… Growing Older without aging
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the New Science of Growing Older without Aging


The Life Extension Revolution


Philip Lee Miller, M.D. with

Monica Reinagel

Health &
Fitness | Bantam
Hardcover | May 2005
26.00 | ISBN 0-553-80353-0



Chapter 1

A New Role for Medicine

Every man desires to live long, but no man would be old.


—Jonathan Swift

Brian became a patient of mine about three years ago. He was 47 years old.

He came to see me not because he was sick but because he wanted to feel

better. Brian had built a successful software consulting firm and had

worked hard to keep his business going while the high-tech industry went

through difficult times. Now he was looking forward to enjoying the fruits

of his labors. “I feel like the next twenty years should be the best of my

entire life,” he told me, “and I want to be in good health. No, in the

best health possible.”

By all conventional measures, Brian was in fairly good health already.

Nonetheless, he felt that he was slowing down. He wasn’t planning to

retire for another ten years or so, but he was finding it harder and

harder to stay focused and motivated at work. His sex life with his wife

had tapered off. To add insult to injury, he noticed that his hair was

getting thinner at about the same rate that his waistline was getting

thicker. In short, Brian was experiencing physical and mental changes

typical for someone his age.

Tina first consulted me at age 66, a little over a year ago. Like Brian,

she wasn’t sick but was sure she could feel better than she did. Tina is a

gregarious, widely traveled woman who has always loved meeting new people

and new challenges. She’d been looking forward to her retirement as a time

when she’d be free for travel and adventure. But she’d noticed that she

had begun to have trouble remembering details and names and felt more

easily fatigued. “I hate feeling like a befuddled old woman,” she said.

“It’s just not who I am!”

Widowed eight years before, Tina was still a warm and vibrant woman with a lot to offer. She was open to the possibility of meeting someone to enjoy
her later years with. But she was becoming less confident about her appearance. She felt that she looked older than she was—and certainly
older than she felt. Although everything Tina described was fairly normal a 66-year-old, she was frustrated and upset by the changes she was


Both Brian and Tina wanted to know what anti-aging medicine could offer.


Twenty-five years ago, it probably wouldn’t have occurred to someone in or Tina’s situation to seek help from a doctor. It would have been
even harder to find a doctor who would have known what to do for them. Neither one of them was significantly overweight; neither smoked or drank
to excess. Because they took reasonably good care of themselves, neither was suffering (yet) from heart disease, diabetes, or other conditions that
might require treatment. By conventional standards, there was nothing wrong with them. They were in acceptable health . . . for their age.

By those standards, people such as Tina and Brian could do little besides for the aging process to unfold, and hope for the best. Along the
way, doctors would assure them that aches and pains, failing body parts, and increasing weakness and frailty were simply a normal part of the aging
process. As the diseases of aging (heart disease, arthritis, osteoporosis, diabetes, Alzheimer’s disease, prostate cancer, etc.) set in, drugs would
be prescribed to manage them.

Most people are accustomed to this style of medicine—and this rather view of the aging process. Anti-aging medicine, on the other
hand, takes an entirely different approach. Whereas the focus of medicine is on the diagnosis and treatment of disease, the
goal of anti-aging medicine is to promote optimal health and wellness throughout every phase of the human life span. This visionary approach is
built on four basic but radical principles:

  • Anti-aging medicine is functional. By this, I mean that we are not just

    concerned with what might be going wrong in your body. Instead, we aim to

    improve and rejuvenate every function of the body—making the body

    stronger, healthier, and more youthful.

  • Anti-aging medicine is preventive. Once full-blown disease has taken

    hold, even the best drugs and therapies sometimes offer only limited hope.

    Therefore, we take aggressive action to prevent the diseases of aging with

    nutritional and metabolic therapies.

  • Anti-aging medicine is holistic. Too often, the conventional medical

    system sees patients as a collection of parts to be fixed by various

    specialists. As a result, many people continue to feel lousy despite the

    fact that they have an entire team of doctors working on them. By

    contrast, anti-aging medicine takes a holistic view of the body and of

    each person. Each aspect of your health is considered and treated in view

    of the whole person.

