Meditate.
Join a social support group.
Strengthen emotional bonds with family and close friends.
Take a multivitamin and mineral supplement (if you are age sixty-five or older).
Maintain a balance of rest and activity.
Explore a new interest.
Take up a challenging mental activity.
Don’t be sedentary—stand up and move throughout the day.
Examine your negative emotions.
Heal injured relationships that are meaningful to you.
Be mindful of lapses and imbalances in your diet.
Address negative stereotypes about aging and ageism.
Consider how to heal the fear of death.
The good news about preventing or even reversing the aging process is that it has become realistically possible. The time of wishful thinking has passed. Increasingly, the medical community knows what we’re dealing with as the body ages, which wasn’t true before—in fact, aging was quite a mystery. There is no single process known as aging. Instead, aging is as multidimensional as life itself. To hear that aging is almost impossible to define will surprise most people. They identify aging with its symptoms—loss of muscle mass, wrinkles, fading vision, and so on. But the symptoms of a cold aren’t the same as knowing the actual cause, and the symptoms of aging are as far removed from the cause as a runny nose is from the cold virus.
Current research has zeroed in on genetic changes as the key, and genetic activity, as we’ve seen, can be strongly influenced by lifestyle.
Since people are living longer, it’s realistic to say that past age fifty, you will enter a second lifetime, and unlike children, who spend the first two decades of life occupied with developing into fully capable human beings, a fifty-year-old can bring a wealth of knowledge, skill, and experience to the second lifetime that now presents itself. In a word, how you age today—or don’t—will turn old age into a rising arc or a steady decline. Despite the influence of genes and biology, the choice is largely yours.
As things stand, the universal experience of growing older can’t be reduced to a single cause or a single result. What society believes about aging and the elderly can be just as important as what’s going on biologically. The adage “You’re only as old as you think you are” points to a third factor, the psychological. Taken altogether, the picture of aging has been confusing, leading to a collection of basic facts that apply differently to each person, as follows:
• Formerly, aging was thought to begin biologically starting around age thirty and proceed at around 1 percent of physical deterioration a year for the rest of a person’s life. Now we realize that this view was tied to symptoms of aging. At the cellular and epigenetic level, signs of impaired function can, and do, begin much earlier.
• The whole bodymind system is affected by the aging process, but not at a predictable rate.
• Because the aging process is so variable, some people are biologically younger than their chronological age, some older.
• Aging leads eventually to death from a specific breakdown in one system (usually the respiratory system). At the time of death, the vast majority of cells are still functioning normally, or at least well enough to keep the person alive.
• For every typical sign of aging, there are at least a few people who improve as they grow older, including in such areas as memory, muscle strength, and mental acuteness. This raises the possibility that aging may not be necessary. If that’s true, why do we age?
Faced with such a confusing picture, medical science couldn’t make aging fit the disease model—aging isn’t the same as getting sick, even though the elderly are more prone to illness than young adults. The holy grail in physics, sought after for many decades, is known as the theory of everything, a unified explanation of all the fundamental forces in the universe. In medicine there is no comparable theory of everything in regard to aging. When you catch a cold, you will exhibit symptoms over the course of a week typical of almost everyone else who catches a cold, but aging takes decades to unfold, and no two seventy-year-olds are exactly or even approximately alike. You are a unique person, and aging highlights your unique qualities.
Anti-aging took a leap forward in the last two decades when it became clear that the aging process is centered on DNA. Now we know, thanks to the field of epigenetics, that a lifetime of experiences constantly affects gene activity, leaving marks or imprints that last a long time. No one can say with certainty if a specific marker lasts for years, decades, or a lifetime, but the crucial fact is undeniable: Your lifestyle has genetic consequences. Even identical twins, born with the same genome, will exhibit gene activity in their seventies that is as different as two siblings who aren’t twins; sometimes the differences will be the same as between two total strangers.
