Longevity and health optimisation
A Functional Medicine approach to feeling better, for longer
Longevity is such a buzz word these days. Longevity supplements, clinics and social media content is popping up everywhere. But what is it really all about, and how can we utilise some of the wonderful longevity research out there to help us live a healthier and longer life?
With it being such a hype, there obviously comes the usual attention seeking non-sense with it, and a lot of confusion of what is legit and how these things actually work.
Rest assured, as always I have done my due diligence and dug right into the research to make sense of it all for you. I have also been lecturing and seeing clients on the topic of health optimisation and longevity from a Functional Medicine perspective since 2017, though it really is incredible what an uptick in attention it has gained recently — which is wonderful! — As the research shows that we really are in control (to a large extent) over our health trajectory, empowering us to take our health into our own hands.
The difference between life span and health span
While us in the Western world have managed to increase our life span over the past century, with the average life expectancy around 80 years, this sadly has not come with good health in those lengthened years for many.
In fact, many now think of it as ‘normal’ to have numerous issues and to be on several medications, think blood pressure meds, statins for cholesterol, anti-depressants, antacids, and the list goes on.
Without being doom and gloom, 1 in 2 will develop cancer (R), 1 in every 6 Alzheimer’s beyond the age of 80 (R), and the list goes on. Other ‘common’ conditions often severely impact quality of life include arthritis, aches and pains, autoimmune disease, hormone issues like PCOS, endometriosis, perimenopause issues, fatigue, frailty and more.
And while much research is still being deployed to find separate drugs for each illness, and these can often be wonderful life savers, many come with side-effects, that then contribute to the development of other issues down the line. (Meh!))
Geroscience — The science of longevity and health span optimisation
Introduce geroscience — or the science of longevity and health span optimisation.
The value of the Geroscience approach lies in the well-established fact that older adults rarely suffer from a single disease. Rather, older adults often experience multi-morbidity. Since aging biology is the main driver of disease susceptibility, reduction in the rate of aging may delay the onset of multiple diseases at once (R).
Geroscience focuses on research into the basic biological mechanisms driving aging, and how these same mechanisms contribute to pretty much most health problems we encounter and dread, such as diabetes, cancers, autoimmune disease, cardiovascular disease, arthritis, Alzheimer’s, aging and more. The idea is that if we address these underlying ‘hallmarks’, we won’t only prevent, slow the onset, or reduce symptoms of one condition, but improve the trajectory and quality of life on many levels and for many conditions (R).
The Hallmarks of Aging
2013 marked a big breakthrough in the science of health optimisation, with the publishing of a paper on the ‘9 Hallmarks of Aging’ (R) , introducing the notion that it is these pathways, and the interconnectedness thereof, that underlie most illness and aging, rather than one pathway and mutation per disease. Much research has since been dedicated to this topic, and recently an updated version with and added 3 hallmarks was published (R, 2023).
These updated 12 hallmarks of aging are:
- Genomic instability
2. Telomere attrition
3. Epigenetic alterations
4. Loss of proteostasis
5. Disabled macroautophagy
6. Deregulated nutrient-sensing
7. Mitochondrial dysfunction
8. Cellular senescence
9. Stem cell exhaustion
10. Altered intercellular communication
11. Chronic inflammation
12. Dysbiosis
Still with me? I know, these words are a handful! Without a major in biology or medical science, chances are they don’t make any sense to you. But bare with me, as I break this down into what that means for the non-sciency person, and how that can empower you to take control of your health and become proactive, rather than sit and wait until illness hits.
What these fancy words basically mean, is that there are certain mechanisms affecting the entirety of our body’s biology. They slowly start to create sludge inside of and surrounding our cells, making our body work less efficiently, increasing the risk of faulty and mutated cells, with subsequent increased risk of all cause morbidity and mortality (Number 1: Genomic instability, Number 2: telomere attrition, Number 4: Epigenetic alterations, Number 4: Loss of proteostasis (R)).
Our body’s energy production engines (mitochondria) start churning out more smoke and exhaust fumes during energy production, damaging cells (Number 7: Mitochondrial dysfunction (R)). This is coupled with a cleaning team that becomes increasingly lazy, allowing this sludge and sick cells to stick around, where they should have been cleaned up (Number 5: Disabled macroautophagy (R)). Some of these stubborn cells have been likened to ‘zombie cells’ that should really die, but refuse to, causing havoc everywhere around them (Number 8: Cellular senescence (R))!
