Muscle Loss, Testosterone and How Much Strength We Can Regain with Dr Oskar Wenbar

Speaker A: 00:00:00

Foreign.

Speaker B: 00:00:05

Welcome to Beyond Longevity, the podcast that explores not just how we age, but how we can build a longer, healthier future for ourselves.

After a stroke left his father bedridden, Dr. Oskar Wenbar watched his father's physical condition deteriorate and his confidence to leave the house disappear.

This drew Dr. Oskar into research on aging muscle.

Why do we lose muscle as we get older?

What happens when we stop moving?

And how much strength can we actually regain?

Dr. Oscar was born in Poland, grew up in Chicago and studied pharmacy in England.

He went on to research aging muscle at the University of East Anglia and today he lives in the UK and is co founder of Ivaro, a digital healthcare company.

In this conversation, we look at what is actually changing inside our muscles as we get older and why that matters for far more than just strength.

We talk about the cells that help muscle repair itself, whether someone in their 70s can still rebuild what they have lost, and what resistance training really needs to involve to be effective.

Then we get into the more contested territory.

Testosterone and other hormones, the muscle people may lose while taking weight loss drugs, and whether biological age tests tell us anything useful.

Where is there good evidence to act?

And where are we getting ahead of it?

Please enjoy my conversation today on Beyond Longevity with Dr. Oscar Wenbach.

Thank you, Dr. Oscar, for joining me today on Beyond Longevity.

You've ended up in quite an interesting combination of worlds.

You've studied aging muscles at microscopic level, you're a practicing pharmacist, and now you run a digital healthcare company.

Where did all this actually start for you?

Speaker A: 00:02:04

That's a good question.

Actually, I went through different sectors.

I think I'm one of those people that like challenges and I'm always looking for the next challenge.

So to give you a little bit of a background about me, I was born in Poland, very kind of working class little town called Bydgosz.

My parents then my dad decided to move to America.

He was a construction worker and we followed shortly after that.

So I grew up in a city called Chicago.

You might have heard of Metropolitan City.

And growing up there, I knew that I was going to go into healthcare.

My parents kind of ingrained that into me.

You know, I was going to be the first person in the family to really be university educated.

So I knew I had to go into kind of healthcare.

I had a passion for that and that was the way forward.

Unfortunately, in America, it at the time cost about 45,000 a year to do a pharmacy degree, so we couldn't really afford that.

What happened was we had a lot of Family in the uk.

So I ended up getting approval for the home rates in the uk.

It was a lot more affordable and ended up doing the pharmacy degree and in England, which was a great experience, I really enjoyed it.

I actually really enjoyed England.

Living in England.

After that, I went to work in hospital.

So when you finish pharmacy, you have kind of three different routes, which is academia, your normal community pharmacy or hospital.

So I found that as more challenging, a little bit different.

So that's exactly what I did.

And I loved, I loved my time in hospital.

It was one of the, one of the best experiences ever.

I worked in a little hospital called Queen Elizabeth Hospital in King's Lynn.

They pretty much let me do everything.

I was working on every single ward and I was learning so much.

So at around this time, my dad unfortunately ended up getting a stroke, which was kind of a big hit on us.

He ended up being bedridden.

He couldn't, he really couldn't move.

He didn't have the confidence to go out of the house.

Really though I kind of saw firsthand the deterioration that caused them both psychologically and physically.

And that went on to then influence what I did.

After that, I realized I wanted to do something even more challenging.

After hospital, I saw a project that my university was running which was based on skeletal muscle aging at the medical school.

And I said, wow, okay, this is something I'm really interested in.

This is looking at sarcopenia, which is age related muscle dysfunction.

And it just kind of clicked, you know, I was like, okay, this is, this is something I want to do.

During those four years I was working in academia, I was running lectures, I was doing workshops and I was doing the independent research and also loved the time there.

Really enjoyable.

At the end of those four years, I realized this is not for me either.

I thought I was going to be, you know, on university lecture.

I thought I was going to be doing all this research constantly.

I thought, this isn't for me.

I need another challenge.

I need something a little bit different.

So in: 2017

I knew from working with companies like Superdrug in the past that this was the future.

Online healthcare was gonna be the next big thing.

You know, this was: 2011

They were starting to do online doctor services.

And I knew that that was where everything was gonna be headed.

And we went from 100 patients to now, over 400,000 patients in that time span.

So it's been an amazing journey.

And I'm currently The chief medical officer for the company.

Speaker B: 00:05:40

Wow.

Incredible story.

It's really interesting how people get into the field of longevity, because very few people set out to end up in the field of longevity.

But it's always very interesting the way they find their way into it.

Now, your sort of speciality, for a time at least, was muscle.

And most of us probably think we understand muscle.

You either have more of it or you have less of it.

