable de-stressing is very important.

Dr. Rangan Chatterjee 42:54 Yeah.

Rose Anne Kenny 42:55 And that only takes a few minutes a couple of times a day, you know? So the, the other thing I, I think that, that we ca- we can take control of, uh, is community, ensuring community, engaging community, being more engaged in our communities. Volunteering. So volunteering will help others who are stressed, and most of the volunteering is now done by people who are coming into their third, fourth, you know, wave of life. Um, and, uh, 70% or something is the figure, and they, they get so much benefit-

Dr. Rangan Chatterjee 43:28 Yeah

Rose Anne Kenny 43:28 ... from volunteering. Mental health problems are significantly less, quality of life is more, is better, and disability is less. We've shown this objectively in people who volunteer, and that's not because they were well enough to volunteer. That's longitudinally, people who do it are less likely to get those negative outcomes. So volunteering is really good, and volunteering gives back to the community, and vo- volunteering may l- well help to buffer some of the challenges that we've just outlined.

Dr. Rangan Chatterjee 43:58 I wanna talk about attitudes.

Rose Anne Kenny 43:59 Yeah.

Dr. Rangan Chatterjee 44:00 Our attitude towards life.

Rose Anne Kenny 44:02 Mm.

Dr. Rangan Chatterjee 44:03 Because if I continue what you wrote about, uh, Jeanne Louise Calment, you, you, you write that she did actually move into a nursing home, I think it was after a fall-

Rose Anne Kenny 44:13 Yeah

Dr. Rangan Chatterjee 44:13 ... aged 110.

Rose Anne Kenny 44:15 Yeah.

Dr. Rangan Chatterjee 44:15 But again, some really interesting things there. Even though she was in a nursing home, Calment initially followed a rigorous daily routine. She was woken at 6:45 AM, started the day with a long prayer at her window. She thanked God for being alive and for the beautiful day that was starting, underscoring her positive attitudes-

Rose Anne Kenny 44:40 Mm-hmm

Dr. Rangan Chatterjee 44:41 ... and outlook. Then she sits on her armchair and does gymnastics wearing her stereo headset, right? So this is fascinating. I've got this wonderful image-

Rose Anne Kenny 44:50 Yeah [laughs]

Dr. Rangan Chatterjee 44:50 ... of this 110-year-old lady basically practicing gratitude every morning.

Rose Anne Kenny 44:54 Yeah.

Dr. Rangan Chatterjee 44:55 Right? And, you know, we've touched on gratitude several times on this podcast over the years. There's really good research on gratitude. It seems as though she naturally had this positive attitude. From what you know, from what you've studied, how important is attitude to the aging process?

Rose Anne Kenny 45:14 Hugely important. That's what I would say. Probably, you know, the most im- important thing that... Now, now, it's hard to change your attitude. I mean, attitude is very much about being an optimist or a pessimist, you know? Um, but, but knowing it's important, people might be able to put more time and effort into creating a positive attitude or being positive or less negative about things. Um, we, we talk about resilience in, in, in the science of aging and what makes some people resilient and others not, and how you perceive yourself aging and your attitude towards your own aging and towards others is a major factor. Um, again, in the TILDA study, we have shown, we've measured perceptions of aging or aging attitudes at baseline and at, and obviously follow-up. And people who saw themselves as 20 years younger than their age, as I do, um, actually were fit- physically fitter and mentally, cognitively better, independent of all of the other factors we were able to adjust for 10 years hence.

Dr. Rangan Chatterjee 46:16 So, so the, so-

Rose Anne Kenny 46:16 So it matters

Dr. Rangan Chatterjee 46:17 ... so the, the, the phrase, "You are as young as you feel" actually has scientific validity.

Rose Anne Kenny 46:24 Yes, it's biologically embedded. [laughs]

Dr. Rangan Chatterjee 46:27 I mean, that is-

Rose Anne Kenny 46:27 Absolutely. Yeah

Dr. Rangan Chatterjee 46:28 ... it's just fascinating that. You know, I, I think a lot about, I guess, what might be considered the more softer aspects of health, right? Attitude, our perception-

Rose Anne Kenny 46:40 Yeah

Dr. Rangan Chatterjee 46:40 ... these kind of things, but-

Rose Anne Kenny 46:41 Yeah

Dr. Rangan Chatterjee 46:41 ... but really they're not, they're not so soft when you start studying them. [laughs]

Rose Anne Kenny 46:45 No.

Dr. Rangan Chatterjee 46:46 The- there's actually hard data on them. I spoke a few months ago with someone called Professor Anice Mukherjee. Um, she's, you know, very, very experienced consultant endocrinologist, a women's hormone expert, and in the conversation, which was all about women's hormones and the menopause, I shared with her some research that I came across showing that in societies where they perceive aging as a good thing, they associate it-

Rose Anne Kenny 47:15 Yeah

Dr. Rangan Chatterjee 47:15 ... with wisdom-

Rose Anne Kenny 47:16 Yeah

Dr. Rangan Chatterjee 47:16 ... um, you know, and life experience, people report less menopausal symptoms.

Rose Anne Kenny 47:23 Yeah.

Dr. Rangan Chatterjee 47:23 Right? So I'm very keen to say I'm not saying that menopausal symptoms don't exist, nothing like that. I'm well aware that they cause huge amounts of problems for many, many women. But it's fascinating to me-

Rose Anne Kenny 47:34 Mm

Dr. Rangan Chatterjee 47:34 ... that when we have a perception in society that actually aging is a good thing, people report less symptoms, and I think that sort of fits with what you're talking about.

Rose Anne Kenny 47:43 Uh, uh, it, the, it's, so, so, so perceptions are internal, okay? They come from ourselves, our personality type, if you like, and, and, and factors that have influenced us through our lifespan, through the life course, which make us, but also from society. Now, that's a really good point that you've raised. If you're constantly getting negative ageist attitudes from the media or from in- individuals or whatever, very hard for you to retain a positive attitude and an optimistic attitude when you're be- being bombarded by, in some cases, subliminal-... ageism

Dr. Rangan Chatterjee 48:19 Mm-hmm

Rose Anne Kenny 48:19 Now, I think that is changing

Dr. Rangan Chatterjee 48:22 Yeah

Rose Anne Kenny 48:22 Um, I s- I even have seen a change over the last decade.

Dr. Rangan Chatterjee 48:25 Really?

Rose Anne Kenny 48:25 I think it's changing. But that unfortunately, during COVID, initially, in the initial stages of COVID, we encountered so much ageism in the policy approaches, the quick fix, fix approaches. And we don't need to go into it now, but I mean, you know, the whole approach to people in nursing homes, the whole approach to-

Dr. Rangan Chatterjee 48:43 Yeah

Rose Anne Kenny 48:43 ... older people being discharged from hospitals, et cetera. I mean, the, a very, very ageist approach.

Dr. Rangan Chatterjee 48:48 If they don't matter.

Rose Anne Kenny 48:48 The whole approach to letting people die on their own and not let their families be with them. You know, the whole thing was, was catastrophic. So, so... And the, and the language that was being used by the media at the time, peoples were being called out because of their age. An 85-year-old woman who had multiple diseases died, et cetera. Now, they stopped that, and I noticed it change during COVID because of the backlash. In Ireland, we used a term, which is a terrible term, called cocoon- cocooning. So everybody over the age of 70 was asked to cocoon, which meant that they stayed in their home and didn't engage with anybody. So the, the subliminal implication of that is you're 70, society no longer needs you. You aren't of value. It's, you know, you, you can stay there-

Dr. Rangan Chatterjee 49:31 Yeah

Rose Anne Kenny 49:31 ... cocooned, terrible word, and no one will notice the difference at a societal level in terms of your input to society. So it is changing, but, but... [laughs] And I was very optimistic, and then COVID hit, and I saw just this negative attitudes towards aging just enveloping everybody again.

Dr. Rangan Chatterjee 49:48 Yeah, I think it's just worth pausing there a little bit because I, I, I really feel strongly that these lockdowns, this social isolation piece, has been so toxic-

Rose Anne Kenny 50:05 Mm

Dr. Rangan Chatterjee 50:05 ... for so many people.

Rose Anne Kenny 50:08 Mm.

Dr. Rangan Chatterjee 50:08 Um, couple of sort of points I just mentioned for, from my perspective. Remember a couple of years ago, um, maybe after the first or second lockdown, I can't remember when, I, once the leisure center had reopened and I went, uh, to go and have a swim, I was chatting to the guy at reception who I hadn't seen for about six months, and we were just having a bit of a chitchat. Um, and he was just saying, "People have changed." He's like-

Rose Anne Kenny 50:38 Oh

Dr. Rangan Chatterjee 50:39 ... "People in their 50s, in their 60s and 70s, who six months previously," he said, "would come in bright, chatting, they're now withdrawn. They look older. They're not saying much." Right? And, and this is the impact, you know, that of course there's many things there, worry, fear, anxiety, whatever it might be, but there's no question that isolating people has had really toxic effects. There's no question about that.

Rose Anne Kenny 51:07 Everything you've said, unfortunately, is factually correct. In the TILDA study, the, um, loneliness increased threefold during COVID. So we were able to track that because it's longitudinal. So we knew what the loneliness parameters were that we were measuring before COVID, and it increased threefold, as did depression increase threefold, independent of any, every- anything again. And we know from animal studies, if you put a monkey in a cage on its own, because we're gregarious animals, as monkeys are, in a cage on its own, and then biopsy the lymph node, which is the engine house for inflammation and immunity, you can find that the genes in the lymph, uh, uh, the genes in the lymph node are upregulated for inflammation.

Dr. Rangan Chatterjee 51:54 [gentle music] Now, I'm a huge fan of VIVOBAREFOOT shoes. I've been wearing them for about 12 years now, and one of the main reasons I love them is because when I'm wearing Vivos, I feel fully connected to the ground beneath my feet. What do we want? We want feet that move naturally. And because Vivos are wide, thin, and flexible, your foot can move in the way that it's meant to. A lot of modern shoes are stiff, they're narrow. They start to manipulate the way your foot functions. Whereas in Vivos, your feet can do what they're meant to do, and that means they help your feet become stronger. There was this trial that showed within four months of wearing Vivos, your feet are around 60% stronger. Your feet are your foundation, and when you've got problems in your feet, it goes all the way up the chain. It can go to your ankle, to your knee, to your hip, to your back, and even to your shoulder and neck. And as a doctor, I have seen back pain, hip pain, and knee pain actually start to get better when people start to wear barefoot shoes. To get 20% off your first order, go to vivobarefoot.com/livemore.

Rose Anne Kenny 53:08 And downregulated for the factors that protect our immune systems. And it's well known with social isolation you're more likely to get colds, and flus, and viruses. So there's biology, um, but, but, but it, it's, it's the long-term toxic effects. 'Cause inflammation is probably, if you were to identify one thing that accelerates the aging process and is culpable for the bi- or causal for the biological changes, it's inflammation. So I, I, I think it, I think that the social isolation has indeed caused biological consequences which may long term be toxic, but worse again, people are finding it really hard to reconnect. Now, this isn't only older per- persons. Younger people-

Dr. Rangan Chatterjee 53:53 Yeah

Rose Anne Kenny 53:53 ... have also suffered a lot-

Dr. Rangan Chatterjee 53:54 For sure

Rose Anne Kenny 53:55 ... and continue to suffer. So I, I, it's something we have to address as individuals, to be aware of it, and to reach out as much as possible.

Dr. Rangan Chatterjee 54:04 I, I think, you know, humans are, you know, we're creatures of habit. You know, we, we get used to new normals very, very quickly.

Rose Anne Kenny 54:11 Yeah

Dr. Rangan Chatterjee 54:11 And I, I really think-We've been deceived by convenience.

Rose Anne Kenny 54:18 Mm.

Dr. Rangan Chatterjee 54:18 Right? There is a cost to convenience.

Rose Anne Kenny 54:21 Mm.

Dr. Rangan Chatterjee 54:21 It is more convenient-

Rose Anne Kenny 54:23 Mm

Dr. Rangan Chatterjee 54:23 ... to meet up with your friends on Zoom. You don't have to go anywhere.

Rose Anne Kenny 54:27 Yeah.

Dr. Rangan Chatterjee 54:27 You just, you know, in your kitchen with your coffee-

Rose Anne Kenny 54:30 Yeah

Dr. Rangan Chatterjee 54:30 ... press join-

Rose Anne Kenny 54:32 Yeah

Dr. Rangan Chatterjee 54:32 ... and you feel you're interacting with them. Now, of course, that can have benefits, particularly for people who live far away. But it ain't the same thing. And I, I also have seen with so many patients and so many friends, they used to go to classes, whatever it might be-

Rose Anne Kenny 54:47 Mm

Dr. Rangan Chatterjee 54:47 ... yoga, martial arts-

Rose Anne Kenny 54:49 Mm

Dr. Rangan Chatterjee 54:49 ... singing. But over the last years they went onto Zoom, and they've never returned back.

Rose Anne Kenny 54:55 Mm-hmm.

Dr. Rangan Chatterjee 54:56 But that convenience, I think long-term can be toxic.

Rose Anne Kenny 54:59 Yes.

Dr. Rangan Chatterjee 55:00 And I don't know how we start reminding people. I keep saying it on the show. I wanna try to remind people to go, "Listen, you wanna do 10 minutes of yoga every night on YouTube?"

Rose Anne Kenny 55:08 Yeah.

Dr. Rangan Chatterjee 55:08 "Great. But still sign up for that weekly class that you used to go to back in 2019."

Rose Anne Kenny 55:14 Because you get so much more from that class bar the yoga. You get the social engagement, and that is, we, we, we have evolved as gregarious animals. [laughs] We have to do it.

Dr. Rangan Chatterjee 55:23 Talking about community, um, in, in your book you wrote in detail, was it Rosetta?

