Turning fifty while writing a book about aging certainly adds a personal touch to the subject. And perhaps that’s why Dr. Michael Greger’s "How Not to Age" is such a hit. Tackling the complex world of longevity, the book is one insightful read!
Dr. Greger spent three years sifting through over 20,000 scientific papers to separate fact from fiction. The result? A book packed with more than 13,000 citations. The goal? To understand aging and show how we might extend not just our lifespans, but our "healthspans" - the years we live disease-free. After all, what's the point of living to 100 if you're sick and frail for the last 20 years?
So, if you've ever wondered why we age, if it's possible to slow it down, or just want a dive into the cutting-edge research, "How Not to Age" might be your thing.
The Hallmarks of Aging
Aging! This weird, inevitable phenomenon has fascinated scientists for decades. One of the most intriguing aspects of aging is how much control we might have over it. Research suggests that only about 15 to 30 percent of our lifespan is determined by our genes. Know what that means? That our lifestyle choices play a significant role in how we age. Before we get to that however, let’s understand aging first.A landmark paper, “The Hallmarks of Aging” cited over 7,000 times in scientific literature, identified nine hallmarks of aging. Let’s go through the 4 most important ones. First up is autophagy. Derived from Greek, it literally means "self-eating." See, when food is scarce, our body becomes a recycler, breaking down cellular components we don't need and turning them into fuel or new building materials. Sort of tidying up and only keeping what's still functional. This process is so crucial that it's been conserved for over a billion years of evolution. In fact, the scientists who unraveled its secrets were awarded a Nobel Prize in 2016.Now, this is where it gets a bit messed up. In our modern world of abundance, autophagy doesn't kick in as often as it should. We're constantly gorging on stuff, so our cells never get the signal to start cleaning. When this cleaning aka autophagy is impaired, it accelerates aging by allowing damaged cellular components to accumulate. And as we age, our autophagy efficiency declines even further. Why does that happen, now? Because of AMPK, or AMP-activated protein kinase! Think of AMP-activated protein kinase (AMPK) as a cellular energy sensor and manager. And AMP stands for adenosine monophosphate, a molecule that's part of our cellular energy system. When energy levels in the cell are low, there's more AMP around, which activates AMPK. When AMPK is activated (because it detects more AMP), it starts various processes to help the cell save and produce energy. One of these processes is autophagy - the cellular "cleaning" we talked about just now. But!! As we get older, AMPK levels drop, reducing autophagy and making it harder for our cells to recharge their batteries to maintain themselves and function optimally. Which then contributes to the aging process. It’s all related!Now, the second of the nine hallmarks we'll explore is oxidation. Oxidative stress happens when there are too many free radicals in the body. Seen The Incredible Hulk? Well, the free radicals are...
The Other Two Hallmarks of Aging
So? Curious about the other two hallmarks? Well, they’re cellular senescence and telomeres! These pieces of the aging puzzle hold profound implications for extending our healthspan.
Let's start with cellular senescence. Fifty years ago, microbiologist Leonard Hayflick made a groundbreaking discovery - human cells in a petri dish do not continue dividing forever. They can only replicate about fifty times before becoming Zombie Cells and entering this irreversible state known as cellular senescence – where they stop dividing. And as we age, more and more of our cells reach this state. But, instead of simply dying off, these senescent cells start releasing a cocktail of inflammatory factors, growth factors, and other signaling molecules. Creating "SASP" (meaning senescence-associated secretory phenotype). By growth factors, we mean molecules that senescent cells release which can affect the growth, and inflammation, and basically all function of nearby cells. The SASP is kind of like a distress signal from the senescent cells - they're trying to flag themselves for immune clearance! The problem is, as we get older, our immune system becomes less effective at clearing them out. So, this SASP just keeps accumulating, disrupting the normal functioning of surrounding tissues, fueling chronic inflammation and all sorts of age-related diseases. On the brighter side though, this whole process is also a protective mechanism against cancer.
Now, what’s with telomeres? In Greger's own words, "At the tip of each chromosome is a protective cap called a telomere.". Like aglets, preventing our DNA from unraveling. But every time our cells divide, a tiny bit of those telomeres is lost. When telomeres become critically short, the cell goes into senescence or death. The cell essentially shuts down to prevent further division and potential cancer. Point being, every time a cell divides, its telomeres get a bit shorter. When the telomeres get too short, reaching the Hayflick limit, the cell can't divide anymore. And as more and more cells hit their division limit, we start to experience the effects of aging. And therefore, telomere shortening forms another hallmark of aging, linked to a host of age-related diseases, from Alzheimer's to osteoporosis. Scary!
