What is Your Healthspan?

When people talk about human longevity, they are usually referring to lifespan, the total number of years we are alive.  At the turn of the 20th century, the average lifespan (life expectancy at birth) in the United States ranged between 45 and 50 years with women on average outliving men.

This relatively short lifespan at the turn of the 20th century was because over 20% of children died before reaching the age of 10 years.  Most often, this was from infectious diseases.  For those surviving to age 80, the average lifespan in 1900 was 85 years.  Today, the average person living to 80 has an expected lifespan of about 88 years.  From this relatively small difference, you might conclude that modern medicine has done little to extend lifespan for those that survive childhood.  Actually, the slight increase in longevity has been a remarkable achievement, given the increasing headwind of lifestyle disease in America over the last 50 years.

While scientists continue their search for how to extend lifespan, the more relevant metric for most is our healthspan, the period of life that one is healthy.  As shown below, the top ten events which are likely to create a state of disease in the average American today tend to occur a decade or two before their expected lifespan has been attained.

Top 10 Diseases and Average Age of Occurrence
COPD * 45
Type 2 Diabetes 54
Lung Cancer 60
Breast Cancer 62
Heart Disease 65
Stroke 65
Alzheimer’s Disease 65
Prostate Cancer 66
Colorectal Cancer 70
Lower Respiratory Infections 75

                * COPD, Chronic Obstructive Pulmonary Disease often results from smoking

By comparing the average age of the first occurrence for each of the most common diseases, we discover that the average person in the United States has a healthspan of only 63-67 healthy years.  When compared with expected lifespans, this implies that the average person can expect to live over 25% of their life in an unhealthy condition.

In each case, the onset of these diseases has a strong correlation with negative lifestyle influences.  In essence, modern medicine as it is most often practiced is more like a fire department responding to an emergency than a home inspector searching for hazardous wiring, improperly stored fuel, or dead batteries in smoke detectors.  By the way, if you haven’t checked the batteries in your smoke detector or carbon monoxide detector lately, new batteries are good for your lifespan and healthspan.  Three out of five home fire deaths occur in properties without working smoke alarms.

Given that the wonders of modern medicine have done little to increase lifespan for those that survive childhood and even less to improve healthspan, you may wonder if there is any hope for the future.  As it happens, there is strong evidence for what we can do today and interesting possibilities for what advances in technology may offer in future years.

At present, lifestyle changes offer the best healthspan improvements when followed consistently.  While early changes in lifestyle provide better results, it’s never too late to gain some healthspan advantages.  If late to the game, modern medicine can still offer solutions for many acute issues and relief for most chronic diseases.  For some conditions (degenerated joints, cataracts, etc.) modern medicine provides remarkable opportunities for improvement.  Unfortunately, without lifestyle changes, the best result on average is an improved lifespan but not a significantly improved overall healthspan. For example, a person choosing a stent to open an artery might have another five years before the procedure has to be repeated (if even possible).  In contrast, a person accepting a lifestyle change may never need the stent unless in an acute situation when diagnosed.

As for advances in technology, there is hope that advances in medicine can one day further extend our lifespan and healthspan.  Unfortunately, aside from acute care situations, few interventions offer the remarkable overall advantages of positive lifestyle changes.

For most of our lives, we tend to think of ourselves as ok if we can live unassisted.  The dilemma is that our health may deteriorate slowly and largely unnoticed until unrepaired damage reaches a critical point.  When the damage can no longer be repaired, health may rapidly deteriorate.  By way of analogy, a metal bridge may be designed to last 75 years and yet may last far longer if maintained in the best condition. As a large complex structure, a bridge has many ways of failing if left unprotected from oxidation.  Similarly, human aging is affected by an accumulation of oxidative damage at the cellular level if not protected.  While these reactions are complex, the basic rules of oxidation tell us that to avoid having our cells “rust,” we must provide the ongoing protection cells need.  Fortunately, the protective antioxidants needed are available in plant-based whole foods.