Rose Anne Kenny 55:29 Rosetta, yeah.

Dr. Rangan Chatterjee 55:30 And, and it was, it was truly fascinating. So I wonder if you could talk us through Rosetta-

Rose Anne Kenny 55:35 Yeah

Dr. Rangan Chatterjee 55:35 ... and what does that teach us about the power of community and social relationships?

Rose Anne Kenny 55:39 This is a great story, and it was probably the start of the link between social sciences and health. Um, so Rosetta was a town in, a small town in Northern Italy, and in the 1800s, they, they needed to emigrate. There wasn't any employment. So they emigrated to a location in the States, in Pennsylvania in the States. They called it Rosetta, the town in the States.

Dr. Rangan Chatterjee 56:02 Wow.

Rose Anne Kenny 56:02 And they, um, they replicated an awful lot of their lifestyles in, in Italy in terms of the, the infrastructure, the way the town was designed, et cetera. And then more and more from Rosetta, Italy, um, emigrated to Rosetta in the USA. And a scientist called Steven Woolf... He wasn't a scientist. He was actually a gastroenterologist, but he got interested in epidemiology, and he was very interested in the brain-gut response, uh, and, and interaction and network. So he had a holiday home near it, um, and he gave talks to towns and villages nearby. And one night he was speaking in one of the towns, and a GP came up to him, a general practitioner, and said, "You know, you're talking about," what was the big killer at the time, cardiovascular disease, um, in men in their m- mid-40s, 50s in the USA. He said, "I'm, I'm working in this town. It's one of a two or three towns I work in nearby, and I'm seeing... I'm not seeing that. I'm seeing people living well into their 65s and beyond." This is in the 1900s, 1930s and '40s. Um, and, and he said, "I'm definitely seeing something different there than the other towns I'm working in nearby." So Steven Woolf didn't just take that as a, you know. He went with medical students the next summer. They took over the town hall, and they did all of the measures we know lead to longevity, 'cause in the interim he'd checked their, their death rate books and found that, yes, it was true, they seemed to be living longer in Rosetta. And he found no suicides, et cetera. So he, they went, and they s- installed themselves in the town hall and started doing blood pressure. They took blood tests for blood glucose at the time, uh, et cetera. And they couldn't find anything. Then they looked at diet, and they couldn't find anything. And I'm sorry to say, but they actually found that [laughs] they were eating, you know, quite, quite luscious pizzas regularly.

Dr. Rangan Chatterjee 57:56 Mm-hmm.

Rose Anne Kenny 57:56 And he, he looked at everything he could think of. Smoking wasn't more common. Exercise, there wasn't any difference in all the factors we're talking about. And he was sitting one morning in the town square in Rosetta on a Sunday, uh, outside the church, and the next thing, the church doors opened, and everybody piled out of church. But they didn't move from there. They stayed outside the church. And for an hour or two afterwards they were still there chatting-

Dr. Rangan Chatterjee 58:20 Mm-hmm

Rose Anne Kenny 58:20 ... kids running around mixing. And he realized that the secret of longevity in Rosetta was Rosetta itself.

Dr. Rangan Chatterjee 58:29 Yeah.

Rose Anne Kenny 58:29 And then he started to explore their, their social engagement, their social networks, their social infrastructure. Three generations living in one household. For, for a to- a town of 2,000, um, civilians at the time, there were 22 different civic societies. [laughs]

Dr. Rangan Chatterjee 58:46 Wow.

Rose Anne Kenny 58:46 People were always doing something. So that was... He, then he, he got other researchers from his university involved who were interested, and social scientists. And they started this whole research field, which is so huge now, of how important sociology is in determining our health.

Dr. Rangan Chatterjee 59:05 It's, it's just fascinating. And particularly what you said, their diets probably weren't that good because, of course, we're trying to promote healthy lifestyles. But what, what does that mean? You know, if you could live by yourself and hit all your exercise targets and hit a clean, organic, no-sugar diet, sleep eight hours a night, right? But you didn't have community, you didn't have connections. You know, who would be better off? And I'm inclined more and more to think-

Rose Anne Kenny 59:40 Mm

Dr. Rangan Chatterjee 59:40 ... that social connections-

Rose Anne Kenny 59:42 Mm

Dr. Rangan Chatterjee 59:42 ... are right at the top of the tree.

Rose Anne Kenny 59:45 I, I, I actually, I believe that.

Dr. Rangan Chatterjee 59:47 R- yeah.

Rose Anne Kenny 59:47 That's why I started when I made my list at the beginning. You asked me what were the top few things, and I said friendship. You know, that's social connection. That's friendship. That's engagement. And we know ourselves, if you've had a good night out, in my case, with the girls, with lots of laughter, um, and, you know, there'll be a couple of drinks involved potentially, very likely. Um, the next day you feel so good.

Dr. Rangan Chatterjee 1:00:10 Yeah.

Rose Anne Kenny 1:00:10 And it's been such a good experience. So we know this. It's intuitive. And yet we need to make an effort, particularly since COVID, to build that now back into our daily routine.

Dr. Rangan Chatterjee 1:00:23 Yeah

Rose Anne Kenny 1:00:24 And you come back to your yoga. That's why it's so much better to go to the yoga class and not do yoga on YouTube on your own all of the time.

Dr. Rangan Chatterjee 1:00:35 You write about the blue zones.

Rose Anne Kenny 1:00:37 Mm-hmm.

Dr. Rangan Chatterjee 1:00:38 And, you know, I'm interested, a- as someone who studies aging, what is it, what is it about the blue zones that you like so much? You know, what is it that they can teach us? And, but what is it that they can't teach us as well?

Rose Anne Kenny 1:00:55 So certainly from the b- blue zones, a lot that we've, um, already rehearsed with respect to Rosetta is evident in the blue zones. They're sort of an exaggerated Rosetta, um, in that there's a fantastic community activity. There's a wonderful, um, talk by a social scientist who went to Sardinia, and she was engaging with this old man o- uh, who was over 100. He was in his kitchen sitting in the corner, and she went to interview him, and she said she didn't get a word in edgeways. There were three generations living in the house. Um, and then i-i- the way his kitchen was positioned, it was the road outside the house was right beside the kitchen window, so everybody passing would see he was sitting there, and they'd hop in to say hello. Some of them he liked. Some of them he didn't like. He engaged with them all, but after they were gone, you know, he would say sometimes, "Can't stand that man," or something. But, but, uh, the, h- her point was, she couldn't get a word in edgeways because there was so much activity in the kitchen. It was like a railway station.

Dr. Rangan Chatterjee 1:01:55 Yeah.

Rose Anne Kenny 1:01:56 And it occurred to her, of course, this is contributing to his longevity. He's constantly being distracted, and variety-

Dr. Rangan Chatterjee 1:02:03 Yeah

Rose Anne Kenny 1:02:03 ... and engaged.

Dr. Rangan Chatterjee 1:02:04 So never been left isolated, never been left alone.

Rose Anne Kenny 1:02:07 At, at no stage was he alone.

Dr. Rangan Chatterjee 1:02:09 And, and look, for people who've never heard the term blue zones before-

Rose Anne Kenny 1:02:11 Yeah

Dr. Rangan Chatterjee 1:02:11 ... perhaps it's worth just giving-

Rose Anne Kenny 1:02:12 I'll tell you, yeah

Dr. Rangan Chatterjee 1:02:13 ... a top line overview.

Rose Anne Kenny 1:02:13 So there, there are five blue zones, and they're import- They're called blue because when they were first identified by the scientists who originally identified them, they marked the zones with a blue marker. So it's no more attract- more, more exciting than that-

Dr. Rangan Chatterjee 1:02:27 [laughs]

Rose Anne Kenny 1:02:27 ... why they're the blue zones. But they're, they're actually in quite disparate areas of the world. I'll tell you where they are. There's Loma Linda in California. It's an Adventist group. And what's... And, and sorry, just to say that underpinning the blue zones is that they have a disproportionately high number of people living to 100 and beyond with good health.

Dr. Rangan Chatterjee 1:02:46 Yeah.

Rose Anne Kenny 1:02:46 Okay? So that's what it is. So Loma Linda. Um, the other one is in Nicoya in Costa Rica. Then you have Sardinia in Italy and, and the blue zone, why Sardinia is a blue zone is people there disproportionately live longer and healthier than mainland Italy just beside them.

Dr. Rangan Chatterjee 1:03:04 Mm.

Rose Anne Kenny 1:03:04 Ikaria in Greece, also an island, and Okinawa in Japan. Now, already you'll, you'll think, "Ooh, they're, they're islands by and large," not all. They're by the sea, and they're all on elevated heights. So they're, they're not at sea level, but they're elevated. Now, the things that they share in common, which scientists now believe have contributed to the exceptional longevity, but healthy longevity, are, I've described to you, great social engagement and civic, uh, engagement, community engagement. But also, um, their diets are pretty much plant-based. That's one thing they share in common. I'm not saying that these are exclusively associated with longevity, but certainly factually they share this in common. Secondly, no processed foods. Little or no processed foods. Low salt.

Dr. Rangan Chatterjee 1:03:51 Mm-hmm.

Rose Anne Kenny 1:03:52 Low sugar in their, in their foods. And they never eat to satiation. And actually, I've a scientist friend, Giovanni, who was working in Sardinia for a while, who's really interested in biological clocks, but he's from mainland Italy. And I asked him, "What did you notice different about Sardinia?" And he said, "They, they, they don't deliberately do calorie restriction, but they are calorie restricting," he said, "and fasting. They don't deliberately do, you know, fasting."

Dr. Rangan Chatterjee 1:04:17 How, how, how are they doing that?

Rose Anne Kenny 1:04:19 They just don't eat as frequently, and they don't fill their plates as much as, as, as we do.

Dr. Rangan Chatterjee 1:04:24 I mean, I appreciate this is secondhand now. You were chatting to-

Rose Anne Kenny 1:04:27 Yeah, yeah

Dr. Rangan Chatterjee 1:04:28 ... one of your colleagues who was there.

Rose Anne Kenny 1:04:29 Yeah.

Dr. Rangan Chatterjee 1:04:30 But is there any more flesh on the bone there? Like, what time were they eating? Did they have smaller plates? Did they finish eating earlier? You know.

Rose Anne Kenny 1:04:36 So they had smaller plates.

Dr. Rangan Chatterjee 1:04:38 Smaller plates.

Rose Anne Kenny 1:04:38 Smaller plates. Smaller plates.

Dr. Rangan Chatterjee 1:04:40 I think that, by the way, I think it's one of the best hacks you can do-

Rose Anne Kenny 1:04:43 Yeah

Dr. Rangan Chatterjee 1:04:43 ... to eat less-

Rose Anne Kenny 1:04:44 Yeah

Dr. Rangan Chatterjee 1:04:44 ... is just have smaller plates.

Rose Anne Kenny 1:04:45 So they had smaller plates, and they-

Dr. Rangan Chatterjee 1:04:46 And you, you perceive you, you have more-

Rose Anne Kenny 1:04:48 Exactly

Dr. Rangan Chatterjee 1:04:48 ... just from that.

Rose Anne Kenny 1:04:49 Yes. Smaller plates. Predominantly smaller plates, and very often wouldn't have a full breakfast. Their, their meal would be a lunch and a, and an evening meal. But neither of those were too heavy in terms of food intake. And then the other things that they had in common were physical activity, as we understand it, was built into their day. It was never called exercise, but they did a lot of walking. They walked everywhere when they needed to do something.

Dr. Rangan Chatterjee 1:05:12 Mm.

Rose Anne Kenny 1:05:12 I saw a video of, uh, by one of the original scientists who discovered the blue zones of a woman in her mid-90s chopping firewood, and she had done that every day of her adult life.

Dr. Rangan Chatterjee 1:05:23 Okay.

Rose Anne Kenny 1:05:23 And she went out the back and, you know-

Dr. Rangan Chatterjee 1:05:25 In her mid-90s

Rose Anne Kenny 1:05:25 ... in her mid-90s chopping firewood. But this was pa- part of her routine, like Jeanne Calment. It was part of her routine.

Dr. Rangan Chatterjee 1:05:32 Do you know what I love about that? There's no kind of fitness tracker on her-

Rose Anne Kenny 1:05:36 No, that's right

Dr. Rangan Chatterjee 1:05:36 ... on her wrist.

Rose Anne Kenny 1:05:37 Yeah.

Dr. Rangan Chatterjee 1:05:37 She's not going, "I need to hit this amount of aerobic a week, this amount of strength a week."

Rose Anne Kenny 1:05:43 [laughs]

Dr. Rangan Chatterjee 1:05:43 She's just chopping wood.

Rose Anne Kenny 1:05:45 [laughs]

Dr. Rangan Chatterjee 1:05:45 She's getting cardio. She's getting strength.

Rose Anne Kenny 1:05:47 Yeah.

Dr. Rangan Chatterjee 1:05:47 She, her VO2 max is going up.

Rose Anne Kenny 1:05:49 Yeah, yeah, yeah.

Dr. Rangan Chatterjee 1:05:50 You know, it, it's... And, and, you know, that's, that's the fascinating thing for me about the blue zones.

Rose Anne Kenny 1:05:56 Yeah.

Dr. Rangan Chatterjee 1:05:56 But if we talk about, you know, exercise for a minute, clearly physical activity is important-

Rose Anne Kenny 1:06:01 Mm-hmm

Dr. Rangan Chatterjee 1:06:01 ... right? And, um, right at the start of this conversation when I asked you if someone was in their 70s, what would you say to them if they wanted to, say, "Professor Kenny-

Rose Anne Kenny 1:06:11 Yeah

Dr. Rangan Chatterjee 1:06:11 ... how can I slow down aging? How can I make sure I'm as well as I can be when I'm 80 or 90?" One of the things you said was to do more, move more.