  • Anti-aging medicine is integrative. Unfortunately, our medical community

    has been fractured into highly politicized camps, with a great deal of

    mistrust and even hostility between the conventional and alternative

    movements. There are some conventional doctors who insist that all herbal

    and nutritional remedies are snake oil, just as there are some alternative

    physicians who consider all pharmaceutical drugs to be poison. Of course,

    neither of these extreme statements is true, and this sort of dogmatic

    rigidity gets in the way of progress. Anti-aging medicine offers the

    distinct advantage of being truly integrative medicine. By remaining

    open-minded but science-based, we can combine the best and most effective

    therapies from conventional and alternative approaches.

It may indeed be normal for people to get weaker, slower, sicker, or more

forgetful as they get older. But I want something better for my patients,

and for you. No matter what your age or health status right now, my goal

is for you to experience a state of exceptional wellness, and to maintain

that healthier, more youthful state as you get older. That, in a nutshell,

is the goal—and the promise—of anti-aging medicine.


With both Tina and Brian, I went through the same steps that you will be

going through in this book, building a comprehensive anti-aging program

that was personalized for their individual needs. First, we analyzed every

aspect of their health, including hormone levels, nutrient status, organ

function, body composition, stress levels, disease risk factors, mood,

performance, and cognitive function. All of these factors are biomarkers

of aging. They indicate the functional status of your cells and organs and

reveal how quickly or slowly you are aging.

Based on this information, I developed programs for each of them. First, I

coached them on diet and nutrition, exercise, stress reduction, and other

lifestyle factors that are the foundation of an anti-aging program.

(You’ll find these discussed in detail in Part III.) Gradually, each of

them implemented a customized program of anti-aging nutrients and hormonal

supplements, based on the science and principles that we will be

discussing in the next chapters. Over the course of weeks and months, as

their cells, organs, and glands began to function better and better, both

Brian and Tina began to notice big changes.

Six weeks after beginning his anti-aging program, Brian was already

feeling on top of the world. He was fired up at work, instead of fighting

off the Monday (and often Tuesday and Wednesday) blues. He’d lost about 8

pounds, although he had not been eating any less, and reported that things

in the bedroom had taken off. “I feel like I did when I was a freshman in

college,” he said. Brian couldn’t wait to continue with the next levels of

the program. Three years later, he has met and exceeded every goal he set

for himself.

If you met Brian today, you’d probably guess he was at least ten years

younger than he is. Although his chronological age is now 50, I would

judge his biological age, as measured by his hormone profiles,

neurological function, heart health, immune status, organ function, and

body composition, to be somewhere between 38 and 43, and holding. Seeing a

patient experience this sort of metamorphosis is the reason I love

practicing anti-aging medicine.

Tina also felt a huge surge in energy during the first few weeks of her

anti-aging program. Over the next three months, she noted steady

improvement in her memory and recall and general mental clarity. Instead

of feeling her horizons narrowing, Tina felt that the world was once again

her playground.

Not only did she feel better, but Tina also looked younger as a result of

the anti-aging therapies she implemented. You could see the difference in

her skin, the way she moved, and her attitude. Coming back from a trip,

she told me that a man in the group who was ten years younger than she was

had asked her for a date! “I never thought I’d see those days again,” she

said. A year later, Tina says she hates to think what her life would look

like today if she hadn’t taken action against aging.

Throughout this book you will meet more people like Tina and Brian, who

not only feel and look years younger as a result of anti-aging therapies

but have also pulled themselves back from the brink of serious disease,

resolved lifelong health issues, and reduced or discontinued unnecessary

or harmful medications.

No matter what your age or current health, anti-aging medicine offers you

the same opportunity. With the program outlined in this book and the help

of a qualified anti-aging medical professional, you can rejuvenate your

body inside and out. You can vastly reduce your chances of disease and

disability. You can enjoy the most vibrant health of your lifetime.


