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Age Later: Health Span, Life Span, and the New Science of Longevity
A groundbreaking work by the founder of the Institute for Aging Research at the Albert Einstein College of Medicine, whose research helps treat age-related illnesses and increase lifespan.
Nir Barzlai, M.D., founded the Institute for Aging Research at the Albert Einstein College of Medicine over twenty years ago. His most fascinating study features a patient population of 600 centenarians--individuals who maintain active lives well into their 90s and 100s--and, more importantly, reached that milestone never having experienced the so-called big four: cardiovascular disease, cancer, diabetes and cognitive decline.
Dr. Barzlai identified three clusters of genetic mutations--connected to levels of cholesterol, growth hormones and peptides produced in their cells' mitochondria--that correlate to centenarians' enviable lifespan and healthspan. In Age Later, he translates those findings to news listeners can use--including taking melatonin and using intermittent fasting--to mimic some of the effects of the "super agers'" genetic code.
Nir Barzlai, M.D., founded the Institute for Aging Research at the Albert Einstein College of Medicine over twenty years ago. His most fascinating study features a patient population of 600 centenarians--individuals who maintain active lives well into their 90s and 100s--and, more importantly, reached that milestone never having experienced the so-called big four: cardiovascular disease, cancer, diabetes and cognitive decline.
Dr. Barzlai identified three clusters of genetic mutations--connected to levels of cholesterol, growth hormones and peptides produced in their cells' mitochondria--that correlate to centenarians' enviable lifespan and healthspan. In Age Later, he translates those findings to news listeners can use--including taking melatonin and using intermittent fasting--to mimic some of the effects of the "super agers'" genetic code.
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Published June 16, 2020
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October 24, 2020
Books by serious researchers on how to defeat aging are now coming out almost as fast as I have time to read them.
This one mostly aims to enable us live in good health to 115, preferably via a few simple pills.
Age Later is fairly similar to Sinclair's Lifespan. At least, the differences are small compared to how they differ from Aubrey de Grey's Ending Aging. I'm a bit concerned by this, since anti-aging research has not yet demonstrated enough results to justify converging on a single strategy. Maybe that's just an artifact of who's writing books?
The book has only a little bit of theorizing about the causes of aging and about why we should expect it to be curable. Barzilai endorses Sinclair's unimpressive attempts at a theory.
Barzilai waits until the last page to mention an argument that aging can, in principle, be fully reversed (as opposed to delayed). To wit, that fetal cells start with an age of zero, even though the egg and sperm show clear signs of being as old as the parents.
Studies of Centenarians
A fair amount of the book is devoted to evidence from centenarians.
Barzilai provides plenty of examples which indicate that they have far from perfect genes and lifestyles. It's unlikely that we can get much in the way of useful advice from this. E.g. exercise clearly helps some people live longer, while others get can away without it. Since I can't tell which category I'm in, I treat exercise as necessary.
One questionable example:
I suggest that Barzilai look for a better textbook. Experts who study pre-agricultural tribes say that people there don't get dementia. I'm pretty sure that's due to lifestyles, not a shortage of APOE4. Also, APOE ε4 Is Not Associated with Alzheimer’s Disease in Elderly Nigerians. APOE4 seems well adapted for the lifestyles of many of our distant ancestors, but not so well adapted to the lifestyles of the most developed countries. Presumably, the APOE4 centenarians had enough features of ancestral lifestyles to meet their particular needs.
Centenarian biomarkers seem to be a more interesting topic. High humanin and HDL levels in centenarians might hint at some promising interventions.
Calorie Restriction
Age Later contains a disturbing claim about the semi-famous University of Wisconsin calorie restriction study (Caloric Restriction Delays Disease Onset and Mortality in Rhesus Monkeys). Barzilai, one of the reviewers of the study, noticed that the monkeys weighed more than was plausible for calorie restricted animals, and got the researchers to admit that a caretaker had given the calorie restricted monkeys almost as much food as the controls.
This apparently means that the study's report of 30% calorie restriction was bogus. Yet my attempts to find discussion of this accusation on the web have turned up nothing. I'm very confused. How can Science just ignore this? Did everyone involved just decide that the deviation didn't last long enough to matter?
Does it mean we should dismiss the whole study? Or conclude that a smaller than reported degree of calorie restriction produced the reported benefits (i.e. that the study understates the benefits)? Barzilai seems uninterested in pursuing this issue. He thinks calorie restriction "works", at least for some humans, but that the costs outweigh the longevity benefits (he prefers a form of intermittent fasting).
Metformin
Barzilai's favorite near term hope for treating aging is metformin. It has been shown to extend life in a number of species, and there's some weak evidence of large benefits in healthy humans. Barzilai makes the human evidence sound stronger than it actually is - the most interesting study showed that diabetics getting metformin outlive non-diabetic controls. However, metformin is only given to relatively healthy diabetics. It's not hard to imagine that patients who were selected to get metformin were unusually healthy except for their diabetes.
