Young Forever

Chapter 1

The Quest for the Fountain of Youth: Is Immortality Possible?

Are disease and death preprogrammed events that leave us powerless victims to their inexorable approach? Or is the secret of vitality and longevity buried in our DNA, our molecules, cells, tissues, and biological networks, the interconnected ecosystem that is our human form? Longevity was common in biblical times. Methuselah died at 969 years old; Noah was 950 years old; Adam was 930 years old. Today the longest-lived fully documented human in history was the smoking, port-drinking, chocaholic Madame Jeanne Calment, a Frenchwoman who died at 122 years old. Emma Morano, an Italian woman who ate three eggs and 150 grams of raw meat a day, died at 117 years old. Circulating the internet is a video of an Arab man who claims to be 110 years old and is father to a seven-year-old son. In India I have heard personal reports of sages and rishis (Hindu saints) who live well past 150 years old. It could be that they have no birth records, or couldn’t count, but that raises the question: What is the limit of human life? Is there one? If we aren’t meant to have a limit, would you want to live to 150? Or beyond?

THE BLUE ZONES—LONGEVITY IN PRACTICE

There are places in the world where people have already cracked the code, without knowing it, resulting in unusual longevity. Dan Buettner, a National Geographic explorer and author, researched the places on Earth with the longest-lived, healthiest communities, called Blue Zones (after the color of the marker an earlier researcher used to circle them on a world map). These communities have up to twenty times the number of people reaching 100 years old or more than in the United States. What makes the communities unique is not their genetics—when Blue Zone inhabitants move to a more modern world, their disease and death rates parallel everyone else’s. It is something else, something I have been on a quest to discover, which led me to visit the Blue Zones. What I witnessed has shaped how I view aging, longevity, and, frankly, living.

JOURNEYING TO SARDINIA

In the summer of 2021, with Dan’s help and advice, I ventured deep into the Ogliastra region of Sardinia, the heart of Sardinia’s Blue Zone, which has the longest-lived men in the world. I was guided by two native Sardinians, Eleonora Catta and Paola Demurtas, and their travel company, There, to the homes and hearths of local Sardinians, into the world of centenarians, an ancient world that has remained much the same for the last 3,000 years. The mountainous region, home to the Sardinian shepherds, is remote and landlocked and has remained inaccessible to conquerors and outside influences until recently. I heard the Sardinians’ stories, witnessed their way of life, ate their ancient foods, drank their antioxidant-rich Cannonau wine.

The people of this region have preserved their ancient foodways. They still follow traditional methods of making cheese, wine, preserved meats, and olive oil and have a deep knowledge of the local plants. They understood that food was medicine even before Hippocrates! They are particular about what their goats, sheep, and pigs eat. They know that the flavors of the food come from the foods the animals eat, from the soil that feeds their plants, vegetables, and fruits. One farmer said to me, “We flavor the meat before we kill the animal.” The flavor comes from phytochemicals in the plants consumed by the animals. They don’t know these compounds are actually good for them. The food just tastes better. Sardinians eat some meat. They also drink goat milk, and their daily diet always includes sheep and goat cheeses.

On one side of a steep valley sat an old, abandoned, crumbling thirteenth-century village and just above it a newer one. In the 1950s the threat of a mudslide forced the villagers to evacuate and move a little farther up the mountain. At the edge of the old, abandoned village, an eighty-four-year-old shepherd, Carmine, sat on an old stone wall, his small rust-colored Panda parked next to him, driver’s door open. He had pulled over when he saw us behind him and wanted to talk. Imagine that in America, someone just pulling over to the side of the road and flagging you down for a chat! He hasn’t left this mountainside since 1989, when he went to visit one of his children on the Italian mainland. Carmine tends his six sheep and one goat, his chickens, and one pig amid his olive orchards, which comprise a 300-year-old olive tree among younger olive trees, growing together with pomegranates, almonds, persimmons, figs, chestnuts, and blackberries. And he grows a large garden of tomatoes, peppers, eggplant, chard, strawberries, and artichokes. He spoke of his simple life, his diet of minestrone soup, which is a staple here. Carmine’s wife had died two years earlier, and he lives with his sister and her two daughters, like most Sardinians who stay in tightly knit family and friend units. His now smaller family can’t eat all the food he grows, so he feeds what remains back to the animals or gives it away. His routine, the simplicity of his life, tending his animals and gardens, chatting with his friends, being useful and part of his community, and his curious mind keep him going. I asked how he spends his time when not tending his land and animals and he said he reads a lot. He opened the hatch of his Panda and pulled out a thick tome on world religions that led to a deep conversation about God, whom he is not so sure about, and climate change and the irreversible destruction of the planet. We spent three hours chatting about his life, touring his farm, and enjoying each other’s company as he hiked effortlessly up and down the mountainside, calling to his sheep to come get a little ancient grain. I struggled to keep up with him as he bounded up the mountainside after his sheep.

