Fantastic Voyage:

Live Long Enough to Live Forever

by Ray Kurzweil and Terry Grossman M.D.

Rodale: 11/2004


Chapter 1

You Can Live Long Enough to live Forever

"Do not go gentle into that good night, Old Age should burn and rave at close of day; Rage, rage against the dying of the light."—Dylan Thomas

“I don’t want to achieve immortality through my work. I want to achieve immortality through not dying.”—Woody Allen

Written at the height of the Cold War, Isaac Asimov’s 1966 science-fiction thriller Fantastic Voyage shifted the public’s fascination from space travel to an even more fascinating journey—inside the human body. In the novel, scientists on “our side” as well as the unnamed “other side” have developed a miniaturization technology that promises victory for whoever can perfect it first. However, the technology has a fatal flaw: the miniaturization wears off quickly.

Professor Benes has figured out a breakthrough that overcomes this limitation, but before he has a chance to communicate his crucial insight, he falls into a coma, with a potentially fatal blood clot in his brain. Against a backdrop of international intrigue, our side sends in a submarine with a team of five people using the still time-limited miniaturization technology to travel inside Benes’s body and destroy the blood clot.

The team includes pilot Owens, who helms the submarine Proteus (now blood cell–size); Duvall, a brilliant neurosurgeon in charge of the medical mission; Peterson, the beautiful surgical assistant (played by Raquel Welch in the highly successful movie version); Michaels, a human-circulatory expert; and Grant, the mission leader from central intelligence. In the course of the drama, readers and moviegoers are treated to a genuinely fantastic voyage through the human body as the intrepid crew battles enormous white blood cells, insidious antibodies, annoying platelets, and a myriad of other threats as they struggle to achieve their goal before the miniaturization catastrophically wears off.

The metaphor of Fantastic Voyage fits our book on several levels. First, we hope to treat you, our readers, to a fantastic voyage through the human body. Our understanding of the complex processes underlying life, disease, and aging has progressed enormously since 1966. We now have an unprecedented ability to comprehend our biology at the level of the tiniest molecular structures. We also have the opportunity to vastly extend our longevity, improve our well-being, and expand our ability to experience the world around us.

Asimov’s fascination with miniaturization was prophetic. We are now in the early stages of a profound revolution in which we are indeed shrinking our technology down to the molecular level. We actually are developing blood cell–size submarines called nanobots (robots whose key features are measured in nanometers, or billionths of a meter) to be sent into the human body on vital health missions. Although we won’t literally be shrinking ourselves to ride inside these nanobots, as in Asimov’s imagined tale (at least not in the next several decades), we will be able to place ourselves in virtual-reality environments and see out of the eyes of these tiny robots. We will be able to control their movements as if we were inside, just as soldiers today remotely control intelligent weapons systems.

Immortality Is within Our Grasp

Do we have the knowledge and the tools today to live forever? If all science and technology development suddenly stopped, the answer would have to be no. We do have the means to dramatically slow disease and the aging process far more than most people realize, but we do not yet have all the techniques we need to indefinitely extend human life. However, it is clear that far from halting, the pace of scientific and technological discovery is accelerating.

According to models that Ray has created, our paradigm-shift rate—the rate of technical progress—is doubling every decade, and the capability (price performance, capacity, and speed) of specific information technologies is doubling every year.4 So the answer to our question is actually a definitive yes—the knowledge exists, if aggressively applied, for you to slow aging and disease processes to such a degree that you can be in good health and good spirits when the more radical life-extending and life-enhancing technologies become available over the next couple of decades.

Longevity expert and gerontologist Aubrey de Grey uses the metaphor of maintaining a house to explain this key concept. How long does a house last? The answer obviously depends on how well you take care of it. If you do nothing, the roof will spring a leak before long, water and the elements will invade, and eventually the house will disintegrate. But if you proactively take care of the structure, repair all damage, confront all dangers, and rebuild or renovate parts from time to time using new materials and technologies, the life of the house can essentially be extended without limit.

The same holds true for our bodies and brains. The only difference is that while we fully understand the methods underlying the maintenance of a house, we do not yet fully understand all of the biological principles of life. But with our rapidly increasing comprehension of the human genome, the proteins expressed by the genome (proteome), and the biochemical processes and pathways of our metabolism, we are quickly gaining that knowledge. We are beginning to understand aging, not as a single inexorable progression but as a group of related biological processes. Strategies for reversing each of these aging progressions using different combinations of biotechnology techniques are emerging. Many scientists, including the authors of this book, believe that we will have the means to stop and even reverse aging within the next two decades. In the meantime, we can slow each aging process to a crawl using the methods outlined in this book.

In this way, the goal of extending longevity can be taken in three steps, or Bridges. This book is intended to serve as a guide to living long enough in good health and spirits—Bridge One—to take advantage of the full development of the biotechnology revolution—Bridge Two. This, in turn, will lead to the nanotechnology-AI (artificial intelligence) revolution—Bridge Three—which has the potential to allow us to live indefinitely.

This, then, is the premise of our book and the case we will make throughout: the knowledge of how to maintain our biological “house” and extend its longevity and vitality without limit is close at hand. We will tell you how to use the extensive knowledge that we do have today to remain healthy as the reverse engineering (decoding and understanding the principal methods) of our biology proceeds.

The 21st Century Is Worth Living to Experience

Most of our conceptions of human life in the 21st century will be turned on their head. Not the least of these is the expectation expressed in the adage about the inevitability of death and taxes. We’ll leave the issue of the future of taxes to another book,5 but belief in the inevitability of death and how this perspective will soon change is very much the primary theme of this book. As we succeed in understanding the genome and the proteome, many dramatic advances in treating disease and even reversing aging will emerge. The first two decades of the 21st century will be a golden era of biotechnology.

Many experts believe that within a decade we will be adding more than a year to human life expectancy every year. At that point, with each passing year, your remaining life expectancy will move further into the future. (Aubrey de Grey believes that we will successfully stop aging in mice—who share 99 percent of our genetic code—within 10 years, and that human therapies to halt and reverse aging will follow 5 to 10 years after that.) A small minority of older boomers will make it past this impending critical threshold. You can be among them. The authors of this book are of this generation and are intent on living through this threshold era in good health and spirits. Unfortunately, most of our fellow baby boomers remain oblivious to the hidden degenerative processes inside their bodies and will die unnecessarily young.

As interesting as the first two decades of this century are likely to be, subsequent decades should lead to even more dramatic changes. Ray has spent several decades studying and modeling technology trends and their impact on society. Perhaps his most profound observation is that the rate of change is itself accelerating. This means that the past is not a reliable guide to the future. The 20th century was not 100 years of progress at today’s rate but, rather, was equivalent to about 20 years, because we’ve been speeding up to current rates of change. And we’ll make another 20 years of progress at today’s rate, equivalent to that of the entire 20th century, in the next 14 years. And then we’ll do it again in just 7 years. Because of this exponential growth, the 21st century will equal 20,000 years of progress at today’s rate of progress—1,000 times greater than what we witnessed in the 20th century, which itself was no slouch for change.
The result will be profound changes in every facet of our lives, from our health and longevity to our economy and society, even our concepts of who we are and what it means to be human. Within a couple of decades we will have the knowledge to revitalize our health, expand our experiences—such as full-immersion virtual reality incorporating all of the senses, augmented reality, and enhanced human intelligence and capability—and expand our horizons.

As we peer even further into the 21st century, nanotechnology will enable us to rebuild and extend our bodies and brains and create virtually any product from mere information, resulting in remarkable gains in prosperity. We will develop means to vastly expand our physical and mental capabilities by directly interfacing our biological systems with human-created technology.

Although human ability to take command of the course of life and death is controversial, we believe that the ability to broaden our horizons is a unique and desirable attribute of our species. And we certainly believe that it is worth the effort to remain healthy and vital today to experience this remarkable century ahead.

A Decades-Long March to Health—or Disease

The leading causes of death—heart disease, cancer, stroke, respiratory disease, kidney disease, liver disease, and diabetes6—do not appear out of the blue. They are the end result of processes that are decades in the making. To help you understand how long-standing imbalances in the metabolic processes underlying life functions can lead to disease, we have developed Ray & Terry’s Longevity Program, which is laid out over the course of this book. (Our program is Bridge One, as mentioned above; Bridges Two and Three are detailed in chapter 2.) The advice we offer on how to keep your body optimally healthy—from what to put into it (“Food and Water,” chapter 4) to how to fine-tune it (“Stress and Balance,” chapter 23)—will enable you to determine your own specific health status and teach you how to take effective corrective action when necessary. Our program does require time and commitment to implement, but the rewards are considerable:

• Significant gains in how you feel, including the alleviation of various discomforts, improved gastrointestinal functioning, reversal of fatigue, improvements in sleep, enhanced mood, and attaining your optimal weight

• A greatly improved sense of well-being and increased levels of energy

• The comfort of knowing that you’re on a path toward long-term health while significantly reducing the risk of chronic diseases such as heart disease, stroke, type 2 diabetes, and cancer

Conventional medical care is geared toward dealing with long-term degenerative processes only after they erupt into advanced clinical disease, but by this time it is often too late. It’s like approaching a cliff but walking backward. You need to recognize that you’re getting closer to the edge and stop. Once you fall off, it’s difficult to do anything about it. This is what Fantastic Voyage is all about: to provide the knowledge and the specific steps to take, sooner rather than later, to extend your life, your vitality, and your well-being.

