Is it possible to overcome aging and not to get sick? What factors lead to aging and can they be "reversed"? O.N. Tkacheva, Director of Russian Gerontological Research and Clinical Center of N.I. Pirogov Russian National Research Medical University, Chief Geriatrician of the Ministry of Health of Russia, discusses these issues.
Olga Nikolayevna, you have been Russia's chief geriatrician since 2015, and in 2018, our president Vladimir Putin, as they say, gave us the order to live a long life, ordering doctors and scientists to focus on solving the problem of life expectancy of Russians. Did this decision of the president scare you, tell me honestly?
No, it did not, because life expectancy worldwide has been increasing over the past decades, increasing by about three years every ten years, which means that over the past 100 years average life expectancy from birth has increased by 30 years.
Naturally, this is due to advances in technology, medicine, pharmaceutical production, but also to improvements in the quality of life in general, comfort, water and nutrition, making our lives safer. The understanding of the importance of a healthy lifestyle and preventive measures is becoming clearer and clearer. By the way, in the context of coronavirus infection, I can say that vaccination has made a significant contribution to increasing life expectancy. So today, when asked whether to be vaccinated or not, the answer is unequivocally yes. Vaccination is the prevention of infectious diseases, and the prevention of non-infectious 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 say that humanity is getting healthier?
This is a very good question. When we discuss the topic of increasing life expectancy, we consider and forecast various options. One of them is an increase in life expectancy, an accumulation of age-associated diseases and an increase in the period of life with disease. We are concentrating on the treatment of diseases. But we need another scenario: an increase in the length of a healthy, active life, and this is achieved through prevention. This is the path the world is taking right now.
Indeed, we are moving towards a good scenario. The period of life with disease remains stable. The period of active life is growing. You can see this by watching the characters in old movies: a 40-year-old man in the post-war 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 strive to be active, to maintain a youthful appearance. While we used to apply the term "healthy aging," that is, aging without disease, now there is the concept of "successful aging. Successful aging implies a healthy appearance and an aspiration to 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 actively develop?
Unfortunately, we are not immortal and talk of immortality seems to me fantastic and speculative. It is necessary to set realistic goals, which we can achieve. But we need to understand that their realization requires new approaches, new technologies and knowledge. Longevity depends on genetics. There is heredity on longevity in the family. It is known from scientific research that longevity is inherited through the maternal line.
Olga Nikolayevna, what do you think about the theory that aging is a program breakage and that if we fix this breakage, we will stop aging altogether, like some trees which live 1000 or more years?
I don't yet see any reason to think about 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 humanity, this would not be a good thing in general. Aging is a somewhat programmed process.
Natural?
Yes, it is natural. But the rate of aging can be different. It can be accelerated or it can be slower. There's a term called "neglected aging," where a person enters a zone where they almost don't age. This is usually people over the age of 90.
There are so many theories of aging. They all have some kind of evidence and their weaknesses. There is no one undisputed theory that everyone agrees on. This suggests that the aging process is very complex. But all theories, for all their differences, can be connected by one principle. Yes, mistakes happen, but do we correct them or not? Is the error correction system working for us or not?
If there is a breakdown at the cellular level, the body has to fix it itself. But at some point the systems of recognition and protection don't work, and the damage remains, errors accumulate, and the functioning of the organism 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 maintain or incorporate an error correction program.
More than 500 such genes are responsible for aging. There are aging genes and anti-aging genes, that is, genes that promote age-associated diseases and, therefore, aging, and genes that, on the contrary, protect us from disease and aging.
So it turns out that it is the protective genes that are more important. We live, sometimes we get injured, we don't eat right, we constantly experience negative environmental influences. It's important that our internal systems are set up to protect, repair, and correct mistakes. And this is the way to maintain and improve these systems, I think, that we have to go, conduct scientific research and develop new approaches to treatment.
And how can we do that? How can we influence the improvement of this error correction system?
In the future, it will be genetically engineered technology. Right now, we can medically intervene in this process. In fact, we are treating disease in a way that helps our body to correct this error. Maybe the technology will change, improve, we will learn how to turn on the protective genes and turn off the genes that are destroying the body. I'm a clinician, I'm a doctor, I see patients with premature aging, or vice versa, with delayed aging, I see age-associated diseases, I know the drugs 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 basic research, experimental work, and today we already have interventions in experiments that can increase the lifespan of, for example, mice by 30 percent or more of their average lifespan. That's a significant increase in longevity. But we need to somehow transfer this to the clinic, and use it to treat people.
