10 min read

Why aging is a biological process you can influence — and the eight hallmarks we can move with the tools we already have.

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There’s a quiet revolution happening in aging research, and most of conventional medicine has missed it.

For most of medical history, aging was something that happened to you. A countdown of years. A slow accumulation of wear-and-tear that, at best, you could survive gracefully. Diseases of aging — cardiovascular disease, dementia, type 2 diabetes, cancer — were treated as separate problems, each in its own specialty clinic.

In 2013, a group of European researchers led by Carlos López-Otín published a paper in Cell that quietly changed all of this. They identified nine cellular and molecular processes — they called them the Hallmarks of Aging — that drive nearly every age-related disease. In 2023, they updated the framework with three additional hallmarks, bringing the total to twelve.^{1 2}

Here’s the part most people miss: most of those hallmarks are modifiable. Some by drugs. Some by lifestyle. Some by the same therapies we use at Aervita every day — hyperbaric oxygen, photobiomodulation, targeted supplementation, lifestyle medicine, peptides, IV nutrient therapy.

Aging is no longer something that just happens to you. It’s something you can influence.

What Aging Actually Is (At the Cellular Level)

The traditional model of aging — wrinkles, joints, memory — describes what aging looks like. It doesn’t explain what aging is.

At the cellular level, aging is the gradual breakdown of how cells maintain themselves. Cells stop dividing when they should keep dividing. They keep dividing when they should stop. They accumulate damaged proteins. They generate more inflammatory signals than calming ones. Their mitochondria — the energy factories — get sluggish and inefficient. Their gut microbiome shifts from a balanced ecosystem to a disrupted one. The communication between cells gets noisier and less precise.

When you experience aging — slower recovery from exercise, the 3pm crash, the morning stiffness, the brain fog that wasn’t there a decade ago — what you’re feeling is the function of those underlying cellular processes degrading.

Which means: improve the cellular processes, and the function improves.

The 12 Hallmarks of Aging

The complete framework, in plain language:

1. Genomic instability — DNA damage accumulates faster than the cell can repair it.
2. Telomere attrition — The protective caps at the ends of chromosomes get shorter with each cell division.
3. Epigenetic alterations — Patterns of gene expression drift over time.
4. Loss of proteostasis — Damaged or misfolded proteins build up inside cells.
5. Disabled macroautophagy (added 2023) — The cell’s “self-cleaning” machinery slows down.
6. Deregulated nutrient sensing — Pathways like insulin/IGF-1, mTOR, and AMPK get noisier.
7. Mitochondrial dysfunction — Cellular energy factories produce less ATP and more oxidative stress.
8. Cellular senescence — “Zombie cells” linger and secrete inflammatory signals into surrounding tissue.
9. Stem cell exhaustion — Tissue repair capacity declines as stem cell reservoirs shrink.
10. Altered intercellular communication — Hormonal signaling drops, inflammatory signaling rises.
11. Chronic inflammation (added 2023) — Persistent low-grade inflammation, also called “inflammaging.”
12. Dysbiosis (added 2023) — Diversity and balance of the gut microbiome decline.

The full list is a beautiful summary of what aging actually is at the cellular level. For the patients we see at our Edina clinic, four of these come up over and over in testing — and they respond especially well to integrative approaches.

The Four Hallmarks We Focus on Most

1. Mitochondrial Dysfunction

Mitochondria are the energy factories inside every cell. As they age, they produce less ATP (the energy currency of the body) and more reactive oxygen species (cellular oxidative stress). The result: fatigue, slower recovery, cognitive decline, reduced exercise tolerance, and the slow drag that most patients describe as “just getting older.”

The good news: mitochondria are responsive. They multiply and improve in response to specific stimuli.

Testing. Standard medicine has no good test for mitochondrial function. In functional medicine, the closest practical tool is the Organic Acids Test (OAT) — a urine panel that measures Krebs cycle intermediates, fatty acid oxidation markers, and B-vitamin cofactor sufficiency. When citrate, succinate, malate, or other intermediates are out of range, it points us toward specific mitochondrial bottlenecks we can address with targeted nutrients.

What helps. Zone 2 cardiovascular exercise, strength training, intermittent fasting, and targeted nutrients like CoQ10, NAD+ precursors (NR or NMN), and L-carnitine. Hyperbaric oxygen therapy (HBOT) has emerged as one of the most potent tools — research from Dr. Shai Efrati’s group at Tel Aviv University has shown HBOT protocols can drive new mitochondrial growth in adults over 60.³ Our ARRC LED Photobiomodulation Bed is another direct intervention: red and near-infrared light (typically 630-850 nm) is absorbed by cytochrome c oxidase — Complex IV of the mitochondrial electron transport chain — which improves ATP production and reduces oxidative stress.⁴ Patients in our Edina practice often notice improvements in energy, recovery, and skin within a handful of sessions.

