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Monday, June 06, 2022

Review: Age Later

 Age Later is a book about healthspan and the lifespan of centenarians.  It examines how long lived people run in clusters of families, and that there's actually not much you can do to join them as of today, given how much of it is genetics. There's no correlation between diet, exercise, healthy habits, and living past 100. Many of the people interviewed and studied smoked, ate badly, and/or didn't bother to exercise, so their genes basically got them through life despite any of the bad habits that they had. You can view this positively or negatively. On the one hand, if you have good genes, it almost doesn't matter what you do --- what's important is picking your parents and grandparents carefully. On the other hand, if the scientists ever figure it out, they can basically eventually give you a pill to grant you those superpowers and it won't matter what else you do --- even smoking would be OK.

The book covers current studies --- one apparently promising one is metformin, which apparently does great stuff, so much so that Singapore considered putting it in the water supply:

Singapore’s population also has a very high life expectancy, at nearly eighty-three, and that’s why I am consulting for Prime Minister Lee Hsien Loong’s office. To give you an idea how desperate the government is to head off a crisis, one of the questions that officials asked me is whether metformin should be put in the water supply. (My answer was no, of course.) (Kindle Loc 2106)

There's another fun section where he talks to Senate Appropriations Thad Cochran from Mississippi:

 A good example of the diverse challenges of raising money for a particular piece of the health care puzzle is what happened when I requested funding from the Department of Defense, which invests significant resources into disease research. During my meeting with then Senate Appropriations chairman Thad Cochran, who’s from Mississippi, I made sure to tailor my pitch to his sense of regionalism. “You know, your state is doing really poorly,” I said. “You have more strokes than anyone, you have more cardiovascular disease.” “Why is that?” he said. “Well, there are two answers. First of all, your people take less metformin than any other state. But there’s really a much more important reason—your people are victims of the good food of Mississippi, this food you can’t stop eating.” He burst out laughing. “That’s great! I’ll remember that! I’ll use it! My people are the victims of the good food of Mississippi. I love it.” (Kindle Loc 2048)

This story highlights why I will never be a good politician. No way would I have come up with that line. OK, let me walk back a bit about the part about exercise:

 Hands down, the most important intervention we have for aging is physical exercise, which has positive benefits for males and females at every stage of life...we know that physical activity is crucial to health span and will increase your chances of passing age eighty. The benefits of exercise for both the young and the old are greater than the benefits we have seen from any particular diet....The interesting thing about exercise is that, in theory, it should be bad for us. It induces oxidative stress, which appears to contribute to aging and disease, and it increases the breakdown of muscle tissue as well as causing some inflammation. And yet exercising is good for us at every age. So what’s going on? (kindle loc 2373-2411)

Clearly there's a ton of room needed to figure out why exercise actually works. There's a study on the effect of metformin on exercise, and apparently metformin's side effects include reducing the impact of exercise on muscle growth, but nevertheless, the people involved do get stronger. They just don't get more/bigger muscle for whatever reason.

There's a section dismissing HGH (human growth hormone) as a good therapy --- there are apparent side effects (like increased chance of cancer), and basically, HGH is most useful for people going through puberty and only prescribed or recommended if they have some genetic defect that prevents them from growing during puberty. What's interesting is that the longest lived people have least response to HGH, except at the megadoses present during puberty.

Another section on diet discusses fasting. Basically, he recommends skipping breakfast. Apparently, not only is it the least important meal of the day, it prolongs your fasting state which does good things for longevity.

All in all, the book doesn't provide easy answers, and does a good job explaining how the author views longevity, while providing optimistic directions. Recommended. 

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