Book Review

Einstein Editions: Age Later and High Risk

Einstein Editions: Age Later and High Risk

By Sue Byrne

Exploring the Science of Longevity

Nir Barzilai, M.D.
Founding director of the Institute for Aging Research at Einstein, the Ingeborg and Ira Leon Rennert Chair in Aging Research, professor of medicine and of genetics at Einstein, and an endocrinologist at Montefiore

Every year, trees signal their leaves to change color and die. Are people programmed to deteriorate in a similar way? Or is it possible to stave off mortality? Nir Barzilai, M.D., who has spent the past few decades researching the mechanisms that drive aging, addresses that question in his new book, Age Later.

Growing old, after all, not only transforms us but makes us susceptible to one or more of the “big four” illnesses: Alzheimer’s, cancer, diabetes, and cardiovascular disease. Dr. Barzilai had long wondered whether the aging process could be targeted like a disease, to slow it down and lengthen the human “health span.”

In 1998, to gain insight into the biology of aging, Dr. Barzilai launched a study of “Super Agers”—people living independently at age 95 and beyond who had not experienced diseases that plagued their peers. Dr. Barzilai and his team focused on Ashkenazi Jews, who are more genetically uniform than other groups, making it easier to spot gene differences and similarities that might be present. The Longevity Genes Project enrolled nearly 3,000 men and women, about 750 of whom were ages 95 to 109 and the rest either offspring of the Super Agers or older adults with no longevity in their backgrounds. Participants were mainly from the New York metropolitan area and had similar education and income levels.

Most of these exceptionally long-lived individuals possessed at least one of the following genetically influenced traits:

  • High levels of good cholesterol—high-density lipoprotein—which protects them from heart attacks and dementia;
  • Unusually low levels of the growth hormone IGF-1 (insulin-like growth factor 1), a protein produced in the liver; and
  • Unusually high levels of mitochondrial-derived peptides, which provide resilience against the stresses of aging.

Many of the Super Agers also benefited from healthy lifestyles and healthy environments. But their most significant common denominator was possessing gene mutations that seem to confer long life spans. Dr. Barzilai and his colleagues have so far identified dozens of such “longevity genes.”

So how can the rest of us improve our chances of becoming centenarians, especially if we haven’t inherited the right genes? Dr. Barzilai is working on that. He co-founded a biotech company that is targeting several hallmarks of aging, and he serves as chief medical consultant for several other companies with a shared goal: developing drugs to prevent Alzheimer’s, diabetes, and other diseases of aging.

In the meantime, he says, the best antidote for aging is exercising for at least 25 minutes three to five times a week. What else helps? Don’t eat too much or too often, and focus on the positive things in life—one of which, in the near future, he assures us, will be drugs that mimic what longevity genes can do.

Published by: St. Martin’s Press, 2020

Stories of Pregnancy, Birth, and the Unexpected

Chavi Eve Karkowsky, M.D.
Associate professor of obstetrics & gynecology and women’s health at Einstein and medical director and clinical liaison of outpatient obstetrics at Montefiore Medical Center

Pregnancy is often used as shorthand for “happily ever after.” But the experience is almost never that simple, as maternal-fetal medicine specialist Chavi Eve Karkowsky, M.D., describes in her new book, High Risk.

Some women—those with an autoimmune disease or a history of miscarriages, for example—already know they’ll need a maternal-fetal medicine specialist, also known as a high-risk-pregnancy doctor, when they get pregnant. But plenty of others might be having a completely routine pregnancy—until they’re not. Maybe their water breaks at 27 weeks. Maybe an ultrasound picks up something not quite right about the shape of the fetal heart.

High Risk offers insights into those complications, but also covers a wide spectrum of reproductive health issues—genetic testing, ultrasounds, miscarriages, preterm births, the dramatic rise in cesarean sections, and the diagnosis of stillbirth.

Pregnancy, Dr. Karkowsky explains, often produces plenty of surprises, and almost nobody (not even some doctors) knows what can happen before, during, and after. “I wish someone had told me” is what she hears often from patients, she writes.

Dr. Karkowsky aims to do just that by telling compelling stories of some of the patients she has seen in her years of practice, in well-written chapters organized like a pregnancy itself: trimesters one, two, and three; full-term pregnancy; going into the hospital (or staying out); and postpartum and beyond.

She also shares her own experiences, including the nausea and vomiting (which affects 70% to 90% of pregnant women) that had her “hating every moment” at six weeks and grabbing the sides of her bed “as if I were shipwrecked on an unstable raft.”

A chapter is devoted to maternal mortality and racial disparities. From 2011 to 2014 in the United States, pregnancy-related mortality rates for Black women were 3.2 times those for white women, a “shameful truth,” Dr. Karkowsky notes. The medical establishment is beginning to understand the scope of the problem, she writes, but countering physicians’ implicit biases (subconscious prejudices) is going to take hard and constant work.

The book concludes with a night on the labor and delivery floor, “routine and amazing, everyday and earth-shattering, all at once.” It begins at 5:05 p.m. after an already busy day at the clinic, when Dr. Karkowsky and her colleagues divvy up the evening’s patients. One has chronic hypertension and three prior cesarean sections; another, eight days past her due date, came in because her water broke; a third patient had just fallen down stairs at 27 weeks; a fourth is already 5 centimeters dilated; and a fifth is recovering from a cesarean and being monitored after a blood transfusion.

Dr. Karkowsky runs from patient room to operating room and back all night, until the morning team arrives at 7:30. She exits the hospital exhausted but upbeat. After all, she notes, she has had “a front-row seat to the most interesting and compelling parts of human experience.”

Published by: Liveright, an imprint of W.W. Norton, 2020

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