Can We Hope for Longevity While Living with Chronic Disease

Healthier life using your DNA

Longevity is a widely discussed topic across social media platforms. While living longer is an admirable goal, the true aim is to extend life with an improved health span—more years of vitality. For many individuals over 60, chronic diseases such as obesity, osteoporosis, high cholesterol, high blood pressure, coronary artery disease, neuropathy, cognitive decline, osteoarthritis, and metabolic conditions such as diabetes are part of their daily experience. 

Modern medicine has extended lifespan by managing these chronic conditions, yet it often results in pharmacopeia for older adults. Is it too late for those with chronic disease to enhance their health span?  Is longevity still attainable or even desirable for those with chronic pain? I believe it’s never too late to improve our health, regardless of one’s stage in life. 

How can we work toward longevity after age 60? Six key areas require focus: personalized nutrition and exercise, optimal sleep, microbiome support, hormonal balance, and genomic testing.  The study of genetic polymorphisms has exploded over the past 25 years.  Some polymorphisms identify which medications are right for the patient and evaluate the genetic pathways contributing to chronic inflammation and disease. Using a patient’s DNA to develop a healthcare plan is referred to as precision medicine. A doctor who is educated in genetics will tailor health strategies for a perfect fit. 

 PERSONALIZED RESTORATIVE MEDICINE OF EAST TENESSEE’S approach: 

Come to me with your chronic diseases.  Maintain your present primary care physician, who will manage your prescription drugs.  My job will be to address the underlying cause of your disease processes.  We will work together to regain your health.  There is no ‘one-off’ for good health.  It takes actual work to get healthy and maintain it.  It will take the two of us to get you back to health.  I’m willing to do the job, are you? 

• Overweight:  obesity is a common chronic disease associated with cardiometabolic complications, including hypertension, high cholesterol, and cardiovascular disease.  Over 140 genes have been determined to be associated with obesity.  So, whether you want to try a GLP-1 inhibitor or not, you must learn to address the lifestyle issues that led you here. You must learn how to maintain your weight loss for the rest of your life. A recent study looked at patients post Semaglutide weight loss and found the average patient gained 2/3 of their weight back. (1).  There must be something more that we are missing with obesity.  Let’s start with real-time information, a continuous glucose monitor, to see how food choices and preferences affect blood sugar levels and metabolism.  From there, design a diet suited to your genetics and lifestyle.  Of course, your hormones and gut microbiome are part of this picture, which will help us in the maintenance phase.   

• Osteoporosis:  A typical osteoporosis diagnosis occurs after menopause, as sex hormones diminish. It can translate to a serious quality of life issue due to a painful hip or spinal compression fracture. Recent trials focusing on probiotic supplementation of postmenopausal women have reported an increase in bone mass density. (2)  research on supplementing Vit D with Vit K 2(3) also shows promise. There is more to be done than merely adding a pharmaceutical to increase bone density.  Let’s investigate your genetics, microbiome, hormones, diet, and activity levels.  Of course, it will take both of us to work on this, but we can make remarkable improvements.  

• High Blood Pressure and/or High Cholesterol: An estimated 50% of adults in the US have hypertension, while 69% of adults over 60 take at least one blood pressure medication.  Cholesterol levels naturally increase with age, but the standard American diet (SAD), low activity levels, and weight gain are the top 3 most common risk factors for both. Cardiovascular disease is the number one killer in America today. The American Heart Association released a paper on Precision Hypertension in 2023 stating that precision medicine, through individual genomic evaluation, will lead to a risk reduction and more accurate treatment options for heart disease. (4) A ‘precision’ approach to both common conditions would require a genomics appraisal of your inherited genetic variables, a detailed look into your adrenal hormones, sleep, diet and microbiome, your activity level, and finally, your mitochondrial health.  

• Coronary Artery Disease (CAD): The rise in CAD is due to several modifiable risk factors:  SAD, central obesity, physical inactivity, smoking, and alcohol excess.  Non-modifiable risk factors are age, family history, and sex.  Then, there are more challenging and modifiable risk factors such as chronic stress, poor sleep, and specific genes involved in pathways associated with the individual’s risk of cardiovascular disease and inflammation.  Many genetic pathways encompass enzyme (e) reactions that convert a precursor (A) into a product (B).  If the polymorphism creates an enzyme that is low activity, then the precursor will build up, but if the polymorphism creates an enzyme that is high activity, then the product will build up.  Fortunately, many enzyme pathways have workarounds to optimize the needs of our body, but you need to know if and where there is a build-up to optimize it.   