But clearly that's not the whole story.

So while I want to talk about, you know, various other things that you have been doing that you are doing, let's start with that.

What actually happens inside a muscle as one gets older?

Speaker A: 00:06:29

I think we have to kind of go back and understand what a.

A muscle cell really is.

So normally when you think of cells, when you go back to your biology textbooks, you always think of these little blobs, right?

And they've got one single nucleus and they've got all these other components.

But muscle cells are completely different to that.

So a muscle cell can be 30 centimeters long.

They're actual tubules, and not only that, but they have multiple nucleus nuclei.

So they're very much adapted to actual movement.

And they're very much different to what we think of as normal cells.

They don't differentiate either.

So normal cells will then split up and differentiate, usually.

So muscle cells have what's called satellite cells, and these are very similar to stem cells.

They kind of just sit there on the surface of the muscle fiber and just wait until they're needed when your muscle gets damaged, then they activate, then differentiate and produce another muscle fiber eventually.

So as we age, all of these components tend to slow down and tend to go wrong.

The satellite cell density typically goes down.

The nuclei density typically goes down.

If you.

If you don't have the right amount of resistance, exercise and general exercise.

And what I did in my research was actually looking at transporters of amino acids into these cells.

These transporters also are less expressed in older tissue.

And the reasons for these are multifactorial.

Generally, as we get older, we become more sedentary.

We don't exercise as much.

Our hormone levels change, both in males and females.

That affects all these components.

And what happens is you also get a proliferation of fat.

So actually, fat cells proliferate into the muscle.

If you see cross sections of people that are active, they're almost all muscle cells, these fibers.

But those individuals that aren't as active start to have these fat cell deposits in between the muscle cell fibers.

So the density of muscle is actually going down Significantly.

And that really, really matters when we get older, because as we get mobility, mobility decrease, the cardiovascular risks go up exponentially.

Speaker B: 00:08:49

You've touched upon something that certainly none of my guests have ever talked about.

So I want to just delve a little bit deeper into it.

It's these satellite cells.

What exactly is it?

What is their job?

What are they waiting to do?

And if I go to the gym and challenge my muscles, what happens to those satellite cells?

Speaker A: 00:09:12

Yep.

So satellite cells are very similar to stem cells, to put it simply.

They don't have a choice of what they differentiate into.

Their normal stem cell will have a gamut of different options in terms of what it can turn into really magical cells.

Right.

A satellite cell has already decided, I'm going to be a skeletal muscle.

So what happens is it turns into a myofibril, and it turns into then a skeletal muscle cell.

They're essentially for repair.

Every person will have a different density of these satellite cells, and the biggest determinant of how many you have is resistance exercise.

So we know the data shows that resistance exercise two to three times a week is the most efficient way of increasing the satellite cells.

We also know that there's a link between aging and the density as well.

So as we age, we tend to have less of these satellite muscle cells.

Speaker B: 00:10:04

So you just said there is a link between aging and the amount of satellite cells in your muscles you have.

How early does this start?

Speaker A: 00:10:14

So this is something we're not.

We don't really fully understand yet.

The.

The data shows that sedentary individuals significantly decrease their satellite cell counts, but there's a link with aging and a decrease in activity.

So whether that's that activity decrease or aging itself that causes these satellite cells to be lower is still up for debate.

But what we see is there's a multitude of factors involved in this.

Whenever we talk about aging, it's always multifactorial.

Right.

And I'd love to see a study where we look at satellite cell density and age itself on all things being equal.

I think that's.

That'd be quite an interesting thing to look into.

My opinion is that there's a definite decline as we age because these muscle cells are being utilized when we have any sort of damage to the muscle.

So it makes sense to me that they would.

Speaker B: 00:11:09

So, not to scare anyone, but could this decline already happen in our 30s or 40s without us even knowing it?

Speaker A: 00:11:18

I think certainly in your 40s.

I would say in the studies that I've seen, we tend to see declines around the age of 35.

And on that at least quantifiable declines.

Again, it's compounded by the fact that if you have a really active 40 year old, that might offset their satellite cell decrease.

That's the caveat, I would say.

Speaker B: 00:11:40

Now, why is losing muscle such a serious health problem?

Why isn't it simply that you just become a bit weaker?

Speaker A: 00:11:49

Yeah, really good question.

So one of the things we studied was the onset of something that's called sarcopenia, those age related muscle dysfunction, muscle decline.

The data shows right now that 28% of men and around 12% of women will suffer from sarcopenia.

What is the significance of this?

A lot of times I hear people say, okay, like this is normal, this is part of aging.

You're not able to walk around this much, et cetera, et cetera.

But so much in hospital and in clinical settings, we see the trigger of decreased mobility as the trigger of when things really start going wrong.

