Healthy Aging: How Prevention Can Counteract the Natural Aging Process of Bones and Blood Vessels

Holistic aging—what does that actually mean?

1. Dr. Orfanos-Boeckel, you have been working in the field of preventive and metabolic medicine for many years. In your view, what does it mean to age healthily in a holistic way—particularly with regard to maintaining normal bone and vascular function?

Dr. Orfanos-Boeckel: Before I began focusing on metabolism and preventive medicine, I worked in internal medicine, primarily in nephrology—that is, in the treatment of patients with chronic kidney disease.

There, I observed on a daily basis what happens when people fail to adopt healthy habits for 20, 30, or even 40 years and no one specifically cares for them. Vascular risk factors such as smoking, obesity, high blood pressure, and disorders of sugar or fat metabolism are particularly harmful to patients with kidney disease—in other words, anything that damages the vascular structures of the kidneys, which are crucial for the filtering function of this organ system. When the kidneys fail, this not only affects excretion and detoxification; other organ systems, such as bone metabolism and red blood cell production, are also pathologically affected.

I particularly enjoyed working in the kidney transplant outpatient clinic back then. The patients we cared for there had been given a new chance at a dialysis-free life with their new organ. Through close follow-up care, including regular blood tests, we were able to significantly reduce the risk of complications leading to graft loss in our patients. If we apply this “measure-act-measure” approach to healthier individuals, we can effectively support the function of the kidneys, as well as the heart and brain, against age-related organ failure.

If we want to age healthily, maintaining good cardiovascular function is statistically one of the decisive factors for our internal health in old age. It is important to know that these so-called “cardiovascular diseases” affect not only the heart but also the kidneys and the brain. Vascular nephropathy, which leads to dialysis, as well as cerebral vasculopathy, which leads to stroke and dementia, also fall under these cardiovascular diseases in the broadest sense, and they increasingly contribute to the need for long-term care in older age. If one wishes to protect the arterial vessels from vascular calcification and its consequences, it is important, on the one hand, to prevent or treat vascular risk factors early on, and on the other hand, to support healthy bone metabolism with regard to osteoporosis. This is because when bone decalcifies due to bone density loss, the vessels are more likely to calcify, especially when significant elevated vascular risk factors are also present.

Side Fact: Age-related metabolic changes begin long before symptoms appear

With increasing age, key metabolic processes change systematically—even when no symptoms are yet noticeable. These biological aging processes affect, among other things, cell regulation, repair mechanisms, and hormonal control systems. In aging research, these are described as the “Hallmarks of Aging”—characteristic features that, over the long term, can form the basis for age-related diseases such as atherosclerosis, osteoporosis, or chronic inflammatory processes. Source: Orfanos-Boeckel, H. (2023). Nutrient and Hormone Therapy – The Prevention Guide. TRIAS Verlag.

Nutrition as the Basis of Prevention

2. Which dietary habits support the normal function of bones and arterial blood vessels—and which nutrients play a particularly important role in this?

Dr. Orfanos-Boeckel: I am not a nutritional physician, so I do not wish to discuss healthy eating in detail here—that is, what exactly that means and how one should structure one’s diet. Furthermore, my experience shows that many women, even though they have eaten very healthily—meaning definitely not high in sugar, no fast food, no processed foods, and not contaminated by environmental toxins, but rather healthy, balanced, regional, organic, and fresh—still exhibit striking nutrient deficiencies in their blood and, by age 47, already have osteopenia in their bone density despite their healthy diet.

In principle, many people exhibit a similar pattern of deficiencies in B vitamins, vitamins C and D, as well as minerals, trace elements, and omega-3s. However, it is impossible to make a blanket statement about who needs what and in what dosage to specifically support a particular organ system, as medical nutritional therapy is a highly individualized process. If you want to use nutrients—as a supplement to a healthy diet—in a medically effective way, you must determine in a laboratory the specific nutrient dosage required to treat the individual’s specific problem in order to truly make a difference internally.

