In her new book, Younger, Dr. Sara Gottfried, our go-to expert for all over-forty health concerns, shows why aging gets a bad rap that isn’t deserved: The steep decline in health, “diseases of age,” and symptoms that we tend to associated with getting older—from belly fat to memory loss—are not a predetermined inevitability based on our genetic blueprints. Only 10 percent of disease is caused by genes—some of which we can turn on and off—and the other 90 percent is lifestyle, says Gottfried. So we actually have an extraordinary amount of control over the length of our healthspan (years of good health) and the grace with which we age (on the inside and outside). Here, Gottfried shares the essential Younger keys to avoiding inflammaging (inflammation causes accelerated aging), staying fit (i.e. tight core, tighter mind), retaining the natural structure and beauty of your face—and extending your own, invaluable healthspan as long as possible.
A Q&A with Dr. Sara Gottfried
Can you talk about the 90/10 conclusion at the heart of the book? How does lifestyle vs. genes vs. the interaction of the two contribute to signs of aging and disease?
Genetics loads the gun, and the environment pulls the trigger. I call this the 90/10 rule: Only 10 percent of disease is caused by your genes, while 90 percent is caused by environmental factors, including the environment you create with lifestyle choices. This gives you a sacred opportunity to change the course of disease and aging in your body by lengthening your healthspan, the period of time in your prime, relatively free of disease. The goal is to upgrade that 90 percent to affect the genetic 10 percent.
Since mapping the human genome, scientists developed an important complementary concept called the exposome—the sum of all exposures in an individual, from diet and lifestyle to behavior, as well as how the body responds to them, and, finally, how these exposures relate to health. These factors have the power to work for or against you, and can adjust how your genes are expressed in your DNA sequence.
“Genetics loads the gun, and the environment pulls the trigger.”
Guess what controls most of your exposome: Your daily habits of body and mind, both conscious and unconscious, including how and how often you move, environmental exposures in your home and office, what you eat and drink, and how you manage or mismanage your hormones. Practical lifestyle tweaks allow you to manage your exposures and personalize your approach to preventing disease and unnecessary aging.
Understanding your exposome requires that you be able to measure exposures and their effects on the body. Your genes produce specific biomarkers that can be detected in your blood, urine, and hair. Health professionals look at biomarkers to accurately measure exposures and their effect, susceptibility factors (including genetic susceptibility), and disease progression or reversal—although it’s not necessary to perform expensive testing before you start the inexpensive cleanup of your body. (There’s a step-by-step protocol in Younger that shows you how to begin the process.)
What’s inflammaging, and what are the big factors behind it?
Five key factors make aging more pronounced after forty, leading to inflammaging—an unfortunate hybrid of increasing inflammation, stiffness, and accelerated aging:
The Muscle Factor
In a high-intensity interval training class, my instructor asked me to box jump, with my feet together, onto an 18-inch box. I did it but it was not graceful; it hit me that my former gymnast body had faded. Your metabolism slows down with age, which means you accumulate more fat and lose muscle. On average, you lose five pounds of muscle every decade after age thirty. If your muscles are replaced with fat, you lose your strength. The key is to focus on preserving and building your muscle mass—you can assess where you are, muscle-mass-wise, with a DEXA scan or Bod Pod measurement of body composition.
The Brain Factor
Your neurons (nerve cells) lose speed and flexibility as you age. Part of the problem is that your brain gathers rust like an old truck left in the rain; free radicals induce damage to cells, DNA, and proteins in a process called oxidative stress if you don’t have antioxidant countermeasures in place (like vitamins A, C, and E). Your hippocampus (the part of your brain involved in memory creation and emotional control) may shrink, especially if you’re stressed. On top of that, excess stress kills brain cells by increasing production of beta-amyloid, which puts the brain at risk for Alzheimer’s disease. The key is to focus on keeping your brain regenerating and malleable as you get older.
