How Aging Research Is Changing Our Lives
aging.nautil.us
aging.nautil.us
> People talk about healthcare, but in essence what we have right now is not healthcare. It’s sick care. Some people see their physician when they’re well, but most people don’t because there’s not much advice that they can give you other than not to smoke and to exercise and all that.
I feel like I identify with this; I want to have conversations with my doctor all the time about routine advice seeking kind of stuff, but I don't because there's nothing wrong, plus it costs a lot. I would love to have a health care plan where conversations during and about being well were expected and included, but I don't see it coming any time soon.
I assume you mean it costs a lot as a total package, including paying for health insurance.
For me, my individual visit to see my doctor costs me $20 per visit, which I do not consider to be expensive.
Even if I paid full price without insurance, $200/month for a doctor's attention and advice isn't that much, it's less than insurance, so maybe I'm irrationally afraid. But either way it's still part of what's keeping me from doing it. That, and if I call for an appointment they ask what's wrong multiple times. They de-prioritize scheduling for appointments when nothing's wrong, and they assume it's a one-time event. I feel like there is a non-negligible social disincentive built-in to calling for help when nothings wrong.
HealthiestYou via UHC is a service where you book an appointment via their app and the doctor calls you back within a few minutes. You can book unlimited appointments at no additional charge.
You do not talk to your regular GP but you do get access to real doctors.
I feel like this illustrates my point quite nicely. I'm not sure, but the addition of "on earth" makes your sentence sound incredulous and rhetorical rather than a genuine question, more of a statement that without symptoms there can't possibly be anything to discuss. Are you by chance under 30?
The definition of whether something's wrong when I visit the doctor is how much pain there is. When they ask what's wrong they always give me a green xerox of a questionnaire that has me circle the number between 1 and 10 rating my pain level. If that number is less than 5, they schedule differently. Non-emergency may mean 2-3 weeks before I get a visit. If it's 1 or 0, they start asking if you really need to see the doctor at all and start giving you online resources.
Ever do any maintenance on your car or your computer when nothing's wrong with it now but you guess might be later if you don't? I have. Ever change oil or free up some disk space? Have you ever optimized some code before you actually measured a performance problem? I have. What are the reasons that we would ever do that or talk to anyone about it before there are actual symptoms?
Have you ever googled a health question to see what other people are doing? I have and I happen to know that Google's index has a lot of content that answers minor and major health and medicine questions. The existence and popularity of health advice online and websites like WebMD suggests you might be underestimating how many people would enjoy the chance to chit-chat with their doctor more often, just to ask stupid questions.
Have you ever just been curious about how things in your body work? Sometimes I know what to do with my body, I just want to learn why it's doing something, and learn it from somebody who went through training. For some topics, I'd rather skip the part where I google it and try to sift through the 90% of bullshit online where people just make up stuff, and talk to someone I trust instead.
I do get the feeling you might be making assumptions about what I said and what kind of questions I was talking about. I'm not sure what you're imagining, but I probably would run out of questions like "how many calories should I eat?" and "should I exercise?" pretty quickly. The body has a lot of moving parts though, and once you have a few surgeries, once you're over 40 and weird things start to happen, once you get curious about why some part of your body isn't doing exactly what you expect, you might end up wanting to ask your doctor some questions about your joints & muscles, or about your esophagus & stomach, or the health of your children, or your hair & eyesight, or your skin or toenails, or whether your family history about this or that is likely to affect you.
I've only just turned 40 and I suppose to be fair, when I was younger I might have felt the same way you do. But my body is changing and my desire to stay on top it is increasing. I've always been fairly healthy, and I know what to do to stay healthy, but in the last decade my body reacts differently to exercise than when I was younger. I've hit a couple of joint issues going to the gym that compromise my ability to do certain exercises. In the last 5 years I've hit some knee problems when running that compromise my ability to run longer distances. I've done minor damage my neck and back mountain biking and skydiving. I'm starting to experience side effects from the surgeries I've had in my life. My digestion is changing and I can't eat all the same food I used to without "adverse" effects. I would love to get regular advice on how to tune myself given the problems I have, often from a sports doctor, but like I said I don't seek appointments for every question that pops into my head because our medical system doesn't really support education and regular preventive care.
