The futurist Ray Kurzweil is not only famous for consistently predicting a technological singularity within decades, but also for his unusual habit of consuming more than 250 supplements per day in an attempt to live to see it. His logic: that if one can live long enough to witness the singularity, one may achieve "longevity escape velocity" and, perhaps, biological immortality (not to mention conscious immortality via mind uploading). While most professing transhumanists cannot afford Kurzweil's fountain-of-youth cocktail, there are many practical, evidence-based interventions that can extend our lives and health.
Getting Old Is Not For the Faint of Heart
First of all, why do we age? This is both a biochemical and a sociological question. The SENS Foundation (Strategies for Engineered Negligible Senescence) has identified seven biochemical causes of senescence:
- Cell loss and atrophy
- Nuclear mutations/epigenetic alterations
- Mitochondrial mutations
- Death resistant cells
- Extracellular crosslinks
- Extracellular aggregates
- Intracellular aggregates
The term "selective shadowing" has been used to describe the accumulation of deleterious pleiotropic effects that occur on the tissue and organismal levels after the process of reproduction (and child-rearing for animals that follow the K-type selection strategy) has produced the next generation. The famous biologist J.B.S. Haldane is credited for observing this phenomenon in human families where lethal, late-onset diseases persist. Despite the obvious negative selective pressure for harmful genetic mutations, late onset diseases such as Huntington's, Alzheimer's, and many of the genetically inherited cancers persist because these diseases do not affect the first few generations of carriers until after the reproductive years.
Whatever the first causes, the effects of aging are well known and feared: sensory loss, debility, osteomalacia, cardiovascular disease, cancers, memory loss, dementia, loss of freedom/autonomy, loss of friends and family with associated grief and depression. Old or young, bond or free, from infection, trauma or "natural" causes, death has been our constant companion -- the great equalizer. Everyone who has ever lived for the last 3,000 generations of modern humans has died. Is it foolish to think we may see this change?
A student of aging is called a gerontologist, and one who cares for the aged, a geriatrician. Call Aubrey de Grey the latter and you will be in for an earful. Perhaps the world's most recognized expert of rejuvenating technologies, this bewhiskered druidic shaman has prophesied that the first human to live to 1000 years old has already been born. As the scientific head of the SENS Research Foundation, de Grey also maintains that the gradual adoption of anti-aging/rejuvenating technologies will extend the lives of people until, theoretically, we can escape the gravid pull of aging and live forever.
Don't Fear the Reaper
The study of death, thanatology, has traditionally been a much neglected subject in the fields of sociology and ecology. Approaches to death in sociology are traditionally split, as are most subjects, between functional and conflict theory-based explanations. Functionalists see death as part of the well-oiled machine of society necessary to recycle resources, free up niches, etc. Conflict theorists see it in terms of competition between old and young, predator and prey. If you want to know what ecologists have to say about death, you would do well to start with the (in)famous work of Malthus on populations, which was an essential piece to Darwin's theory of natural selection. In essence, without the hot breath of death on our necks, evolution would not happen.
Psychology has been much more robust in dealing with the emotional and behavioral responses to death, in humans at least, with the development of terror management theory. As far as we know, we are the only animals who know we will die. This uniquely human condition leads to three traditional responses to death: hedonism (YOLO!), stoicism (No pain, no gain!), and Eastern escapism (Get me off of this crazy thing!).
In his very popular online course, Yale professor of philosophy Shelly Kagan takes on the topic of death, critiquing belief in the soul or an afterlife, defending the mind-brain hypothesis, and embracing what we call "the Good Death." Third-wave CBT (cognitive behavioral therapy) which focuses on acceptance and mindfulness, follows closely the long-held humanist philosophy of "living in the present" and balancing the desires of your current and future selves. It provides a framework to balance the spontaneity of hedonism with the responsibility of stoicism, and provides well documented relief to a variety of existential pains. These approaches raise the question: is it wrong to want to live forever?
Rage, Rage Against the Dying of the Light
"I don't want to achieve immortality through my work, I want to achieve it by not dying!" (Woody Allen, aka Ray Kurzweil with a sense of humor)
The transhumanist response to death (neo-vitalism/techno-vitalism) is an oddity in this milieu of philosophies which all accept death a priori as the natural and right conclusion of existence. Transhumanism is a collection of philosophies and ambitions, which seeks human enhancement, life extension and the synthesis of the biological and technological towards a non-Darwinian, guided evolution aimed at nothing short of economies of abundance, immortality, apotheosis and rescuing the universe from the Big Chill.
