By Sean Moloughney, Editor04.08.24
Both globally and domestically, the proportion of older people is growing. By 2030, an estimated one in six people on the planet will be aged 60 years or over, equating to about 1.4 billion people, according to the World Health Organization (WHO). By 2050, that number is expected to nearly double to 2.1 billion people.
In the U.S., according to census data, 12.4% of the population was age 65 years or older in the year 2000. In 2010, that figure rose slightly to 13%, and in 2020 that number jumped to 16.8% with the Baby Boomer generation starting to reach their retirement years beginning in 2011. By 2030, it’s expected that 20% of the total U.S. population will be 65 or older.
Related: Introducing the Health and Longevity Conference & Showcase — Sept. 12 in NYC.
Age is the single biggest risk factor for prevalent diseases like cardiovascular disease, cancer, and neurodegenerative diseases like Alzheimer’s.
However, perhaps more than ever, people are motivated to live healthier lives into their senior years. At the same time, scientific understanding about aging and the role that interventions like nutrition and lifestyle can play in slowing health decline has advanced rapidly.
In fact, the formula has been shown to work, as observed in communities around the world, which have been identified as “Blue Zones.”
After an expedition to Okinawa, Japan in 2000 to investigate longevity there, Dan Buettner, a National Geographic Fellow and a team of scientists set out to explore other regions of the world with the healthiest, longest-living populations.
Buettner’s exploration built on the demographic work that Gianni Pes and Michel Poulain outlined in the Journal of Experimental Gerontology, which identified the island of Sardinia, Italy as the region with the highest concentration of male centenarians.
After analyzing demographic data, Buettner identified five regions of the world that engage in similar lifestyle habits, such as consuming a plant-heavy diet and prioritizing strong social networks. Buettner refers to these commonalities as the Power Nine in his book The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest.
Along with Okinawa and the Barbagia region of Sardinia, those Blue Zones include Ikaria, Greece; Nicoya, Costa Rica; and Loma Linda, California (Seventh Day Adventists).
The nine lifestyle habits Buettner described that allow these communities to thrive include 1) natural movement that is ingrained in daily life; 2) a strong sense of purpose; 3) stress management, which he refers to as “downshifting”; 4) the 80% rule, or eating only until about 80% full; 5) a plant-centric diet; 6) moderate wine consumption (except for Adventists); 7) belonging and spirituality; 8) prioritization of family and closeness to loved ones; and 9) strong social networks that support healthy behaviors.
While geography, genetics, social stressors, and systemic socioeconomic issues present barriers to sustaining those habits more broadly, Buettner’s conclusions and writings offer valuable insights into practices of health and longevity.
For example, sedentary lifestyles and poor dietary habits have led to a rise in Metabolic syndrome, a condition that may include risk factors like abdominal obesity, high blood pressure (BP), impaired fasting blood glucose, high triglycerides, and low HDL (good) cholesterol.
A research paper published in JAMA in 2020 that updated analysis of metabolic syndrome prevalence through 2016 indicated incidence rose to 34.7% of U.S. adults, from 33% in 2007. Researchers noted that prevalence of metabolic syndrome increases significantly with age. Prevalence was 19.5% among those aged 20-39 and 48.6% among those 60 and older.
As seen in the dietary habits of people who live in Blue Zones, the Mediterranean diet—emphasizing the consumption of vegetables, fruits, whole grains, nuts, seeds, beans, legumes, and healthy oils such as extra-virgin olive oil (EVOO)—has been shown time and again to offer many health benefits.
Monounsaturated fatty acids (MUFAs) found in EVOO and omega-3 polyunsaturated fatty acids (PUFA) from fish are understood to contribute to the beneficial effects of the Mediterranean diet (MD) along with other nutrient-dense staples.
A review published in Nutrition Today (2017) noted that “Observational studies with older adults illustrate the positive association of a MD eating pattern on health through reductions in BP, blood cholesterol, diabetes, inflammatory markers, coronary syndromes, CVD, body mass index (BMI), and obesity.”
In February (2024) researchers reported in the British Journal of Nutrition that adherence to a Mediterranean diet and eating at least two portions of fish per week were beneficial against depressive symptoms, especially in older women.
These findings are representative of the emerging field of nutritional psychiatry, which continues to develop data supporting a role for healthy dietary patterns in depression onset and symptom management, according to researchers writing in Molecular Psychiatry (2020).
