We need one victory…
How to overcome old age?
Natalia Leskova, "Scientific Russia"
Is it possible to overcome aging and not get sick? What factors lead to aging and can they be "canceled"? This is discussed by O.N. Tkacheva, director of the Russian Gerontological Research and Clinical Center of the N.I. Pirogov RNIMU, Chief geriatrician of the Ministry of Health of Russia.
– Olga Nikolaevna, you have been the chief geriatrician of Russia since 2015, and in 2018, our President Vladimir Putin, as they say, ordered us to live a long time, ordering doctors and scientists to focus on solving the problem of life expectancy of Russians. Did this decision of the president frighten you, tell me honestly?
– No, it didn't scare me, because life expectancy around the world has been growing over the past decades, increasing by about three years every ten years, i.e. over the past 100 years, the average life expectancy from birth has increased by 30 years.
Naturally, this happens in connection with the development of technology, medicine, pharmaceutical production, but also in connection with improving the quality of life in general, comfort, improving water supply and nutrition, which makes our lives safer. Understanding of the importance of a healthy lifestyle and preventive measures is becoming clearer. By the way, in the context of coronavirus infection, I can say that vaccination has made a significant contribution to increasing life expectancy. Therefore, today, when asked whether to be vaccinated or not, the answer is unequivocally one – "yes". Vaccination is the prevention of infectious diseases, and the prevention of non–communicable diseases is the control of risk factors for the development of these diseases.
– Olga Nikolaevna, we can say without a doubt that humanity is getting older, but can we at the same time say that humanity is getting healthier?
– This is a very good question. When we discuss the topic of increasing the life expectancy of the population, we consider and predict different scenarios. One of them is an increase in life expectancy, the accumulation of age–associated diseases and an increase in the period of life with diseases. We are focused on the treatment of diseases. But another scenario is needed – an increase in the duration of a healthy, active life, and this is achieved through prevention. The world is now following exactly this path.
Indeed, we are moving according to a good scenario. The period of life with diseases remains stable. The period of active life is growing. This can be seen by watching the heroes of old films: a 40-year-old man in the postwar years looks noticeably older than our 40-year-old contemporaries.
– Yes, for many, life at this age is just beginning.
– Thus, we note that the period of active life increases, aging slows down. People tend to be active, keep a youthful appearance. If earlier we used the term "healthy aging", that is, aging without diseases, now the concept of "successful aging" has appeared. Successful aging presupposes a healthy appearance and striving for something new, a development that lasts a lifetime.
– Maybe in this case it is possible to abandon the term "aging" if a person is healthy and continues to develop actively?
– Unfortunately, we are not immortal, and talking about immortality seems fantastic and speculative to me. We need to set realistic goals that we can achieve. But you need to understand that new approaches, new technologies and knowledge are needed for their implementation. Life expectancy depends on genetics. There is a hereditary longevity in the family. It is known from scientific research that longevity is inherited on the maternal side.
– Olga Nikolaevna, how do you feel about the theories that aging is a breakdown of the program, and if we fix this breakdown, we will stop aging altogether, like some trees that live for 1000 years or more?
– I do not yet see any reason to think about the infinity of life and immortality. It seems to me that even from the point of view of the philosophy of life and the development of mankind, this will not be very good in general. Aging is a process to some extent programmed.
– Natural?
– Yes, natural. But the rate of aging can be different. It may accelerate or it may take place at a slower pace. There is such a term "negligible aging" when a person enters a zone where he almost does not age. These are usually people over the age of 90.
There are a lot of theories of aging. All of them have some kind of evidence and their weaknesses. There is no one indisputable theory that everyone agrees with. This suggests that the aging process is very complex. But all theories, with all the differences, can be connected by one principle. Yes, mistakes happen, but do we fix them or not? Does the error correction system work for us or not?
If there is a breakdown at the cellular level, then the body itself must eliminate it. But at some point, the recognition and protection systems do not work, and the breakdown remains, errors accumulate, the functioning of the body changes. This is how aging happens. Errors can be in metabolism, at the level of systemic inflammation, immune or hormonal system. It is important for us to learn how to support or enable an error correction program.