My approach is to examine each person who comes to me individually and to determine on a case-by-case basis which specific nutrients are lacking, where the weaknesses lie, and how these can be addressed with nutrients, hormones, and, if necessary, medication. And of course, I also discuss nutrition, but most women who come to me already eat very consciously. If one wants to achieve a functional protective effect on the bones through metabolism in these health-conscious women, one must use bone-relevant nutrients and hormones beyond or in addition to their diet.

Vitamin D and its co-factors play a particularly important role in bone metabolism. These are primarily calcium, magnesium, vitamin K2, and another nutrient that unfortunately cannot be named here because there is no approved health claim for it. But determining exactly what and in what dose is needed to produce a safe, bone-building or protective effect internally requires careful assessment, because only by tailoring this to the individual can you achieve health improvements. You can’t apply a one-size-fits-all approach. That would be like asking me: What kind of exercise should I do to be fit? It’s all individual—it has to suit you as a person, and it should be fun, too!

So, when it comes to nutrients, I follow a very individualized approach, and that means that while we can talk about nutrients in general terms, we must examine each person individually to determine exactly who needs what and how much to create a proper, healthy, functioning metabolism.

Every lab value has its own specific measurement. I’ve written about this in my books—how each nutrient must be measured precisely. Some are in serum, some in whole blood; some require centrifugation, others need to be refrigerated. The subject is highly complex, and the pre-analytical work is incredibly labor-intensive—it’s not something you can just replicate on a whim. It is a truly demanding, specific form of nutritional medicine.

“But it’s impossible to make a blanket statement about who needs what and in what dose to specifically support a particular organ system. […] Because only by determining this on an individual basis can one bring about changes in health.”

Nutrients for Structure and Elasticity

3. Which micronutrients are particularly relevant for maintaining the normal structure and elasticity of bones and blood vessels—and what should women going through menopause pay attention to?

Dr. Orfanos-Boeckel: First of all, I must say that I think it’s important to speak of nutrients and not of “micronutrients.” I find this important because the word “micro” confuses people and is also factually inaccurate. Micro is too small—because the amounts you need to take are massive. The term “micronutrient” therefore doesn’t apply at all to omega-3 or vitamin C, where the required daily dose can sometimes be several thousand milligrams per day.

Now, specifically regarding your question: I use bone density testing to assess bone health, and I can tell you this: In addition to strength training, exercise, and not smoking, it helps to eat a healthy diet—one that is nutrient-rich, protein-rich, and consists of high-quality foods. In addition, it is very beneficial to ensure an adequate intake of the key nutrients that bones require for normal metabolism. These include, first and foremost, vitamin D and the co-factors calcium, magnesium, vitamin K2, and another nutrient that unfortunately cannot be named here because there is no approved health claim for it. But vitamin A, vitamin C, B12, zinc, manganese, and certain amino acids are also needed to keep bone metabolism functioning properly. Also very important for healthy bone metabolism are the hormones that influence it. In addition to vitamin D, these include other steroid hormones such as estradiol, progesterone, DHEA, and testosterone.

Lifestyle Factors and Regeneration

4. How do factors such as sleep, exercise, and stress management influence cellular health and energy production—and what role does metabolism play in this context within the framework of healthy aging?

Dr. Orfanos-Boeckel: I wrote a bit about healthy behavior in my first Green Book. The answer to this question is vast, so I’d like to focus here only on the gap that I can fill—drawing on my expertise in internal medicine and nephrology—to complement what experts have already described countless times on this topic.

Healthy food, sleep, regeneration, no stress—these are the foundations for healthy aging. Beyond that, however, based on my medical experience, it makes sense to look inward—that is, to measure the biochemistry in the blood—and objectively assess what can or must be done functionally within the metabolism to promote health and healthy aging. You can’t tell whether you’re aging well or poorly in terms of your metabolism.

