Claudia von Boeselager[00:00:50]:
My guest today is Professor Andrea Maier, a powerhouse in the world of longevity science. She's a double professor at the National University of Singapore and Ridge Universitate Amsterdam, a physician scientist with over 25 years of experience and a globally recognized voice in aging research. With more than 400 publications and a research focus spanning biological aging, geoscience and precision longevity medicine, Andrea is on a mission to improve anti aging therapies out of the lab and into clinical practice. She's the co founder of Chi Longevity and the NUS Academy for Healthy Longevity Longevity, where she's leading groundbreaking work to not just extend lifespan, but to make those extra years vibrant, independent and full of life. Today we'll unpack what it really means.

Claudia von Boeselager [00:01:38]:
To reverse biological age, the future of.

Claudia von Boeselager [00:01:40]:
Gerotherapeutics, and why aging is the most important medical frontier of our time. Please enjoy. Welcome to the Longevity and Lifestyle Podcast. Professor Andrea Maier, of course, it's such a pleasure to have you with us today. To start off what was your first a deep interest in longevity and healthspan medicine. Where did it come from? Was was there a particular moment or experience that sparked your mission to redefine how we age?

Prof. Andrea Maier [00:02:07]:
Luckily, I'm inspired every day. So every day there's one moment I say okay, that's the reason why why you do it. But I have many of these kind of events in my life where I say okay, that's the reason why why I do it. And it really is grounded in conversations and in observations of older individual where I say to be as you are at this moment in time and how can that be possible? And that led to research towards why we age and the in the end also into clinical implementation of what we what we know. But in the end I Think that our body is beautiful. Like the beauty is very often being defined on the outer side. Sometimes I look in the mirror and say, sure, so many wrinkles and canines, so much great, we look wonderful, Andre. But looking really in the inner sight and understanding that these wrinkles, that this sort of gray hair is also growing at the moment at the inner side and how to stop that, that's really the passion I have.

Claudia von Boeselager [00:03:08]:
How can we optimize the health of aging individuals?

Prof. Andrea Maier [00:03:12]:
You know, for some people that looking at statistics, right, so the WHO predicts that by 2030, so not far off, one in six people will be over 60 years old. And I see so many people resigning themselves to decline as if it's just part of getting older. Right, but you say it doesn't have to be. So you've said that aging is not inevitable, but treatable. What led you to that belief? And how does this change the future of medicine as we know it?

Claudia von Boeselager [00:03:39]:
So first of all, it's a success of medicine that we all actually can celebrate 60 times our birthday. So that's, I think, very important because we often say, okay, we are growing aging nations and this is not good. So there's something negative around it. And that's also called ageism. So I think we have to be very, very clear that something positive we have. I think the language is changing a little bit that a 60 year old is not old. If you would say to my husband, hey, you are old, you would say, whoa, no, this is not true. Even not retired, and I don't want to retire.

Claudia von Boeselager [00:04:17]:
So I think the entire perception of age is changing. We now have a growing consumer market actually asking for an answer like how old they really are. Is a 60 year old a 60 year old? And of course, no, it's not, not the case. And here biological age comes, comes in. So consumers, you, me and others around the globe are now wanting tests to actually see how old they are. And so there was. A 60 year old is not a 60 year old. A 70 year old is not a 70 year old.

Claudia von Boeselager [00:04:51]:
And that brings me to your question, like, how can I say that we could change the aging trajectory? Because we already see that the aging trajectory is very different between individuals. Which means if that's already different, why couldn't we change that? And very often we see in January and February, lots of people in the gym and they are changing their body and they're changing how they act. Most of the times it drops in March and in April. But anyway, you see that our body is very, very powerful. To change if it's being exposed, the body being exposed to the right interventions. And there was a 60 year old is most of the time not a 60 year old biologically. And I think we really have to shift the paradigm. Not asking how old are you? Maybe we should even ask how old do you feel? Which is very important.

Claudia von Boeselager [00:05:43]:
And then measuring how old the body really is.

Prof. Andrea Maier [00:05:47]:
I love that. How old do you feel? And so going back to my Irish grandfather lived until the tender age of 94 and he would never talk to people over the age of 50. He's like, they just complain about aches and pains. It's so boring. So he had like this young heart and I think that kept him alive. But I do believe it's like how you feel.

Claudia von Boeselager [00:06:05]:
Right.

Prof. Andrea Maier [00:06:05]:
And your perception of it. So I love that point.

Claudia von Boeselager [00:06:08]:
Yeah. Who are surrounded by younger people live longer. So also if you are looking at married couples, the males who are married to younger females, they also live live longer. I think it's also called the exposome. What is our actually our environment. It's very, very important. So I think it's a secret. You should also do.