2. Chronic Inflammation (“Inflammaging”)

If you read only one section of this article, read this one. Chronic low-grade inflammation — what researchers call “inflammaging” — is now considered one of the most important drivers of nearly every age-related disease, from cardiovascular disease to Alzheimer’s to type 2 diabetes.⁵

The challenge: chronic inflammation rarely shows up on a standard lab panel. CRP and ESR — the inflammation markers your primary care doctor checks — are blunt instruments and often miss low-grade inflammation entirely.

What helps. Identifying and removing inflammation triggers (food sensitivities, gut imbalances, environmental toxins, chronic infections, sleep debt, unmanaged stress). Targeted nutrients: omega-3s, curcumin, resveratrol, vitamin D. HBOT modulates inflammatory cytokines and shifts macrophages toward their anti-inflammatory phenotype — adding a fourth hallmark to its impact list.

The goal isn’t to “treat” inflammation. It’s to find and remove what’s driving it.

3. Altered Gut Microbiome (Dysbiosis)

Your gut microbiome shapes immune function, neurotransmitter production, hormone metabolism, and even the absorption of the supplements you take. As people age, microbial diversity declines and pro-inflammatory species often replace anti-inflammatory ones. The downstream effects show up as digestive symptoms, mood changes, joint pain, autoimmune flares, and metabolic dysfunction.

What helps. Comprehensive stool testing (GI-MAP, GI Effects, or similar) to map what’s actually living in there. Targeted dietary work — increased fiber diversity, fermented foods, removal of inflammatory triggers. Strategic probiotic strain selection (not just “a probiotic”). Sometimes antimicrobial or antifungal protocols. Sometimes prebiotics. Sometimes nothing at all if the patient already has a robust microbiome.

We see profound improvement in patients when we get this right — and frustrating plateaus when we skip it.

4. Cellular Senescence (and Telomere Attrition)

Cellular senescence is what happens when cells stop dividing but don’t die. They linger. They secrete inflammatory signals that disrupt the cells around them. In aging research, these are called “zombie cells” — and as we accumulate more of them, we accelerate aging in nearby tissue.

The exciting research here involves senolytics — compounds that selectively clear senescent cells. Fisetin (a flavonoid found in strawberries), quercetin, and the prescription combination of dasatinib + quercetin are all being studied actively. The Mayo Clinic has published promising data on diabetic kidney disease using senolytic interventions.⁶

But there’s a less talked-about tool that targets this hallmark — and one more besides. In a 2020 study from Hachmo and colleagues at Tel Aviv University, healthy older adults completed a 60-session HBOT protocol while researchers measured both senescent T-cell populations and telomere length in isolated blood cells.⁷ After the protocol, participants showed:

• A measurable reduction in senescent immune cells
• A significant increase in telomere length (around 20% in certain immune cell populations)

That second finding is the bigger headline. Telomere attrition is its own hallmark (#2 on the list above), and short telomeres are linked to nearly every disease of aging. This was the first human study to show that an environmental intervention — not a drug — could lengthen telomeres in older adults.

HBOT now influences at least four of the twelve hallmarks at once — mitochondrial dysfunction, cellular senescence, telomere attrition, and chronic inflammation. Add stem cell mobilization (next section), and the count is five. Few other tools in functional medicine have that kind of reach across the framework — which is one of the reasons we built such a robust hyperbaric program at Aervita.

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September Promo — The Hallmarks Protocol Pack

To make the exact protocol from the Hachmo 2020 study practically accessible, we’re offering 35% off a 60-session HBOT pack through September 30 — the same protocol that produced the telomere lengthening and senescent cell reduction described above.

A 60-session commitment is serious. The discount makes the protocol financially accessible without changing the science. Limited chamber availability — call our Edina clinic to discuss whether the protocol fits your case and to join the waitlist (security deposit required to hold a slot).

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The 2023 update to the Hallmarks of Aging added dysbiosis to the list for the first time — recognition of what functional medicine practitioners have been working with for years.

Other Hallmarks Within Reach

The four hallmarks above are the ones we test for, target, and track most often. But several others on the list are also influenced by the everyday tools of integrative medicine — sometimes powerfully.

Loss of Proteostasis. Heat shock proteins (HSPs) are the cell’s internal repair crew — they refold misfolded proteins and clear out damaged ones. Two of the most reliable ways to upregulate HSPs are exercise and heat exposure (sauna).⁸ Regular sauna use has been linked in long-running Finnish cohort studies to lower all-cause mortality, lower cardiovascular events, and reduced dementia risk — and HSP induction is one of the proposed mechanisms.

Disabled Macroautophagy. Autophagy is the cellular self-cleaning system. The most potent trigger of autophagy is fasting — including time-restricted eating and fasting-mimicking diets (FMD).⁹ Valter Longo’s work has demonstrated that periodic FMD protocols can drive autophagy and other longevity pathways without the difficulty of true prolonged fasting.

Deregulated Nutrient Sensing. The hallmark with the cleanest lifestyle intervention. mTOR, AMPK, and IGF-1 signaling are all modifiable through exercise, dietary protein cycling, and caloric restriction or its mimetics.¹⁰ Patients don’t need to fast for a week — consistent strength training and a few protein-cycled days each week shifts these pathways favorably.

