Why We Aren't Anti-Aging, We Are Pro-Healthy Aging
In 2020, we are officially declaring the war on aesthetic aging over. For years, people have fought wrinkles with lotions and needles, dyed-away gray hairs, and straight-up lied about their age. Slowly but surely, though, that's all changing. These fading strands and laugh lines are being accepted and embraced as signs of a well-lived life. Collectively, we're posting more makeup-free selfies, engaging in more positive self-talk, and emphasizing the role that whole foods, movement, and mental health play in both looking and feeling like the best versions of ourselves.
Simultaneously, a new paradigm of aging is emerging in the scientific community. Researchers, like Harvard geneticist David Sinclair, Ph.D., are beginning to identify compounds and lifestyle practices that may actually counter the internal processes that contribute to aging, and the conversation is evolving from how we can add years to our lives to how we can ensure that those years are vibrant and healthy, too. Which is overall encouraging news, because, as functional medicine physician Frank Lipman, M.D., puts it, "What good is living 100 years if you're sick for half of them?"
In many ways, these trends overlap, and emerging science on what may help counter aging on a cellular level is reinforcing many of the healthy lifestyle habits we here at mbg have long been preaching. In other ways, the boom in research is leading to novel discoveries that provide us with even more tools in our health-enhancing, life-extending box—and that prompted experts to question whether aging could actually be "treated" one day as its own health condition.
Here, we dig into some reasons we're so excited about in the future of aging research, plus some longevity trends you can expect to hear more about in 2020.
Why we need to think more about health span, not just life span.
This increased interest in healthy aging comes at a crucial time. We are currently experiencing unprecedented growth in the aging population. By 2050, the number of Americans over 65 is expected to nearly double to 88 million, and worldwide, this age group is projected to make up 17% of the total population. Currently, about 80% of people over 65 are living with at least one chronic disease, and 77% are living with two or more chronic diseases.
And while modern medicine has helped extend life span, now the focus needs to be on improving the quality of those in those extra years, or "matching health span to life span," says Matthew Ehrlich, M.D., author of The Vail Method: Getting Better Not Just Older. This will not only benefit people who are entering older age but their caregivers and our overburdened health care system as well.
Of course, as Lipman pointed out at revitalize 2019, "You're not going to stop the aging process [altogether]," but aging certainly doesn't have to be a bad thing, as many assume. It doesn't need to be synonymous with poor health, cognitive decline, low energy, and loss of strength anymore. "We are finding out more about why we age and what we can do to positively affect our longevity genes and age in a much more graceful way."
Is aging treatable? A new way to think about getting older.
For the first time, we are starting to see research that targets aging as a health condition in and of itself. Finding ways to regulate those "longevity gene" pathways referenced by Lipman above (specifically the mTOR, AMPK, and sirtuins) is central to scientists' work in identifying lifestyle habits, nutritional compounds, and future drugs that could slow and even treat (yes, treat) aging.*
As Sinclair views it, aging is most definitely a disease, and the FDA classifying it as such will help the field move forward even faster, allowing for more research and development of drugs to target processes that lead to age-related disease. "The definition of a disease is that over time you lose function, you become decrepit, disabled, and eventually, if it's a bad disease, you die from it," says Sinclair. "That sounds a lot like aging, right? If you go to the medical dictionary, the only difference between aging and a disease is that a disease affects less than half the population—and that 50% cutoff is completely arbitrary."
How likely is that to happen? In 2018, the World Health Organization classified aging as a disease and added it to the International Classifications of Diseases system. And right now, scientists at the Albert Einstein College of Medicine are examining the anti-aging effects of metformin in the Targeting Aging With Metformin (TAME) study. If researchers can show significant benefits of metformin in delaying problems such as cancer, dementia, stroke, and heart attacks, the FDA may consider classifying aging as a treatable condition.
But why study metformin? This widely prescribed diabetes drug, derived from compounds in the French lilac plant, has been noted for its benefits beyond diabetes—and Sinclair predicts it will be the first drug prescribed specifically to treat aging. Turns out, "metformin had a protective effect against cancer, heart disease, and frailty in patients taking the drug for long-term diabetes treatment," says Sinclair. "Which sounds a lot like a molecule that can slow aging." Animal studies have also confirmed that metformin can improve life span, and, more importantly, health span in mice. And, in a first-of-its-kind study in humans published in September 2019, researchers were actually able to take 2.5 years off participants' biological clock using a combination of metformin, dehydroepiandrosterone (DHEA), and growth hormone.