See here and here for balanced summaries of metformin. My guess is that metformin is valuable for the large number of people who are developing insulin resistance, although it's healthier, and usually possible, to avoid insulin resistance in the first place.
Barzilai does note that he considers metformin just a first step in handling aging, and he hopes it will pave the way for more ambitious research.
Funding
There's a good deal of money for research into patented treatments for aging that would likely be expensive, but not much funding for cheap treatments such as Metformin.
Barzilai sees it as critical that the FDA now recognizes aging as a disease. I see that as only having moderate effects on the cost of getting a treatment for aging approved (e.g. any aging treatment ought to qualify as a cancer treatment, but trials might need twice as many patients if only the cancer benefits count). Barzilai recounts evidence that progress is being held back much more by the reluctance of funding agencies, such as the NIH, to consider aging a disease (or is their reluctance due to a presumption that it's untreatable?), yet somehow he doesn't say that it's important for the NIH to classify aging as a disease.
Barzilai has done a great job of convincing the FDA to more or less agree to a definition of aging that recognizes it as a disease which is worth curing.
The definition seems mostly appropriate. Barzilai complains that the FDA rejected the use of diabetes as evidence of age-related loss of health. Barzilai is mostly right here. The FDA seems to be demanding that aging be defined in terms of outcomes that are clearly quite harmful (stroke, dementia, death). Diabetes doesn't guarantee a big decline in quality of life. Cancer is a more complicated story, and is likely the most critical aspect of aging to fix - how did the FDA decide to include it but not diabetes?
The definition is pretty likely to exclude just about any treatment that doesn't help with aging. But I have some concerns that it might end up locking in criteria that are overly expensive to meet. E.g. if epigenetic clocks prove to be reliable measures of age-related health, trials which use those clocks as the primary outcome might be an order of magnitude cheaper.
Barzilai expresses doubts about epigenetic clocks, because "methylation may not be such a reversible process." That's odd, since there was a study showing reversal in humans which was published in time that it could have been squeezed into the book, and an RCT showing reversal published shortly after Age Later. It seems clear that our main doubts about epigenetic clocks ought to be the risk that the clocks are just symptoms, not causes, of aging.
Conclusion
Age Later is a moderately good book, probably appropriate for influencing funding agencies to shift a bit more money to aging research. It's a bit more focused than I'd like on small improvements.
It didn't quite convince me to buy stock in Barzilai's company, CohBar.
This one mostly aims to enable us live in good health to 115, preferably via a few simple pills.
Age Later is fairly similar to Sinclair's Lifespan. At least, the differences are small compared to how they differ from Aubrey de Grey's Ending Aging. I'm a bit concerned by this, since anti-aging research has not yet demonstrated enough results to justify converging on a single strategy. Maybe that's just an artifact of who's writing books?
The book has only a little bit of theorizing about the causes of aging and about why we should expect it to be curable. Barzilai endorses Sinclair's unimpressive attempts at a theory.
Barzilai waits until the last page to mention an argument that aging can, in principle, be fully reversed (as opposed to delayed). To wit, that fetal cells start with an age of zero, even though the egg and sperm show clear signs of being as old as the parents.
Studies of Centenarians
A fair amount of the book is devoted to evidence from centenarians.
Barzilai provides plenty of examples which indicate that they have far from perfect genes and lifestyles. It's unlikely that we can get much in the way of useful advice from this. E.g. exercise clearly helps some people live longer, while others get can away without it. Since I can't tell which category I'm in, I treat exercise as necessary.
One questionable example:
Most striking, two of the centenarians had variants that are a major risk factor for Alzheimer's (APOE4) - the textbooks say they should have been suffering from dementia at age seventy and dead at eighty
I suggest that Barzilai look for a better textbook. Experts who study pre-agricultural tribes say that people there don't get dementia. I'm pretty sure that's due to lifestyles, not a shortage of APOE4. Also, APOE ε4 Is Not Associated with Alzheimer’s Disease in Elderly Nigerians. APOE4 seems well adapted for the lifestyles of many of our distant ancestors, but not so well adapted to the lifestyles of the most developed countries. Presumably, the APOE4 centenarians had enough features of ancestral lifestyles to meet their particular needs.
Centenarian biomarkers seem to be a more interesting topic. High humanin and HDL levels in centenarians might hint at some promising interventions.
Calorie Restriction
Age Later contains a disturbing claim about the semi-famous University of Wisconsin calorie restriction study (Caloric Restriction Delays Disease Onset and Mortality in Rhesus Monkeys). Barzilai, one of the reviewers of the study, noticed that the monkeys weighed more than was plausible for calorie restricted animals, and got the researchers to admit that a caretaker had given the calorie restricted monkeys almost as much food as the controls.
