The laws of genetics apply even if you refuse to learn them.
—Alison Plowden
I’m no supermodel. In fact, obesity, hair loss, anxiety, and Alzheimer’s disease run in my family—not a pretty genetic picture for middle age and later life. My mother ate sparingly while pregnant with me, as was the fashion in 1967, an era of Twiggy and miniskirts. Mom’s diet turned on my famine genes while my chromosomes were being knit in her womb, meaning that I’ve had a lifelong struggle with blood-sugar problems and rapid weight gain (a lot more on these topics later). I’ve grown up idolizing actresses such as Katharine Hepburn, Sigourney Weaver, Diane Keaton, and Julia Roberts. They were slim and tall, but I was pudgy and short.
Now, when I start to wonder why it’s so freaking hard to stay mentally and physically fit at fifty, I remind myself that my genes program me to be a two-hundred-pound anxious diabetic with thinning hair. All things considered, maybe I’m not doing so badly.
Think about Angelina Jolie, Jennifer Lopez, Julianne Moore, Gisele Bündchen, and Helen Mirren. It’s easy to believe they won the genetic lottery. Perhaps they hail from a long line of superwomen with flawless skin, flat bellies, perfectly balanced hormones, and fast metabolisms.
It’s their job to look amazing, and they are extremely motivated to look good as long as possible as they age. Their taut abdominals and gravity-defying posteriors grace billboards, Victoria’s Secret catalogs, and Sports Illustrated covers. They have proportionally similar metrics: Gisele Bündchen, the world’s highest-paid model, is five feet eleven and weighs 126 pounds, and her bust-waist-hip measurements (in inches) are 35–23–35. Angelina Jolie is five feet eight, weighs 128 pounds, and measures 36–27–36. Their paychecks and magazine gigs depend on their enviable measurements. Even in her sixties, at five feet four and with 37–27–38 measurements, Helen Mirren rocked a coral bikini on a beach in Italy, looking better than me and most of my girlfriends.
That’s great for those women, but the rest of us flounder. I don’t know about you, but sometimes I feel like I was born to wrestle with my weight, skin, energy, and sex drive. In college, my weight ballooned. In medical school, my skin broke out and my adrenals broke down because of stress. I craved sugar and carbs and rarely ate vegetables. I drank gallons of coffee, hardly slept for a decade, and bought fat jeans. Then I had two kids. Need I go on?
Maybe you’ve been told that your muffin top or memory problems aren’t your fault; they are simply programmed by your genes. It doesn’t seem fair. When I was in my forties, my battle only seemed to get harder as I navigated the challenges of crazy work hours, perimenopause, grief, breast lumps, aging parents, tight clothes, travel, and stress. Eventually, I learned that there’s a spiritual lesson in my battle with age and that my mess is my message.
The female body is magnificent, but it doesn’t come with a lifetime warranty or an owner’s manual. You’re the result of millions of years of evolution, but many of the adaptations that helped your ancestors survive are now making you fat and wrinkly and are no longer needed. But your genetic code—the DNA sequence that is the biochemical basis of heredity in all living organisms—is only a small part of the story. Your DNA is a unique, one-of-a-kind blueprint that is specific to you. Even if you haven’t been dealt platinum genes, you can still look great and age more slowly.
The fact is that scientists have found new ways for us to take control of our genes. For example, the naughty aging genes usually associated with fat and wrinkles can be altered with diet, exercise, and other lifestyle choices. Simply put, by turning your good genes on and your bad genes off, you can actually prevent aging—no matter how old you are.
Gisele’s measurements are unattainable for the average American woman—who is five four and 164 pounds with a thirty-eight-inch waist— but even if you have fewer of the good genes and more of the bad genes, you can still lose weight, improve your skin, and change how your DNA controls your body and mind. You don’t even need a large staff of trainers and chefs to hold you to your exercise regimen and diet; you can appear to have lucky genes whether or not you actually have them.
The truth is that around 90 percent of the signs of aging and disease are caused by lifestyle (and the environment created by your lifestyle), not genes.1 The neighborhood of your body—how you live and the world you create, internally and externally—is more important than your DNA when it comes to how you look and feel now and for the next twenty-five to fifty years. So let’s clean up your neighborhood.
