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Looking back in time brings back mixed feelings: Should we have bought that house? Sold the piano nobody played? What about the lives of our great-great grandparents devoid of modern luxuries? We can treasure moments in time, balance the baggage of our past against our dreams for the future, but we cannot escape time itself.

A few years ago, I met Carlo Rovelli in London while on a book tour from my previous book, The Genetics of Health (Simon and Schuster, New York, 2017).

“Photo-aging or sun damage is the biggest cause of skin aging. Any other organ can hide its mediocrity behind layers of, well, skin.”

Rovelli was discussing his book The Order of Time (Penguin Books, 2017). In a previous interview with Discover magazine, Rovelli had said:

“Einstein’s 1905 paper came out and suddenly changed people’s thinking about space-time. We’re again in the middle of something like that. When the dust settles, time—whatever it may be—could turn out to be even stranger and more illusory than even Einstein could imagine.”

I was especially interested because speaking of the passage of time, skin reflects the passage of time more than any other organ. Photo-aging or sun damage is the biggest cause of skin aging. Any other organ can hide its mediocrity behind layers of, well, skin. If a liver or a kidney was not up to the mark, you may never know unless you were to take a medical test or examination. Skin wears its health like a badge for all to see, everything is unashamedly laid bare.

FUN FACT

“Physics suggests that the variation in time due to altitude is too small for humans to perceive because it is of the order of 90 billionths of a second over a 79-year lifetime”

Over more than 25 years, I have spent every day looking at skin patterns –rashes, moles, skin cancers, tattoos, wrinkles, assorted beautifications and uglifications on the skin of over 150,000 people. I’ve also learnt that however old one is, everyone wants to look younger.

As a child, I had a keen interest in physics. The aspect that fascinated me the most was to do with the relativity of time. Time moves faster at altitude because the further away you are from the earth’s surface, the gravitational force warps the effect of time. This is explained by Einstein’s theory of general relativity.

Rovelli mentioned that his lab had an atomic clock on the ceiling and another on the floor to demonstrate the scientific fact that time passes faster at higher altitudes. Rovelli narrated a story about Albert Einstein’s discovery of time being bent by gravity, saying that Einstein had found that Swiss clocks at different heights in Zurich’s railway station were almost impossible to synchronize. Indeed, scientists have known for decades that time passes faster at higher elevations. About a decade ago, scientists at the National Institute of Standards and Technology (NIST) decided to study the warping of time on a practical scale, at a dimension of one foot above the ground. For the first time—rather than esoteric physics experiment conducted in space or using high-flying rockets, a simple experiment was designed to answer this question: Do you age faster when you stand a couple of steps higher on a staircase?

“Telomeres are cellular timekeepers, does that mean we age faster in the mountains that we would if we lived at sea level? As someone who loves the convergence of sciences, I asked this question of skin biology: Does our skin age faster at altitude? “

Physics suggests that the variation in time due to altitude is too small for humans to perceive because it is of the order of 90 billionths of a second over a 79-year lifetime. It seems strange but is true. If you were to live your life standing on a block, time would pass faster for you than if you stood on the ground. It needs sophisticated devices such as NIST’s aluminium quantum computing clocks for us to comprehend the scale at which time is sped up by altitude.

George Henry Lewes, in his book The Physiology of Common Life (1860) once called a cell a true biological atom. If our physical clocks go faster at higher altitude, it is true of cellular clocks? We already know that when it comes to leucocytes (white cells) in the blood, animal studies suggest that the telomere length is elongated at a moderate altitude, but not at a high altitude. Telomeres are cellular timekeepers, does that mean we age faster in the mountains that we would if we lived at sea level? As someone who loves the convergence of sciences, I asked this question of skin biology: Does our skin age faster at altitude? After all we all see wrinkled faces of women in the Himalayas—are the wrinkles caused by photo damage from the sun?

In 2002, Dr Gustavo Gonzales conducted a study on Peruvian women living at above 13,000 feet (4,000 metres) in the Andes and compared the levels of certain adrenal hormones (DHEA and DHEA-S dehydroepiandrosterone and dehydroepiandrosterone sulphate) with women that were living in the capital city, Lima (500 feet above sea level). The team found that the blood levels of these hormones decline as we get older. DHEA has been known to be important for mental and physical health. Gonzales’s team found that DHEA levels in women living at high altitudes were less than half of the levels found in the other group. He wrote: “These hormonal changes might have a significant effect on the lives of women living in high altitude areas such as the Andes, the Alps, the Rockies, and the Himalayas … “The early decline in the concentration of these hormones in women living at high altitude may suggest that women age earlier at high altitudes.”

Till Rosenband, leader of NIST’s aluminium ion clock team, suggests that such super-precise clocks can help us understand geophysics and geology. It echoes my view that specialties such as dermatology and plastic surgery have viewed wrinkles almost geologically as fault-lines on skin, to be pulled and pushed or stretched—neglecting the underlying physiology. A few years ago, I wrote an article about “Why the geological approach doesn’t work for wrinkles: The need to move from anatomy to physiology.”

Cosmetic medicine has become fundamentally about obliterating these lines without thinking about the physiological changes that lie beneath. Indeed, recent research shows that under each new wrinkle that forms, there lies a new lymphatic vessel. What this means is—if someone looks older suddenly, it is likely that there could be an underlying health issue. We still don’t know if stretching out skin to remove these wrinkles affects these lymphatic vessels negatively, and this is possible. But we do know that wrinkles are more than skin-deep. Aging can be measured both biologically and chronologically. A team in Denmark looked at this issue in 1976 as part of the comprehensive Copenhagen General Population Study in a research project that spanned 35 years. The study recorded visible signs of chronological aging in people –-such as wrinkles and baldness—and looked for any correlations with biological aging. The results showed that cholesterol deposits on the eyelids, earlobe creases, bald spots and receding hairlines indicated that a person’s biological age was older than the chronological age – in other words, the body was older than the age in years. Wrinkles, on one hand, revealed nothing about the body’s biological age. On the other hand, the more wrinkles you have especially around your ears, the higher your risk of developing heart disease. Your skin is essentially a mirror of your state of health. But in standard medical practice, specialties are so divided into silos—that in focusing on the organ one specializes in, one forgets to treat the whole patient. And this –-the move to patient-centred medicine—is something I hope will happen with time.