It's very tricky, because a person's disease occurs over a certain period of time, and we can only fix some end points. When we look at human aging, it's a lifelong process, and every study has to go on for a lifetime. So we only have experimental studies on mice or other subjects that end literally within a few months.
In observations involving humans, we can estimate a person's biological age rather than their passport age in order to assess how our interventions affect their biological age.
Does the presence of disease always affect a person's lifespan?
These factors are far from always interrelated. For example, one elderly patient may have many diseases, take medications, but still be in good shape, go to work, go to concerts, walk, do Nordic walking, and so on. And the other patient, who may be even younger in his passport, has a smaller set of illnesses, but already has dementia or age-related weakness, and 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. You shouldn't confuse disease and aging. Geriatricians know how to diagnose these conditions and know where there are aging problems and diseases.
Olga Nikolayevna, let's talk about the breakdowns in the body which occur most often. It's clear that these are cancer and cardiovascular problems, which you work with quite closely as a scientist. How urgent are these problems for our country and for all of humanity? What conclusions do you draw from these studies?
Indeed, cancer pathology is one variant of aging: the control of cell division is broken, pathological cells start to divide uncontrollably. In cardiovascular diseases, on the contrary, the replicative activity of cells decreases. The pathogenesis of cardiovascular disease 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, there is a lot of connective tissue in the vessel wall.
Both conditions lead to the fact that organs and tissues do not receive a proper blood supply and begin to function improperly. The blood supply to the myocardium is disrupted - coronary heart disease develops. Blood supply to the brain is disrupted, cell oxygenation decreases - cerebrovascular and neurodegenerative diseases develop, including Alzheimer's disease.
Against the background of aging and accumulation of errors, systemic inflammation syndrome begins, the anti-inflammatory system fails to cope, C-reactive protein levels increase. 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?
Certainly, yes, because acute inflammation in covid infections in some cases turns into autoimmune processes, in which the body begins to produce protection not against the coronavirus, but against its own cells. In general, any autoimmune process accelerates aging due to this inflammatory process.
Here we are back to talking about aging theories. The inflammatory mechanism is one of them. Another theory is the metabolic theory, where 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 are also people with insulin resistance syndrome and early vascular aging. Diabetes mellitus is a model of premature aging. You never diagnose diabetes in 100-year-olds. They usually don't have obesity. They may be overweight or even mildly obese, no more than grade I. People with morbid obesity or severe diabetes do not live to be 100 years old.
Why does everyone age in different scenarios?
People differ in many biological indicators, habits, life histories and diseases. There are also different aging patterns. Some people develop a heart attack, some people have a stroke, some people have Alzheimer's, some people have cancer, some people have chronic obstructive pulmonary disease with emphysema, with pneumosclerosis, some people have deforming osteoarthritis and osteoporosis. Many have several diseases, all variants are intertwined, but initially there are probably common mechanisms of development of this or that pathology.
Gerontologists say that we should start to act earlier, at the stage of pathological mechanisms' formation. Now we are dealing with prevention of diabetes, cancer, heart attack and so on. And our task is to look at these common factors and prevent not age-associated diseases, but aging itself. That would be more effective. But we do not know how to do this yet.
Olga Nikolayevna, when talking about long-livers, you said that these are people who, as a rule, do not suffer from severe obesity or diabetes. What other features do they have in common? Can we isolate them?
Yes, long-livers have common traits, and it's very easy to name them. We can analyze the so-called "blue" zones where people live long lives - Sardinia, Costa Rica, California, Nicoya, Okinawa in Japan, where there are a lot of 100-year-old people. I have been to Okinawa, Japan, visited with fellow gerontologists a village of long-livers. It was an unforgettable experience and a very rewarding experience.
How interesting!
Yes, we went to visit a long-lived woman. Her mother died at the age of 109. All of this woman's brothers and sisters also lived (or are living) very long. 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, no helpers. When we visited her, she had a dance class. She dances every day, and she likes it very much. And in general, she is very active. She is small, skinny, active. Eats very little. She is very friendly. When I asked her: "What would you like? What plans?" she said, "I'd like to travel, visit my grandson. He lives in Tokyo, and I'd like to visit him."
She doesn't go to doctors. But medical care for long-livers is well organized. She has prosthetic teeth. She had cataract surgery, artificial lenses installed, and her vision is very good.
These are very important geroprotective techniques. Vision decreases with age, it entails rapid aging. We need to restore vision as early as possible. This is the key to a longer life expectancy. She wouldn't live 100 years if she couldn't see or chew.
Social activity is very important. In this village of long-livers, the atmosphere is very friendly, our interlocutor spends a lot of time on the outdoor terrace of her house, communicating with neighbors.
