Telomere Length & Cellular Health: 7 Years of Clinical Experience

Marcela V. Young, M.D.

Sure, well, first of all, thanks for having me, you know, it’s an honor to be in a panel with you and so many other, very well known people in Telomere biology, which I, by the way, consider mentors of mine. So thank you. Well, it’s a long story, but we’re gonna try to make it short. So yes, I did train in OBGYN and then I trained in internal medicine, but essentially for the last 20 years or over 20 years, I’ve been practicing internal medicine. So, you know, from med school, through all my years of experience in internal medicine, I have built, I have focused on diseases. Right, on disease diagnosis and disease treatment. And basically just think about it from an organic point of view, right? 

But, you know, I think about when I was in medical school and I think this is what would have driven my desire to go into longevity medicine. I have been really curious and really passionate about the molecular basis of everything, which we learn a little bit in, you know, biochemistry, which by the way, was my favorite subject in med school. But, you know, just to know the why of the why and why things happened, right? But then we’d go on, you know, straight forward to, organic medicine. And we learned about the organs you know, when they get sick and what we need to do to make them better. 

So essentially that’s what I practiced for 20 plus years, in Greenville, South Carolina, which is where, where I live. But, you know, always with that focus of, you know, knowing that there was something else, there was more that can be done. And, you know, it just happened that I decided to do my fellowship training and certifications in age management medicine in 2011. And that opened up a new whole area of my practice. Which if I’m talking to a patient, I tell them, well, this is the preventive side of the practice. And this is the reactive side of the practice. 

So very shortly into my conversations with patients, I explain this, I want them to know where they are, because my name is known. I practice in the same city for many years and patients come to me for different reasons. Most of my patients are patients that are pretty healthy or they want to stay healthy. They’re health conscious. They want to stay healthy. I’ve done practice, I’m not in a hospital. I’m not a hospital employee, I am private practice. Which makes my life a lot easier. 

In fact, I would say that this is the best stage of my career. Not only because of the type of medicine that I’m practicing now and the rewards that I get from seeing my patients getting better and better and feeling better and better, but also because I don’t have to deal with, which the majority of the audience, I hope is not dealing with. And if they’re dealing with, it’s probably something that we all know physicians don’t like. So I very early on, I talk to them about it. I just want you to know where you are. I’m still practicing internal medicine. I mean, I’m still, you know, I’m not, I am in full age management medicine practice, but I still continue and shrinking and shrinking. Because that’s my goal, the internal medicine side, but I want them to know where they are. 

So we talk about reactive medicine versus proactive medicines and the differences. So that’s essentially how I approach, I say, okay, you know, if you have a problem, you’ll come to me. And you know, we will take care of it, which is what almost a hundred percent of patients are accustomed to. But by the way, we offer this other side of the practice, in which we’ll focus on healthy aging. And let’s talk about aging. And I open up my conversations with patients in that manner and you know, us, and everybody knows people have this pre-concept about what aging is. 

Aging is inevitable. Aging is something that brings connotations of negative, negative diseases, impairments, dependencies, lack of functionality, et cetera, et cetera. And most people in their mind consider that this is inevitable. And so they are very glad to hear that no, that this stage is not inevitable in this century it’s not inevitable. We do now have the tools, the scientific tools. We know what causes aging. In fact, I even tell them, you know, aging has been defined by United nations in 2017 as a disease. I share with them.

Joseph M. Raffaele, M.D.

I’d like to respond to that. I mean, what you have somebody, you say that somebody who’s coming to you maybe as an age management or longevity patient in preventative medicine side, and they don’t have any diseases. Now you’ve given them a disease, how do they respond to that?

Marcela V. Young, M.D.

