The Lucky Years: How to Thrive in the Brave New World of Health (11 page)

I really do believe that the cures for many of our maladies are already inside us. In addition to learning more about our molecular and genetic brakes and switches, including those among cancer cells, we’re also gaining traction by discovering entirely new metrics, such as stem cells. These are unspecialized cells capable of renewing themselves through cell division. They are the body’s reservoir of ground-zero cells that can develop into a distinct, specialized cell such as a muscle cell, red blood cell, or neuron (brain cell). When a stem cell divides, each new cell has the potential either to remain a stem cell or to become (“differentiate” to) another type of cell with a specific function. As adults, stem cells are largely dormant. For some reason, they are turned off and hibernate. But what if we can find ways to turn them back on and treat various ailments like never before? Such a feat might not happen solely through therapies like parabiosis, but I trust we’ll find other approaches.

The world of stem-cell research is poised to expand exponentially. We have only just begun to explore their use in therapeutics and how they may one day help us stay one step ahead of disease and degeneration—without triggering cancerous growths. In 2015, Ben Dulken and Anne Brunet of Stanford University published a paper that presented an interesting question: Are we missing something when it comes to understanding the difference between how men versus women age? They wrote: “A glance at the list of the human individuals currently living over the age of one hundred ten—supercentenarians—reveals a surefire strategy for achieving such exceptional longevity: be female. Out of the fifty-three living supercentenarians, fifty-one are female. No other demographic factor comes remotely close to sex in predicting the likelihood of achieving such an advanced age.”
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Among mammals, females in general tend to live longer than their male counterparts do. Why is this so? Theories abound, from genetic factors carried on the Y (male) chromosome and the fact men only have one X chromosome (thus potentially rendering them more susceptible
to deleterious recessive traits) to the hormonal advantages in women that confer better longevity. Evolutionary hypotheses have suggested that men and women have adapted to be fit for different needs. Females put more time and effort into having and rearing children than males do, resulting in changes to DNA that may code for longevity. Of course, these ideas are difficult to test experimentally and remain conjecture. But in all the years of debating the topic, we’ve forgotten one important part of the equation: the male versus female stem cell.

Because one of the hallmarks of aging is the decline of stem cells’ functionality, we must ask whether the aging of stem cells differs between men and women, and whether this has consequences for disease and life span. Studies thus far have shown that some stem-cell populations in females are superior to those in males thanks to estrogen, the female sex hormone. Stem cells destined to be blood cells, for example, are more abundant in female mice than in male mice, an effect that is dependent on estrogen signaling. A similar paradigm has been described in neural stem cells where estrogen increases the proliferation of these cells in a transient manner that fluctuates throughout the menstrual cycle.

Estrogen signaling is not the sole contributor to differences in stem-cell regulation between the sexes. Other studies have shown that females also exhibit increased capacity for rapid wound healing and liver regeneration, processes that are likely dependent on resident stem-cell populations. So females tend to show increased stem-cell self-renewal, regeneration potential, and in some cases, proliferation. But the big question remains: Does this tendency toward increased self-renewal in females alter the capacity of stem cells to regenerate tissues throughout aging? Does it actually influence longevity?

In recent years, we’ve also heard a lot about telomeres, which are the strands of DNA at the ends of chromosomes. Because they protect our genetic data and make it possible for cells to divide, they’ve been hailed as a linchpin to health and are believed to hold some secrets regarding
how we age and develop disease. But despite the initial excitement for measuring telomeres and drawing strong correlations—shorter telomeres and shorter life—the evidence has been decidedly mixed and confusing. In fact, a 2015 study in
Human Molecular Genetics,
using data from 50,000 cancer cases and 60,000 control cases, showed that the longer your telomeres were, the higher the risk for lung cancer.
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The role of telomere length in health will be a complicated one, and it is too early now to know its meaning.

While telomere shortening has been associated with the aging process, we don’t know yet whether shorter telomeres are just a sign of aging, akin to gray hair and wrinkles, or whether they actually
contribute
to aging. Those are two very different things. Once we figure out why gender can be such a factor in the aging process, it’s possible we’ll no longer look at telomeres in the same way, which may be reflecting how fast one is aging and not commanding the process.

If you’ve ever been to a school reunion, you’ve seen the difference between those who have become fat and bald before their time and the ones who look like they haven’t aged a day since you last saw them. I can’t tell you how many times I meet couples of the same age who look vastly different in their physical “age.” And what I find most striking is that nine times out of ten, the younger-looking individual has something else that’s not nearly as present in the “older” person: positivity. Optimism. An upbeat personality, a perspective that sees the glass as half full.

It’s cliché, but it’s true: having a positive outlook about the world and even the future of medicine is key to health. I see it every day in my practice, even among those who are prone to depression and do what they can to manage it successfully. And it’s easier to be optimistic if you remember that breakthroughs are about to happen in many areas of medicine (not just oncology) that will change how you engage with doctors and how you live.

A great example of a new technology that will soon change our lives and help us to positively extend them is called near-infrared spectroscopy (NIRS). It’s been around for a while in very large and expensive machines found in major corporations and labs. In simple terms, without getting into the chemistry and physics of the technology, every chemical in nature has a certain and unique profile on the electromagnetic spectrum—the range of all possible frequencies of electromagnetic radiation. This means every object has a different spot on the electromagnetic spectrum, based on the chemicals that make it up; the electromagnetic profile of any given thing is the characteristic range of electromagnetic radiation it emits or absorbs. An apple, for example, has a different profile than an apricot or an aspirin. So imagine taking a handy little device and putting it up against an object and getting an immediate readout of all the chemicals in that item. That’s what you could do if you had a database of all the possible profiles.