Some of the many ‘age-related’ conditions resulting from the above ‘sludge’ and hallmarks of aging being expressed excessively, include:
- Neurodegeneration such as Alzheimer’s, Parkinson’s Disease
- Diabetes
- Cardiovascular disease, including atherosclerosis, strokes, heart attacks, blood pressure
- Arthritis and degenerative disc disease
But also conditions messing with quality of life much earlier on, such as:
- Cancers
- Autoimmune conditions such as Hashimoto’s, Crohn’s, Multiple Sclerosis, etc
- Hormonal issues such as endometriosis, PCOS, infertility, fibroids and cysts, perimenopause trouble
- Fatigue
- And more.
This all still sounds doom and gloom to you? Well, the wonderful part is that we can do something about it!
We can in fact address these factors, make our cellular machinery and inner biology run smoothly again, get the cleaning service to do its job more thoroughly. This then not only impacts, prevents, reverses or at least slows the onset or severity of ONE disease, but pretty much all of them!
While many conditions and symptoms might seeminly be unrelated, they are interconnected by this underlying cogwheel machinery, that if this runs smoothly, halleluja, we feel great on ALL LEVELS, and if they start becoming rusty and not run so smoothly, we might start intially with fatigue, painful perios, a layer of belly fat, anxiety or such, whose underlying trigger, if not addressed and persisting for decades, down the line contribute to autoimmune disease, cancers, etc etc.
A Functional Medicine approach to longevity and the hallmarks of aging
Now even within the longevity research community, there are different camps on how to approach these underlying trigger, ie hallmarks. Many researchers are prioritising finding drugs to stop these pathways, one at a time. Think metformin, or other ‘longevity’ drugs, that have gained tremendous interest also from the public.
And while these can work wonders to act as circuit brakers if a person’s biology is really ‘messed up’, they most often do come with potential side effects. For example metformin, while hailed as the magic longevity drug, for its insulin sensitising (and other) properties, some research suggests it might not be the be all, end all — and in fact might dampen VO2 max (a marker for cardiovascular fitness) in already fit individuals and the results one gets from endurance exercise. Aspirin, again often used to lower inflammation (one of the hallmarks of aging), can cause issues with bleeding and gut health.
Functional Medicine takes a slighlty different approach, and rather than adding in drugs that might cause other issues in the long run, it looks at the underlying trigger for these ‘faulty mechanisms’. It aims at restoring the body’s natural function by removing what is causing our biology not to work as it should.
Some of the most common underlying trigger for our biology to stop doing their job properly, often include:
- Chronic infections (viral, fungal, mold, bacterial, parasites) both in the gut and systemically that trigger inflammation (Number 11: Chronic inflammation)
- Pollutants like heavy metals and plastics that cause free radical damage
- Over-eating which doesn’t give the body a chance to ‘clean up’ after itself. We have this wonderful process of autophagy (=’self-eating’) which can gobble up and remove mutated, sick and old cells and make space for new and healthy ones. However, we need to be in a fasted state to do this properly. Much like it is very hard to tidy a home when there are people running around. It’s best to get everyone out of the house, and then do a proper deep clean. Some of you might have heard of factors like sirtuins, AMPK, NAD+. These all get upregulated by fasting and caloric restriction, increasing both health and life span (Number 6: Deregulated nutrient-sensing (R)).
- Under-eating nutrients. While overeating is a big factor in reducing how our body works, not getting enough of all the nutrients we need to function properly is too. This includes building blocks like proteins, vitamins and minerals needed for cell processes, and omega 3s that help quench inflammation. Many people are overfed and obese, yet starving for the right nutrients.
- An imbalanced gut microbiome, with either chronic overgrowth of ‘bad’ bacteria/ funghi, parasites, or not enough of the good and healthy bacteria to keep the digestive tract healthy, leading to systemic (ie whole body) inflammation (Number 11: Chronic inflammation, Number 12: Dysbiosis (R)).
