Studies into telomeres – DNA structures linked to the ageing of cells – date back eight decades. But since telomeres were the subject of the 2009 Nobel Prize in Physiology or Medicine, they’ve become the centre of attention in scientific communities and are already being used as health biomarkers in spa lifestyle programmes.

Telomeres are caps at the ends of our chromosomes which prevent them from fraying as our cells replicate. As a cell ages, its telomeres become shorter and when they fall below a certain length, the cell can no longer divide and dies. It’s this cell loss that causes ageing in the body.

However, the ageing of our cells doesn’t always match our chronological ageing because, in addition to normal ageing, telomeres can be worn down through an unhealthy and stressful lifestyle. Conversely, it’s also been found that telomerase – an enzyme stimulated by healthy lifestyle – including enhancing wellbeing – can protect telomeres from shortening and may even lengthen them, effectively reversing the age process.

A telomere test can analyse the length of your telomeres to accurately measure your biological age and provide an evaluation of health – ie the longer your telomeres, the more healthy both you and your cells are. It can even show disease risk – cells with shortened telomeres may function poorly and have been linked to age-associated diseases such as osteoporosis and dementia.

Until now, the ability to measure telomere length has only been available through blood tests. But in the near future, US company Telome Health Inc plans to launch the saliva-based TeloTest™. Telome Health has been founded by leading telomere experts (see further on) and the test is exciting news for the spa industry because saliva samples can be easily collected in a test tube at the spa or at home. This single test might soon become the gold standard for gauging overall wellbeing and an opportunity for spas to provide a wellness diagnostic tool.

THE POWER OF KNOWING
Sha Wellness Clinic in Spain (see SB09/2 p38) is one of the most recent examples of a spa taking advantage of advances in the study of telomeres. In January, it launched a seven-day Anti-Ageing Program – costing E7,000 (US$9,350, £5,850) – that includes telomere analysis, via blood samples, to diagnose a person’s biological age. This information is then used in lifestyle and nutrition consultations to improve the guest’s state of overall health.

Indeed, telomere length is one of the best biomarkers of overall health status, indicating the impact of diet, fitness, toxins and chronic stress. Telome Health, for example, will offer a TeloAge report where your personal telomere length is presented compared to a range of a healthy control population in your age and gender group, to gauge how you measure up to the healthy average. Repeating the tests over time give you the best view into how your cells are ageing, and whether your current lifestyle is working for or against you.

At ReNove Med Spa in Delaware, in the USA, Dr Michelle Parsons uses telomere testing to optimise her recommendations to clients for lifestyle changes. She says: “When a test reveals an older physiologic age [than their chronological age] clients are relieved to discover there are ways of slowing telomere shortening through lifestyle changes. In this respect, it’s not merely a static test but a useful tool to measure positive change in their health.”

But how do we know all this? And what lifestyle aspects (bad or good) have been proven to have an impact on telomeres?

LANDMARK RESEARCH
Elizabeth Blackburn, an American biological researcher, first observed telomeres in the 1930s and in 1985 Blackburn, with graduate Carol Greider, discovered the telomerase enzyme. Blackburn and two colleagues received the 2009 Nobel Prize in Physiology or Medicine for “the discovery of how chromosomes are protected by telomeres and the enzyme telomerase”.

In 1990, reknown biochemist Calvin Harley showed that telomeres shorten progressively in human cells. He was instrumental in demonstrating that this is a cause for cellular ageing and that telomerase can prevent this action.

In 2004, Elissa Epel, a leader in health psychology and behavioural medicine at the University of California, San Francisco, pioneered research linking stress to immune cell ageing.

She showed that the perception of stress as well as actual stressful events or thoughts are related to telomere shortness and reduced telomerase activity. In plain words she proved that stress ages you at a cellular level. And in a 2008 study, published in scientific journal The Lancet Oncology, Epel, Blackbrun and physician Dr Dean Ornish showed “lifestyle changes can significantly increase telomerase activity” with positive changes taking place in just 90 days.

In November 2010, a group of Harvard University researchers published results from a study in Nature. The experiment involved mice that were genetically engineered to lack telomerase so they aged prematurely and died. In a second group of mice, they turned on the telomerase gene with shocking results. For the first time ever, the aged state of an animal was reversed and the mice became young again, growing darker hair in the process.

