Patrick Obolgogiani (00:07)
Dr. David Cox, welcome. You spend as I would imagine pretty much all entire working life on diet, aging, which will come back to dementia. But then actually quite recently in May you wrote a piece about breath work. I'm curious, like what made you go here and and spend weeks learning about breathing.

David Cox (00:26)
Of course, yeah. Well, I actually became like really interested in breathing while researching and writing my book, The Age Code, because lung capacity is this really interesting biomarker for how well you're aging. and there's some really, really interesting research which basically shows that w worsening lung health is linked to all kinds of age-related diseases, from high blood pressure to frailty, even cognitive decline is actually related to lung aging, which is really fascinating. So if you can slow that and sort of keep your lungs

kind of healthier for longer, that makes a massive difference to your health. And I think while this probably sounds unexpected to people, there's actually some surprising links between nutrition and lung health. So for example, if you're eating a poorer diet, if you're consuming too many calories, you're more likely to be building up internal fat in the abdominal cavity, which will restrict your diaphragm and your chest wall movement and your ability to breathe. So that's one key way in terms of what you're eating can drive lung aging.

And we also know for example that a diet richer in omega-free fish oils can actually protect the walls of your lungs from damage from things like air pollutants. So there's all these kinds of links and after discovering all of that I thought it'd be really interesting to go right a big feature delving into the science of breath work and looking at what we know so far.

Patrick Obolgogiani (01:43)
Hmm, fascinating. Yeah, I didn't know about the link between, for example, omega 3s and and the lung lung walls.

When I'm curious, like what did you expect to find if you think about what were the preconceptions coming into researching this piece you you wrote? And you already alluded to some of the actual findings, but what did you actually find kind of combining the what you already knew with breathing?

David Cox (02:03)
Yeah, well I think, you know, like probably lots of people listening to this podcast, I'd read the book Brieve by James Nestor. So I was already kind of interested in some of the science behind Breathwork and obviously that book played a big role in catalyzing this whole field. And so I just kind of wanted to understand where is the science right now, you know, because obviously, you know, while breathwork has this fascinating ancient history, you know, going back to

Cultures in China and India thousands of years ago, in terms of modern science, it's still quite a nascent field. I mean, I discovered when I was writing my BBC Ps that there's this crazy staff, actually, half of all the modern research into breath work has been done in the last six years. So we are really just at the very beginnings of actually trying to understand, you know, like how it can help our bodies and in a modern scientific way. And there's still a lot to learn, but I think I was fascinated by a few things. You know, there was this.

Discovery is this where w which I spoke to one scientist and he mentioned that we all tend to hyperventilate, which is taking more than fifteen breaths a minute. and I think some of the early findings in various studies that you know altering your breathing can lower levels of stress hormones like cortisol, lower the amounts of inflammation in your body and kind of sort of give you this sort of nervous system reset in a way was really, really fascinating because

We have this big problem in the modern world where our immune systems are basically constantly on high alert for various reasons and sort of we kind of need this little bit of extra assistance and, you know, trying to resolve levels of inflammation in our bodies. So I think I kind of came away from the piece feeling that, you know, breathwork can definitely offers, you know, a big difference and kind of, you know, essentially serve as this kind of life hack which can probably help a lot of people who are overly stressed.

Patrick Obolgogiani (03:55)
Yeah. And did you change your own habits in breathing in some way? I guess when you're reading about it's easy kind of remember to breathe less so I breathe that's slower. But is it something that kinda stuck with you after writing it?

David Cox (04:06)
Definitely, because I mean you know, if you speak to anyone in this field, they are so passionate about what they do. And for interviewing a bunch of scientists, I ended up getting like a a whole load of essentially one-to-one like lessons on how to do different types of breath work. So that was really interesting. And at the same time I was putting the piece together. I was actually doing a lot of the initial publicity for the age code and doing breakfast television, which is quite daunting. It's kind of my first time.

doing that in a studio. So I actually got into doing some of these breathing techniques, like for example, the four seven eight method of breath work where you're basically like breathing in for four seconds, holding your breath for seven seconds and breathing out for eight seconds. And I ended up doing that as a sort of a way in kind of in the green room backstage to calm the nerves. And I think it definitely helped.

Patrick Obolgogiani (04:53)
Yeah. Yeah. No, that's beautiful. Maybe zooming out a little bit, originally I believe you did your neuroscience PhD at Cambridge, right? And then ultimately it didn't quite go that route, at least as a kinda full time career. I'm curious to know like what what's going through your mind then and and when what sparked you to t choose a different route than maybe some of the people you were studying with.

David Cox (05:14)
Well, it doesn't sound it's probably not as quite as big a shift as it sounds, because

Patrick Obolgogiani (05:18)
Mm.

David Cox (05:18)
I was already doing a lot of journalism while I was doing my PhDs. So

Patrick Obolgogiani (05:21)
Right.

David Cox (05:22)
you know, I was I was, you know, kind of by day sort of researching schizophrenia and by night I was writing health features for The Guardian and the BBC and I'd already already been doing that for a for a few years. And yes, I be I mean, I was contemplating going on to do a pa a postdoc, but my field was psychiatry, which is basically chronically underfunded, even though

affects so many people in society. And so, you know, I mean, I always felt I was kind of part scientist, part storyteller, and I'd seen the difference that really effective science communication can make in terms of driving attention and ultimately funding to different areas of health and medicine. And I think I just reached this point when I I kind of felt maybe I can actually make more of a difference in some ways on the outside as a science communicator. So

I decided I'd give full time journalism a go and yeah, nearly ten years later still going.

Patrick Obolgogiani (06:14)
No, but I think you're right that it's there's probably communicators in that same space who don't have the, you know, credibility one word to put it, but like it's more about actually understanding what you're writing deeply. and so it's like probably gives you a different lens to which

Both like as an example and did this breathwork piece, like understanding what are the underlying mechanisms in the body and in the mind more importantly, pr I assume is quite useful when you're when you're doing any article about anything in in health and wellness.

