Skip to main content
FishtownFish wrapped around the rod of AsclepiusMedicine
Philadelphia Primary Care
Articles
Digital Health Literacy
Cut through health misinformation
Symptoms
What your body is telling you
Treatments
Protocols, prescriptions, therapies
Longevity
Medicine 3.0 strategies
Heart Health & Risk
Protect your heart & vessels
Metabolism
Insulin, blood sugar, weight
Hormones
TRT, thyroid, menopause, andropause
Performance
VO2 max, muscle, sleep, gut
Playbooks
Step-by-step frameworks
About
Meet Dr. Ash
Your Physician
GER·O·SPAN
Our Clinical Framework
What People Say
124 patient reviews across 6 platforms
Pricing & Membership
Transparent membership pricing
FAQ
Common Questions
Get Started
You Are as Old as Your Arteries
Fishtown Medicine•5 min read
4.96 (124)

You Are as Old as Your Arteries

Ashvin Vijayakumar MD

Medically Reviewed

Ashvin Vijayakumar MD•Updated December 29, 2024
On This Page
  • What is the difference between chronological and biological age?
  • Why do generic wellness biological age tests fall short?
  • What is the DunedinPACE test and why does it matter?
  • Why measure biological age? Validating real interventions.
  • Actionable Steps in Philly
  • ✦Key Takeaways
  • Common Questions
  • Can I actually reverse my biological age?
  • How accurate is the DunedinPACE biological age test?
  • Is biological age testing covered by insurance?
  • How often should I retest my biological age?
  • What lifestyle factors most affect biological age?
  • Does smoking speed up biological aging?
  • Can supplements slow biological aging?
  • Is DunedinPACE better than the Horvath clock?
  • Deep Questions
  • How does methylation actually drive biological aging?
  • Why does insulin resistance accelerate biological age so much?
  • How does Zone 2 cardio influence rate of aging?
  • Can poor sleep alone push DunedinPACE above 1.0?
  • How does muscle mass relate to biological age?
  • What role does ApoB play in epigenetic aging?
  • Why is grip strength a useful proxy for biological age?
  • How does chronic stress change DNA methylation?
  • Can alcohol use change DunedinPACE results?
  • How do environmental exposures in Philadelphia factor in?
  • What is the relationship between biological age and dementia risk?
  • Should I worry if my first DunedinPACE result is high?
  • Can fasting or time-restricted eating slow biological aging?
  • How does sauna use affect epigenetic age?
  • What is an immune age and how is it different from biological age?
  • How do I interpret a DunedinPACE score with my doctor?
  • Scientific References
  • Related at Fishtown Medicine

Get a preventive doctor that knows you.

Consult Dr. Ash
TL;DR30-second take

Biological age is how fast your body is breaking down, measured by changes in your DNA called methylation. The DunedinPACE test gives you a rate of aging score. Aging at 0.8 years per chronological year means you are buying time. Aging at 1.2 means you are speeding up.

We all know someone who looks 40 but is actually 55. We also know the opposite, the 30-year-old executive who looks worn out before their first meeting. This is not just good genes. It is a measurable physiological state driven by methylation, the process by which your body turns genes on and off.

In my practice, I have watched two patients with the same birthday show very different aging rates on the same panel. One was a Fishtown bartender pulling double shifts on 4 hours of sleep. The other was a remote engineer in Northern Liberties walking the river trail every morning. Same age on paper. Different speedometer reading.

What is the difference between chronological and biological age?

Chronological age and biological age tell two different stories about how you are aging.

  • Chronological age: Fixed. Moves forward at exactly 1.0 year per year.
  • Biological age: Malleable. Can move faster (greater than 1.0) or slower (less than 1.0) depending on inflammation, stress, and metabolic health.

If you are aging at a rate of 1.2 years per calendar year, your body is wearing down faster than time itself. If you are aging at 0.8 years per calendar year, you are effectively buying time.

Why do generic wellness biological age tests fall short?

Generic wellness biological age tests fall short because they rely on noisy blood markers that swing with everyday illness and stress. Many basic biological age tests on the market are built on blood markers like albumin, creatinine, and CRP (C-reactive protein, a marker of inflammation). This is called phenotypic age. It is useful, but it changes if you have a cold or a bad night of sleep.

We go deeper. We analyze DNA methylation, the chemical tags on your genome that turn genes on or off. Those tags are far more stable than a single blood draw, which means the signal is cleaner.

What is the DunedinPACE test and why does it matter?