Eric Verdin is spot on, in my opinion, we have sick care, not health care.
The running and lifting communities do an ok job giving people basic safety training, but the way people do these repetitive motions over and over and over for years without variation will frequently lead to injuries in the long term. It's still a net gain for health, but there's something about just the intention to be "a runner" or "a lifter" that sets you on a path to injury.
The alternative is movement practices that span a much wider range of motions. Tai Chi is a good example. Yoga probably is not, based on the way your average teacher will teach it (goal-oriented, fast, and repetitive).
But really if you want to limit your exposure to injury, you need to learn to be active all day long, to find exercise and resistance in everything you do, learn to read which activities your body needs more of, and go seek them out, and learn how to heal from things you're doing too much of.
Runners World can't really advise you on that because if it's not running it's not really on topic.
Many of your examples/analogies fall outside 2x/month. Yes, I do perform maintenance on my car and computer, but not 2x a month.
When I've had medical issues that warrant seeing a doctor I first do my own research online so I know what questions to ask. Very rarely has the doc revealed something to me that I didn't already learn as part of my research. The only real value I've received is if tests were needed or procedures or medication was indicated. These have never required twice monthly contact.
I have similar issues to you (sans the surgeries) and when I consult with my doc he (my GP is male) gives me the information I need. Unless something significant changes then there's nothing new he can tell me two weeks later.
Completely agree we have sick care, not health care. Then again if suddenly 2x consults with a doc were made available for free that wouldn't change anything. Medical science still has a lot to figure out in terms of 'health'. Many of the treatments prescribed aren't actually backed up by good empirical evidence. My brother-in-law is an MD and he reminds me of this often.
I'm 50 years old.
Observational data suggests that eating a diverse diet (but not too much food that you become overweight), being moderately active, limiting alcohol intake, and avoiding smoking is healthy. Observational data can be confounded, but it's not like we have (or are likely to have) randomized controlled trials of different approaches to healthy living. (How long should the trial run before you decide that the null hypothesis is true?)
So, most doctors aren't going to have much to say about what healthy living truly is.
The combined total of the entertainment industry (keeping you on the couch for money) and the healthcare industry (money made from complications of staying on the couch), is something like a whopping 1/4th of US GDP.
Where is this "ton of information on healthy living" and what level of evidence do you have for it?
I don't doubt that there is a set of things that people can do to be healthy. I do not think that there is much information about what those steps are. Again, there is plenty of writing on the topic, but little information.
It's a landmark, decades long (began in 1948) research study that revolutionized health guidelines and what factors in death and heart disease.
I would be delighted to learn that there is a trove of actionable, research-backed information about healthy living that we aren't taught in medical school, residency, or cardiology fellowship. My patients would benefit if I could provide them with this information. I don't think it exists, but if it does, who can point me to it?
I don't have links handy (edit: apparently I have a few) but just from reading over the years, it seems that the highest impact things you can do (that you have direct control over) to avoid the diseases of aging (both physical and mental degeneration, as well as the usual lifestyle diseases like diabetes and heart disease) while increasing or at least maintaining one's quality of life include (1) regular strength training, (2) endurance training, (3) avoiding processed foods and eating significantly more vegetables, (4) minimizing visceral body fat levels, and (5) always be learning something new (particularly relevant for lowering risks for cognitive degeneration).
For more specific and actionable advice:
1) Every able-bodied adult should invest anywhere from 6 months to 2 years of dedicated strength training to build muscle mass and strength. The benefits are numerous and well-documented (e.g., https://en.wikipedia.org/wiki/Strength_training, http://startingstrength.com/article/science-medicine/barbell...). A somewhat arbitrary floor recommendation would be to maintain a level of strength that allows you to deadlift twice your bodyweight and accomplish 20 pull ups in a row. This is a non-trivial level of strength that requires training, but is achievable for most people with intelligent (but not necessarily complicated) training. Any competent strength coach can take you there. Reading the book Starting Strength by Rippetoe would be my recommendation of where to start.