Claudia von Boeselager [00:06:28]:
And hopefully it thrives in your family that you are being surrounded by younger people.

Prof. Andrea Maier [00:06:34]:
Do you think there's a correlation then with the blue zones that typically there's intergenerational families. Right. So like in Sardinia or in Okinawa, they are living within that family environment and much more supported. Do you think that keeps them young?

Claudia von Boeselager [00:06:48]:
Absolutely. You don't per se have to live with family members, but you have to live in a tribe. So in principle, humans are not a good species to be isolated, but we are living solitary. And that's most important. Surround yourself by others, be exposed to other opinions, to other environments, share meals with each other. All that is associated already with a higher life expectancy and most of the times also with happiness. If you can choose with whom you share your meal.

Prof. Andrea Maier [00:07:18]:
Exactly. We know from Harvard's longest learning study that started in 1938. Right. That that social connection piece is just so, so essential. Which makes sense.

Claudia von Boeselager [00:07:26]:
Right.

Prof. Andrea Maier [00:07:26]:
You know, we know that as long as we can find people that bring us joy. And globally, we've extended life expectancy 73 years, but the average person still spends the final 10 years in poor health. Why do you think the concept of healthspan hasn't caught up with lifespan and public perception yet?

Claudia von Boeselager [00:07:43]:
We just did surveys around the globe to ask people if they know what lifespan is and if they know what healthspan is. So nearly everybody, 90% knew what the term Lifespan actually means, and a little bit on the countries is 40 to 50% of the population. I was amazed. I thought, whoa, this is a massive amount of people who really understand, okay, it's health spend in health, the duration being healthy. So I was really now inspired by this because we also ask, okay, would you like to do and expand your healthspan? Most of them, yes, they understand, the public understands what it is to really be on earth in a hopefully happier but especially healthier way. So people understand what healthspan is. So the question now is how can we close the gap between healthspan and lifespan? But I would like to also tell you a little bit about the trouble we have with the term healthspan, because healthspan as a term is even not really defined. It's very loosely defined.

Claudia von Boeselager [00:08:48]:
I just said duration, so the number of years in health. But if you're looking at the definitions of health, even there's lots of arguments around what is really healthy, are you healthy when you have a disease, if you are taking medication, etc. We just did a systematic review, so looking at the entire literature around the globe until a couple of months ago, and we found that in the literature there are 162 different definitions of healthspan. That's so troublesome because if we are talking about healthspan, we first really have to define it and hopefully it will be a who definition to really define who is then healthy, not healthy. And how can we actually measure it? Because we also have to take into account that it's not only roughly 10 years of the gap between whatever the health span is and the lifespan, but we already know that at the age of 50, the average 50 year old has the first chronic disease. And I would say, hey, there's already a failure of an organ system. That's the reason why you have a conventional disease, you are taking medication. So shouldn't we actually say, okay, when you have the first chronic disease as an age related disease that you are not, or you are actually losing that span of health?

Prof. Andrea Maier [00:10:04]:
And that's the beauty of this space, is that so many diseases start early on and if you can catch them on time and later go on to some testing modalities, you can reverse them, you can prevent them from actually taking place for the majority of cases as well. Well, so it's, it's quite exciting. I'd love to touch on biological aging. And biological age is, you know, quite a buzzword, but few understand, I believe, what it really measures. And we see research, for example, that came out from JAMA in 2022 that reducing biological age by three years can cut mortality risk by 14%. So all these great statistics, but how do you define biological age and how does it differ from chronological age for people trying to understand this?

Claudia von Boeselager [00:10:45]:
So everybody listening now knows what chronological age is. Hopefully just look at your password and you know, so it's just the time being spent on, on earth until until now. The biological age is very different because it's really determined how well you are maintaining your body, what kind of exposure your body had in the past 10 years, 20 years. If you are 60 now, then 60 years, and how that body dealt with these kind of exposures. And exposures can already be. And don't stop doing it. But it's breathing like we are using our body and while breathing in oxygen, our cells take up the oxygen, they are radicals, etc. So while using something, we also have little cracks, have little wrinkles.

Claudia von Boeselager [00:11:35]:
In the end, we tried always to quantify how old is this people, this person really? And that's the reason why I just asked you, how old do you feel compared to how old are you? Because this is the first very, very good biomarker of aging indicating the biological age. So we don't have to go to the GP and say, okay, please take blood. But we can already ask ourselves, how old do you feel? We and others have shown that if people judge themselves three years younger, there are. There's a huge survival benefit. People will live longer. If you are judging yourself as the same age, you have a higher mortality rate. If it's even older, that's not good. But we also know that our judgment is quite accurate because then we looked at people are saying, I feel three years, five years, 10 years younger.

