Transcript

[music]: [00:00:00] Knock, knock,

Will: knock, knock. Hi.

Hello, and welcome to Knock Knock. Hi, with the Glaucomfleckens, I’m Will Flanary, also known as Dr. Glaucomflecken. 

Kristin: I’m Kristin Flanary, also known as Lady Glaucomflecken.. Are you feeling 

Will: old these days? 

Kristin: I sure am. Feeling, you know, I hit 40. I mean, yes and no. Don’t sure. Don’t feel as old as I thought that I would.

No. At 40. But I, I am aware that it is getting up there. 

Will: I just recently hurt my back weightlifting. Yeah. So I am feeling a little bit old. Yep. Um, but we have Eric topple here to That’s right. Make us feel a little bit better. Like maybe we can become not old. Yeah. 

Kristin: I always love talking to Dr. Topol because he is such an optimist that no matter what, very optimistic, the optimistic, the bad news is optimistic.

He can always find a way to like. You know, make you feel uplifted 

Will: now, beginning of this conversation [00:01:00] with him, which is, that’s absolutely fascinating. Uh, um, I, I was skeptical. I’ve been skeptical about this whole, like mm-hmm. You see the guy? Yeah. You’re a little spicy. You see the guy on Twitter who’s like, I’m gonna loop till I’m 150.

He’s like, come on dude. Like, he like, he’s like, he has like a blood boy. He is like, yeah. Taking blood from his son. There’s, you 

know, yeah, I know. The one you see 

all kinds, you know, the guy. So, um, so I, the, it kind of puts a, a bad taste in your mouth with the, the whole aging 

Kristin: right 

Will: area, but there’s so much more to it than we see on social media.

Yeah, that’s what I came away with. 

Kristin: There is a lot of snake oil, like that is true. 

Will: Exactly. But, 

Kristin: but there’s also some good stuff. 

Will: Right. So, uh, Dr. Uh, Eric Topel, uh, y’all know him. He’s, he is. Incredible guy, um, prolific author, researcher. He’s got a new book, um, called Super Ages, an Evidence-Based Approach to Longevity.

Um, and it’s, it’s, uh, just a fascinating look into this whole topic. And [00:02:00] we get into, we talk about, you know, a little bit about, you know, you know, the, the, the good stuff that’s happening versus the stuff that you can’t really trust on social media. Right. And like, just, and um, and just going in depth into what exactly.

Contributes to aging and 

Kristin: yeah, there’s a lot that we’ve learned. It turns out how 

Will: healthcare might, might change in the future. Mm-hmm. Uh, with, with, uh, you know, being more individualized versus like population based recommendations. Right. So anyway, uh, I came away thinking, man, we are like, I, I feel talking to him makes me feel like we’re in the stone ages of medicine.

Yeah, right. 

And like we have, we have such a long way to go, but also it’s right there. 

Kristin: Yeah. 

Will: It’s so close. 

Kristin: We kind of know how to do it now we have a roadmap, so a little bit. 

Will: Let’s get to it, shall we? All right. All right. Here is Dr. Eric Topel.

What should, what should do in there, buddy? I’m so glad you asked. Oh, I’m being a Dex. 

Kristin: Oh, are you? 

Will: Yeah, that’s what they sound like. Those 

Kristin: [00:03:00] little mites, 

Will: Uhhuh, I, if you put a microphone in front of them, I’m sure they would probably most likely maybe sound like that. 

Kristin: You think so? I 

Will: don’t really know. 

Kristin: Oh, well, let’s see how much you do really know.

Will: Oh, you’re gonna quiz me? Yeah, let’s do it. 

Kristin: What are the only two main species of dex mites found in humans? 

Will: Uh, type one and type two. 

Kristin: Uh, close Dex foor, which are found in the eyelash follicles. Okay. And dex revis, which are found in the meibomian glands. Okay, 

Will: sure. Yeah. Okay. Next one. Next question. 

Kristin: Okay. Why do people with Dex blepharitis often feel itchy eyelids first thing in the morning?

Will: I know this. And, uh, because they avoid light and come out at night to mate. Oh yeah. There’s, they’re mating on your eyelids while you’re sleeping. 

[music]: Super. 

Will: Is that, is that a, how does that make you feel? So gross. And so people wake up that itchy, irritated feeling ’cause they’ve been moving around and the eyelash follicles all night.

Kristin: Mm-hmm. Yeah. Yeah. Great. 

Will: I’m surprised you even brought that up. 

Kristin: I know. I’m just trying to get used to these mites since Demodex Blepharitis is such a common disease and we keep talking about them, and 

Will: [00:04:00] that’s a big step. That’s a big step. Thank you. There’s a prescription eye drop though that’s available for Demodex Blepharitis.

Yes. To learn more about these mites and Demodex blepharitis, visit mites love lids.com for more info. Again, that’s M-I-T-E-S-L-O-V-E-L-I-D s.com To learn more. This ad is brought to you by Tarsus Pharmaceuticals. Kristen, I gotta tell you about a new podcast that every clinician should know about. 

Kristin: Good.

Tell me. 

Will: This is the sepsis spectrum. Okay. It’s by the Sepsis Alliance and Critical care educator, Nicole Kic. This is really important. Each episode is about confronting blind spots and sepsis and antimicrobial resistance education. A lot of this stuff usually doesn’t make it into textbooks or compliance training.

Kristin: That’s weird because it’s super important. 

Will: Yeah. Everybody needs to know about this stuff. You can listen to the sepsis spectrum wherever you get your podcast, or watch it on the Sepsis Alliance’s YouTube channel. To learn about how you can earn free nursing CE credits just by listening. Visit sepsis podcast.org.[00:05:00] 

All right. We are here with the one and only Eric Topel, a friend of the pod. Friend of Glaucomflecken. Right. Eric, thanks so much for coming back on with us. Oh, it’s a real treat to be with you both. Well, you’ve got a, um, a new book. Uh, we’re gonna be talking a lot about that. This, this is like an area of, of, of, of health.

Of, um, health information that I feel like is really exploding. You got a lot of people talking about, about reversing aging. Like there’s these, these, like these buzz words that you’ll see on social media. Um, and, and I, I love, you know, what you did with this book and just trying to like lay all of this out and what all the different factors that, that go into, uh, into aging and what you call the health span.

Um, and so my first question to you, uh, what would you say to a 39-year-old who’s had testicular cancer twice in an outta hospital cardiac arrest? [00:06:00] Um, what, what, what is that person’s health span? I just, just, just outta curiosity. No. Not thinking about anybody in particular. Asking for a friend. Asking your friend.

Exactly. 

