Dr. S. Jay Olshansky is a Professor in the School of Public Health at the University of Illinois at Chicago, Research Associate at the Center on Aging at the University of Chicago and at the London School of Hygiene and Tropical Medicine, and Chief Scientist at Lapetus Solutions, Inc. He has received multiple scientific awards, including the Irving S. Wright Award from the American Federation for Aging Research.
Dr. Olshansky is the co-author of multiple papers related to longevity, mortality, and population aging, and the areas of his current research include estimates of the upper limits to human longevity, opportunities and challenges related to population aging, how morbidity changes over time, and forecasts of the size and age demographics of the population with and without medicines that address the underlying mechanisms of aging. We had the opportunity to interview Dr. Olshansky at International Perspectives in Geroscience, a conference hosted at Weizmann Institute of Science (Israel) on September 4-5.
Would you please give us a brief insight into how life expectancy in the United States has been changing over the last century and how will today’s life expectancy change in the near future, say, in the year 2050?
Life expectancy in 1900 was about 50. Today, it’s close to 80. The vast majority of that 30-year rise in life expectancy was the result of reductions in infant and child mortality. In the latter third of the 20th century to today, we’ve seen reductions in middle age and old age mortality. We experienced a dramatic increase in life expectancy, like never seen before in history, in the matter of a single century. It was mostly because we saved the young; that can only happen once. Once you’ve saved the young, you then have to achieve gains in life expectancy by saving middle-aged and older people.
We’re now at a time where the vast majority of the gains are going to have to come from saving older individuals, and the problem is that aging gets in the way; the vast majority of the population in the United States and elsewhere in the developed world is now exposed to aging. So, in the absence of modifying the biological process of aging, the rise in life expectancy must decelerate. It has already decelerated and probably will continue to do so.
Some population subgroups are actually going to do significantly worse in the future. For example, Hispanics have the highest life expectancy in the United States today. That’s going to disappear probably within the next 20 years, and it will disappear because the majority of the high life expectancy for Hispanics is associated with being first-generation migrants. Second- and third-generation Hispanic migrants do much worse than first generation migrants. So, as second and third generation migrants grow older, they will dominate the mortality component for that population subgroup; life expectancy is going to drop. By 2050, if we don’t slow aging, I wouldn’t be surprised if the life expectancy isn’t far different from where it is today in the United States.
Would it still grow a little bit, or would it decline?
It might decline.
What are the factors that will be contributing the most to this decline?
It depends. We anticipated way back in 2005 that obesity would be the major impact; it has had a major impact for sure. We didn’t anticipate the negative effects of opioids and the early-age mortality that opioids are contributing to. We will see a re-emergence of infectious diseases, which will take out young people. Any time young people die, it has a dramatic negative effect on life expectancy. You have to balance the negatives against the positive. On the positive side, there are going to be breakthroughs that allow us to generate more and more survival time for people who make it out to older ages. Maybe a breakthrough in cancer will allow us to manufacture survival time. The problem is that we’ve reached the point of diminishing returns. If you save a child, you add decades to life; if you save somebody who’s 70, 80, or 90, you add incrementally smaller and smaller amounts of lifespan because aging gets in the way.
What about ecological problems? What role do they play?
Unknown. Climate change will contribute to the re-emergence of infectious diseases. I anticipate infectious diseases will make a comeback. I actually wrote a paper on this several years ago, suggesting that we’re going to experience a fifth stage of the epidemiologic transition. The fifth stage will be characterized by the rise and re-emergence of infectious diseases. Part of that has to do with the fact that we’ve become a much older population, and an older population tends to be an immunocompromised population; you add in HIV/AIDS, radiation treatments for cancer, chemotherapy, various other types of treatments that influence the immune system. Plus, you’ve got a lot of people living in nursing homes and prisons and an ability to transport pathogens across the globe in a matter of hours, and we basically set ourselves up for the explosive emergence of infectious diseases.
