What is Aging?

This question sounds silly. After all, can't we all recognize aging when we see it?  Sagging skin, graying hair, loss of muscle and increasing fat, especially around the waist, faulty memory, and slower thinking and reactions - these are just a few of the obvious manifestations of aging.  While it is easy to point out an aging person, it is not be so easy to define what aging is.  Why is it important to be able to define aging when considering anti-aging medicine evaluation and therapy?  One of the main reasons is to be able to understand the fundamental difference in focus of anti-aging medicine  compared with traditional medicine.

The scientists who study aging are called gerontologists, from the Greek word for 'old man,' geron. Gerontologists define aging as follows: a continuous, universal, progressive, intrinsic, and deleterious (CUPID) process that decreases a organism's ability to maintain homeostasis in the face of environmental stressors and therefore increases the organism's likelihood of dying. You can think of the acronym, CUPID, as representing the cute little angel whose arrows of aging bring you closer to the interview at the pearly gates. Mnemonic devices aside, don't be put off by the technical sounding nature of this definition, for thinking about each of its parts will help you challenge your preconceptions about aging and in the process help you to understand the rationale behind anti-aging medicine.

Aging is a continuous process.  Notice two things about this first aspect of the definition. First, it doesn't say anything about when the process starts. Most of us assume that aging starts at birth, or if you think you are a little smarter than average, that it starts with conception. Both of these assumptions are wrong. Most organisms don't start to age materially until sometime just after they acquire the ability to reproduce. From conception to reproductive maturity, the organism is developing, not aging. And so the continuous decline doesn't begin until considerably after birth. Second, once the process has begun, it continues inexorably if left unfettered, though it may be slowed down.

Aging is a universal process.  That is, if you are a member of a species that ages - not all do, in fact many don't (more about this later) - then you will age. This is to distinguish aging from other deleterious processes that can decrease one's ability to maintain homeostasis, i.e., diseases. If you are infected with HIV, aspects of your functioning will decline, particularly your immune system function, but this is not aging. Traditional medicine see it as important to treat the declining immune system of an AIDS patient, but less so of the older adult principally because the latter is not a disease, it happens to everyone.

Aging is a progressive process.  It gets worse with time. The effects of the aging process accumulate with time. When these processes cause a critical level of decreased or aberrant function in an organ, disease sets in. Which organ system it occurs determines which is more likely to cause death or significant disability.

Aging is an intrinsic process.  This separates it from the effects of infectious diseases, trauma, starvation, or predation. If one were kept in an ideal environment, fed an ideal diet, exercised the right amount, and were not subjected to stressors one could not handle, one might live a lot longer than average. But many of the manifestations of aging would still set in,  start to do so just after reproductive maturity, and one would die before about 125 years or so.

Aging is a deleterious process.  This part is obvious, but needs to be said.  Aging is not benign and is not desirable. Any older person you ask would love to be rid of the list of manifestations of aging above. This does not mean, however, that growing older is deleterious or that older people are not desirable. Anti-aging medicine physicians are often accused of fueling the fire of the cult of youth and therefore of being 'ageist.'  But this is not the case. One can honor and value the wisdom acquired with years of experience and still be against the process that tears down the mind and the body.

With this definition of aging one can now see the rationale behind anti-aging medicine.  Even in the absence of a any disease, the aging process results in decrements in appearance and function of virtually all of organ systems. These decrements are harbingers of diseases to come and even if the diseases never become clinically apparent, the loss of appearance and function are undesirable. Anti-aging medicine takes these changes seriously and applies therapies, both behavioral, nutritional, and pharmaceutical to prevent and reverse them.

But what about the potential side effects of applying some of these therapies to healthy, disease free individuals?  The credo of medicine since antiquity has been, “Primum non nocere,”  or “First do no harm.”  Many physician’s say that they do not want to apply an anti-aging therapy until there are long, long term studies - 10 to 20 years - because they do not want to violate the “First do no harm” dictate.  When one looks at the harm that the aging process itself does, then one begins to see the risk/benefit ratio of many of these therapies in a different light. One of the purposes of this website is to provide for you information about the benefits of anti-aging therapies, the risks of the aging process, and how to determine what they are for your particular situation.

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