The Anti Clock

THE ANTI-CLOCK

I have spent many Sundays glued to the television, and two Netflix series that I found fascinating were ‘Live to 100: Secrets of the Blue Zones’ and ‘Don’t Die: The Man Who Wants to Live Forever’. The former delves into the lives of five communities that live the longest and healthiest. These are residents of the ‘Blue Zones’ — Okinawa, Sardinia, Ikaria, Loma Linda, and Nicoya. Their secret lies in a plant-based diet, walking, gardening, focus on peace of mind, family bonds, and community support. The second series is a dichotomy and features a wealthy entrepreneur Bryan Johnson, and his obsession with anti-ageing. His wealth and energy are totally channelled into radical regimens including 54 dietary supplements, sleep regulation, exercise, gene therapy, plasma exchanges and gadgetry to reverse his biological clock and make him younger each day. He spends 2 million dollars each year to defy age and become 18 again. It raises questions about accessibility, ethics and psychological implications when I hear him talk. Two contrasting approaches towards the same goal — longevity and health.

Our genes are what we inherit. What we do after we are born is what we become. We don’t just want to live long, but we want to look youthful too. Youth has become a commodity. What we do not realise is that the actors and social media influencers often conceal their medical issues behind their exalted, glorified external appearances. Health and beauty are two sides of the same coin — they need to be unified.

The Brazilian butt lift (BBL) is the most popular and highly advertised cosmetic procedure, with Turkey being the murky hub for the same. Yet this dangerous surgery kills 3,000 people annually. A mother of five children in Gloucestershire died recently of a BBL. A well-known Indian actress died after a selfadministered cocktail of anti-ageing injections. The beauty industry is booming. Around 50 billion dollars were spent on Botox, hyaluronic acid fillers, lasers, skin lifts and cosmetic procedures in 2024. India is vying with the United States (US), Brazil and Japan for the top spot in aesthetic procedures. Surgical procedures include breast augmentation, liposuction, nose jobs, hair transplants and dental procedures. Medical tourism is flourishing, and the mushrooming of substandard, unethical clinics continues to claim lives. It is unregulated and only a minimum standard of service exists. Anti-ageing cannot — and should not — be confused with longevity and health. Beauty is only skin deep. Gen-Z seems to be infatuated with fillers rather than with what fills their insides.

What causes ageing? Growing old is a ubiquitous, inevitable, ongoing phenomenon. Hippocrates and Aristotle blamed ageing on diminishing ‘vital heat’. Modern-day scientists have proposed that it is genomic damage, cell senescence, mammalian target of rapamycin (mTOR) pathway and a reduced pool of stem cells that make a person age. ‘Inflammaging’ is an interesting concept where the human body is in a constant low-grade ‘sterile’ inflammatory state due to oxidative stress. Sirtuins are a fascinating family of proteins responsible for deoxyribonucleic acid (DNA) damage repair and are the focus not just of longevity but also of anti-cancer research. The endocrine theory discusses hormonal changes, and the immune theory emphasises immunosenescence in biological ageing. Ageing is such a complex process beginning at birth and culminating in death. Ultimately, it is the genes and the environmental factors that together interplay to determine biological age versus chronological age.

There are two subsets of phenotypes which are generating considerable interest — the ‘Metabolically unhealthy non-obese’ (MUNO) and the ‘Metabolically Healthy Obese’ (MHO). We have all read about the ‘YY paradox’ where the thin-fat Indian, Dr. Yajnik, and the Caucasian Dr. Yudkin had identical body mass index (BMI) but the former had a much higher body fat content.

So, is it all genetic expression or are there environmental determinants too? Ageing starts by the third decade with reduced cardiac output, maximum attainable heart rate and aerobic capacity. The blood vessels begin to harden, and gradually the blood pressure creeps upwards. People develop a mid-life paunch and gain a couple of kilograms each year. One fine day you realise that your trousers no longer fit. The laboratory results come back with elevated lipids and sugars. The clock keeps ticking, and routine activities cause tiredness and breathlessness. It's not just the mid-life crisis that we are talking about. The muscle mass decreases, testosterone levels fall with reduced libido, and bones become brittle. Reflexes are slower, falls and accidents happen, sleep becomes fragmented, and memory lapses lead to awkward moments. It feels depressing to see our bodies age. These grim changes happen at a much faster pace in diabetics, cardiac and renal patients.

