Ageless Aging presents a pioneering new way for women to age—an ascent that includes feeling youthful and vital while gaining wisdom, resilience, and experience. It provides a holistic, actionable plan that will help women make use of all the tools available to them as they grow older. Maddy Dychtwald will help you navigate the gender and health paradox of longevity, healthspan and perceptions of aging.
One of the big stories of our time is that we’re at the dawn of a longevity revolution that has never happened before. What’s more, women are leading the way, living an average of six years longer than men. (The estrogen our body makes is thought to be the key, as it promotes the expression of longevity-associated genes and the creation of antioxidant enzymes that can then protect against the harmful effects of inflammation— although, of course, we lose this protection after menopause.) But that perk has a major downside: according to an analysis of data from the World Health Organization’s Global Health Observatory, the average woman in the United States will spend the last twelve years of her life in a cascade of poor health. This combination of longer lifespan but poorer healthspan is what is now generally referred to as the gender and health paradox. In other words, our healthspans and lifespans are out of sync. As you can imagine, this means you may be more limited in the activities you take part in. Your healthcare costs may go up, too, which means that your money— which already has to last longer than men’s, owing to our longer lives— gets even more stretched.
How old do you think you are?
Popular myths and stereotypes about our worth and value decreasing as we get older are just that: myths and stereotypes. We women are not destined to become vulnerable, frail, and sick as we age, nor are we destined to become socially isolated and irrelevant. We have to believe these truths ourselves first. Dolly Parton once said, “I don’t think about my life in terms of numbers. I ain’t never gonna be old, because I ain’t got time to be old.” Research has shown that our preconceived, stereotyped notions of chronological age can dictate how we age— even how old we look, feel, and behave— which makes many of us (like Dolly) feel boxed in. Yale gerontologist Becca Levy, PhD, has conducted considerable research into the effects of preconceptions about age on health outcomes, and her findings are nothing short of astonishing. Perhaps the most jawdropping is a finding from her 2002 research that followed hundreds of people over age fifty in a small Ohio town for two decades: those who had a positive view of aging had a median survival rate that was 7.5 years longer than those who saw it through a negative lens. According to Levy, “The single most important factor in determining longevity— more important than gender, income, social background, loneliness or functional health— is how people think about and approach the idea of old age.” Levy’s research shows that viewing the aging process and capabilities of older people—including yourself—positively can help ward off many of the things we tend to fear the most about living a long time. It halves the risk of cardiovascular events (such as heart failure, heart attack, and stroke), helps ward off mental illnesses such as depression and anxiety, encourages a quicker recovery from bouts of disability, and even reduces the risk of developing Alzheimer’s. Best of all, her research shows that it’s never too late to amend your views of aging to become more positive.
It’s not just Levy and her team of researchers who are uncovering the power of how we think to positively— or negatively— affect our healthspan and lifespan. The nascent field of geroscience is now revealing that there are more factors within your control that influence how you age. For instance, “age identity,” or what chronological age you identify with no matter how many years you’ve lived, has an effect. When Korean researchers did MRI scans of women and men over forty, they found that the brains of those with a lower age identity had significantly more gray matter in their brain compared to others whose subjective age matched their chronological age. (Gray matter makes up the outermost layer of the brain and is associated with perception, processing sensations, and the ability to think and reason—it also plays a role in memory. Gray matter often shrinks in those with Alzheimer’s disease.) In other words, your body is impacted by how old you think and feel you are. Perhaps it’s time that we stopped thinking of our age as an absolute.
The science of aging
Aging is a lifelong process that begins in the womb and continues until we die. Certain predictable changes happen at the cellular and molecular levels as humans live longer. These hallmarks of aging not only help us understand why we become more prone to chronic disease the older we get, but also point toward ways we can positively influence the aging process itself. Using the hallmarks of aging as a guide, scientists are now looking for cures for age-related conditions and even, according to many longevity experts, a potential cure for aging itself. (Yes, there is a group of scientists and thought leaders who think of aging itself as a disease to be cured.)
When I spoke with James Kirkland, MD, PhD, director of the Center of Aging at Mayo Clinic, he explained that the hallmarks can be influenced positively. Better yet, he said, “We’ve found that when you target one [hallmark of aging], you tend to affect all the rest.” For those of you who, like me, want to understand the science of what’s going on in their own bodies, here’s a nutshell description of the hallmarks of aging that longevity experts are looking to positively impact:
• Cellular senescence. One of the hallmarks of aging that we have longknown about is senescent cells— cells that have stopped dividing butdon’t die. They are normally swept away by the immune system, but this removal does not keep up with new senescent cell generation that occurs with aging and in a number of diseases. While some level of senescent cells is normal and even beneficial (researchers theorize that senescent cells are what produce the factors that trigger labor in pregnant women), when they accumulate and persist— as often happens with living longer— they contribute to inflammation and most of the other pillars of aging that follow.
• Shortening or dysfunctional telomeres. In 1982, Elizabeth Blackburn at UCSF and Jack Szostak at Harvard discovered telomeres, which are specialized structures made of genetic material and proteins that are found at the ends of our chromosomes. They’re like the plastic tips on your shoelaces. Every time a cell divides, the telomeres get a little shorter. Once telomeres get short or dysfunctional enough, that cell will stop dividing and will die or become senescent.
• DNA damage. Your genetic material incurs damage thanks to the byproducts of normal cellular processes and environmental influences (such as radiation exposure from flying in airplanes or heavy metals ingested in food or supplements).