2) The benefits of endurance training are similarly well-documented (e.g., https://fivethirtyeight.com/features/the-5k-not-the-marathon...). The actual modality doesn't matter, but the only thing I know anything about is running so I'll stick with that. Rowing or swimming or hiking would also be great. A non-trivial goal to try and hit would be a level of fitness that allows you to run a 5k in ~20 minutes or less. If you search r/running, you'll see that this is surprisingly achievable as well. You simply have to work your way up to anywhere from 30-50 miles per week of running at a conversational pace. A good place to start would be Couch to 5K followed by Bridge to 10K. Then follow the 10% rule for weekly increases in mileage. The Running Order of Operations linked in the r/running sidebar has great recommendations. (Other tips would be to make sure you're running slow enough; the conversational pace tip is one metric, but another is to make sure your heart beat stays below 180-[your_age]. Running the first few months with a metronome app going in the background at 180 bpm and trying to sync your steps to it and trying to minimize how loudly your steps are will also minimize the impact forces and help you run more efficiently.)
3) Nutrition is filled with a bunch of contradictory advice, but there are some pieces of advice I like that seem unlikely to change in the future. In terms of what to eat, Michael Pollan's "Eat food, not too much, mostly plants", is a great place to start. Another person I encourage people to look up is Rhonda Patrick. She's a researcher who summarizes a lot of research about nutrition and its interaction with physiology and genetics. If you follow Pollan's advice of avoiding processed foods and eating more plants, you'll be much better off. But if you know the current state of your nutrition (e.g., based on what you're eating, how your weight is changing from week to week, blood panels to check for nutritional deficiencies, etc.), then Patrick's advice to get at least 100% of your RDA of various micronutrients will serve as a great framework for how to modify your diet further. Sites like Cronometer.com or NutritionData can compare your current diet and show you the likely distribution of your nutrient intake based on your diet and allow you to model what the addition or subtraction of various foods would do to that distribution. For example, you might find that you're regularly deficient in choline, and mucking around on Cronometer might show you that the addition of 2-4 eggs to your daily diet would resolve that.(Other really useful resources include Wikipedia and examine.com)
4) The strength and endurance recommendations above are made much simpler if you aren't overweight. But instead of chasing abs (not that there's anything wrong with that), I'd recommend trying to get leaner until you've minimized the amount of visceral body fat you have. Visceral body fat is something that has a lot of evidence suggesting it's connected to several disease states (http://www.health.harvard.edu/staying-healthy/abdominal-fat-...), so minimizing it gives you a non-vain metric and motivation for getting leaner that should increase your health along a variety of objective metrics. Now you can't spot reduce fat, so the only way to reduce visceral body fat is to lose body fat in general (genetics determines at what point in your fat loss journey your body decides to dip into your visceral body fat stores for energy). The sidebar in r/fitness and r/loseit have more information on this improving body composition, but the main points are to maintain a caloric deficit (https://examine.com/nutrition/what-should-i-eat-for-weight-l...) and eat enough protein (aim for 1 gram of protein per pound lean body weight; https://examine.com/nutrition/how-much-protein-do-i-need-eve...).
5) Anyone who's done any time dipping into the research on the diseases of cognitive decline (e.g., Alzheimer's) will know that, in addition to diet and exercise, one of the most important things you can do to lower one's risk is to maintain a life-long habit of learning new things. By that I don't mean trivia or a Wikipedia page per day (though there's nothing wrong with that), but the learning of things that require you to really work for improvements. I'm talking about stuff like music and playing instruments, foreign languages, pure mathematics, chess, go, art, dance, etc. You have a lifetime so you don't have to choose just one, just make sure it requires you to put in the work and struggle a bit for improvement. Coursera's Learning How to Learn course would be an excellent place to start for the "how" of this, and your own interests will probably lead you to the "what". (For languages, I'd recommend the book Fluent Forever.)
The only other major factor that seems to really contribute to long-term health is something that isn't entirely within your control, but you should still put a lot of effort into it: regular interactions with people you love like family and friends. If you don't have those, try and go out of your way to expose yourself to more people so that you can find your people.
Other things in research that have been getting more attention include things like meditation and practicing gratitude, but their benefits aren't as objectively measurable as the above, though they're probably well worth investigating and putting time in to.
