Slowing or even reversing the ageing process is the holy grail for some scientists and everything from drugs to blood infusions and laughter is being investigated.
As Astar Young was approaching the age of 65, it occurred to her that she didn’t have any plans in place for the years ahead. “I’ve always had a 5- or 10-year plan, from the moment I started work,” she says. “I don’t know why I didn’t factor in 65. It was this distant number, then all of a sudden it was coming at me and, for the first time in my life, I had no idea where I was going.”
Young is an Auckland florist with her own YouTube channel, Astar’s Place. A dynamic woman who has always had energy to spare, she was alarmed to realise she had been subconsciously viewing 65 as the autumn of her life, the start of an inevitable decline.
Deciding to overhaul her health, she embarked on a cleansing juice fast. It didn’t go well. Then, through friends, she was introduced to Paulina Giraldo-Perez and Raphael Aggio – aka Dr Pauli and Dr Rapha – two Auckland-based biological scientists who have stepped away from academia and started a health coaching practice, Konciencia.
Learning more about their programme, Young and her partner, civil engineer Steve Protheroe, 69, were keen to give it a go. “It is very much science-based,” explains Protheroe. “When they described the outcomes that they hoped to achieve for their clients, I thought I could benefit.”
Since the couple signed up in January last year, the Konciencia programme has transformed many aspects of their lives. “There was meditation and breathing work to be done, sleep to be improved, exercise to be increased, food to be eliminated,” says Young. “The shock for me was getting rid of everything in my kitchen that wasn’t real food. I thought I knew real food but I didn’t.”
Thanks to this lifestyle reset, she has dropped 4kg and Protheroe 8kg, which they put down to cutting out sugar and starchy carbohydrates along with an intermittent fasting regime. The benefits go far beyond weight loss. Protheroe has started running again and Young has taken up martial arts. They both wear Oura rings – a device that tracks biometrics, including sleep and heart rate – and are increasingly pleased with the data they are seeing. Perhaps most importantly, they feel better.
Now that Young no longer considers herself in the autumn of life, she is full of plans for the future. “I don’t know that I’m into longevity, I’m just into being well,” she says. “And I think a lot of people don’t understand they could be feeling better.”
‘Scienceploitation’
Young isn’t alone in wanting to extend the summer of her life for as long as possible. As the boomer generation grows old, a whole industry is springing up to help them do it optimally. Longevity and regenerative medicine have arrived, as well as specialist doctors and a whole world of supplements, devices and diagnostics. According to market analysis site Longevity.Technology, US$5.2 billion was invested globally in 2022 in longevity-related companies.
With no shortage of hype when it comes to healthy ageing, it can be particularly difficult to separate the science from the “scienceploitation”. That is one of the reasons Giraldo-Perez and Aggio saw a need for their service, translating science and guiding people to use it for their own benefit.
As well as working one-on-one with a small group of clients, they are developing an online programme. “With the people we’re working with, we always begin with what their objective is, what they want,” says Aggio. “Many people say they want to be as healthy as they can as they get older, so then we’ll ask, ‘What do you want to use that health for?’ Once you have a clear purpose, that gives you the energy and motivation.”
There is an element of biohacking – tips and tricks to help the body function at peak – to what they offer. One programme uses DNA testing to identify an individual’s biological age and refine their regime. And they recommend supplements such as creatine to help muscle strength and promote brain health. But none of that is a replacement for basic healthy habits.
“Biohacking and the genetic stuff – it’s awesome,” says Giraldo-Perez. “But we’re not going to talk about supplements unless you’re eating, moving and sleeping well and staying hydrated. Those fundamentals come first.”
Understanding the biology behind the changes they are making also gives clients more motivation, says Giraldo-Perez. “We’re empowering people with the knowledge to improve their health.”
