Chapter 3

The Five Pillars

The Longevity Revolution

Most popular diets and the experts behind them fail to take into consideration the most important reason to adopt a diet in the first place: living to a very old age and “dying healthy.” We are so used to associating death with cancer, heart disease, or another illness that the concept of “dying healthy” seems alien. But this is the promise of the “longevity revolution.”1 Indeed, the concept is now strongly supported by experiments in simple organisms, mice, rats, monkeys, and humans. Based on biogerontology (study of the biology of aging), preventive medicine, and longevity research, we now know that the later years of life, even when life is extended, need not be associated with poor health and disease.

For example, the mice and rats we treat in the lab with different longevity diets live up to 40 percent longer and have far fewer diseases despite their longer lifespan compared to mice on standard diets. Long-term studies of monkeys on a calorie-restricted diet demonstrate a major reduction in disease incidence as well as lifespan extension. This is consistent with our recent study associating high protein intake with cancer and mortality in humans. In addition, we discovered that, as with the long-lived mice lacking growth hormone receptors, the Ecuadorian people with the same deficiency in the GH receptor rarely develop either diabetes or cancer and appear to be protected from age-dependent cognitive decline and possibly other diseases. Thus, dietary interventions that affect particular genes or genetic changes in those genes directly can extend not only longevity but healthy longevity in mice, primates, and humans. According to these studies, a precise Longevity Diet accompanied by periodic fasting-mimicking diets (which I describe in chapters 4 and 6, respectively) can, by regulating the set of “longevity genes,” extend the healthy lifespan.

I’ve been lucky to see this kind of healthy longevity with my own eyes. In the past ten years, I was able to make many visits to the two oldest people in Italy: Salvatore Caruso, 110, and Emma Morano, 117, who have both now passed away. Emma was also the oldest living person in the world, and the oldest ever in Italy’s recorded history. Both retained good memory skills, engaged in many activities on their own into old age, and were remarkable examples of healthy longevity. Emma exemplifies the importance of genetics on longevity (her diet wasn’t particularly healthy), whereas Salvatore shows the influence of diet on human health. Thus, the study of people and populations with record longevity represents one of the key pillars I have used to identify the Longevity Diet described in this book.

Who Do You Listen To?

Among the longevity factors within your control, what you eat is the primary choice you can make that will affect whether you live to 60, 80, 100, or 110—and more important, whether you will get there in good health. So when it comes to dietary recommendations, it’s crucial to listen to the right people. In an Internet-centered world, perhaps the most dangerous development for your health is the chaos generated by the idea that everyone can give dietary advice. It is essential to determine whether a so-called diet expert has the appropriate range of knowledge before deciding whether he or she is qualified to give you dietary advice.

On a recent train ride from Milan to Genoa, I had one of many entertaining experiences underlining that everyone believes themselves to be a diet expert. An old building administrator from Genoa explained how his wife’s omelets were the key to maintaining his weight and health. The woman next to him protested that eggs have high cholesterol and that her pasta and zucchini were much healthier. When five such “dietary experts” had made their recommendations, they wondered why I had not jumped in.

“I think you’d better cut down on the number of fried eggs per week,” I told the retired administrator.

“You know, I don’t think I like you,” he replied.

Because everyone eats, everyone feels he or she knows enough about food and health to give advice. Recently a woman asked me what I thought she and her son should eat to stay healthy. After hearing my advice, she responded, “I think the best thing to do is to eat everything in moderation.”

I asked her, “Would you fly on an airplane that you had personally designed?”

She knew the correct answer to that question was absolutely not. Most planes are designed by teams of world-class engineers working at major aviation companies like Boeing and Airbus, using technology and insights going back to the Wright brothers and even Leonardo da Vinci. Why would you be willing to make key decisions that affect whether you and your loved ones will get cancer, diabetes, cardiovascular disease, and many other illnesses based on the silly idea that one should “eat in moderation”? What does that even mean?

In the class I teach on nutrition and longevity at USC, I ask my students how many calories there are in a bagel. Most think it’s around 100 or 150 calories. In fact, most bagels provide between 250 and 500 calories, without cream cheese. When I started directing clinical trials in which participants are told exactly what to eat, I discovered that most people have no idea what it means to eat 0.36 grams of protein per pound of body weight per day. Even experienced health journalists have told me, “I wasn’t sure if you meant that I should eat fifty grams of protein or fifty grams of food that contains proteins per day.”

I mean protein, not food that contains protein. This minor misunderstanding alone could cause someone to become malnourished or sick—50 grams of garbanzo beans contains only 5 grams of protein, just 10 percent of what adults need to stay healthy.

I have also learned that “moderation” is relative. Consider the following daily menu: a glass of milk, two eggs and bacon, a small steak, a slice of cheese, some carrots, some pasta, a chicken filet, a salad with ranch dressing, a piece of cake, and two soft drinks. To many people, this represents eating in moderation. Yet this is the type of diet that has made the United States one of the world leaders in obesity and related diseases. The key to adopting a longevity diet is finding books, like this one, written by scientists or clinicians who have mastered as many of the Pillars of Longevity as possible. Although most healthy people will be able to make these dietary changes on their own, I do recommend if at all possible that you consult with a qualified medical doctor or registered dietitian, at least initially, and especially if you have food allergies and might need help personalizing the diet to your needs. You already bought this book, so you’re on the right track.