More than 500 of these genes are responsible for aging. There are aging genes and anti-aging genes, that is, genes that contribute to the development of age-associated diseases and, consequently, aging, and genes that, on the contrary, protect us from diseases and aging.
So it turns out that protective genes are more important, that is, protective. We live, sometimes get injured, eat incorrectly, continuously experience negative environmental influences. It is important that our internal systems are configured for protection, recovery and error correction. And that's the way to maintain and improve these systems, I think we should go, conduct scientific research and develop new approaches to treatment.
– And how can we do this? How can we influence the improvement of this error correction system?
– In the future it will be genetic engineering technologies. Now we can medically intervene in this process. In fact, we treat diseases in such a way as to help our body correct this mistake. Perhaps technologies will change, improve, we will learn how to turn on protective genes and turn off genes that destroy the body. I am a clinician, I am a doctor, I see patients with premature aging, or vice versa, with delayed aging, I see age-associated diseases, I know the medications that can help us cope with these diseases. But it is quite obvious that the fight against aging lies in the plane of translational medicine.
We have very interesting fundamental research, experimental work, and today there are already interventions in the experiment that can increase the life expectancy of, for example, mice by 30 percent or more of their average life expectancy. This is a significant increase in life expectancy. But we need to somehow transfer it to the clinic, use it in the treatment of people.
This is very difficult, because a person's disease occurs in a certain period of time, and we can only fix some endpoints. When we consider human aging, it takes a lifetime, and each study should go virtually a lifetime. Therefore, we have only experimental studies on mice or other objects, which end literally within a few months.
In observations involving humans, we can assess a person's biological age, rather than passport age, in order to assess how our interventions affect biological age.
– Does the presence of diseases always affect a person's life expectancy?
– These factors are not always interrelated. For example, one elderly patient may have many diseases, take medications, but at the same time be in good shape, go to work, to concerts, he walks, does Nordic walking and so on. And the other – maybe even a younger patient on the passport, with a smaller set of diseases, but already having dementia or age-related weakness, is already sitting in a wheelchair. He is quite old biologically. He already has muscle atrophy because he can't walk, he can't take care of himself. Do not confuse illness and aging. Geriatricians are able to diagnose these conditions and know where the problems of aging are and where the diseases are.
– Olga Nikolaevna, let's talk about those breakdowns in the body that happen most often. It is clear that these are cancer and cardiovascular problems, which you deal with quite closely as a scientist. How relevant are these problems for our country and for all mankind? What conclusions do you draw as a result of these studies?
– Indeed, oncological pathology is one variant of aging: control over cell division is disrupted, pathological cells begin to divide uncontrollably. In cardiovascular diseases, on the contrary, the replicative activity of cells decreases. The pathogenesis of cardiovascular diseases is largely tied to the development of arteriosclerosis, that is, an increase in the stiffness of the vascular wall. Atherosclerosis is the formation of fatty plaques in the vessel wall. And arteriosclerosis is fibrosis of the vessel wall, when it becomes very dense, a lot of connective tissue appears in the vessel wall.
Both conditions lead to the fact that organs and tissues do not receive proper blood supply and begin to function incorrectly. The blood supply to the myocardium is disrupted – coronary heart disease develops. The blood supply to the brain is disrupted, oxygen saturation of cells decreases – cerebrovascular and neurodegenerative diseases develop, including Alzheimer's disease.
Against the background of aging and the accumulation of errors, the syndrome of systemic inflammation begins, the anti-inflammatory system does not cope, the level of C-reactive protein increases. This inflammation is not associated with infectious agents when it is acute. Prolonged and sluggish, "smoldering" inflammation is one of the mechanisms of aging.
– Can we say that a new coronavirus infection can also contribute to the aging process?
– Of course, yes, since acute inflammation with covid infection in some cases turns into autoimmune processes, in which the body begins to develop protection not against the coronavirus, but against its own cells. In general, any autoimmune process accelerates aging due to this inflammatory process.
