Setting Your Health Baseline: How Old Am I? Biological Age Tests
Biological age tests determine how old your physical body is, in contrast with your calendar age. They are necessary to set your health baseline so you can measure if treatments actually reverse aging.
“We are living in exciting times. Several treatments appear to reverse epigenetic aging.” — Dr. Steve Horvath, leading biological clockmaker
Biological Age Test History
Biological age testing is a young field, with the first epigenetic clock being created in 2009 by Axel Schumacher followed in 2013 by significant advancements to use multiple tissue samples by doctors Gregory Hannum and Steve Horvath. With first-generation DNA methylation-derived epigenetic clocks, it is possible to take cell samples, analyze them using these clocks, and accurately guess the donor’s calendar age within 3.6 years.
Alternate methods to estimate chronological age using transcriptomic and proteomic data, saliva or telomere length, have proven less accurate as there are multiple challenges in biological age testing.
Biological Age Tests — How Fast Am I Aging?
According to Dr. Horvath, “Aging manifests in 30 year olds.” If you are fortunate enough to be just 30 years old, you should consider taking a biological age test to set your health baseline. If you are older, it still makes sense to establish a starting position, then test annually to see how you progress.
Dr. Horvath’s latest technology includes PhenoAge and GrimAge from the non-profit Clock Foundation. GrimAge provides epigenetic clock testing for physicians and aging researchers for preclinical and clinical studies. It is considered the best estimation of all-cause mortality as the rate of change in GrimAge shows an increased hazard ratio for predicting death. If the rate of change moves up quickly, you are likely in trouble and should seek medical help.
GrimAge has received global scientific validation for accuracy in tracking age. As of 2019, GrimAge is 18% more accurate than calendar age and 14% better than previously-described epigenetic biomarkers. In predicting time to coronary heart disease, GrimAge is 61% more accurate than chronological age and 46% better than previously-reported epigenetic biomarkers. Also, GrimAge outperforms in predicting time to cancer and time to menopause. Of note, if patients are sick when taking the GrimAge test, it affects the results because blood health factors show the illness.
As of August, 2022, Dr. Horvath has created and tested GrimAge2 which is even more accurate as it factors in whether patients are smokers and biomarkers for Hemoglobin A1C and C-reactive protein. According to GrimAge2 predictive factors for increased longevity, it is very important to maintain high levels of vegetable intake, good levels of HDL cholesterol and healthy lung function. Additionally, Cystatin C levels (better kidney function) and growth differentiation factor 15 (improved response to injury) aging biomarkers benefitted significantly during a study of injecting young blood plasma into 18 volunteers once per week over 10 weeks.
Dr. Horvath has found that blood and buccal (cheek swab) cells are the best indicators for testing aging. For comparison, they are also testing animals such as cats, dogs and even elephants as part of 3rd-generation, pan-mammalian clocks.
Biological Age Tests — Available for You!
Unfortunately, GrimAge is not providing direct to consumer testing at this time. Here are publicly available biological age test options:
Aging AI (free)
- Enter your results online from a basic blood test.
- Provides accuracy within 5.5 to 5.9 years depending on the amount of data entered.
- Neural network improves on prior linear regression epigenetic clocks for people older than 59 by factoring in dangerous conditions.
- Developed based on 142 publicly available data sets from several human tissues. Not designed for testing bloodwork.
- Predicts higher age acceleration for those prone to tumors, for cells that exhibit age-related changes in vitro, such as immune and mitochondrial dysfunction, and for samples from patients with multiple sclerosis, type 2 diabetes, and HIV, among other conditions.
- At-home finger-prick blood test which is mailed back in.
- Glycans are sugar molecules that surround and modify proteins in your body. Glycan Age claims they respond to your lifestyle choices and indicate the inflammatory state of your immune system, which in turn determines your biological age.
- They believe measuring the amount of good and bad glycans can determine biological age.
- Good glycans decrease with age. Bad glycans increase.
- Their accuracy level is unclear. They are trying to benchmark against telomere lengths of a variety of cells.
- Their results have large variations (up to 38 years in one of their examples) against chronological age. They do not have mortality studies.
- Testing a single indicator (glycans) is unlikely to accurately reflect all aspects of biological aging.
Index by Elysium ($499)
- At-home saliva-based epigenetic test kit developed by Professor Morgan Levine, Ph.D., at Yale School of Medicine and former employee in Horvath’s lab.
- Analysis of 100,000-150,000 biomarkers using an Illumina chip, an upgrade on her work creating PhenoAge (considered the second clock) in Dr. Horvath’s laboratory.
- Epigenetics involves changes in your biology caused by modifications in gene expression rather than the underlying genetic code itself. Factors that can influence your epigenetics include your diet, exercise habits, alcohol consumption, and stressors like sleepless nights.
- Provides biological age plus Cumulative Rate of Aging, the pace at which your body has aged for every year you’ve been alive.
InnerAge 2.0 from InsideTracker ($249, discounted if buying multiple tests)
- Tracks 13 biomarkers for women and 17 for men
- Combination of advanced bloodwork (blood test included) and lifestyle factors
- Provides results as Personalized optimal zones – Based on your age, gender, ethnicity, activity levels and goals. Indicates impact on your biological age from each marker.
- Offer premium “Ultimate” plan with 43 biomarkers for $659
- Offers a nutrition database with over 7,500 food items scientifically proven to improve specific biomarker levels. Additionally, receive advice on hundreds of supplements as well as lifestyle and exercise suggestions to help you reach your optimal zones.
