In February 2020 it was already apparent that COVID-19 is clearly a gerolavic disease. Gerolavic stemming from Greek géros, an old “old man” and epilavís, “harmful”, meaning it is much more harmful to the elderly. After analyzing the data coming from Wuhan and the Diamond Princess cruise ship, I started working on a paper to recommend the use of several known geroprotectors as a way to protect the elderly. On March 3rd I arrived in London and met an academic physician and healthcare entrepreneur, Dr. Dina Radenkovic, who I previously met at the JP Morgan Biotechnology Conference earlier in the year in San Francisco where we discussed how advances in artificial intelligence can be used to drive drug discovery in the aging field. Dina was still practicing academic medicine at Guy’s and St. Thomas Hospital, one of the most prestigious hospitals in the UK that became the national Covid-19 center. She generously agreed to collaborate on the paper where we were supposed to be co-authors. Unfortunately, on March 12th the WHO classified COVID-19 as a global pandemic and Dina decided to withdraw from the paper to avoid any potential controversies of the public misinterpreting our critical analysis of some of the novel, not yet fully clinically proven, anti-aging interventions as endorsed clinical recommendations and as publications of government employees became a very sensitive topic. She has subsequently published several research papers on the risk stratification of patients in Covid-19 and the effect of the virus on the cardiovascular system.
Introducing Dr. Dina Radenkovic, a longevity physician
Today, Dr. Radenkovic is one of the youngest longevity doctors with multiple academic papers serving as a Chief Science Officer (CSO) of Hooke, a health management program and longevity research center, built around the emerging principles of geroscience. However, it took a lot of work to get here.
She was born in South Serbia during the turbulent war times of the Balkans. Early on, she developed an interest in mathematics and natural sciences and received numerous awards at national and international competitions in math, physics, biology, and chemistry. At the age of 14, she took a human biology class and fell in love with human physiology. And here she was very lucky. Her father, being a professor of histology and embryology encouraged her to work at the wet lab, collect chorionic villi and study the growth of embryonic tissues under the microscope.
After the war, Dina moved to London and got into UCL Medical school, where she got a dual degree in medicine and physiology. She was a good student and got multiple awards including number one in preclinical medicine and the physiological society annual prize for the best overall performance in physiology BSc. She founded Be The Change UCL, the largest multi-disciplinary student-led quality improvement initiative, and won the National NHS Quality Improvement Championship in 2016. She was scouted by Brent Hoberman to present at the exclusive event in London called the Founders Forum, where she pitched in front of technology leaders Erich Schmidt and other technology moguls. Rubbing shoulders with the captains of the industry she further developed a passion for longevity and aging research. She started “Watch Out Diabetes”, a digital gestational diabetes prevention program, which became part of the NHS Glucofocus Accelerator.
After UCL, she worked on a variety of clinical and research projects at the Barts Heart Centre and Massachusetts General Hospital and had a research post at Harvard University, working in the field of preventative cardiology. Later she was an academic doctor at St Thomas’ Hospital, worked on the frontline during the Covid-19 pandemic, and was a visiting Research Fellow at the Twins Research, King’s College London. And recently, she decided to focus on longevity full-time as a CSO of Hooke
I decided to ask Dr. Dina Radenkovic a few questions:
You are a very young and successful doctor, what motivated you to get into longevity medicine?
I really tried hard to study the lipids driving atherosclerotic disease, systemic damage to the blood vessels throughout the human body that begins in adolescence. For one of the projects, I was using some of the non-linear models on the UK Biobank population and collaborating with researchers at Stanford and the Buck Institute. I was also working on a paper with my colleague Moshen Mazidi (King’s College) and Maciej Banach(University of Lodz) on the ApoB/ApoA-I ratio in the USA patient dataset which showed that the ratio of these apoproteins that broadly speaking are often reflective of one’s bad cholesterol to good cholesterol ratio, predicted not only the cardiovascular but cancer mortality and these were closely related to the functioning of T-cells of the adaptive immune system. While biology tends to be rather complex and unifying explanations end up often being ridiculed oversimplifications that do not give these interlinked physiological systems it’s merit, I would say that the general consensus here was that the major chronic diseases that cause humans to die – atherosclerosis, type 2 diabetes, many cancers, dementia and probably to an extent age-related macular degeneration, tended to be related to the general reduction in body’s immune system and an increasing degree of chronic inflammation that occurs with aging. Therefore, with my mentors, I decided to try and address the causes of the causes, which in our view was age-related immune decline. This is, again, an oversimplification and not the way I would present my scientific work at an academic conference, but I hope it explains the key findings that got me into the field of longevity.
