“Let’s say your chronological age is 40, and your biological age, which can be discerned by blood tests, bone density and the condition of your cornea, your liver or your microbiome (personal community of microorganisms), is 43,” Israeli obstetrician and gynecologist Ariel Ravel suggests in his new book, “The Imperatives of Future Medicines."
“What if I enumerated 10 things that, if you do them, you’ll not only set back your biological and chronological clock – you’ll even manage to take three years off your age – for the sake of argument here, to 37?
I’d say, go for it.
“It will sound strange, but I think that longevity is largely a decision. It demands that each of us to make decisions and act accordingly.”
For more than a decade, the question of biological as opposed to chronological age has been preoccupying physicians, wellness experts, people who have recovered from serious illness and so-called senior citizens who are in good health and want to maintain it. For Prof. Ravel, 61, the preoccupation with this issue led to writing a book, after he spent a sabbatical at the Stanford Center on Longevity, in California.
In 2019, that center, in cooperation with the Technion – Israel Institute of Technology in Haifa, developed a method to extend the “age of the immune system” – an index that predicts mortality in adults, based on genetics, health-related and environmental history and external events.
Openness to new technologies has in any case been an inseparable part of the career of Ravel, who for example weaves anecdotes about sniffing hormones into everyday conversation. Following is the story he uses to open his new book, which is in Hebrew (an English version is forthcoming): It’s about a young Muslim woman who had to undergo aggressive chemotherapy, which caused her to become permanently infertile.
Because Islam does not allow implantation of the egg of one woman in another woman, Ravel – who established an egg-donor program at Hadassah University Medical Center in Jerusalem, and has been involved for years in in vitro fertilization and efforts to minimize invasive surgery in fertility treatment – decided to perform a new, previously unsuccessful procedure. He froze a piece of the patient’s ovarian tissue, and eight years later transplanted the tissue back into the patient. This helped to restore ovarian function – and the woman was able to become pregnant and give birth without an egg donation.
Ravel: “I think that gynecology, the specialty I chose, is one in which you have to make decisions in a state of uncertainty. Should the baby be delivered now by Caesarean? I am not always completely sure that this is the right choice, but I must make a decision one way or the other. There is a certain type of person who pursues this specialty and undergoes the training for it: [learning] to make decisions when you don’t have all the data.”
Thus Ravel begins “The Imperatives of Future Medicines,” which presents new research, concrete examples and personal stories, all of them informed by groundbreaking medical technologies that can extend and improve the quality of life.
For example, he describes cases where a biopsy is done on a fetus to determine its potential as a donor of bone marrow to a sick sibling; where stem cells from a fertilized egg are used to print a 3D pancreas to cure diabetes; and where a specialized robot is used to remove a prostate removal in order to prevent impotence; and also discusses the popularity of pressure chambers and examination of intestinal microbes.
All of the above involve moral dilemmas, of course. For his part, Ravel writes from a perspective of economic, social and ethical awareness that is in sync with transhumanism: a scientific and philosophical movement that advocates using any and all of the latest and most sophisticated technologies available to enhance one’s health, happiness and longevity.
With this in mind, one feels impelled to ask the physician-author for suggestions for helping our parents and grandparents. But Ravel, whom I caught in the middle of a bike tour in Greece, does not agree to focus on the older generations and thus leave children out of the equation. That’s apparently his first tip: Regardless of age we all must make the effort, and the sooner the better.
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“To set back the biological clock, we should focus on three things: our financial situation, our brains and keeping our bodies moving,” he says. “In terms of research, both in Israel and abroad the connection has been proven between one’s economic status and longevity. This isn’t new. And it’s not only about access to advanced medicine, high-quality nutrition, a gym and a psychologist, which cost money – but also about taking a day off from time to time, or deciding to devote time to leisure activities with people one is close to.”
According to Ravel, many people are troubled by financial issues, for example, whether to become a salaried employee or be self-employed, whether to invest money or reduce one’s mortgage – and all of these have health implications.
“Not everyone can do this," he admits, "but let's say a 40-year-old man whose business is not thriving should consider whether it’s not time to close the company down and take on a salaried position. Or if the kids are grown and you have an apartment in Jerusalem, and it doesn’t serve your needs any more – maybe you should consider moving to an outlying area and creating passive income from [renting out] the apartment in town.
In favor of volunteering
In this country, where the cost of living keeps rising, many people don't have the luxury of dealing with such decisions.
“I agree, but the economic situation of most people in Israel is better than that of most people on the planet. Excellent medical care, good water and sewage infrastructures, police of reasonable quality and personal security on the street – these are better than in most countries. The rights of women, children, members of the LGBTQ community, all of these have been improving.”
Distress and deficiencies are certainly present in our lives, Ravel emphasizes, but there are other, surprising ways to improve our financial situations, and as a result to enhance health and longevity. And they are actually connected with the need to focus on our brains.
“Volunteering," he suggests, "is an activity that people treat as a luxury, by thinking: I can’t even make a living like I should so why should I volunteer now? But the complete opposite correlation has been found: People who volunteer usually improve their economic status. In times when there is an employment crisis, volunteering gives one a feeling of satisfaction and appreciation. We understand that we’re part of a social fabric, and people need what we have to give, even at times when we don’t feel appreciated enough.”
Here too, being part of a community comes into the picture.
