The Longevity Solution: Rediscovering Centuries-Old Secrets to a Healthy, Long Life

First Published in 2019 by Victory Belt Publishing Inc.

Copyright © Dr. James DiNicolantonio and Dr. Jason Fung

All rights reserved

No part of this publication may be reproduced or distributed in any form or by any means, electronic or mechanical, or stored in a database or retrieval system, without prior written permission from the publisher.

ISBN-13: 978-1-628603-79-8

The information included in this book is for educational purposes only. It is not intended or implied to be a substitute for professional medical advice. The reader should always consult his or her health-care provider to determine the appropriateness of the information for his or her own situation or if he or she has any questions regarding a medical condition or treatment plan. Reading the information in this book does not constitute a physician-patient relationship. The statements in this book have not been evaluated by the Food and Drug Administration. The products or supplements in this book are not intended to diagnose, treat, cure, or prevent any disease. The authors and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained in this book.

Author photos by Megan DiNicolantonio and Dean Macdonell

Cover design by Justin-Aaron Velasco

Interior design by Elita San Juan and Charisse Reyes

Printed in Canada

TC 0119

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CONTENTS

PREFACE

CHAPTER 1: AGING: NATURE DOESN’T CARE HOW LONG WE LIVE

CHAPTER 2: CALORIE RESTRICTION: A DOUBLE-EDGED SWORD

CHAPTER 3: mTOR AND LONGEVITY

CHAPTER 4: DIETARY PROTEIN

CHAPTER 5: PLANT VERSUS ANIMAL PROTEIN

CHAPTER 6: THE OPTIMAL AMOUNT OF PROTEIN

CHAPTER 7: FASTING

CHAPTER 8: TEA

CHAPTER 9: RED WINE AND COFFEE

CHAPTER 10: EAT MORE SALT AND MAGNESIUM

CHAPTER 11: HEALTHY AND UNHEALTHY FATS

CHAPTER 12: THE BLUE ZONES: THE LONGEST-LIVING CULTURES

CHAPTER 13: FULL PLAN FOR HEALTHY AGING

EPILOGUE

ENDNOTES

A Note from Dr. DiNicolantonio

In my previous two books, The Salt Fix and Superfuel, I tackled several long-standing nutritional fallacies, particularly the forty-year-old lies that salt is bad for you and vegetable oils are good for you. The Longevity Solution builds upon these works by exploring the mysteries of mTOR, dietary protein, and calorie restriction and looking at the dietary habits of the healthiest humans on the planet to unlock the secrets of healthy aging. The Longevity Solution also covers the benefits of intermittent fasting, collagen and glycine, green tea, coffee, and red wine. Finally, Dr. Fung and I lay out five easy-to-follow steps for a longer, healthier life.

Perhaps you believe that following the government’s Dietary Guidelines for Americans, with its familiar mantra of less salt, more vegetable oils, and more carbohydrates, will keep you healthy. Unfortunately, my years of cardiovascular research and Dr. Fung’s years of practical clinical experience have convinced us that this dietary advice is almost completely wrong. For example, eating meals based on highly refined carbohydrates will put you in a perpetual cycle of high and low blood glucose that keeps you hooked on these foods (a state known as carbohydrate dependence). The Dietary Guidelines also neglect to mention that the Japanese and other long-lived Asians tend to eat high-salt seafood dishes and avoid refined vegetable oils—doing the exact opposite of the U.S. government’s recommendations.

Simple dietary changes can help you break the cycle of carbohydrate dependence, kick your metabolism into high gear, and jump-start your longevity genes. Intermittent fasting is a great example of one such simple change. Fasting resets your metabolism, allowing new, better cells and proteins to replace older ones. This out with the old cells, in with the new process of self-repair is called autophagy, and increasing autophagy through fasting is just one biohack that might help extend your life span as the body is busy with self-repair instead of growth, which promotes aging. Other dietary patterns commonly found in long-lived populations, such as drinking red wine, tea, and coffee, are easy to follow and improve both health and longevity.

Let The Longevity Solution be your official guide to improving your health with simple, easy changes to your diet and lifestyle that you can start implementing now! Activate your longevity genes and start promoting cellular repair rather than cellular despair.

