In an increasingly specialized and fragmented medical system, internal medicine remains one of the few medical specialties that preserves a comprehensive view of the patient.

The internist sees the body as an integrated system, in which subtle signs such as variations in metabolism, blood pressure, lipid profile, or inflammatory markers can signal cardiovascular, oncological, or metabolic risks at an early stage. At a time when chronic diseases are developing at increasingly younger ages, the role of the internist becomes essential: recognizing early what is not yet a disease, but is no longer a state of health. 

Dr.Claudiu Iosub, internist, explains the key milestones in the development of chronic diseases, longevity, and most importantly, what we can do to preserve our health for a longer period.

There are several diseases responsible for a considerable decline in quality of life: cardiovascular diseases, diabetes, cancer, and cognitive decline. What are the most important factors we should monitor to reduce, as much as possible, the risk of these conditions? 

The diseases responsible for reduced quality of life are often the consequence of activated stress responses, and they share a common denominator. Ideally, we would remove individuals from the environment that triggers these reactions and detach ourselves from modern civilization in order to counteract them, but this is not a realistic solution on a population-wide scale. 

What remains is to address the consequences of these responses, and the main indicators of metabolic imbalance, cognitive decline, vascular complications, or cancer are weight gain, increased blood pressure, dyslipidemia, and dysglycemia. Monitoring and managing these factors remains one of the most effective ways to extend the disease-free period and delay the onset of irreversible complications.

There is a lot of discussion about inflammation and the health risks associated with it. Do you consider monitoring inflammatory markers important for health? If so, what tests do you recommend for evaluating inflammation in the body?

Inflammation is also a consequence of stress responses and develops as part of this broader metabolic imbalance. There are laboratory tests that measure inflammation, mainly erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), while methods to address it are generally indirect, most commonly involving statin therapy. 

A patient with metabolic imbalance should be approached holistically, not in isolated segments, such as treating arterial hypertension without also addressing dysglycemia or dyslipidemia. Tests for inflammation are part of a broader metabolic and cardiovascular screening panel and should not be performed in isolation or with the sole purpose of reducing inflammation.

From a medical perspective, how do you define the aging process? 

The aging process is the progression of a complex genetic program that begins with the first cell division of the human embryo. It includes childhood growth and development, the completion of the adult reproductive stage, and ultimately the involution associated with old age. 

These stages may progress more slowly or more rapidly depending on environmental conditions and genetic predisposition. 

At what age does biological aging begin? 

There is no “standard” age at which the aging process begins. These milestones are specific to each generation and have changed throughout the recent evolution of human life. Beyond ethical or religious perspectives, the human body is a biological organism that is born, reproduces, and eventually dies.

In unfavorable external conditions, genetic mechanisms are activated that increase reproductive capacity and, at the same time, shorten lifespan, allowing more individuals to cope with natural selection and ensuring the survival of the species.

In a favorable environment, individuals tend to reproduce more slowly, live longer, and experience a slower aging process.

In order to keep age-related conditions under control, what parameters and medical indicators should be monitored, from what age, and how often?

The main mechanism that governs cell division, growth, and aging is the endocrine system, with cortisol, also known as the “stress hormone,” playing a central role. 

Cortisol has a sterol structure and is produced by the body in larger quantities under unfavorable conditions. Its main mechanism of action is the activation of transcription factors in the cell nucleus. As a result, cell division and metabolism accelerate, resources such as glucose, cholesterol, and fatty acids are mobilized, and oncogenes may become activated. Cells divide more rapidly, replication errors occur, and this can ultimately lead to cancer. At the same time, metabolism becomes dysregulated, which contributes to the development of diabetes and dyslipidemia. Higher nervous activity is also stimulated, and the consequences may include mental health disorders and cognitive decline. 

The age at which stress responses begin has decreased with each generation since the 1940s–1950s, representing one of the costs of modern civilization and lifestyle. 

If in the 1960s and 1970s type II diabetes (insulin resistance) was typically found in obese elderly individuals, and myocardial infarction was mainly seen in the same age group, in the 2020s we are seeing the same form of diabetes in children aged 10–12 and myocardial infarction in patients aged 20–25 who do not have genetic or metabolic conditions that would otherwise increase this risk. Practically, starting in adolescence, body weight, blood pressure, complete blood count, inflammatory markers, blood glucose, lipid profile, liver transaminases, renal function markers, and urinalysis should be monitored annually.

What kind of  lifestyle changes have the greatest proven impact on longevity and metabolic health?

The lifestyle measures that can delay the consequences of stress-related reactions are primarily diet and physical exercise.

A diet low in refined carbohydrates, saturated animal fats, and salt, combined with daily physical activity, is recommended.

These recommendations are easy to give but difficult to maintain, because a body governed by stress tends to “demand” higher amounts of carbohydrates and fats, while exercise is often difficult to sustain in the context of reduced muscle tone.

Even so, these remain the most effective ways to delay the onset of cardiovascular disease and extend the disease-free period.

Are there any supplements, vitamins, or therapies that you recommend to prolong health?

Prolonging health is only realistically achievable through periodic screening for the main metabolic, cardiovascular, oncological, and central nervous system diseases, along with early treatment using medications whose effectiveness has been demonstrated in scientific clinical trials. 

There are only a few classes of drugs that truly meet this criterion. Although medicine may appear vast, the effective solutions are relatively limited and their impact is often modest. Supplements, vitamins, and alternative therapies do not currently have a scientifically proven role and have not been properly evaluated in clinical trials, largely because they are not standardized in composition or manufacturing process. 

However, they may provide a placebo effect, offering a sense of satisfaction and hope that an alternative option with possible benefits has been explored. They are generally not recommended, but neither are they contraindicated, and quality of life may sometimes improve through the optimism they create.

How can an internist help a person who is concerned about health and longevity?

Internal medicine is the foundation from which all medical specialties have evolved, and residency training includes rotations through most of these disciplines.

An internist may not perform procedures such as coronary angiography or transesophageal echocardiography like a cardiologist, but they can interpret an electrocardiogram, a chest X-ray, a complex set of medical tests, and prescribe treatment for the most common cardiovascular conditions.

The same principle applies to other subspecialties. The internist has the essential diagnostic and therapeutic knowledge required to manage a broad range of medical conditions, while referring highly specialized cases to organ-specific specialists.

If the family doctor is the entry point into the healthcare system, the internist acts as the “gatekeeper” of the medical clinic, able to assess, prioritize, and guide diagnosis and treatment for a wide spectrum of conditions.

They can recommend and interpret age-appropriate investigations starting from early adulthood, and support primary, secondary, and tertiary prevention of the main medical conditions that serve as warning signs of premature aging.