Dr. Vishaka Shivdasani in a Fireside Chat with Rtn. Anushka Jagtiani on Longevity and Disease Reversal
Rtn. Anushka Jagtiani: Longevity is the global craze these days. It’s the new buzzword. Of course, everyone wants to be immortal, but you always talk about health span over lifespan. What differentiates conventional medical practice from longevity medicine?
Dr. Vishaka Shivdasani: The average lifespan in India 30 years ago was about 60 years. Does anyone know what the average lifespan is today? It’s about 72 to 73 years. In urban India, it’s even higher, which means modern medicine, particularly emergency medicine, has done a fantastic job of helping us increase our lifespan. But has it been able to do much for our health span? Sadly, the answer is no.
The last decade of life is often spent battling complications of diabetes, heart disease, dementia and different kinds of cancer. That is where the conversation shifts from lifespan to health span.
If I were to tell you that someone could help you live to over 90 or even 100 years while remaining mobile, recognising your children and travelling the world, who wouldn’t want to live those extra years? Every hand would go up. But if I changed the question and said you would live to 90 or 100 but spend the last decade bedridden, with a catheter, constantly visiting different specialists, I can guarantee all those hands would come down. That is why we talk about longevity and health span, not just lifespan.
Conventional medicine is brilliant. It is excellent at treating acute diseases and managing illnesses once they have appeared. Longevity medicine asks a different question: what can we do 10 or 20 years before someone develops diabetes, obesity, which is a disease, or heart disease? We intervene much earlier, and that represents a fundamental change in the narrative and the way we treat our patients.
Rtn. Anushka Jagtiani: Wonderful. As you always say, Dr. Vishaka, we must add life to our years, not years to our life. I think that is so well said.
Can looks be deceiving where health is concerned? Most of us assume that someone who is slim, fit and looks young must be healthy. But what parameters do you use as a doctor to assess someone’s health?
Dr. Vishaka Shivdasani: First of all, looks can be very deceptive, particularly in this context. The Indian, or Asian, phenotype is often described as TOFI, which stands for “Thin Outside, Fat Inside”. You could be very lean and slim, someone who looks like me, yet be metabolically completely dysfunctional. I could have insulin resistance or fatty liver. I don’t, just for the record, but I could have all of these conditions while appearing perfectly healthy. That is why we never judge health by appearance alone.
Instead, we measure metabolic parameters. These tell us not only how you are ageing today but also how you are likely to age 10 or 20 years from now.
I am going to share five parameters that every person in this room should know. You should use them as a measure of your current health and as an indicator of what could happen in the future. The next time you visit a specialist or have blood tests done, pay attention to these five metrics because they will tell you whether you are truly healthy.
First, your blood pressure should be below 120/80 without medication.
Second, your fasting blood sugar should be below 90 without medication.
Third, if you are a man, your HDL, or good cholesterol, should be above 40. If you are a woman, it should be above 50.
Fourth, if you are a man, your waist circumference should be under 40 inches. If you are a woman, it should be under 35 inches.
Finally, your triglycerides should be below 150. The newer guidelines, however, recommend keeping them below 100.
If three of these five parameters are outside these ranges, then you are what we call metabolically dysfunctional or you have metabolic syndrome.
Every conversation about health, whether in this room, in the media or anywhere else, should eventually come back to one question: how close am I to these metrics, and what can I do to get closer to them?
In the United States, only 12% of people are metabolically healthy. Just 12%. We do not yet have equivalent figures for India, but I suspect our numbers may be even more concerning because we are known as the diabetes capital of the world. The closer you are to these targets, the fitter and healthier you are likely to be.
Rtn. Anushka Jagtiani: Maybe it’s a good thing we don’t have the numbers for India yet. They would probably be quite alarming. I am sure everyone is going to go home and find a measuring tape after hearing this.