The Hormone Factor
With age, both men and women make less testosterone, leading to more fat deposits at the breasts, hips, and buttocks. Women produce less estrogen, which normally protects the hair follicles and skin. Lower levels of estrogen and testosterone may weaken your bones and your sex drive, and may trigger hair loss and heart disease. Your thyroid gland slows down, too, and, along with it, your metabolism, so the bathroom scale can climb a few pounds per year (or even per month). Your cells become increasingly insensitive to the hormone insulin, which leads to rising blood sugar in the morning. As a result of higher blood sugar, you may feel foggier and experience stronger cravings for carbs, then notice more skin wrinkling along with an older-looking facial appearance. The right food, sleep, exercise, and detoxification support can reverse many of these age-related hormone problems.
The Gut Factor
About 70 percent of your immune system lies beneath your gut lining, so it’s where, if your immune system is overstimulated, excess inflammation and even autoimmune conditions can start. Your gastrointestinal tract contains three to five pounds of microbes. The DNA from your microbes are collectively known as your microbiome. Imbalance in your microbiome may cause you to make more enzymes such as beta-glucuronidase, which raises certain bad estrogens and lowers your protective estrogens. Further, excess stress raises corticotropin-releasing factor, which pokes holes in your gut. Finally, high stress can make you absorb nutrients poorly, especially B vitamins, which you need for: converting food (carbohydrates, fats, protein) into fuel; making DNA in your cells; keeping nerves and blood cells healthy; preventing anemia, fatigue, and premenstrual syndrome; producing serotonin for mood and melatonin for sleep (and breast cancer risk reduction); and to control levels of inflammation in the blood, as measured by biomarkers such as homocysteine.
The Toxic Fat Factor
Toxins from the environment accumulate in your fat—scientists call them gerontogens. Similar to how carcinogens increase your risk of cancer, gerontogens can cause premature aging. These include pollution, cigarette smoke, heavy metals, UV rays, chemotherapy, contaminated drinking water, preservatives, and pesticides. While exposure to certain poisons is inevitable, we can address the genetic tendencies that cause you to accumulate them.
Which genes most affect aging; what’s important to know about them?
The three most important genes to know about are MTHFR, CYP1A2, and APOE:
MTHFR (methylenetetrahydrofolate reductase)
Provides instructions for making an enzyme crucial to the processing of vitamin B9 and amino acids, the building blocks of proteins. Also helps you detoxify alcohol.
APOE (apolipoprotein E)
Tells cells to make a lipoprotein that combines with fat and transports cholesterol particles in the blood and brain. People with the bad variant of this gene, APOE4, don’t recycle cholesterol, which leads to higher levels of low-density lipoprotein (LDL, or bad cholesterol) in the blood. Women with APOE4 have a threefold greater risk of developing Alzheimer’s disease (more below).
CYP1A2 (cytochrome p450)
Codes for an enzyme that breaks down caffeine and other chemicals. More than half the population are “slow metabolizers” and cannot tolerate more than 200 mg of caffeine without side effects, such as stress, jitters, and a higher risk of heart disease. On the other hand, those who metabolize caffeine quickly receive a longevity benefit from coffee.
What are the pros and cons of genetic testing? Do you need to get your genes tested in order to really impact your body’s aging process?
While testing can provide fascinating insights to help understand your genetic makeup, the reality is that 99.5 percent of human DNA is identical from one individual to the next. So the way your DNA functions vis a vis aging is very much the same for all of us. Furthermore, you have a lot of genes, so parsing each one’s significance is almost impossible: In one study that looked at 2.8 million genes in 320,485 individuals, 100 different genetic variants were found to contribute to BMI. Also, remember that only 10 percent of disease is caused by your genes; 90 percent by environmental factors, which may turn genes on and off.
The other thing to know is that genetic testing is not 100 percent accurate. Even the most commonly performed tests may be off because of the orientation of the gene, which is sometimes read forward and sometimes read backward on the chromosome. If you decide to get genetic testing, results should be taken in the context of your particular risks and reviewed with a knowledgeable health professional who understands the interplay between genetics and the environment and limitations of the tests done.
The good news for those who want to test is that it is increasingly more affordable (about $200 to map important genes). You can check out 23andMe.com, which offers a mail-in, home DNA testing kit that uses a saliva sample. After analysis, the results are posted directly onto a personal online account. I recommend this test because it is an easy, convenient, and affordable way to assess your genetic makeup. Other affordable testing resources are Pathway, and smartDNA. (All of these will tell you about the above-mentioned genes, along with many others.)