David Cox (06:41)
a hundred percent because you know, as you as you know, there's so many claims now and the amount of noise is just growing. And I think obviously very few health journalists actually have, you know, a PhD or even a masters in a particular area of science. And I think just having that sort of extra level of academic knowledge and kind of knowing a little bit about how to scrutinize what is a good paper and what isn't a good paper definitely helps when I don't know, trying to cut through the noise and trying

tease apart what actually really is worth reporting on and, you know, what should be what should be treated with more scepticism.

Patrick Obolgogiani (07:17)
Hmm. Well let's talk about that because like you've covered now many different areas of health, like this mental health, nutrition, aging, dementia, and and probably more. Like I'm I'm curious what's the pattern here? Like how does a health idea go from, you know, a paper where it's maybe anecdotal into a headline and then like a supplement? Like how how do you think about that that picture and then what have been some of the learnings over the decade when it comes to the journey from from from an idea?

David Cox (07:44)
Well it's definitely it's definitely changed a lot in the last ten years. I think that's the first key thing to say, because I guess what used to happen is some obscure science would be elevated in the s into the spotlight through maybe the claims of a celebrity or some well known public figure, and then the media would publish a deluge of stories on this and then that would spawn like a massive industry. I mean, I feel gluten is perhaps the best kind of like example of that. But now it's happening

Patrick Obolgogiani (08:12)
We go deeper.

What do you mean by that?

David Cox (08:14)
As in for example, you know, back in the early 2010s, there were like a load of celebrities who started talking about gluten. You know, I'm I'm gluten intolerant, you know,

Patrick Obolgogiani (08:22)
Right.

David Cox (08:23)
it's n it's not right for me. I cut gluten out of my diet and now a lot healthier. I mean that was really, really intensely covered by the media. And then suddenly, you know, almost overnight, every restaurant was offering gluten-free options or, you know, noting whether something contained gluten and you know, every supermarket, the you know, supermarket shelves are still filled with

gluten-free products and so that's I think a really good example of how something can just mushroom overnight through, you know, celebrity attention of then the media. So now it still happens, but in a very, very different way. it's all happening through social media and this has all changed I think it's in simply in the last five to eight years. You know, a a good example of how it happens now is the glucose me measuring craze, you know, people getting the continuous glucose monitors, those kind of little discs.

you'll see on people's arms and

Patrick Obolgogiani (09:11)
Yeah. I've had one, yeah.

David Cox (09:14)
Yeah. We've all we've all tried it, I think the last kind of five years. And you know, that didn't really begin with the with the traditional media. It all kind of began based on the back of some academic findings, which then got picked up through various influencers and startups who grew massive social media channels on the back of that and marketing campaigns. And then the media kind of came in and was sort of more kind of scrutinizing. Is there anything to the claim? So

The media now tends to sort of come a bit later in the picture than it did in the past.

Patrick Obolgogiani (09:45)
Yeah, no, that's very true. Like the new media, which this this probably includes that this kind of podcast is definitely seems to be moving first and some of the social media happens first and the media reports on the social media, which is kind of funny how it how it can work these days. I'm curious,

David Cox (09:59)
Exactly.

Patrick Obolgogiani (09:59)
like, over the a decade you've been reporting, like is there a particular story that that you

then maybe you would do differently now and it could be, I don't know, the the evidence changed or just the way you did it changed. Like I'm curious to hear any any kind of take takeaways from that you would want to share?

David Cox (10:15)
Yeah, that's a that's a good question. I mean, I think the one which maybe comes to mind is actually is actually keto, funny enough. So I did a big piece twelve years ago on the ketogenic diet and

Patrick Obolgogiani (10:26)
Yes.

David Cox (10:26)
you know, a lot of really, really interesting research, you know, which has been happening for like a long time about how keto can be really, really good for people with epilepsy. And so I kind of wrote this piece kind of looking at that. I think now if I did it, I would treat some of the the thing the

the the the points I made in that piece of a little bit more nuance. You know, I was twenty-five when I wrote it. I was midway through my PhD at the time. And I think I think keto still has a really interesting role to play for people with epilepsy, perhaps people with type two diabetes, like certain segments of the population. But in recent years you've just had so much misinformation on social media about, you know, eating more and more saturated fat, more and more protein and some of people a lot of people taking the keto ideas.

an extreme with things like the carnivore diet. And I do think from you know all my writing about nutrition and aging that can have a very damaging effect on people's health over time. And you know, there's a lot of people now on YouTube who started making some really wild claims about how keto can help with everything from slowing cancer progression to dementia with virtually no evidence. So if I was gonna write that piece now, it would be very, very different. It would still be, you know, looking at some of the positive aspects, but you know

It would be a much more wary piece, I think.

Patrick Obolgogiani (11:42)
Yeah. No, it's it seems like the the the world of I wanna say culture wars, but the just like social modification, it's not prone to nuance at all. And the same is true

David Cox (11:51)
Yeah.

Patrick Obolgogiani (11:53)
with things like the don't know if you follow the conversation about the mouth tape and there's like people that are so for it, like literally everyone should wear this and yeah, a bit more nuance where we're actually it can be useful for many people, but not everyone for y not for everyone. So that nuance easily lost. And I think people like yourself have the

annoying responsibility to actually hold that nuance every single time.

David Cox (12:13)
Exactly. And it's tricky. I think nuance, we are losing more and more nuance in our society, which is a problem because, you know, how do you convey nuance in, you know, a video clip of forty five seconds? You d you just can't, you know, you can't get

Patrick Obolgogiani (12:25)
Can't

David Cox (12:25)
into that sort of, you know, the sort of the grey areas, which you can in a two thousand word news article. and also there's the f also the fact that, you know, just simply the algorithms and social media are just prioritizing the kind of the wildest, most extravagant claims, which then just funnels and pushes people to kind of

like go for kind of wilder, more provocative statements, even if there's nothing backing backing them up, because that's the only way you cut through nowadays. So it's it's a big problem, particularly in health,

Patrick Obolgogiani (12:51)
Yeah.

David Cox (12:52)
I think.