Dr. Vishaka Shivdasani: You absolutely should. Go back and look at your blood work and measure your waist circumference as well. What are the earliest warning signs that you’re ageing faster than you should? There are two kinds of ageing: chronological age and biological age.
Chronological age is the number on your passport. You can’t change it. Biological age, however, reflects how quickly your cells are ageing. It tells you the true age of your biology.
You can estimate this through the metabolic metrics I mentioned earlier, but there are also clinical signs that you can observe.
Take the example of Anil Kapoor, who appears to look 20 years younger than his actual age. Compare him with his brother, who many people would say looks much older. They share the same genes and belong to roughly the same generation, yet they look remarkably different.
You need to pay attention to your own health trajectory. Compare how you feel today with how you felt a year ago, not even a decade ago. Has anything changed? Is your strength lower than it was six months ago? Are you no longer waking up feeling refreshed? Do you wake up feeling groggy? Are you finding it difficult to fall asleep? Do you become extremely sleepy two hours after eating a meal?
Many people say they simply need an afternoon siesta. An occasional episode is normal. We all have days when we don’t sleep well or wake up tired. The concern is when these symptoms become a consistent pattern. That is often a sign of metabolic decline.
Similarly, if you are a woman experiencing persistent hormonal imbalances over several months, you need to investigate them. These are your body’s signals that it is beginning to lose its metabolic resilience.
Rtn. Anushka Jagtiani: Could you briefly tell us which diseases stem from poor metabolic health?
Dr. Vishaka Shivdasani: All chronic metabolic diseases stem from poor metabolic health, starting with obesity, Type 2 diabetes, fatty liver disease, heart disease, many forms of dementia, certain types of cancer, sleep apnoea and PCOS.
If you look at the physiology behind these conditions, they are all different chapters of the same book. They all result from chronic inflammation, insulin resistance and excess fat deposition. The treatment is, of course, personalised and based on everyone’s reports, but the underlying principles remain the same.
Rtn. Anushka Jagtiani: So the principles are the same. Coming to treatment, Doctor, you have helped thousands of people come off medicines that are often considered lifelong, such as statins, blood pressure medication and insulin. What is your strategy?
Dr. Vishaka Shivdasani: We use a six-pronged approach. I actually wrote about it in my book during the COVID pandemic.
The first thing we look at is nutrition. We begin by looking at what is on your plate. In India, we are so afraid of eating enough protein, despite being one of the most protein-deficient populations. We fear protein because we think it will damage our kidneys. We fear fat because we think it will cause heart attacks and land us with a cardiologist. But when it comes to carbohydrates, we feast on them.
We eat carbohydrates at breakfast, lunch and dinner, and in between meals as well. Khakhra, thepla, fafda, whatever you name, carbohydrates dominate our diets. We are a carbohydrate-rich country, and excessive carbohydrate intake contributes to metabolic dysfunction and all the issues I spoke about earlier in relation to the five metabolic parameters.
At the clinic, I encourage patients to reduce carbohydrates. I don’t believe in complete elimination, but I do believe in moderation. We increase good-quality protein and encourage healthy fats. I don’t believe in low-fat products because low-fat, by definition, usually means high carbohydrate. So, if you’re consuming low-fat curd or low-fat milk, my advice is simple: throw it in the dustbin.
Beyond nutrition, we also focus on gut health, sleep, appropriate supplementation, exercise and social connection. Anyone who has watched Dan Buettner’s documentary on the Blue Zones will know that the strongest predictor of both health span and lifespan wasn’t diet or exercise alone, but social connection.
Make time for meaningful relationships. They reduce stress, activate the parasympathetic nervous system, help control blood pressure and reduce the risk of heart disease. I haven’t gone into each of these areas in detail because of the limited time we have today, but this is how we help reduce medication.
I should also add that my primary objective is never simply to reduce or eliminate medication. My goal is to make the patient metabolically healthy. If, as a result of improving their metabolic health, they no longer require certain medications, that’s wonderful. But that is the outcome, not the objective.