In a world of plenty where food is always available, eating more than we need has become the norm.  As a result, diseases related to consuming excess calories have also become the norm.  Hundreds of studies have also shown that eating less can extend our lifespan and healthspan if we restrict calories consumed without limiting nutritional needs.  Of course, you may wonder, how can I eat less when I’m feeling hungry?  The simple answer is to avoid addictive foods.  The full answer may require that we talk about why this has been challenging in your situation.  Just know that the key to successfully controlling calories is in eating more of the right foods.  This is where plant-based whole foods can help regulate your appetite by letting you eat enough to be satisfied without being concerned about overeating.

Each of us will have a lifespan that is, to some extent, affected by our genetics.  Fortunately, not all inherited genetics is destiny.  Many aspects of our genetic makeup are influenced by lifestyle.  This is especially the case when it comes to the parts of our genetics that affect healthspan. 

In a recent study, it was found that for people following a good lifestyle (diet, exercise, stress management), dementia rarely develops, even for those whose genetic markers indicated a strong likelihood of dementia.  In contrast, the study group that practiced an average lifestyle had a high rate of dementia for those with genetic markers for dementia.

The take-home message is this, for a large number of common diseases; your genetics is not your destiny.  Your destiny is determined by your lifestyle.  For a person wanting to have the best health possible after age 40, a positive lifestyle change is the best health insurance available.

Nancy Neighbors, MD

Advice From a Centenarian

When you can get your driver’s license renewed at the age of 104, people are bound to ask, “How did you do it?”  For Dr. Ephraim Engleman’s, his ability to play the violin until age 102, continue working as a doctor past age 100, and maintain a sense of humor were hallmarks of his remarkable life.  As for how he did it, Dr. Engleman’s unorthodox top ten commandments for longevity included avoiding air travel (you see more from cars), keep breathing, and enjoy your work, whatever it is, or don’t do it.  For more about Dr. Engleman’s life, read “Happy to 102: An Interview with Ephraim Engleman.”  At age 100, Dr. Engleman was interviewed by Mark Shaper of the Growing Bolder Insider.  In that interview, Dr. Engleman reveals, with a touch of humor, his top ten list of unorthodox commandments for longevity.

While I can’t endorse all of Dr. Engleman’s recommendations, when someone reaches 104 and can still renew their driver’s license, it’s hard to argue that they aren’t an authority.

A Modest Proposal

            Instead of trying to save Medicare and Social Security from creating budget-busting deficits in future years by raising taxes and deductibles, why not subsidize healthier foods rather than sugar, meat, dairy and grains used to make high glycemic processed foods.  With better nutrition, Americans would have more productive years before retirement.  A person in excellent health could enjoy working an additional ten years and look forward to the additional savings as a cushion against expenses in retirement.

            This is a plan to address the root cause of what could become unmanageable deficits by simply shrinking the difference between the average lifespan and the average healthspan.  In this more favorable scenario, most would have a chance to save longer for retirement; the cost of healthcare would diminish significantly, with the bonus being a higher quality of life.  As a nation, our competitive advantage would be enhanced by a larger pool of talented workers with reduced labor cost due to less healthcare cost.

            Quality of life is something we individually treasure.  As it happens, in a world of jointly shared cost (insurance) it’s something we must learn to jointly treasure.  With advancing technology and new multimillion-dollar medical treatments being introduced each year, there is no possibility for cost controls without rationing or addressing the root cause, which is the difference between life span and healthspan.

            Want to be part of the solution?  Just know that lifestyle change is the best solution we have today and that a plant-based whole food diet is the best place to start.

Published by Nancy Neighbors, MD

... Dr. Neighbors provides a blend of traditional family medicine and evidence-based lifestyle medicine in Huntsville, Alabama. When indicated, lifestyle change is recommended as the first line of therapy.

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