Elan Vital Longevity Institute

Biomarkers of Aging

Andrew Pauli, M.D., Medical Director & Health Coach

Élan Vital Longevity Institute, Bellingham

Aging has been seen as that inevitable process of physical deterioration leading up to disability and death which we all will experience. The new specialty of Anti-Aging Medicine seeks to apply the latest science to lengthen both your lifespan as well as your healthspan. There are many techniques beyond just taking a multi-vitamin which can enhance the normal function of tissues and organs, thereby enhancing your youthful vitality and postponing disability and death.

But which organs and tissues should receive the highest priority in this effort? Let's look at what are the top 10 Biomarkers of Aging, and some things one can do to improve them. Doctors Evans and Rosenberg in their book Biomarkers found that 70- to 90- year olds could reverse their Biomarkers of Aging. You can, too, whether you are 40 years old or 80, if you make it a priority.

Muscle Mass. If your muscle mass is higher, that you are more likely to live longer and healthier. Decreased muscle mass (also called "sarcopenia," literally "less flesh") results in an "older" physiology, because muscle burns more fuel than fat tissue. In fact, while most people step on a scale and focus on their weight, as an Anti-Aging doctor, I am more concerned about their ratio of body-fat mass and lean-body mass. Fat tissue is metabolically inactive, since its function is to store energy. Muscle cells are very rich in mitochondria, which are the energy processing factories in cells. Thus, if we focus on increasing muscle, more energy will be used and the fat stores will decrease.

High muscle to fat ratio causes increased metabolism, increases aerobic capacity, triggers the muscles to use insulin better - thereby decreasing the risk of diabetes - and improves the blood levels of HDL, the "good" cholesterol.

Muscle Strength. Muscle strength is related to muscle mass, and has similar benefits. Muscle strength is also dependent on the use of the muscles. Use of muscles puts beneficial stress on the tendons, ligaments and bones, thereby increasing bone density. Low bone density or osteoporosis is a major risk factor for broken hips, disability and related death in the elderly. Add the increased risk of falls due to low muscle strength and you have a double whammy of a risk.

Basal Metabolic Rate (BMR). This is the rate of your body's metabolism when you are in the resting state, or in other words, how much energy, or calories, are being expended at rest. Yes, even at rest your body is burning fuel resulting in heat production. As you get older, your decrease in muscle mass results in lower metabolism, thus causing a reduction in BMR of 2% per decade. We tend to continue our eating habits from youth onward. As our BMR decreases, we are feeding our body more calories than it needs, which is then stored as fat.

Body Fat Percentage. Increased body fat is associated with many chronic diseases, including diabetes, cardiovascular disease, stroke, and autoimmune diseases. The healthy way to lose fat is not to "lose weight" but rather increase muscle and increase metabolism. In my clinic, I use bioimpedance analysis to follow my clients' body composition, both body-fat and lean-body mass. This enables adjustment of diet and exercise based on composition, rather than just weight on a scale. Bioimpedance analysis, a quick and accurate electrical measurement, also gives important information about your cellular hydration (how youthfully plump the cells are), and your nutritional status.

These first four biomarkers are related and are the most important. They are all improved by exercise, as well as optimal nutrition, nutritional supplementation and advanced hormone optimization.

Aerobic Capacity. Aerobic capacity, the body's ability to process oxygen in a given time, requires healthy lungs, a powerful heart and a good vascular network.

Blood Sugar Tolerance. The body's ability to move sugar from the blood into the cells decreases with age. This critical function requires the cells to respond to insulin which is normally released from the pancreas when blood sugar rises. When the cells are less able to respond to insulin, it is called glucose intolerance or insulin resistance. This is a pre-diabetic state which can progress to diabetes. As blood sugar tolerance worsens, the body is exposed to higher levels of glucose and insulin. This results in premature aging of many organs through damage to the tissues, resulting in vascular disease and tissue inflammation. As noted, vascular supply is important for aerobic capacity. Diabetes, also called Type 2 or adult-onset diabetes, is a devastating disease. It is associated with premature aging as well as cardiovascular disease, stroke, nerve problems, blindness, gangrene and amputation. Unfortunately, there is an epidemic of Type 2 diabetes, even occurring now more often in children! Excessive consumption of starches and sugar is the primary cause.

Cholesterol/HDL Ratio. Most everyone has heard of cholesterol and its association with heart and vascular disease. HDL or High Density Lipoprotein-Cholesterol is known as the "good" cholesterol because of its role in scavenging oxidized cholesterol, which is the real culprit behind cholesterol-related vascular damage. It is important to keep the cholesterol/HDL ratio down through exercise, low saturated fat intake and optimal hormonal adjustment. I would also warn you not to assume that if your cholesterol number is low, naturally or through medication, that you thereby have no risk of heart disease and don't have to follow other health suggestions. Cholesterol-related risk accounts for less than half of the causes of atherosclerotic vascular disease. I screen and treat for these other causes at my clinic.

Blood Pressure. Elevated blood pressure or hypertension is known as "the silent killer" since it has no symptoms until a stroke or heart attack occurs. Some cultures do not have increases in blood pressure with age, but the United States certainly does. Exercise, less starchy foods and salt restriction can result in substantial lowering of blood pressure. Treating the symptom of hypertension with medication alone is definitely less desirable as whatever fundamental process led to the hypertension in the first place will still be going on and likely having effects at other organs in the body.

Bone Density. Lowered bone density, known as osteopenia or osteoporosis, tends to be more frequent as we age. A fall onto a hip or leg made of weak bone can be deadly or debilitating. These can occur in men or women. The most known strategy for prevention of low bone density is calcium intake. While calcium is needed, it certainly isn't enough. Bone needs other important minerals, vitamins and nutrients, including protein which makes up its matrix. Adequate hormone levels (not just "estrogen") are essential. Ongoing exercise as a stimulus for bone formation is also critical.

Body's Ability to Regulate its Temperature. A number of factors come to play here, including decreased sweating, decreased thirst and water intake, decreased mitochondrial function, and decreased thyroid hormone. A deficit in temperature regulation puts you at risk for problems in hot or cold weather.

A recent scientific conference on aging biomarkers came up with many more markers and less agreement among the scientists at hand on the importance of any one. Nevertheless, you shouldn't wait for the scientists to do ten studies on each biomarker ever conceived before you start working on slowing and reversing your aging.

Evans and Rosenberg make the point for exercise positively affecting most of these biomarkers. I agree. Everyone should be doing exercise for strength training and aerobic exercise several times weekly. And of course I recommend you consult your doctor before starting any exercise program if you have been inactive or having medical problems. In general, starting slow and increasing the level of exercise gradually is best.

As an Anti-Aging doctor, however, I know that optimal improvements on these biomarkers will occur when, in addition to exercise, many other factors are evaluated and tuned. For example, a race car, in addition to needing running of the engine to break it in, also needs tuning of its ignition, carburetor, suspension, tires, etc. A human body is much more complicated and needs tuning in many areas for optimal performance. In addition, the human body is connected to a brain, a mind and a spirit, and does not work optimally unless these are likewise well adjusted.

©2002 Élan Vital Longevity Institute