I recently received an e-newsletter from a respected doctor with the subject line “Growing older is inevitable, aging is optional.” Here’s the thing, actually: Stuff wears out; aging is not optional. Starting in our 30s our normal physiology starts shifting in the direction of entropy, affecting the functioning of our brains (vision, mood, cognition, and sensation), digestive tract, reproductive abilities, the strength of our bones, and more. There is obviously great individual variation both within one individual (my hair is only a bit gray, but my glasses were progressive by the time I was 50) and between individuals (my brother went gray in his 20s!). But gradually, and inexorably, the changes of physiology as we age are well known, and thankfully now measurable and actionable, if we know what we’re doing.

Our natural lifespan

Opinions abound as to what is our natural lifespan. The Bible might have us counting our lives in centuries, but most modern thinkers opt for somewhere between 75 (“Life really isn’t living past the age of 75,” says Ezekiel Emanuel, one of the architects of Obamacare) and 125 (the goal of the 93-year-old billionaire David Murdoch, who has poured hundreds of millions of dollars into antiaging research and education).

We can look at our natural lifespan by looking at the lifespan of primitive people, living in the environment in which they evolved, with little to none of the toxic effects (stress, chemicals, pollutants) of modern life. Many primitive people die early in life, succumbing to injuries and illnesses that modern people face with impunity. If they live to middle age, however, their lifespan is something like ours, living to their 70s, but without the evidence of chronic diseases reaching epidemic proportions in our modern world. Whether we examine recent primitive people (in New Guinea and other places) or the skeletal remains of the ancients, people living in a preagricultural, preindustrial world show little to no evidence of tooth decay, diabetes, cardiovascular disease, or obesity. The health of these indigenous elders suggests that with modern knowledge and medicine we can live significantly longer. But will we live it well?

Options for Aging

We have several options available to us as we crest over the peak of middle age and look toward our sunsets, so to speak. We can follow the suggestions of health advisors such as Dr. Andrew Weil, and follow a sensible diet, stay active and relax, and come to peace with our position as an elder of the world. This means doing our best to stay out of the medical system and accepting gracefully what happens, including medical treatments as they become necessary.

We can turn to our medical system and rely on so-called preventive exams (mammograms, colonoscopy, and the like), which detect disease early rather than prevent it altogether, and then resort to the recommended treatment for these diseases, which may significantly extend our lives but at a diminished quality of life that often gets out of our control.

We can consult an antiaging specialist and restore all our hormone levels to those of our teenage years, thereby resuming both menstruation (in women) and our adolescent libidinal desires—and use plastic surgery to keep looking the part.

We can draw up our bucket list, and spend what time we have left indulging in the glory of long-forgotten dreams.

Or we can choose what I call strategic aging, where we become intimate with the physiology of aging, a science unto itself, and we do self-inventories to see which parameters apply personally, and adjust accordingly. Strategic aging is not about recapturing youth; it is about maximizing our vitality in the present moment. Ideally, we combine this ongoing health exploration with finding our “North Star,” the cause or purpose that calls us passionately (see page 45). A North Star is very different from a bucket list, because it is not about looking backward and it will never be crossed off. For example, David Murdoch may make it to 125 in part because of his diet of vegetables, fruits, and fish, but also because his North Star is teaching others about healthy aging. In other words, his health practices and his North Star are in complete alignment. He gets out of bed each morning to help others age better.

The Guts of Strategic Aging

As an example of strategic aging, let’s first look at the function of our digestive system from top to bottom. Not only can we do the same for the other systems, you must do it for all the systems of the body. Why? Because they’re all related. I hope you’re ready for some nitty-gritty details. That’s where the value lies!

The Mouth: Several things can go awry with age, starting with a diminished sense of taste, causing us to eat a smaller variety of food with less pleasure. We can restore taste somewhat by keeping zinc levels normal, continuing to challenge our taste buds with new foods, and avoiding habitual eating. We get zinc from animal products (eggs, dairy, meat, fish) or from supplements.