Patrick Obolgogiani (12:53)
Yeah. No, I'm sure we could spend the rest rest of the hour talking about health communication, which by the way is a important topic and I think, you know, we of course have have a

very small role for now play on it, but I think you do a bigger one. I think overall the industry needs to be there to help educate people on what's true and and as as we discussed, h hold a nuance. But the trade-off there is, as you mentioned, like the effectiveness, because memes are one of the most effective ways to convey ideas. So you almost like if you if you wanna, if the end goal is to change people's mind and help them behave in a way that is best for their health, then you almost need to play the game in some ways.

But but yeah, maybe there's a there's a way there's a a forum for each thing and and there's like different ways to play the game to actually be effective.

David Cox (13:39)
Yeah, yeah.

Patrick Obolgogiani (13:41)
let's talk about the book. So you've wrote the age code, partly as a my understanding of like a corrective mechanism towards this like whole longevity hype that is very prominent in the current discourse, particularly in Silicon Valley, but also I feel like

Elsewhere, like what is the specific hype that you feel we're we're getting wrong at the moment?

David Cox (14:01)
Well, I f I just felt there was this real kind of disconnect because, you know, if you follow all the la the longevity discussions the last few years, everyone's talking about can we live to one hundred and fifty, can we live to two hundred? And I felt it was really missing a very key point, which is that people in reality are actually getting iller faster. So healthy life expectancy in the UK, which is the number of years of good health you have before you get a disease, is actually on the decline in the last ten years. And that's the case in many, many

countries around the world. So I was like, we're kind of missing the point with all this, you know, can we become sort of immortal discussions? You know, people are actually maybe aging too quickly. And I think the real key thing which should make a big difference to a lot of people's quality of lives is, you know, helping more people live into their 70s and their 80s disease-free. You know, that would reduce the burden on health systems around the world. And we already have the tools to do that. You know, we

the whole idea of whether a human can live to a hundred and fifty probably depends on some far out technology and some regenerative medicine which isn't quite there yet. But, you know, we already have the tools to keep more people healthier for longer. So that was the idea behind the age code. You know, what can we learn from the super ages, the people who reach their nineties, still disease free? You know, we have these decades long nutrition studies now, w w which talk about like sort of how to slow aging and how to protect against disease. So

I wanted to delve into all of that and I guess give people some actionable and simple tips which you know they can make in their everyday lives which can make a big, big difference over time.

Patrick Obolgogiani (15:34)
Yeah, yeah. I definitely want to get into some of the things you learned there. But before we do, maybe it's useful to kind of stay here for a moment around this hyping, 'cause we just talked about how much there is, and it would be nice to give the listener some tools to to think about what to believe in and how to conform your own intuitions and beliefs. let's start with the like you probably get pitched a lot of ideas all the time. Like what

What makes you believe into a health claim and vice versa? What makes you kind of think that maybe that is theoretically it could be, but there's no evidence for it? How do you actually do that?

David Cox (16:08)
Yeah, I mean I think the the interesting thing is obviously as a health journalist, you're getting dozens of emails a day from so many different people. I mean, ninety-five percent of the time what people are kind of approaching you with isn't so much, you know, a kind of a new concept. It's just pure self-promotion. You know, look at my new supplement, like look at my new company. And I think for me to kind of really sort of take interest in something, there's gotta be some wider science behind it. There needs to be multiple people working on this different idea and

you know, some some some clinical trials, you know, some you know, I so I I I'm looking at what's the evidence and also for the person who's trying to push this to me, what's their end game? You know, how are they making money out of this? How much do I trust them? How much are independent people also sharing their idea and their enthusiasm about this, you know? And I feel that's the same for for people, you know, when they they cut encounter claims on social media, you know, I think there's maybe a almost like a free step

sanity check which anyone could apply, you know. I think step one is just simply is there any science behind this? And you know nowadays, you know, just a quick Google or look at the AI overview can kind of give you a sort of a sense of that. I mean the second thing which is the most important is if it's coming from an influencer, how is this person making money? You know, they're not producing this video out of the goodness of their heart, particularly they're doing it full time. So what's their angle on this? Is it a paid ad?

Or why do I they want to promote this? You know, and so understanding that ulterior motive helps give you that sort of natural skepticism. Same with a paper, you know, look at the conflict of interest. Who has actually funded their this research, you know, or is it is it generally done completely independently? And then finally, I think the big thing is, is this reproducible? You know, are other people working on this? Have other people found similar similar evidence?

And is this based on five people or is it based on five thousand people? And that's a big, big thing, because you know, the more if it's a general trend, then the more more you can trust it.

Patrick Obolgogiani (18:10)
Yeah. Yeah. I can speak as someone who's on the other side of the table, kind of trying to build something that's novel. It's it is challenging that, you know, you have limited resources and you're, you know, we did invest into this quite, you know, decent study with the University of Kent to try to validate some of the claims around accuracy. But then the the question is how do we communicate the idea that there is this like underlying body of research, which I think you went deep into during your BBC piece, on how does breathing affect our nervous system?

And like both as a as a window and as a way to to change it. So like you're kind of sitting on this like giant shoulders of like what's been done already. But then the claims you're making is that we can tap into that and you try to kind of make the most out of that. But you're right, like ultimately you need to have enough sample size to actually

be credible in and when making those claims. I'm curious, like, because like one problem is there's like there's no evidence. But then there's maybe a bit more difficult problem is when there is something, there is a study that claims something, but the interpretation is maybe wrong. And we're seeing maybe this play out now in the I don't know if you've seen the the trial for Aura. And it's not going too deeply into that, but there are lists there's the BIC now trial ongoing in the US where they're kind of basically challenging the claim of having 95% accuracy.

for the sleep stages as a kind of overblown marketing claim. But I'm just curious, like when when you said you look at the study, like where does it actually break? Is it more like the the sample size tend to be tends to be too small? Like what does disconnect usually is between like a actual stuff and then just overblown claim?

David Cox (19:41)
Yeah, I think there's a there's a couple of things. I think a common one is just very, very small sample size, you know. I've I or or you know, kind of trying to sort of draw s two strong conclusions over things just done in like in cells or animals, you know, or if it's a wearable, I think like another one is, you know, again, people trying to kind of like twist the stats like a little bit, like something isn't actually significant if you look at the P values, but they're still trying to kind of like

sort of reframe it as if it is significant and so I think there's there there's stuff like that which you have to be kinda aware of. Those are always the first the first few things I look at.