Rtn. Anushka Jagtiani: Not the first objective. I think our wonderful Gujaratis in the audience may be a little disappointed. I’m sorry, but it looks like you’ll have to cut down on the khakhras!
Moving on, are there specific tests or markers that help assess longevity?
Dr. Vishaka Shivdasani: Absolutely. We begin with the blood parameters that I mentioned earlier. Beyond that, we can look at genetic factors and other specialised biomarkers. In fact, some of these tests are very simple.
One example is grip strength. We use a small device called a dynamometer in our clinic. It measures upper body strength and provides valuable insight into how well you’re aging today and what your future health trajectory may look like. Grip strength is one of six or seven important longevity markers that we routinely assess.
In fact, Sadia from my clinic is here today, and she’s brought the dynamometer with her. If anyone would like to check their grip strength afterwards, please do. Sadia, would you mind raising your hand? There she is.
Another important assessment is the sit-to-stand test. Maintaining balance is incredibly important because, as we age, we become more prone to falls and fractures, and those can have serious consequences.
When you exercise, don’t focus on just one type of activity. Even something as simple as standing up from a seated position without using your hands for support is a useful indicator. Try standing up slowly without holding onto anything. Just be careful not to fall!
That’s excellent. Very well done. At this rate, we’ll all be having this conversation again in 50 years because everyone seems determined to live a long life.
Another useful balance assessment is standing on one leg. I’m wearing heels, so I won’t demonstrate for too long, but try standing on one leg for 30 seconds, then repeat on the other side. If you’re struggling, focus your eyes on a fixed point in front of you. That often improves balance.
If you can comfortably reach 30 seconds, that’s a positive longevity marker.
There are several other biomarkers as well, but these are among the simplest. People often assume longevity is all about expensive genetic testing. It isn’t.
I can often tell a great deal simply by watching someone walk into the room. The speed and quality of your gait are important markers. I observe how you get up after sitting, your waist circumference, and your general physical condition. Combined with your medical history, I can often make a fairly accurate assessment of your current health, sometimes even before looking at your blood reports.
The encouraging part is that all these markers are modifiable. If your balance isn’t good, if you struggle to stand, or if your walking pattern isn’t ideal, these things can be improved.
That’s exactly what we teach our patients. We show them the correct protocol so they improve safely without injury. It doesn’t usually take more than a few months before we see significant improvements in these parameters.
Rtn. Anushka Jagtiani: That’s wonderful, and it’s great to see that everyone did well in the sit-to-stand test.
Coming to another important topic, there’s so much focus today on gut health and its role in both physical and mental wellbeing. What’s the connection between gut health and longevity?
Dr. Vishaka Shivdasani: It’s enormous.
People often think the gut’s only function is digestion, but that’s far from the truth. I always say it’s not just what you eat, it’s what you assimilate. To absorb nutrients effectively, your gut has to function optimally.
There is a very strong gut-brain connection, which is why the gut is often referred to as the body’s second brain. Around 70% of your immune cells are located in the gut, so it plays a central role in immunity.
Think about it. If you’re about to give a speech or sit an examination and you’re extremely anxious, many of us experience butterflies in the stomach or suddenly feel the need to rush to the bathroom. The stress originates in the brain, yet the gut responds immediately. That tells you how closely the two are connected.
The gut is connected to every part of the body, including your muscles. If you don’t absorb nutrients efficiently, you can develop sarcopenia, lose muscle mass and gradually become stooped with age. Many people focus only on increasing protein intake when, in reality, they also need to improve their gut health.
In India, almost everyone over the age of 40 comes to me complaining of belching, bloating or constipation. Among those over 70, constipation often becomes one of the biggest challenges affecting their quality of life.
I see this every day in clinical practice. Many metabolic diseases are associated with constipation. For example, in women with breast cancer, I insist on addressing constipation because oestrogen can be recycled within the body. I don’t want to become too technical, but that process can have important implications.