I think infectious diseases will make a comeback. Will we be able to combat them as effectively as we did in the early 20th century? I don’t know the answer to that. Plus, we have the emergence of pathogens that are resistant to all antibiotics. So, we’ve got a series of potentially negative events that are likely to happen. How we react to them, I just don’t know. If we will be successful, I’m hoping we’re successful in combating them, but we will have another pandemic. It’s not a question of if, it’s when, and I don’t know what it’s going to be exactly, an influenza or some other type of pandemic. We have seen some unusual strains of Ebola that have been transmitted to different parts of the world. Ebola would be particularly frightening. There’s a lot of uncertainty.
So, our healthcare system should strengthen even more in order to be able to cope with all that.
I would hope so.
Some experts in our field believe that the natural limit to human lifespan is somewhat hard and that we cannot live longer than 120 years on our own, even if we’re lucky to have the genes. Other researchers say that this natural limit is not important at all because they believe that rejuvenation biotechnology therapies, which will be targeting the main mechanisms of aging, will be able, in theory, to promote health so much that extreme longevity will be an inevitable side effect. What gains in lifespan can we realistically expect if a complex therapy that addresses each currently known hallmark of aging becomes accessible to the public?
I honestly don’t know for a therapeutic intervention like the one that I talked about earlier today, or that others have talked about, whether that’s senolytic compounds, treatments for insulin signaling, or metformin; nobody really knows. What bothers me about these claims of exceeding 120 is that every single one of the numbers that somebody comes up with is made up out of thin air. There’s no science behind it at all. As soon as somebody says any number higher than 122, it’s made up. So, if somebody says 150, I usually ask, well, where’d you come up with that one? Somebody says, 200, where’d you come up with that one? To me, it doesn’t matter. If you say 150, 200, 500, or 1000, they’re all exactly the same to me: made up.
This is science that we’re doing here, so we shouldn’t be in the business of making up numbers. When it comes to life expectancy, nobody has any idea of how any of these therapeutic interventions are going to influence the metric. Nobody can know definitively. But I can tell you precisely how much it would have to influence death rates in order to get life expectancy up to 100, or 120, or 130. It’s a very daunting task, once you see what the statistics look like and what’s required to get life expectancy up to 120.
You mentioned lifespan, not life expectancy. Lifespan is one person. I don’t really care about the world record for human longevity. I mean, it’s interesting, it’s fun to talk about, but we’re talking about one person. The one mistake I would avoid is assuming that because one person can live to 122 that we all can, which is flawed reasoning. It’s the same reason why the world record for the one-mile run, which is 3 minutes, 43 seconds today, cannot be achieved by most everyone else. To suggest that we all can run a mile in 3:43 is the same as suggesting we can all live to 122. It’s just not even genetically or biologically plausible. There is no plausibility to that line of reasoning at all. So I wouldn’t draw any conclusions at all based on the observation of one person.
Do you think that these gains might be bigger than they would be in a situation where we defeat just one age-related disease?
Yes, a cure for cancer would yield about a 3.5-year increase in life expectancy; a cure for cardiovascular disease would yield about a 4- to 4.5-year increase in life expectancy. A slowdown in the rate of aging, if it simultaneously influences heart disease, cancer, stroke, and hopefully Alzheimer’s, the gain might be larger than what we see from the elimination of any single disease. Again, I’ve intentionally not tried to estimate the gain in longevity that would result from a deceleration in the rate of aging, because I don’t really care what the gain in life expectancy is. I would care about the gain in healthspan, as it’s easy to make the case that the gain in healthspan would be huge. Again, I argue that we should not be focusing on addressing lifespan. I don’t think we should be paying close attention to that.
What is your view on whether aging is a disease or not, and so you think that it should be classified as a disease in the ICD-11 as suggested by an international group of experts in 2018?
