Tuesday, January 28, 2014

The Longevity Paradox: Why Is Living to 100 Easier for Some People Than Living to 90 is For Most?

Are you curious to know the 'absolute rules' that if followed will always add many more years to your life? 

If you are reading this expecting me to provide you with such rules, let me apologize in advance.
I have searched for them for the past three years by speaking with over 1,000 senior citizen patients, including several over one-hundred years old, and by reading over 50 books, 40,000 clinical studies/abstracts, and countless online articles, and I am sorry to say that I don't believe they exist. Among books like The Blue Zones, The Longevity Project, Successful Aging, The Art of Living Long, A History of the Human Body, etc., I just can’t find any clearly proven advice. I’ve studied material from the Okinawa, New England, and Albert Einstein College of Medicine Centenarian studies, read publications from the SENS Research Foundation and available proceedings from International Longevity conferences. 

The reason there doesn’t seem to be any absolute right answer is because when it comes to living fifteen or more years beyond the average life expectancy there appears to be a paradox. (In fact, in the late 90s, a compendium of studies was published with the title, The Paradoxes of Longevity.)
Take smoking for example. There is no question regarding the association of cigarette smoking with lung cancer. Cigarettes are considered dangerous and responsible for producing debilitating lung diseases, which can sometimes—but not always--be lethal. Not every cigarette smoker develops lung cancer, and for that matter, not every lung cancer patient previously smoked or had major exposure to second-hand fumes or other chemicals.   

In Daniel Buetner's book The Blue Zones, he reveals five places, such as Sardinia, Italy and Nicoya, Costa Rica, scattered around the globe that harbor relatively high concentrations of centenarians, people aged over 100. He ascribes their longevity to living a certain healthy lifestyle. It often comes down to the food they eat, the physical activity they do, their attitude towards life and family, etc.  However, in these same areas there are plenty of friends, family, and neighbors who lived remarkably similar lives and yet died much earlier. Not surprisingly, in searching out the life expectancy for these ‘Blue Zone’ areas, I found that they are for the most part only a few years higher than life expectancies in other parts of the world with far fewer centenarians and that’s after you average in the centenarians. 

Yet, books and articles are published incessantly offering the ‘secrets’ and ‘keys’ to living to 100 if you follow a few similar rules such as eating properly, being physically active, getting the right amount of sleep, managing stress well, being social, etc. But do these actions always matter? If you lived the optimal life, will you add many more years to your life? The answer is complicated.
For some people, living a sub-optimal life may result in premature death such as in the case of the morbidly obese person who develops heart disease and type 2 diabetes, and succumbs early. Commonsense and plenty of supporting science affirms the notion that certain lifestyle activities, such as a sedentary life and poor eating habits may lead to premature chronic diseases such as diabetes, heart disease and cancer. But, ‘may’ is not always. 

To prove my point, let me share my own recently completed informal, admittedly unscientific, but revealing research project. The project involved accumulating all the stories about centenarians published online in 2013. Most of the stories were identified through a Google alert email for the keyword "longevity." After identifying over 50 stories, I searched each story for the centenarians' 'secret' or 'key' to longevity. I created a chart of the first 50 individuals I randomly came across that offered a reason for the centenarian's extended longevity.

Here are the results.  

The oldest centenarian was 114, with many having turned 100 just last year. 35 were women and 15 were men.
Here are the reasons they gave. It adds up to 50+ reasons because some offered more than one:
18 attribute it to (hard) work and physical activity

10 attribute it to regular alcohol consumption

6 attribute it to strictly never drinking or smoking

14 attribute it to a good attitude towards life and/or to their faith

1 to Anacin pills

1 to love of roller coasters

1 to good doctors

1 to cafe lattes (long before they became popular)

1 to marrying a man thirty years younger

1 to eating bacon

1 to eating Italian food

1 to eating junk food

1 credited  cigarettes and 1 credited cigars (and yet, no lung cancer)

2 claimed no explanation

Since I put this chart together, I came across four more stories for 100, 104, 108 and 109 year
olds. The 100 year old claimed his longevity was due to eating lots of strawberry ice cream,
just like his father did, who lived to 104. The 104 year old credited her longevity to her love
of eating chocolate and drinking hot chocolate.  The 108 year old stated that it was in part
due to never marrying and avoiding the accompanying decades of stress. The 109 gave her
key to longevity as not eating a lot and never between meals.

Now as you review this list, it should be clear that there were no absolute reliable and
consistent reasons as to why any of them lived past 100. In fact, scientists at Albert Einstein
College of Medicine and at Boston University, who have been studying centenarians for many
years, concur that there is no single absolute explanation for centenarian longevity. The current
thinking is these longevity winners possess a number of small genetic variations that work
together as a group to confer benefit to them. According to Thomas Perls, a Boston University
professor of medicine and director of the New England Centenarian Study, "Twenty percent of
the population has the genetic wherewithal to get to be 100."

So what does that mean for the eighty percent that represent the rest of us who may not enjoy
such gene variations? Should we even bother to engage in a healthy lifestyle if there are no
guarantees or absolutes? Why deny ourselves that piece of chocolate cake or bother to get out
of our chairs and move at all if good health and longevity simply come down to winning the
gene lottery?

The answer is that even though there are no absolutes when it comes to your health, there are
probabilities and possibilities.

A healthy lifestyle increases the probability of a healthy life even as the possibility for poor
health, like the inexplicable cancer, still exists. An unhealthy lifestyle increases the probability
for poor health like heart disease and cancer, even though the possibility does exist that you
will escape such devastating illnesses and still live to 100 like the few who did in the review
cited above. On this point, the preponderance of scientific evidence is clear, although not
absolute. For me it all comes down to what Louis Pasteur once said, which is that "Chance
favors the prepared mind." In other words, sometimes we make our own luck.

So the next time you read an article claiming that one thing or another is the absolute way to good health and extended longevity or books like Grain Brain or Wheat Belly that claim that certain foods are absolutely bad for you, you should realize that such absolutes simply don't exist (although I can't only say that with absolute certainty).

So beware of people claiming they have absolute answers for you. They can't be certain; no one can today, although the future may tell a different story (See my previous post about the inevitability of death).

The old adage that one man's poison may be another man's food should come to mind. What works for one person, may not work for another. You may still live to 100 by eating junk food, smoking, and never exercising. You won’t be the first and probably not the last. You could also win the next Powerball lottery. But if I were you, I wouldn't place all my bets on it, especially, when it's your life and health at stake. 

 I can’t tell you if that’s an absolute lesson worth learning, but it’s pretty darn close.

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