Longevity & Healthspan

Paul: [00:00:00]

Supercentenarians and remarkable age records exhibit patterns  indicative of clerical errors and pension fraud.

 Howard: [00:00:11] I look at the chart and I look at their age and they're younger than me, or we're the same age.  

Paul: [00:00:18] Hey, Howard,

Howard: [00:00:19] Hey, Paul

Paul: [00:00:20] How's it going?

Howard: [00:00:22] it's, it's been a super week so far.

  Paul: [00:00:24] We thought we talk a little bit about healthy aging, as opposed to the other kind. I think everyone's in agreement that healthy aging sounds a lot better than unhealthy aging, but there's some really great nuances that are worth talking about here because too often people get stuck on the idea of just lifespan. Like how long are people living? Oh, why are we not living longer than were our parents, grandparents? Than we were a generation ago? Gains in aging haven't really improved but,  and you make this point nicely, but that's  the wrong lens to bring at least in terms of thinking about healthy aging.

Howard: [00:00:57] Without a doubt. I have conversation every day, almost in the office. I don't want to live to 90 if I have to use a walker and a hunched over and I can't leave my home. And I'm on 17 different medications and seeing 14 different doctors. It's just not my idea of a. A healthy aging at, at all. So the number is not really what's critical.

Paul: [00:01:23] No, it's more this idea of, of health span rather than lifespan, right? This idea. How long are you living in a way that the, I, the way I like to put it is that the younger version of you would have thought was at least somewhat acceptable as because we have this tendency to move the goalposts and say, well, No, at least I'm not dead yet, but that's not really what you might have 10 years ago or 20 years ago might've said was what you were hoping for at that age.

It's really about healthy aging. Not just that you've been able to keep your heart going for up until age, whatever.

Howard: [00:01:53] Right. I, I mean, I love the centenarian studies,  they, they die of the same diseases that you and I die of. They just do it later in life. They have this 20 year gift, and then they just drop off the curve quickly.

Paul: [00:02:11] I liked the idea of you were, I think it was in something you sent me, but this idea of squaring, the head squaring, the curve. Why don't you describe what you mean by that?

Howard: [00:02:20] Yeah, so squaring off the health span curve. and I can't take credit for that. I did read it somewhere. but the lifespan curve,  we ramp up and we reach adulthood and. Hopefully on no medications and have no medical problems. And then we're living at peak health quote unquote peak health, and for most people, unfortunately that only gets us to about late forties or early fifties.

And then that curve starts to slowly dip. Downward and you're adding medical conditions and you're adding medical problems. And all of these are going to result in other problems, such as pretension, leading to kidney failure, a blindness, and it's just a slow dwindling, a downward spiral. with the last year you life spent in and out of hospitals, for at least half the time.

So the idea of squaring it off is staying up at your peak health. on few, if any medications able to do whatever activities you want to do and walk around the block, et cetera, until you reach the,  your nineties. and then, like I said, you will die of cardiac disease or stroke, et cetera, but it'll be quick.

Paul: [00:03:38] Yeah. Yeah. And the idea in having. No I've seen it. We've seen it with relatives. We've seen it with others that this idea, this long slow death by a thousand cuts, we've talked about this before, but a couple of falls or broken hip repeated trips to the hospital, get this incredible proliferation of medication.

Some of which interact in unexpected ways. This is a, this is a tough road and not a road that I think a priority that anyone. Was hoping to live after age, whatever. This is not their idea of healthy aging at all. That's just, it's just aging, right?

Howard: [00:04:13] Right. and people,  it creeps up on us. We don't really see it because you don't feel like you're hypertensive. Your doctor says your blood, pressure's a little high, so let's, let's put you on this. He notices you have,  a little belly fat,  you need to lose some weight, but he's not telling you about the metabolic syndrome and everything that, that carries along with it.

Yeah, he's not telling you you're going to develop diabetes type two in five or six years to no. One's telling you how this movie ends. Right. And it just slowly creeps up on you. And like, we've talked about with respect to COVID. We normalize that. We normalize that with tripping, that we're weaker, that it's harder to go upstairs, that we're more short of breath.