A Note from Dr. Fung

People often believe that the secrets to longevity lie in the newest gee-whiz technology or the latest, greatest supplement. Paradoxically, the secrets to healthy aging have been communicated to us for centuries, and sometimes millennia, as they’ve been handed down from generation to generation. The Longevity Solution rediscovers these ancient lost secrets—and shows how they’re supported by what we now know about biology. Recent research has uncovered the science behind ancient longevity-promoting practices such as restricting calories; optimizing dietary protein; drinking tea, coffee, and red wine; and eating more salt and natural fats. The more things change, the more things stay the same.

These ideas are not the latest and greatest fads. They are tried and true. They have been used since antiquity and were traditionally accepted as important facets of wellness. Ancient peoples knew that they worked, but modern science is just now figuring out the reasons behind their success. These secrets have been hiding in plain sight. We just didn’t know where to look.

People are always searching for what they can add to their diet to extend life and improve health. Over the years, the list has become endless. Supplements of vitamins A, B, C, D, and E have been touted as the next great cure-alls. One after the other has failed, sometimes miserably. The problem is that we’re not asking the right questions. In addition to asking What do I need to eat more of to get better? we need to ask What do I need to eat less of to get better? The Longevity Solution asks both questions—and, more importantly, answers them.

The legendary Spanish conquistador Juan Ponce de León (1460–1521), like many of his bloodthirsty contemporaries, sought fame and fortune through exploration of the New World. He settled in the part of Hispaniola that is now the Dominican Republic, before serving as the governor of Puerto Rico for two years. When Christopher Columbus’s son, Diego, replaced de León, he was forced to set sail once again. He had heard native tales of a fountain that would restore youth to anyone who drank from it. As part of his next phase of exploration, Ponce de Léon searched for this elusive source of longevity.

He explored much of the Bahamas and is believed to have landed near the present-day town of St. Augustine in northeast Florida in 1513. He named this newly discovered land Florida, from the Spanish word florido, meaning full of flowers. He continued his explorations throughout the Florida coast and the Florida Keys but died never having found the elusive fountain of youth.

This well-known story is likely entirely fictional. Ponce de León’s writings make no mention of his search for the fountain of youth, and his vigorous explorations were for more pedestrian reasons—to find gold, identify lands for colonization, and spread Christianity. But the notion of a mystical substance that can reverse aging is so powerful that this legend has endured all these years. Interestingly, the legend of a fountain of youth predates de León; similar stories are part of the Middle Eastern, medieval European, and ancient Grecian cultures. Can aging really be reversed? Has science succeeded where Ponce de León failed?

What Is Aging?

Let’s start by looking at what aging is. Everyone instinctively knows what it means to age, but to successfully tackle any problem, science requires an accurate definition. We can view aging in several ways.

First, aging is often obvious because of a change in appearance. Gray hair, wrinkled skin, and other superficial changes signal age. These physical changes reflect underlying physiological changes, like decreased pigment production in hair follicles and decreased skin elasticity. Cosmetic surgery changes appearance but not the underlying physiology.

Second, we can view aging as a loss of function. Over time, women have decreasing fertility until ovulation eventually ceases completely during menopause, in a process largely determined by age. Bones become weaker, increasing the risk of breaks such as hip fractures, which are problems we rarely see in young people. Muscles also become weaker, which explains why champion athletes are invariably young.

Third, at the cellular and molecular levels, response to hormones decreases with age. For example, high insulin (a fat- and glucose-storing hormone) or thyroid hormone levels won’t benefit you much if your cells no longer respond to those hormones. Mitochondria, the important cellular components that produce energy and are commonly known as the powerhouse of the cell, become less efficient and less able to produce energy. The declining efficiency of an aging body results in higher rates of illness and disease.

Increasing age exponentially increases the risk for disease and death. Heart attacks, for example, are virtually absent in children but common in the elderly. Aging is not a disease itself, but it increases the chances of developing diseases, which makes it the best target to stop or reverse chronic diseases. Age, in chronological years, is a river—irreversible and flowing in a single direction. But aging, in physiological years, is not. Many factors contribute to aging and disease, and in this book, we primarily consider the aspects that are influenced by diet.

Given the overall functional decline, why do organisms age at all? In short, aging is the accumulation of damage. Young animals, including humans, have a high capacity for repairing the damage of everyday life, such as when children scrape their knees. Species’ survival depends on the ability to repair this damage: for example, in healing wounds or broken bones. With age, this ability to repair damage diminishes in all respects—whether it is to fight infections, clear arteries, or kill cancer cells. But this decline is not a natural, foregone conclusion. Nutrition and lifestyle determine much of the speed and extent of the aging process. Long-lived, healthy populations around the world that eat few processed foods show us the possibility of slowing the aging process.