No matter how diligent about self-care we might be, the ageing process is happening inexorably. Biological ageing starts relatively early – by the age of 30 it has become established in our cells. As we reach later life, more of those cells will exhaust their ability to divide and will become senescent. Those that survive will be too worn out to do their job properly. We will lose muscle mass and strength. Our immune system will fail to protect us from infection and, instead, fuel chronic inflammation. Proteins will start to misfold and clump, forming the amyloids associated with Alzheimer’s. Our microbiome will change. Our DNA will be damaged.
Slowing that process, perhaps even reversing it and extending life, is the holy grail for biogerontologists. Right now, scientists are coming at this from all directions, with repurposing existing drugs being one area of strong interest.
A candidate is Rapamycin, a drug known as an mTOR inhibitor that appears to influence cell ageing. It has been shown to delay several diseases in mice and is now being trialled in dogs. It is currently used to prevent organ rejection after transplant surgery as well as to treat some cancer patients.
Then there is metformin, a drug widely prescribed to treat type 2 diabetes and under investigation for its anti-inflammatory effects and its potential, like Rapamycin, to target age-related cell changes.
Meanwhile, the market is crowded with age-defying supplements, many of them with at least some scientific backing. Harvard professor of genetics David Sinclair is focused on warding off the DNA damage that comes with age. His lab has found a role for a signalling molecule, NAD+ (nicotinamide adenine dinucleotide), which declines steadily with age. In experiments with mice, treating them with its precursor, NMN (nicotinamide mononucleotide), restored muscle vitality, reversed blood vessel damage and boosted stamina.
Of course, mice have a short lifespan – 12-18 months – and other differences in their biology, but Sinclair’s team hope this will pave the way to treatments that will rewind the clock for humans. In the meantime, encouraged by his progress, people are already investing in supplements that promise to support NAD levels. These often blend NMN with polyphenols such as resveratrol and quercetin that are designed to protect the body from inflammatory damage. Sinclair himself is said to take one of these formulas.
As science continues to progress, researchers are trialling everything from stem cell therapies to growth hormone injections and infusions of youthful blood. One or all of these may be the path to enduring youth in the future, but so far only mice have been proven to have benefited.
Live well, stay positive
Irish geriatrician Rose Anne Kenny believes a modest deceleration of the rate of ageing is already realistic and that we have within our reach many of the tools to delay our decline by about seven years. Kenny is a professor at Trinity College Dublin and principal investigator on The Irish Longitudinal Study on Ageing (Tilda). Her book, Age Proof: The New Science of Living a Longer and Healthier Life, explores evidence-based methods of lowering biological age and her key message is that we have more control over the rate at which we deteriorate than we might imagine.
“It appears that 80% of the process is not about genes but rather environmental and behavioural factors,” says Kenny. “We know this predominantly from studies with monozygotic twins who share exactly the same gene base but their ageing process differs. That process probably begins in childhood and the earlier we start to intervene the better, but there is a lot of evidence that we can modify it at any age. It’s never too late.”
Some of her suggested interventions are exactly what you would expect: sleep well, eat healthily and not too much, stress less, move more. Others may be more surprising. For example, Kenny’s research group has done work to show that simply feeling younger than one’s chronological age slows the pace of ageing, irrespective of diseases and disorders, possibly because it reduces inflammation in the cells.
In the Tilda study, researchers measured attitudes towards ageing alongside the physical and cognitive health of participants – things like muscle strength, walking speed, memory and attention. Those who responded positively to the attitudinal questions were found to be ageing more slowly than those with a negative view of getting older. “I would say this mental attitude is influencing us at a cellular level,” says Kenny.
Becca Levy, a professor at Yale University and a leading expert on the psychology of successful ageing, has also done work to show that attitudes have an impact on how well we age. Her study on the inhabitants of the small town of Oxford, Ohio, found that negative age beliefs are potentially shedding up to 71/2 years from our lives.
How society perceives older people plays a part, too. Whether through TV shows, other media or those around you, if you’re constantly bombarded with the idea that being older means you are diseased, confused and incompetent, it will have an effect. “External attitudes matter,” says Kenny. “It’s very difficult for an individual to remain positive if you’re constantly exposed to negative stereotypes and messaging.”