Dr. Eric Topol: Yeah. Um, well, uh, the fact that, um, you’re here talking about this and that. Uh, you were saved by your, your spouse, this person right here. Yeah, that’s right. Yeah. Yeah. I mean that’s, you know, uh, but you could still become a super ager. Um, yeah, you could still go to 85 plus without, you know, further cancer, uh, neurodegenerative disease or.

Heart related 

Will: diseases. You still could do it. I still could do it. Oh, hope 

Kristin: is not lost. 

Will: Yeah. Well, I mean, ca I’m done with testicular cancer. Don’t, I don’t, a third, third. We’re not getting that one. Again, I don’t have a third testicle Eric to, to, so I, I’m safe from that. So give us a, a just tell us why you decided to write this.

[00:07:00] Let’s start there. 

Dr. Eric Topol: Yeah. There were a few things that contributed. So for one, we had done this really big welder study. Investing seven years of getting, gathering 1400 people who are over age 85, uh, average age 89, never been sick, no medication. Very hard to come by these kind of people. Wow. Yeah. Yeah. And then we did whole genome sequencing and we thought we’re gonna get the secret genomic underpinnings of health span.

What we got was basically nothing. Wow. It was the same as the elderly, you know, the people 65 plus match for age with all these things, and cancer and Alzheimer’s and whatnot. So it said, Hmm. This is not so simple as a genetic story. Now, some of these had family patterns, but most of them were like Mrs.

Lee Rusal, who I present my patient in the book. Yeah. Who you know, she’s 98. She’s amazing. And her, all her elders, her parents, her brothers died, uh, in their fifties and sixties, [00:08:00] and they’re like the last person standing. So that is yet another, uh, reflection that it’s not just in our genes, 

[music]: right? 

Dr. Eric Topol: So that’s, I think what is liberating here, that a lot of what we can do here.

Is not programmed, embedded in, I mean, it’s a lot of this is, uh, our lifestyle and especially our immune system paying much more attention to our immune system. In what way? Well, you know, it’s the immunosenescence, these immune cells that get, um. Basically dysfunctional. Don’t protect us as we get older.

Now, you, you two are really young, but I’m talking about people like me. You know, 

Kristin: we’re not as young as we’d like to be, Dr. Choppa. Well that’s, that’s 

Dr. Eric Topol: pretty widespread. Yeah, right. I’d like to be your age or younger, but, um, no, it turns out in older folks, uh, 60 plots. You see this immunosenescence with immune protections down and [00:09:00] dysfunctional, and then leading to inflammaging, which is basically, oh, 

Kristin: basically I love your languaging and the wildly elderly, and now inflammaging, tell us what that is.

Yeah, 

Dr. Eric Topol: so basically the immune cells, they’re, they’re putting out all these cytokines and chemokines, all these things that are attracting. Big time inflammation, which is untoward. So it could be in the wall of an artery where you get atherosclerosis or heart attack, or it could be in the brain reacting to these proteins like beta, uh, beta amyloid and tau.

Or it could be that it’s, uh, allowing cancer, uh, to propagate. So that’s how we get in trouble with these three big age related diseases. And 

Kristin: it seems like the immune system is like in the healthcare research space a lot these days. Is that accurate? Like are we learning more about that, that we didn’t used to know?

Dr. Eric Topol: Yeah, it’s really exciting, uh, because it, [00:10:00] as you know, in the clinic, we can’t even measure the immune system, you know? Yeah. We have this cockamamie, uh, ratio of the neutrophils to the lymphocytes. That’s it. I mean, there’s no way to tell about B cells and T cells and antibodies and the whole works, and it’s a very complex system.

But recently, as of, uh, end of 23, 20 23, this guy who’s, uh, Tony Wis, Coray a brilliant. Scientist at Stanford, he basically discovered organ clocks. 

[music]: And 

Dr. Eric Topol: so these organ clocks, they took, you know, thousands of plasma proteins, used AI and said, oh, these are the proteins that track your immune system. These are the ones that track your brain aging, your heart aging, um, you know, each organ of your body.

And so actually now there’s a new paper that’s showing, for example, the immune system. Or the brain clocks are the most important for health span. And like another example is, uh, women in menopause who [00:11:00] took estrogen, they, their immune system shifted to a much younger immune system. 

Kristin: Interesting. 

Dr. Eric Topol: Yeah. So they avoided immunosenescence and inflammaging and you know, so that, I mean, we’re learning so much because we now have a way to measure the immune system.

Through its proteins, we’re gonna have even more direct ways to measure it. But as I review in the book, that is what appears to be the reason why people have extraordinary health spans. And it fits into the model like what do you eat? Uh, your exercise, your sleep, uh, your environmental exposures, everything fits into this inflammation immune system model that gets us into trouble or keeps us really 

Will: healthy for.

Long period. So we, we have research, like high quality research that that shows that, that ed, that, uh, exercise nutrition really does play a role in this because my, obviously, like I, I, you know, when you go through [00:12:00] medical education and training, you’re like taught to be skeptical about stuff like this, you know?

And so I. Every time I see, you know, talk about, about, you know, reversing aging or your age clock stuff like this. I’m, I’m always thinking, well, you know, these people that are super ages, like it is genetics, it’s gotta be genetics, you know? Yeah. But, um, but this is like just hearing you talk about, this is the first time I’m, I’m really like.

Convinced 

that it might be something else. I don’t dunno if I’m convinced 

yet, honestly. Like, because, uh, e even like Immunosenescence, like you think that genetics play a, a role in that as well, right? Well, no, you’re making a good point because 

Dr. Eric Topol: you don’t see it in the DNA. Mm-hmm. Okay. So in order to to understand a person’s immune system, you gotta do perturbations.

You gotta make special measurements. So you won’t see it in a genome unless they have some rare immunodeficiency, you know, mutation. So [00:13:00] yeah, there, there may well be a heritable story here, but it isn’t the one we thought. 

Kristin: Yeah. That gets into the omic piece of your book, right? Is that what you’re talking about?

Dr. Eric Topol: Yeah, exactly. That you know, between the genes, there’s a protein, and we’re not talking about protein craze. Eating. Uh, that’s another story. Yeah. Overdose of protein. But there’s a protein craze right now because of this ability to measure like 11,000 proteins in a milliliter, two milliliters of blood, right?

Wow. Inexpensively. And that’s how we’re learning a lot of this stuff because we never had a way to look into a person’s, all their organ systems, their immune system. And so that was another reason why I wrote the book is, Hey, you know what? There’s a lot of complete BS out there. Pseudoscience, right? You know, there’s longevity clinics and longevity companies and anti-aging supplements and so much bunk out there, but there’s also some really exciting science of aging advances.

