This is an admirably comprehensive list of what drives the aging process. And you have managed to translate it for the layperson to understand.

Far from being critical, I’d like to add some personal critique of your choice of categorization. It is something that I also have voiced with respect to the AHA’s Life’s Essential 8” concept: the mixture of lifestyle habits with biomarkers. I’ll get to that in a moment.

First, let’s differentiate the two. In Life’s Essential 8 the behaviors are sufficient exercise, sufficient sleep, no smoking, and a prudent diet. The biomarkers are BMI, blood lipids, blood pressure, and blood glucose. I think that this classification lacks coherence.

The four biomarkers get out of whack, so to speak, because of not meeting some or all of the four lifestyle behaviors. My point? By placing the biomarkers on equal footing with the behaviors that cause their derailment, the LE8 concept downgrades the supremacy and causative role of the health behaviors. It encourages people to think, “Oh, I don’t do exercise, but for my hypertension, I take my pills.” That’s not the preferred choice.

In your post, I fully subscribe to numbers 1, 2, 3 & 5 as the four health behaviors. Number 6 is an essential one that LE8 actually missed out on.

Possibly in the AHA’s next iteration, we’ll see it as the ninth item (maybe they call it then Life’s Necessary 9; after all they seem to love alliterations, with LE8’s predecessor being Life’s Simple 7). But the AHA is laser-focused on heart health, and skin cancer doesn’t show up on their radar. Understandable.

Back to your post: Risk No. 7 can be summarized as frailty. It is the consequence of too little exercise and insufficient protein nutrition. Since we can quantify frailty, it is also a biomarker, which, again, is a consequence of the aforementioned behaviors. Stay strong enough, keep your bones strong enough, and you’ll attenuate the risk of falling. Personally, I see frailty as the next frontier in gerontology. Because those who pass the triple-digit age mark in a generally healthy state are still frail and ultimately die of it.

Risk No. 4, oxidative stress, inflammation, and AGEs (advanced glycation end products) are all biomarkers of underlying detrimental health behaviors that precede these biomarkers’ derailment.

Risk No. 9 Genetics. Yes, on first blush, this is an unmodifiable risk factor. BUT this view precludes the main point that I always emphasize in my work: When one’s lifestyle matches one’s genetic predisposition, lifelong health and functionality is virtually assured. The problem is, that we can’t read the recipe for the perfect lifestyle match from our genome.

What we do know is, that the “perfect match” does not necessarily require that any given individual has to score a perfect 10 for every lifestyle behavior. Each one of us has a certain robustness against some sort of lifestyle insult. Look at George Burns who still acted at age 99, and was as healthy as a horse despite smoking 9 cigars a day. Or our former German Chancellor Helmut Schmidt. Same habits. They were the extremely rare specimen whose violation of your risk No. 3 didn’t harm them. What I want to illustrate is that being able to violate some of the strict rules, and still being able to stay fit, healthy, and fully functional, is the message that I want to get out. It makes staying healthy and choosing the right path so much more palatable to the people who we, quite frankly, often overwhelm with our constant barrage of “don’t do this” and “do that”.

That’s why my team and I have operationalized (for the first time actually) a layperson capable way of finding their perfect behavior-genome match through a clinically valid trial-and-error method (the N-of-1 single case experiment) about which you can read on our website (https://www.adiphea.com/en/n-of-1-for-indvidualised-lifestyle-medicine/) or watch a brief explanatory video on its home page.

So, not to leave the wrong impression, please don’t take my response as criticism. It is absolutely not. It simply reflects my personal view of how we should approach the path to healthy longevity.