This apparently means that the study's report of 30% calorie restriction was bogus. Yet my attempts to find discussion of this accusation on the web have turned up nothing. I'm very confused. How can Science just ignore this? Did everyone involved just decide that the deviation didn't last long enough to matter?
Does it mean we should dismiss the whole study? Or conclude that a smaller than reported degree of calorie restriction produced the reported benefits (i.e. that the study understates the benefits)? Barzilai seems uninterested in pursuing this issue. He thinks calorie restriction "works", at least for some humans, but that the costs outweigh the longevity benefits (he prefers a form of intermittent fasting).
Metformin
Barzilai's favorite near term hope for treating aging is metformin. It has been shown to extend life in a number of species, and there's some weak evidence of large benefits in healthy humans. Barzilai makes the human evidence sound stronger than it actually is - the most interesting study showed that diabetics getting metformin outlive non-diabetic controls. However, metformin is only given to relatively healthy diabetics. It's not hard to imagine that patients who were selected to get metformin were unusually healthy except for their diabetes.
See here and here for balanced summaries of metformin. My guess is that metformin is valuable for the large number of people who are developing insulin resistance, although it's healthier, and usually possible, to avoid insulin resistance in the first place.
Barzilai does note that he considers metformin just a first step in handling aging, and he hopes it will pave the way for more ambitious research.
Funding
There's a good deal of money for research into patented treatments for aging that would likely be expensive, but not much funding for cheap treatments such as Metformin.
Barzilai sees it as critical that the FDA now recognizes aging as a disease. I see that as only having moderate effects on the cost of getting a treatment for aging approved (e.g. any aging treatment ought to qualify as a cancer treatment, but trials might need twice as many patients if only the cancer benefits count). Barzilai recounts evidence that progress is being held back much more by the reluctance of funding agencies, such as the NIH, to consider aging a disease (or is their reluctance due to a presumption that it's untreatable?), yet somehow he doesn't say that it's important for the NIH to classify aging as a disease.
Barzilai has done a great job of convincing the FDA to more or less agree to a definition of aging that recognizes it as a disease which is worth curing.
The definition seems mostly appropriate. Barzilai complains that the FDA rejected the use of diabetes as evidence of age-related loss of health. Barzilai is mostly right here. The FDA seems to be demanding that aging be defined in terms of outcomes that are clearly quite harmful (stroke, dementia, death). Diabetes doesn't guarantee a big decline in quality of life. Cancer is a more complicated story, and is likely the most critical aspect of aging to fix - how did the FDA decide to include it but not diabetes?
The definition is pretty likely to exclude just about any treatment that doesn't help with aging. But I have some concerns that it might end up locking in criteria that are overly expensive to meet. E.g. if epigenetic clocks prove to be reliable measures of age-related health, trials which use those clocks as the primary outcome might be an order of magnitude cheaper.
Barzilai expresses doubts about epigenetic clocks, because "methylation may not be such a reversible process." That's odd, since there was a study showing reversal in humans which was published in time that it could have been squeezed into the book, and an RCT showing reversal published shortly after Age Later. It seems clear that our main doubts about epigenetic clocks ought to be the risk that the clocks are just symptoms, not causes, of aging.
Conclusion
Age Later is a moderately good book, probably appropriate for influencing funding agencies to shift a bit more money to aging research. It's a bit more focused than I'd like on small improvements.
It didn't quite convince me to buy stock in Barzilai's company, CohBar.
October 12, 2020
I read this in less than 24 hours because a lot of it was only worthy of skimming. The author's tone is boastful, the writing and editing are poor, and . . . there just isn't much here. I agree with the top Amazon review: "I do not recommend this book. There was a lot of research done on longevity. It seems that genes are an important factor. But to me, the take-away from the book is that maybe someday there will be a pill to help."
Don't bother.
Don't bother.
April 4, 2020
I won Age Later as part of a giveaway. The book was well written. It's not a fast read since the author is part of a study on aging so the book reads like peer reviewed journal article only longer. There are interesting tidbits about aging and stories about individuals/families that make the reading less dry. But the book doesn't present the reader with any new information. It boils down to what we were told as kids "you are what you eat" and "get some exercise". Those with good genes can balance out any indiscretions like lifelong smoking/drinking but Barzilzai points out that there is not one gene that ensures longevity.
October 28, 2020
Just 3 stars. I have read books that provide a deeper level of recommendations on aging in a healthy way. The author is obviously a very smart medical doctor, but he seems to offer "soft" ideas - "We just don't know yet" or "it depends" kinds of concepts. While I understand this, that is not the reason I picked up the book. I took a few concepts away but will not be incorporating others (mainly his medical supplements).
July 3, 2020
I appreciated how the author was willing to offer more insights of his research, what they were thinking at some point or the other, what challenges they faced, and how they go beyond, all these besides the medical recommendations to stay sharp and in good shape.