You know, they don’t, they’re surprised really it’s a disease? But not because I’m telling them you’re sick. Actually, what I see is a relief. Oh really, so there is something we can do? So I do not have to give into this. Okay, this is gonna happen to me sooner or later, based on what grandma told me she had, what type of disease, or what did that die of? You know, we do have all these tools, you know, I go straight to the science and I explained the science to them, but now there’s scientific tools that we can intervene. So without intervention, yes. You know, the process is gonna continue, the degenerative process of the body, the cells. And I go straight to the cells and I talked to them a lot about the cells. And I give them very simple examples. 

You know, people don’t think this way, examples, such as, you know, each cell of your body is like an engine of a car. You know, there’s this complicated mechanism. And of course we would talk about the cells greatly much more complicated, but it needs all these things and they need to function and they need to communicate and they need to do this. And essentially what we want to do is we wanna bring your cells to where your cells had when you were 20, or when you were 30. 

Things that you have been loosing little by little, by little throughout your life. But if could tune them up and bring them back to what they needed or what they had when you were 20 or 30, then it’s very logical to think, and very simple to think things they’re gonna work better. And so the reaction going back to your question is that of surprise, but in a great positive way. They feel relieved, really, nobody told me this before. We can do that. I just did not even know that we can do that. A few patients do know. A few patients are very well read and they already know a telomere is. You know, but the majority of them, they don’t.

Joseph M. Raffaele, M.D.

What tools do you use to sort of tell patients how their cells are doing in the aging process?

Marcela V. Young, M.D.

Well, there’s a very comprehensive panel of biomarkers of aging. That, you know, the physicians are in this specialty know well. But you know, metabolic changes, hormonal changes, nutritional changes, telomere attrition. You know, we do a very comprehensive panel of all the biomarkers of aging. So when they first visit, they’re a little bit, they leave the office a little bit thinking, okay, this sounds great, but let’s see. The second time they come, when I have all the results of this panels, including the telomere length, they’re very excited. 

And, you know, even if we do a telomere length on someone and it’s not what they were expecting it to be, or is shorter than their, you know, criminological age, or it’s longer. I’m sorry, shorter then their chronological age, meaning their biological age it’s older. Then of course, they’re not very happy, but you know, there’s always this encouragement that we’re gonna start this program, and we’re gonna created this program. And in a year later, I’m going to show you, that all of those biomarkers, including you’re telomere length, it’s gonna be better. And when they see it in black and white, then they really, they really get excited. 

So, you know, of course compliance is everything. I tell my patients, this is 50/50, we’re a team, right? Because we all know, you know, the importance of lifestyle in all of this. I mean, this is one thing we knew. And we’ve always known, lifestyle, which is in my opinion, as an internist, the only preventive approach that we had with patients, you know, counsel them three times a year. If we saw them three times a year, about their lifestyle habits, but that’s it, we’d never did an internal medicine, anything preventive, right?

Joseph M. Raffaele, M.D.

Right, yeah. We we’re too busy putting out the fires.

Marcela V. Young, M.D.

Right we’re too busy. Or even what patients think is preventative, is not prevention is early detection, you know. Colonoscopy, mammogram, you know, and everything calls it prevention, but it really is not prevention. So the patients are very receptive, very receptive.

Joseph M. Raffaele, M.D.

How do you approach the discussion? Because I know that I’ve gotten emails and calls from other doctors who’ve measured telomere length on their patients, and sometimes it comes back quite short and that can be quite disconcerting to a patient. How do you go about explaining what that means and what can be done about it? What’s your elevator discussion about what a telomere is?

Marcela V. Young, M.D.

Look, I try to keep always a positive attitude and I try to transmit that my patients. I do always tell them long telomeres are youth and health, short telomeres are aging and disease. These telomeres are shorter than they should be. You’re aging faster than you should. And your chances of getting any of the diseases of ages, which are full of them, right? Except accidents and infections, your chances are much higher. So let’s work with it now, this is a big incentive because we can reverse this. We can make this better. And we see it. I mean, I did my training, Joe in 2011, and since 2011, approximately, I have been measuring telomeres and I have been treating my patients with the telomeres activators. I use TA-65 exclusively. And I see progress. I do see progress. I see progress, clinical progress. And I also see progress on their telomere testing, and I see a progress in all the biomarkers.

