For most of human history, human longevity stood at around 40 years, give or take a few. And the lifespan for most humans followed the same type of pattern, for many, a brutal ending at birth or within a couple years after, for the rest, a relatively safe run through adolescence and young adulthood. They progressed through adulthood, enduring the injuries and ailments that accompanied a mostly adverse environment, and if they were lucky, they facilitated the advancement of several offspring through childhood and into adulthood themselves. While most of our ancient ancestors had the physiology to make it into old age, their environment had other ideas.
Ironically, as we “evolved” from hunter-gatherer, to farmer, to factory worker, we seemed to actually be creating an environment that fostered more things that could kill us than things that could help us live longer. The air we were breathing got worse, the food we ingested got less natural as well as the liquids we started drinking, and the products we were inhaling. For a while we were experiencing the worst of both worlds, the high infant mortality rate of our hunter gatherer ancestors as well as the lifestyle causes of death of the modern era.
Then, around the turn of the 20th century, we began cleaning up our urban environment through improved hygiene and sanitation, as well as developing antibacterial medicines. This was the one-two punch that has drastically reduced infant mortality throughout the world. These changes vastly improved our expected lifespan (life expectancy at birth), but did little for the maximum age that humans could expect to live. In fact, even today, our life expectancy, at the age of 75, has gone up very little (see graphic below).
For every improvement we experience in human lifespan, we seem to create a new setback. Many of the diseases that we face as adults today, didn’t even exist a few hundred years ago. All of the improvements we have made up to this point in our modern society have come with a price.
As we “cure” one disease, we extend our lifespan just enough to face another disease that is waiting in the wings. Most of these diseases are man made, some are not. These new diseases are the obstacles that make up the gauntlet that we must face as we extend our years. The good news is that, generally speaking, the problems that we create for ourselves, are ones that we can solve.
The Gauntlet
The gauntlet is the list of mortal obstacles that we humans have faced for the entirety of our existence on planet earth. Throughout most of human history, the gauntlet made its appearance early in our lives, at childbirth or even sooner. It played a significant role throughout our early childhood, then it gave us a break starting in our late childhood through our early adult years, only to reappear in our late 30’s or 40’s, more or less. At this stage in our lives, the build up of damage from a lifetime of hard living took its toll and the end came not too long into these years. Becoming grandparents was the goal, becoming great-grandparents was not.
Today, the gauntlet looks much different. We have all but conquered the mortality of childbirth and early childhood and we have developed ways to extend the lives of those who have lived far longer than our ancestors. Unfortunately, there is a whole slew of new diseases and ailments that afflict us during our middle years, most of which are either man-made, self-inflicted, or both. These are the obstacles we face in the gauntlet of today.
The good news is that most, if not all, of these are preventable and in many cases are curable, just through a change in lifestyle. For some it may be just a minor change, for most it will be a major if not dramatic change, but for all the change is possible, and the result will be the addition of years, if not decades of quality life.
Diseases of Childbirth, Childhood, and Adolescence
In 1900, pneumonia and influenza, tuberculosis, and enteritis with diarrhea were the three leading causes of death in the United States, and children under 5 accounted for 40 percent of all deaths from these infections (CDC, 1999a). Today, only pneumonia (in combination with influenza) is among the top 10 causes of death overall or for children. Today, death from infectious diseases in America has been all but eliminated for children under five.
After five, the leading causes of death are related to accidents and sadly, homicide. Beginning in adolescence, increasing age also brings increases in causes of death linked to individual behaviors involving diet, exercise, smoking, alcohol use, and similar factors. Until our 30’s and 40’s, the cause of death was up to the individual or those around them.
"The overarching hypothesis is that our bodies evolved within a highly active context, and that explains why physical activity seems to improve physiological health today." - University of Arizona anthropologist David Raichlen
Diseases Throughout Middle Age
“A large body of research shows that one’s aging trajectory is largely determined by how we are in middle age. Those with lower blood pressure, LDL cholesterol, blood glucose, and body-mass index (BMI) in the forties and fifties, the study found, stood a much better chance of living to age eighty-five without any major health problems.”
Throughout our childhood, adolescence, and early adulthood, if something were to threaten our lives, it was generally a result of external forces, not from disease. But as we begin to enter our middle age years, the consequences of a less than healthful way of living begin to catch up with us. Diseases like cancer and heart disease rapidly ascended to the top two causes of death in our mid to late 40’s.