March 16, 2021
The author and his team of researchers at the Albert Einstein College of Medicine of Yeshiva have been working with a group of centenarians (a person who is a hundred or more years old) to understand why some people live healthy, happy lives until age 120+, while some fall sick and die before they hit 60.
In this book, he shares the story of how his research has shaped over the years and the fascinating discoveries his team made along the way. The tone is conversational, but you've to pay a lot of attention so you don't miss out on what's being conveyed.
Being from an academic background myself (I have a masters degree in civil engineering, have pursued several research papers in reputed journals, and am pursuing my Ph.D. in geotechnical engineering), I find a lot of the stories relatable, especially the lackadaisical attitude of the government towards research and how hard it's to convince the authorities to get funding for a project.
Why it's so hard to read
Dr. Nir Barzilai is the founding director of the Institute for Aging Research, the Nathan Shock Center of Excellence in the Basic Biology of Aging, and the Paul F. Glenn Center for the Biology of Human Aging Research at Albert Einstein College of Medicine of Yeshiva University.
For such a well-educated person, you can imagine how scientific most of the language would be and how it'd be difficult for you to understand if you don't have at least a basic knowledge of high-school science.
Why you should read it anyway
The author discusses some fascinating concepts, namely:
- By treating one disease at a time, we're just exchanging one disease for another. If we found a way to delay the onset of all diseases by at least 20 years, we could delay aging, enabling humans to contribute to society for a far longer period.
- By practicing certain habits, we can reverse the biological clock and actually become "younger." The author discusses what you should do and how to go about it.
In this book, he shares the story of how his research has shaped over the years and the fascinating discoveries his team made along the way. The tone is conversational, but you've to pay a lot of attention so you don't miss out on what's being conveyed.
Being from an academic background myself (I have a masters degree in civil engineering, have pursued several research papers in reputed journals, and am pursuing my Ph.D. in geotechnical engineering), I find a lot of the stories relatable, especially the lackadaisical attitude of the government towards research and how hard it's to convince the authorities to get funding for a project.
Why it's so hard to read
Dr. Nir Barzilai is the founding director of the Institute for Aging Research, the Nathan Shock Center of Excellence in the Basic Biology of Aging, and the Paul F. Glenn Center for the Biology of Human Aging Research at Albert Einstein College of Medicine of Yeshiva University.
For such a well-educated person, you can imagine how scientific most of the language would be and how it'd be difficult for you to understand if you don't have at least a basic knowledge of high-school science.
Why you should read it anyway
The author discusses some fascinating concepts, namely:
- By treating one disease at a time, we're just exchanging one disease for another. If we found a way to delay the onset of all diseases by at least 20 years, we could delay aging, enabling humans to contribute to society for a far longer period.
- By practicing certain habits, we can reverse the biological clock and actually become "younger." The author discusses what you should do and how to go about it.
September 20, 2024
There is some interesting science here and some even better one liners from the centarians he studies. I have a hard time forgiving the author for his blithe dismissal of estrogen replacement therapy. If it were just suffering through 3-4 years of hot flashes and disrupted sleep nbd. What I resent him ignoring is the catastrophic thinning of vaginal and nether region tissue. If every time he peed, pooped or had sex his tissue tore I bet he would think it was a big deal. Ditto the sudden onset of osteoporosis and blood sugar regulation. Wrinkles and dry skin I can handle, being a sexless, diabetic cripple, not so much.
March 3, 2025
Barzilai offers an optimistic, personal, and anecdotal view that lacks depth. He drifts into pseudoscience, eg. claims about prayer and reflexology.
April 25, 2021
Ugh. I really wanted to like this book but at some point I simply screamed NO and tossed it. Virtually the entire premise of the book seems to be that the secret to be a happy and healthy centenarian is to be blessed with good genes--so that you don't have to worry about smoking, lack of exercise, or being obese. For the rest of us, there may be hope in the future for a pill or treatment that will tweak our DNA to mimic that of the genetically blessed centenarians. The search for the pill or treatment will be driven by cruel and painful experiments on mice and monkeys (ethics and compassion be damned) financed by big pharma. I shudder at the thought of creating a super race of long lived humans with manipulated genes derived from experiments littered with dead and suffering sentient beings.
April 21, 2021
Detailed map of efforts to find aging, but perhaps it comes down to genetics, and doses of Metformin? Slightly different than genetics (implied) and exercise pushed by the mainstream. Perhaps the best distillate would be Move, Hydrate, Stuff your face less (Whatever your intake drop 10%) and Use your stress rather than be consumed by it.
June 5, 2021
I get that he is a doctor and researcher and trying to help people as they age. I feel that he is too focused on pharmaceuticals as the answer. We all know that drugs come with risks. I also think one of the critical messages is that longevity is by and large genetic and with lifestyle changes we can live well into our later years. I am going to opt for the drug-free option!