The onset of sarcopenia is associated with 78% major cardiovascular event, 78% increase, 62% increase in heart failure, and 83% increase in all cause mortality.

We're not just talking about, okay, these patients don't have enough muscle.

The fact that they don't have enough muscle is then leading on to all these other secondary problems that are very serious.

There's a number of reasons why that happens, and the simplest would be, for instance, insulin resistance.

So what happens is muscle tends to uptake glucose from the bloodstream.

The less and less muscle you have, the less reserve of this you have.

So the more of that blood glucose is going to be sitting in your bloodstream, which can cause a number of health issues, cardiovascular issues, and then insulin resistance.

It also causes inflammation, general inflammation, and cytokines that are inflammation prone.

The truth is we don't actually fully know exactly why, because an 83% increase in all cause mortality.

There's some things that we haven't defined yet exactly what's going on.

Why is this muscle so important to have?

Speaker B: 00:13:35

So I'm quite fascinated by these satellite cells because as I said, I don't think many people talk about it.

How important do you think satellite cells are to the whole story of why we lose muscle?

And can we measure satellite cell reserve in younger people and then learn something useful about how well they're going to age or is there no correlation?

Speaker A: 00:14:04

So satellite cells are one part of the picture.

You're looking at also things like nuclei density as well.

So the best way to have an idea of what a person's state is, is to do a biopsy.

So you do a muscle biopsy.

Essentially it's, it's a very thick needle that's then inserted into the thigh.

This is quite invasive.

I would say it's quite painful.

You're essentially taking out a bit of muscle and then putting it under a microscope.

Whether that's something I would routinely recommend, I don't think so.

There's other blood markers that you have of, of longevity as well, but biopsy is the only way of doing it.

But I don't think biopsy is something I'd recommend.

Speaker B: 00:14:44

No, no, definitely not.

I was just wondering, you know, if one were to do a biopsy, if there's a correlation between how many satellite cells one has as a younger person, if there's a correlation to what happens.

Speaker A: 00:14:58

In old age, the data is not conclusive on that.

And that's a very good question and something I would like an answer to.

It gives you a picture of what the situation is with the muscle at that point of the biopsy.

But that can all be improved with resistance exercise with balancing hormone levels.

So it doesn't necessarily mean that someone's doing a biopsy at 25 and, and they're gonna tell them, oh wait, you're gonna get sarcopenia when you're 70.

It's really gonna depend on what their lifestyle factors are, what their hormone levels are.

It's really multifactorial.

Speaker B: 00:15:32

So that leads me to my next question.

Let's say somebody in their well 40s or 60s or 80s has neglected their muscles for whatever, 20, 30, 40 years.

How much can they actually recover?

And is there a point where the biology becomes less forgiving?

Speaker A: 00:15:52

Let's say, surprisingly a lot.

From the research that we have done, we've taken aged mice and by balancing hormone levels, we were able to get those satellite cells back to the same levels that the young animals were showing in other research.

We can see that the satellite cells do increase even when, when you're in past 70, I don't know about exactly 80.

I know around the 70 year mark they do increase significantly just from resistance exercise, not necessarily back to levels of when you were 25.

It's amazing how robust the system is.

So they do actually increase and it is reversible.

Speaker B: 00:16:30

So when you say resistance training, what exactly does that mean?

Telling somebody go and lift weights is not terribly helpful to most of us.

Are there any rules that one can follow?

How often, how heavy?

Speaker A: 00:16:43

Yeah, sure.

Personally, I've been working out since I was 16.

I did a lot of sports and all sorts of different training regimes.

And the one I would recommend is progressive overload of muscle resistance training two to three times a week.

Whenever we talk about longevity in general, anytime anyone asks me about, okay, what's the most proven thing about improving longevity?

And I say to them that 100% definitely exercise.

If you're going to do one thing, you need to do that.

So two to three times a week, resistance training, progressive overload, a weight that you can only do around 10 to 15 reps of, ideally coupled with aerobic training as well, that's the best way to achieve longevity and increase the satellite cell count.

Speaker B: 00:17:31

So on various social media platforms, we often hear that lifting weights raises growth hormones and activates satellite cells.

Is that as such a useful explanation or have they just turned a complicated process into sort of a nice social media sentence?

Speaker A: 00:17:53

It's certainly an oversimplification.

Growth hormone's an interesting one.

Growth hormone tends to be the.

The best way to increase growth hormone is by activating very large muscle groups.

So that would be something like squats.

So we see in the research that if you're performing squats with heavy weight, that does actually increase your growth hormone.

I think what, what happens on social media is a lot of times people kind of exaggerate the effect of this.

You're not going to achieve like 10x your growth hormone by doing that.

It's definitely something you should be doing, but it's not going to make, you know, an incredibly massive difference.