Patrick Obolgogiani (20:18)
Yeah. One recommendation I have is for a tool consensus AI. If people haven't checked that out, it's pretty useful where it is able to kind of give you answers to simple questions by looking at multiple papers and looking at the averages. And also there's a human curator on quality of a paper. So they're able to at least give a marker of like what is the probabilistic truth here based on everything we have. And also look at the nuance between like is this better paper than that between the sample size and so forth. So

highly recommend for these some of the difficult claims, particularly in nutrition, which we'll get into in a moment.

David Cox (20:49)
Nutrition I think is the most tricky of all, definitely, definitely.

Patrick Obolgogiani (20:53)
Yeah.

Let's let's talk about that. So couple years of investigation. if somebody were to change one thing during the dinner tonight, what should it be?

David Cox (21:04)
I mean, I think actually with dinner, the interesting thing is actually having a smaller dinner. Like there's a really fascinating emerging science of chronolutrition, which kind of suggests that the balance of how we're having our meals each day is kind of the wrong way round. So most of us we eat a big dinner and a relatively small breakfast and lunch. And there's actually growing evidence that it really should be the other way around. We should be having a big breakfast, big lunch, and a smaller dinner. And, you know, hardly anyone does that, but

the concept is that if you have a big dinner, it's gonna end up disrupting your sleep, which is really, really important. It's the time when the body repairs, it's important for the for the immune system. But if you're actually kind of like changing that balance and having a smaller dinner, and particularly if you can eat a little bit earlier, like like six PM for example, that's gonna be much, much better in terms of, you know, allowing your body to get good quality sleep. And over time that will make a big difference for aging.

Patrick Obolgogiani (21:58)
And is there a different mechanisms beyond the influence on the on the sleep? That the depth of the sleep?

David Cox (22:05)
Yeah, well I think the really interesting thing is that, you know, our bodies have kind of evolved to carry out a lot of the daily kind of cleanup and repair mechanisms in the middle of the night, you know. So for example, at about three AM, that's tends to be the kind of time when you get like basically a lot of the body kind of degrades c proteins which have kind of changed shape o you know during the course of lights of the day and kind of creates new lights of new functional proteins.

But because so many of us are eating much later into the evening, the body's not getting like sort of anything near the time it needs to carry out a lot of these crucial repair operations because it's still digesting food. and that's a massive issue with modern life. So the body's having to compress all of these really, really important repair jobs into a smaller amount of time during the night. And not all of these things are timed to happen kind of during deep sleep. So if you're not getting as good sleep quality overall.

that's really going to, you know, over years, decades, make a difference to how well you're aging.

Patrick Obolgogiani (23:09)
And how do you look at is a huge hype at least the last five years has been this intermittent fasting, where you have this like sixteen-hour window where you don't eat. And it sounds like this correlates pretty well with that, but then I've at least listened to some of the experts in the field that most of the impact of intermittent fasting and the benefits of it come from just cutting calories. And basically if you just control for that in the studies, you end up with the same result. Like how do you how do you see intermittent fasting playing a role here? Or does it at all?

David Cox (23:37)
I mean intermittent fast is is a really interesting one. I mean I and I d I do think that the whole like so the fact that people are eating less is is a big factor in the success of intermittent fasting. But there's another kind of key thing which I think a lot of people don't realise. If you ask the majority of people who intermittently fast, they skip breakfast and they kind of eat between like the hours of like midday and eight pm, which is the wrong way to do intermittent fasting. Like most of the intermittent fast is a kind of like later in the day.

Actually, if you if you intermittently fast, you probably should start at eight in the morning and kind of finish at four PM or six PM. And if you do it that way round, then that's going to be way better for you over time because the issue with a lot of the intermittent fasting people is that they're eating late into the evening, which then disrupts sleep. So that's the key nuance in intermittent fasting, which you know people don't often miss out on.

Patrick Obolgogiani (24:28)
Yeah, yeah. Have you seen

studies of people like of tracking people at timing window? is do you know?

David Cox (24:35)
Yeah, but so there's a guy called Sachin Panda at the Sulk Institute in s in San Diego who I spoke to about all of this and he he made this point. He said it's you know, when you actually look at the people who do it properly, you you see big benefits. And there's a really fascinating nutrition study in France. It's called the NutriNet Sante Database, and it's several hundred thousand people. And when they looked at clues to preventing heart disease,

They found that not skipping breakfast, which again, you know, if you're doing intermittent fasting between eight PM and four PM, you're you know, you're gonna be have to be having breakfast. and you know, kind of eating an earlier dinner were the two big things which stood out in terms of reducing heart disease. So that's kind of one kind of tangential explanation for why which sh shows how you know the the right intermittent fasting window can make a big difference.

Patrick Obolgogiani (25:22)
Yeah, that's fascinating. Yeah, they

I would imagine that for a lot of people, intermittent fasting was kind of a nice way to reframe what they were already doing, which is to skip breakfast and to have just coffee because they didn't have appetite. but I I do wonder like you have all these, you know, we talk about Mediterranean diets and we all always refer to, I mean, I guess the blue zones has been partly already busted as a myth. But there is like people that are have go well into their old age in the southern Europe. So the southern European countries, and I believe in many of those countries you eat quite late dinner.

But it it sounds like in this in this French cohort, which probably includes those people, still the ones who are having early dinner had better health health consequences. Interesting.

David Cox (26:01)
Yeah, well

I think I think the blue zones is is quite an interesting one because, you know, there there's there's been like a lot of myths about them. But, you know, I think the interesting thing is we still know that there are people who, you know, live into their nineties without any diseases. And, you know, they're not just in scattered around in certain likes of hot spots of the world. You know, you find pockets of superages in every country. And I think, you know, when you look at the epidemiological studies and you look at the people who are doing really, really well.

overall some of these trends, you know, really actually do seem to play out. So, you know, people don't s skip breakfast, you know, they're not eating crazy big meals late into the evening. So, you know.

Patrick Obolgogiani (26:39)
Yeah.