November 4, 2022
This book was interesting, very optimistic on the future of battling aging. The focus on adding more healthy years not just more years. The section on Metformin was good, the only drug currently known to have a positive effect on all 4 of the most serious causes of aging. It's a little repititious of all the info in the other books on aging I've been reading, so I guess I'll wait a few more years to read another.
June 9, 2024
When I entered the giveaway for this book, I thought it would be a self-help book about what I could do to age healthier and live a better quality of life. This was not that book.
This book was a synopsis of D. Barzilai's research studies in anti-aging, and the drug studies he is currently involved in. While the information they learned was interesting (at first-- it got to be a bit repetitive), it was mostly focused on two routes-- genes or Metformin (or a new, not yet developed drug).
So, if you have a genetic tendency to live longer and healthier, yay for you. If not, you are SOL and better hope this new-fangled drug emerges in time to help you. Normally a self-help book arms you with actionable steps that you can take. This one just left me feeling like there was nothing I could do.
I won this book in a Goodreads Giveaway.
This book was a synopsis of D. Barzilai's research studies in anti-aging, and the drug studies he is currently involved in. While the information they learned was interesting (at first-- it got to be a bit repetitive), it was mostly focused on two routes-- genes or Metformin (or a new, not yet developed drug).
So, if you have a genetic tendency to live longer and healthier, yay for you. If not, you are SOL and better hope this new-fangled drug emerges in time to help you. Normally a self-help book arms you with actionable steps that you can take. This one just left me feeling like there was nothing I could do.
I won this book in a Goodreads Giveaway.
December 26, 2021
« We are finally able to say that aging as we know it, is over ».
As if these are the actual words pasted across the back cover….
The book does anything but elucidate aging. A book describing the research career of a scientist. Could have been summed up in 1 chapter. Not worth the read in my opinion.
As if these are the actual words pasted across the back cover….
The book does anything but elucidate aging. A book describing the research career of a scientist. Could have been summed up in 1 chapter. Not worth the read in my opinion.
December 11, 2022
This is mistitled: It's not really the secrets of centenarians, but the history of the biochemistry involvement in the fight against aging. It was interesting at times, but not very useful, and I really didn't care to hear about the foibles of the author's biotech company
September 29, 2022
“Evolution has faced a lot of challenges and perfected our biology through trial-and-error experiments over billions of years. So when scientists make a discovery, we first asked, ‘Why did evolution create it this way?’ “
I didn’t realize that evolution was a rational creative force. The story of the evolutionary origin of mitochondria once having been a bacteria that ended up getting enveloped by a goopey cytoplasmic mass to create cells as we know them today… that requires more faith than I have. And this is emblematic of much that I found frustrating about Age Later.
Throughout the book, the author’s reasoning doesn’t seem to hold together well. Besides his origin theories, he seems to talk in circles: ‘Some people live longer because they live longer.’ At other times the author points to promising research (nature provides many examples of exchanges between longevity and reproduction!)… but the evidence is always far from conclusive, often based on animals, and while he’s considering a hypothesis, he will give a handful of examples where nature exhibits proofs to the contrary. Ultimately, the author identifies 3 “Top Secrets” that he has discovered- even though not all SuperAgers (centenarians) have all of them (of course). These are high good cholesterol, low levels of growth hormone IGF-1, and high levels of mitochondrial derived peptides... not exactly things that are within our grasp to control… by natural means anyway. Dr. Barzilai’s goal was to find an existing drug that could target multiple hallmarks of aging like inflammation, metabolic dysregulation, and mitochondrial quality. To this effect the second half of the book reads like a promotion for his research on targeting aging with the diabetes drug metformin. Regarding the difficulties of drug research in general, he acknowledges, “pathologies we thought were unrelated are actually so closely connected that it’s impossible to disregard the integrative nature of human physiologies as we search for answers to our questions about the biology of aging,” hence the reason that pharmaceutical/drug interventions usually cause unintended harms by side effects. Yet, in spite of this, this is the tack he will take. After all, he is a biotech and drug researcher, and the search for a miracle pill to help humans delay the aging process is his life’s work. Meanwhile, I am glad that this book is over so I can move on to more pragmatic endeavors.
I didn’t realize that evolution was a rational creative force. The story of the evolutionary origin of mitochondria once having been a bacteria that ended up getting enveloped by a goopey cytoplasmic mass to create cells as we know them today… that requires more faith than I have. And this is emblematic of much that I found frustrating about Age Later.