You can only find out exactly where the individual weak points in your metabolism lie by having a blood test. I call these weak points “disease markers”; I have explained this term in detail in my books. And in addition to these disease markers, the key health indicators that deviate from their optimal levels when the first metabolic disturbances occur are also of interest. And with nutrients and hormones—which are, on the one hand, “health-promoting substances” but also key substances—you can then actively intervene to optimize shifted key values and lower rising disease values.

Side Fact: Disease Values – Early Markers for Later Diseases

Disease values are classic laboratory parameters such as LDL cholesterol, HbA1c, creatinine, or CRP. They usually rise continuously as metabolic diseases progress. The further they deviate from low, healthy ranges, the higher the risk of structural organ damage. From a preventive perspective, even mild, persistent deviations are relevant, even if no acute disease is present yet. Source: Orfanos-Boeckel, H. (2023). Nutrient and Hormone Therapy – The Prevention Guide. TRIAS Verlag.

Take, for example, bone demineralization and bone resorption: There are two values in the blood that can be measured, which I call bone disease markers. These two parameters rise as bone resorption increases. This breakdown, characterized by the rise in these values, then leads over the next few years and decades to a loss of bone density, which can be objectively identified in bone density measurements as osteoporosis with a T-score below -2.5. My goal is to intervene at this early stage of the rise in these bone disease markers, before imaging years later reveals a pathological, usually irreversible loss of bone density—and possibly an osteoporotic fracture—has occurred. I want to influence this process, which can cause illness for years or even decades, at an early stage.

Osteopenia, the precursor to osteoporosis, and osteoporosis itself, can also affect a woman who eats healthily, sleeps perfectly, and otherwise does everything right. Simply because she has a genetic predisposition to it. That’s precisely the point: We women, regardless of whether we’re perfect or not, go through menopause and we have our genetics. And even if we behave perfectly, we can still develop osteopenia or even atherosclerosis (hardening of the arteries). That’s what I’m getting at: we need to objectively assess whether what we believe—that we’re healthy—actually holds true on the inside.

This is a key takeaway in my work, which I’ve now described in three books: even a woman who lives a perfectly healthy lifestyle can still develop age-related diseases internally. Nature shuts down our ovaries at a certain age; starting at 40, progesterone levels steadily decline, and by 50 at the latest—sometimes much earlier—estrogen production ceases entirely. However, bones need estrogen to prevent excessive breakdown, and they need progesterone as well as androgens like testosterone and DHEA to rebuild themselves. This doesn’t mean that diet, exercise, and medication aren’t important. Nutrients and hormones complement healthy lifestyle habits and are intended to help delay the need for strong medications at an early age.

My fundamental approach is to use complementary nutritional and hormonal medicine as a foundation for healthy daily habits. As I said, this is the complementary gap—and my expertise lies in identifying, through laboratory testing, where the weaknesses are, where the risks of future illness lie, and how to counteract them with nutrients and hormones from the inside out, using the body’s own substances in a biochemical process.

Side Fact: Key Values – When Too Much or Too Little Is Problematic

Key values have a narrow physiological optimal range within the reference range. Both excessively high and excessively low levels can impair metabolic regulation. These include, for example, calcium, sodium, potassium, insulin, cortisol, or estradiol. Unlike pathological values, they do not rise or fall in one direction only but can become imbalanced in either direction. Source: Orfanos-Boeckel, H. (2023). Nutrient and Hormone Therapy – The Prevention Guide. TRIAS Verlag.

Implementing Prevention in Everyday Life

5. Many people want to take early action for their health but don’t know where to start. Based on your experience, which preventive measures can best be integrated into everyday life?

Dr. Orfanos-Boeckel: In my view, this question cannot be answered in general terms either, as the most important step in between is missing. If I am to recommend measures, I must first conduct a diagnostic evaluation. And to conduct a diagnostic evaluation, I must first engage with the person, find out where they stand. And then I must provide individualized advice on what and how they should act in the specific area where preventive measures are needed.