Another term I came across while kind of researching your work is the AGE. could you just explain like I'm a I don't know, ten year old, fifteen year old, like what are we talking about here? and what's the kind of consequence of how I should cook when I'm doing cooking at home?

David Cox (26:55)
Yeah, well AGEs are probably like the biggest driver of aging, which, you know, no one has heard of. So v these things, they they contribute to everything from the visible sides of aging, which we're all familiar with, like wrinkles, to the more kind of hidden invisible stuff like your heart losing elasticity. even they even are now thought to kind of contribute to, you know, increasing your risk of cancer and dementia as well. So

But basically what they are, if you think of the browning on food, you know, when you fry a steak at like under dry heat and it it sort of brown blackens on the outside, or you know, if you put anything under the barbecue, you kind of get that blackening. That is actually AGEs. So their their n their full name is advanced glycation products, and they're formed by this chemical reaction which you get between either proteins and fats and sugars when they're exposed to dry heat at high temperatures.

And the issue basically with these things is your body can cope with, you know, a certain number of them. but modern eating is kind of bombarding our body with AGEs, either through ultra-processed foods, because they're formed within those foods, or through the way we're cooking, like through roasting or frying, all of this cooking at dry heat, which is like blackening the food. And the issue f with that is twofold. You know, if you accumulate like so too many AGEs like within your body.

They bind to proteins like collagens, which is in the in the skin, and kind of drive them out, causing them to sort of become like stiffer, which is why your skin kind of loses elasticity and forms wrinkles. they also activate a sensor within your immune system called RAGE, which basically causes the production of a lot of inflammation, a lot of oxidative stress, these key drivers of aging. So if you're just consuming too many AGEs on like a regular basis.

you're that's just gonna be driving more inflammation within your body. so there's a number of reasons why they're bad. And in the book I kind of I point out again there's some nuance here. You know, it's not about never having a barbecue or never frying a steak ever again. It's just about trying to get a little bit more balance within our cooking methods. So the antidote to AGEs is water based cooking. So things like steaming or boiling or things like that. And doing a little bit more of that, a bit more slow cooking.

and a little bit less cooking at dry heat.

Patrick Obolgogiani (29:15)
Hm. Yeah, makes sense. And where does something like microwaving sit in this? It's like not quite dry heating. It's I guess it's anyway gonna be processed most likely, because you're not cooking with it anyway.

David Cox (29:27)
What interestingly actually I think microwaving is probably better than pan frying because it's very, very quick, you know. So you are exposing heat food to very, very high heat, but you're doing it in like a minute or two minutes rather than, you know, if you're barbecuing, you are exposing that meat to a lot of heat for about half an hour, which you know is giving more time for AGEs to form. So I mean, if you are going to kind of cook microwaving or actually air frying is the better shout.

Patrick Obolgogiani (29:56)
I actually recently just heard apparently there's a trend now, I can't remember where it's coming from, but basically cooking in a kettle but without any any water, but you kind of

Still it it's feels like steaming. So you put like garlic at the at the bottom, they have all these veggies and they protein and all raw and just hold that there like with heat for like I think I guess an hour at least, probably more. And apparently somehow that kinda all the stuff like they basically release some enough moisture that it becomes almost like steamed, all the stuff in there. I don't know if you have come across anything like that.

David Cox (30:26)
Yes. I mean it's interesting actually how some of these things kind of go in in cycles because this sounds a little bit like there was like a revolutionary new idea of slow cooking, which was developed in the seventies and the whole idea was to try and keep more nutrients within the food. Also make it a bit more flavourful. 'Cause actually one thing

Patrick Obolgogiani (30:41)
Hmm. Yeah.

David Cox (30:43)
with slow cooking is it really brings out the flavour a lot more. So, you know, I think we're now just getting lots of a lot of these kind of newer variations on a theme and yeah, the the v the the kettle idea sounds sounds very similar to that.

Patrick Obolgogiani (30:56)
Yeah. Maybe speaking of nutrients, one of the things I believe you argue is that the micronutrients play a bigger role than than macros, which a lot of a lot of us obsess over, particularly enough protein. Partly I guess because of a tea has been quite vocal about having enough and quite a big amount compared to what most people are having, but

What are the if if unlo of course I guess the ideal would be to have your blood work done so you actually can see what which one are you deficient in, but what are the ones that you know are most likely most of us in the West gonna be deficient in when it comes to micronutritions?

David Cox (31:28)
Yeah, I think micronutrients are really, really interesting because no one really talks about them. And, you know, they are incredibly important for so many processes within our body. And I do think there's a decent argument that that some of the things we think of as kind of midlife decline and aging are perhaps related to the fact that we're just simply chronically deficient or just not getting enough of certain key micronutrients. So I think a classic one is actually magnesium.

you know, y magnesium is found in things like chia seeds, brown rice, oats, leafy greens, almonds, all those kinds of foods. And magnesium is incredibly important because it helps cells respond properly to insulin, which in turn, you know, is moving blood sugars, like sort of in from the blood into your cells for for energy. And you know, there there's a there's a decent argument from the stats, at least here in the UK, that a lot of people are just not getting enough magnesium. And

At the same time, we've also got this rise in type 2 diabetes in the young. I mean, there was a new study a c about a month ago which showed that there's more women in their 20s now getting type 2 diabetes. And I wouldn't be surprised if that's directly linked to magnesium. I mean an another key one which also affects a lot of people in their fifties and onwards is actually B vitamin deficiencies because as the gut ages, it becomes less good at creating some of the B vitamins you need. So

You're just needing a bit more of them from from your diet. And a lot of people are becoming deficient in in B vitamins and that can contribute to everything from cognitive decline to even how rapidly your DNA is aging. So, you know, that's another one which can make a big, big difference.

Patrick Obolgogiani (33:06)
And the I remember reading somewhere that the magnesium even played a role with our nervous system and how we sleep, although I think there's different types of magnesium, so the gly glycinate or something was the one that was found here. Like I don't know how much you've delved into this, but like are there a lot of variations between the impact of different types of magnesium?

David Cox (33:24)
I think so. I mean it's it's not something which I I kind of got too deep into in the book. I think just

Patrick Obolgogiani (33:28)
Mm.