Why does weight loss normally show up in our faces as we age, while it seems to get so much harder to lose belly fat? What can help tone the core if we’re seeing this kind of weight loss resistance?
As you age past forty, weight loss shows up in the face because of declining estrogen, collagen, and bone density. In addition, you become more resistant to estrogen starting around age forty-three, as a result of perimenopause (the two to ten years that precede your final menstrual period). I used to think of menopause as a cliff I would fall from around age fifty, but now I know that subtle hormonal shifts begin many years before that final period. Collagen acts like structural integrity for the facial structure, and as estrogen declines, so does collagen. Weight loss exacerbates the flip of what physicians call the triangle of youth (described below).
Belly fat is biochemically different than fat elsewhere and is known as white fat, a visceral fat that invades your inner organs with inflammatory messengers like interleukin-6 and TNF-alpha. It is harder to lose this type of fat, as opposed to brown fat found in the back and neck that keeps the body warm and your metabolism high. The inflammatory brew of bad chemicals in belly fat causes you to age faster than someone who has only minimal visceral fat.
“Really, sitting is the new smoking.”
The first step to losing belly fat is to get enough sleep, so your body maintains optimal levels of growth hormone and can be equipped to bounce back after injuries. The second is to stop sitting so much! Really, sitting is the new smoking: Not only does it increase your risk of diabetes and heart disease, but it can even make your belly look fat by tightening your hip flexors and increasing your waist circumference. So get up and move!
Overall, exercise helps convert white fat into useful brown fat that ultimately facilitates burning calories and generating heat. Exercises that get your hip flexors working properly and tuck your belly back behind your abdominal muscles where it belongs are great. Practice yoga at least three times per week for a half hour to strengthen your core, cut out belly fat, and get the added benefit of releasing stress and tension.
What is the triangle of youth, and how do we preserve it? How do we slow down collagen loss?
If you draw a line across the cheeks from ear to ear and close the triangle by drawing a line from each ear to the chin, the widest part of the face is at the cheeks. But as you age, the cheeks deflate, and with gravity, fat moves down. Your body makes less collagen, and the collagen it does make is less elastic, which means your skin becomes less thick, less firm. Your bones thin, which causes the cheekbones to shrink further. Excess skin moves to the jaw. The widest part of your face is now at the jawline—the triangle of youth is flipped upside down. After a certain point, collagen no longer undergirds the architecture of the facial skin and bones.
Your body will continue to produce collagen throughout your life, but the manufacturing process slows down with age and lack of maintenance. After age twenty-five, you lose collagen at a rate of 1 percent per year, and that rate increases up to 2 percent in your forties. By age sixty, you’ve lost half of your collagen.
But modulating estrogen levels with lifestyle changes can slow down the loss of collagen. I believe in improving your skin from the inside out, i.e., stimulating the body to make more collagen by filling micronutrient gaps (like vitamin C and essential fatty acids). This strategy helps boost the collagen-producing skin fibroblasts to make more collagen.
Here are a few specific tips:
- You can drink a collagen latte (recipe in Younger) to boost production of collagen type III. Collagen is rich in antioxidants, lowers blood pressure, and improves bone density, skin, hair and nails. (When given in a randomized trial to women aged thirty-five to fifty-five, collagen hydrolysate, at a dose of 2.5 to 5 grams per day, improved skin elasticity in eight weeks.)
- Another source rich in collagen is bone broth.
- If you have symptoms of low estrogen (such as droopy breasts, thinning bones, and dry mucous membranes—i.e. in the nose and throat), consider adding maca to your supplement regimen. It has been shown to raise estrogen levels and reverse anxiety, depression, and low sex drive.
- Take vitamin C, approximately 1,000 mg per day.
- Consider a high-quality fish oil supplement of 2,000 mg per day, plus gamma linoleic acid, 2,000 mg per day.
You mentioned that exercise can also make a (youthful) difference on our skin—can you explain some of the science behind this?
