Anti-aging: myths and reality

Sofia Zygmond, Radio Liberty 

The world's population is aging, and the dynamics of aging is taking on alarming proportions, primarily in developed countries that produce three quarters of the gross world product. Already today, a quarter of the Swedish population is over 65 years old, and among those born in 2000, half, according to Laura Fratilloni, director of the Center for Anti-aging Research at the Karolinska Institute in Stockholm, will live to 100 years. In the UK, about 80 percent of national income is produced by baby boomers - those who were born in 1946-64, and in Italy by 2030 there will be more pensioners than active workers. The aging of the population leads to an increase in medical care costs, because the risk of cardiovascular and oncological diseases, Alzheimer's disease increases with age. 

"Treating an aging society requires trillions of dollars, and in the future these costs will only increase," says gerontologist professor Jay Stewart Olshansky from the School of Public Health at the University of Chicago. Another trend associated with the aging of the population in developed countries is the rapid growth of the market for so–called "anti-aging medicine" – numerous commercial technologies that promise to slow down age-related changes. To do this, it is allegedly enough to be tested in an anti-aging clinic, to carry out a number of procedures, to include certain dietary supplements (dietary supplements) in your diet.

The correspondent of Radio Liberty figured out whether antiage medicine of this kind is based on a solid scientific foundation or is it just a desire to cash in on everyone's fear of inevitable old age.

There are several competing theories on this, although all of them, according to Laura Fratilloni, are interrelated. Aging in the most general sense can be understood as the body's ability to adapt to various life situations decreasing with age. This is accompanied by a slowdown in the process of cell division, a decrease in the ability of tissues to self-renew, metabolic disorders, malfunctions of the cardiovascular and nervous systems.

According to a fairly generally accepted point of view, 30-35 percent of longevity is genetically determined. Accordingly, aging is also associated with genetic factors: for example, it may be programmed changes in gene expression that turn on or off at a certain point in life. Another reason, or rather a factor of aging, may be the gradual failure of the immune system – the body is more susceptible to infectious diseases, autoimmune processes, tumors and is recovering worse as a result of environmental influences.

Endocrine theory suggests that aging is associated with hormonal changes (and, accordingly, the replenishment of the necessary hormones in the body can slow it down). According to another point of view, aging determines the rate of oxygen utilization in cells. Some experts are sure that free radicals are driving us to the grave. In part, a more reasonable hypothesis connects aging with telomeres – special areas at the ends of DNA molecules that shorten with each cell division.

In other words, apparently, aging is not much like the flu, from which antiviral drugs can be cured – this is a complex process that is influenced by many complex biochemical factors. Although in the last two decades the search for "pills for old age" has been one of the most popular and rich areas of biological research, it is still difficult to expect that we will be able to cure old age with the help of a single drug. Neither can we from a hangover.

It is curious that some of the promising work in the direction of ways to slow down aging is faced with the fact that candidates for effective drugs simultaneously increase the risk of developing cancer – as it happens in studies based on an epigenetic or antioxidant approach. This even led some experts to make the assumption that there is a kind of relationship between aging and cancer, trade off: slowing down the first increases the risk of the second and vice versa. Maybe there is an evolutionary explanation for this? However, other scientists are sure that there is still no such connection between aging and cancer: in particular, in a study by a group of Danish scientists led by Kaare Christensen, more than 8 thousand identical twins were studied, statistics showed that longevity just implies a genetically determined low risk of cancer.

But this does not prevent the clinics of "anti-aging medicine" from flourishing, which, if they do not directly guarantee eternal youth, but rather transparently hint that it is quite possible. What technologies are offered in this segment of the services market, and what do evidence-based medicine specialists think about them?

find out which of the vital organs will age earlier and what can be done to slow down aging. For example, the passport age of a patient may differ from the biological age of the heart, which in a forty-year-old may correspond to the condition of a 55-year-old. And then you will be prescribed how to support the heart. However, Professor of medicine Laura Fratilloni from Karolinska Institutet, Stockholm, Aging Research Center, is very skeptical about this approach: "we do not have scientific confirmation that medicine has good markers for conducting such studies," she says.

At the same time, the level of cortisol, the hormone DHEA (an indicator of the andro-synthetic activity of the adrenal glands), melatonin (lack causes insomnia, fatigue, depression), and other hormones are determined. Tests show how hormone levels change throughout the day and, as often stated in anti-aging clinics, help to individually select hormonal treatment, for example, using creams with microdoses of bio-identical hormones or even hormonal patches, presumably complementing the patient's endocrine system. To this, it is often suggested to add treatment with growth hormone (HGH) and insulin-like growth factor (IGF-1).