Speaker B: 00:18:27

We all know, because of, you know, social media, if nothing else, that's protein feeds muscles, just to put it very simply.

Speaker A: 00:18:37

That's right, yeah.

Speaker B: 00:18:38

So if you look at how aging muscles use amino acids and make new proteins, can we think of it this way, that if protein is the building material, aging muscle becomes worse at getting those building materials through the front door?

Speaker A: 00:18:58

That is true, and that is what we found in my research specifically.

So we were looking at amino acid transporters, and these were not expressed to the same degree as they were in the younger muscle tissue.

And again, this is something that's.

That's actually linked to hormone levels and is multifactorial.

But yes, you can actually, you can test skeletal muscle and see how much uptake of amino acids like leucine.

So there's a transporter called LAT2.

It transports large amino acids.

You can see how much of that amino acid is making it into the skeletal cell.

What we did was we actually tagged this with a radioactive isotope and then we measured how much amino acid uptake it was performing.

And yes, that's true.

As we age, these transporters downregulate and they don't work as well.

Speaker B: 00:19:47

And I think you found that fast twitch fibers in particular affected.

Why does that matter?

Speaker A: 00:19:53

In everyday life, fast twitch fibers generally help with gait.

Losing those fast twitched fibers is quite dangerous in terms of mobility.

It actually increases the chances of falls and fractures.

Speaker B: 00:20:09

These are the fibers that I rely on if I trip on a pavement and I need to hold out my hands and catch myself.

Speaker A: 00:20:16

Right, yeah, exactly.

Your body weight shifts and you kind of have to quickly kind of readjust and it keeps you from falling down those stairs or tripping.

And what happens in the elderly populations once you start losing a lot of those fast twitch fibers, it's very dangerous because you're going up the stairs and that fall can mean a lot of damage.

It can mean a broken hip, it can mean hospital stay of multiple months.

And again, these things just kind of compound.

If you're going to be sedentary for a few months because you fell, when you get out, you're going to be even worse off.

You're going to have even less of those fibers.

It's always this vicious cycle.

Speaker B: 00:20:52

I think for sure you are also very involved and have done a lot of research with hormones, especially testosterone.

But before we get to testosterone, I want to talk about another hormone that I think needs explaining before we move onto testosterone.

And I think we need to explain dht.

Dihydrotestosterone.

Some listeners may know DHT as the hormone they've heard about in connection with losing hair.

Speaker A: 00:21:25

Hair loss, yeah.

Speaker B: 00:21:26

But it also acts on the muscle.

So what exactly is DHT and what does it have to do with testosterone?

Speaker A: 00:21:34

Well, DHT is much more potent.

What we normally say is more androgenic than testosterone.

Testosterone converts into DHT and it tends to work in a muscle in a much more active, direct way.

If you had the same amount of testosterone and the same same amount of dht, the DHT is a lot more potent.

And a lot of people think, okay, this is a, this is a bad thing.

DHT is a bad thing because it causes hair loss, et cetera.

And honestly, no, because it's the main active in skeletal muscle.

Skeletal muscle really needs DHT in order to function, in order to keep this satellite cell reserve, in order to make sure that the muscle is working properly.

Speaker B: 00:22:15

I believe in your research you took aging mouse muscle fibers and exposed them to dht.

Speaker A: 00:22:22

Yeah, so we exposed them to dht.

I believe it was about an hour exposure and then we looked at the cross sections, we looked at the amino acid transport into the muscle.

It was really surprising when we, when we did the cross sections under the microscope, you couldn't tell the difference.

You were looking at the, the young muscle cells and we were looking at the old ones, and they were just very similar.

The satellite cell counts were similar, same for the amino acid to transport numbers.

So it was, it was very surprising actually to see that, to see how much the rebalancing of hormones and how much this skeletal muscle actually depended on DHT to function and to keep these kind of safety guardrails in place.

Speaker B: 00:23:09

So the results were quite surprising in making you realize what an important role hormones might play in muscle aging.

There's quite a leap from mouse experiments saying DHT changed the protein synthesis in isolated mouse muscle fibers and then bringing it to the human correlation by saying optimizing testosterone will help humans age better.

What evidence was required to cover that gap?

Is this a pivot from sort of a lab work into a testosterone in humans?

Speaker A: 00:23:50

We always learned in academia, we never make definite statements.

We always say this research suggests that this might be the case.

That is the case here.

So we have the data to show that it's likely that hormone balancing, increasing DHT back to normal levels, will make this muscle fiber function better.

Have we got enough data with humans?

No, we don't.

And that, I think, needs some more looking into.

We need to look at exactly the biopsies after the treatments.

This is something that really needs to be done more of.

We do have outcome measures.

We know that people that take testosterone replacement therapy have better outcome measures, have better mental health outcome measures after they start the treatment.