Rose Anne Kenny 1:06:20 Yes.

Dr. Rangan Chatterjee 1:06:20 And, and I know I've heard you talk about that before, and it's something I've become aware of now. I'm in my mid-40s.

Rose Anne Kenny 1:06:25 Yeah.

Dr. Rangan Chatterjee 1:06:26 But I'm realizing that actually movement-I was chatting to people at this family do at the weekends. I was saying, one thing I'm realizing, you just cannot get away with not moving. Once you stop moving, it goes downhill very rapidly.

Rose Anne Kenny 1:06:42 Yes.

Dr. Rangan Chatterjee 1:06:42 And as you get older, you gotta move more.

Rose Anne Kenny 1:06:44 Yeah.

Dr. Rangan Chatterjee 1:06:45 And so I'm massively increasing now how much I move. And a lot of this is just, it's not anything flash, it's just walking more.

Rose Anne Kenny 1:06:51 Mm.

Dr. Rangan Chatterjee 1:06:51 Just walking an hour a day, and then trying to, you know, just trying to build that in more and more. But what I find fascinating, particularly as aging is being spoken about and sold to a lot of us in the health space, it's a lot about tracking and hitting various metrics, and this will be good for your strength, this will be good for your heart, this will be good for cardio. And what you see in the blue zones is that no one's measuring a damn thing.

Rose Anne Kenny 1:07:19 No.

Dr. Rangan Chatterjee 1:07:19 Right? These guys aren't thinking about, "Oh, I need to get my resistance in. I need to get my cardio in." What's your perspective on that? 'Cause that's fascinating. That's really, really interesting to me.

Rose Anne Kenny 1:07:29 So I don't do any tracking or anything, 'cause actually, frankly, it would stress me. Um, uh, I, I, I, I think with respect to the blue zones, it was built into their natural day. So for us, how would we do that? Yes, go for a walk, but also when you've to nip down to the shop for groceries, give yourself the extra 10 or 15 minutes to walk down-

Dr. Rangan Chatterjee 1:07:49 Yeah

Rose Anne Kenny 1:07:49 ... to the shop for, or get on your bike. I cycle to work all of the time because some days that's my only way of getting any activity into my day. Um, and, and that is very doable, you know, to... There are other op- o- opportunities. The other thing about the blue zones is they did them in nature.

Dr. Rangan Chatterjee 1:08:06 Mm.

Rose Anne Kenny 1:08:06 So there was a lot of n- of nature, the sea obviously, but also a, a, a green nature. And I think we underestimate how good nature feels.

Dr. Rangan Chatterjee 1:08:16 Yeah. There's also, though, purpose to their movement.

Rose Anne Kenny 1:08:19 Mm.

Dr. Rangan Chatterjee 1:08:19 Right? And-

Rose Anne Kenny 1:08:20 Mm

Dr. Rangan Chatterjee 1:08:20 ... again, I think really trying to go deeper below physical activity. You know, as you said at the start, right, you were in an Irish television interview talking about diet and exercise-

Rose Anne Kenny 1:08:30 [laughs]

Dr. Rangan Chatterjee 1:08:30 ... and the, the, the TV presenter's like, "Oh, come on." You know?

Rose Anne Kenny 1:08:34 Yeah. Yeah. Yeah.

Dr. Rangan Chatterjee 1:08:34 It's, it's almost boring.

Rose Anne Kenny 1:08:36 Yeah.

Dr. Rangan Chatterjee 1:08:36 People have heard it that many times-

Rose Anne Kenny 1:08:37 Yeah

Dr. Rangan Chatterjee 1:08:37 ... right? But we know movement is important.

Rose Anne Kenny 1:08:41 Mm-hmm.

Dr. Rangan Chatterjee 1:08:42 And we're well aware that in Western society now, frankly in all societies, our jobs are sat down.

Rose Anne Kenny 1:08:50 Yes.

Dr. Rangan Chatterjee 1:08:51 Right? We're sitting in cars.

Rose Anne Kenny 1:08:52 Zoom.

Dr. Rangan Chatterjee 1:08:52 We're sitting on sofas. We're on Zooms, right? So it's harder. You know, in the blue zones, I know a, a lot of them, you know, it's part of life. You have to move to get food. You have to move to get in the garden and pick the vegetables, right? So it's not as if they've necessarily got more willpower than us; it's built into how they function.

Rose Anne Kenny 1:09:10 Yeah.

Dr. Rangan Chatterjee 1:09:10 But the thing I've been thinking about, Rose Anne, is that movement has a purpose to it.

Rose Anne Kenny 1:09:17 Yes.

Dr. Rangan Chatterjee 1:09:18 Walking to the shops has a purpose to it. Standing on a treadmill, right, or walking on a treadmill or running on a treadmill, like if you got someone from a, um, a tribe-

Rose Anne Kenny 1:09:32 [laughs]

Dr. Rangan Chatterjee 1:09:33 ... and you put them on a plane and brought them here.

Rose Anne Kenny 1:09:35 [laughs]

Dr. Rangan Chatterjee 1:09:35 Can you imagine what they might think looking at someone in a gym in their Lycra on a treadmill going-

Rose Anne Kenny 1:09:40 Yeah

Dr. Rangan Chatterjee 1:09:40 ... "Yeah, but th- they're not going anywhere," right?

Rose Anne Kenny 1:09:43 [laughs]

Dr. Rangan Chatterjee 1:09:43 And I guess, look, I get it. I'm not saying there's no purpose here.

Rose Anne Kenny 1:09:46 Yeah. Mm.

Dr. Rangan Chatterjee 1:09:46 But it's, it's quite interesting that the movement has a purpose. That-

Rose Anne Kenny 1:09:49 Yeah

Dr. Rangan Chatterjee 1:09:49 ... lady in her mid-90s-

Rose Anne Kenny 1:09:50 Yeah

Dr. Rangan Chatterjee 1:09:50 ... is chopping wood.

Rose Anne Kenny 1:09:51 Yeah.

Dr. Rangan Chatterjee 1:09:51 Well, that's-

Rose Anne Kenny 1:09:52 Had a purpose, yeah

Dr. Rangan Chatterjee 1:09:52 ... for a purpose, for the fire.

Rose Anne Kenny 1:09:53 Yeah.

Dr. Rangan Chatterjee 1:09:54 But we're often doing movement without any purpose.

Rose Anne Kenny 1:09:57 Mm.

Dr. Rangan Chatterjee 1:09:57 We're trying to meet a very dry public health guideline, 150 minutes of moderate activity a week.

Rose Anne Kenny 1:10:04 Yeah.

Dr. Rangan Chatterjee 1:10:04 Now, I understand we need guidelines, but I just think sometimes they're so dry.

Rose Anne Kenny 1:10:08 Yeah.

Dr. Rangan Chatterjee 1:10:09 They don't have... I don't think they connect with people.

Rose Anne Kenny 1:10:12 But you can flip that. Look at your day and say, "Okay, if I want to build walking or cycling into my day, what is it about my day that I can restructure slightly so it's not, you know, as you s- you know, th- that, that fixed interval, but just a liquid part, a fluid-

Dr. Rangan Chatterjee 1:10:30 Yeah

Rose Anne Kenny 1:10:30 ... part of my day?" I've got some people now in, in, in, in the hospital I'm working in who've looked at that and thought, "Okay, the solution is I'm gonna walk X, you know, three-quarters of my way to work or whatever I can possibly do, give myself that little bit more time in the morning and make that happen. I'm going to n- have face-to-face meetings with people rather than Zoom people-

Dr. Rangan Chatterjee 1:10:53 Yeah

Rose Anne Kenny 1:10:53 ... and make myself go to their office. And okay, it'll take more time, but actually, A, the face-to-face is good for both of you. You get a much better outcome. I think this face-to-face interview is better than if we did it by Zoom. Um, but also you're getting, you're getting your so-called activity built into the day. So there are-

Dr. Rangan Chatterjee 1:11:11 Yeah

Rose Anne Kenny 1:11:11 ... we can make a difference.

Dr. Rangan Chatterjee 1:11:12 Yeah.

Rose Anne Kenny 1:11:12 We can walk to school with the kids in the morning. It is feasible-

Dr. Rangan Chatterjee 1:11:16 Yeah

Rose Anne Kenny 1:11:16 ... for most of us.

Dr. Rangan Chatterjee 1:11:17 A- and I think we have to. Look, I w- I just wanna acknowledge that some people I know can't walk anymore. They struggle with movement. They might have an illness. They might have an injury. They might be in a wheelchair. So I wanna acknowledge that and make sure we're-

Rose Anne Kenny 1:11:30 Yes, of course

Dr. Rangan Chatterjee 1:11:30 ... including them within the conversation.

Rose Anne Kenny 1:11:32 Of course.

Dr. Rangan Chatterjee 1:11:32 And of course if one is in a wheelchair, let's say you can move your arms, for example, then there are movements that you can do. In fact, Jeanne Louise Calment, as you, as we mentioned, when she was in her nursing home, you know, she did gymnastics every morning while she was sat on her armchair.

Rose Anne Kenny 1:11:48 Yeah.

Dr. Rangan Chatterjee 1:11:48 She would flex and extend her arms and her hands and then her legs, right? Oh, this is interesting. Nurses noted that she moved faster-

Rose Anne Kenny 1:11:59 Yeah

Dr. Rangan Chatterjee 1:11:59 ... than other residents who were 30 years younger, right?

Rose Anne Kenny 1:12:02 Yeah. Yeah.

Dr. Rangan Chatterjee 1:12:02 So that's really, really interesting to me.

Rose Anne Kenny 1:12:04 Yeah.

Dr. Rangan Chatterjee 1:12:04 And I don't know how you do this. I have a few kind of, um, personal movement rules, as it were, which I really try and apply, and I've really tried to apply them even more since I had children. So one of them is I will very, very rarely take a lift or an elevator.

Rose Anne Kenny 1:12:23 Yeah, me too. Yeah.

Dr. Rangan Chatterjee 1:12:24 I'm always taking the stairs at the airport.

Rose Anne Kenny 1:12:27 That's it.

Dr. Rangan Chatterjee 1:12:27 If I do drive to the supermarket, I park the furthest away I can from the entrance rather than the nearest one, and my kids now know. And actually, the, the, the great thing is, because the kids keep seeing this-

Rose Anne Kenny 1:12:39 Uh-huh

Dr. Rangan Chatterjee 1:12:39 ... and they've seen it for a number of years and they know, like if we go to the local supermarket and we've parked-We'll always take the stairs there and back with our bags. I think once recently, I'd hurt my foot, and I was thinking, "Oh, you know, shall I get the lift?" I was looking at the lift, and I think my, I think it was my son said, "Come on, Daddy, we always take the stairs."

Rose Anne Kenny 1:13:00 Yeah.

Dr. Rangan Chatterjee 1:13:00 And I thought, "Yeah, good. Yeah-

Rose Anne Kenny 1:13:02 Yeah

Dr. Rangan Chatterjee 1:13:02 ... I'm taking the stairs."

Rose Anne Kenny 1:13:03 Yeah.

Dr. Rangan Chatterjee 1:13:04 And so, again, trying to flip it to go where can we in our modern, urbanized, let's say Western, uh, lives, how can we put in practices and rules that become our norm? Do you know what I mean? It's what becomes our norm.

Rose Anne Kenny 1:13:20 And you-

Dr. Rangan Chatterjee 1:13:20 Whenever I get off a plane, I'm always taking the... I've been sat down.

Rose Anne Kenny 1:13:26 Yes.

Dr. Rangan Chatterjee 1:13:26 I don't wanna take that escalator.

Rose Anne Kenny 1:13:27 No.

Dr. Rangan Chatterjee 1:13:27 And, and honestly, normally I'm the only person on the stairs.

Rose Anne Kenny 1:13:29 I was just gonna say that. It's, it's... We don't take- So there are things we can do that are easy. That's a great, that's a great way to look at it, and that's looking at your day and saying, "Okay, anything I can possibly do." I always take the stairs at, at work, uh, rather than the elevator, and it's six flights up, and I feel great after it, and sometimes I do it two or three times a day, and that- that I'm thinking, "Well, at least I, I got that much in." Um, so, so we can build it into our days.

Dr. Rangan Chatterjee 1:13:56 Yeah.

Rose Anne Kenny 1:13:56 It's a mindset. And you said earlier on convenience, and since COVID, particularly with Zoom and convenience, that's all about convenience as well. So it's a different way of looking at convenience-

Dr. Rangan Chatterjee 1:14:05 Yeah

Rose Anne Kenny 1:14:05 ... and actually flipping it to be to, to, to our benefit.

Dr. Rangan Chatterjee 1:14:09 Two things about movement that I'd like your perspective on. One is sarcopenia. The other one is how fast we walk. Can you speak to those two things? 'Cause they're, they're really interesting and super relevant to how we age.

Rose Anne Kenny 1:14:24 So sarcopenia is, it's, it's a fairly r- new diagnosis, if you like, or disorder that we've become aware of, and it's an infiltration of skeletal muscles. They're the muscles we use for moving. Um, and it's very much age-related, um, much more prevalent than we thought. I mean, in people who don't move much, 70% have this sarcopenia. Um, and what it is, it's fairly toxic to skeletal cells, and actually, sarcopenia is probably underlying what we know of, uh, as frailty because muscles maybe haven't been moved as much as-

Dr. Rangan Chatterjee 1:15:01 Mm-hmm

Rose Anne Kenny 1:15:01 ... they were moving because that's how you prevent sarcopenia, by keeping muscles moving, continuously waking up those muscle cells and muscle tissues to, to keep functioning. Um, and as we get older, they need to be reminded to keep moving.

Dr. Rangan Chatterjee 1:15:17 And is this particularly resistance training and strength training that we're talking about here, or is it just generalized?

