Floating the longevity balloon

Poets, philosophers, writers and scientists have all been fascinated with the idea of immortality and have approached this age-old quest in their own ways.

While living forever is not possible, addressing specific metabolic profile parameters can increase lifespan (the number of years someone lives) and more crucially — healthspan — the number of years of healthy living without chronic disease.

The science of longevity and preventive healthcare includes genetic testing, recommendations on diet, nutraceuticals (supplements, bio enzymes), exercise, sleep, and emotional health. For many, anti-ageing is a rabbit hole that no one really knows leads to where. What’s more, to enter this so-called rabbit hole, one may well have to break the bank! Consider the 45-year-old American entrepreneur and venture capitalist Bryan Johnson who reportedly spends $2 million a year on anti-ageing treatments and claims that his biological markers have indicated that he is now five years younger than his physiological age. Prof David Sinclair, author of Lifespan and professor of genetics at the Harvard Medical School says he has inculcated into his life the practices he has been researching and they have made him 10 years younger than his ‘real’ age.  

Such claims aside, while researchers are aware that no single magic bullet will make us live ‘forever’, increasing healthspan is possible, with a few caveats. Healthspan as opposed to lifespan is living a longer life without chronic disease. The science of it all is still nascent and is currently beyond reach for most of us. While the West has embraced longevity research enthusiastically, especially due to the billionaire boost the concept has got, it has yet to find any breathing ground in India. However, more than the promise of an eternal ‘fountain of youth’, what research on longevity can do is shift the focus to preventive and pre-emptive medicine rather than curative treatments. This shift in focus is what a country like India, with its abysmal public healthcare systems, will perhaps benefit from. 

How does preventive care work?

Preventive care is primarily about addressing metabolic changes by testing for biological markers. “Metabolic disorders are the main cause of disease. How our metabolism can get rid of toxins and utilise the nutrition pool available is key,” explains Darshit Patel, founder of Decode Age, a Bengaluru-headquartered longevity research company.

Bestsellers like Life Force by Tony Robbins, and Outlive by Dr Peter Attia delve into this much-ignored yet deeply relevant aspect of preventive medicine. Dr Attia calls it medicine 3.0, as opposed to our current medicine 2.0 which treats human frailty. This search for an elusive elixir begins with testing for healthspan — instead of waiting for the disease to strike. The idea is to test the genome, epigenome and microbiome and imbibe changes accordingly, thus potentially preventing the disease. Crucially, preventive healthcare is not just about identifying markers and popping pills, as is popularly believed. Mostly it is about eating right, adequate exercise and healthy living. Surely, living a healthy life in your 90s ought to be inspirational enough, is it not?

Currently, hospitals in India do not offer any preventive care. Still, a few start-ups are “getting conversations started on preventive and healthspan screening,” says Dr Vishal Rao, surgical oncologist at a leading hospital. 

The science behind it

The epigenome and microbiome control the human genome — and our genes are like switchboards, says Dr Rao. “Our genes are like the keys on the piano. The question is who plays them and in what tone?”

Thus testing epigenetics and microbiome can shed light on the cellular processes. “Something is happening within the body between ages 20 to 40 allowing diseases to grow. What if we can prevent damage by reading the signs early? Let’s target ageing from a preventive healthcare perspective; we measure biological ageing with a DNA methylation test — a tool being used worldwide to measure biological age,” says Shah. Epigenomics (how the environment is affecting our genes) is the first step. “Since all diseases start metabolically in the gut — the microbiome test helps scientists go into the depths and analyse deficiencies, levels and how they relate to the heart, brain, kidney etc,” he adds. Essentially, this process encourages us to be proactive and not reactive regarding our health.

The need for a genomic profile

Aditi Shetty, 36, was diagnosed with inherited type 1 diabetes at 24. Today, she carries an insulin pen, which has drastically changed her lifestyle, yet there are days when it depletes her sunny persona. Contemplating a microbiome and epigenetic test, she says it, “will help me understand my gut health, since I also have thyroid.”

