Is there a scientific basis for the quest to extend human life and health? Or is anti-aging medicine all quackery?
To most of us, the questions are more than academic. We have family and friends we’d like to keep around longer, thank you, and if firsthand experience is the only way to learn about the whole nasty business of age-related mental and physical decline, frankly, we’d just as soon skip it.
The search for an answer—or answers, because there’s little consensus in this field—inspires the smart and irreverent tour of history, science and personality that is Eternity Soup: Inside the Quest to End Aging, a new book by science and medical journalist Greg Critser. (Read an excerpt here.)
Critser is no stranger to taking on American health obsessions and addictions—and has been critically acclaimed for his thorough work on a single subject. He’s also the author of the best-selling Fat Land: How Americans Became the Fattest People in the World, an indictment of fast-food marketers, and Generation Rx: How Prescription Drugs Are Altering American Lives, Minds and Bodies, an attack on the pharmaceutical industry and the over-medicated society that it feeds on.
Eternity Soup probes our quest for immortality and the multibillion-dollar aging industry it has spawned. He spoke with the AARP Bulletin about this latest project.
Q. Isn’t it natural for all creatures to age, sicken and die?
A. Until fairly recently, yes, there was the notion that aging was natural. Our maximum age span was thought to be genetically predetermined.
Q. Has that changed?
A. In the 1980s genetic studies on fruit flies, mice and fish started showing maximum life span was mutable. One of the most interesting observed the Pacific rockfish, which lives about 150 years. What’s interesting is why they ever died. Their auto-immune systems and internal organs were perfectly intact at death. They probably only died of disease or predation. These kinds of observations started changing the notion that life span was fixed, that aging was inevitable.
Q. The idea is not just to increase maximum life span but health span too, right?
A. Generally the holy grail of all this is what they call “rectangularizing” the morbidity curve; instead of people getting sicker and sicker as they get older, they’re healthier until the time they die. We compress the time that they suffer.
Q. One of scientists’ three main strategies to counter aging involves slowing the body’s bad processes through calorie restriction [CR]—eating less than you need to feel full. Sounds painful.
A. Yeah, life without pizza. There’s definitely a reason I’m not doing it. The more important reason, though, is we don’t know if it works in human beings. We know that it works in fruit flies, worms, mice, maybe in primates, but that’s very unclear. Let’s say human beings could do it. There’s one extrapolation that says the most you’re going get out of it is an extra six to seven years. Six to seven more years of no pizza. It doesn’t seem to be worth it.
Q. Another strategy is to replace our lost fuel—meaning, supplement hormones, like testosterone and human growth hormone, that naturally decline with age.
A. Where CR is kind of a 20th-century scientific notion, this notion of replacing just what you lose is really a 19th-century notion. The first experimental pills, made from extracts of dried cow, pig, monkey, sheep and dog organs, came in the late 19th and early 20th centuries. The anti-aging industry has seized on this idea and said, well, we can provide it in a better way. We can make it in a cream rather than a pill. It’s pretty clear that estrogen or testosterone taken that way does work to boost cognition, increase muscle tone, reduce abdominal fat and cholesterol. It’s very unclear if it’s safer or not, or more efficacious than pills.
Q. And then there’s the repair-the-worn-parts model.
A. The engineering approach is the most interesting and shows the greatest promise. If you think about it, in a way, we’re already doing it. Whenever you do a surgery, you’re reengineering the body so if you take that to a whole new level, yeah, you could definitely extend maximum life span and you could probably make life expectancy much more healthy. It’s never seen as anti-aging medicine, but stem cell research will probably extend people’s life expectancy significantly because the application of stem cell principles involves the use of a person’s own cells to repair damaged organs or, as the book details, to grow new ones. In fact, a big breakthrough came when the book was being printed: Spanish researchers grew a new trachea for a woman whose own was damaged in a battle with cancer. Now, she has a new one, made with her own cells.
Q. So anti-aging medicine is not all hooey?
A. Commercial anti-aging medicine, which claims to slow down the process of aging, extend life expectancy, and perhaps expand maximum life span, is greatly overstated. It doesn’t take into account that people have different reactions to potions and notions.