The most recent breakthrough in anti-aging is the finding that the aging process begins young. In a 2015 Duke University study headed by Daniel W. Belsky, the focus was on biological age (how old your body is) as opposed to chronological age (how old you are by the calendar). Traditionally, the aging process has been studied primarily in old people, who already show symptoms of lifestyle disorders. Instead, the Duke team looked at 954 young people, tracking the biomarkers for aging at three different time points between ages twenty and forty: “Already, before midlife, individuals who were aging more rapidly were less physically able, showed cognitive decline and brain aging, self-reported worse health, and looked older.” This finding helps boost the idea of anti-aging by pushing the whole issue back decades before the signs of disease and infirmity are advanced. As we’ve been demonstrating throughout this book, a long trail leads to the start of many disorders, and now aging, which affects every system in the body, joins the list.
Finding the most reliable biomarkers for aging is still controversial—the possibilities range from deep neural networks to T-cells and epigenetic markers. Only when this issue is settled can anti-aging be measured with confident accuracy. Right now there is no gold standard for measuring aging. This isn’t a surprise, given that the process is incredibly complex and affects each person differently. Yet by any standard, the burden of anti-aging rests with each individual, not with the promise of a silver bullet in the future.
As you make your choices today, keep one thing in mind. Just as you are unique in the way you age, anti-aging will also be unique. The more you understand the aging process, the better you can individualize your anti-aging program. Here are the most important variables that affect aging in general, according to the best recent research.
1. Satisfying relationships with family, friends, and community
2. Emotional resilience, the ability to bounce back from setbacks and losses
3. Stress management
4. Anti-inflammation, including diet and “inflamed” emotions like anger and hostility
5. Good sleep every night
6. Meditation, yoga, mindful breathing
7. Moderate physical activity throughout the day. Standing up and moving to break up long periods of sitting
8. Positive attitudes toward aging and the passing of time
9. Absence of toxins, including tobacco and alcohol
10. Youthful mindset—curious, open, always learning new things
Listed roughly in the order of priority, these variables provide insight into how people age well. We should note, however, a cutting-edge theory of aging that holds inflammation responsible for every aspect of the aging process. Although unproven, this theory may be the wave of the future, considering that so many lifestyle disorders basically occur in old age and at the same time are linked to low-grade chronic inflammation.
As with every aspect of a healing lifestyle, waiting until you show visible symptoms of aging comes too late. Aging is the ultimate example of a creeping, incremental change surrounded by a litany of influences. Anti-aging is also incremental but clear in its strategy: maximize the positive input your bodymind receives every day and minimize the negative input. Input is an all-embracing term, but the best research points to the areas everyone should focus on, which is what our “Do” and “Undo” recommendations are about.
We present only one age-specific choice on the “Do” list—taking a multivitamin and mineral supplement if you are over sixty-five (see this page for why this choice is important). The other choices pertain to your welfare and happiness right now, based on the notion that a happy life is built upon being happy every day. The longest-running study on aging is the Harvard Study of Adult Development, now eighty years old, which arrived at findings summarized in a headline at the website Harvard Gazette: “Good genes are nice, but joy is better.” The study began in 1938 with the intention of following 268 Harvard sophomores throughout their lives. (The subject population was later expanded and diversified. Only 19 of the original subjects were still alive in 2017, but their 1,300 offspring are being studied, along with their wives and additional inner-city volunteers.)
Robert Waldinger, a psychiatrist and professor at Harvard Medical School who now heads the study, reports: “The surprising finding is that our relationships and how happy we are in our relationships has a powerful influence on our health. Taking care of your body is important, but tending to your relationships is a form of self-care too. That, I think, is the revelation.” This finding fits into previous points we’ve been making about heart disease, for example, where answers on social support or a spouse who expresses love turn out to be good predictors of who will exhibit symptoms of heart problems and who won’t. At the opposite extreme, to quote Dr. Waldinger: “Loneliness kills. It’s as powerful as smoking or alcoholism.”
These findings aren’t tentative or confined only to an upper social group. As the article on the Harvard study goes on to say: “Close relationships, more than money or fame, are what keep people happy throughout their lives, the study revealed. Those ties protect people from life’s discontents, help to delay mental and physical decline, and are better predictors of long and happy lives than social class, IQ, or even genes. That finding proved true across the board among both the Harvard men and the inner-city participants.”
