1. Background

The average EU life expectancy is around 83 years. However, healthy life expectancy is only about 64 years. Our last 20 years are often spent in poor health and constrained physical suffering, leading to increased household and social costs and other difficulties.

However just 20% of aging is genetic, while 80% is environmental and lifestyle factors. As a result, each individual can optimize their longevity with the right lifestyle habits.

This page is intended for health professionals and enthusiasts who are interested in understanding the core concepts behind healthspan extension and what we do at Rx Longevity.

2. Demographics and Context

Today, there are about 100M Europeans above 65, and 50M from the United States. In the western world 30% of the population will be older than 65 by 2030 (from 22%).

At the same time, frailty is a silent epidemic that affects 49% of seniors (frail (7%) or pre-frail (42%)). A frail individual can cost up to 10,000€ per year in health costs alone (in Europe), 10x more than a non-frail person of the same age. This does not include the social cost of dependency and the impact to their families. But frailty has proven to be reversible with early diagnosis and treatment.

Frailty is the result of a long degenerative period. It often starts with a chronic pain like osteoarthritis (which 70% of seniors suffer). This pain leads to a more sedentary lifestyle, which further reduces mobility. This leads to a loss of strength and muscle mass, which can increase the risk of falling. Risk of falling can lead to a hip replacement and other problems, and is a key predictor of frailty and dependency. Your risk of falling is a KPI to optimize if you want to enjoy a healthy lifespan.

As life expectancy increases, maintaining and improving the ratio of Healthspan over Lifespan becomes even more important to maintain our wellbeing state.

3. State of the Art in Longevity

People refer to different things within the theme of longevity. Shady "anti-aging" creams have done little to support projects claiming to increase life. However today there is credible research and projects that aim to extend life. "The hallmarks of aging" was released over 10 years ago by researcher Carlos Lopez Otin. This paper classifies the 9 different ways in which people age, and this has served as a framework for many. The different approaches to extend life can be divided in these groups:

3.1. Pharmacological:
‍Over 50 pharmacological solutions are currently being tested in humans for their potential in slowing the aging process. Many of them have already proven their efficacy with animals; however, their application in humans requires more effort, time and investment. Some of the most promising molecules are metformin, rapamycin, or senolytics. These activate or inhibit the metabolic pathways related with the ageing process, like the anabolic pathway mTOR. However, because ageing is a multifactorial process where numerous processes and mechanisms take place, it is not reasonable to think of a single pharmacological solution for ageing. Amongst the problems we must consider the possibility of dangerous secondary effects in the long term.
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3.2. Genetic Therapies and Cellular Therapy:
Human ageing  is a natural physiological process, resulting from the progressive disfunction and exhaustion of a set of molecular and cellular events during life. The possibility of manipulating, by switching on and off the expression of genes present in these events opens a myriad of possibilities. The most promising areas are being researched on animals and are leading in the direction of epigenetic reprograming of characteristics related to the ageing process and death of senescent cells, as well as regeneration of tissue and stem cell organs. One of the most promising aims to maintain the length of telomeres via genetic expressino of telomerese enzyme, avoiding the shortening of chromosomes and the associated aging. In mice, life has been extended up to 20% without disease. Celullar reprogramming enables hte gathering of certain cells to regeente a damaged organ. Risks have to do with tumour development and the disfunction of tissue and systems. Other lines of investigation, even more revoluationary, are based on the knowledge from immortal animals. They suggest that genes could hold hte potential for immortailty and that we must understand it, decypher and then manipulate it with the objective of awakening the potential immortal nature of our genes.

3.3. Bioengineering Research.
Other lines of research seem to come from science fiction and far from the clinical practice. But we have all been witnesses of the exponential advances in science and technology. Numerous groups and entities are researching cryopreservation, replacement of bioidentical organs, nanorobots, robotic-tissue integration, etc.

3.4. Research in prevention medicine, regeneration and lifestyle medicine.
This line is more consolidated and offers more realistic and available treatments today. It is often compared to car maintenance, in that a better maintenance and repair strategy will help your car live longer. While it sounds simple, it is cheaper and effective for all groups of people.
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Rx Longevity's strategy is based on research founded on that philosophy. This line of thought does not exclude the others, but we believe that there is still a lot that can be optimized with healthy lifestyle strategies, primary prevention, secondary prevention and regenerative medicine. Our Healthy Longevity Plan integrates all the actionable knowledge already in existence in 2022 in a coherent manner, such that we do not need to live those last 20 years with bad health, pain and disease when in many cases it could have been prevented or reverted.

