AGE RIGHT - Turn Back the Clock with a Proven Personalized Antiaging Program by Karlis Ullis, MD, with Greg Ptacek, Simon & Schuster, New York, 1999, 320 pp, $23. ISBN 0-684-84197-5

Dr Karlis Ullis, a sports medicine and rehabilitation physician at UCLA who has served as a physician at five Olympic games, explains to us why some friends at age 50 look 40 and, conversely, some friends at 26 look 40. He starts with a discussion of the rapidly moving science of antiaging clinical medicine, genetics, biochemistry, and biotechnology. It took 18 centuries, at the rate of 2 days every year, to increase life expectancy from 30 years in the Roman Empire to an expectancy of 40 years in 1870. Why did life expectancy double in the next 130 years so that babies born today can expect to live to be 80? The control of infectious diseases increased longevity, but did little to prolong genetically determined life expectancy. Aging is a process, elements of which can be halted or even reversed.

Dr Ullis has a practice in Los Angeles where many of his patients are actors and models who look younger than their chronological age because of laser wrinkle removals, breast implants, tummy tucks, buttock lifts, collagen injections, and ultrasound liposuction. But they still suffer the "four D's" of advanced aging--discomfort, disability, drugs, and doctors. Their bodies suffer from decreased muscle and bone mass, decreased water content and increased fat levels, all things that cosmetic surgery cannot reverse. Ullis also has patients in their 20s, who appear on magazine covers and in television commercials with sculptured physiques, and yet have signs of advanced aging.

Although our taste peaks at age 6, eyesight at 10, bone density at 20, the emphasis of this book is what can be expected by age 50. The brain shrinks 6%, resulting in a loss of cognitive abilities that may be offset by a greater accumulation of knowledge and experience, sometimes called wisdom. Dopamine and acetylcholine, two of the three major neurotransmitters rapidly decline, while the third, serotonin, usually remains at youthful levels. Vision becomes farsighted, with difficulty adjusting to darkness from a loss of the rods--photoreceptors--in the retina. As our lens hardens and yellows, we lose color perception for yellow-blue. We are experiencing a tidal wave of hearing loss in our youth from listening to loud music. Half of all men will have some balding. Half of all men and women of European descent will have at least some gray hair (onset is a decade later in non-Europeans). The bladder loses its elasticity, which means less capacity and more trips to the bathroom. Vaginal walls become thin, lubrication decreases, sperm counts dramatically decrease, and erections take twice as long. The heart will have beaten two billion times and begin to enlarge as the elasticity of the arteries decrease. The lungs lose their elasticity and the capacity to breath declines 20%.

Humans have been thinking about aging for a long time. After quoting Greek philosophers of the fifth century BC, Ullis zooms across the centuries of alchemists, wizards, shamans, snake-oil salesmen and elixirs of eternal life--tipping his hat to Ponce de Leon, who at least discovered Florida in his search, to the French physiologist Charles-Edouard Brown-Sequard who promoted the extracts of crushed animal testicles as the fountain of youth.

In 1961, Leonard Hayflick (Sacramento Medicine, November 1996) discovered cellular aging. He proved that cells have a finite life. After dividing about fifty times, cells suddenly stop, weaken, and die. (Two exceptions are cancer cells, which produce death, and sperm, which produces life.) This programmed cell death is call apoptosis and gives rise to the notion of an "aging clock."

In the last 30 years, theories of aging have fallen in and out of fashion. The Los Angeles Gerontology Research Group at the UCLA School of Medicine identified 25 current theories. These can be classified into two schools: The "school of chance" that includes the classic "wear-and-tear" theory, which purports that the bodies 7 trillion cells produce an "accumulation of trash," including the toxic free radicals. The "school of grand design" is much neater. Death is not some messy, random biological event, but is programmed into our cells. Find the genetic switch to the aging clock, and the aging process can be halted or even reversed. The telomere theory of Hayflick is currently out of favor, and the alternate master plan waiting in the wings is thought to be in the Human Genome Project, which is in the process of mapping all of the 100,000 human genes by the year 2005.

Ullis gives us the "Three Pathways" of physical, mental, and emotional aging with case studies and recommendations for each. He also offers six antiaging lifestyle strategies: 1) Avoid exposure to aluminum and other environmental metal and toxins. 2) Eat less animal protein. 3) Deal with chronic stress. 4) Exercise regularly. 5) Make friends and lovers. 6) Stimulate your brain. Woven in with all the pathways and strategies are the practical discussions of supplements, dietary, and exercise regimens, much of which is in easy-to-use workbook fashion. Lastly, he gives us his projections for the 21st century in an epilogue.

This book is professionally developed and of practical use for our profession. Different portions can easily be sampled independent of each other, perhaps even during a patient's missed 15 minute appointment.

Del Meyer, MD