Rose Anne Kenny 1:15:22 It's, it's predominantly strength training. It's predominantly strength training.

Dr. Rangan Chatterjee 1:15:25 So why is it, do you think, that we need guidance on strength training, which makes people think about the gym, which is off-putting for many people? Yet in the blue zones, from what I understand-

Rose Anne Kenny 1:15:41 Yeah

Dr. Rangan Chatterjee 1:15:41 ... the people who are living to 100, 105, 110 aren't really going to the gym.

Rose Anne Kenny 1:15:45 No, but they're doing strength training, 'cause she was chopping wood, and they're lifting the crates of, of fish that they carry in from the sea, et cetera. And they're, you know, they're, they're, they're, um, going to the s- stores and walking back with their bags of whatever they're carrying, et cetera. I mean, s- strength training is, it, it can be part of an aerobic exercise, pa- part of a walking exercise. It doesn't have to be deliberately weightlifting. Again, y- y- your analogy of the treadmill was brilliant. [laughs] Likewise, they came and saw people lifting heavy things while seated on a very strange chair-

Dr. Rangan Chatterjee 1:16:18 [laughs]

Rose Anne Kenny 1:16:18 ... in a gym. You know, that would have the same probably-

Dr. Rangan Chatterjee 1:16:20 Trying to keep their back straight-

Rose Anne Kenny 1:16:21 We-

Dr. Rangan Chatterjee 1:16:21 ... and in a certain posture, like, what, what, what-

Rose Anne Kenny 1:16:23 They would say-

Dr. Rangan Chatterjee 1:16:23 ... what are you guys doing?

Rose Anne Kenny 1:16:24 ... what the hell is this about? So, so we can do s- we can build strength training into our, into our daily routine as well. We, we, we, um, b- just because the, of the way our society has evolved, we're not really doing strength training that much as part of our day. We buy the wood in, in the local s- supermarket and then throw it in the boot of the car when we're... and drive home, et cetera. So, so that's why we have to focus more on strength training.

Dr. Rangan Chatterjee 1:16:52 It, it's been eroded everywhere. Like, even for those people who engage with online shopping, which is very common these days, right? Which is very time-saving. But a lot of online shops now, the driver will bring the shopping in-

Rose Anne Kenny 1:17:10 I know

Dr. Rangan Chatterjee 1:17:10 ... and put it in your kitchen.

Rose Anne Kenny 1:17:12 I know.

Dr. Rangan Chatterjee 1:17:12 Right? Now, I get it. Not everyone does that. Not everyone has access to that. But it's just another example of how bit by bit any movement that we did have is just being slowly [laughs] eroded away.

Rose Anne Kenny 1:17:24 Yeah. Uh, uh, it comes back to the convenience thing. Everything we're doing is about convenience. But in fact, convenience isn't necessarily what's best for us.

Dr. Rangan Chatterjee 1:17:32 Mm.

Rose Anne Kenny 1:17:33 So, um-

Dr. Rangan Chatterjee 1:17:35 Do you strength train?

Rose Anne Kenny 1:17:36 I do.

Dr. Rangan Chatterjee 1:17:36 And, and-

Rose Anne Kenny 1:17:37 I do weights. [laughs]

Dr. Rangan Chatterjee 1:17:38 We-

Rose Anne Kenny 1:17:38 I'm one of those people that they'd be shocked at.

Dr. Rangan Chatterjee 1:17:41 When did you start doing weights?

Rose Anne Kenny 1:17:42 I have always loved the gym.

Dr. Rangan Chatterjee 1:17:44 Oh, have you?

Rose Anne Kenny 1:17:44 Yeah, I've always loved the gym, and I've always done-

Dr. Rangan Chatterjee 1:17:46 So this wasn't, it wasn't that your research taught you things that you thought, "Wow, I need to get in the gym"?

Rose Anne Kenny 1:17:51 No.

Dr. Rangan Chatterjee 1:17:52 You were al- already doing it.

Rose Anne Kenny 1:17:53 I've always, I, I've always liked the gym, so I've, I've always done the gym. Not as frequently during the week when I had younger children, et cetera, but I've, I've pretty much always done the gym.

Dr. Rangan Chatterjee 1:18:03 Okay. So what in your behaviors has changed on the back of your research?

Rose Anne Kenny 1:18:12 Right. Now, [laughs] the re-

Dr. Rangan Chatterjee 1:18:14 If anything

Rose Anne Kenny 1:18:14 ... the reveal moment. Oh, it has. It has. Um, definitely my diet has changed. I've d-

Dr. Rangan Chatterjee 1:18:20 Really?

Rose Anne Kenny 1:18:20 Oh, yes. I'm, I, I, I, uh, absolutely. Like, I wouldn't dream of having a bar of chocolate now. [laughs] Which I mean, or anything. I try, really try hard not to have processed foods. Now, I will. Um, I clearly have pr- processed foods that I can't help. But, but, but generally speaking, my diet has changed an awful lot. I don't eat nearly as much red meat. I eat much more fish and much more vegetables, and eat nuts and seeds, et cetera, whereas I wouldn't have done that before. So diet definitely. I've reached out to friends.I was working really hard focusing on my family, um, and I hadn't been engaging as much at all, and I've reached out to groups of people that I went to school with, that I went to college with, um, and we're now all part of different WhatsApp groups. I'm on four different what- WhatsApp groups from my past. Um-

Dr. Rangan Chatterjee 1:19:07 Is that still good, WhatsApp groups?

Rose Anne Kenny 1:19:09 It's, it's, it's brilliant because now we're meeting up regularly.

Dr. Rangan Chatterjee 1:19:13 Yeah.

Rose Anne Kenny 1:19:13 So one group meets once a month. Another group meets twice a year, whatever, but we're meeting up, and it's fantastic. And the thing about meeting up at this stage in your life is, you know, there's no baggage. You have nothing to lose.

Dr. Rangan Chatterjee 1:19:27 [laughs]

Rose Anne Kenny 1:19:27 You're not, you know, it doesn't matter who you are or what you are. You knew this person who, uh, uh, in a time gone by, you shared an awful lot together.

Dr. Rangan Chatterjee 1:19:36 Yeah.

Rose Anne Kenny 1:19:36 That's so different from anything you'll engage with with somebody new now, and it's very precious and very rich. It's a fantastic experience. We've a great laugh. There's a lot of sharing, and if somebody in the group isn't well or whatever, they share that, and we bolster them in that. So that's been, that's been something different. I don't drink as much. So I'm-

Dr. Rangan Chatterjee 1:19:54 We're talking about alcohol, right?

Rose Anne Kenny 1:19:55 Alcohol. So I try not to have... I mean, I don't drink at all at the moment, and I have very long periods when I won't drink at all. And then-

Dr. Rangan Chatterjee 1:20:04 And how do you find that? You live in Dublin, right?

Rose Anne Kenny 1:20:06 Yes.

Dr. Rangan Chatterjee 1:20:06 How do you find that socially?

Rose Anne Kenny 1:20:08 Much more socially acceptable now than it used to be. When I was going to college or as a young doctor-

Dr. Rangan Chatterjee 1:20:14 Yeah

Rose Anne Kenny 1:20:14 ... we worked hard, and we played hard. That was what we did. Um, that is... I find it socially much more acceptable, particularly with the younger people, um, and younger students and doctors that I'm engaging with. The, the drinking culture is changing definitely. Now, they may be using other substances, but, but there's certainly, I think, it's more acceptable now for people not to drink.

Dr. Rangan Chatterjee 1:20:36 Well, it was interesting when earlier on [laughs] when we... in, in our conversation, you mentioned, you know, what you do in your 20s, um, really can make a difference-

Rose Anne Kenny 1:20:46 Yeah. I know

Dr. Rangan Chatterjee 1:20:47 ... in terms of how you age. I, I was thinking back-

Rose Anne Kenny 1:20:49 I know

Dr. Rangan Chatterjee 1:20:49 ... to my days in Edinburgh as a medical student, thinking-

Rose Anne Kenny 1:20:52 Mm. I know

Dr. Rangan Chatterjee 1:20:53 ... you know, I'm not sure much-

Rose Anne Kenny 1:20:55 I know

Dr. Rangan Chatterjee 1:20:55 ... of what I was doing back then was helping-

Rose Anne Kenny 1:20:57 Mm

Dr. Rangan Chatterjee 1:20:57 ... my aging. But I guess related to that, one of your other core messages is that it's never too late.

Rose Anne Kenny 1:21:05 No, it isn't ever too late. Yeah.

Dr. Rangan Chatterjee 1:21:06 Right? It's never too late to make a change.

Rose Anne Kenny 1:21:07 Mm-hmm.

Dr. Rangan Chatterjee 1:21:07 And I think that's a really important message. Can you just speak to that a little bit? Because people may go, "Oh, yeah, in my 20s this happened," or, "In my 30s and 40s I was a carer. I, I was really, really stressed." We can still make changes even if we've had maybe some toxic behaviors in the past?

Rose Anne Kenny 1:21:24 So, okay, I'll, I'll approach that in two ways. Um, we, we, we certainly can make behaviors, and there have been cha- changes that make a difference. There have been studies of patients in wheelchairs, for example, who have started strengthening exercise programs, upper limbs or whatever they can, whatever they can move, and they've had an over holis- overall benefit, including a benefit in some of the epigenetic activity by doing that. So that's, that's that cohort. So I use that as an example because people would assume, oh, you know, I think very often that that's not something that you're gonna modify, but you can. Within the context of whatever your disability, you can-

Dr. Rangan Chatterjee 1:22:06 Wow

Rose Anne Kenny 1:22:06 ... modify other beneficial a- aspects, including sarcopenia. But the second thing is there is, um, a, a recent study, a randomized control trial, where four different interventions were used. One half of the study just carried on as ever, and the other half of the study modified diet, did exercise to 60 to 80%, so whatever they could do maximally, they did it to 60 to 80%, for 30 minutes five days a week.

Dr. Rangan Chatterjee 1:22:37 Would that be the equivalent of, let's say, a, a-

Rose Anne Kenny 1:22:40 W- walking-

Dr. Rangan Chatterjee 1:22:40 ... a brisk pace walk?

Rose Anne Kenny 1:22:41 A brisk pace walk so you're too breathless to talk.

Dr. Rangan Chatterjee 1:22:43 Got it. So nothing-

Rose Anne Kenny 1:22:45 S- simple stuff

Dr. Rangan Chatterjee 1:22:45 ... crazy.

Rose Anne Kenny 1:22:46 Simple stuff. So that's... So they modified, um, a diet, and the diet was very much, um, a microbiome-focused diet, so lots of diversity, polyphenols, carotenoids, et cetera, probiotics, and the exercise was as we've discussed. But they also, uh, did breathing exercises a few times a day to modify stress and to calm stress, and they also, um, worked with sleep and in- invoked different measures which would improve sleep. Epigenetic markers were measured at the beginning of the study. That's the biological clocks I was talking about earlier on. And the study lasted for eight weeks and at the end of the study. And remarkably, I think, in the cases which, um, it had these changes, uh, these interventions in the eight weeks, everybody complied. That was the first thing. They watched compliance very carefully. Epigenetics showed that their aging clocks had reduced by 3.6 years. Isn't that amazing?

Dr. Rangan Chatterjee 1:23:50 Hold on, hold on.

Rose Anne Kenny 1:23:50 In eight weeks. [laughs]

Dr. Rangan Chatterjee 1:23:52 Okay. In eight weeks-

Rose Anne Kenny 1:23:54 Yeah

Dr. Rangan Chatterjee 1:23:55 ... by focusing on small changes in our lifestyle, small changes that are under our control-

Rose Anne Kenny 1:24:04 Yeah

Dr. Rangan Chatterjee 1:24:04 ... they could change their biological aging-

Rose Anne Kenny 1:24:09 Yes

Dr. Rangan Chatterjee 1:24:10 ... by over three years.

Rose Anne Kenny 1:24:12 Yes.

Dr. Rangan Chatterjee 1:24:12 In just eight weeks.

Rose Anne Kenny 1:24:13 Yes.

Dr. Rangan Chatterjee 1:24:14 That is utterly remarkable.

Rose Anne Kenny 1:24:16 It is. Now, I don't know whether that would be sustained. I can't imagine it would because what I'm saying is that there must have been a rapid change over the acute phase-

Dr. Rangan Chatterjee 1:24:25 Mm

Rose Anne Kenny 1:24:25 ... while, uh, while the systems were being-

Dr. Rangan Chatterjee 1:24:28 Rebooting

Rose Anne Kenny 1:24:28 ... rebooted, and then it would... the calibration would kind of, uh, st- stay off.

Dr. Rangan Chatterjee 1:24:32 Well, it's a bit like, you know, I don't know, if you are completely untrained, you, you don't lift weights or anything, right?

Rose Anne Kenny 1:24:40 Yeah.

Dr. Rangan Chatterjee 1:24:40 And then let's say you go to the gym.

Rose Anne Kenny 1:24:42 Yeah.

Dr. Rangan Chatterjee 1:24:42 The first two weeks-

Rose Anne Kenny 1:24:44 Yeah

Dr. Rangan Chatterjee 1:24:44 ... you start, you're, you're gonna start seeing muscles popping out everywhere.

Rose Anne Kenny 1:24:47 Yeah, yeah.

Dr. Rangan Chatterjee 1:24:47 You know, your body is gonna start-

Rose Anne Kenny 1:24:49 Yeah

Dr. Rangan Chatterjee 1:24:49 ... adapting very-

Rose Anne Kenny 1:24:50 Yeah

Dr. Rangan Chatterjee 1:24:50 ... very quickly, and then that-... can often start to plateau-

Rose Anne Kenny 1:24:53 Yeah

Dr. Rangan Chatterjee 1:24:53 ... unless, of course, you're challenging it in different ways. It's, it's that kind of biological principle really-

Rose Anne Kenny 1:24:57 Yes

Dr. Rangan Chatterjee 1:24:57 ... isn't it?

