Like a real-life Benjamin Button—only by design—the curious case of Bryan Johnson is a story for the ages. But not for the aged. In his Netflix documentary, Don’t Die: The Man Who Wants to Live Forever, the tech billionaire tells of how he spends $2 million a year to reverse the effects of aging.
From injecting his own face with body fat from a donor for a wrinkle-free, smoother facade to shocking his penis three times a week to thwart erectile dysfunction, the longevity-obsessed influencer appears not to be afraid of anything—except growing old. He says aging is a disease, and he’s determined to find a cure. But aging isn’t a disease. It’s a process.
Angela Roberts, Western’s Canada Research Chair in Data Analytics and Digital Health in Cognitive Aging and Dementia, says when aging is described as a disease, it implies that growing old is something to be managed and treated. And that’s not how she sees it. At all.
“We have to think about aging as a process. It’s something that unfolds over time that we can optimize. And it’s a natural part of our lives,” says Roberts, a principal investigator at Western’s Canadian Centre for Activity and Aging. “We start aging from the time we are born. And with modern medicine and modern science, there are many, many ways we can step in to optimize what that journey looks like and what that trajectory looks like. That’s how I prefer to define it.”
Words like journey, even trajectory, are far more optimistic and frankly, constructive than describing aging as a disease. By the early 2030s, Canada is expected to join the ranks of “super aged” countries, a title already held by Germany and Japan, where 20 per cent of the population (one in five) are 65 and older. And by 2050, more than 2.5 million Canadians will be on the plus-side of 85 years, more than double the number in the 2021 census.
“For the next two or three decades, Canada’s older population—65 years and older—will continue to increase and we are not prepared to meet the needs of this changing demographic. One response is to increase the amount of long-term care, but this doesn’t make sense policy wise,” says Jane Rylett, scientific director of the Canadian Institutes of Health Research (CIHR) Institute of Aging, based at Western. “Long-term care is needed and critical, but we should also be investing in promoting and researching better health span, better brain health, better bone health and support for other forms of housing and mobility for older persons in the community.”
Rylett prefers the term ‘health span’ to lifespan, as it places the emphasis on a healthy life versus just a life. The end goal shouldn’t be just to live longer, but to optimize and increase the years you spend in good health, both mentally and physically, and how to make lifestyle choices to increase your healthspan.
“One of the important issues to consider about how we age and increase our health span is how we relate to the world and the environment around us and how that impacts the way we age. The way we do that can alter the trajectory of aging,” says Rylett, a physiology and pharmacology professor at Western’s Schulich School of Medicine & Dentistry. “Maintaining social connectedness, how we eat, how we sleep, how we are physically active, all impact our physical health, our mental health and also the way in which we age.”
We have to think about aging as a process. It’s something that unfolds over time that we can optimize. And it’s a natural part of our lives.
Angela Roberts, Canada Research Chair in data analytics and digital health in cognitive aging and dementia
Life in the slow lane
Jay Stock, by his own admission, is not an aging expert. A professor and bioarchaeologist in Western’s department of anthropology, his research is focused on human adaptability and skeletal biology throughout the lifespan. Now, we know lifespan’s an ugly word, but analyzing health span is trickier when examining neolithic remains from the Stone Age.
“When discussing healthy aging, I want to mention something which leans to the dark side. And you may not want to print this in a story about aging, but death comes for us all,” says Stock. “All sexually reproducing organisms age and die but what’s unique about humans is that we have a life history that is stretched, compared to other primates and animals, with a very long post-reproductive lifespan, and so, in a sense, our whole life is in the slow lane.”
Whether it’s treating aging like an extreme sport, in the case of Bryan Johnson, or maximizing the health span with exercise, diet and mental wellness, there is a natural, inevitable consequence of stretching human life longer, compared to other species. It’s an unfortunate by-product of how bodies work, how cells work and how DNA works. It’s unfortunate, but also unique.
