Stay younger, longer: Cleveland Clinic’s Dr. Michael Roizen on slowing the aging process, the key to longevity, and more

When it comes to health, wellness, and longevity, Dr. Michael Roizen has all the answers. On the latest Walker Webcast, he joins Willy to discuss how to determine your real age, why when you eat matters, how to boost your immune system and reduce stress, and so much more. 

Dr. Roizen, Chief Wellness Officer at the Cleveland Clinic and former Head of Anesthesiology and Pain Management at the University of Chicago and Cleveland Clinic practices internal medicine with a “real age” focus. He coaches patients on lifestyle changes, placing a high importance on the role of food and other habits that can assist in reversing the disease process. As an award-winning author, Roizen has authored or coauthored five number-one New York Times bestsellers including, Real Age: Are You as Young as You Can Be?, which is set for release in September 2022. 

To kick things off, Willy asks Dr. Roizen to help explain the difference between your body’s real age and its calendar age. He then discusses why we should care about what we eat but also when we eat. Melatonin, insulin, and the sensitivity of several receptors in your body all play a significant role in your health. Dr. Roizen discusses what it means to have a lifestyle tuned by the sun, why you should eat in a smaller window of time, and how the change of circadian genes can alter aging. He says that people have the ability to change their rate of aging and weight with simple lifestyle adjustments. They also briefly address the role of alcohol and its impact in this realm. 

Shifting the conversation towards the immune system, Willy asks Dr. Roizen what can be done to help boost it—which is especially important while we’re in the midst of a pandemic. While exercise is an essential player in immune health, it can become an added stress on your body if it is not incorporated in the right proportion. They also address how to think about sleep, diet, daily habits, and the influence of sugar on the immune system. 

What position is best for sleeping, and what role does stress play? Dr. Roizen dives into all of this, including why pain and stiffness in the mornings can be a sign of inflammation, rather than injury. We then learn about the record-high, worldwide stress levels and the importance of stress reduction. Dr. Roizen talks about his journey in helping to establish the Stress Free Now program.

Willy asks Dr. Roizen about his role as the Head of Anesthesiology and Pain Management at the University of Chicago and Cleveland Clinic. Was the opioid pandemic avoidable? Dr. Roizen recounts the trainings he conducted for their employees and how he found this issue to be preventable amongst staff with the right training. 

The two then take a look at the Great Age Reboot and how life expectancy has changed through the years. They close by discussing the human genome project and the fourteen areas of advancement that are proving to be most influential, all of which are keys to improving longevity for life. 

Key ideas: 

0:51 Willy welcomes Dr. Michael Roizen
1:16 Shout out to the next two guests in the pipeline
4:22 Dr. Michael Roizen’s incredible bio
7:47 Real age versus calendar age
11:10 Daily habits that can change your DNA
16:34 The role of alcohol
18:23 The immune system and how to boost it
20:50 The best sleep positions
23:05 The role of stress and need for stress reduction
27:24 Position as Head of Anesthesiology and Pain Management, and the opioid pandemic

Links: 

Learn more about Dr. Michael Roizen and connect with him on Instagram. 
Pre-order his newest book, The Great Age Reboot on Amazon.
Check out Walter & Dunlop’s website. 

Webcast transcript: 

Willy Walker: Good morning, everyone. Welcome to our first Walker Webcast of 2022. Having just crossed the three million total listeners threshold at the end of 2021, I'm really excited about what is to come in 2022 for the Walker Webcast. What better way to start the new year than with such a terrific guest in Dr. Michael Roizen. 

Before I dive into Dr. Roizen's impressive bio, a couple of quick programming notes: Next week, we will have our quarterly discussion on the macroeconomy and commercial real estate with Dr. Peter Linneman (a mutual friend of Dr. Roizen and mine.) My discussion with Peter continues to attract huge audiences, and after having just read his quarterly letter, you're not going to want to miss next week's webcast. The following week, I have former grand slam tennis champion and number one tennis player in the world, Jim Courier, joining me from the Australian Open. Given that Australia just changed their country's COVID policy to allow Novak Djokovic to play in the Australian Open, it will be fascinating to discuss with Jim not only his career to becoming the world's number one tennis player but also what is going on in the tennis community around the globe. And after Peter and Jim, we have an amazing lineup of guests to discuss everything from where to invest in 2022, how artificial intelligence is changing our world by the minute, and how to lead a major financial services organization. 

I wrote an email this morning to a number of people at Walker and Dunlop, highlighting three articles in today's Wall Street Journal. The first, that OPEC just increased their daily production by 400,000 barrels, clearly stating that they don't think Omicron will slow down the global economy. Second, that investors are piling into the distressed debt of senior care facilities, reinforcing the sentiment that we may be near the end of the pandemic when senior care facilities can get back to something closer to normal. And finally, the exemption by Australia and the NBA to allow Novak Djokovic and Kyrie Irving, respectively, to resume playing. While the Omicron variant is very clearly here and impacting all of our lives every day, there seem to be clear signs from the market that we are getting close to the end. I very much look forward to hearing my guest's thoughts on that topic. 