The next day we went to visit Giulia Pisanau, who had turned 100 years old three months earlier. We talked for hours about her childhood. She was born in 1921. Her family had eleven children, and they were so poor during and after World War I they would each eat one potato a day and one egg split among all of them. She drank goat milk every day as well as minestrone soup, often with just a few zucchinis and a potato. She never married and worked for a family in Cagliari, the big city in Sardinia, for decades. Then she retired and built her own home. She spent her time doing embroidery, walking around her neighborhood, and hanging out with her friends. Still sharp, she does crossword puzzles every day. Her secrets to longevity: Do not be jealous or angry, take walks, do not stress about life, and live in gratitude. She is a wealthy woman, rich in love, meaning, and purpose. And she has no ailments except a slow thyroid and a little arthritis.

The next day we visited Sylvio Bertarelli, a shepherd who lives in much the same way his ancestors have for thousands of years, on the same land perched on a mountaintop, tending his herd of 200 goats and sheep, each with its own name and personality. Sylvio and his son grow their own olives and make their own olive oil. They cultivate an ancient form of wheat called grano cappelli and make their own Cannonau wine, fresh goat and sheep cheeses, cured meats, and flatbreads. Sylvio lives with his wife, daughter, and son and has no Wi-Fi or computer and barely any cell service. He is surrounded by his community of twelve close childhood friends who show up for sheep-shearing season and hunting excursions every year. I asked him if he experiences much stress. He paused a long while and said his biggest stress is when a goat goes missing in the middle of the night.

Everything they eat comes from their land. Tradesmen like builders are paid in cheese and milk. In the past, Sylvio and his family ate meat five times a month; now they sacrifice only the ornery animals. They eat cheese and drink milk from goats and sheep every day. During my visit, we feasted on olives, peppers, flatbread, strong cheeses, fresh goat cheese, cured meats, puffed little bread pockets (pistoccu fritto), pork and sheep roasted over an open wood fire, little potato-filled pasta with fresh tomato sauce (culurgiones), minestrone with potatoes, pasta and zucchini, malloreddus pasta with sausage, fresh tomatoes from the garden, and seadas—little fried cheese pockets drizzled with honey—for dessert, all washed down with fresh Cannonau wine served in a clay pitcher. The family runs both the farm and a restaurant, which they operate out of their house. It was an easy afternoon and evening of laughter and food and community and love.

IKARIA: A PLACE OF WILD FOOD

I visited another Blue Zone, Ikaria, Greece, and encountered much the same spirit of self-reliance, deep community, preserved ancient foodways, and an environment that naturally supports a healing diet, love and connection, and daily movement up and down the steep mountains.

Every day the Ikarians, some of the longest-lived humans on the planet, drink tea made from wild herbs, including sage. Turns out it is full of the same phytonutrients that green tea has, epigallocatechins, which are powerful detoxifying and anti-inflammatory antioxidants that act on our longevity switches. Is that part of the secret to their longevity? The Ikarians’ diet consists mainly of wild food. Bitter and sweet wild greens. Foraged mushrooms. Wild herbal teas. All super sources of medicinal phytonutrients. The wild sage tea they drink daily has the same powerful protective longevity phytochemicals as green tea without the caffeine. They eat very little sugar—just a little preserved fruit, such as lemons and oranges, from time to time. Wild foods have the most powerful types and highest concentrations of phytonutrients, which surely contribute to their longevity. In fact, all the food is technically organic, though you’ll never see a certification (or a food label at all, for that matter!). That is just how they have farmed and foraged for centuries.

