Some Notes on "Anti-Aging" Programs

Robert N. Butler, M.D.

Some individuals and organizations would have us believe that aging is not inevitable and that "immortality is within our grasp." These same individuals believe that there exist well-validated biomarkers of aging that can be used to design individualized "anti-aging" programs. This approach is expensive and includes poorly validated interventions such as improving antioxidant status and replacing growth hormone (GH), testosterone, dehydroepiandrosterone (DHEA), and melatonin.

Although growth hormone levels decline with age, it has not been proven that trying to maintain the levels that exist in young persons is beneficial. It is conceivable that age-related hormonal changes may serve as useful markers of physiological aging. However, this has not been demonstrated experimentally for either humans or animals. Although hormone-replacement trials have yielded some positive results (at least in the short term), it is clear that negative side effects can also occur in the form of increased risk for cancer, cardiovascular disease, and behavior changes.

It might even turn out that lower growth-hormone levels are an indicator of health. Research findings indicate that mice that overproduce growth hormones live only a short time, suggesting that growth-hormone deficiency itself does not cause accelerated aging, but that the opposite may be true. The the risk/benefit ratios for testosterone replacement and GH treatment have not been established in older persons, and trials of DHEA have failed to show significant clinical benefits in normal aging.

Clinical trials to investigate the risks and benefits of these and other potential interventions are either still going on, or have not yet provided definitive answers. It therefore pays to be cautious until adequate clinical trials have been completed and analyzed.

It is important to study substances that might have favorable effects upon the promotion of health (such as the possibility that some anabolic hormones might protect, if only for a short term, against the frailties of old age). However, it is not proper to market such substances with unsubstantiated claims. Moreover, there is no FDA supervision to assure that hormonal products marketed as "dietary supplements" are safe or effective or even contain the ingredients listed on their labels.

The concept of "anti-aging medicine" contrasts with modern gerontology which distinguishes between aging as natural phenomena and diseases, and the role of aging per se as a risk factor for diseases. Anti-aging medicine is not recognized as a specialty by mainstream medicine or the insurance industry. Its practitioners should be distinguished from mainstream clinicians who are concerned with health promotion and disease prevention. Advancement of more favorable lifestyles with attention to diet, exercise, tobacco cessation and early identification of risk factors, measurements of functional status and disease markers is a desirable and achievable goal. For example, it is important to lower cholesterol levels through exercise or the use of pharmacological agents like statins, and to detect hypertension and diabetes early in order to effect appropriate control and prevent the often lethal consequences of both. But doctors who claim to have the ability to measure "biomarkers of aging" and favorably affect them are not scientifically-based.

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Dr. Butler (1927–2010) was a prominent gerontologist who founded and directed the International Longevity Center, an applied research and policy center, whose mission was to help individuals and societies address longevity and population aging in positive and productive ways. One of the center's reports, Biomarkers of Aging: From Primitive Organisms to Man, highlighted the need for more research into the mechanisms and markers of aging. Another report, Is There An Anti-Aging Medicine?, examined claims for various anti-aging strategies.

This article was revised on March 20, 2003.
The biographcal sketch was revised on December 11, 2011.

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