But again, we need to follow that up with the researcher on the biopsies and get actually more solid data on that.

Speaker B: 00:24:43

Let's move from lab into real life.

We talk a great deal now about women's hormones changing with age.

And male hormone aging is a little bit different and probably much less well understood by most people.

What actually happens to testosterone in a healthy man as he gets older?

Speaker A: 00:25:05

The decline in testosterone starts occurring after the age of 25.

It's a fairly linear decline, but the symptoms aren't noticed until you reach a certain threshold.

So usually we say that's 12 millimolar.

We're around there.

And up until then, the individual might function just fine.

You know, they might have a slightly more adipose tissue, they might have slightly less muscle mass.

But the problem of testosterone is it you don't really notice the effects until it really drops to A point where it's quite low.

We're seeing a lot more instances of this now, especially with kind of all the additives in the environment.

We're seeing that, that men have lower testosterone than they ever did.

And this is a problem because of mental health issues.

And this is, this is a problem because of fertility.

We're seeing that men are less fertile.

And it's also, we're, we're seeing more evidence that it's also important for women.

There's a whole lot of work being done at the moment about testosterone and its importance.

And also in women, and especially post menopause, we're seeing, they're really benefiting from replacement.

Speaker B: 00:26:17

So the decline begins for everyone at the age of, you know, around 25.

And the decline, you know, is inevitable and it is linear.

But is there much variation between the decline in the men or is that pretty standard?

Speaker A: 00:26:36

Some men will never be testosterone deficient.

So if we talk about levels, for instance, they, maybe they start at 25 and by the time they're 40, they might be, you know, at 15.

Clinically speaking, they're, they're fine, they're still experienced a decline, but not to the point where we, we see that as treatable because it's not, it's not gonna, under that threshold of what's considered treatable.

This is a good, actually topic of discussion.

It's, there's a lot of discussion in the, in these testosterone circles.

These clinicians are asking the question of whether actually do we need to stick to 12 or should if a man wants to be at a higher testosterone level, should we keep him at that?

But that's something that's a little bit controversial.

Speaker B: 00:27:27

Yeah, so this is exactly why I think the language becomes really important.

Because treating somebody whose body isn't producing enough testosterone, you know, is one thing.

Optimizing testosterone in an otherwise healthy aging man sounds like something slightly different.

So when one uses the phrase hormone optimization, what exactly are they trying to optimize?

Speaker A: 00:27:51

I think this goes into the question of aging as a field of medicine as well.

I mean, there's been a lot of stigma around.

Do we treat someone when we have a defined deficiency, or do we try to keep someone in optimal health?

And the idea behind optimization would be that, well, why can't we have this 40 year old man with the testosterone levels of a 29 year old?

Is there an issue with that?

Are there any risks involved with that?

Do the risks outweigh the benefits?

And, and this is a personal question, and this is also a question to the clinician, because it really depends on that individual if they got high blood pressure, probably not.

If they don't have any other risk factors and this is what they want, we're still physiological.

So a lot of clinicians don't see any reason why they wouldn't do that.

Speaker B: 00:28:46

So you think it's a personal, let's call it choice of the patient and the clinician obviously to treating a medical deficiency and bringing that person back to par.

And at what point are you trying to make a middle aged man feel like 20 or 30 again?

Speaker A: 00:29:10

I'm actually part of the Androgen Society in America, which does a lot of conferences on these topics and there's a lot of good discussions that we have about exactly this and looking at the research and making sure that it's evidence based on.

And as long as we keep the physiological, the current research is showing that there's not any increased risk in terms of cardiovascular, in terms of prostate health, et cetera.

If that is the route that the clinician wants to go down, then that is appropriate.

Now I think there's this stigma around testosterone that we can never really shake.

Think of testosterone, think of these bodybuilders injecting testosterone in a gym.

And it's just not applicable to what we're talking about because testosterone itself at a physiological level is nowhere near what a bodybuilder would be using.

So they would be using synthetic anabolic derivatives that are, you know, 10 times the strength and, and they'd be using 10 times the levels.

And you get all sorts of side effects when you enter that area.

But when you're talking physiological levels of testosterone, we're actually seeing more benefits than risk.

Now we used to think actually that testosterone increased the risk of prostate cancer.

And now there, there was a very large study that came out recently that debunked that.

So actually at physiological levels there wasn't a higher risk.

Same for cardiovascular risk.

We used to think testosterone increased cardiovascular risk.

That's not true.

Speaker B: 00:30:39

I think that's a very, very important point you make.

And it's really important to distinguish these synthetic testosterone and the huge quantities that the bodybuilders take and the medical application of it for men who need it to come back to normal levels, not any exaggerated levels.

