At the Fourth Eurosymposium on Healthy Ageing, which was held in Brussels last November, Elena and I met Dr. Kris Verburgh, a medical doctor who is especially interested in biogerontology and the potential of this field of study to turn medicine on its head.
Dr. Verburgh is only about 33 years old and has already written several science booksβone of which, written when he was only 16, made him the youngest science author in Europe. Another prominent interest of his is nutrition, which he believes is one of the best, if not the best, ways we currently have to slow down the march of aging and buy ourselves more time to live until the rejuvenation age; his latest book, The Longevity Code, is centered around this topic.
Dr. Verburgh is also a strong supporter of the idea that AI will play a more and more important role in research, leading the way to a not-too-far age of personalized medicineβthis was one of the theses he touched upon during the panel in which he participated at EHA.
Also a researcher at the Free University of Brussels, Dr. Verburgh agreed to this interview with us, where he shares his thoughts about aging, rejuvenation, and how both are perceived by the medical establishment.
As a medical doctor, what is your view on the idea that aging is not a one-way street and may be amenable to intervention?
Fascinating recent research shows that aging can be partially reversed in lab animals. These studies are important: they show that aging doesn’t have to be a one-way inexorable decline into frailty and decrepitude but that aging is a plastic process that is amenable to reversal. The ultimate goal of aging research isn’t simply just trying to slow down aging anymore but actually trying to partially reverse the aging process. Addressing aging itself is the most powerful method to address many aging-related diseases at the same time and keep people healthy for as long as possible.
What evidence has convinced you that this view is correct?
In various recent studies, old mice were rejuvenated. Old, inactive mice with grey fur get turned into active, younger-looking mice with a shiny black fur, while their cells and organs work and regenerate better. Such rejuvenation can be accomplished in various ways. One way is by epigenetic reprogramming. The epigenome is the complex molecular machinery that surrounds the DNA that determines which genes are active or switched off. When we get older, the epigenome gets dysregulated; some genes that shouldn’t be active become activated, like cancer-promoting genes, and vice versa. By using Yamanaka factors in a cyclical way, researchers could rejuvenate mice. Another way is by clearing away senescent cells. The older we get, the more that senescent cells accumulate everywhere in our tissues. These cells secrete substances that damage healthy neighboring cells. Senescent cells in the skin damage healthy skin cells, which plays a role in the formation of wrinkles. Senescent cells in cartilage damage the cartilage, contributing to osteoarthritis. Studies show that when you eradicate senescent cells, you partially reverse aging symptoms. Scientists are working on much other interesting technologies, not just to slow down aging but to also partially reverse it. Examples of such aging therapies are cross-link breakers, lysosomal enzyme therapy, aging-vaccines and autophagy-inducers to clear up aggregated protein, next generation stem cell therapies, telomere elongation, rejuvenating components in young blood, etc. We are living in very interesting times because scientists never before have had access to so many new biotechnology tools that finally enable them to impact the aging process.
What first got you interested in addressing aging?
As an MD, I realized that the best way to keep people healthy for as long as possible is by addressing the root cause of the majority diseases that afflict them, which is aging itself. Aging is the driving factor behind heart disease, Alzheimer’s disease, osteoporosis, sarcopenia, eye diseases such as macular degeneration, and so on. Addressing aging is the most powerful method to address all these diseases at the same time and is much more effective than focusing on treating only the individual diseases.
Do you have a particular model of aging that you favor, such as the Hallmarks of Aging, SENS, or the deleteriome?