That really make, make, [00:14:00] make us relook at how the process of 

Will: aging in our body. How do you, how do you navigate that? Because like you said, like everybody has got a supplement. Everybody has got, you know, you know, uh, boost your boost, boost your immune system, whatever, and this is all I, I feel like that really is a detriment to some of like the real work that’s being done.

Yeah, because the general, general public 

Kristin: won’t be able to distinguish. I mean, even the educated public. Yeah, it’s hard. It’s hard to distinguish. It’s hard to distinguish people. 

Dr. Eric Topol: Well, the Glaucomfleckens don’t have a supplement. They’re hawking, right? We do not. No, you don’t. All, there you go. We never will that, that’s how you tell, okay.

If you’re, if you have somebody hawking a supplement, then you know they’re not credible because none of them have any data to support them. And furthermore, some of them are hawking, taking rapamycin. Rapamycin, as you know, is a potent drug used for transplant rejection. Now they don’t know what dose there.

There all these leaderboard [00:15:00] of rapamycin takers, some of ’em are taking this dose every day, every week, every this and that. No one knows the dose. But the point is, if you don’t know, you can’t measure the immune system. You could be really immunosuppressed from a low dose. You know, it’s so highly variable.

So it’s dangerous and people, uh, that’s another thing is supplements. These clinics, rapamycin, all these things that have no data to support their safety, no less their benefit. But on the other hand, there’s a bunch of really interesting science, um, you know, biotech companies that are trying to reverse aging.

It’s very aggressive, uh, reverse aging that carries a lot of risk, but at least it works really well in mice, you 

Will: know? Yeah. 

Dr. Eric Topol: Uh, not, we don’t know about in people, but that is another reason why there’s a lot of excitement in the field. ’cause you could reprogram cells or you could get rid of the, these lytic, senescent cells.

Um, you know, there’s a lot of approaches out there that maybe one of them [00:16:00] will click. Maybe we’ll be able to reverse aging someday, but that’s not imminent. 

Kristin: Hmm. Okay. 

Will: Uh, te how I, I think a lot of people are interested right now in, in the nutrition side of things. Yeah. You hear a lot, obviously with, with RFK Junior and the, the MAHA things that he’s doing.

So tell us how, um, how nutrition plays into this and what’s your takeaway with nutrition and aging? It, 

Dr. Eric Topol: it’s big. Um, you know, these three diseases take 20 years to manifest from, you know, they’re incubating. That’s one common thread that a lot of people don’t realize, and so how we eat over the course of our lives, particularly starting younger, has a way to keep inflammation down.

And so an anti-inflammatory diet like the Mediterranean diet, mainly plant-based, that has been validated in not just randomized trials, which are unusual, you know, long term randomized trials, but [00:17:00] also this amazing study recently of 105,000 people. Followed for 30 years, um, and only 9% reached 70 with, uh, no age related diseases.

And those 9%, what do you think they eat? 

[music]: Yeah. 

Dr. Eric Topol: So, you know, a diet that’s really rich in the kind anti-inflammatory foods, not um, uh, animal, particularly red meat derived ultra processed foods. A lot of things that are bad for you. And so this is, I think one of the, the problem we have with these nutrition and exercise and sleep and things we talk about, it’s hard to get people to adopt these things unless they know they’re at a particular risk.

Then you get a much better chance that people actually getting serious about it. 

Will: I see. So being able to, to maybe use some of the, the new technology we have to assess someone’s risk. Could, could push them [00:18:00] into, you know, more lifestyle behavior changes. Yeah. Yeah. That, 

Dr. Eric Topol: that’s the new, new thing here is that, uh, taking a person’s all their layers of data, so their electronic health records, their labs, even labs that are thought to be in the normal range that we as physicians miss because we don’t see an asterisk or something in red.

But if you see trends within the normal range, set points, that could be important. Mm-hmm. AI picks that up. And you could look at a person’s retina with ai and you can see, predict all these diseases except for cancer, but every disease, otherwise five to seven years ahead of time. And then you have genes.

What? And protein. Well, yeah, we’ll go back to that. Yeah. Oh, by the way, there’s a company recently this month, or June I should say, uh, that got a, you know, a mammogram. Yeah. Expert radiologist. That’s, they read mammograms every day. They don’t pick up that AI can that within three to five years, that normal mammogram, [00:19:00] that person is going to get breast cancer.

How do you like that? Wow. So we can pick up risk in people. The retina can tell us if someone’s gonna get Parkinson’s or Alzheimer’s five to seven years before they ever have any symptom. And then you have ai, the symbol. That’s news to me. Proteins. Yeah. So that’s why I wrote the book really is I, I mean, I wanted to put out there the exciting stuff.

Sure. You know, right now it’s, it, it, you could say it’s a little down right now with the gutting of medical research and you know, these things that are happening. It’s very, there’s 

Will: a very pessimistic, yeah, 

Dr. Eric Topol: yeah. But there’s a lot of great stuff going on in this whole biomedical space right now. So that’s the excitement and the optimism I’m trying to transmit.

We can particularize risk. We can say, you know, the risk, no, we couldn’t do it for testicular cancer, unfortunately yet, but for the common cancer mm-hmm. Colon, breast, you know, uh, lung, prostate, we can do that now with a polygenic risk [00:20:00] score. And, uh, with looking at body wide aging clocks and, and specific, um, forecasting.

So we can say years in advance that you know, you’re at risk for this particular condition. 

Will: That’s incredible. How, how are his, how is this work being done? ’cause, ’cause obviously this is not just like, you can’t go into your primary care office and 

Kristin: Yeah. Where do you go and get 

Will: the, so, so where is, are these, are these like, you have to 

Kristin: be a research subject?

Are 

Will: these randomized trial? Like what’s, where is this coming from? It’s gonna have to 

Dr. Eric Topol: be grassroots. Yeah. It’s because. You know, as you know, we don’t keep up. Our field doesn’t change. No, doesn’t keep up. It’s very slow. It’s kind of sclerotic. And so the data’s here. Like for example, the, the condition that most of us fear the most is Alzheimer’s.

Right? And now we have this incredible breakthrough test to add to the mix. So let’s say you have a family history. Or you have this a POE four aliya, which about fourth of us have, [00:21:00] uh, or you have a polygenic risk score for Alzheimer’s. Now there’s a blood test, uh, that’s widely available. It’s been out for two years that almost nobody knows about P Tau two 17.

Now that test, which is basically uh, a site on the tau protein that you get in the blood, it tells you if you’re at risk for Alzheimer’s in your life. If it’s low, it picks it up 20 years ahead. So if you’re, if you’re 50 and you have a low P to two 17, you’re looking pretty good, right? Mm-hmm. But if it’s high, it’s modifiable.