Cancer
Cancer occurs when something goes awry in a cell's life cycle, usually having something to do with its genetic coding. A cell loses its ability to regulate its number of divisions and it begins to grow out of control. At the same time, our immune system’s ability to counter and control this growth becomes inhibited, allowing the growth to continue to a point where our immune system will ignore the growth. This is where our body has lost its ability to take care of itself and medical treatment is our only recourse (usually).
The causes of cancer are almost all related to lifestyle. We know smoking greatly increases the risk of lung cancer, heavy drinking is the major cause of cirrhosis of the liver which can lead to liver cancer, but there are other leading risk factors like chronic inflammation, which is highly associated with all cancers and is caused primarily by obesity and/or diet.
Heart Disease
There are multiple conditions that fall under the umbrella of heart disease, the most concerning of which is Coronary Artery Disease (CAD). CAD most often occurs when the walls of the coronary arteries get clogged with plaque (atherosclerosis) preventing the proper flow of blood from the heart. This can result in acute events such as a heart attack or sudden cardiac arrest, as well as more chronic events such as heart failure.
While some heart diseases are inherited or can even develop through no fault of our own, the development of CAD is almost completely the result of lifestyle choices. The leading, almost exclusive causes of heart disease include - high blood pressure and cholesterol, smoking, overweight and obesity, diabetes, poor diet, and lack of physical activity.
Liver Disease
The liver is an organ about the size of a football. It sits just under your rib cage on the right side of your abdomen and is essential for digesting food, storing nutrients, and ridding your body of toxic substances. The liver is very tough and will keep working even if badly damaged, and can continue to repair itself until it's severely damaged. But when this damage is sustained for a long time, the effects can become irreversible, eventually leading to its failure.
This accumulation of damage leads to scarring (cirrhosis) which, if unchecked, leads to one of two pathways. The scarring becomes so bad that the liver eventually just fails, or the scarring leads to the development of cancer. In both cases of liver failure, the only option is to have the liver replaced.
There are various causes of this scarring, but the two most common are also the ones we have the most control over. Heavy, long-term consumption of alcohol, puts an incredible strain on the liver's filtering capabilities, which leads to its scarring. Obesity and insulin resistance (which many times are related) are associated with the build up of fat in the liver. This excess fat acts as a toxin to liver cells, causing liver inflammation, which may lead to a buildup of scar tissue in the liver.
Diabetes
Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of short-term energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells. This is toxic.
There are two main types of diabetes, type 1 diabetes and type 2 diabetes. If you have type 1 diabetes, your body does not make insulin. People with type 1 diabetes need to take insulin every day to stay alive. If you have type 2 diabetes, your body does not make or use insulin well. You can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. In most cases, type 2 diabetes is a lifestyle disease.
As of 2015, 30.3 million people in the United States, or 9.4 percent of the population, had diabetes. More than 1 in 4 of them didn’t know they had the disease. Diabetes affects 1 in 4 people over the age of 65. About 90-95 percent of cases in adults are type 2 diabetes.
Over time, high blood glucose leads to problems such as - heart disease, stroke, kidney disease, eye problems, dental disease, nerve damage, and foot problems.
Diseases After Middle Age
This is the age group that really starts to experience the human mortality rate doubling time (MRDT) of 8 years, with death rates of more than double of the previous age group. By age 65, heart disease and cancer have swapped places at the top, with chronic respiratory and cerebrovascular disease appearing out of nowhere and jumping up into the top five. Alzheimer’s has also made its appearance on the top ten list pushing past diabetes to number five.
Chronic Respiratory (COPD)
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It's typically caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions.
Development of COPD leads to a reduction or loss of physical activity due to reduced lung capacity. This reduction of cardiorespiratory function leads to reduced energy levels fueling a self-perpetuating downward spiral toward a complete loss of mobility.
Cerebrovascular Disease (Stroke)
A stroke occurs when a blood clot or atherosclerotic plaque blocks a blood vessel that supplies blood to the brain, resulting in the death of brain cells. A clot, or thrombus, may form in an artery that is already narrow.