Claudia von Boeselager [00:12:31]:
Then we looked at, okay, how many diseases do already have? So what is really intrinsically in their cells, their biological age. And what we were able to find is that individuals who already have a chronic disease very often age related, that they judge themselves older. So we have that intrinsic measurement already in us, which could be used as a very, very important tool. So we are asking all our patients, how old do you feel? And of course you should not think about it because then you are rationalizing it. But just have that clear answer once you are asking another very nice one is asking a group of individuals, how do you think how old is that person? So that's the assessed age by others, because the first one is what do I feel? And others, if they are judging you, how old you are. Somebody also this, this age is also very associated with mortality or the other way around with survival. And also that is associated with age related diseases. So again, here just judging how is somebody looking like just the face, but also how is the movement of somebody is very indicative already for the biological age of individuals.

Claudia von Boeselager [00:13:51]:
So measuring biomarkers of aging is, I would say was already integrated always in my clinical practice for 25, 30 years. Because, hey, I look at individuals and I get that, that sort of clinician gut feeling, hey, maybe let's look a little bit deeper. And then we have all these wonderful tools now to really measure on biological level, on clinical level, but also with digital devices, how old somebody is amazing.

Prof. Andrea Maier [00:14:19]:
That is fascinating what power the mind has over the trajectory, excuse me, over the trajectory of aging and potentially also disease. So if you convince yourself, right, that oh, I feel 25 stay this way forever, it sounds like you have research that shows that people will not necessarily stay 25 biologically, but they will stay fundamentally younger. Right?

Claudia von Boeselager [00:14:39]:
Is that right? Yes and no. Because you can also really mislead and not see, hey, you are really diseased and not taking action. That's the other side of the coin. So it works in both directions. And if you cut out the extremes, then the judgment, the inner judgment you have is very, very powerful because you feel how you slept, you feel how much aches you have in your muscle, you feel how good you memorize things, how good your cognition is.

Prof. Andrea Maier [00:15:12]:
Most of the times I love the Henry Ford quotes. Whether you think you can or you think you can't, you're right. So if you focus on the aches and pains and that becomes your whole world, it's going to amplify, right? Versus you think, oh, oh, I'm, you know, young and fit and healthy and I can still do this. Then you go and do it, you're like, oh, I can, you know, so you get the reinforcement of it. So I'd love to discuss the different biological age testing. So in your view, how accurate are tools that we currently have like the methylation clocks or glycan age, which looks at glycans and inflammation in the body. What's your preference in use when you look at biology, biological age?

Claudia von Boeselager [00:15:46]:
So I, I run a clinical practice. It's in, in, in in Singapore, but also in the Netherlands and, and around the globe called QI longevity. And what we really do, and we have the capacity to do that, we are looking at all clocks which are available, which are valid enough to implement into clinical practice. Because what we discovered in the past 10 years is that the pace of aging Is very different between you and me, between the one who is listening now and the neighbors. So we, as humans, we are aging very, very, very differently. That's also the reason why our biological ages are so different at the age of 60. But we also discovered that in our body, the internal organs age very differently. So it is not that if my brain is faster aging, that also my lung and my heart and my muscles, that they also are faster in the aging process.

Claudia von Boeselager [00:16:49]:
So this pace of aging in different organ systems is very different within us, not only between us, but especially also within us. And the mechanisms why that organ is aging is also different, which means that I might age because of something in my brain which is different compared to my heart. So to tackle that as a clinician, I need to understand what's going on. I need to understand what kind of aging process I am exposed to in my brain versus my lungs and my heart. Which means that I also need different tools to measure the biological age. Very often we think about the biological age being one number, but that's absolutely what we now know. Incorrect, because overall I might have a certain age, but then my brain age might be higher or lower. My heart age might be.

Claudia von Boeselager [00:17:42]:
Might be different in the mechanism. So that's the reason why we have the capacity achieve longevity, that we are using most of these tools which are validated. And what does validating means mean? It is, it needs to be applied in humans. So it's very important, not just mice, very big cohort studies, that we actually know that there is an association with an outcome, that it's meaningful. And very importantly is that the methodology being used that that is valid, that I measure what I want to measure. And that's also accurate, which means that if I'm measuring it today, I will get the same results or nearly the same results tomorrow in 10 days time. And that's very important. So we are using really our biomarkers of aging.