Exercise keeps your skin young and may turn around sagging and other forms of skin aging even if you don’t start to exercise until later in life. When you’re around age forty, the outermost layer of skin, called the stratum corneum, thickens and becomes more dry, flaky, and dense. The underlying and inner-most layer of skin, called the dermis, starts to thin. But not in everyone. With exercise, your outer layer of skin doesn’t thicken as early, and your inner layer of skin doesn’t become thinner. In one study, Mark Tarnopolsky, a professor of sports medicine at McMaster University, took a group of sedentary people, twenty to eighty-six years old, and had them exercise for thirty minutes, twice a week, jogging or cycling at a moderate-to-vigorous pace (65 percent of max heart rate). At the end of three months, researchers found that the outer and inner layers of the older subjects’ looked like that of the twenty- to forty-year-olds’.
What did you learn about longevity from studying other cultures?
Five cultures in the world are famous for the longest-living residents. They have certain habits in common that switch on the right genes and switch off the wrong genes when it comes to aging, which results in people living twelve years longer on average than the rest of the world. (Think of it as DNA whispering.) They all live on the coast or in the mountains. They eat fish. They consume fresh food in season. They dine on a particular superfood that is rich in antioxidants, such as seaweed in Okinawa, Japan, where women live the longest, or olive oil and red wine in Sardinia, Italy, where men live the longest. These cultures arrived at a particular combination of genes and lifestyle that protects them from the ravages of aging. By adopting some of these principles, you can also benefit.
“These cultures arrived at a particular combination of genes and lifestyle that protects them from the ravages of aging.”
One of the cultures that intrigues me the most is based in Icaria, a mountainous island in Greece with a wonderful quality of life. Icaria is more isolated than other Greek islands (it’s about a ten-hour ferry ride from Athens), so it’s been spared most of the trappings of tourism, including fast food and a fast-paced life. As a result, the island even now is a great laboratory for a different way of life.
Icarians live ten years longer than most Europeans. Icarians of all ages run up and down their hilly landscape daily. The island boasts the most ninety-year-olds in the world, with one in three people surviving to ninety. Hardly anyone has dementia or depression.
While no single factor explains longevity across the board, it’s fun to peek inside a few of the typical daily activities of an Icarian to get a glimpse of how he or she achieves such a long healthspan: Walk like a goatherd, intermittently fast, eschew retirement, live without a watch or alarm clock, eat over 100 species of wild greens.
Can lifestyle changes affect Alzheimer’s?
Two-thirds of people with Alzheimer’s are women. By 2050, the number of people age sixty-five and older with Alzheimer’s disease is expected to have tripled. Every five years after age sixty-five, an individual’s risk of developing Alzheimer’s doubles. After you hit age eighty-five, the risk is almost 50 percent.
The most well-known Alzheimer’s-related gene is APOE4, which has the strongest impact on your risk. You inherit a copy of the APOE gene (e2, e3, or e4) from each parent. According to neurologist and UCLA professor Dale Bredesen of the Buck Institute for Research on Aging, in people with Alzheimer’s disease, the balance between opposing signals is off, leading to a net effect of truncated nerve connections (synapses) and lost memories of important information.
Dr. Bredesen set out to understand what’s driving this process; he conducted an initial small study examining how a comprehensive functional medicine program could reverse memory loss. One of his first patients, who he called Patient Zero, was a sixty-seven-year-old woman with two years of progressive memory loss. She was considering quitting her job, which involved analyzing data and writing reports. By the time she reached the bottom of a page she was reading, she would need to start again at the top. She got disoriented when driving, and sometimes forgot the names of her pets. Her doctor told her that her memory loss was genetic (her mother also suffered from it) and there was nothing to be done.
“Cognitive decline can be treated with lifestyle changes,
and women have an advantage.”
She started Bredesen’s program, following some, but not all of the steps. Still, after just three months, all of her symptoms subsided: she was driving with no navigating issues, remembering phone numbers, retaining info she was reading. Here’s what she did do:
- Cut out refined carbohydrates, gluten, processed and packaged foods.
- Added vegetables, fruit, wild fish.
- Fasted for three hours between dinner and bedtime, and at least twelve hours between dinner and breakfast.
- Bought an electric toothbrush and flosser and used them regularly.
- Started practicing yoga and, later, became a yoga teacher. She practices yoga sixty to ninety minutes a day at least five times per week.
- Practiced transcendental meditation twice per day for twenty minutes.
