Life Span or Health Span?
"Good news, America: We're living longer!" trumpeted USA Today. "Life expectancy in the USA rose in 2012 to 78.8 years — a record high," said the paper, quoting statistics from the Centers For Disease Control and Prevention (CDC). And in a press release dated May 19, 2016, the World Health Organization (WHO) announced that worldwide "life expectancy increased by 5 years between 2000 and 2015, the fastest increase since the 1960s." These statistics are certainly worth celebrating. They tell us that not only is lifespan increasing, but they indicate that modern medicine is winning against life-threatening diseases. But is increased lifespan truly good news for everyone?
What Do the Statistics Mean?
Reading these statistics, we could be tempted to assume that most of us will live 78.8 years or that with a 5-year projected increase in life expectancy, we can each plan on five more years than grandpa had. "He lived to 80, so I'll live to 85," we might think. Yet determinations on life expectancy don't quite work that way. Life expectancy is an average number, calculated for a population, and takes into account things like infant mortality and child mortality. When the very young in a population are dying in relatively large numbers, the life expectancy for the population is quite low. Here's an example. If I have three children, and one dies at age 3 from whooping cough, one is in a car wreck and dies at age 51, and the other lives to age 87, we could say the average life expectancy of my progeny is 46. That number is misleading, right? And even though calculating life expectancy for a population is more complex than taking the average of three numbers, it still leaves us with an inaccurate impression of how long someone in that society should expect to live. That's the challenge of statistics.
If we want to know what statistics really mean, we have to ask an actuary. Actuaries calculate risk for insurance companies and the like, and they're a whiz at crunching data into meaningful numbers. They tell us that life expectancy numbers aren't accurate predictors of how long we'll live. These numbers, say the actuaries, are primarily useful for comparing health policy across countries. If an actuary wants to know how long a person should expect to live, he calculates probable life span by analyzing the median age of mortality, which is the most common age at which people die. And based on the median age of death, say the actuaries, we should probably plan to live longer than the average life expectancy statistic leads us to believe. One British actuary calculates that if death rates were to remain constant, girls born now would live to age 90, and boys to age 86. That's quite a bit longer than the CDC's 78.8 expected years.
More is Always Better, Right?
With longevity increasing, researching the relationship between longer years and health is becoming popular. One study inspired headlines such as "Life Can Be Healthy Past Ninety" and "Living Past 90 Doesn't Doom You to Disease, Disability." The articles cheerfully reported on a study involving two groups of centenarians who not only enjoyed a longer lifespan, but also a longer health span (healthy years). They didn't spend their extra years languishing with chronic diseases. The researchers were fascinated. What was making these centenarians live healthy longer? If the source of their health span could be discovered, then maybe health could be extended for the general population. When the data came in, alas, the hope of a winning ticket died. The researchers concluded that the unusual health of these particular centenarians was due to fortunate genetics rather than environmental factors. It appeared that the centenarians were born with genes that delayed the body's reaction to insufficient levels of Vitamin D. In most individuals, insufficient Vitamin D leads to decreased cognition. With this group, however, their genetics protected them from the effects of less-than-optimal levels of Vitamin D and therefore afforded them a better quality of life for more years. Other than being born with exceptional genes, researchers found no other reason for the extended years of health. In fact, the researchers noted that good health for these individuals couldn't have been predicted. "Our centenarians were not practicing particularly healthy behaviors: 60 percent of men and 30 percent of women were smokers, less than half exercised regularly, and approximately 50 percent were overweight or obese," said Sofiya Milman, MD, the study's lead author. Smoking, obesity, and lack of exercise are certainly not a formula for health. If our hopes for extra years spent in good health are solely pinned on a roll of the genes, then most of us gamblers are out of luck.
Unlucky or Unhealthy?