“If we think about stretching the health span, as an evolutionary biologist, I will say it starts with an extended childhood. We have an extended period before we become an adult compared to any other species. We have a long adult life, and then a long post-reproductive life, and all of those stages, if we look at human evolution, are crucial to what makes us human,” says Stock.
So yes, childhood—including the oft-lionized first 1,000 days—is crucial for the development of one’s body, brain, metabolism and immune system. If we didn’t have that extended time, we likely wouldn’t be human—at least as we know it. But the other end of the spectrum is also critical. And for the issue of aging, maybe more so.
“We know in many hunter-gatherer and farming societies, grandmothers often contribute more calories to the group than fathers, and grandparents, in general, were essential for human evolution by teaching us how to be cooperative members of our communities,” says Stock. “The standard life course for a human is to be active from birth to death, and to be an integrated part of a community, to always be contributing.”
The standard life course for a human is to be active from birth to death, and to be an integrated part of a community, to always be contributing.
Jay Stock, professor and bioarchaeologist, department of anthropology
A person is a person because of other people
Population studies show adults over 80 are the world’s fastest growing demographic and in Canada, they are quickly outpacing other age groups. Yet, despite this trend, society is woefully unprepared in terms of health care, housing, accessibility and social programming.
Roberts and her collaborators in the international SuperAging Research Initiative are studying a growing number of the 80-plus set who have memory abilities at least as good as those in their 50s and 60s and at least average cognition in other areas such as problem-solving and managing multiple tasks.
“Older people serve a valuable role in society. SuperAgers are important teachers, reminding us how to live and the mistakes to avoid,” says Roberts. “SuperAgers are a reflection of our history and society, and we need that reflection today more than ever.”
Studying SuperAgers was never about showcasing exceptionality or even finding the fountain of youth. (Though that would make for a superb secondary finding.) Roberts and her fellow researchers wanted to understand what happens in the body and the brain of people living with neurodegenerative conditions. Not in younger adults, which is so often the case in clinical trials, or animal models, but actual people with lived experience.
“The SuperAging Research Initiative is about finding people old enough, meaning 80 and older, who may have a brain disease, but have not yet developed any of the clinical implications yet,” says Roberts. “Now we have a legitimate control group for healthy aging, not a biased dataset based on perceived results from younger participants.”
Beyond great data, Roberts has also encountered great people. And that’s where the real learning happens when studying SuperAgers.
“One of the things they all share in common is that every one of them is always looking forward. SuperAgers are children of pre-Second World War. They’ve known adversity, they’ve known hardship, yet they persevere,” says Roberts. “That said, you have to dig to get stories from the past. Every conversation with a SuperAger starts with what they’re doing today, or next week or next year. That’s a very specific and optimistic mindset and I believe that’s the real secret of SuperAgers—this sense of optimism, which stems from actively pursuing relevancy and ongoing social connectedness.”
A few years into the SuperAging Research Initiative, a key takeaway so far is the discovery that SuperAgers possess a higher density of autonomic neurons, which drive the heart and gut and connect the brain and the rest of the body, in the anterior cingulate cortex. (This is a region in the frontal lobe of the brain that governs attention, reward processing and error detection.) Next, the researchers want to determine whether SuperAgers have a predisposition to have a higher density of these neurons, or if these neurons pre-exist, and are flicked into action throughout the health span, fueled by social activity and behaviour.
Rylett, who studies cellular and molecular neurobiology of the aging brain and age-related neurodegenerative diseases, has found similar findings in her work with older adults tied to social connectiveness and synaptic plasticity. Her primary research is investigating cholinergic neurons, nerve cells that send messages in the brain, and how their dysfunction and loss impact the onset of neurodegenerative conditions such as Alzheimer’s.
Synaptic plasticity is the human brain’s superpower, allowing it to change its structure and function in real-time to adapt to various situations and environments. Critical to development, learning and memory, brain plasticity can falter if a person is fighting neurodegenerative conditions.