In their expert review, Marx et. al. stated: “The mechanisms of action associating diet with health outcomes are complex, multifaceted, interacting, and not restricted to any one biological pathway. Numerous pathways were identified through which diet could plausibly affect mental health. These include modulation of pathways involved in inflammation, oxidative stress, epigenetics, mitochondrial dysfunction, the gut microbiota, tryptophan–kynurenine metabolism, the HPA (hypothalamic-pituitary-adrenal) axis, neurogenesis and BDNF (brain-derived neurotrophic factor) ... and obesity.”
That offers a long runway for future research. For now, a study published in the Annals of Neurology (February 2024) noted that a healthier diet is associated with reduced dementia risk and a slower pace of aging.
Researchers analyzed data from the Framingham Offspring Cohort, specifically those 60 years of age or older who were free of dementia, and also had available dietary, epigenetic, and follow-up data.
The article determined that higher adherence to the Mediterranean-DASH Intervention for Neurodegenerative Delay diet (MIND) slowed the pace of aging as measured by the epigenetic test DunedinPACE and reduced risks for dementia and mortality.
An estimated 6.9 million Americans age 65 and older are living with Alzheimer’s in 2024—73% of which are 75 or older—and many more are likely undiagnosed, according to the latest data from the Alzheimer’s Association.
Almost two-thirds of Americans with Alzheimer’s are women. However, women tend to live longer and it’s still unclear if women are more likely to develop AD, if they are less likely to die earlier in life from other causes, or if other factors account for the differences between men and women.
Although data indicate that a person’s risk of dementia at any given age may be decreasing slightly, the total number of people with Alzheimer’s or other dementias in the U.S., and other high-income countries, is expected to increase dramatically due to the sheer size of the population that’s reaching older age.
Additionally, increasing rates of diabetes and obesity—risk factors for dementia—among younger people could compound the problem down the road.
Barring the development of medical breakthroughs to prevent or cure Alzheimer’s, the number of people aged 65 and older with the disease is projected to reach 13.8 million by 2060.
The social and economic burden of Alzheimer’s and other dementias is significant. More than 11 million Americans provide unpaid care for a family member or friend with dementia. An estimated 25% of dementia caregivers are part of a so-called “sandwich generation,” meaning they’re caring for an aging parent as well as at least one child.
In 2024, health and long-term care costs for people living with Alzheimer’s and other dementias are projected to reach $360 billion.
A study funded by the National Institute on Aging (NIA), published in Proceedings of the National Academy of Sciences in February (2024) noted that, “Estimates of biological age, as measured by epigenetic changes such as DNA methylation (DNAm), can aid prediction of age-related health outcomes, including multiple chronic diseases, impaired cognitive function, functional limitations, and mortality in older adults. However, other factors, such as demographics, socioeconomic status, mental health, and health behaviors, are comparable—and often more robust—predictors of late-life health outcomes.”
As opposed to chronological age, biological age refers to the accumulating damage, physiological changes, and loss of function that occur in a person’s cells over time, authors noted. Not everyone’s mind and body ages at the same rate given variables like genetics, environment, diet, lifestyle, etc.
Starting in the 1980s researchers sought to identify age-associated biomarkers that could be used to measure and understand, or even slow, halt, or reverse aging in order to reduce chronic disease.
Several iterations of “epigenetic clocks” have been developed in recent years, including first generation (Horvath and Hannum), second generation (GrimAge and PhenoAge), and third generation (DunedinPACE).
Writing in the Proceedings of the National Academy of Sciences, scientists examined the association between epigenetic age acceleration and age-related health outcomes, including death, by using these three types of epigenetic clocks.
“The second and third generation clocks, which were designed to improve on earlier clocks, were capable of predicting functional limitations of daily living and impaired cognitive function,” authors wrote. “Along with traditional social and behavioral predictors of health, epigenetic age measures are a valuable tool for aging research and predicting health outcomes later in life.”
Originally intended to assist clinical researchers, epigenetic clock tests are also available to curious consumers interested in evaluating their overall health. The utility of these biological age tests, in isolation, at the individual consumer level, is questionable.
However, advancements in understanding of the aging process continue to draw interest.
For a long time, he added, researchers didn’t truly understand the mechanisms behind aging. “Now we’re finding all sorts of the underlying causes for aging, and we’re in a position, perhaps, to do something about it.”
Ramakrishnan went on to tell WIRED that he thinks of aging as “an accumulation of chemical damage to our bodies.”