With regard to the aging and disease question, as I’m sure you’re aware, this has been around since the late 1970s – and probably sooner. Aging is no more a disease than puberty or menopause, and in my view, it would be a mistake to create such a classification. Those advocating for this often have a vested interest in such a classification, but there are several reasons not to do so beyond the important one already mentioned. The idea of creating an ICD code for aging was first proposed in the late 1970s, and it was never successful for one obvious reason – if an ICD code for aging were created, it would render meaningless almost all information on the death certificates of many people past age 65 and most people past age 85. The problem is that physicians are trained to detect and treat disease, and since many of the diseases that appear in later life have aging as their primary risk factor, the tendency would be to overuse the aging ICD code. The rich information now appearing on death certificates would be diluted – and for many, it would disappear entirely.
The other main reason not to call aging a disease is because it’s fundamentally ageist. Since everyone ages, and since aging grows as a risk factor the older we get, calling aging a disease would mean that all older people are diseased because of their age – not because they have any particular disease. This in itself is discriminatory. Dr. Bob Butler, the scientist that coined the term “ageism”, was strongly opposed to calling aging a disease for this very reason.
While I agree with many scientists that aging can and should be inherently modifiable, and that interventions are forthcoming that will slow/modify the rate of aging in favorable ways, there is no need to label it a disease in order to do so. The FDA has already come on board with this, so it is counterproductive when other scientists suggest that we need an ICD code for aging.
When many people hear about the idea of healthy life extension for the first time, they argue that one of the downsides will be overpopulation. Could you please tell us if science actually confirms that? What are the other possible social implications of living longer, positive and negative, that we would expect?
Let’s deal with this overpopulation issue, which comes up every single time. It’s almost nonsensical. There’s about 7.5 billion people on the planet today. We are inevitably going to somewhere between 9 to 10 billion by mid-century, no matter what; even if birth rates go down, even if death rates go up, we are inevitably going to 9 to 10 billion people. That’s a demographic certainty, unless there’s some catastrophic event. That has to do with momentum that’s built into the age structure of the population that’s associated with past levels of fertility dating back 100 years, has to do with population size and birth cohorts.
If we achieved immortality today, which I would argue isn’t going to happen, but, hypothetically, let’s assume we became immortal. No more deaths; the growth rate of the population would then be defined by the birth rate. The birth rate is roughly 8 to 10 per thousand, which means that the growth rate is a little less than 1%. A growth rate of 1% means that the population doubles about every 70 years. Since immortality isn’t going to happen, the growth rate is inevitably going to be significantly less than that.
In other words, we’re going to get to 9 to 10 billion people, no matter what. By mid-century, we may be a little bit higher, maybe a little bit lower, depending on where life expectancy goes. The issue of overpopulation is not an issue at all. Nobody should even be discussing it. I understand why they do, but, demographically, there isn’t any support for that line of reasoning at all.
I would say that the biggest challenge associated with what’s going to happen when we slow aging is that we’re going to produce a lot more healthy older people. Well, you and I, hopefully, will say “That’s a challenge I want to have.” Because the alternative is a lot more unhealthy older people; which would you rather have, a lot more unhealthy older people or a lot more healthy older people? There’s an obvious answer: I want a lot more healthy older people. You produce a lot more healthy, older people, you’re going to challenge retirement programs. Social Security, even Medicare, will be challenged somewhat. So, we modify these programs to accommodate the production of a lot more healthy older people. But, if you weigh the alternatives, there is no question which direction we should be going.
In your recent study, Longevity and Health of U.S. Presidential Candidates for the 2020 Election, you try to investigate if age should be considered while choosing the best leader for the country. Could you please share the main conclusions of your study?
Sure. The main conclusion is that the number of times we travel around the Sun should not be a litmus test for the presidency of the United States or any other country for that matter. Age should not be relevant; it should be that the cognitive functioning, the ideas that these presidential candidates bring to the table, should be the only variable that we use. Their age should be irrelevant; whether it’s young or old should not matter. The bottom-line conclusion is that the large increase in the number of older candidates for President is a wonderful sign and signal, which is a reflection of our modern world, where we’ve produced a lot more healthy, vibrant, older people who can do anything, including be President of the United States. My overall conclusion is that the ages of these individuals should be completely irrelevant and should not be addressed at all in any of these discussions or debates.