Throughout the book, the author’s reasoning doesn’t seem to hold together well. Besides his origin theories, he seems to talk in circles: ‘Some people live longer because they live longer.’ At other times the author points to promising research (nature provides many examples of exchanges between longevity and reproduction!)… but the evidence is always far from conclusive, often based on animals, and while he’s considering a hypothesis, he will give a handful of examples where nature exhibits proofs to the contrary. Ultimately, the author identifies 3 “Top Secrets” that he has discovered- even though not all SuperAgers (centenarians) have all of them (of course). These are high good cholesterol, low levels of growth hormone IGF-1, and high levels of mitochondrial derived peptides... not exactly things that are within our grasp to control… by natural means anyway. Dr. Barzilai’s goal was to find an existing drug that could target multiple hallmarks of aging like inflammation, metabolic dysregulation, and mitochondrial quality. To this effect the second half of the book reads like a promotion for his research on targeting aging with the diabetes drug metformin. Regarding the difficulties of drug research in general, he acknowledges, “pathologies we thought were unrelated are actually so closely connected that it’s impossible to disregard the integrative nature of human physiologies as we search for answers to our questions about the biology of aging,” hence the reason that pharmaceutical/drug interventions usually cause unintended harms by side effects. Yet, in spite of this, this is the tack he will take. After all, he is a biotech and drug researcher, and the search for a miracle pill to help humans delay the aging process is his life’s work. Meanwhile, I am glad that this book is over so I can move on to more pragmatic endeavors.
April 2, 2020
This book is full of interesting material for those interested in growing old gracefully and with health. It underlines that the process is not a passive one. I think anyone who cracked the cover could find something interesting inside.
There is a great deal of research referenced by the author. I am not acquainted with his field of expertise so I cannot advise about the accuracy or reliability of his information and reporting. That is not a criticism. I simply haven't the knowledge base to make a cogent comment about that element of the book. I imagine specialists in many fields will find the research intriguing.
I am almost 68. I do weight training with a certified strength and conditioning specialist who has also guided me to eating patterns suited for functional strength and conditioning. I do aerobic workouts as well. Many basic concepts in the book were familiar to me. I'm pleased to see information about the importance of exercise and eating patterns in a format that will reach many people.
One aspect of the book I admire is the emphasis on the foundational aspect of current research on health and aging. This would be a great book for someone working on a masters degree or doctorate to read as they are considering their thesis topic.
The fact that I only gave the book only four stars is because I do not feel qualified to assess the science and research found in it.
There is a great deal of research referenced by the author. I am not acquainted with his field of expertise so I cannot advise about the accuracy or reliability of his information and reporting. That is not a criticism. I simply haven't the knowledge base to make a cogent comment about that element of the book. I imagine specialists in many fields will find the research intriguing.
I am almost 68. I do weight training with a certified strength and conditioning specialist who has also guided me to eating patterns suited for functional strength and conditioning. I do aerobic workouts as well. Many basic concepts in the book were familiar to me. I'm pleased to see information about the importance of exercise and eating patterns in a format that will reach many people.
One aspect of the book I admire is the emphasis on the foundational aspect of current research on health and aging. This would be a great book for someone working on a masters degree or doctorate to read as they are considering their thesis topic.
The fact that I only gave the book only four stars is because I do not feel qualified to assess the science and research found in it.
November 6, 2025
I have read many books on longevity, health, and wellness. Age Later: Secrets of the Healthiest, Sharpest Centenarians has a different research-based approach. Author Nir Barzilai located over 400 individuals in the northeast region of the United States who had been living independently as of ages 95 - 109. He also studied their offspring as well. He calls them Super Agers.
Most people are ill for an average of five to eight years prior to death. By contrast, most centenarians are only ill for about five to eight months before they die. The healthcare costs of the average person who lives past 100 is 30% of those of an average person who dies in their seventies.
Barzilai and his team had three hypotheses about what makes centenarians so special genetically.
1. Centenarians have a perfect genome without any variants or errors or imperfections.
2. Centenarians have had very healthy lifestyles and environments.
3. Centenarians have the same variants in their DNA as the rest of us but were protected from negative effects by other variants in their DNA.
I won't provide any spoiler alerts about the outcomes of the research and the three hypotheses.
Very interesting approach.
Most people are ill for an average of five to eight years prior to death. By contrast, most centenarians are only ill for about five to eight months before they die. The healthcare costs of the average person who lives past 100 is 30% of those of an average person who dies in their seventies.
Barzilai and his team had three hypotheses about what makes centenarians so special genetically.
1. Centenarians have a perfect genome without any variants or errors or imperfections.
2. Centenarians have had very healthy lifestyles and environments.
3. Centenarians have the same variants in their DNA as the rest of us but were protected from negative effects by other variants in their DNA.
I won't provide any spoiler alerts about the outcomes of the research and the three hypotheses.
Very interesting approach.
July 26, 2021
Interesting overview of the current longevity science. I was especially interested in the study on metformin as an anti aging medication, as I had only found reports on it helping those with diabetes. This book suggests it helps prevent type 2 diabetes in people as they age. I was confused however when he lists what he does/takes and he only says NMN and not metformin?? I also wish he had discussed analogs that could be similar, such as berberine.