Teeth: Many of us start losing our teeth, partly to periodontal disease and partly due to bone loss in our jaws. Periodontal disease occurs less in those who don’t eat a lot of fermentable carbohydrates (sugar!) and who keep their mouth well-rinsed, using salt water or perhaps herbal mouthwash and massage their gums with those little bristly brushes. Risk of tooth loss is increased if your CoQ10 levels fall. So if you’ve lost the taste for eating organ meats like heart, you’ll need supplements. If you’re over 50, you no longer activate CoQ10 well into ubiquinol, so you’re better off going straight for the ubiquinol to boost your CoQ10 levels. This will help your gums, your brain, your immune system, and more. It’s all related. Exercise for the jawbones involves chewing difficult foods: meat on the bone or raw carrots. Use it or lose it!

Swallowing: Older folks don’t swallow as well as younger ones. You can work around weak swallowing by eating in a relaxed frame of mind: The goal here is to stimulate your rest-and-digest parasympathetic nervous system and tone down your fight-or-flight sympathetic nervous system. You can strengthen your swallowing abilities by gargling: vigorously! Loudly! Regularly! Give it a try. You’ll not only help yourself swallow, you’ll reduce your risk of gastroesophageal reflux disease and infections of the small bowel.

Acid and Reflux Disease: Acid not only helps us digest our food, it also enables digestion to proceed in its normal (downward) rather than its backward (upward) direction, which results in reflux. Alas, older people make a lot less acid than younger people. So if you have a bit of reflux, adding acid to your food (lemon, vinegar, or the supplement betaine) can enhance your overall digestion and help the normal motion of your digestive tract.

There’s no getting around the fact, though, that our stomach’s absorptive forces aren’t what they used to be, so it’s important to choose food wisely. The concept of “nutrient density” describes food that includes a rich supply of nutrients among the calories you consume. Look for nutrient-dense foods, and eat proteins and fats together to enhance absorption. Avoid foods with empty calories. They aren’t worth the heartburn.

The Small Intestine: This should be a place of digestion and absorption. It is rich in digestive enzymes and relatively devoid of the healthy bacterial probiotics that belong farther down in our colon. But many older folks suffer from too much bacteria in the small bowel (small intestinal bacterial overgrowth or SIBO), causing bloating and indigestion, and interfering with the normal digestive and absorptive work to be done. The most effective lifestyle techniques to prevent SIBO is to eat in a calm environment and don’t eat at night. Adopt an overnight fast of 12 hours, including at least 3 hours before bedtime.

The 12-Hour Fast: During a long fast, the gastrointestinal tract shifts to inactive mode and sends in the housecleaners, aka the migrating motor complexes, which perform a “sweep” operation of the upper intestine, moving the majority of the bacteria, the probiotics, down to the colon where they belong. This housekeeping isn’t nearly so effective when the gut is still working on late night snacks. Meanwhile, with fewer calories in the pipeline, our brains perform a kind of triage, saving sustenance for the healthy cells and speeding up the process of sacrificing the less than healthy cells. The process, called apoptosis, removes a drain on the brain’s energy systems. Thus an additional value of the overnight fast is clear thinking and cognitive longevity.

The Colon: This is the proper and important home of our “microbiome,” the complex array of bacterial and fungal species that not only keep our digestion regular but contribute to the regulation of every aspect of our metabolism, immune function, and nervous system. As we age, we tend to selectively lose one of the main players in our colon, namely Bifidobacterium species. The best way to restore them is to consume them (look for Bifido-rich yogurt or probiotic capsule) and to provide them the food they need to live on in our colons: lots of vegetables, maybe a little fruit, while avoiding the toxic (heavy) doses of sugar that might feed competing species.

Poop: When your digestion is properly supported, your senior citizen poop should look as well formed, exit as gently, and float or sink as consistently as it did when you were 20 years younger. So pay attention to any changes.

