Longevity Metrics

Benjamin Franklin: “Search others for their virtues, thy self for thy vices”

-             Poor Richards Almanac

The best way to maximize longevity in 2023 is not a drug, supplement, or other high tech therapeutic; its Lifestyle medicine.

Wonder Medicine specializes in the translation of longevity technologies into clinical practice. This includes things like rapamycin, exosomes, and metformin. But we would be misguiding you if we did not focus, first and foremost, on lifestyle.

What is Lifestyle Medicine?

Per the American College of Preventative Medicine: Lifestyle medicine is a medical approach that uses evidence-based behavioral interventions to prevent, treat and manage chronic disease.

I would take this a step further even. For me, Lifestyle includes:

1.          Thoughts

2.        Behaviors

3.        Environment

4.        The People Around Us

With environment being particularly relevant and underappreciated in most medical settings. These 4 things drive both health and un-health. By optimizing these four things, a person can greatly extend both lifespan and health span. 

Focusing on behaviors alone, will not be enough. This may be why conventional medicine downplays lifestyle changes. If you only address behaviors, changes don’t happen, and as such, the strategy fails.

But this is a shame because lifestyle changes are the only definitively proven way to extend the length of human life in 2023. From epidemiological studies, it appears that people who live a healthy lifestyle can add approximately twelve years to their life (range: 5-15 years). 

Death at 88 instead of 76 years, most often accompanied by contraction of morbidity. 

 
For the full post check out the Wonder Medicine Blog Available at: https://www.wondermedicine.com/wonder-medicine-blog

Dia de Los Muertos and Longevity

The day of the Dead. What can the dead and this Mexican cultural holiday teach us about longevity? 

Is there more to the story than candy, spooky witches, monsters, tricks, and treats. Let's find out

What is day of the Dead?

-       A holiday most often celebrated on Nov 1st or 2nd.

-       Its strongest traditions and ties are to the Mexican culture.

-       On Dia de los Muertos, people remember and honor their past loved ones.

-       Representations of human skulls, marigold flowers, home alters with pictures of passed loved ones, pan de Muertos (the sharing of alimentacion or “nourishment”), are the hallmarks of this day. 

-       The roots are debated, but this tradition may date back to Aztecs society.

-       Dia de los Muertos brings families and communities together, celebrates life, and death.

-       I encourage you to Celebrate this magical holiday, Dia de los Muertos, along with all the fun and spookiness of Halloween, and depending on your beliefs, along with Christian traditions of All hallows eve (all Saints Day and All souls day – that actually has a similar message that just isn’t really practiced in my experience)

See complete blog post at: https://www.wondermedicine.com/wonder-medicine-blog

The 6 BIG Benefits of Longevity 

Be a victim or conquer longevity. You must choose!

Longevity

-       Longevity Definition: Long existence or service 

-       Human longevity relates to both existence (remaining alive) and service (remaining useful).

-       I strive for nothing less than long existence and long service for both my patients and myself

My favorite part of Avatar II, Way of the Water:

-       “Teach them our ways so they don’t have to deal with the shame of being useless”

-       It blows my mind how many people are ok with being useless to society in 2023

My hospitalized elderly patient: “Keep me alive doc”

Me: “what makes you want to keep living”

Patient: “I have grandkids”

-       But these people cannot watch their grandkids because their health is too poor. In fact, they need assistance even to perform activities of daily living (ADL)

-       Like avatars of the sea, I would find this inability to contribute meaningfully: shameful.

-       Being useful is about more than just pride. It is about service to the community.

-       Service is what life is all about. If you are unhappy with your life, I suspect this is huge part of the problem.

Longevity is the Key

-       By striving for longevity you are forced to become the best version of yourself right now.

-       The best version of you, right now, will be able to live, thrive, and serve the longest.

-       As such longevity, or as we call here, the Full Scope, is your best vehicle for health, extreme productivity, and service both now and in the future


See Wonder Medicine blog for complete show notes.

Live to 100: Secrets of the Blue Zones

-       2023 Netflix documentary, 4 episodes

-       Based on the 2008 book: “The Blue Zones: Lessons for Living Longer from People Who’ve Lived the Longest.”