“Initially the damage occurs to our molecules, starting with our genome and then to the proteins that the genes specify and make, and then to our organelles and the cell’s ability to get rid of defective products.”
When a cell senses a certain level of damage, it goes into senescence. With age, a buildup of senescent cells can lead to inflammation and tissue damage. “And if stem cells, which are responsible for regenerating tissues, become senescent or die (apoptosis), you get a depletion of stem cells, and you have problems regenerating tissue—you have problems just maintaining the organism.”
As the protective caps at the end of DNA strands, telomeres play a vital role in preserving the information in our genome.
As a normal cellular process, a small portion of telomeric DNA is lost with each cell division. At a certain point, when telomere length gets too short, the cell undergoes senescence and/or apoptosis.
Again, research indicates that telomere length, which can be affected by various lifestyle factors, can affect the pace of aging and onset of age-related illness.
“Studies of model organisms as well as patients with telomerase mutations have shown that short telomeres result in dire consequences,” researchers wrote in Physiological Reviews (Aubert and Lansdorp, 2008). “It seems plausible that, with age, the proliferation of an increasing number of cells in normal individuals is compromised by progressive telomere loss.”
However, they added, this isn’t categorically bad, “as restrictions in the proliferation of somatic cells pose a barrier for the growth of aspiring tumor cells. Unfortunately, the telomere mechanism that limits the growth of premalignant cells also provides strong selection for cells that no longer respond to the DNA damage signals originating from short telomeres. Such cells are genetically unstable and have greatly increased ability to acquire genetic rearrangements that provide further growth advantages. The intricate involvement of telomeres in both aging and cancer ensures that pathways involving telomeres and telomerase will remain subject to intensive studies for many years to come.”
Indeed, that was back in 2008. Researchers today continue to pursue the intricacies of aging.
About the Author: Sean Moloughney has been the Editor of Nutraceuticals World since 2012. He can be reached at smoloughney@rodmanmedia.com.
In the U.S., according to census data, 12.4% of the population was age 65 years or older in the year 2000. In 2010, that figure rose slightly to 13%, and in 2020 that number jumped to 16.8% with the Baby Boomer generation starting to reach their retirement years beginning in 2011. By 2030, it’s expected that 20% of the total U.S. population will be 65 or older.
Related: Introducing the Health and Longevity Conference & Showcase — Sept. 12 in NYC.
Age is the single biggest risk factor for prevalent diseases like cardiovascular disease, cancer, and neurodegenerative diseases like Alzheimer’s.
However, perhaps more than ever, people are motivated to live healthier lives into their senior years. At the same time, scientific understanding about aging and the role that interventions like nutrition and lifestyle can play in slowing health decline has advanced rapidly.
Theory and Practice
The formula appears fairly simple in theory: a varied and balanced diet should focus on whole foods, mostly from plants; regular exercise/movement; proper sleep and stress management; and healthy social connections are all well-established components of health and longevity.In fact, the formula has been shown to work, as observed in communities around the world, which have been identified as “Blue Zones.”
After an expedition to Okinawa, Japan in 2000 to investigate longevity there, Dan Buettner, a National Geographic Fellow and a team of scientists set out to explore other regions of the world with the healthiest, longest-living populations.
Buettner’s exploration built on the demographic work that Gianni Pes and Michel Poulain outlined in the Journal of Experimental Gerontology, which identified the island of Sardinia, Italy as the region with the highest concentration of male centenarians.
After analyzing demographic data, Buettner identified five regions of the world that engage in similar lifestyle habits, such as consuming a plant-heavy diet and prioritizing strong social networks. Buettner refers to these commonalities as the Power Nine in his book The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest.
Along with Okinawa and the Barbagia region of Sardinia, those Blue Zones include Ikaria, Greece; Nicoya, Costa Rica; and Loma Linda, California (Seventh Day Adventists).
The nine lifestyle habits Buettner described that allow these communities to thrive include 1) natural movement that is ingrained in daily life; 2) a strong sense of purpose; 3) stress management, which he refers to as “downshifting”; 4) the 80% rule, or eating only until about 80% full; 5) a plant-centric diet; 6) moderate wine consumption (except for Adventists); 7) belonging and spirituality; 8) prioritization of family and closeness to loved ones; and 9) strong social networks that support healthy behaviors.
While geography, genetics, social stressors, and systemic socioeconomic issues present barriers to sustaining those habits more broadly, Buettner’s conclusions and writings offer valuable insights into practices of health and longevity.