David Cox (33:29)
purely because magnesium as a whole is just involved in so many just like so many chemical reactions throughout the body. I mean, and I think the the the kind of the key message is maybe, you know, not s not to kind of focus on like certain types of magnesium, but just getting more magnesium in general into the body, which I think can make a big difference. But perhaps I think for certain specific disorders, particular types of magnesium could

And and can actually play a role.

Patrick Obolgogiani (33:55)
Yeah, no, it's and particularly I guess as you mentioned, if you get it from whole food, then probably they will have multiple of these, so you'd have to worry about it. It's only when you're supplementing where it becomes play a role that you have citrus citrates or something else. And I guess I was personally keen to kind of look and look into it mostly for my migraines or headaches. and that's why I found this one to be the most correlated with with relieve relief or at least prevention. but but not sure.

Cool. I guess many of the things we've covered already go into the things that are best we have a lot of evidence for, like AGEs. he talks about the timing of of your eating and the the amount, of course. But I'm curious like what were the things that were had maybe not as much evidence. So you were

kind of on the verge, should I add it or not? And I'm c keen to hear both the things you ultimately decide to add that had maybe not as much evidence but you believed they might be true. And maybe some stuff that it is in the same category, but decided to leave it out for now. What's what's part of that category?

David Cox (34:49)
Yeah, good question. I mean, I think one thing I found really interesting is this concept of dietary acid load. So the idea that like a lot of us are basically eating very acidic diets. So the whole the reason is because a lot of us are just consuming a l huge amount of protein and like non enough minerals like magnesium and potassium and things like that. And protein is broken down into amino acids, which as the name suggests are metabolized

As acidic substances into the body. And so there's a growing school of thought that our bodies are kind of getting bombarded with more and more acids over time. And this is perhaps driving kidney aging. It's putting more strains on the kidneys because the kidneys are the organs which have to deal with all the acids at the end of the day. So, you know, eating an acidic diet could accelerate kidney aging. But also there's another really interesting idea in aging science that

you end up just getting kind of more of these acids just accumulating in the in the fluid which kind of surrounds cells and over time can actually affect the pH of the cell and cause proteins to change shape. And there's some people who now believe that perhaps over time eating a very, very acidic diet could contribute to f the development of things like chronic pain, perhaps even Parkinson's. And you know, there's some people who are now suggesting that this sort of accumulation

of acids at this like kind of subclinical level, like in and around our cells, could be a new hallmark of the of aging. So I found found that really, really kind of compelling because, you know, everyone's spoken like sort of for years about the importance of the balance plate. You know, having some protein, having some carbohydrate, and having twice as much fruits and vegetables. And and the reason for that is because you're getting enough minerals that way to counterbalance the acids. So

I I i it's an emerging idea and there still needs to be more evidence for this idea that a high dietary acid load could be contributing to chronic pain and Parkinson's, but I thought it was interesting enough based on what I was reading to include it as one of the chapters in the book. Plus it also correlates with some of the themes within nutrition science which people have been talking about for many years anyway. So that was one.

I think at right at the end of the book I was just talking about, you know, some kind of new ideas and and technologies which perhaps could be used, you know, when we spot people who are like aging too too quickly, what can we do? And what are kind of some of the far-off ideas as well as changing the diet, which can make a big, big difference. And you know, I looked at, for example, there's this hormone called clotho, which we know kind of declines basically from like our twenties onwards.

And it's thought to be a kind of like a master regulator within the body. So it contributes to everything from maintaining muscle, maintaining brain health. And there's some people who are now looking at the idea of using vaccines to take your clothho levels when you're like in your 50s and restore them to back when you're you're in your twenties. And it's a really wacky, fara idea, but a fascinating concept if it works. And you know, we do not have enough evidence to suggest that that's gonna be safe or

what the long term of effects of that could be. But it was quite eye-catching. And so I decided to just include it in the final chapter. But then there's some other ideas like epigenetic reprogramming, like trying to reprogram the DNA of certain cells back to a younger state. And I ultimately ended up kind of like leaving that out because I didn't want to focus on too many things which which we don't really know enough about.

Patrick Obolgogiani (38:24)
Yeah. Yeah, there's lots and maybe just a quick comment on the acidity. I remember reading about a topic many, many years ago. So I guess was it from ancient Chinese or somewhere like I guess there's been like thoughts around those things, but I guess you some of them might be now more and more valid, whereas some I'm sure was was maybe not based on anything. I remember at least reading about the fact that well, not the fact that but about this idea that even though citrus so like

the the juice of citrus if you squeeze it into water, it's as acid, right? But apparently, according to that at least ten years ago, it actually reduces your acidity it's alkaline when you process it. But I don't know, do do do you know if it's true or not?

David Cox (39:02)
Yes, yeah, yeah, that's very true. It's is really fascinating. Yeah, citric acid actually is metabolized in the body as yeah, as an alkaline substance. so that yeah, really, really fascinating. so yeah, there's there's a lot of things where some of these old ideas are, you know, kind of like now sort of coming to s you know back again as like modern kind of aging science. But I think the big thing which we need need is like a trial which kind of shows that, you know, counter reducing your dietary acid load can maybe

redu slower disease progression or reduce risk of disease over time. At the moment all we have is epidemiology showing that people who have the highest dietary acid load are more at risk of certain conditions. But you kind of need to show the other way that doing something about it definitely makes a difference.

Patrick Obolgogiani (39:46)
Yeah. Maybe s just that summarizing a little bit the conversation, one of the things and and kind of tie back to the breathing and bring it into this envelope of aging, one of the things we talk about

and Albio's is the idea of breathing as the fourth pillar of health, where you have sleep, nutrition, and exercise. And it feels like there's this element which is key to our stress levels, nervous system, but also affects even the way in which metabolized food and and so forth. So it's like as as the other three, it affects everything else. So they kind of together work around. I'm curious, like, based on all the work you've done and now including this most recent longer piece into the breathing world, like where do you feel?

they stack up or like is there a way you kind of maybe think about them in dominoes where as a human being you focus on this, it helps with that. How do you kind of rank them if you had to in and from a someone just trying to change their life for the better?

