Longevity and Healthy Aging: Two Competing Visions

Part 1 of 5: Introduction, Four Medical Experts on Healthspan, and Why This Actually Matters

Introduction

The celebrity doctors Mark Hyman, MD, and Peter Attia, MD, have both recently released books on how to live longer and healthier. Hyman’s Young Forever: The Secrets to Living Your Longest, Healthiest Life (2023) and Attia’s Outlive: The Science & Art of Longevity (2023) have much in common but also vital differences.

American Exile offers a long-form appraisal of both — in conversation with our previous discussion (Jul 9, 2022) of two earlier and related books, Longevity…Simplified. Living A Longer, Healthier Life Shouldn’t Be Complicated (2022) by Howard J. Luks, MD, and The Barbell Prescription: Strength Training for Life After 40 (2016) by Jonathon M. Sullivan, MD, PhD.

This long-form appraisal is divided among five posts. The first, which you are reading now, provides an introduction and discusses Healthspan, a concept shared by all four of our medical experts: Sullivan (2016), Luks (2022), Hyman (2023), and Attia (2023).

The second post will discuss our four longevity experts on Exercise. The third post, on Diet and Metabolic Health. The fourth post, on Bio-Hacking with supplements, off-label prescription drugs, and technology. The fifth and final post, on Emotional Health and with some concluding remarks.

Necessary disclaimer: neither American Exile nor your author Data Humanist provides medical advice. None of the posts in this series on Longevity should be understood as medical advice.

Healthspan

Such legalese now out of the way, we will start with some common ground and key concepts, the first being Healthspan (formerly known as “the Compression of Morbidity”).

Luks (2022) defines Healthspan as “the number of years that you live relatively disease-free—free of neurocognitive decline and free of a chronic disease burden that threatens your quality of life.”

                               Image copyright Luks, 2022. Cited under Fair Use.

So, according to Luks (2022), the purpose of “improving our healthspan is to keep us active, alert, and mobile to the very end. Ultimately, we may not live longer, but we will live better.”

Sullivan (2016) understands it much the same:

Exercise medicine may preserve you from disease that will cut your life short, but it won’t extend your natural healthy lifespan. The power of any true geriatric medicine, including exercise medicine, is not longevity but compression of morbidity: shrinking the sick and dysfunctional part of our dying into a smaller and smaller slice of our lives.

….

You’re not playing this game for more years. You’re playing this game for better years.

Attia (2023) and Hyman (2023) are in agreement with this general distinction between Healthspan and Lifespan.  But both — and much more so in the case of Hyman — are concerned with more years as well as better years.

Attia on Age-Related Decline vs. Hyman’s “Forever Young”

Because effects of natural aging matter regardless of general health, Attia (2023) wants to delay or reverse these effects as much as possible:

I’m as free from “disability and disease” as when I was a twenty-five-year-old medical student, but my twenty-something self could run circles around fifty-year-old me, both physically and mentally. That’s just a fact. Thus the second part of our plan for longevity is to maintain and improve our physical and mental function.

Hence Attia (2023) proposes a paradigm shift — “Medicine 3.0” — which “places a far greater emphasis on prevention than treatment.” Whereas “Medicine 2.0 [our status quo] focuses largely on lifespan, and is almost entirely geared toward staving off death,” Attia’s proposed “Medicine 3.0 pays far more attention to maintaining healthspan, the quality of life.”

That said, his visualization (2023) essentially matches that of Luks (2022):

                             Image copyright Attia, 2023. Cited under Fair Use.

Likewise, Attia’s (2023) description of the desired outcome largely matches that of Sullivan (2016) and Luks (2022):

We outlive our life expectancy, and we also exceed society’s expectations of what our later life is supposed to look like. Instead of a lousy Marginal Decade, we get to enjoy what feels more like a “Bonus Decade” — or decades — when we are thriving in every dimension. This is our objective: to delay death, and to get the most out of our extra years. The rest of our lives becomes a time to relish rather than to dread.

Although he is committed to more years, Attia (2023) is not obsessed with pushing against the generally recognized boundaries of human life expectancy — around 120 years. He does hold that we can greatly improve average life expectancy and quality of life (Healthspan) in our final decades. In his words:

Longevity does not mean living forever. Or even to age 120, or 150, which some self-proclaimed experts are now routinely promising to their followers.

This serves as counterpoint to Hyman (2023), who proclaims: “I plan to live to be 120, maybe even 180, in good health, savoring the miraculous gift of this life every day.” Hyman (2023) also holds that at “sixty-three I feel like I am twenty-five years old” and “my body is stronger than ever” with a “biological age [of] forty-three.”

In terms of physical and cognitive performance, Attia (2023) judges himself to be half the man at fifty years of age than he was at twenty-five. In contrast, Hyman (2023) claims he is coming into his peak physical strength at sixty-three. Which quite frankly does raise questions about Hyman’s earlier fitness — and his other benchmarks for comparison.

We have a wealth of real-world data about athletic performance and age. We also have the infamous quatrain by Paul Dirac, Nobel Laureate for Physics:

Age is, of course, a fever chill
That every physicist must fear.
He’s better dead than living still,
When once he’s past his thirtieth year.

This concern with age-related cognitive decline is supported by research — telling, although by no means conclusive. For example, Simonton (1991) found that “on average, a scientist’s creative productivity begins near age 30, attains a peak around the 40th year, and gradually comes to a close shortly after age 50” [ref]. For Attia (2023), age-related physical and cognitive performance declines are real — and present major challenges to quality of life and hence Healthspan.