Ageism rules
Is New Zealand ageist? A survey of 1780 people for the 2021 Attitude Towards Ageing report by the Office for Seniors – Te Tari Kaumātua revealed that over a third believe age discrimination is a serious issue and almost a quarter sometimes feel invisible because of their age (those aged 50-64 were more likely to feel this than the population as a whole). Negative stereotypes were more common than positive. Older people were seen as slowing down, frail, wrinkled, with health issues. On the plus side, most respondents said they had respect for older people.
In the wider world, there are other encouraging signs. The World Health Organisation is working on a Global Campaign to Combat Ageism, and the UN has declared this the Decade of Healthy Ageing. Even the fashion industry is getting in on the act – in October, 89-year-old actor Maggie Smith became the face of luxury leathergoods company Loewe.
Social cues
Along with attitude, the quality of your social networks can add years to your life. This has been known since the 1960s when American researcher Stewart Wolf coined the term “the Roseto effect”. He was interested in why the inhabitants of Roseto, Pennsylvania, a population of mostly Italian immigrants, had far lower rates of heart disease than elsewhere in the US. When he started to investigate, he couldn’t find anything about their diet or exercise habits to explain it. Finally, he concluded that the closeness of the community was responsible. The people of Roseta were extremely social – often three generations lived beneath the same roof – and there was very little loneliness.
“Since then, there has been more research that has shown very clearly that the influence of social relationships and loneliness on mortality are comparable to well-established risk factors like smoking,” says Kenny.
It seems that being friendless switches on genes known to increase inflammation, which is the background for age-related diseases. And being persistently lonely in midlife appears to make people more likely to develop dementia and Alzheimer’s.
Kenny’s research in Ireland has shown pandemic lockdowns had a lasting impact on levels of social isolation. “We looked at loneliness in people over 50 before, during and after Covid,” says Kenny. “It increased threefold during Covid, and unfortunately, we haven’t gone back to pre-pandemic levels.”
Kenny adds that if she could prescribe only one thing to boost wellbeing it would be good, frequent engagement with friends, and it is something that she has put more effort into. “I’m consciously making an effort to meet people. I’ve made contact with friends from school and college that I hadn’t seen for 20 or 30 years and I also joined a choir recently. I thought, what is the point in me preaching about all of this? I know the evidence. I know the data, I’m sharing it with everyone and I’m not doing any of it myself. So, I’ve changed a lot of behaviours over the last 10 years.”
Kenny has also taken up cold-water swimming and endures a cold shower every morning. The theory behind this is that exposing the cells to mild stress triggers recovery and repair mechanisms. One of the chemicals it increases is the neuro-transmitter noradrenaline, which regulates the activity of cells and is involved with a host of functions in the body. “Responsiveness to noradrenaline declines with age, so any stimulus that enhances its activity is important.”
Making time for a good laugh is a priority for her, too. As we age, we tend to laugh less. The research shows that while children laugh as much as 400 times a day, older adults tend to laugh only 15 times. Laughter is beneficial at a chemical level because it lowers stress hormones which, in turn, stabilises blood sugar, regulates blood pressure and reduces inflammation. It also increases endorphins, which helps the immune system.
“Having a good laugh is very good for you,” says Kenny, highlighting a link to social isolation. “It’s almost impossible to have a really good laugh on your own. You need someone else there.”
As director of Mercer’s Institute for Successful Ageing at Dublin’s St James’s Hospital, Kenny puts a strong emphasis on creativity, too. “The evidence around creativity is very persuasive. People involved in weekly art participation have better physical health, fewer doctor visits and less medication usage, coupled with better mental health. At the institute, we have a central hub where patients, families and staff can let their creative juices flow. There is often music happening there, dance, art exhibitions, poetry readings – and it’s for everybody.”