Joseph M. Raffaele, M.D.

And your practice is comprehensive. You do, have been doing for a long time, hormone replacement therapy in both men and women, hormone optimization, I guess, is a better word for it. So you have that approach. You have lifestyle, you have diet, exercise, it’s a comprehensive approach. I know that you take to this sort of thing. How do you explain how those kind of work together to a patient with the telomere biology, the results?

Marcela V. Young, M.D.

Well, you know, actually the laboratory that I use to measure telomeres, it’s Life Lengths. And the report of their telomere test helps me a lot with that. Okay, so, you know, here’s a page in which it shows, all right, these are all the things that will make your telomeres shorter. These are all the things that will help make your telomeres longer. So let’s go one by one by one by one, right? You know, sleeping, gotta sleep. You know, you are under a lot of stress, well let’s talk about managing your stress. 

You know, your hormone levels are suboptimal. Let’s optimize your hormone levels because of the importance of hormonal optimization. And I explain all that, why they are so important, because the knowledge of people in general, about hormones is very limited. And the science supports a huge evidence on the benefits of hormone optimization. So there’s this, I educate my patients a lot, Joe. I really take a lot of time and I educate them. I think that an educated patient is a patient that is going to be more compliant and it’s the patient that is going to succeed. 

So we talk about all that. We talk about that you need discipline mentation, and we measure the biomarkers and we tell them why this, you need this supplement versus others. We talk about quality of supplementation, you know, and that’s very important because every day I measure you know, biomarkers, but just to give you a very common one vitamin D and I see people taking vitamin D and having a very low vitamin D levels. So, you know, we talk about quality of what they take, because, you know, as you know, it’s highly an unregulated, so quality is very important.

Joseph M. Raffaele, M.D.

Sure.

Marcela V. Young, M.D.

So, you know, and yeah, diet, we do have a specific program that patients enroll, in which we only do nutrition. In fact, their visits are just for nutrition. So we don’t do anything else, other than talking about nutrition. And, you know, it’s three months long. They come every two weeks and we talk about nutrition.

Joseph M. Raffaele, M.D.

Is this for weight loss, primarily?

Marcela V. Young, M.D.

Not really, I mean, I see this is very surprising, but I see approximately 85% of my patients are pre-diabetics. Pre-diabetics defined, by an elevated basal insulin level and an elevated insulin resistant level, you know. And by that, we always talk about optimization, right? So we want the basal insulin levels not to be within the parameter of the laboratory. We want it to be really low because it should be really low.

Joseph M. Raffaele, M.D.

The lower the better.

Marcela V. Young, M.D.

The lower the better, exactly. So I define them as pre-diabetics, and I tell them that they’re pre-diabetic because with time if that is not corrected by diet mainly, well we use Metformin a lot as well, for that reason and for the longevity reasons as well. But you know, they get better. Their numbers get better and inflammation. And again, everybody’s in hormonal to be stationed. Obviously we do a very thorough, I do a very thorough screening, in regards to who I give hormone optimization and what type of hormones, right? Because, you know, everybody’s different. And some people, in my opinion, some people benefit from doing full hormonal optimization. And some people need to be, the regimen needs to be modified according to their medical history.

Joseph M. Raffaele, M.D.

Right.

Marcela V. Young, M.D.

But, you know, everybody is on nutritional supplementation. Everybody is on telomeres activators, TA-65. Everybody’s in the nutritional program. And we talk about exercise, in my practice I don’t have an exercise physiologist, but I personally give them all the exercise recommendations.

Joseph M. Raffaele, M.D.

Well, you worked with, Doctor Gonzalez in NeoLife, right? He’s an exercise physiologist when you were supplementing NeoLife in Madrid. So I guess you learned a lot over there.