I would also add from a general macroeconomic standpoint that we ended 2021 with a Goldilocks economy. The Dow Jones Industrial Average, ending the year around 36,500 and the ten-year Treasury around 150, is something that if you rewound the tape a year and asked the world's savviest investors to give you what they would say would be an incredible outcome for the year. I doubt they would have gotten close to those numbers. Inflation is clearly prevalent throughout the economy, but the inflationary pressures in December did play a large role in stopping the profligate spending and new bills coming out of Washington. I'll take 6% inflation any day, over $3T of spending and increased taxes. And while rates have run 15 to 20 basis points from the start of the year, we need to keep in mind that a 167 10-year is still dramatically low. For most of the 2000s prior to the Great Financial Crisis, the 10-year Treasury sat between 4-5%. 

So, to my guest? This is one of the most amazing bios I've had the pleasure of reading. I'm going to try and move through it as quickly as possible, but there's so much good stuff in here that gives context to my guest that I want to make sure you don't miss it.

Dr. Michael Roizen is a graduate of Williams College and Alpha Omega Alpha graduate of the University of California San Francisco Medical School. He performed his residency in internal medicine at Harvard's Beth Israel Hospital and completed public health service at the National Institutes of Health in the laboratory of Irv Kopin and Nobel Prize winner Julius Axelrod. 

Dr. Roizen is the co-founder of RealAge Inc., which he sold in 2006 but still chairs its scientific advisory board. Dr. Roizen is a past chair of the Food and Drug Administration Advisory Committee and a former editor for six medical journals. He has published more than 185 peer-reviewed scientific papers, 100 textbook chapters, 30 editorials, four medical books, and received 13 U.S. and many foreign patents. 

He was first on the faculty at the University of California, San Francisco, then chaired the Department of Anesthesia and Critical Care at the University of Chicago and then became dean of the School of Medicine and Vice President for Biomedical Science at the State University of New York Upstate. He then became chair of the Anesthesiology Institute at the Cleveland Clinic and, in 2007, was named Chief Wellness Officer at the Cleveland Clinic. The first such position in a major health care institution in the United States. 

Dr. Roizen's first general audience book Real Age: Are You as Young as You Can Be?, became a #1 New York Times bestseller. Other books include the New York Times bestseller, The Real Age Diet, The Real Age Makeover, YOU The Owner's Manual, written with Health Corps founder Dr. Mehmet Oz, (also a #1 New York Times bestseller) and he has authored or coauthored four #1 New York Times bestsellers and nine Top 10 bestsellers. 

He and Dr. Oz write a daily newspaper column syndicated to over 100 newspapers by King syndication. His newest book, The Great Age Reboot, with coauthors Peter Linneman and Albert Ratner, which we will discuss today, will be on bookshelves and Amazon in September of 2022. 

Finally, Dr. Roizen still practices internal medicine using the RealAge metric to motivate his patients. He routinely takes patients at the Cleveland Clinic Wellness who are in the midst of struggling with tobacco, heart, diabetic or arthritis problems. He coaches them with simple but persistent lifestyle changes to live, feel, look, and be younger. He really enjoys getting them to throw away their medications when they are no longer needed and teaching them the role of food and other simple steps in reversing the disease process. 

Mike, first of all, thank you so much for joining me. I will tell you, just reading your books and researching this discussion has changed my life. Since reading What to Eat and When, I have not had dinner. And since reading the Great Age Reboot, I have called up my insurance broker and thought about canceling my life insurance policy. So, we're going to dive into those two things in a moment. But the day after tomorrow, Mike is your 76th birthday, but your real age is closer to 55 years old. Can you explain to us what your real age is?

Dr. Michael Roizen: Your real age is the actual age of your body as opposed to your calendar age from which you can be many years older or younger. So, we now say 60 is the new 40. So, for the majority of people who want to, you will live like the average 40-year-old in 1980 at age 60. But it's not that hard to do it. Pretty soon and that is the only reason I write books is because of compelling new science. So, What to Eat and When was written when the science of intermittent fasting got to be enough human studies that we could say that that was a really appropriate strategy to try and do for slowing aging. The Great Age Reboot now is the science that says that we're going to be 40, while our calendar age is 90. And a lot of that will change everything else, which is why Peter Linneman and Albert Ratner are a part of it because the economic and political changes that occur with that are substantial and can be planned for. 

Willy Walker: So, we're going to jump into all that in a moment. But before we get to that, I believe it's just under 70 million people who have done the real age questionnaire. When someone completes that, what does it tell them? So, you're talking about someone who's 90 who is actually acting like they're 40 or feels like they're 40. How do you determine what your real age is? 

Dr. Michael Roizen: So, you can go and take that. I got the privilege of being at the University of Chicago when Charlie Becker was there, who did the net present value of investments and won the Nobel Prize in Economics for it. And so, when we started this, I actually contacted him, and we worked together and did the net present value of health changes. For example, if you walk 10,000 steps a day compared to the typical American, you are about 4.6 years younger. It's a little different for men and women, but that's what the computer does, and it does it covariance. But essentially, what it is is what's the net present value of your health choices? And it goes over 157 things for men and 158 for women that influence your rate of aging. 

