People have long said that aging and taxes are the only two certainties in life. However, while proper tax planning and avoidance strategies can mitigate the inevitability of taxes, science is making surprisingly rapid progress in addressing the second certainty: aging.
In recent years, gerontologists have begun to challenge the conventional wisdom about the inevitability of aging. We are now closer than ever to the possibility of separating chronological age from physical ability, potentially halting what is currently seen as an inevitable decline. Aging is not simply the result of the passage of time; it is caused by the accumulation of cellular and molecular damage, which builds up until it triggers serious and life-threatening health issues. The exact age when these issues arise varies from person to person, but they are, at present, unavoidable. We refer to these age-related conditions as comorbidities, which are defined as the presence of one or more diseases or conditions simultaneously affecting a person.
Comorbidities are usually chronic, long-term conditions that can interact with each other. For example, diabetes can lead to complications with the heart, kidneys, and vision if left untreated, and can also damage nerves, causing diabetic peripheral neuropathy. Where the future may differ from today is in how we address these conditions. Currently, we treat comorbidities with medications and other interventions after they have become difficult to manage. In contrast, anti-aging medicine aims to intervene earlier, before these conditions reach a challenging stage. The primary shortcoming of current medical practice is that we intervene too late, when the conditions have already progressed significantly.
Drugs like senolytics, which target the removal of damaged cells, offer potential to delay the onset of comorbidities and extend healthspan. While this is only the beginning of a complex journey toward making aging a manageable condition, the early signs of success are promising. These interventions could buy valuable time for people who are currently in middle age or early old age, giving them the opportunity to benefit from more advanced therapies in the future.
Some of the key conditions that are classified as comorbidities include:
In my opinion, future generations will look back and mark June 25, 2000, as the turning point in the war on aging. On that day, at the Marriott Hotel in Manhattan Beach, California, Dr. Aubrey de Grey realized that directly curing aging might be extraordinarily difficult, but an alternative path to significant life extension was possible. This approach, known as the "engineering approach," focuses on repairing or mitigating the damage that aging causes at a cellular and molecular level. Many, including myself, believe that this approach holds the most promise for combating aging over the next 10 to 20 years, potentially leading to comprehensive rejuvenative interventions.
Achieving the goal of bringing aging under decisive medical control will require an unprecedented level of interdisciplinary collaboration and long-term commitment. The recent success of pharmaceutical companies working together to develop COVID-19 vaccines may serve as a blueprint for the kind of cooperation needed in the fight against aging, and could be a game changer in this effort.
The key to understanding the engineering approach to aging is recognizing that a true cure for aging is unlikely in the near future. While common sense dictates that the ideal outcome would be to actually cure aging, we must realistically acknowledge that this goal remains out of reach due to gaps in our knowledge, particularly in understanding metabolic processes. Instead, we should focus on building upon what we currently know. Our greatest strength lies in identifying why the body deteriorates with age, though we still lack the ability to intervene effectively in the metabolic mechanisms driving this decline.
A question I am often asked is, "How long before we can cure aging?" To answer this, it’s important to keep in mind that we are already extending life expectancy by two months every year (or approximately five hours per day), a trend that has been consistent for the past 30 years that is showing some signs at the moment that there will be an imminent acceleration. This is due to rapid medical progress in the treatment of some chronic diseases which are becoming more manageable with a large number of breakthroughs in various stages of clinical trials. When you also consider that many experts, myself included, believe there is a better than 50% chance of managing aging within the next 10 to 20 years, the prospect becomes quite intriguing.
As for the timeline for an actual cure, I would estimate that we are at least 100 years away from achieving it. However, an alternative approach exists: instead of focusing solely on curing aging, we should aim to manage it by repairing the accumulated damage that causes deterioration over time. This should be our primary goal because, while we understand the types of damage that need to be addressed and how they accumulate, we know far less about how to slow aging or modify metabolic processes. Therefore, we must work from our current point of knowledge, where we can already see a potential path forward with a high probability of leading us to the desired outcome.
This is the essence of Aubrey de Grey’s theory, and other similar approaches and collectively these offer the greatest promise for success in the first half of this century, because we are already making significant progress in the critical areas needed to turn this vision into reality.
I am confident that taking this route potentially eliminates the need to find a cure for aging itself. By doing so, we bypass the challenges created by our limited knowledge of metabolism and the aging process. What Aubrey de Grey refers to as "engineered negligible senescence" (SENS) could potentially extend life indefinitely, even as the underlying aging process continues. However, it's important to recognize that while the theory of SENS, developed by de Grey over 20 years ago, appears increasingly achievable, it is not the only possible approach. There may well be a variety of intervention bundles similar to SENS that could lead to similar results many of which are already in trials.
The key to unravelling age related decline lies in our understanding of the genetic and biochemical processes that lead to metabolic damage. This understanding allows us to envision what is known as the engineering approach. Aubrey often asks, "How long will a house last?" The answer, of course, is that if you maintain it properly, it can last indefinitely. Similarly, Aubrey suggests that if we find a way to repair the damage accumulated during the first 50 or 60 years of life, we can extend healthy lifespan without needing to fully understand the aging process itself. We only need to know enough to repair the damage and potentially extend healthy life by, say, 20 or 30 years and repeat the process at regular intervals.
Many people assume that slowing the aging process would be easier than reversing it. This assumption seems logical at first glance, and indeed, the initial therapies are likely to focus on slowing the aging process and increasing health span. Current research indicates that achieving an additional 7 or 8 years of healthy life is within reach, with promising developments in areas such as Senolytic drugs and NAD+ precursors like NMN and NR see this link.
Other areas are also worth exploring such as a number of pharmaceuticals for example Metformin shows promise as an agent that could influence the aging process, largely due to its effects on metabolic pathways, inflammation, and cellular health. However, while the research is compelling, especially in animal models, more data from human clinical trials, like the TAME trial, is needed before it can be definitively recommended as an anti-aging therapy
It’s actually quite straightforward to follow. Here’s how it works: Let’s assume you are 60 years old at the time of the first intervention or treatment. This early, and somewhat imperfect, therapy repairs about 25 years’ worth of accumulated damage. Now, fast-forward 10 years—chronologically, you would be 70 years old, but biologically only 45.
Now, here’s the key to the whole theory: Twenty years after the first treatment, when you are 80 chronologically but biologically 55, you and your doctor may notice that the damage left unrepaired from the first treatment, combined with new damage accumulated over the past two decades, is once again posing a health risk. This is the point where you would need a second intervention or treatment.
The impact of this second intervention is crucial. By the time 20 years have passed, medical advancements will have significantly progressed. While the first treatment bought you an extra 20 to 30 years by repairing a large portion of the damage accumulated over your 60 years of life, it did not fix everything.
However, with the second treatment, not only will the latest therapies be able to repair all the damage that was addressed in the first intervention, they will also be able to repair some of the damage that could not be fixed 20 years earlier. In essence, though you are now 80 and receiving the second intervention, this improved set of therapies will repair both the 20 years of new damage and some of the remaining damage from the first treatment.
This means that even though you’ve aged 20 more years chronologically, you will be biologically younger after the second intervention than you were after the first. This is the core of Aubrey de Grey’s theory: it’s not a cure for aging, but it doesn’t need to be. The goal is to "buy time" with regular interventions every 10 to 20 years, with increasingly effective treatments, potentially allowing life to be extended indefinitely.
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