Paul: [00:05:00] and you, and it's all of a sudden in ecological terms, you  enter a different regime. I, and I was remarking this to you the other day that. I'll go out running and I'll go for a long trail running. And I realize I'm the only person my age. When did that happen? Right. And so you're looking around and thinking, Oh,  look all these other people aren't doing this.

So I have to catch up with this guy and everything else. And suddenly you realize now that I'm actually the only person like me out here, and that's not because I'm some  super mathlete, blah, blah, blah, genetically gifted. It's. Just I'm happened to be an addict for the sorts of things I do. And then all of a sudden you do it long enough and you notice there's not a lot of other people doing it anymore.

And it's a really striking a striking observation when it finally hits you see that you're out there and it's like, yeah, it's just me.

Howard: [00:05:49] So what percent of your runs would you say because you want to, and what percent of your runs are because you feel you need to do this to stay healthy.

Paul: [00:06:00] I have very low on the need scale. For me, I would say I'm I'm 98% because it is who I am and what I do. And 2%, if that even means anything, because I'm trying to do it to stay fit or whatever. Yeah. So I joke what about this all the time, because I will read articles about,  how to get enough exercise and how to do this. Now, time pressures aside and I'm the first to concede that a lot of people don't have as flexible an existence as I do. But let's put that aside for one moment that people still struggle to find enough time or to find enough motivation is maybe a better way to put it, to get out and do stuff. And I'm at the exact opposite end. Like I literally, this morning had to remind myself that it's not okay to go for a hard 20 K run, because I went for a really hard run yesterday. And you can't do it again today, Paul, so don't . And so for me, I'm at that other end of the continuum, and that's probably in part why I'm still doing this because it's, it's just innate as opposed to me feeling an obligation.

Howard: [00:06:58] That's great. I'm probably 75%. Love it. And 25% you just have to do it. And I wake up every morning and I see my motivations in, in the kitchen trying to cook their breakfast, and  I'm in the office. I'm seeing people and I'm looking up and I'm seeing someone they're overweight, belly fat, visceral fat, a metabolic syndrome, four or five medications, limping around and thinking about a knee replacement. And then I look at the chart and I look at their age and they're younger than me, or we're the same age.

Paul: [00:07:33] Isn't that remarkable though.

Howard: [00:07:34] it is, but it's so troubling and I have to work hard so I'm not that person.

Paul: [00:07:41] Yeah, I ha I, you get much more directly than I do. And I, I get it more by its, by its absence that I just literally don't see me. I'll be out doing stuff. And I'm the only one of me doing this,  I don't really care anymore, so it's fine. It doesn't make any difference, but for awhile it was when it suddenly dawned on me that you're, you're running with people who are 10 and 15 years younger and all these other things. It's, it's not that I have some  strange obsession with running with young people. There just aren't the other ones.

Howard: [00:08:10] Right? And I fully understand that I hit the genetic lottery, right.  to a large degree, we are genetically happier, and phenotypically better expressed. but still, I. Yeah. If we let ourselves go, we will end up there quite easily.

Paul: [00:08:29] There's no question. It's not an experiment I'd like to run, but I, I see it in friends of mine who were following along the same path until 10 years ago, and then suddenly changed. So. And maybe this is a good point to digress into these centenarian studies, which are really interesting and hitting the genetic lottery and what have you. The gist of these studies is that, and there's been a whole bunch of books and studies and other things about that, and even people have come up with these terms of art for it, but this notion of blue zones and. parts of the world where there's a higher percentage of people who live into a ripe old age, centenarian specifically, and some of the drivers of that. And the work is not without its critics, but it's interesting in that it does untangle to a degree, the genetic component versus the lifestyle component.

I mean, these are not people who've, who've.  I've been so lucky as they let's take the case of some of the Italian  centenarian studies. It's not because they have a gym next dootr. It's not because they're all doing,  some  funky workouts every day. This is something else altogether.

Howard: [00:09:26] Absolutely. And I think people who are interested in this,  and listen to these two hour podcasts and buy,  27 different supplements. or sip ketones are,  losing the big picture. They're not this way because of just what they eat. They're not this way only because of genetics.

 that they're always walking. They're always out there. They're always with big family groups, they all prepare dinner together. They're living, they're  loving, they're laughing, they're drinking wine, they're eating pasta. They eat very little meat. They eat very little protein and in some regions, and they routinely live,  beyond a hundred in full possession of the mental faculties and physical prowess,  they're, they're, they're able to walk these hills and stairs and fields.