Scientific Breakthroughs Make Staying Young Possible
I am a physician who trained at Harvard and MIT, but I was never taught the secrets to staying young. I didn’t learn about them in medical school because many of them weren’t yet discovered. It took a confluence of factors to create a new protocol for aging slowly. It took the Human Genome Project, which wasn’t completed until 2003. It took affordable genetic testing, testing that up until five years ago cost about ten thousand dollars and now costs about two hundred dollars. It took bigger and better computers that could handle the volume of data that genomes provide—data sets that are so large and complex that novel data-processing applications had to be invented. It took me personally testing myself and, through trial and error, finding the genetic switches that control metabolism, weight, disease, and aging. Then it took refining my protocol for thousands of patients and women who work with me online before I learned the best, most scientifically proven ways to reprogram genes with specific lifestyle and mind-set changes.
In the process, I discovered what helps people not just look young but also feel young, and, even more exciting, I learned how DNA plays a part in overall aging and what we can do to alter the way our DNA is expressed. Who wouldn’t want to influence her genes for the better?
Some women have asked me how this book is different from my previous books, The Hormone Cure and The Hormone Reset Diet. The first two books focus on your hormones, but this book will show you how to overcome and transform your genetic history and tendencies, particularly when it comes to aging. Feel destined for cellulite, saddlebags, and belly fat? Nothing seems to help your aging skin or declining libido or flagging energy? Does your family have a long history of Alzheimer’s, cancer, or heart disease? This book is for you. Let’s expand not only your life span but also your healthspan—the period during which you are able to thrive, free from disease and in hormonal harmony. Whether you are thirty-five or sixty-five, this protocol will help you prevent signs of aging and feel healthier and stronger than ever before.
The strategy of the Younger protocol is to interpret the warning signs of age in your body—the worsening vision, the thinner skin, the weaker lungs, the faulty memory—and turn them around. My goal is not to pick off one disease at a time (such as Alzheimer’s, diabetes, or age-related cancers) but to delay or prevent all of these conditions, since they have a similar root cause: aging in any form. This means that by delaying one condition, you delay them all. This is the basis of functional medicine, the emerging system of medicine that engages the whole person, not just an isolated set of symptoms, and works from the inside out to address the root cause of disease and accelerated aging.
Plump Cheeks
I became interested in my genetic contract—the rules of my DNA and how they are expressed in my body—when I was thirty-nine. Something happened that I didn’t expect: my cells started to betray me.
Let me explain. I was at a decent weight with a body mass index (BMI) of 25, right on the border between normal and overweight. I never thought of myself as middle-aged, but there I was, facing down forty, the official threshold. (Middle age is defined as age forty to sixty-five.) I heard from friends and family that I needed to get to my ideal body weight before forty because my metabolism would slow down precipitously then and future weight loss would come not from my belly, but from my face.
Apparently, in the physics of aging, volume in the face equals youthful vigor. Dermatologists even have a term for it: the triangle of youth. If you draw a line across the cheeks from ear to ear and then close the triangle by drawing a line from each ear to the chin, the widest part of the face is at the cheeks. But as you age, thanks to gravity, cheeks deflate, and fat moves south. Your body makes less collagen, and the collagen that it does make is less elastic, so your skin is not as thick and firm as before. Your bones thin, so the cheekbones shrink. Excess skin moves to the jaw, and now the widest part of your face is at the jawline, and the triangle of youth flips upside down.
Was this true? I decided to separate fact from fiction by applying my medical knowledge to my own aging body, just as I had done previously with hormones.
During this investigative period, I learned many surprising truths about aging. Much to my dismay, I discovered that fat loss does indeed occur in a woman’s face, as opposed to her belly, after a certain age because collagen no longer undergirds the architecture of the facial skin and bones. Even so, I also learned that modulating estrogen levels with targeted lifestyle changes can slow down the loss of collagen. For instance, you can drink a collagen latte to boost production of collagen type III. Despite what you may think, not everything is inevitable when it comes to aging. I can promise you that we do have considerable control over the process.