Shifting Public Health Challenges
While many infectious diseases have been managed successfully over time, our modern era has presented new challenges.For example, sedentary lifestyles and poor dietary habits have led to a rise in Metabolic syndrome, a condition that may include risk factors like abdominal obesity, high blood pressure (BP), impaired fasting blood glucose, high triglycerides, and low HDL (good) cholesterol.
A research paper published in JAMA in 2020 that updated analysis of metabolic syndrome prevalence through 2016 indicated incidence rose to 34.7% of U.S. adults, from 33% in 2007. Researchers noted that prevalence of metabolic syndrome increases significantly with age. Prevalence was 19.5% among those aged 20-39 and 48.6% among those 60 and older.
As seen in the dietary habits of people who live in Blue Zones, the Mediterranean diet—emphasizing the consumption of vegetables, fruits, whole grains, nuts, seeds, beans, legumes, and healthy oils such as extra-virgin olive oil (EVOO)—has been shown time and again to offer many health benefits.
Monounsaturated fatty acids (MUFAs) found in EVOO and omega-3 polyunsaturated fatty acids (PUFA) from fish are understood to contribute to the beneficial effects of the Mediterranean diet (MD) along with other nutrient-dense staples.
A review published in Nutrition Today (2017) noted that “Observational studies with older adults illustrate the positive association of a MD eating pattern on health through reductions in BP, blood cholesterol, diabetes, inflammatory markers, coronary syndromes, CVD, body mass index (BMI), and obesity.”
Nutritional Psychiatry
The Mediterranean diet has proven useful in addressing many other age-related health challenges as well.In February (2024) researchers reported in the British Journal of Nutrition that adherence to a Mediterranean diet and eating at least two portions of fish per week were beneficial against depressive symptoms, especially in older women.
These findings are representative of the emerging field of nutritional psychiatry, which continues to develop data supporting a role for healthy dietary patterns in depression onset and symptom management, according to researchers writing in Molecular Psychiatry (2020).
In their expert review, Marx et. al. stated: “The mechanisms of action associating diet with health outcomes are complex, multifaceted, interacting, and not restricted to any one biological pathway. Numerous pathways were identified through which diet could plausibly affect mental health. These include modulation of pathways involved in inflammation, oxidative stress, epigenetics, mitochondrial dysfunction, the gut microbiota, tryptophan–kynurenine metabolism, the HPA (hypothalamic-pituitary-adrenal) axis, neurogenesis and BDNF (brain-derived neurotrophic factor) ... and obesity.”
That offers a long runway for future research. For now, a study published in the Annals of Neurology (February 2024) noted that a healthier diet is associated with reduced dementia risk and a slower pace of aging.
Researchers analyzed data from the Framingham Offspring Cohort, specifically those 60 years of age or older who were free of dementia, and also had available dietary, epigenetic, and follow-up data.
The article determined that higher adherence to the Mediterranean-DASH Intervention for Neurodegenerative Delay diet (MIND) slowed the pace of aging as measured by the epigenetic test DunedinPACE and reduced risks for dementia and mortality.
An estimated 6.9 million Americans age 65 and older are living with Alzheimer’s in 2024—73% of which are 75 or older—and many more are likely undiagnosed, according to the latest data from the Alzheimer’s Association.
Almost two-thirds of Americans with Alzheimer’s are women. However, women tend to live longer and it’s still unclear if women are more likely to develop AD, if they are less likely to die earlier in life from other causes, or if other factors account for the differences between men and women.
Although data indicate that a person’s risk of dementia at any given age may be decreasing slightly, the total number of people with Alzheimer’s or other dementias in the U.S., and other high-income countries, is expected to increase dramatically due to the sheer size of the population that’s reaching older age.
Additionally, increasing rates of diabetes and obesity—risk factors for dementia—among younger people could compound the problem down the road.
Barring the development of medical breakthroughs to prevent or cure Alzheimer’s, the number of people aged 65 and older with the disease is projected to reach 13.8 million by 2060.
The social and economic burden of Alzheimer’s and other dementias is significant. More than 11 million Americans provide unpaid care for a family member or friend with dementia. An estimated 25% of dementia caregivers are part of a so-called “sandwich generation,” meaning they’re caring for an aging parent as well as at least one child.
In 2024, health and long-term care costs for people living with Alzheimer’s and other dementias are projected to reach $360 billion.
