the New Science of Growing Older without Aging
Fitness | Bantam
Hardcover | May 2005
26.00 | ISBN 0-553-80353-0
A New Role for Medicine
Every man desires to live long, but no man would be old.
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.
THE PROMISE OF ANTI-AGING MEDICINE
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.
DELIVERING ON THE PROMISE
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
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
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.
HOW AND WHY DO WE AGE?
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.
THE AGING YOU CAN SEE IN THE MIRROR
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
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.
WHAT CAN BE DONE TO SLOW 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
THE FUTURE HAS ARRIVED
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.