(precursor) A ---- e ---> B (product) 

A very common genetic variation of an enzyme called MTHFR can lead to abnormal levels of homocysteine, which is known to be involved in CVD. (5)This enzyme's low activity causes the precursor to build up. 

• Neuropathy:  A terrible disease that can have many causes:  Diabetes, vitamin deficiencies (6), viruses, Lyme disease, alcoholism, toxins or chemotherapy, and rarely vaccines.  This diagnosis is an absolute suffering for the patient and will typically require some form of pain medication, antidepressants, and seizure medicine as a primary pharmacologic treatment.  In precision medicine, there are many genetic polymorphisms associated with neuropathy but also many pharmacogenetic lists of medications causing neuropathy.  That is why genetic screening is the first line of testing for these patients, as well as a thorough lab review and a detailed neurologic exam to pinpoint the sensory profile of the disease.  Mitochondrial function, nerve conduction studies, blood tests, and possible nerve biopsies can confirm the type of neuropathy.  Patients with high-risk polymorphisms may benefit from a different drug to mitigate neuropathy risks.  For some, enzyme pathways may be bolstered to improve neuronal function and sensation. (10) 

• Cognitive Decline:  This is a genuine concern for adults over 60.  Mild cognitive impairment (MCI) is close to 25% for those over 65 and reaches closer to 50% for those older than 75.  The most significant risk factors are age, genetic predisposition, sex(female), and other chronic diseases.  Many mitigate risk factors are smoking, vision or hearing impairment, sleep disorders, excessive alcohol use, social isolation, poor nutrition, and lack of physical activity.  By addressing the modifiable risk factors early, we can reduce MCI by 40%.  Just increasing physical activity to high levels can lower the risk of dementia by nearly 15%. (7)  Precision medicine utilizes mitochondrial function, genetic polymorphisms, hormones, metabolic health, and microbiome to optimize the patient’s function. Both aerobic and strength training are used to improve circulation and insulin resistance, and lastly, a diet high in polyphenols can help oxidation and inflammation. 

• Diabetes Type 2:  DM II is a chronic disease that is responsible for 80% of preventable deaths in the world.  The most important medical intervention for diabetes is to prevent the complications that develop from this disease.  Kidney disease, blindness, CVD, stroke, neuropathy and heart attack are unfortunately all too common in diabetic patients.  Precision medicine provides excellent care for diabetics given the longer doctor interaction times, focus on prevention and personalized treatment plans. (8)  New research is suggesting the gut microbiome in diabetics is associated with systemic inflammation and chronic kidney disease. (9)  Mainstream medicine’s focus on diagnosis and treatment is limited compared to a precision medicine model. Precision medicine allows time to educate the patient about preventable outcomes.  Patients do not understand the nature of diabetes, and to prescribe a pill and not educate on diet and exercise is proving to deliver poorer outcomes.   The patient will begin to understand how diet, obesity, microbiome, genomics and hormones all may directly or indirectly impact the disease and their health. 

References 

1. Wilding, JPH (2022).  Weight regains and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism. August 24(8): 1553-1564 

2. Zhao, F (2023). Bifodobacterium Lactis Probio-M* improves bone metabolism in patients with postmenopausal osteoporosis, possibly by modulating the gut. European Journal of Nutrition. March; 62(2):965-976. 

3. Ma, M (2022). Efficacy of vitamin K2 I the prevention and treatment of postmenopausal osteoporosis: A systematic review and meta-analysis of RCT’s. Frontiers in Public Health. August:(10):1-13. 

4. Dzau, V (2023).  Precision Hypertension.  AHA Hypertension. December; 81(4): 702-708. 

5. Hageh, C (2023).  Homocysteine levels, H-Hypertension, and the MTHFR C677T genotypes:  A complex interaction. Cell. June:9(6):1-9. 

6. Yang, H (2020). New perspective in DM neuropathy: From the periphery to the brain, a call for early detection and precision medicine. Frontiers in Endocrinology. Jan:10 (929):1-13. 

7. Bredesen, D (2023).  Precision Medicine approach to Alzheimer’s disease: Rationale and implications.  Journal of Alzheimer’s Disease. Nov: 96(2):429-437. 

8. Tobias, D (2023). Second international consensus report on gaps and opportunities for the lineal translation of precision diabetes medicine. Nature Medicine.  Oct: 29:2438-2457. 

9. Iatcu, CO (2022). Gut microbiota and complications of type-2 diabetes.  Nutrients. Jan:14(166):1-30. 

10. Ziegler, D (2021). Current concepts in the management of diabetic polyneuropathy.  Journal of Diabetes Investigation. April: 12: 464-475.