Marcela V. Young, M.D.

Yeah, yeah, yeah, yeah.

Joseph M. Raffaele, M.D.

Dr Dante, right.

Marcela V. Young, M.D.

Yes, yes, yes, yes. We were co-founders of a NeoLife clinic, which was the first age management medicine clinic in Europe, basically. And so that was very, very rewarding, very interesting. I’m no longer associated with that. And then in 2018, I opened the first age management medicine in a clinic in Argentina, which by the way, is where I am now seeing patients.

Joseph M. Raffaele, M.D.

Lucky you.

Marcela V. Young, M.D.

Well it’s yeah, it’s nice. It was a little difficult to get in due to all the COVID restrictions, but I’m here.

Joseph M. Raffaele, M.D.

Right. So tell me, you’ve had some interesting cases of patients that get baseline and then have changes in their telomere length. Want to tell me about a couple of those?

Marcela V. Young, M.D.

Yeah, yeah. I’m gonna look at numbers because this is all numbers, right? But, you know, as I’ve told you on the previous conversation, I do look at their median telomere length. And I also look at the 20% of their short telomeres, which in my opinion are more specific for that patient because sometimes we see median numbers changing, but it is my opinion that as the database grows and it’s continually growing because more and more people are getting their telomeres checked. It also the diversity of that database increases. 

So I like looking at the 20 percentile of the short telomeres because I consider that to be more clinical relevant. And that’s what I tell patients, you know, sometimes patients show a very low median telomere length. And then when we flip the page and we go to the 20 percentile of their short telomeres, it’s much better. So I say, you know, what I explained to them is, this is, this is you. We discarded all the long telomeres in your sample and your specimen. And we just are looking now at your short telomeres. And we do the 20 percentile. And if this number is better, it’s better than it looked in the first page. So, you know, we have some patients and because of reagents that have changed, I don’t go back to 2015. I mean, with the laboratory. So I’ve had a few patients in which, you know, let me pause for a second. Not getting shorter is success. I think you would agree with me.

Joseph M. Raffaele, M.D.

Absolutely. If your telomeres don’t get shorter than you’re doing great.

Marcela V. Young, M.D.

Right, and if they get longer, you’re doing fantastic.

Joseph M. Raffaele, M.D.

Right, and maybe they needed to get longer, if you’re like, depends on how old you are. But yeah, as a general rule, most people are getting their telomeres tested, getting a little longer is a good thing.

Marcela V. Young, M.D.

Exactly. So, you know, we have a patient over here that in 2019, his telomere were a 10 kilobases. And 2020, it was 10.2. But when I looked at the 20 percentile, his 20 percentile in 2019 was 4.7 kilobases. And in 2020 was 6.1. So this is, this is a very nice improvement.

Joseph M. Raffaele, M.D.

So how would you interpret that by saying that, you had a decrease in the critically short telomeres because your 20th percentile is now higher, relatively than your median, the change in it. And that’s goes along with the biology that we know telomeres activators go after the shortest, telomeres itself goes after the shortest telomeres. So if you’re lengthening the telomeres in your bottom 20th percentile, the really, really short ones, then the average length of your 20th percentile is gonna go up, more than the ones that are really long. It doesn’t add that much telomere length to the longer ones. So that’s kind of what we would expect to see. And that I think, you know, does show the benefit of the 20th percentile versus the median telomere length.

Marcela V. Young, M.D.

Right, I have another one. A third one, in which, you know, and again, 2019, a year, right, to 2020, it was 9.5. In 2020 10.4 and the 20 percentile is 4.9, it went up to 6.1 and on and on. I mean, I have in this page and I don’t want, you know, just for the sake of time, go through everything. But I have about 16 samples that I just pull from my own database. And, you know, Life Length helped me a little bit to pull out because obviously they have, you know, a lot more organized because they do all the research. So you know, there is no question that I see improvement.