I exercise and diet and um, you know, better sleep, health and all that stuff. So here we have a big breakthrough, probably the biggest in my lifetime, to modulate the risk of Alzheimer’s, but nobody knows about it, and least of whom are the physicians. Okay, sure. And, um, you know, this test should be, now, I wouldn’t advise it as I write in the book for everyone, right?

But for people who already know they have some increased [00:22:00] risk, this could be really helpful. To prevent Alzheimer’s real potential that we have right now. 

Will: And, and the, the pathophysiology behind, um, behind nutrition, sleep, you exercise, whatever it is that is able to modify that risk is just decreasing inflammation.

Exactly. So here you are 

Dr. Eric Topol: by really getting serious about the lifestyle factors. And there will be medications too. Like for example, as you know, that Gluc Gluc glucagon-like peptides, GLP one family of drugs, they’re now in big time Alzheimer’s trials, which will report out later this year. Uh, but that may be one of the first classes of meds that prevents Alzheimer’s and people at high risk.

Mm-hmm. But no, if you take the data for, um, their, uh, lifestyle factors. Yeah, that suppress, uh, in people with, uh, these neuro markers, [00:23:00] these plasma protein markers, it’s really quite extraordinary. You can reduce the markers by 50, 60, 80% by really getting your lifestyle in gear. 

Kristin: Gosh, it’s one of those things that’s like so simple, right?

Like the, it’s what you hear since you’re an elementary school kid, right? Like you gotta move your body, you gotta eat healthy food, you gotta get enough sleep. But it’s so hard to do even though it’s such simple like instructions. Well, I think, right? I think modern life makes it tricky. 

Will: Well, I think, I think the key and, and, and what you’re talking about is, is just putting.

Those things into a, an individual context Yes. For you. Yeah. 

[music]: Personalizing health for you as 

Will: opposed to just, you know, patient comes in, you know, you, you check their, their labs, their, you know, look at their, the medicines they’re on. Be like, okay, well we need you to, you know, stop smoking. We need you to, uh, to exercise three times a week, 20 minutes, you know, three [00:24:00] times a week.

Um, eat less fat. You know, that, that’s all just very general, right? Yeah. That’s something that, that, okay, you can read that in a textbook. Um, but the new thing here it seems is, is just like you are applying that to this person’s biology, this individual’s biology, which 

Kristin: yeah, 

Will: that, that’s incredible that we can do that.

Dr. Eric Topol: It is incredible and you’ve kind nailed it. And there’s another dimension to this. So before recently when we had these organ clocks and these other protein markers, biomarkers, we could say you had a risk like polygenic risk. You have a risk of colon cancer, higher risk, or you have a higher risk of heart disease.

But now we can say whe, which we never had that before for the AI can project. Let’s say you have two PT O2 17 measurements, it’s gonna tell you when you’re gonna start having mild cognitive impairment if nothing is done, you know, the [00:25:00] natural history. So it can predict the natural history, so it’s very precise, accurate medical forecasting.

We never had this dimension of time. Specificity individualization. This is really unique. 

Will: Yeah. How, how accurate is that though? Because, I mean, I’m assuming this forecasting is relatively new. Yeah. And so, you know, we’re, it’s, it’s kind of projection at this point because patients haven’t maybe reached that timeframe.

Right. 

Dr. Eric Topol: Right. So we are gonna have to do some prospective studies to nail some of this down. Yeah. Um, you know, so. It’s ripe for that, right? Uh, but at least you can see through the, like for example, the exercise studies and have people with PT two 17 uhhuh, you see such a marked reduction, you would extrapolate that that’s gonna defer.

Maybe even prevent the disease. So it’s getting these types of, of prospective studies that to validate all that we’re seeing right now. But the good thing is these tests are not expensive. The organ [00:26:00] clocks, the Pox two 17, even the multi cancer early detection tests. Now you’ve probably seen all this stuff about get a total body MRI.

Yes. Yeah. And you’ve probably seen it, which is ridiculous. Yeah. ’cause it could make things much worse when you have um, something that is an incidental finding, right? That gets a rabbit hole. You gotta get a biopsy and you have bleeding in your liver and or collapse alone or anyway before you need a total bottom.

Right. If you are at high risk for cancer. You have, for example, other evidence that, uh, something is going off track. Could be your immune cock, it could be a particular organ. Then you can get a blood test, you know, multi cancer, early detection test, and that’s a lot better to pick up cancer microscopically, right?

Mm-hmm. Because when it’s on an MRI, if it’s a real deal, you, you already have billions of cells that could well have spread to other parts of the body. So that’s why the, we have this new opportunity in medicine. Yeah. [00:27:00] For, for savvy, uh, patients, uh, yeah. Public 

Will: people to know about. Let’s, let’s take a break.

And I got, I have lots of questions, so let’s go. We’ll come back, we’ll come back in a film.

All right. We are back with Eric Topel. 

Kristin: Yes, I have, um, a might be a silly question, but not being in medicine, I don’t know. It’s what’s coming to my mind. How, if all of this is about inflammation at the core of it, how, how do NSAIDs play into this? 

Dr. Eric Topol: Yeah, so the problem like, can I just pop some 

Kristin: ibuprofen for the rest of my life and be fine?

Well, you know, 

Will: it’s a good question. Your kidneys 

Dr. Eric Topol: will not be fine, but yeah. Yeah. It’s a good question. Uh, really, um, because we haven’t had such potent anti-inflammatory. So NSAIDs like Ibuprofen, naproxen, they’re not that potent. They will help with, you know, some [00:28:00] inflammation, but they’re not like the GLP one drugs.

Mm-hmm. That not only knock down inflammation throughout the body, but in the brain too. That’s seems to be their main benefit. Long before people lose weight, they’re getting great anti-inflammatories. So one of the big exciting parts of the future of medicine is our gut hormone. Who would’ve thought that?

Will: Yeah, yeah. 

Dr. Eric Topol: Uh, I, I, I, I dunno about you in, in med school will, but when I was in med school, there was only one gut hormone. It was like insulin. Right? Yeah. You know? And now there’s 15 of them, you know, and every one of them is getting made into a drug, a memetic, right. And they get combinations. And so it turns out the gut hormones.

They make edge sets look like nothing. You know, they’re so potent and they get into the brain. They talk to the brain. So these gut hormones talk to the brain and the immune system, and they are so potent, and that’s why there’s lots of promise for these GLP one drugs to help to [00:29:00] prevent not just Alzheimer’s, but we may all be taking these someday in pill form.

I, I, I’m a very anti forma person in general. Yeah. I mean. I almost ended my career by taking on Merck and Vioxx, uh, which is, uh, another anti-inflammatory, relatively weak, but this time it hit it big. I mean, there’s this, yeah, you’ve only seen the beginning. If you think Ozempic or Muro is big, I mean this, it’s much, much, much more extensive than that.