Willy Walker: And I'm assuming the delta gets bigger as you get older. 

Dr. Michael Roizen: That's exactly right.

Willy Walker: So, it compounds?

Dr. Michael Roizen: As the new science starts, the compounding gets even much bigger. And maybe you'll talk next week with Peter Linneman about how that compounding means. He really convinced us that starting early is a policy change the U.S. needs to make like Australia, Singapore and Holland have done to reduce wealth and equality. 

Willy Walker: So, in your book, What to Eat and When, the core question is, why should we care about when we eat? 

Dr. Michael Roizen: So, we always thought the sun controlled sleep, and that was about it. But the hormones that the sun affects aren't just melatonin, but our insulin as well and the sensitivity of a number of receptors. Over centuries, we have always had our lifestyle tuned by the Sun so eating more early, less later, and eating in an eight-hour window to get ketosis every day does two things: it changes your circadian genes and changes the genes that function relating to metabolism and aging. Now I've said an awful lot there, so let me just tell you that you are a genetic engineer. Even if you don't know what DNA is, you change the way your DNA functions by your habits every day. So, for example, when you get to ketosis, your body thinks you're in survival mode. That is, you're going to die. And so, it starts to preserve and recycle your proteins and other structures. When you then eat, so let's just say you have a 14- or 16-hour window of fasting every day. Once you get past 14 hours, you start to be in ketosis, and your body goes into survival mode. It turns on genes that recycle your old cells. Then when you eat again, hopefully the correct food, that means food that will love your body and your brain back. When you get to eating again, you start to grow new cells, so it slows your rate of aging considerably. 

We used to think it was calorie restriction, but the way calorie restriction worked is people ate in a small time frame, so they were getting this benefit. Animals as well. So, you're a genetic engineer. The whole point of "what to eat and when" is that by changing the time period, you change your rate of aging, and you change your weight. So, one of the things that happen is you're more insulin sensitive in the morning, more resistant in the evening. So, a calorie is a calorie in the test tube. But in your body, a calorie eaten early is less of a calorie then when eaten later. How much less? It's about 15% less. So, eating the same number of calories earlier in the day versus late in the day makes you less likely to be obese. 

Willy Walker: So, in your book, there's a study that showed that if you eat 70% of your calories for breakfast, you lose weight versus 70% for dinner, you gain weight. So, it is really just that your body can absorb those calories much more effectively during the day. And if you're having a big dinner and you go to bed, basically your system shuts off. Therefore, those glucose stores turn into fat and metabolize as fat rather than being used as energy during the day. Is that what it means to a layman like me who's trying to figure out the science behind this? Is that pretty much it? 

Dr. Michael Roizen: That's pretty close. I don't know if everybody knows how much work you do in preparation for these podcasts or webcasts, but I am blown away. I've been on many webcasts and a lot of TV shows. No one does the amount of work you do, so you should know that. So essentially: that's right. You get a switch that changes from using the calories and getting rid of them to storing the calories the later in the day you eat them. If you eat later in the day or closer to sleep, you are more likely to store those calories. 

Willy Walker: So, one of the challenges that I've had since I started to do this, Mike, is that I haven't had family dinner, so I was just curious, how is your social life? 

Dr. Michael Roizen: Well, you know, I am a science nerd, so a lot of my time in the evening is spent reading medicine. But the rest of the time, I'm also a Cavalier Browns and Indians (they're now Guardians) season ticket holders, so a lot of my social life is going to sporting events with people. Hopefully, I am into the sporting event enough that all I have is a glass of wine. So, I try not to eat before 11-11:30 in the morning and finish eating by 7:00 or 7:30 in the evening. So, I get 16 hours of getting into ketosis every day. 

Willy Walker: So, it's my understanding that your coauthor Dr. Michael Crupain has a salad for dinner and a glass of wine. And I was curious about the glass of wine because lots of books you read on dieting and things of that nature say, leave the alcohol behind. I was very surprised that Mike, and I believe you as well, will have a glass of wine along with that light dinner. Talk to me for a moment about alcohol and its impact.

Dr. Michael Roizen: We’ve always thought, and this was based on a number of studies on what we call a J-shaped curve and all-cause mortality from alcohol. If you are a teetotaler, you have a higher all-cause risk then if you drink a half to two drinks a day and that as you drink four or five your risk of mortality gets substantial. That’s been questioned, but it looks like there still is a J-shaped curve with the lowest risk for all-cause mortality, especially from cardiovascular disease being in the one half to one drink a night for women. Now we think it is maybe three or four nights a week and one to two drinks a night for men, again three or four nights a week. We make sure everyone understands one drink a night is not seven drinks on Friday night. It should be spaced out. So, the J-shaped curve seems to hold still. There are some questions about it, but if you haven't started drinking, don't start for this reason. If you are, it is a reason to make sure you space it out. 

