Aging, says professor Andrea Maier, is a disease that can be treated. But then you don’t have to wait for the decline to start.
Our healthcare is a care of the sick, says Andrea Maier. “Doctors wait for the ailment to show up. When a man of say fifty years comes to the doctor for an annual check-up, the result is often: fine, all values are normal. Please come back again next year. Until they are no longer normal and the man has diabetes. In most men of fifty, those values are no longer okay, they have steadily gotten worse. Medicine assumes that this decline is part of it, but in my profession we say: we should not wait for the values to be abnormal, we should strive for them to be optimal.”
Andrea Maier is a professor of aging, but she says she is involved in longevity medicine. “Aging is a disease that can be treated. If you see that someone’s sugar level is rising, you can reduce the risk of diabetes with changes in behavior and lifestyle and thus extend someone’s healthy lifespan. That is important for that person and for healthcare in general. A large part of the costs is spent on age-related diseases.”
Andrea Maier (Aurich, Germany, 1978) is an aging researcher and professor of gerontology at the Free University in Amsterdam and professor of internal medicine and geriatrics at the University of Melbourne, Australia. She is also director of the Healthy Aging Center in Singapore.
She receives in a fantastically restored shipyard in Zoeterwoude – “we have also given our house a rejuvenation treatment”. Outside, dog Fritz jumps enthusiastically against the French doors, inside she serves tea with apple turnovers and strawberries. “I bought one because it tastes so good, the other because of the health benefits. Did you know that strawberries contain a substance that may prevent aging? You have to eat a lot of strawberries for it to take effect, like a pound a day. But you could concentrate the substance in a pill.”
The body
Zeitgeist makes the body shine this summer. In the coming weeks you will read about the benefits of bare feet, how old we will become, lanky bodies and how beautiful we really are.
Five years ago she gained fame with her book Eternally sustainable. Media paid a lot of attention to her claim that life expectancy in the Netherlands will increase considerably. According to her, anyone born in the middle of this century would have an average of 110 years ahead of them. And a few even 140 years. But that was not her main message. It was her concern that people grow old healthily. That they can counteract the decline. Check your own oil level more often, was her motto.
Isn’t aging or deterioration just a natural process? Something you should not want to influence with medical interventions?
“I don’t know what you mean by ‘natural process’. I never use that term. It is true, aging exists, it is accompanied by phenomena that become more common with increasing calendar age. But there is a jellyfish that doesn’t age, at least we don’t see it. And the naked mole rat can live to be thirty years old, while the common rat can live up to five years at the most. So what is natural? I’ll be the last to say we don’t have to age. But that doesn’t mean we can’t slow down or reverse the process.”
What exactly do you mean by aging?
“That’s very simple. Aging is the damage that the body incurs during use. The scratches you see on the outside, such as the wrinkles and gray hairs, are also on the inside. Organs that no longer function properly due to the damage. The connective tissue has also become less, muscles are weaker, cells no longer communicate well, proteins are not folded properly.
“Look, as soon as the body asks something from a cell, such as: contact other cells, it springs into action and that causes irreversible damage. The question is: how well does a cell deal with this? Usually, when the damage is too great, cells are cleared by the immune system, but sometimes they go into a kind of hibernation state. They no longer divide, but they still secrete substances that the immune system is attracted to. This gives rise to inflammatory reactions that damage the healthy cells around it. That’s how the problems pile up. Older people have proportionally more of these dormant, or senescent, cells. And these are a cause of many diseases of old age such as arteriosclerosis, dementia or cancer.”
So aging is an accumulation of cells that no longer function?
“That’s one of the mechanisms. We know nine! Aging is also a result of changes in the DNA, in our genes. In epigenetics, to be exact. We have all been given genes at birth, but these can be switched off, depending on our behaviour, for example because a so-called methyl group blocks everything. Then you may have the gene that your immune system needs to fight viruses, but then the gene no longer works. The amount of epigenetic changes is a measure of aging. But you can also measure aging by the quality of the stem cells, by the lipids in your blood, or by the folding of your proteins.”
You can therefore read from all those processes how much someone is aging.
“Yes, we can even put a number on it. How old is the body really, what is the biological age? Large cohort studies have been conducted to examine the relationship between age and the risk of certain age-related diseases. And how that relates to those values, such as the amount of sleeping cells or epigenetic changes. This has resulted in a calibration curve, a biological clock that indicates whether someone is older or younger than their calendar age.”