I also wonder about the potential and impression of conflict of interest, which he does not address at all. He says the researchers are usually out of the loop when it comes to the financial benefit of their work, and his forming companies and daughter companies that are all interrelated is good. But if they are inherently tied to financial success and have all their investors awaiting their results to be positive, that could cause them to be influenced in their interpretation. Hopefully the insistence on double blind studies remains, but I have certainly heard of people being invited to participate in studies, where it is not only not double blind, but the participants have to pay 'a nominal fee' for the medications/supplements.
David Sinclair sold one of his companies to a big pharmaceutical. He is so dogmatic about his beliefs it worries me about his ability to remain impartial and unbiased.
I also wonder about the potential and impression of conflict of interest, which he does not address at all. He says the researchers are usually out of the loop when it comes to the financial benefit of their work, and his forming companies and daughter companies that are all interrelated is good. But if they are inherently tied to financial success and have all their investors awaiting their results to be positive, that could cause them to be influenced in their interpretation. Hopefully the insistence on double blind studies remains, but I have certainly heard of people being invited to participate in studies, where it is not only not double blind, but the participants have to pay 'a nominal fee' for the medications/supplements.
David Sinclair sold one of his companies to a big pharmaceutical. He is so dogmatic about his beliefs it worries me about his ability to remain impartial and unbiased.
December 4, 2025
Dr. Nir Barzilai relates his quest to study and find factors which can be somehow incorporated into a drug that can slow or halt the condition of aging in the human body. The book is fairly exhaustive on the studies and trials that went into finding these factors which gets a bit medically wonky at times. He concludes that the quest is still very much in progress and he believes eventually will result in breakthrough discoveries which will lead to the development of such drugs that will make people live longer.
The study stems from a look into the lives of centenarians and trying to determine factors that contributed to there longevity. Somewhat surprisingly many did not have attributes that we would consider healthy or conducive to long life. Genetics seem to have a greater role. From this experimentation compounds seemed to hold some promise but nothing we could take right now. He does relate in a conclusion things we may pursue to help in leading us in the right direction. Skipping to this point might save some time in slogging through all the research that leads up to the conclusions. A good work in progress none the less.
The study stems from a look into the lives of centenarians and trying to determine factors that contributed to there longevity. Somewhat surprisingly many did not have attributes that we would consider healthy or conducive to long life. Genetics seem to have a greater role. From this experimentation compounds seemed to hold some promise but nothing we could take right now. He does relate in a conclusion things we may pursue to help in leading us in the right direction. Skipping to this point might save some time in slogging through all the research that leads up to the conclusions. A good work in progress none the less.
October 9, 2022
Good synopsis of Dr Barzilai's research into the aging process and his clinical trials designed to postpone many of the diseases of the elderly. Included is an interesting sidebar of a small biotechnology company startup and the daunting dual tasks of obtaining both federal and private funding. The premise of Dr Barzilai's theory is extremely old age, relatively free of disease, is more a matter of genetics rather than environmental factors such as exercise and healthy eating. He quickly brushes aside the "Blue Zone" phenomenon discovered by Dan Buetner by stating that there are nearby villages whose lifespans are much less. This was presented without any data to substantiate his assertion. In a similar manner, he dismisses the "Telomere Effect" research of Dr Elizabeth Blackburn. Dr Barzilai's theory may ultimately be proven correct but his dismissals of current aging theories comes across as jealous and intellectually arrogant.
February 24, 2023
This isn't a full review, but having read many other reviews I noticed two things. First, quite a few people expressed disappointment with the practical guidelines the author offered for improving longevity. Second, a lot of people were left with the impression that Dr. Barzilai thinks longevity is more a function of genes than anything. On the first point, much of what is offered is nothing new. On the second point, Barzilai is not saying your genes are your destiny, he is saying super centenarians have distinct metabolic advantages over the rest of us, but If we play our hand well and take advantage of medicines developed from the research he has conducted there is great hope for all of us to live longer healthier lives. Finally, it is worth adding is that Barzilai does an exquisite job of explaining the research that has been done, that he has done, to improve longevity and he reveals a lot of very interesting insights from his works in a very clear and understandable way.
July 16, 2025
This book is about how to live longer and healthier. It is written by a physician/researcher.
I’m struggling how to rate this book. Some of the chapters I would rate a “5” and others didn’t interest me. For example, I thought the chapter regarding cholesterol was excellent. I did read the whole book but my best advice is to read the chapters that interest you and learn from them and just skim or skip the other chapters.
Critique - the author is very knowledgeable regarding the subject matter. However, at least some chapters are not written in easy to understand layman’s language. At times, he sounded like he was writing to inform the general public, but other times he got into way too much scientific detail and appeared to perhaps be trying to appeal to readers who might be able to provide grant money for his research. He mentioned the need for grant funding frequently.
I’m struggling how to rate this book. Some of the chapters I would rate a “5” and others didn’t interest me. For example, I thought the chapter regarding cholesterol was excellent. I did read the whole book but my best advice is to read the chapters that interest you and learn from them and just skim or skip the other chapters.