Willy Walker: So, let's turn to the immune system for a moment, particularly given the prevalence of COVID and the Omicron variant running throughout the world and our country. When you talk about boosting your immune system, what can we do to help do that during these times? One of the interesting things that I read when I was researching for you, was exercise, and I'm somebody who does quite a bit of exercise. And one of the things that you say is do your normal amount of exercise, but don't push it because going beyond your normal amount of exercise actually brings your immune system down. What are the things that we all ought to be thinking about, whether it's exercise, sleep, and diet at this time to help us boost our immune systems? 

Dr. Michael Roizen: Well, the data we have is somewhat limited, but let me go and say what you can conclude from the data. One is, if you were to get a vaccine, having three days of good sleep and a week or two of a multivitamin beforehand increases the take rate of that vaccination. So, the data we have is on common colds. We have some with the other coronaviruses but not the COVID 19 viruses. And it looks like 1) Sleep beforehand for six and a half to eight hours, 2) multivitamin for three weeks beforehand, 3) and do exercise at your usual pace. Doing more than two hours in a row that is, marathon runners have an increased risk of common colds and susceptibility to infections beforehand. Sugar decreases the ability of your white cells to kill and engulf bacteria and viruses. So, it is a healthy diet with low sugar. So, what you're doing on intermittent fasting is absolutely perfect for maintaining it. Now where's the conflict from what I'm saying now to your question before about alcohol? Because alcohol does impede your immune system, and we think some of that is because of the sugar in alcohol. And so, one of the compromises I make is that glass of wine in the evening. 
Willy Walker: So, you also talk about how we should sleep, not how long we should sleep, but how we should sleep on our back, on our sides, which I was fascinated by. 

Dr. Michael Roizen: Yeah, this is actually one of the most interesting things is if you can and don't have sleep apnea, then the best position for your musculoskeletal system is on your back with a pillow under your knees. If you're going to sleep on your side and you worry about sleep apnea or have some problems sleeping on your back, then it is on your side, but not in the fetal position, but is stretched out with a pillow again between your knees. The point of this is many of us wake up with pain on getting out of bed or stiffness. That's actually an inflammatory process. So, pain in the morning is inflammation. Pain in the evening is an injury. So, pain in the morning is you want to do things that decreases inflammation and stretches you at night rather than contracts you. 

Willy Walker: And also, as it relates to COVID and where COVID sits with SARS, it was more embedded in the lungs and therefore wasn't as transmissible as the COVID 19 variant, whereas now this is sitting in our nasal passages, so, therefore, being on your side is better than on your back. Am I correct in that? 

Dr. Michael Roizen: Yes. So, in other words, the reason that sleeping face down now is used in the ICU is exactly that. 1) It gets some better aeration, but 2) but it keeps the infection from getting worse, from coming from your nose into your lungs. So, if you got infected, sleeping on your back is not the thing to do, you want to sleep with your head slightly down so your nasal secretions drain outward rather than into your lungs or gut. 

Willy Walker: Stress is a big inhibitor of your immune system running properly. I know you wake up every morning and kiss your wife, Nancy, which brings your stress level down tremendously. But talk for a moment about our society today and the fact that it appears that we have more stress than we've ever had at a time when we actually should be de-stressing ourselves and not increasing stress. We read these stories about flight rage and people getting on airplanes and accosting flight attendants, and all the kind of built-up anger and animosity in our society today and what that's doing to people's stress levels. From what I've read of what you've written, we all ought to be chilling out and trying to get along with each other because the stress is impeding our immune systems. 

Dr. Michael Roizen: Yes, you are exactly right. Stress and toxins like tobacco are some of the worst things for our immune system, if you will. Stress management is one of the best. So, we developed a program called Stress Free Now at the Cleveland Clinic. If we'd known how to market it, we'd have beaten Calm and all the others by a long shot because it's actually a much better program. It is part of our Reboot Your Age app. But what it is, we've now done studies using the Pittsburg Perceived Stress Scale (PSS) developed at Carnegie Mellon University in 1979 to 83. So that's when we have the standards for. In America, the standard is higher, which means more stress, but in 1979 to 1983, it was 12:1 for men, 13:7 for women. It was thought that women had higher stress levels due to their caregiving responsibilities. We tested that in about 10 different cities in the United States, in Canada, France, Saudi Arabia, Abu Dhabi, India, China, and 14 different countries. In any case, the average stress level worldwide was 19.1. No country had a level that was below 18.5. That's five standard deviations above the mean in 1979 to 1983 and was associated with the development of chronic disease. 

If you do this Stress Free Now program and we publish it, and so it's a randomized controlled trial, we used nurses in different hospitals and the Cleveland Clinic. You're able to reduce by just doing one of the 12 techniques. And so, we go through 12 techniques, such as deep breathing and guided imagery, progressive muscle relaxation, meditation, et cetera. If you do one of those techniques regularly, you're able to reduce the stress level of that population into the normal range or even below the normal range. So, we've done this in many different health care institutions. The world is at a much higher stress level now then it was in ’79 to ’83 and it is at a level now that in ’79 to ’83 that would have been associated with the development of a chronic disease such as Type 2 diabetes or osteoarthritis. 

I practice in executive health at the Cleveland Clinic and in wellness, and almost all the executives will say, I give stress. Everyone has stress. So, stress reduction is something that we all need to practice.