Other researchers are finding empirical evidence of that misfortune. In a study which reviewed the data on morbidity and mortality, researchers have found that while life span is increasing, the age of onset of disease hasn't been delayed. We're simply living more years with illness than we were before. "For example, the incidence of a first heart attack has remained relatively stable between the 1960s and 1990s and the incidence of some of the most important cancers has been increasing until very recently." Incidence of diabetes has also increased, and "the proportion of the population with multiple diseases and the number of diseases comorbid in an older individual has also increased." The researchers further note that the gains made against hypertension and elevated cholesterol reflect the use of medication rather than reduced incidence of these conditions. And while disability of older individuals has been reduced, this may reflect "improvements in technology, living environments, or slowing the progression of disease through treatments." While slowing the progression of disease and making life easier for those affected by illness are worthwhile public health concerns, they are not the same as preventing or delaying the onset of disease. The study concludes: "People aspire to live out their lives in good health and to die a good death without suffering, disease, and loss of functioning. However, compression of morbidity [reducing the length of illness] may be as illusory as immortality. We do not appear to be moving to a world where we die without experiencing disease, functioning loss, and disability."
Not All Years are Created Equal
Around the globe, people are living sicker, longer. That is the conclusion reached by a recent study funded by the Bill and Melinda Gates Foundation. Examining data from 188 of the world's 195 countries, researchers found that healthy life expectancy has increased by 5.4 years, while the global life expectancy at birth has increased by 6.2 years. The gap between the two numbers is where extended years of illness fit into people's lives. The researchers in this wide-reaching study have identified the reasons most responsible for lost years of health. "By 2013, the five leading causes of DALYs [disability-adjusted life-years] were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries." The study's lead author, Professor Theo Vos, and his colleagues conclude that "global health is improving." They say, though, that "population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems." While statistics like those generated by Professor Vos and his team are most useful for anticipating the public health needs of a population, they indicate problems not only facing public health officials, but also facing the thousands of individuals who will be living longer, sicker.
Decline into Disability
"Many elderly people decline into years of progressive disability, then become invalids. If instead most people enjoyed reasonable vigor right up to the end, that would be just as exciting for society as adding years to life expectancy," asserts an article in Atlantic Monthly entitled 'What Happens When We all Live to 100?' Cutting edge research, says the article, is shifting away from fighting the diseases common to aging and instead look for the cause of aging itself. For one California research house in particular, the Buck Institute, solving the mystery of senescence is part of its mandate. The Buck Institute's scientists, says the article, are making real progress in the quest for the fountain of youth. However, since researchers at the Buck Institute and elsewhere are still experimenting with worms, flies, mice, and yeast, it seems that it might be a while before they figure out how to keep humans feeling youthful into their senior years. The article notes that "in addition to being ethically fraught, human trials of a life-extension substance will be costly, and might take decades."
Most of us, unfortunately, don't have decades to wait on a cure for aging. Apparently, neither do the researchers working for the Buck Institute. Gregg Easterbrook, who wrote the Atlantic Monthly article, toured the facility. He noted that "society’s obesity problems are not in evidence there. Everyone takes the stairs; elevators are viewed as strictly for visitors. If there is a candy machine on the 488-acre grounds, it is well hidden. ... Lunch was an ascetic affair: water and a small sandwich with greens; no sides, soda, or cookies." It would appear that the Buck Institute scientists are putting their confidence in what we already know to be true for health and longevity: lifestyle choices make a big difference.
Treating Disease or Treating Age
Doctors, researchers, and scientists cannot force individuals to adopt health-promoting lifestyles. And since most of the population is unwilling to significantly alter their lifestyle or is confused about what really promotes long-lasting health, the illnesses are coming on fast and furious. The medical community acknowledges that it can't keep up. Felipe Sierra of the National Institute of Aging says "the big focus of what’s known as 'geroscience' — understanding the relationship between aging and age-related diseases — is discovering ways to slow down the aging process and delay all chronic conditions." This is a major shift in focus for the medical community. In the past, medicine has focused on individual illnesses. That's why there is research against specific types of cancer, research into the causes and treatments of high blood pressure, research on how to treat patients after a heart attack or stroke. But as the population ages and sickens, the medical community is finding it cannot keep pace. In an acknowledgement that a comprehensive approach is needed, Sierra admits, "Treating one [disease] at a time is failing."