Now, having said that, any time any of these presidential candidates that are over 70 make a mistake on camera, it’s automatically attributed to their age. They’re called gaffes. People have been making gaffes in their 30s, 40s, and 50s; their age should not be used as the basis for concluding that they’re not qualified to be President. It’s the ideas that they bring to the table, not the chronological age of their bodies, that matters.
Even though the study implies that age is just a number for this demographic group, and that advanced age should not sound alarming, is there still a reasonable limit in your opinion to the age of a presidential candidate, and what factors could define this limit?
No, there’s no limit. There’s no reason why somebody can’t be president at 80, 85, 90, 95. Have you ever met a super-ager? Super-agers are these folks that make it out past the age of 80 that are cognitively functioning at the level of a 50 year old; I sat around a table of super-agers. If I closed my eyes, it was like I was around a group of teenagers that were really smart. So, no, the age of the individual should not be taken into consideration at all.
This was a little over a year ago at Northwestern University; this was the super-ager project run by Dr. Rogalski, and she brought in all of her super-agers, and we took photographs of all of them. We could document the facial ages of these individuals with the hypothesis that the facial ages of many of these extremely healthy older individuals was probably younger than their chronological ages. We’re not done with that research yet.
I must admit that I was a bit surprised when I was reading the paper about the presidential candidates. In my view, political activities are still a huge responsibility that comes with huge stress, which is a factor that contributes to accelerated aging. But people in the corresponding demographic group seem to be very fit, despite their age. There are obviously some strong factors that should be promoting their healthy longevity. If we wanted everyone else in the country to enjoy the same lifelong health as this group, what kind of changes should we, as a society, make to achieve that?
One of the contributing factors we know that’s associated with the exceptional health and longevity of Presidents, and probably presidential candidates, is that they’re all highly educated, they tend to be wealthier, and they all have access to the best health care in the world. Well, if we created a human population that was all highly educated, all wealthier, with all access to the best health care in the world, we probably would experience some rather dramatic increases in healthspan, without influencing the biological process of aging. It’s right in front of us, it’s right under our nose. It’s not like we don’t know what’s contributing to this.
Having said that, probably very few of us would be able to withstand the rigors of running for president or being president, because of the high stress that’s associated with it. Chances are, these folks that are presidents or presidential candidates are already self-selected for being able to handle the stress of that situation very effectively.
I wouldn’t assume by the way that stress leads to accelerated aging for presidents or presidential candidates. I mean, that’s what led to my article that I published in 2011, and that observed longevity of U.S. presidents, and demonstrated that it’s not true. Presidents don’t experience accelerated aging; in fact, they live longer than average. In spite of the stress. It’s possible that they may be able to handle stress much more effectively. It may not be harmful at all, just like smoking is not harmful for some subgroups of the population. Remember, Jeanne Calment lived for 122 years, and she smoked for 100 of them.
You’re known to have coined the expression “Longevity Dividend” around 10 years ago. Since then, you have been one of the most active proponents of scientific research on developing interventions that could delay aging and postpone or prevent age-related diseases. What advice do you have for supporters of healthy longevity who are trying to educate the general public about the need for more research on aging? What arguments should they be using?
The hardest thing is that everyone has this disease model in their head. Then, they go see a doctor and all they talk about are diseases, “what diseases do you have?” Nobody really understands, including many of the physicians that are treating their patients; they don’t know or understand the importance of the biological process of aging as the primary underlying risk factor for everything that goes wrong with aging bodies. Getting the public to understand the difference between aging and disease is foundational.
Once they understand that, they recognize that a therapeutic intervention to modulate aging will have a cascading effect on everything, all at once. There should be a groundswell of support for work in this area. Who wouldn’t want a single therapeutic intervention that simultaneously lowers the risk of everything? Heart disease, cancer, stroke, Alzheimer’s… I want to be younger longer. The only way this can be achieved is by slowing or manipulating the biological process of aging. I don’t see any other way around it; influencing one disease at a time won’t work. It’s entirely possible that influencing one disease at a time might make health conditions worse for future cohorts. That was actually the point that I made at the end of my presentation, that we have to be careful what we wish for: longer life without increased healthspan would be harmful.
