Dr Rupy: Just a quick announcement before today's podcast. This is actually part one of a four-part podcast series I'm dedicating to how to reverse ageing. Yes, this is all about gerontology, which is for a lot of us a subject matter that hasn't really crossed the mainstream barrier. It's all about ageing as a disease process and how to treat it. You're going to find the next four podcasts in this series absolutely fascinating and Sue is a perfect guest to kick it off because she really lays out the history of this industry, this scientific field, and I know you're going to absolutely enjoy this podcast. So without further ado, here it is and look out for the next three after this week's.
Sue Armstrong: And one of the clearest messages that came from my book, which I found absolutely fantastic, was that the single biggest risk factor for that whole panoply of geriatric diseases is the ageing process itself. So if we can come, they're the branches of the tree. The roots of the tree are the ageing process, your immune system that's getting old, your senescent cells that are accumulating, the inflammation in all sorts of things. All of these things. So if you can treat, if you can find a way of slowing that process or ameliorating that process, you can actually affect all kinds of things.
Dr Rupy: Welcome to the Doctor's Kitchen podcast with me, Dr Rupy, where we discuss the most important topics and concepts in the medicinal qualities of food and lifestyle. This is the podcast to learn about actionable changes to your diet and your lifestyle that can lead to health benefits. My guest today is Sue Armstrong, who is a writer and broadcaster specialising in science, health and development. But as you will learn, her career has spanned so many different topics, it's incredible. She has written one of my favourite books from 2019. In fact, it might be one of my all-time favourite books. It's an incredible story of ageing and the area of gerontology that has garnered a lot of interest. It's essentially how we can treat and reverse ageing. Yes, I know it sounds far-fetched, but trust me, at the end of this podcast, which is quite long, I definitely realise it's one of my longest, but you will learn so much more about the science behind this fascinating industry and topic that spans a lot more than just lifespan, it's about quality of life. Her book, Borrowed Time, is a must for anyone's reading list who wants to dive into a topic that spans cancer, inflammation and other diseases of ageing that we can treat if we get to the root cause of what is going on. You can find all of this information and more on thedoctorskitchen.com where you can also sign up for the newsletter and you'll get weekly recipes as well as lifestyle tips to help you improve your wellbeing and live the healthiest life possible. Please follow my guest as well on Twitter, it's @Armstrong_Sue and check out the book again. All the links are going to be on the website, thedoctorskitchen.com. Give this a five-star review if you enjoyed the podcast as well, it really does help spread the message. I'm not going to talk for much more. The only last thing I'm going to say is the recipe that you hear me cooking for Sue can be found on my YouTube channel as well. Again, thedoctorskitchen.com, you'll find all the information there. I'm going to stop talking now and get on to the podcast. Thank you so much for coming in, Sue. It's an absolute pleasure to have you here. I was actually reflecting today that it's amazing. I'm in such a privileged position where I can read an incredible book and I can invite you, the author, to come down and share a meal with me and then chat about it.
Sue Armstrong: Well, it's a great pleasure. I mean, this is a really unusual way of doing it. Usually you sit sat in some dusty little studio with somebody talking to you from miles away and it's awful. This is lovely and I get to get a meal as well.
Dr Rupy: You get a meal, you get a free meal out of it. So we chatted on the phone and I remember you saying that you like pomegranates. So I've basically made a meal around that. I'm going to roast some chickpeas in dukka. I don't know if you've had dukka before.
Sue Armstrong: No.
Dr Rupy: It's kind of like za'atar, it's like an Egyptian spice blend with sesame seeds, coriander, fennel, some cumin in there, a little bit of chilli. It's not too hot. I'm going to roast that with a little bit of oil and then we're going to build a salad around it. So a bit of smoky hummus on the bottom, some fermented pickled onion that I've got here, parsley. You okay with parsley?
Sue Armstrong: Yes, I love parsley. Yes, yes.
Dr Rupy: Okay, good. Because some people it's a bit, you know.
Sue Armstrong: Why, I don't, why don't people like parsley?
Dr Rupy: I think so genetically, there is a variant that makes people adverse to coriander, I know.
Sue Armstrong: Yes, I know that one.
Dr Rupy: And I think there might be something similar with parsley because it can be quite off-putting, but more so with coriander. But anyway, you're not one of those, so we're going to go with the parsley. And then I'm going to put in some grilled artichoke as well and a little bit of seasoning. Sound good?
Sue Armstrong: Sounds wonderful.
Dr Rupy: Great, great. So tell me about how you got into broadcasting because you have done a lot more than just the incredible book about ageing and gerontology, which we'll get into in a little bit. But you've had some incredible experiences ranging from broadcasting about HIV to Nelson Mandela. Tell us about how you got started.
Sue Armstrong: Well, I got started in journalism. I grew up in a medical family, completely medical family, and I was always interested in medicine, but I always wanted to be a writer. But nobody in my family knew how to become a writer and they thought if you're a writer, you have to, you're a novelist, and I didn't have novels in me. And so I did all sorts of bits and pieces and I did a bit of travelling and so on. And then when I was a very, very young mum, I had this urge to do it. So I just started writing at my kitchen table. And got lots and lots, along the way I kept finding people who believed in what I was doing and gave me an opportunity. And then I met somebody who said, well, you know, because I had got two small boys and I needed some more work. And somebody said to me, you know, the World Health Organisation has all these articles which are sent in from the field by doctors that need sprucing up to put them in their journals and so on. So why don't you write to WHO? So I wrote to WHO and had a great big lump in my throat thinking, this isn't going to work. It'll go in the bin like most proposals do. It just happened to land on the right desk. And this guy got me to do some editing, then he took me over to Geneva and he became my mentor and he was wonderful. And I happened to be working at WHO when on a freelance writing assignment when the first mention of HIV appeared in that little, that little crusty little journal, what was it called? Morbidities and Mortalities Weekly Report, which is a statistical thing from CDC in the States. Okay, yeah. And any really interesting statistics that come out, suddenly they find there's a blip in something. So they write a little note at the bottom and say, does anyone know what's happening here? And this was gay men in California with pneumocystis carinii pneumonia.
Dr Rupy: Which is an atypical pneumonia that is one of the pathognomonic features.
Sue Armstrong: Yeah, absolutely. And so he, then they'd had this, they'd had this big meeting at CDC and they dumped all the papers on my desk and said, you know, we don't know what this is, but write us something about it. So I wrote something about it. And, you know, it then grew and grew and so I stuck with the story. And then, but I was always freelance. And then, I got involved in lots and lots of things. And then I started working for New Scientist magazine, went out to South Africa working for New Scientist. Wow. Always as a freelancer and followed my nose wherever interesting stories came up and that's it. And then I came back to Britain from South Africa and decided I wanted to do, again, I wanted to do long-form stuff rather than just everyday journalism. And I did, well, I did one on a, oh, I did one years and years and years ago on for kids on smoking and what, what's in it for you, a kids' self-help book. That was years ago. And then I did one on a Namibian freedom fighter in the 80s. And then I did the AIDS book and I did and then, then these last two with the ageing one and the P53 one on cancer.
Dr Rupy: P53 one, yeah, which we'll definitely come back to in terms of when we talk about reversing ageing and the important genetic mechanisms that protect us. But that's fascinating. Your, your, your history and and your career has just been, it's spanned so many interesting topics.
Sue Armstrong: Well, it has, but I mean, that's, that's the massive privilege. I, I keep on thinking to myself, what a privilege. You know, you can be an extremely nosy person like I am. And you get a passport to, it's your job to go and ferret out stuff. And it's just, when I went out to South Africa, New Scientist had never had anybody out there during the apartheid years. And so I was going out to South Africa and I said, can I string for you there? So the sky was the limit. There was just any story I wanted to cover basically. It was wonderful, really wonderful.
Dr Rupy: And you, you were privileged to be one of the few to witness Nelson Mandela coming out of prison.
Sue Armstrong: I was. I mean, that as, as I think I've said before, that just sometimes you, you look back on things in your career, like with the AIDS thing, and I realised, okay, I witnessed the birth of the history of AIDS. And none of us knew that we were watching that arise and gradually it did. But with Mandela, we all knew to be outside the prison, this was history being made there and then. And it was just wonderful. But there was a little bunch of us working with the main BBC correspondent. And so we were deployed around the place and I was deployed to go and outside the prison.
Dr Rupy: Wow.
Sue Armstrong: So I was waiting outside the prison when, when he came out and it was an intoxicating moment as you can imagine.
Dr Rupy: I can imagine, yeah. And that must have just been like, it's one of those things that you'll just never ever forget, I'm guessing. It's just one of those pivotal moments in history. I think it's, everyone remembers where they are at certain, I remember where I was during the 9/11 incident. I remember even Kobe Bryant recently as well. I remember who told me. I was actually working in A&E at the weekend when it, when it occurred. And somebody told me to check my phone. I was like, oh God, that's terrible. It's one of those incidents, isn't it?
Sue Armstrong: Where were you when Mandela was released? Can you remember?
Dr Rupy: Oh, I don't know. I think I was too young.
Sue Armstrong: Oh, you were too young. Yes, I know. Oh my God, that's the thing. I think my parents told me about that, but yeah, yeah, I can't, I can't remember.
Sue Armstrong: Because I was going to say when Kennedy was assassinated too, you know, Kennedy will be a historic figure to you.
Dr Rupy: Yeah, you know, I wasn't there. So just to go back to the recipe very quickly.
Sue Armstrong: It's wonderful.
