Spain continues to be one of the countries with the highest life expectancy in the world. The Ministry of Health's report on 'Life Expectations in Spain' placed the average at birth in 2020 at 82.2 years (85 in women and 79.5 in men). “The increase in longevity consistently exceeds expectations. For every year that passes, life expectancy extends by approximately 3 months,” says Dr. Ángel Durántez on his social networks. That is why a reflection on how we age is necessary. “The idea is to die young as late as possible,” says the specialist, one of the pioneers in Spain of Medicine for Healthy Aging and Proactive Preventive Medicine.
Graduated in 'Age Management Medicine' in the United States from the CERF (Cenegenics Education and Research Foundation), he is also the author of the book Young at 100, all the keys to living longer and better (La Esfera de los Libros). Dr. Durántez, member of SEMAL (Spanish Society of Anti-Aging and Longevity Medicine) and member of SEMED (Spanish Society of Sports Medicine), has appeared on the Forbes 2018, 2019 and 2020 list as one of the 100 best doctors in Spain .
There are people who look 50 at 30, while others look 40 at 60. How does aging work in some bodies and in others?
From a scientific point of view and especially in the last decade, we began to understand the epigenetic marks and molecular changes that occur in our cells with aging. Spanish authors have signed articles in this regard. In 2013, Cell magazine published The Hallmark of Aging, where Carlos López-Otín talked about nine marks of aging. In January 2023, an update was released where thirteen brands already appear.
What are those aging marks?
This is what happens in our cells as we age, such as the decrease in the functionality of stem cells, the shortening of telomeres (ends of chromosomes), accumulation of senescent cells, chronic inflammation... Also intestinal dysbiosis, for example. example. We know that this produces a deterioration in cellular function. There are also genes related to aging that stop working properly, in some people sooner than in others. All of this gives the epigenetics of aging, which is why some at 80 years old can run a half marathon or have magnificent cognitive function, and others cannot. The final epigenetic result is a mix of genetics and the ambiome, our interaction with the environment, how we behave well in life (if we exercise, if we eat properly...).
What percentage of aging is genetic and what percentage is ambiome, and is it in our hands?
We carry 20 or 30% of genetics, the rest, 70 or 80%, is ambiome, we have it in our hands. When you are very young, genetics weigh more, but as you get older the result depends more on your lifestyles (if you have smoked, if you have used sunscreen...). At the end of life, once again, genetics have weight because it has been proven that those who far exceed the average life expectancy have genes that protect against aging.
Is aging something natural or is it already considered a disease?
The tendency is to consider it a disease. There is quite a debate about this, because it is a bioethical issue. In 2022, the WHO describes a disease code called “intrinsic decline related to aging.” I was considering calling it “advanced age” but it is too subjective a term. What happens is that when there is a code it can be investigated as if it were a disease. We can say that aging is considered the mother of the diseases that we will end up having over time.
From what age do we definitely start to age? You talk about programmed senescence…
Throughout our lives we go through four phases, three moments of aging. In the first we do not have diseases and it lasts until we are 35 or 40 years old. From that age onwards, the majority of the population has some medical diagnosis, even if they do not feel sick. After 60, most people feel average, unwell or very unwell. Starting at 80, 50% of the population is dependent in their daily lives. When to start taking control of your health seriously? Between the ages of 35 and 40, the decline in health associated with aging begins. It has been seen that in these three moments of life there are methylation changes in our DNA. It seems that there is a programming of senescence at different times, although it cannot be categorical.
What is proactive preventative medicine that you are pioneering?
It is included in what we call the 21st century health paradigm, which complements reactive medicine - doing something when you are sick - with a vision aimed at prevention. In medical school they tell you: “don't do anything until it's necessary.” This would be a twist: “do what you can before the disease arrives.” It is the medicine of "pes", preventive, proactive, predictive, personalized, precision and pleasant, since you go to the doctor not because you are sick, but because you want to remain healthy. It is trying to move the point from 60 towards 70 or 80 years.
Can that medicine predict what diseases I will have?
If I do a checkup, I can see in your blood tests and medical history, for example, a tendency toward poor management of carbohydrate metabolism. I can see if there is a history of diabetes in your family. I can use different diagnostic methods (putting glucometers even if you are a healthy person, for example), see your intestinal microbiota, see how you sleep... With all that, we determine if you have a tendency towards diabetes, hypertension or adenomatosis. This way we can implement very personalized preventive actions, including carrying out genetic studies, sequencing the genome... There are dozens of tests!
Always in private medicine, for those who can pay for it. Is it expected to reach the public?
It is a cutting-edge, frontier medicine, it is in its first steps. This year a service of this medicine was inaugurated in a public hospital in Israel, it is great news. They will welcome 2,000 patients of different ages and will perform tests and measurements to confirm what aging is like in each population group.
You say that we should not settle for being “normal”, normal is not optimal. What does it mean?
The ranges of normality in medicine are established so that 95% of the population falls within that normality, the level of demand is very low. If we place these biomarkers at a point further away from the disease, they will distance us more effectively from the pathology. Systolic (high) blood pressure is considered to be above 140, but a truly good value is below 120. Fasting glucose should be below 90, LDL cholesterol can be below 116 or below 100 in In other cases, the optimal uric acid is below 5.5... And so on with dozens of biomarkers.
To what extent is physical exercise the key to healthy aging?
We have to move, let everyone do what they can. The long-lived societies of the so-called blue zones are characterized because the population has very active lives, even if they do not do sports: they work in the garden, fish, ride a bike, climb stairs... The tendency in modern society is to sit, take the car and go up in the elevator. Get moving! What we call physical activity is non-exercise thermogesis activity: walking to places, standing up, working standing or sitting on a fit ball to exercise the core, getting up from the workplace from time to time... Then we have the exercise, which is when you put on your shirt and pants to train. Another thing is sport, when you go to play a tennis match. But the important thing is to move.