Claudia von Boeselager [00:18:33]:
We are, we are using the most validated tools. And think about whole white genome scans, think about the best chips to measure the epigenome, so the iterations on top of the genes. So everything which is hugely sound in terms of methodology, we are using in clinical practice, but especially also in research to then make even much more sense and bring the R and D components into the field of longevity and then eventually applying in clinical practice. So we are doing the entire omics approach, but very often, also often forgotten, because it seems to be not attractive and sexy, is the clinical assessments. So measuring the speed of the brain as we would measure the speed of the Internet or the WI fi. So we have to measure how our brain is being wired in my view, what the lung capacity is, what the heart capacity is, what the power of our muscles are, what our smell is, how good we hear, how good we see. Most of the times that's what we are tackling. But think about smell, taste, very important.

Claudia von Boeselager [00:19:42]:
Think about our quality of our hair, not only hair density, but also how much cortisol level cortisol is inside. So what is the stress level? So there's a huge amount of clinical investigations we can do to investigate the biological age and then also the digital biomarkers. So all the variable devices we have which are very indicative for our biological age if used appropriately.

Prof. Andrea Maier [00:20:08]:
Do you see very often a huge discrepancy, let's say in brain age versus cardio age or lung capacity? What are some things you could share from results that you've come across?

Claudia von Boeselager [00:20:18]:
Yeah, very, very often. And one very, I think obvious example, think about somebody who smoked for 30 years coming to the clinic after five years of non smoke or three years non smoke, it doesn't really matter. So this lung was exposed to toxins because of smoking. So it's very likely that radicals really damage this lung. So it's very, very obvious. It would be weird if that would not be the case, that the lung is five to 10 years older compared to the, to the heart or compared to the brain. And very often we see that the other organs then also are a little bit older. But there, there are extremes and there are so many other examples of this.

Claudia von Boeselager [00:21:01]:
So we very often see that there is an age differences in years by 3, 4, 5 years within our body. So think about 10% in a 50 year old, so it's plus minus 5%. That's very often what we see. If it's much, much more, very often then it's determined genetically. For example, of course there are drivers to heart disease, there are drivers to cognitive decline and there was dementia. So then we are really looking, okay, why is there so much discrepancy within that individual between the organs? And then we are really looking at the genome, we are doing it anyway. But then it really makes sense to see, okay, what actually happens or what kind of lifestyle was there in the past. Can we actually investigate the cause why there is such a discrepancy now? I learned a lot while knowing how different I am in the inside.

Prof. Andrea Maier [00:22:01]:
What came up for you out of curiosity, if you're happy to share.

Claudia von Boeselager [00:22:05]:
There are a couple of pain points.

Prof. Andrea Maier [00:22:08]:
If you're happy to share if you don't want to, don't worry.

Claudia von Boeselager [00:22:11]:
So you can look for example at the vascular system. I have to make sure that my lipids are low, etc. Because I'm running, I'm coming out of a family where really vascular diseases are running. So I have to make sure that I do everything to not have the plaques, for example in the end in my heart and have the very elastic vessels. And luckily so it's very easy to do because you have, if you have a vegan, vegetarian, et cetera diet. Low fat fats in principle are good, but if you know what you eat, you can manipulate the body so much even if you have genetic determinants of diseases later in life. And this is just one example and I'm not talking about that I'm older in my vessel stage, but I really want to optimize myself. So minus two years is not good enough.

Claudia von Boeselager [00:23:00]:
Let's get it into minus four or minus five. So really not hitting the edge of being normal, of being average.

Prof. Andrea Maier [00:23:08]:
And what would be the 80, 20 of cellular aging that most people don't realize.

Claudia von Boeselager [00:23:13]:
What would you say, first of all, love yourselves. I think we never, we never realized that we are consistent of 100 trillion cells and they all, they're all working together that we actually staying in shape. It's so wonderful. They are producing collagen for example, or they produce fibers that we are sticking together. I think that's the most important part. Be excited about your cells, about you as a, as a body and be excited about the biology inside that you can actually manipulate that the challenges with yourself that you can reverse what you just did. For example, eating this pizza. Nothing about pizza, I love pizza.

Claudia von Boeselager [00:23:55]:
But you're exposing your, your entire cellular system to something which is crying for help and realizing that. And it's so easy to do. I would say I don't care if you know much, if you love yourself and if you love and you understand that this is the only body you have, that's it.

Prof. Andrea Maier [00:24:14]:
I'd like to look at senolytics and some synolytics and animal studies increase lifespan by 30% with synolytics have been shown to extend healthspan in animals. Do you think we're close to clinically applying them safely in humans?

Claudia von Boeselager [00:24:27]:
Yes, yes and no. And we already partly do that but we don't have a very good yet understanding. So first of all, senescent cells are cells which are not replicating any more of the arrows sticking in our. They're staying in our body, we are accumulating them with chronological age. They're everywhere in our body.