Aging Accelerates at Forty
Let’s look at what’s actually happening in your body. By the time you reach middle age, there has been an unseen, predetermined, twenty-five-year process of cellular decline. (Don’t freak out—I will show you how to circumvent this problem, no matter how close or far you are from forty.) Cellular decline progresses insidiously, unobserved by most people, perhaps including you and your well-intentioned doctor. You may notice it as muscle tightness, an emerging paunch, lingering hangovers, or difficulty reading labels, or you may recognize it by the fact that staying in shape seems to require ten times the effort. Your endocrine glands, from your ovaries to your thyroid, start to sputter and gasp in their hormone production. Then muscle mass declines and gets replaced by fat, and suddenly you realize—like I did on a recent fitness spree—that the activity of jumping is no longer an option. You start waking up at four in the morning for no good reason. Words you’ve used for decades evade you.
Unlike a fine Bordeaux, your body does not get better with age. Before you pour yourself another glass of wine to lament the facts of middle age, permit me to share some good news with you. Due to recent scientific breakthroughs, middle age now offers you a profound opportunity to reprogram your genes and your body. I urge you to take this seriously before decay, or what we can refer to as accelerated aging, sets in, leading to not just minor annoyances like hair loss but also alarming diseases such as Alzheimer’s and breast cancer. In fact, the Centers for Disease Control and Prevention reported that in 2015, for the first time in several years, longevity declined, due to an uptick in heart disease, diabetes, stroke, and Alzheimer’s.2 If those diagnoses seem abstract and irrelevant to you now, consider that by the year 2030, 20 percent of the population will be sixty-five or older (compared with 13 percent in 2010).3 New cases of Alzheimer’s will rise by 35 percent,4 while new cases of breast cancer are expected to rise by 50 percent.5 You don’t want to be included in those statistics.
Using my medical education and practice as well as my own very personal struggle as a woman in a middle-aged body, I have developed a seven-week program called the Younger protocol to change the course of your aging body and grow your healthspan.
Five Aging Factors Gone Wrong
After forty, you begin to feel the effects of getting older. You can’t indulge in French fries, sugary cocktails, and ice cream—or if you do, you can’t get away with it. Gray hairs show up. When you’re on your feet most of the day, leg veins no longer snap shut, and an unmistakable bulge of fluid collects at your ankles. You can’t read your smartwatch without glasses (happened to me last week!). Your hormones are suddenly out of whack, and you find yourself sad, moody, tired, or chubby for unclear reasons. Your back goes out when you travel. You’re not as stress resilient, and when you get a lousy night of sleep, you don’t bounce back as easily as you once did. Why? Five key factors make aging more pronounced after forty, leading to inflammaging—the unfortunate hybrid of increasing inflammation, stiffness, and accelerated aging. Keep in mind it’s not your age that’s the enemy, it’s the loss of function, and these are the culprits:
1. The Muscle Factor. Your metabolism slows down with age, which means you accumulate more fat and lose muscle. Think of aging as beginning in your muscles. The decline may not be noticeable at first, but on average, you lose five pounds of muscle every decade, so you definitely start to observe the change over the course of middle age. On the cellular level, your mitochondria become tired, a process known as mitochondrial dysfunction, which may make you feel more fatigued during and after exercise or cause muscle pain. Your mitochondria are the tiny powerhouses inside your cells that turn food and oxygen into energy. You have a thousand or two mitochondria inside most of your cells, and if they’re gunked up with debris and damage, you will feel tired and achy. Causes range from eating empty calories such as sugar, flour, and overly processed foods to exposures to toxins. In summary, if left alone or ignored, your muscles usually get more doughy as they’re replaced with fat, and you’re not as strong as you used to be. The key is to focus on preserving and building your muscle mass as you age past forty.