Supplementary measures
Ageing is unlikely to happen for a single reason and delaying it by seven years will involve multiple approaches. Kenny doesn’t believe there is enough evidence yet to justify any of those high-priced supplement blends but she does think taking vitamin D is useful for older people who might not spend much time outdoors exposing themselves to sunlight and whose skin has a reduced capacity to produce the vitamin. She adds that supplementing with polyphenols such as resveratrol and fisetin may have some benefits, and there is no harm in taking the minerals magnesium and zinc within the recommended doses.
As for tracking personal health data, Kenny believes it is worth knowing your heart-rate behaviours and keeping an eye on blood pressure, cholesterol and blood sugar levels.
“With some of the dynamic new equipment, we can measure a lot of those things over a 24-hour period and get biofeedback, which I’m sure alters behaviours to a certain degree.
“I’m also thinking of doing continuous glucose monitoring. There aren’t many ways of finding out what your individual optimal diet is without knowing what your glucose peaks and troughs are, so I’m going to test that on myself.”
Bridging the gap
Until now, de-ageing has mostly been the province of the wealthy. At the far extreme are people like tech billionaire Bryan Johnson, who is said to have received blood transfusions from his teenage son and spends millions each year following a rigorous lifestyle plan with the aim of slowing or even reversing his biological ageing.
Johnson, 46, has even created an online forum and leaderboard, the “Rejuvenation Olympics”, for the longevity community – people with a lot of time and money to dedicate to themselves.
For those of us who are not part of the Silicon Valley set, the future doesn’t look rosy without some sort of intervention. On average, we are likely to spend the last 15 years of our lives suffering from the complications of one of the big four diseases: cancer, dementia, cardiovascular disease or diabetes. Even if we do live longer, that extra time could be spent coping with disability.
Meanwhile, very little of our health system spend goes on preventing disease before it happens. Instead, we rely on medication to treat it once it arrives.
In 2018, Grant and Louise Schofield decided to try to do something about this. They had been watching as their parents’ generation experienced a decline in quality of life and an increase in the medications needed to keep them going. Grant, a professor of behavioural nutrition and physical activity at Auckland University of Technology, was particularly frustrated at the gap between what science is telling us about preventive lifestyle medicine and what actually happens in medical practice.
“Millions of dollars are spent doing research, then nothing changes,” he says. “I don’t think there is any hope of change without alternative action because the pharmaceutical interest in medicine is so pervasive.”
With Louise, who has a background in corporate wellbeing, he came up with Prekure, a social enterprise that provides training for a new breed of health professional.
“This is the exact opposite of the doctor in a lab coat and stethoscope writing out a prescription,” says Grant.
Prekure is on a mission to change the face of healthcare and extend human “healthspan” by teaching people how to prevent, manage and reverse chronic diseases and mental health problems.
So far, they have upskilled more than 1500 health professionals. They are also training an army of health coaches – 500 at this stage, with the goal of 50,000 globally by 2027 – offering online courses ranging from six months to two years that give a grounding in coaching skills and scientifically proven preventive lifestyle medicine. And Prekure has a strong focus on helping Māori and Pacific communities.
“We strongly believe that we can train you up no matter what your background,” says Louise. “We attract a lot of 40-, 50- and 60-year-olds, who come to us with life experience. We’ll give them the tools to walk alongside clients and help them with anything from mild to moderate depression to reversing diabetes, and do it on their terms and without judgment.”
Many of us are well aware of what we should be doing to set ourselves up for a longer and healthier life, but still don’t quite seem to manage it.
“It’s not a knowledge problem – it’s a doing problem,” says Louise. “And it’s not easy – life gets in the way. So, to have a coach that you connect with and to have some accountability, that really does make a massive difference.”
The Schofields hope that once they prove their approach to preventive lifestyle medicine works, they will get government buy-in. Then, having a health coach will become accessible for more New Zealanders, and hopefully some day, doctors’ surgeries won’t be filled with so many patients needing treatment for preventable lifestyle-related disease. “Right now,” says Louise, “there may not be a lot of people saying they want a health coach, but there will be in the future.”