Willy Walker: Before we move into what you did on the wellness front at Cleveland Clinic because the data is so compelling. I think it's very insightful to both individuals as well as corporate leaders on how you can make a difference in the wellness and health of your population base. Before taking that job, you were the head of anesthesiology at Cleveland Clinic and also pain management, which included 180 operating units and 28 pain therapy intervention units. I just read Empire of Pain by Patrick Radden Keefe, all about the opiate crisis in the United States and the Sackler family's role in that. And there's a television show that my wife and I are watching right now that is quite something talking about that pandemic, if you will. I guess my question to you, Dr. Roizen is this: was the opiate pandemic avoidable? 

Dr. Michael Roizen: Well, I don't know whether it was totally avoidable because the drug developed by Paul Janssen, who sold his company to Johnson and Johnson, fentanyl is so good. When I accepted the job as a department chair of anesthesia, critical care, and pain management at the University of Chicago, the first thing I did was I called a friend through squash named Doug Talbert. Doug ran the largest treatment center for physicians in 1985 for physician drug addicts. And I said to him, how do we prevent it? And he said, you have to shut the OR’s down for three days at the start of your residency and teach people how dangerous these drugs are, and scare the hell out of them, and teach them how to do interventions. They're going to have to do them if they don't have all of their friends controlled this way. So, what we did is we shut half the operating rooms down, which was a costly thing to do, and we did this three-day program at the University of Chicago. We trained over a thousand trainees during that entire time and had large staff, nurses in the ICU, etc. We had a total of two people get addicted, and they got addicted to Propofol and had avoided the training program, but fentanyl is so good you can't try it once without getting addicted. If you look at the heroin, Demerol, and morphine, they all cause a little dysphoria, a little dislike, some nausea, and vomiting. Fentanyl often doesn't cause any of these side effects. So, one dose and you can get addicted on it. When I came to the Cleveland Clinic as chair of Anesthesia, Critical Care and Pain Management, the hardest negotiation was with Toby Cosgrove over that three-day reduction because it's very expensive to reduce your operating rooms and do interventions on one another. And that was so powerful that in the time at the Cleveland Clinic and we did randomized drug testing, we had zero in my time at the Cleveland Clinic when we did that. Is it preventable among physicians and nurses? I believe so if you do enough education and understanding, don't try it once because these drugs are way too good. Similarly, with Purdue Pharma drugs, they're very good. There are very low side effects; constipation is one of their major side effects until you get to respiratory depression, which is, of course, a narcotic effect. So, the point is, I don't know if it was avoidable with the development of these good drugs. One of the things that kept it down from ‘85 to recently was that fentanyl was much harder to synthesize, and no one knew the formula, which is why Johnson and Johnson was able to keep that drug so well. They also make carfentanil. 

One of the experiments we did just to show you how powerful carfentanil is. Remember, there were hijackings in the late 80s and 90s. Using the economics department at the University of Chicago and the mathematics department, we made a study to spray a kind of carfentanil in and then run around with Narcan and save all the people who were regular passengers and pilots and stewardesses, but not the hijackers. And we couldn't. I mean, the problem is you would lose some of the passengers that way. But that's how strong carfentanil is. You get a little on your skin and you can die from it. So that's one of the things that is now being synthesized. It's a horse anesthetic or a big animal anesthetic is why it got developed, but it is so powerful. 

Willy Walker: You mentioned Toby Cosgrove when he was running the Cleveland Clinic, and you give him a lot of credit for having put you into the role of chief wellness officer. And then the outcomes that you achieved, Mike, are stunning as it relates to the wellness of the over 100,000 employees inside the Cleveland Clinic system. You cut smoking from 15.4% of the employee base, down to 2%.

Dr. Michael Roizen: This just shows you what a leader does. So, there were a couple of high-profile surgeons, big producers, and well-known nationally excellent surgeons who were smokers. And they refused to quit when Toby banned smoking on campus. They said, "we're gonna smoke in our offices." Toby said, "You're going to have to find new offices because I'm going to fire you." And they kept smoking, and Toby fired them. If he was willing to fire them, he's willing to fire anyone else, right? So that changed the whole thing. And people understood that he was serious and that we were serious as a healthcare organization, we should stand and help our employees get healthier. 

Willy Walker: So, you used significant incentives, and I read, there was a Rand study said that incentives don't work in getting people to do wellness programs unless the incentives are really big. So, what does really big mean because you clearly got the incentives to work at Cleveland Clinic? 

Dr. Michael Roizen: To give everybody an understanding, our average workforce age was 47. It was a little skewed, more female. When you look at it on a national level, 6% have "six normals plus two". Six normals mean normal blood pressure, normal body mass index, no cotinine tobacco end products, et cetera, in their urine. So, I can go over why we chose six normals plus two, which was shown in the Medicare database. We got up to about 44% from 6% which was the national average for age 47 years old, with our demographics to 44%. And we did that by giving people at least a third of what we save, don't spend on health care back. And he honored that, so we ended up at the upper limits allowed by law, which is $1,540 in our premium back for achieving six normals plus 2. The plus 2 is to see a primary care practitioner every year and immunizations up to date. That was even before COVID. Covid isn't included yet. But in any case, we got over 44%. We're spending 38% less than our competitors or our trend line. In addition, our employees are spending around $250M or less in copays and premiums. We've saved a little over $1.4 billion over the 11 years for our one hundred and one thousand employees and dependents. 