Would you like to tell us about the projects that you’re working on right now?
My colleagues and I are trying to transform the various industries that are associated with life events, like life insurance and health insurance, so that they can bring aging biology and aging science to bear in their decision making. It creates a much more fair and equitable way of assessing risk in individuals. It’s complicated, but it’s just another way of saying that we’re bringing aging science and aging biology to use in other industries. It’s inevitable that it’s going to happen and it’s going to work. Getting them to understand the value is hard because they’ve been doing the same thing for the last 200 years, which is an old-fashioned form of assessing risk. We’re saying that the time has come to wake up and smell the science. If we were to implement rejuvenation therapies or therapies to delay the processes of aging right now, what would be the biggest bottlenecks to actually allowing people to benefit from them?
For disseminating it, it’s going to be cost. If it’s an expensive intervention, it will be inequitably distributed, like anything else of value. There isn’t anything of value that is equitably distributed in the population. If it happens to be an inexpensive therapeutic intervention, like metformin, I think one of the major hurdles we’ll have to overcome is getting doctors to understand the value of administering a therapeutic intervention that has been documented to work.
Right now, one of the biggest hurdles is setting up clinical trials that are required in order to test the therapeutic value of this type of intervention and also the fact that it doesn’t do harm. There’s a lot of exciting work going on in senolytics right now; you heard a discussion earlier today. I don’t know if senolytics are going to prove to be the panacea that they sound like they might be. We have to do the trials; we have to know whether or not it works and whether it’s safe. There have been plenty of instances in the past where therapeutic interventions of one kind or another have made their way to the public, like growth hormone, for example, which began being used by a lot of people prematurely before it was tested for safety and efficacy and ended up doing harm. We should not be administering anything to the public until we know with certainty that it’s safe. Number one, it has to be safe, and number two, it does what we say it does. Until then, it shouldn’t be administered; no one should be taking it, including and especially the scientists that have developed it.
One cannot stop scientists from experimenting with their own bodies, especially if there are some ethical concerns related to the safety of the treatments. For instance, Dr. Gregory Fahy had to test his therapy to regrow the thymus gland on himself first; he became its patient zero. I think it was an important step to further scientific research on this method, which is currently bearing fruit. Reversing epigenetic aging by 2.5 years is pretty impressive.
If it’s a scientist who wants to experiment on their own body, that’s their prerogative. As soon as we cross over and start experimenting on other people’s bodies outside of the context of clinical trials, I think that there’s a problem with that. I would not be in favor of anyone promoting or administering therapeutic interventions before we know that they’re safe and efficacious. Are you personally doing something to extend your healthy life? I’ve already been tested genetically. I’m a carrier of the FOXO3 gene and the APOE e2 genetic variant; both are associated with exceptional longevity. You saw a picture of my father, who was very healthy at age 95. I’m hopeful that I make it to that age as healthy as he did. But am I taking any supplements, any intervention of any kind at all, designed specifically for the purpose of influencing longevity? No. Why? Because there are none that are proven. As soon as something is proven, I’ll be first in line.
What about lifestyle?
I exercise as often as I can, usually five days a week. Nothing in excess. Probably one of the more important lessons I learned early on was that it’s okay to really do what you want, but nothing in excess. Any time I’ve done anything in excess, I’ve paid a price for it, every single time. I was just thinking about this the other day. It doesn’t matter; even too much exercise in excess is problematic. In fact, I injured myself in my early 30s trying to run a four-minute mile, and I’m paying the price today. I tore a muscle in my back that’s never fully healed and never will heal completely. I tore my piriformis muscle, and the actual way in which I’m holding my right leg now is stretching that piriformis muscle continuously to relieve the pain.