Prof. Andrea Maier [00:24:49]:
The zombie cells. Yeah.

Claudia von Boeselager [00:24:51]:
Yes. So everywhere we. We took skin biopsies or muscle biopsies, we did not take brain biopsies, don't do that. But everywhere you are looking for senescent cells, you will nearly be able to, to find them. So they are there. The question is, are they good or bad? Very often, if I get the question, is senolytics good? I think yes, but partly because they're also there for a reason. Because the reason is that they are not replicating anymore and they might have a proper good function. Because if we are looking at development and we are looking at wound healing, it's maybe not good to remove them so they have a certain function.

Claudia von Boeselager [00:25:28]:
But we know that at older age they are just too much. So that's the reason why we think that senolytics, so removing the senescent cells so lytic, that might, might help. And indeed the mice model is really showcasing that the mice are less frail and they're living longer, etc. So the question is, when and how should you apply senolytics in humans? So we start as a sort of boost therapy every. Every year at the age of 20, or is it once you have an organ full of the senescent cells and then you are going for a big, big bolus? So we have not really. Or should you do it chronically? So every day a capsule. So we don't know yet. And I think this is a very important point, when to start and then whom to start and especially for which organ to start.

Claudia von Boeselager [00:26:22]:
Because we are talking about senescent cells, but now we know that it's not just one cell, it's a huge variety of cells. So if you want to attack a senescent cells, you first need to know which cell to attack. So then make a drug to specifically attack that cell. It's a little bit like in cancer. Like if we are talking about senolytics, we would say anti cancer therapy. Everybody would say, okay, for what? Like what are we talking about? Is it which cancer? Yeah, brain or the breast and the colon and the prostate. That's where we are. So we have to now learn to go from, okay, anti cancer therapy to go into.

Claudia von Boeselager [00:27:03]:
And the biology is there, we know, and we can measure the senescent cells, how to be specific and timely to remove them, to not have that damage in the end. Which senescent cells could actually and do produce. I would say most importantly is try to not accumulate many, many more of senescent cells because try to avoid, prevent the accumulation of senescent cells. And we did. So it's not removing them, so prevent that they, that they are there. So it's the other way around. It's real prevention. And we showed that, and it will be published soon, that a high fat diet, for example, is inducing senescent cells.

Claudia von Boeselager [00:27:52]:
And there are many.

Prof. Andrea Maier [00:27:54]:
So like ketogenic diet, essentially, yes, but.

Claudia von Boeselager [00:27:58]:
These are all in mice studies. We are now looking for literature, but it's not there. So we have to do trials. Which of our lifestyle habits induce senescent cells, which we then could say, okay, you can either choose to have senescent cells. In the end, you might need a drug and a therapeutic to remove them, or you could change actually your lifestyle, your diet, etc. And we also know that some drugs might actually induce senescence, but it's too early to talk. So first removal, but also prevention of accumulation.

Prof. Andrea Maier [00:28:32]:
What do you do for preventing senescent cells? Yeah, is it like sauna? Is it some detox things like. I'm just out of curiosity.

Claudia von Boeselager [00:28:42]:
I would say the literature is not very advanced to say that this is specific to senescent cells. There is very good sauna literature that you are feeling better, you have a better vascular, muscularization, etc, super good. But I don't think that we can yet say, okay, these are the hallmarks of aging or this is the mechanism being attracted to that. So no. And by the way, very often also the wellness therapeutics we have at the moment, which is a huge hype, they are not well understood, they are in smaller studies, if at all in studies to actually see if it's the effect of these wellness measures or it's just because you feel better. And there's a huge placebo effect too, by the way. Sauna is really great and it works and lots of experience. The other ones, it's a little bit more adaptable.

Claudia von Boeselager [00:29:33]:
But I don't say don't do it. Very importantly, if you have the money to spend on it, like you can make your own choice and it might not be, I don't know if it's harmful. There's lots of discussion about ice passes, etc. Heart attacks. But be careful what you do and do it wisely.

Prof. Andrea Maier [00:29:54]:
I have to always laugh when people are like, yeah, you know, I'm biohacking, I'm doing sauna and then cold plunge. I'm like, you know, my German grandmother 120 years ago was doing this. You know, this is not like a new biohack that the world needs to know about. And you know, if you look at Scandinavian countries in particular, they have such an amazing sauna routine. They're living so happy, healthy and aging so well as well. So it's funny how some things are now considered like biohacks, but actually they've been around for so long and I want to dig into QI longevity and what you're doing there a bit more. And so my understanding is you build personalized protocols based on genetics and microbiome and digital phenotyping and more. Can you talk us through what a first visit would look like for someone looking to optimize their aging process?