The key to controlling the aging process lies in a better understanding of

how and why we age the way we do. Only then can we take steps to slow or

reverse that process. In just the past few years, we have gathered an

enormous amount of new information about how our bodies age. This insight

has already led to dramatic advances in effective anti-aging therapies,

with the promise of more to come in the very near future.

Aging, we have learned, is not just a matter of mechanical wear and tear,

cellular exhaustion, environmental toxins, or genetic programming. It is

not simply hormonal, nor is it caused entirely by free radical damage,

pathogens, or structural changes. And yet, all of these things play a


  • Cellular “programming.” To a certain extent, the decline in function and

    wellness we experience as we age is programmed by nature. The cells in

    your body are continually reproducing, replacing old and damaged cells

    with new ones. But every cell, even the ones that are newly formed, has an

    internal clock that remembers how old you are. That clock determines how

    that cell behaves, affecting how quickly the cell responds to messages

    from other cells and what quantities of hormones, enzymes, and other

    cellular chemicals are produced.

  • Biochemistry. As cellular behavior changes with age, the result- ing

    changes in biochemistry and hormone profiles have a sort of domino effect

    throughout the body. Your metabolism slows, and more fat is stored under

    the skin and around organs. The body breaks down muscle and connective

    tissue more quickly, while its rebuilding capacities slow down. The

    digestive system becomes less efficient at extracting nutrients from food.

    Cells and organs become less effective at detoxification functions. Nerve

    cells in the brain shrink and stiffen. The immune system becomes less

    vigilant against invading microbes or mutated cells.

  • Environmental influences. The effects of changing biochemistry on your

    organs and tissues are compounded by factors from the external

    environment. Every day, our bodies are bombarded by ultraviolet radiation,

    assaulted by free radical molecules, and exposed to a multitude of bugs

    and germs as well as natural and man-made toxins. All of these interact

    with our genetic “program” to speed (or slow) the aging process.

  • Heredity. In addition to the changes that are programmed to occur as we

    get older, we each also have a unique set of inherited genetic influences

    that affect how quickly or slowly we age, and may predispose us to certain

    diseases or conditions.

  • Lifestyle factors. Our daily lifestyle habits, such as how much sleep we

    get, how much stress we are under, and what we eat or don’t eat, also play

    a huge role in how our bodies cope with the internal and external factors

    that drive the aging process.

We’ll be discussing all of these aspects in greater detail in the coming

chapters. But even this brief outline shows that aging is a very complex

process involving many factors. Figure 1.1 on the following page shows how

these various factors interact with one another and flow down through

multiple, overlapping layers of cause and effect. Notice that the typical

symptoms and diseases of aging, seen at the very bottom of the diagram,

are actually the culmination of a very long process that begins much

earlier, long before we are old or even middle-aged.


Let’s make this abstract discussion a bit more concrete by looking at a

specific example of the aging process—one you can observe in the mirror.

As we get older, the smooth, firm, and unlined skin we all have when we

are young gradually becomes looser, less firm, and increasingly creased

and wrinkled.

Like all aging, skin aging is the result of a combination of genetic and

environmental factors. As we get older, changes in cellular behavior lead

to changes in hormone levels that cause the skin to become thinner. The

barrier function of the skin, which attracts and retains moisture in the

skin, also becomes less effective, making the skin drier as well.

Underneath the skin is a flexible support structure made up of collagen

fibers. But aging skin cells produce more collagenase, an enzyme that

breaks down collagen. At the same time, the cells become less responsive

to signals that tell them to increase production of fresh collagen.

Because the skin is breaking down collagen faster than it is replacing it,

the collagen layer underneath the skin begins to shrink and collapse. On

the surface, the skin becomes loose and spongy and begins to fold in on

itself, forming lines and wrinkles.

All of this is part of the genetic program for aging. The speed and timing

of your particular aging program will be determined in part by heredity.

But environmental factors greatly compound these genetically triggered

changes in skin function. Ultraviolet radiation from the sun further

stimulates the production of collagenase, the enzyme that breaks down

collagen. It also creates enormous numbers of free radicals in the skin.