Your gut is truly one of the most important organs in your body, and you need to do everything you can to keep it functioning well.
Rtn. Anushka Jagtiani: Great. As we don’t have much time, I’d like to move to another important topic: Alzheimer’s disease and dementia. A lot of people seem to be developing these conditions, and they have a huge impact on quality of life. On the other hand, someone like the legendary rock star Mick Jagger has just turned 83. He’s still mentally and physically sharp, performing with the energy of someone from Gen Z. So, how do we all age like Mick Jagger and avoid dementia?
Dr. Vishaka Shivdasani: I was just speaking to Dr. Khan before this session, and we were saying how dramatically dementia has increased. When I first started practising, I would see a case once every few weeks. Today, I see patients with dementia every single day. We are also seeing younger people developing Alzheimer’s disease.
The encouraging news is that many of the risk factors for dementia are modifiable, which means they are within your control. People often say, “My parents had diabetes, Parkinson’s disease or Alzheimer’s disease, so it’s inevitable that I’ll develop it too.” That simply isn’t true. There is a great deal that you can do to reduce your risk.
Keep your blood pressure under tight control. Keep your blood sugar under tight control. Maintain a healthy waist circumference because excess body fat contributes to chronic low-grade inflammation, or what we now call inflammaging.
Stop smoking. Stop drinking alcohol. I may lose a few brownie points by saying this, but even one alcoholic drink contributes to brain shrinkage over time, so alcohol really needs to go.
Exercise is one of the most powerful interventions you have. It increases something called Brain-Derived Neurotrophic Factor, or BDNF, which supports the health of your neurons, keeps your brain agile and helps preserve cognitive function.
There are many aspects of brain health that remain under your control. So don’t assume that because your parents had a particular disease, your future is predetermined. Genetics account for only about 20% of the picture. The remaining 80% is influenced by epigenetics and lifestyle.
Rtn. Anushka Jagtiani: That’s reassuring. It’s encouraging to know that dementia isn’t necessarily inevitable.
Dr. Vishaka Shivdasani: Before we move on, I’d like everyone in the room to remember three words: Jagger, rain, bicycle. We’ll come back to them later. No cheating and no looking at your phones!
Rtn. Anushka Jagtiani: Right, I won’t repeat them then!
Moving on to what is probably one of the hottest topics today: weight-loss drugs such as Ozempic and Mounjaro. Do you think people are using them recklessly? Someone wants to lose five kilograms for a cousin’s wedding, and they simply decide to take Ozempic. Who is actually an appropriate candidate for these medications?
Dr. Vishaka Shivdasani: Let me begin by saying that these are remarkable medical discoveries and extremely effective medications. I prescribe them in my clinic almost every day.
However, we need to understand that they are metabolic drugs, not cosmetic drugs.
I frequently have brides or people from the film industry coming to me saying they need to look a certain way for a wedding or before appearing on camera. That’s common. But if someone wants to lose five kilograms before a holiday in Ibiza or simply for cosmetic reasons, these are not the right medications.
These drugs carry a wide range of potential side effects and should only ever be prescribed under proper medical supervision.
Personally, I prescribe them only for overweight patients with diabetes or when a surgeon refers a patient because their weight needs to be reduced before surgery can be performed safely. Those are the kinds of indications I consider appropriate.
If someone comes to me saying they simply want to lose five kilograms, my answer is no.
There is also a proper protocol that must be followed. If you’re taking these medications, you must ensure that you’re consuming adequate protein because they can lead to significant muscle loss, and loss of muscle mass is one of the fastest ways to compromise your long-term health.
Patients also need a comprehensive evaluation, including blood investigations and imaging such as ultrasonography, to ensure there are no underlying medical conditions before starting treatment.
Rtn. Anushka Jagtiani: That’s very important to know. These medications really shouldn’t be used casually.
If someone wants to add 20 or 30 high-quality years to their life, what should they do?