Attia’s Medicine 3.0 vs. Hyman’s Functional Medicine

In contrast, Hyman (2023) seems to assume these age-related declines have been or will be shortly bio-hacked — and appears to offer himself as an example of “Young Forever.” Otherwise, his definition of Healthspan generally overlaps with that of Sullivan (2016), Luks (2022), and Attia (2023).

Hyman’s (2023) illustration of Healthspan below:

                            Image copyright Hyman, 2023. Cited under Fair Use.

Hyman (2023), like Attia (2023), also proposes a paradigm shift: not labelled “Medicine 3.0” but “Functional Medicine:”

Functional medicine suggests that all diseases have a root cause (etiology). We must find and address all the factors or causes that contribute to disease.

So focus on prevention, not cure; focus on creating wellness, not treating sickness; and so on, etc. Very much like Attia’s “Medicine 3.0.” Or, as Hyman (2023) cogently states [italics his]:

Functional medicine is the science of creating health. When you create health, disease disappears.

One should qualify as Attia (2023) does, the Art and Science of creating health — as health is a practice that will vary per individual person, requires that person’s active engagement, and cannot be simply prescribed or imposed.

What Does It Matter?

Along with Healthspan, we can identify four other related topics shared by all or most of our MDs writing about Longevity: Exercise, Diet and Metabolic Health, Bio-Hacking (with supplements, off-label prescription drugs, and technology), and Emotional Health. We will take each in turn, but first — why does any of this matter?

Doctors want to sell books and get invited on podcasts and talk-shows. Academic researchers need funding. Moreover, the quest for the Fountain of Youth or the Peaches of Immortality or the Alchemist’s Stone or Whatever cuts across cultures and history. Same old, same old — the wealthy and powerful patronizing the learned and ambitious in the hopes of defying or at least delaying annihilation.

Don’t say “but this time it’s different.” Yet whether the average human lifespan is significantly increased or not, the current Longevity research does matter. Even if we do not live longer, we can still live better — healthier.

Improving Healthspan Matters Because …

Improving Healthspan matters because we have an aging population in the highly developed nations, especially those nations known as “the West.” As this is American Exile, we will focus on the USA.

According to PRB (2019), the “number of Americans ages 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060, and the 65-and-older age group’s share of the total population will rise from 16 percent to 23 percent.”  

Or, to cite a government affiliated source, “older Americans are one of the fastest-growing demographics”, according to the ACL (2022):

In 2019, there were 54.1 million people age 65 and older (up from 39.6 million in 2009). The population is projected to reach 80.8 million by 2040 and 94.7 million by 2060.

So how is our aging population currently doing in terms of Healthspan? In other words, in terms of freedom from the major chronic diseases?

The American People are Aging like Shit

American Exile covered earlier the public health catastrophe already underway for the younger generations: please see “Foie gras for Big Pharma: A note on American Children and Liver Disease” (Jun 25, 2022) and “Decolonizing Health to Fight Fatphobia?” (May 16, 2022).

But let’s focus for now on the current Healthspan vs. Lifespan situation — rather than speculating that the future must be better, worse, or the same. Our source below is the American CDC (2023: 1, 2023: 2).

                                Image Source USA CDC, 2023. Public Domain.

According to the CDC (2023: 1), six in ten American adults have a compromised Healthspan; four in ten American adults, a significantly compromised Healthspan. Notice that CDC is tracking adults here, not just the elderly. Additionally, chronic diseases help account for the majority of annual health care expenditures (2023: 2) — which is measured in trillions of dollars.

So how is the USA doing on squaring the curve as Luks (2022) puts it, on extending Healthspan to edge of Lifespan? According to the recent CDC reports cited above, not well. Not well at all. There is more at stake here than the vanity of billionaires who wish to live forever — even if such vanity remains a major driver in longevity research.

If we could square the curve, if we could extend Healthspan to edge of Lifespan, we could annually save trillions of dollars in healthcare expenditures. We could reduce human misery and suffering on a massive scale. We could et cetera.

But doing so on such scale, as it will turn out, means we must run head-long into Big Food, Big Pharma, Big Medicine, Big Tech, and our own Federal Government. Let all that rest for now. We will return to it later.

Preview of Parts 2 to 5

In these quests for Longevity, let’s review what proposals and solutions our medical doctors have on offer. We come now to the concerns of Exercise, Diet and Metabolic Health, Bio-Hacking (with supplements, off-label prescription drugs, and technology), and Emotional Health.

As a preview, good news and bad. It seems we could democratize extending Healthspan, but not Lifespan. Responsible individuals do have great control over their individual health outcomes. You can have better years. But only the affluent elite do and will have access to the Bio-Hacking tools meant to significantly advance Lifespan. Which, truthfully, has not yet become feasible for our species — we only have some promising results with lab mice. As the poet Robert Burns noted in 1785:

                                 The best laid schemes o’ Mice an’ Men
                                                   Gang aft agley

Next in our series, Exercise — the intervention for which we have the most agreement among our medical doctors, and indeed have the most data in terms of high-quality peer-reviewed studies.

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Necessary Disclaimer: American Exile does not offer medical advice, and none of our five posts in this series on Longevity should be understood as such.

Sources are cited in text. The four primary books discussed above: Sullivan (2016), The Barbell Prescription: Strength Training for Life After 40; Luks (2022), Longevity…Simplified. Living A Longer, Healthier Life Shouldn’t Be Complicated; Hyman (2023), Young Forever: The Secrets to Living Your Longest, Healthiest Life; and Attia (2023), Outlive: The Science & Art of Longevity.