When Ayesha Lobo recently went to a diagnostic lab, she had a scare — her cervical cancer marker was in the red. Her trusted doctor was quick to refute the result. Testing is great, but it can scare people, and be counter-intuitive. “Since the science is nascent, technicians could be inexperienced to test such genetic markers; there is a need to improve diagnostics and personnel,” she says. In another case, the tests revealed heart blockages and a 56-year-old man underwent immediate angioplasty, probably saving his life.

Supplements, nutrition and nutraceuticals, lifestyle changes, adequate sleep, muscle strengthening, cognitive tasks and a focus on emotional health (most important but overlooked) are recommended after genomic profiling. Shah’s team also adds activities to increase neuroplasticity, “if you are right-handed, use the left. Do the wrong things right. This improves neuron function. These are simple tricks to manage ageing-related cognition,” he explains.

What Indians are doing wrong

The traditional Indian diet has high carb and sugar content, overcooked vegetables in seed oil, not to mention late dinners and sedentary living. Reducing the consumption of processed foods, sugar, red meat and having a light early dinner and exercising 200 minutes a week can go a long way. The biggest hurdle for Shah, even with his parents, is the mindset that ageing is inevitable and one has to grimace and bear it. “The day we get sick, we see the doctor. We treat the symptoms, creating a veil,” he says.

According to Tony Robbins, muscle strength is considered a vital sign now. Increasing strength and bone density can help make the 80s the new 60s. Sleep is also largely overlooked, and many NIH studies are terming the lack of it a silent killer. “Eight hours is key. A lack is a precursor to illness,” says Dr Deepak Saini of the IISC’s Longevity Lab.

“Being fit and being healthy are not mutually inclusive. Being fit does not mean being healthy. The quantum of “fit” individuals who died while gymming is proof. Visceral fat is the most important game changer today as it determines how your body is going to adapt to various diseases. Visceral fat cannot be burned by exercising, it is only burnt by fasting,” says Dr Rao.

Can we reverse ageing?

Dr Deepak Saini has been studying ageing for over 12 years. Exploring the ageing phenotype, and why at 40 our cells start to deteriorate, Dr Saini speaks about the inevitability of cellular senescence (irreversible cell cycle arrest with age) and looks at molecular players which can indicate where the damage occurs in a cell.

These empirical measures of ageing show the weakest link dictating systemic ageing. “When one’s physiological ageing differs from chronological, decline begins. My group has been interested in discriminating between these two features by using molecular markers, to predict the physiological age of an organ. With epigenomic and microbiome testing, pertinent interventions can help reverse some damage,” says Dr Saini.

A rich man’s prerogative

The epigenetic test can cost up to Rs 18,000 and the microbiome Rs 9,000, but efforts are being made to reduce costs, to make them accessible to all. That said, anti-ageing tests are likely to remain a rich man’s endeavour for a long while. Doctors also caution about too much testing and advise prudence. The brain tends to focus on the negative, thus testing can also add needless worry. And if you think an unhealthy lifestyle can be erased by testing, and following recommended protocols, think again. Health begins with how you live.

A centre for longevity in the offing?

The Karnataka government recently initiated discussions with longevity experts from the Indian Institute of Science, and others to form an Indian Centenarian Consortium with its own Centre for Longevity and longevity clinics. The ICC hopes to address ageing by roping in centenarians for research. Recent (and evolving) data shows 20,000 centenarians in Karnataka, making it a veritable blue zone.

As India grapples with disease care and treatment delivery, the ICC would aim to shift the conversation from illness to wellness, address aspects of biological ageing, and look for possible disease reversals. The fundamental shift would be to look at primary and secondary prevention — at both the policy and individual levels. The idea is to diagnose early — evidently, just working on treatment and building hospitals is not the answer to the healthcare crisis the country is currently facing.

Challenges of an ageing population

India has more than 50 per cent below 25 and more than 65 per cent below 35, according to the World Population Prospects 2022 published by the UN Department of Economic and Social Affairs. This 'youth bulge' is predicted to last till 2025. In some decades, India will, naturally, have to deal with an ageing population. Age-related decline will put an immense burden on the already rickety healthcare. A declining fertility rate, and a low retirement age of 58-60 when compared to Spain and Italy’s 66-67, for instance, will also exacerbate this problem. Several research reports pegged the global longevity and healthspan industry market size at $67.2 billion in 2023 and predict that it will touch $98.6 billion in 2028.