Is aging inevitable? The answer might seem obvious, the question itself even silly. But it all depends on how you view aging—and inevitability.
If you see it as traditional medicine does, aging is pretty much an obstacle course of diseases to be anticipated, diagnosed and treated. Accompanied, even if you’re healthy, by a steady deline in your functional abilities.
Sure, traditional medicine is all for prevention—things you can do to increase your odds of outrunning the heart attacks and strokes and cancers that become more common as we get older. You know the list: Eat right and exercise, check your cholesterol, don’t even think about smoking. If you’re serious about staying healthy, you have your annual physical, a colonoscopy at 50, maybe a daily dose of fish oil. All good. But how good? Specifically, how good for you? Traditional medicine can’t really tell you with much precision. And even if you get a clean bill of health at that annual physical, your relief might be tempered by how you actually feel: Less energetic, able and sharp than just a couple of years ago. You went from three sets of tennis to two, you tell your doctor, and now you’re down to doubles. Well, says the doctor, you’re getting older. Count your blessings—your numbers are fine, see you in a year.
There are two problems with this traditional approach to aging. First, it waits until you get sick to treat the diseases of aging. By then, it might be too late to treat it effectively enough to restore you to full health and vitality. And second, it ignores the most basic fact of aging: Everyone ages differently. Traditional medicine takes a one-size-fits-all approach, and that makes prevention a bit of a crapshoot. So is aging inevitable? By traditional standards, it is. When I was practicing conventional internal medicine fifteen years ago, I was that doctor who told an otherwise healthy patient who complained about his diminished stamina on the tennis court that it was only to be expected—he was getting older, just like everyone else.
That’s not what I say now. As a practitioner and clinical researcher in the expanding field known as Age Management Medicine, I have come to see aging in a fundamentally new and much more promising light.
There is no question that there are diseases of aging, the big three being cardiovascular disease, cancer and Alzheimer’s. But in Age Management Medicine, we reject the traditional definition of aging as simply the natural manifestation of these diseases. Instead, a growing body of research and clinical evidence has led us to view aging itself as a process. A set of processes, actually, that cause the cells in our vital organ systems to gradually break down in both structure and function—with matching consequences for the body as a whole. These processes are inevitable—unless we intervene. And while there may be different views about how to intervene, there is no doubt that we can, with undeniable benefits. So it is the processes of aging that we treat—rather than waiting for the disease and debilitation they cause to announce themselves.
It’s a funny line by the doctor of The New Yorker cartoonist’s imagination. But it fairly reflects the actual philosophy behind this new view of aging and my approach in particular. It’s not quite turning the clock back or finding the mythical fountain of youth. But it is taking the view that aging, as we have come to know it, is not inevitable.
It all flows from what’s known as the evolutionary theory of aging, which comes down to this: Mother Nature has a highly orchestrated plan for getting us from birth to our peak reproductive years—but doesn’t much care what happens after that. It’s why aging is nothing if not random. Two people can be born on the same day and seem twenty years apart by the time they reach their sixties. The basic reason we age so differently is that it’s an aggregation of three factors. Lifestyle, sure. Genetics, definitely. But it’s also life history—the cumulative effects of diet and lifestyle, as well as illness—throughout your life. And of course the relative weight of these factors influencing the aging of any one person has an infinite number of combinations.
For these reasons, the evolutionary theory of aging has given birth to a worldwide field of research and clinical practice that challenges the notion of a natural aging process that can’t—or shouldn’t be—altered. Is it really tinkering with Mother Nature’s plan, as some have suggested, if Mother Nature has no particular plan? This shouldn’t be interpreted as a denial of the aging process. In fact, it’s the opposite. It’s about understanding it, and finding ways to alter its course, just as medicine tries to alter the course of every other process that’s bad for you. Call it, simply, aging well.
The first step to aging well is to know how well you are aging.
The essence of Age Management Medicine is its focus on how the processes of aging affect each organ system on a cellular level, and the body as a whole. In my practice, I take it a step further. The PhysioAge approach uses established diagnostic tests to make unique assessments: Actual measurements that tell us how a person’s systems are aging. And that allows us to spot, with increasing precision, structural and functional declines long before they become clinically obvious—and much harder to reverse.
These assessments amount to biological markers of aging — biomarkers for short. We use them to appraise, for instance, how someone’s cardiovascular system is aging, compared to others their age. A precise measurement of the stiffness of that person’s arteries can tell us years and even decades before if he is on a trajectory to have an earlier heart attack or stroke than someone else. Based on the numbers, we prescribe therapies that have been shown to be beneficial, then we measure and monitor at intervals to see if they’re working for that particular person. That last part is key because those aging processes we’re so focused on play out differently in everyone. They even vary from system to system within each person. The idea, of course, is to intervene in an individual’s aging—altering the course of history for that person. But to do that, we need to know as precisely as possible how they are aging. And we need to see solid evidence that the measures being taken—in both senses of the word—are changing the biomarkers for the better.
We are bombarded these days with health-related news media reports and internet information. Almost all of it has something to do with aging. Some of it is wrong. Some of it is about selling you something. And even the credible information can seem definitive only until something else contradicts it—or until some researcher, expert or health reporter interprets it that way.
This is why we need evidence that a particular action is having the desired effect—whether it’s hormone replacement therapy, a nutritional supplement, or just a lifestyle change. And the only evidence that really matters to any one person is the kind that shows whether something is working for them. This is what I mean by evidence-based medicine—not the evidence of a large clinical study, but the evidence that shows up in one person’s biomarkers. Even a persuasive study in a respected journal might not necessarily apply to you if you are not like the average of the people in that study. Or it might apply to you, but not precisely in the way reported. Recommendations on the benefits of specific dosages of Vitamin D, for example, could be valid for one person and not another.
Indeed there’s great danger in making broad assessments of large clinical studies and applying them to everyone. A prime example is the Women’s Health Initiative Trial. In 2002, it was reported that the study found that hormone replacement in post-menopausal women carried heavy risks of cancer. What got lost was that the vast majority of women in the study were on average much older than women just entering menopause—and thus carried a higher level of risk factors for the adverse events reported. Breaking out the subset of women in the study with characteristics similar to the average newly menopausal woman, the results largely confirmed the safety and efficacy of HRT. But it’s taken a decade for that reappraisal to take hold the way the initial reports did almost instantaneously.
The Bottom Line: Healthspan
The goal of the age management approach, and the biomarker method in particular, is staving off the diseases of aging, of course. But aging well means more than not being sick. A parallel goal—and the one that goes to the heart of this new paradigm in aging—is to improve a person’s day-to-day, functional life over a span of many years. It’s not about just living longer but about living healthier longer. Not lifespan but healthspan: the number of years you’re healthy and vital—unencumbered, to the fullest extent possible, by the effects of aging that we can all live without. Lifespan is something we all share and it’s pretty much out of our hands. But we each have our own healthspan, and it’s something we can have a hand in.