Who Is the Enemy?

It is wise to consider the process of reversing and overcoming the dangerous progression of disease as a war. As in any war, if the enemy is at the gates—or worse, inside the gates—it’s important to mobilize all the means of intelligence and weaponry that can be harnessed. That’s why we’ll advocate that key dangers be attacked on multiple fronts. For example, we’ll discuss 10 approaches that should be practiced concurrently for preventing heart disease, particularly for people with elevated risk factors.

But if fighting disease and extending longevity and vitality is a war, who is the enemy? At the top of the list we should put ourselves. Of course, health issues get our attention the moment clinical disease strikes, but most people fail to focus on prevention and health enhancement in a timely manner before the onset of overt symptoms. Unfortunately, the medical profession is oriented toward detecting and treating these conditions only after they reach the point of crisis (symptom-control medicine), so most people receive limited guidance on disease prevention from their health professionals. You should not wait for others to show you the path to healing; the only person who can take responsibility for your health is you.

Our second enemy is the disease process itself. Our bodies evolved when it was not beneficial to the survival of the species for people to live beyond their child-rearing years and compete for the tribe’s or community’s limited food and other resources. Only a century and a half ago, life expectancy was 37 years.7 If we want to remain vital for as long as possible, we cannot simply rely on the natural order that biological evolution has given us.

The third enemy is an increasingly vocal body of opinion that opposes extending human longevity on the basis that it supposedly violates the essence of human nature. Author Francis Fukuyama, for example, considers research that might extend human longevity beyond its current fourscore years to be immoral.8 Opposition to certain biological technologies such as stem cell research is delaying vital therapies for a wide range of diseases. We should note that we don’t consider these thinkers themselves to be our adversaries but, rather, their regressive ideas. The essence of the human species is to extend and expand our boundaries. Ultimately, such opposition will end up being mere stones in a torrent of innovation, with the continued flow of progress passing around these barriers. But even minor delays will result in the suffering and death of millions of people.

Public Health Recommendations Are Compromised at the Start

Many people believe that public health recommendations, such as the Department of Agriculture’s Food Pyramid, represent our best collective wisdom.9 People typically then go on to compromise (weaken) these recommendations further to meet their own priorities and circumstances without realizing that the recommendations come already pre-compromised. The result is ineffectual guidelines and a double compromising of health.

The recommendations for vitamins, for example, continue to be dominated by the RDA (recommended dietary allowance) system. But these address only minimal levels to avoid specific vitamin deficiencies and do not begin to reflect the levels required for optimal health.12 Dietary recommendations in general are severely watered down. For example, the nutrition guidelines for people with type 2 diabetes fail to recommend sharp reductions in carbohydrates,13 and the recommendations on fat consumption are the same as for the general public.14 The guidelines from the American Diabetes Association are completely ineffective, despite the fact that the condition, particularly in its early stages, can be largely controlled through nutrition. The same observations can be made regarding dietary recommendations for avoiding heart disease, the nation’s number one killer.15

When we discuss the ineffectual nature of public nutrition guidelines with some health professionals, they counter that their patients won’t even follow these weak recommendations, let alone stricter ones. Our counter to that is that people don’t follow the weak guidelines precisely because they don’t work. Actually, following stricter recommendations is easier in many ways.

Take, for example, carbohydrate consumption. Eating carbohydrates, particularly those with a high glycemic index (those that convert rapidly into sugar in the bloodstream), causes cravings for more carbohydrates. Attempting to “moderately” reduce consumption of carbohydrates turns out to be very difficult because a moderate reduction does nothing to fend off cravings. It’s like suggesting that smokers simply reduce the number of cigarettes they smoke each day. But sharply reducing carbohydrates, particularly high-glycemic-index ones, effectively eliminates cravings, like quitting smoking altogether. It is far more motivating to follow a program that has the potential to make a dramatic difference in your immediate and long-term well-being.

As another example of compromised recommendations, the public health guideline for folic acid supplementation is 400 micrograms (mcg) per day, which may be a reasonable general recommendation. However, for someone with elevated homocysteine levels—a major cause of cardiovascular disease—the recommendation remains 400 mcg per day, which is inadequate to reduce dangerous homocysteine levels. Folic acid supplementation of 2,500 mcg or more per day, however, is safe and effective in reducing homocysteine (as are other recommendations, which we will discuss).

16 The same situation holds for recommendations on “optimal” blood lipid (fat) levels. Public health guidelines state that total cholesterol should be below 200 milligrams per deciliter and that the ratio of total cholesterol to HDL cholesterol should be under 4.6. But even people who achieve such “optimal” levels suffer heart attacks.

How often does a person who consistently maintains a truly desirable lipid profile suffer a heart attack? The answer is almost never. But are such levels really achievable by most people? The answer is yes, they are. So why not set these as the targets?

Our philosophy is to provide optimal recommendations based on the latest research. A great deal is known about ways to modify the long-term destructive health trends that result in the vast majority of deaths and chronic diseases. We’ll offer our best knowledge of effective measures, and you can decide for yourself what changes you are willing to make.

Dynamic versus Static Testing
Another unique aspect of our program is the extensive use of dynamic rather than static testing for early detection of abnormalities whenever possible. Dynamic tests measure the body’s response to changing, or “stressful,” physiologic conditions, while static tests simply provide measurements under baseline (resting) conditions. The exercise stress test, typically done on a treadmill to evaluate cardiac function, is an example of a common dynamic test. In an exercise test, the electrocardiogram (ECG) tracing is monitored both at rest and under conditions of increased workload. Many more patients with early cardiac disease can be detected by an exercise test than by a resting (static) ECG alone.
Another common dynamic test performed by conventional physicians is the glucose tolerance test for the diagnosis of diabetes, which is more sensitive than the static fasting blood sugar test. Yet, as we will see in chapter 9, “The Problem with Sugar (and Insulin),” the standard glucose tolerance test measures only blood sugar levels in response to a dietary sugar challenge (ingestion), so it still misses many early cases of diabetes. By also measuring insulin levels, using the glucose-insulin tolerance test we recommend, many additional cases of diabetes and sugar intolerance can be diagnosed. If we go a step further and add a simple insulin challenge test—a test performed by only a handful of physicians around the country—it is possible to detect numerous cases of insulin resistance, one of the most dangerous risk factors for a host of chronic diseases suffered by a significant segment of the population.

In chapter 13, “Methylation—Critically Important to Your Health,” we discuss abnormal homocysteine metabolism, a risk factor for heart disease, stroke, and Alzheimer’s disease that is carried by more than one-third of the adult population. Yet many cardiologists still don’t perform even the static test on their patients to determine risk levels, and most large U.S. cities don’t have a single cardiologist outside of a teaching hospital who performs the dynamic and far more accurate, yet inexpensive, homocysteine stress test that we recommend.
Early detection of risk factors is a hallmark of our program. By performing dynamic stress tests when appropriate, you can substantially increase the effectiveness of your screening processes.

The Pillars of Our Longevity Program

We’ve organized Ray & Terry’s Longevity Program around the activities and primary physical and metabolic processes that lead to either disease or sustained health. Our program combines the best of both conventional and alternative medicine. Many people have the view that conventional medicine is scientific, whereas alternative medicine reflects unverified folk traditions. The reality is that there are many conventional medicine practices that have not been scientifically verified, while there are many “alternative” practices supported by impressive research and verification.

Alternative medicine is not a single integrated methodology. Rather, it consists of a broad array of ideas that fall outside of conventional medical practice. Indeed, many of these ideas are not well grounded in science or in practical results. We’ve drawn our ideas from the best of conventional medicine, alternative medicine practices with convincing research on safety and efficacy, and cutting-edge developments in biotechnology and nanotechnology.

Partnering with Your Health Professional

It would be difficult to follow a program of this comprehensive nature without a personal guide. Our philosophy has been to draw upon the best from both conventional medicine and alternative schools of thought in an unbiased fashion. So to follow the ideas in our program, you will need access to both worlds.
Your personal physician is trained to deal with diagnosing and treating catastrophic illness, but most physicians are not well prepared to provide guidance in the type of aggressive illness prevention that we address in this book. Unfortunately, disease prevention is not a major focus of mainstream medicine. Moreover, the critical issue of nutrition receives almost no attention in our nation’s medical schools. An ideal approach is to find a physician who combines the best of multiple traditions.

More and more physicians have seen the limitations of practicing orthodox conventional medicine. They have begun to transcend the deep conditioning from their years of medical training, and they (and even more so their patients) have started to experience the joy that comes from thinking outside the box. Many such physicians have joined professional associations that serve as resources to train physicians in cutting-edge nutritionally based medical therapies, offering formal education and examinations to ensure competency. (For a list of certified practitioners and physicians in your area, see Even within the field of nutrition, we are dismayed by how many dietitians—people in the field of nutrition—rigidly follow the highly compromised public health recommendations.