We cannot stop Father Time, but we can certainly slow down the ticking of the clock. English poet John Gay wrote, “Exercise thy lasting youth defends.” In 1966, five healthy 20-year-olds in Dallas spent three weeks of their summer vacation in bed as part of the ‘Dallas Bed Rest and Training Study’. Their metabolism and cardiac function worsened to men twice their age. Then they were subjected to eight weeks of intense exercise, and their body fat and cardiac indices were better than their baseline. They had actually reversed a part of their ageing. The moral of the story is to mobilise patients early after an illness or surgery. The same five volunteers were re-evaluated when they turned 50. After six months of a structured endurance exercise programme, they lost substantial weight, improved aerobic capacity and managed to slow down — albeit not reverse — the clock. A sensible exercise programme has to include endurance exercises like walking, jogging, swimming or bicycling to improve the cardiac function. The machines in the gym are fine as long as we use them under supervision. Resistance exercises using light weights are vital for muscle and bone health. Yoga, stretching and balancing exercises protect the joints and maintain flexibility. The endorphins counteract anxiety and low mood. Rest is rust, movement keeps the body young. In a long-term follow-up of 16,936 Harvard Alumni, those who walked, climbed stairs and played sports had a 39% lower risk of heart disease and 24% lower risk of stroke than their sedentary classmates. The benefits of exercise include improvement in diabetes, hypertension, fatty liver, impotence, osteoporosis, depression, immunity and Alzheimer’s, to name a few. It increases life expectancy by more than two years.

There are a number of magic concoctions on social media to reduce ageing, but consider these with a pinch of salt. An overdose of simple things like turmeric (haldi) can cause curcumin hepatotoxicity. Cut down the saturated fats and include monounsaturated fatty acids and omega-3 in your diet. Processed foods, salt, simple sugars, smoking and alcohol reduce years. Our diet lacks sufficient protein and needs more of these. Think before you order. It’s not the carbs and the fat — it's the proteins that matter. Big biceps are not the same as muscle strength. An octogenarian loses around 8 kg of muscle mass. Sarcopenia causes falls and fractures.

Darwin proclaimed that it is ‘survival of the fittest.’ We may not be able to prevent cataracts from developing or prostates from enlarging, but we can age healthier, more gracefully and certainly slow down the tick-tock of the clock. We should target ‘optimal’ rather than ‘normal’ laboratory reports. Our prime focus has to be mental and metabolic health. You can’t stop the clock and live forever.

“No one is so old that he does not think he could live another year.” — Cicero

Dr. Monica Mahajan

Editor-in-chief,
The Max Medical Journal

Advisory Board

Dr. Sandeep Budhiraja
Mr. Anas Abdul Wajid
Dr. Anil Handoo
Dr. Vinitaa Malhotra Jha

Editor in Chief

Dr. Monica Mahajan

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Dr. Poorvee Mathur
Dr. Saroj Sabath
Ms. Oshita Taneja Narula
Ms. Taruna Sharma
Mr. Manul Kamthan
Dr. Ritika Pan Banerjee
Dr. Angad Sekhon

International Editors

Dr. Eric Livingston
Dr. Mumtaz Patel

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Dr. Abhinav Verma
Dr. Ajay Gupta
Dr. Anil Handoo
Dr. Ankit Bhatia
Dr. Anju Shukla
Dr. Bela Makhija
Dr. Deepak Bhasin
Dr. Ganesh Mani
Dr. Garvit Chitkara
Dr. Gyanendra Agarwal
Dr. Kaustav Talapatra
Dr. Man Mohan Mehendiratta
Dr. Meenu Walia
Dr. Mitusha Verma
Dr. Mukesh Rathore
Dr. NP Singh
Dr. Nivedita Dhingra
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Dr. Prem Kumar Ganesan
Dr. Prasoon Shamshery
Dr. Puneet Arora
Dr. Punish Sadana
Dr. Rahul Arora
Dr. Rajesh Ahlawat
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Dr. Shailesh Sahay
Dr. Suman Lal
Dr. Surveen Ghuman
Dr. Vandana Soni
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Dr. Vishal Ramteke
Dr. Vishwas Sharma
Dr. Vivek Bindal
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