That’s where lifestyle issues (diet and nutrition) come into play. If

there are sufficient antioxidant reserves in the body, excessive free

radicals are largely neutralized. But if nutrition is poor and antioxidant

levels are low, the free radicals can damage skin cell membranes, causing

changes in pigmentation that show up as age spots or darkened patches of

skin on the hands and face.

Of course, aging affects more than just the cosmetic appearance of skin.

It also affects its health and function. Many people, for example, spend a

lot of time outdoors in the sun when they are young. And yet skin cancer

is relatively rare in younger people. But as we get older, skin cancer

becomes more and more common. Why?

At any age, ultraviolet rays and free radicals can damage the DNA in skin

cells, causing them to mutate and begin abnormal replication. This is the

first step toward developing skin cancer. But in a youthful, healthy body,

these mutated cells are destroyed by the immune system before they can

cause a problem. As we get older, hormonal and cellular changes render the

immune system less vigilant. As a result, mutated and malignant cells are

more likely to survive and continue dividing, eventually forming cancerous


Do you see how genetic, biochemical, environmental, and lifestyle factors

interact to cause the changes in structure and function that we can

observe in aging skin? These same factors are affecting every system,

organ, and tissue of your body. Together, they produce the effect that we

know as aging.


The good news is that we can do a lot to reduce, correct, or compensate

for the many biochemical and metabolic changes that occur as our bodies get older. At the genetic level, we are getting very close to

isolating and identifying the precise parts of the genetic code that cause

our cells to function differently as we age. This may eventually allow us

to halt or reverse the genetically programmed changes that contribute to


In the meantime, we can compensate for age-related hormonal declines with

bioidentical hormone replacement protocols. This can help to prevent the

changes in biochemistry, metabolism, and cell function that lead to poor

health as we age.

Nutrient protocols can enhance immune surveillance, support organ

function, improve detoxification, and improve cellular repair. Dietary and

lifestyle changes support metabolism, detoxification, and disease

resistance. On the environmental front, we can reduce our exposure to

radiation, toxins, and pathogens. Each of these approaches is described in

detail in the chapters that follow.

Any one of these steps will lead to a remarkable improvement in your

health. In fact, you will come across many nutrients and therapies in the

following pages that at one time or another were heralded as the silver

bullet that would prevent all aging. As the field of anti-aging medicine

has matured, we now know that as powerful and important as these

discoveries have been, no one hormone or vitamin can prevent aging.

Just as there is a cascade effect in aging, with changes triggering

further changes and effects compounded by other effects, anti-aging

therapies likewise have cascading and compounding effects. The true power

of anti-aging medicine is the integration of all of these tools into a

comprehensive approach.


Anti-aging medicine is now the fastest-growing medical specialty in the

United States. This reflects more than merely a change in attitude and

philosophy. It reflects the enormous scientific advances that have been

made in our understanding of the causes and treatments for aging.

It also recognizes the economic and social imperative we face as senior

citizens become the largest sector of our society. With dwindling

government resources and a crippled medical safety net, the pursuit of

anti-aging therapies is a matter not of vanity but of survival.

It’s no longer acceptable or responsible for doctors to dismiss a gradual deterioration of function and wellness as “what happens when you get
older.” It’s also not good enough to medicate symptoms as they arise, using pain relievers, antacids, arthritis drugs, and cholesterol
medications. We must find a way to remain healthy, vital, and productive
as we enjoy the longer life span that modernity has made possible.

The program you are about to embark upon will allow you to grow older
without becoming aged. It will maximize your chances of not only a long
life but a long and healthy life. Anti-aging medicine is more than just a
medical specialty. It is the future of medicine and the future of



Excerpted from The Life Extension Revolution by
Philip Lee Miller, M.D. and the Life Extension Foundation with
Monica Reinagel Copyright © 2005 by Philip Lee Miller, M.D. . Excerpted by
permission of Bantam, a division of Random House, Inc. All rights
reserved. No part of this excerpt may be reproduced or reprinted without
permission in writing from the publisher.