However, as noted by Cynthia Pearson, director of the American National Women's Health Network, such creams and patches are not certified as medicines, have not been clinically tested for side effects, and no one knows for sure, for example, "what the hormone level should be during menopause." This attitude is shared by other experts. Laura Fratilloni advises to treat hormonal "therapy" very carefully, since the effectiveness of these techniques is not confirmed by science – the "amazing" stories of individual patients who have become younger by 20 years and share their experience on the websites of anti-aging clinics are not enough.

Sofia Milman, the head of a study conducted at Albert Einstein College in New York concerning research on the potential benefits of replenishing growth hormone deficiency, agrees with Fratilloni. Scientists have found that low levels of growth hormone in the elderly, on the contrary, can reduce the risk of age-related diseases. "Growth hormone helps fat metabolism and smoothes the skin, but such a "Hollywood type of longevity" will not help the health of older people and the anti–aging strategy in general," says Sofia Milman.

It is claimed that the remedy is effective because it "contains stem cells." Fratoglioni's comment is brief: "More research is needed, the results are far from being implemented."

And here's what Laura Fratilloni says: "The fact that oxidative stress causes cancer is nothing more than a hypothesis so far. At the same time, we have convincing scientific evidence of such specific risk factors as smoking, excessive alcohol consumption, obesity, sedentary lifestyle, unhealthy diet. These factors strongly correlate with the so–called age-related diseases: cancer, cardiovascular diseases, dementia," the specialist is sure. Fratelloni does not recommend monitoring free radicals by blood analysis, because it is too early to draw any conclusions based on the results - more scientific research is needed.

In theory, it measures the activity of plasma antibodies in response to individual foods and chemicals. About 300 types of food are tested in clinics, and as a result, the patient receives instructions on which foods he should refuse altogether, what to eat moderately, and what can be eaten without restrictions.

But the scientific validity of this method has not been confirmed, it cannot be considered as part of the therapeutic diagnosis for the attending physician. "However, if the test results convince a person to think about a diet and get further advice from a specialist nutritionist, then this will help reduce the risk of certain age-related diseases. for example, diabetes," says Ivan Mach, president of the Czech Association of Nutritionists. He believes that the role of nutrition in the prevention of cancer is underestimated.

Neurotransmitters play an important role in the work of the nervous system, including the brain, and anti-aging doctors claim that their level decreases with age, which affects our productivity, mood, and family relationships. However, experts of evidence-based medicine are sure that it is more than naive to believe that the analysis of morning urine reflects the picture of what is happening in the cerebral cortex. According to the results of the analysis, the doctor in the anti-aging clinic will offer you dietary supplements and an appropriate diet, with the help of which the detected deficiency can be replenished. "This will certainly increase the sales of dietary supplements manufacturers and bring dividends to the clinic that sells supplements, but there is no need to talk about the scientifically proven effectiveness of this technique," comments Laura Fratilloni.

Laura Fratilloni does not dispute that telomeres may be related to aging, however, she urges to treat the analysis itself and the therapy following it with caution: "So far, only studies are relevant. The technology is far from mass adoption," she believes.

This, of course, is far from a complete list. We can also recall the chelation therapy, with the help of which heavy metals are removed from the body – in fact, the effectiveness of the approach has not been proven, and the research results are far from being implemented in clinical practice. And what about the magical anti-aging supplements? After all, the fern extract from Central America Polypodium Leucotomos supposedly protects the skin from ultraviolet radiation, and resveratrol (natural phytoalexin) has an antitumor, anti–inflammatory effect. It turns out that clinical trials of the usefulness of resveratrol in humans have not been conducted at all (although it has been proven in mice that this phytoalexin prolongs life). In order to verify the effectiveness of this remedy, more research is needed, these supplements are far from clinical implementation, as, indeed, are most of the others from the long list recommended by anti-aging clinics. Laura Fratilloni does not believe in fern or other dietary supplements.

Thus, almost all the methods recommended and used by anti-aging clinics are actually far from mass implementation, and patients, without knowing it, become guinea pigs.

At the same time, Professor Pyotr Fedichev, a supporter of the programmable theory of aging, whose company is engaged in biotechnology, believes that lifestyle changes can, in principle, increase an individual's life expectancy by five years, but will not lead to a radical increase. Pyotr Fedichev believes in reprogramming the "aging code", but in the near future a person should hardly expect a breakthrough – scientists are still learning to reprogram only laboratory animals.

Gerontologist Professor Jay Olshansky from the University of Chicago School of Public Health is not surprised that interest in anti-aging medicine is constantly growing, but considers its effectiveness to be purely hypothetical. According to Olshansky, the anti–aging market is pure fraud, although there are promising developments, such as biomarkers of certain oncological diseases or, possibly, telomere analysis. Over time, when more clinical research experience is accumulated, this can also be beneficial in medical practice.

"In fact, we are talking about the management of aging, and this can be achieved by the combined efforts of bio-gerontologists, specialists in traditional, preventive and predictive medicine, biology, genetics and other areas whose representatives are looking for reserves of vital activity of the human body," states Jay Olshansky.

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28.10.2015