Dr. Alexandra Dalu on Anti-Aging Medicine: From the ER to Prevention

Eleven years as an emergency physician, then a shift to anti-aging medicine: Paris-based Dr. Alexandra Dalu chose to treat people before the emergency. An author, an open-water swimmer and a lover of numbers, she talks prevention, sleep, the lymphatic system and the health myths that hold us back.

Becoming a doctor: a late calling

When did you decide to become a doctor?

Very late. I was good at everything in school; I could have been a PE teacher. But I loved science, and I wanted a career that would never bore me and that I could practice anywhere in the world. Biochemistry, physics, the human body: medicine came naturally. I also loved detective novels and science fiction, so at first I wanted to be a medical examiner. And science fiction is here now: science has been moving at an exponential pace over the last decade.

From the ER to anti-aging medicine

You were an emergency physician for eleven years. Why the change?

We were working 80 to 90 hours a week. ER doctors may have a little more mental and physical stamina than average, but we're not superhuman. And then there were the patients we saved who said: "We'd love to see you again at your practice." In the ER, there's no practice; you never see patients again. Wanting to follow people over time, and seeing what could have been avoided, led me to prevention.

"We can't prevent everything, and we shouldn't lie to people. But some things could have been avoided."

What exactly is anti-aging medicine?

It was born in the US in the 1990s, with a simple idea: you're well, but you could be better. You want to protect yourself from what your parents or grandparents went through. We're not here to tell you you'll never get sick again. That doesn't exist; we leave that to the gurus. But we can delay illness, and if it does come, make it less severe and manageable with fewer medications. High blood pressure managed with a healthy lifestyle and one treatment is not the same as high blood pressure with three or four treatments and dangerous spikes.

Why shouldn't we wait to see a doctor?

People tend to wait: a little pain, a little tired, a little out of breath. We're not here to dramatize, but to ask: why wait? See your primary care doctor at least, and plan your prevention around your family history.

Sleep, the first pillar of longevity

Sleep comes up a lot when you talk about health.

It's the foundation. We talk about eating well and exercising, much less about sleeping well. Athletes make sleep their top priority. At night, the body produces growth hormone: someone who sleeps well gets real cellular renewal. If you want to feel good and age well, whatever your age, you have to sleep well. And a sleep disorder is a medical condition: it's not a bad night because your neighbor threw a party, it's a sleep debt that builds up week after week.

"If you want to feel good and age well, whatever your age, you have to sleep well."

Do we really need eight hours of sleep?

It depends on the person. As France's National Institute of Sleep and Vigilance explains, everyone has a chronotype, a genetic program present in all our cells. Short sleepers tend to be night owls, efficient late and not morning people. Long sleepers feel tired around 10 p.m. and wake up refreshed at 6 a.m. The real question is: do you keep waking up tired? If it lasts more than three months, see a doctor, because it can point to something else: a thyroid problem, sleep apnea, or in women, a cardiovascular issue in the making.

The lymphatic system and lymphatic drainage

What role does the lymphatic system play in your practice?

A central one. My generation of doctors already worked with physical therapists, and pneumatic compression therapy has existed for a long time, especially after certain cancer treatments that can cause lymphatic retention. Lymphatic drainage has always been almost medical. When the pressure inside the vessels is off, fluid leaks out: that's water retention. As a reminder, it's not the water you drink, it's inflammatory fluid. Drainage helps bring it back into circulation. After a good session, people often feel a strong urge to urinate: a sign the system is moving again. In France, it's even covered by national health insurance.

"Water retention isn't the water you drink. It's inflammatory fluid."

Do you recommend it often?

Often. Extra weight puts mechanical strain on the vessels. And women have more venous insufficiency than men, because of hormones. Depending on the case, an occasional session is enough; some people need it twice a week, others every ten days. It's almost the patient who finds the right rhythm. Then there's compression, all the way to compression socks for sports. Your brand, which I'm fond of and find particularly subtle, makes leggings you mostly wear to work out. There's the exercise you do, plus your smart garment that also works on the entire lymphatic system. I think it's a great idea.

That was exactly our starting point. With the first prototypes, I measured my friends' thighs, and we saw a reduction in water retention. Then the challenge was to move beyond the medical stigma, ugly and uncomfortable, and create something desirable.