David Cox (40:38)
I mean i it's so difficult to separate them because you know they're all interlinked, you know. As as I said earlier, your your diet can, you know, improve how improve your lung function and that then improves your breathing and so it's it is it's tricky. I mean, I feel like diet would probably go number one for me. I think just purely for the wealth of evidence and also the fact that, you know, if you're exercising but not eating well.

There have been some studies which show you're still aging faster, you know. Your body isn't an oven, it can't just like soak up and burn everything that you're throwing at it. so I think diet is probably the most important one with exercise a close second because it is very true that you know it's it is use it or lose it as you get older. You know, exercise is so important for muscle, for bone, it's even really important for brain health. We now know that.

Doing enough exercise triggers the releases of different hormones within the body, which helps support the brain. So, I mean, those two have to be, I think, the top two. I think stress is a really interesting one because we know that stress drives aging, but it's so hard to do something about stress. You know, all of us are gonna be exposed to a certain level of stress within our lives, whether we can help it or not, you know, through family, through work, otherwise. So

In some ways I find stress one of the kind of the less interesting ones because it's a hard very hard pillar to tackle. I think sleep we now know. You know, sleep until about ten years ago, people didn't really give that the attention it deserved. We now that know that sleep is so important for the immune system, so important for brain health, and particularly from an aging perspective, you know, for repair. You know, we spend so much of our time being active and doing damage to our body.

We need to give our body enough time to repair all that damage. And if you're getting eight hours sleep, but also good quality sleep and doing that over time, you know, sleep regularity, going to sleep at the same time, like consistently on a regular basis, seems to be almost as important as the quality of sleep that you're getting. So I think maybe those those three pillars are like top. But then I do think breathing is a very, very interesting one because it comes into like the stress.

And I think breathing w so many of us are living our lives now in this kind of state of hyperarousal and you know constant activation. And breathing can be this way of just resetting. And just because a lot of us are, you know, breathing badly without even thinking about it, we're breathing too quickly. And also we know that if your breathing isn't optimal, that is gonna affect your sleep. You know, sleep apnea is

one of the, you know, kind of I think it's it's very much on the rise is a chronic disorder and that's linked to so many different age related diseases. So breathing I feel okay it's yeah it comes below diet, exercise and sleep, but I think it's a definitely important other pillar which we're just starting to learn more about.

Patrick Obolgogiani (43:38)
Yeah. And I guess it also depends how you frame the question. If it's like which one of these has biggest impact is a different question from where do you think people should start as a behavioral change? Because for me at least, and I think I've noticed the same with others, the exercise tends to be one where

It's kind of easy to start with. And when you do that, it almost automatically makes you eat healthier. And then

David Cox (44:00)
Yeah.

Patrick Obolgogiani (44:00)
when you do the two, you are automatically sleeping better when you're doing success. Look at it. It's the one that feels like the domino that tackles the rest. Whereas eating well doesn't always mean you will actually move at all.

David Cox (44:11)
Yeah.

Patrick Obolgogiani (44:11)
so it's like it doesn't work both ways and sleeping well, it helps, but doesn't doesn't move you necessarily. People leave sleep ten hours in the night, then are equally lazy the next morning. and I feel like breathing has this tendency where if if done, for example, with with resonance breathing, where you're adjusting, regulating your nervous system, you just make better choices in your life. You're a bit more present, you're like less this wired and tired type of thing. So it then affects the first bit of the the exercise. You make it more likely by being making better choices being

more kind of yourself basically so that it feels like it could have the from a behavioral standpoint this like domino layer not because it's like the biggest domino because it's the one that can actually tackle the next one but remains I think there's some evidence that we need to actually back that up that claim.

David Cox (44:53)
Yeah, I mean I completely agree. I think interestingly as well, if you're breathing better, exercise is probably going to be more pleasurable and you're gonna be more likely

Patrick Obolgogiani (45:00)
Yes.

David Cox (45:01)
to exercise. You probably will also get the benefits of exercise a lot more. So, yeah, all of these things are very, very interlinked. And yeah, I like that point you make about choice. You know, definitely. I think with a lot of these things, if you're if you're living more optimally, you're making better choices.

Patrick Obolgogiani (45:17)
Maybe last point there on wearable, because you've done, I'm sure, a lot of writing and researching into wearable industry and where it's been going for the last ten years. I'm just curious to hear from you, where do you see this going? Like you've you've had now a couple of big players emerge with Aura and Whoop, and then a plethora of new players emerge, some that are doing kind of

Similar form factors with rings and and bracelets and then some now that are kind of there's I think one on on your temple, right? And there's of course we're on the on on torso. Just curious to hear where you where you think this is all going, as someone kinda observing it from the from from as journalists and also where do you wish it would go to actually start impacting people's people's health.

David Cox (45:54)
Yeah, I mean I think it's a fascinating industry. I mean, I think it has a massive role to play in preventative health. And I think one of the really interesting things wearables can do is just act as that little regular nudge into making healthier habits. I mean, I'll give you one example. like a couple of years ago I tried a new wearable which was measuring they found a way of measuring hydration index. I think they were using some of the technology behind pulse oximetry and

getting a sort of an estimate of like whether you were a little bit dehydrated. And it was so fascinating, you know, for the n for the month I wore that wearable, I never drank as much water because I was constantly just seeing lots of on, you know, on my on my smartwatch my my hydration measure and and I was sort of in the minus and I like, actually I do feel a bit di dehydrated and it was making me a lot more mindful about actually getting, you know, eight eight glasses of water a day. So

I feel that it it it can make a big, big difference. I think what it needs to really, you know, achieve its potential is a couple of things. first of all, you know, we need we wearables which are actually like so kind of regulated in terms of are they measuring, you know, what they say? You know. I think Apple Watch people are now pretty confident in like sort of heart data to to the extent that I think, you know, doctors will actually, you know, use

Apple Watch heart rhythm data to make clinical decisions. And we need that for more of these other wearables as well. Like so you kind of almost need more independent testing of the sleep sensors. How accurate really are they in terms of measuring your sleep quality over a period of time? You know, same with things like hydration index, same with other things like that. So I think hopefully we can get to a point where maybe, you know, at the moment in in healthcare, the issue is.