Will: It makes you wonder how it took so long for us to. Well, 

Kristin: the, we didn’t have to technology before, right? 

Will: Well, we were also stupid. 

Dr. Eric Topol: We were stupid. 

Kristin: Okay. Eventually. 

Dr. Eric Topol: In what way? In what way? Oh, I mean, I wrote about in the chapter on the GLP one drug Yeah. And obesity. Yeah. Uh, they reviewed this amazing story.

So Novo Nortis is the one that came up with this idea for ozempic. Uh, but the, these drugs have been around for 25 years. [00:30:00] They were only using diabetes. GLP one drug and uh, they, the people with diabetes, they didn’t lose any weight. Maybe two pounds, three pounds. Okay? And so no order to say, well, we’re not gonna study an obesity.

These people don’t lose weight. Uh, so there’s this, uh, scientist, Lata Newtson at Novo Nortis who we gave the breakthrough award for Science Magazine. And we had to find out was she really the one that did this, right? Uh, and she did. We had to get all these D Denmark d Danish translations and she was the one.

Anyway, she kept telling the people at Novo Nortis, you have to test it. Obesity, it’s gonna work, have to, it took them years to finally. You know, put up the funds to do it and look what happened and set off a, a, a revolution in obesity management. Now, if we had had GPT back then right? To Ask, we would’ve said, do you think it would work in obesity?

It probably would’ve said [00:31:00] yes. Right? Um, anyway, it took one scientist, um, at a company to push hard for years, and she, by the way, she’s the same one who’s pushed for Alzheimer’s. 

Kristin: Oh wow. So 

Dr. Eric Topol: if that clicks, that’s gonna be, you know, a twofer for her. Yeah. Uh, just amazing how we missed her. You know, think all the people that were morbidly obese.

With all these other issues that we miss for decades, because I’m not testing you for obesity. Right. Okay. Sorry. 

Kristin: No, you, you’re the experts. Sorry, I wanna hear what you have to say. 

Dr. Eric Topol: I mean, anyway, I wish we don know about it a lot sooner. Yeah, sure. Absolutely. 

Kristin: Um, but going back to the gut, so you said that those gut hormones, um, you know, those drugs can get into the brain.

Yeah. Um, I have in another lifetime. Some experience in cognitive neuroscience. And I remember back then, gosh, this was 15 years ago now, um, they [00:32:00] were just starting to talk about the gut brain connection. Yeah, 

[music]: yeah, yeah, exactly. Um, 

Kristin: so I’m curious about, like, I haven’t kept up over the last 15 years, but I’m, you know, I’m, I’m assuming that that is, this is now a continuation of what we were hearing about back then, but how is it that they get.

That they can communicate with the brain. Yeah, like there, there’s the blood brain barrier. So what’s, how are they getting around that? 

Dr. Eric Topol: It’s amazing. This has exploded in these recent years. Uh, and it’s a fascinating area because the gut brain axis goes through many different channels. So it goes through the vagus nerve directly to the brain, to the brainstem and hypothalamus.

It goes through hormones and it can actually, uh, signal. Um, the hypothalamus pituitary axis, cortisol, um, then there’s the gut microbiome. 

[music]: Mm-hmm. The 

Dr. Eric Topol: gut microbiome has all these metabolites. They can get into the brain, cross the blood brainin barrier directly as some of the newer, [00:33:00] uh, gut hormones penetrate the blood-brain barrier directly.

Ozempic doesn’t do that very well, nor does, uh, semaglutide Tirzepatide, but some of the other ones go right. They’re very small molecular weight, and they go right into the brain, have even higher penetrance. So all these different ways through the gut hormones, uh, through the neural connects through the vagus nerve, which is quite impressive.

And then through the gut, uh, microbiome. And it’s metabolites. It’s, it’s this gut brain thing and brain, gut, you know, goes both ways. Right? 

Will: Right. 

Dr. Eric Topol: Like for example, who would’ve guessed that you take this DLP one drug and you stock don’t want to drink alcohol, you don’t want to gamble, you don’t want have nicotine.

Yeah. You don’t, you know, nail, no nail biting. I mean, ’cause who would’ve guess migraine headaches. The list keeps growing all the time. And a lot of this is due to the effect of, uh, the brain, uh, [00:34:00] communication, the gut brain story. Yeah. Mean I do we know the mechanisms possible? 

Kristin: Yeah. By which those things are happening.

Dr. Eric Topol: It’s a, uh, it’s our friend inflammation. Okay. Of course. Uh, yeah, of course. Everything’s inflammation. No, basically the reward cycles Yeah. In the brain are, they get rewired. 

Kristin: Uhhuh, okay. But 

Dr. Eric Topol: there’s some part of that that is, uh, this untoward inflammation in the brain that it’s. It’s helping to prevent or reduce it.

But yeah, I mean the, the addiction thing is the one that is so, uh, unanticipated. Yeah. That’s bad man. And I think we’re still, we’re still learning about that. But again, if there ever was, I, I make the, the joke about how, you know, way to a man’s, uh, heart is through his stomach, you know? Yeah. The way too, turns out the way to a, the way to a human’s health span.

Through the gut brain axis, I mean Wow. Yeah. Yeah. It’s, it’s wild. Uh, and we’re, we’re, we’re learning about it. It sounds 

Kristin: like it might be working on the limbic system. Is that Yeah, true. Yeah. Yeah. Okay. 

Will: Exactly. Yes. Yes. Definitely. 

Kristin: Interesting. 

Will: The, [00:35:00] the, the skeptic or the, or maybe the conspiracy theorist, I don’t know, would say this is all too good to be true.

Yes. Like we we’re, we’re, we’re, we are. Uh, accepting this medication with open arms for so many different, uh, indications that, uh, we’re setting ourselves up for some fall to happen. I agree. What do you, what do you say to that? It’s 

Dr. Eric Topol: really important to be skeptical, especially when you’re seeing something like, you know.

This 

Kristin: miracle drug. 

Dr. Eric Topol: Yeah. Yeah. You know, we never had How many, 

Will: how many miracle drugs have there been in your lifetime? 

Dr. Eric Topol: Yeah. Uh, I, I still don’t know of one, actually. This could be the class. Yeah. Um, yeah. I mean, this is, is, I mean, statins, I wrote in the book about, you know, statins have been one of the most impressive for preventing heart disease, especially in people who already have a heart disease.

Mm-hmm. But after that, you know, this is right up there [00:36:00] now. I’ve wanted to say where, where did they have to be doing something really bad? They have to be, there’s no free lunch with these drugs. Right, right, 

Kristin: right. 

