What Is Longevity? Unlock the Remarkable Power to Live Longer

Quick Take: Why Longevity Medicine Matters and How It Can Help You Live Better for Longer

Longevity is not just about adding years to your life, but about increasing the number of years you enjoy good health. Ageing is a natural process influenced by both your genes and your environment, and most chronic diseases become more common as we get older. Longevity medicine focuses on optimising your body, slowing the ageing process, and reducing the time spent in poor health by using lifestyle changes, personalised care, and new therapies. At Agami Health, our goal is to restore balance, boost vitality, and help you take control of your health for a longer, healthier, and more fulfilling life.

Longevity is a buzzword right now that everybody will define differently. For some it means aiming to radically extend lifespan with futuristic experimental methods or treatments. For others it’s maintaining vitality and good health for longer (health span) and for many it’s just about being happy and living life to the fullest.

Neither of these interpretations are wrong, but none of them give the full picture.

Chronic diseases rise exponentially as we age, not in a linear way. For those who prefer, a recent study  shows that there are step-like jumps in the underlying biology of ageing in humans at a few points in life, around the mid-40s and 60 years of age.

We know instinctively that older people get more diseases. There aren’t many teenagers who have heart attacks, strokes, arthritis, diabetes or who die of infections like the flu or Covid. But why? What is the mechanism by which the body becomes “old”? What happens to our cells and the systems in our body that they just seem to fail. Is it the implications of stress on our body? Is it our lack of sleep? Is it inevitable?

Even without disease, people just know when they start to feel “old”. There is a continuum of changes that occur that people will see and feel. Just by looking at someone you can usually guess their approximate age. Their face, their hair, their body shape, the way they move. All these things are external manifestations of some internal change that is occurring with age.

What is Longevity

The term itself is a little unfortunate in that the main natural interpretation, given it contains the word “long”, is that it is something to do with length of life. This is certainly part of the idea here. This we refer to as life span: the number of days you are alive. So, what is longevity, really? While some people focus solely on extending the maximal human lifespan, most see longevity as more than just living longer. Instead, what is longevity if not the pursuit of living a good, meaningful, and healthy life?

Aside from relatively small groups of people who are focussing solely on increasing the maximal human lifespan, most people see longevity as some variation on “living a good long life”.

Vitality, vigor, sharpness, strength, happiness, joy, purpose. All these terms are the more meaningful interpretation of longevity, and one that most people align with more. This we refer to as health span. When we ask what longevity is, we are really considering both the quantity and quality of life. Factors such as genetics, lifestyle choices, diet, exercise, access to healthcare, and even mental well-being all play crucial roles in determining longevity. By understanding what is longevity, we open the door to scientific research and personal choices aimed at promoting healthy ageing, delaying the onset of age-related diseases, and enhancing overall quality of life.

Squaring the Health Span Curve

In 2023, the Office for National Statistics (ONS) said that the average person could expect to live in good health for around 61.5 years. This means with an average life expectancy of just over 81, the average person is going to have 20 years of a poor (or at least suboptimal) quality of life.

The diagram below shows this graphically. It shows quality of life (on the y axis) over your years of life (on x axis).

Perhaps the main goal of longevity medicine (and certainly ours at Agami Health) is to compress this period of morbidity to as little as possible. In other words, giving you many more good years in good health. In doing so, we are likely to also increase your life span, but this is a happy side effect when the quality of life and functioning of the body is much improved.

The Epigenetic Pianist – What Determines Your Longevity?

Now we know that various things play a part here in determining your longevity and life expectancy, by either of those definitions stated so far. People often blame their genetics for their health challenges. While genetics play a part in your health outcomes, it is a relatively minor part in most diseases. Genetics accounts for only 10% of human disease(,with 90% of diseases being environmental. When we say environmental, we mean how the environment interacts with our cells to produce a pattern of expression of your genes that promotes disease. The way gene expression is controlled is described by epigenetics.

A useful analogy here is to think of your genes as the keys on your piano, and think of epigenetics as the pianist playing this piano. 

Everybody has a set of keys with different notes, but the song that is played throughout your life depends on many factors. 

Extending the analogy below will explain better:

The Orchestra:

• Genetics
  • The keys on your piano. You are born with these and cannot change them for life.
• Epigenetics
  • The pianist playing those keys who decides the song

The Modulators:

• Environmental exposures
  • Damage the keys on your piano as well as the pianist which lead to the keys not playing the right notes or the pianist playing the wrong keys
  • Think toxins, air pollution, smoking, drugs, microplastics, artificial chemicals in ultra-processed foods
• Nutrition
  • Perhaps the main conductor of the epigenetic pianist
• Exercise
  • Creates resilience in your pianist to play a symphony even in challenging situations or when stressed
• Stress
  • Creates pressure on the pianist and forces mistakes in the rendition
• Sleep
  • The maintenance guy who keeps your piano operating in tip top condition

The Song:

• Transcriptomics – the code that is read from your genes
  • The sound of each key played
• Proteomics – the proteins made from the code of your genes
  • The tune played
• Metabolomics – the end outcome in the cells of all the molecules and compounds (metabolites) produced from
  • How the song actually sounds in the concert hall

The Audience:

• Biological systems and organs
  • Sections of the crowd in the concert hall

In this analogy, conventional medicine is based on judging the song by the reaction of the crowd, the resulting effect on the organs of your body. Play a beautiful symphony, and the crowd stays happy. Play a bad tune and sections of the crowd start to play up, or leave. 