Here we return again to the conversation about the theories of aging. The inflammatory mechanism is one of them. Another theory is metabolic, when we say that the basis of aging is, for example, the lack of sensitivity of peripheral tissues to insulin. Insulin is a very powerful anabolic hormone. Insulin resistance syndrome can be easily recognized clinically. People with abdominal obesity are people with insulin resistance syndrome and early aging. Patients with type II diabetes mellitus are also people with insulin resistance syndrome and early vascular aging. Diabetes mellitus is a model of premature aging. In 100-year-olds, you never diagnose diabetes. As a rule, they do not have obesity. They may be overweight or even slightly obese, no more than grade I. People with morbid obesity or severe diabetes do not live to the age of 100.
– Why does aging occur in everyone according to different scenarios?
– People differ in many biological indicators, habits, life history and diseases. There are also different models of aging. Someone develops a heart attack, someone has a stroke, someone has Alzheimer's disease, someone has cancer, someone has chronic obstructive pulmonary disease with emphysema, with pneumosclerosis, someone has deforming osteoarthritis and osteoporosis. Many have several diseases, all variants are intertwined, but initially there may be common mechanisms for the development of a particular pathology.
Gerontologists say that we need to start acting earlier, even at the stage of the beginning of the formation of pathological mechanisms. Now we are engaged in the prevention of diabetes, cancer, heart attack and so on. And our task is to reach out to these common factors and prevent not age–associated diseases, but aging itself. It will be more efficient. But we don't know how to do it yet.
– Olga Nikolaevna, speaking about centenarians, you said that these are people who, as a rule, do not suffer from severe obesity and diabetes. What other features do they have in common? Can we highlight them?
– Yes, centenarians have common features, and they can be very easily named. We can analyze the so–called "blue" zones where people live for a long time - Sardinia, Costa Rica, California, Nicoya, Okinawa in Japan, where there are a lot of 100-year-olds. I was in Okinawa, Japan, and visited a village of centenarians together with my gerontologists. This is an unforgettable experience and a very useful experience.
– How interesting!
– Yes, we went to visit a long-lived woman. Her mother died at the age of 109. All the brothers and sisters of this woman also lived (or live) for a very long time. Our interlocutor lives alone in a very small house with a small garden. The house is very clean and tidy. She does everything around the house herself, there are no assistants. When we came to her, she had a dance lesson. She dances every day, and she really likes it. And in general, she is very active. Small, thin, mobile. Eats quite a bit. Very friendly. When I asked her: "What would you like? What are the plans?", she replied: "I would like to travel, to visit my grandson. He lives in Tokyo, and I want to go to him."
She doesn't go to the doctors. But medical care for centenarians is well organized. She has prosthetic teeth. She was operated on for cataracts, artificial lenses were installed, and her vision is very good.
These are very important geroprotective technologies. Vision decreases with age, this entails rapid aging. Vision should be restored as soon as possible. This is the key to a longer life expectancy. She wouldn't have lived for 100 years if she hadn't seen and couldn't chew.
Social activity is very important. There is a very friendly atmosphere in this village of centenarians, our interlocutor spends a lot of time on the outdoor terrace of her house, communicates with neighbors.
– Let's talk about the contribution that your gerontology center makes to solving all these problems.
– Our center conducts scientific work in two directions. The first topic is aging medicine. We can treat elderly people, we know how to treat them, and we know how to preserve their quality of life and how to prolong their life. We have doctors who have been trained and specialized in the treatment of very elderly people. We operate on people aged 90 and older. We recently had an operation on a 96-year-old patient, her hip joint was prosthetic. When we were a crown hospital, we had patients both 95 and 97 years old. We have also successfully nursed them.
Another direction is gerontology, the science of aging. We are engaged in translational research in the field of aging, and in this sense we are a unique and only center in Russia. We do not work with experimental animals, but work in a clinic, trying to evaluate the achievements that were obtained in the experiment and transfer them to the clinic. This is called translational medicine.
