Insight for Healthy Aging

Individuals age at different rates. Survival to the 10th decade, with mental and physical faculties more or less intact, reflects a favorable genetic predisposition together with reduced risk of degenerative disease (Sebastiani P, Perls TT, 2012). However, at midlife, robust health depends primarily on environmental factors and well-recognized behaviors, including adequate diet and nutrition, exercise, and stress management (Gorelick PB et al. 2017). Therefore, a realistic goal for personalized healthcare would be to help individuals maintain vigor, vitality and independence during their later years via healthful behavior change.

Examination of diets and lifestyles of healthy aging populations, together with research regarding the aging process presents a dual challenge: a) to develop and apply innovative approaches that promote healthy aging, before debilitating illness occurs; b) to facilitate patients' adherence to requisite lifestyle changes. We propose that insight problem solving offers an effective approach to formulate innovative solutions to meet both objectives.

A Personalized Approach to Healthy Aging

Though a decline in mental and physical ability is an unavoidable consequence of the aging process, individuals may age faster, or slower, than norms for a given cohort. How can a "fast ager" become a "slow ager"? Answers to this question require novel solutions.

Studies incorporating several biomarkers suggest that the aging process follows a progression in which early events set the stage for later manifestations. As an example, "pre-diabetes" (slightly elevated fasting blood glucose 100-120 mg/dl) precedes the appearance of full-blown type 2 diabetes.

According to the American Diabetes Association, prediabetes affects 38% of American adults. Those over 60 are even more susceptible. Prediabetes increases the risk of clinical diabetes by 70%.

Prediabetes is recognized as a reversible condition through weight management and increased physical activity (Tuso P, 2014). Furthermore, pre-diabetes has antecedents: Approximately 25% of normo-glycemic individuals exhibit dysregulated carbohydrate metabolism according to continuous post-prandial glucose monitoring (Hall H et al, 2018). Additional biomarkers suggest antecedents for other age-related diseases and conditions including stroke, chronic heart disease, hypertension, atherosclerosis, cancer, non-alcoholic liver disease, osteoarthritis, autoimmune disease and obesity.

Functional somatic syndromes may be "canaries in the coal mine" for degenerative diseases and early aging. As an example, Metabolic Syndrome - characterized by abnormal glucose metabolism, dyslipidemia, and abdominal adiposity - is associated with increased risk of stroke, heart disease, type 2 diabetes, and obesity.

Detailed mechanisms have not been defined. Possibilities include oxidative damage to organs and vessels, insulin resistance in adipose and muscle tissue, hepatic insulin resistance, and impaired pancreatic function. Regardless of the underlying causes, ultimately solutions require a holistic approach.

Early Aging Cascade

As a concept map to formulate insight-generated strategies that promote healthy aging, we propose an early aging cascade:

Hypothetically, modifiable risk factors initiate a series of physiological events that ultimately lead to chronic disease and early aging. In this context, external events such as exposure to pollutants, pathogens, cigarette smoke, as well as a compromised diet, physical inactivity, inadequate sleep and chronic stress create sustained metabolic imbalance among organ systems. In the next stage perturbed homeostasis is linked to oxidative (free radical) damage and depletion of antioxidant defenses. Indeed, there is consensus that chronic inflammation and oxidative stress increase the risk of chronic, treatment-resistant conditions of old age.

Functional Medicine and Complementary Medicine rely on diagnostic biomarkers to detect early stage disease processes (Textbook of Functional Medicine, 2010). Early signs and symptoms represent "flashing caution lights." In the final stage of the aging cascade, they lead to degenerative disease and shortened lifespan.

We propose a cost-effective approach to prevent age-related disease and optimize an individual's "health span" interrupts early stages of the aging cascade. Breakthroughs to define mechanisms and antecedents of disease processes in aging require new perspectives. The emerging interrelationship of the brain and gut and the burgeoning field of systems biology present such opportunities.

Furthermore, the Early Aging Cascade highlights the importance of healthy lifestyle choices. Collaboration between healthcare providers and patients moves beyond prescriptive advice to encompass personalized holistic solutions. Fresh insights are needed: Changing unhealthy habits is notoriously difficult, as illustrated by the lack of long-term success with calorie-restricted diets. Insight problem-solving provides the opportunity to move beyond entrenched ideas and formalized analysis.

Bottom Line: ILI advocates a holistic approach to prevent early aging and subsequent chronic disease. Insight provides an ancillary route to reduce chronic inflammation and oxidative stress, to correct metabolic imbalance, and to promote individual lifestyle change and commitment to life-long healthy aging.

References

  • Sebastiani P, Perls TT. The Genetics of Extreme Longevity: Lessons from the New England Centenarian Study. Front. Genet. 2012;3:277. doi:10.3389/fgene.2012.00277.
  • Gorelick PB, et al. Defining Optimal Brain Health in Adults: A Presidential Advisory from the American Heart Association/American Stroke Association. Stroke 2017 Oct; 48(10): doi:10.1161/STR.0000000000000148.
  • Tuso P. Prediabetes and Lifestyle Modification: Time to Prevent a Preventable Disease. The Permanente Journal 2014; 18(3):88-93. doi:10.7812/TPP/14-002.
  • Hall H. et al. Glucotypes reveal new patterns of glucose dysregulation. PLOS Biology July 24, 2018. doi: 10.1371/journal.pbio.2005143.
  • Textbook of Functional Medicine. Jones DS, Editor in Chief. The Institute for Functional Medicine 2010.