Medicine done this way allows you to assess whether the song was good or bad in the end, but doesn’t help you understand how to create the symphony. The future of medicine is about understanding how all of the above factors can be optimised to play a perfect symphony every time.

Longevity medicine is about understanding how to control the pianist, maintain the piano, the keys and assess all the things driving failures in all of these as we age, and in doing so being able to perhaps prevent the onset of disease altogether.

What is ageing?

We are yet to really be able to define what cellular ageing is but studies like the one cited earlier give us some insights into what goes wrong with age at a deep cellular level.

Some common themes emerge around how the systems within the body start to fail. Reverting to the piano analogy, think of these systems as being their own sections of keys on the piano, for which all the other parts of the analogy apply. 

Below are some major examples of systems that show ageing.

1. Nutrient Metabolism
   1. Your body’s ability to handle and process nutrients efficiently declines with age, particularly with continual over-nutrition with poor quality foods in industrialised countries
   2. The resulting root cause of so many other issues is obesity
2. Energy production
   1. The process by which your body makes energy mostly requires oxygen. This process like any energy conversion is inefficient and energy is wasted when the fuel is burned.
   2. How efficiently and cleanly your body can produce energy without damaging your cells declines over the years
3. Immune system
   1. Our immune system becomes imbalance and sometimes stuck in the wrong state – inappropriately over or under active, making us prone to chronic inflammation or severe infections respectively
4. Inflammation
   1. A consequence of the imbalanced immune system above, which leads to downstream damage across all your organs
5. Lipid metabolism
   1. A big driver of narrowing of your arteries (atherosclerosis) leading to reduced blood supply to tissues. In the heart and brain this culminates in heart attacks and strokes respectively, two of the leading causes of death.
   2. Narrowing of the arteries supplying your heart and your brain are the number one and three causes of death in the UK after dementia.
6. DNA damage and repair
   1. As a result of all of the above (and more), your DNA takes more hits and is damaged more often. Your body’s intrinsic repair mechanisms also decline and as a result lead to dysfunctional cells which spur on disease.
7. Telomere shortening
   1. These are protective caps that protect the end of your DNA. Telomeres shorten over time naturally and are also susceptible to damage from many factors (some stated above). Once they shorten enough, they cause the cell to become senescent (a “zombie” cell) where it actually releases molecules that damage other cells and tissues around it.

These are but a few examples of the changes we see in ageing, but these are really perhaps just hallmarks of ageing. They do not yet tell us why these occur, what drives these changes to occur more as we age? Is ageing a failure of the body’s repair and homeostasis mechanisms, or is it genetically wired in by design?

Why do we age? What Longevity Science Reveals Around Growing Older

The deeper question within the study of what is longevity is, why do we age? Science does not yet have a definitive answer to this fundamental aspect of the ageing process.  We are not even close to having the answer to this question yet. A theory is that ageing is an inevitable process following the laws of physics, in that disorder (entropy) in a closed system will tend to only increase over time. The human body delays the inevitable and maintains order using energy input into the system, but it is only delaying it and over time it can’t keep up with the increasing pressure towards disorder.

An alternative theory is that ageing is a failure of the body’s ability to maintain homeostasis. Homeostasis is the process of reaching and maintaining perfect balance in a system. The body tightly controls every variable in its biological systems in a range that is optimal for function. In keeping with the idea of entropy, these homeostatic mechanisms require energy otherwise disorder and disease will inevitably ensue. The conclusion of this train of thought here being that if we can maintain the body’s homeostatic mechanisms optimally, then we will not see ageing.

There are studies that show that we can delay, slow and potentially even reverse markers of ageing, which would suggest that with enough capability to manipulate the system, beating ageing is a realistic aspiration. Even if we can extend maximal human lifespan, whether this is a desirable feat or not is a different debate altogether.

A genuine consideration here though is that when studies compare markers of ageing (biological clocks), and define slowing or reversal, they are really just defining optimal health as younger. What we think of as slowing or reversing ageing is merely just returning the body to its optimal state of functioning. There is no proof that even in its optimal state, the body will not continue to age as this may be an entirely independent process. 

So, can we extend life?