Aging is very complex. Scientists have tried to boil it down into a few important aging mechanisms, or reasons why we age, such as epigenetic dysregulation, mitochondrial dysfunction, cross-linking, DNA damage, telomere attrition, or protein accumulation. However, it’s very unlikely that all of these aging mechanisms are equally important. Personally, I believe that epigenetic dysregulation is one of the more important causes of aging. When the epigenome is dysregulated, it can lead to more DNA damage, protein accumulation, cross-linking, and so on. In nature, a 30-year-old egg cell in a 30-year-old mother can be reprogrammed to zero years after fertilization so that a baby is born young, and it is composed of cells that are zero years old, not 30 years old like the mother. That is mainly accomplished by the epigenetic reprogramming of the fertilized egg cell. Also, during the cloning process, in which an old somatic nucleus from an old cell is transferred into a egg cell, the old nucleus gets reprogrammed into a much younger state, and this is also mainly through epigenetic changes. One of the most impressive studies in which aging was partially reversed is a study in which scientists epigenetically reprogrammed cells.
Do you agree with the idea that targeting the aging processes directly has the potential to delay, prevent, or even reverse multiple age-related diseases at once?
Yes. Aging is the root cause of aging-related diseases like cardiovascular disease or Alzheimer’s. Animals in which aging is retarded not only live longer but also get these diseases much later. They stay healthy for a much longer time. Long-lived species get aging-related diseases much later. Bowhead whales, which can live up to 220 years, do not get heart disease, cancer or Alzheimer’s disease when they are 90 years old, like we do. They get these diseases when they are 200 years old. Postponing aging is the most powerful way to keep people healthier for a much longer time.
Lots of people are focusing on curing single diseases, such as heart disease, cancer, and so on. However, even if we could cure one of these, would it really make much difference to our lifespans?
Addressing individual aging-related diseases, like heart disease, is not enough to really make an impact on the health of people. Even if we suddenly have a magical cure that could fix all heart disease, which is the most important cause of death in most developed countries, people would live only about 2.8 years longer. That is not much. People wouldn’t die of heart attacks anymore, but they would still die a few years later of another aging-related disease, like Alzheimer’s or cancer. So, therefore, it’s paramount to address aging itself, instead of treating individual aging diseases.
Current medical practice often tries to use an infectious disease approach to age-related diseases; in other words, it treats symptoms rather than causes. Why has medicine been slow to embrace the concept of treating age-related diseases by treating the aging processes directly?
Aging is often not a very well-taught subject at medical school. In medicine, most emphasis is put on treating aging symptoms and not on addressing the underlying cause, namely aging itself. Many MDs still think that aging is mainly caused by free radicals and DNA damage. Also, in medicine, aging is often considered to be a natural process, so there is no imperative to treat it. While most MDs consider aging to be a natural process, many aging researchers consider aging to be a 100 percent heritable, 100 percent fatal multisystemic disease caused by evolutionary negligence. In medicine, aging of individual organs is called a disease: aging of the heart is called heart disease and aging of the brain is called Alzheimer’s disease, but aging of the whole body is not considered a disease. It would be much more interesting for medical students to approach diseases from an aging viewpoint and to also deepen their understanding of diseases. Take, for example, heart disease: many MDs will say that it’s not really caused by aging, but brought about by white blood cells that accumulate in the blood vessel wall. However, if you look deeper, you see that that this happens because of typical aging processes, like lysosomal dysfunction in the white blood cells, Β making them stack up oxidized cholesterol and accumulate in the blood vessel walls, telomere attrition of the endothelial cells in the blood vessel wall so the endothelial cells let through more white blood cells, senescence and epigenetic changes in the stem cells in the blood vessel walls, and so on. We urgently need to train MDs more about aging, the process that causes most of the diseases that they will treat on an everyday basis.
Why have many medical doctors not embraced the idea that aging can be addressed directly?
Sometimes, this is because they haven’t seen the recent studies that show that aging can be partially reversed, or it’s because they have not sufficiently been educated in aging and how it causes so many aging-related diseases. All too often, aging is considered as too complex a process to interfere with. However, you do not have to understand all the intricacies of aging to do something about it. For example, four simple Yamanaka factors, cyclically applied, can rejuvenate cells. We don’t have to exactly know all the specific aging pathways that are impacted by these Yamanaka factors. We just see that it works.