Dr. Eric Topol: And so you, you go down the list like pancreatitis and, you know, uh, slowing the GI tract so you get, uh, obstruction and, you know, there are some bad things that can happen.

But either they don’t happen or they’re very rare and the, this is really interesting. So, uh, Daniel Drucker, who’s one of the people who’s been one of the pioneers in this field up at University of Toronto, he pointed out, and I didn’t realize it, that when most drugs, when you take them, the side effects are parallel to the efficacy.

You don’t get one without the other. Right? So this is like the only class of drugs where you take these injectables for the first few weeks. You get a lot of GI side effects, like, you know, it could be diarrhea, constipation, severe nausea, and then that goes away, but the efficacy doesn’t go [00:37:00] away 

[music]: Wild.

Dr. Eric Topol: Yeah. So there is some rare eye disease, uh, question. There’s a couple out there that are dangling, but overall, I mean, 12% of Americans. Are taking these as prescription drugs right now that doesn’t even account for all the people out there taking it microdosing and, you know, whatever. This is 12% of Americans, and by the way, they’ve been around one form or another for, you know, 25 years.

Wow. So we haven’t, if we, if we were gonna see a side effect that was, you know, really, uh, big and common, it should have appeared by 

Will: now. 

Kristin: Yeah. 

Will: So you, you talk about how, you know, a lot of the interventions that we’ve talked about, the investigations that it were, were still years out from, from these being incorporated into like clinical use.

Um, yeah. So let’s, let’s go into the future. Let’s go like, you know, 20 40, 20 50. What, what do you, what do you think a visit [00:38:00] with your internist or your primary care doctor will look like? 

Dr. Eric Topol: Well, firstly, if we get a project that far in advance, if we do what we can do, we’re gonna have a lot more, uh, wildly super ages right now, they’re the minority and 60 people, 65 and older.

90% have one of these diseases, if not two or three. So we’re gonna see that flip occur. And the reason we’ll see the flip is. Hopefully by then we got everybody on the same, um, uh, page as far as let’s prevent these disease. Let’s find your risk. Sure. And we’re gonna have, we’re gonna take all your layers of data.

If, if you want it, I mean, this will be the norm. Yeah. So instead of saying, oh, well you need to get a Pneumovax and you need to get this, uh, healthcare maintenance stuff, no, we’re going to go in healthcare prevent mode. We’re gonna gonna prevent these three diseases. We’re gonna get all these layers of data, your genes and your proteins, and, you know, looking at [00:39:00] these scans.

With ai, your retina or your other scans, and we’re gonna say, this is your risk, this is when it’s gonna occur. This is how we’re gonna prevent it. We’re gonna put you on these medications, uh, to add to the lifestyle factors. And we will see if, you know, if, if probably is not much as in the US as we’ll see in other countries.

Yeah, other countries, they really care about their population evenly. You know, as healthcare as a human right here, we got a little, we got a little different model, right? Yeah. 

Will: We’ve got some 

Dr. Eric Topol: problems. 

Will: Yeah, we’ve got some 

Dr. Eric Topol: problems, but, you know, in places where they really wanna prevent diseases. Yeah. Which are the economical, you know, that’s the dream, right?

That’s, that’s what you need to do. We’ve been talking about this since the, you know, since the beginning of time, and we never could prevent these diseases. And now we have a, a blueprint or a template to do it. So by 2040. 2050. If we haven’t done this by then, then, then we’re really, we failed. Yeah, yeah.

Totally. 

Will: Yeah. And we’re, we’re we’re talking about a, like a blood test. [00:40:00] Yeah. Right? Yeah. Like just a blood test that can do all that can Well, and you, 

Dr. Eric Topol: you get your body wide aging, aging through a saliva test. S methylation. Okay. And then you get the blood, the blood test gives you your protein markers like P 17 and then your, all your 11,000.

By then it’ll be 20 some thousand. Not that it makes that much different. All the important. Uh, proteins in your, uh, plasma. Now you said you remember how we went a little cuckoo about the genome being sequenced? Sure, yeah. Back in 20, the year 2020. Mm-hmm. We did, we, we basically gave the genes too much top billing.

Yeah. That it was gonna be the code of life and, you know, the secrets and Yeah. Operate our operating searches. Well now. The proteins and the genex together, that’s what’s giving us this big advantage that we didn’t have. And then of course, you, each person has billions of data points now, and you can’t, no doctor, no brilliant, whoever person could [00:41:00] interpret all the data.

That’s how we need ai. I know there’s a lot of backlash against ai, but this is, I think, the perfect Sure, uh, strength of where AI 

Will: kicks in. Yeah. So, so. Do you think that population based public health recommendations are just, are gonna kind of just go away? Like, like everybody needs to get a colonoscopy by age 45.

Like now it’s just gonna be, you’re gonna go in, you’re gonna have your, your own personal panel of things and, and, and data. And then your doctor will be able to look at that and be like, okay, you should start getting a colonoscopy or some kind of screening test when you’re 56 based on this. 

Dr. Eric Topol: Exactly. No.

The way we do it now, how could we be so dumb? The only thing we use that sounds kind, dumb. Years of life. Oh, you’re 50. You better have this test. Oh, if a woman, you’re age 40, well, we’re gonna do a mammogram. We’re gonna do it, you know, every other year for the rest of your life. Well, guess what? Only 12% of women ever develop breast cancer throughout [00:42:00] their whole life.

Why do we put the other 80, 80%. Through this. Yeah. That is just incredible. And the same thing for each type of cancer we use age. Yeah. Well, as you know, we got people now in their twenties and thirties that are developing colon cancer, breast cancer, you know, like we’ve never seen before. But we should be able to pick those people up too.

Shouldn’t be age as the singular, uh, criteria. It’s just amazing. 

Kristin: Yeah. So, you know, speaking of 2040 and 2050, you said if we haven’t done it by then, you know, that leads to a question though, which is all of, not all much of healthcare research and funding right now is being dismantled. So, yes. How, I mean, nobody can predict the future, obviously, but how do you see that playing out with all of this?

Like, is that gonna put us back. Maybe by 20, 40 and 50 we’re still kind of in the same place. ’cause we’re just gonna have to play catch up [00:43:00] in the 20 years between Or what do you think? Yeah, 

Dr. Eric Topol: it’s a great question. Uh, I’m very worried about it. 

Kristin: Yeah. 

Dr. Eric Topol: Uh, I, I think that, um, you know, our problems are largely us, um, confined.

There’s a whole, a whole world out there that could, you know, chase these things down and do the validation that we need to, you know, really show that this is the way to go. We’ll probably go and get it done. You know, I, I’m, I’ve always been an optimist and I’m thinking the situation we’re in right now, which is pretty desperate, 40% reductions across all the board for biomedical research.