Our “Do” choices focus on this key finding. The more social support you have and the happiness you find in relationships will continue to affect you throughout your lifetime. In the “old” old age, as outdated attitudes are labeled, the golden years were a euphemism for being stuck in a rocking chair and being of no use to society once you passed sixty-five. In addition, people looked forward to being happy after they retired, setting this as their main goal rather than being happy here and now. The ethos dictated that you worked as hard as possible during your prime years and postponed happiness until you retired; it was one of the perks, so to speak, of not having to work. In the “new” old age, a set of attitudes still evolving, chiefly among baby boomers, there is no intention of retiring as long as one’s work is useful and fulfilling. In aid of this, people intend to preserve their healthy status for as long as possible, preferably until the final illness.
Where the “new” old age needs to grow is in the area of social support and relationships, because happiness for too many people is still an individual project. The ethos of American individualism stands at the opposite pole from a communal society like Japan or countries with policies of social welfare, like almost every European nation. In our list of “Do” choices we present meditation as something where going it alone seems mandatory, but even there, people who join meditation groups are more likely to keep up their practice.
The most valid measure of quality of life is how happy you are, how fulfilled and contented your lifestyle has made you. People who spend their careers becoming secure financially often lack any but rudimentary skills in sustaining a happy relationship. We can’t address this problem in full—that would take ten times more space than we can devote to it—but Deepak’s book The Ultimate Happiness Prescription makes the following points:
• Happiness is hard to predict. People think that they will be happier when they have more money, a baby, a job promotion, and other external factors, but there is no correlation between these expectations and actually being happier. While having enough money and security is an important component of being happy, beyond that point making more money doesn’t increase happiness and often has the opposite effect of adding more stress to a person’s life.
• Because it is so unpredictable, happiness should be addressed today rather than postponed for the future.
• Each of us has an emotional set point, like the body’s metabolic set point, that chiefly determines our mood from day to day. After an unhappy event, whether it’s a bad breakup or a financial loss, we return to our set point, generally within six months.
• Even taking this set point into consideration, the current psychological understanding is that at least 40 to 50 percent of happiness depends on lifestyle choices.
• In the world’s wisdom traditions, the fickle nature of human happiness cannot be solved by seeking happiness externally. Only by finding a level of the mind that is established in inner peace and contentment can the problem of unhappiness be solved—this is in keeping with our chapter on the end of suffering.
The choices offered on the “Undo” list revolve around a central theme: getting unstuck. You have to be as resilient in your approach to life as your cells are. If you are rigid in habits, behavior, and attitudes, you will incrementally decrease the ability of your cells to thrive and remain strong in the face of challenges. Remember, the bodymind is a single process operating with hundreds of subprocesses twenty-four hours a day. No experience goes unheeded. Clenching your mind is the same as clenching your fist—at a certain point you will develop a cramp.
Begin today to look at the negative attitudes that tend to increase with age if you aren’t mindful of them. These include the following:
“Growing old is horrible. It’s all downhill from here.”
“The prospect of death is terrifying.”
“The best years are behind me.”
“The past was a lot better than today.”
“You can only look out for number one.”
“People always let you down.”
“Time is running out.”
These attitudes and beliefs are not testable against reality one way or another—they are held not for factual reasons, but for emotional ones. The whole point is how you choose to feel about your life and the future. If you hate and fear the thought of growing old, aging will become more and more negative as time passes. Every new sign of growing older, from graying hairs to pains in your joints, will be another reason to hate and fear where life is taking you. Limiting belief systems are the major obstacles to healthy aging. It is important in mind, body, and spirit to always be looking forward to something, today and tomorrow, while not obsessing about the past.
Since every belief is a personal creation, it can also be uncreated. We devote Thursday to core beliefs and how to change them, but for now, the undoing process involves a few mindful steps:
• Associate with inspiring, happy older people, beginning today.
• At the same time cultivate connections with young people.
• Don’t participate in conversations in which people complain about aging.
• Every negative belief about aging can be countered by consciously replacing it with a positive belief, as follows:
~ “Growing old is horrible. It’s all downhill from here.”
~ Replace with “My life is a rising arc. The best is yet to come.”