- Began taking melatonin at night; her sleep went from four or five to seven or eight hours per night.
- Also added these supplements: methylcobalamin, 1 mg/day; fish oil, 2,000 mg/day; vitamin D3, 2,000 IU/day; CoQ10, 200 mg/day.
- Exercised aerobically for 30 to 45 minutes, four to six days per week.
Now at seventy, Patient Zero has no symptoms of cognitive decline. She works full-time, travels internationally, feels better than she did decades ago, and even has a high libido.
So cognitive decline can be treated with lifestyle changes, and women have an advantage, especially if they’re able to correct hormone imbalances as they start to appear. When you take care of the brain, it takes care of your mind and, by extension, you.
Behaviors That May Harm Brain and Mind
(and Increase Your Risk of Alzheimer’s)
Although 60 to 80 percent of your risk of Alzheimer’s is related to genetic factors, only about half of this risk is through APOE. (Other genes such as APP, can cause Alzheimer’s, but it’s rare). The five previously mentioned factors that contribute to inflammaging also increase your risk of declining cognition and Alzheimer’s. Other culprits include:
There’s a wash that runs through your brain at night while you sleep, that removes damaging and toxic molecules associated with neurodegeneration, basically the decay of your brain. When you don’t get enough sleep, you don’t get the full shampoo from your glymphatic system so you feel leaden and toxic.
Lack of Stimulation
When you stop engaging in cognitively stimulating activities like crossword puzzles, games, baking, gardening, or staying up on current events, your brain can go south. Picking them up again can help reverse mild to moderate symptoms of Alzheimer’s.
Lack of Community
Stronger social ties are proven to lower blood pressure and boost longevity, and have more of an impact on health than smoking. Having no social ties is an independent risk factor for cognitive decline. Talking to another person just ten minutes per day improves memory and test scores.
When your gut microbes and their DNA are out of balance, you may crave sugary foods in order to feed the troublemaking microbes, thereby inducing a vicious cycle of more cravings and more bad microbes. Problems with the microbiome are associated with autism, anxiety, and depression.
What are simple adjustments we can make that help us age more healthfully and gracefully?
Here are five simple things to add to your daily regimen in order to ease your body’s aging process:
Drink Organic Wine
If you do consume alcohol, red wine reduces mortality by more than 30 percent according to a meta-analysis of sixteen studies. I suggest eliminating or really limiting all alcohol but red wine, and recommend drinking one glass of it twice per week. But many wines contain a long list of additives, including sugar, tannin (beyond the tannins that occur in oak-barrel aging), acids, enzymes, copper sulfate, coloring agents, dimethyl dicarbonate (DMDC, a microbial-control agent designed to kill microorganisms), and fining agents. In other words, wine can be chock-full of toxins—which is why you want to drink wine made from organic grapes. It turns out that in addition to being better for your health and the planet, organic wine can also taste superb, although you may need to adjust your palate and experiment to find ones you like. A few of my favorite brands (that taste similar to non-organic wines I used to love): Quivira, Preston, Truett-Hurst, Lambert Bridge, and Emiliana Coyam.
Swap Coffee for Matcha Latte
Matcha is green tea that has been finely ground into a powder. With matcha you’re drinking the entire green tea leaf, not just tea water, which is partly why it’s so much more nutrient-dense than standard green tea. Matcha tea is high in antioxidants and amino acids (like L-theanine, which increases serotonin, dopamine, and GABA, and has a calming effect). The caffeine in matcha may help focus energy, minus the jitters.
Eat More Wild-Caught Fish
Marine fat is full of omega-3s and omega-6s, healthy fats that can actually keep you from gaining weight. Enjoy low-mercury, wild-caught fish, such as salmon, cod, steelhead trout, or halibut, two to three servings per week. They lower your cortisol levels, increase lean body mass, and improve vagal tone (as measured via heart rate variability), as well as raise DHA and vitamin D levels, both of which are good for the skin and mind.
Sleep on Your Side
Your brain’s glymphatic system works best when you’re sleeping on your side. I use a pillow between my bent legs to pin myself in a side-lying position, which helps decompress my low back. Sleeping on your right side activates your vagus nerve, which is key to stress resilience.
