The 10 Biggest Hallmarks of Aging and How to Combat Them

During the height of the COVID-19 pandemic, Michael Aziz, MD, a primary care physician, internist, and author of The Ageless Revolution, began noticing a disturbing pattern: Even relatively young Americans were dying at far higher rates than those in places like Japan and South Korea. What was going on?

“The mortality rate in other countries was up to 10 times lower than in the U.S.,” says Dr. Aziz. “Even among young people. That’s when I realized that Americans are aging far too fast — on the inside.”

This revelation became the foundation for his latest book, which presents aging not as a natural decline, but as a treatable, measurable process — one that modern science gives us more control over than ever before.

So what are we supposed to do with that knowledge? Rather than obsessing over the latest biohacking trend or newest medication, Dr. Aziz urges people to focus on the big picture: understanding what’s happening to the body as it ages, and how small, science-backed steps (taken consistently) can slow or even reverse some of the damage. That starts with lifestyle, smart supplementation, and working with medical providers who understand aging as a condition worth treating.

Still, no single pill or protocol will unlock long-term vitality on its own. According to Dr. Aziz, aging well requires a more integrated strategy — one that considers how multiple systems in the body interact, decline, and (with the right care) regenerate.

Taking a more holistic approach toward longevity

Aging doesn’t happen in one spot or system: It’s a full-body process. According to Dr. Aziz, it’s more like “a symphony of interwoven breakdowns” that accumulate slowly over time. That’s why laser-focusing on a single trend — whether it’s red-light therapy or intermittent fasting — won’t cut it. “You can’t just rely on medication and then keep eating McDonald’s,” says Dr. Aziz. “It’s about your lifestyle, your stress, your sleep, your gut health. It’s all connected.”

The 10 hallmarks of aging

In The Ageless Revolution, Dr. Aziz outlines 10 hallmarks of aging — a framework for understanding where aging happens in the body and how to fight back. Think of this list as a roadmap, not a checklist. You don’t need to master every minute detail, but a general awareness can help guide better choices.

1. Loss of protein quality: As we age, cells begin producing low-quality, misfolded proteins, which disrupt function and contribute to disease.
2. Altered cell communication: Hormones and nutrients stop signaling properly between cells.
3. Loss of stem cells: These are the body’s built-in repair system. As we age, we run low on them, and they lose the ability to regenerate tissue. This limits healing and speeds degeneration.
4. Deregulation of nutrient sensing: Our cells rely on four key nutrient-sensing pathways to process food and energy efficiently. Overeating overwhelms these systems and accelerates aging.
5. Loss of telomeres: Telomeres are protective caps on our chromosomes that wear down with each cell division. When they become too short, cells stop dividing, leading to aging and disease.
6. Zombie cells: Damaged cells that refuse to die clog up your system, spreading inflammation and harming nearby healthy cells. Clearing these “zombie cells” is key to longevity.
7. Chromosome instability: Over time, DNA damage builds up. If left unrepaired, these mutations can disrupt normal cellular functions and increase the risk of cancer and other age-related conditions.
8. Mitochondria dysfunction: Mitochondria are your cells’ power plants. As they break down, your cells lose energy, triggering fatigue, cognitive decline, and poor organ function.
9. Epigenetic alteration: Lifestyle choices — from smoking to diet — can chemically modify your DNA, changing how genes behave. These changes are reversible, making this a powerful area for intervention.
10. Gut health: Your gut bacteria influence immunity, inflammation, mood, and metabolism. An unhealthy gut can throw off everything from heart health to brain clarity.

If you’re scratching your head right now and wondering when this became a cellular biology class, we get it. But here’s the good news: You don’t need to remember every term or process. What matters is understanding the bigger picture. And more importantly, that you actually have some control over it.

“You don’t need to be a scientist to slow down aging,” says Dr. Aziz. “You just need to be willing to change the way you think and take action.”

What does taking action look like?

According to Dr. Aziz, it’s about building momentum, not perfection, and certainly not getting swept up in whatever wellness trend is going viral this week.

The first step is simple: master the basics. That means eating clean, staying active, prioritizing solid sleep, and managing stress. “Much of longevity comes down to lifestyle,” Dr. Aziz explains. “It’s not about expensive interventions. It’s about doing the simple things right, over and over again.”

From there, it’s about seeing the body as one connected system. Aging doesn’t happen in silos, so neither should your efforts to slow it. “The mistake people make is isolating one area, like just focusing on diet or only looking at hormones, when in reality, all of it matters,” he says. “Your cells don’t work in isolation, and your health plan shouldn’t either.”

What about supplements?

Supplements can help fill in gaps, but only when chosen wisely. Dr. Aziz recommends starting early and sticking with ingredients that are supported by science, like fish oil and vitamin D. “These aren’t gimmicks,” he says. “They’re part of a longer-term strategy to help your body function at its best.” He adds, “Supplements are like insurance,” says Dr. Aziz. “We’re not all living in Sardinia or Okinawa, eating fresh produce and fermented foods every day. High-quality supplements can help fill in those gaps, but they need to be evidence-based and safe.”

Another area of growing interest in healthy aging involves polyphenols, especially those found in cocoa, like cocoa flavanols. These plant-based nutrients have been studied for their potential to support blood vessel health, cognitive function, and circulation —all of which tend to decline with age.

One example is CocoaVia, a supplement that delivers concentrated cocoa flavanols in clinically studied levels. It’s third-party tested for purity and potency, and may help promote healthy blood flow, which plays a vital role in delivering oxygen and nutrients to aging tissues.

And as Mark Hyman, MD, bestselling author of Young Forever: The Secrets to Living Your Longest, Healthiest Life, pointed out, cocoa flavanols don’t just taste good, they work. “They help your body produce nitric oxide, which relaxes blood vessels and improves circulation. That gives your brain cells a boost of oxygen and nutrients, which is foundational for keeping your cognitive function sharp,” he says. “I like CocoaVia’s products because they prioritize quality, and each one is tested to guarantee purity, potency, and safety.”

So where do you start?

If all of this still feels like a lot, Dr. Aziz offers one final piece of advice: Start small, but start now.

Another key step is finding the right practitioner. “The average physician still isn’t trained to think of aging as something we can manage or treat,” Dr. Aziz says. “You need someone who’s not just looking at your cholesterol or your blood pressure, but someone who understands what’s happening at the cellular level.”

Ultimately, you don’t need to know how to pronounce “proteostasis” or memorize every pathway in your cells. What matters is knowing that how you live affects how you age — and the earlier you incorporate healthy habits in your routine, the better the payoff. “The tools are here,” says Dr. Aziz. “Now it’s time to use them.”

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The information provided on this site isn’t intended as medical advice, and shouldn’t replace professional medical treatment. Consult your doctor with any serious health concerns.