It is being seen that muscle mass is closely related to healthy aging. Is that so?
Completely. One of the problems of aging is the fragility that goes hand in hand with sarcopenia, the loss of muscle mass, related to the risk of falls and other diseases. Muscle is not only used for movement or lifting weight, it is an organ that releases myokines, substances that are good for the arteries and our brain. You have to work your muscles, not only do cardio, but also strength. And this works for women, men, adults and children. All!
In addition to the guidelines that we already know... What eating habits influence aging well?
Eat little and eat a Mediterranean diet, apply calorie restriction to your daily needs, and if it is a little less, even better. Eat fruit, vegetables, nuts, limit red meat, eat olive oil and legumes, drink two or three liters of water a day and limit ultra-processed foods.
What do you think of fasting?
12-hour fasts already work. You can also do the 16-8, 16-hour fast and 8-hour intake window, with it being better not to have dinner than to skip breakfast. This does not need to be done every day and keep in mind that some people tolerate it better than others. There is also the famous Valter Longo diet, with a fasting period of five or six days, one month on, one month off, limiting daily calorie intake to about 1,000.
Isn't fasting dangerous?
It has been done all our lives, it is Lent for Christians, Ramadan for Muslims, or Grandma's broth week. Human beings have been doing it all their lives.
What dietary supplements really help your health as you age?
With the way we eat today, with many processed and ultra-processed foods, with intensive crops, with preservatives, dyes, antioxidants, pesticides... The nutritional density of food is not what it was years ago. It is difficult to have optimal levels of nutrients, even if we eat a diet that we consider balanced. When we do analyses, we very often see that markers that have to do with diet are not at their optimal level, despite eating well. We complement that with supplements.
For example?
We measure omega-3 levels, which have to do with the intake of oily fish. The most common thing, even in people who are careful to eat well, is for omega-3 levels to be at low or suboptimal levels. On the other hand, as we age, our intestinal microbiota and our ability to absorb nutrients alter, and that is where it makes sense to prescribe a good supplementation.
When it comes to sleep, what helps with healthy aging?
Sleep hygiene, having established times to go to bed and get up, avoiding white lights at night, avoiding electronic devices before going to bed, avoiding brain activation and intense physical activity at night... These are generalities, each person is different. different. Dinner should be light, and it is advisable to go to bed after digesting, with a good pillow, in darkness, with a suitable temperature, in the absence of noise...
After a certain age, is it normal to wake up during the night?
From the age of 40 you begin to have fragmented sleep, there are nocturnal awakenings due to poor digestion, pain, discomfort, family responsibilities... But if you go back to sleep, accumulate 7 hours of sleep and do not have daytime sleepiness, nothing happens. . Many people say they sleep poorly, but in reality this is not the case. You have to be careful with psychotropic drugs. Aging causes the acrophase of melatonin - the peak - to be lower.
How does stress affect us in all this?
Anxiety and stress are probably what ages us the most. We have been trying to address these situations and how to manage them all our lives. There are mindfulness techniques, but not everyone is able to achieve focus or not think. In the end, praying or going to a church or temple is a form of introspection, you have to search for inner peace and everyone can search for it however they want or can.
Anti-aging hormone therapy is on the rise. What advantages does it entail?
One of the characteristics that occur with aging and the causes that produce it is that hormonal levels decrease, except for cortisol and insulin, which increase. This drop in hormones is related to a loss of functionality. It is seen very clearly at the time of menopause, there is a sharp decline in some hormones in a few months, and many women perceive the symptoms associated with this, with the drop in estradiol, estrogen. Hormonal level optimization therapy has been seen to produce an improvement in vitality and well-being, in various aspects ranging from sexual function to strength, mood, or neurocognitive function. In addition, hormones function as prevention of diseases related to aging.
There is a lot of talk about the hormonal chip or pellet…
It is one way of doing it, of providing the hormones, but there are other ways of application: creams, suppositories, injections, tablets, pellets... It all depends on the hormones to be prescribed.
And what risks does this hormone therapy entail?
We are in a moment of hormonophobia, of fears generated as a result of the abuse of hormones for purposes that are not correct: to develop a lot of muscle in the gym, for sports doping or for the food industry, in livestock farming. On the other hand, some therapies are linked to the appearance of some type of cancer. In the WHI study published in 2002, pseudohormones were used and their use was linked to breast cancer and thromboembolism. This generated a halo of hormonephobia, fears, and suspicions. There are constantly studies that show the benefits of well-targeted hormonal therapies.
What are geroprotectors and how can they be used against aging?
For a decade now, scientific interest in acting on the signs of aging to reverse them is enormous; many laboratories are working on it. Geroprotectives are substances, supplements or drugs that can have an effect on some of the marks, acting on the cause of aging. The Anglo-Saxons call it longevity medicine, and studies published in Nature Aging or The Lancet already talk about actions in stem cells, gene therapy, cellular reprogramming, parabiosis, metformin, rapamycin, spermidine... They are geroprotectors that are in the study phase. Rejuvenation medicine will bring us spectacular changes, what can come is very important.
The longevity record is 122 years... How long will we live?
A mathematical study says that by the time those born around 1950 reach the point of average life expectancy (they are now over 70 years old), many will escape to later years. There will be a large group of people over 100 years old. The French woman who lived to be 122 years old was a specific case, but in a few decades this will be more common. A wave of a few thousand supracentenarians (over 110 years old) will arrive and there will be a greater chance that the longevity record will be broken.