The Most Important Principle: Continual Exploration

The knowledge represented here is inherently dynamic. This is not a fixed program that one simply adopts. The most important principle of the program is continual active exploration of new knowledge from multiple sources:

• Newly available diagnosis and treatment options resulting from the emerging biotechnology revolution

• New insights into natural therapies

• Your own growing personal knowledge of available health information

• New personal knowledge about your own condition

• We plan to update the information in this book on our Web site (see and through future editions of this book. A list of resources also appears on the site.

Most health books offer just one or two new ideas. Ours is different in that it provides dozens that are incorporated into a single integrated program. Based on our research, we believe that the recommendations in Fantastic Voyage will enable you to dramatically reduce your risk of disease in the future while quickly boosting your well-being in the present. Our core idea is that we now have the knowledge to determine where each of us is located in the progression of these decades-long degenerative processes and reverse them.

The support for this concept is rooted in decades of investigation and years of collaboration. Many of the simpler ideas presented in other contemporary health books are valid, but there is no single silver bullet that can address all of the key issues, given the complexity of our bodies and brains. Typically, other health books present one or two ideas combined with a lot of preaching. Instead, we provide a high density of ideas on how to harness contemporary longevity knowledge to transform your health.

Ideas have immense power to transform reality, but only if they are put into practice. There are two ways to use this book:

• Select ideas you find appealing and add them to your personal health program. We expect this is how many readers will benefit from this book.

• Follow all of the recommendations of Ray & Terry’s Longevity Program, which we designed as an integrated and comprehensive approach to nutrition, lifestyle changes, and cutting-edge medical therapeutics.

Health is not simply the absence of diagnosed disease; it’s a path toward ever-greater physical, emotional, and spiritual well-being. There is always the potential to improve your personal health.


Chapter 2

The Bridges to Come

“Life expectancy will be in the region of 5,000 years . . . by the year 2100.”
—Aubrey de Grey

Biological systems are remarkable in their cleverness. In the 15th century, Leonardo da Vinci wrote, “Human ingenuity may make various inventions, but it will never devise any inventions more beautiful, nor more simple, nor more to the purpose than nature does; because in her inventions nothing is wanting and nothing is superfluous.” We share da Vinci’s sense of awe at the designs of biology, but we do not agree with him on our inability to improve on nature. Da Vinci was not aware of nanotechnology, and it turns out that nature, for all its apparent creativity, is dramatically suboptimal. For example, the neuronal connections in our brains compute at only 200 transactions per second, which is millions of times slower than today’s electronic circuits.

Despite the elegant way our red blood cells carry oxygen in our bloodstream and deliver it to our tissues, it is still a slow and cumbersome system, and robotic replacements (respirocytes) already on the drawing board will be thousands of times more efficient than red blood cells. The reality is that biology will never be able to match what we will be capable of engineering once we fully understand biology’s principles of operation.

Another major component of the coming revolution is molecular nanotechnology, which will ultimately enable us to redesign and rebuild, molecule by molecule, our bodies and brains.1 The timing of these two revolutions—biotechnology and nanotechnology—is overlapping, but the biotechnology revolution is leading the full realization of nanotechnology by a decade or two. That’s why we describe these as the second and third bridges, respectively, to radical life extension. Most of the material in this book is Bridge One material—ways to take maximum advantage of the most advanced diagnostic testing and preventive strategies currently available so you can get to Bridges Two and Three.

A Bridge to a Bridge to a Bridge

This book describes three bridges.

1. The First Bridge—Ray & Terry’s Longevity Program—consists of present-day therapies and guidance that will enable you to remain healthy long enough to take full advantage of the construction of the Second Bridge.

2. The Second Bridge is the biotechnology revolution. As we learn the genetic and protein codes of our biology, we are gaining the means of turning off disease and aging while we turn on our full human potential. This Second Bridge, in turn, will lead to the Third Bridge.

3. The Third Bridge is the nanotechnology-AI (artificial intelligence) revolution. This revolution will enable us to rebuild our bodies and brains at the molecular level.2

These emerging transformations in technology will usher in powerful new tools to expand your health and human powers. Eventually, the knowledge represented in this book will be automated within you. Today, however, you have to apply that knowledge yourself. We will talk about each of these three bridges as they relate to the topics under discussion. In each chapter, we will begin with Bridge One strategies that you can apply starting today. Where relevant, we will include a tantalizing look at what Bridges Two and Three have to offer in the near future.
Bridge Two:

The Biotechnology Revolution

As we learn how information is transformed in biological processes, many strategies are emerging for overcoming disease and aging processes. We’ll review some of the more promising approaches here, and then discuss further examples in the chapters ahead. One powerful approach is to start with biology’s information backbone: the genome. With gene technologies, we’re now on the verge of being able to control how genes express themselves. Ultimately, we will actually be able to change the genes themselves.

We are already deploying gene technologies in other species. Using a method called recombinant technology, which is being used commercially to provide many new pharmaceutical drugs, the genes of organisms ranging from bacteria to farmyard animals are being modified to produce the proteins we need to combat human diseases.

Another important line of attack is to regrow our cells, tissues, and even whole organs, and introduce them into our bodies without surgery. One major benefit of this therapeutic cloning technique is that we will be able to create these new tissues and organs from versions of our cells that have also been made younger—the emerging field of rejuvenation medicine.

As we are learning about the information processes underlying biology, we are devising ways of mastering them to overcome disease and aging and extend human potential. Drug discovery was once a matter of finding substances that produced some beneficial effect without excessive side effects. This process was similar to early humans’ tool discovery, which was limited to simply finding rocks and natural implements that could be used for helpful purposes. Now that we can design drugs to carry out precise missions at the molecular level, we are in a position to overcome age-old afflictions. The scope and scale of these efforts is vast; the examples in this book are only a small sampling of the most promising ideas. We’ll provide additional compelling examples in the chapters ahead.

Not Just Designer Babies, but Designer Baby Boomers

Gene technologies will comprise three stages: (1) influencing the metabolic expression of genes, (2) blocking or modifying gene expression, and (3) somatic gene therapy. Let’s discuss how these imminent technologies might impact your personal voyage into the future.

Influencing the metabolic expression of genes. Science does not yet have the ability to change your genes (although this is starting to work), but by knowing what genes you have, you can make appropriate lifestyle choices and engage in preventive strategies to influence their impact. As we’ll discuss in chapter 11, you already have the tools to read a portion of your personal genetic makeup and use this information to guide your lifestyle, nutritional, and supplement choices. You can use this information to design an individualized protocol to avoid diseases and progressive degenerative conditions for which you are genetically predisposed.
Blocking or modifying gene expression. Although we do not yet have the means to alter genes themselves, we are beginning to be able to alter their expression. Gene expression is the process by which your genetic blueprint is read and its instructions are implemented. Every cell in your body has a full set of all your genes. But a specific cell, such as a skin cell or a pancreatic islet cell, gets its characteristics from only a small fraction of all the genetic material it carries—the portion of genetic information relevant to that particular type of cell.3 Since it is possible to control this process outside the cell nucleus, it’s easier to implement these genetic blocking strategies than therapies that require access to the inside of the nucleus.

Gene expression is controlled by peptides, molecules made up of sequences of amino acids and short RNA strands. Scientists are just beginning to learn how these processes work.4 Many new therapies now in development and testing are based on manipulating this gene expression process to either turn off the expression of disease-causing genes or turn on desirable genes that may otherwise not be expressed in a particular type of cell.

Two evolving therapies for blocking or modifying gene expression are antisense therapy and RNA interference. The target of this therapy is the messenger RNA (mRNA), which is transcribed (copied) from DNA and then translated into proteins. For damaged or mutated genes, researchers are exploring ways to block the mRNA created by these genes so that they are unable to make undesired proteins. The repair process uses mirror-image sequences of RNA, called antisense RNA. These sequences stick to the abnormal protein-encoding RNA, preventing it from being expressed.5

In the RNAi (RNA interference) approach, researchers construct short double-stranded RNA segments containing both the “sense” and “antisense” strands. These match and lock on to portions of the RNA that are transcribed from mutated genes. This blocks the native RNA segment’s ability to create proteins, effectively silencing the defective gene. In recent tests, using both RNA strands in this way has been dramatically more effective than using just the antisense strand. In many genetic diseases, only one copy of a given gene is defective. Because you get two copies of each gene, one from each parent, this approach leaves one healthy gene to make the necessary protein.6

Somatic gene therapy. This is the holy grail of bioengineering. This third stage will effectively change the genes inside the nucleus by “infecting” the nucleus with new DNA, essentially creating new genes.7 The concept of changing the genetic makeup of humans is often associated with the idea of “designer babies.” But the real promise of gene therapy is to actually change our adult genes.8 These new genes can be designed to either block undesirable disease-producing genes or introduce new ones that slow down and reverse aging processes.

