Is life extension a pipe dream?

This interview with Anette Breindl was recorded on September 7, 2022 and transcribed using Sonix AI. Please check against audio recording for absolute accuracy.

Peter Bowes: Anette, welcome to the LLAMA podcast.

Anette Breindl: Hi, thank you for having me. It’s a pleasure to be here.

Peter Bowes: Yeah, it’s really good to talk to you. This is a big report. It covers so much ground. Let’s start with what you set out to achieve. Give me a sense of the goals and aspirations of this report.

Anette Breindl: Sure. So Bio World is a specialty publication that is focused on drug discovery and the biopharma industry to a large extent. So we, you know, would look at the pharmacological aspects of these things, and I have been writing for them for a while. So this got started when we noticed that there was a large number of financings that companies in the anti aging space were getting a lot of money from investors and venture capitalists. And I am sort of old enough to have remember the last time this happened, which was maybe around 2007, 2008, eight, maybe 15 years ago. So my interest was piqued because the last time, which we can get into if you want to, but there was a lot of interest, but then it did not end in success as far as bringing new pharmacological anti-aging interventions to market. So I was curious how the science of aging and extending lifespan or healthspan because you are right, it is about healthspan much more than lifespan. How that had changed in the meantime. And like most people, I think I still had the idea that it is pie in the sky sort of goal. But then I started talking to researchers who are doing extremely rigorous research on the science of lifespan extension and realized that there is a lot going on and that in some ways it is not a pie in the sky goal at all. It is something that has been achieved multiple times in animal models, never in humans. You know, in a clinical trial to date, which is hard to do because aging, those are long trials if it works. Right. And that piqued my interest. And then as I said, bio world covers the biopharma industry. So we were also interested in the financing interest in more detail than that. And in the question of how you would bring these drugs to market, whether, you know, and if they were to be FDA approved, how would you do that? Because the FDA does not consider aging a disease. So aging is not an approved end point for clinical trials. So we were also curious about how the people who were investing were hoping to get a return on their investment. So those were all aspects we looked at in this report.

Peter Bowes: Just before. And that’s fascinating. Let’s be before we dive into that further, just give me a little perspective on your own experience. You’re not and this is interesting. You’re not necessarily coming at this with a breadth of experience in the longevity sphere.

Anette Breindl: No, my background is in science and I cover all aspects of science that are relevant to the biopharma industry. So I do a lot of work looking at specific diseases and what the progress is there. And one of the interesting the key thing about aging, of course, is that it if you slow down aging, you reduce the risk of multiple diseases at once. And that is really what people are trying to achieve. I mean, I’m sure there’s also billionaires out there who are trying to cheat death. But I think in terms of the people doing research on it, that is really what they are trying to achieve. The director of the American Federation of Aging Research Nir Barzilai. He calls it dying young at a very old age.

Peter Bowes: So yeah, we’ve had Nir Barzilai on the podcast a couple of times and he’s doing fascinating work and he is a great guy and he’s a great raconteur as well. So it’s always fun to talk to you. One thing you just said in terms of aging per se, and the FDA not recognizing aging as a disease is a hugely controversial area in itself, because I’m sure some of the scientists that you spoke to do consider aging to be a disease in itself, which I personally I know a lot of the people find just difficult to get your head around this what seems like a natural process of getting older, which is what aging is, that that in some way is the disease. And I’m just curious in terms of your own thoughts on this, whether you were persuaded or you’ve formed a view on that?

Anette Breindl: I am not sure. Honestly, I can see both sides of the issue. It is inevitable, right? And you will never stop chronological aging, right? We are a day older today than we were yesterday and so is everyone else. The biological aging that goes along with that. I can see why it would be considered a disease. I can also see why the FDA would say, well, aging itself is really not the issue because there are perfectly healthy 85, 90, 95 year olds. And so what do you really want to look at there in terms of slowing down aging? You know, and my both my grandparents lived quite a long time. My grandfather lived to be 89 and then died in his sleep one night, you know, for him. And I’m not saying that he was never sick and was not frailer as he got older, but I would say that he did have what we’re all looking for, that healthy aging. So it is possible. And I think the idea or I you know, I think a good goal of anti aging research is to bring that sort of long healthspan followed by a period of brief decline, a brief period of decline, hopefully to many more people.

Peter Bowes: That’s the compressed morbidity that you’re referring to that there’s so many scientists refer to. So let’s dive into the interventions, the possible interventions that we can use to extend our lifespan or indeed healthspan and focus on pharmaceuticals or nutraceuticals. There is a distinct difference there, but I think that is a big part of what you were looking at. I suppose a broad question is from all of your conversations and your studies of this, what did you see that was potentially the most useful?