The DunedinPACE test (Pace of Aging Calculated from the Epigenome) measures how quickly your body is aging right now, using methylation patterns from a blood sample.

Older clocks (like the Horvath clock) acted like an odometer, telling you total miles driven. DunedinPACE acts like a speedometer, telling you your current velocity.

  • The metric: Your current rate of aging.
  • The goal: Slow the car down.

Why measure biological age? Validating real interventions.

Data without action is vanity. We measure biological age to validate the work we are doing together.

If we put you on a Medicine 3.0 strategy, Rapamycin, Metformin, Zone 2 training, or advanced sleep architecture, we want to know if it is working.

  • Baseline: Rate of aging = 1.05.
  • Intervention: 6 months of focused optimization.
  • Retest: Rate of aging = 0.85.

That is proof. That is return on investment for your time, money, and effort.

Longevity Medicine

A personalized longevity strategy starts with knowing your real baselines.

Start Your Longevity Assessment

Actionable Steps in Philly

A simple plan to start measuring and slowing your rate of aging.

  1. Establish a baseline: Run a DunedinPACE test through a verified provider (we use TruDiagnostic) before changing anything else. You need a starting line.
  2. Audit the four big levers: Review your sleep duration, resistance training frequency, ApoB level, and fasting insulin. These four move the speedometer more than any supplement.
  3. Retest at 6 to 12 months: Repeat the test after a focused intervention period. Compare the new rate of aging score to your baseline to confirm progress.
✦

Key Takeaways

  1. Speed matters: It is easier to slow the car down than to put it in reverse. Start early.
  2. Stress ages you: High cortisol strips methylation tags off your DNA. Stress management is anti-aging.
  3. Metabolic integrity matters most: The single biggest accelerator of biological aging is metabolic dysfunction (insulin resistance).

Scientific References

  1. Belsky DW, et al. "DunedinPACE, a DNA methylation biomarker of the pace of aging." eLife, 2022.
  2. Horvath S. "DNA methylation age of human tissues and cell types." Genome Biology, 2013.
  3. Levine ME, et al. "An epigenetic biomarker of aging for lifespan and healthspan." Aging, 2018.
  4. Lu AT, et al. "DNA methylation GrimAge strongly predicts lifespan and healthspan." Aging, 2019.
  5. Fiorito G, et al. "DNA methylation-based biomarkers of aging were slowed down in a two-year diet and physical activity intervention trial." Aging Cell, 2021.

Related Articles:

  • ApoB & Heart Health
  • VO2 max: the longevity vital sign
  • Grip strength and healthy aging
  • Advanced Cancer Screening - layering Galleri and Prenuvo on top of standard screening
  • What the NHS-Galleri Trial Actually Showed - the honest read on the largest multi-cancer early detection trial ever run
  • Stroke Prevention in Philadelphia - the 2024 AHA/ASA guideline applied across BP, GLP-1, diet, CRF, and insulin resistance
  • Sleep & Recovery

Dr. Ash is a board-certified internal medicine physician at Fishtown Medicine in Philadelphia. He uses advanced geroscience to help patients quantify and control their aging process.

Related at Fishtown Medicine

  • Cognitive Health - the longevity-relevant inputs to brain health
  • Sleep & Recovery - sleep architecture as a longevity lever
  • Oral Health and Longevity - the oral microbiome's link to systemic disease
  • Bone Density - DEXA, osteoporosis, and the case for early bone monitoring
  • Coffee and Longevity - what the data actually says about coffee for healthspan
Medical Disclaimer: This resource provides clinical context for educational purposes. In the world of precision medicine, there is no one-size-fits-all approach. The right plan must be matched to your unique lab work, physiology, and performance goals. Consult Dr. Ash to determine if this approach is right for you, particularly if you have chronic health conditions or are taking prescription medications.
Ashvin Vijayakumar MD (Dr. Ash)