Animal studies began in the 1970s and 1980s, and now a range of “transgenic” animals, including cattle, chickens, rabbits, and sea urchins, has been successfully produced. The year 1990 marked the first attempts at human gene therapy. The challenge remains to transfer therapeutic DNA into target cells so that the DNA will then be expressed in the right amounts and at the right time.

Let’s look first at how transfer of new genetic material occurs. A virus is often the vehicle of choice. Long ago, viruses developed the ability to deliver their genetic material to human cells, often resulting in disease. Researchers now simply remove the virus’s harmful genes and insert therapeutic genes instead, so the virus then “infects” human cells with these beneficial genes. This approach is relatively straightforward, but viral genes are often too large to pass into many types of cells, such as brain cells. Other limitations of this process include the length of DNA that can be transferred. The precise location where the new viral DNA is integrated into the target cell’s DNA sequence has also been difficult to control. In addition, such “infections” can trigger an immune response, resulting in rejection of the new genetic material.9

The deaths of two participants in gene therapy trials a few years ago caused a temporary setback, although research has since resumed. One patient died from an immune response to the virus vector. The second patient, suffering from “bubble boy” disease—essentially, he was born without an immune system—developed leukemia, which was triggered by the improper placement of the gene transferred into his cells.10 This second death points to two major hurdles that must be crossed for gene therapy to succeed: how to properly position the new genetic material on the patient’s DNA strands and how to monitor the gene’s expression. One possible solution is to deliver an imaging “reporter” gene along with the therapeutic gene. The reporter gene provides image signals that allow the gene therapy to be closely monitored. The process is permitted to proceed only if the placement of the new gene is verified as correct.11

Physical injection (microinjection) of DNA into cells is possible but prohibitively expensive. Exciting advances have recently been made in other means of transfer. For example, fatty spheres with a watery core, called liposomes, can be used as a molecular Trojan horse to deliver genes to brain cells. This opens the door to treatment of disorders such as Parkinson’s disease and epilepsy.13 Electric pulses can also be used to deliver a range of molecules, including drug proteins, RNA, and DNA, to cells.14

One option is to pack DNA into ultratiny (25-nanometer) nanoballs for maximum impact.15 This approach is already being tested on human patients with cystic fibrosis. Researchers reported a “6,000-fold increase in the expression of a gene packaged this way, compared with unpackaged DNA in liposomes.”

Yet another approach uses DNA combined with microscopic bubbles. Ultrasonic waves are used to compress the bubbles, enabling them to pass through cell membranes.

Recombinant Technology: Betting the Family Pharm

We are already using gene therapy in other species. By modifying the genes of bacteria, plants, and animals, we can cause them to create the substances we need to combat human diseases. Recombinant proteins made by combining DNA from more than one organism are now being manufactured by bacteria, a novel biotech appropriately referred to as pharming. In recombinant technology, the genetic material that codes for a desired protein is spliced into the DNA of certain species of bacteria, which then go to work making this protein. Given how fast bacteria multiply, it’s easy to create significant amounts of proteins this way. Insulin was the first molecule to be created synthetically by recombinant technology, so that insulin-dependent diabetics are no longer reliant on injections of beef or pork insulin. Many diabetics developed allergic reactions or high levels of antibodies against the foreign proteins found in the beef- and pork-derived insulin preparations. With recombinant human insulin, this is no longer a problem.
Children with growth hormone deficiency (dwarfs) used to rely on injections of hGH (human growth hormone) derived from the pituitary glands of human cadavers. It took a lot of cadavers to provide enough hGH for just one child for a year. There was also the risk of certain infections. Recombinant hGH has solved this problem and substantially lowered the price of this therapy. It has enabled adults with growth hormone deficiency to be treated as well.

Genes from proteins have also been spliced into “immortalized” human kidney cells and are now being pharmed to create proteins found useful in treating patients who have suffered strokes, as well as numerous other illnesses.16 Patients with chronic kidney disease are deficient in a protein made by the kidneys called erythropoietin. Without erythropoietin, severe anemia results and frequent transfusions are needed. By inserting the genes that code for this protein into hamster cells, drug companies have been able to create enough erythropoietin to avoid the need for transfusion for many dialysis patients.

New methods involving traditional farm animals are also being found. Cows produce large amounts of milk, so splicing DNA into the genes that code for milk is a valuable technique. The DNA that codes for egg protein is now being used so that the eggs of transgenic (containing a gene or genes artificially inserted from a different species) chickens will contain useful proteins. In the near future we will have pharms where the animals have had their genes altered so that their milk, eggs, or even semen will produce recombinant proteins to help treat currently untreatable or only partially treatable conditions, such as multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, hepatitis C, and AIDS.

Pharmers won’t be restricted to using animals. Plants, particularly types with high protein content such as corn or tobacco, can be reprogrammed to produce substances of great value. In Japan, for instance, a strain of genetically modified rice contains a protein that will kill the hepatitis B virus.
Therapeutic Cloning

One of the most powerful methods of applying life’s own machinery to improve and extend life involves harnessing biology’s reproductive mechanisms in the form of cloning. Cloning is an extremely important technology, not for cloning complete humans but for life extension purposes. Therapeutic cloning creates new tissues to replace defective tissues or organs.

All responsible ethicists, including these authors, consider human cloning at the present time to be unethical, yet our reasons have little to do with the slippery (slope) issues of manipulating human life. Rather, the technology today simply does not yet work reliably. The current technique involves fusing a cell nucleus from a donor to a recipient egg cell using an electric spark and causes a high level of genetic errors.17

This is the primary reason most of the fetuses created in this way so far have not made it to term. Even those that do survive have genetic defects. Dolly the Sheep developed an obesity problem in adulthood, and most of the cloned animals produced thus far have had unpredictable health problems. Scientists have a number of ideas for perfecting this process, including using alternative ways of fusing the nucleus and egg cell without the destructive electrical spark. Until the technology is demonstrably safe, however, it would be unethical to create a human life with such a high likelihood of severe health problems.

However, the most valuable applications of cloning technology are not for the purpose of cloning entire human beings but to create human organs, such as hearts or kidneys. This uses germ line cells—those in the prefetal stage (before implantation of a fetus). These germ line cells go through differentiation, which can then be developed into specific organs. Because differentiation takes place during the prefetal stage, most ethicists believe that this process does not raise ethical concerns, although this issue has been highly contentious.18

A team of researchers led by Woo Suk Hwang and Shin Yong Moon of Seoul National University in South Korea has taken an important step forward toward perfecting this technology. In an article published in Science, they announced they had successfully cloned a line of human pluripotent stem cells, the type that has the potential to turn into any type of cell the body needs. Their cell line had already undergone 70 reproductions without incident.19 This research paves the way for significant gains in the production of healthy human-replacement tissues and organs derived from a cloned stem cell line.

Defeating programmed cell death. Therapeutic cloning relates to telomeres, which are strings of a repeating code at the end of each DNA strand. These repeating codes are like a string of beads, in which one “bead” falls off each time a cell divides. This places a limit on the number of times a cell can replicate—the so-called Hayflick limit. Once these DNA beads run out, a cell is programmed for death. Recently, it was discovered that a single enzyme called telomerase can extend the length of the telomere beads, thereby overcoming the Hayflick limit. Germ line cells create telomerase and are immortal. Cancer cells also produce telomerase, which allows them to replicate indefinitely. The identification of this single enzyme creates important opportunities to manipulate this process to either extend the longevity of healthy cells or terminate the longevity of pathological cells, such as cancer.

It is interesting to reflect on the remarkable stability of the immortal germ line cells, which link all cell-based life on Earth. The germ line cells avoid destruction through the telomerase enzyme, which rebuilds the telomere chain after each cell division. This single enzyme makes the germ line cells immortal, and indeed these cells have survived from the beginning of life on Earth billions of years ago. This insight opens up the possibility of future gene therapies that would return cells to their youthful, telomerase-extended state. Animal experiments have shown telomerase to be relatively benign, although some experiments have resulted in increased cancer rates.

There are also challenges in transferring telomerase into cell nuclei, although the gene therapy technology required is making solid progress. Scientists such as Michael West, president and CEO of Advanced Cell Technology Inc., have expressed confidence that new techniques will provide the ability to transfer telomerase into cell nuclei and overcome the cancer issue. Telomerase gene therapy holds the promise of indefinitely rejuvenating human somatic (non–germ line) cells—that is, all human cells.