Hippocrates, the ancient Greek father of modern medicine, long ago acknowledged nutrition as the cornerstone of health and longevity. Famine is one of the Four Horsemen of the Apocalypse, but the modern problems of obesity, insulin resistance, and diabetes are equally deadly. In both cases, the foods we eat play an important part in promoting or preventing all these issues.

One important damage-repair mechanism is called autophagy. (The fact that the 2016 Nobel Prize in Medicine was awarded to Yoshinori Ohsumi for his discoveries of mechanisms for autophagy underscores how vital this process is.) In autophagy, cellular parts called organelles are broken down and recycled periodically as part of a wide-ranging quality control system. Just as a car needs regular replacement of oil, filters, and belts, a cell must replace its organelles regularly to maintain normal function. As cellular organelles pass their expiration dates, the body ensures that old organelles are removed and replaced with new ones so that no residual damage impedes function. One of the key discoveries of the last quarter century is that the foods we eat heavily influence these damage control procedures.

Evolution Doesn’t Care Whether You Age

You might think that evolution would perfect our damage control responses, allowing us to live forever. But evolution doesn’t care if you age or even if you survive. It ensures the survival of the species, not the individual. Once you’ve had children, your genes will survive even if you don’t, so there is no natural selection toward longer-lived species. This reasoning is behind the theory of aging known as antagonistic pleiotropy. Despite its name, the theory is relatively simple.

Evolution by natural selection works at the level of genes rather than for individual organisms. We all carry thousands of different genes and pass them to our children. Genes best suited to the individual’s environment survive better and enable the individual to produce more offspring. Over time, these beneficial genes become more widespread in the population. Age plays a large role in determining the effect of a gene on the population.

A gene that is fatal at age 10 (before a person has children) is rapidly eliminated from the population because the person bearing that gene is unable to pass it on. A gene that is fatal at age 30 will still be eliminated (albeit more slowly) because people without that gene have more children. A gene that is fatal at age 70 might never be eliminated because the gene will have passed into the next generation long before it manifests its deadly effects.

Antagonistic pleiotropy suggests that genes have different effects at different stages of life. For example, a gene that increases growth and fertility but also increases the risk of cancer in old age means more children but a shorter life span. This gene would still spread in a given population because evolution favors survival of the gene, not the longevity of an individual life. One gene might have two different, unrelated effects (pleiotropy) that are seemingly at odds with one another (antagonistic). Survival of the gene is always given priority over longevity of the individual.

This particular gene described codes for a protein known as insulin-like growth factor 1 (IGF-1). High levels of IGF-1 promote growth, allowing organisms to grow larger, reproduce faster, and weather wounds better. That’s a huge advantage in the competition to survive in order to have children. However, in old age, high IGF-1 contributes to cancer, heart disease, and early death, and by that time, the gene has already passed into the next generation. When growth/reproduction comes up against longevity, evolution favors reproduction and high IGF-1 levels. This is the fundamental and natural balance between growth and longevity.

Viewed in this manner, the fight against the ravages of aging is a fight against nature itself. Aging is completely natural, although the extent and speed are variable. Living and eating completely in tune with nature does not prevent aging. Nature and evolution do not care about your longevity; your genes’ survival is the only concern. In a sense, we must look beyond nature to slow or prevent aging.

Aging and Disease

Shockingly, and almost without precedent in human history, children today might have shorter life spans than their parents.¹ The twentieth century witnessed huge and steady advances in medicine and public health that significantly increased average life expectancy. But recently, an epidemic of chronic diseases is threatening to reverse that enviable record.

Before the modern industrial era, with its advances in sanitation and medicine, infectious diseases were the main natural causes of death. In the United States in 1900, life expectancy at birth was 46 years for a man and 48 years for a woman, due largely to high infant and childhood mortality.² But those who survived childhood had a good chance of surviving to older age. The top three causes of death in 1900 were all infectious diseases: pneumonia, tuberculosis, and gastrointestinal infections.³ These infectious diseases can affect people at any age, although children and the elderly are especially vulnerable.