I am neither a sports medicine specialist nor a nutritionist, nor am I a psychotherapist specializing in stress. I am an internist with a background in nephrology, and my approach is always to first look at the blood to see what the person’s metabolism is actually like. And if I see certain values there, I naturally also perform imaging as a supplementary measure. The idea is to keep an early eye on the areas where we often develop diseases later in life—namely cardiovascular diseases, such as heart attacks, heart failure, but also kidney failure, stroke, and dementia—and to look closely at them, because signs of where preventive measures can be taken appear as early as 20 or 30 years beforehand.

Prevention naturally starts with healthy behavior—I also described this in my first book with the “Big Five” and the “Little Three”—but as an internist, my focus is on gaining precise insight into the current internal blood status through specific blood tests. Does the person have an increased risk of developing atherosclerosis? Is there an elevated lipoprotein(a) level? Is there hypercholesterolemia? Is there perhaps an early sign of kidney failure? Does the person have high blood pressure? Where does it make sense to change behavior? Or are medications necessary after all if the genetic predisposition is unfavorable and behavior is already very good, leaving nothing left to improve?

Side Fact: The reference range is not automatically the optimal range

Laboratory reference ranges statistically indicate which values are common in a population. However, they do not necessarily define the individual optimal range for long-term metabolic health.

Especially with nutrients or certain hormones, a value can fall within the reference range without being optimal from a preventive standpoint. 

Source: Orfanos-Boeckel, H. (2023). Nutrient and Hormone Therapy – The Prevention Guide. TRIAS Verlag.

I believe the question underestimates not only aging itself but also the disease-causing dynamics of the aging process. Aging itself comes at a cost; certain things happen regardless of how we behave. That’s just the way it is—we are finite and will die one day, no matter what we do now. Of course, we can influence a great deal through our behavior, but there is a limit somewhere. On top of that, many of us don’t have the time or money to spend the whole day focusing on our optimal health.

And in that regard, I think it would be much better to first take a look at an individual’s blood to see what’s actually going on inside, and then act specifically, rather than continuing to recommend blanket, general health measures.

I think it’s important in prevention to meet the individual where they are and look at what’s important and what isn’t so important on a case-by-case basis. I’m not strict, and I can still help someone who smokes because they need it to relax avoid developing diabetes or suffering an osteoporotic fracture—conditions for which smoking naturally poses a higher risk. What I mean is, I don’t believe that the patient has to be perfect first before I, as a doctor, can help; rather, I help no matter where the person stands. And that’s only possible through a thorough diagnosis, where you can determine which measures are specifically useful and necessary for that person.

My experience is that, in this process, the more a person engages with themselves, the more they gain self-knowledge and then naturally begin to make their daily life healthier. People are neither stupid nor lazy. They simply know too little about what is truly relevant to them personally and what actually works.

Focus on Women – Hormonal Changes and Vascular Health

6. During hormonal transition phases such as menopause, many bodily processes change. What role can targeted nutrient supplementation—within the scope of its approved effects—play during this phase?

Dr. Orfanos-Boeckel: Yes, the question doesn’t quite make sense to me, because I would say that young people benefit greatly from nutritional therapy, since we all have a deficiency in all the substances I’ve mentioned in my books anyway.

When a woman enters menopause, hormonal changes are added to her “normal” nutritional needs. And the most important thing during this time is to address hormone replacement therapy. Hormones are very important for bone health. Nutrients are also important, and exercise is of course important too, but when a woman enters menopause, her well-being and sleep may not improve with nutrients alone. That’s when hormones help.

Side Fact: Menopause – Medically and Socially Relevant

Menopausal symptoms such as sleep disturbances, exhaustion, or mood swings can have a significant impact on work capacity and quality of life. At the same time, hormonal changes during this phase of life are associated with changes in bone and vascular metabolism. Early medical evaluation can therefore help to better understand individual risks. 
⁠Source: Orfanos-Boeckel, H. (2023). Nutrient and Hormone Therapy – The Prevention Guide. TRIAS Verlag.