Progress in growing new tissues and organs from stem cells is developing rapidly. Robert Langer’s team at MIT has grown primitive versions of human organs such as liver, cartilage, and neural tissues. Their technique involves growing cells on specially designed biodegradable polymer scaffolds, which are spongelike structures with the approximate shape of the desired organ. Langer and his team wrote, “Here we show for the first time that polymer scaffolds . . . promoted proliferation, differentiation and organization of human embryonic stem cells into 3D structures.”
One of the challenges in growing new human organs in this way is creating a functioning system of new blood vessels. Researchers at MIT and Harvard Medical School have constructed a working synthetic vascular system using two computer-etched biodegradable polymers sandwiched together to create capillaries only 10 microns (millionths of a meter) wide, as well as arteries and veins up to 300 times wider.20

One exciting approach that bypasses the ethical controversy of using fetal tissue, while also providing a substantial source of stem cells, which are currently limited in quantity, is parthogenesis, or so-called virgin birth. Adding certain chemicals to unfertilized human egg cells can turn them into embryos, which might then act as a source of new stem cells.21 These embryos, called parthenotes, can never become babies, so there should not be an ethical issue in destroying tissue that is destined for destruction anyway. Another intriguing idea is for a woman to create parthenotes from her own egg cells to create stem cells with her own DNA, thereby avoiding potential rejection of foreign cells by a patient’s immune system.
Human somatic cell engineering. This is an even more promising approach that entirely bypasses the controversy of using fetal stem cells. These emerging technologies, also called transdifferentiation, create new tissues with a patient’s own DNA by converting one type of cell (such as a skin cell) directly into another (such as a pancreatic islet cell or a heart cell) without the use of fetal stem cells.22 There have been recent breakthroughs in this area. Scientists from the United States and Norway have successfully converted human skin cells directly into immune system cells and nerve cells.23 Hematech, a biotechnology company, has reprogrammed fibroblast cells back into a primordial state where they can be converted into other types of cells.

Consider the question: What is the difference between a skin cell and any other type of cell in the body? After all, they all have the same DNA. As noted above, the differences are found in protein signaling factors. These include short RNA fragments and peptides, which we are now beginning to understand. By manipulating these proteins, we can turn one type of cell into another.24
Perfecting this technology would not only defuse a contentious ethical and political issue, it would also offer an ideal solution from a scientific perspective. If you need pancreatic islet cells or kidney tissues—or even a whole new heart—to avoid autoimmune reactions, you would strongly prefer to produce these from your own DNA, not the DNA from someone else’s germ line cells. And this approach uses your own plentiful skin cells rather than your rare and precious stem cells.

This process would directly grow an organ with your genetic makeup, and the new organ could have its telomeres fully extended to their original youthful length, effectively making the new organ young again.25 That means an 80-year-old man could have his heart replaced with the same heart he had when he was, say, 25.
The master gene that enables stem cells to remain youthful and pluripotent (able to differentiate into virtually any type of other cell) has been discovered and named nanog by a team at the Institute for Stem Cell Research in Edinburgh, Scotland.26 “Nanog seems to be a master gene that makes embryonic stem cells grow in the laboratory,” says Ian Chambers, one of the team’s scientists. “In effect this [gene] makes stem cells immortal.” The insight is a big step in being able to turn any cell, such as a skin cell, into a pluripotent cell, which can then be transformed into any other type of cell.

Reversing Human Aging

Our understanding of the principal components of human aging is growing rapidly. Strategies have been identified to halt and reverse each of the aging processes. Perhaps the most energetic and insightful advocate of stopping the aging process is Aubrey de Grey, a scientist with the department of genetics at Cambridge University. De Grey describes his goal as “engineered negligible senescence”—stopping us from becoming more frail and disease-prone as we get older.27

According to de Grey, “All the core knowledge needed to develop engineered negligible senescence is already in our possession—it mainly just needs to be pieced together.”28 He believes we’ll demonstrate “robustly rejuvenated” mice—mice that are functionally younger than before being treated, and with the life extension to prove it—within 10 years, and points out that this demonstration will have a dramatic effect on public opinion. Showing that we can reverse the aging process in an animal that shares 99 percent of our genes will profoundly transform the common wisdom that aging and death are inevitable. Once demonstrated in an animal, robust rejuvenation in humans is likely to take an additional 5 to 10 years, but the advent of rejuvenated mice will create enormous competitive pressure to translate these results into human therapies.

Earlier in the evolution of our species (and precursors to our species), survival was not aided—indeed, it would have been hurt—by individuals living long past their child-rearing years. As a result, genes that supported significant life extension were selected against. In our modern era of abundance, all generations can contribute to the ongoing expansion of human knowledge. “Our life expectancy will be in the region of 5,000 years . . . by the year 2100,” says de Grey. By following the three bridges described in this book, you should be able to reach the year 2100, and then, according to de Grey, extend your longevity indefinitely.

De Grey describes seven key aging processes that currently encourage senescence and has identified strategies for reversing each. Here are four of de Grey’s key strategies:

Chromosomal (nuclear) mutations and “epimutations.”29 Almost all of our DNA is in our chromosomes, in the nucleus of the cell. (The rest is in the mitochondria, which we’ll come to in a moment.) Over time, mutations occur, that is, the DNA sequence becomes damaged. Additionally, cells accumulate changes to “epigenetic” information that determine which genes are expressed in different cells. These changes also matter because they cause cells to behave inappropriately for the tissue they’re in. Most such changes (of either sort) are either harmless or just cause the cell to die and be replaced by division of a neighboring cell. The changes that matter are primarily ones that result in cancer. This means that if we can cure cancer, nuclear mutations and epimutations should largely be harmless. De Grey’s proposed strategy for curing cancer is pre-emptive: It involves using gene therapy to remove from all our cells the genes that cancers need to turn on in order to maintain their telomeres when they divide. This will not stop cancers from being initiated by mutations, but it will make them wither away before they get anywhere near big enough to kill us. Strategies for deleting genes in this way are already available and are rapidly being improved.

Toxic cells. Occasionally, cells get into a state where they’re not cancerous, but still it would be best for the body if they died. Cell senescence is an example, and so is having too many fat cells. In these cases we need to kill those cells (which is usually easier than reverting them to a healthy state). Methods are being developed to target “suicide genes” to such cells, and also to make the immune system kill them.

Blocking the telomerase enzyme is one of many strategies being pursued against cancer. Doing this would prevent cancer cells from replicating more than a certain number of times, effectively destroying the cancer’s ability to spread. There are many other strategies being intensely pursued to overcome cancer. Particularly promising are cancer vaccines designed to stimulate the immune system to attack cancer cells. These vaccines could be used to prevent cancer, as a first-line treatment, or to mop up cancer cells after other treatments.30 We’ll discuss Bridge Two strategies against cancer in more detail in chapter 16, “The Prevention and Early Detection of Cancer.”

Mitochrondrial mutations. Another aging process identified by de Grey is accumulation of mutations in the 13 genes in the mitochondria, the energy factories for the cell.31 The mitochondrial genes undergo a higher rate of mutations than those in the nucleus and are critical to the efficient functioning of our cells. Once we master somatic gene therapy, we could put multiple copies of these 13 genes within the relative safety of the cell nucleus, thereby providing redundancy (backup copies) for this vital genetic information. The mechanism already exists in cells for nucleus-encoded proteins to be imported into the mitochondria, so it is not necessary for these proteins to be produced in the mitochondria itself. In fact, most of the proteins needed for mitochondrial function are already coded by the nuclear DNA. There has already been successful research in transferring mitochondrial genes into the nucleus in cell cultures.

Cell loss and atrophy. Our body’s tissues have the means to replace worn-out cells, but this ability is limited in certain organs, says de Grey. For example, the heart is unable to replace cells as quickly as needed as we get older, so it compensates by enlarging surviving cells using fibrous material. Over time, this causes the heart to become less supple and responsive. A primary strategy here is to deploy therapeutic cloning of our own cells, as described on page 22.
Evidence from the genome project indicates that no more than a few hundred genes are involved in the aging process. By manipulating these genes, radical life extension has already been achieved in simpler animals. For example, by modifying genes in the C. elegans worm that control insulin and modifying sex hormone levels, the life span of the test animals was expanded sixfold, the equivalent of a 500-year life span for a human.32 As we gain the ability to understand and reprogram gene expression, reprogramming the aging process in humans will become increasingly feasible. The idea that aging and dying are inevitable is deeply rooted, but this age-old perspective will gradually change as gene therapies are successfully demonstrated over the next two decades.

Bridge Three: Nanotechnology and Artificial Intelligence

As we “reverse engineer” (understand the principles of operation behind) our biology, we will apply our technology to augment and redesign our bodies and brains to radically extend longevity, enhance our health, and expand our intelligence and experiences. Much of this technological development will be the result of research into nanotechnology, a term originally coined by K. Eric Drexler in the 1970s to describe the study of objects whose smallest features are less than 100 nanometers (billionths of a meter). A nanometer equals roughly the diameter of five carbon atoms.

Rob Freitas, a nanotechnology theorist, writes, “The comprehensive knowledge of human molecular structure so painstakingly acquired during the 20th and early 21st centuries will be used in the 21st century to design medically active microscopic machines. These machines, rather than being tasked primarily with voyages of pure discovery, will instead most often be sent on missions of cellular inspection, repair, and reconstruction.”35

Freitas points out that if “the idea of placing millions of autonomous nanobots (blood cell–sized robots built molecule by molecule) inside one’s body might seem odd, even alarming, the fact is that the body already teems with a vast number of mobile nanodevices.” Biology itself provides the proof that nanotechnology is feasible. As Rita Colwell, director of the National Science Foundation, has said, “Life is nanotechnology that works.” Macrophages (white blood cells) and ribosomes (molecular “machines” that create amino acid strings according to information in RNA strands) are essentially nanobots designed through natural selection. As we engineer our own nanobots to repair and extend biology, we won’t be constrained by biology’s toolbox. Biology uses a limited set of proteins for all of its creations, whereas we can create structures that are dramatically stronger, faster, and more intricate.