Q. For instance?
A. The biggest single example is human growth hormone. I like to say HGH’s greatest effect is on your wallet. It slims the wallet very effectively because it costs about 1,000 bucks a month, on top of the doctor’s monitoring fees. We know that HGH is absolutely essential—we produce it ourselves—for heart health, resistance against infectious disease growth, et cetera. It’s very unclear, however, what adding it does. In some people it clearly builds muscle mass, decreases fat mass, makes for better blood profiles, better insulin profiles, better cognition. In other people, it does nothing.
Q. You have fun describing the annual conference of the American Academy of Anti-Aging Medicine . What are some of the products you saw?
A. The funniest one was Virgin Again. This was a lubricant that claimed it could restore a woman’s virginity. I have no idea what the “mechanism of action,” as the FDA would call it, was. Another claimed to restore your relationship to gravity. It claimed we all have perturbed relationships with gravity, and if we could only reestablish the one we had at birth, we would all be healthy again.
Q. There’s a name for such claims, isn’t there?
A. A lot of it is quackery. On the other hand, academic critics have gone way overboard in raising red flags about safety.
Q. Which treatments look safe?
A. Testosterone supplementation poses few safety risks except to those with a high familial incidence of cancer. The risks posed by human growth hormone appear modest to minor if used with monitoring.
Q. If it were feasible to extend human life span, could we as a society afford to do it?
A. If we could use engineering processes to really alter fundamental physiology and add, let’s say, 100 years to maximum life span, that would have some pretty huge impacts. Some people claim it would bankrupt the health economy. Others say, well, wait a minute. You’re going to have much healthier people and that’s going to cost less.
Q. Are there other problems besides cost with extending human life?
A. Well, there are all the philosophical problems. Leonard Hayflick, who’s sort of the father of cell division theory, said you would end up with all the wrong people living too long. Tyrants would live forever; the rich would live forever. You’d have problems with parents who used anti-aging medicine and children who didn’t.
Q. You say the anti-aging game seems to consist of either solid science paired with a poor product, or an attractive product backed by lousy science. How’s that?
A. Let’s take on the establishment’s gerontologically correct compound: One that they can kind of all agree is at least safe and probably will do something for you is resveratrol, based on a compound made from the skin of red grapes. That compound has been shown to extend the life span of mice that are obese and eat a high-fat diet.
Q. So that’s promising, right?
A. However, when they did the experiment with mice that were not fat and that ate a regular diet, it did not work. They did not get any life span extension. Also, when human beings have an impaired insulin-growth factor level they do very poorly on resveratrol. They get sick easily. They die easily of infection. So, the benefits of resveratrol have been enormously overstated. And the establishment has been very slow to concede that.
Q. How can ordinary people tell the difference between legitimate science and hucksterism in this field?
A. I don’t think they can. A perfect example: You’re 65. You go to see an anti-aging doctor. You have a hormone deficiency. One hormone level will be low, so prescribing a 65-year-old guy light doses of testosterone will probably help him. But doctors don’t stop there. They try to load you up with every nutritional supplement you possibly could buy. You’ve spent hundreds, maybe thousands of dollars before you walk out of the office, and there’s no evidence at all that any nutritional supplement will make you live longer.
Q. What kind of advances can we expect to see from anti-aging science in our lifetime?
A. We will probably see some academic science medical studies start to pay off, maybe in terms of better drugs, maybe better able to reduce inflammation, reduce high blood pressure and high blood sugar—and those are really the critical big issues. Almost all human beings will either get high blood pressure or uncontrolled sugar as they get older. The same with high blood fat, that’s a pretty universal thing that happens. It may be that resveratrol will not be sold as anti-aging medicine but as a diabetes drug.
Q. Didn’t you cite a prediction of a one-year gain every 20 years?
A. That was an extrapolation by a Stanford professor. I think that’s pretty optimistic.
Susan Morse, a Washington-area freelance writer, is a former health editor at the Washington Post.