We have a number of scientific laboratories. Laboratory of Cardiovascular Aging, Laboratory of Metabolic Aging and Endocrine Age-associated Disorders, Laboratory of Aging of the Musculoskeletal System, Laboratory of Clinical Pharmacology and Pharmacotherapy. We are engaged in the study of medicines, the issues of their influence on the aging process. We have a translational medicine laboratory. We keep our own register of centenarians and super-centenarians. We study models of healthy aging. It is very important that such studies be conducted here in Russia, because in every country there are factors such as traditions, dietary habits, lifestyle, genetics that significantly affect the health of the population and the mechanisms of aging. We cannot unconditionally broadcast the research results obtained in other countries.
For example, the gut microbiota and aging are a new and very promising area of scientific research. Millions of microorganisms live in our intestines, about which we do not know everything.
When new methods of studying the gut microbiota appeared, we saw that this is a huge number of microorganisms with their own unique set of genes. They secrete a huge amount of biologically active substances, which then affect our health, our life expectancy. Today it is already known that the microbiota of centenarians has its own characteristic differences. Once Mechnikov said that you need to drink kefir to live for a long time, and it turned out that this is correct to some extent. What we eat affects our life expectancy.
– Olga Nikolaevna, what else do you need to do to prolong your healthy life, besides eating fermented dairy products?
– First, we need to remember one simple thing: aging begins with the prenatal period. A person has not yet been born, and he already has the speed of aging. And this speed depends on two factors: the uniqueness of the genetics of the fetus itself and the health of the mother. It depends on what her blood pressure is during pregnancy, metabolism, fetoplacental blood flow, how well the blood supply to the placenta is going, and so on. Therefore, when couples are just planning a pregnancy, it is very important that a woman follows a healthy lifestyle.
In general, the sooner we understand that a healthy lifestyle is an important component of longevity, the better. It's very trite, what I'm going to tell you, but, nevertheless, it's true. Quitting smoking, alcohol abuse, weight control, blood pressure, cholesterol, motor activity – you can't live without it for a long time. If you want to be healthy, move. You can't think of anything better here. All anti-aging programs that are sold very expensively somewhere in elite clinics in Switzerland are, among other things, programs for the introduction of drugs that increase strength and muscle mass. The smaller the mass and strength of your muscles, the faster you will age. Muscles are an endocrine organ that secretes a huge amount of biologically active substances. And when you move, a lot of anti-inflammatory mediators are released.
Nutrition is equally important. If a person eats unlimited and harmful foods, of course, it is also very difficult to talk about longevity. It has already been proven that you need to eat at least 500 grams of raw vegetables and fruits a day. This is fiber, this is what cleanses our body. You need a sufficient amount of proteins, fats, carbohydrates. Everything has to be balanced.
The amount of vitamin D must be controlled, especially with age: the older a person is, the worse vitamin D is produced in his skin. And, as a rule, we need to give vitamin D supplements. We need to monitor the level of vitamin B, the deficiency of which occurs with age due to a violation of absorption in the gastrointestinal tract.
It is a well-known fact that the profession affects life expectancy. For example, conductors have a long lifespan. It is generally known that the higher the level of education, the longer a person lives. On the one hand, basic education is important, and on the other hand, as I have already said, we must continue to learn something all the time, we must not be lazy. Be sure to learn something new every day.
– For example, I learned a lot of new things today, I can give myself a plus sign. What role does stress tolerance play here?
– Stress is an interesting phenomenon. Stress for a long time, causing anxiety, has adverse consequences. Short-term stress, but strong, is also very dangerous for health. But it is necessary to distinguish stress from situations that we perceive as stress, but this is only an incentive for development, activation of adaptation processes, for example, excitement before a public speech.
Resistance to "bad" stresses, the ability to quickly get out of a state of stress, is of great importance. At our clinic, consultations are currently being conducted on healthy people in order to assess their biological age and develop an individual plan aimed at preventing aging. Psychologists who determine resistance to stress must also participate in this consultation. We underestimate the impact of stress on aging and the development of diseases. If a person plunges into his stress, this leads to a breakdown of regulation and diseases. The ability to control yourself, to manage your psychoemotional state is extremely important. Despondency, as you know, is considered a mortal sin, it shortens life.
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