What I Got Wrong About Aging (Even as a Medical Doctor)
For a long time, I believed I understood aging. And yet, I got some very important things wrong. Medicine itself teaches us to look at aging through a narrow lens. This is what I had to unlearn.
I Thought Aging Was Mostly Genetics
It is not. Genetics matter, but far less than we once believed.
Large twin and population studies suggest that roughly 20–30% of variation in lifespan is explained by inherited genetics, with the remainder shaped by environment and behavior such as metabolic health, physical activity, nutrition quality, sleep, and stress physiology.
At a biological level, gene expression is responsive to inputs, and epigenetic mechanisms help regulate how genes behave. While we cannot rewrite our DNA, we can influence the conditions in which our biology operates. These changes accumulate across the life course and shape aging trajectories.
Genes set the baseline. Daily inputs shape the outcome. Aging is not a fixed script. It is a dynamic process.
I Thought Disease Was the Main Problem
It is actually dysfunction.
Medicine is structured around diagnosing disease states. Diabetes. Hypertension. Osteoporosis. Dementia. But aging biology does not begin with diagnosis. It begins with gradual loss of physiological reserve.
Insulin resistance is linked to higher risk across multiple domains, including cardiovascular disease and is increasingly associated with cognitive decline and several cancers.
Loss of muscle mass precedes frailty and falls.
Arterial stiffness precedes hypertension.
Mitochondrial function and energy metabolism often shift with age and can contribute to fatigue and cognitive changes, even before a diagnosis appears.
By the time a disease label appears, the underlying systems have often been drifting off course quietly and predictably. The real target is not treating disease. It is preserving function.
I Thought Prevention Was Mostly About Screening
It is not.
Screening is valuable, but it is often misunderstood. Most screening tools are designed to detect disease once it has already developed, not to prevent it from forming in the first place. A normal result can be reassuring, but it can also create a false sense of security.
Many chronic conditions do not appear suddenly. They develop gradually, through years of subtle biological changes that remain invisible to standard tests. By the time a screening result turns abnormal, underlying dysfunction has often been present for a long time.
True prevention focuses upstream, before pathology becomes measurable. It looks at glucose regulation, muscle preservation, inflammatory balance, hormonal signaling, sleep architecture, and stress response. These systems shift quietly, often decades before a diagnosis is made.
Cardiorespiratory fitness and muscle strength are among the strongest predictors of later life independence and mortality, yet they are rarely treated as core clinical targets. Insulin sensitivity influences cardiovascular disease, cognitive decline, cancer risk, and musculoskeletal health, yet it is often addressed only after blood sugar crosses diagnostic thresholds.
Screening asks whether disease is present. Prevention asks whether the biology that leads to disease is being supported. Prevention works best long before numbers look alarming.
I Thought More Information Would Automatically Lead to Better Health
It does not.
We live in an era of endless data. Biomarkers. Wearables. Genomics. But biology does not improve through information alone. It improves through behavior sustained over time.
Behavioral research suggests that too much information without prioritization can increase anxiety, decision fatigue, and inaction. More testing can even worsen outcomes if it creates stress without a clear path to action.
The question is not how much you can measure. It is what you can actually change.
I Thought Discipline Was the Main Driver
Environment matters more. Health outcomes follow context.
Built environments shape movement. Food systems influence nutrition. Work culture dictates sleep and stress. Social norms affect alcohol use, recovery, and rest.
Chronic stress alters cortisol signaling, insulin sensitivity, immune regulation, and even brain structure. No amount of personal discipline can fully override an environment that keeps the nervous system constantly activated.
Behavior is not a moral trait. It is an adaptive response to surroundings.
I Thought Longevity Was Expensive
It does not have to be.
For a long time, I equated aging well with access. Advanced testing. Premium supplements. Wearables. Specialised clinics. While some tools can be helpful, they are not foundational. Scientifically, the strongest predictors of healthy aging are also the least expensive.
Walking and regular movement.
Resistance training to preserve muscle.
Adequate sleep.
Basic metabolic health.
Limiting ultra processed foods most of the time.
Strong social connections.
Many of the most powerful longevity interventions are negative cost.
What makes longevity feel expensive is mostly marketing. Tools can be useful when they change decisions, but the fundamentals still drive most of the benefit.
I Thought It Was Too Late to Change After 40 or 50
It is not.
One of the most damaging myths in aging is the idea that meaningful change has an expiration date. Research shows that improvements in strength, insulin sensitivity, cardiovascular fitness, and even aspects of cognitive function are possible well into later decades of life. Muscle remains responsive to resistance training in older adults, and metabolic health can improve with lifestyle changes at almost any age. The slope of decline is not fixed.
Intervention timing matters but starting later is still profoundly better than not starting at all.
I Thought Decline Was Inevitable and Linear
It is not.
Aging is not a straight line downward.
Periods of stability, improvement, and resilience are possible, especially when foundational systems are supported. Many aspects of aging accelerate not because of time alone, but because of inactivity, loss of muscle, chronic inflammation, and metabolic dysfunction.
What looks like “normal aging” is often accelerated aging.
I Thought Longevity Meant Living as Long as Possible
It does not.
Length of life without quality is not success. Longevity science increasingly focuses on healthspan, the years lived with independence, cognitive clarity, mobility, and purpose.
The goal is not adding years at any cost. The goal is adding good years.
Aging is often discussed as a problem to be solved or a threat to be outrun. But it is neither. It is a long biological conversation between our bodies and the lives we lead. That conversation begins earlier than most people realize, and it continues quietly, whether we pay attention or not.What deserves more focus is not perfection or optimization, but stewardship. How we move, eat, rest, recover, and relate to others shapes how resilient our systems remain over time.