Fishtown Medicine | Longevity

2418 E York St, Philadelphia, PA 19125·(267) 360-7927·hello@fishtownmedicine.com·HSA/FSA Eligible

Book Your Diagnostic

Frequently Asked Questions

Common Questions

You cannot reverse your biological age in a literal sense, but you can recover function and slow the rate at which you are aging. We prefer the term "slowing the pace." If you can consistently age at 0.8 years per calendar year, you accumulate a meaningful survival advantage over a decade.
The DunedinPACE biological age test is the current gold standard for predicting morbidity (disease risk). It correlates strongly with grip strength, cognitive decline, and facial aging in long-term studies.
Biological age testing is not covered by insurance. Epigenetic testing is considered investigational by most insurers. We offer access to these tests through TruDiagnostic at negotiated rates for our members.
Most patients retest their biological age every 6 to 12 months. This timing gives interventions enough runway to show a real signal without overreacting to short-term noise.
The lifestyle factors that most affect biological age are sleep quality, resistance training, dietary pattern, alcohol intake, and chronic stress. Insulin resistance and visceral fat are the biggest metabolic accelerators.
Yes, smoking speeds up biological aging significantly. Nicotine and combustion byproducts move methylation patterns toward an older profile, and the effect shows up clearly on DunedinPACE.
Some supplements may slow biological aging when paired with foundational habits. The strongest evidence sits with omega-3, vitamin D, and creatine, but no supplement replaces sleep, training, and metabolic control.
DunedinPACE is generally more useful than the Horvath clock for tracking interventions. Horvath estimates total accumulated age, while DunedinPACE captures your current rate of change, which is what you can actually move.

Deep-Dive Questions

Methylation drives biological aging by adding or removing chemical tags on DNA that change which genes get expressed. As you age, methylation patterns drift in predictable ways, silencing genes that protect tissue and activating genes linked to inflammation. DunedinPACE reads that drift.
Insulin resistance accelerates biological age because it drives chronic inflammation, glycation (sugar damage to proteins), and mitochondrial stress. Those processes change methylation patterns in ways that show up directly on epigenetic clocks.
Zone 2 cardio influences rate of aging by improving mitochondrial density and fat oxidation, which lowers metabolic stress on every cell. Patients who add 3 to 4 hours per week often see fasting insulin drop, which tends to track with a slower DunedinPACE.
Yes, poor sleep alone can push DunedinPACE above 1.0. Chronic short sleep raises cortisol, lowers growth hormone pulses, and worsens insulin sensitivity. Each of those mechanisms shows up on epigenetic clocks over months.
Muscle mass relates to biological age through metabolic reserve. More muscle means better glucose disposal, better insulin sensitivity, and a stronger fall buffer in older age. Sarcopenia (muscle loss) tracks with faster biological aging.
ApoB plays a role in epigenetic aging by driving vascular inflammation. Elevated ApoB (a marker of atherogenic particles) correlates with faster vascular aging on imaging and on methylation panels.
Grip strength is a useful proxy for biological age because it captures total body protein status, neuromuscular function, and recovery capacity in one cheap test. Studies show grip strength predicts mortality independently of chronological age.
Chronic stress changes DNA methylation by keeping cortisol elevated and shifting tags on genes involved in inflammation and immune regulation. Over years, that pattern reads as accelerated biological aging.
Yes, alcohol use can change DunedinPACE results, particularly at heavier intakes. Alcohol disrupts sleep, raises inflammation, and stresses the liver, all of which feed into a faster pace of aging.
Environmental exposures in Philadelphia, like air particulates near I-95 and older lead-paint housing stock, can contribute to faster biological aging. We screen for relevant exposures when patients live or work near heavy traffic corridors.
The relationship between biological age and dementia risk is meaningful. Faster pace of aging on DunedinPACE correlates with worse cognitive trajectories and earlier signs of decline in long-term cohort data.
You should not panic if your first DunedinPACE result is high. A single result is a starting line, not a verdict. The point is to identify which levers (sleep, training, metabolic health, stress) to pull and to retest in 6 to 12 months.
Fasting or time-restricted eating may slow biological aging in people with metabolic dysfunction, mostly by improving insulin sensitivity. The signal is weaker in lean, already-healthy people.
Sauna use may modestly affect epigenetic age by triggering heat shock proteins and improving cardiovascular function. The data is early but consistent with broader cardiovascular benefit.
Immune age is a measure of how old your immune system looks based on T-cell ratios and inflammation markers. It overlaps with biological age but focuses on infection and cancer resilience specifically.
To interpret a DunedinPACE score with your doctor, look at the rate of aging number alongside your sleep, labs, and training data. The score only matters in context. A 1.05 in someone with terrible sleep is a fixable problem.

Ready when you are

Start your intake

Dr. Ash reads every intake himself, and answers questions personally - usually within a few hours.

Related Intelligence

Healthspan vs Lifespan: Why Living Longer Is Not Enough | Philadelphia

Healthspan vs Lifespan: Why Living Longer Is Not Enough | Philadelphia

Americans live to about 78 but spend the last 12 years sick and dependent. A Philadelphia primary care practice on why healthspan is the real metric.