Insilico Medicine (not publicly available)
- Researching the microbiome to determine age.
- Accuracy to within 6 years.
- Biological targeting platform PandaOmics focused on identifying anti-aging drug candidates.
Levine Phenotypic Age (free)
- A downloadable spreadsheet to enter 9 factors from blood work results
- Developed from studies on over 11,000 adults
- Calculates your phenotypic age and expected mortality
LifeLength — HealthTAV telomere length testing ($410)
- Blood test for short telomeres associated with many age-related illnesses and declining health.
- Telomere length is not accurate for predicting mortality.
myDNAge — Blood and urine tests ($299 each) based on the first generation version of the Horvath Clock
- Company is not affiliated with Dr. Horvath.
- Claims to be the Most Accurate Biological Clock, but provides no evidence.
- Target over 2,000 CpG sites, much fewer than competitors.
- Offer a Dog Age Test kit ($299), although free with other purchase.
PhotoAgeClock (not publicly available)
- Based on left and right eye photos of over 8000 people.
- Mean-Average Error rate within 2.3 years. Varies by age of participant.
- Not considered official because it doesn’t use cellular biomarkers.
Real Age by ShareCare (free) online questionnaire and results
- Created in 1999 by Dr. Michael Roizen, Chief Wellness Officer of the Cleveland Clinic.
- Currently owned by Sharecare, a health and wellness platform.
- 15-20 minutes to answer questions about your health and lifestyle.
- 45 million people have taken it.
- Provides your “real age” and tips to improve your health.
- Of note, they still recommend daily aspirin. See Keep Health’s article for the risks.
- Used by 16+ anti-aging clinical trials including from Harvard, Cornell and OneSkin.
- Blood test using methylation testing.
- Receive suite of comprehensive epigenetic reports.
- Raw data available for personal download
- Here’s how their lab works.
Tru Me Labs (TruAge $110)
- At-home mail-in DNA-based saliva epigenetic test kit.
- Use methylation on only a tiny fraction of the billions of nucleotides in your DNA. Claim an unproven statistical error of approximately 4.75 years.
- Only provides your calculated biological age as a result. Lack rigor and transparency in their methodology.
- Results can show huge and unlikely differences in chronological vs biological ages.
- Tracks multiple biological clocks, using biomarkers that show the rate of aging at the molecular, cellular, tissue, organ, and system level.
- Users upload their data from photos, surveys, biological samples, and activity trackers into an AI system which provides a personalized to-do list to promote healthier aging.
- Believe their AI method will be more powerful than Horvath’s models for detecting aging.
- 5 most important predictors; (Albumen) liver function, metabolic function (glucose), urea (renal), erythrocytes (respiratory), hemoglobin. (Side note: Dr. Horvath — agrees with Dr. Polina on these targets.) Facial features, microbial taxa can be factored in too.
- Smoking under the age of 40 has much more impact on human aging than after that.
- Accuracy between 6-7 years. Expected to improve rapidly with more datasets.
Major Flaws in Biological Age Tests
Current biological age tests report a single result per person. In actuality, parts of our body are at different biological ages. For example, your heart can be biologically younger than your liver. Keep this in mind as you think about your body holistically. See biohacker Brian Johnson’s Personal Measurement Site as a comprehensive example of aging factors that can be tested. Future biological age tests may provide individual age clock results on each of the list of longevity biomarkers.
Separately, many biological age tests ask for your chronological age as part of their determination of your biological age. This should not be necessary and could influence your results if they use it in their formula to determine your biological age.
Best Articles Comparing Biological Age Tests
The following authors have written good articles on their experiences using some of the above biological age tests.
- What’s My Age Again? Reviewing Three Online Biological Age Testing Tools — Nick Engerer (Levine, Aging.AI, Real Age)
- The DNA Test That Tells You Your “Real” Age (Index by Elysium)
- InsideTracker InnerAge Review from InnerBody Research. Includes 25% discount code.
Anti-Aging Clinical Trials
The following clinical trials are using biological clocks to measure the impact on aging.
TRIIM by Greg Fahy and Robert Brooke
- Phase 1 initial study on 9 male humans showed a 2.5 year reduction in GrimAge using a cocktail of thymus gland treatment drugs.
- Phase 2 TRIIM-X indicated it would have 85 participants and conclude in November, 2022. However, as of August 2022, only 20 men and 6 women have enrolled in TRIIM-X. The study uses multiple agents in combination with personalized doses of recombinant human growth hormone (somatropin), metformin, and DHEA. Both trials have had participant issues with finger stiffness, carpal tunnel syndrome, arthralgias and prostate-specific antigen spikes in about 1/3 of participants. Many participants have reported significant improvements in their health and enjoyment of life.
- Investigating the potential benefits of 90 days of NR supplementation on recovery time and mortality using GrimAge.
- Preliminary results were achieved in December 2021 and End of Study results will be reported after December 2022.
- For more on the benefits and safety profile, see Keep Health’s NR article.
Databases of Genes which Impact Aging
For the curious, here are two public databases maintaining the known list of genes which impact aging.
GenAge — database of genes which impact aging
SynergyAge — a curated database to examine the combination of multiple genes on lifespan, seeking to identify synergistic and antagonistic interactions of longevity- associated genes via BioRxiv.org (BioArchive). Run by Gabriela Bunu, PHD student at the Romanian Academy.