Dr Rupy: Oh, great, already. Yeah. I've just put some leaves around the outside, some of the smoky hummus with harissa. The onions, what I've done is I've sliced them in half moons, put them in a mixture of hot water, vinegar, salt, sugar, and some fennel seeds and coriander seeds and just left them. You don't need to marinate it overnight. It's one of those quick pickles that you can actually leave for about half an hour and it just turns these into like beautiful jewels of red onion. Some of the grilled artichokes, the oil of which is really, really well marinated, so it's perfect for chickpeas.
Sue Armstrong: And is that, is that olive oil that's in there?
Dr Rupy: Yeah, this is just olive oil, yeah. And I've put those, the chickpeas in there and when they're, when they're ready, I'm going to pull them out. I think they might be ready in a second actually, because you don't need to do too much in terms of the chickpeas, just pop them in. So tell me about how you actually went into gerontology itself. Like what was the triggering interest for this amazing world of reversing ageing? I mean, I've got tons of questions I want to ask you, but I'll save that for the second part. But how did, how, when did it actually come onto your radar?
Sue Armstrong: Well, I, I did a series of radio programs for the BBC on the biology of sometime back. And I did the biology of addiction, the biology of appetite, the biology of all sorts of things, biology of stress. And one of them was the biology of ageing. And I went over to the States as you do because there's all, you know, the national institutes of everything over there. And I found it very interesting. And when I'd done my P53 book, Bloomsbury came to me and said, what would you like to do next? And my first choice was I wanted to write a book about vultures because in South Africa I became very fond of these birds and they are wonderful and they've had a very bad press. And he said, he said to me, well, you know, there's good news and bad news. I love your idea, but I've just, the bad news is I've just signed somebody else up to write about that. Oh, really? So go away and come back with another idea. So I suddenly thought, well, you know, every day one's hearing about ageing. And I had these lovely bits and pieces and I thought, that's, that'll be an easy one. Whoa. No. It was, it was massive once you get into it. I mean, I realised that it's a just a huge canvas. And at first I was very ambitious. I wanted to look at the philosophy of of, whether we want, you know, of longevity and whether we wanted to live longer and and all sorts of things. So I wanted to look at that. And I wanted to look at the demographics and personal things and the psychology and so on. Then I realised that in fact, there's quite a number of books on, could we live to 150? Could we live to 500 years? Could we live to a thousand years and would we want to? And I thought, there's quite a lot already on that, but there's very little that's actually looking inside the body. And I'm always curious about what's going on inside. And getting older myself, you know, I began to get aches and pains and stupid little things. And I thought, what's actually happening? So I took a leaf out of Gunther von Hagens. You remember he did that wonderful exhibition, the body worlds. Have you seen his body worlds?
Dr Rupy: Yes, yes, I have. Yeah, I went, this was when I think I was in medical school in Cardiff. Incredible exhibition. I actually do remember when I watched that for the first time because he did the live autopsy on channel four.
Sue Armstrong: Yes, he did. He did.
Dr Rupy: I don't know whether it'd be allowed anymore now. I mean, this is when channel four was pretty edgy. And I was like, oh God, that's terrible. It's one of those incidents, isn't it?
Sue Armstrong: Where were you when Mandela was released? Can you remember?
Dr Rupy: Oh, I don't know. I think I was too young.
Sue Armstrong: Oh, you were too young. Yes, I know. Oh my God, that's the thing. I think my parents told me about that, but yeah, yeah, I can't, I can't remember.
Sue Armstrong: Because I was going to say when Kennedy was assassinated too, you know, Kennedy will be a historic figure to you.
Dr Rupy: Yeah, you know, I wasn't there. So just to go back to the recipe very quickly.
Sue Armstrong: It's wonderful.
Dr Rupy: Oh, great, already. Yeah. I've just put some leaves around the outside, some of the smoky hummus with harissa. The onions, what I've done is I've sliced them in half moons, put them in a mixture of hot water, vinegar, salt, sugar, and some fennel seeds and coriander seeds and just left them. You don't need to marinate it overnight. It's one of those quick pickles that you can actually leave for about half an hour and it just turns these into like beautiful jewels of red onion. Some of the grilled artichokes, the oil of which is really, really well marinated, so it's perfect for chickpeas.
Sue Armstrong: And is that, is that olive oil that's in there?
Dr Rupy: Yeah, this is just olive oil, yeah. And I've put those, the chickpeas in there and when they're, when they're ready, I'm going to pull them out. I think they might be ready in a second actually, because you don't need to do too much in terms of the chickpeas, just pop them in. So tell me about how you actually went into gerontology itself. Like what was the triggering interest for this amazing world of reversing ageing? I mean, I've got tons of questions I want to ask you, but I'll save that for the second part. But how did, how, when did it actually come onto your radar?
Sue Armstrong: Well, I, I did a series of radio programs for the BBC on the biology of sometime back. And I did the biology of addiction, the biology of appetite, the biology of all sorts of things, biology of stress. And one of them was the biology of ageing. And I went over to the States as you do because there's all, you know, the national institutes of everything over there. And I found it very interesting. And when I'd done my P53 book, Bloomsbury came to me and said, what would you like to do next? And my first choice was I wanted to write a book about vultures because in South Africa I became very fond of these birds and they are wonderful and they've had a very bad press. And he said, he said to me, well, you know, there's good news and bad news. I love your idea, but I've just, the bad news is I've just signed somebody else up to write about that. Oh, really? So go away and come back with another idea. So I suddenly thought, well, you know, every day one's hearing about ageing. And I had these lovely bits and pieces and I thought, that's, that'll be an easy one. Whoa. No. It was, it was massive once you get into it. I mean, I realised that it's a just a huge canvas. And at first I was very ambitious. I wanted to look at the philosophy of of, whether we want, you know, of longevity and whether we wanted to live longer and and all sorts of things. So I wanted to look at that. And I wanted to look at the demographics and personal things and the psychology and so on. Then I realised that in fact, there's quite a number of books on, could we live to 150? Could we live to 500 years? Could we live to a thousand years and would we want to? And I thought, there's quite a lot already on that, but there's very little that's actually looking inside the body. And I'm always curious about what's going on inside. And getting older myself, you know, I began to get aches and pains and stupid little things. And I thought, what's actually happening? So I took a leaf out of Gunther von Hagens. You remember he did that wonderful exhibition, the body worlds. Have you seen his body worlds?
Dr Rupy: Yes, yes, I have. Yeah, I went, this was when I think I was in medical school in Cardiff. Incredible exhibition. I actually do remember when I watched that for the first time because he did the live autopsy on channel four.
Sue Armstrong: Yes, he did. He did.
Dr Rupy: I don't know whether it'd be allowed anymore now. I mean, this is when channel four was pretty edgy. And he, he inspired, I think, a whole generation of people to go into medicine based on those exhibitions. I think it's still going on, doesn't it?
Sue Armstrong: It does. They're all around the place. And you know, they were, they were very controversial because people thought that it was ghoulish because they were real people. You know, it wasn't just bits of anatomy. They were real people and he'd got this special way of of embalming them, plastination. And it was just so exciting this exhibition. And it made me realise, you know, you've got a pain in your shoulder, you've got a pain in your hip or something. You've got a pain in your kidneys. You don't really, you don't really know where they are if you haven't ever dissected a body. So I thought, well, I'll do the Gunther von Hagens treatment. I'll peel back and have a look inside. And I found it just the most fascinating quest. I really did.
Dr Rupy: Yeah, yeah. I'm just going to grab these chickpeas out because they are just about ready. I don't want to get them too brown.
Sue Armstrong: And how do you tell when, when they're ready? Just a little bit brown.
Dr Rupy: Just looking at them and the smell and just the fact they're a tiny bit brown. And that's all we're looking for with the salad because I want it to be a warm salad. But they look like they've got a bit of colour there.
Sue Armstrong: Yeah, yeah.
Dr Rupy: If you put it in too long, they start popping around your oven and then you've got a whole oven full of chickpeas.
Sue Armstrong: A big cleaning job.
Dr Rupy: Yeah, exactly. Yeah. I remember the, some of my fondest memories at medical school were during doing anatomy sessions because we, we were really fortunate. At Imperial, we actually had our own cadavers that we would share with essentially about 15 of us. And most medical schools have pro-sections, so everything's already pre-dissected. And then, you know, you're just essentially get guided by one of the anatomy demonstrators. But one of the things that we were taught right from day one is to be exceptionally respectful of the, of the cadavers. They, these were real people who'd given their bodies for science. And I guess the same thing could be said of body worlds as well because, you know, people have had donated their bodies for science and that it does inspire the new generation. Even though it does seem a bit ghoulish, it's, you know, reality of life.
Sue Armstrong: It is. Yeah. Well, when I did the pathology book, I actually went to Kentucky to the body farm that was set up by this guy, Bill, Bill Bass. And it was the first body farm where he was putting bodies around in, in sort of in nature to see how a body does decompose when, you know, after a murder or something like that. And I went along thinking, well, you know, he'd take me to his office and we could sit and chat. And he said, no, I'm going to take you to the facility. Oh, wow. And it was wonderful. It was, it wasn't in the least bit ghoulish. It really wasn't. They, as you say, they showed such respect. And these people had contributed so much to our knowledge about really important things. So yeah, I think, I think bodies are really very important things, very, very special things and you have, I have huge respect for the people who are prepared to, you know, aid our knowledge by passing on.
Dr Rupy: Totally. And I think, and we'll talk about it in a bit, but one of the bits where you talk about the Alzheimer's citizen community, essentially people who were responsible and willing to, you know, undergo research, chat to researchers, like the, I think it was the Jenkins family. And they've, you know, they've been pivotal in expanding our knowledge of this horrendous condition that afflicts millions of people around the world. And that needs to be paid a lot of credit to, I think. It's not just about people in labs and doctors, it's actually us as a community.