An Israeli company has done just that, funded by a Kickstarter campaign. Their low-cost handheld tool can study a pill, for example, compare the pill’s profile against a cloud database, and come back with “ibuprofen, brand Advil.” Besides eliminating fake drugs, it will bring peace of mind to patients by preventing pill mix-ups. This technology could also be used to point at a plate of food and characterize how much protein, fat, and carbohydrates are in a snack or meal. Or it could analyze your urine in a toilet and tell you how well hydrated you are. The possibilities are endless, and this kind of data may prove to be more useful for real-time medicine than what’s in your medical record.

Even the medicine itself will become easier to swallow. If you’ve ever choked on a pill that was too big, help is on the way, thanks to three-dimensional printing technologies that are revolutionizing the manufacturing of drugs. In the future, 3-D printing that helps create everything from toys and mechanical parts to new organs, biological tissues, and prosthetics will also be employed to make smaller drugs that dissolve quickly, no matter their dosage. A pharmacy of the future may just be a printer and a drawer of chemicals, where the pharmacist
is able to print, on demand, any medication, just by having its chemical structure.

What gets me especially enthusiastic about the Lucky Years is that we’re encountering innovations and revelations, when we least expect them, that put past headlines to shame. In December 2014, for example, I did a segment for
CBS This Morning
about “the end of antibiotics” and the coming crisis of lethal superbugs that are totally resistant to all of the antibiotics in our arsenal. The British prime minister David Cameron had just released a report he had commissioned, warning that if antimicrobial resistance was not controlled, it could compromise the advances of modern medicine and swallow up to 3.5 percent of the global economy.
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The report went on to state that increasing rates of drug-resistant infections could lead to the death of some 10 million people and cost upwards of $100 trillion by 2050.

Currently, drug-resistant bacteria infect at least 2 million people a year in the United States and kill 23,000. In 2014, the World Health Organization warned that such infections were happening all over the world, and that drug-resistant strains of many diseases were emerging faster than new antibiotics could be developed to fight them. Compounding the problem is the fact that many drug companies have stopped trying to develop new antibiotics so they could focus on other, more profitable types of drugs.

We blamed the antibiotic-resistant strains on human invention and profligate use of antibiotics in medicine and livestock. But just in the past year, we’ve realized that the capacity to resist antibiotics might be a natural part of bacteria’s evolutionary history. Antibiotics actually come from bacteria, which produce them to protect themselves from other bacteria so that they can effectively compete for limited food and other resources. So developing resistance to other bacteria’s antibiotics would make sense as a defensive maneuver. A 2014 study revealed dozens of species of bacteria in a four-million-year-old cave that are resistant to both natural and synthetic antibiotics.
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Such a finding supports a growing understanding that antibiotic resistance is as old as bacteria themselves. It’s natural and hardwired in the microbial gene pool.

A photo from the depths of Lechuguilla Cave in New Mexico, a place isolated from human contact until very recently. This is where researchers found dozens of antibiotic-resistant bacteria and identified many of the mechanisms for antibiotic resistance in nature.

“The end of antibiotics” was an unnerving, chilling segment to produce, to say the least; it seemed so realistic and doomsdayish at the time. But no less than a month later, I was back on the morning news again, this time applauding a group of Northeastern University researchers who’d found a new method to extract bacteria that live in dirt to yield a powerful new antibiotic.
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In these newly identified bacteria from a grassy meadow in Maine (that could only be grown when the bacteria were cultured in dirt!), a compound called teixobactin was discovered that could cure severe superbug infections. Best of all, the drug works in a way that makes it highly unlikely that bacteria will become resistant to it. Moreover, the method developed to make the drug has the potential to lead us to a treasure chest of other natural compounds to fight infections—molecules
that were previously beyond our reach because the microbes that produce them could not be grown in the laboratory, as no one had yet tried to grow bacteria in a laboratory with dirt. All of a sudden, the doomsday scenario had changed, from one discovery! As for dealing with the extravagant use of antibiotics, I trust we’ll find alternatives to how we treat livestock, as well as develop an over-the-counter test for humans, similar to a pregnancy test, to determine whether they are infected with bacteria to begin with. Then they can decide which course of treatment is best.

My whole point in highlighting the example of discovering new antibiotics where we least expect them is to show that the news, especially in health circles, can change in an instant. Just when we hear horrible news that deflates our hope for a better, healthier future, another piece of news trumps it. Which is why holding on to optimism is important. Every laboratory is a beacon of hope; every medical conference is a meeting of possibility. People distrust Big Pharma, but it is where much of the good news comes from.

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Optimism will help you choose how you age, but to fully enjoy the Lucky Years, you must learn how to use the technology that will help you take control of your health. Don’t be afraid of this process. Get comfortable with gadgetry and terminology. It’s like the difference between going out to dinner every night versus using your own kitchen at home and learning how to cook. You can make all your meals, and it starts to feel powerful, and you then patronize restaurants (i.e., go to the doctor) for something special (i.e., analyzing health data). Technology can help ensure compliance. In the past, doctors took on the role of being the scolding parent. They put people back on the straight and narrow. But we can use technology to remind ourselves what to do and to compel us to change our behavior.