Joseph M. Raffaele, M.D.

You invariably see improvement, or you start out with a certain dose and then have to change the dose because you don’t see it. Or how does that work for you? What’s been your experience with that.

Marcela V. Young, M.D.

Right, people that have had very, very short telomeres, I do increase the dose. But I don’t have that data to share with you right now. Just majority of my patients, the great majority of my patients have taken 250 units of TA-65 a day, yeah. I wish I had the data but I don’t because I don’t see a lot of patients with really, really short telomeres. And the ones that I see are very non-compliant. So the follow ups are not.

Joseph M. Raffaele, M.D.

You don’t get them.

Marcela V. Young, M.D.

I don’t get them or they don’t do what you tell them, you know, it’s like I say, you take the TA-65, but you don’t do all these other things. I can not tell you that in a year, I’m gonna show you improvement.

Joseph M. Raffaele, M.D.

Mhmm.

Marcela V. Young, M.D.

It’s just interesting when I’m in Argentina and I lecture here, you know, and I put the slide about TA-65, everybody picks up the phone. And they want to take a picture of the magic bottle, right. And although it is almost magic, you know, they have to do their part and the patients that I see with very short telomeres are not compliant, as you can imagine. And when I see adults, I mean, I know we do see children with short telomeres, but I don’t see children, I see adults.

Joseph M. Raffaele, M.D.

Right, yeah. And those are usually kids with genetic mutations that are pretty, I mean. What’s the shortest telomere length you’ve seen, and what’s the longest one? And then have you made any correlation between that and other biomarkers or state of health or anything?

Marcela V. Young, M.D.

I don’t know what the number is, when you are above the blue line, which is in 95%. I don’t know what the number is because they stop.

Joseph M. Raffaele, M.D.

Uh oh, right.

Marcela V. Young, M.D.

But let’s see, I would say that now we’re going to the median, right?

Joseph M. Raffaele, M.D.

Or 20th percentile, either.

Marcela V. Young, M.D.

I guess the, the 95 percentile is a little bit above 13. Right, so I’m happy to tell you I was there.

Joseph M. Raffaele, M.D.

Lovely.

Marcela V. Young, M.D.

I’ve been taking TA-65 since it existed. So I don’t know what it was before I started, but I started at the same time, the testing and the TA-65. And the shorter is, I guess you are below, when you’re in the 5 to 10 percentile, you are a little bit over 8 in kilobases.

Joseph M. Raffaele, M.D.

Right.

Marcela V. Young, M.D.

So have I seen them below that? Yes, I have. I’ve seen them below the five percentile, I have, yeah.

Joseph M. Raffaele, M.D.

Yeah.

Marcela V. Young, M.D.

And like in this particular patient, she’s off the charts. I just did just reveal it’s a she, she’s definitely, I will show you that she’s off the chart.

Joseph M. Raffaele, M.D.

That’s very high, yeah. Anything about her clinically that goes along with that? I mean, is she more youthful in appearance? Does she have fewer? I mean, I didn’t see what the age was. What was it, how old was she at the time?

Marcela V. Young, M.D.

I don’t have that. I don’t have that in the report because it’s all, you know, there’s no names it’s all codes.

Joseph M. Raffaele, M.D.

Oh, okay.

Marcela V. Young, M.D.

There is no age, but I believe she is 50, in her 50’s, mid 50’s.

Joseph M. Raffaele, M.D.

Okay.

Marcela V. Young, M.D.

Yeah. I mean, I personally with the experience and I’m sure you feel this way. I can look at a person before we mention the telomeres and pretty much predict what it’s gonna be. I can not only look at the patient, but listen to the patient. Know about their medical history, know about other lifestyle habits, what they do, what they don’t do and predict. And it’s pretty much right on. I’ve had a few surprises, but I mean, sometimes patients say, well, I don’t wanna, I don’t know if I want to know where my biological age is. And I really feel, sometimes, I don’t say it if I think it’s gonna be low, but if I think it’s gonna be good or at least consistent with the chronological age, I’ll make a comment. And then I guess it’s clinical experience, right?