Sue Armstrong: Absolutely. Well, I mean, look at AIDS as well. Just look at AIDS. It was so much the activists who pushed the science and helped the science and worked with the doctors and so on, the people who really were on the front line. Phenomenal. So I think it's very important actually to get, yeah, to recognise the contribution that ordinary people have.
Dr Rupy: Definitely. Yeah. Right. This is your salad.
Sue Armstrong: Wow, wonderful.
Dr Rupy: Just to recap, we've got the roasted chickpeas with the dukka. We've got tons of things there for your gut health, plenty of different phytochemicals in the greens. We've got some ferments in there as well, a little bit of grilled artichoke and some pomegranates, obviously.
Sue Armstrong: And the phytochemicals do what? What's, what's?
Dr Rupy: So phytochemicals are like my favourite subject. They're literally like thousands of them. I think we've isolated over 5,000 now. And they are essentially micronutrients that we don't recognise as necessary or essential like vitamins and minerals, but they are responsible for different processes including cell signalling, mitochondrial function. They change the function of some of our longevity genes like certain ones and. Yeah. There's some incredible stuff that we know about phytochemicals and that's why it's all about nutrient density. It's about diversity and colours. To to simplify it, you want to get as much complexity into your food as possible. So having two or three different portions of vegetables or fruits at every meal time is one of the best ways you can improve your longevity and overall wellbeing.
Sue Armstrong: So and I mean with the calorie restriction aspect of longevity, they they call themselves cronies now because it's calorie restriction, optimum nutrition. You have to make sure that you get all the nutrients. You know, you're not deficient in anything because that'll, that'll cut off your longevity completely.
Dr Rupy: Absolutely. Yeah, because I remember I think you talked about in the book where it's not just about calorie restriction, it's actually about the nutrient milieu. It's and I can't remember the researcher that you, you probably know, but when you optimise calorie content and the energy density of food with nutrient density, then you can have some potential further benefits, right?
Sue Armstrong: Yes. Yes. Yes.
Dr Rupy: How was your lunch?
Sue Armstrong: It was delicious. Really, really delicious. I I love the smokiness. I love the mixture of things, the crunchiness and so on. And I absolutely loved that. What is it called? The dukka.
Dr Rupy: The dukka. Yeah, yeah.
Sue Armstrong: Really, really good.
Dr Rupy: I'll pack some up for you so you can use that in some of your salads.
Sue Armstrong: Because there's lots of interesting little flavours. There was, there was aniseed and there were lots of things you could identify separately. It was wonderful. Really perks it up.
Dr Rupy: Good, good. And I learned about how to make pomegranate molasses for yourself. So I'm going to be using that in a video later. First of all, I want to, I want to talk about just how important I think it was that you injected a beautiful narrative into your writing behind the laboratory researchers because for a deeply scientific book, it was absolutely gripping. You know, there were stories of lions, story of like, drosophila, the fruit flies with memories. I just thought it was fantastic. And for everyone who's listening and watching as well, it's definitely one of the books that I think was my favourite, one of my favourite reads of 2019.
Sue Armstrong: That's wonderful to hear.
Dr Rupy: I'm glad.
Sue Armstrong: I was, I'll just say, the thing about adding stories to it, I I found this wonderful quote from an American astrophysicist called Janna Levin. And she said, and I saw it in New Scientist and it sprung out at me. I thought, yes. She said, science without storytelling collapses to a set of statistics and a ledger full of data. And I thought that's exactly it. It goes on the shelf and nobody knows about it. And science is so exciting. And the people, you know, they're, they are, they're seen as people just in their white coats just pouring over stuff. They've, what goes on in their minds and their imagination and their ideas are fascinating. And the things that they do, you know, they blow up bits and pieces and as you say, they tame lions, they do all sorts of stuff. So I get the back stories of these people because I like to see what brought them into the field they're in as well.
Dr Rupy: Absolutely, absolutely. And I think it's so important you do that because behind every new character in the book, you do a little bit about, you know, how they look or like, you know, what their colleagues think of them and what their upbringing was and how they went into the field as well because ageing as a, as a research area was kind of, well, it's definitely had a branding issue up until the last perhaps decade or so. Now it's like the new thing to do. But back in the days where people were looking through microscopes in the 1960s and 70s, it wasn't the most attractive. In fact, like you say in the book, a lot of people were discouraged to go into ageing medicine.
Sue Armstrong: Absolutely. They they they didn't think there was a future in it for one thing. But the other thing was it was so stigmatised as being associated with snake oil salesmen and narcissism, you know, people who just wanted to sort of the fountain of eternal youth. And it was pie in the sky. I mean, there were always people who were prepared to pay for that, but that wasn't science any longer. It was myths and and dreams. But so gerontology had a bit of an image problem, but it's it's so exciting. It's making such great advances and so on.
Dr Rupy: Yeah. And there's two things I want to ask you, but I want you to answer them at the end if that's all right. The two things are, do you think that gerontology and the notions that we can reverse and delay ageing is a narcissistic endeavour that is, you know, when people parallel it to climate change, whether that's a good or a bad thing. And do you think lifespan is plastic? I already have an idea as to how you're going to answer those, but we're going to come back to those at the end of this conversation. How do we differentiate real gerontology versus the immortalist sort of brand that it's had?
Sue Armstrong: Well, I think when, when I started out, I thought that the immortalists and the transhumanists, I thought they were probably a little lunatic fringe and I could have a few nice chapters on that. Then I realised that in fact, there are a lot of seriously good scientists who are very keen on that sort of thing. But you can tell the difference because the the the, I mean, gerontology has, it's a very wide field. But most of the people, what they're selling is the idea of increasing the healthspan, not the lifespan necessarily. If you increase the healthspan, sure, you're going to live on to your sort of natural age. But that's, that's not the thing. What they're wanting to do is help people to live independent, healthy lives as far as they can into old age. Because at the moment, you may have two, even three decades of really ill health, which is miserable. So what they're wanting to do is shorten that period and keep people in their own homes so that they drop off the perch having had a good life.
Dr Rupy: Yeah, absolutely.
Sue Armstrong: As somebody said, I want, I want to, I want to die young. I want to die, I want to die young at a very ripe old age. And I think that's, that's the message really.
Dr Rupy: I definitely think that's like the overarching message I got from the book is that's what we should be aiming for considering, you know, the amount of morbidity that we have, the piling off of medical complications and diagnoses that we currently think ageing is related to at the moment, certainly in the NHS healthcare system. One of the thing that I noticed, and I don't know whether it was intentional or not, but you talk a bit about the hallmarks of ageing, the telomerase issues, the protein misfolding, and then essentially the chapters are going into each of those hallmarks of ageing individually and giving the backstory behind that. Was that something that you did intentionally or?
Sue Armstrong: No. It wasn't. I mean, what I normally do is I set off with an idea and I do huge amounts of research. I get very excited by it and then I start to write and it it finds, it writes itself, you know, the story sort of evolves. I think the hallmarks of ageing were very good because they were an organising principle. They were the things because people say, what is ageing? You know, you look at a person, you don't know necessarily how old they are. And so it's it's a bit like time. It's one of those things we all know what ageing is until you try and pin it down. And so those hallmarks pin it down. And I think to that extent, they were obvious things to write chapters about, you know, like senescent cells and like telomeres and all of that sort of thing. They were obvious things to choose, but it wasn't the organising principle I used.
Dr Rupy: Okay. It was the one that was. It seemed like, you know, you took us all on a journey through all these different features of ageing, which I mean, I feel like just having this conversation with you and reading the book, I've learned so much about a field that I never knew existed when I was at medical school. And just the thought that ageing could be seen as a disease that is treatable and have underlying root causes. If we can attach ourselves to trying to think about how we treat those mechanisms, then it reveals a lot of ways in which we can treat other conditions, conditions associated with inflammation, conditions associated like cancer, for example, and the uncontrolled cancerous growths. So that's what I find really interesting about it. So the hallmarks of ageing, I've got them here because I can't remember them, but epigenetic changes, changes in cell communication, inflammation, the build up of senescent cells. Perhaps we should talk about senescent cells. What are senescent cells and why do they occur?
Sue Armstrong: Senescent cells are actually very interesting. They're they're they're one of the hottest fields in gerontology and trying to do something about ageing. What they are is, if you go back to the beginning, you know, how our bodies build themselves and develop and maintain themselves is through cell division. So the cells divide and they create a clone. They reproduce their DNA and they hive off a clone. Now, over the years, because it's happening the whole time, these, it's very easy for our DNA to make a mistake. And so we have a natural limit to the number of times our DNA can change. And when it comes to the end of that, which is measured by various things, which you can talk about. But when we come to the end of that, the cell senesces. It it stops dividing any longer. Some of them, but most of them don't die. They they they stick around. And they gradually, they're there for a little while and then they get cleared away by the immune system. So they're there the whole time. And the very word senescent cells sounds as though this is synonymous with ageing. But in fact, we start creating senescent cells almost in the womb in the development process because it's part of, you know, you need senescent cells to, you need cells to die so that you can clear them away so that you can mold the body and all of that sort of thing. So development is, senescent cells are part of development as well. But as I say, they get cleared away by the immune system. What happens is as our immune system begins to get a bit ropey as we get older, it's not so efficient at clearing away the senescent cells. And the senescent cells stick around and then they start to cause problems because they haven't died, they carry on metabolising, which is burning sugar to create energy. So they go on creating free radicals and damaging things. But they also secrete things into their environment. And this is where the problem lies because some of the secretions from the senescent cells are what they dissolve the collagen. And the collagen is what sticks our cells together and gives us nice springy skin when we're young. And it dissolves that and that's when you get the wrinkles and the baggy bits. So in a way, I mean, they're they're an anti-cancer mechanism because if while the DNA is being copied, you make mistakes, part of those mistakes is what evolution is all about. But you can also make mistakes that can be very dangerous and even lethal. And so you want to stop cells having the capacity to do that, start with new stuff. So that's the thing. So it's basically an anti-cancer mechanism. And the irony is that when these cells leach out, when they leak the stuff into the collagen and get rid of the collagen in places, they leave gaps in the tissue. And sometimes there's little bits of cancerous cells that are hanging around in the tissue kept in check by firm young flesh and a strong immune system and so on. Your immune system begins to be a bit ropey, your collagen is beginning to leave spaces and so on. And some of those cells can grow, which is one reason why cancer tends to be something that spreads a little bit when you're when you're older. So they're very, very interesting. But one of the things I always find fascinating about biology, it's never just a simple, this does this and this does that.