~ “The prospect of death is terrifying.”
~ Replace with “Fear never solves anything, including this.”
~ “The best years are behind me.”
~ Replace with “I can create a better future if I choose to.”
~ “The past was a lot better than today.”
~ Replace with “Dwelling on the past cancels out the possibilities of today and tomorrow.”
~ “You can only look out for number one.”
~ Replace with “All my life I have looked out for others, and they have looked out for me.”
~ “People always let you down.”
~ Replace with “People fundamentally are doing their best.”
~ “Time is running out.”
~ Replace with “There’s always enough time.”
Since beliefs are held for emotional reasons, we aren’t saying that positive beliefs are always factually true, only that your emotional state is where the most powerful motivations lie. That’s a very significant part of aging successfully. Having a positive attitude toward it makes an enormous difference given that decades of living are involved. Positive thinking, however, tends to be superficial and therefore not as important as self-acceptance. When you have that, even the worst indignities of old age—which of course we want you to avoid—don’t turn into a downward spiral. A strong sense of self weathers any storm.
Now that it’s accepted that people age differently, it’s critical to know why. Aging is such a holistic process that you might suppose that no simple answer about why we age differently will ever emerge. But that may not be true at the cellular level. Cells have their own lifespan, ranging from the early stages, marked by rapid division and fresh renewal every time a cell divides—this is the period molecular biologist Elizabeth Blackburn calls luxuriant growth—ending with a stage in which no more divisions occur and the cell is tired and unreliable in performing its basic functions—this is the period known as senescence.
A senescent cell breaks down on several fronts. It sends out faulty chemical messages and fails to interpret incoming messages correctly. Its ability to heal itself slows down and eventually comes to a halt. Pro-inflammatory substances can start to leak out through the cell membrane into surrounding tissue and the bloodstream. It seems more and more possible that when our cells age, so do we.
The most striking support for this theory comes from research into our genes and specifically a section of DNA known as a telomere, which caps the end of each chromosome like a period ending a sentence. Telomeres are “noncoding” DNA, meaning that they have no specified function in building cells, but they are far from passive. Their function seems to be to preserve cells. Every time a cell divides, which happens constantly somewhere in the body, its telomeres are shortened. Longer telomeres are typical of young cells in the stage of luxuriant growth; shortened or frayed telomeres are typical of weary senescent cells.
The leading researcher on the subject is someone we’ve already briefly mentioned—molecular biologist Elizabeth Blackburn, who shared the 2008 Nobel Prize in Physiology or Medicine with Carol Greider of Johns Hopkins and Jack Szostak of Massachusetts General Hospital for their discovery of telomerase, the enzyme that replenishes telomeres. Now the head of the Salk Institute in La Jolla, California, Blackburn covers every aspect of cell aging and renewal in her 2017 book, The Telomere Effect, coauthored with her close research colleague of fifteen years, health psychologist Elissa Epel. They convincingly describe telomeres and levels of telomerase in the cell as our best marker yet for the mysterious and multifold process of aging. This also implies that by increasing one’s telomerase levels and thereby causing telomeres to grow longer, a healthy lifespan can be founded on cells that keep renewing themselves for decades.
In their book, Blackburn and Epel cite a startling actuarial prediction. There are currently around 300,000 centenarians existing around the world, a number that is rapidly increasing. According to one estimate, reaching age one hundred is about to become so commonplace that one-third of children born in the United Kingdom will live to be centenarians—the issue of protecting your cells is suddenly more urgent than ever. We highly recommend reading Blackburn and Epel’s book—its wealth of information needs to be absorbed in detail. But the bottom line is to understand what puts your telomeres at high risk and low risk.
The book’s survey of all the pertinent research dovetails with everything we’ve been discussing under a healing lifestyle, as follows:
Your telomeres are at low risk if you
~ Have no exposure to severe stress.
~ Have never been diagnosed with a mood disorder.
~ Enjoy good social support, including a close confidant who gives good advice, friends who listen to you and with whom you can unburden yourself, and relationships in which love and affection are shown.
~ Exercise moderately or vigorously at least three times a week, preferably more.
~ Get good-quality sleep for at least seven hours a night.
