BIG IDEAS: Aging as a Disease

Treating aging as a disease changes the calculus of the healthcare profession. It moves beyond managed decline to actively seeking solutions. If we look we’ll find them because aging and death are not an inevitable phenomenon; it’s just a process.

Storytelling typically follows an arc; beginning, middle, and end. There are the halcyon early days of innocence and discovery, followed by the middle years of conflicts and tough life lessons, and finally, an end where stock is taken, wounds healed, and then loving acceptance is achieved as the screen grows dim and then goes dark. That is the arc of most movies and books, and we love the format; it reminds us of the arc of our lives that we long for.

Perhaps this accepted arc of our lives is why we have so many accepted sayings and metaphors for aging that ends in death. “The autumn of one’s life,” comes to mind. The seasons come with regularity and there is nothing one can do about it.

What all aging metaphors have in common is the commonly held belief that aging is a natural and inevitable, and often, desirable process that should be lightly resisted and then accepted. It is the natural order of things, and while there is no official numeric designation where a life ended ceases to be a ‘tragic’ death and converts to ‘a life well lived,’ in the US sense, I speculate that the number is 60 years. Make it three score and your death is part of the natural order.

Anyone who has witnessed a 60 year old person die knows that the ending is often not nearly so peaceful and natural, and looks more like a person with a degenerative disease that is slowly succumbing to the multiply complications. They are in pain, and they struggle. A person with ALS dies slowly as the disease moves forward and inhibits their vital life functions. An 87 year old man with dementia compounded by pneumonia follows a similar arc, except the ALS victim is seen as a death that should have been resisted and the 87 year old is seen as nature taking its course. Is an 87 year old person with ALS the same as a 47 year old person with the same disorder? I’d speculate not, because the 87 year old has logged their time, received their allotted portion, and they can move on. The disease doesn’t discriminate, but we do.

But what if aging is not the natural and inevitable order of things, and is simply another sort of disease path? What if aging is not the diminishing of some sort of mythic life force that gets used up, and death past any age is a not a fitting way to end the story?  What if aging is simply the result of accumulated damage from living, and can be addressed? What if it can be slowed way down? What if it can be stopped? And what if it really can be reversed?

David Sinclair and the Information Theory of Aging

David Sinclair is a researcher who has written extensively about the aging process and what science is uncovering. In his excellent book ‘Lifespan” he discusses what is known as the information theory of aging. It is backed by experimentation and is vying to replace the “worn out” theory of aging.

Your body, Sinclair asserts, has a slow and a fast way of adjusting to the earth’s many situations. The genius of nature, exhibited in so many living organisms, from apples to humans, is its ability to adapt so that there is a chance of a successful adaptation to earth’s never-ending change. Change can come slow or fast and so humans are biologically prepared for both situations.

The slow way to adapt and change is the encoding of DNA in to your cell, Sinclair explains. The long coded strands of DNA in each human cell have four nucleo-bases: cytosine, guanine, adenine, and thymine. These inputs are paired up and linked together to make the classic double helix formation. In this copying mechanism, the lessons of the past are passed on to the next generation; your function, form, and features are saved, copied and distributed to your offspring. This is the basics of genetics and it’s highly efficient at accurately copying the information pattern of a life form and adapting it over long periods of time. This is like a digital file, in Sinclair’s analogy. It’s the “save as” menu option and it works really well.

But the stability of this system is a disadvantage in a fast changing environment. It just takes too many generations to adjust the millions of base pairs to optimize for new situations, so humans have another adjusting mechanism know as the epigenetic function. This, in Sinclair’s analogy, is the analog world. This feature doesn’t make adjustments to the generations; it makes adjustments to you, right now, depending on what’s happening. It is in this system that the DNA base pairs are put in to action. Epigenics are how the genes express themselves, and why your liver cells, which have a full copy of your genome like the rest of your cells, knows to be a liver cell.

It is in the misfiring of your epigenetic systems that you get cancer, or a host of other ailments. There are no DNA base pairs that are coded for cancer; nature would not so that, but if those DNA pairs became malformed by an assault from the environment, something like 30 years of cigarette smoke, then the cells starts to proliferate as mass in the lungs, which in turn destroys the legitimate lung function. Skin cancer is the damage from the accumulated effects of the sun. Food requires processing and that can create damage. Viruses, injuries, depression, extreme heat and cold.. all of this which can be summed up as life. Damage happens when you live. Some of that damage does not properly heal. The cell still has the same DNA base pairs, but is’t epigentic expression goes all wonky. So, it is in your epigenome you age. The damage is the result of the loss of information in the cell about what the cell is supposed to be doing. The cell looses is function and ceases to contribute to the body.

So, in short, aging is loss of information which is the result of improperly repaired damage from living.

But, if the information theory of aging is true, that is incredibly world changing good news. If that loss can be stopped as the damage occurs, then aging stops with it. Or as Sinclair teases in the book, on a wider scale, if the whole system can be reset at one time, and the epigenome result back to adult maturity, then aging is not just stopped, it is reversed.

Imagine the changes to life are this is true and we start acting as if it’s true. Aging cold be treated early and education about the aging process could be baked in to health curricula everywhere. Repair and reset, rather than managed decline, would radically alter life on this planet as people saw the first 50 years of their lives as only the beginning. Gains in knowledge and efficiency would more than overcome the resource demands of more people, if that was in fact, the outcome of longer life, and the healthcare industry as we know it world cease. There would be acute care from accidents and other assaults, but the chronic cases driven by age could be slowed, and perhaps one day stopped.

It’s not impossible. Some, like Sinclair, say it’s inevitable.