Dr Rupy: That's exactly the point I wanted to to come on to because we make it seem as if it's quite binary. Oh, senescent cells, get rid of those, those are bad. But actually, like you just said, we need senescent cells. They secrete factors.
Sue Armstrong: Absolutely we do. Absolutely we do. And what they found is that one of their jobs is when you get a wound or something like that, they congregate around the wound and they bring in the healing, they they call in the other things to heal wounds and so on. If you don't have senescent cells around, the wound healing is very much slower. And one of the fascinating things is that you look at things like some of these amphibians like the axolotl, you know, which is a little sort of newt thing. Chop off its tail or chop off its arm and it will regrow it again. And what they've found is that the buds of where you get regeneration of these limbs and so on, you get an absolute cluster of senescent cells. So they have got things that are important. But the problem is as we get older that they stick around just too long and they accumulate. They should be recycled the whole time with, you know, with the immune system. And that's where the problem comes. So you don't want to get rid of them altogether. You want to, I mean, some people, I've seen them written about as zombie cells because they do do damage and things. I keep thinking this is a terrible thing to call them because it makes them sound as you say, just a bad thing. But we wouldn't get very far without them.
Dr Rupy: Yeah.
Sue Armstrong: So, you know, so you need to find ways of clear, making sure that they're cleared out fast enough and they're not hanging around too long. Yeah, that's the most important thing.
Dr Rupy: So this is really interesting because I think most people will think about, you know, senescent or zombie-like cells because of the the name that, you know, we should be just getting rid of them. But like you just said, with the amphibians who can actually regrow limbs and stuff like that, they cluster around the limbs and then you have these senescent cells and then they get recycled. So it might be an issue with the recycling of senescent cells. And that again, I suppose goes down to our immune system and the other factors that are responsible for removing.
Sue Armstrong: That's right. Well, that's right. There's so many, nearly all of these systems, you know, so often science goes in, it homes in on a very small area, but you have to sort of stand back and see it. And the reason, you know, senescent cells are fine if they stay, if they stay just as long as they should stay, when you've got a nice young immune system coming along and saying, hang on a minute, it's your time's up and getting rid of them. But if it isn't, if your immune system is beginning to get a bit ropey, can't find its way to the senescent cells and so on. So it's all of these things working together. That's the thing.
Dr Rupy: I love the analogies in the book. Richard Faragher, who who is lectured me on the nutritional masters course that I was on, talks about the immune system of old people like one of those hotlines that you ring up. I just thought that was fantastic.
Sue Armstrong: He made me laugh so much. I so enjoyed interviewing Richard. We, I'd keep listening to my interview and there's loads of peals of laughter because he had these wonderful analogies.
Dr Rupy: Yeah, they're brilliant. The analogy was your young immune system is there to ready and get rid of senescent cells and clear all the inflammation factors, whereas in the old age, it's almost like you're getting through to the immune system hotline and you're told to wait and you're like, the immune system will be with you, just hold on and you're waiting for 10 minutes.
Sue Armstrong: Your call is important to us. Hang on. And then you get some green sleeves music or something and you listen to that for ages. And meanwhile, you've dropped dead.
Dr Rupy: Exactly. Yeah. So the the the slow mechanisms behind the our immune system might be at the heart of why we see issues related to to ageing. One of the thing that I wanted to talk about was um, your meeting with uh, Judith Campisi, I think it was. And um, you've written a whole book on P53. Um, tell us about P53 and its importance to uh, ageing in general.
Sue Armstrong: Well, Judith Campisi was fascinating because um, she was working in ageing science. And um, she was working on senescent cells and at one point, the people working in ageing and the people working in cancer weren't really talking to each other. You know, they were each working in their own sort of silos and they'd have their conferences and so on. And I went to a P53 conference and Judith Campisi was there and she she's the senescent cell lady. Now, as I say, senescence is one of the mechanisms to um, help us uh, prevent cancer. And P53 is a one gene that we have in all the cells of our body and it's a tumor suppressor gene. And it's one of its chief functions is to parole around and see that when our DNA is being copied to um, when our cells are dividing, that the DNA is copied faithfully. And if it spots that the DNA hasn't been copied faithfully and there's a danger there, it stops the cell and it either calls in the repair team or and then it mends it and then it starts, it starts cycling again. Or it um, decides, well, you really are a danger. And so it can kill the cell and it gets the kill, gets the cell to commit suicide, a process called apoptosis. So P53 is there doing this job the whole time. But senescence is the one where it stops the cell cycling and and so, so senescent cells and cells which have stopped cycling and P53, P53 is one of the mechanisms by which stops them cycling. And so these two things were very, very important. And the cancer people who were looking at P53 suddenly realised, yes, ageing is just the other side of the coin. It's the price we pay to keep our cells to to to prevent cancer and so on. So it was fascinating. And I met Judith at the P53 conference and then when I started doing this, I thought, wow, I'll go and see her again. She's a most impressive lady. She really is.
Dr Rupy: The way you describe her in the book as, you know, a very mild-mannered, softly spoken woman. And I remember just thinking, imagining like what she speaks like. And then I watched an interview with her actually with Dr. Rhonda Patrick online. And it's she's exactly how I imagined. You have this crazy ability.
Sue Armstrong: But she's also, she's she's lovely and graceful. She's sort of like a ballerina. She's lovely. She's got this halo of lovely dark hair. She was wonderful. And she and and so bright, you know, and she she just told, she was brilliant at describing how all these things work.
Dr Rupy: Yeah, yeah. And so how does that relate to, I think you remember you're talking about P21 and all these other sort of genes. How how does that relate?
Sue Armstrong: It's all that these, P21 is another one in in the sort of um, P53 is the center of a hub. And what they reckon is, and I don't know whether this is still current, whether this is what they still believe, but it's it's the key tumor suppressor. And so it gets fed signals from above which say, hang on, we've got something bad happening here. P53 goes and has a look. Then it calls in a whole lot of other genes. And if there's something messed up with the network below or the network feeding into it, then you can get cancer. But if P53 is doing its job absolutely right, um, you shouldn't be able to get cancer. But there's all kinds of things in the network that can go wrong and and stop P53 doing things right.
Dr Rupy: Right. We talked a little bit about calorie restriction before. That, I think has hit the headlines and people are generally aware that eating less may be related to increased healthspan. What is your overall sort of message about the whole calorie restriction community? They they sound wonderful, first of all. I remember you talking about the biosphere project with one of the professors who, you know, in the name of science, restricted calories for this incredible experiment in the middle of the Arizona desert.
Sue Armstrong: They didn't intend to do it. They didn't intend to do that. It was just a survival, right?
Dr Rupy: Yeah.
Sue Armstrong: No, well, um, calorie restriction was, um, it has a very long history. It went back, I think it was the 1930s. There was a guy working in, now I can't remember his name. He was an American guy working in, um, the agricultural sector, I think. And he was looking at, um, animal health and so on. But he restricted the calories of rats and he discovered that if he had some rats all in a cage, if he gave them a specific diet, if which was, you know, full of the right nutrients. If you restricted the calories of some and just let others eat as much as they wanted, the ones with very restricted calories, eating an optimum diet but very restricted calories, they lived a lot longer than the other ones. And so he thought this was an interesting thing. And other and it was a flurry of interest and then people didn't get really interested in until sort of 50 years later, Roy Walford, who was the professor of pathology, a very eccentric professor of pathology in one of the universities in California, he cottoned on to this and he looked at it. And people by that stage had found that if you calorie restrict a worm, one of the little, you know, the model organisms that they use in labs, the worms, the mice and the fruit flies and so on. You made a huge difference. With the worms, you could increase their lifespan tenfold. With the flies, they could do it fivefold, I think it was, or or twofold. With the mice, it you could give them an extra 50% life. And they did it also on macaque monkeys. But Roy Walford wasn't waiting for the macaque monkey research. He said, you know, what works for mice and rats and all these other things, I'm sure it'll work for me. So he started restricting his calories. And he went around with a very, very low calorie diet and very aesthetic and so on. But then he was asked to be the um, medical officer on this experiment in the Arizona desert where they built a sort of terrarium and it was supposed to be a self-sustaining um, ecosystem and it was supposed to mimic what it would be like to live on Mars or live on the moon or something terrible like that. And the systems were all supposed to feed back loop and they grew their own food and they, you know, they had, um, they breathed, they got some animals in there, but they had plants which would change, you know, take in the CO2 and so on. So it was all supposed to be self-sustaining. And of course, it didn't work out like that. They went very short of oxygen down to about 14% of what they should have. So they were all a bit scratchy. And their food, they weren't very good at producing their food. And so they found themselves, Roy Walford had to restrict their calories very much. And there's a wonderful picture of them that I found where they're all sort of pouring over this very, very depleted looking dining table and thinking, what can we eat? And they're all very thin. So it was a, it was an enforced experiment. And but what he, he then sort of checked their physiology and he said it was absolutely fascinating. He found very much the same thing that they'd found in the rats and the mice and the worms and so on. That all kinds of measures were really, really good. Their their sugar control, their, um, just lots of things were really good. And so he reckoned this really worked. And Roy Walford wanted to live to 120 years, but terribly sadly, he got motor neuron disease and he died in his mid-70s. Anyway, so he was the sort of poster child for for um, calorie restriction. And now there's a huge community around the world, not huge, several thousand people around the world and they all eat very little. I mean, they they call the cronies, is that?