Paul: [00:10:20] It's remarkable. And this, the studies have talked about different parts of the world, but I think Italy, Japan, a couple of others where  these centenarian groups have been identified.

Obviously this has brought the critics out of the woodwork, but one of the more entertaining responses I saw to some of the stuff was a great paper earlier this year. There was one by a fellow  at a  data science Institute in Australi a. It's looking at super centenarians and remarkable age records. And, the Ted, the headline alone will give you a sense. This is just great: Supercentenarians and remarkable age records exhibit patterns  indicative of clerical errors and pension fraud. So what's great about this paper and it's by no means uniform. But he points out that it's at least worth considering that there's no doubt there are these centenarians; there's no doubt that they're more likely to find in some places than others.  One of the strongest predictors of their existence is crappy vital statistics. So we don't actually have a lot of confidence about that birthdays. And the other one is they live in parts of the world by where by lying about your birth date you were able to get pension sooner.

Howard: [00:11:28] Unbelievable.

Paul: [00:11:29] It's a fabulous, there's a, there's a, so there's a whole strand of work as people, I think in some ways it's  a rear guard action to fight against the idea that there is anything going on here, but it's at least intriguing that while that centenarians and supercentenarians exist, that possibly that there's a group within the group that's mostly just engaged in pension fraud. great.

So let's maybe we  jump from the, the idea of the super centenarians and so on. But to this broader point you were making, which is that it's not just about the diet. It's not just this Mediterranean diet issue. It's not just about, you need to drink this, you need to eat that. It's more  about the entire way they comport their lives. As you say, they're more active, they're living, they're loving, they're doing all the things they do. Their lives are more holistic, really.

Howard: [00:12:17] And we can't forget, they hit the genetic lottery as you pointed out, to some degree, but it's their entire lifestyle that is contributing to their longevity and any of those people like us who are seeking to optimize their own health, towards a longer health span and healthier lifespan, it, it pays, to, to key in your attention on all of these variables and not just high fat, low carb, et cetera.

Paul: [00:12:53] And we see some similar evidence. There's great studies of not just this is getting away from centenarians, but in terms of a more holistic approach, with hunter gatherer tribes, where until we showed up and started feeding people, horrific diets and made them more sedentar., But high blood pressure for example was largely non-existent among hunter gatherer tribes until they began adopting aspects of a Western lifestyle. This was just, this didn't even exist. The notion that over your lifespan and,  you see these great curves showing how the propensity for higher blood pressure by decadal cohort in the United States, as if that's perfectly natural and then many of these hunter gatherers studies show a, basically a flat line from birth to death. That blood pressure was always somewhere around a hundred over 70, almost the whole time and never really changed. We've convinced ourselves -- again, normalizing -- that something I natural was natural because it happens to us and never thought about why it happens to us and doesn't happen in other places.

Howard: [00:13:53] It's fascinating. it's like bunions, I think we talked about that. We only see bunions in shoe wearing populations.

Paul: [00:14:01] That's right. That's right. So if you see people who are largely unshoed populations, you see much more foot splay and all sorts of things. And bunions, this whole idea that you might be wearing a shoe that doesn't fit isn't, it's just, it's a foreign notion.

So let's talk about, as we  work away from what's going on and talk about what you can do about it. We  alluded to this already. But there are mechanisms by which the body cleanses itself and deals with cellular detritus and, all of the  housekeeping stuff that goes on inside the body. And those are natural, but there's been lots of talk and work lately about how you can induce more housekeeping if you will inside the body.

Howard: [00:14:38] Yeah, so I think you're talking about autophagy.

Paul: [00:14:42] And while trying desperately not to say the word. Yes.

Howard: [00:14:46] So autophagy is theoretically cleaning out all these proteins or cells or components of cells that are not functioning well any longer, the thought being we have all these senescence cells, that say that used to secrete a hormone in response to, A biomarker, but now they're no longer responsive to the biomarker and they're just pumping out this hormone in the body has lost the ability to shut them down.