Rose Anne Kenny 1:24:57 Yes. But well, and there will be further studies to look at it. I mean, they just looked at this eight-week period, but this is the first study to look at an intervention in older, uh, male adults, uh, like this, which has shown a change in the epigenetic clock. Um, so there will be other studies looking longer term, et cetera, et cetera.

Dr. Rangan Chatterjee 1:25:17 A- and I w- you know, you mentioned epigenetic clock, right? And if I go back to the start of this conversation where we were discussing that 80% of our aging biology is within our control. So what's going on with the other 20%? Is it genes? And when you say epigenetics, what do you mean?

Rose Anne Kenny 1:25:37 Okay, great question. So genes are the 20%, epigenetics are the 80%. So the epigenetics are the dynamic, movable features that are on our genes which are influenced by the environmental factors we've been talking about, like diet and like exercise and like social engagement, et cetera. The genes are the fixed DNA, which in animal models we can, uh, manipulate and change, but not in humans. So they're the fixed bits. We can't do anything about the genes, but the 80% are epigenetic. So they're m- they're methyl groups that are stuck onto the genes-

Dr. Rangan Chatterjee 1:26:18 Mm

Rose Anne Kenny 1:26:18 ... that are kind of opening up and closing down, and opening up and closing down, and they're giving signals to the cells to produce this protein, to make this energy in the cell, to get the autophagy going, which is the, the truck that take... gets rid of the toxins that the energy produces from-

Dr. Rangan Chatterjee 1:26:36 Mm

Rose Anne Kenny 1:26:36 ... the cell, et cetera. So the dynamic piece of the process is what we refer to as epigenetics, and we have a way of measuring that, and that measurement gives us biological aging of the cell. In other words, the vitality of the cell.

Dr. Rangan Chatterjee 1:26:52 Yeah, really, really interesting. So what we can actually do about it.

Rose Anne Kenny 1:26:56 Yes.

Dr. Rangan Chatterjee 1:26:56 You know, Rose Anne, one of the things I really, really liked in your book was in the introduction. I'm just gonna read it to you because I think it is-

Rose Anne Kenny 1:27:03 Mm-hmm

Dr. Rangan Chatterjee 1:27:03 ... so, so key. "I never ask a patient their age, but rather base decision-making on an assessment of a person's biological age derived from a traditional physical examination and history. No two 83-year-olds are the same. One can run a marathon, and the other is a frail nursing home resident. So making a clinical treatment judgment is very different for each and not related merely to a number."

Rose Anne Kenny 1:27:36 Yeah.

Dr. Rangan Chatterjee 1:27:37 Now, I think this, I think, sews together quite a few things that we've been talking about today, how much our perception of aging influences how we age, how quickly we age, but also if I think about as two doctors sitting here-

Rose Anne Kenny 1:27:54 Yeah

Dr. Rangan Chatterjee 1:27:54 ... having a conversation, we can stereotype patients. You know, how do you, how do, how do we report, how do we present case histories, right, to our colleagues?

Rose Anne Kenny 1:28:05 Mm-hmm.

Dr. Rangan Chatterjee 1:28:05 Okay, 58-year-old male.

Rose Anne Kenny 1:28:07 [laughs]

Dr. Rangan Chatterjee 1:28:07 Um, you know-

Rose Anne Kenny 1:28:09 Yeah, yeah

Dr. Rangan Chatterjee 1:28:09 ... two children-

Rose Anne Kenny 1:28:10 Yeah

Dr. Rangan Chatterjee 1:28:10 ... works as an accountant. You know-

Rose Anne Kenny 1:28:12 Yeah

Dr. Rangan Chatterjee 1:28:13 ... w- stereotype, stereotype, stereo-

Rose Anne Kenny 1:28:14 Yeah

Dr. Rangan Chatterjee 1:28:14 ... literally start to influence how our colleagues are going to hear that story, right? And I think it's really good for all of us to be aware of our biases, right? Because it's, it's like time, right? This is getting quite philosophical now, but it's, it's like time, right? One hour of time, yes, we can measure it by a clock, but one hour of watching paint dry and one hour of having, you know, a beautiful conversation with you, who's flown over from Dublin to have this conversation with me in my studio, it's a completely different experience.

Rose Anne Kenny 1:28:50 Mm.

Dr. Rangan Chatterjee 1:28:50 It's the same one hour, but you can't really compare those two one hours because the experience is so different. And in the same way, this whole thing about asking people how old they are-

Rose Anne Kenny 1:29:02 Mm

Dr. Rangan Chatterjee 1:29:02 ... like more and more I think it's highly problematic-

Rose Anne Kenny 1:29:05 Yeah

Dr. Rangan Chatterjee 1:29:05 ... because we're, we're conditioning what we think they should be doing or how much they can do simply from an age. And we all know people in our lives of the same age who are, you know, wildly different, don't we?

Rose Anne Kenny 1:29:17 Yeah. Um, that, uh, your analogy was fantastic there. Um, uh, and we- we're... Well, I, I can only speak to my own profession as yours, medicine. We're-- I think we're really bad at stereotyping.

Dr. Rangan Chatterjee 1:29:29 Yeah.

Rose Anne Kenny 1:29:30 Um, and, and, and then that's coupled with how we deal with somebody, how we manage their condition, et cetera, and their... or how we view their prognosis.

Dr. Rangan Chatterjee 1:29:41 Yeah.

Rose Anne Kenny 1:29:42 Um, I, I... Now, I, I don't have solutions for that.

Dr. Rangan Chatterjee 1:29:45 Yeah.

Rose Anne Kenny 1:29:46 I don't know how we step away from that. I, I, I say-- When I'm teaching, I say, "Don't ask people their age." You know, you make a judgment call on your-

Dr. Rangan Chatterjee 1:29:53 Yeah

Rose Anne Kenny 1:29:53 ... assessment, and that's really important, 'cause that will make the young doctor actually look at s- how somebody's walking. How re- how often do people actually measure... And I'm always saying, "Right, so what, what's their walking like?" They're, "Well, I didn't get them up," or, you know, "It was late at night," or whatever. But we need to watch people's gait, make judgment calls on objective measures like that-

Dr. Rangan Chatterjee 1:30:14 Yeah

Rose Anne Kenny 1:30:14 ... rather than, than age. But I don't have a solution to that.

Dr. Rangan Chatterjee 1:30:17 It's just-

Rose Anne Kenny 1:30:18 I just-

Dr. Rangan Chatterjee 1:30:18 Look, I, I think-

Rose Anne Kenny 1:30:19 It's hard

Dr. Rangan Chatterjee 1:30:19 ... not everything has a solution for it, but I think for me, the take home is just be aware of it.

Rose Anne Kenny 1:30:25 Yes.

Dr. Rangan Chatterjee 1:30:25 Just be aware of that bias, not only for a doctor, but when I'm interacting with anyone in my community, or friends, or their parents, you know, don't just assume that because someone is a certain age, that they will want to do certain things or, you know, certain things are off limits, for example.

Rose Anne Kenny 1:30:44 But in that, in that context, it's awfully important to ask people about their past. You, you get a completely different patient in front of you-

Dr. Rangan Chatterjee 1:30:52 Yeah

Rose Anne Kenny 1:30:52 ... if you find out what, what their, what their life was like, what they did. I mean, you... Suddenly, it's like a black and white drawing becomes full of color-

Dr. Rangan Chatterjee 1:31:02 Yeah

Rose Anne Kenny 1:31:02 ... when you... And it, and it easily-- It makes it much easier for you to contextualize your engagement with that person and how you're going to treat them.

Dr. Rangan Chatterjee 1:31:10 Well-That's one of the joys of our job, isn't it?

Rose Anne Kenny 1:31:15 Yeah.

Dr. Rangan Chatterjee 1:31:15 That's one of the joys of being a doctor is you, you get this really intimate window into your patients' lives. It's, it's deemed okay in the patient-doctor interaction to open up about things-

Rose Anne Kenny 1:31:29 Yeah

Dr. Rangan Chatterjee 1:31:29 ... that in other settings wouldn't happen. So I would say that's one of the great privileges of being a medical doctor. You-

Rose Anne Kenny 1:31:35 Yeah

Dr. Rangan Chatterjee 1:31:35 ... you get to experience stuff, and-

Rose Anne Kenny 1:31:37 Yeah. It, but we feel so much better, you feel as an individual so much better about having shared that with someone. I mean, I, that's why I am passionate about medicine, because I think that it affords us opportunities of engagement-

Dr. Rangan Chatterjee 1:31:50 Yeah

Rose Anne Kenny 1:31:51 ... that I don't think a lot of other professions do, but also passionate about slow medicine, and we're losing that. So tests have become much more sophisticated, much more easily accessible, and very often we don't give enough of time for the patient to tell us what they think is going on. They, [laughs] by and large, will give us the diagnosis in 90% of cases.

Dr. Rangan Chatterjee 1:32:13 I, I, I completely agree. So when I was at medical school in the end of the 1990s, we were told by our professors back then that the history is everything.

Rose Anne Kenny 1:32:26 Yes.

Dr. Rangan Chatterjee 1:32:26 Right?

Rose Anne Kenny 1:32:27 Yes.

Dr. Rangan Chatterjee 1:32:27 Or, or most of it.

Rose Anne Kenny 1:32:28 Yes.

Dr. Rangan Chatterjee 1:32:28 Right? So what the patient tells you.

Rose Anne Kenny 1:32:30 Yes.

Dr. Rangan Chatterjee 1:32:31 I've been practicing for over two decades. I passionately believe that if you give patients time and space, they will pretty much tell you almost everything that you need to know.

Rose Anne Kenny 1:32:43 So do I, yep.

Dr. Rangan Chatterjee 1:32:45 In this era now of, you know, fancy testing, diagnostics, do you still share the same viewpoints?

Rose Anne Kenny 1:32:54 Oh, I sh- I, I believe that, absolutely.

Dr. Rangan Chatterjee 1:32:56 Yeah.

Rose Anne Kenny 1:32:56 And I'm practicing, and that, that, I, I g- I get virtually everything I need from spending time, but it is time, and particularly, uh, uh, with older patients, you have to be prepared to be patient and give the person time. However, it's harder, I find, to share that approach with some of the younger doctors that I'm dealing with because, you know, there's an adrenaline rush when you're a young doctor, and you wanna get the angio done now and see what-

Dr. Rangan Chatterjee 1:33:29 Yeah

Rose Anne Kenny 1:33:29 ... the vessels look like, you know. Um, so I find it harder and harder-

Dr. Rangan Chatterjee 1:33:34 Yeah

Rose Anne Kenny 1:33:34 ... to, to persuade young doctors that honestly you'll get it from the history, 'cause that's not very exciting to them when they've so many other exciting opportunities.

Dr. Rangan Chatterjee 1:33:45 You know, I very much am drawn to the human side of medicine. I very much have been drawn to what's the message behind the words of what my patients are saying.

Rose Anne Kenny 1:33:56 Yes. The other, the other thing that I would enc- that we should be encouraging, I think, and it falls out from all of this, is intergenerational transfers of knowledge and sharing, so that if you, y- y- uh, as doctors, if you give time to the patient to tell their story, you will learn so much. But in, in life, um, y- younger people spending time or having friends who are older, and likewise, people who are older having friends who are in younger generations, that's not common anymore.

Dr. Rangan Chatterjee 1:34:28 Anymore.

Rose Anne Kenny 1:34:29 Anymore. And it was. And, and I think that's something else that we can, individuals listening to this could make an effort to do, because you'll gain from it.

Dr. Rangan Chatterjee 1:34:37 That's what you see in the blue zones, don't you? That a lot of this intergenerational-

Rose Anne Kenny 1:34:41 Absolutely

Dr. Rangan Chatterjee 1:34:41 ... not just where they live, how they-

Rose Anne Kenny 1:34:43 Yeah

Dr. Rangan Chatterjee 1:34:43 ... socialize and interact. It's not uncommon-

Rose Anne Kenny 1:34:45 Yeah, no

Dr. Rangan Chatterjee 1:34:45 ... from what I understand-

Rose Anne Kenny 1:34:46 That's it

Dr. Rangan Chatterjee 1:34:46 ... for a 20-year-old to be hanging out with a 70-year-old, which has-

Rose Anne Kenny 1:34:50 That's, yeah

Dr. Rangan Chatterjee 1:34:50 ... huge benefits for both parties.

Rose Anne Kenny 1:34:52 Yeah. Yes, yes, that's right.

Dr. Rangan Chatterjee 1:34:53 On the subject of, you know, continuing what we just said about the kind of things patients open up about when they're talking to their doctor-

Rose Anne Kenny 1:35:03 Yes

Dr. Rangan Chatterjee 1:35:03 ... if the environment is right-

Rose Anne Kenny 1:35:05 Yes

Dr. Rangan Chatterjee 1:35:05 ... if the clinician is being attentive, for example, you've written an entire chapter on sex and intimacy-

Rose Anne Kenny 1:35:13 Mm-hmm

Dr. Rangan Chatterjee 1:35:14 ... with respect to aging. Now, this is a topic that is not often spoken about. It's a little bit taboo for many people to talk about this. So my first question is-

Rose Anne Kenny 1:35:26 Mm-hmm

Dr. Rangan Chatterjee 1:35:26 ... were you nervous when writing it? Why, I guess, did you think it was so important to put this chapter in?

