Dr. Fitzgerald’s latest research peer-reviewed publication (published March 2023 in the journal Aging) reports on a case series of women who followed a structured version of her 8-week bioage-targeting protocol. Collectively, the participants reduced their biological age by an average of 4.60 years compared to their baseline.
In this month’s blog, we pose some key questions to Dr. Fitzgerald about why she continues to stay focused on this space, why this new research is important, how we should think about this in the context of other anti-aging interventions that are being studied, and more. Read on to find out what she says.
To access the press release of the new paper, click here: New Research Suggests Biological Age Reduction is Possible Through Diet and Lifestyle Chances
As a functional medicine expert, what drives your interest in longevity and why should we be paying attention?
Dr. Fitzgerald: We know that we’re losing ground on healthspan and lifespan in the U.S. and really around the world. It’s an extraordinary reality we’re facing. And that’s because the standard interventions that we have to address chronic diseases are woefully inadequate. And the diet and lifestyle habits we’ve been taught are really driving these multi-pandemics of chronic disease.
Functional medicine is effective at tackling chronic diseases, which makes functional medicine a good solution to these pandemics. However, we can take this a step further and we can push functional medicine into the front of the longevity field. Biogerontologists are interested in how to extend lifespan, and they’re doing this in really creative ways (the science of it is incredibly interesting). However, they don’t have the background of functional medicine to bring to the subject.
I think these two fields need to meet and fuse together, and each of their strengths need to be applied. Aging itself is the biggest risk factor (by far) for all of these chronic diseases that functional medicine is so expert at. And that’s really the bottom line of why functional medicine needs to train its lens on longevity. This will allow us to move forward with really extraordinary medicine.
I think there’s a potential epiphany there for those of us practicing functional medicine – to shine a light on this power that we have and unify our thinking towards addressing the aging problem. While we will continue to use the tools that we so frequently lean on – advanced labs, diet, lifestyle, et cetera – we’ll be able to tighten our lens, tighten our interventions, and I think that will make us that much more effective.
What is the connection between functional medicine/longevity and epigenetics that we should all understand?
Dr. Fitzgerald: We’ve been in this omics revolution – referring to the collective technologies used to identify and measure groups of biological molecules like proteins (proteomics), metabolites (metabolomics), genes (genomics), epigenetics (epigenomics). The omics revolution has been bubbling in the scientific community for really many decades, and you can think of functional medicine in part as the clinical application of the omics revolution since we are interested in interconnected systems biology and root cause of disease.
In addition, we know that one of the key hallmarks of aging is dysregulation of epigenetics. So gene expression really becomes problematic predictably as we age and, because all of these predictable changes happen to the epigenome, we’re able to measure aging by looking at the epigenome – by looking at DNA methylation patterns.
Research is showing that not only is epigenetics one of the core hallmarks of aging, but it may be actually a root cause of aging. So, these predictable epigenetic changes may actually be a programmed cause of aging, which is then the biggest risk factor for all the chronic diseases. Therefore, if we address epigenetics, we may ultimately be addressing the aging phenomenon itself, and by extension all the associated diseases of aging.
Any of us practicing functional medicine have been paying attention to mapping the genome, measuring the microbiome, et cetera. And now measuring epigenetics (biological marks on our genome that regulate gene expression). I think all of us intuitively knew in functional medicine that we had to be changing epigenetic expression. We had to be. Our interventions must be changing which genes are on and off. I think we’ve all had that sort of intuitive knowing, but it was a matter of having the technology available to us to measure it, which we now have.
Being somebody who’s steeped in functional medicine, but also has a background in laboratory science and nutritional biochemistry, I’ve been particularly focused on this. And I think having a smart partner in Romilly Hodges to think through how we might very intentionally move epigenetics favorably led to us designing a diet and lifestyle program that of course leans heavily on functional medicine, but also moves it forward through the lens of this omics revolution, if you will, through the lens of how can we use these tools that we know so well specifically to optimize gene expression.
That became something of a mission for us when we conducted our first study and were able to see that it appears we did slow or reverse biological aging. And now we’ve shown the same potential in a follow-up case series.
Tell us about your new case series publication: Why is this new peer-reviewed research important?
Dr. Fitzgerald: In our first randomized, controlled clinical trial, because we needed to isolate aging as a measurable outcome, and minimize potential confounding factors, we needed to look at middle-aged, very healthy men. Middle-age because that is when these gene expression changes really become prominent. And we wanted healthy men because we didn’t want to look through the lens of a disease process. We know diseases are pro-aging and they will push the aging pattern forward. People with these chronic diseases of aging are – no surprise – biologically older. So we needed to control for that and only recruit healthy men.
On the other hand, women in the middle-aged bracket could fall anywhere from premenopausal to postmenopausal, and the associated hormone influence would make it difficult for us to interpret signal from noise because there would be the difference in hormones. And the influence of hormones on gene expression has been clearly documented.