Through this lens, the death of a sentient human being is a tragedy, an incalculable loss of subjective experience and memory, genetic diversity and reproductive potential. To make matters worse, this tragedy occurs 150,000 times every day and the vast majority of these deaths are now non-infectious and non-traumatic -- they are due to inborn errors of homeostasis, and potentially curable. The race for the cure of death is on.
Ray's Regimen and Other Singularity Diets
Of the 250 supplements Ray takes per day, he lists his top three for living to see the singularity as coenzyme Q10, an important substrate for oxidative phosphorylation in mitochondria; phosphatidylcholine, a more stable and less inflammatory phospholipid monomer for cell membranes; and Vitamin D, which is thought to have global endocrine and immunologic activities in the body but so far in clinical trials has only shown value in preventing falls in the elderly and slightly decreasing all-cause mortality (as an aside, my medical school scholarly project was in Vitamin D which large swaths of the medical community still consider on par with snake oil for anything but bones). In addition to these he ingests omega-3 fats, large quantities of electrolyzed alkaline water with Magnesium, green tea, resveratrol found in red wine, the dependable statin found in red yeast rice, as well as regularly donating blood to prevent iron overload and stimulate the bone marrow.
Ray has teamed up with Terry Grossman M.D., a specialist in anti-aging medicine from Denver CO. They have written two books together, Fantastic Voyage: Live Long Enough to Live Forever and Transcend: 9 Steps to Living Well Forever. Their Q&A page for the first is informative. They also run a site where their entire regimen is available, but keep in mind that it will cost you about $1500 for a 3 month supply.
The life extending options en vogue within the transhumanist community, including aggressive supplementation and cryopreservation, are well beyond the means of most transhumanists. This may lead to a sense of individual anomie if professing followers are unable to live out their values.
Beyond cost, there are also significant concerns about the efficacy of these activities. After all, there have been no recorded, successful human resuscitations after cryo and there have been no large, longitudinal, randomized studies of the Kurzweil-Grossman cocktail on survival, much less for safety. Such studies would be feasible, although relatively complex to carry out due to the sheer number of supplements, and would require funding, staff, subjects and lots of time.
Studies have been conducted on many of these supplements individually, with absent to minimal significant differences in primary outcomes from placebo. Attempts to extrapolate the additive effects of all of these together are fraught with methodological problems (confounders, biases, insufficient power to support primary hypothesis, etc.). Simply put: the data does not support, or is insufficient to say whether or not Ray's regimen is better than placebo. Where experimental data has not illuminated our understanding it is reasonable to look at observational data, or natural experiments which broach the same topics.
There are areas around the world where small, culturally homogeneous groups live into their hundreds in statistically significant numbers. These "Blue Zones" include Loma Linda, California; Nicoya, Costa Rica; Sardinia, Italy; Icaria, Greece; and Okinawa, Japan. Studies of the diets and habits of these groups have revealed striking similarities, including high integration of the elderly into community life, vegetarianism, low rates of smoking, sunshine, a culture of physical activity, and relative caloric restriction. The diets of these communities are most consistent with the Mediterranean type, high in healthy fats, vegetables, legumes and lean protein.
A popular book entitled The China Study (2005) by T. Colin Campbell (a biochemist), Thomas Campbell, his son (a physician), and Jacob Schurman (a nutritional biochemist), looked at the relatively lower rates of Western diseases such as atherosclerosis causing coronary artery disease and strokes, diabetes, breast, prostate and bowel cancers among the Chinese and attempted to draw causal relationships between plant-based diets, lower cholesterol and lower levels of these diseases. It is on my reading list for the near future.
I recently had a patient who came to me after seeing his dentist who noticed a suspicious growth in his mouth. He had stayed away from doctors prior to this and was understandably distraught and in need of my help. We created an open and healing relationship, and the patient revealed to me his plans to begin an "anti-cancer" diet, based on vegetarianism, also known as the alkaline ash diet. I had heard of this hypothesis before, but not in medical school or other reputable, scientific contexts. Desiring to continue our relationship of mutual trust and cooperation, I gave my assent as I did not see any serious harm inherent in this. I also involved the help of a specialist who biopsied the lesion, and the result was a benign growth. As we discussed these results he was relieved and expressed a desire to continue the diet anyway as a means of controlling high blood pressure and blood sugar which we had discovered during his workup, as he was very hesitant to begin taking prescription medications to treat these problems. I expressed that lifestyle modification is the most important intervention for these problems, but that he would probably require pharmacological help to achieve his goals and decrease his risk in a meaningful way.
Herein lies the danger of such alternative approaches: they are not effective substitutes for proven medical therapies. Other anti-cancer, anti-inflammatory anti-oxidant diets are currently making the rounds. Enticing in their simplicity, the basic science behind these interventions may appear to lend credibility to the average person, but as with any medical therapy they should also lend themselves to scientific scrutiny and evidence before they should be trusted.