Now you've touched upon the US and the UK and I think you've said that the hormone treatments as such is being underused in Britain compared to the States.

Why do you think Britain is so cautious about testosterone?

Speaker A: 00:31:21

I can certainly attest to that whenever I go to America that the general idea behind testosterone replacement is a lot more accepted in the uk.

That just doesn't seem to be the case at all.

And a lot of it has to do with they're not being the appropriate clinicians or specialists in the UK in the same number that they are in America.

A regular GP is not going to really delve into the science.

They're going to think testosterone, increased prostate cancer, increased heart attack risk, but that's not the case anymore.

We know that's not the case.

For example, endocrinologists in the U.K. also, a lot of times don't deal with that.

They'll deal with things like diabetes.

So I think the training is an issue and I think that stigma around testosterone is still a lot more prevalent in this country than in America, unfortunately.

Speaker B: 00:32:12

Yes.

I mean, testosterone as a word, as a topic, has become much more prevalent and discussed because it's very often, you know, now on podcasts and social medias, private clinics.

So testosterone, I think, has gone from something that many men barely talked about unless they were in the bodybuilding world, to something that's now, as I said, being discussed pretty much constantly on social media and so on.

Do you think that has been beneficial for men's health or do you think it's swung the other way and just now become a free for all or.

Speaker A: 00:32:54

It's a fine line.

I think when I speak to my friends in America, you know, they'll openly say, I'm on testosterone replacement therapy.

It's been really great for me.

You know, I get my blood done and everything's fantastic.

When I speak to individuals in the uk, they probably would keep that secret, you know, it's probably the stigma is still there.

I've never heard anyone say to me, yeah, yeah, I'm on testosterone replacement.

So I don't think that's healthy.

I think it's healthier to be more open about it, transparent about it, and really make sure you're not abusing it.

People that want to abuse these things, they're going to go down the bodybuilding route, they're going to go down the illicit drug route.

There's not a whole lot of benefit in terms of bodybuilding if you're just getting normal levels and then you constantly getting your blood tested.

It's not something that's kind of recreationally abusable to the same extent as anabolic steroids.

And I think that's what we need to understand.

It's, it's.

The two things are just not the same.

Speaker B: 00:33:53

Definitely.

They're not the Same.

So let's bring this a little bit back to where we started because muscle is the reason we're talking about hormones and all that in the first place.

So as a real life example, let's take two six year old men doing exactly the same resistance and weightlifting program and one has genuinely low testosterone and the other one have perfectly normal testosterone.

How differently would you expect their muscles to respond?

Speaker A: 00:34:26

So the individual with the normal testosterone levels, it's going to be easier for them to move up in strength, it's going to be easier for them to gain that lean muscle and it's going to be easier for them to shift the fat.

The individual with the lower testosterone levels, they're going to be much more prone to obesity, they're going to find it a lot harder to shift that weight.

And there's an element of psychology involved in this because if you see people that are, you know, progressing more and there's, you think to yourself, why am I doing this?

There's something wrong, I can't, I can't get to the, to the state that I want to be.

That's got a knock on effect on their motivation and then wanting to go to the gym again, which I think is quite, quite an important aspect as well.

The other thing I would mention as well, which is quite relevant is I'm sure you're aware of the, the GLP1 craze at the moment and I have a lot of people are on GLP1 inhibitors and the main problem we're seeing with those is that they're really decreasing the amount of muscle because they're reducing the fat along with the muscle.

And what happens, that individual perhaps stops the GLP1 and then they gain the majority of the fat back, back, but no muscle.

I think we're going to have an epidemic of people that are deficient in skeletal muscle and I think it's going to be a big issue in the.

Speaker B: 00:35:47

Healthcare system, absolutely no question about it.

It's a whole new era of things that come up that we haven't studied and we're not sure yet.

So it's interesting and exciting and needs to be looked into very carefully.

Now another thing that I think needs to be looked into very carefully are peptides.

They're everywhere now and everyone is talking about them.

And the great majority of people taking peptides are buying them from the gray market.

Though there are doctors that do offer them in a careful and measured and, you know, proper way.

What's your thought and reaction to all this?

Speaker A: 00:36:37

You know, it's really funny, because I remember going to the States about six months ago, there wasn't much talk about peptides.

A little bit more recently, maybe three months after that, and every single person I spoke to is talking about peptides now, you know, and these are clinicians and they're either prescribing them themselves or they're actually also using them themselves.

So it honestly has really blown up in a way that I never anticipated.

And the interesting thing is it's nothing really new that we're seeing.

A lot of these peptides have been around for over a decade.

Tessamorelin, thyrmorelin, have been around for well over 10 years now.

And I think it goes back to the GLP1.

So I think people are.

They're comfortable injecting and they're looking at other things that, well, this works really well for weight loss.