2. The Brain Factor. Your neurons (nerve cells) lose speed and flexibility. Alcohol makes you foggier than it did, and you lose sleep. Connections between neurons, called synapses, are not what they used to be, so finding words may become an issue. The balance shifts toward more forgetting and less remembering. Part of the problem is that your brain gathers rust like an old truck left in the rain; free radicals induce damage to cells, DNA, and proteins in a process called oxidative stress if you don’t have antioxidant countermeasures in place (like vitamins A, C, and E). Research indicates that if you’re female and around forty-three or older (that is, in perimenopause), your brain becomes resistant to the lubricating and mood-lifting benefits of estrogen. Gluten, found in wheat and flour products, may make the problem worse. Your hippocampus—the part of your brain involved in memory creation and emotional control—may shrink, especially if you’re stressed. As if that weren’t bad enough, excess stress kills brain cells by increasing production of beta-amyloid, which then forms disruptive plaques that harm synapses further, putting the brain at risk for Alzheimer’s disease. The key is to focus on keeping your brain regenerating and malleable (or “plastic”) as you get older.
3. The Hormone Factor. Your hormones change for the worse. With age, both men and women make less testosterone, leading to more fat deposits at the breasts, hips, and buttocks. Women produce less estrogen, which normally protects the hair follicles and skin. Lower estrogen-to-testosterone ratios may trigger hair loss and heart disease. Unfortunately, your thyroid gland slows down and, along with it, your metabolism, so the bathroom scale climbs a few pounds per year (or even per month). You get cold more easily. Your thyroid may become lumpy or attack itself. Your cells become increasingly insensitive to the hormone insulin, which leads to rising blood sugar in the morning. (After you hit age fifty, blood-sugar levels rise approximately 10 mg/dL every decade.) As a result of higher blood sugar, you may feel foggier and experience stronger cravings for carbs, then notice more skin wrinkling along with an older-looking facial appearance.6 Older adults are less able to maintain sleep, leading to chronic sleep deprivation, which results in more wear-and-tear hormones (e.g., cortisol) and fewer growth-and-repair hormones (e.g., growth hormone). More cortisol and less growth hormone translate into even more skin wrinkling, facial aging, and higher morbidity and mortality.7 Lower levels of estrogen and testosterone may weaken your bones and your sex drive. The key point is that the right food, sleep, exercise, and support for detoxification can reverse many hormone problems associated with aging.
4. The Gut Factor. Of course, there’s overlap between these various factors. About 70 percent of your immune system lies beneath your gut lining, so it’s the place where your immune system can get overstimulated, leading to excess inflammation and even autoimmune conditions. Your gastrointestinal tract contains three to five pounds of microbes, mostly bacteria and a small amount of yeast, that exist in your mucosa from your mouth to your anus. The DNA from your microbes outnumber your human DNA a hundred to one and are collectively known as your microbiome. Several studies show that your microbiome may affect your hormones, including estrogen and testosterone. Imbalanced microbes and their DNA may cause you to make more enzymes such as betaglucuronidase, which raises certain bad estrogens and lowers your protective estrogens. Further, excess stress raises corticotropinreleasing factor, which pokes holes in your gut, leading to food intolerances, more stress, and lower vagal tone, an indicator that your nervous system is out of whack. Finally, high stress can make you absorb nutrients poorly, especially B vitamins; it’s as if your body requires a full parking lot to function well and age slowly, and the missing B vitamins are empty parking spaces, waiting to get filled. But don’t get lost in the details; just know that your gut can accelerate or decelerate your clock.
5. The Toxic Fat Factor. When you’re trying to preserve your youth and health, toxins from the environment accumulate in your fat. Scientists call them gerontogens. They are similar to how carcinogens increase your risk of cancer, and they can work against you and cause premature aging. Pollution, cigarette smoke, heavy metals, UV rays, chemotherapy, contaminated drinking water, preservatives, and pesticides can all conspire against you. Take chemo for breast cancer as an example—it may add fifteen years to your chronological age, so that you die earlier but without cancer. Additionally, fat deposited in your belly is biochemically different than fat elsewhere; it makes an inflammatory brew of bad chemicals that causes you to age faster than someone who has only minimal visceral fat. While exposure to certain poisons are inevitable, we can attack the genetic flaws that cause you to accumulate them.
The net result of these five factors is a vicious cycle of more inflammation, an overactive immune system that’s ready to attack normal tissues, and faster aging. In the following chapters, you’ll learn how to disarm, prevent, and reverse these five factors and change the expression of genes that influence them. If you are tired of the sinking feeling that you are getting older, slower, and fatter by the day, turn the page and discover how you can unlock your genes and live longer, stronger, and better than ever.