Today’s situation is different. The top two causes of death are cardiovascular disease and cancer, and both diseases correlate tightly to age. Cardiovascular disease, which includes heart disease and stroke, is the number-one cause of death in the United States, accounting for one in four deaths, and its incidence increases dramatically with age.⁴ Children rarely suffer heart attacks, but by age 65, the majority of us have developed some form of cardiovascular disease.

The story is the same for cancer. Children and young adults each account for only about 1 percent of new cancer cases each year.⁵ Adults aged 25 to 49 account for about another 10 percent, whereas people aged 50 and older account for around 89 percent of all new cancer cases. Other diseases with clear links to aging include cataracts, osteoporosis, type 2 diabetes, Alzheimer’s, and Parkinson’s. These diseases of aging are responsible for approximately two-thirds of the roughly 150,000 deaths that occur around the world every single day. These are diseases that affect hardly anyone younger than the age of 40. In the industrialized West, the proportion of people who die from aging-caused diseases approaches 90 percent.⁶

As modern medicine conquered infectious diseases like smallpox, one consequence of this success is an aging population with its inherently higher risk of chronic diseases. But that’s not the whole story. The seemingly unstoppable and unparalleled obesity epidemic is putting our health at increasing risk of cancer and heart disease. There are many dietary and lifestyle modifications that you can adopt to reverse this risk of chronic disease.

Aging is the slow accumulation of cellular damage due to a decreasing ability to repair it. The result is a low level of inflammation, which is so characteristic of aging that it’s been termed inflammaging. Oxidative stress, a condition in which free radicals (highly reactive molecules with an unpaired electron) overpower the body’s internal antioxidant system, rises with age. However, you can make lifestyle changes that can increase your odds of healthy aging. You can increase not just your life span, but your health span. Nobody wants to spend their last years frail, sick, and in a nursing home. The prevention of aging is about more years of healthy life during which you’re free of disease and other drawbacks of old age, you feel vigorous and energetic, and you have an enthusiasm for living. Longevity means extending youth, not extending old age.

Fig. 1.1: Causes of inflammaging

Evolutionarily Conserved Mechanisms

Simple one-celled organisms called prokaryotes, such as bacteria, are the earliest forms of life on earth and are still abundant today. Eukaryotes, more complex but still single-celled organisms, first appeared approximately 1.5 billion years later. From those humble beginnings came the multicellular life forms called metazoans. All animal cells, including in humans, are eukaryotic cells. Since they share a common origin, they bear a resemblance to one another. Many molecular mechanisms (genes, enzymes, and so on) and biochemical pathways are conserved throughout evolution toward more complex organisms.

Humans share approximately 98.8 percent of their genes with chimpanzees. This 1.2 percent genetic difference is enough to account for the differences between the two species. It might be even more surprising to learn that organisms as far apart as yeast and humans have many genes in common. At least 20 percent of genes in humans that play a role in causing disease have counterparts in yeast.⁷ When scientists spliced more than 400 different human genes into the yeast Saccharomyces cerevisiae, they found that a full 47 percent functionally replaced the yeast’s genes.⁸

With more complex organisms, such as the mouse, we find even greater similarities. Of more than 4,000 genes studied, fewer than ten were found to be different between humans and mice. Of all protein-coding genes—excluding the so-called junk DNA—the genes of mice and humans are 85 percent identical. Mice and humans are highly similar at the genetic level.⁹

Many aging-related genes are conserved throughout species, enabling scientists to study yeast and mice to learn important lessons about human biology. Many of the studies cited in this book involve organisms as diverse as yeast, rats, and rhesus monkeys, and they vary in the degree of their similarity to humans. Not every result applies to humans, but in most cases, the results are close enough that you can learn a great deal about aging from them. Although it is ideal to have human studies, in many cases these do not exist, which forces us to rely on animal studies.

Fig. 1.2: Genomic similarities between humans and animals

Theories of Aging

The following sections outline the principles of several theories of aging and our verdict on the plausibility of each.

DISPOSABLE SOMA THEORY

The disposable soma theory of aging, originally proposed by University of Newcastle professor Thomas Kirkwood, holds that organisms have a finite amount of energy that can be used either in maintenance and repair of the body (soma) or in reproduction.¹⁰ Like antagonistic pleiotropy, there is a trade-off: If you allocate energy to maintenance and repair, then you have fewer resources available for reproduction. Because evolution directs more energy toward reproduction, which helps propagate its genes