What else is there out there that I can use?

Speaker B: 00:37:34

I mean, let's not forget insulin is a peptide and that's been around for much more than just a decade.

Speaker A: 00:37:40

So, yeah, the first synthesized drug, I think it was actually insulin.

So there's nothing new about peptides.

They're very old drugs.

I think it's the route of administration that made them more accessible.

Everyone's okay, I'm just gonna pin these peptides.

It's fine.

I'm seeing in the, you know, in the milk communities that people are increasingly asking, oh, what's.

What stack of peptides are you on, et cetera.

This happened in America, you know, a few months ago, but I think it's coming to the UK now.

I think everyone's kind of starting to talk about it.

Speaker B: 00:38:12

Let's talk about something else that I think everybody's talking about.

Nad, nmn, nmr.

What is your thought on that?

Where do you stand?

Speaker A: 00:38:24

I like nmn.

I take NMN every day.

David Sinclair actually has got a study in review at the moment, and I was looking at that the other day on NMN supplementation and on longevity.

And interestingly, I.

They had a cohort of female and male mice and the female mice showed a significant increase in longevity, but not the male ones, which is quite interesting.

I didn't delve that much into it, but both groups showed an increase in health span, though, so in kind of actionable, definite measures on how they were in terms of mobility and activity.

So once that study is published, I think it's going to give it a bit more credence.

It's still under review, so it's a bit too early to tell.

I think there's Some things that we don't know about NMN in terms of side effects and what, what else it might do.

There were some concerns about cancer as well because it can potentially drive cancer self growth.

But I think it's exciting.

I think nmn, if you take an NMN supplement, it increases N a D plus.

We know that for sure.

And I think that's, that's a very significant finding.

Speaker B: 00:39:36

So we've talked a lot about measuring, you know, measuring your satellite cells via biopsy and obviously testosterone and blood markers we haven't talked about, but that's obviously something that people are testing.

The one thing we haven't talked about is biological age.

What's your thought on measuring and testing your biological age?

Speaker A: 00:40:05

I haven't seen any evidence of a compelling marker that we could really use as a determiner of aging.

I'm a big proponent of blood testing.

I think that's incredibly important.

If we're using inaccurate markers, it's potentially going to lead us astray.

We're going to be looking at glycination or some, or sulfurination or some of these other markers.

And is it going to be accurate?

Is it actually going to lead us in the right direction?

I know for, for a fact if we're testing the blood, we can isolate deficiencies, we can correct them.

We could look at what our health state at that moment is.

So I, I always recommend that and I think that's very important.

So the Data says that 17% of people are needle phobic as well.

I suspect it's a lot more than that because this is self reporting and a lot of people just don't want to do these tests.

You know, especially men, they, they just say, oh, okay, I don't want to see my bloods, I don't want to do it.

And I think we're at a point where it's more and more accessible.

So I don't know if you.

Have you heard the Tasso devices?

Speaker B: 00:41:13

No.

Tell us about it.

Speaker A: 00:41:14

So I hate taking bloods.

I actually get, I get really clammy.

I start passing out if someone puts a needle in my arm.

The Tasso device is essentially like a leech.

You know, you put it on your shoulder and it's painless and it just takes a while.

You put another vial if you need to and then you, you take it off essentially.

And for me that was an absolute game changer.

And there's, there's a number of devices like this on the market that are being made at the moment.

So these suction devices that you can put on your arm, completely painless, take your blood, send it off.

I absolutely love it.

I've done free trials of that now and, you know, I. I get a printout of my bloods and I'm like, oh, wow, this is great.

Okay.

My cholesterol's good, I need to.

Or maybe my B12 is a bit low, I need to take a little bit more.

It's fantastic.

I would recommend that to anyone.

Speaker B: 00:42:04

Yeah.

Wow.

I mean, I'm not squeamish about needles at all.

You know, I take my own blood if I could.

Speaker A: 00:42:09

So on a population basis, I think men are more needle phobic.

Speaker B: 00:42:13

But this, this new device sounds amazing.

I mean, I've never heard of it, but is that.

Is that something that's.

That's readily available or is it only in private practice?

Is it in the UK or the us?

Tell us more about this.

Speaker A: 00:42:25

No, it's available.

Tasso has made the device.

I think they're doing a Tasso plus or another version of it.

So when they sent that to me to try, I was like, yes, I want to do this and I want to offer it to our patients as well, because it's going to.

It's going to be great.

I don't know if you've ever done the finger prick tests, but, oh, God, I hate them so much because you sit in there and you're like, you're like milking your finger for, like, you know, 20 minutes and you still haven't got enough blood and you need to do it again.

Speaker B: 00:42:52

And I'm like, okay, it sounds simple, but it's worse than drawing blood from a vein, I think so, yes.

