As a physician leader, Medical Director, Chief Medical Officer, and teacher, I am dedicated to advancing the science of wound healing. Most weeks, I am involved with helping complex patients heal challenging wounds of all types. Wounds are a unique window into many aspects of health and physiology, and especially into the aging process itself. Wounds reveal the body's repair processes in real time — and you can watch what speeds that repair up and what slows it down. Those lessons don't stay in the clinic. The same forces that decide how fast our tissues heal also shape how we age.

That's what this letter is about.

Repair is not a fixed rate

For more than two decades I cared for patients with wounds that would not heal — in emergency departments, in hyperbaric chambers, and in wound clinics. A wound is one of the few places in medicine where you can see the body's repair machinery at work, week after week, in the same person.1

What struck me most was how variable that machinery can be. Two people the same age, with the same kind of wound, can heal at completely different rates. And the same person can heal quickly during one season of life and slowly during another. The rate of repair is not a fixed number set by your birthday. It is changeable, and often dramatically. In fact, some remarkably simple things can alter the healing of a chronic wound, just as simple things affect the ways we age.

Once you've watched that happen a few hundred times, you start asking the obvious question: what really moves it, under the surface? What is going on at the cell-level, and what does it teach us about remaining healthy, at any age?

The same levers, everywhere in the body

The honest answer is that the things that govern how fast a wound closes are the same things that govern how well the rest of the body maintains itself over time.

  • Blood flow and oxygen. Tissue can't rebuild what it can't supply. The vascular health that helps a wound heal is the same vascular health that protects your brain, your heart, and your muscles as you age.
  • Inflammation — in the right amount. A wound needs an inflammatory signal to start healing, then needs that signal to resolve. Inflammation that never switches off is corrosive, and chronic, low-grade inflammation — “inflammaging” — is one of the most consistent themes in the biology of aging.2,3
  • Fibrosis is becoming a hot topic in medicine, for very good reasons. Scar tissue is one example of "fibrosis," we can all relate to. Scars are composed of nonliving collagen fiber, rather than healthy, living cells. Deranged healing produces scar-like tissue, not vital healthy tissue. Fibrosis is also at the heart of visible, and functional aging; healthy, functional tissue replaced by scar-like, dysfunctional tissue, causing many diseases associated with aging.4 Fortunately, we know how to adjust some of the levers that drive fibrosis.
  • Protein and the raw materials. You cannot build new tissue out of nothing. Adequate protein and other nutrients are not optional for repair — at any age, but especially as we get older, when the body starts to use protein less efficiently.5
  • Sleep. Much of the body's repair and clean-up happens while you sleep — the brain even clears metabolic waste more efficiently during it.6 Short-change sleep and you short-change the rebuild, and put many closely regulated bodily processes off-balance.
  • Movement and Physical Effort. Activity drives circulation, muscle maintenance, and a long list of repair signals. Stillness does the opposite. The key is regular practice of the kinds of activity that drive these positive changes.
  • Stress and the hormonal background. The hormonal environment a wound heals in is the same environment your whole body lives in. Chronic stress hormones blunt repair, often to the point that healing essentially stops. What is fascinating is that these same hormonal "signals" are continually influencing the rate of aging, and affecting tissue repair in every organ system in the body.

None of these is exotic. That's the point. The inputs that decide whether a wound heals are mostly the same daily inputs that decide how you age — and almost all of them are things you have some – perhaps even a great deal of say over.

Aging as a repair problem

It's tempting to think of aging as a clock that only ticks one way. But much of what we experience as aging is a slow shift in the balance between damage and repair. Damage accumulates in everyone — across a dozen interacting processes biologists now call the “hallmarks of aging.” The question is how well, and how quickly, the body keeps up with it.3

That way of looking at aging – as something we drive and influence – matters, because a clock is something that happens to you, while a balance is something you can influence. Not infinitely, and not magically — but meaningfully. Wounds taught me that repair responds to how we manage our health. There is a saying in wound specialist circles: "to heal the hole in the patient, you have to take care of the whole patient."