Dr. Vishaka Shivdasani: Build your metabolic resilience.
Go to the gym. Build muscle because muscle is the organ of longevity. It acts like a sponge, absorbing glucose and improving insulin sensitivity.
If you enjoy eating carbohydrates or sweets, make sure you build enough muscle to help your body process them effectively. Healthy muscle keeps you metabolically fit, reduces your risk of falls as you age and helps you enjoy not only a longer life but a much better quality of life.
Rtn. Anushka Jagtiani: Wonderful. Thank you, Dr. Vishaka, for helping all of us millennials, Gen X and boomers become a little more like Gen Z.
Thank you so much.
ROTARIANS ASK
Question 1: What are your views on veganism? And why is it that sometimes the body is willing, but the mind isn’t?
Dr. Vishaka Shivdasani: Once again, I may lose a few brownie points here, but I am not a fan of veganism. Vegetarianism is a different matter, but I see vegan patients every single day who are nutritionally depleted.
They commonly develop vitamin B12 deficiency, protein deficiency, excessive hair loss, weakness and even sarcopenia, which is the loss of muscle mass.
When you hear about someone who is exceptionally fit despite being vegan, it’s often because they’re taking a very large number of nutritional supplements. Personally, I don’t think that’s the ideal way to live.
As for your second question about why the mind isn’t willing, it’s important to look beyond willpower.
Suppose you plan to work out in the morning but simply don’t feel like it. Rather than blaming yourself, work backwards. Did you sleep well? If not, why not? Did you consume caffeine too close to bedtime? Did you exercise too late in the evening? Did you drink alcohol?
Your body usually gives you the answer. It’s often not a failure of willpower but a consequence of your physiology.
Question 2: You said give up alcohol, but some say beer is good for preventing kidney stones?
Dr. Vishaka Shivdasani: Many of those studies have been sponsored by the alcohol industry. The well-known studies promoting red wine, for example, have often been funded by winery owners.
Similarly, people sometimes say that beer is good for preventing kidney stones. Even if there is a very specific benefit in one narrow context, I can suggest numerous medical and lifestyle alternatives that help prevent kidney stones without making you metabolically unhealthy.
I recently discussed this on a podcast. Someone argued that people should drink fruit juice every morning because it helps increase iron levels. While that may improve one specific marker, it can simultaneously create a host of other metabolic problems.
We shouldn’t focus on one isolated benefit. We need to look at health as a whole.
Question 3: Would a long-term dietary change have any impact on the body? For example, if someone has been a non-vegetarian for 20 years and then becomes vegetarian, or if someone has been vegetarian for 30 years and then starts eating meat, how does that affect the body?
Dr. Vishaka Shivdasani: It doesn’t have a significant impact, provided your macronutrients remain reasonably balanced.
It’s a myth that vegetarians cannot get enough protein. You simply need to combine your protein sources correctly, and you’ll meet your requirements.
If someone who has been eating a non-vegetarian diet switches to vegetarianism, the primary difference is the source of protein. Meat is one source of protein, but everything else, including fibre, vitamins, antioxidants and many micronutrients, is readily available through vegetarian foods, often in greater quantities. So I don’t think the transition itself is a problem.
Question 4: What are your views on wearable health trackers?
Dr. Vishaka Shivdasani: Yes, I’ve used them myself. I wore the WHOOP strap for a while, and I’ve also used the Garmin. I’m something of a guinea pig when it comes to these things. I’ve tried continuous glucose monitors (CGMs) and many other devices.
I think they’re excellent tools for understanding your own biology because what works for you may not necessarily work for me.
The problem begins when people become obsessed with the numbers. That even started happening to me, so I eventually stopped using all of them.
Use these devices long enough to understand your body, make the necessary lifestyle changes and then stop depending on them.
Some people wake up in the middle of the night worrying that they haven’t had enough REM sleep or deep sleep and then become anxious trying to fall asleep again. That completely defeats the purpose.