Anette Breindl: I will preface my remarks with saying that, you know, none of these have been shown to extend lifespan in humans and that the things that I see are mainly people working on prescription drugs or variants thereof. There are a few drugs that have been shown to extend lifespan in animals and that are used medically that are either FDA approved or a drug like aspirin, for example, extends lifespan in mice, but only in males. So that’s another big thing about aging research. A lot of it is surprisingly sex specific. So the aspirin was is something that that has been shown by the interventions testing program of the National Institutes on Aging to again extend lifespan in male mice.

Peter Bowes: Another commonly used drug which is metformin, which is a diabetes drug. And going back to Nir Barzilai, he is doing extensive research on the potential longevity benefits of metformin. I think the jury is still out there, but is that something that you looked into?

Anette Breindl: Yes. And again, you know, the jury is still out on everything as far as humans are concerned. But that is something where people are hopeful that it would be lifespan extending. Again, a lot of these drugs. We think they work one way. And then if somebody takes the time to really look at at the cellular level, then it turns out that they do several things or other things. You know, I see that again and again in research on everything. It’s fascinating with cancer drugs, you know, you think they do one thing and then somebody looks at a cell study and says, no, actually it’s this. So with metformin, it’s clearly an anti diabetes drug. Whether that is why it extends lifespan is really not clear. But yes, that is another one that is an old and generally used and quite safe drug that people have hopes for. And yes, if you know, Nir Barzilai is is spearheading those those trials to see whether it will work in humans.

Peter Bowes: Something you’ve already touched on a little bit is the the gender differences in terms of of healthspan and what we, most of us, I think, probably acknowledge that women live longer than men. I’m curious to know whether any of the interventions that you studied are going to close the gap between male and female lifespan.

Anette Breindl: So that is an interesting question because what most people know and what I knew going into the research as well, is that women have the longer lifespan. Now women have a shorter healthspan than men, so they spend more of their time in poor health. And that was something I was not aware of. So closing the lifespan gap, maybe. I think it is also very important to think about closing the Healthspan gap because there is the possibility also of exacerbating these existing inequities because, for example, aspirin, you know, it works in male mice. If it works in males too, then you could close the lifespan gap, perhaps. But women then relative to men, would be worse off than before, Right? If it doesn’t work in them, which is also not entirely clear from mice, you know, it might work in women, but, you know, say it is in people the way it is in mice. It works in men and not in women. So then you have a longer lifespan in men, but you don’t have a better health span in women. So, again, you know, women are relatively worse off than before. And that is something to be careful about. But yes, it’s fascinating. I also where people have looked and fruit flies and mice. There are definitely genetic contributors to longevity and they seem to be different for males and females, which is just fascinating to me. And I still don’t know why that would be so. But that was one of the most interesting things for me to come out of doing this research for the series.

Peter Bowes: This is the Live Long and Master Aging podcast. Anette Breindl is the coauthor of a special report on Aging, recently published in the magazine Bio World. Annette, I’m interested in what happens when these and as you refer to just now, it is a long, long process sometimes developing these new interventions. Longevity research, by its very nature takes a long time. But let’s assume that we do have a new pharmaceutical or nutraceutical intervention that becomes available. It is approved by the FDA. The next challenge, of course, is to get it out to people who can benefit from it. And one of the huge problems in the world at the moment is the inequity in terms of access not only to regular medicines, but something that some people would still see as very specialized, something that is focused on our longevity. That is a big challenge moving forward to ensure that all of this and the gazillions, it seems dollars going into longevity research ultimately benefits everyone equally.

Anette Breindl: Yes, it is. That is a challenge that will need to be worked out. Even if these drugs are cheap. It is really not clear with pricing whether they would stay cheap if they were approved as anti aging drugs. In some places I think you could get them fairly easily. This really gets into how the health care systems are organized. Right. And in the United States, for example, because people switch insurances a lot, it is difficult to get preventive medicines covered. And one of the folks I talked to, the CEO of Cambrian Biotherapeutics, who is a wonderful guy doing very interesting work in this space, and he said that, you know what these drugs really are are multi morbidity prevention tools. So they prevent multiple illnesses. They are a little bit like the Swiss Army knife of anti-aging, right? That would be the idea. You take this anti-aging drug and you are less likely to get cancer, you are less likely to get heart disease, you are less likely to get osteoporosis.