Dr Rupy: They call the cronies.
Sue Armstrong: Calorie restriction, optimal nutrition. But I interviewed one over Skype in California. And I thought it was going to be a dreary interview. I thought, you know, he'd be a, he'd be a bit of an evangelist and so on. He was wonderful. He was terribly funny. He didn't take himself too seriously. And I said to him, you know, it's not a very social sort of thing, a few lettuce leaves and a bit of lemon and so on each day. Um, have you made friends? And he said, well, I I lost quite a lot of them because he said, I was an evangelist at the beginning and I would bend anybody's ear and he said, I, you know, a lot of them sort of crept away. But he was very funny. But he'd been doing this for some time. But um, just just before I interviewed him, the results from the monkeys, the macaque monkeys came in. And of course, macaque can live to sort of 30 years. So it was a very long time they um, they needed to do the experiment to see whether it actually increased their lifespan. What they found was the bad news was it didn't increase their lifespan. But it did increase their healthspan. They they fell off their perch at the very end. And the same with the flies, very often, or or the mice, very often, they died at a ripe old age, you know, sort of maximum lifespan, but not more. Um, they died at a ripe old age. You couldn't tell what they'd died of. There was no pathology. So, you know, something had gone. Maybe they'd run out of stem cells or whatever. But um, so he thought this was really, really good news. So the guy that I interviewed in California, this was just before um, Thanksgiving. And he said he was going to enjoy Thanksgiving this time. But he was going to keep lowish calories, but because what they discovered was, uh, you don't have to eat a really spartan diet, but you need to be careful of your calories and so on. But it doesn't need to be sort of half starvation type thing. So he could let up a little bit. But so, so just looking at your nutrition, and you love this message, looking at your nutrition, making sure you get the right things and not too much of it. Don't overload your system with having to sort of detoxify and get rid of too much stuff. Um, works wonders and you can it really makes a big difference. So that's where you get the biggest bang from your buck. Good nutrition, um, moderate portions and so on, but not, not too spartan. So you can enjoy yourself.
Dr Rupy: What what's become quite popular in the fasting community, I think, or just generally people who are biohacking or try to optimize their nutrition, are three levers. I'm quoting Dr. Peter Attia, who's podcast I listen to religiously. Uh, of calorie restriction, dietary restriction, and time restriction. So calorie restriction will be energy control. Dietary restriction would be, you know, not eating crap food, basically, high poor quality fats and um, in some cases, yes, lowering refined carbohydrates, etc. Uh, but there's also time restriction, which goes on to circadian rhythm disruption. And I find that super interesting. Have you looked into that much or?
Sue Armstrong: I, well, I, I, I tripped across that while I was doing the research because, uh, there's, um, an Indian, uh, neuroscientist, actually, he's a gerontologist at the Buck Institute in California.
Dr Rupy: Dr. Rao.
Sue Armstrong: Yes, Ram Rao, wonderful. And he was telling me all about this and then I read up quite a lot about it. But he's very strict about that, that you should not eat, you should have sort of eight hours between your last meal at night and your breakfast and so on. And you should keep to some of these things. And you shouldn't have your big meal at that stage. But um, and I was very interested in that and I've read quite a lot about that. And the same thing with the guy who is actually managing to have some effect in treating Alzheimer's. But it's terribly difficult to follow. It really is. It's a lifestyle change that I have found too difficult because I tend not to stop till quite late in the evening and I like, I don't like to have a big meal at lunchtime particularly.
Dr Rupy: Yeah, yeah. I think that would be quite off-putting for most people who, you know, will live a lifestyle which involves office work, which involves not having a kitchen in the middle of the day. I'm very lucky to have one most of the days when I'm not working in A&E. Um, the the general sort of advice that I give to people is to eat in a general window. And that can be starting off with 12 hours if you like, or 12 to 13 hours. If you start eating at 8:00, then finish eating by 8:00 p.m. or 9:00 p.m.
Sue Armstrong: Really, that's what you suggest?
Dr Rupy: Yeah, as a general rule of thumb. And what that does, I think, inadvertently is just makes sure that people aren't eating out of boredom. Because if you're sat in front of the TV and it's 9:00 p.m., feeling peckish, you've had dinner maybe an hour or so ago, you're going to reach for the popcorn, you're going to reach for the sugary snacks and stuff. If you know and you're strict with yourself about, okay, well, I'm not eating now, then it probably reduces your energy consumption. So inadvertently might be having those effects. But I think there is definitely something in time restriction.
Sue Armstrong: Absolutely. There's there is a synergistic effect between those three elements. Absolutely. There's no question of that. At least from what I've read and from what I've heard. But as I say, I find you with all of these things, um, the messages are things that we've heard over and over. The same with exercise and so on. But what I found interesting when I was actually looking at it is we hear these messages and there's so much noise, they get contradicted and so on. What we don't often hear is the biology behind it. And that's what I was really looking at. So I was looking at the biology of the calorie restriction. I was looking at the biology of um, exercise as well. And it's not just building up muscles, it's keeping your immune system healthy and all of that sort of thing. So there's a lot of, you know, sort of, ah, that's why I've been told to do that. That was the message that came out.
Dr Rupy: And it was really interesting the bit about Dr. Rao because he's trained in Ayurvedic medicine, which I need to, I need to look into a bit more. It's definitely my heritage. It's definitely something that influenced me um, through my mum when I was overcoming my own medical issues that we spoke about before. Um, but a lot of the principles within ancient medicine, I think are sort of coming full circle where we're beginning to understand what we knew intuitively perhaps thousands of years ago, which I find quite, it's just interesting. It's like.
Sue Armstrong: It's fascinating. It really is. And it's interesting what Ram was telling me. He got really sort of um, excited about the whole thing because he realised I was very interested and I am interested because I come from a very medical background myself. But my dad years and years ago started talking about holistic medicine. It was always with in inverted commas because it wasn't a mainstream thing then. And this was looking at how everything works together. And at that stage, I had just given birth to to babies and I had done some psychoprophylaxis, which is trying to ease, deal with the pain without taking lots of gas and air and lots of pethidine and things like that. And um, and it was brilliant. And I was so skeptical beforehand. I thought this is a load of baloney. But I went along with it, you know, having a little giggle behind my hand, me and my husband at the sort of evangelist who was teaching us this stuff. And it worked like a dream when I came to the actual childbirth. And so my dad got very interested in that and meditation and so on. And so he started to suggest meditation to his patients and things too.
Dr Rupy: How progressive.
Sue Armstrong: So this was a long time ago. So I'm interested in um, some of the things which, not everything, absolutely not everything. And I'm sort of super skeptical of just embracing them all and dismissing uh, rational, scientific medicine, um, Western medicine. Um, but I think one needs to have an open mind. And the interesting thing about Ram was he said that at first his wife, they moved to California and she couldn't get satisfaction for her health problems. So she wanted to go to an Ayurvedic doctor. And the Ayurvedic doctor said to her, said to Ram when he came along with her, you should study this. He said, no, no, no, no, no. I'm a neuroscientist. I'm a Western trained. No, no, no. And then he said, well, we've got a course at the weekend. Why don't you just pop along? And he popped along and his mind really opened. But he and this other guy who was also one of the top gerontology neuroscientists in the States, I think he'd been the director of the Buck Institute of Ageing at one point. He got very interested in this and he found that when he started talking about this sort of thing, you know, it was really difficult to get funding for it because it's seen as fringe and it's it's seen as snake oil stuff. So again, you're up against this sort of stigmatized thing. But personally, I haven't anything to lose by keeping my mind open. Though, um, I think you can go too far.
Dr Rupy: Yeah. And I I I totally agree.
Sue Armstrong: You have to you have to keep your critical faculties, but don't close your mind to it completely.
Dr Rupy: Definitely. Yeah. And I think I think that's incredibly progressive of your father because we're talking over lunch about how he was a tropical medicine specialist and then went into general practitioner um, thereafter and your experiences in Sudan and all these different places around the world. Um, but for for someone back then to be talking about meditation and these holistic practices, I mean, that's incredible.
Sue Armstrong: It was. It he he he was that sort of, he had that sort of mind. He was very curious about all sorts of things. And you know, um, I think one of the things that you probably find this very much as a GP, that it isn't just the science. I remember my dad actually wrote an article and I was at WHO at the time. And we used to get articles that had been in the paper and so on and put them in the journals. And my mentor at WHO would gather these things. And he took this article by Dr. Peter Abbott and he said, look at this, there's a fascinating article written about the art of medicine. And um, he said, I think we should, we'll write to the author and see if we can put this in our journal. And I said, I'll write to the author. I said, I'll phone him if you like. And it happens to be my dad. Because it really was about what does the patient feel is wrong with them? What, what, what are their beliefs about all this sort of stuff and so on. You need to, it needs to be a dialogue, a real dialogue with the other person's superstitions or understanding and all of that sort of thing. So Dad was really into the art of medicine as well as the science.