So the thought being two, and if you induce autophagy, via fasting that you will kill these cells off. the proof being the proof they claim is that when humans faste their livers, shrink, their organs shrink. and you get this mental clarity and you feel great. And then you refeed and, all these systems kick into play that, cleanse your, insides. I don't know that we have proof that this exists in humans to any great degree based on fasting. Almost certain, we don't have proof that it happens in two days, three days or four days. I know there are a lot of studies in mice, but  I think a mouse metabolism is,  10, 20, a hundred X, that of humans.

So it's really hard to try and compare the two. and then. there's no proof that it extends lifespan. to my knowledge, I know Walter Longo and others are working on this area and I find the literature fascinating to read, but not enough so that I'm going to stop eating for five days.

Paul: [00:16:32] Yeah. Yeah. That's the problem here, I think it is part of the reason why as quickly as intermittent, fasting and longer cycle fast. Came into vogue,  relatively recently it feels like its moment already passed. I think it's in part, not because it doesn't work or maybe it does or doesn't, but because we didn't, people weren't seeing an impact necessarily right away, or at least one that was beyond.

The obvious ones, like maybe they were trying to slow their metabolism and lose weight or something. But in terms, in terms of this notion of  of the house escaping notions of cellular cleansing and other things, that's not something that shows up right away. It's going to show up. It's probably gonna show up over,  deck over a decade or decades, not something you can see.

And let me ask as impatient humans, we struggle with those kinds of things. And so these things fall off, fall off the agenda.

Howard: [00:17:24] Right. I mean, I use, I F which I prefer intermittent feeding, cause I don't, I don't know what the definition of fasting is, but I don't, I don't consider eight, 18 hours to be a fast. I just think it's a good way to limit your caloric intake. and there are too many people who believe that breakfast is still your most important meal of the day.

Paul: [00:17:46] It's only important if you're a shareholder in a breakfast cereal company. But it's super important, but otherwise, no, I mean, but it's, it's a great example of one of those myths that took hold and made people feel like they had to have something first thing, rather than hanging on lunch or whenever else. And essentially having that, that intermittent fast or feeding or whatever you want to think of it as

Howard: [00:18:09] Correct. Yeah. And the store is that how these cereals came about back in the 1800s are just scary.

Paul: [00:18:17] I know it's really incredible. The other thing, the other stream that's related to this, and this goes more to your intermittent feeding is that I've seen, there's a lot of really interesting work talking about, and I didn't realize this until recently, but how much cellular  stress your body is put under having to process food that you ingest. And that while sometimes stress is good and the body needs that to trigger all kinds of different activities, including that housekeeping function, that it's not such a great idea to go  for a while, decade, a couple of decades ago, we thought 20 years ago that instead of where we're going now with just say two meals a day and intermittent feeding. Back then the idea was you should eat light meals all the time. Never be hungry.

Howard: [00:19:00] Right. Five small right. Five small meals a day.

Paul: [00:19:03] Five small meals a day. And what it turned out, among the other consequences of that, according to some of the research I've been reading is that your body was perpetually under cellular stress because you never stop forcing it to have to deal with food. Your liver was under stress. We were under pressure to deal with this constant digestive process. And it's really, there's quite an interesting body of work on this that  ties into this whole idea that  by going the other direction all we actually did was introduce new stressors in the body, which more than compensated in an unhealthy way for what we thought we were doing, which turned out to be a bad idea. Anyway, cause people are terrible at keeping track of what they eaten. If you say, if you tell them to eat six times a day, they just end up eating too much.

Howard: [00:19:43] What makes,  nutritional epidemiology studies so difficult in general because you're relying on human recall and,  an honesty, it's quite a challenge.

Paul: [00:19:54] Yeah. And you're also relying, we are also relying on an incredible war, that's constantly going on these days, you couldn't see it in the past so much, it would just be  these, these, these, these articles you'd see in the paper, red wine, good for you, red wine, bad for you. But now these are full stakes Maginot line stuff, entrenched groups blowing each other up and in between the two trenches, between nutritional forces who are largely conducting the battle in social media. it's just astonishing. The diet Wars is a pretty ugly place.

