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Make Them Good Years

Howard Rohleder

MANY YEARS AGO, a Wall Street Journal article quoted a source as saying, and I paraphrase, “Young-old age should last as long as possible, while old-old age should last 15 minutes.” Those of us who have visited nursing homes can all relate to this.

Public health initiatives and medical breakthroughs have extended lifespans significantly over the past 100 years. In his bestselling book Outlive: The Science and Art of Longevity, Peter Attia argues that we should focus not just on lifespan, but also on healthspan. The latter is a measure of how well we live, not necessarily how long. 

Attia emphasizes that “longer lifespan with no improvement in healthspan is a curse, not a blessing.” His goal is to increase people’s healthspan so that they maximize their chances of avoiding chronic disease, thereby reducing the portion of their lives that they spend frail and infirm. 

Attia believes that healthspan is about preserving these three elements of life for as long as possible:

  • Brain: How long you can preserve cognition.
  • Body: How long you can maintain muscle mass, functional movement, and strength, balance, flexibility and freedom from pain.
  • Spirit: How robust is your social support network, as well as your happiness, mental health and sense of purpose.

As an expert in longevity and preventive medicine, Attia has researched the ways we can achieve greater healthspan. He identifies four chronic conditions that have emerged in the developed world as the greatest contributors to reduced healthspan. His “four horsemen of the Apocalypse” are:

  • Atherosclerotic disease. This includes cardiovascular disease and cerebrovascular disease.
  • Cancer of all types.
  • Neurodegenerative disease, including Alzheimer’s disease, Parkinson’s disease and various types of dementia.
  • Metabolic dysfunction. This is a spectrum of everything from hyperinsulinemia to insulin resistance to fatty liver disease to Type 2 diabetes.

These four diseases account for more than 80% of deaths among those over age 50 who don’t smoke. Reducing their toll is a primary focus of Attia’s work. Much needs to be done.

Western medicine seems more focused on curing disease than preventing it. As an example, Attia cites how our medical system has evolved in the treatment of Type 2 diabetes. A person approaching middle age might see his blood sugar rise over time. At some point, the patient is defined as pre-diabetic and later diabetic.

No good comes from being diabetic—it’s a risk factor for all four horsemen. Once the patient has a diagnosis of diabetes, the medical system intervenes, potentially spending thousands of dollars. Yet, for years, the patient was marching steadily toward this point, and prevention could have averted both the physical and financial costs.

The book traces the evolution of medicine. Medicine 1.0 is how disease was treated up to the mid-1800s. This medicine had no foundation in science. Rather, it was based on “direct observation and abetted more or less by pure guesswork.”

Medicine 2.0, the current industry practice, waits until someone has become sick before initiating treatment. Modern medicine has a phenomenal ability to diagnose and treat complex diseases and respond to medical crises. It’s adept at dealing with trauma and infection.

Attia believes that what he terms Medicine 3.0 should focus on identifying negative trends early so we can zero in on prevention. In the diabetes example, early intervention might prevent the disease entirely before it can cause irreparable damage.

There is much evidence—and also much hype—around prevention. He says the greatest surprise in his research is the incredible power of exercise. When he began his dive into the evidence, he expected exercise to be important. What surprised him was how vital it is to our health.

On the flipside, he found that many claims about nutrition are based on weak studies. No doubt, proper nutrition is important, and he identifies some clear dos and don’ts. But fad diets or the constant drip of headlines saying this or that is or isn’t good are just noise.

The book can be read at two levels:

  • How does this relate to me and how can I increase my healthspan?
  • What does his research say about how the practice of medicine—and the insurance industry—should evolve, so we reach the next level of preventive care?

We can always learn and improve our current lifestyle. I would have benefited from reading this book at age 40 rather than 65. Even so, reading it now, I see that my health goals track well with Attia’s recommendations.

As a numbers person, I’ve always monitored my health measures: body mass index (BMI), blood pressure, cholesterol, glucose, triglycerides, and PSA, a measure of prostate health. If you don’t know your current state, it’s hard to map a path to improvement. I have also done well with aerobic fitness, but struggled with strength training.

Goals for how you live after 65 can also be defined in terms of function. This can mean completing daily activities without becoming short of breath, being able to get down on the floor—and then back up again—to play with grandkids, and managing household chores and bills without assistance. If these are your goals, too, what you do in the 20 years before retirement can determine your success.

Long ago, I identified that there’s a consistent theme in articles about disease prevention. For almost any chronic disease, the prescription starts the same: don’t smoke, maintain a normal BMI and blood pressure, exercise, minimize alcohol consumption, eat sensibly and get enough sleep. These universal principles are covered in great detail in the book. It’s never too late to start them.

I was introduced to Attia’s thinking through a podcast that I was, coincidently, listening to at the gym. The book is 496 pages long and some parts went into greater detail than I was willing to absorb. I did make some changes in my approach to exercise as a result of reading it, however. As much as I don’t like it, I’ve upped my strength training at the gym. The book also encouraged me to continue refining my diet.

Howard Rohleder, a former chief executive of a community hospital, retired early after more than 30 years in hospital administration. In retirement, he enjoys serving on several nonprofit boards, exploring walking paths with his wife Susan, and visiting their six grandchildren. A little-known fact: In May 1994, Howard was featured—along with five others—on the cover of Kiplinger’s Personal Finance for an article titled “Secrets of My Investment Success.” Check out his previous articles.

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