“Research by Prof. Howard Litwin of the Hebrew University’s Israel Gerontological Data Center, that focused on men who lived alone shows that who went to synagogue lived longer than those who did not. The theory is that a man sees familiar faces every morning, and if he misses services one day, someone will call and ask if he’s all right and maybe bring him a bowl of soup, so he is connected to a certain community that supports him. It doesn’t have to be a synagogue, it can be a bridge club, a book club, a walking or running group. Belonging to a community helps induce health and longevity."
Volunteering is also a means of improving one’s economic wellbeing because it helps combat loneliness and improve one's self-image. That is, one beneficial deed brings a series of implications that improve the quality of life and increase longevity. Also, having to deal with a health crisis, despite the upheaval it causes, can often be empowering when it comes to making changes.
Ravel: “For example, take a situation like a breast tumor, which requires chemotherapy or radiation therapy. Let’s say the woman in question gets through the treatments successfully. Usually she will also have met with a nutritionist and will have made changes in her diet, like consuming more vegetables or less sugar. If she smoked or drank significantly, she would certainly stop.
"Perhaps she will begin to make sure she sleeps more – an important issue that we can talk about endlessly in terms of maintaining good heath, as well as watching one's weight. Maybe she also invests in some sort of therapy, to reduce stress. Or she begins to engage in some sort of exercise or other physical activity that improves her self-image, which allows her to spruce up her wardrobe. Such changes might lead her to make other changes, in her career or hobbies."
So the change is holistic?
“Not only is it holistic, it also extends outward, because that woman will urge her friends to get checked by a doctor and perhaps facilitate early detection [of a disease]. And maybe her family will adopt better eating habits or increase the frequency of their physical activity."
Indeed, movement is the last and most important element that Ravel says we must focus on, in order to live longer. “If the imaginary 40-year-old woman wants to reduce her biological age to 37, she must engage in physical activity, on a daily basis,” he says. “It’s more important to do an easier workout every day than to do a tough one twice a week, as some people do.
On one hand we have cutting-edge technologies and on the other, for many of us, daily life means sitting for long periods at a computer, at work and sometimes afterward.
“There’s no doubt that in the past we moved around a lot more. But many of the jobs people did then were not healthy. Is working in agriculture or a laundry good for the body? Not necessarily. Still, I believe that in our digital reality we are missing out on opportunities – especially for interaction with people. It’s true that today you can order anything online. But it wouldn’t hurt if you walk to the local grocery store instead. That way we’ll not only stretch our legs but we'll also get some fresh air, meet acquaintances, chat a bit and feel less lonely."
Making sure we get the right nutrition, enough sleep, exercise and human interaction – we know those are the right things to do, but implementing all of them turns out to be difficult.
“No doubt. But perhaps it would help us to think of the very core of everything we’re actually talking about here, which is carpe diem, seize the day. In other words, understanding that we mustn’t waste a single day. Everyone must ask themselves every day: What can I do to advance the goals I’ve set? What things should I buy so that there will be nutritious products in my refrigerator? How can I help my parents or grandparents this week to deal with loneliness? What volunteer work can I engage in, in the next few days – to help youth at risk, to transport disabled people to the doctor, to contribute to an organization I care about?
"That is, I must translate my decisions into acts and see how I can dedicate my day to a number of things that I’m dealing with. How do I maximize pleasure and minimize suffering, first of all for myself and then for the environment?”
Genuine optimism and purposefulness seem to characterize Prof. Ravel’s overall approach. When asked how he himself preserves his energy, continuing to look forward while also pausing or even rolling back time – he skips to the future. “Optimism is vital when it comes to changing our awareness. However, a good feeling without having engaged in real activity achieves certain goals, but only partially,” he explains.
Time to walk away
Sometimes, Ravel continues, "I ask myself and others: If you could jump ahead five or 10 years and look back with a smile, what processes would you like your former self to have put into motion? And, how would that former self have wanted to see you in 10 years' time? If you’d like to start swimming, change your profession, spend more time with friends – it’s a sign that now is the time to attend to those things.
"It’s also important to see the glass half full. To look back and say to yourself: ‘You know what? Things are not bad at all.’ Maybe, for example, you have difficulty juggling career and family, but at least there is a career and there is a family. And now there’s this goal before you.
“For example, I have two parents, ages 84 and 85. This year I have made sure to visit them even more frequently. I don’t want to tell my future self: I wish I’d visited them more. The same goes for my grandchildren. I don’t want to tell myself that it’s a pity I didn’t spend enough time with my grandson when he was little, or it's a shame I didn’t take him to swimming lessons. So I take him to the lessons and put off a business meeting or time with friends by one hour.”
Improving and extending your life is not only a matter of changing habits and engaging in new pastimes, Ravel says, but also of learning to relinquish relationships or activities that may not suit who we are today. He reveals, for example, that after years of observing the religious commandments, like keeping the Sabbath and adhering to the dietary laws, he decided to leave them behind.
“Perhaps they were significant or useful in the past," he says, "but since our mental resources are limited, and because I felt they were no longer useful to me, I decided not to attribute importance to this whole issue.”
So, sometimes you have to make a decision and walk away from something.
“Certainly. Personally I got out of a marriage that lasted almost 40 years; we decided together to untie the knot. Some people would say ‘oh no!’ And some would say – if a relationship doesn’t work anymore, maybe one should start anew. It’s not that I want to encourage people to break up. I’m encouraging them to ask questions, to not be afraid to make changes, to decide not to continue in a marriage, a job or in encounters that aren’t good for you out of inertia, or because of the feeling that ‘at least I have this.’
"The idea of carpe diem demands that you sometimes take steps that aren’t necessarily popular: to put yourself in the center, but in a positive way.”