Atherosclerosis is a primary cause of cerebrovascular disease. This occurs when high cholesterol levels, together with inflammation in the arteries of the brain, cause cholesterol to build up as a thick, waxy plaque that can narrow or block blood flow in the arteries. This plaque can limit or completely obstruct blood flow to the brain, causing a cerebrovascular attack, such as a stroke or TIA (transient ischemic attack).
Strokes can occur at any age, but they are more likely to affect people over 65 years old. In 2009, 66% of hospitalized people due to strokes were over 65 years old.
Factors that increase the risk of stroke and other types of cerebrovascular disease include - hypertension (high blood pressure), smoking, obesity, poor diet, lack of exercise, diabetes, and blood cholesterol levels of 240 milligrams per deciliter (mg/dl) or higher.
Alzheimer’s Disease
Alzheimer's disease, the most common form of dementia, is characterized by the accumulation of two types of protein in the brain: tangles (tau) and plaques (amyloid-beta). Eventually, Alzheimer's kills brain cells and takes people's lives.
Alzheimer's disease is a progressive neurologic disorder that causes the brain to shrink (atrophy) and brain cells to die. Alzheimer's disease is the most common cause of dementia — a continuous decline in thinking, behavioral and social skills that affects a person's ability to function independently.
For the other 99%, amyloid and tau are closely associated with Alzheimer's, but many things may contribute to the development of symptoms, such as inflammation in the brain, vascular risk factors, and lifestyle.
Some autopsy studies show that as many as 80% of individuals with Alzheimer's disease also have cardiovascular disease.
There is no treatment that cures Alzheimer's disease or alters the disease process in the brain. In advanced stages of the disease, complications from severe loss of brain function — such as dehydration, malnutrition or infection — result in death.
Frailty and The Fall
Frailty is the loss of strength, speed and energy that can whittle away at independence as we age, is what awaits us should we conquer the diseases of the longevity gauntlet.
Frailty increases the risk of infections, illnesses that have to be treated in the hospital, falls and even disabilities. In a study of 594 older adults, Johns Hopkins researchers found that frailty doubles the risk of surgical complications, lengthens hospital stays, and increases the odds of leaving independence behind (moving to a nursing home or assisted-living facility) after a surgical procedure by as much as twentyfold.
The diabolical nature of frailty is that it happens so subtly, that we won’t even realize that it is happening until it is almost too late. We will start to feel weaker, more tired, or even exhausted, and we will chalk it up to the effects of aging. This acceptance will lead to the downward spiral of frailty. This complacency is what will seal our fate.
Ultimately, the consequence of frailty will be the fall.
If you talk to almost anyone who is in the advanced age group, there is one thing that they will tell you as to why they are not as active as they used to be. It is the fall that they sustained. Their stories are almost universal - "I used to run, hike, or bike so many miles per day, and then one day I fell. This might be down the stairs, off a curb, or slipping on a wet floor, but whatever it was, it laid them up for an extended period of time, and then, best case scenario, is that they got back to exercising but just could never get 100 percent healed, and ultimately failed to ever get back to their former condition.
The fall will speed up the downward spiral into frailty, whose path will include assistance in living and eventually the nursing home. We do not want to end up in the nursing home. While the fall may be inevitable and out of our control, its effects and consequences are not. Adopting a lifestyle of vigorous exercise, proper nutrition, and a positive outlook will not only pay off in the short-run, but the benefits will compound for us well into "old age."
Conclusion
With 70% of people in the US on prescription drugs (50% in the UK), it seems that as lifespan inches upwards, disease is skyrocketing. The irony is that many advances in modern medicine are fighting the very problems that modern life itself has created.
Remember: Every pharmaceutical that we take comes with a consequence (side effect), so we need to be very careful in how we assess the cost/benefit of any drug, or any thing for that matter, that we put into our bodies.
“80% of all deaths are lifestyle related.”
When it comes to diseases of lifestyle, modern medicine is searching for cures, but all it can ever hope to come up with are treatments. There will never be a “vaccine” for cancer, or lung disease, or heart disease, or diabetes, or Alzheimer's. There will only be treatments, if we are “lucky”, and prevention.
The obstacles that the gauntlet has laying in wait for us may seem daunting and leave us feeling a bit hopeless, but the truth is that by making the right lifestyle choices we can avoid most, if not all, of these obstacles in the first place.
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