Oh, and make sure you prioritize getting sufficient amounts of high quality sleep. HN has had conversations in the past about this.
In general, "use it or lose it" seems to be a universal law when it comes to one's mind and body.
At least as far as the strength goes, maintenance only requires 2 workouts per week of perhaps an hour apiece.
The body was meant to be used. And people assume it's less capable than it is, even in old age, but there are people who only started training late in life that have exceeded my strength recommendations.
As long as your experimental design says you should. You don't have a scientific outcome until the trial is over, so stopping makes no sense on a scientific basis.
Will this initiative double the amount of time that we've got the full capacity of our 20s and 30s? Or will it just allow people a prolonged, half-century tour of the twilight years, from 70 to 120?
Statements above are based mostly on The Brain That Changes Itself by Norman Doidge[1] which I highly reccomend. Plus just listen to some old folks that you can tell are still quick - Warren Buffet 86, Chomsky 88, James Harris Simons 79 and so on.
1. https://www.amazon.com/Brain-That-Changes-Itself-Frontiers/d...
I didn't mean to show by these examples that this is the default, or even that it's common. I don't think it is. But I hope it's getting better, mostly thanks to the technological progress which can be stimulating for those who choose to make use of it.
But if you look at aggregate data on chess players' ratings as they get older, or university professors' publication rates (and citations on the papers they do publish), it's really hard even for strong-willed thinkers to stay on top of their craft in their 60s and beyond.
For every Warren Buffett in business, there are a lot of Sumner Redstones ... holding on to power, but quite erratic as age takes its toll. Getting old is nasty stuff.
Wow 3 of them! And it helps to ignore the (likelihood of) older people who kept using their brains and now have mush upstairs.
Trying to keep a damaged machine running without repairing the damage is expensive and futile. How far does changing the oil in a car or pressing the accelerator harder get you if you never fix anything that goes wrong in the engine? Similar situation.
The future will be radically different because researchers are now resolved to treat aging as a medical condition, to investigate the causes, and to intervene. The debate now is over the best way to go about it, and alas most of the research community remains fixated on the path that will cost a great deal and achieve next to nothing, which is to say efforts to alter the operation of metabolism so as to modestly slow down the aging process. Calorie restriction mimetics, autophagy enhancement, and etc.
If you want better results, you have to look to the rejuvenation research of the sort carried out by the SENS Research Foundation, the Big Pharma groups clearing amyloid, the new senescent cell clearance startups, etc. Slowing aging by altering metabolism is the expensive road to nowhere. Repairing the causes of aging is the more efficient, faster road to rejuvenation of the old and the prevention of aging.
> There currently is an upper limit, and the upper limit is probably around 115, 120. You have a very large number—100 billion people to choose the number of people that have ever lived—and you have only one who has made it through to 122, Jeanne Calment. The second oldest was 119. It does seem there is an upper limit. Some people have shown that in the last hundred years, even though we have progressively increased the average lifespan, the number of people who live above 115 has not increased.
I also couldn't help but think that his remarks about immortality being the naughty "I-word" is a roundabout way of addressing some of the excitement stirred by a certain slightly sensationalistic wizardly chap in the aging field.
[1] https://sciencealert.com/turns-out-crispr-gene-editing-can-c...
One mechanism that springs to mind here is the accumulation of transthyretin amyloid, found in one small study to be the majority cause of death in supercentenarians, but which appears to have only a smaller impact on mortality in younger old age - it is implicated in something like 10% of heart failure cases, for example. Can we argue that advances in medicine and public health over the past century have had little to no impact on the accumulation of misfolded transthyretin deposits in tissues, and thus this mechanism acts as a limit on life span? Or do some of these improvements in fact produce an small, incidental reduction in amyloid burden in later life? The evidence to support any of the possible positions on these questions is presently lacking.
Whatever the state of effective limits on life span today, however, the limits on life span tomorrow are determined by progress towards rejuvenation therapies. There are treatments under development that can clear transthyretin amyloid from tissues, for example, such as the work of Pentraxin Therapeutics, or the catalytic antibody development funded by the SENS Research Foundation.