Speaker A: 00:42:58

Yeah.

Speaker B: 00:42:59

What was it called again?

Speaker A: 00:43:01

It's a Tasso.

T A S S O.

Speaker B: 00:43:03

So that's not available on the NHS at the moment.

Speaker A: 00:43:07

Oh, I wish it would be.

I think they should make it available, I really do, because, like, why are we still stuck in the past?

The problem is when you start having people that are just, you know, not having the treatments, not having the bloods because they're.

They don't want to.

They get anxiety, et cetera, and then you have no idea.

You can't actually assess them properly, you can't identify problems quickly and that's so important.

Speaker B: 00:43:33

Great, we're almost at the end.

Let's leave on a positive note here.

And if one of our listeners is in his or her 70s and is thinking, oh, gosh, you know, I've left it way too long to do anything about my health, my longevity, what would you tell them, is there any hope for them?

Speaker A: 00:43:55

Well, first of all, there is.

The data says that there is.

Certainly at 70, there's still a lot that you can do.

Whenever someone comes up to me and says, oh, Oscar, you know, what's the best thing I could do for longevity?

You know, I always say get your bloods done first, stop thinking about supplements, get a bloodstone first, as we talked about, and then exercise.

Even someone in their 70s should have an oversight of what their bloods are, what they're missing out on their diet and make sure that they're getting those resistance exercises in and make sure they're doing the aerobic exercise as well for their cardiovascular health.

And those are your basics, those are your bread and butter stuff.

You know, if you're going to start off with something that's, that's something that you should start off with.

Speaker B: 00:44:35

So before I ask you my five rapid fire questions that I ask all my guests, I just want you to sort of tell our listeners what are the blood tests, the essential blood tests that they should take that everybody should.

Speaker A: 00:44:48

Do regularly for men that are, you know, over the age of 30, you should be doing your hormone panels.

You'd be getting estrogen, your testosterone, pre testosterone you should be getting.

Here in the UK we have a very low amount of sunlight as you know, so you should be looking at your vitamin D levels.

Vitamin B12 is important as well.

You're going to probably get a full blood count anyway.

So it's important to see exactly if you have any deficiencies.

It really depends on your diet.

If you have a diet that's low in meat, you should be getting your iron levels checked, your magnesium levels checked.

Those are the kind of basics.

It's not so much the complexity of the test, it's the regularity of it.

Just because your levels come back well in January doesn't mean you're going to be fine in August.

It's important to just keep taking these, these tests and making sure you stay on top of your blood levels.

Speaker B: 00:45:45

Yeah, good advice.

Well, listen, Dr. Oscar, thank you so much for joining me on Beyond Longevity as I threatened you with.

Here are my five rapid fire questions.

Here we go.

What's the single best piece of advice you would give your younger self?

Speaker A: 00:46:03

I would say strive for impact.

Make sure that that's the, that's the goal of what you're doing.

Help as many people as possible.

Speaker B: 00:46:12

Name one habit everyone should adopt for a longer, healthier life.

Speaker A: 00:46:16

Lift weights.

Speaker B: 00:46:18

Yeah.

If you weren't in longevity science, what career would you have chosen.

Speaker A: 00:46:23

I would have done more coding.

I love healthcare and I've always wanted to be.

Didn't want to stay in it.

But I think I could have made an impact as well if I was on the IT side of things.

Speaker B: 00:46:35

What microdose habit 5 minute routine of small daily action yields outsized longevity benefits?

Speaker A: 00:46:43

Meditation.

I love meditation.

Mindfulness, a deep meditation.

Do that every day.

It's a great thing to do.

Speaker B: 00:46:50

And what's the craziest longevity myth you've encountered?

And is there any truth to it?

Speaker A: 00:46:56

This is one that annoys me a lot.

And it's collagen supplements.

People are thinking they're gonna take these collagen supplements and they're gonna get collagen in their bones and their skin.

And that's just not how it works.

It gets broken down and in the gut.

Speaker B: 00:47:10

Thank you so much.

That was really very interesting, very insightful.

Thank you for joining me on Beyond Longevity.

Speaker A: 00:47:18

It's been great.

Thank you so much for having me.

Speaker B: 00:47:22

Dr. Oscar's father's experience shows us how much we stand to lose when we lose mobility.

But this conversation also gives us reason to be hopeful.

It is never too late.

Even in late age, our muscles can still respond to resistance training.

Dr. Oscar's work on hormones raises questions worth studying.

The results in mouse muscle do not yet tell us what treatment will work for people.

For now, his most practical advice is also the clearest.

Keep moving, build strength, and do not assume you have left it too late to start.

Thank you to Dr. Oscar Wenbach for joining me today on Beyond Longevity.

And thank you for listening.

Please rate, review and subscribe.