“When looking at plasticity in the brain, it is really driven by activities and social interactions,” says Rylett. “Physical activity, including regular exercise, can also drive generation of more adult stem cells in the hippocampus and other areas of the brain, so I think it’s really important to consider the impact of social connectiveness and activity on healthy aging.”
Jane Rylett, Scientific Director, the CIHR Institute of Aging
Long-term care is needed and critical, but we should also be investing in promoting and researching better health span, better brain health, better bone health and support for other forms of housing and mobility for older persons in the community.
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Tree rings
Jessica Kaulback, Sivri. Ink on paper. Relief print created from the stump of a fir tree. ©Jessica Kaulback (heartwoodink.com)
The axe forgets but the tree remembers
There is a growing body of evidence that our experiences early in life shape our health span. In 2022, Stock and his collaborators published a study that showed bone development very early in life is closely linked to the development of the brain.
Stock is now studying ‘altriciality,’ or humans being born helpless, research which helps us understand how living much of our early life swaddled and carried in a Baby-Björn can be tied to skeletal fragility and fractures later in life. While swaddling and carrying a baby doesn’t directly cause bone deterioration, any act delaying an infant’s ability to muck about and get moving does.
“We build bone in utero that starts deteriorating the second we’re born. And the ultimate cause of early bone loss is the dramatic pause of neuromuscular development in the first six to 12 months of life,” says Stock. “We’re the only species whose skeletons regularly collapse under our own body weight, but understanding why some people are more susceptible depends on research that spans the entire life course.”
Studies show bone tissue development runs on an entirely different time scale than other physiological systems. It takes about 20 years to build human skeletons and then they go about rebuilding themselves during maintenance and repair periods on eight-year cycles.
Stock, who teaches Evolution, Ecology, and Human Health as well as a course titled The Anthropology of Cyborgs, isn’t proposing we outfit our newborns in designer sneakers and unleash them into the wild or implant bionic body modifications. But this predilection for nurture over nature gives him pause.
“As a species, we are predisposed to osteoporosis from infancy,” says Stock. “And because of our early life helplessness, humans start out behind the 8-ball compared to other species. In fact, in the first year of life, we lose bone at a rate roughly five times faster than astronauts in space, who experience rapid bone loss due to the lack of gravity. But the deterioration stops around the time we learn to walk.”
Stock is collaborating with health sciences professor and physiotherapist Tina Ziebart and Dr. Jenny Thain, a geriatric medicine professor in the Schulich School of Medicine & Dentistry, to build an interdisciplinary team in Western’s Bone and Joint Institute to advance understanding and promote bone health throughout the health- span.
“Coming back to increasing lifespan, the Bryan Johnsons of the world have lost the plot,” says Rylett. “Frankly, it’s an ageist perspective. There are some high-profile wealthy persons who want to live to 120 or beyond, but it does not make sense to only extend their lifespan. There is no thought about the impact on their health.”
Rylett says we need to further explore the Blue Zones—regions of the world, like Okinawa, Japan, where people live longer and healthier lives than average—and foster opportunities for aging in place, like natu-rally occurring retirement communities (NORCs), for older adults to thrive and survive. Unlike retirement homes, assisted living facilities and long-term care homes, NORCs are not purpose-built to care for people as they age. Rather, they boast a variety of housing types that mirror the ever-changing population dynamics of older adults. (Ontario has 1,941 NORCs where at least 30 per cent of residents are over 65, according to a report from the National Institute on Ageing and NORC Innovation Centre, part of the University Health Network.)
“There is so much more we can do as a society beyond only adding beds to long-term care facilities. This is just another form of ageism and older adults internalize all of them,” says Rylett. “They stop themselves from engaging in activities. But we don’t want them to stop. We have to encourage them and put things in place, from our health-care system to our housing infrastructure, to allow older persons to remain active and contributing members of our society.
“Again, this is not about increasing the lifespan. If it happens, that’s a bonus, but it’s the health span that’s critical. We’re not trying to add more years to life. It’s about adding years of active participation in life.”
