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The term aging has long been feared in beauty circles, ultimately giving rise to the term anti-aging—or the idea that there are, in fact, myriad products and treatments that can help reverse the physical signs of a long life, one wrinkle, fine line, and sun spot at a time. Then came the 21st century’s wellness awakening, with its nods to self-care—and self-love, which vilified the idea that any of these things needed reversing in the first place and embraced the notion that each passing year should be celebrated rather than dreaded and feared as the end of vibrancy and vitality. Feeling good is the new looking good, our modern adage insists.
But what if every chronological year means feeling worse—creaky, tired, and, well, old—even if the latest biohacking fad promises a few more years of longevity?
“Longevity for the purpose of longevity is ridiculous. I mean, I don’t want to live the last 20 years of my life in a coma in a hospital or demented in a nursing home. I want to ride my bike and go for a run or make love or go skiing,” says Mark Hyman, MD, a functional-medicine doctor who is helping change the narrative around aging as an inevitable physical and mental demise by considering our overall health span instead of just our life span. “If I can’t do the things I want to do as I age, then that’s a decline in my health span. And what’s really exciting is that we’re now looking at ways that we can dramatically change that trajectory.”
A big part of what Hyman describes as “a powerful shift in paradigm” is understanding the difference between our chronological age—the fixed number of years that have passed since we were born—and our biological age, a number that reflects the health of our body’s systems and how well they work together, which can, according to Hyman and many of his colleagues, be reversed. “This is not just about some idea of preventing the bad stuff in the future,” he suggests. “We can get healthier and we can reverse chronic diseases now.” It’s the subject of Hyman’s latest book, Young Forever: The Secrets to Living Your Longest, Healthiest Life, which offers a blueprint on how to successfully roll back the biological years by identifying the key hallmarks of aging—things like deregulated nutrient sensing, hormonal dysfunction, inflammation, insulin resistance, and an impaired microbiome—and offering practical ways to optimize these functions with food, supplementation, and lifestyle changes.
The somewhat novel idea of being able to tangibly control our own biological destiny has popularized platforms and services such as Harvard University professor and biologist David Sinlair’s new Tally Health, which amassed a nearly 270,000-person wait list ahead of its launch last month: A simple cheek-swab kit can tell you your biological age while a monthly membership offers practical and personalized guidance on keeping that number in decline. (Hyman’s Function Health, which is currently in beta, aims to similarly empower users with a membership model that provides access to a number of biomarker tests and detailed insights from a global network of experts.) Here Hyman offers a SparkNotes primer for his latest bestseller, including this piece of advice, which he’s happy to provide free of charge: “if you want to fuck up every one of your hallmarks of aging, then you should eat more sugar.”
Vogue: Maybe a good place to start this conversation is to define functional medicine. How exactly is it different from more recognizable medical disciplines?
Mark Hyman: Functional medicine is where all of medicine is going. It’s the clinical application of the understanding of systems biology and systems medicine: The body is a network, and it’s a network of networks, so we need to see it as an interconnected web that has to be in balance. When that information system breaks down, we get disease. We can’t go about the reductionist model of disease-based treatment anymore. We have to understand these underlying mechanisms that drive all disease. We have to work with multimodal interventions, look at multiple factors, instead of this one-drug, one-disease model that’s been going on for so long. It has completely failed us. Diabetes, heart disease, cancer, or autoimmune diseases—they’re all like the branches on a tree, and the root causes are few. For example, insulin resistance is one of the biggest hallmarks of aging in that it can cause heart disease and cancer and diabetes and dementia. If this hallmark is causing disease, what’s causing the hallmark? That’s where the lens of functional medicine comes in.
I’m not a doctor, but this kind of thinking just seems intuitive!
It’s like T. Huxley said when he heard of the theory of evolution: “How stupid not to have thought of that!”
Your new book breaks down what you have defined as the hallmarks of aging. What exactly are these hallmarks?
There are nine that are classically talked about. I added one, which is the microbiome.
The microbiome: so hot right now.