Currently, there are no proven medical interventions in humans that extend lifespan reliably (despite what many businesses in the longevity space will have you believe). There are however many things within your control that have been shown to increase your chances of living a long life:

1. A high cardiovascular capacity – VO2 max
2. High muscle strength and mass
3. Fibre rich diet, rich in natural whole foods and minimising ultra-processed foods
4. Social connection
5. Stopping smoking
6. Minimising alcohol intake
7. Avoiding environmental toxin exposure

You will notice that none of these things involve medications or medical interventions. This speaks to how young the field of longevity medicine is, such that we just do not have enough data on medical interventions to support their capability to extend lifespan. It also is great news because there is so much that you can do to control your trajectory here in terms of both life span and health span.

Below are some examples (not an exhaustive list) of interventions that are showing early promise perhaps in achieving life span extension in the coming years.

1. Rapamycin
2. Metformin
3. Senolytics
   1. Dasatinib
   2. Quercetin
   3. Fisetin
4. Acarbose
5. Spermidine
6. Caloric restriction

Note it is not coincidental that more than half of these interventions impact nutrient metabolism in some shape or form. This speaks to the biggest mismatch I believe between our genetics and our current environment – food. Your body’s ability to process the nutrients you eat and generate energy from them to support balance is one of the key biological systems that is fundamental to life itself as well as ageing. 

Evolution doesn’t care about longevity

Evolution only cares about getting us to reproductive age. There are many genes in our DNA and biological processes that exist because they help us achieve reproductive success. The very same gene that proves beneficial in our youth (when we are growing and developing) can become drivers of disease many decades later. This term is known as antagonistic pleiotropy.

One of the biggest examples of this is our genetic prowess in being able to store nutrients. Humans have evolved through natural selection to survive and thrive through periods of famine. As a result, we have genes that have been selected to help us store energy as fat. In times far gone where food was scarce, this was vital to survival. Now of course the food environment and eating patterns are very different.

Humans have not evolved to eat an excess of calories consistently, particularly calories from such energy dense, processed foods. The result is a pandemic of metabolic diseases that essentially stem from excess fat being deposited in and around organs and causing dysfunction. Conditions like obesity, diabetes, fatty liver (now called MASLD), cardiovascular disease all have roots in poor metabolic health which results from the body’s innate tendency and limitless possibility to store excess energy as fat.

Another fascinating example of this double edged sword phenomenon is a gene variant known as apoE4. The apoE gene is involved in controlling cholesterol metabolism in the body, particularly the brain. Carrying an apoE4 variant of the gene supports brain development in childhood but also aids the body in mounting a robust immune response to certain infections. The trade off in older age is that carrying two copies of apoE4 is associated with a 10-15x increased risk of Alzheimer’s dementia.

These 2 examples show that in order to prevent chronic diseases of ageing and to support healthy longevity, we cannot rely solely on lifestyle alone. We need a different approach to address this problem, and this is why longevity medicine is coming to the forefront of medicine now. We need a larger toolbox.

A shift in thinking – redefining disease

There are paradigm shifts going on now in how we approach human health and disease. These are key if we are to defeat the epidemic of chronic disease and disability that exists in an ageing population around the world. I see two major shifts in thinking:

1. There is a growing understanding that we must start to define disease and dysfunction much deeper at a cellular and systemic level rather than rely on late stage traditional diagnoses of “diseases” in isolated organs.
2. The need for personalised medicine where we can truly understand the state of an individual’s underlying biology and create treatment plans tailored specifically to them. This is a leap forward from conventional medicine that still relies on population level protocols and guidelines that assume a disease is the same in every individual so can be treated the same.

There is also an appreciation that optimal health is not merely the absence of disease. Imbalance and dysfunction are the precursors to disease, sometimes by as many as 10-15 years.

All kinds of medicine have a common aim of improving health outcomes. Longevity medicine differs in that it aims to do this with greater foresight, insight and understanding of your biology at a much deeper personalised level. Longevity medicine aims to rebalance the imbalances (some of which were mentioned above) of ageing to mitigate what seems to be the biggest risk factor of all disease, age.

Our ethos at Agami health

We have three guiding principles in our practice here at Agami Health, which combines longevity medicine with a precision and functional medicine approach to health and disease:

1. Proactively intervene to restore balance and resilience in your body’s natural restorative mechanisms to prevent chronic diseases of ageing
2. Improve vitality and cellular function to slow down ageing
3. Leverage the right tools to continue to support optimal holistic wellbeing through your life, in the physical, cognitive and emotional domains of health

Agami is a Sanskrit word for “the power of your actions today to change your tomorrow” and we aim to empower all our clients with the right tools, support and data to take charge of their health and redefine their longevity.

Almost everyone has a reason they want to enjoy more good years. Different things drive different people, but ultimately everybody would love to have more health and vitality.

Our goal at Agami is to align people with the core values they hold and support them to align their health trajectory onto a path of longevity.

Longevity medicine is the future, but it is also here now and evolving every day.

Hit “Book A Discovery Call” at the top of this page or the “Your Journey” tab for more information on what your longevity journey could look like with us at Agami Health.