As I have said, I based the great majority of dietary recommendations in this book not on my opinion, but on the Five Pillars of Longevity and the solid, consistent, scientific, and clinical evidence they provide. I don’t talk about “miracle diets” or “cures,” and I stay away from fad diets promising weight loss. Changing your diet to gear it toward healthy longevity will take some work. But it will be much easier than you imagine, and in many cases it will be more beneficial than drug therapies when you factor in both efficacy and side effects. Not to mention saving money on doctors and medications. In the long run, the life-extending benefits will be well worth the effort.

I’m confident in these claims because of the positive results achieved by thousands of people I have studied—either personally or through basic research, clinical trials, and genetic and epidemiological studies. I’m also confident because most of my recommendations for everyday diets match the diets of the very-long-lived populations that I, and other experts like Craig Wilcox in Okinawa, have studied. These individuals are concentrated in “blue zones,” a term coined by Michel Poulain and Gianni Pes, and made popular by author Dan Buettner, to identify longevity hot spots, where diet and physical activity levels are believed to be a key factor in successful longevity. This book also takes into account dietary habits that were common in our history. For example, my disease-treatment recommendations in the later chapters of this book, specifically the fasting and fasting-mimicking diets, are based on scientific and clinical studies; but many of these interventions find echoes in ancient practices, such as religious fasting. Historically religious fasting was not adopted to prevent or treat disease but, since it was common for our ancestors and has now been tested on thousands of people, we know it to be generally feasible and safe.

The Five Pillars of Longevity

Most people are discouraged and often confused by nutritional news. Nutrient groups (fats, proteins, and carbohydrates) and also specific foods like eggs and coffee have all been described in scientific journals and the media as both good and bad for you. How do you decide what’s right for you and your health? In fact, proteins, fats, and carbohydrates can be considered both good and bad for you depending on type and consumption. For example, proteins are essential for normal function, yet high levels of proteins, and particularly those from red meat and other animal sources, have been associated with increased incidence of several diseases. So we need a better system to filter out the noise and extract beneficial dietary information.

This is why I formulated the “Five Pillars of Longevity.” This method is based on my own studies and also on the studies of many other laboratories and clinicians. It uses five research areas to determine whether a nutrient or combination of nutrients is good or bad for health and to identify the ideal combination of foods for optimal longevity.

I believe that many popular strategies and diets are inappropriate or only partially correct because they are based on just one or two pillars. This is important because while one nutrient may be protective against one condition or disease, it can negatively affect another, or it can protect middle-age individuals but hurt the very young or the elderly. An example: In adults age seventy and below, eating a relatively high-calorie diet will in most cases lead to weight gain and an increase in the risk for developing certain diseases. Yet in individuals over age seventy, the same diet and the consequent moderate weight gain can be protective against certain diseases and overall mortality. This is why it is important to follow the advice of someone who has an in-depth understanding of the complex relationship between nutrition, aging, and disease.

The Five Pillars of Longevity create a strong foundation for dietary recommendations and a filtering system to evaluate thousands of studies related to aging and disease, while also minimizing the burden of dietary change. When dietary choices are based on all the Five Pillars, they are unlikely to be contradicted or undergo major alterations as a consequence of new findings.

3.1. The Five Pillars of Longevity

THE FIVE PILLARS OF LONGEVITY:

Applying the Five Pillars of Longevity

As an example of how to apply the Five Pillars to analyze a diet’s efficacy, let’s examine the very popular high-protein, high-fat, and low-carb diet, such as the Atkins and Dukan diets. Should you go on this diet just because an “expert” told you that a small clinical trial or even a large epidemiological study shows that it causes weight loss and may lower cholesterol? The answer is definitely not, since when you analyze these diets, they are often based on just one or two pillars, rarely taking into account the entire foundation needed to support the selection of a diet that will optimize health and longevity. These are the diets that tend to get debunked over time. When you look at multidisciplinary studies, you realize that the high-protein, high-saturated-fat, and low-carb diet is one of the worst for your health. Populations with record longevity do not eat this way, and theoretical, clinical, and epidemiological studies supporting this kind of diet’s long-term and longevity benefits are very few. Also, if we examine the laboratory studies, we see that both high protein intake and high saturated fat intake are associated with aging and disease, an additional and key vote against a high-protein, high-saturated-fat diet.

As you can see, even when a diet is touted as having been clinically studied, it doesn’t mean that it has been studied as rigorously as necessary, so it is always wise to hesitate before adopting a new diet, and to look into how many of the Five Pillars it is based on. As we have shown in both our human and mouse studies, one diet fits most but does not fit all, and the levels of some dietary components must be modified depending on a person’s age and physical state and based on his or her genes. In my laboratory, we treat food as a complex mixture of molecules—each capable of causing remarkable changes in your body, which is its own complex mixture of molecules.

If it already sounds confusing or difficult to follow, don’t worry, I will make it as simple as possible in chapter 4.