By Paul E. Lemanski, MD, MS, FACP

Editor’s Note: This is the 122nd in a series on optimal diet and lifestyle to help prevent and treat disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.

Medicines are a mainstay of American life and the healthcare system not only because they are perceived to work by the individuals taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of Type 2 diabetes, heart attacks, strokes, cardiovascular death and even some cancers.

In the first 121 installments of the Non-Medicated Life, a healthy diet and lifestyle has been shown to accomplish naturally for the majority of individuals most of the benefits of medications in the prevention of the chronic medical conditions mentioned above. Recently, there has been interest in looking at aging itself as a disease process and therefore as a legitimate target of prevention strategies collectively termed longevity medicine. Longevity medicine’s goal is not simply to prolong the lifespan, but even more to prolong the healthspan, that is disease free survival to advanced age. The purpose of this article is to explore the relationship between lifestyle and longevity medicine, as overlap exits.

Lifestyle medicine’s focus is on evidenced-based behavioral interventions for chronic diseases that are largely a consequence of poor choices in lifestyle related behaviors. Such interventions may include a healthy, predominantly plant-based diet, regular exercise, restorative sleep habits, stress management, the avoidance of substances that increase health risk and social support. The goal of lifestyle medicine is to prevent, treat, and the reverse chronic diseases such as Type 2 diabetes, hypertension, obesity, and cardiovascular disease. Lifestyle medicine may also prevent, slow the growth of, and help treat certain cancers.

Behavioral modification is achieved through education, coaching, shared decision making, and professional and community based social support. Lifestyle medicine practitioners often work in interdisciplinary teams including physicians, dietitians, health coaches, exercise trainers, and psychologists. Lifestyle medicine attempts to avoid unnecessary over-dependence on medication while improving health outcome and thereby reducing healthcare costs. Lifestyle medicine makes use of detailed family history, detailed physical exam, routine blood testing, routine preventive screening, and imaging to identify early disease and predisposition to disease. At the same time that lifestyle medicine minimizes medication, it adheres to the national guideline targets of treatment typically achieved with medication.

Longevity medicine is an emerging field of personalized preventive medicine involving a more high-tech approach with advanced imaging and advanced lab tests to identify early disease and the genetic predisposition to disease. Also referred to as anti-aging medicine, longevity medicine’s goal is to reduce disease by delaying aging itself because disease occur more commonly with advancing age. Moreover, delaying the aging process not only increases lifespan, but also the healthspan – years lived in good health.

This delay of aging is achieved by the use of emerging cutting edge science including geroscience (the study of aging mechanisms), genomics, epigenetics (controlling which genes are read), and artificial intelligence driven diagnostics. Longevity medicine makes extensive use of esoteric biomarkers of aging including genomic testing, DNA methylation, telomere length, as well as tests such as V02 max (maximum oxygen utilization), and continuous glucose monitoring. Such testing may be quite expensive limiting access despite lack of definitive proof of efficacy.

Longevity medicine interventions may take the form of diet modification, exercise (aerobic but also resistance training), and behavioral change. However, it also may include medications and an array of oral supplements, and sometimes IV infusions. Moreover, many of its interventions are still considered investigational or extrapolated from animal studies. Research in model organisms like mice, worms and primates have proved life extension through caloric restriction, genetic modification, and pharmaceutical agents. While human trials are ongoing, to a significant extent, therapies used in practice lack long-term human data and some longevity researchers have helped create a demand for anti-aging medications and supplements that may lack definitive proof of efficacy.

For example, metformin (originally extracted from the French lilac and then synthesized into a drug) has been shown to lower blood glucose in Type 2 diabetes. Metformin has been shown in mice to increase lifespan by 6% – the equivalent of five years in humans. In a human study of 41,000 patients with Type 2 diabetes metformin was shown to decrease the risk of dementia, cardiovascular disease, cancer, frailty and depression. Definitive proof of efficacy in those without diabetes is lacking. Despite this, some longevity medicine practitioners recommend metformin even without a diagnosis of diabetes or pre-diabetes, and such recommendations may be premature.

In a similar manner, resveratrol, an antioxidant in grape skins has been tested on yeast and increased the lifespan of yeast from 25 cellular divisions to 34, an increase which in humans would amount to an additional 50 years of life. This was a similar effect to that obtained by caloric restricting yeast – a proven life extending strategy. Moreover, when caloric restricted yeast were given resveratrol there was no further increase in lifespan, suggesting that resveratrol and caloric restriction worked through the same mechanism. Such studies have led some researchers to take resveratrol on a daily basis in large, non-physiological doses, which could not be achieved by diet alone with both definitive benefit and potential risk not proved.

In another example NMM (nicotinamide mononucleotide) has been shown to boost levels of NAD (nicotinamide adenine dinucleotide) a molecule crucial for energy production and DNA repair. In animal studies, NMN has demonstrated it can prolong lifespan and delay aging. A 2024 NMN supplementation study increased the median lifespan of female mice by 8.5% and maximal lifespan by 7.9%. Both male and female mice showed improvements in healthspan, including delayed frailty, improved metabolic health and beneficial changes in the gut microbiome. Again, on the basis of such research some longevity medicine practitioners recommend daily NMN supplementation creating a demand for a substance whose efficacy in humans is not definitively proved.

Despite the differences, lifestyle medicine and longevity medicine are not mutually exclusive approaches, but are complementary. Lifestyle medicine can provide the foundational habits to prevent, treat and potentially reverse disease. Longevity medicine offers advanced testing, biomarkers of aging, and potential medication and supplements, to slow the aging process and prolong the healthspan. By awaiting additional human data, utilizing risk benefit analysis for any intervention, and seeking additional natural/dietary ways to slow the pathways of aging, made clear by longevity medicine, it can serve a unique role. The goal of both is helping people to lead longer, healthier lives, while remaining independent and vigorous as they age. 

Paul E. Lemanski, MD, MS, FACP (plemanski3@gmail.com) is a board-certified internist practicing internal medicine and lifestyle medicine in Albany. Paul has a master’s degree in human nutrition, he’s an assistant clinical professor of medicine at Albany Medical College, and a fellow of the American College of Physicians.