- Being in fight-or-flight mode too often (ie stressed out). Short term stress is healthy and can make us stronger. For example, exercise, saunas and ice baths are short term stressors. However, we then need enough rest in between ‘stress sessions’ to reap the benefits. In exercise physiology we call this supercompensation, where we initially dip after a workout, and need to wait for enough recovery to occur until the next training stimulus, to get stronger, and not weaker in the long run. A similar thing applies to other stressors, including also emotional stress. When we are stressed, our body switches on the ‘fight-or-flight’ system, which directs blood flow towards the organs needed to run away from a perceived tiger — great for short term survival! However, this comes at the cost of our overall biology, as it shunts blood away from most of our other organs, such as the digestive tract, reproductive organs, and any type of healing and restoration. We cannot heal and repair in fight-or-flight mode. This can only be done when we are in a relaxed (parasympathetic) mode. Even our thoughts can contribute to whether we are in fight-or-flight, or healing mode. There is research coming out on how people in a deep meditative state, or that visualise health, actually secrete healing and restorative molecules. You might have heard of Dr. Joe Dispenza and his ‘miraculous’ healing results of his meditative/ visualising participants. He has partnered up with univerrsity reserachers out in California to measure biomarkers in the blood. More on that fascinating topic in a future post (Number 10: Altered intercellular communication (R)).
- Hormonal and neurotransmitter imbalances, which mess with cellular communication (Number 10: Altered intercellular communication (R)), contributing to symptoms like painful periods, infertility, perimenopause chaos, mood swings and more.
- A dysregulated circadian rhythm, with not enough sleep or not enough sunlight to trigger certain clocks we have inside of our body, needed for the smooth running and maintenance of bodily functions.
Addressing one fancy enzyme and pathway and developing an expensive drug often sounds ‘fancier’ than looking at the bigger picture and addressing the ‘basics’ at the root
Are we sleeping enough? Living a purposeful life, with enough time spent in the parasympathetic restorative mode, or are we priding ourselves of being extremely busy and always in fight or flight? Do we eat nutritious foods with adequate breaks between meals, or do we overload our body with junk food and excessive calories and snacking? Do we slather on synthetic creams and love our daily dose of microplastics from take away meals and coffees, or go the extra mile to get natural, toxinfree products and a stainless steel or glass mug? Do we feed our gut microbiome to be strong and healty, or overeat sugars that feed pathogenic yeast overgrowths?
Within a Functional Medicine approach to longevity, we look at and work on those underlying factors. Most of the longevity strategies are the same for all, but there are some individual variations and special emphasis.
For one, we all have different genetic predispositions, that make one person get away with certain things while the other doesn’t, or one pees out more zinc when stressed than someone else, needing more zinc in their life, etc. We can test these with DNA health testing.
On the other hand, by the time you read this, you will have likely already spent decades on this planet, with a good chance that certain things might have accumulated inside.
Within Functional Medicine we like to TEST, rather than GUESS, what is going on, so we can come up with a personalised and targeted strategy for YOU. For example, most of my patients have a fungal overgrowth issue called candida, that requires a certain temporary strategy to get rid of, while others don’t have that issue.
Same applies to heavy metal load, mold toxicity and more.
Another strategy is to test ‘predictive biomarkers’, that assess markers linked to overall health or all cause mortality and morbidity. These include markers like inflammation, blood sugar balance, nutrient levels and more. And while these might often be in the ‘ok’ ranges, we take it one step further, and assess whether they are in ‘optimal ranges’, with the goal to keep everything running as smoothly as possible.
Often these markers, while in ‘normal’ but suboptimal ranges, already put strain on the body that we aren’t (yet) aware of, but that might slowly degrade our biology, and over decades, contribute to the development of all kind of health problems.
One example being vitamin D. Normal levels can range anywhere from 20 -200 nmol/l, depending on the lab, but research shows that to optimally prevent cancers, autoimmune disease and more, we want those levels to be around 100–150 nmol/l!
Our goal is to optimise long before there already is an issue, as usually the fact that an overt illness is presenting itself, means that the ‘cogwheels’ of our body’s machinery are that ‘rusty’ that it has come to a halt, and getting it all to work smoothly again can take a lot of effort, yet often, if the person puts in the hard work, can slow the progression, or in an ideal scenario, even reverse this.
I will go into more detail of the different strategies we can implement to improve longevity and which predictive biomarkers to run to be able to make proactive choices, tailored to one’s unique biology. We all do have genetic predispositions that can make us more prone towards running into issues with one or several of these underlying trigger quicker than perhaps your friend or neighbour.
However, you might have heard the saying, genetics loadd the gun, our environment (epigenetics) pull the trigger. More on that some other time too :).
With that said, I hope you found this to be interesting and empowering!
Speak soon, in health,
Mirthe