 Howard: [00:20:28]  I think that's one of the reasons why you probably left Twitter. it is, it is an incredibly dark community.  from those who don't believe the LDL hypothesis for heart disease, cardiac mortality to those on the plant side, to those who only eat steaks and meat. And there are some there who are willing to have a conversation and point to literature and research and answer, the public's questions that they have about pursuing these diets. And then there's those that will just annihilate you for mentioning the science that's counter to their arguments.

Paul: [00:21:14] People are, are so entrenched and are fighting unbelievably fiercely. All you had to do was look at the recent, was it four or five years ago, the wars over sugar induced by a couple of books and some, some talks. But it was as if there was nothing else more important going on in the world than this current battle over how much sugar should be in your diet. But extrapolate that across the entire diet landscape and you get a sense of, of, of how fierce the warring is in this stuff. And  it's good to see the stuff come out in the open, but it's also, I think, incredibly confusing for people because they end up feeling like they have, they're completely unmoored and I'd have no idea anymore what I should be doing, how often when, and if I can consume this or if it's just going to give me cancer next Tuesday. Right. And, and that's the, and that's the tragedy. Yeah. a that's a terrible tragedy. And I think what happens then is, and this is a classic human response. In the face of complete uncertainty, people just say, screw it and whatever the hell they want.

Howard: [00:22:14] right? Well, we get, and we get an egg paper every month. Yeah. Eggs are good. Eggs are bad. Eggs are not terrible. Eggs are really terrible sandwich coffee. and people have taken this, avoid ultra processed carbs to the point saying that all sugar is toxic or all carbs are toxic and you can't be a runner and be on sugar.

Paul: [00:22:41] it's terrible. So let's try and summarize by saying, what do we know now, other than ignore the diet Wars on Twitter. If you had to summarize down to a couple of key messages for people, I always liked Michael Pollan's line that,  eat food, not too much, mostly plants.  I quite like that idea at least as a starting point.

Howard: [00:22:59] That's where I start with most people. And I try to start with the point that they need to avoid reading too much and going too far down a rabbit hole and that we truly are all individuals. and  our genotypes matter, our phenotypic expression, so which ones are on and which ones are off.

And then our microbiome.  We have more DNA in our gut than we have. In our body and we don't, own any of it. Right. It's all the bacteria in our system. So some of us can metabolize some things, fats and carbs and complex carbs and some can't. So all these things create a difficult situation for people where they're trying to understand why a diet that worked for their best friend, isn't working for them.

Paul: [00:23:54] And the body is just such a, an entertainingly perverse system. I love the work that's been done over the last, I don't even know how long, few years looking at -- and there was a great New York times piece about it a few years ago, about the winners of the biggest loser competitions. I'm sure you've seen that stuff.

But the gist being though that a huge fraction of them, right after this was over with, had put back on 60, 70% of the weight. Now, if you've just stopped right there, everyone rolls their eyes and says, well, of course they did because they had no discipline or they returned to their old diet, or whatever else.

But the interesting thing is that turned out not to generally be the case. Many of them stayed on exactly the same diet they were on or at least close to it, and yet gained all the weight back. So the perversity was, their metabolism has slowed so much that starvation diet almost was enough to cause them to gain weight.

And again, not everyone, back to your point about genotypes and phenotypes. Not everyone had this consequence, but a large enough proportion of them did that it actually became quite striking how many people had gone through this incredible weight loss, had their metabolism basically stop, and never really got cranking again. And as a result, a diet that you and I would find,  bird-like starvation, was enough for them to put weight back on. .And there's the body at work right there that you, what would seem like good advice, stops being good advice after a while because it causes your body to act in ways that mitigate exactly what you're trying to do.

Howard: [00:25:25] Exactly,  set points and the brain gut access, and the neural networks involved and the hormones like leptin, et cetera, all are, these are just such fascinating topics. And sadly, they're working against so many of us.

Paul: [00:25:41] I've said this to friends of mine who were trying to drop weight to be faster runners on hills, the best thing you could do now is actually eat a lot more than you think you should. And the reason is because you're trying to kick start your metabolism again and not have your body think that you're in  starvation mode.Because then what happens is you end up with no energy stores and it actually begins to work against you. And I've seen this, especially among some of my more competitive athletic friends. so often that it's really  striking.