Can you tell me more about the clinic Hooke?
Hooke London is founded on this principle of proactive longevity medicine. Science’s understanding of aging has undergone a revolution in the last thirty years. Increasingly, we are seeing that ageing can be controlled with drugs and lifestyle interventions that help to slow the rate of change. We are also trialing several of in-development deep ageing clocks, some of the most advanced ones developed by Deep Longevity. Everyone in the longevity field is aware that these surrogate markers of biological ageing are absolutely essential in order to be able to conduct rigorous randomised controlled trials and provide class A evidence of anti-ageing interventions.
Together, as a multidisciplinary team, we work collaboratively to turn cutting-edge research into practical, evidence-based advice for our members. Hooke really is a place where data-driven medicine meets exceptional service and support.
The Hooke London approach is underpinned by intensive diagnostic screenings that take place three times per year. Our process includes blood analysis, genetic testing, physical and mental health consultations, musculoskeletal fitness and nutritional assessments. Our clinical team translate this data into personalised health and lifestyle plans, designed to help every member achieve their goals and live happier, healthier lives. Our team-based approach is modeled on the clinical panels who treat, train and advise elite professional athletes. Our individual specialists work together, joining the dots between their fields to create a head-to-toe plan that supports the member as the whole person, rather than a disparate kit-of-parts. We also provide ongoing support, advice and encouragement to members, to ensure they feel the benefits of our work for years to come, not just for January. This means cultivating long-term relationships, regular retesting and adjusting health plans over time, as circumstances and life stages change. For many, signing up with Hooke London will be the best investment they’ve ever made.
I got into the longevity research over 16 years ago and from one perspective, the pace of progress is very impressive and we saw more advances during the past decade then during the entire recorded human history. From another perspective, there are virtually no longevity- and performance-extending procedures available in the clinic today or nearing the clinic in the near future. Which are of longevity research excites you the most?
Thank you Alex for this question. I honestly think that we are in one of the most exciting fields in the world and I hope that the tragedy of the Covid-19 pandemic will help us understand the importance of life sciences and further accelerate the influx of talent, resources and capital into the space. Health should be regarded as a necessary foundation for a prosperous society.
1. Deep Ageing Clocks – we already discussed these, and we truly have the honor to collaborate with Deep Longevity among others, on clinical validation of these. I am excited about new aging clocks based on metabolomic and proteomic signatures. Epigenetics so far seems to show improvements for example 6 months after quitting heavy smoking but is less likely to show a change after the introduction of moderate daily exercise for 4-6 months, thus it might not be dynamic and sensitive enough to truly track personalised lifestyle changes. I am yet to see more date on the microbiomics and transcriptomics and telomere lengths have shown to be tricky so far.
2. Advances in artificial intelligence especially federated learning and split learning that might have particular application in longevity medicine where we struggle with the need of long term follow up periods and numerous isolated small datasets with strict confidentiality issue of sharing, so I think bioinformatics will be the key.
3. New generation of wearables that will really allow us to have a lab in the house and stop guessing what we need but tailor our daily work, exercise, supplements, food, sleep and social life based on our daily markers. Many of these already exist and I am fortunate enough to have the pleasure to collaborate with many of these companies, examples are: daily urine strips that measure your stress and vitamin levels like Vessel so you can see how much Magnesium you need to take each day as it has a very wide recommended dose range, continuous glucose monitoring to show you your unique blood sugar responses to different foods and how these are affected by the time of the day you consume them and your cortisol levels, sleep and recovery with Oura ring, exercise intensity and heart rate variability with Whoop, 6 Lead ECG with the Kardia device and many others.