• Epigenetic dysregulation. There are a multitude of chemical compounds and proteins that attach to your DNA— known as your epigenome— which dictate whether a gene is turned on or turned off. As you age, epigenetic shifts tend to turn on more bad genes, such as those that promote inflammation, and turn off more good genes, such as those that suppress tumors.
• Mitochondrial decline. Your mitochondria are organelles located within your cells that produce the energy needed to fuel the myriad functions of your body. Over time, these energy factories lose efficiency.
• Stem cell depletion. Stem cells play an important role in repairing and replenishing the body. As we age, they decline in quantity and can mutate, impairing their function.
• Glycation. This is what happens when a sugar molecule bonds with a protein or a fat, and the end result— known as a glycation end product— can ccumulate as you grow older, contributing to wrinkles, cataracts, atherosclerosis, and Alzheimer’s (this speaks to why it’s so important to be super mindful about your sugar consumption).
• Other cellular processes—i ncluding intracellular communication, nutrient sensing, and maintaining the right balance of proteins within cells— decline in a predictable way with age.
Take control of your hallmarks of aging
Today, thanks to rapidly growing interest in the subject, scientists, doctors, and research institutions increasingly view aging as malleable, something that can be impacted, slowed down, and maybe even reversed. For instance, we’ve known for decades that calorie restriction appears to extend life and delay biological aging (the first animal study to document the link was published in 1935). Then in the 1990s, UCSF microbiologist Cynthia Kenyon upended the idea that aging was an unavoidable, irreversible process when she discovered that a single genetic mutation could significantly expand lifespan in worms, and the race was on to develop products to fight aging and the diseases and conditions that can occur as we live longer. Kenyon’s groundbreaking work has led to a flurry of longevity research worldwide. According to Longevity Fund founder Laura Deming, researchers are “trying to figure out what kinds of damage accumulates with age, how to reverse that accumulation, and then search for the physical or biological aging is also a measure of your body’s ability to function, and it is influenced greatly by your diet, exercise, and other lifestyle choices. You could be age fifty- four chronologically but have a biological age that is younger, about the same, or older than the number of years you’ve been alive. Slowing down or even reversing your biological aging process is an essential part of ageless aging— it’s decoupling your chronological age from your overall physical health. It’s extending your healthspan to better match your lifespan so that you have the energy, passion, and vitality to make the most of your longevity bonus. For instance, when I tested my biological age (using a test that analyzed my epigenetics), my biological age was fifty- two. At the time of testing, I was chronologically seventy one. Needless to say, I felt gratified that all the steps I’ve taken to age more agelessly seem to be having a positive impact. If I can do it, so can you! switches we can flip in human biology to increase lifespan.”
Goodbye (and good riddance) to the 70/30 rule
When viewed through the lens of the hallmarks of aging, physical aging is a complex process of things just wearing out. We now know that each of us can affect the pace at which our own wearing out happens. Prior to Cynthia Kenyon’s work, the common assumption in both science and medicine was that, while lifestyle certainly played a role in health and aging, it was greatly outweighed by genetics. That was the original 70/30 rule: 70 percent of aging and longevity was determined by genetics, and just 30 percent was based on lifestyle and environment.
In 1998 that assumption was flipped on its head once and for all by key findings of the MacArthur Foundation Research Network on Successful Aging (an initiative that brings together a multidisciplinary team of researchers from a variety of institutions to study the most pressing challenges of our time), which asserted that 70 percent of our health and longevity is firmly under our control, based on lifestyle andenvironment, and only 30 percent is controlled by our genes. As Dr. John W. Rowe, director of the MacArthur Foundation aging initiative and founding director of the Division on Aging at Harvard Medical School, puts it, “People are largely responsible for how they age.” Since then, we’ve realized that’s even more true than initially suggested, as scientists have proposed that the ratio is actually closer to 80/20 in favor of lifestyle and environment. And that ratio has just been refined even further: Google’s Calico Labs, a biotech firm focused on researching the biology that controls aging and lifespan with the hope of discovering and developing interventions that enable peopleto live longer and healthier lives, recently asserted that 90 percent of our health and longevity is controlled by our lifestyle and environment
and only 10 percent by our genetics. I’ll take that math any day. There’s no question this is a game changer. Lifestyle management has emerged as the most potent tool in our ageless aging toolbox. Of course, it isn’t a new idea— we’ve been hearing “Move it or lose it” and “You are what you eat” for years. The difference is that today we have a swiftly growing body of scientific evidence and data to underscore exactly how important these choices are, and which ones produce the very best results.
From what we understand at this point, the true power of lifestyle comes from epigenetics, which determines which genes get expressed and which don’t. And the choices you make every day affect your epigenetics. I spoke to Dr. Stephen Kopecky, a cardiologist at Mayo Clinic, author of Live Younger Longer, and a huge proponent of prevention, who explained it this way: “It turns out that good lifestyle turns on good genes and turns off bad genes. And so, even people with bad genes can lower their risk of having heart attacks and dying early by 75 to 80 percent.” Your lifestyle can’t change your predisposition toward disease; that’s in your genes. But it can certainly lower your risk; that’s epigenetics.
Excerpted from Ageless Aging by Maddy Dychtwald.
Relevant reading
Crusade to Heal America
The never-before-told story of the woman who moved mountains for medical research and human health.