It’s gonna slow this down. Undoubtedly. Yeah. Uh, and I’m still trying to figure out where the, all the, the $20 billion, uh, at of ni h where’s that going? You know, but Right. Um, if we, if we prioritizes still, we have the means to be able to get it done if we get philanthropy to kick in. Mm-hmm. 

[music]: Right. 

Dr. Eric Topol: [00:44:00] Um, you know, we have these billionaires who have invested in these companies to reverse aging 

Will: when 

Dr. Eric Topol: they were young.

They wanted to be rich. Now they’re rich. They want to be young. 

Will: Yeah. So if they 

Dr. Eric Topol: want to do that instead of just investing in the company, that’s gonna make them a lot of money. Invest in doing this. Right. But I, I, I hope that, we’ll, we’ll figure out a way to do this, uh, here in the us, uh, because it is so exciting.

I mean, uh, in my, uh, long career, I’ve never seen anything. As, as so propitious and and exciting in medicine as preventing the diseases. Right. Which we were incapable of doing. And actually I think this could be the biggest contribution of AI ever. This is like a new frontier opportunity. Yeah. For ai.

That’s why Dennis Ave and Jeffrey Hinton and a lot of the leaders of AI endorsed the book and have really gotten excited because they were thinking of it, oh, oh, we’re gonna discover new drugs. Well, maybe, but this is a [00:45:00] much more realistic thing. Yeah. Is that, um, AI analytics for a given person will determine risk way in advance and help cross the disease or put it off for, for a very long time.

Awesome. 

Kristin: Yeah, it is awesome. I, you know what, I don’t think we actually said, um, we’ve been talking about these three diseases that are in the book, but can you tell people what those three are? Just 

Dr. Eric Topol: Oh, right. Yeah. So cancer, the common forms of cancer, neurodegenerative predominantly Alzheimer’s and Parkinson’s.

Mm-hmm. And then, uh, heart disease, we’re talking about atherosclerotic type heart disease. Um, and so that’s coronary artery disease. Cerebrovascular disease, heart attack, strokes at all things. So those are the three diseases that account for well over 80%, not only of age related diseases, but for most deaths, most interruptions of health span are due to those.

And by the way, they’re incredibly costal. 

Will: Yeah. 

Dr. Eric Topol: To treat [00:46:00] somebody with Alzheimer’s, I mean cancer treatment, shit, I mean. Yeah, 

Will: right. 

Dr. Eric Topol: Uh, treating somebody with heart failure. Um, so we, we have got to prevent these diseases and for now, once we have this big chance, I hope we’ll follow through. 

Kristin: Yeah. What does it show for idiopathic cardiac arrest?

Just curious. 

Dr. Eric Topol: Yeah, yeah, yeah. Well, I don’t know. Yeah, that’s a tough one. Enough for a friend. Another one. Yeah. So, um, arrhythmia is, um, you know, there are some that are genetically. The sodium channel. Yeah. SCN five is one that is associated and Long QT syndrome. So we know a bunch of genetic, uh, conditions that can account for, uh, sudden cardiac arrest, but we still need to learn more about that.

Right? Yeah. Um, but again. Atrial fibrillation is the most common arrhythmia. Mm-hmm. And while it doesn’t cause cardiac arrest, it’s a big factor for stroke. 

Will: Yeah. 

Dr. Eric Topol: And now we know [00:47:00] the genetics are really potent for predicting atrial fibrillation and the lifestyle factor. A lot of people don’t know that if you’re at risk for atrial fibrillation or you’ve had.

Losing weight, getting lean is like one of the greatest things you can do. So we’re learning still, I think we’re done better on atrial fibrillation ’cause it’s more common. 

Kristin: Yeah. And 

Dr. Eric Topol: a big genetic determinant. And we need to do better for sudden cardiac arrest. 

Kristin: Yeah. Yeah. Ventricle is the one I’m interested in.

Yeah. 

Dr. Eric Topol: I I know it. I get it. Totally. I get it. I mean, now we, we have a remedy in terms of a. ICD but we don’t have a good prevention, which we really need to have. Yeah, right. 

Kristin: Interesting. 

Will: Yeah, I, you know, there’s the, you know, talking about the funding and like, where yeah. How are we gonna keep pushing this forward?

Uh, obviously like tech has a, a vested interest in Sure. In building this up and, and going forward with this. [00:48:00] And, uh, to your point. Dr. Topol, you, you’d hope that these billionaires would also, um, be interested in, in making sure we have like validity, scientific Yeah, yeah. Data to show this, this is worth pursuing.

This is, this is a direction we need to go because the data supports it. Um, I mean, 

Kristin: that would just make it a better investment, right? Yeah. You would think, well, 

Will: you would think so, but I mean, I mean that’s also very costly though. Yeah. And so there’s gonna be some. I don’t wanna say altruism in that, but, but just part of the greater good is, is to make sure that we study these things well enough.

And, and maybe that’s a little bit outside the wheelhouse of the VC companies and the 

Dr. Eric Topol: No, well, you’re bringing up an essential point, and this is another outgrowth of the science of aging. Which is exciting because these companies that are doing cellular reprogramming and lytics and [00:49:00] stem cells and all these other things to try to reverse aging well, how are they gonna get approved?

Yeah. Are they gonna, you know, right. Wait 10 years and you talk about investments in clinical trials. Now it turns out these same markers and proteins, these clocks, organ clocks. Markers. If you can show that you radically change the age of that organ of interest or the marker like the PTA two 17, that would probably make it for regulatory approval.

It’s like LDL cholesterol. If you lower that substantially, that would reduce heart disease. So I would think that we could do trials and get the answers in a year or two for prevention, you know, to get you basically, it wouldn’t say you prevent the disease. But it provides surrogate evidence because otherwise you’re talking about following patients for many, many years.

And sure, we should do that too, but it makes for very expensive [00:50:00] clinical trials. We could get the answers quickly because the metrics of aging, that’s where the big jumps have been. Most people are saying, oh, well the big jump is we can reverse aging in a mouse or a rat. Mm-hmm. And I’m saying, oh, well, uh, that’s nice.

But what about those mice that get cancer when you reverse their. Yeah, they’re, they’re aging. Whereas here we’re not introducing risks. We’re actually just looking for, can we change the clocks? These clocks are so informative. Yeah, and I think it’s one of the biggest breakthroughs in our aging of science is that people aren’t paying attention to the clocks.

Will: Well, if, if you, if you change the organ clock for the eyeball and you start making me do cataract surgery on people who are like 110, I don’t know how I’m gonna feel about that. But you know, it is what it is. It’s fine. 

