The Longevity Paradox: Why Is Living to 100 Easier for Some People Than Living to 90 is For Most?

Are you curious to know the 'absolute rules' that if followed will always add many more years to your life? 

If you are reading this expecting me to provide you with such rules, let me apologize in advance.

I have searched for them for the past three years by speaking with over 1,000 senior citizen patients, including several over one-hundred years old, and by reading over 50 books, 40,000 clinical studies/abstracts, and countless online articles, and I am sorry to say that I don't believe they exist. Among books like The Blue Zones, The Longevity Project, Successful Aging, The Art of Living Long, A History of the Human Body, etc., I just can’t find any clearly proven advice. I’ve studied material from the Okinawa, New England, and Albert Einstein College of Medicine Centenarian studies, read publications from the SENS Research Foundation and available proceedings from International Longevity conferences. 

The reason there doesn’t seem to be any absolute right answer is because when it comes to living fifteen or more years beyond the average life expectancy there appears to be a paradox. (In fact, in the late 90s, a compendium of studies was published with the title, The Paradoxes of Longevity.)

Take smoking for example. There is no question regarding the association of cigarette smoking with lung cancer. Cigarettes are considered dangerous and responsible for producing debilitating lung diseases, which can sometimes—but not always--be lethal. Not every cigarette smoker develops lung cancer, and for that matter, not every lung cancer patient previously smoked or had major exposure to second-hand fumes or other chemicals.   

In Daniel Buetner's book The Blue Zones, he reveals five places, such as Sardinia, Italy and Nicoya, Costa Rica, scattered around the globe that harbor relatively high concentrations of centenarians, people aged over 100. He ascribes their longevity to living a certain healthy lifestyle. It often comes down to the food they eat, the physical activity they do, their attitude towards life and family, etc.  However, in these same areas there are plenty of friends, family, and neighbors who lived remarkably similar lives and yet died much earlier. Not surprisingly, in searching out the life expectancy for these ‘Blue Zone’ areas, I found that they are for the most part only a few years higher than life expectancies in other parts of the world with far fewer centenarians and that’s after you average in the centenarians. 

Yet, books and articles are published incessantly offering the ‘secrets’ and ‘keys’ to living to 100 if you follow a few similar rules such as eating properly, being physically active, getting the right amount of sleep, managing stress well, being social, etc. But do these actions always matter? If you lived the optimal life, will you add many more years to your life? The answer is complicated.

For some people, living a sub-optimal life may result in premature death such as in the case of the morbidly obese person who develops heart disease and type 2 diabetes, and succumbs early. Commonsense and plenty of supporting science affirms the notion that certain lifestyle activities, such as a sedentary life and poor eating habits may lead to premature chronic diseases such as diabetes, heart disease and cancer. But, ‘may’ is not always. 

To prove my point, let me share my own recently completed informal, admittedly unscientific, but revealing research project. The project involved accumulating all the stories about centenarians published online in 2013. Most of the stories were identified through a Google alert email for the keyword "longevity." After identifying over 50 stories, I searched each story for the centenarians' 'secret' or 'key' to longevity. I created a chart of the first 50 individuals I randomly came across that offered a reason for the centenarian's extended longevity.

Here are the results.  

The oldest centenarian was 114, with many having turned 100 just last year. 35 were women and 15 were men.

Here are the reasons they gave. It adds up to 50+ reasons because some offered more than one:

18 attribute it to (hard) work and physical activity 10 attribute it to regular alcohol consumption 6 attribute it to strictly never drinking or smoking 14 attribute it to a good attitude towards life and/or to their faith 1 to Anacin pills 1 to love of roller coasters 1 to good doctors 1 to cafe lattes (long before they became popular) 1 to marrying a man thirty years younger 1 to eating bacon 1 to eating Italian food 1 to eating junk food 1 credited  cigarettes and 1 credited cigars (and yet, no lung cancer) 2 claimed no explanation
Since I put this chart together, I came across four more stories for 100, 104, 108 and 109 year olds. The 100 year old claimed his longevity was due to eating lots of strawberry ice cream, just like his father did, who lived to 104. The 104 year old credited her longevity to her love of eating chocolate and drinking hot chocolate.  The 108 year old stated that it was in part due to never marrying and avoiding the accompanying decades of stress. The 109 gave her key to longevity as not eating a lot and never between meals.
Now as you review this list, it should be clear that there were no absolute reliable and consistent reasons as to why any of them lived past 100. In fact, scientists at Albert Einstein College of Medicine and at Boston University, who have been studying centenarians for many years, concur that there is no single absolute explanation for centenarian longevity. The current thinking is these longevity winners possess a number of small genetic variations that work together as a group to confer benefit to them. According to Thomas Perls, a Boston University professor of medicine and director of the New England Centenarian Study, "Twenty percent of the population has the genetic wherewithal to get to be 100."
So what does that mean for the eighty percent that represent the rest of us who may not enjoy such gene variations? Should we even bother to engage in a healthy lifestyle if there are no guarantees or absolutes? Why deny ourselves that piece of chocolate cake or bother to get out of our chairs and move at all if good health and longevity simply come down to winning the gene lottery?
The answer is that even though there are no absolutes when it comes to your health, there are probabilities and possibilities.
A healthy lifestyle increases the probability of a healthy life even as the possibility for poor health, like the inexplicable cancer, still exists. An unhealthy lifestyle increases the probability for poor health like heart disease and cancer, even though the possibility does exist that you will escape such devastating illnesses and still live to 100 like the few who did in the review cited above. On this point, the preponderance of scientific evidence is clear, although not absolute. For me it all comes down to what Louis Pasteur once said, which is that "Chance favors the prepared mind." In other words, sometimes we make our own luck.

