News Spotlight

2023-11-07 Spotlight: ‘Aging is a disease’

DignityMA editor’s note: This is a provocative article about aging and longevity. The Post has received over 800 comments online. We welcome comments from Dignity Digest readers which can be submitted via Comments may be posted in future issues of The Digest.

‘Aging is a disease’: Inside the drive to postpone death indefinitely, The Washington Post (free access), November 6, 2023, By Karen Heller

Longevity has become an industry, a subject of bestsellers, podcasts, and newsletters. But is a life meted out in metrics, often for a price, worth it?

It’s 11 a.m., which means tech tycoon Bryan Johnson has already consumed his three daily meals, including dinner, and will fast until 6 a.m. tomorrow. By day’s end, he will have ingested more than 100 pills, mostly supplements. He will stop drinking water to ensure a solid night of slumber, which averages 8 hours 39 minutes. How does he know this? Johnson tracks everything.

Johnson, who lives in Los Angeles, is the founder of Blueprint, an “experiment to explore the future of being human.” He is also its principal product, spending $2 million annually to slow the process of aging in his body, continually monitoring a “few hundred” biomarkers and, for his vegan diet, eating 70 pounds of vegetables every month. Johnson maintains an exacting daily “anti-aging” exercise regimen while investigating more ways to improve his body. “I’ve been doing a lot of male reproductive organ rejuvenation,” he shared. “I’m getting my penis injected so that they can measure arterial flow.”

His dizzying daily protocol shames boot camp. With 8 percent body fat, Johnson has a chronological age of 46. His biological age, an entirely different matter in today’s quest for longevity, contains multitudes: “My left ear is 64, my heart is 37, my diaphragm is 18, and my cardiovascular capacity is in the top 1.5 percent of 18-year-olds.” Johnson’s axiom: “Don’t die. This is the first time in the history of the human race where we can say with a straight face, ‘Don’t die.’” Unlike many other longevity enthusiasts, Johnson does not promote supplements or a paid subscription program, though he markets his own olive oil (two 25-ounce bottles for $60), which constitutes 15 percent of his daily caloric intake.

The United States is having a senior moment. We’re flush with older adults. More than 10,000 people turn 65 every day.

“Aging is a disease, one that is treatable,” said nutritionist and longevity wellness authority Serena Poon, 47, on the phone from the United Arab Emirates. Poon and business partner David Sinclair, a Harvard geneticist and co-author of the best-selling “Lifespan: Why We Age—and Why We Don’t Have To,” were on a global tour, enlightening audiences and potential investors, spreading the word of a longer, healthier life.

Last year, Poon and Sinclair signed with entertainment goliath WME. They’ve launched a wellness company and a skin-care line ($75 eye cream, $125 for “age-defying” serum), and they co-host longevity programming on YouTube and Instagram while exploring multiple media opportunities. On her website, Poon promotes supplements ($32.95 to $91.95) and ritual cleansing aids, including the two-ounce, $58 Aura Cleansing Mist with Bulgarian Rose Water, endorsed by actress Kerry Washington.

As recently as last year, Poon wished to live to 120, said to be the length of Moses’s life. Now, she’s reluctant to name a number but is ebullient about the future of our later years. In his book, Sinclair, 54, writes that “aging is going to be remarkably easy to tackle. Easier than cancer.” Also, that “we can treat it in our lifetimes.”

We live in the gold-and-gene rush of Longevity Inc., an industry marketing the decathlon of wellness that Bank of America labeled “ammortality” and projected will reach $600 billion by 2025. Instead of a fountain of youth, we have a Mt. Olympus of supplements. Metformin, resveratrol, and rapamycin are promoted as transformational wonders in slowing aging. In the pursuit of a longer and healthier life, nutrition, exercise, sleep, a swarm of biomarkers, emotional well-being, and social engagement — basically everything — are areas for improvement and constant monitoring, a life meted out in metrics, often for a price.

In recent years, longevity has become many things. It’s a vast, accelerated area of research for scientists and tech moguls, the holy grail of biohacking and potential El Dorado of biotech wealth. An area of infotainment: a pole vault onto the bestseller list, a buzzword of podcasts hosted by Sinclair, Peter Attia and Andrew Huberman (whose science-based program often deals with the subject) — scientists and doctors with exquisite academic pedigrees who sometimes interview each other. A lodestar for diets, do-this-don’t-do-that newsletters and lifestyle coaches. A branding opportunity for emollients, olive oil, trademarked wellness programs and more supplements.

In the longevity world, time is a fungible concept. Aging is something to be battled and slain. A burgeoning apothecary of serums and humectants is marketed as “anti-aging,” whatever that is. Longevity coaches promote programs capable of “reversing aging.”