Use the technology as a learning tool, not as something you become dependent on.
Question 5: What are your views on protein shakes? Should we be taking them? And what about sattu?
Dr. Vishaka Shivdasani: First of all, let’s be clear that sattu is much higher in carbohydrates than protein, so it isn’t really a protein shake.
If you’re referring to whey protein or plant-based protein powders, I’m a big supporter. I personally have a protein shake every single day.
If you’re unable to meet your protein requirements through food alone and you don’t have any significant kidney disease, then by all means use a protein supplement. It’s one of the most effective nutritional investments you can make.
Question 6: Aren’t protein powders bad for the kidneys?
Dr. Vishaka Shivdasani: No. That’s a myth.
Unless someone has end-stage kidney disease, or another serious medical condition where protein intake genuinely needs to be restricted, protein powders are perfectly safe.
The only other situation where you might need to reconsider is if your gut health is very poor and you’re unable to digest or absorb protein properly, which is actually quite common.
Otherwise, protein supplements are suitable for most people.
Even for people with kidney concerns, there’s a blood test called Cystatin C, which gives a much better assessment of kidney function and helps determine whether higher protein intake is appropriate.
Question 7: Would you recommend plant-based protein?
Dr. Vishaka Shivdasani: If your gut isn’t functioning particularly well, plant protein is often easier to digest.
However, if your gut health is good, whey protein has much better bioavailability, so that’s generally my preference.
Question 8: My question is about intermittent fasting. What are its disadvantages? Is it acceptable to eat just one meal a day?
Dr. Vishaka Shivdasani: Everything in medicine and health should ideally be done under medical supervision. Just because something is trending on Instagram, WhatsApp or social media doesn’t mean it’s right for you.
Intermittent fasting, in itself, is an excellent tool. However, I don’t believe it should be practised seven days a week. There’s an important concept called metabolic flexibility. You want to train your body to switch efficiently between burning carbohydrates and burning fat. That means fasting on certain days but deliberately eating an extra meal on other days so that your metabolism remains resilient.
I practise intermittent fasting myself. In fact, I’m fasting today because I find that I think most clearly when I haven’t eaten. My last meal was at 8.00 p.m. yesterday, and I’ll have lunch after this session.
I generally fast three or four days a week, and I think that’s an excellent approach. Doing it every single day can sometimes become counterproductive. There are also situations where intermittent fasting isn’t appropriate. People with sarcopenia should avoid it because they already have reduced muscle mass.
Ideally, menopausal women should also avoid prolonged fasting because they are already at greater risk of inadequate protein intake and muscle loss. It becomes very difficult to consume sufficient protein within a restricted eating window.
OMAD, or one meal a day, should generally not be followed by people with thyroid disorders or by menopausal women.
Like most things in medicine, there are benefits, limitations and individual considerations. When done correctly and under proper guidance, intermittent fasting can be extremely beneficial.
Question 9: What are your views on biohacking?
Dr. Vishaka Shivdasani: First of all, biohacking is a very broad term. It covers a huge range of interventions. In fact, if anyone is interested, the country’s largest longevity summit will be taking place at the Fairmont on the 15th. Around 30 global experts will be speaking there, and I’ll be speaking on gut health, biohacking and longevity biomarkers.
The science of biohacking is still in its early stages. At present, we don’t have sufficient long-term evidence to determine which interventions genuinely improve health and longevity over time.
If something is truly capable of changing long-term health outcomes, we need high-quality studies to demonstrate that, and those studies take time. Until then, it’s sensible to approach many of these interventions with a healthy degree of scepticism.
That said, there are some simple biohacks that are well supported. For example, taking a 10-minute walk after a meal is extremely effective in helping people with diabetes lower their blood sugar. That’s a biohack that genuinely works.
Ultimately, it depends on what type of biohacking you’re referring to. If it’s a relatively safe intervention with little risk of harm, there’s no problem in trying it.