Dr. Eric Topol: Yeah. I, I think ophthalmologists are pretty safe for this. All this, but, uh, everyone’s good.

You know what, what, did you ever think though that the retina Yeah, I was gonna ask 

Kristin: about that’s, what is it about the retina? [00:51:00] Like, what’s going on there? There’s been, 

Will: there’s been a lot of, of work. Um, I, I, I’ve, I’ve, you know, Eric knows more about it than I do, uh, and looking at the retina vasculature and the, the, the cellular biology of the retina and yeah.

And being able to, to. Mostly a lot of the work’s been done in like diabetic retinopathy, uhhuh, and, and, but sounds like it’s gone even further than that. Well, but what is it? Why, 

Kristin: why the retina of all things? 

Dr. Eric Topol: Well, the retina, 

Will: it’s the only place you can visualize the blood vessels. You can visualize the actual vasculature in, situ you.

Yeah. 

Dr. Eric Topol: Right. And, and it’s the small vessels that are so important and, and an indicator. But we used to think, oh, it’s just a window into the brain. But as, as will pointed out, we’re getting a handle on how good is the blood pressure control, how good is the diabetes control? You can tell the calcium score of the heart arteries through the, the retinal vessels.

So you can avoid getting a calcium score, CT scan. You can tell about the risk for Alzheimer’s and [00:52:00] Parkinson’s. You might might’ve thought that because of that window into the brain. Uh, but also many other things like, you know, being able to diagnose lupus from the retina. Uh, being able to predict liver disease, kidney disease from the retina and people who don’t have any liver or kidney disease.

Yeah. So it it, to your point though, we, these are some of the black box features of ai. Mm-hmm. Like for example, if I gave will a retina picture of a person and I said, is this from a man or a woman? Your chance of getting that right, even though you are an expert ophthalmologist. 50%. Yeah. 50%. Not very. Just chance.

And a AI gets it 98%. Oh, come on. 

[music]: Wow. 

Dr. Eric Topol: Yeah. Yeah. It sees things we don’t see. Yeah. It’s super human. Yeah. And we want to take advantage of it’s superhuman qua uh, uh, features, you know? 

Kristin: Yeah, for sure. 

Will: Amazing. Well, um, 

Kristin: this is in, this is blowing my mind. Yeah, I know. 

Will: We could, we could keep talking for hours. But, uh, Eric, we’ll, we’ll [00:53:00] stop here.

Uh, your book, super Ages and evidence-based approach to longevity. Uh, fascinating stuff. So everybody go check that out. Yeah. Um, and, uh, we really appreciate you having on, uh, coming on. 

Dr. Eric Topol: Well, I, I, I can’t imagine a more fun conversation than with you too. I always get a kick out of it, so thanks for having me again.

And, uh. Gotta keep in touch with you and next, when you doing your next graduation speech? I don’t, I don’t know. Yeah. Not until maybe next year, but, uh, I, I, I, I had a do one this past, uh, may. Oh, yeah. Uh, at Mount Sinai. Oh. And okay. I, again, I went back and reviewed yours, but I just can’t be you. I mean, I can’t, I can’t introduce myself as a TikTok doctor and all this, but, you know, mine is so boring.

I wish I could Doctor 

Will: Whatcha talking about We’re a costume. We’re a costume. It helps. You’re true. Good. Oh man, you’re so good. Well, you know, we gotta be the first stop whenever you write the book about like AI and humor and whenever that’s, uh oh. You know, so anyway, it’s, it’s not doing so well on [00:54:00] that front.

It’s great. I’m still safe. I’m still safe there. It’s not Chad gt lots of dad jokes. It’s not very funny. So humans are better at that. Absolutely. Yeah. All right. Thanks a lot again, Harrick. Thank you.

Well, there’s some optimism for you. 

Kristin: Yeah. We were just talking about how all the healthcare news is awful, and then here comes Dr. Eric Topel to save the day. 

Will: I know. Uh, it is interesting to hear, you know, it’s so easy to have like a down opinion on like the anti-aging stuff because mm-hmm. Well, because there’s much, it comes through a filter of social media risking Yeah.

And it’s a bunch of garbage mo mostly. So hearing like. Someone’s who’s more on the inside and knows a lot in the actual science and research Yeah. Is really dealing with the science of it. Um, it makes me more hopeful for all this aging stuff. 

Kristin: Yeah. It’s kind of inflammation. I know of inflammation. It 

Will: tell us what you thought.

Uh, if you have any thoughts on this topic, uh, you can reach [00:55:00] out to us by email. Knock, knock high@humancontent.com. Visit us on our social media platforms, human content pods. It’s where you can find all the human content podcast offerings. Oh, thanks to all the great listeners leaving feedback and reviews.

Um, if you subscribe and comment on your favorite podcasting app, we’re on YouTube and give you a shout out at Jim Belcher. Two on our YouTube channel. Said, Kristen, you aren’t old, you’re just mature. 

Kristin: Oh, thank you. Is that 

Will: better? 

Kristin: I am not sure. 

Will: The way to tell if you are old is when you can’t have fun anymore.

Kristin: Oh, 

Will: there you go. 

Kristin: Okay. So 

Will: stay young, have fun. Uh, full video episodes are up every week on our YouTube channel at Glaucomflecken. We also have a Patreon. Lots of cool perks, bonus episodes, react medical shows and movies, hang out with other members of the community early. Had free episode access. I ran out of.

Right out of air, out of breath, interactive q and a. Lifetime events, much more. patreon.com/ Glaucomflecken. Speaking of Patreon, community perks, new members, shout out Barbara w Barbara. Woo-hoo. Hi. Thanks for joining us. [00:56:00] We’ll find a job for you. It’s something that is fun. It’s always fun. Something to do.

Yeah. We need an artist. You are you an artist? Are you a, a cook? We can also use a, a great shell always as part of our community, we need someone 

Kristin: to cook us the Mediterranean diet food. 

Will: Oh, absolutely. Shout out to all the Jonathans, Patrick, Lu, C, Edward, K, Mary, and W, Mr. Granddaddy Caitlin, C Brianna, L, M, P, Cole, Mary, H, Keith, g, Parker, Muhammad, L David, H, Kayley, A, Gabe, Gary, M Eric, B, Marlene, Scott, Mar, Marlene, S sorry, Marlene, S Scott, m, Kelsey, M, Dr.

Hoover, Sean, m Hawkeye, MD, bubbly, salt, and 

Kristin: Sean. 

Will: A virtual head, not to you. All right. Uh, Patreon roulette time. Random shout to someone on the Emergency Medicine tier, Joshua G. Thank you for being a patron and thank you all for listening. We’re your host, bla, also knows the Glaucomflecken. Executive Producers Are Will Krista Planar.

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[music]: knock.

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