I visited ninety-seven-year-old Panagiotis and his eighty-seven-year-old wife, Alkea. They were joyful, cuddly, and happy. She cooked a meal for us of wild-greens pies, fresh garden salad, and local eggs with greens and wild mushrooms served with local Ikarian wine that had not been bottled. At eighty-seven, Alkea was spry and bright-eyed, looking 20 years younger. She tended her large, terraced gardens and fruit trees and grew and preserved all their food for the year by herself, climbing the steps and steep hillside terraces with ease. Movement is built into their life. They don’t retire. They wake up with more things to do than they can get done in a day, and they are surrounded by a rich community of lifelong friends and loved ones. These are the simple principles of happiness and longevity.

Younger Ikarians are preserving the old ways. Phillip, another local I visited, makes wine in the ancient ways written about by Homer. He crushes heirloom Fokiana grapes with his bare feet, pours the juice into 200-liter clay pots buried in the ground, and leaves it to ferment gently, without additives or starters. It is a fragile wine, organic only because that is how they grow the grapes, grapes that are hardened by rough soil and challenging conditions and therefore high in protective phytonutrients. He also preserved a whole leg of a pig in the traditional ways: He placed the fresh leg on a bed of grape leaves, covered it in sea salt, washed it in wine, then hung it over a fireplace and smoked it with herbs. A pig’s or lamb’s leg can feed his family for a whole winter. He served us steamed grape leaves and stems seasoned with sea salt and homemade olive oil, foraged wild mushrooms, fresh goat and sheep cheese, and bread made from zea flour, an ancient grain consumed by Alexander the Great to maintain his strength. Zea is also known as emmer wheat, which is high in dietary fiber, has double the protein content of regular wheat, and has far more magnesium and vitamins A, B, C, and E, while having very low levels of gluten. I left feeling happy, nourished, and loved!

It was a privilege to peek into the Sardinians’ and Ikarians’ ancient ways, to see the care with which they grow food and tend to their animals, the deep understanding they have that flavor originates not in the animal or plant itself but in where and how it is grown, in what the animals eat, in the wild plants rich in medicinal phytochemicals, and in the depth of the love and connection they feel toward their family, friends, and community. Science now clearly links nutrient density and the flavor of a food to its phytochemical richness—whether it is a strawberry or goat cheese or prosciutto. This is what makes food medicine; this is the type of food we want washing over our DNA, regulating our epigenome, the system that controls all our gene expression, and all our biological networks. These communities don’t have to go to a gym, buy organic food, or mindlessly scroll through social media. Embedded in the very fabric of their lives are medicinal foods, movement up and down the mountains, deep, lifelong friendships and community, and the slow savoring of life together. We have to make adaptations in our modern lives and find good food at farmers’ markets or Whole Foods, and go to the gym to work out, but there is much to learn from the Blue Zones, from the simplest practices we have drifted away from in our nuclear families and our solo, individualistic pursuits, to our removal from nature and natural cycles and knowing the source of our food. We cannot go back to live in the world of a thousand years ago, but we can learn the lessons of the Blue Zones and build our own zones within our homes, our family, our friends, and our community.

The lessons are clear. Live close to nature. Love deeply. Eat simple food raised sustainably (ideally by your own hands). Move naturally. Laugh and rest. Actually live. (And live longer, as it turns out.)

HEALTH SPAN VERSUS LIFE SPAN

But what does it look like to actually live longer? Depends on whom you ask. Most of us witness our grandparents and parents aging and getting sick, often dying long, slow, painful deaths punctuated by multiple doctor and hospital visits and supported by dozens of medications for almost as many diseases. If you’re like the majority of the world witnessing the slow decline and the onslaught of chronic diseases associated with aging, living longer does not look appealing. At all. But if you ask the communities living in the Blue Zones, they’d likely tell you that living longer looks about the same as any other stage of life, just with a bit more life experience. In fact, in Dr. James Fries’ landmark study, “Aging, Natural Death, and the Compression of Morbidity,” published in the New England Journal of Medicine in 1980,¹ he made it very clear that if people maintained their ideal weight, didn’t smoke, and exercised regularly, they would live long, healthy, vigorous lives. And when it came time to die, they would go quickly, painlessly, and cheaply. Those who were overweight, smoked, and didn’t exercise died long, painful, expensive deaths. The healthy group dramatically lengthened their years of disease-free life, that is, their health span (how long they maintained their health) and their life span (how many years they lived), while the unhealthy group often spent decades in various states of disease and dysfunction, resulting in a dramatic loss in quality of life and a burden for themselves, their families, and the health care system.