Willy Walker: So, your CFO said it wasn’t savings, you didn't have to spend the money. And you're going to have to explain to me how the CFO of the Cleveland Clinic says that it's not true savings if you didn't actually go spend the money. That number Mike, is just staggering. And by your calculation, you just said over $1.4 billion of total savings.

Dr. Michael Roizen: Right. 

Willy Walker: The last time I heard you talk about what was going to the savings account, the retirement accounts of the Cleveland Clinic employees, it was a calculation on your behalf of almost $200 million of additional, if you will, funds in those retirement accounts of the Cleveland Clinic employees who participated in this. Is that correct? 

Dr. Michael Roizen: That's correct. If they had put the savings into their HSA, their retirement account, their account could be shifted to retirement at age 65. It was around $250M in savings. Now that was two years ago. There's an additional probably close to 50, maybe even $100 million since I'd have to do the calculations. 

Willy Walker: What I find to be so interesting about it is that the incentives are there, and they're real and defined. And then the second thing is that the six normals, it's not even to the degree of getting people to do something they don't want to do. It's just getting those six, if you will, biomarkers in line. And if you can get those in line paying rewards for it, the outcome has just been unbelievable. 

Dr. Michael Roizen: Yeah. So, what we did is when Toby appointed me, I said, “What can we do to help our employees?” Everyone was doing process. That is, you get paid if you got your variables measured or you got your LDL or whatever measured. You got paid if you did 10,000 steps a day or whatever, it was for three months. But those are process. What mattered to the health outcomes, whether people stayed healthy, whether they needed hospitalization or needed health care was from Medicare. It was actually the Chicago public employee’s unions in 1946; the gas, electric, and water companies agreed to have their lives followed until they died —their medical costs. And if they had six normals: normal blood pressure, which probably is most important, normal LDL cholesterol, and normal body mass index. It doesn't have to be normal it’s not going into the obese range from overweight, the normal fasting, but your hemoglobin a1c, no cotinine in the urine. And then, the one thing we used process for was the stress program completed. When we started it as I could not do stress at the Cleveland Clinic. As Toby said, I give stress like many executives, and people have to buck up when I give it. So, I don't want that as a measure. But in any case, the quest to see a primary care practitioner and get the values every year. By the way, the primary care practitioners love this because all of a sudden people were actually taking the blood pressure pills and doing the things rather than ignoring it. So, what happened is that in the Public Employees Union of Chicago, a 70% reduction in the development of chronic disease, they live 30% longer, so their total medical costs for the rest of their life were about 50% less. That's why we did that policy. 
And what happened is, Toby said, we will keep going up in the incentive as we save more money and give them that money back. And we'll do it as the basis of the long. And we did an active lobbying campaign during the ACA, PPA construction to try and get prevention as able to be paid for up to 30%. And if the secretary of HHS says tobacco can be included, you can get up to 50% difference in health care premiums. So, we did. We are at the 30%, now the largest allowed by law. And so, it's about $1,500 to $1,540 a year reduction to employees now for that. And that's how we do it. 
Where was the cross point? When you give a small amount, you actually see employees inhibiting other employees from doing it because they say: they'll make it mandatory. When you get large enough, everyone starts to do it. So that large enough was around in 2015, $680, we started seeing that all the barriers to people not doing it got broken down. And as you keep going up, you break down more of those inhibiting barriers. 

Willy Walker: So, I want to shift gears to the Great Age Reboot and just talk about longevity and on what your upcoming book talks about as it relates to the economics of all this. So, if I were born in 1800, my lifespan on average would be 36 years. If I were born in 1928, it would be 55 years, so I'd be dying this coming year. If I were born in 2000, it would be 78 years. And right now, if I was born in 2016, I'd have an 80-year average lifespan. But your work and your research basically says, throw those numbers out the window because technology and innovation will make it so all of us can live a lot longer. Reading your book got me really, really excited because on page 27 of your book (and it may move between now and when it actually gets published,) it shows that my age in 2021 at 55 years old, that a female born in 1967, which is the same year as me, had a life expectancy of 74 years old and that by 2030, my life expectancy will have increased by 60 years to 115 years old. So, I need you to explain to me, Mike, how I just found 60 years of life expectancy. 

Dr. Michael Roizen: Well, you didn't find about 36 or 40. But let me go through there. I told you that you're a genetic engineer because each of your choices change which of your genes are on or not. When the Human Genome Project started, we expected there were enough DNA base pairs in your nucleus to find three hundred thousand genes, but there were only 22,500 or so found by both human genome projects and what they call the rest of the DNA. They initially called it junk DNA. Subsequently, seven years later, it was found out it was actually switches, little rheostats, like a rheostat on the wall that governs which of your genes are on or not. And you have an amazing amount of rheostat material. So that is, you have 280,000 equivalents in genes as rheostat, switches. 