One application we’ll discuss further in chapter 7, on digestion, is to disconnect the sensory and pleasurable process of eating from the biological purpose of obtaining optimal nutrition. Billions of tiny nanobots in the digestive tract and bloodstream could intelligently extract the precise nutrients we require, call for needed additional nutrients and supplements through our body’s personal wireless local area network (nanobots that communicate with one another), and send the rest of the food we eat on its way to elimination.

BioMEMS. If this seems particularly futuristic, keep in mind that intelligent machines are already being injected into our bloodstreams today. There are dozens of projects under way to create bloodstream-based biological microelectromechanical systems (bioMEMS) with a wide range of diagnostic and therapeutic applications.36 There are already four major conferences devoted to these projects.37 BioMEMS devices are being designed to intelligently scout out pathogens and deliver medications in precise ways.

For example, nanoengineered blood-borne devices that deliver hormones such as insulin have been demonstrated in animals.38 Similar systems could precisely deliver dopamine to the brain for Parkinson’s patients, provide blood-clotting factors for patients with hemophilia, and deliver cancer drugs directly to tumor sites. One new design provides up to 20 separate reservoirs that can release the different substances at programmed times and locations in the body.

39 Kensall Wise, a professor of electrical engineering at the University of Michigan, has developed a tiny neural probe that provides precise monitoring of the electrical activity of patients with neural diseases.40 Future designs are expected to deliver drugs to precise locations in the brain as well. Kazushi Ishiyama at Tohoku University in Japan has developed micromachines that use microscopic spinning screws to deliver drugs directly into small cancerous tumors.

41 A particularly innovative micromachine developed by Sandia National Labs has actual microteeth with a jaw that opens and closes to trap individual cells and then implant them with substances such as DNA, proteins, or drugs.

42 Complex structures at the molecular level have already been constructed. In some cases, building blocks are borrowed from nature. In fact, copying or manipulating naturally occurring molecules to accomplish specific goals is a cornerstone of present-day nanotech research. DNA turns out to be a useful structural tool because the unzipped strands can be organized into structures such as cubes, octahedrons, and more complicated designs. A team at Cornell University used portions of a natural enzyme, ATPase, to build a nanoscale motor. Another team at the CNRS Institute in Strasbourg, France, has successfully used carbon nanotubes to deliver a peptide into the nuclei of fibroblast cells. Many approaches are being developed for micro- and nanosize machines to perform a broad variety of tasks in the body and bloodstream.

Programmable blood. One pervasive system that has already been the subject of a comprehensive conceptual redesign is our blood. In chapter 15, “The Real Cause of Heart Disease and How to Prevent It,” we will discuss a series of remarkable conceptual designs by Freitas for robotic replacements of our red blood cells, white blood cells, and platelets. Detailed analyses of these designs demonstrate that these tiny robots would be hundreds or thousands of times more capable than their natural counterparts.

Nanopower. Developing power sources for these tiny devices has already received significant research attention. MEMS (microelectronic mechanical systems) technology is being applied to create microscopic hydrogen fuel cells to power portable electronics and, ultimately, nanobots that will be introduced into the human body. One strategy is to use the same energy sources—glucose and ATP—that power our natural nanobots, such as macrophages, a type of white blood cell that is designed to destroy harmful bacteria and viruses. A Japanese research team has developed a “bio-nano” generator that creates power from glucose in the blood. Another team at the University of Texas at Austin has developed a fuel cell that uses both glucose and oxygen in human blood.

43 Continual monitoring. Sensors based on silicon nanowires have shown the potential to detect disease almost instantly.44 Using any bodily fluid, such as urine, saliva, or blood, diseases including cancer can be detected at very early stages. According to the study leader, Charles M. Lieber, professor of chemistry at Harvard University, this technology will enable you to “give a drop of blood from a pinprick on your finger and, within minutes, find out whether you have a particular virus or genetic disease, or your risk for different diseases or drug interactions.” This approach can also be used for detection of bioterrorism threats.

Within several years, we will have the means of continually monitoring the status of our bodies to fine-tune our health programs as well as provide early warning of emergencies such as heart attacks. The authors are working on this type of system with biomedical company United Therapeutics, using miniaturized sensors, computers, and wireless communication. Researchers at Edinburgh University are developing spray-on nanocomputers for health monitoring. Their goal: a device the size of a grain of sand that combines a computer, a wireless communication system, and sensors for heat, pressure, light, magnetic fields, and electrical currents. In another development, a research team headed by Garth Ehrlich of the Allegheny Singer Research Institute in Pittsburgh is developing MEMS-based sensor robots that can be implanted inside the body to detect infection, identify the pathogen, and then dispense the appropriate antibiotic from the device’s internal containers.

45 One application they envision is preventing bacterial infections, a major cause of hip joint replacement failure. Ehrlich points out that today, “the only recourse for such patients is the traumatic removal of the implant, which results in additional bone loss, extensive soft tissue destruction, months of forced bed rest with intravenous antibiotics, and significant loss of quality of life due to complete loss of mobility.”

Nanosurgery. Nanobots will make great surgeons. Teams of millions of nanobots will be able to restructure bones and muscles, destroy unwanted growths such as tumors on a cell-by-cell basis, and clear arteries while restructuring them out of healthy tissue. Nanobots would be thousands of times more precise than the sharpest surgical tools used today, would leave no scars, and could provide continual follow-up after certain surgical procedures. Nanobot surgeons could even perform surgery on structures within cells, such as repairing DNA within the nucleus. These nanobots will require distributed intelligence. Like ants in an ant colony, their actions will need to be highly coordinated, and the entire “colony” of nanobots will need to display flexible intelligence. Distributed systems that display intelligent coordination is one of the key goals of research in artificial intelligence—developing computers that emulate human intelligence.

One of Freitas’s more advanced conceptual designs is a DNA repair robot. Billions or even trillions of such robots could go inside all of your cells and make repairs as well as improvements to the DNA in the genes. Freitas points out that it may be more efficient to just replace all the DNA in a gene with a new corrected copy rather than attempt to make changes to individual nucleotides.

Here’s an original idea: replace the genetic machinery altogether (the cell nucleus, ribosomes, and related structures) with a small computerized robot. The computer would store the genetic code, which is only about 800 megabytes of information, or about 30 megabytes using data compression. The computerized system replacing the nucleus would then perform the function of the ribosomes by directly assembling strings of amino acids according to the computerized genetic information. These computers would all be on a wireless local area network, so improvements to the genetic code could be quickly downloaded from the Internet. It would not be necessary for the computer replacing each cell nucleus to have a complete copy of the genetic code, since these computers will be able to share their information. One major advantage of this approach is that undesirable replication processes—for example, of pathological viruses or cancer cells—could be quickly shut down.

Intelligent cells. A hybrid scenario involving both biotechnology and nanotechnology contemplates turning biological cells into computers. These “enhanced intelligence” cells could then detect and destroy cancer cells and pathogens, or even regrow human body parts such as organs and limbs. Princeton biochemist Ron Weiss has modified cells to incorporate a variety of logic functions that are used for basic computation.47 Boston University’s Timothy Gardner has developed a cellular logic switch, another basic building block for turning cells into computers.48 And scientists at the MIT Media Lab have developed ways to use wireless communication to send messages, including intricate sequences of instructions, to computers inside modified cells.49 By attaching gold crystals comprised of less than 100 atoms to DNA, they were able to use the gold as antennae and selectively cause the double-stranded DNA to unzip without affecting nearby molecules. The technique could ultimately be used to control gene expression through remote control. Weiss points out that “once you have the ability to program cells, you don’t have to be constrained by what the cells know how to do already. You can program them to do new things, in new patterns.”

We are also making exponential progress in understanding the principles of operation of the human brain. Our tools for peering inside the brain are accelerating in their price-performance, and the ability to see small features and fast events. An emerging generation of brain-scanning tools is providing the means for the first time to monitor individual interneuronal connections in real time in clusters of tens of thousands of neurons. We already have detailed models and simulations of several dozen regions of the human brain, and we believe that it is a conservative projection to anticipate the completion of the reverse engineering of the several hundred regions of the brain within the next two decades. This development will provide key insights into how the human brain performs its pattern recognition and cognitive functions. These insights in turn will greatly accelerate the development of artificial intelligence in nonbiological systems such as nanobots. With a measure of intelligence, the nanobots coursing through our bloodstream, bodily organs, and brain will be able to overcome virtually any obstacle to keeping us healthy. Ultimately, we will merge our biological thinking with advanced artificial intelligence to vastly expand our abilities to think, create, and experience.


