Can we measure your body's biological age? 

Is aging a contained biological process we could put a reliable number to and then treat directly, instead of waiting for it to show up later as heart disease, diabetes, or Alzheimer's?

That's the question Dr. Nir Barzilai has spent three decades chasing. He directs the Institute for Geroscience at Albert Einstein College of Medicine, founded the Longevity Genes Project (which has studied more than 600 centenarians and their kids), and dreamed up TAME, the trial that first got the FDA to treat aging itself as a measurable outcome.

In this new episode from our NextLevel series, he talks about why he thinks centenarians handle illness completely differently than the rest of us, which drugs already sitting in pharmacies might be quietly slowing aging down, and what's still missing before any of this can be proven in a clinic.

Five Key Takeaways

1. Centenarians get sick for weeks, not years.

In Barzilai's Longevity Genes Project, nearly a third of centenarians had no diagnosed disease and took no medications at all, evidence that healthy aging compresses illness into the very end of life rather than spreading it across decades.

2. Some drugs already prescribed for other conditions may be slowing aging itself.

Barzilai's team scored every lifespan-extending drug on a 12-point scale, and metformin, SGLT2 inhibitors, GLP-1 agonists, and certain osteoporosis drugs all topped the list, each shown to reduce disease and death well beyond their original use.

3. The FDA already agreed aging can be a trial endpoint, back in 2015.

Barzilai's TAME trial convinced the agency to accept a cluster of age-related diseases as a single measurable outcome. It stalled afterward on funding, not science, and he believes a similar trial today would get the same green light.

4. Predicting your biological age and proving a treatment changed it are two different problems.

Existing clocks estimate how old you biologically are, but Barzilai's new project, FAST, mines old drug-trial data for the rarer kind of biomarker that visibly shifts within months, the missing piece needed to prove a treatment is actually working.

5. You don't need a drug or a biomarker to start.

Exercise, sleep, diet, and social connection already make people substantially more likely to reach 90, and Barzilai says testing one variable at a time in your own life can meaningfully change your trajectory right now.

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