Rose Anne Kenny 1:35:33 So I wasn't nervous in writing it, because I've had a bit of a journey, as it were, in, with respect to this topic, and the person who opened my eyes to this is a girl called Stacy Lando, who's a professor of gynecology and aging in Chicago, and she is passionate about this area, and started writing, uh, maybe 20, two decades ago, um, in, uh, with respect to sexual activity and aging. Um, so I'd followed her and her work for some period of time, and have become very friendly with her, actually. Um, and I, I've been really interested in the area, and it's, what, what fascinates me about it is it's almost like it's, it's invisible in society. It's not discussed. And when I became enthusiastic about it at the dinner table, 'cause we always made an effort when the boys were in school to kind of get together and we al- had an evening meal together. I would say, "Oh, gosh," start talking about something I'd learned about sexuality and aging, and they went, "Right, Mum, we're gone now. We've eaten. Thank you. We're leaving the table. I don't want any more. No more." Like it just... I think younger generations find it im- almost impossible to conceive that there would be sexual activity between, you know, older persons. In the TILDA study, 70% of couples are still sexually active, and our mean age now is 68, but that's the data for, for the, from the first wave of the study. So it's, it's, it's common. Um, we, it's becoming more discussed. It's be- we're becoming more aware of it at a societal level. We as doctors don't talk to patients enough about it. We don't ask patients, "Would you like to discuss sexual activity on a regular basis?" S- People, I think, find it hard to discuss it on an in- individual level. So I had no problem writing about it at all, because I'm-Very enthusiastic about it, and I think it's something that we need to be discussing more. And there are issues with it as people get older. Um, erectile dysfunction is not uncommon. Now, erectile dysfunction can occur at any age, and probably one in three, as you know from your-

Dr. Rangan Chatterjee 1:37:27 Mm-hmm

Rose Anne Kenny 1:37:27 ... general practice men have experienced it at some stage or other, and there's lots and lots of reasons f- for it. But there are reasons which need to be investigated, um, even if it's intermittent, and it can be indicative of underlying atherosclerosis, that's thickening of vessels, blood vessels, uh, in, in, in older adults. When I say older, people 50 and above, and that needs to be investigated early. Uh, you know that iceberg we talked about? That's the process happening down here below the threshold of the iceberg. It can be, uh, managed early.

Dr. Rangan Chatterjee 1:38:02 Yeah, I, I think that's a, a very important take-home for people that we perhaps haven't spoken about enough on this podcast, which maybe [laughs] speaks to exactly what you're talking about, about how taboo this topic is. But I think a lot of people, women and men, don't realize that e- erectile dysfunction could be-

Rose Anne Kenny 1:38:22 Yeah

Dr. Rangan Chatterjee 1:38:23 ... an early warning sign that you already have thinning of the blood vessels in your heart.

Rose Anne Kenny 1:38:27 Yes, yeah.

Dr. Rangan Chatterjee 1:38:27 Like, the blood vessels exist everywhere.

Rose Anne Kenny 1:38:29 Yes.

Dr. Rangan Chatterjee 1:38:29 You know, if there's a problem-

Rose Anne Kenny 1:38:31 Yes

Dr. Rangan Chatterjee 1:38:31 ... with your erections-

Rose Anne Kenny 1:38:32 Yeah

Dr. Rangan Chatterjee 1:38:32 ... that could be a problem in your heart, so if you're having it, you, you really should get that checked out, particularly-

Rose Anne Kenny 1:38:36 100%, yeah

Dr. Rangan Chatterjee 1:38:37 ... if you're 40s, 50s, 60s.

Rose Anne Kenny 1:38:39 So that's very important to, to be aware of. That can be an indicator also of un- uh, of, of, of early-stage diabetes, et cetera, et cetera.

Dr. Rangan Chatterjee 1:38:46 Mm-hmm.

Rose Anne Kenny 1:38:46 So it needs to be ... And then for women, vaginal dryness is a huge issue. So some of the reasons why older people don't take part as frequently in sexual activity is because it's painful or uncomfortable, particularly for women. Now, that can be dealt with. So dry mucosal surfaces, we know about dry eyes, dry mouth postmenopausally, but dry vagina, dry vulva is also not uncommon, and it can be dealt with with ho- hormone replacement therapy, local hormone therapy, and gels. But there's something that we should be discussing with our patients, and I really think as doctors, for those age groups, we should just ask about it, "Have you any problem with..." And if there's a problem, that'll open up the discussion.

Dr. Rangan Chatterjee 1:39:29 So how does this relate to aging, right? So let's say a couple want to be intimate-

Rose Anne Kenny 1:39:35 Mm

Dr. Rangan Chatterjee 1:39:35 ... and have sex as they're older. Okay, so that's a desire, but in terms of the biology of aging, how does sex and intimacy play, play a role?

Rose Anne Kenny 1:39:45 Oh, well, this is really interesting because actually, um, it probably decelerates the aging process.

Dr. Rangan Chatterjee 1:39:51 Decelerates it.

Rose Anne Kenny 1:39:51 Yeah, it's really good. It-

Dr. Rangan Chatterjee 1:39:53 And are you, you know, to get really granular here-

Rose Anne Kenny 1:39:55 Yeah

Dr. Rangan Chatterjee 1:39:56 ... are we talking about the act of sex, so intercourse, or are we talking about intimacy? Because intimacy-

Rose Anne Kenny 1:40:04 Probably both.

Dr. Rangan Chatterjee 1:40:05 Both.

Rose Anne Kenny 1:40:05 Because, yes, because it's the neurohumoral consequences of intimacy probably that predominate in terms of decelerating the aging process, probably through a, a, a attenuating any inflammation at a cellular level.

Dr. Rangan Chatterjee 1:40:21 Neurohumoral. Couple of fancy-

Rose Anne Kenny 1:40:23 Okay, sorry

Dr. Rangan Chatterjee 1:40:23 ... words there. What does that mean for the-

Rose Anne Kenny 1:40:24 Okay, neuro is the nerves that are involved, usually autonomic nerves, predominantly sympathetic, so nerves, and humoral are the hormones involved, including oxytocin and, and the, the feel-good hormones we know about, endorphins, you know, dopamine, serotonin, et cetera.

Dr. Rangan Chatterjee 1:40:38 So intimacy helps to slow down the aging process.

Rose Anne Kenny 1:40:44 Intimacy does. Now, the act of s- aging itself is equivalent to... I, I did have the figure in the book. I think it's something like four minutes on a treadmill, b- but it mightn't even be that.

Dr. Rangan Chatterjee 1:40:55 What's this, sorry? Intimacy?

Rose Anne Kenny 1:40:56 The, the ac- the act of, the actual int- sexual intercourse, the act of, uh, sexual intercourse.

Dr. Rangan Chatterjee 1:41:01 Okay.

Rose Anne Kenny 1:41:02 So the, the added value of that, over and above the neurohumoral effects of intimacy, is exercise [laughs] and you can get that another way. So it's probably, probably predominantly the intimacy that is having the beneficial effects.

Dr. Rangan Chatterjee 1:41:15 So if we just take the big-picture look, one of the things I, I, I think has come through from this conversation, you make it very clear in the introduction in, in your book that there's no one thing that determines how quick you're gonna age or how slow you're gonna age. It's a combination of factors.

Rose Anne Kenny 1:41:30 Yes.

Dr. Rangan Chatterjee 1:41:30 Right? There's multiple things, and of course, we all live different lives, so, you know, we c- we can all get there. We can all slow down the aging process, I guess, by doing what we can within the context of our lives, so not everyone is going to be able to do everything. Now, in relation to what we've just been talking about, sex and intimacy, of course, many people will feel that they're not in a relationship, right?

Rose Anne Kenny 1:41:58 Yeah.

Dr. Rangan Chatterjee 1:41:58 May- many people may feel that... Or they are, let's say, happily married, but both themselves and their partner no longer wish to engage in intercourse, right?

Rose Anne Kenny 1:42:07 Yeah.

Dr. Rangan Chatterjee 1:42:07 So let's just be really clear what we're saying. We're not saying that that's a bad thing necessarily, are we? You know, what's the, what's the message there for people?

Rose Anne Kenny 1:42:17 So the message there for people is of course it's individualized, and there are people, there are lots of studies to show that there are people who are not sexually intimate who have very good quality of life and are happy with that status quo.

Dr. Rangan Chatterjee 1:42:31 Mm.

Rose Anne Kenny 1:42:32 It's only if whatever your situation is is causing you worry or stress or unhappiness that it's not good.

Dr. Rangan Chatterjee 1:42:40 Mm.

Rose Anne Kenny 1:42:40 But if you're getting pleasure from whatever the state, either, you know, being single and not having any sexual intimacy, being in a couple but not having sexual intimacy, or having intermittent sexual intimacy, um, it's whatever is making you happy, and, and as long as it's not stressing you and making you unhappy. That's what's toxic.

Dr. Rangan Chatterjee 1:43:01 Let's talk about sleep. Uh, what is the relationship between sleep and aging? And I, I've gotta say one of the things I really, really enjoyed reading about was these four sleep chronotypes.

Rose Anne Kenny 1:43:12 Oh, yeah. [laughs] Yes. Uh, I reckon I'm a lion. What do you think you are?

Dr. Rangan Chatterjee 1:43:16 I'm definitely a lion.

Rose Anne Kenny 1:43:17 Okay, yeah. [laughs]

Dr. Rangan Chatterjee 1:43:18 From, from, from the description in your book-

Rose Anne Kenny 1:43:20 Yeah, yeah

Dr. Rangan Chatterjee 1:43:20 ... I'm a lion. Um, in fact, let- shall we... Do, do you wanna go through those?

Rose Anne Kenny 1:43:24 I'll go through them. So there are four types. There are dolphins, lions, bears, and wolves. Um, and the wholePoint about this is what, what's our chronotype? Our chronotype is almost our personality type coupled with our 24-hour circadian rhythm.

Dr. Rangan Chatterjee 1:43:44 Okay.

Rose Anne Kenny 1:43:44 Now, all of our cells have a 24-hour circadian rhythm, and they're all governed by a central clock in the brain called the suprachiasmic nucleus-

Dr. Rangan Chatterjee 1:43:54 Mm-hmm

Rose Anne Kenny 1:43:55 ... SCN. Um, and it basically, every single thing about us is governed by that. Um, so that at nighttime when it's dark, different rhythms are turned off and different rhythms are turned on, and then in the daytime, different rhythm- rhythms turned off and on. That's what's important. Now, our chronotypes, which are our sort of personality types coupled with our rhythm, are roughly divided into four groups. There's the dolphins, the lions, the bears, and the wolves. Dolphins struggle to fall asleep, sleep approximately six hours, wake up unrefreshed, may experience anxiety, irritability. They're perfectionists. Lions, medium sleep drive, wake up early, lots of energy, little energy at bedtime. I'm almost supine after 9:00 in the evening.

Dr. Rangan Chatterjee 1:44:42 Yeah, me too.

Rose Anne Kenny 1:44:42 I'm useless. Optimistic, overachievers, go-getters-

Dr. Rangan Chatterjee 1:44:46 Yeah

Rose Anne Kenny 1:44:46 ... health-conscious, e- eat well, take exercise, and they're leaders, right?

Dr. Rangan Chatterjee 1:44:51 Yeah, I, I definitely-

Rose Anne Kenny 1:44:52 Maybe we're choosing [laughs] maybe we're... Anyway.

Dr. Rangan Chatterjee 1:44:54 Maybe we like to think of ourselves in this way, but I, I, I think-

Rose Anne Kenny 1:44:57 No, I'm pretty much a lion

Dr. Rangan Chatterjee 1:44:58 ... I think I'm a lion.

Rose Anne Kenny 1:44:59 Yeah. And then bears are deep sleep at night, rise with the sun, strive to be healthy, team players, hardworking, easy to talk to, and they've good people skills. And then the wolves, I'm married to a wolf, um, wake up in a haze, groggy in the morning, I recognize that, energy in the evening, so he's much better in the evenings, tend to miss breakfast, come alive after dark, creative, pessimistic, moody, comfortable alone. And they're, they're very often the, the, the chronotype which is actually aligned with great creativity. Um, and they're also most likely to be addicted [laughs] than o- other sorts of chronotypes. And by that, we mean to... N- my husband is not, by the way. But by that we mean to alcohol and drugs or, or gambling, uh, behaviors. They're very often wolves in their chronotype. They're just fun chronotypes.

Dr. Rangan Chatterjee 1:45:47 They are fun.

Rose Anne Kenny 1:45:47 They've been shown to be scientifically more or less aligned, um, um, to-

Dr. Rangan Chatterjee 1:45:52 And what, what benefit is there for us knowing what we are?

Rose Anne Kenny 1:45:57 So the point is that all of our society is orientated towards the dolphin, the lion, and the bear, but the poor old wolf finds it really difficult, 'cause they come to life later on in the afternoon and the evening. And about one in five of us, 20%, are, are wolves. To, to comply with the timetable that society sets, i.e., be in school at 8:00 or 9:00 in the morning, you know, come home at 4:00, et cetera, go to bed early, get up early in the morning, they struggle with that. That's the first thing. The second thing is our chronotypes are very closely aligned to f- sleep habits, as you can see from the description, also to food intake. So, um, it's a, i- it, it's important that people who have the latter chronotype we described, the wolves, are aware that they're more likely to get health, negative health outcomes from negative lifestyle behaviors. And I'm sorry if that sounds miserable, but it's just that they're more likely to overeat-

Dr. Rangan Chatterjee 1:46:55 Mm

Rose Anne Kenny 1:46:55 ... or maybe over-drink. Um, and, and that's part of their struggle with this imposed clock which isn't their natural clock. Um, now, now, you can turn that around, and that's the good news, um, by bit by bit bringing the, um, clock that you are comfortable with as a wolf into maybe the bear or lion clock. And d- by doing that, to do that, by going to bed, uh, i- i- consecutive nights 15 minutes earlier, but you have to stick to it. You have to be very rigid with yourself and stick to that until you kind of get more into a natural clock. And that does reset some of the-

Dr. Rangan Chatterjee 1:47:39 Yeah

Rose Anne Kenny 1:47:39 ... neurohumoral, we're going to come onto again, changes that are very closely aligned with the circadian rhythm.