This is not a promise that you can stop aging. It's a more useful idea than that: the pace of aging is partly negotiable, and the terms of the negotiation are mostly ordinary — what you eat, how you move, how you sleep, how you handle stress, and how well you protect your blood vessels from harmful stimuli along the way. There are also some remarkably effective – and natural – substances or supplements that have been proven to favorably affect the rate and effects of aging.

What this means for you

If our bodily repair mechanisms are so responsive, then the goal needn't be to chase the latest molecule. It simply boils down to creating the conditions your body requires to keep up with the damage of living — consistently, over years. The unglamorous inputs do the heavy lifting. The exotic ones, where they help at all, help at the margins.

In the letters ahead, I'll take these one at a time — what the research actually supports, where the hype outruns the evidence, and what's worth your attention and what isn't. I read the studies so you don't have to, and I'll tell you when the honest answer is “we don't know yet.” You will want to look at some of this research for yourself, I'm certain, because it is not just promising, it is actionable, and clearly effective.

I will be covering other topics of interest as well, because my nearly 40 years in medicine have taught me something else, and that is that the science moves much faster than clinical practice, and not for good reasons. Adoption of clearly evident breakthroughs is painfully slow.

There is a kind of clinical inertia that puts the pace of medical progress increasingly out of step with the rapid breakthroughs being made in other fields. This has always been a source of deep frustration to me, and it has also been a source of inspiration that keeps me as excited about the future of medicine now, as I was as a new Medical School graduate.

I research new developments incessantly, and unsurprisingly, this has led me to be an early adopter of breakthrough treatments that even years later, my colleagues don't know about. A new development in 2019 enabled me and my teams to reduce mortality to nearly zero in a disease that normally has a 70% annual mortality rate. The treatment for this disease is so simple, and cheap that it baffles me that it has not received more attention. I teach this new treatment to other doctors when I speak at medical conferences, and guide my team to implement it when we diagnose a new case of the disease, but my commitment to you is that I will share useful breakthroughs that are based on solid evidence, that you can take back to your own primary healthcare provider, and implement yourself.

I came to these insights by a long, slow route, through studying wounds and seeing patients through incredibly challenging situations. I watched and studied the effects of simple differences in diet, lifestyle, and other choices, and how they correlated with disease, and more positively, which ones led to improvements in functional, and biological age. Wounds turned out to be a window onto something much larger for me: how we age, and how we can age well.

That's the work, and I'm glad you're here for it.

Dr. Marc Gitterle is a physician in wound care and hyperbaric medicine and the author of Growing Young: A Doctor's Guide to the NEW Anti-Aging.

References

  1. Gurtner GC, Werner S, Barrandon Y, Longaker MT. Wound repair and regeneration. Nature. 2008;453(7193):314–321. doi.org/10.1038/nature07039
  2. Franceschi C, Garagnani P, Parini P, Giuliani C, Santoro A. Inflammaging: a new immune-metabolic viewpoint for age-related diseases. Nat Rev Endocrinol. 2018;14(10):576–590. doi.org/10.1038/s41574-018-0059-4
  3. López-Otín C, Blasco MA, Partridge L, Serrano M, Kroemer G. Hallmarks of aging: an expanding universe. Cell. 2023;186(2):243–278. doi.org/10.1016/j.cell.2022.11.001
  4. Lu et al., "Prevalent mesenchymal drift in aging and disease is reversed by partial reprogramming." Cell2025;188(21):5895–5911. DOI (PMID 40816266)
  5. Bauer J, Biolo G, Cederholm T, et al. Evidence-based recommendations for optimal dietary protein intake in older people (PROT-AGE Study Group). J Am Med Dir Assoc. 2013;14(8):542–559. doi.org/10.1016/j.jamda.2013.05.021
  6. Xie L, Kang H, Xu Q, et al. Sleep drives metabolite clearance from the adult brain. Science. 2013;342(6156):373–377. doi.org/10.1126/science.1241224