Chapter 3

Our Personal Journeys

“To fight a disease after it has occurred is like trying to dig a well when one is thirsty or forging a weapon once a war has begun.” —The Yellow Emperor’s Classic of Internal Medicine

Before we embark on our Fantastic Voyage together, beginning with chapter 4, we would like to reveal a bit of our personal histories. In this chapter, we each explain how we arrived at the point where sharing this health information became a priority for us and how our lives intersected to create this book.

My story begins on the outskirts of Vienna, Austria, in 1924, with the death of my paternal grandfather from heart disease when my father was 12. My father carried on with his two passions: the Boy Scouts and music. In 1938, my father’s musical talent came to the attention of an American patron of the arts, who helped sponsor his escape from Hitler’s Europe. This enabled my father to immigrate to America, where he developed a national reputation as a brilliant concert pianist, conductor, and music educator.

I came along in 1948 and had the opportunity to study music with my father from the age of 6. When I was 15 he also developed heart disease. My father was the kind of person who, when he encountered (then novel) health ideas, such as cutting down on salt, adopted them immediately without a second thought. Unfortunately, we had very little insight into heart disease in the 1960s, and he died of a heart attack in 1970 at the age of 58. I was 22 years old.

I remained painfully aware of this family health legacy, which hovered over me like a cloud on my future. At the age of 35, I was diagnosed with type 2 diabetes. I was prescribed conventional treatment with insulin, but this only made things worse by causing substantial weight gain, which in turn created an apparent need for more insulin. As is typical in someone with type 2 diabetes, I already had high insulin levels, so this was a very bad idea indeed.

A digression is in order here. Starting at the age of 8, I became a passionate fan of Tom Swift Jr. and read all of the available books in this popular series. In each volume, Tom Swift and his friends would get into a terrible jam (and usually the rest of the world along with them). Tom would retreat into his lab and think about how this seemingly impossible challenge could be overcome. Invariably, he would come up with a clever and ingenious idea that saved the day. The moral of these tales was simple: there is no problem so great that it cannot be overcome through the application of creative human thought. That simple paradigm has animated all my subsequent endeavors.

So, in the spirit of Tom Swift, I decided to take matters into my own hands, approaching the issue of diabetes from the perspective of the available scientific literature. I tried to engage my doctor in a discussion of the issues, with only limited success. While he talked to me to some extent, he clearly had little interest in doing so, and admittedly, I was unusually demanding. Finally, exasperated with my persistent questions, he said, “Look, I just don’t have time for this; I have patients who are dying that I have to attend to.”

Not one to be easily put off by attempts to appeal to my sense of guilt, I couldn’t help but wonder whether any of these dying patients might have benefited from earlier explorations into ways to prevent disease. I decided to change doctors and, fortunately, found a physician, Steve Flier, M.D., with an open mind and, since he was just setting up a new practice, some time on his hands. My personal exploration, assisted through my dialogue with Steve, led to a set of health ideas that enabled me to get off insulin and control my diabetes simply through nutrition, exercise, and stress management. I lost more than 40 pounds and never felt better. I went on to articulate these ideas in The 10% Solution for a Healthy Life (Crown Books) in 1993, which became a best seller.

The ideas in the book kept me in good health and off diabetes medications for the next decade. Then, in 1999, I met a brilliant and open-minded fellow traveler, Terry Grossman, M.D., at a futurism conference organized by the Foresight Institute. Terry and I struck up a conversation and discovered a wide range of common interests, particularly in health and life extension. Our discourse quickly evolved into a close friendship and an intense collaboration on a wide range of health issues, with a sprinkling of other futurist issues thrown in as well, which has lasted and grown to this day. I’ve learned a great deal from Terry and hope that I’ve contributed ideas and insights to our partnership in return.

I can say that our relationship has been a uniquely fruitful intellectual journey of exploration and discovery. For one thing, I find the scientific issues underlying human health fascinating, particularly now that we are beginning to understand genetic and metabolic pathways in the language of information science. And for someone who has a keen interest in the 21st century and all of the marvels it promises to bring, I particularly appreciate the potential of this knowledge to enable us to actually live to see (and enjoy!) the remarkable century ahead.
This book represents the results of our collaboration, which in turn has built upon each of our decades of study of health issues. It is necessarily a work in progress and will always remain incomplete. My own work on technology trends indicates that human knowledge is growing exponentially and that the pace of progress is accelerating. Nowhere is this insight more evident than in the field of health. It seems that Terry and I discover at least one exciting new health insight each week (perhaps we are now down to one every six days!). It is fair to say that a number of our ideas have evolved significantly during the two-year period it has taken to produce this book.

I continue to devote a significant portion of my intellectual and physical energies to the pursuit of my personal health and health insights. I am able to use the same scientific method and information science skills in this endeavor, and I find the subject as intellectually satisfying as my other career as a pattern recognition scientist and inventor.

Along the way, I have encountered two unexpected conflicts. If you see someone standing precariously on a ledge, oblivious to the danger of a great fall, you feel a sense of obligation to inform that person of his or her unrealized plight. If the person is someone you care about, the urgency is even greater. I have not had to look very far to find many others who are desperately in need of the knowledge I have gained. Typical are adult male friends with elevated cholesterol, strong family histories of heart disease (or diagnoses of their own heart disease), and perhaps a few extra inches around the middle. Others include adult female friends with family histories (or their own diagnoses) of cancer.

Invariably, I get drawn into extended conversations on the topic of preserving health and well-being through nutrition and lifestyle. Often, these turn out to be longer conversations than either of us expected. To make the case, I feel compelled to go through a lot of the evidence. Then there are more subtle issues. Why aren’t the standard medical recommendations good enough? This is mostly genetics anyway, isn’t it? What happened to moderation?

If I make it through these issues, I’m inevitably asked to address the big question of palatability. Sure, you’ll live a long time, but who wants to live that way? If you eat this way, maybe it just seems like a long time! I maintain that this can be an enjoyable, even liberating way to eat and live, but it takes a bit of explanation.
The second conflict has to do with proselytizing. Being a scientist and a trained skeptic, I was always turned off by people with singular agendas. People out to save my soul or even just my health and well-being were strongly suspect. I have felt very uncomfortable, therefore, in this role myself, telling other people how they should eat or live. Recognizing my own resistance to these types of messages, I also realize what I am up against in terms of getting people to take these ideas seriously.

Ultimately, I feel a responsibility to share my knowledge on these issues, but I also need to achieve a certain loving detachment when it comes to people choosing their own eating and living styles. This is not an easy balance to achieve. It is hard not to feel some pride if someone accepts our ideas and then shares with me their excitement at 30 lost pounds or 50 lost cholesterol points. If nothing else, such experiences demonstrate that I was successful in communicating my thoughts.
I have come to consider it my responsibility to empower people to set their own priorities and to make their own compromises. That’s what I object to in the public health recommendations. They come precompromised, as if the American people were incapable of making their own decisions on these matters. As it has been said, “Lead me not into temptation, I can get there on my own.” We can deliver a complete message, and readers can consider it on their own terms and in their own time. Any follow-up is up to you.

Even this limited goal of effective communication is a challenging one. We have all, by necessity, erected formidable barriers to messages on health. We could hardly survive if we allowed all of the thousands of messages that bombard us daily to get through. It’s particularly difficult to penetrate the subtle yet common misconceptions, fears, and folklore—not to mention conflicting advice from experts—that underlie the public understanding (and misunderstanding) of nutrition and health. Food and its images are deeply interwoven in our rituals, fantasies, and relationships. While most people profess ignorance of nutrition and health, almost everyone maintains strongly held views on the subject and its relationship to the rest of our lives. Getting people’s attention, let alone truly broadening someone’s perspective, is not an easy task. But that is the challenge of any writer.
I have now influenced many people to adopt our ideas for improving
their health, while Terry influences many patients through his longevity-oriented medical practice in Denver. The physical and medical results that friends, relatives, associates, and many others have achieved have been deeply gratifying.

For myself, I feel that the cloud that I so strongly perceived during my 20s and 30s has dissipated, and I look forward to a long and healthy life, indeed to seeing (and enjoying) the century ahead. It is too bad that I cannot go back and share this knowledge with my father. Unlike many people, he accepted health and nutritional advice readily and easily. Unfortunately, the knowledge was not available in time to help him. If it were, he could be alive today.

I began my medical career some 24 years ago as a conventional physician. But after 15 years in practice, I found myself being drawn toward “integrative” medicine, “the field of health care that focuses on how biochemical individuality, metabolic balance, ecological context, genetic predisposition, lifestyle patterns, and other factors have the potential to strongly influence human physiology and the push-pull dynamics of health and disease.”1 As I began to study health from an integrative perspective, I became fascinated with the prospects for correcting imbalances in human physiology on a more individualized level. In 1994, I came to the realization that there were avenues available for me to help my patients in addition to conventional medical care. Focusing primarily on control of a patient’s symptoms, which is the fundamental basis of what I had been taught in medical school, was no longer enough.