Joseph M. Raffaele, M.D.

Yup. Have you, do you do any of the other testing, like the lymphocyte subset panel or any of those tests to get experience with that?

Marcela V. Young, M.D.

No.

Joseph M. Raffaele, M.D.

Yeah, I mean, that’s an extra cost and a lot of patients don’t want to bear that at times. I just was curious whether you had seen anything. In terms of, sort of what patients might, I know since you’re doing a lot of other things, perhaps it’s a little difficult to tease out of you, anecdotal reports of improvements or adverse effects? Anything that occurs when they’re taking TA-65, for instance, I’ve had patients and other doctors tell me about their patients. Who’ve had documented improvement in presbyopia and also in myopia if you see anything like that.

Marcela V. Young, M.D.

Improvements, yes. Improvements, yes. I haven’t seen any adverse effects at all. Not even one.

Joseph M. Raffaele, M.D.

I haven’t either.

Marcela V. Young, M.D.

0%, but improvements, yes. Visual scheme, hyperpigmentation of the skin.

Joseph M. Raffaele, M.D.

Reduction in that?

Marcela V. Young, M.D.

Reduction.

Joseph M. Raffaele, M.D.

Oh really, interesting. Do you use the cream at all?

Marcela V. Young, M.D.

I did personally use the cream and I have a few patients, they use the cream. At the beginning of patients response is, well, you know, I’m taking this orally, so it should go to all my cells. And so I explained to them it’s a booster for your skin.

Joseph M. Raffaele, M.D.

It’s a higher concentration. It gets into your skin, then you’re gonna get from your blood for sure. And there is a randomized controlled trial data for improving skin appearance and wrinkles. Fritz Stern did that study a number of years ago showing beneficial effects. Finding it’s better to go with it orally versus transdermally directly on the skin.

Marcela V. Young, M.D.

Particular with the hyperpigmentation of face and neck. Yeah, I’ve seen significant improvement and, you know, people feel better they report they feel better. What I went over, when I talked to them about it is, I want to be realistic with them and know they’re going to feel better. I know intellectually that their cells are getting younger, so they are gonna be better, whether they have a wow effect like they do. For instance, when you do hormone replacement therapy, I try to lower expectations and say, this takes time. It takes years to be, for your telomeres to shorten, it’s gonna take time. At least a year and what we seen in a study in Spain, that you did that, you know, a year, at least a year is what we need to wait to, to really see, to see the benefits.

Joseph M. Raffaele, M.D.

Yeah, no, and I talked to patients about it. I almost explain it like it’s a sort of a blood pressure medication or a cholesterol lowering medication in some ways, because it, I don’t set expectations that they’re necessarily gonna feel different or like a bone density metric measure medication, because bone density is kind of an interesting analogy. You know, you lose bone very slowly and you get it back slowly, but whatever therapy you use to get it back, you know, even if you stopped that therapy, you still have that bone it’s not like a blood pressure medication you stop and all of a sudden your blood pressure goes back to what it was. 

You know, you’ve built up telomere length over the year of therapy. On average from the Spanish trial that we did, it was about 0.3 kilobases of telomere length. You’re not all of a sudden going to go back to a year ago, you’re going to then start losing telomere length at the same rate that you did prior to being on the telomere activator. And that’s going to take time the same as if you stopped some antiresorptive medication, you start losing bone again at that same rate. 