Dr Rupy: That's amazing. I've definitely got to read that. And um, if I haven't come across it, it sounds something that I may have already read maybe a few years ago. Um, but that that brings me on to a point actually about um, pediatrics. Um, I'm taught by some of my really respected colleagues in pediatrics to trust the intuition of the parents, the mother. If they know that there's something wrong with the child, don't brush it off. It's not always, the child could be presenting and they might, they might look fine to you, their observations might be, but there's something off, just look into it a little bit. You never know, there could be something there. And I think it's the sort of like intuition that we can't quite tangibly quantify, but we should respect.
Sue Armstrong: Absolutely.
Dr Rupy: And that that really does speak to me even in clinical practice in A&E as well.
Sue Armstrong: In everything, and geriatric medicine and gerontology or, I mean, right the way through, if if the people who know a person very well are uneasy about something, it's worth listening to them until they become a real pain in the backside. And that brings me to a point about um, so there's two things I want to talk about, nutrient sensing genes that we'll talk about in a second, but the story about the patient with a Wegner's, um, Werner's, sorry, the the condition where they age very young.
Dr Rupy: Werner's, sorry, Werner's. Yeah, I'm thinking about something completely different.
Sue Armstrong: Werner's syndrome.
Dr Rupy: Werner's syndrome, um, and how, I think it took him till his 30s to get the diagnosis.
Sue Armstrong: Terrible, terrible, terrible. Yes. I mean, Werner's syndrome is a is is really, really sad. It's one of these um, uh, premature ageing conditions. And literally, you you start to get all the sort of symptoms of ageing, not all of them. This is why it's just, um, you get a lot of the symptoms. You start to get arthritis, you start to get heart problems, you can even get sort of dementias and things like that very early on. And um, but this guy that I met with Werner's, uh, he said that he he he loved to run. He he was a, he loved to do sports and so on, but he'd get absolutely crippling things with his knees and his joints and so on. And he had a whole lot of, and he had diabetes as a very young person. Nobody, you know, whenever he went for checkups and so on, they would, he'd go to a rheumatologist or he'd go to a dietitian or something, all of these different people would know, would find something wrong with him and they'd give him, tinker around with bits and pieces, but he could never get satisfaction. But he went to a doctor at one of the, um, at his business, at his workplace, they all had a, um, an MOT from some doctor. And she was just very wise and she said, I wonder if all of these things are related, if the, if we're on to something here. And sure enough, and I can't remember exactly how he found out. I think he had to have, um, he had a gene test, yes. And they, and they found it. But, you know, too often that's the, that's the story. It's they're focusing on an individual symptom and not seeing the big picture.
Dr Rupy: It really did resonate with me because I think that spells out a lot of what we do wrong with modern medicine. There's a lot of things that we do right. I'm not discrediting that at all. But what we do wrong is siloing symptoms and giving individual diagnoses as if that's going to change it. And I think I remember from the chapter, you know, he got the diagnosis and was like, oh, and there's going to be something that we're going to do about it, right? But actually, it comes down to this issue of treating ageing like a disease and we don't actually have that many treatments. We just treat things individually. But um, the issue about treating symptoms in isolation, I think is something that that mars a lot of what we do as Western medical practitioners. Um, and for someone to have waited that long, it leaves a bit of a bad taste in my mouth.
Sue Armstrong: It does. It's terrible. And I think, I mean, one of the fascinating things about, you know, he had a lot of the different um, facets and the pathologies of ageing. And so they were all looked at separately. But actually, to a great extent, that's been one of the problems with geriatric medicine. You've got the person who'll deal with your Alzheimer's, the person who'll deal with your diabetes, the person who'll deal with your heart, the person who'll deal with your joints, the person who'll deal with your bones, not looking at them all in one. And one of the biggest messages that comes out of my book, which I found absolutely fantastic, was that the single biggest risk factor for that whole panoply of geriatric diseases is the ageing process itself. So if we can come, they're the branches of the tree. The roots of the tree are the ageing process, your immune system that's getting old, your senescent cells that are accumulating, the inflammation in all sorts of things. All of these things. So if you can treat, if you can find a way of slowing that process or ameliorating that process, you can actually affect all kinds of things. And that's what comes, you you mentioned earlier something that I know will probably set a lot of your listeners really their their teeth on edge when you say, you know, ageing as a disease because we're all getting old and it's terribly stigmatizing and it's inevitable. You cannot stop time. But what you can do is perhaps slow the the process itself. But it's very provocative, the very idea that ageing might be a disease. But when you recognise that it's the root cause of all of these other things and that if you can do something about the root cause, you can actually prevent or ameliorate a lot of the other things, then it makes sense to look at it as a disease process in its own right. Because up until now, um, pharmaceutical industry isn't interested in an anti-ageing pill because so what? It it sounds like it's just a sort of cosmetic thing. But if you can label this as, if if this is something that the NHS says, yes, well, we can do something about it at this stage. If it's, if it's labeled as a disease, it's then something that's worth intervening in. And big pharma are the only people with the clout to actually go after those kind of drugs. So, you know, it's it's a double-edged sword. I hate the idea of pathologizing old age or medicalizing old age. But if it's going to um, release the log jam of people wanting to actually translate what they've learned about gerontology into something that's going to affect all those or prevent or ameliorate those other diseases, then it's worth looking at how, how we call it and whether it is a process that we should be intervening in.
Dr Rupy: There's so much of that I really want to unpack because I think right at the start of your book when Richard Faragher is talking about the amount of money spent on ageing as a or issues with ageing, it's it's pitiful considering the amount of money that we spend on treating illnesses of old age.
Sue Armstrong: Pitiful. It's pitiful. Isn't it something like, what is it? Is it a third? Is it it's nearly a half of of the of the um, NHS budget goes on people over the age of 65. So you've got this massive need and we're we're people haven't, the policy makers and the funders haven't cottoned on to the fact that this is where the research needs to be, not on each of the individual pathologies, but on the root cause.
Dr Rupy: Yeah. And dig a little bit deeper and this is what I'm so passionate about food and we really should be looking at our lifestyle and food as medicine because medicine being the um, use of interventions and substances to prevent as well as treat illnesses. Um, we really need to be looking at the foundations of how we actually uh, prevent a lot of the illnesses that are burning our healthcare systems globally, not just in this country. Um, I want to go on to back to calorie restriction because it brings me on to the topic about nutrient sensing genes. Um, I think it's become quite fashionable to talk about Foxo and uh, the other nutrient comes from the DAF2 gene that I think was isolated in the worm. But uh, tell us about Foxo because I find that whole, that whole uh, area of nutrient sensing super, super exciting and the different lifestyle factors that we can do to turn on these nutrient sensing genes.
Sue Armstrong: Well, Foxo is a very big part of what's called the nutrient sensing mechanism. And just in its simplest way, it this is, its job, and I'm not sure that it's Foxo itself, there's a whole lot of them and I can't remember exactly which gene does what, but it's part of an absolutely crucial nutrient sensing mechanism which is always looking to see what fuel comes in and how best to spend it. And this is why um, this is one of the things they think is so important in calorie restriction that they reckon if you've got um, a low, low amounts of fuel coming in, then your body will say, well, we ought to divert this towards maintenance and um, upkeep of the body rather than laying down fat and that sort of thing. So this is super important. And yeah, so basically, it's a, it's a mechanism which will allocate the resources as they come in. And it's just crucial to everything. Everything we do, every way our body works goes through that system and it gets, you know, its own resources allocated by that system. So it's very, very important. But as you say, um, when they were looking at the genes which do increase longevity, the longevity genes, there was one or two of them, there's, yes, DAF2 and there's one which they call age one, the first one they found, which they tinkered around with that and they found they could increase the um, lifespan of worms and so on massively. And people got very excited by that because they realised that it's not just wear and tear, which a lot of people had just thought um, ageing was a question of we've been around a long time, you know, buffeted by the weather and the what we eat and stress and all sorts of things. That's what ageing is. But they realised it does have um, there are a lot of genes sort of regulating it as well. And that was and when they tinkered around with some of those, just some individual genes, they managed to make huge differences in these animals. But then people sort of step back and they see this comes out in the media and they think, oh wow, can they do that for humans? Well, you can't do exactly that, just tinker around with some of these genes, even if we've got the same ones, you can't tinker around with your age one and keep you going to 500 or whatever.
Dr Rupy: Yeah. Or 10 times as long as you might live.
Sue Armstrong: Yeah, yeah.
Dr Rupy: And I think it's quite fashionable to think, oh, if I just upregulate this particular gene, whereas actually in reality that I think you said in the book, there's over 300 different genes that are related to lifespan.
Sue Armstrong: Well, that's, that's the thing. But they reckon that um, 25 to 30% or something of your lifespan, your natural lifespan is, you know, down to the genes and the rest is uh, you know, your environment and the interaction of your genes and that sort of thing. So the genes do have a role to play, but so many things have a role to play. That's that's the truth. But this nutrient sensing mechanism of which Foxo is a massive part is one that they really, as you say, they're focusing on some of those really important genes in that.
Dr Rupy: One thing I I find quite interesting about the whole lifespan gene theories, not theories, but you know, that the whole nutrient sensing mechanism is that in reality, they only represent sort of 20%, I think, of lifespan, whereas the rest of it is all about your lifestyle, which makes me quite excited because it's not as if your lifespan set is set from birth as we were sort of led to believe when we were, you know, we just encoded the human genome. Um, there's a lot that we actually have within our control using things like calorie restriction, some other elements of lifestyle that we'll probably go into later.