4. Making medicine feel good. They say wellness is the new high end fashion. Understanding pathophysiology of the disease better means that we can screen for it and intervene early. It also means that we medicalise people at the younger age and ask them to do something about a disease while they are still probably completely asymptomatic. That is not easy, hence we need to make lighter version of preventative medicine feel better. People should have their health lists to reduce the number of sick lists in later life. Good healthy habits and not necessarily pieces of new branded clothing should be regarded as ‘desirable’ and ‘fashionable’.
I think by working on human longevity and increasing time spent in good health, we will feel we have more time. Having more time will enable us to do more good rather than make rushed decisions optimising for short term gains. It is the concept of delayed gratification and restriction for the pursuit of something bigger and better. It could mean a lot for the progress in science and engineering and the benefits for the society. Most advances in biomedical science take time!
What longevity interventions do you practice?
I try to practice what I preach but I must admit that following a healthy lifestyle is not easy when trying to work hard and care for others and I certainly have my weaknesses and inner battles.
Medically, I have yearly full-body MRI and regular colposcopies and smear tests. I have physicals and bloodwork every 4 months. I wear the CGM twice per year. I wear an Oura ring to help me track my sleep and the MyZone belt to quantify exercise and I enjoy the team element of competing with colleagues over our weekly exercise progress.
I always try to get 7-8h of sleep and cannot think clear after 2 sleepless nights. I try to do the fasting mimicking diet during long haul flights and changes in time zones. I do time restricted eating of 8-10h per day and try to have at least 1 day a week when I achieve at least 18h fast. I still struggle with >24h fasts if I need to get out of bed. I enjoy boxing twice a week, running 10km runs once or twice a week and then the rest is gym and dancing and getting daily steps through little walks. My diet is mostly Pescatarian and I rarely eat meat. I have never smoked and don’t drink alcohol. I do have a sweet tooth and I am trying to manage stress levels and design my macroenvironment in such way that a bit of 85% dark chocolate or honey with some yoghurt and berries or oats and cinnamon will suffice. If I see I am going too crazy, I try to speak to myself and see what the underlying reasons are driving my behavior and address these. Often, these are not immediately solvable but at least acknowledging them, stopping and reflecting and saying I am better than that sometimes helps.
I change my supplements regularly based on what I am optimising for in each trimester and bloodwork results. At the moment, I take Vitamin D as I had Vitamin D deficiency in February 2019 despite small supplementation, folic acid as I am in reproductive age, Magnesium as it helps with muscle recovery, sleep and sugar craving, vitamin E high dose as there are meta-analysis showing reduced cervical cancer risk, 1 brazil nut as a source of selenium, vegan spray with very low doses of iron, iodine (which I was a bit low in the spring) and B12 and in the last quarter of 2020, I started taking pure NMN. During Covid-19 and the cold season, I also take vitamin C and zinc. I love extra virgin olive oil, avocados and fish, so try to get my Omega 3s from food only and use nutritional software to hit the targets.
Most importantly, wherever possible, and at times very difficult in 2020, I try to keep an optimistic view and follow my intellectually curious scientific mind and use the life-long learning as my sense of purpose.
There are many young girls in the world who are choosing what to do in life and which career to choose. Do you have any advice for them?
1. Start with what you want not with what is possible and then reverse engineer it.
2. Create a thinking structure and stick to it. I often like Conrad Wolfram’s DACI (define the problem, abstract to computational form, compute, interpret the results).
3. Start looking after yourself and your health as early as possible. In elementary school, before I left for the mathematical department, I used to skip PE so I can do more math classes. I discovered the beauty of amateur sports in late teens during medical school as I realized it is the key to a calm mind and a healthy body. Especially in medicine but also with increasing demands to deliver at work, there is a culture to push ourselves, pull out ‘all-nighters’, take too many energy drinks, caffeinated supplements, stimulant, and cognitive enhancing drugs exaggerate in competition and toxic stress. Try to be the best you can but not at the cost of your mental and physical health, in the end, life is about the little good things we do every day.
Time is relative and if we do our job well, the kids of today should have more of it, in good health, and hopefully preserved climate and environment with even better technologies.
When starting the “Women in Longevity Medicine” series I thought that it would be easy to find female medical doctors actively engaged in aging research, publishing in high-impact journals, and practicing medicine. However, it turned out to be a difficult task. In the case that you know of outstanding individuals fitting these criteria, please put us in touch for a possible article.