-       By Dan Buettner, Journalist, National Geographic Explorer, New York Times Best Seller

What is a Blue Zone

-       Geographic location where people’s life expectancies are much much higher than in other parts of the world

-       A much higher percent of people live to 100 years of age than other areas. 4x more people than in the USA.

Original 5 Blue Zones

-       Started with Gianni Pes and Michael Poulain's 2004 paper: Identification of a geographic area characterized by extreme longevity in the Sardinia Island.

-       Dan Buettner read this and then established 4 more Blue Zones with the help of epidemiologists (bluezones.com)

-       SARDINA, ITALY

-       OKINAWA, JAPAN

-       NICOYA, COSTA RICA

-       ICARIA, GREECE

-       LOMA LINDA, CALIFORNIA, USA

4x more likely to live to 100 than in the US. Life expectancies > 85 years, apposed to 76 years in the US.

Dan Buettner’s Theory on Why People in Blue Zones Live Longer

-       CONNECT (INVEST IN RELATIONSHIPS MORE. KEEP FAMILY AROUND MORE, FRIENDS)

-       OULOOK (DAILY RITUALS, FAITH, SHOW UP, PURPOSE VOCABULARY)

-       MOVE NATURALLY, (GARDEN, WORK, WALK everywhere, sit on the floor),

-       EAT WISELY (WHOLE FOODS, HEAVY PRODUCE, WINE, MODERATION)

According to the US CIA, Singapore has the second highest life expectancy at birth in the world at 86.5 years (second to Monaco, 89.6 year average life expectancy, < 1 sq mile in the French Riviera, < 40k residents, tax haven, wealthiest location in the world, high performers flock to Monaco)

SINGAPORE 

- Island in SE Asia. 2nd highest population density of any country in the world, globalized, one of four main languages is English. 283 square miles. 5.5 million residents.

- 80% of people own CARS in the US. 11% of people own CARS in SINGAPORE, PUBLIC TRANSIT USED BY HALF THE POPULATION EVERY DAY. Build in natural scapes in cities, good city planning with lots of walkways, < 10% obesity, Low healthcare costs (in spite of living longer)

- KEEP OLDER FAMILY MEMBERS OUT OF CARE HOMES - (NEEDS TO BE EARNED, HARDER IN THE USA per below)

Singapore Physician Philosophy and how to live a long time.

Why do you like being a doctor?

1)    TREAT A PATIENT, FEEL JOY (enjoy the process)

What advice would you give someone who wants to live a long time?

2)    WORK HARD EVERYDAY, BE HONEST, HUMBLE (get to work)

-       Work hard and enjoy the process. No wonder the people in Singapore are living longer…..their doctors are giving much better advice and generally enjoying their job as a physician.

We all have weaknesses. 

These weaknesses will eventually limit your life and longevity tremendously.

Train these weaknesses out and become the best version of yourself.

See full notes at: 
https://www.wondermedicine.com/wonder-medicine-blog

Blog post about this podcast available at: https://www.wondermedicine.com/wonder-medicine-blog

Three Things to improve your longevity today.

1.     Exercise

-       Stop pretending to care about longevity or health if you are not exercising

-       Bodies in motion stay in motion, bodies that stop, soon stop forever

-       Plus the best way to keep your brain health and prevent dementia is to exercise regularly.

-       Build your bank account of muscle and movement reserve

-       Your job is not exercise. Walking is not enough unless your are elderly. But even then you should be strength training as well

-       Dynamic movements through big ranges of motion always better. Don’t limit yourself

-       Be results driven. Measure strength, VO2 max, and other objective metrics.

-       Avoid injury by starting slow and progressing slow, injuries are killers as we get older.

-       Learn how to fall

-       Focus on Eccentric strength as well as concentric, stop dropping the weights.  