“Estimates of biological age, as measured by epigenetic changes such as DNA methylation (DNAm), can aid prediction of age-related health outcomes, including multiple chronic diseases .... ”
Epigenetic Clocks
Turning back to epigenetic testing, these tools warrant further discussion given their continued development and application in clinical research.A study funded by the National Institute on Aging (NIA), published in Proceedings of the National Academy of Sciences in February (2024) noted that, “Estimates of biological age, as measured by epigenetic changes such as DNA methylation (DNAm), can aid prediction of age-related health outcomes, including multiple chronic diseases, impaired cognitive function, functional limitations, and mortality in older adults. However, other factors, such as demographics, socioeconomic status, mental health, and health behaviors, are comparable—and often more robust—predictors of late-life health outcomes.”
As opposed to chronological age, biological age refers to the accumulating damage, physiological changes, and loss of function that occur in a person’s cells over time, authors noted. Not everyone’s mind and body ages at the same rate given variables like genetics, environment, diet, lifestyle, etc.
Starting in the 1980s researchers sought to identify age-associated biomarkers that could be used to measure and understand, or even slow, halt, or reverse aging in order to reduce chronic disease.
Several iterations of “epigenetic clocks” have been developed in recent years, including first generation (Horvath and Hannum), second generation (GrimAge and PhenoAge), and third generation (DunedinPACE).
Writing in the Proceedings of the National Academy of Sciences, scientists examined the association between epigenetic age acceleration and age-related health outcomes, including death, by using these three types of epigenetic clocks.
“The second and third generation clocks, which were designed to improve on earlier clocks, were capable of predicting functional limitations of daily living and impaired cognitive function,” authors wrote. “Along with traditional social and behavioral predictors of health, epigenetic age measures are a valuable tool for aging research and predicting health outcomes later in life.”
Originally intended to assist clinical researchers, epigenetic clock tests are also available to curious consumers interested in evaluating their overall health. The utility of these biological age tests, in isolation, at the individual consumer level, is questionable.
However, advancements in understanding of the aging process continue to draw interest.
A Natural Process
In an interview with WIRED, Venki Ramakrishnan, Nobel laureate and author of Why We Die: The New Science of Aging and the Quest for Immortality, said: “The tools of molecular biology are becoming more and more powerful every year. That’s leading to big advances in understanding processes, but it’s also giving us tools for tackling some of these problems.”For a long time, he added, researchers didn’t truly understand the mechanisms behind aging. “Now we’re finding all sorts of the underlying causes for aging, and we’re in a position, perhaps, to do something about it.”
Ramakrishnan went on to tell WIRED that he thinks of aging as “an accumulation of chemical damage to our bodies.”
“Initially the damage occurs to our molecules, starting with our genome and then to the proteins that the genes specify and make, and then to our organelles and the cell’s ability to get rid of defective products.”
When a cell senses a certain level of damage, it goes into senescence. With age, a buildup of senescent cells can lead to inflammation and tissue damage. “And if stem cells, which are responsible for regenerating tissues, become senescent or die (apoptosis), you get a depletion of stem cells, and you have problems regenerating tissue—you have problems just maintaining the organism.”
As the protective caps at the end of DNA strands, telomeres play a vital role in preserving the information in our genome.
As a normal cellular process, a small portion of telomeric DNA is lost with each cell division. At a certain point, when telomere length gets too short, the cell undergoes senescence and/or apoptosis.
Again, research indicates that telomere length, which can be affected by various lifestyle factors, can affect the pace of aging and onset of age-related illness.
“Studies of model organisms as well as patients with telomerase mutations have shown that short telomeres result in dire consequences,” researchers wrote in Physiological Reviews (Aubert and Lansdorp, 2008). “It seems plausible that, with age, the proliferation of an increasing number of cells in normal individuals is compromised by progressive telomere loss.”
However, they added, this isn’t categorically bad, “as restrictions in the proliferation of somatic cells pose a barrier for the growth of aspiring tumor cells. Unfortunately, the telomere mechanism that limits the growth of premalignant cells also provides strong selection for cells that no longer respond to the DNA damage signals originating from short telomeres. Such cells are genetically unstable and have greatly increased ability to acquire genetic rearrangements that provide further growth advantages. The intricate involvement of telomeres in both aging and cancer ensures that pathways involving telomeres and telomerase will remain subject to intensive studies for many years to come.”
Indeed, that was back in 2008. Researchers today continue to pursue the intricacies of aging.
About the Author: Sean Moloughney has been the Editor of Nutraceuticals World since 2012. He can be reached at smoloughney@rodmanmedia.com.