Sadly, because of our toxic diet and poor lifestyles, life expectancy in America has been on the decline since 2015, and COVID-19 has taken another three years off the life expectancy of those most burdened by chronic disease—Black, Latino, and Native American populations. The World Health Organization estimates that the average person spends the last 20 percent of their life in poor health. That’s an average of about 16 years. If you live to be seventy-six years old, that means that starting at age sixty you are on your way out!

This data continues to prove that if you choose your lifestyle habits well, you can live a long, healthy life and pass quickly when the time comes.² In other words, your health span can equal your life span. And this is just by applying three simple lifestyle habits: don’t smoke, stay at your ideal weight, and exercise. It doesn’t incorporate any of the other advances we cover in Young Forever that will help you access a dramatically enhanced level of health and vitality.

Nobody wants to suffer. And no one wants to live to be 100 or even older in a state of disease and disability. The good news is that you won’t have to if you start to incorporate the principles in this book now—whether you are ten or 100, they work! It is never too late. In fact, one Journal of the American Medical Association study found that starting seventy-year-old participants on a Mediterranean diet and walking regimen reduced the risk of premature death by 65 percent!³

The prevailing view is that if people live longer, they will be a burden on society. The opposite is true if that population is healthy. They have wisdom, knowledge, and skills that can improve the social and economic well-being of society overall. And they won’t cost more; in fact, extending healthy life is projected to save trillions and trillions of dollars in our economy. Dr. David Sinclair, a professor of genetics at Harvard and leading aging researcher, published an analysis in Nature Aging entitled “The Economic Value of Targeting Aging.” Through rigorous data analysis he estimated that by improving the health span of the average American (shortening or eliminating years of illness during the last 20 percent of their life) and extending life span by one year, we could save $38 trillion a year. If we extend life span across the population by 10 years, we can save $367 trillion—but only if we improve health span.⁴ That is nearly ten times the total annual health care expenditure in America alone.

Today 90 percent of the United States’ almost $4.1 trillion in health care expenditures is on lifestyle-preventable chronic disease—heart disease, cancer, diabetes, dementia, kidney disease, hypertension, and so on.⁵ What is even more frightening is the juggernaut of disease and the overwhelm of our health care system as our currently very unhealthy population ages. A 2018 study found that 88 percent of Americans are in poor metabolic health—meaning they are on their way to heart disease and diabetes and dementia and cancer.⁶ Published in 2022, just four years later, another large study found that fewer than 7 percent of Americans are metabolically healthy, in other words, have normal blood pressure, blood sugar, cholesterol, and weight, and have not had a heart attack or stroke!⁷ During the COVID-19 pandemic, 63 percent of hospitalizations could have been avoided by a healthy diet.⁸ Those most affected by COVID are the obese, chronically ill, and elderly (who nearly all have a chronic disease).

The moral of the story: Focusing on staying healthy pays big dividends in both the quality and length of our lives as we age, and it is never too late to start.

Most of the villagers I met in the Blue Zones have a health span equal to their life span. Many arrive at 100 years old active, healthy, imbued with a sense of purpose, and connected in a deep web of community. Obviously, the goal is not to become a shepherd or live in a mountain village. The key is to integrate the habits and behaviors that consistently have been proven to prevent disease and enhance your vitality and quality of life. Each of us would achieve the same longevity, filled with vibrant health, joy, and fulfillment. How do we do that? You don’t have to ditch your phone, your job, or your home, or change your genes. By following the principles and the plan in Young Forever you can look forward to a longer life, a life where your health span equals your life span.

LONGEVITY SCIENCE: REIMAGINING AGING

Before you dismiss the idea that biological aging is an inevitable part of life, imagine if we considered aging a disease. Like other diseases it would have a cause, symptoms, and a natural history. If we didn’t address this disease, eventually we’d die, just as we would from other diseases. Imagine if we reframed our approach to aging. To do this, we must challenge a few entrenched beliefs about aging.

First: We must imagine that getting older doesn’t inevitably mean getting weaker, slower, sicker, feebler, or more dependent. Almost everyone knows someone in their nineties who still dances, cooks, drives, spends time with loved ones, reads books, does puzzles, and thoroughly enjoys being alive. It shouldn’t be an anomaly but the norm. Hiking, skydiving, living, and loving past 100 years old should be what we expect.