Pay Attention: You should consider critically every aspect of your digestion: How’s your appetite? Do you burp or bloat? Many older folks need supplemental stomach acid and/or digestive enzymes, and you can experiment with that on your own. SIBO is a tough and multifaceted problem that usually requires handholding from a wise nutritional counselor. For more information, one good book is Digestive Health with Real Food, by Aglaee Jacob, M.S., R.D. A good online resource is amazon.com/Natural-Solutions-Digestive-Health-Jillian/dp/1454910313

The Bones of Strategic Aging

Bones are constantly being remodeled by the removal of old bone and synthesis of new bone to take its place. Around the age of 30, the balance starts swinging toward more removal and less synthesis, but you can optimize bone synthesis by taking these steps:

• Keeping vitamin D levels between 40 and 65 mg/mL. You get vitamin D from sun exposure, seafood, lard, and supplements. Absorption declines with age, so keep checking.
• Getting calcium from foods (dairy, leafy greens) rather than as a supplement, which is more hazardous than beneficial.
• Getting vitamin K2 (as MK7) from fermented foods or supplements.
• Hard muscle work: a muscle pulling vigorously against its bony tether strengthens the bone.
• Optimal hormone levels: Avoid excessive thyroid or cortisol hormones and maintain adequate sex hormones, including estrogen, testosterone, and DHEA.
• Supplementing magnesium to keep levels optimal. Choose a chelated form with –ate in the name, such as magnesium glycinate.
• Ensuring that you’re getting minor nutrients such as boron and strontium, which may be important.

The Brains of Strategic Aging

A Case Study in Reversing Dementia

Even a couple of years ago dementia seemed a one-way street to nowhere. But now, thanks to researchers like Dale Bredesen, PhD, a professor of neurology and director of the Mary S. Easton Center of Alzheimer’s Disease Research at UCLA, we have hard evidence that cognitive function can be restored. Dr. Bredesen believes that dementia is like a leaky roof with 30 holes in it. The pharmaceuticals that have been tested to treat dementia may succeed at fixing a single hole, but don’t come close to solving the problem. So Dr. Bredesen worked with 10 patients with varying degrees of dementia using a comprehensive lifestyle approach. In the first three to six months, all but one of the patients showed some improvements. Here’s one case study, published in the journal Aging, that speaks for itself.

A 67-year-old woman presented with two years of progressive memory loss. She held a demanding job that involved preparing analytical reports and traveling widely, but found herself no longer able to analyze data or prepare the reports, and therefore was forced to consider quitting her job. She noted that when she would read, by the time she reached the bottom of a page she would have to start at the top once again, since she was unable to remember the material she had just read. She was no longer able to remember numbers, and had to write down even 4-digit numbers to remember them. She also began to have trouble navigating on the road: Even on familiar roads, she would become lost trying to figure out where to enter or exit the road. She also noticed that she would mix up the names of her pets, and forget where the light switches were in her home of years. Her mother had developed similar progressive cognitive decline beginning in her early 60s, had become severely demented, entered a nursing home, and died at approximately 80 years of age. When the patient consulted her physician about her problems, she was told that she had the same problem her mother had had, and that there was nothing he could do about it […]

After three months [of our program] she noted that all of her symptoms had abated: She was able to navigate without problems, remember telephone numbers without difficulty, prepare reports and do all of her work without difficulty, read and retain information, and, overall, she became asymptomatic. She noted that her memory was now better than it had been in many years. On one occasion, she developed an acute viral illness, discontinued the program, and noticed a decline, which reversed when she reinstated the program. Two and one-half years later, now age 70, she remains asymptomatic and continues to work full-time.

1. She eliminated all simple carbohydrates and lost 20 pounds;
2. She eliminated gluten and processed food from her diet, and increased vegetables, fruits, and non-farmed fish;
3. She began yoga, and ultimately became a yoga instructor;
4. She began to meditate for 20 minutes twice per day;
5. She took melatonin 0.5 mg po qhs;
6. She increased her sleep from 4–5 hours per night to 7–8 hours per night;
7. She took methylcobalamin 1 mg each day;
8. She took vitamin D3 2000 IU each day;
9. She took fish oil 2000 mg each day;
10. She took CoQ10 200 mg each day;
11. She optimized her oral hygiene using an electric flosser and electric toothbrush;
12. She reinstated hormone replacement therapy that had been discontinued following the WHI report in 2002;
13. She fasted for a minimum of 12 hours between dinner and breakfast, and for a minimum of three hours between dinner and bedtime;
14. She exercised for a minimum of 30 minutes, 4–6 days per week.

Surprise information about Heart Disease…

• Saturated fat and cholesterol in the diet do not lead to heart disease.
• Heart disease is more closely associated with inflammation and sugar load than cholesterol levels.
• Over the age of 60, the higher your total cholesterol, the longer you are likely to live.