Several years ago I became aware of a Kansas-based Mormon pseudo-scientist named R. Webster Kehr and responded publicly to some of his claims about medicine and science in general and his abuse of religious authority. As a supporter of science and a believer in evidence I encourage my patients and readers to ask for help from qualified professionals before investing your time, money and potentially your life and health in a new or unproven alternative therapy. The quacks are out there: be skeptical and demand evidence. If I can be of help, I will be happy.
That's Nice, Now Show Me the Evidence
A search in PubMed, the central database of the National Center for Biotechnology Information, for citations containing the term "transhuman" reveals only about 5 results (mostly from the French International Journal of Bioethics), the term "human enhancement" yields about 80, and the term "anti-aging" about 1,920 (see the image below: the inflection point is about the year 2002, the bar on the far right represents the current year). This is a picture of a movement that is already in place, but has not yet coalesced into a recognizable field of scientific study.
The US Preventive Service Task Force (USPSTF), a panel of independent experts under the auspices of the HHS (Dept. of Human Health Services) and the AHRQ (Agency for Healthcare Research and Quality) issues recommendations for prevention of morbidity and mortality tailored to age, sex and risk factors, based on rigorous assessment of quality evidence currently available for various conditions (see figure below for hierarchy of quality evidence). These recommendations are categorized by letter grade with an "A" grade meaning the evidence strongly supports that the intervention prevents disease and the benefit is greater than the risk on the population level. These guidelines are widely accepted and followed by the medical community, but individual circumstances often require further customization for each patient. I would recommend visiting their site and putting in your own information to see what recommendations are applicable to you, and discuss these with your doctor.
What Would You Do, Doctor?
As a first-year resident fresh out of medical school, it is difficult for me to objectively evaluate the evidence behind each of these supplements and lifestyle modifications, so I can only imagine the challenge a lay person would have deciding what advice to follow. One of the reasons why fad diets and supplements are so alluring is the novelty, while the sound advice hasn't changed much since the time of Hippocrates.
The mainstay of medical advice is a healthy diet, regular exercise and restful sleep. Diet, in medical terms, does not apply to a transient experiment in intake modification, but what you eat over the long term. Healthy diets can consist of almost anything, except excessive refined or simple carbohydrates, but usually include multiple servings of vegetables, unsaturated fats and lean protein. Regular exercise is considered maintaining an elevated heart rate for greater than 45 minutes 5 times per week. Restful sleep requires good sleep hygiene, proper oxygenation and avoiding swing shifts, alcohol and blue light exposure within one hour of retiring for bed.
Beyond these no-brainers there is still little modern medicine has to offer for weight control (short of bariatric surgery) or sleeping aid, and there is currently no safe substitute for exercise. Surgical weight loss is the most effective medical intervention for morbid obesity (BMI greater than 40), with the Roux en Y gastric bypass leading the field of surgeries in terms of long term weight loss and maintenance, reversal of diabetes and other metabolic derangements, but is associated with vitamin deficiencies and the usual significant risks of surgery. There are several new medical devices which are less invasive to place than having gastric bypass (or sleeve) such as the Vagal nerve blocker and intragastric balloon, but long-term data for these has not yet been gathered, and the data for lap bands has shown more harm than benefit. Medical weight loss is another booming field, however, and for the first time in 10 years, two new weight loss drugs were approved by the FDA last year, Belviq-Lorcasserin and Qysimia, a combination of two older drugs, phentermine and topiramate. The jury is still out on their effectiveness, as most of the initial, promising data come from industry studies and the drugs are still under patent limiting their widespread use.
So far I have raised the questions, "Is it foolish to think we may witness a cure for death?" and "Is it wrong to want to live forever?" The first question may be answerable by science in the future, but the second is a question of values and would be better explored in the realms of ethics, morality and spirituality. My top evidence-based recommendations for the average transhumanist who wishes to extend the life and health of their body would be the following:
- Wear sunscreen while you get plenty of sunshine
- Eat as many fruits and vegetables as you can stand
- Control your blood pressure and cholesterol, with medication if needed
- Receive recommended immunizations
- Stop smoking (alcohol and caffeine are OK in limited amounts)
- Improve sleep hygiene
- Reduce stress and increase conscious action through mindfulness
- Find somebody to love safely and responsibly
- Exercise as much as you can, but avoid injuries and overexertion
- Don’t take stupid risks: a long life is a risk-averse one
In the meantime, May You Be Well, Live Long and Prosper!