Which, when you pause to consider, is a chronological impossibility.
Longevity inspires international travel to Blue Zones, the five identified global regions where residents live longer lives that have fueled a product line, a shelf of books by Dan Buettner and the recent Netflix docuseries “Live to 100: Secrets of the Blue Zones.” There are longevity coaches like Nicole Marcione, 48, who writes a newsletter, hosts a podcast, and conducts private coaching of her SexySmart Aging: Blending the Science of Longevity with the Art of Sensual Living course, $5,000 for 12 weeks. Marcione said “the dream is to be very healthy and independent until three days before you drop dead at 100 years old.”

Many people share that dream. But living to 100, even 120, may not equal a better life, especially if a fitter body isn’t accompanied by agency, hope or sharp cognition. There are ethical concerns as to whether it’s responsible to desire a century of life in a time of climate crisis, an expanding global population and an epidemic of loneliness, particularly if our partners and peers may not be there to share it. To some critics, the financial and time investments in a longer life — or, more precisely, the hope of a longer life — suggest an extended exercise in narcissism, so many more years of Me Time.

A burgeoning cohort of old people has attendant societal and economic costs to younger generations. An unwillingness to move on, to yield the floor, potentially prevents fresh talent and opportunity from blossoming. As an example, look no future than our current Congress, among the oldest in history with mounting public concerns about the health of Senate Minority Leader Mitch McConnell (R-Ky.), 81, and that of the late Sen. Dianne Feinstein (D-Calif.), who died while in office at age 90. The age of President Biden, 80, is a major issue in polls among voters; less so for Donald Trump, 77.

“The reality is that you’re adding time at the end of your life. You’re not getting two decades of being in your 20s,” said Ezekiel J. Emanuel, an oncologist and the vice provost for global initiatives at the University of Pennsylvania. “We’re really bad judges of our abilities and our own limitations.”

Emanuel wrote the 2014 Atlantic essay “Why I Hope to Die at 75,” which argues that our prime years of productivity are well behind us by the time we’re senior citizens and that “this manic desperation to endlessly extend life is misguided and potentially destructive.” The imperative to live a long life is, “to some degree, we have this built into our system, survival of the fittest, survive to reproduce,” said Emanuel, one of the architects of the Affordable Care Act. “These people tend to be a little egotistical, that the world is not going to be able to live without them. There’s this element that they’re very special people who ought to live a long time.”

Now 66, Emanuel still champions these sentiments. “This obsession with physical activity now for maybe an increased chance later on that you’re going to be more physically fit is questionable. There are no guarantees,” he said. “You could come down with a cancer, Parkinson’s disease or multiple sclerosis or Lord knows what.”

Longevity has become a buzzword and industry due in part to tremendous advances and investment in research. The pursuit of a longer life is a constant in history, faith, and myth. The promotion of anti-aging elixirs is “the world’s second oldest profession,” said S. Jay Olshansky, 69, an authority on aging at the University of Illinois at Chicago. The difference, he said, is that, “finally, the science has caught up with the idea.”

Our quest for a longer, healthier life is rooted in several factors, including fear. Never underestimate the human condition — that we alone among animals are aware of our inevitable demise — as a formidable motivator and economic engine.

Old age and infirmity aren’t respected in much of our culture. We’re a young nation that seizes on the new. Throughout history, old age was venerated, synonymous with wisdom, partly because, for millennia, few humans made it to 50. But 50 is child’s play in an age of supercentenarians, people who live to 110.

We’re less comfortable with the inevitability of our final days. For much of history, death was a persistent, relentless part of daily life: for children, for women in childbirth, for young men in battle. Because of wondrous advances in medicine, death has become a rarity in many Americans’ daily lives. In an increasingly secular nation, fewer people find comfort in the promise of an afterlife.

“I think that the wealthier we become and the more unhappy we are, the more we have to search for meaning in this life,” said Attia, 50, a physician and the co-author of the chart-topping “Outlive: The Science & Art of Longevity.” Attia runs a science of longevity subscription program ($149 a year or $19 a month) while operating a private practice with an extensive wait list.

U.S. longevity rates have declined in recent years compared with other high-income nations, not only because of the pandemic, but also due to poor diet, lack of exercise, drug and alcohol abuse, inadequate and unequal health care, suicide and homicide. There’s a fervent desire to reverse decades of bad habits. “People are gaining back the years that they lost through unhealthy lifestyles,” Olshansky said. “We’ve been really good at shortening our lives. We’re masters at it.”

The pandemic and more than 1 million U.S. deaths contributed to an increased interest in longevity. “People’s perspectives on their own health and mortality shifted with covid, a sense that we really had to look at how we’re living,” Poon said.

No one can put a number on how long anyone will live, but there is a growing effort to reduce the number of ailing old people who tax families and health care, to invest now in a healthier outcome later, a longevity 401(k). This raises the issue of who will look after the super old if the best-supplemented and diet-restricted plans don’t result in glorious health. The United States has a national shortage of caregivers, who are routinely underpaid and undervalued.