Let's talk about the contribution that your gerontology center makes to solving all these problems
There are two areas of research at our center. The first topic is the medicine of aging. We can treat the elderly, 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 are trained and specialize in treating the very elderly. We operate on people 90 years and older. We recently had an operation on a 96-year-old patient, and we prosthetically replaced her hip joint. When we were a coronary hospital, we had patients aged 95 and 97. We successfully nursed them, too.
Another field is gerontology, the science of aging. We are specifically involved in translational research in the field of aging, and in this sense, we are unique and the only center in Russia. We don't work with experimental animals, we work in the 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. Cardiovascular aging laboratory, metabolic aging and endocrine age-associated disorders laboratory, musculoskeletal aging laboratory, clinical pharmacology and pharmacotherapy laboratory. We study drugs and how they affect the aging process. We have a translational medicine laboratory. We keep our own registry of long-livers and super-long-livers. We study models of healthy aging. It's very important that such research takes place here, in Russia, because in every country there are such factors as traditions, nutrition, lifestyle and genetics, which have a considerable influence on the health of the population and mechanisms of aging. We cannot unconditionally translate the results of studies obtained in other countries.
For example, the gut microbiota and aging is a new and very promising area of research. Millions of microorganisms live in our intestines that we don't know everything about.
When new methods of studying gut microbiota appeared, we saw that this is a huge number of microorganisms with their own unique set of genes. They secrete a huge number of biologically active substances, which then influence our health, our life expectancy. Today it is already known that the microbiota of long-livers has its own characteristic differences. Mechnikov once said that it is necessary to drink kefir in order to live a long life, and it turns out that this is correct to some extent. What we eat affects the length of our lives.
Olga Nikolayevna, what else should you do to prolong your healthy life besides drinking yogurt?
First of all, we should remember one simple thing: aging begins in the fetal period. The person is not born yet, but he has already laid the rate of aging. And this speed depends on two factors: on the uniqueness of the genetics of the fetus itself and on the health of the mother. Her blood pressure, metabolism, fetoplacental blood flow during pregnancy, how good is the blood supply to the placenta, etc. Therefore, when couples are still planning a pregnancy, it is very important that the woman maintain a healthy lifestyle.
Generally, the earlier we understand that a healthy lifestyle is an important component of longevity, the better. This is very trivial, what I will tell you, but nevertheless, it is true.
Not smoking, not abusing alcohol, controlling weight, blood pressure, cholesterol, being active - you can't live a long life without it. If you want to be healthy, move. You can't do better than that. All anti-aging programs, which are very expensive sold somewhere in elite clinics in Switzerland - are, among other things, programs for the introduction of drugs that increase strength and muscle mass. The lower your muscle mass and strength, the faster you will age. Muscle is an endocrine organ that secretes a huge amount of bioactive substances. And when you move, a lot of anti-inflammatory mediators are released.
Equally important is nutrition. If a person eats unrestricted and unhealthy foods, of course, about longevity is also very difficult to talk about. 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 enough proteins, fats, carbohydrates. Everything has to be balanced.
The amount of vitamin D must be controlled, especially as we get older, the worse vitamin D is produced in our skin. And, as a rule, we have to give a supplement of vitamin D. It is necessary to watch the level of vitamin B, the deficiency of which comes with age because of impaired absorption in the gastrointestinal tract.
It is a well-known fact that occupation affects life expectancy. For example, conductors have a longer life expectancy. It is generally known: the higher the level of education, the longer a person lives. On the one hand, basic education matters, but on the other hand, as I said before, you must continue to learn something all the time, you cannot be lazy. Every day you have to learn something new.
For example, I learned a lot today, I can give myself a plus sign. What role does resistance to stress play here?
Stress is an interesting phenomenon. Stress over a long period of time, causing anxiety, has adverse effects. Stress that is short-term, but severe, is also very dangerous to health. But we must distinguish between stress and situations that we perceive as stress, but it is only a stimulus to develop, to activate adaptation processes, for example, excitement before a public speaking.
Resilience to "bad" stresses, the ability to get out of a state of stress quickly, is important. In our clinic, relatively healthy people are currently being counseled in order to assess their biological age and develop an individualized plan aimed at preventing aging. Psychologists are also necessarily involved in this counseling to determine stress tolerance. We underestimate the impact of stress on aging and the development of disease. If a person is immersed in their stress, it leads to dysregulation and disease. Knowing how to control oneself, how to manage one's psycho-emotional state is extremely important. It is known that dejection is a mortal sin, it shortens life.