-       You will only be is strong as your weakest component and this will be your Achilles heal when you age, so stop ignoring it and fix it. Stop skipping leg day

-       If you would talk to our exercise physiologist, Callie, ditch the chair

2.     Sleep

-       Give yourself 8 protected every night. Don’t stress if you cant sleep the whole 8 hours

-       Living a healthy lifestyle will improve sleep. Do more during the day. Think and move more, vigorous exercise and light exposure early in the day can really help

-       Give your kids more time, particularly in the morning

-       Avoid z drugs, benzos, alcohol

-       Cannabis, makes you wake up more groggy, less REM sleep, people often require more sleep to feel the same amount rested

3.     Perseverance with positivity

-       I have asked every person above 90 I have taken care of their secret to longevity. I am over 300 people at this point. 90+ percent of the time they either say “keep moving” or “stay positive.

-       Toughen up, life is hard

-       Work, retirement is a killer, work gives people meaning and keeps the brain active.

-       Force yourself to do hard things that are uncomfortable, cold plunge. 

-       Lean into all your weakness always

-       Don’t give up.

Overview

-       new 10-to-20-minute podcast every Monday
-       the science, philosophies, and actional information around health, longevity, and performance
-       meant to help listeners become the highest performing individual possible
-       Increase your lifespan, healthspan, and view your life through the full scope

See a blog about this episode at: https://www.wondermedicine.com/wonder-medicine-blog

 
Disclaimer

-       Free content, no adds, no junk, just the facts
-       This podcast does not create a provider patient relationship between the listener and the full scope team.
-       This podcast is not intended to treat, diagnose, or cure your personal medical problem.
-       If you want professional medical advice, check out Wonder Medicines Longevity and Performance Program

Summary

Phosphocreatine is a molecule that can recharge ADP into ATP. This provides energy to skeletal muscle and the brain. Dietary and supplemental creatine can raise the bodies stores of phosphocreatine, providing additional energy. In this podcast, we discuss creatine, what is is, how it works, why it is useful, and how to supplement it.

Morbidity and Mortality

After age 30, most people loose around 5% of their muscle mass per decade. Six million people in the United States are diagnosed with Alzheimer’s dementia and this number is increasing every year. As such, preserving muscle and brain function are cornerstone of all anti-aging strategies.

Story

Creatine was first discovered in muscle in 1832. For over 100 years, it has been known that supplementing creatine increases phosphocreatine levels in skeletal muscle. Since the early 1990s, creatine has been marked as a dietary supplement. The use of creatine has become extremely popular over the last 3 decades and its potential benefits to cognitive and nerve function have only recently been explored/discovered.

Key Points

1. Creatine is a small amino acid like, nitrogenous molecule found in skeletal muscle and the brain.

2. Creatine is phosphorylated to phosphocreatine by creatine kinase. Phosphocreatine can then transfer a phosphate to ADP, making ATP. ATP is a molecule that is the main source of energy for the body.

3. Improved strength, bone health, cognitive function, recovery from TBI, heart health, and improvements in triglyceride are often seen with creatine supplementation.

4. Supplementing 5 to 10g of creatine a day should be considered in many individuals, including non-athletes. Creatine has an excellent track record for safety, but possible side effects will be discussed.

5. Muscle cramps are common when taking creatine. Stay hydrated and consume adequate salt. Be careful not to overuse your muscles or injure yourself when taking creatine.

References

-        Forbes SC, Cordingley DM, Cornish SM, Gualano B, Roschel H, Ostojic SM, Rawson ES, Roy BD, Prokopidis K, Giannos P, Candow DG. Effects of Creatine Supplementation on Brain Function and Health. Nutrients. 2022 

-       Creatine. Wikipedia.

-       de Souza E Silva A, Pertille A, Reis Barbosa CG, Aparecida de Oliveira Silva J, de Jesus DV, Ribeiro AGSV, Baganha RJ, de Oliveira JJ. Effects of Creatine Supplementation on Renal Function: A Systematic Review and Meta-Analysis. J Ren Nutr. 2019 

-       Aguiar AF, Januario RS, Junior RP, et al. Long-term creatine supplementation improves muscular performance during resistance training in older women. Eur J Appl Physiol. 2013

-       Chilibeck PD, Chrusch MJ, Chad KE, Shawn Davison K, Burke DG. Creatine monohydrate and resistance training increase bone mineral content and density in older men. J Nutr Health Aging. 2005

-       Groeneveld GJ, Beijer C, Veldink JH, Kalmijn S, Wokke JH, van den Berg LH. Few adverse effects of long-term creatine supplementation in a placebo-controlled trial. Int J Sports Med. 2005

Summary

Metabolic syndrome is a medical condition characterized by unhealthy and markedly deranged metabolism. Over 50% of United States adults have metabolic syndrome and another 40% are at risk of developing it (90% of US adults!). Metabolic syndrome is the great killer of our time, a global pandemic, and the leading risk factor for most all major chronic diseases.