What can we do to encourage more medical doctors to consider ways of treating the aging processes directly in order to treat multiple age-related diseases at once?
We should explain more that aging causes most diseases that MDs deal with, such as heart disease, cancer and Alzheimer’s. We should explain more how aging originates and the fascinating new insights and studies regarding reversing aging. We should emphasize more that slowing down or reversing aging is the most powerful method to keep people healthier for a much longer time. We should avoid the term “anti-aging”, because this term is loaded with unproven therapies, but instead use the term biogerontology, which is the scientific field that studies aging.
Is the field of medicine prepared to address the silver tsunami, and how might biogerontology help with this problem?
Medicine is very ill-prepared to address the silver tsunami. Medicine is badly prepared to even do something about the many chronic diseases that impact people today. Medicine mainly focuses on treating diseases when it’s too late, such as when people already have had a heart attack or when people already have cancer. Too little emphasis goes onto preventing diseases through healthy nutrition and lifestyle in general. We know that, in many cases, type 2 diabetes and heart disease can be reversed. Unfortunately, this doesn’t happen for most people, because they get very ineffective, watered-down health and lifestyle advice in the best case and only medication in the worst case. It’s unfortunate to see how the root cause of their problems is not addressed. With the aging population, and the many aging-related and metabolic diseases that come along, this problem will only compound and could lead to the bankruptcy of health care systems and insurance industries of whole countries if we are not going to do something drastic about it. Giving people an app or a walking stick with a sensor is not going to really address the issue.
What approaches and technologies that may address the aging processes in the near future are you most optimistic about?
I am enthusiastic about modulation of the epigenome to really impact the aging process. Clearing senescent cells is also promising. It’s a low-hanging-fruit approach to aging, given that it is quite easy to clear senescent cells despite the fact that it would mainly extend median lifespan and not maximum lifespan. New technologies like CRISPR proteins, which allow scientists to much more accurately reprogram genes, and transcriptomic drugs, like mRNA, siRNA and microRNA, are also promising to tackle aging and aging-related diseases. I estimate that in the next 10 to 15 years, the first therapies to treat aging will come about.
What can we do now to slow aging down and stay healthy while we wait for these approaches and technologies to arrive?
The method we have to live longer now is our food. Next come exercise, psychology, sleep, relationships, and so on. However, only nutrition can impact maximum lifespan, while exercise can at best extend median lifespan. Eating lots of animal protein, especially red meat, sugar and starchy foods, and trans fats accelerates aging. We should eat less red meat, fried foods, sugary foods, potatoes, pasta, bread, and rice and should consume more vegetables, mushrooms, fruit, nuts, white meat, fish, green tea, and other nutrients that can slow down aging.
Do you currently engage in any practices to increase your longevity?
Of course. I eat healthy. Now and then, I fast. I try to get enough sleep and exercise. I do meditation and practice positive psychology to improve happiness. I take supplements, such as vitamin D, iodine, magnesium, B vitamins, nicotinamide riboside, and others. Some people go even a step further and take metformin or low-dose aspirin. However, healthy nutrition is more impactful on extending lifespan than supplements or drugs.
What is the biggest barrier to progress in the field?
One big barrier is lack of money. Many scientists cannot pursue great ideas or develop promising technologies because they don’t have enough funding. Biotech research is extremely expensive. Governments should provide much more funding to study and address aging, which is the main cause of the silver tsunami that could bankrupt them and that causes 86 percent of healthcare expenses. Many problems can be solved if enough money is thrown at them. Another important barrier is a lack of knowledge. If you are not aware of the recent progress made in the aging field, and of what new companies and start-ups are working on, you tend to think that tackling aging is impossibly difficult to do. However, you could be pleasantly surprised. Scientists and investors are now working on fixing aging; they consider death to be a technical problem that can and must be solved, and they look at the human body as a complex, walking and talking amalgam of 3D algorithms that can be reprogrammed into a more youthful state. Recent studies show that they might not be far off.