Critique - the author is very knowledgeable regarding the subject matter. However, at least some chapters are not written in easy to understand layman’s language. At times, he sounded like he was writing to inform the general public, but other times he got into way too much scientific detail and appeared to perhaps be trying to appeal to readers who might be able to provide grant money for his research. He mentioned the need for grant funding frequently.
June 13, 2022
Interesting book and I enjoyed the audio version's narrator. The short section with concrete action steps could be improved/expanded. I liked reading about the study on centenarians (my fellow jew people oh yeah!) but I agree with others that the conclusion seemed to be "get lucky to be born with good genes" or "someday maybe we will have gene therapy" which is not so helpful here and now.
One thing I have noticed while bingeing longevity books is that the information is very repetitive between authors. Perhaps they could band together and just write one really good book? They all use the same analogies too - especially the one about the Wright brothers and flight. Come on guys.. be more creative.
Also, on that note, this has nothing to do with this book/author but where are the females writing in this field?
One thing I have noticed while bingeing longevity books is that the information is very repetitive between authors. Perhaps they could band together and just write one really good book? They all use the same analogies too - especially the one about the Wright brothers and flight. Come on guys.. be more creative.
Also, on that note, this has nothing to do with this book/author but where are the females writing in this field?
November 23, 2022
I passed about halfway on this nonfiction physiological/biomedical book, as it wasn't my cup of tea, emphasizing a bit too much the Pharma drug development of magic pills that can help any takers live past 100. The text was a somewhat jarring combination of deep dives into experimental DNA research which might intrigue an advanced biomedical student, and random profiles of centenarians and their daily habits and attributes. Ironically, for this book, one elderly "superager" is praised for not taking any meds, while so much of the rest of the book is about making even more new meds available for people.
One valuable insight I did get out of it was a "nature v. nurture" observation. Forthwith, in terms of living past 100, this is about 75% genes, 25% lifestyle; for achieving healthy longevity, on the other hand, it is the reverse: 75% lifestyle, 25% genes. Amen.
One valuable insight I did get out of it was a "nature v. nurture" observation. Forthwith, in terms of living past 100, this is about 75% genes, 25% lifestyle; for achieving healthy longevity, on the other hand, it is the reverse: 75% lifestyle, 25% genes. Amen.
January 14, 2024
Who wouldn't want to live longer? I know I would. I want to be an energetic grandpa, living an active, healthy life. If you like me and want to know about the latest medical developments, this book is for you. But be prepared: if you don't have a medical education, you won't understand the half of it. At least I didn't. Most parts were simply beyond my knowledge and understanding.
Usually, I consider a nonfiction book worth reading if I have a few takeaways. Something that could improve my life, make things better or easier for me. This book delivered a few insights that could help to make some changes in my life to indeed, age later. I could squeeze the content into two chapters that I really can use. With the four stars I appreciate the work put into the book because - if you have the medical background and understand the stuff - I believe the material is quite good.
Usually, I consider a nonfiction book worth reading if I have a few takeaways. Something that could improve my life, make things better or easier for me. This book delivered a few insights that could help to make some changes in my life to indeed, age later. I could squeeze the content into two chapters that I really can use. With the four stars I appreciate the work put into the book because - if you have the medical background and understand the stuff - I believe the material is quite good.
December 8, 2022
I skimmed the parts where the author talks about his own research projects and other research projects. I learned a few new things: 115 is the maximum potential life span for our species, life span is genetic only for the very oldest, decreased mortality rate for a 72-year-old woman with 4400 to 7500 steps per day, a BMI of 27 (which is overweight) has the lowest mortality rate (subcutaneous fat is protective but visceral fat is harmful), only extra-virgin olive oil is helpful, skipping breakfast (adults) may contribute to a longer life, optimistic people and people with a strong purpose in life have longer life spans
May 11, 2020
Interesting read packed with ALOT of data and research by Nir Barzilai ; however I was left wanting to know the secret; the outcome of all the research. A lot of variables with different people but still informative and insightful. I have kept book to go back to and re read to gleam additional insight to the secret to a long life. Not an easy read but one that anyone on a quest for a healthier and longer life should read. BUT do not expect a single list of do's and don'ts or a diet plan...…...
November 27, 2022
If you’re looking for good information about aging, I’d suggest another book or just online research. If you want someone to tell you all the missed opportunities and background scoops into how the research was actually done, maybe check this out. But really the stories weren’t all that good other than to make sure you understand how hard the guy works and how many friends he’s made along the way.
November 9, 2025
“Age Later” presents a readable and engaging exploration of longevity research by a credible scientist. However, its hopeful tone and broad scope mean that for some readers the practical payoff is modest. If your expectations are aligned accordingly, it’s a good addition to your bookshelf—but it may not become a transformative “how-to” manual.
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