Which diseases does the medical research community feel they are failing to treat? Public health advice gives us a clue as to which diseases these may be by the types of health conditions the public is being encouraged to monitor. The University of Pittsburgh Center for Aging and Population Health (CAPH) has produced "10 Keys to Healthy Aging." This list suggests the conditions which lead to disabling disease in later years. In order to live healthier into old age, CAPH says people should:
- Lower systolic pressure
- Regulate blood glucose
- Lower LDL cholesterol
- Be physically active
- Maintain healthy bones, joints and muscles
- Stop smoking
- Participate in cancer screenings
- Get immunized regularly
- Combat depression
- Maintain social contact
Don't Wait for the Anti-Aging Drugs to be Developed: Eat Plants
Analysing the list, it becomes apparent that six out of the 10 items which lead to common illnesses faced by senior adults can be directly affected by dietary choices. Eating a low-fat diet of whole plant foods, free from added oil, will lower systolic blood pressure, regulate blood glucose, lower LDL cholesterol, help maintain a healthy musculoskeletal system, lower cancer risk, and help combat depression. Two more items on the list can be affected by a low-fat WFPB (whole-food plant-based) diet. People who choose to eat better usually feel better; they find they need to exercise to burn their excess energy. And many people who value a health-producing lifestyle enjoy getting involved in social groups where plant-based eating is celebrated. PlantPure Nation sponsors PlantPure Pods all across the country which meet regularly to promote healthy eating. Engine 2 and Forks Over Knives sponsors events around the country, and there are many social media groups like my Support Groups or my Facebook page where friendly people support each other in a low-fat WFPB lifestyle.
Although people who eat a plant-based diet may be friendly, plant-based foods are fierce combatants of the diseases identified as national and international enemies of healthy aging. According to 'Your Older Years: Life Span or Health Span' published in the Pittsburgh Post-Gazette, "Eighty percent of Americans 65 and older have at least one chronic condition — cancer, cardiovascular disease, arthritis, diabetes, dementia or Alzheimer’s disease, among others — with 50 percent having two." Yet each of these conditions may be prevented, halted, or sometimes reversed by eating a low-fat diet of whole plant foods. Confirming the results of the study conducted by the Bill and Melinda Gates Foundation cited above, the WHO reports that heart disease and stroke killed 14.1 million people in 2012, nearly half the fatalities of the next eight causes of death combined. Yet simply eating a diet of low-fat whole plants is known to be a powerful healer for the cardiovascular system and has been proven to prevent recurrent cardiovascular incidents. With plants offering a solution to the top enemies of public health, adopting a low-fat plant-based diet merits the consideration of individuals looking for ways to escape the statistical probability of prolonged years of illness.
Health Span Matters More Than Life Span
The prospect of a longer life is only truly exciting if we can anticipate enough mental and physical health to enjoy those years. After searching the world for the secrets of societies rich in healthy centenarians, Dan Buettner, author of The Blue Zones, concluded that "diet does tend to be the entrance ramp for better health." He noted that vegetables — primarily beans — are a common factor between the groups. Buettner even identified one Blue Zone in California, the state that gave the world McDonald's. This group of Seventh-day Adventists prove that health and longevity aren't dependant on genetics (the religious group comes from diverse backgrounds) or centuries-long traditions (the church has only existed about 150 years). Diet and lifestyle keep Loma Linda, CA, Adventists mentally alert and physically active as they age, and age, and age.
As the life span of the world increases thanks to medical advances in sanitary practices, education, advances against infectious and parasitic diseases, and slow but steady advances against chronic disease, we each need to assess how we can best plan for our later years. Just as increasing years will affect how we plan our financial future, we must make provisions for the future of our health. Few will be satisfied with their extra years if their lifespan is significantly longer than their health span. But in order to provide for those extra years of life, we must make decisions now. The lifestyle diseases of high blood pressure, kidney disease, diverticulosis, obesity, high cholesterol, diabetes, many forms of cancer, and cardiovascular disease can all be prevented with a low-fat, oil-free diet based on whole plant foods. As we begin to eat a more natural, plant-based diet, our taste-buds will heal. We will lose our cravings for meat, dairy, and eggs. Instead of being over-stimulated by sugar, salt, oil, and refined grains, our taste-buds will begin to appreciate the subtle flavors of vegetables, legumes, fruits, and grains. When a few nuts and seeds are occasionally added for variety and flavor, these whole plant foods constitute a balanced diet that will support our life and health for many decades to come.
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