But there's no evidence that will happen. I can imagine being headed towards 150-year lifespans, there's just no evidence we're on that track right now.
I'm not entirely sure where the interviewer was going with this statement, though.
> There’s a lot of Silicon-Valley buzz about longevity and many startups working to develop immortality pills.
I've yet to hear of a startup working on an "immortality pill."
Also see Peter Thiel's work on blood change.
The next thing is NMN (nicotinamide mononucleotide) but currently it's way too expensive to buy for individuals. There are some Chinese labs synthesizing it for cheap but unless you have access to a lab I wouldn't trust it's what it says it is. Though it's very likely that we will see accessible supplements in the next 3 years.
In fact, NMN was so promising in rats/mice that Keio university in Tokyo just started human trials.
NR (the stuff you can buy already) gets converted to NMN in your body though.
I for now am taking NR (not elysium) daily until some big study tells me not to or until I find a reliable NMN source. What has been discovered so far convinced me to give it a try just for the offchance that it's really doing what people say it does.
We live in exciting times and I am very much looking forward to see what the next years has to offer.
See for example these entities working on means to selectively remove senescent cells, with Unity Biotechnolgy being the one connected to Buck Institute researchers:
http://unitybiotechnology.com/
http://www.siwatherapeutics.com/
The presence of senescent cells have been shown to directly cause failure of regeneration, fibrosis, fibrotic lung diseases, loss of tissue elasticity, blood vessel calcification, faster progression of atherosclerosic lesions, arthritis, chronic inflammation, immune system dysfunction, and retinal degeneration, just to name a few items from papers published in the past two years. More links are being established in research papers with each passing year. The removal of these cells has been shown in mouse studies to quickly reverse the age-related progression of many of these items.
Oisin will follow later this year or in 2018, if they keep to the standard way in which things work in biotech companies following an A round.
I have no idea what SIWA will be doing; they have been around on life support for a while, and now resurrected by the newfound money coming into the field. I'd imagine that their next step would be some form of trial, though it is unclear as to where exactly they are in their animal study schedule.
There are people self-experimenting with senolytic drug candidates now, though not in any way that will provide useful data. If you draw the line at candidates for which there is in vivo evidence in mammals, you're left with just the chemotherapeutics and foxo4-dri. (A pity that fisetin has no in vivo evidence yet...). The chemotherapeutics are worth skipping over, since they are ugly chemicals and really only a starting point for the development of analogs without the horrible side-effects, and foxo4-dri hasn't been tested in any formal way in humans yet.
At the pace at which new drug candidates are emerging and being tested, a couple of years from now would be a good time to be self-experimenting.
I remember reading that if you got enough ST you essentially get the same cardiovascular benefits of cardio but I can't find the source.
• "Selfish" vanity, fear, etc. including accumulation of wealth, power, etc.
• A desire to remain with loved ones, including pets, and to keep loved ones around, including celebrities.
• A safeguard against unexpected "unfair" death, e.g. getting murdered, assassinated or dying in a freak accident, or terrorist attack etc.
• Carrying out long-term plans that take longer than human lifespans.
• Participating in projects that take longer than human lifespans and may not be easily restocked with new humans: e.g. traveling interstellar distances in confined spaceships.
- The aforementioned "plans" and "projects" may simply mean the preservation and protection of certain things, ideas, cultures, rituals and records that cannot be automated or archived.
• A desire to explore more of the universe than can be done in a mortal lifespan.
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And the following possible ways where one or more of the above goals may be achieved:
• Cloning. You basically get a new person that may or may not be "as good" as the loved person/pet/celebrity you wanted to preserve.
• Mind/Memory archival/copying.
• Repairing/Rejuvenating one body for as long as you can.
• Separating the brain from the body and having it remotely control multiple "backup" bodies.
• Reincarnation. This of course assumes a "higher" plane of existence where our "true selves" actually live; e.g. this reality being a VR MMO that you can only play for as long as you paid for.
"First, if you hear the word immortality, just run"
No one is talking about immortality here.
After all, it's the culmination of all medical research, whether intended or not. What happens when science "solves" aging and disease? What will we call the state where people just don't die unless killed?
I don't think this is an accurate description of cloning.