Stem Cell Exhaustion. Hyperbaric oxygen has a documented effect here too — but the mechanism matters. A 2006 study by Stephen Thom showed that a single HBOT session doubles circulating CD34+ stem cells, with cumulative effects across a treatment series.¹¹ HBOT doesn’t repair stem cells; it mobilizes them from bone marrow into circulation, where they can support tissue repair throughout the body.

That brings the total to at least eight of the twelve hallmarks where the tools of integrative medicine, properly applied, can move the dial in the favorable direction. The pace of research suggests that number is only going to grow.

Why Most People Miss This

Conventional medicine, by design, waits for a disease before it intervenes. Your annual physical screens for type 2 diabetes, cardiovascular disease, and certain cancers — but only after they’ve developed enough to register on standard tests. The hallmarks of aging are happening for years, sometimes decades, before any of those screens turn positive.

In our Edina practice, we see this gap most clearly in adults in their 40s and 50s — people whose annual physicals keep coming back “normal” even as fatigue, brain fog, and slower recovery start to creep in. The standard system isn’t built to find what’s actually happening at the cellular level.

This is the gap that integrative medicine fills. We’re not trying to replace your cardiologist or your primary care doctor. We’re trying to do the upstream work — identifying and addressing the cellular drivers of aging — so the diseases never develop in the first place.

That’s the philosophical core of Aervita: proactive vitality instead of reactive treatment. And it’s the work that makes the biggest difference when patients commit to it over years, not weeks.

The Return Evaluation: A Snapshot in Time

If you’ve been a patient with us before but haven’t been in for a while, we want to bring you back for a focused check-in.

September is Patient Reactivation Month at Aervita: $75 off a 30 minute focused re-exam, a visit where we review what’s changed since we last saw you, retest the markers that matter, and map out where the next 90 days should go. Call or text us at 952-213-6386 to claim it. The discount is applied by our front desk, so it will not come off an online booking.

For patients we haven’t seen in 12+ months, this is the right time to come back. You don’t need a new crisis. The goal is the opposite — to make sure one doesn’t develop while you weren’t looking.

We’ve grown the team by five people during the refinement, so appointment availability is the best it’s been in a long time. Spots will fill.

Call or Text 952-213-6386 to Claim $75 Off →

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Aging is a biology you can influence. Let’s see what your biology is telling you now.

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Slowing the Hallmarks of Aging, Together

If this article did its job, aging looks less like a mystery and more like a checklist — twelve mechanisms, several of them measurable and modifiable today. That’s the work we do at Aervita: biomarker panels to see where your aging biology actually stands, hyperbaric oxygen, PEMF, and red light to support the cellular side, and memberships that make the consistent rhythm affordable.

For readers who want to go deeper into the primary science of aging, the National Institute on Aging maintains an excellent library of research summaries. And when you’re ready to turn reading about aging into a plan for your own healthspan, an $84 Initial Health Assessment at our Edina clinic is the simplest place to start — book here, or explore more on the Aervita blog.

References

1. López-Otín C, Blasco MA, Partridge L, Serrano M, Kroemer G. The hallmarks of aging. Cell. 2013;153(6):1194-1217.
2. López-Otín C, Blasco MA, Partridge L, Serrano M, Kroemer G. Hallmarks of aging: An expanding universe. Cell. 2023;186(2):243-278.
3. Hadanny A, Daniel-Kotovsky M, Suzin G, et al. Cognitive enhancement of healthy older adults using hyperbaric oxygen: a randomized controlled trial. Aging. 2020;12(13):13740-13761.
4. Hamblin MR. Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophysics. 2017;4(3):337-361.
5. Furman D, Campisi J, Verdin E, et al. Chronic inflammation in the etiology of disease across the life span. Nature Medicine. 2019;25:1822-1832.
6. Hickson LJ, Langhi Prata LGP, Bobart SA, et al. Senolytics decrease senescent cells in humans: Preliminary report from a clinical trial of Dasatinib plus Quercetin in individuals with diabetic kidney disease. EBioMedicine. 2019;47:446-456.
7. Hachmo Y, Hadanny A, Abu Hamed R, et al. Hyperbaric oxygen therapy increases telomere length and decreases immunosenescence in isolated blood cells: a prospective trial. Aging (Albany NY). 2020;12(22):22445-22456.
8. Laukkanen JA, Khan H, Zaccardi F, Laukkanen T. Association Between Sauna Bathing and Fatal Cardiovascular and All-Cause Mortality Events. JAMA Internal Medicine. 2015;175(4):542-548.
9. Bagherniya M, Butler AE, Barreto GE, Sahebkar A. The effect of fasting or calorie restriction on autophagy induction: A review of the literature. Ageing Research Reviews. 2018;47:183-197.
10. Most J, Tosti V, Redman LM, Fontana L. Calorie restriction in humans: An update. Ageing Research Reviews. 2017;39:36-45.
11. Thom SR, Bhopale VM, Velazquez OC, et al. Stem cell mobilization by hyperbaric oxygen. American Journal of Physiology – Heart and Circulatory Physiology. 2006;290(4):H1378-H1386.

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