So, when you do stress management, for example, you change and successfully do it. You decrease about a hundred and fifty genes that produce inflammatory proteins and you turn them off. That's why stress management is so important. You get to turn off your inflammatory producing protein genes. Well, what we now know from this is we know a lot about, because of the Human Genome Project, how to edit genes and how to look for genes that are associated with aging. Yamanaka got the Nobel Prize, I think, in 2012 for four genes that he found that were able. When you did these in mice you rebooted the mouse from an old mouse back to a young mouse. So, imagine you've got all genes you had when you were eight cells old and didn't have any brain or didn't have a heart. And so maybe we could, the thought was, develop a new brain and new heart by turning the right genes on? 

Well, there are 14 of these areas. CRISPR-Cas9 gene editing is one, and stem cell reproduction is another, harvesting old cells is another.  Anyway, 14 of these areas that have all been done in at least two animal species. So, they're not fly by night. And what that means is there's a great likelihood with more than an 80% probability that the group of these will be able to make you feel 40 when you're 90 and have a life expectancy. And we're really conservative when I say 115, because in animal species now they've just done that a second time rebooting mice and rats from literally they were 107 years old, back to 40, and they did it a second time. So, there are now 170-year-old rats rebooted back to 40. The equivalent human age. So, whether any of these will work in humans, we aren't sure. But the spinoffs, just imagine one of the spinoffs is heart failure. An abnormal protein causes about 30% of heart failure with CRISPR/Cas9 they've edited out that gene in six Australians who had that and changed their life expectancy from six to eight months to 18 years. So, with these people with heart failure. They're doing it with sickle cell anemia as well. So, the spinoffs are changing our life expectancy and quality of life right now. Peter Linneman and Albert Ratner are going to the economic changes and why this is a solution to our economic problems, rather than longevity being a causal. 

Willy Walker: Your projections in the book are that by 2050, we've got a U.S. population of 450 million people, whereas the Census Bureau is right now projecting a U.S. population in 2050 of 390 million. And so, you just think about that extra 60 million people in your chart, you're projecting that by 2050, there will be half a million Americans who are over 120 years old. By the way, when I pulled my insurance policy to take a look at this thing, it only goes to 100 years old, and my return on the insurance policy is 4.23%. If I live until I'm 100 years old, which is the whole reason I'm sitting there going, why am I going to continue an investment? If I die tomorrow, it's obviously a great return for those who benefit from my life insurance policy. But if I live beyond 100 years old, the return on the life insurance policy is ridiculously low, right? 

Dr. Michael Roizen: And in fact, a whole bunch of policies until recently gave your beneficiaries zero. If you lived past 104, they've now adjusted that to one hundred and twenty many of the insurance companies. But if you look in the small print, it's really amazing. So, if you owned a life insurance company, you want to sell life insurance and not annuities, if you will. And people often ask, “well, what about COVID-19? We've heard that it shortened life expectancy.” That's what we call periodic life expectancy. Would you die of COVID-19? Would the death rates of Covid-19 persist every year in the future? That didn't happen in any pandemic, and we don't expect it to with this. But cohort life expectancy, how long is your cohort going to live? We think it is still going to live a lot longer. In fact, a lot of the science developed because of COVID-19 will help you live longer. 

Willy Walker: So, talk about cohorts because I think that's a really interesting one. You mention in the book Mike, a study at Johns Hopkins University talking about people who had hearing difficulty between the ages of, 40 and 50, or maybe 45 and 55. And those people who were hard of hearing during that period of their lives ended up developing dementia at twice the rate of those people who didn't. And that whole sensory piece to it as it relates to our longevity and interacting with cohorts and being engaged in society is such an important component to all of this. Is it not? 

Dr. Michael Roizen: People gotta understand how well you read the book because that's kind of a small sidebar. So that's right, our senses of hearing, smelling, and seeing we've done a lot to reboot them, that is, to be able to do them. So, on your cell phone now, thanks to Walmart; instead of it being a $5,000 device to get a good hearing aid, there's now $500 at Walmart for things that really can change the rate of hearing. And that's one of the things about Medicare, I think they were trying to get in, and I don't know whether they did get it or not in the prior Bill in that hearing and devices were going to be paid for to some degree. But in any case, you're hearing and saying, Yeah, I can get a device in and a hearing aid that you can't even see that I can adjust with my cell phone that is low cost and will keep me engaged with my cohort. And that's one of the most important things. When you look at the studies out of the British civil servants or Alameda County, which are both great studies, it was the number of people you engage with as friends, that you're vulnerable to, including your spouse or others, in one month. When it hits six, you live a lot longer than when it's zero, one, or two. So, engaging with other people. And one of the things we think that hearing is so important is that engagement and that socialization. A couple of the things is having a purpose in life, having a goal in life as well as having friends, are absolutely key for longevity. 

Willy Walker: You mentioned previously a number of the emerging technologies, senolytics. You mentioned in the book Hyperbaric Chambers, Lengthening Telomeres, you mentioned plasma exchange research going on at UC Berkeley that slows the aging process.