Claudia von Boeselager [00:30:39]:
Yeah, sure, sure. It's fun, I can tell you, but it's also. It's a long. It's a long day. The clients stay five to six hours with us, and it's challenging. So of course we. We take blood and stool samples, saliva, urine, everything here. Whatever we can get, we take because we really want to understand what the biology is.

Claudia von Boeselager [00:31:01]:
And then there is lots of physical testing and not the routine physical testing as of course the VO2 Max. But also think about combining, measuring your power while doing cognitive exercises. So how good are we in our daily tasks to use our brain together with our lungs together with our heart, and really seeing where we can slings are in the communication of our organ systems. And we really want to challenge that because what we discovered in the past, I think 10, 20 years out of research, is if you're just testing one organ, you might get an answer, that's fine. But if they have to work together as an orchestra, you really have to challenge them. And you have to challenge it that you really give them a very, very difficult piece. And then you see how the sound like is. So that's what we are doing during the clinical testing.

Claudia von Boeselager [00:31:59]:
So none of the organs is not being measured. So we are measuring smell, we are measuring taste, we are measuring the hearing and cardiac function, the vascular system. So a huge assessment rate. And I think it's. It's fun. We call now we are going to the gym and doing the assessment one.

Prof. Andrea Maier [00:32:18]:
For the people testing or for the actual patients, because I wonder how they leave. Are they a bit exhausted or do they feel like, okay, I've achieved it.

Claudia von Boeselager [00:32:25]:
It's also very powerful for us because if we do not understand, first of all what the real driver is to come to the clinic, the real driver to maybe live longer, if that's the aim, or having less diseases, of less aches or whatever, we need to really understand what is the point we have to work on. And of course we will come up with all the biology and we will make up a story that has to fit with the purposes of our clients, what they want and what they want to achieve. Because otherwise compliance is zero. Like if we come up with a very nice menu, but it's not to the taste of the clients, we have a problem. It's not the problem of us that we cannot diagnose, but nothing will happen. So the psychologist really plays a very important role and the dietitians play a very, very big role, really understanding why do you have the habits as you have, why do you make choices? Who is cooking? Do you love cooking? Who is cooking for you, maybe where do you eat? With whom do you eat? To really also make sure that in the end the recipes we give are actually feasible for implementation. And that's aligned with, for example, biological testing of the microbiome. So testing the gut microbiome to see what the diversity is, what kind of species are inside, what kind of functionality they have to really then link it and grow the knowledge already while testing with the client to see, okay, do you understand if you do this, that might happen and we will see if that really happened in your gato.

Claudia von Boeselager [00:34:00]:
Most of the times it's the case. So we are taking really the client through the test, but while doing the test, it's already a learning journey. Okay, why do we do that? And what could you actually expect? And then we are attaching them and most of the clients already have it to digital devices. And so we are using the digital devices clients already have. So it can be rings or it can be smartwatches, whatever you have. We are agnostic and we are linking it to our EMR system. So the medical record, and we also attach a continuous glucose monitoring system. And then we are given a package in a box with all the challenges for at home.

Claudia von Boeselager [00:34:40]:
There's food inside. So from lots of very nice potato chips to an apple, to the protein bar, etc, to really challenge to say, now you are seeing what that means for your glucose metabolism, how your, your body really reacts. So, and then they're really exhausted and we are very, very happy. They are happy. And that concludes the assessment and lots of other tests and questionnaires and everything else. And then directly the journey starts, because we got already so much information that we can give most of the times, huge personalized advice, what the first steps are. And then we are working with our clients for the next coming six, six months. And in between Once we are getting test specs saying, okay, let's refine it a little bit and, and giving that that knowledge.

Claudia von Boeselager [00:35:31]:
So it's really shaping the beauty of the body.

Prof. Andrea Maier [00:35:35]:
Oh, it's beautiful because it's so comprehensive as well. And I think, I mean, some people get overwhelmed and I wonder how you help adherence. So I love that you look for that. Why, like, what's the purpose? What's going to help them? In what cases do you see the highest levels of adherence? What's those whys that people have that really stick to it?

Claudia von Boeselager [00:35:51]:
Many of our clients have it. And I think I see it also in the, in the clinic being run at Alexandra Hospital, the publicly funded. Once people understand where they are in their journey of the aging trajectory and they are provided with solutions they understand, then compliance is much, much higher. You will reach much higher compliance if their loved ones also understand why they do it. So what we really do is a family approach and we even integrate friends. Because if somebody loves to eat together with certain individuals with certain habits, like that will be a tough call because hey, who's going to change? Is it then our client not eating anymore with the individuals and being depressed in the end? And it's not funny anymore to live or is it changing the environment? So I think the whole approach and understanding where people live, what kind of surrounding is very important. Like if people are having poor sleep, very, very low REM sleep and deep sleep, we can measure that. But this is not meaningful if we do not ask how much noise there is in the room.