In the same year, Blackburn, Harley, Epel and molecular biologist Jue Lin co-founded Telome Health in an attempt to widen the reach of telomere testing.

Fast-forward to today’s breaking news. In a large clinical study, the average telomere length was measured in 100,000 patients from Kaiser Permanente, one of America’s biggest care organisations. Using the saliva-based TeloTest, it was found that individuals who had short telomeres had increased risk of death in a three-year follow up period, and that smoking, heavy alcohol consumption, lower levels of education and poor environments were associated with short telomeres, while moderate exercise was associated with longer telomeres.

The size of the Kaiser study goes a long way towards validating previous findings. Currently, there are more than 10,000 peer-reviewed scientific publications in existence which show that exercise, more and better sleep, healthy food choices, meditation and more are linked to preventing telomere shortening. So what does all of this mean for the spa industry?

TURNING BACK THE CLOCK?
Scientific research has revealed that stress is high on the list of factors that can prematurely shorten telomere length. In this aspect, the relaxing nature of spas and the therapeutic value of many of their treatments make the ‘spa intervention’ an important option to improve ageing status, and even reverse the negative effects of premature ageing. Clearly we can point to telomere molecular measurement as a potential validation for the restorative and stress reducing treatments offered by spas.

Although there are no large, controlled clinical trials published yet, given the multitude of existing studies, researchers say it’s possible and likely that the following may help with maintaining or even lengthening telomeres:
* Increasing exercise: adding four to five training sessions in your week
* Improving nutrition: implementing a low-fat diet, with less red and processed meat and talking with a nutritionist about dietary supplements that activate the telomerase enzyme
* Improving metabolism: starting a weight loss programme
* Enhancing wellbeing: reducing psychological stress and depression and increasing feelings of personal control and purpose in life
* Decreasing stress: adding yoga and meditation to lifestyle programmes

OPPORTUNITIES FOR SPA OPERATORS
In June 2012, Epel outlined the potential of telomere health to a host of spa leaders at the annual Global Spa & Wellness Summit (GSWS) in Aspen, US. She said: “telomere science is just the tip of the iceberg,” and that as the connection between healthy behaviour and the measurable forestalling of disease and cellular ageing grows stronger, “the implications for the spa and wellness industry is profound” (see SB12/3 p54).

There are two clear opportunities for spas to use telomere diagnostics. Firstly, in helping to prove the effectiveness of corporate wellness programmes (see SB12/4 p24). Stress-reduction in staff is one of the key goals for corporate employers worldwide, making spas and spa services a number one choice in the workplace wellness industry which, according to the World Economic Forum, is worth US$30bn-plus (E22.5bn, £18.9bn)pa.

One of the many ways spas can participate in wellness packages for such companies is to provide TeloAge diagnostic information about a person’s health that can then point back to the value of the stress-reducing spa services.

Secondly, spas can get in on the personalised wellness movement that’s gaining momentum. The World’s Youngest Populations study by Euromonitor showed that at the beginning of 2012, half of the world’s population was aged over 30 – and a growing number of this demographic have an interest in actively managing their health. Knowledge about your health status is empowering, and can lead to a shift towards healthy lifestyle behaviours.

In the Boomers Value Realignment Study, conducted in 2011 by real estate advisory firm Civano Living, it was reported that 84 per cent of baby boomers in the US are “somewhat to very interested” in “health and fitness programmes designed for them.” Measuring and tracking telomere length as an overall health barometer will be an integral component in this personalised wellness revolution.

John Kao, chairman of the US Institute for Large Scale Innovation, who also spoke at the GSWS highlighted the industry’s need to “move from the ‘event-driven’ model and create much more sustainable connections and experiences”.

The ability to benchmark one’s health through telomere testing, followed by a take home programme, and a six-month retest is an effective way to stay connected to the spa clientele. With a simple saliva telomere test, the tracking of the impact of various spa wellness therapies on telomere health is a reality.

As the evidence mounts that core spa approaches modify telomeres – one of the few changeable parts of the human genome – a major opportunity arises.