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Healthspan and Longevity, An Overview

Written by: Dr Tim Trodd (Functional Medicine)

Healthcare is going through rapid change. Health is not a binary concept, not either health or ill-health but a spectrum. Our goal should be to be at the optimal end of the health spectrum, in other words, as healthy as we can achieve. This will lengthen our lifespan (increase longevity) and our healthspan, the length of time we spend in good health.
This may sound obvious, but the healthcare systems of today are not geared for this, we are stuck in an old paradigm of disease detection and treatment. Change is coming, There is an explosion of interest in this area, ready access to information, testing and easy access to Artificial Intelligence and processing power that will enable individuals to choose and monitor their healthcare program.

What Is Ageing?

Ageing is a universal biological process, not a disease. Once we have reproduced and nurtured our offspring, our genes will no longer be helpful to us; actually, we consume resources without benefiting our genes. As a result, evolution has programmed us to grow old and die.

Take a hypothetical 75-year-old who may have trouble getting out of a chair and walking a small distance. To a doctor, this may be due to a disease such as Osteoarthritis or heart failure, but the big picture is that this is due to ageing. He or she has probably reached the end of their “Healthspan”, ie they will not regain health again in this lifespan. Their body systems have deteriorated to the point that they are losing the ability to influence their environment. That same person, however, is not that badly off; they probably had some friends who had already died. They are not the worst off, that is true, BUT they also have a friend who plays golf four times a week, visits the gym most days and, skis with his family and lives a vibrant life.

These different outcomes for a 75-year-old have little to do with chance; you may get run over by a taxi, or you may have genes for heart disease and diabetes, but with modern medicine, the majority of the difference in outcomes is down to lifestyle. How did that person maintain their health in their 40s, 50s and 60s? Exercise, diet, sleep etc. By the time a person has lost their health, it is too late to change their lifestyle. The 75-year-old living an active, vibrant life did not get there by chance but because of choices that he had made decades earlier.

Take another hypothetical person, a 45-year-old who has come to a fork in the road; they have high blood pressure, high cholesterol and/or high blood sugar. Do they choose to take medicines for these problems as proposed by the Doctor or reassess their lifestyle, get advice on how to improve their health through diet and exercise a take a new healthier path. Perhaps they choose a combination of both paths due to their circumstances, but they are far more likely to be a healthy 75-year-old if they choose the healthy route.


As ageing and loss of health primarily affect our ability to influence our environment (walking, manipulating and talking), testing physical abilities strongly predicts all-cause mortality (ACM), that is, death in a given time frame. The usual tests in a medical health check, such as Cholesterol, are far less predictive of ACM than physical testing. In the future, we will see more use of tests such as grip strength, VO2 Max and DEXA body scanning to determine body composition.

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What Do I Have to Do?

If you take an active approach to Healthspan and Longevity, you must have resources, time and motivation. Choosing to manage health for the long term in your 40s has a cost, both in terms of time and finance and seeing the big picture. Planning for the future is a particular cognitive skill that not everybody possesses. We can liken this to quitting smoking; every smoker knows the dangers of smoking, but some are not able to reconcile the pain of quitting today with the enormous advantages they will get later on. In other words, you have chosen to spend time, perhaps experience some discomfort and spend money today when a significant part of the benefit will not be felt for decades.

A key is sustainability. I advise patients to choose an anti-ageing program they enjoy; it is far more likely to be sustained. Somebody who goes on a radical diet and exercise regimen and stops after a while is probably worse off; they have failed and are less likely to try again. It helps to make your plan enjoyable; this often means making it social, which has benefits all of its own, or pushing for an achievable goal.

It is important that this should not be seen as a choice between modern medicine and a lifestyle approach. Most of us will need some medical treatment as we age, be it blood pressure, cholesterol, or other therapy. This does not preclude a lifestyle approach, which is far from it.

Healthspan and Longevity Resources and Focus Areas

#1 Diet:

Food contains protein, fat, sugar, minerals, vitamins, fibre and numerous bioactive compounds such as polyphenols. Our diet also directly affects our microbiome; a healthy microbiome is a key health need.

Everybody starting a longevity program must consider diet. As we age, we need fewer calories, and we become worse at handling sugar; we will need to eat less and avoid simple carbohydrates.

If you look at the diets of societies that age well, they have some things in common. They maintain energy balance; they contain a lot of fresh foods, do not consume junk food or processed food, contain a few simple carbohydrates, and consume a wide range of vegetables, nuts, seeds, and fruits.

A given food can have a different quality depending on how it is produced; for instance, grain-fed meat has a completely different and less beneficial fat profile than grass-fed meat.

Any diet will need to accommodate personal preferences and food allergies and intolerances. This is a complicated area with no set solution. Professional input and monitoring should be available on a Medicine 3.0, Healthspan and Longevity program.

#2: Exercise

Exercise is integral to a healthy ageing program. This should be aimed at maintaining aerobic capacity (think of this as “fitness”) and muscle mass and strength. Without active management, we will all lose aerobic capacity, muscle and strength as we age; it will then come to a point where we lose the ability to walk, rise and use our hands, leading to some form of assisted living. 

Starting a fitness program is never too late, but earlier is better. This means that your fitness program has to be sustainable. All programs should have an element of Zone 2 (cardio exercise at a moderate level) training, strengthening and social. Not everyone can incorporate high-intensity training for the long term; it can cause too much discomfort.

An overlooked need is the need to get outside in nature. In a recent study in the British Medical Journal, exercise is more effective for depression than SSRIs (drugs such as Prozac, Lexapro and Effexor), and the most effective exercise of all is walking. This reflects that when walking, you are usually in nature, earthed, in a quiet environment, and away from the stress of the modern world, with a benefit of all its own.

Healthspan

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#3: Wearables

We now have access to various wearable medical devices to help collect health data. We can already collect data on the pulse, heart rhythm, oxygen levels, sleep, exercise HRV (stress), blood pressure, VO2 max (calculated), and blood sugar, all with a graphical representation on our phones. The data available and quality of analysis will continue to grow. These data, particularly the trend over time, are invaluable for monitoring health, much more valuable than a snapshot in the Doctor’s office when you may be under stress. The key is to process and synthesize the data into your program.

#4 Where Does Covid Fit In?

Covid has illustrated an important point about ageing. People with Diabetes and Obesity were far more likely to die of complications of COVID-19 than their peers of the same chronological age. This is due to their chronic condition, which advances their biological clocks. They are 70 but react to COVID-19 like they are 80 years old because their biological clock is aged 80, hence the increased mortality.


In addition, we know that some patients will get Long Covid with symptoms such as brain fog and fatigue after the initial illness, and this is an area of particular interest to me. Medicine approaches this in its standard way and seeks a specific treatment. The point is that logically, Long Covid cannot be caused by the COVID-19 virus because all humans have had COVID-19  by now, but only a few of us have long Covid. Therefore, the illness is not caused by the COVID-19 virus but by how an individual reacts to the COVID-19 virus.

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Topics: Health & Wellness, Wellness & Functional Medicine, Longevity

Dr Tim Trodd

Dr Tim Trodd

Family Medicine, Functional Medicine, General Practice

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