Peter Bowes: Which is crucial, isn’t it, Because focusing on people becoming less likely to suffer from those killer diseases of old age, ultimately there’s going to be a financial reward in terms of reducing the cost of health care for people over, let’s say, 60, 70 or 80 years old.

Anette Breindl: Yes. So that is also a complicated question. Whether you save money altogether or at least like you can, you could some people worry that, well, if everybody lives to be 100, right. The health care costs are going to go through the roof. What appears to happen and it differs sort of by disease. So if you cure diabetes of a 50 year old, for example, the economic modeling says that you could both extend their life span and decrease their medical costs over the course of their entire life because they just need so many fewer interventions overall that even though they need them over a longer time, it still ends up costing less money. For others, the data is not so clear. Overall, though, the that’s the key to the increased healthspan. Right. What we see usually with people is that they incur a lot of their medical costs in the last two years of their life. So they’re pretty healthy. And then oftentimes, at least and then the last two years, there are really more and more interventions, which is sort of a consequence of the era of high tech medicine. Right.

Peter Bowes: I was just wondering and you almost answered my question before I asked it there, when you mentioned the fact that the general view is that if we do all live to a ripe old age of 90 or 100 years old and therefore health care costs are going to rise because there are going to be so many people in that group of people. It’s almost a defeatist attitude when you think that really the goal is healthspan. And the idea is that hopefully we are nurturing people’s health to a point that they have that healthspan and get to the age of 90 or even 100. And they are still relatively healthy, they’re still involved in society, they’re still contributing, possibly even in some cases still working. And again, there’s going to be a positive financial reward to that. People talk about the the longevity economy in a in a positive sense. It may seem like a distant dream to some people to enable people at such a great age still to be healthy and active and productive. But it would be great, wouldn’t it, if that was the goal.

Anette Breindl: Yes. And I think for many people working on longevity and anti-aging drugs, that is indeed the goal. You know, nobody wants to spend 30 years with dementia instead of ten years with dementia right so.

Peter Bowes: Right.

Anette Breindl: And it is like I said, it’s complicated in terms of the economics, but it does seem like it is at least possible to do that, that you could have a longer, healthier life with lower medical costs overall. And so you would not bankrupt the medical system with these drugs. Again, one issue is to actually get them to people, because in the United States, for example, it’s very hard to convince insurance companies to cover things. And anti-aging drugs would have their own problems because when when they’re old, everybody is on Medicare. So the insurance companies don’t have that incentive. Elsewhere it might be easier. But again, if the drugs become expensive, they could have the best benefit potentially for people in poorer countries now who have poorer health. But equity and access is going to be something that will need to be addressed.

Peter Bowes: Let’s move away from drug interventions. And clearly, and certainly from my own experience of talking to many scientists and researchers on this podcast, it doesn’t all necessarily come down to pharmaceuticals. There are other ways potentially. And I know this isn’t something that is the focus of your report, but clearly taking an umbrella approach to this, there are lifestyle interventions as well that could potentially add a few healthy years to our lives.

Anette Breindl: Certainly the one for which there is the strongest evidence, I think at this point is intermittent fasting and low calorie diets. Low calorie diets are a lifestyle intervention that clearly works.

Peter Bowes: Perhaps you could just title they’re eating less as a society. If we just cut the amount of food that we eat that it would. And it is one of the strongest areas of research that you can talk about fasting. There are so many different types of fasting. Even the phrase intermittent fasting is quite confusing because people interpret it in different ways. It could just be time restricted eating where you limit the hours while you’re eating. But the evidence is and again, I’ve got a personal interest in this because I’ve looked at and tried a lot of these interventions, but they’re very promising, aren’t they?

Anette Breindl: It does seem to me that they are. One interesting thing and one thing that I think more research needs to be done on is that what works for men in that area is not what works for women. So that is another and that is something that I don’t think has been addressed enough. But yes, the fasting does seem like a promising thing, although I don’t know whether, you know, catch 22 where there is the man who tries to make his life as boring as possible because it will seem longer. So to me, permanent food restriction sounds a little bit like that, right? The days seem very long because you don’t get to eat. But no, but there is also good evidence that it is good for the body. Although how it is good for the body is another thing that on a cellular level, a lot of these things are made to be worked out. Probably most of them.