Sue Armstrong: Absolutely. But this whole debate about um, our maximum lifespan. Yes, our genes give us, you know, if you come from a family of of long-lived people, it tends to be you've got the genes um, are working in in in your favour. But um, there's a huge debate as to whether there is a natural limit. And you know, there was this woman in um, in France, Jean Calment or whatever her name was, who died at 120, 126 or something. And they reckon that was the upper limit. And there was big debate about if you keep the body healthy, can you go on a lot longer than that? Can you over not override it, is is that really the natural lifespan? And no, it it hasn't been resolved. It really hasn't. There are people who are passionately think there is an there is a maximum lifespan and there is and people who think that no, if we can easily override that by lots of healthy health and all of that sort of thing.
Dr Rupy: Yeah, because I remember you go into the arguments actually back like, you know, I think it was in the 1950s or you'll probably be able to correct me, about how we used to think if you give a cell a perfect environment, a nutrient dense medium, you can allow them to live indefinitely. But actually, that's not the case. And there is a set point, isn't it? I think we.
Sue Armstrong: There is, yes. Yes. Now that, that's actually a fascinating story. And because, you know, okay, there's a lot of um, hocus pocus in in uh, you know, Eastern type medicine or this is what people are worried about. There's a lot of hocus pocus in all sorts of things. But there are also lots of little dogmas in science and in medicine. And one of them was Alexis Carrel, who won a Nobel Prize, um, and he was a, he had ostensibly kept the cell from a chicken heart alive in a test tube or in a petri dish for years and years, for decades. That's what he said. And so the the the the the idea grew up, the dogma grew up, the received wisdom was that these cells will go on and on. They they divide, you know, they were dividing and dividing and dividing. They were dividing cells, that they will go on dividing forever, as long as they've got the right temperature and the right medium and so on. But what, then you got this guy, Leonard Hayflick, who came along and he was a cell biologist and he was working in Philadelphia. And he was a really seriously good cell biologist and he was creating cell lines for that they were working on vaccines for viruses. And he noticed in his lab that all of the cells, they would go for so many cycles and then they would stop. And he did this and did this and did this and he said it looked as though this was a natural thing. He was doing nothing wrong with his um, uh, medium or anything like that. So he started to get really interested. So he put out this paper that cells have a natural lifespan and then after that they will stop dividing. And this was such um, a challenge to the dogma. But what they discovered, he turned out to be absolutely right, but he couldn't get his paper published for a long time and then in the end he did. And of course, it's now well known that the cells do have a finite lifespan and they do then senesce. Um, but what, what, what, what they discovered was when it finally did come out, what had happened was the Alexis Carrel, of course, was not um, doing all his own experiments. He'd got this team of lab technicians. And apparently, they were finding their cells dying after a certain time and they thought, oh shit, you know, this is not what's supposed to happen. I must have done something wrong. I've got the temperature wrong or I haven't put the right medium in. So they'd just change the cells and go on and on. And Alexis Carrel would come in and look and just assume it was the same cell. Just hadn't dared admit it.
Dr Rupy: So the laboratory staff were literally changing.
Sue Armstrong: They were. Yes. But I presume they were doing it individually rather than saying to their pals, I've done this because they thought, you know, I've slipped up so they didn't admit it. And then Leonard Hayflick came along. And the great thing is now it's recognised that cells have that and I think they have varying ones depending on the different tissues and so on. But this is known as the Hayflick limit. They reach the end of that Hayflick limit. And that's where people then say, well, how does it know when it's come to the end of the limit? And that's where you get your telomeres.
Dr Rupy: Yes, yeah. And that brings us beautifully on to your incredible interview that, did you meet Elizabeth Blackburn?
Sue Armstrong: I didn't. I didn't meet her. No, unfortunately, I didn't. There was one or two people that, you know, I couldn't get around to see them all. But there was lots of material because she'd won a a um, Nobel Prize. And the Nobel um, site on the website is wonderful because you have a wonderful biography, you have interviews with the people, you have their speech to the Nobel people. So it's really super good.
Dr Rupy: But people then said, well, how would a cell know when it had reached the end, when it had reached the Hayflick limit?
Sue Armstrong: And what we've got on the end of our chromosomes is these little um, things called telomeres. And they're, they, somebody has described them as like being, being like um, the caps on the end of shoelaces. They're little caps on the end of your chromosomes. And every time your DNA um, copies itself, a little bit of this gets chipped off and the telomeres don't get copied, they get chipped off. And when they get too short to protect the chromosome adequately, then the cell knows it's time to senesce and so it doesn't divide any longer. But then people were wondering, um, what it is that keeps the telomeres going and and all of this sort of thing. And Elizabeth Blackburn was the person who found this. And this was absolutely fascinating because then they found an enzyme that um, will, that you can repair the telomeres and so you can ostensibly override the senescence of cells with this stuff. So, you know, all of these little bits and pieces come into the picture and it's just fascinating. And that's what I love about following these stories. You find yourself thinking, well, I wonder how that works and why such and such. And then you, you get the opportunity to go and speak to these people or phone them or read about them and so on.
Dr Rupy: Totally. Yeah, because like the way the story, it feels like a story because you've written it as almost like it's this novel and you're discovering things and it's fantastic. But if someone was just going into, you know, doing a Google search on anti-ageing, they probably wouldn't find out about all these different things that feature into the whole, the root cause of what actually is leading to ageing.
Sue Armstrong: No, they wouldn't. I mean, there's there's lots of stuff about, um, there's probably stuff now, quite a lot of stuff about what they call senolytics, which is drugs to get rid of the um, senescent cells and so on. Um, because that, that is a really hot area. But what they've managed to do is Richard Faragher, who you've mentioned several times, he and um, his wife, Lizzie Osler, and another person, I think Lorna Harris, down in another university, they were working on a drug which can tinker around with the senescent cells and what makes them senesce and all this sort of thing. And just, just tinker around so that you can get rid of some of them or get rid of the ones that you don't want and this sort of thing. Absolutely brilliant. So there are lots of little things coming along in the pipeline. But but not sweep away the whole lot, not just, you know, cleanse your body of senescent cells or something.
Dr Rupy: Exactly. Yeah. It's almost like you might need to, you'd have to think about how you dose and actually how you intervene and introduce these different chemical compounds because, like you said, a senolytic, getting rid of every senescent cell in your body is not a good thing. It's almost like you might need to cycle them. And the same thing with calorie restriction and fasting, people don't really know how to use this as a clinical tool at this point because there are so many different, there are vast different effects depending on the person, their background, their genomic history.
Sue Armstrong: Well, absolutely. I mean, the thing as you'll have found with nutrition is that it is so difficult to control for because what you eat and and its its relationship with exercise and so on, it affects everything in the body. So to actually pinpoint what's gone in and where it's gone and what effects it's had is so, so difficult. So, so yes, so these, these are, these are really, really difficult areas of science. But what they're trying to do with the senolytics, I mean, with the calorie restriction is find some sort of drug which they can use instead of restricting calories. But I mean, you know, to a certain extent, I'm sure it could be useful. I'm sure it would be very useful, but it also seems like the lazy way around, you know. You can eat, eat all these cream cakes and you can, you can pig out and then just take a pill and it'll sort out your nutrient sensing mechanism or whatever.
Dr Rupy: Yeah. It's one of the mechanisms by which I think resveratrol is purported to work, right, as being a calorie restriction mimetic, I think is as it's described. And I think early on, it was thought not to have efficacy, but now there's a resurgence in the research that's actually proving, you know what, it could actually mimic calorie restriction to the point where it could be a supplement to take. And I know a lot of people prior to the research actually, you know, being founded and actually saying definitively, yes, it might have a use in most people, are using it. And perhaps safely, I'm not too sure what the side effects are of high dose of resveratrol. But you certainly can't get it from dry peanuts and wine in the doses that we're talking about, right?
Sue Armstrong: And and and dark chocolate.
Dr Rupy: And dark chocolate as well. Yeah. That brings us on to, so the the the difference in um, what clinical effect there is is based on your your culture, your ethnicity. And you describe that a bit in the discussion around Alzheimer's and inflammation. So there's that the community of Tsimane, I think they're called.
Sue Armstrong: The the the the Tsimane people in in, I think it's the Bolivian Amazon. Absolutely fascinating because, yes, they've found, I mean, the brain and Alzheimer's is still a huge black box. I mean, they've, as I was saying earlier, they've made huge advances in understanding the brain and knowing what the brain does, but there's still huge bits of the jigsaw missing. And so we haven't really got to the bottom of Alzheimer's. But what they've found, they have found that there are risk factor genes and there's one called APOE4. And we have APOE several versions of that. And there's E2 and E3 and E4. E4 is the bad one. And they reckon that um, increases the risk of Alzheimer's, I think up to 12 times or something. It's quite a nasty one. But this is and they found, you know, this is where suddenly they suddenly realised that their research has been focused on white males, not so much on women, not so much on other ethnic groups. And they found among the Tsimane, it's actually protective against Alzheimer's. They found the same or against dementias of any sort. They found the same, it's got very much an ethnic thing. They found the same, it doesn't have the same risk factors in or the risk um, profile in Nigeria. So all kinds of things, which is really fascinating. So they looked back and they thought, well, what is this all about? And they reckon that this gene might also, because one message that has to come across is that one gene doesn't do one job. Genes can do so many different jobs. They can produce so many, depending on where they're switched on and when they're switched off and all that sort of thing. They've got lots of roles. And so you look at one and you say, like with P53, this is a tumor suppressor. It's doing lots of other things as well. And um, APOE4 is doing a lot more than just increase your risk for Alzheimer's. And one of the things they find is that it's probably very good for if you've got um, intestinal parasites and that sort of thing, it's protective against those kind of things. So that's why it's persisted in some of these communities. So there's all kinds of really interesting things. So it makes them realise that you you need to um, broaden your research base of who you're doing the research in, who and yeah, women, there's a gender effect and there's an age effect and there's a um, ethnic background effect in a lot of these things.