Claudia von Boeselager [00:37:14]:
And even if we don't measure the noise levels, because very often people are trained to sleep in this noisy environment because they don't know. But having a decibel and a number attached to it is so much more powerful to then, okay, what could we do? Or light curtains like pillows. It's so easy. But you have to understand where you live. And people don't see it anymore because it's daily routine. You have to break that up and understand. And then you, you make little changes which can be very, very powerful.

Prof. Andrea Maier [00:37:54]:
Beautiful. You said that only 20 to 30% of longevity is genetic and the rest is environmental or behavioral. Why do you think so many people still chase the magic supplement? Does it? We've been so ingrained and trained that there might be a magic supplement instead of starting with personalized lifestyle changes.

Claudia von Boeselager [00:38:11]:
I love supplements, by the way. Very powerful. They're ingredients. They are molecules which can really help us. And they help us in the clinic and as physicians also to help their clients. What would I do if I wouldn't have a very good quality vitamin D supplement? Give it to me. Because we need it at some point sometimes. So there's nothing against supplements.

Claudia von Boeselager [00:38:33]:
I think what we discuss is, okay, what can we do in terms of the lifestyle really making it attractive, not big steps and not five different steps in one. So not going to the gym, sleeping better, not drinking alcohol and changing. Absolutely. Your diet, it's not working. It's little steps where you think, okay, I feel better. And I could even quantify that. So always looking for something which you can measure or you have a measurement that you can ask, okay, on a scale of 1 to 5, how did it go? And then adding and sometimes removing and adding again to find that recipe of very good adherence with a maximum clinical output. And I think that very often clinicians do not have time and health coaches are very often not available.

Claudia von Boeselager [00:39:25]:
We are very, very lucky to have the best, best health coaches in our clinic. So they are very, very good to, I wanted to say around the world, I don't, I don't know, but I love them. So that's most important. They're very, very good. Whoa. They are good. It's so important to get that understanding working with individuals and also get that pill because that, that one supplement also helps for the compliance. It's not that then the compliance is, is worse.

Claudia von Boeselager [00:39:55]:
So we always combine it, of course, if necessary and we combine it based on the needs of that individual because there is not one supplement everybody should actually take needs to be tailored to the biological clinical needs of that individual.

Prof. Andrea Maier [00:40:13]:
What are some of your personal favorite supplements? Which is obviously not for everybody and everyone should seek medical advice. But just out of curiosity, Andrea, what.

Claudia von Boeselager [00:40:21]:
Do you take at the moment? Again, nothing.

Prof. Andrea Maier [00:40:25]:
You do like a cyclical, sometimes on, sometimes off or just depends.

Claudia von Boeselager [00:40:29]:
Absolutely. Because I'm measuring myself and based on what I need. So I try really at the moment to really optimize my diet and while doing so I would really love to understand in a, in a non diluted way what the potential actually is. And my diet was already very, very good. I just want to polish it further and I do not want any interference at this moment in time. I took for a, a time AKG alpha ketoglutarate. I but measuring first and then measuring again. I, I tried nicotinamide mononucleotide, so measured first NAD levels, then took it for three weeks.

Claudia von Boeselager [00:41:11]:
Then there was not an increase. I increased the dosage and measured again no. So which means I'm charged enough. I don't need it. So really testing how the body works, is that biohacking? I don't know. I do it as a physician for myself. Exactly. But really understanding what works and especially when for individuals.

Claudia von Boeselager [00:41:31]:
So I can tell you on Friday evening I will take many supplements because I'm a long flight. So we have times where we are exposed to changes, for example, time differences where. Absolutely. Supplements, if, if taken correctly can have a huge, huge impact.

Prof. Andrea Maier [00:41:51]:
Yeah, amazing. For the average person already doing basics, right. Like let's say they're eating well, moving regularly. What's one maybe lesser known intervention that could dramatically improve their aging trajectory, what would you say?