Dr. Michael Roizen: The plasma exchange is now a randomized controlled study at2b/3, which for people who follow the FDA when you get two-three three studies, it then becomes approved. Therapeutic plasma exchange takes out half of your blood volume and gives you your cells back and fresh albumin and saline. It used to be you had to do an exchange. People would get young blood. In Silicon Valley, there was a young blood company where you take blood from a young person and transfuse it into a guy who was older. Now it appears you don't have to do that. All you have to do is do plasma exchange. You can get paid for it in the same way. If you want to do it now by donating plasma, they pay you to do the same thing. But in any case, they give you your cells back. 
What was done in this Ambar, randomized controlled trial, four countries where the Cleveland Clinic and University of Pittsburgh were both involved in the US. Randomized Controlled showed that plasma exchange once a week for eight weeks and then once a month for six months. It didn't just slow the rate of dementia but actually reversed it in people with mild Alzheimer's disease. Now that's one study that has been completed. They're now enrolling a second three study. But this is amazing. And this is essentially what they're harvesting is old cells. So, it's a drug senolytic without a plasma exchange, getting rid of the old plasma. The old proteins in your plasma gets rid of some of senolytics cells which is old cells that make other cells around them old. So, one of the techniques is therapeutic plasma exchange. And if you want to follow it, you can follow Ambar on Google. But the other point is if you've got someone in your family with early dementia, this is something to talk to their practitioner about the Ambar study and whether they should start donating plasma. 

Willy Walker: So, when I hear you talk about that specific example and in your book, you talk about lots of other ones, you talk about CRISPR technology used to edit the cells of a young man who I think of you, you used the name Johnny. I'm assuming that's not his real name, who had pancreatic cancer and how successful that gene editing has been and a UVA study on glioblastoma and some incredible results they've had. And as I read about all these Dr. Roizen, I was thinking about a presentation I saw by Andreessen Horowitz about two months ago, where they put up all these fintech companies and they put up PayPal and they put up Square, and all these and they were trying to impress all of us, that fintech was going to take over the world and particularly take over the financial services industry. And they said all of these fintech companies added together are worth $500 billion, and they said that to try and impress everyone in the room. And I raised my hand and said, “but you realize that the market cap of JPMorgan Chase, one company, is $500 billion.” And my question to you is all of these unique investments or changes can be like fintech to help on a specific thing. Our eyes, our hearing, what have you. But what’s the JPMorgan? What's the one that is really going to push the needle and take over to make it so that we can get to these numbers that you're talking about in the book? 

Dr. Michael Roizen: Well, all of them are contributing. All 14 areas are helping with specific problems and are advancing. So, for example, one of those and the epigenetic rebooting -- giving an adenovirus with an epigenetic rebooting protein reverses retinitis, reverses the loss of retinal cells that is accompanied with macular degeneration. So, each one of these is developing an area to help. Now what you're saying is, is there a reboot where I come into the car wash at one end as an old car and I come out as a new car at the other end. And the answer is, if you want to bet on that, we don't know whether that will happen. But that's really either induced tissue pluripotent tissue regeneration or epigenetic rebooting. Calico, the Google spinoff that's looking at aging is for the first few years, they started in a different sphere, but they've now switched to this and are really advancing the field greatly in this induced pluripotent regeneration that started with the Yamanaka factors of getting the rat now from one 170 to 40 twice. So that would be the bet on it.  But I think each of the 14 areas will contribute to lengthening our lifespan by a decade from hence. But by 2050, if you make it to the 20-30, you're going to get to be a lot younger. But if you make it to 2050, there may be that car wash reboot, but we don't know that yet. 

Willy Walker: And isn't the punchline to it all that all the work you've done in your career to get people into the six normals that you got to have the base health to be able to have all this help you? That if you let the six normals get out of line, if you're not taking care of yourself on a daily basis by eating enough and sleeping enough and just doing the normals, you're probably going to get some disease that takes you down before the car wash is actually developed. 

Dr. Michael Roizen: We worry that's the case. That's right, and the key point is you can do things healthily now, and we can change things from a rule base like Australia has to help decrease wealth inequality and health inequality as we go forward. But it is your choice now. I mean, you are a genetic engineer. And so, each day is your choice of engineering your genes in a way that helps you live younger, longer. 

Willy Walker: Well, with that, I will say it was your choice to join me today, and it was a huge pleasure. I have, as I typically do, a couple more pages of notes to go through with you, but I run out of time, but I look forward to, if you will, part two of this once the Great Age Reboot is out there and others can read it and you and I can then go through it in more detail and ask you more specific questions on it. Dr. Roizen and thank you so much for joining me today. It's been a real pleasure. 

Dr. Michael Roizen: For those who want more information, then go to GreatAgeReboot.com. And when the book comes out, they'll get notified. But in addition, we have an app that will help them, and their practitioner help them stay as young as they want to be. 

Willy Walker: I would go to the Great Age Reboot website and also just Google Dr. Roizen, and you will be led to a lot of other things that can be very helpful to your life. 

So again, Mike, thank you so much. It was an absolute pleasure and everyone who joined us today, thank you, and we'll see you again next week. 

Dr. Michael Roizen: Thank you.