I recommend flossing at least twice a day. One of the best strategies for increasing healthspan, flossing fosters longevity, independent of brushing your teeth, as does seeing the dentist at least twice per year (I go quarterly). People who don’t floss have a 30 percent higher risk of mortality, and if you see the dentist only once per year, mortality is 30 to 50 percent higher. Flossing can prevent periodontal disease after as little as one month of regular use.
What about bigger changes that are worth it?
Improve your exposome with positive exposures via saunas (dry and infrared) or heat (hot tubs or steam rooms). There’s the most evidence showing that dry saunas help you age well, but infrared saunas are close behind. Sauna heat stressors reset the body and activate longevity genes. Sauna bathing is also relaxing; it eases stress while adding to your healthspan.
Treat yourself to a Muse Brain-Sensing Headband for game-ifying meditation. Because meditation reduces how you perceive stress, it has the power to help you maintain optimal levels of health. Muse assesses your brain’s state and then provides concordant music or other sounds to easily enter a meditative state. This makes meditation fun, and there’s even a self-competitive feature to encourage you to grow your practice.
Sleep is magic, a vital health boost for both body and brain. You want to make sure you’re getting all you can from your sleep time. I used to skimp on sleep whenever my schedule got more demanding, particularly during the fifteen years while I completed my medical training—followed by child rearing. I’d tell myself that I did well on six hours of sleep, but the truth is that only 3 percent of the population has the short-sleep gene, known as DEC2—and I’m not one of them. Now I have a 9 p.m. screen curfew—no binge-watching TV or late-night emails. I light candles, use the sauna with my husband, and take a bath with Epsom salts and essential oils. Whether you are currently getting the minimum of 7 hours of nightly sleep or not, I recommend that you use a tracker (like Jawbone or Misfit) to get to know your sleep patterns. I aim for at least an hour of deep sleep, which is when your memories are consolidated.
You mentioned that it’s important for individuals to understand their personal motivation for lengthening their healthspan—why is that significant?
In order to succeed, you need to articulate your why. You have a belief about aging. It’s a touchstone that probably made you read this article and it can be cultivated while you’re developing new habits that will keep you young. It’s your motivation to act, even when it’s difficult or inconvenient. Your why is far stronger than willpower or following certain lifestyle changes because you think it’s a good idea. Your why is deeply personal and will sustain you over the long term.
“Your why is far stronger than willpower or following certain lifestyle changes because you think it’s a good idea.”
My why for de-aging is that I want to live a long life with my husband, hiking our favorite trails in Point Reyes National Seashore, having long conversations that I cherish, watching my two daughters grow up into fabulous, interesting women, and taking care of my future grandchildren should my girls choose to have kids.
Aging is inevitable, and there should be beauty in the process for women. How can we recognize and celebrate this as/for women in our forties, fifties, sixties, seventies, eighties, and so on?
I believe there is tremendous beauty in the process of aging generally, and navigating the sometimes rough waters of middle age specifically. There is beauty in the authentic seams of life, the lines of pleasure and pain. There is something about middle age, from forty to sixty-five, that catalyzes a fresh take on aging. My mother talks to me about disappearing, about becoming more obsolete, when it comes to the covers of her favorite magazines or social media. I do not feel obsolete, but I know that some women do.
I want to encourage women to harness that energy—which may feel like anxiety, fear, or even depression about aging—and use it to change the conversation about the lived experience of growing older. Fear about aging is sometimes a catalyst, a divine message from the wisdom of your body about approaching the aging process in a new way. Maybe your body wants to transmute that anxiety into something more pure and mission-based, something that no longer follows the rules of the social obligations into which we were born. There is comfort and trust in the unraveling of ego structures that no longer define who we are: Thankfully, age can help us make a beautiful shift from ego-based perspective to soul-based perspective.
Article by Goop:
Sara Gottfried, M.D., is the New York Times bestselling author of The Hormone Cure and The Hormone Reset Diet. Her new book Younger publishes in March 2017. After graduating from Harvard Medical School and MIT, Dr. Gottfried completed her residency at the University of California at San Francisco. She is a board-certified gynecologist who teaches natural hormone balancing in online programs designed to help women can lose weight, detoxify, and slow down aging.
The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of goop, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.