There’s a desire to reverse pervasive ageism, to reimagine and redefine what people’s later years might look like. “Younger generations will view us differently. They won’t see us as ‘old,’” Olshansky said. “I’m far more productive now than many kids.”

Programs for achieving a healthier, longer life can differ. Attia is an evangelist for biomarker monitoring and exercising, and he’s less concerned with diet. He promotes building upper-body mass and achieving VO2 max, the maximum amount of oxygen the body uses during exercise. Attia works out around 14 hours a week, splitting his regimen equally between conditioning the upper and lower body, and lifting the equivalent of his weight (185 pounds) in 30-second intervals for 20 minutes. He’s a fan of “rucking,” moving with added weight to your back. (He runs for three miles around his Austin neighborhood wearing 50 pounds.) Attia tells his clients that “it’s not the money that’s going to cost you. It’s the time because you can’t buy health.”

Valter Longo, director of the University of Southern California’s Longevity Institute and author of the best-selling “Longevity Diet: Slow Aging, Fight Disease, Optimize Weight,” encourages fasting, restricting calories and skipping one daily meal, though never breakfast. Huberman and Sinclair extol the benefits of cold-water immersion (shower, bath, lake) to improve body and brain health. Many longevity authorities eschew alcohol and view sugar as abominable, dairy as problematic and bread as verboten. Everyone advocates better sleep. Attia suggests sleeping in a room cooled to around 65 degrees.

A highly regimented life can make pleasure seem like an afterthought — unless your idea of pleasure is a highly regimented life and rigorous exercise. Routine fasts and a strict diet can be buzz kills to someone’s social life.

The key to being healthier needn’t be complicated or expensive, said Olshansky, who has studied longevity for about four decades. It comes down to five words: “Exercise more and eat less.” Then again, he noted, “you could be coached on all of that and still die at the same age.”

In 2000, Olshansky and biologist Steven N. Austad made a bet that came to be known as the Great Longevity Wager. Austad, 77, an authority on the biology of aging at the University of Alabama at Birmingham, believes that someone born in 2001 will live to 150 and be of sound mind. Olshansky thinks not — though perhaps someone will make it to 130, surpassing Jeanne Calment, who, in 1997, died at 122.

Austad is unsurprised that some people are trying to classify aging as a disease. “If you can convince the [Food and Drug Administration] that it’s a disease, and you can show that your products delay aspects of this disease, then insurance would pay for it,” he said.

“There’s sort of this desperate hope out there that we’re all going to live hundreds of years. My concern is that the field is going to overpromise. They’re going to exaggerate,” Austad said. “We have dozens of ways to make mice live longer. We haven’t proven that in humans.” Mice have very short lives, around two years, so any improvement in the lab is noteworthy, Austad said, while “humans already live longer lives than other terrestrial mammals.”

Compared with our ancestors and other species, many of us will enjoy a wealth of years. Is it greedy to strive for more?

“A 150-year life is still a mortal life,” said Ryan McAnnally-Linz, 39, who co-wrote the best-selling “Life Worth Living: A Guide to What Matters Most,” named for the popular Yale course that he teaches with fellow divinity professors Miroslav Volf and Matthew Croasmun. “The pursuit of longevity can go awry if it is, in effect, a denial, an unwillingness to face the fact of mortality, to wrestle with its implications of how we can and ought to live.”

McAnnally-Linz, associate director of the Yale Center for Faith & Culture, views the aspiration for a longer, healthier life as a hope of reframing worth in later years. “We’re a very productivity-oriented culture with a sense that a life’s value is in what it makes, what it does in the world,” he said. “Older people tend to be viewed as ‘less productive.’ It can be very hard to see what the purpose of a life in its twilight years is.”

Poor health is frequently linked to income inequality in the United States. People with two jobs, patchwork child care and dependent older relatives may not have the means, the time or the desire for a longevity coach or a vigorous exercise regimen. The wellness industry tends to cater to clients who can pay strangers to help them feel better about themselves.

“Any time you see lots of resources invested in individualized products, it does raise alarm bells for me about the social implications and the social inequities,” McAnnally-Linz said. “All things being equal, it is good for people to live longer, to be healthier for longer. If that becomes our highest goal, then I think we might be selling ourselves short. We would extend our lives without deepening it.”

The pursuit of longevity risks becoming a full-time occupation, worrying about the future instead of living in the now. “I don’t spend all my time thinking about how long I will live, because I think you don’t live doing that,” Austad said.

Emanuel won’t opt for a heart valve, chemotherapy, or dialysis to extend his life. He’s sticking to a good 75 years.

“All of us work better with a deadline. It has a way of eliminating or reducing our human proclivity to procrastination,” he said on the phone from Norway, where he had recently biked “a century”: 100 miles.

“If you somehow end up living to 85, fully physically functioning and mentally functioning, that’s great, too,” Emanuel said. “But that’s not the goal. The goal isn’t to live a long time. The goal is to live a meaningful life.”