Yeah. It’s very important! You’ve got a whole soup of bugs that live inside you, and they have important interactions with your overall health and your immune system and your weight and your metabolism. So it’s important to keep your inner garden healthy by fertilizing it with the right foods that the bugs like to eat—prebiotic fibers like asparagus, artichokes, and plantains and probiotic foods like miso, kimchi, sauerkraut, and pickles. I would actually say that one of the most important hallmarks of aging is deregulated nutrient sensing. That’s a mouthful, but essentially it means how we interact with food, what it does to our biology, and what different things get turned on or off depending on what we eat or don’t eat, how we eat, and when we eat. So that’s where you’ve probably heard about things like low-carb diets or low-protein diets or calorie restriction—all of these things are in the longevity dialogue, and they all work through these meta pathways. If we’re constantly overstimulating or understimulating or unstimulating these pathways, we end up with disease and we end up with rapid aging. The good news is that these are modifiable things that go wrong, and if we focus on these, then we can actually change the trajectory of our biological aging and reverse our biological age.
How has the overall concept of longevity changed the dialogue around aging?
We live in an ageist culture, but what we’ve seen around us as normal aging is actually abnormal aging. It’s a manifestation of our environment, our choices, our diet, our lifestyle. The average person spends the last almost 20% of their life in poor health—that’s not good. But we’ve come to sort of assume that’s just normal. It’s normal to get weaker, it’s normal to get more frail, it’s normal not to be able to do the things you wanna do. It’s normal to get all these chronic illnesses. But it’s not. These are the abnormal phenomena that are happening as a result of how we’re living. Those are the hallmarks of aging gone awry.
Is there a point of no return when it comes to our ability to reverse our biological age?
Well, that’s the exciting thing about this work. The body has this incredible capacity for repair and renewal and regeneration if we provide the right conditions. At any point in time, we can reverse our biological age and we can get healthier.
And a major first step in this biological age-reversal process is quitting sugar, per one of the book’s bold claims: “If there’s one intervention to extend life, to prevent or reverse chronic disease, it would be to dramatically reduce or eliminate sugar or fine starches from your diet.” Why is sugar so bad for us?
It has to do with the way it impacts the hallmarks of aging. So all the longevity switches are adversely impacted by sugar—obviously the insulin-signaling pathways, it screws all those up in the wrong direction, and it drives DNA damage, mitochondrial injury, oxidative stress. And it accelerates inflammation throughout the body. It damages your proteins.
So, like, no sweets? At all? What about all the alternatives to the hard stuff?
There’s definitely a concern with a lot of them too because we’re always looking for some way out of that addiction. But the truth is these alternatives are addictive too because they stimulate the same dopamine pathways, the same sweet receptors in the tongue as sugar. We’re still trying to get that dopamine hit. But it doesn’t have to be no sugar. Think of it as a recreational drug: You know alcohol isn’t good for you, but if you have a shot of tequila on a weekend or a glass of wine here and there, it’s not a big deal.
What should you be eating for longevity?
Eat from nature’s medicine cabinet, and just focus on upgrading the phytochemicals in your diet because that’s where the medicine is. In the book, there’s a whole chart of all the different phytochemicals and what they do to our biochemistry. The power of food as medicine should be the guiding principle of what you choose to eat, as well as the quality of the food as best as you can achieve it. Make sure you’re also eating for your microbiome and including adequate good fats like olive oil, avocados, nuts, and seeds. All of these omega-3 fats are super important. Then just avoid foods that you basically don’t recognize. The more processing, the worse it is for you. As you age you also need adequate protein, particularly in the morning. That means 30 to 40 grams or more in the morning, ideally after a workout. That will help build muscle, and muscle is the currency of aging; if you lose muscle, you lose function and your metabolic health goes down and everything kind of goes down with it.
You also dedicate space in the book to how stress can have a major impact on our biological systems.
We just keep accumulating chronic stress—it’s a physiological phenomenon. Eventually that stress response causes us to get sick and burn out.
What are some easy, achievable ways to practice stress reduction?
Look, stress is not going away for any of us, so we have to learn ways of discharging it. There are ways to reset, like how we reset our phone or our computer, and learning how to do this is really important. Personally, I meditate in the morning for 20 minutes. I’ll try to meditate in the afternoon too. After this call, I’m going to meditate! And often I will do yoga and breathwork. You can also use other more passive resetting tools like hot and cold therapy, saunas, cold baths— exercise is great for stress reduction, and being in nature, being with friends, cuddling. All these things help our bodies get into a parasympathetic state. You just have to learn how to activate your parasympathetic system. Because it doesn’t happen automatically. Relaxation takes work!