Read Deep Dive
Medicine 3.0 Philadelphia | The Systems-Biology Model of Longevity

Medicine 3.0 Philadelphia | The Systems-Biology Model of Longevity

What Medicine 3.0 means and how a Philadelphia primary care practice uses it to extend healthspan, not just lifespan.

Read Deep Dive
Metabolic Health Doctor Philadelphia | Insulin Component of Longevity

Metabolic Health Doctor Philadelphia | Insulin Component of Longevity

Stop settling for "normal" lab results. Our Philadelphia metabolic health clinic uses advanced testing (HOMA-IR, CGM) to detect insulin resistance and optimize energy.

Read Deep Dive

New patients

Talk it through with Dr. Ash.

If anything you read here raised a question, start with a short intake - your story in your own words. Dr. Ash reads every one personally, and you can text or email us anytime.

HSA/FSA eligible
No initiation or cancellation fees
No copays
Start your intake →
FishtownFish wrapped around the rod of AsclepiusMedicine
Philadelphia Primary Care
2418 E York St, Philadelphia, PA 19125Primary care in PhiladelphiaHome visits in Greater PhiladelphiaPricing & MembershipGER·O·SPAN: our clinical frameworkDigital Health Literacy

Serving Fishtown · Northern Liberties · East Kensington · Olde Richmond · Port Richmond · Old City · Callowhill · Poplar · Center City · Center City West · Art Museum · Bella Vista · Chestnut Hill · Fairmount · Fitler Square · Graduate Hospital · Logan Square · Manayunk · Queen Village · Rittenhouse · Roxborough · Society Hill · Southwark · Bryn Mawr, PA · Gladwyne, PA · Villanova, PA · Wayne, PA · Cherry Hill, NJ · Haddonfield, NJ · Medford, NJ · Moorestown, NJ · Voorhees, NJ

Explore by topic

Women’s Health
  • Perimenopause
  • Menopause 3.0
  • PCOS
  • Fertility
Men’s Health
  • Testosterone (TRT)
  • Sleep Apnea & Low T
  • Andropause
  • Low Libido
Metabolic
  • Medical Weight Loss
  • Ozempic vs Metformin
  • Fasting Protocols
  • Visceral Fat
Cardiovascular
  • apoB & Heart Health
  • apoB vs LDL
  • Lp(a) Cholesterol
  • ED & Heart Risk
Longevity + Performance
  • Healthspan vs Lifespan
  • Biological Age
  • VO2 Max
  • Zone 2 Training
Supplements
  • Magnesium
  • Creatine
  • Omega-3
  • Foundational Stack
  • Supplement Guides
Care in Philadelphia +
Direct Primary Care in Philadelphia, PAConcierge Medicine in Philadelphia, PAConcierge vs DPC in Philadelphia, PALongevity Medicine in Philadelphia, PAPreventive Care in Philadelphia, PAExecutive Physical in Philadelphia, PAAnnual Physical in Philadelphia, PAHealthspan Optimization in Philadelphia, PAFunctional Medicine in Philadelphia, PASame-Day Sick Visits in Philadelphia, PATestosterone Replacement Therapy in Philadelphia, PAPerimenopause Care in Philadelphia, PAMenopause Care in Philadelphia, PAThyroid Treatment in Philadelphia, PAPCOS Care in Philadelphia, PAGLP-1 Weight Loss in Philadelphia, PAMetabolic Health in Philadelphia, PAHormone Optimization in Philadelphia, PAAdvanced Lipid Testing in Philadelphia, PAVO2 Max Testing in Philadelphia, PADEXA Scan in Philadelphia, PACGM in Philadelphia, PALong COVID Care in Philadelphia, PAChronic Fatigue Treatment in Philadelphia, PAPOTS Treatment in Philadelphia, PAMCAS Treatment in Philadelphia, PALyme Disease Care in Philadelphia, PABrain Fog Treatment in Philadelphia, PASleep Disorders Treatment in Philadelphia, PAStrep Throat Treatment in Philadelphia, PAUTI Treatment in Philadelphia, PASinus Infection Treatment in Philadelphia, PASTI Testing in Philadelphia, PATravel Medicine in Philadelphia, PAPre-Op Clearance in Philadelphia, PASports Club Medicine in Philadelphia, PA

Made it this far? You’re already most of the way there. let’s get started → Dr. Ash reads every word personally.

Content is for educational purposes only and does not constitute medical advice.

TermsPrivacyScope of PracticeClinical Independence