After completing medical school in Florida, I did my residency in Colorado and then moved to the mountains west of Denver. During the 15 years I practiced there, I worked as a young version of an old-fashioned general practitioner. I delivered babies at the local hospital, was the doctor for the local jail, and gave the annual talk about the “birds and the bees” to all the fifth-grade boys. I practiced medicine like a typical small-town GP and, by and large, felt satisfied with the care I was providing. I realized that most people I “treated” weren’t really getting better, but they were receiving high-quality conventional care. Through prescription drugs, I was quite adept at bringing symptoms of high blood pressure, diabetes, or heart disease under “control.” While this meant my patients’ numbers were better—blood pressure or blood sugar was lower, or there was less chest pain—the underlying disease processes continued unchecked. This bothered me.

Life is a continual learning experience and, as a physician, I have come to regard pain as among the sternest but most effective of life’s teachers. Thanks to a major knee injury suffered on a local ski slope some years ago, I found myself in the formal role of patient for the first time in my life, and I sought conventional medical care. I went to the best orthopedic surgeon I knew, a colleague I held in enormous respect.

After several modalities of conventional treatment still left me with constant residual pain in my knee, I did what I have since discovered many of my patients have been doing for years: I began to look at alternatives. Along with life’s teachers are life’s angels, who show up in most unexpected places at most unexpected times. My angel appeared in the form of a patient advocate of alternative medicine. Through his persistence, this individual forced me to open my eyes to an entirely new, to me, parallel world of medical alternatives.
In my family, medical doctors were treated with a certain amount of reverence, and conventional medical care was the only alternative. Yet, my patient advocate of alternative medicine—and angel—taught me that there was an entirely different paradigm of medical care available, completely separate from the world of prescription medications and surgery in which I had lived for so many years. I learned that vitamins and herbs could actually be used to treat diseases. He convinced me to try to treat my painful knee condition with a specific herbal concoction derived from the inner bark of a certain type of pine tree that grew only in the south of France.

Feeling like something of a traitor—perhaps a bit like Adam and Eve nibbling at the prohibited fruit—I squeamishly began to take pine bark capsules. It took more than three months but, much to my surprise and gratification, the pain in my knee that I had been experiencing for over a year and a half went completely away. Being a scientist, I decided to perform an experiment to see if my improvement was really the result of the herbal concoction, a placebo effect, or simply a coincidence. I quit taking it. My knee pain returned with a vengeance. I restarted the pine bark extract and, within a few weeks, the pain went away. I repeated the sequence once again: I quit taking the nutritional extract and the pain returned. I restarted it and the pain resolved. As a physician, I am well aware of placebo effects, but these generally go away after a limited period of time. I continued taking the extract, and after a few years I noticed that the pain was gone whether I took it or not. I suspected this was probably just the natural course of the healing process; nevertheless, the nutritional extract seemed to have given me pain relief earlier on, and my interest in alternative medicine was piqued.

I undertook a serious study of integrative medicine with an emphasis on nutritional medicine. I began to learn how to treat diseases with vitamins and other nutrients rather than, or in addition to, prescription drugs. And the more I learned, the more I wanted to know. I went to numerous complementary medicine conferences and read everything I could find about nutritional medicine. There was so much to learn, I felt like I was back in medical school again.

As my knowledge and understanding increased, I slowly began to offer my patients the option of continuing with the conventional treatments they had been receiving from me (in most cases, prescription drugs) or the opportunity to try treatments involving dietary changes or nutritional supplements, either in place of or in addition to conventional care. I was surprised to find that the overwhelming majority of my patients wished to take advantage of these options.2
My patients did far better on combined care than they had on prescription medications alone. Over the past 10 years, I have treated thousands of patients who had serious chronic illnesses with nutritional protocols that I have learned and modified for my practice. For example, I see a large number of people with coronary heart disease. Most of these patients come to me looking for an alternative to some type of heart surgery that has been recommended to them. For some, I concur with their cardiologists and recommend immediate surgical intervention because the disease is too far advanced. Yet, for the significant majority, I find that the nutritional and lifestyle program I recommend for heart disease, involving diet, exercise, aggressive supplementation, detoxification, and stress management—as well as prescription drugs when needed—staves off heart surgery. At the same time, I am able to document quantifiable improvements in these patients’ conditions, such as going from abnormal to normal cardiac stress tests, eliminating angina pain, and improving exercise endurance.

I derive particular satisfaction from successfully treating people with diseases for which conventional medical practice has little to offer. Age-related macular degeneration (AMD) is the leading cause of vision loss in older individuals in this country, yet presently there are no prescription drugs or surgical procedures that can help prevent the inexorable decline toward blindness. To their credit, conventional ophthalmologists have recently begun to recommend multivitamin/mineral supplementation for their AMD patients based on the AREDS (Age-Related Eye Disease Study) sponsored by the National Institutes of Health.3
Yet, like Ray, I find the conventional supplement recommendations pre-compromised or too watered down, particularly since I have a family history of macular degeneration, and I don’t feel that slowing down the rate of visual decline is enough. I want my patients’ vision to improve. This requires a more aggressive nutritional approach: combining dietary strategies with much larger doses of vitamins and minerals and working to correct digestive disturbances that inhibit absorption of nutrients. Using this approach, it is possible for patients to stabilize and even improve their vision.4 This is rarely seen with one- or two-pills-a-day supplementation alone.

Among the greatest devastations for young parents is learning that their child suffers from one of the autistic spectrum disorders. Yet I get enormous satisfaction treating children diagnosed with such diseases. I have nothing but admiration for the dedicated pediatricians, allied health personnel, and special education teachers who have devoted their lives to working with these children. I am saddened, however, by the ineffectiveness of their approaches, which rarely alter the progression of these disease processes.

Our program involves a special diet (avoidance of wheat and dairy products), aggressive nutritional supplementation, correction of digestive disturbances, and detoxification strategies.5 The majority of children we treat under the age of 6 experience some degree of improvement on this regimen.

There is a long list of ailments for which conventional medicine alone provides limited benefit: chronic degenerative neurological diseases such as Parkinson’s disease and multiple sclerosis; digestive disturbances, including irritable bowel syndrome, colitis, and Crohn’s disease; and multisystem diseases such as fibromyalgia and chronic fatigue syndrome. For these, an integrated approach, using complementary therapies, is of considerable benefit. Tens of millions of American adults suffer from type 2 diabetes, obesity, high blood pressure, and elevated cholesterol. In the majority of cases, it has been my experience that where our program is followed strictly, the prescription drugs used to treat these conditions can be either reduced or eliminated entirely.

As the years passed and I gained more experience with nutritional medicine, I decided to write a book to share what I had learned with people outside of my practice. With the assistance of several physician colleagues and friends, I completed The Baby Boomers’ Guide to Living Forever in April 2000.

In the course of researching the topic of nanotechnology for this book, I met Ray at the 1999 Foresight Institute Conference in Palo Alto, California. He was there as one of the nation’s foremost futurists. Overhearing Ray discuss his interest in nutritional supplementation and other life extension therapies, I struck up a conversation. I asked him to look over the manuscript of my book and write a “testimonial” paragraph for the back cover, which he kindly agreed to do. A few months later, he flew from his home in Boston to my clinic in Denver to undergo one of the comprehensive health assessments and longevity evaluations we offer.
My nutritional medical practice in Denver has its share of celebrity patients, and Ray Kurzweil is one of them. Ray is unique in that I devote more of my time attending to his health concerns than any dozen of my patients, celebrity or otherwise, put together. But, then again, Ray is quick to admit that he is unusually demanding. I am not surprised that Ray became frustrated with a previous physician who preferred to spend his time on patients who “were dying.”

For my part, I have no regrets whatsoever about the amount of time I spend working with Ray on his personal health issues, or the fact that I have to defend every single opinion or suggestion I offer to him. Ray is another of the angels who have entered my life to guide me in the right direction. I feel a special sense of mission in helping him remain alive and well for many years into the future, as this unusually creative and gifted individual, who has already brought so many wonderful insights and inventions to the world, has much yet to share. He has also helped me to refine my focus and leave no loose ends in any medical endeavor.
Moreover, a number of other benefits accrued from the process of working with Ray. In the course of refining his personal health program, he and I began to explore numerous health-related topics, including diet, nutritional supplementation, exercise, detoxification therapies, hormone replacement, and even protection from NBC (nuclear, biological, or chemical) terrorism. We’ve both learned a great deal from our intense collaboration on health issues. Our dozens of e-mails back and forth turned into hundreds and now number in the tens of thousands. So much information was passed between us that we decided to organize it as the basis for a book.

As members of the baby boomer generation, Ray and I have more than a casual interest in our program. Since we are both now in our mid-50s, demographic analysis would ordinarily suggest that we each have perhaps 25 years left, with gradually declining vitality and health. By following the advice presented in this book, and with some help from the accelerating technologies that Ray speaks about, we hope to be not only alive but vital and “young” a quarter century from now—right at the time corridor when the prospects for truly radical life extension are likely to occur. It is our fervent hope (bolstered by extensive research) that by following the suggestions offered in Fantastic Voyage, we and our readers will be able to significantly increase our chances of being alive when extreme longevity becomes commonplace. To that lofty goal, we raise a toast—of freshly squeezed organic vegetable juice—in the hopes that we can join together with our readers to celebrate the 22nd century.