Claudia von Boeselager [00:42:07]:
I don't know what eating well is, so I also used it, but when I use it, I say I know my glucose levels, I know my microbiome, I know my cognitive function and I tailored it to it. I don't think that we have a very good understanding of what eating well is. And I think while taking yourself as a sort of proof of principle, how good could I be? Food is a very easy one. And I can tell you it's not even so costly because eating healthier very often does not mean that it's much, much more expensive. If you cut off your red meat and a processed food, you can actually buy the vegetables, which could actually improve your lipids and your glucose and other metabolism. So if you have of course, the capacity to cook and if you know how to do it, and I'm a very bad cook, so by the way. But knowing the ingredients is very important. So if I would advise, if you want to have a little bit more of a dietary, first measure your, your, your gut health, measure your microbiome, like know who your friends are.

Claudia von Boeselager [00:43:26]:
So you have to treat us as your.

Prof. Andrea Maier [00:43:28]:
You've got H. Pylori, you, you don't want that either, right?

Claudia von Boeselager [00:43:31]:
Yes. No H. Pylori, you don't want. And I think it's very obvious if for some people, if you have, have it, some people live with it, have. And interventions might be very, very easy to eat, for example, more Greek yogurt, more fermented foods, etc. So there is that. I love interventions where I know, okay, if I test this, I do that. And that's very important.

Claudia von Boeselager [00:43:55]:
And I think these are the hacks you can do yourself at home, measuring it, doing it. Do you feel better? Do you feel more energetic? For example, and I'm not talking about the cold bath and the ice bath or the cryotherapy, whatever you want, like start with the essentials and make them sexy. So start with the dinner where you say, okay guys, I cooked it for the first time and let's try. And I read about it. Look, these are X amount of fibers. These are these ingredients. Have you heard about ergothione in mushrooms? I have chosen the mushrooms with lots of ergothyanin and make it playful. And I think one's knowledge just really your DNA to your DNA really understand how to treat yourself and you make better choices.

Prof. Andrea Maier [00:44:42]:
I love that.

Claudia von Boeselager [00:44:43]:
I'd love to hear if there's any pizza. And I don't say which, which one, the D one, the door one. And then I love it sometimes to do it. And then I it's nearly there, it's nearly being delivered and I love it. And I cannot withstand of doing it. And then an hour later, like I feel 20 years older. And we know it's not good, this coma.

Prof. Andrea Maier [00:45:12]:
To your point before, about making it sort of fun, what I find with children as well is when they better understand it's not just eating broccoli, to eat broccoli, but like what it actually does that it's amazing for your brain, et cetera, et cetera, breaking it down. I feel that education piece can be so beneficial to making it a game changer and even getting, you know, kids to eat stuff that sometimes I'd be like, oh, I don't even want to eat this. So I love that anecdote you mentioned before, Andrea. What are the biggest myths you hear from patients or the public about aging that frustrate you because they're just simply not true or they're not scientifically proven. I'm curious.

Claudia von Boeselager [00:45:48]:
The myth that of course that you can do something, etc. I think most importantly for me is that very often I hear or I see, it's not even hearing, but people neglect themselves. They see it because of fear of not having the understanding. Being in a situation where if our body would be a car, the car crashes and we already knew 10, 20, 30 years before it happened. And you are arriving in the emergency department. And I love the emergency department, Emergency department. I'm the best physician, like from a feeling perspective in the emergency, because adrenaline is in there. I love it.

Claudia von Boeselager [00:46:33]:
I say, geez, why did you crash this car? Why can't we prevent that? And very often people know, but they do not know what to do to change it. And I think here it's the most important point. How do we make sure that everybody understands the environment is there for that change and that better understanding that it might not be useful to crash the car. And of course, very often they say it's a myth, you cannot do anything. Yes. But it's not true. Like we all know very often in most of the diseases what's going to occur and we are just trained to wait.

Prof. Andrea Maier [00:47:11]:
Yes. So to everyone out there, proactive care is always so much better than waiting until it's too late. It's been such an inspiring conversation. Andrea. Thank you so much for your time. For listeners wanting to dive deeper into your work and follow you and we can link everything on the show, notes, where would you send them to? Maybe social media, website, etc.

Claudia von Boeselager [00:47:31]:
Yes, absolutely. Follow the NUS Academy for Health and Longevity. That's Longevity Academy. SG. Have a look at G. We have lots of information also there and I'm Quite active on LinkedIn. Just type in my name and you will find my face with not so much gray hair as I have now.

Prof. Andrea Maier [00:47:55]:
Yeah. I had so many more questions I wanted to ask you. I absolutely adored our conversation. Maybe at some point we can have around two maybe when some of your research papers come out as well. Do you have a final ask or recommendation or any parting thoughts or message for my audience today?

Claudia von Boeselager [00:48:09]:
Love your body. You only have one.

Prof. Andrea Maier [00:48:12]:
Beautiful. Thank you so much for taking the time to come on. Thank you to your audience for listening.

Claudia von Boeselager [00:48:16]:
Thank you.