When we mention "preventible", we do not say that you can prevent cancer today. But you can diagnose it earlier to reduce mortality risk, or have a better diagnostic, and you can do everything in your hand to reduce the non genetic risks. The Healthy Longevity Plan we propose at Rx Longevity covers the different pillars of a healthy longevity. While we are already touching all pillars, we currently focus more on physical condition because it has the most impact in the shortest term to many of the preventable diseases and quality of life. As we grow, we will put more emphasis in the other pillars.

4. Reasonable longevity objectives as of 2022

In general terms, living longer than 100-110 years is not very viable as of 2022, but we can live with the following objectives: Stay robust, agile, able to move by ourselves and enjoy our hobbies and passions until we reach 100. Enjoy a cognitive health that allows us to continue learning. Identify and prevent our risks to suffer the main mortal diseases and those that cause dependence in time to define a radical treatment that reduces the risk of death of secondary effects.

Here we must identify: 
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- Cardio-cerebro vascular, main cause of death and inability, is preventable in 95% of the cases.
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- Cancer: each cancer has a different diagnostic but we can identify early almost every one of them and change their evolution.
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- Alzheimer, even if the main concern has to do with the state of living, also causes death. As of today it cannot be reverted and in most cases it cannot be prevented, although some researchers like Dr. Bredesen suggest it can be prevented with lifestyle. It is the disease we fear most adn the one we must identify on tiem to stop its evolution.

- Musculo skeletal diseases linked to osteoarthritis: they are not mortal but cause pain and are the main origin of sedentary lifestyle and hte development of multiple other problems, apart from the pain itself. They are not preventible but its evolution can be delayed and it is becoming more clear that it can be reverted (regenerated).
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- Metabolic diseases: Diabetes, hypetension, choleterol, seem to be normal after 65, but they accelerate the whole degeneration process because they are related to the whole cellular functioning system. They can be controlled with medication but they can be reverted with adequate strategies and are one of the main mortal diseases risks.

5. Medical approaches to extend healthspan

 The objective is to have a full checkup of all my key indicators to trend their progress and evolution.

Primary Prevention or Lifestyle Medicine:
In order to optimize my health I need to know and visualize what great areas of work exist and have a plan for each of them. The main pillars are: 
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5.1. Physical Exercise
This pillar is the base of every strategy because a sedentary person cannot compensate inmobility with anything else. The loss of muscle, balance, agility, joint mobility and biological processes have an impact in frailty and their whole biology.
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5.2. Healthy Nutrition
As we age, many processes worsen and the quality of our cells becomes even more important. It is fundamental to have a balanced diet in quantity and quality, and there are many different compositions that can help fight specific diseases.
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5.3. Cognitive Health
Nobody wants to live with cognitive problems but we do not often think of our brain as an organ that we need to take care of just like our heart. New research suggests that preventive healthy lifestyle strategies can do a lot for the healthspan of our brain.

5.4. Sleep and Rest.
Sleep triggers regeneration processes, and neural and cellular recovery. It affects our immune and emotional systems and it is often disregarded. After 65, because of retirement and metabolic changes, imbalances often take place with great secondary effects in perceived health. They can be identified, prevented and recovered.

5.5. Emotional Health
Emotional health is closely linked to the wider strategy and it has been researched that it can be modified at every age. Happier people live longer (and happier). With age some circumstances change, like solitude, mourning of friends, family, loss of interests in hobbies, loss of routines and jobs, that can affect greatly. Health professionals can help us adapt to those changes.
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5.6. Breathing and cellular oxygenation.
This one can be of lesser importance if we carry on an adequate physical exercise strategy. Urban pollution cannot be compensated.
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5.7. Regeneration strategies.
During the aging process we lose some of the recovery capacity of the normal celullar regeneration process. We must identify the natural mechanisms to build the right strategies.
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- There are stem cell treatments whereby regeneration processes are accelerated by infiltrating stem cells in specific locations so they can differentiate and regenerate tissue. This is often used to deal with joint pain.
- Anti-inflammatory diet, a physical exercise strategy and good sleeping patterns and protocols have a great impact in cellular regeneration.
- Supplements. After 65, the human body absorbs nutrients more poorly and often needs even more, so there are some supplements that are absolutely necessary and some other which vary depending on specific deficits. At 20, if some vitamins are missing, nothing really happens, but at 70 this deficit can be noted.
- Terciary prevention: The management of diseases we already suffer, like chornic pain, or the adequate usage of drugs we need. We should include a pharmacogenetic optimization to benefit from the right dose at the right times of the day while reducing secondary effects.

Altogether, It is important to know how I am in order to identify my own risks. In order to do that, you need to know the main biomarkers you need to track, which includes a combination of tests and diagnostics in what we call an Annual Diagnostic Agenda at Rx Longevity.