you know, you have your kind of midlife NHS health check up here in the UK at like forty, and then you get a few more screening tests for various cancers and that's basically it pretty much. And we're measuring only to the the most basic things like blood pressure and cholesterol and stuff like that. And so I think perhaps weareballs, you know, if they we can be certain that they're accurate enough, can really, really help doctors out by providing this sort of suite of data on everything

from how much you're exercising to how well you're sleeping to how well you're breathing. And then maybe doctors when when you see them for for that checkup, they will have this kind of suite of data points and maybe AI will come in and be able to kind of draw automatic conclusions. And then we can maybe stave off certain diseases ahead of time because your doctor will say, Well look, you know, I have your data. I know that you're consistently only sleeping for five and a half hours a night.

you know, you need to prioritize that like a little bit more or you're just not moving enough. If you did twenty minutes more exercise a week for you that could make a big difference. And so I think it can it can definitely play a role in preventative health, but it needs to be integrated within the health service in some

Patrick Obolgogiani (48:49)
Yeah, that's a fascinating topic. And it's something we've been also pondering is when you think about the long term vision, where's this all going? And it that would make sense to integrate it into an existing system that is in theory at least incentivized to keep you healthy as long as possible and to empower

David Cox (49:03)
Yeah.

Patrick Obolgogiani (49:04)
the people that are making those choices for you, which the doctors. So I guess

David Cox (49:08)
hundred percent. I I t I tell you one one interesting area where some w which is kind of related to that is in terms of it's it's a big issue obviously here in the UK lots of you know hospitals are constantly you know overcrowded. there's an issue of you know we need to kind of discharge more patients early but how do you do that safely? And there's a number of interesting trials taking place where they basically fit patients with a whole variety of wearables, discharge them back home and then kind of monitor them virtually.

And then if they kind of see any red flags from the data, they then bring them back into hospital. But it's a way of, you know, tr a way of safely discharging patients sooner. And also, you know, we know that the longer people stay in hospital, you know, it's it's bad for their rehabilitation, it's bad for their risk of getting infections. So that's a really interesting thing which will come in more and more as we go go forwards through wearables.

Patrick Obolgogiani (50:01)
Yeah, no, it's a beautiful point. As we start wrapping up, a couple of rapid fires and then we'll start we'll start closing. What is the one health claim that you wish went dead?

David Cox (50:10)
Well I know Peter Atier does push this, but I actually to be honest the whole idea that we need to be getting more protein. I mean the average person is getting more than enough protein than we actually need. And I think the the real thing which a lot of people just aren't getting enough of is fibre, which can make a much bigger difference to aging over time.

Patrick Obolgogiani (50:28)
And what about one thing that is maybe sounds boring, but it's actually underrated and really works.

David Cox (50:33)
I mean that actually would just would be fibre, you know. I just find

Patrick Obolgogiani (50:36)
I get.

David Cox (50:36)
the the studies on fiber are so, so interesting, you know. Even if you take people who are in the early stages of frailty and you actually up their fibre intake consistently for six months, you can see the reversal of different types of different elements of frailty. So that's one which can make a big difference across the life course.

Patrick Obolgogiani (50:58)
Hm. And we've touched a little bit on supplements, but is there anything that is actually worth people considering?

David Cox (51:05)
I mean I feel omega freeze, you know, a lot of people don't like eating oily fish and omega freeze we know can make a big, big difference in all kinds of aspects of, you know, slowing the aging process. And if you're over fifty, getting a B vitamin complex I think is another big thing which is increasingly emerging as being really important.

Patrick Obolgogiani (51:23)
And with omega three, are you thinking of like one gram or like what's the dosage that you would recommend based on what you know?

David Cox (51:28)
It seem it se

it seems to be one gram. one gram a day seems to be the optimal from the studies I've seen so far. But I think the key as well with omega free is try get one with an antioxidant like vitamin E in it as well, 'cause they tend to be higher quality and you know there's there's a a little bit of an issue with the quality of omega free supplements. So yeah, get one with some antioxidants in as well.

Patrick Obolgogiani (51:49)
Yeah. And I think we we covered a lot, but if we try to very kind of distill it down, like if someone listening there in their let's say forties, fifties, they're a bit tired, they've read all these contradictory things about th about about aging, where do you think they should start? What's the easy kind of lever to pull and start this journey?

David Cox (52:05)
I think one of the interesting things is just like take an honest look at what you're eating, you know. if you're say eating sixty percent ultra-processed foods, like many people in the UK are, you know, just try and like so shift that balance a little bit. Like it doesn't mean eliminating processed foods in entirely, because that's pretty much impossible to do. But try and maybe maybe make that sixty percent whole foods, forty percent ultra-processed foods. maybe just consider, you know.

thinking about the timing of of of when you eat. Like you know, maybe not every day, but say four days a week, try and have your biggest meal for morning and lunch and a smaller dinner. Or just try and do that for two weeks and see how you go and see whether that's something you can maybe commit to over time. Because some of those things can make make a big, big difference. And if you're feeling a bit achy, you know, kind of getting more joint and muscle pains, that is perhaps a sign that you could be

You know, not getting as much omega free as you need because omega free plays a really important role in muscle and joint health over time.

Patrick Obolgogiani (53:04)
Yeah, that's beautiful when to start wrapping this down. So the age code, where can people learn more about yourself, your work and and the book?

David Cox (53:13)
Yeah, so the book is available to buy pretty much all major bookshops. It's on Amazon of course. you can buy the English language version pretty much everywhere around the world. and yeah, follow me on LinkedIn. I post there all the the latest articles I I write and I'm also on YouTube, Instagram and TikTok as the handle Dr. David Cox Health. So please do go find me on there.

Patrick Obolgogiani (53:36)
Amazing. David, thank you so much. And we'll make sure to link two of those in the show notes. But with that, wish you a lovely rest of the week. And thank you everyone for tuning

David Cox (53:43)
Thank you so much.

Patrick Obolgogiani (53:43)
in.

David Cox (53:44)
Pleasure speaking.