Ask The Dr.: Lessons In Longevity

Six ways your biological age matters more than the number of candles on your cake.
Rest, movement and stress-relief practices can all combat premature aging. Photo: Aaron Burden

by Dr. Frank Lipman 

You’re probably familiar with the old saying: “Age is only a number.” Well, it’s one cliche that’s actually getting at something real. Think about your peers. One middle-aged friend’s physical appearance seems to have hardly changed in the years you’ve known her and she says she feels much the same as she ever did. Another peer is, let’s be generous here, showing some wear and tear and has clearly lost a step or two. Maybe you fall somewhere in the middle? 

Then, take a look at your parents’ generation and the contrasts are likely to be even more startling. Some are going strong, looking and feeling great, while others are fighting chronic conditions, like heart disease and Type 2 diabetes, that are taking big bites out of the quality of their lives now and will most likely shorten them on the back end. 

So, really, when we think about age, we should consider it in terms of two numbers: your actual chronological age and what researchers and some forward-thinking clinicians are now calling “biological” age, which captures the differences in how our bodies change over time. The good news? Medical science is in the first stages of being able to measure the biological processes that underlie aging, and clinicians—myself included—who embrace “longevity medicine” can use that information to tailor therapies and target lifestyle upgrades to slow that process down. So, how to slow down your aging and work on extending your health span? Read on. 

It’s all about aging—and we’re all doing it 

Conventional medicine tends to see the world as binary: You’re healthy, until one day, your blood pressure or your blood sugar or your cholesterol levels cross a somewhat arbitrary threshold and then you’re considered not healthy. Out comes the prescription pad, you’re off to the pharmacy and taking your seat on the pharmaceutical merry-go-round. 

Longevity medicine, however, takes a different approach, viewing your health and wellness through the lens of aging. It’s no accident that most of us get diagnosed with serious illnesses and health concerns as we pass through our middle years, sometimes in our 40s and very commonly in our 50s and 60s. The reality is, our bodies are starting to go downhill (sorry to be so blunt) as soon as we get into our mid-30s. But, in longevity medicine, with its more in-depth understanding of what’s going on at the level of the organs, the cells, even the genes, plus the technology and data to measure it more comprehensively, we can identify which parts of your physiology may be slipping at a faster rate than the rest of you. From there, we can take steps to intervene, ideally, before your primary care doc writes you that first pharmaceutical prescription and/or larger health problems get a toehold. 

What causes aging? 

For decades, researchers hunted for some single explanation for why, over time, our bodies functioned less and less well, usually in subtle ways in our middle years, and pretty dramatically as we progress into elder-hood. Today, the best research is telling us that there is no one single smoking gun; it’s a handful of different, interrelated processes that come together to ensure that an 80-year-old looks and feels different than her 30-year-old self. (As well, those forces play out differently in different people; two 80-year-olds may have very different biological ages.) Though a full accounting of this biology is a long one, know that there are a bunch of bad actors at play in the aging game, including: DNA mutations; damage to our cell’s power plants, the mitochondria; shortening of the telomeres that help regulate cell division; clogging up of the cells’ garbage disposal system, or autophagy; difficulties producing properly functioning proteins, the building blocks of the human body; an imbalanced microbiome; and inflammation at the cellular level. 

Measuring the damage: the biomarkers of aging 

Fortunately for us, this more sophisticated understanding of aging isn’t just theoretical. It’s given rise to a new generation of diagnostic tests that can assess the biomarkers of aging—in other words, the physiological changes that, if left unchecked, may over time result in a range of different life-altering diseases. It’s no longer just about measuring one particular aspect of the body that increases the risk of a particular disease, for instance blood pressure or blood sugar, important as they may be. Some of the diagnostic work that longevity medicine doctors do is a refinement of past diagnostic testing, with better, more precise ways to measure things like hormone levels and cardiovascular or metabolic function, while some tools are entirely new. For example, I’m part of the vanguard of clinicians now making use of testing that analyzes sugar molecules, glycans, that attach to the most common immune system antibody in our blood. That sounds esoteric, but it’s giving us a valuable window into the immune system and how it helps drive the aging process. When we’re younger, inflammation is part of the body’s healthy response to injury and infection. The older we get, the more likely the fires of inflammation keep burning for no good reason, eventually exhausting the ability of the immune system to defend against real threats. (Some theorists think “inflamm-aging” is the term that best describes most of the bad things that accompany getting older.)

What to do about aging: try reversing your biological age

In my practice, I work closely with patients to come up with the combination of anti-aging therapies that is right for them. For some patients it may be hormone replacement therapies, using bioavailable hormones from a compounding pharmacy, if appropriate—declining sex hormones, especially in women during and after menopause, are responsible for dips in overall health as well as troubling symptoms, and they can be addressed. For other patients, we may make use of new peptide therapies, injections of natural compounds—technically speaking, short chains of amino acids—that interact with the body to improve a range of body functions, everything from wound healing to better hair growth. For just about all my patients, we’ll also arrive at the right complement of supplements for additional support. 

The lifestyle essentials

I believe longevity medicine may transform the way we practice medicine over the coming decades. It is making good on the promise of functional medicine, that is, getting at the root causes of our health problems rather than just treating a bunch of symptoms. And at the bottom of most of what ails us is the aging process that we’re all going through. You can’t get more “root” than that. 

Back to basics 

By now, the essentials of healthy living shouldn’t be news to Purist readers, even as doctors are just beginning to get a more precise readout on their good effects with high-tech diagnostics. Eating whole foods, avoiding junky processed food and sugar in all its forms, is such a potent way to lower inflammation and maintain a healthy weight and metabolism. 

Movement—whether it’s an exercise program or just everyday physical activity—positively impacts just about every aging process that researchers have so far identified. Stress does the opposite. Constant high levels of stress hormones like cortisol and adrenaline age us before our time. 

Consequently, getting enough high-quality sleep and engaging in whichever calming practices suit us best, from sitting meditation to walking in the woods to taking a hot bath, is another crucial way to slow down that aging clock. And, of course, we’re more than just physiological clocks. By fully embracing our humanity, by developing the social connections that bind us to families and friends, we make our lives worth living, for as long and as healthily as possible.