Alrighty! Now you know the problems (or at least the top 4 problems). It’s time for the solutions!
Watch Your Diet
At the very beginning we said our lifestyle choices play a major role in how quickly this rust of old age sets in, remember? So, let's see how what you eat impacts those aging hallmarks we just covered. Greger has some food recommendations:
The clear standout? Nuts. Nuts are a longevity snack, no kidding! Studies show that even just a handful or two per week can cut your mortality risk in half, comparable to jogging for several hours. From lowering cholesterol and improving artery function, to reducing your risk of strokes, heart disease, cancer, and more, nuts are the superstar. Possibly because they are a unique blend of healthy fats, fiber, antioxidants, and other plant compounds. And luckily, eating nuts doesn't even lead to weight gain, despite their calorie density. But not all nuts are created equal, walnuts seem to reign supreme. They have some of the highest levels of antioxidants and omega-3s of any nut, plus they're the only ones shown to significantly improve artery function. So reach for walnuts whenever you can.
Next we have the mortal enemies of all 6 year olds – vegetables!
Leafy greens like arugula, spinach, and kale are jam-packed with nitrates that can actually slow our metabolism, helping us conserve energy. Plus, their antioxidants can help neutralize the inflammatory effects of air pollution, one of the leading global causes of premature death. And let's not forget berries - the darlings of the fruit world. Whether it's antioxidant-rich blackberries, brain-boosting blueberries, or inflammation-fighting tart cherries, these colorful gems are like fountain-of-youth elixirs. Their vibrant pigments, called anthocyanins, don't just give them their hues - they also have profound anti-aging effects throughout the body, from improving heart health to protecting vision. The best part? You don't need to start popping expensive supplements or guzzling exotic "super-fruits" to reap the benefits.
So, simply enjoying a big salad, a handful of nuts, and a bowl of berries each day can go a long way in extending both your lifespan and your healthspan.
These foods become the secret agents of your body, fighting off the free radicals and keeping your metabolism humming! What a way to keep aging at bay, huh! Now, what should you steer clear of?
Not on the Menu!
You now know the good guy, but what about the not-so-good guys? These not-so-good foods might as well be wearing 'I heart Aging' t-shirts, because they're that bad! And to meet them, let’s turn to Blue Zones. Certain regions around the world have remarkably high concentrations of centenarians – people who have reached the ripe old age of 100 or more. These so-called "blue zones" have captivated researchers for decades. They share several key characteristics, and the most striking similarity is that 95-100% of their diet comes from plant-based sources, with a heavy emphasis on whole, minimally processed foods.And that’s where we get our Blue Zones Food Guidelines from – a set of dietary recommendations distilled from more than 150 surveys! And what does it say?#1: Reduce dairy. While a splash of milk in your morning coffee might seem harmless, the research suggests we'd be better off reducing our dairy intake. Compared to plant-based protein sources, dairy has been linked to a higher risk of premature death. Next on the list is retreat from meat! Processed meats like bacon, sausage, and deli cuts are THE worst offenders. These are packed with harmful compounds that can wreak havoc on your health. Your best move? Swap out animal proteins altogether in favor of wholesome plant-based options. And eggs! But while eggs may be better, they're still not the healthiest choice. Studies show that when it comes to the risk of premature death, eggs fall somewhere in the middle - not as bad as processed meats, but nowhere near as beneficial as plant-based proteins. This may be due to the fact that animal proteins, particularly the branched-chain amino acids like leucine, are more potent activators of the mTOR pathway - a key driver of aging. Individuals eating plant-based diets tend to consume about 30% fewer of these mTOR-accelerating amino acids, which could partly explain their longer lifespans and lower cancer rates. What about fish? Surely that's a healthier option, right? Well, not exactly. Most studies actually show no association of Omega found in fish with reduced cardiovascular mortality. In fact, one surprising finding is that fish can be even worse than red meat when it comes to raising LDL aka bad cholesterol levels, which increases your risk of heart disease and stroke. Crazy, right?Next! We all know that sugar is the dietary villain! So, slash your sugar consumption if you want to extend...