It is an illusion to believe that you can prevent osteopenia and osteoporosis by taking a little vitamin D—if you have certain genetic predispositions, that simply isn’t enough. Vitamin D is good, of course, and it’s also good to have relationships, to be happy, and to spend time in nature.

But I am an internist; I am interested in the processes of our internal biochemistry, and I am specifically concerned with the early degenerative processes that are usually overlooked in internal medicine. Curative intervention often comes far too late—only when a person feels something or when something breaks down—and then there are guidelines, surgeries, pharmaceuticals, and technical medicine. The idea, however, is that the onset of disease can be detected as early as 20 or 30 years in advance, and that one can intervene not with drugs but with the body’s own substances, and can also specifically optimize behavior—and then, by the time you’re 60 or 70, you’re simply in better shape.

This is done in dentistry, it’s done in dermatology as well, and perhaps especially because there, the doctor and patient—or rather, the female doctor and patient—can look together at the organ in question, and also because teeth can cause very distinct pain. A kidney doesn’t do that, nor does a bone, and a heart doesn’t always do it either—you might feel a little something, but coronary heart disease doesn’t really hurt unless it’s advanced and you have angina pectoris. You don’t notice dementia that quickly either. That means these are things we don’t notice for years and decades, not a single symptom. And that is precisely why—just as in dentistry, where teeth are examined early and regularly—we must also check blood values early on. This allows for prevention, and then prevention also has a strategy, a system. You can plan it logically, tailor it to the individual, and verify whether it improves health. You can objectively assess whether what you’re doing is effective by regularly measuring blood values.

“The idea, however, is that the onset of the disease process can be detected as early as 20 or 30 years in advance, allowing intervention not with pharmaceuticals but with the body’s own substances.”

The Future of Preventive Medicine

7. Which developments in research on healthy aging processes and preventive medicine do you currently consider particularly promising?

Dr. med. Orfanos-Boeckel: To be honest, I deeply regret that there is no research being conducted in nutritional and hormonal medicine—for whatever reason that may be; apparently, it is not considered important enough. On the other hand, there are a lot of high-tech developments—which I don’t follow in detail—involving whether to undergo blood cleansing to remove environmental toxins, or whether to develop drugs that can, so to speak, target and prevent the root causes of aging.

There are many interesting medications already in use in internal medicine that certainly have potential in terms of healthy longevity. In internal medicine, these include SGLT inhibitors, semaglutide, statins, and sartans. With women, one must always start with a lower dose rather than beginning with the dosage used in studies conducted on men.

A great deal of research is currently being conducted in this area, and we’ll see what ultimately prevails. Most of the time, it comes down to who has the most money to invest in such research projects. But the market has recognized the potential of longevity—and, more broadly, of things that help us stay healthy as we age. There are a great many such things, and certainly some that may ultimately not be all that important.

What I think is most important is that in outpatient medicine, people are examined individually and specifically at an earlier stage, their personal risk of aging poorly and pathologically is objectively assessed, and then they are given targeted advice and active intervention. This isn’t a big deal; for example, during the Check-up 35—which you can have done every three years starting at age 35 at your family doctor’s office—in addition to fasting blood sugar, total, HDL, and LDL cholesterol, and two or three disease-related markers—such as HbA1c, creatinine with GFR, quantitative CRP, or Lp-PLA2—which provide more specific information about whether someone is at risk of developing diseases in the coming decades. If these values rise, this would naturally require individualized intervention to prevent further increases in these health markers. But this refined and earlier screening—which is also monitored over time and actively tailored to promote health—would have great potential to better protect the population against these common age-related metabolic diseases and their consequences.

“Curative intervention comes far too late—only when a person feels something and when something breaks down [...]. The idea, however, is that the onset of the disease process can be detected as early as 20 or 30 years in advance, and that intervention can be made not with pharmaceuticals but with the body’s own substances, and behavior can be optimized in a very specific way—and then, by the time you’re 60 or 70, you’re simply in better shape.”

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