Second: We must disrupt the existing medical paradigm. The practice of medicine today is reductionist and siloed and ignores the current science that has revealed the body to be one whole integrated system or network. If you have psoriasis, arthritis, heart disease, diabetes, irritable bowel, and depression you may be referred to six different specialists, but all these problems are caused by inflammation. You will be given the best drugs to treat the symptoms of each disease based on the latest medical research, but none of the specialists is likely to address the disease’s root cause. For example, food sensitivities as well as imbalances in the gut and microbiome can cause all these conditions and diseases. They are not separate and distinct problems. Treat the cause or causes, and the symptoms and diseases disappear.

Your body is not a set of independent organs. It is a weblike ecosystem. The same root cause can result in multiple different symptoms and conditions. Address the causes and provide the conditions for health, and diseases go away as a side effect.

FUNCTIONAL MEDICINE: A NEW APPROACH TO HEALTH CARE

In the groundbreaking textbook from Harvard scientists called Network Medicine: Complex Systems in Disease and Therapeutics, the authors present a radically different view of medicine, a model that challenges our current organ-based, single-disease, single-drug model. They explain it this way: “Network medicine embraces the complexity of multifactorial influences on disease. While network medicine offers a fundamentally different approach toward understanding disease etiology (cause), it will eventually lead to key differences in how diseases are treated—with multiple molecular targets that may require manipulation in a coordinated, dynamic fashion.”

The authors referred to this radically different approach to health care as “network medicine”; I and many of my colleagues call it “functional medicine.” Functional medicine suggests that all diseases have a root cause (etiology). We must find and address all the factors or causes that contribute to disease. If your roof is leaking, you need to find the hole and patch it. And if you have multiple holes, you must fix them all. The good news is that most of the root causes are treatable through diet and lifestyle interventions—practices available to almost anyone. This approach will change how we treat disease. Rather than suppressing symptoms with medication, we can map out the root causes and address all of them with multiple simultaneous interventions that restore and enhance optimal function. Functional medicine is the science of creating health. When you create health, disease disappears.

The body comprises seven dynamically interconnected, networked systems that underlie all disease—155,000 diseases, in fact. What are these systems?

When these systems are in dynamic balance, health and longevity are the natural consequences. Disrupt any system and disease and aging occur. Functional medicine provides a road map to assess all the environmental, lifestyle, and predisposing factors—genes, stress, toxins, trauma, microbes, diet, allergens, and so on, that cause imbalance in these systems. We identify the what (symptoms) and the why (too much or too little of what is needed for health) so we can determine the how (removing the impediments to health and adding the ingredients for health). This allows us to focus on the personalized strategies for lifestyle interventions and managing our environment to create the best outcomes, prevent chronic disease, and extend healthy life span.

Functional medicine asks a different series of questions than traditional medicine does. How do we create health? How do we optimize function? How do we reverse dysfunction caused by the normal ravages of our modern world where most of us live and eat in a toxic food and nutritional wasteland, where we sit most of the day, where we live in a sea of toxic industrial chemicals, where the stress of our lives and society and global existential threats like climate change and totalitarianism and the digital persuasion economy that drives our thoughts, emotions, and actions are usurping our free will?

Within our bodies is a powerful innate healing system. We simply need to activate it by removing and avoiding the inputs that negatively impact our seven systems and provide what these systems need to function optimally. Put simply: take out the bad stuff, put in the good stuff. The Young Forever Program is designed to do just that, and to activate our innate healing system to prevent and reverse disease and help you live longer and better.

THE FUTURE OF MEDICINE IS HERE

This book is a road map to extending both your health span and your life span using the science and tools available today. Emerging advances in technology and longevity science are pushing the limits of our imagination, but even without the promise of these advances we can take advantage of revolutionary discoveries in the field of longevity. We now know how to control our master longevity switches through diet, lifestyle, supplements, and even medication and arrive at 100 years old in good health. We can reverse disease, enhance our bodies’ repair systems, regenerate and repair cells and tissues, and turn back our biological clock. Getting to 120 or 150 or 200 (while still feeling youthful and vibrant) will soon be possible with therapies and innovations just on the horizon. If you can maintain your health for another 10 or 15 years you will be alive when we might reach longevity escape velocity—when our scientific advances will keep pushing death off indefinitely.