If I understand correctly, you can distinguish different clocks in my body. Are they somewhat synchronized?
“Interesting question. A few years ago we thought so. These studies show that the differences between people are greater than between the clocks within one person. But they are not completely synchronized. I myself am 44 years old according to my passport, but according to most clocks my biological age is 39. Except when I look at my immune system. Then I’ll be 47. I knew that weakness, I have some allergies, I’m prone to infections, but now I can quantify it.
“And I could do something about it, but first I want to know what works and what doesn’t. In terms of outdated defenses, the evidence is still weak.”
But can you reduce aging, can you repair damage?
“Of course it is. It starts with getting rid of that black-and-white thinking from conventional medicine. That you are healthy as long as you are not sick. We must learn to maintain our bodies. Just as you regularly service your car and change the oil, you also need to keep your body in shape.
“That can be done with supplements or medicines, but it starts with a healthy lifestyle. I find it almost unethical to prescribe medication or give a new knee to someone with adult-onset diabetes or a worn-out knee before you have helped that person exercise more and eat healthier.
“There is a lot to be gained from that lifestyle. If the average Dutch person were to switch from a Western diet to an optimal diet, his health would improve enormously. A 60-year-old gets an average of six more years. An octogenarian still three years old. There is a lot of scientific evidence for that.”
A healthy lifestyle
The body needs high-quality nutrients. But we don’t feed on that, says Andrea Maier. “We put bread, chocolate or pizza in it. It’s amazing that the body can do something with that. We do not see food as the main source of maintenance of the body.”
The optimal diet does not include red meat, she says. “Minimum amount of white meat and little fish. Many legumes, on the other hand, and also many fruits and vegetables. A handful of nuts a day and water and tea.”
And it matters when you eat it. “We often eat throughout the day. As a result, the body does not get the chance to repair damage. Damage from digestion, but also from all other cell activities. So it is good to fast intermittently, for example by not eating for 16 hours every day. A lunch and an evening meal and nothing else. That works.”
It is also important to get enough exercise. How much is not so clear. “We know that with every extra step, the risks are reduced on all fronts, both physically and mentally. How much exactly? Ten thousand steps a day sounds nice, but there is no scientific proof for that number.”
According to Maier, we need to create an environment in which it is fun to go to the gym or go for a walk. “Now you know why we have a dog.”
Ultimately, it is everyone’s responsibility to keep the body healthy. “People tend to put their fate in the hands of their doctor. “Doctor, what are you going to do?” No, do I say: ‘What are you going to do?’ Most patients do not find a visit to their doctor satisfactory until they receive a prescription. I did that once. I wrote down a block three times a day. On foot. Are you serious, doctor? That’s when the conversation really got going.”
What about those supplements and drugs? Is there evidence for that too?
“Fewer. Dozens of natural substances are being investigated that could delay aging. Just like existing drugs that may have a beneficial side effect. Take lithium. That is an anti-psychotic drug that is also in drinking water because of this application. In neighborhoods with high concentrations of lithium, people seem to live longer. But is that because of the lithium?
“Another example is the alpha ketoglutarate, not a drug, but a natural substance that is part of the citric acid cycle. Recently there was a study in which subjects had taken this drug for seven months. According to their biological clock, they were eight years younger.”
Eight years younger? By a dietary supplement?
“We also found that to be a very large effect. We have decided to repeat that study.”
Doesn’t that contradict your basic idea? That you prescribe medication to people to prevent them from getting sick and needing medication?
“You think that’s unnatural? I find that a difficult one. It’s almost a semantic discussion. Is it natural for my body to age? My point is that we learn how to keep our bodies in the best condition.
A greater danger, I think, is the proliferation that is emerging. Many companies offer tests to determine biological age. There is also a lot of demand for it. Just like their rejuvenation cures. I don’t want to pass judgment on those companies, but evidence for those cures is still lacking. There is no indication whatsoever that a blood infusion or stem cell therapy has any effect. But there is a danger that this field will be cast in a bad light due to some incorrect applications. On me and my colleagues is the heavy burden of living up to the fact that we can treat aging.”
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Previous articles in this DST series on The Body:
Why journalist Rick Pullens would like to be a fish
How Daniël Rovers (46) became addicted to ‘The Netherlands on the move’