Howard: [00:26:10] I've run into the same thing. I tried keto for a while. I wanted to see what it was like only cause I won't, I won't recommend something unless I try it. and I could run forever, but it just didn't feel right. And I ran less efficiently. I just had the issues with it. And then I went back back to carbs, but I tried to stay low enough, but I kicked into, I kicked in enough carbs to shut off my ketosis engine or ketone, consuming and lactate engine that I just lost glycogen and  just crashed on these runs. So I'm like, screw this.

Paul: [00:26:48] That's a big part of the problem. And the other is that the body gets in these setpoint ruts so quickly that in a sense, you have to surprise it on a regular basis. Longer gap between meals, shorter gaps between meal, varieties of foods, and what have you, no different than challenging your body with respect to the kinds of exercise you do. And it's actually helpful to challenge your body in terms of what you ingest, not necessarily ingesting like razorblades or something. That's not the  challenge I'm thinking about here,

But,  but nevertheless challenging it. So, let's jump away from, in terms of ideas about what people can do to get to the point where you're eating food, mostly plants, not too much. I still think that we almost should be a book called Supermarkets for Dummies. I don't think people know how to navigate supermarkets whatsoever. it's, it's just, it's almost like it's set up to cause you to do the exact opposite of what we're suggesting.

Howard: [00:27:40] Oh, of course, I'm sure it's a giant psychological experiment

Paul: [00:27:44] It's like Ikea it's like Ikea or something, right?

Howard: [00:27:47] I tell everyone a one eat before you go. and you do not want to walk the supermarket hungry and you want to stay in the outer aisle. That's where your fresh meats, veggies and fruits are

Paul: [00:27:59] Yeah. the whole center of the store. I tell people, treat it as, as if it's had a recent dump of radioactivity, it's a bad place to go, hide from the radioactivity around the periphery of the, of the grocery store. It's much safer there.

Howard: [00:28:13] Or eat first and go in with a list and stick to your list.

Paul: [00:28:17] And in terms of, I guess, the non diet stuff, if you had to guess how important is some of the stuff we've learned in terms of like walking, loving, groups? I was an engineer from long ago. I long thought that stuff was just voodoo chatter, but I completely flipped on a lot of that. I think that it's vastly more important than we'd like to concede and that I will, I will say that one of the negative consequences of coronavirus and other things is watching people lose their ability to spend more time in groups and feel more like they're part of the community. Cause that genuinely matters. We're  a gregarious, naked ape.

 Howard: [00:28:55] we are a social species without a doubt,  a loneliness kills. I think there's more than enough research on this. and we all sense  from personal experience. so it really is a  lifestyle, longevity and having a long, healthy, health span, means that you're walking, means that you're making plans with friends and family, you're staying close to your family. you're not working,  from six in the morning to nine o'clock at night every single day. especially if it's just to close another deal,  you really gotta keep it simple. you can't take it with you. you might as well be here. You might as well enjoy it.

Paul: [00:29:39] Maybe this is a good note to end on, but I, I  think that the idea of health span versus lifespan is  so important that we spend -- economists in particular -- too much time thinking about. Well, cause one of their favorite measures of a prosperous society is how long people live. It doesn't factor into those models ,  how long they're living healthily. So I'm largely dismissive of those kinds of models that I think we, because we measure the wrong things, so often we end up doing the wrong things and the thing we're measuring wrong is just simple lifespan, not health span, that if we actually measured health span, I  think we'd see, things are worse than we think they are. That not only have we plateaued in terms of lifespan, we've probably gotten worse in terms of health span. As you say, people,  50 year olds coming into your office with a body age is probably 10 or 20 years older than that.

Howard: [00:30:29] Yeah.  unfortunately for the first time in history, we are not living as long as our previous generations.

Paul: [00:30:39] Not living as healthily.

I don't want it to be some period where I just, I'm in God's waiting room, just hanging around. I want to just do my stuff that I enjoy doing until I can't do it. And then again, this is health span and, and,  cutting off the curve. But I, at that point I want to stop.

Howard: [00:30:56] Absolutely it listen, if you enjoy your work and there's a sense of purpose, are you really working?

Paul: [00:31:02] I'll say this. This is my positive note to end on is I, I aspire to one day fall face first into my porridge at the table having had her, 90 years of really good runs. So anyways, thanks, Howard.