So I tell them that you’re doing it to preserve the organ. And then it is, you know, particularly for hormone replacement therapy is sort of synergistic because those are helping cells to divide, to, you know, replenish tissues. And that the telomeres activator, in addition to helping, you know, your white blood cells, which is what we’re measuring it in, are presumably turning on telomeres and lengthen telomeres in stem cells and other tissue niches. So that then you can regenerate and replace the cells that you’re asking more off to make your muscles bigger with testosterone or growth hormone. And they, you know, so they get that synergistic kind of approach to it, which I think then makes them think, oh, wow, just thinking about the whole process for me. And I think that’s why it dovetails nicely with hormone optimization you know, in my, in my practice.

Marcela V. Young, M.D.

Osteoporosis is a perfect example. And, you know, because you know, like you said, it’s a synergistic program. It’s not just one component it’s everything. It’s the hormone optimization, it’s the nutritional, you’re bringing balance to your vitamin D, your TA-65 and making your telomeres longer, counseling about their exercise and their diet. I haven’t used prescriptions for osteopenia or osteoporosis in years.

Joseph M. Raffaele, M.D.

No, I mean, with diet and supplements.

Marcela V. Young, M.D.

And I check their bone density and they’re better and better and better. So that is really, really rewarding. And, but you know what, one thing I wanted to mention to you and this brings us back to almost the beginning of our chat, but something that I’ve mentioned that statistically there is really an eye-opener the United nations now come up with this statistics that in 2050, we’re gonna have 2.1 billion people over the age of 60, and then naturally the increases of Alzheimer’s and cancer and cardiovascular disease increases every five years, doubles. You know, that’s a paradigm. We need to be looking into aging. We need to be looking into what can we do because that’s a problem. That’s a huge problem. We’re gonna have a lot of older people, but they’re not gonna be well. 

There’s another study from Yale that we were talking about last time that says that, you know, from the 20th century to 21st century, that we’re gonna live extra 30 years. Where only 18 months of those are gonna be of healthy, functional life. And so how could you not be interested in the science of aging and everything that we can do, you know, from a longevity medicine point of view, to help people, you know, age well and stay well until the last day.

Joseph M. Raffaele, M.D.

That’s the phrase die young as old as possible.

Marcela V. Young, M.D.

Exactly.

Joseph M. Raffaele, M.D.

I mean, I think that that shift has taken place, you know, with the advent of the TAME Trial, the first time the FDA is going to look at multiple end points of disease onset to see, you know, if Metformin can help keep people healthy and disease free for a longer period of time. I think that’s gonna open the doors for other therapeutics that don’t have a specific disease indication, but have a, you know, some biomarker of aging as, as the indication. And that really is the way it needs to go, because the goal is not just to be disease free. My patients coming in to me and they want to not only, you know, remember the tennis score, but be able to play singles tennis again, or continue to play singles tennis. 

They don’t want to watch them go down the same pathway that their parents went from, you know, the debility into Alzheimer’s disease over 20 years. And there is, as you said earlier in the beginning of our discussion that I think aging is really a technological problem at this point. I’m not sure that we know exactly what causes it, but we know that it is something that can be changed because we’ve done it in animal models that are quite close to what humans are. I mean, we’ve lengthened lifespan in mice in smaller organs and smaller organisms organisms. There’s the dog aging trial that’s going on right now with Rapamycin. So I think, you know, if we can see a 30% increase in healthy aging lifespan in them, that translates into 30 more years of good aging in humans.

Marcela V. Young, M.D.

Absolutely, I’m sorry. But yeah, we were talking about this interview, you know, I mean, from a practical point, which is where I’m coming from, I’m not a researcher, I am a clinician. If I talk to a patient about aging being a disease and they look at me and how is that? We’re all gonna get old. I say, well, but now we know what causes or we know the majority of the things that cause aging. We may not know them all, but we know a lot of them, we know how to intervene when know how to do, to reverse them. And how is that different than any other disease? It’s the same. We know how to diagnose it. We know how to treat it. And the end result is people feel better, look better. And when I look at the papers, black and white there biomarkers are better. So, you know, I do understand that we have a lot more research coming our way, but I think that we are very well positioned and going in a very good direction.