Beverages
Ever heard that the human body is 70% water? FYI, it’s only true for newborns. Older adults are like at 50%. As we age, we become more susceptible to dehydration due to reduced thirst sensation and kidney function. So, what should we drink to stay healthy and hydrated? A panel of health experts, including Dr. Walter Willett from Harvard, ranked beverages from best to worst. Their top choice? Water, unsurprisingly. Tea and coffee tied for second place, preferably without sweeteners. At the bottom of the list were soda, beer, and… whole milk!!First thing, that old advice to drink eight glasses of water a day is bogus. NO solid evidence on it. In fact, studies on water consumption and mortality have mixed results. Some show benefits, while others don't. But don't throw out your water bottle just yet. Based on current evidence, women are advised to drink four to seven cups of water daily, while men should aim for six to eleven cups. But be cautious about drinking more than three to four cups per hour to avoid diluting your electrolytes.Both green and black teas show promise. Cause teas are packed with antioxidants, ready to kick those free radicals to the curb! One extensive review found that drinking three cups of tea daily might decrease the risk of early death by 24%. But adding milk might cancel out these benefits. Coffee lovers, your daily brew is associated with health benefits, too! Yeah, tea might have a slight edge. So, maybe swap occasionally?Now, let's address the elephant in the room: alcohol. For years, we've heard about the potential benefits of moderate drinking, especially red wine. But guess what? A comprehensive global study concluded that "the safest level of drinking is NONE." Even light drinking appears to increase cancer risk. The supposed benefits of alcohol for heart health? Those likely resulted from flawed studies that misclassified former drinkers as lifelong abstainers. And probably because of the lifestyles of wine drinkers. No offense to anyone, but balance of probability says if you're drinking a glass of wine with dinner, you're probably high-end (with access to healthier diet and habits) and not a broke father of 4, with endless life stresses.What about fruit juice? While it's better than soda, it's not as beneficial as whole fruit. Interestingly, tomato juice might be the healthiest option, associated with lower cholesterol and improved artery function. Also, drink it...
The Rest of Your Lifestyle
Food choices are important, but they’re not only thing in your lifestyle, y’know! Other factors impact our health and longevity, too! Like, exercise. Exercise is basically a tune-up for your cellular engines. It revs up your body's antioxidant defenses and even kickstarts your autophagy into high gear. Who knew a gym could be anti-aging, right?The American College of Lifestyle Medicine, of which Greger is a founding member, recognizes exercise as a key component of health. However, physical activity and its connection with longevity is more complex than you might think. Studies have shown that adhering to four simple healthy lifestyle factors - not smoking, maintaining a healthy weight, exercising for 30 minutes a day, and eating a diet rich in fruits, vegetables, and whole grains - can significantly reduce the risk of chronic diseases. For instance, these habits may eliminate up to 90% of diabetes risk and 80% of heart attack risk. But when we look at exercise alone, the picture becomes murkier. Some studies suggest that occupational physical activity like manual labor is associated with shorter lifespans, not longer ones. So, what's the takeaway? Exercise is undoubtedly beneficial for health, but the key seems to be moderation - aim for about an hour of vigorous exercise daily, with at least a day or two of rest each week.Next is your weight. Over the last four decades, obesity rates have tripled among older adults. This isn't just about aesthetics - it's a serious health concern. Obesity is associated with accelerated cellular aging, declining physical and cognitive function, and increased risk of dementia. In a study of centenarians, less than 2% of women and none of the men were obese. The type of fat matters too. Visceral fat, the deep fat that wraps around our internal organs, is particularly dangerous. But t's also the easiest to lose. Our bodies seem to preferentially shed this villainous visceral fat first when we lose weight. Also, you might think that being skinny is always better, but that's not quite the case when it comes to longevity. The largest studies in the United States and around the world found that having a normal BMI between 20 and 22 is associated with the longest lifespan. To put that into perspective, for someone who stands 5 feet 6 inches tall, the ideal weight range for longevity would be about 124 to 136 pounds. Cool?Next is sleep!! So...
Chapter 9
Details coming soon.
Summary
Aging is a complex process influenced by various factors, many of which are within our control. By making informed lifestyle choices, particularly in areas such as diet, exercise, sleep, and stress management, we just might extend our healthspans!! Live long and prosper!
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About the Author
Michael Greger, M.D. FACLM is a physician, New York Times best-selling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, among countless other symposia and institutions; testified before Congress; has appeared on shows such as The Colbert Report; and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial. In 2017, he was honored with the American College of Lifestyle Medicine with its Lifestyle Medicine Trailblazer Award.
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