Absolutely. Since they're beautiful, you can wear them beyond workouts. But personally, I want people to exercise, to think: these are my workout clothes, and I can wear them at home too.

Compression and exercise: a doctor's take

"If I work out three times a week, I don't need drainage or compression." True or false?

Three workouts a week is great, keep it up, mixing balance, core work, strength, endurance and flexibility, as public health guidelines and the WHO recommend. Massage or drainage around exercise is also very interesting: during effort, the muscle draws in blood and tightens. If working out in compression feels good to you, don't change a winning team: it helps reduce fatigue, which means better performance and better recovery. When you take it off, blood flows back and circulation gets a boost. It's not essential, but it can be necessary for some people, and it's worth trying.

"It's not essential, but it can be necessary for some people. It can only be an extra tool."

Do you wear compression yourself?

Compression socks, ever since medical school, like all my doctor friends: on hospital shifts, you stand for hours without moving. Surgeons wear them too. And as a hiker, I wore them for hiking and skiing: I performed better with them.

Moving more, even if you don't like exercise

You're very athletic yourself.

In my family, everyone exercises, like brushing your teeth. I'm from Le Havre, on the Normandy coast: you learn to swim in cold water, and everything feels warm after that. Windsurfing, board sports, running, and above all open-water swimming, down to about 61°F (16°C).

And for people who don't like exercise?

Do whatever little you can. Start with a sports physical therapist, or simply walk faster: two half-hours of brisk walking a day, gradually faster. For people who don't feel comfortable at the pool, a stationary bike with music helps them reclaim their movement. Water aerobics often wins people over, and back home, many people walk in the sea in wetsuits: it builds muscle, supports drainage, and if you fall, you don't get hurt. With empathy and listening, there's always a solution.

"Do whatever little you can."

Two health myths, debunked

"Hormonal imbalance is a 50-year-old woman's problem."

False. Illness has no age. Children have glands, so hormones, and imbalances can happen in both sexes, at every age. Too many kids are still labeled "the chubby one in the family": if their siblings aren't overweight, see a pediatric endocrinologist. Men also have a thyroid and a pituitary gland, which can malfunction. When in doubt, see an endocrinologist.

"Eating gluten-free is always healthier."

It's healthier if you have celiac disease, which is diagnosed through blood work and exams with a gastroenterologist. In that case, gluten becomes a poison. If it's just poor digestion, don't eat what bothers you, but don't deprive yourself of what you enjoy if it does you no harm. As an adult, you're your own best barometer. That doesn't mean skipping the doctor: some diagnoses come late.

Peru, altitude and why life is precious

Your most memorable trip?

Peru. I climbed above 16,000 feet. At altitude, you walk like you're on the moon, completely out of breath. And when you come back, you feel incredible for ten days or two weeks: altitude naturally stimulates the production of erythropoietin. Hypoxia is widely studied in anti-aging medicine, but I would never have climbed Everest: I don't like danger. As a doctor, you see people die. Life is precious.

"There aren't enough of us"

What should we understand about doctors today?

I love numbers. To do the job well, you'd need one doctor for 10 patients. In France today, it's one for 100. Patients wait, which is hard for them above all, and we do everything we can, out of conviction. It's not a complicated job. It's a job that has become complicated, because there aren't enough of us.

Her pearl of wisdom: "Let's take action"

One piece of advice for our audience?

When you give advice to women, you give it to men too. So I'll give it to everyone: take action. Let's take action. Our times are missing something concrete.

"Take action. Let's take action. Our times are missing something concrete."

Your questions for the doctor

What is anti-aging medicine?

In France, anti-aging medicine is a recognized medical practice focused on preventing age-related disease and preserving health for as long as possible, based on family history, sleep, nutrition and physical activity.

How long should fatigue last before you see a doctor?

According to Dr. Dalu, waking up tired again and again for more than three months is a reason to see a doctor, since it can point to a sleep disorder or another health issue.

Is water retention the water you drink?

No. It's fluid that has leaked out of the vessels and is inflammatory in nature. Lymphatic drainage helps bring it back into circulation.

Should you wear compression when you work out?

It's not essential, but it can help some people: compression may reduce fatigue and support recovery. The best approach is to try it and listen to how you feel.

This article is for informational purposes only and does not replace medical advice.