Joseph M. Raffaele, M.D.

Well, you think about, I mean, at least you and I am sure. I mean, it was controversial at one point, probably still is, but I mean, the same concept is really thinking of menopause as a disease. Yes, it’s universal. If a woman lives to be old enough, past 50, but that doesn’t mean it was intended. That doesn’t necessarily mean that it’s a good thing. And we know there’s so many deleterious consequences to menopause. So as far as I’m concerned, you know, menopause is a disease just as aging is because it happens to everybody and it means that then you should address it and treat it. I mean, going from an estradiol level, between 50 and 250 for the first 50, or well not the first 50, the first 40, the last 40 years of your life before you’ve gone through puberty, after you’ve go through puberty, you know, to going to nothing. It’s a deficiency syndrome.

I mean, besides all the political correctness that goes along with it, I mean, who can’t see that? I often tell my patients with regard to that when they’re sitting across from me, you know, your husband, who’s 55 has four times the level of estrogen that you have right now, think about that. So, you know, and that’s why he’s not grumpy and flashing and has brain fog. So I’m just asking you to get back to that level. And likewise, with the aging process, you know, you want to slow down that gradual 1% decline in virtually every organ system that we see, starting in your mid to late twenties. And by the time you’re in your fifties or sixties, it really starts to have some clinical impact in you. 

Even before then, if you try to do something at a very high level, you know, the idea is to treat that decline in organ function, which starts at the cellular level, as you mentioned, and then again at the molecular level with the telomere. So it’s an exciting field. I mean, that’s what, you know, we’re both internists and, you know, there are probably not a whole lot of super happy internists out there because I think they’re focusing, still on the disease model, but we’re using the disease model to now focus really on healthy aging. Which is, you know, what telomere biology is about really to a large extent. And I think that the future’s gonna be incredibly exciting. I mean, I may end up working for another 30 years, which would be a good thing, you know?

Marcela V. Young, M.D.

Yeah, absolutely. I feel the same way. Like I mentioned, initially, I can’t tell you an other better stage of my career than this one. This is great. It’s so rewarding and I’m super happy doing what I’m doing. And I wanted to, I wanted to mention something about hormone and women and menopause, but I’m fascinated about, or I would say I’m passionate about treating perimenopause because it’s such an underdiagnosed stage in a woman’s life. And it’s such a prominent in terms of symptomatology stage of their life, anywhere between 35, 40 and 50, 55, it’s incredible. And being an internist I’ve been there, I’ve done this personally dealt with patient and you know, well, you might have arthritis or fibromyalgia, or, well, maybe you’re not sleeping well because you know, you’re raising kids and you’re at the prime of your career, or it may be stress. 

And, you know, you start treating a woman on perimenopause and you recognize that if you don’t ovulate, you don’t have progesterone or at least the months you don’t ovulate and you don’t have testosterone. You have a little bit secreted by the adrenal glands, but you know, you replaced this hormones on women and clinically, they do incredibly better. So that by itself, after so many years of being an internist and seeing women going through this until I did my own training, and I started looking at hormone replacement as part our longevity medicine program. That I learned, how much can we help? We can help a lot.

Joseph M. Raffaele, M.D.

Yup, yeah. Well, listen, it’s been really fantastic talking to you, hearing about your experience with two patients in telomere biology and the case reports. And I look forward to seeing you at one of the meetings really soon. Although I’m a little jealous that you’re down in Argentina right now with the summer coming up rather than the winter that we’re moving into here.

Marcela V. Young, M.D.

Yeah, we’re gonna have to organize something for you to be here.

Joseph M. Raffaele, M.D.

Yeah, I’d love to visit Argentina again. Again, thank you very much Marcela.

Marcela V. Young, M.D.

You’re welcome, it’s a pleasure.

Joseph M. Raffaele, M.D.

We’ll talk soon, take care.

Marcela V. Young, M.D.

Take care, bye.