~ Consume omega-3-rich food three times a week while avoiding processed meats, sugary sodas, and processed food in general. A whole-food diet is best.
~ Are not exposed to cigarette smoke, pesticides, and insecticides.
The opposite is also true.
Your telomeres are at high risk if you
~ Are being exposed to severe stress in your life.
~ Have a history of being medically treated for anxiety or depression.
~ Lack social support from friends and family.
~ Lead a completely sedentary lifestyle with no regular exercise, even light activity like walking.
~ Suffer from chronic insomnia or cut your sleep shorter than seven hours a night.
~ Consume a diet high in fat, processed foods, and sugary sodas, with no attention to sufficient fiber and omega-3 fatty acids.
~ You are exposed to cigarette smoke, pesticides, insecticides, and other chemical toxins.
These points summarize the research-supported risk factors presented by Blackburn, and as with any risk-based program, some people are more affected than others. Severe stress is one of the most thoroughly damaging factors—in one study, caregivers who tended Alzheimer’s patients had shortened telomeres that predicted a shortened lifespan of between five and eight years. Blackburn also lists a number of commercial labs where people can pay to have their telomerase level analyzed.
It’s also significant that the lifestyle choices known to decrease the risk of heart disease, particularly the intensive one devised by Dean Ornish (see this page), have a beneficial effect on telomere length. Extending the program to cancer, Ornish had another impressive finding. A group of men with low-risk prostate cancer were selected for study. (Low risk means that their cancer was at an early stage and slow growing. Prostate cancer can take decades to advance, and the current recommendation advises balancing the risk and reward of doing any active treatments, a change from the era when any cancer was immediately treated and usually aggressively.)
The men were put on a variant of the heart-disease protocol: they ate a low-fat, high-fiber diet; walked for thirty minutes a day; and attended regular support group meetings. Stress management was included, and there was training in meditation, mild yoga stretching, and breathing. At the end of three months the group that was on the program had higher telomerase levels than the control group, which meant that their cells were aging better. Stress seemed to play a key role, because the greatest increase in telomerase occurred among the men who reported having fewer distressing thoughts about prostate cancer. Ornish followed some of the men for five years, and those who stuck with the program showed telomeres that had increased by 10 percent, reversing the usual expectation as cells age.
If stress levels determine how well or badly our cells age, this should show up in meditation studies, and it has. Blackburn cites two studies conducted at meditation retreats that were three weeks and three months long. At the end of the three-month retreat, meditators had higher telomerase levels compared with the control group. In the three-week retreat meditators showed longer telomeres in their white blood cells than the control group, which showed no change.
How long would it take for these effects to appear, and how intensive does your dedication to meditation have to be? There is no definitive answer, but probably the best clues come from a collaborative study that we carried out with Blackburn and other leading researchers, conducted at the Chopra Center in Carlsbad, California. Women in good health were divided into two groups. One group enjoyed a spa vacation without other interventions. The other group went through a program led by Deepak that included meditation and a variety of Ayurvedic treatments. At the end of the week everyone reported feeling better, which attests to the likelihood that most people are in sympathetic overdrive, because simply going on a week’s vacation improved their sense of well-being.
In the same vein, there were improvements in gene expression (activity) in both groups, including the chemical pathways that trigger inflammation and the stress response. There also appeared to be a meditation effect on telomeres and telomere-protective genes. These occurred in the meditation group among experienced meditators. The fact that it took only a week to produce results that started to be significant points to the conclusion that you are doing your cells some good almost as soon as you take up meditation and that the practice needs to be regular and long lasting.
We are encouraged by how strongly telomere research validates the healing lifestyle this book advocates. It also underlines the conviction that cells benefit directly, at the genetic level, from conscious lifestyle choices. Blackburn ends her book with a visionary Telomere Manifesto that would prioritize protecting our cells as a part of parenting, social relations, the fight against income inequality, and global outreach for the planet. Like all visions, this one depends upon individual decisions, and one comes away from The Telomere Effect even more persuaded that anti-aging begins by keeping our cells in a state of renewal. If there are no new startling things to do, becoming more optimistic about your own aging is valuable in itself.