Peter Bowes: Yeah, it is still ongoing research and I suppose a little caveat to what you were saying. It might for people who haven’t tried fasting. And again, it doesn’t have to be extreme fasting by any means. It doesn’t even have to be 24 hours. Fasting can just be a significant break in that circadian that 24 hour circadian rhythm that can still be beneficial. And as someone who does that, you get used to it and it becomes part of your lifestyle and you don’t really think about it. Whether it’s going to extend my healthspan ask me in 30 or 40 years time, we’ll find out. I’m interested and we established at the beginning that clearly you are coming at this and it’s good that you are from an independent perspective without decades of preconceived ideas maybe about the longevity industry. So I’m curious, looking at everything that you studied, was your mind changed or influenced in any way and perhaps even applying it to yourself and your lifestyle? Because this is about ultimately lifestyle for all of us. Was there anything that you heard in your discussions that may set off a little bell in your mind thinking, Yeah, that sounds interesting. Maybe it’s just something I should do myself.

Anette Breindl: Honestly, I live a reasonably healthy lifestyle, right? So certainly it brought home, I think, the fact that I am in middle age now and that the things we do now do pay dividends later. It is interesting. And if you’ve had Nir Barzilai on the podcast, then you know that too. There is, I think you get to be a healthy 80 year old through lifestyle choices. In part at some point genetics really seemed to take over, right? I don’t know whether Nir ever talked to you about Helen, his 105 year old woman who smoked for more than ninety years, which was just amazing to me.

Peter Bowes: That some people seem to have the longevity gene and that no matter what they do, they achieve a great healthspan and lifespan. And I think the point is, though, that those people are in terms of numbers, it’s minuscule.

Anette Breindl: Yeah, no, they are. It really is very minuscule. You will. And those are the lucky ones and you don’t know which one you’re going to be. So I am not advocating, you know, rolling the dice and smoking because you could live to be 100. You know, you are and much more likely to find yourself with cancer at a younger age than that.

Peter Bowes: Did it give you pause in terms of looking ahead the decades ahead? You’re in middle age. I like to think I’m in middle age as well. Some people would argue that being over 60 is just on the edge of middle age, but nevertheless, that’s my positive outlook. Did it give you pause to think about the decades ahead for you and perhaps how you aspire to grow older?

Anette Breindl: It gave me hope that by the time I need them, these medications might be there. I have to say I have to get back to my grandfather again, who lived to be 89 and then died in his sleep. That has long been, you know, a hope of mine that it could be like that. And my grandmother, too, she lived to be 94 and she had a stroke about six months before she died. So those last six months were she was not in good health. But up until then, she really was. You know, the lifestyle interventions I saw with them was that they sort of always had a social life, an active social life. I don’t even know that they exercise much. They walked a lot.

Peter Bowes: Do you think there is a danger of and perhaps even conversations like this, that people are given false hope based on the science and the research that is going on? And I mentioned before, there’s a tremendous amount of money being invested in longevity research. But just looking at people around the world at the moment, the cost of living crisis that people are going through, there are so many other issues that are dominating people’s lives that their health and longevity is perhaps sometimes the last thing that they are thinking about. And you use the phrase maybe you have hope that in the future the pharmaceuticals will be there to help you get through the later years. I wonder if people put too much hope in that area and that perhaps putting more of an emphasis on the today and the now on what we can do to achieve a better health today and tomorrow will perhaps be more appropriate.

Anette Breindl: I see your point. I do worry there about inequities again, right? Because some people can do a lot more lifestyle tweaks than others, and especially right now with, you know, as you were saying, the cost of living crisis. I was in the supermarket the other day and this lady was saying that she would have to switch from peppermint to chamomile tea because she could not find the cheap generic chamomile tea. Now, you know, I am lucky enough that when the chamomile tea is not there and I want chamomile tea, I buy the organic chamomile tea that costs, you know, three times as much, probably in my German supermarket here. So I. I think it is good for people to think about what they can do. I think it is also good for people to not beat themselves up over what they can’t do and when they are stressed about lifestyle things and when money is tight. Sometimes just getting through the day today. And again, I agree that that you’re right, that it is good to think about these things in your day to day life and think about what you can do. But it is not possible for everyone and everyone does deserve that. I think.

Peter Bowes: I think that is a good way to finish this. And it really interesting and the report is in some detail more detail than we’ve had an opportunity to go into now. But thank you so much for talking to us.

Anette Breindl: Oh, thank you for giving me the time to talk about this. It is really a fascinating area and thank you for your podcast. I think it’s a very important area.

Peter Bowes: I appreciate it. Thank you so much. And if you would like to read more about this report, I’ll put a link to it in the show notes for this episode of the LLAMA podcast. You can find that at our website, LLAMApodcast.com. That’s LLAMAPodcast.com. 

Peter Bowes: The LLAMA podcast is a Health Spun Media production. We’ll be back soon with another episode. In the meantime, I wish you the best of health and thank you for listening.