Gerontology is the scientific study of aging. It’s a relatively new field, pretty well dominated by research PhDs. Certainly it’s a science that was virtually nonexistent when I was in medical school, back when preventive medicine itself got little more than lip service.
With the recent arrival of anti-aging medicine/longevity medicine, MDs started paying more attention to the various theories about aging that gerontologists had been exploring. How many of those theories could be translated into clinical results, whether by teaching the public that a healthy long life was within the realm of possibility or just by making people aware that a few lifestyle changes and nutritional supplements could contribute to longevity.
Many ideas for longer life do require qualification, as in “might benefit longevity.” But there are no guarantees generally when it comes to health. You can do everything right–nutrition, exercise, supplements–and still get some dreadful disease and die young.
“Why me?” you plead. Nobody knows. Best guess is that it’s some susceptibility in your genetic make-up. Less scientific guesses: past life malfeasance or the homeless guy you passed without contributing was really an exterminating angel.
But seriously, when it comes to thinking about longevity, there are broadly two approaches.
Approach One: Are we simply programmed to age?
Genetic theories explore why some families live great long lives while others don’t. At first, these sound difficult to control (“In my family everyone dies of heart attacks in their 50s”), but there are numerous steps to take (diet, exercise, quitting cigarettes) that can help shape your epigenome so you don’t capitulate to your genetic risks. Take charge, thumb your nose at your genetic inheritance, and fool the naysayers.
The neuroendocrine theory of aging was one of the first to be explored. It was based on the slow decline of the hypothalamic-pituitary system with diminished production of estrogen in women, testosterone in men, and cortisone in both. With declining hormones, people aged, and when hormones were restored to the levels of earlier decades they often looked and felt younger. This was all fairly subjective, though, since whether testing lab animals or patients themselves, hormones didn’t necessarily add years.
The immunological theory of aging posits that the immune system is programmed to decline over time, which leads to increased vulnerability to infectious disease and thus aging and death. As you get older, your antibodies lose their effectiveness, and new diseases, including Covid-19, can’t be combatted as effectively by your body. This causes cellular stress and eventual death. An inefficient immune response has been linked to cardiovascular disease, inflammation, Alzheimer’s, and cancer.
Approach Two: Damage and error theories
The Free Radical Theory of aging has been immensely popular for more than 70 years. The idea is that being exposed to free radicals (altered oxygen molecules) from unhealthful diets and our environment damages our cells and renders them susceptible to chronic illnesses (heart disease, certain cancers) and accelerated aging. In this case, we as diligent patients have some control. There is mounting evidence that certain diets (such as the Mediterranean way of eating) and antioxidants do have a positive effect on disease prevention and subsequently longevity.
The most powerful antioxidants are:
The Decline Theory of aging is related to your mitochondria, the energy-producing power plants found in every cell of your body. Mitochondria create adenosine triphosphate (ATP) and, as we age, become less efficient at doing so. As a result, when we’re older we’re just not as energetic as we once were, though we all know high-energy people in their 80s and 90s (read about Maestro Blomstedt and Pinetop Perkins in last week’s Health Tip). You can protect your mitochondria with the antioxidants listed above and also jump-start your anti-aging therapies with infusions of NAD+ to raise your ATP and glutathione.
The Glycosylation Theory Any time you see the prefix “glyco,” think glucose (sugar). This is the newest theory of how we age and relates to our intake of sugar and how it binds to proteins in our cells, causing them to function inefficiently. We can track this impairment using the common test for diabetic screening and management, HbA1c (Hemoglobin A1c). People with poorly controlled diabetes, with their elevated HbA1c levels, are indeed more susceptible to chronic illnesses. Improve the control and lower the HbA1c and conditions improve. Most interesting, the mainstay prescription medication to lower HbA1c, metformin, has recently been shown to increase lifespan in lab animals.
Next week and in the weeks to come, more about longevity medicine, lifestyle changes, supplements, prescription meds, and infusion therapies.
Be well,
David Edelberg, MD