 
Story

Chronic diseases are contagious. This is because thoughts and behaviors are contagious. As fast food companies, ultra-processed food, soda and other sugar sweetened beverages, and the American lifestyle spreads around the globe, so too does metabolic syndrome.

Key Points

1 Metabolic syndrome is both caused by and can be cured by the way a person lives their life (behaviors).

2. Insulin resistance, unhealthy cholesterol, high blood pressure, and weight gain are symptoms of metabolic syndrome.

3. The risk of multiple chronic diseases including diabetes, heart attacks, strokes, and even cancer is increased in those with metabolic syndrome.

4. Avoiding ultra-processed foods, exercising regularly, sleeping adequately, and managing stress are the best ways to prevent and treat metabolic syndrome.

References

-https://www.nhlbi.nih.gov/health/metabolic-syndrome/diagnosis

- Lustig, Robert. Metabolical: The Lure and Lies of Processed Food, Nutrition, and Modern Medicine. Harper Wave, 2021.

- Saklayen MG. The Global Epidemic of the
Metabolic Syndrome. Curr Hypertens Rep. 2018 

- Lemieux I, Després J-P. Metabolic Syndrome:
Past, Present and Future. Nutrients. 2020

- Shi TH, Wang B, Natarajan S. The Influence of
Metabolic Syndrome in Predicting Mortality Risk Among US Adults: Importance of
Metabolic Syndrome Even in Adults With Normal Weight. Prev Chronic Dis. 2020.

- https://www.heart.org/en/health-topics/metabolic-syndrome/symptoms-and-diagnosis-of-metabolic-syndrome

Summary

What is your plan for medical care as you get older? Most people don’t know. While 87% of people say they want to die at home, just under half of people do. In this episode we discuss goals of care, comfort care, palliative care, hospice, code status and more.

Morbidity and Mortality

Medical errors are the 3rd leading cause of death in the United States (sorry healthcare team…its true). As people get older, sicker, and frailer, their chances of being hurt by healthcare increase dramatically. At some point for everyone, the benefits of aggressive medical care are outweighed by the risks.

Story

In 1900 the average life expectancy in the United States was 47.3 years. By 2019, life expectancy had increased to 78.8 years. This was largely due to public health measures like clean water, lifesaving antibiotics, and vaccines. However, life expectancy is now trending down-ward. 

Key Points

1. Comfort care is when the main goal of care is person’s quality of life

2. Palliative care is a medical discipline that helps people cope mentally, physically, and spiritually with severe illness. People on aggressive medical and comfort care can utilize palliative care.

3. Code Status concerns a patient’s wishes when they are dead. It has nothing to do with their medical care while alive.

4. Hospice is a program centered around comfort care for those persons expected to live < 6 months. It is under-utilized and our current medical incentives push people away from it. 

References

-       Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manage. 2007 Mar;33(3):238-46. 

-       https://hospicefoundation.org/Hospice-Care/Hospice-Services

-       Hughes MT, Smith TJ. The growth of palliative care in the United States. Annu Rev Public Health. 2014;35:459-75. doi: 10.1146/annurev-publhealth-032013-182406. PMID: 24641562.

-       Gomes, B., Calanzani, N., Gysels, M. et al. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care 12, 7 (2013)

-       Adair T

-       Who dies where? Estimating the percentage of deaths that occur at home

-       BMJ Global Health 2021

-       QuickStats: Percentage of Deaths, by Place of Death — National Vital Statistics System, United States, 2000–2018. MMWR Morb Mortal Wkly Rep 2020

-       Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016

-       Google searches and numerous sites describing “comfort care”, “palliative care”, “End of life care”