Dr. Rangan Chatterjee 1:47:46 Yeah. It's really, really interesting. I think, you know, knowledge is always a good thing, isn't it? And at least knowing our tendencies-

Rose Anne Kenny 1:47:54 Yes

Dr. Rangan Chatterjee 1:47:54 ... can be helpful. They can help us realize why certain things are easier for us. You know, I'm, you know-

Rose Anne Kenny 1:47:59 Yes

Dr. Rangan Chatterjee 1:48:00 ... I find getting up early a piece of cake.

Rose Anne Kenny 1:48:02 Yes.

Dr. Rangan Chatterjee 1:48:03 It's no problem.

Rose Anne Kenny 1:48:03 Yes.

Dr. Rangan Chatterjee 1:48:03 I love doing it.

Rose Anne Kenny 1:48:04 Yes.

Dr. Rangan Chatterjee 1:48:04 I love getting up. I love-

Rose Anne Kenny 1:48:05 Yes

Dr. Rangan Chatterjee 1:48:05 ... getting after the day first thing in the morning.

Rose Anne Kenny 1:48:08 Yes.

Dr. Rangan Chatterjee 1:48:08 Um, whereas not everyone in my immediate environment [laughs] -

Rose Anne Kenny 1:48:12 Yeah

Dr. Rangan Chatterjee 1:48:12 ... let me put it like that, is the same, right?

Rose Anne Kenny 1:48:14 Yes.

Dr. Rangan Chatterjee 1:48:14 So in fact, you, you raised something really interesting. You're a lion, and your husband is a wolf.

Rose Anne Kenny 1:48:20 Yes.

Dr. Rangan Chatterjee 1:48:21 Um, is there an issue if our partner is not the same chronotype as us?

Rose Anne Kenny 1:48:25 Do you know what? Once you understand what's going on and you understand that this is a physiological behavioral thing, it makes it so much easier. And, and I think that each to his own in that context.

Dr. Rangan Chatterjee 1:48:36 Yeah.

Rose Anne Kenny 1:48:37 And, and as you said, knowledge is, is, is very powerful, and understanding it makes a huge difference.

Dr. Rangan Chatterjee 1:48:42 Yeah. I think it's great. I think the thing which you did mention, which I just wanna highlight, is that, well, first of all, society is set up in a certain way which makes it easier for certain chronotypes. But one thing I've found very much so is that, yes, there may be a genetic kind of template that you find easier, but some of that is shiftable. You know?

Rose Anne Kenny 1:49:10 Yes.

Dr. Rangan Chatterjee 1:49:10 If you don't expose yourself to light as much in the evening, if you bring your eating times-

Rose Anne Kenny 1:49:15 Yeah

Dr. Rangan Chatterjee 1:49:15 ... earlier, if when you see natural daylight in the morning, if you can do that first thing-

Rose Anne Kenny 1:49:21 Yeah

Dr. Rangan Chatterjee 1:49:21 ... you know, get up early and expose yourself, you can actually... I wouldn't necessarily say reset, but almost reduce the effects. Like, I know-

Rose Anne Kenny 1:49:31 Yes

Dr. Rangan Chatterjee 1:49:32 ... there's some studies, I spoke to Professor Satchin Panda about this, who's done a lot of the time-restricted eating research at the Salk Institute-

Rose Anne Kenny 1:49:37 Yeah

Dr. Rangan Chatterjee 1:49:37 ... in, in California.

Rose Anne Kenny 1:49:38 Yeah.

Dr. Rangan Chatterjee 1:49:39 You know, he spoke to me about a study where they took people camping without electronic devices, and how it's amazing how so much of what we think our natural bedtime is-Actually is due to our lifestyles-

Rose Anne Kenny 1:49:53 Mm-hmm

Dr. Rangan Chatterjee 1:49:54 ... is due to our light exposure-

Rose Anne Kenny 1:49:55 Yeah

Dr. Rangan Chatterjee 1:49:55 ... at what time we're eating caffeine, at what time we're eating our evening meals. Whereas if you go camping without electronic light, you know, you're just exposed in nature to natural light, you're eating earlier. Actually, our bedtimes are often quite different. Our natural bedtimes are often quite different from what we think.

Rose Anne Kenny 1:50:12 Yeah, absolutely. So that nucleus, the suprachiasmic nucleus, it is linked directly to the eye, and it responds most strongly to exposure to darkness or to light. And remember, it is the mother clock that sets all the other clocks in our cells. So if we are retuning it, if you like, by exposure to light first thing in the morning, and then darkness at night, that will help greatly because that clock is what's attuned to your chronotypes. I have an, the... I, I cite a, a, a very famous, um, Irish Gaelic footballer, actually in his 90s, and when I was chatting to him one day, I asked him about his day, and he gets up first thing in the morning, and he goes outside and takes the air. He just goes outside every single morning and gets some f- some real natural light. Natural light is very important. Then the corollary of that is to help with sleep, make sure your room is really dark.

Dr. Rangan Chatterjee 1:51:15 Yeah.

Rose Anne Kenny 1:51:15 Because that's how, that's how-

Dr. Rangan Chatterjee 1:51:16 It's-

Rose Anne Kenny 1:51:16 ... our biology is responding.

Dr. Rangan Chatterjee 1:51:18 I- it's basic stuff-

Rose Anne Kenny 1:51:19 Mm-hmm

Dr. Rangan Chatterjee 1:51:20 ... that I think needs re-emphasizing time and time again. Because we hear this stuff all the time, right?

Rose Anne Kenny 1:51:29 Mm-hmm.

Dr. Rangan Chatterjee 1:51:29 But if hearing it once meant that we would change our behavior-

Rose Anne Kenny 1:51:35 Yeah

Dr. Rangan Chatterjee 1:51:36 ... well, I wouldn't have a podcast. [laughs]

Rose Anne Kenny 1:51:38 [laughs]

Dr. Rangan Chatterjee 1:51:39 You know, I wouldn't be writing books.

Rose Anne Kenny 1:51:40 Mm-hmm.

Dr. Rangan Chatterjee 1:51:40 You wouldn't be writing your book.

Rose Anne Kenny 1:51:41 Mm-hmm.

Dr. Rangan Chatterjee 1:51:41 It's like, if we just heard it once, your diet and movement-

Rose Anne Kenny 1:51:44 Mm-hmm

Dr. Rangan Chatterjee 1:51:44 ... is important, and we did it-

Rose Anne Kenny 1:51:45 Mm-hmm

Dr. Rangan Chatterjee 1:51:46 ... there would be no need for us to keep talking about these messages around the world.

Rose Anne Kenny 1:51:51 So I'm going to put a challenge to you now, right? So the other big thing is blue light. That's really bad for that suprachiasmic nucleus. And certainly I am guilty of this. At night, I just check for one minute my email or my text messages just before I go to bed, right, go, before I go to sleep. And you get on, and then an hour later, you're still trawling through something. You have just exposed your poor old nucleus to all of that blue light immediately before it's supposed to s- switch off all your systems and allow the, the systems which kick in to get rid of toxins in the brain to kick in. Blue light is really bad, and it's, we should try to abstain from it for about an hour before going to bed. I mean, we've evolved with familiarity with yellow light, fires, et cetera-

Dr. Rangan Chatterjee 1:52:43 Mm-hmm

Rose Anne Kenny 1:52:44 ... and yellow light bulbs until very recently. Blue light is very new to, to us. The wavelength of blue light is not good for that nucleus in terms of the circadian rhythms. So if possible, we should try to n- And that's something else I've changed, that behavior, is not looking at anything on a computer or on my phone for about an hour before I go to bed.

Dr. Rangan Chatterjee 1:53:07 Yeah, I mean, it's, it's something that's so difficult for people to do. They're so addicted these devices. [laughs] It's-

Rose Anne Kenny 1:53:14 Well, you know, I went to a meeting in Barcelona recently, a cardiology meeting. Was leaving very early in the morning, like 4:30, leaving the house in the taxi, almost at Dublin Airport, and I thought, "Oh, gosh, my phone. I've forgotten my phone." There was no way I could go back for it. I had my laptop. So for four days, I had no phone. I was wearing one of those Garmin devices as part of an experiment that one of my research students was doing, and my mean heart rate went down from 74 during the day to 66 because I had no phone.

Dr. Rangan Chatterjee 1:53:48 Okay.

Rose Anne Kenny 1:53:48 And I was able to, in the evenings after the meeting, go home and log on to my emails and do it, but I was in control. I was making the choices there. I didn't have any tanging or pinging or light alerts in the background, and that just shows how much, I didn't realize it before this, but how much impact that was having on my cardiovascular system.

Dr. Rangan Chatterjee 1:54:10 That, that is absolutely incredible. I'd love to see that done on a, on a wider trial-

Rose Anne Kenny 1:54:16 Mm

Dr. Rangan Chatterjee 1:54:16 ... because I just, I just don't think we, we realize the insidious-

Rose Anne Kenny 1:54:22 Mm-hmm

Dr. Rangan Chatterjee 1:54:22 ... nature, the w- the way being on the entire time has crept in where it is now the norm for so many of us.

Rose Anne Kenny 1:54:30 Yes.

Dr. Rangan Chatterjee 1:54:31 For me, one of the most powerful things I can do for my health, if and when I remember to do, and I've got to say at the moment, I'm being really good with it, is I charge my phone in my kitchen.

Rose Anne Kenny 1:54:42 Yeah.

Dr. Rangan Chatterjee 1:54:42 You know, so when I'm in the house, I leave it downstairs. It doesn't enter my bedroom.

Rose Anne Kenny 1:54:46 Yeah.

Dr. Rangan Chatterjee 1:54:47 So by not entering my bedroom, it's automatically, you know, the, the friction there to actually go and get it is huge. It's just not gonna happen. Whereas if it's there-

Rose Anne Kenny 1:54:57 Yes

Dr. Rangan Chatterjee 1:54:57 ... it is very hard-

Rose Anne Kenny 1:54:58 Yes

Dr. Rangan Chatterjee 1:54:58 ... for people to resist.

Rose Anne Kenny 1:54:59 Yeah.

Dr. Rangan Chatterjee 1:54:59 And of course, when people say, "It's my alarm clock," it's always like, you know, alarm clocks, you can get them for about a fiver on Amazon.

Rose Anne Kenny 1:55:06 Yes.

Dr. Rangan Chatterjee 1:55:06 You know, it's-

Rose Anne Kenny 1:55:07 Yes

Dr. Rangan Chatterjee 1:55:07 ... or wherever, you know.

Rose Anne Kenny 1:55:09 Yeah.

Dr. Rangan Chatterjee 1:55:09 Your secondhand charity shop, whatever [laughs] it might be, right?

Rose Anne Kenny 1:55:11 Yeah, yeah.

Dr. Rangan Chatterjee 1:55:11 You can get them.

Rose Anne Kenny 1:55:12 Yeah.

Dr. Rangan Chatterjee 1:55:13 I, I, I'm always looking with patients and myself for what are the kind of one-time behaviors that, the kind of upstream behaviors I can do that automatically downstream change things. And I think not bringing your phone into your bedroom, if you can-

Rose Anne Kenny 1:55:29 Yes

Dr. Rangan Chatterjee 1:55:29 ... is such a powerful way of doing that-

Rose Anne Kenny 1:55:31 Yes

Dr. Rangan Chatterjee 1:55:31 ... where you're, you're not gonna be looking at blue light. You're not gonna be looking at your email. You're not gonna be getting caught up on Twitter in something. But of course, people find it hard to do. A- and I also wanna acknowledge that some people need to be on call for certain things.

Rose Anne Kenny 1:55:44 Yeah.

Dr. Rangan Chatterjee 1:55:45 Sick family members, whatever it might be. The way I tackle that, 'cause that is something that is real in my life, is I have a landlineAnd I've got a mobile.

Rose Anne Kenny 1:55:55 Mm-hmm.

Dr. Rangan Chatterjee 1:55:55 And now I know a lot of people these days don't have landlines anymore. I do, and only immediate family have my landline number.

Rose Anne Kenny 1:56:05 Yes.

Dr. Rangan Chatterjee 1:56:05 So therefore, I can put my mobile phone off-

Rose Anne Kenny 1:56:08 Yeah

Dr. Rangan Chatterjee 1:56:08 ... and I know if someone in my immediate family needs me, there's an emergency, they can get me.

Rose Anne Kenny 1:56:13 Yes.

Dr. Rangan Chatterjee 1:56:14 And so again, I don't want to say that's for everyone. I share that in case there's anything in there that's helpful-

Rose Anne Kenny 1:56:19 Yes

Dr. Rangan Chatterjee 1:56:19 ... for someone, but these are small things that make a massive difference.

Rose Anne Kenny 1:56:21 They're tiny things, but it's awfully hard to do. I panicked when I realized I didn't have the phone, and by the end of the four days, I kinda thought, "Do I really have to pick up my phone again?" And within 24 hours, I was right back there. A- and I really noticed it this time, the pinging and the background constancy of it-

Dr. Rangan Chatterjee 1:56:40 Yeah

Rose Anne Kenny 1:56:40 ... and the expectations by others that I was available. You know?

Dr. Rangan Chatterjee 1:56:45 Yeah.

Rose Anne Kenny 1:56:45 It, it's almost, it's a terrible pressure that we're putting on ourselves.

Dr. Rangan Chatterjee 1:56:49 When we talk about the biology of aging and slowing it down, what exactly does sleep do?