However, of course, we’re incredibly interested in publishing on women, and we are prescribing the program to women all the time. So clearly I’m bullish on the idea that this is going to have a powerful influence in women. And I can see anecdotally that it does, in myself and in others who I track with laboratory data.
We had the opportunity to write up a case collection on the first adherents to the program as we started to offer it within a data-driven and monitored structure just over a year ago. And they happened to be middle-aged women. These case series participants got biologically younger by well over four years, after eight weeks of the intervention.
What’s also interesting is that these women were biologically younger at the start of the program suggesting that, similar to our first cohort, they were a healthy bunch.Anecdotally, the earliest adopters of our program tend to be those people who are really kind of savvy biohackers, so they tend to start relatively healthy and in this case it looks like participants got healthier in their bioage in response to doing our intervention. This is validating both that we might be onto something with this intervention being able to target underlying aging mechanisms, and that it works in women as well.
Of course, this is simply another set of data points in an ongoing research journey. We’ll need to continue the research efforts in larger participant populations but these are important findings that give us further proof-of-concept indications that we can move the needle on biological age with these interventions.
Can others access the same protocol you used in this research?
Dr. Fitzgerald: The participants in the case series publication followed the same protocol we used in our original clinical study, with just some very minor tweaks to include water intake guidelines and a slightly different delivery format. This protocol is what we also call the Younger You Intensive, and it’s written up in my book and it’s what we use in our 8-week group programs. It’s also what our clinicians use with patients as needed. It’s a program that is widely accessible since it is based on food and lifestyle modifications, a fact that was pointed out during the peer review process of this latest publication.
It’s also possible to access the DNA methylation-based biological age testing that we used in our research. Since this is a fast-moving field, however, the generations of biological age testing have evolved since we first started researching. Now, we’re using a third generation clock called the Pace of Aging. This is also accessible to consumers, and is incorporated into our Biological Age Laboratory Test Package. We’re very excited about it and we’ll continue to conduct research using this particular clock.
How do we think about this research in the context of other anti-aging research, which tends to focus on more aggressive interventions?
Dr. Fitzgerald: It looks like there will come a time when we will comfortably be living to 120 or more, and we will have quality of life during that time. This is the concept of achieving healthspan, not just lifespan, which is arguably as equal a goal. There are going to be more aggressive drug interventions and gene editing interventions that we will all likely be considering probably more than a decade from now.
It’s difficult to understate the amount of brain power and money going towards cracking the aging code in billionaire-funded companies like Altos Laboratory (funded by Jeff Bezos among others). They’ve recruited the very best scientists the globe over to try to crack what’s happening with the aging code. And of course, a big piece of that is working at the level of epigenetics. They are making progress, but none of these options are ready for clinical use and widespread adoption yet. Not even nearly ready. What does this mean for us right now?
Right now, we’re on this “longevity bridge,” on our way to these more aggressive interventions – and on the bridge are those things that we can enact right now, that are showing favorable impacts on biological age. So currently the best tools that we have are targeted diet and lifestyle, which are things we know favorably influence gene expression and favorably influence longevity.
Our program, intermittent fasting, exercise like the elements of our program – these are all essential as we walk along this longevity bridge. Even when we get to the other side and we hit those more aggressive interventions, there will be no escape from choosing food or choosing movement, et cetera. And knowing that if we deliberately choose the most impactful forms of food, exercise, et cetera, we can increase the anti-aging potency.
Don’t forget that the program we researched isn’t just about “general” heathy eating and living. We specifically designed the protocol to target epigenetics and DNA methylation. And we think that’s likely the reason why its impact on biological age seems so impactful.
What are you working on next in this space?
Dr. Fitzgerald: I’m very excited to be looking a little more deeply at other genes that we influenced the expression of over the course of our research. I’m interested in seeing whether there were other modifications relating to gene expression beyond the clocks themselves.
There are about 30 million methylation sites on the genome – many more than are used within biological aging clocks. So, there are many, many, many places where we can influence gene expression, specifically via DNA methylation changes. When we step back and look at the whole genome, there are patterns of aging that happen outside of the clock too, and we can see that we tweaked some of these. So, we’re looking at the aging question from other angles beyond the clocks. That’s an analysis that we’re working on right now and I’m very excited about that. We’ll be submitting that for publication soon.
In general, we also continue to work on making what we’re doing broadly available. We think this research is sufficiently important to make it as accessible as possible. We want the bioage test to be easily accessible. We want this program available to anybody who wants it at a reasonable price point. We are currently running a group program that provides access to and support for the study protocol at an affordable price point, and led by the same team that has worked on our research itself. Our clinicians and our team are also trained and available for those who want a very individualized experience of the program.
As used in Dr. Fitzgerald’s clinical studies
There are only two supplements that our study participants took and that are part of the Younger You Intensive plan – Phytoganix and Ultraflora Intensive Care. Everyone who follows the Younger You Intensive should take at least these two. Even though we didn’t use it in our study, I also recommend a liver supplement and a beet supplement, since many people find it hard to get the daily recommended amount that we had our study participants eat in food form.