Experts believe metformin may activate similar pathways as caloric restriction to stimulate autophagy—or cellular cleaning. This cellular upkeep is believed to be a key factor in extending health span. "It's a relatively safe AMPK pathway activator, and that's thought to mimic the effects of fasting and exercising," says Sinclair, who takes metformin daily as part of his healthy aging regimen.
So, what does the future of healthy aging look like for someone who likes to keep things natural?
If you're scratching your head, thinking, "I don't want to take prescription drugs, even if they could promote healthy aging; isn't there something more natural?" there's still reason to be excited.
Some experts believe that advances made in this field could actually lead to advances in the supplement world by helping us home in on natural compounds that have similar characteristics to these drugs. "What I've always done in my practice is I look at what the pharmaceutical companies are talking about, what they're doing, then I reverse engineer that to supplements," says renowned integrative medicine physician Robert Rountree, M.D. "Then I go, OK, is this a pathway we really need to pay attention to? Is there any research that any herbs or nutrients affect it? Berberine, for example, seems to modulate some of these nutrient-sensor pathways like AMPK, so it's kind of a natural mimic of metformin."*
One class of supplements is generating a lot of buzz in the healthy aging space already: NAD-precursors, which include nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN).* In the body, these compounds are converted into nicotinamide adenine dinucleotide (NAD+)—a molecule that's crucial for mitochondrial health and cellular energy production but naturally declines with age. The safety and effectiveness of NR—a newly discovered form of vitamin B3—is supported by much more human data than NMN. Due to NR's smaller, less complex molecular structure, it may potentially be more bioavailable than NMN.* Studies have found that supporting NAD+ levels, by supplementing with NR, can enhance mitochondrial function and extend life span in mice.* Maintaining NAD+ levels may also stimulate sirtuin activation.* Sirtuins are a class of genes that help protect cells from age-related decline, triggering the production of new mitochondria and maintaining the length of telomeres—the end caps on DNA associated with longevity.*
There's a growing body of research into the longevity-boosting benefits of periodically stressing out your body. Hormetic (or pulsatile) stressors, which put the body into a state of perceived adversity called hormesis and activate longevity pathways, can include things like intense exercise, exposure to cold temperatures, and—perhaps the trendiest of them all—fasting.
Both time-restricted eating (going 12 to 18 hours without eating in a day) and fasting (periodically going three to seven days without food) have garnered the attention of longevity experts, and so far, it looks like you don't need to go to extremes to reap some benefit—Valter Longo, Ph.D., director of the USC Longevity Institute, suggests sticking to a very reasonable 12-hour eating, 12-hour fasting window. "It's really the way lots of centenarians and people who live a long life have always done it," he says.
But longevity experts like Peter Attia, M.D., who does four seven-day fasts per year, believe autophagy, that cellular cleanup process associated with longevity and a number of health benefits, doesn't really kick in until day three of a longer fast. Research still needs to hash things out a bit on the fasting front, but, at minimum, making sure you're allowing yourself to get a little hungry now and then throughout the day seems to be a good strategy for promoting healthy aging.
You may be wondering, "if I try all this stuff, how do I know if it's working to extend my health span?" Well, in the not-too-distant future, you may also be able to purchase a test that actually determines your true biological age. Recently, Sinclair and a colleague, Steven Horvath, developed what's called an epigenetic clock that's "right on the cusp of being commercially available."
"Now we can take a DNA sample from any part of your body, typically the blood, and I could tell you how old you are—within a few percents—biologically," says Sinclair. In addition to validating your hard work, this could also be the kind of thing that really kicks your butt into gear on those healthy lifestyle habits if your chronological age is 25 but your biological age is 40.
Our prediction: Science will make it easier than ever to feel good about aging.
The truth is, embracing aging and all the gray hairs that come with it is way easier when you feel good, healthy, and strong—and thanks to this burgeoning field of aging research, we're gaining more insight every day into the habits, supplements, and dietary strategies that may slow the aging process from the inside out so we live really, really well for longer than we thought possible.*
But just remember, cautions Lipman, regardless of how enticing any one age-countering strategy sounds, effectively boosting health span still "needs to be a multipronged approach, involving things like what, when, and how much we eat; how we exercise; how we deal with stress; the amount of good restorative sleep we get; our relationships."
We can't wait to see where the science of aging will go in the next year, but in the meantime, let's stop the anti-aging nonsense and accept the fact that aging (i.e., living) is freakin' great—especially now that we can do it healthier and happier than ever.
If you are pregnant, breastfeeding, or taking medications, consult with your doctor before starting a supplement routine. It is always optimal to consult with a health care provider when considering what supplements are right for you.
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