Rose Anne Kenny 1:56:57 Sleep is very important. I'm tentative about saying this, because if people are poor sleepers and you emphasize how important sleep is, y- you know, one, one thing you don't want to do is, is make people more anxious about the fact that they're not sleeping. So when we're talking about this, we'll t- also talk about solutions, hopefully, that might help people. Sleep is very important. Seven to nine hours sleep is what is recommended, um, as we get older. Now, now, our, our, our clocks, our biological clocks, not our biological clocks, our chronotropic clocks change as we get older. So we don't sleep as much with age. Um, so that might be an issue. Um, but sleep is the time when our bodies get a chance to get rid of all of the toxins. It's a time when our brain gets a chance to consolidate the memories we've learned during the day, and to, um, store them in long-term memory. It's, it's a recharging period. It was, it was, was thought that our brains were dormant or almost-

Dr. Rangan Chatterjee 1:57:59 Mm-hmm

Rose Anne Kenny 1:57:59 ... dead [laughs] during sleep, but then once we had EEG, we realized that actually it's the most active period for our brains in the 24-hour cycle. It's working really hard-

Dr. Rangan Chatterjee 1:58:09 Wow

Rose Anne Kenny 1:58:09 ... to get rid of toxins, to, to be refreshed and ready for the next day. And people who have shorter sleep are more likely to get cognitive impairment and dementia in the longitudinal studies, and they're more likely to have inflammatory consequences, like poor immune responses to viruses or indeed cardiovascular disease. So sleep is very, very important.

Dr. Rangan Chatterjee 1:58:31 So, you know, like, it's always hard with sleep, isn't it?

Rose Anne Kenny 1:58:36 Yeah.

Dr. Rangan Chatterjee 1:58:36 As, 'cause as you say, there will be people with, um, young families-

Rose Anne Kenny 1:58:41 Yeah

Dr. Rangan Chatterjee 1:58:42 ... uh, young children who are struggling and, and often they can hear that and go, "Oh, man, you know, I'm sleep-deprived, I'm knackered. What, what can I do? You know, I'm gonna speed up the rate at which my biological clock ages." [laughs] And I think we have to acknowledge that. We have to recognize that it is tough. It's really tough for adults, for many adults now who don't have help around them, you know?

Rose Anne Kenny 1:59:04 Or night shift workers.

Dr. Rangan Chatterjee 1:59:05 Or night shift workers.

Rose Anne Kenny 1:59:05 I mean, you know, people who have to work at night. I mean, the evidence that the night shift is not good for your health is quite strong. Um, but we have to, we have to have workforces who work at night. We've worked at night for a significant-

Dr. Rangan Chatterjee 1:59:20 Yeah

Rose Anne Kenny 1:59:20 ... proportion of our, of our lives. Um-

Dr. Rangan Chatterjee 1:59:23 So what are your top tips, then, for people?

Rose Anne Kenny 1:59:25 So what, what can we do about it? Exercise during the day helps, okay? But not immediately before you go to bed, because what exercise does is it triggers your whole autonomic nervous system and gets it all lively and active and awake, and y- you're gonna be awake when you're going to bed. Try and, so try and have a chilling period for a period of time, um, maybe an hour before you go to bed. Read a book or do something to de-stress. Meditate if possible. Make sure the room is dark. We've said that before. Some people find a hot bath or a hot shower helps before sleep. There are foods which are not good, and there are foods which help. So foo- any foods which contain tyramine. Tyramine is a precur- cursor to noradrenaline. Noradrenaline is one of the transmitters involved in the sympathetic system, and that's the fight or flight system. So any foods which contain tyramine will keep you awake at night.

Dr. Rangan Chatterjee 2:00:17 And what are those foods?

Rose Anne Kenny 2:00:18 They are the, like, blue cheeses, dark cheeses, um, um, preserved meats, um, bolognese sauce, anything with additives in it like that. They're not good. Foods which contain tryptophan, which is a, one of the, um, um, proteins involved with serotonin, which is a relaxing, um, if you like, compound, are, are good, and that would be foods such as cottage cheese, um, almonds, the teas we know about. Um, believe it or not, fatty fish like salmon.

Dr. Rangan Chatterjee 2:00:56 Mm-hmm.

Rose Anne Kenny 2:00:56 There was a great study in 95 men in each cohort where they ate, uh, salmon before going to bed three times a week versus a group who just ate the same equivalent of protein, but taking different meats with it, and the salmon eaters, their sleep improved over a period-

Dr. Rangan Chatterjee 2:01:12 Wow

Rose Anne Kenny 2:01:12 ... significantly over a short period of time. So omega oils, all, they, they help. Um-

Dr. Rangan Chatterjee 2:01:17 So that's essentially saying for that particular group that was studied, eating fish in preference to meat, if people are choosing to consume animal protein-

Rose Anne Kenny 2:01:28 Yeah, yeah

Dr. Rangan Chatterjee 2:01:28 ... you're saying fish seems to be better-

Rose Anne Kenny 2:01:31 Yes

Dr. Rangan Chatterjee 2:01:31 ... in terms of promoting good sleep-

Rose Anne Kenny 2:01:32 Yeah

Dr. Rangan Chatterjee 2:01:32 ... as opposed to meat in the evening.

Rose Anne Kenny 2:01:34 Yeah, and I've given a whole list. There's quite a large list-

Dr. Rangan Chatterjee 2:01:37 There is a huge list in the book

Rose Anne Kenny 2:01:37 ... of things which help. And, and the other thing to be aware of is foods that are high in fiber may impact on sleep at night, because they just require more activity from the gut to break down the foods.

Dr. Rangan Chatterjee 2:01:49 Mm.

Rose Anne Kenny 2:01:49 So there are things for people to be aware of. Um, and I, and...If, if there are some technologies now which are evo- emerging, and you've probably discussed this on your, on your show before, which, which may help some people, and they're worth trying, pink noise, white noise. What they do is they, uh, they influence the rhythm of, of the brainwaves during sleep, the non-rapid eye movement waves and the rapid eye movement s- waves, and may help. And there are also technologies which actually marry the noise with the different slow waves, which is what you want, to get-

Dr. Rangan Chatterjee 2:02:30 Wow

Rose Anne Kenny 2:02:30 ... more slow wave activity, which may be of benefit. They've been shown to be of benefit in some studies and not of benefit in other studies. So my own take on that is this could be very individualized, but definitely, I think, worth trying.

Dr. Rangan Chatterjee 2:02:43 And for those people who are in that stage of life where, let's say, they're struggling, for example, young parents-

Rose Anne Kenny 2:02:48 Mm

Dr. Rangan Chatterjee 2:02:48 ... young kids, they're not sleeping particularly well at the moment. In terms of a message of hope for them, let's say you go through three or four years of sleep deprivation whilst your kids are young. It's certainly something that I did.

Rose Anne Kenny 2:03:01 Yeah.

Dr. Rangan Chatterjee 2:03:01 My wife did.

Rose Anne Kenny 2:03:01 Yeah.

Dr. Rangan Chatterjee 2:03:02 Right? Um, how detrimental is that? Or is it just one of those things that happens in life at a particular time, but as soon as you are able to, and if you can, get back on track with your sleep, then, like, from a, from an aging perspective, is that okay? Does it get back to normal?

Rose Anne Kenny 2:03:20 Well, first of all, the vast majority of people do get back on track to whatever their normal-

Dr. Rangan Chatterjee 2:03:23 Yeah

Rose Anne Kenny 2:03:23 ... sleep rhythm is. That's the first thing. And secondly, there's very little evidence that that period of time has a negative impact, particularly on longer term consequences on the aging process.

Dr. Rangan Chatterjee 2:03:34 I think a lot of the core messaging in your book and from your research is that it's not about the one-off things. It's about what are you doing, you know, 80% of the time, by and large-

Rose Anne Kenny 2:03:46 Exactly

Dr. Rangan Chatterjee 2:03:46 ... you know, month after month, year after year. I- is that a fair reflection of your message?

Rose Anne Kenny 2:03:50 No, that's a very fair reflection. It's about consistency, and it's a, it's a, it's a, it's the long game, [laughs] uh, you know-

Dr. Rangan Chatterjee 2:03:57 Yeah

Rose Anne Kenny 2:03:57 ... particularly if you, if you start the game early.

Dr. Rangan Chatterjee 2:04:00 Yeah. I gotta say, we, we've been ch- chatting for a long time, and there's so much more to talk about. You, you've, you really have written a wonderful book, Age Proof. It's, it's so succinct. It's full of science and research, but it's also very, very practical. So I can see why it's proven so popular with people. I did wanna cover this. I'm not sure we got a time to go into it in detail, but there's one chapter on purpose-

Rose Anne Kenny 2:04:27 Mm

Dr. Rangan Chatterjee 2:04:27 ... and laughter-

Rose Anne Kenny 2:04:29 [laughs]

Dr. Rangan Chatterjee 2:04:29 ... which is really interesting. Any kinda top line thoughts on those two things you wanna share?

Rose Anne Kenny 2:04:34 Well, first of all, laughter is really important, and we know this intuitively 'cause we feel good after, but it releases a whole lot of neurohormones, which are, which are very important for us, and that's actually used therapeutically now. I'll just cite one study which I find amazing, is that people who had had a heart attack, who, who were exposed to laughter therapy, were 48% less likely to get a recurrence of a heart attack. Now, that's a massive figure. So, so that's the benefit. So just carry that moment and know that laughter matters. Laughter is a way of us to bond socially, so it's all tied up with this whole social engagement piece.

Dr. Rangan Chatterjee 2:05:08 Yeah, and it plays into what you said about friendships before.

Rose Anne Kenny 2:05:10 Yeah, absolutely.

Dr. Rangan Chatterjee 2:05:10 Like, if I think about hanging out with my best mates, what do we do? Well, we do lots, but one thing we're, we're always doing is laughing when we're together, right? So-

Rose Anne Kenny 2:05:19 It's-

Dr. Rangan Chatterjee 2:05:19 ... you know, a- again, that speaks to everything, that they're not all in isolation. They all... All of these behaviors-

Rose Anne Kenny 2:05:26 Absolutely

Dr. Rangan Chatterjee 2:05:26 ... kind of-

Rose Anne Kenny 2:05:26 Interact

Dr. Rangan Chatterjee 2:05:27 ... interact

Rose Anne Kenny 2:05:27 And, you know, kids laugh 400 times a day. There are studies to show this. Toddlers laugh 400 times a day. But we, we laugh so much l- less as we get older. So let's introduce laughter as part of it. [laughs] As, as-

Dr. Rangan Chatterjee 2:05:40 So laughter really is the best medicine

Rose Anne Kenny 2:05:42 ... laughter is the best medicine. And then purpose. Purpose is terribly important. And, and actually our... my message about that is anything can have purpose. You know, m- if making a shopping list and go down to the shop to get the st- that's purpose. You, you can create purpose in your day. We need to feel purpose. If we feel we have no purpose or, or almost unwanted or unnecessary, and we come back to this whole concept of social isolation of people over 70 and cocooning people over a certain age, if we feel we have nothing to contribute, we have no purpose, that's really bad for us from a physiological perspective.

Dr. Rangan Chatterjee 2:06:20 Yeah, one of the things in that chapter I particularly liked, and it's something you just echoed now, is that you can find purpose in anything. It really makes me think of what we were saying about attitude.

Rose Anne Kenny 2:06:36 Yeah.

Dr. Rangan Chatterjee 2:06:37 Right? Like, you know, the going to get the shopping can be seen as a chore. "Oh, man-

Rose Anne Kenny 2:06:45 Mm-hmm

Dr. Rangan Chatterjee 2:06:46 ... I gotta go and get the shopping now," or whatever it might be. But you can actively reframe that. You know, maybe a bit of gratitude, maybe a bit of, "Oh, wow, I, I get to go and actually get the food now that feeds my family or feeds me and my partner," or whatever it might be.

Rose Anne Kenny 2:07:00 Yes, yes.

Dr. Rangan Chatterjee 2:07:01 And I know it sounds very soft and very simple, but I honestly believe that you can train yourself to have this attitude. You can train yourself-

Rose Anne Kenny 2:07:09 Yeah

Dr. Rangan Chatterjee 2:07:09 ... to look at the positive side of everything, even washing the dishes.

Rose Anne Kenny 2:07:12 And, and purpose is tied into control, and we need to be in control. There are lots of, lots of studies showing that. In an employment hierarchy, those who are in control, that is one of the most important contributors to good health in those individuals compared to those who maybe are often in the bottom of the, of the hierarchical chain and have no control. They have to do what they're told, et cetera. So purpose is part of that. Purpose, if you can reframe it, um, gives you control over your life.

Dr. Rangan Chatterjee 2:07:46 Yeah.

Rose Anne Kenny 2:07:47 It is your purpose and you're framing what your purpose is, therefore you're in control, and that's really good for us biologically.

Dr. Rangan Chatterjee 2:07:53 Yeah. I love that. I gotta say, I've so enjoyed our conversation.

Rose Anne Kenny 2:07:59 Mm-hmm.

Dr. Rangan Chatterjee 2:07:59 Uh, I enjoyed meeting you a few months ago at the Book Festival-

Rose Anne Kenny 2:08:02 Yeah

Dr. Rangan Chatterjee 2:08:02 ... and speaking with you and having all our panel discussions. I've really enjoyed reading the book. Uh, just to finish off, what would your top tips be for people to say, "Professor, I wanna slow down the rate at which I age. What can I do?"

Rose Anne Kenny 2:08:18 I would say build an even stronger friendship group, keep moving, and move a little bit more every year, not less, more every year, and be cautious about your diet.

Dr. Rangan Chatterjee 2:08:36 Love it. Thanks for coming on the show. If you enjoyed that conversation, I think you are really going to enjoy this one about what and when to eat for longevity.

Speaker 2:08:45 This is probably the most effective diet that's ever been promoted on the planet. This protects our body against decay, disease, and the root causes of aging. It's not only good for you, but will make you live longer