Dr Rupy: Yeah, there's definitely like an underrepresentation across the board with different ethnic backgrounds and that, you know, if we didn't do research there, we wouldn't understand or find out about the Nigerian paradox, which I find fascinating. And I think, you know, just labeling APOE4 as an allele that we know is bad, it's again, it it appeals to that sort of reductionist mentality that we need to get rid of in science.
Sue Armstrong: And it's one of the things that's quite dangerous when people have their genomes read. You know, somebody will come along and say, oh my God, I've got APOE4. Um, I'm at such and such a risk. And it's not quite as simple as that. It really isn't. It's not, it's not, you know, as most of the time, your genes are not your destiny. They're, they're, they they may play a very big role. There are certain genes like the familial Alzheimer's, the Alzheimer's that runs in families, the hereditary type. That does seem to be, it is your destiny. If you have the mutant gene or the that version of the amyloid precursor protein, the APP gene, then, you know, you're going to get it at some point, which is pretty sad. And there are one or two genes that really are nasty like that. But most of the time, it's not your destiny. There's lots of little things can be done to.
Dr Rupy: Yes, yeah. There's, I think there's only, there's around a hundred or so genetic mutations that definitely lead to a phenotype, so a physical attribution of the genetic makeup that you have that will essentially determine, they're deterministic genes, whereas there are, I don't know how many, but there are plenty more snips or single polynucleotide polymorphisms rather, that will lead to variants that in some cases you can change with your environmental influences as well that's under your control. Um, one of the things that I wanted to talk about was um, you're meeting with Dale Bredesen who uh, is a is a colleague I've met him a couple of times in the sort of functional medicine community. I think his, he was the guy who was the head of the Buck Institute at one point.
Sue Armstrong: Oh, he was. There you go.
Dr Rupy: He was the one that Ram Rao spoke to and he was one of the people who didn't say to Ram, you know, you're barking mad. This is all your Eastern um, nonsense sort of stuff. And he listened and he went, he read Rao's books and was bowled over.
Dr Rupy: Yeah, absolutely. And I think his wife or partner, I think she practices with that sort of Ayurvedic mindset even though she's conventionally trained as well. Um, he again was someone who's like a hard-lined 40-year career history of being a, you know, conventional neuroscientist who's now come to realise that Alzheimer's and perhaps even ageing on a grander level has multiple factors that we need to consider when it comes to treatment. And we can't think of this, you know, singular paradigm of one symptom or one illness and one set of treatments. It's actually looking at the whole thing.
Sue Armstrong: That has to be one of the really biggest messages that comes out of this whole field. And it's a very strong message in my book. It really just rises out of the book that that's absolutely so.
Dr Rupy: Absolutely. And so from from everything that you've sort of gathered over the extensive, I mean, it must have taken you, how long did it take you actually? This book?
Sue Armstrong: It didn't take a hell of a long time. I mean, when I work on these things, I just put my head down and I get mega fascinated by it and then. I think it took me two years.
Dr Rupy: Two years. Okay. Well, that that's a long time for me anyway. Yes, it wasn't a few months. Um, out of everything that you've learned, what do you think about those two questions that I asked you at the start? So is, you know, uh, ageing um, is it a narcissistic endeavour? Uh, and is lifespan plastic? And if so, what can we do about it?
Sue Armstrong: Okay, is it a narcissistic endeavour? I think, um, it absolutely isn't a narcissistic endeavour. And I think we've got to forget that side of things. There's certainly that um, there are a lot of people who actually are really interested in um, pushing the limits and um, living for, you know, maybe five centuries or whatever. The immortalists and also the transhumanists who think that maybe we can download our brains into computers, get rid of these pesky bodies and so on. That is the sort of lunatic fringe, but there are a lot of people doing that. And if that's your your thing, then, you know, you can run with it. But and that I do find narcissistic because we've got too many people in the world already. It has massive implications for everything, for the dynamics within families, for um, who's going to, you know, working environments, resources, everything. So I do find that narcissistic and particularly because, you know, having done the travelling I've done around the world, there are so many other things that need fixing in this world. People who are starving, people who are terribly poor and all of this sort of stuff and drought and so much that we could put our very good scientific minds towards. So I think that just to look at, oh, I don't like the idea of dying, I must preserve myself. I find that really off-turning. But the search for um, increased healthspan, I think is absolutely massive, not just important, it's vital. We can't any longer afford the cost of the NHS, the cost, we don't know how to care for everybody. We just don't. So the more we can do to keep all of us, ourselves, healthy right up to the last few years, hopefully, and independent, that has to be just a wonderful thing. It really does. And certainly it's something I want. And you say, is is it going to be possible? Um, yes, there's massive amount. What one of the things, um, the genetic studies have been fascinating and they have, tinkering around with these genes, they've shown that you can do a massive amount. The, I think the biggest message that comes out of that is not, oh, we've also got age one and Foxo and all this sort of thing and and DAF2, we can do things with them. What those research, that research says is this is something which is malleable. It's plastic as they say in inverted commas. You can do something about it. So with that knowledge, then it's really important to try and do something. And as I say, Richard and his colleagues and a whole lot of people are getting, getting places with helping to clear away the um, excess senescent cells. But another very big thing, you know, this exercise thing is hugely important. And one of the things I found interesting was there's, and this is again a lovely little story, in our bloodstream, one of the first responders in our immune system when something is wrong in the body is your neutrophils. And they're going around in your in your um, blood system and they hear ding ding ding, there's something wrong, there's a microbe on board. So they literally push their way between the cells and they go off to find this thing and engulf it and that's it. And then they call in all sorts of other players in the immune system. Well, as you get older, these things lose their sense of direction and they go blundering on, where did I hear that? Where did I hear that? Literally making trouble for things. And the lovely thing is, I I gave a presentation the other day and I looked up and I found this on the internet, a picture of a neutrophil coming out of the bloodstream and going to find a a microbe and engulfing it. Oh, and I thought this is absolute Christmas. So, you know, and that's happening in our bodies the whole time. But as we get older, they get bad at doing this thing. But what they've found is that, so our immune systems are getting elderly. What they find is sitting, sedentariness is really, really bad because our immune systems, our um, sedentary muscles, muscles that aren't moving, keep on pushing out little triggers to the immune system, pro-inflammatory signals saying, come here, come here, come here. Um, even just standing up, putting weight on your muscles, counteracts that. It sends anti-inflammatory signals. So you need to be getting up, not sitting at your desk the whole time. And one of the women, the immunologists in Birmingham who was discovering all this stuff, she said she goes for a run in the morning before she goes to work. And she thinks that's wonderful. If she sits at her desk all day, it completely overrides almost any good she's done. So she was saying, so she's now got herself a standing desk. Um, because just literally standing at things is important or nipping up to make a cup of coffee or nipping across the corridor to speak to your friends or something. So, as I say, at the beginning, that what's important, we get all these messages about do this, do this. What I have was looking for is the explanations and you get the explanations. And it's really changed the way I lead my life, apart from this not eating at the right time.
Dr Rupy: That was, that was literally going to be my final question actually. Are there, apart from standing, I mean, I use a standing desk. I think it's brilliant. Yeah, yeah, it's over there in the corner. Um, I uh, I I I've learned a lot about this, this uh, area and just nutrition in general and I've made some changes to my lifestyle. I eat largely plant-based. I have a general eating window. Um, a few other things.
Sue Armstrong: What time do you finish, what time do you have your supper then at night?
Dr Rupy: I try to have it at like six or seven. And then I leave at least like a two or three hour gap before going to bed. Um, if I can, but that doesn't stop me on a Friday or Saturday if I'm going out to dinner with friends and we're going at 8:00 p.m. I'm like, oh, I'm not going to eat now. No, no. I think.
Sue Armstrong: So you're not, you're not one of those evangelists.
Dr Rupy: I'm not an evangelist. And I don't think people should be because I think part of the enjoyment of life is actually having a dinner with your friends, you know. And this can get a bit all-encompassing sometimes.
Sue Armstrong: It can. Well, that's, that's the the crony community can get can be a bit a bit tough, but but the guy I interviewed was wonderful.
Dr Rupy: Yeah, yeah. So out of your two-year journey of researching this and obviously your P53 book as well that I'll make sure I link in the podcast notes. Um, what are the things, what are the main things that you've changed?
Sue Armstrong: I think, uh, I I I take a lot of exercise anyway. I think, I think the the eating thing has been very persuasive. I yeah, I think I've just, I think I've just got more disciplined about these things. You know, I I I sometimes you just think to yourself, oh, catch the bus. But um, you know, I got very used to because I love walking. I got very used to factoring in how long it was going to take me to get places because I much prefer to be out. I'm, you know, I'm not very good at sitting still, even though I've sat still for this hour. My legs crossed, dying to set off somewhere. But um, so every so often you just die to get on the bus and then I think to myself, no, and then I and I will walk up the stairs and things like that. And yeah, and and also very much not sitting for four hours at a time in front of my computer.