Am I taking anything? No. Are there some things that I should be doing? That probably would be helpful; I probably would benefit by losing about 20 pounds. How much I would benefit is uncertain, because my family has a history of carrying excess weight in their stomach, and they all live into their 90s. I’m probably more than slightly overweight, so I probably would feel better if I lost some weight. But do I need to drop because of longevity? Probably not. But, no, I’m not taking anything. In fact, I’m only taking one medication now, which I only started. I’m 65. For a 65 year old male to not take any medication for anything at all is pretty unusual, but I started taking one medication for prostate growth last year, and I’ll be on that for the rest of my life. I’d love to see a fix. But other than that, at 65, I don’t really feel any differently than when I was in my 30s and 40s. I can’t run as fast. In fact, I pretty much stopped running; I replaced it with walking, recognizing that there are problems associated with using these hinges. For 60 years, I have no problems with my knees and hips, and I want to keep it that way. I do know that once you get out into your 60s and 70s, if you continue to run, you’re wearing down these joints at a pretty rapid rate. I’d like to keep my joints as healthy as possible, so I replaced my running with walking, even though I’m unhappy about it. And cycling.
What about your diet? Are there any peculiarities in it?
I eat pretty much just about everything, but in moderation. I have dramatically reduced my intake of sugar, and I have dramatically reduced my intake of dairy, only because I’ve learned that it eliminates my heartburn. I had heartburn when I was younger, and I found a way to eliminate my heartburn through dietary modification, and then I learned what foods to eat at certain times of the day and what foods not to eat at certain times of the day to avoid problems with indigestion, and it works beautifully. What I did was I essentially learned about how my body works, and it’ll be different for each of us. You might be sensitive to certain foods that I might not be sensitive to. For each of us, learning about how we work, the mechanics of our own body, I think is essential. I actually learned that lesson by adopting a particular dietary lifestyle for about 60 days, which was a regimen called Whole 30. You basically remove most foods from your diet with very few options for about 60 days, and when you do that, a lot of your health problems disappear in those 60 days, which happened to me.
One of the interesting things was that I had a blocked sinus for about 20 years. When I went on this Whole 30 diet, the blocked sinus opened up and disappeared. It’s an anti-inflammatory way of eating. Then, I reintroduced foods, one at a time, to see what the effect was. It was absolutely eye-opening to learn about what my body liked and didn’t like. Once I learned all those lessons, I adopted them, I avoided this food and chose these foods. It really was very powerful, quite frankly.
I would say removing sugar had the biggest impact, and I didn’t really understand what the impact would be, but it was pretty powerful. The other thing it did was it intensified the flavor of all the food that I was eating by removing sugar, including fruit, by the way. Fruit doesn’t taste like it used to; it tastes much better, just by eliminating all sugar in the diet. I didn’t eliminate it all. I’m probably still going to go out and maybe have a dessert of some kind or another.
Do you have a take-home message for our readers?
Rule number one, don’t exaggerate. Don’t lie. Don’t misrepresent science. There’s no need. You don’t need to do any of those things, to support the work that needs to be done to modulate aging. There’s enough people growing old today, living out into their 70s, 80s, 90s, 100, even 110 plus, to support the logic and the line of reasoning behind the research that we all want to see happen. No need to lie; no need to exaggerate.
No need to conduct experiments on your own bodies, wait for the research to be done. I know some people aren’t willing to wait, and they want to conduct experiments on their own bodies. At one level, I get that. I have a cousin, for example, who just turned 90. He was asking me about taking a compound that was being sold by a well-known scientist. And he said, “What can you tell me?” I said, there’s good science behind it. We don’t have the definitive evidence to tell you whether or not it works. Will it do harm? I don’t know. Might it do some good? I don’t know, maybe, but there is legitimate science behind this. I would say that a 90 year old conducting an experiment on his own body is different than a 50-year-old conducting an experiment because the 90-year-old has much less time, and I get the logic and the rationale behind that. As a Professor of Public Health, would I recommend that anybody take any of these interventions? No, absolutely not, before they’re tested for safety and efficacy. It cannot be supported, and it shouldn’t be supported, especially by an organization or a foundation that is advocating, we’re all advocating for the same thing, which is healthy life extension. So, I think the message really should be the same for all of us: Let science take its course.