If we adopt new ways of looking at our health, we can do a better job of matching our life span (how long we live) to our “health span” (how long we live free from chronic disease or other health problems), says Attia, the author of “Outlive: The Science & Art of Longevity.”
In a phone interview, Attia talked about “the Four Horsemen of Chronic Disease” — cardiovascular disease, cancer, cognitive diseases (such as Alzheimer’s) and metabolic diseases (such as Type 2 diabetes) — and new ways to plan for longevity. The following was edited for length and clarity.
Q: Many people fear living to be 100, imagining loneliness, poor health and solitude. Should living so long be our aim?
A: I don’t think it should, actually. A lot of those fears are really valid. I think a better goal is to maximize health span. When you do that, you will automatically get a longer life span. If you improve your health span, so that when you’re 80, you actually function like a 65-year-old, it’s almost impossible to not also get five to 10 years of life-span extension.
Q: One of the ways to improve health span is through something you call “the Centenarian Decathlon.” What is it, and how do we train for it?
A: It’s a mental model which says that the greater the specificity with which you train for your physical goals, the more likely you are to achieve them.
I think back to the very first goal I ever had, which was to run five five-minute miles. That’s a lot more specific than saying I want to be able to run five miles. If you want to achieve that, you have to train with far greater specificity than if you just want to able to run five miles. And this is true across the board. And it’s what’s necessary to achieve remarkable feats.
I ask patients to think specifically about what they want to be able to do when they are in their 80s or older, and to start training for that when they are in their 40s or 50s or 60s.
Q: You mean, for example, if you want to hike for two miles when you’re 80.
Q: Why won’t just hiking every day in the years leading up to that prepare you to continue walking outdoors?
A: Because as you age, the degradation of strength, stamina, balance, lower leg variability is so profound that it is insufficient to just hike two miles when you’re in your 40s and 50s, and assume that’s going to get you doing the same thing when you’re 80. When you’re 80, you have to aim much higher. … The Centenarian Decathlon is asking, “What do you want to do in your marginal decade?” And the more specific you can make it, the better, because you’ll be able to train for it, and increase the odds that you will be ready for it.
Q: And if you want to lift your great-grandchild when you’re 80, you need to do what, exactly, when you’re 50, 60 and 70?
A: To safely pick up a 30-pound child from the floor, you need hip flexibility and abdominal and spinal stability to get into a low squat position, then you need to be able to pick up a 30-pound weight. It’s harder to do a squat with weight in front of you because it requires more core stabilization and more scapular stability [shoulder strength]. This essentially means you need to be able to do a 30-pound goblet squat at the age of 85. … By the time they’re 85, most can’t even do the goblet squat, without any additional weight. So just on that one metric of strength, we have something that we need to train for.
Q: You say exercise is the most important tactic for longevity, but more than 60 percent of Americans do not get enough exercise. Can sedentary people undertake the vigorous training that you recommend?
A: If you’re starting from zero, just getting to 90 minutes a week of exercise will result in a 15 percent reduction in all-cause mortality [including the Four Horsemen]. That’s dramatic. I mean, we don’t have drugs that can reduce 15 percent all-cause mortality across the board. And the good news is it’s not just like this abstract thing of “we’re adding a couple of years to your life.” No, no. You’re going to feel better in three months.
Every person who saves for retirement, in my view, is doing something slightly more difficult. Because in the short term, you get nothing out of saving for retirement. … And I would say with these other changes that we ask people to make, at least they’re getting a benefit today.
How is anybody supposed to find time for this? I would just say, if you’re not going to make time for this, what are you making time for?
Q: Most of us succumb to one of those Four Horsemen. What do these diseases have in common?
A: Cancer, cardiovascular disease and neurogenerative diseases, Alzheimer’s being the most common, are all exacerbated dramatically by metabolic disease. So, if you have Type 2 diabetes, your risk of those other diseases goes up dramatically.
Q: You suggest getting ahead of these diseases by screening, gene testing or digging deeply into bloodwork to uncover markers that, frankly, most insurance companies won’t pay for. What do you say to patients, and your critics, about why these things are worth doing?
A: I guess the question is, what’s the alternative? The alternative is continuing to do what we’re doing. How is that working out? Not so well. So, if herculean preventive measurements are too expensive, treating them is costlier.
Is it expensive to get a $1,000 CT angiogram when you’re 40? Yes, it is. Do you know what it costs to get a stent placed? Or to get a bypass when you’re 65? Unfortunately, if you really want to take prevention seriously, you’re on the hook for the cost.
Q: Does this mean that only rich people can live healthfully to 100?
A: Screening is simply one small part of this. Far more relevant to increasing your health span is not whether or not you’re getting a CT angiogram, it’s whether you’re doing all of the other things that we talked about vis-à-vis sleep, nutrition and exercise. You don’t have to be wealthy to do those things.
Q: Isn’t it true that even if you do all of this, the Horsemen could still come for you?
A: Isn’t there a chance that if you save for retirement, your investments will sour before you need to draw the money out? Yeah, of course, there is. But if you don’t do these things, you dramatically increase the odds of things not going well.