So the next time you read an article claiming that one thing or another is the absolute way to good health and extended longevity or books like Grain Brain or Wheat Belly that claim that certain foods are absolutely bad for you, you should realize that such absolutes simply don't exist (although I can't only say that with absolute certainty).

So beware of people claiming they have absolute answers for you. They can't be certain; no one can today, although the future may tell a different story (See my previous post about the inevitability of death).

The old adage that one man's poison may be another man's food should come to mind. What works for one person, may not work for another. You may still live to 100 by eating junk food, smoking, and never exercising. You won’t be the first and probably not the last. You could also win the next Powerball lottery. But if I were you, I wouldn't place all my bets on it, especially, when it's your life and health at stake. 

 I can’t tell you if that’s an absolute lesson worth learning, but it’s pretty darn close.

When It Comes to Longevity, To Live or Not Live Long, Is Hardly The Question

The recent Pew Research Center Survey that revealed that Americans do not want to live past 100 continues to generate much fanfare. When I read the survey, I was hardly surprised that the average responder chose ninety as their ideal final age. With articles like, “Mom, I Love You. I Also Wish You Were Dead. And I Expect You Do, Too” that appeared two years ago in New York magazine, and the similarly timed “How to Die...What I Learned from the Last Days of My Mom and Dad” that was published in Time magazine, it shouldn't come as a surprise to anyone else. Both articles poignantly described how difficult the end of live is when you are among the oldest old and near death. They reaffirmed for most people a misguided view of aging in America. Fortunately, for those among you who aren't quite ready to set a deadline for your demise, both authors' circumstances were the exception to the rule and the benefits of living long outweigh the negatives.  More about that later.

Centenarians Among Us

Meanwhile, hardly a week goes by these days without some small town newspaper featuring a story about a local centenarian (no wonder, their ranks are swelling). Almost in lockstep, each story describes some secret longevity sauce uniquely offered by their age-wizened seer.  Most of us read such stories with a "that's nice," but don't otherwise think twice about it.  These centenarians are aberrations to most of us, something to be admired from afar, but not worthy of our aspirations. We may be intrigued by them, but most of us don't want to be them.  In addition, our society, unlike many others, has little reverence for the most aged among us. Why grow so old, we think to ourselves, to only feel neglected or unwanted?  Though we may be momentarily entertained by stories about the athletic triumphs of ninety-plus year olds like the recent article in the Wall Street Journal, most Americans prefer not to outlive their vitality, and apparently believe that means passing by age ninety.

Average Americans

As fate would have it, one of my patients last week when asked specifically how long he wanted to live answered without hesitation that ninety would suit him fine. Bemused, I thought to myself, "hello average American." When questioned what sway ninety held, he almost robotically responded that ninety was the age that he thought he would stop fully functioning and was prepared to move on. With all due respect to this patient and all the others who were surveyed by Pew and answered similarly, they may be wrong to choose ninety as their final age.  By the time we finished our visit, my patient agreed. Please let me tell you why.

The Race

I like to use analogies. In this instance, I used a racing analogy. When one races towards a finish line, the goal is to cross it, not reach it. Imagine, if the goal was to simply reach it. Given the momentum, the runner would have to slow done long before the goal in order to come to a complete stop at the goal. Similarly, to desire to die at ninety basically means that we choose to lose our vitality in our eighties. Vice a versa, if we wish to live to one hundred, it means that we are seeking to remain very vibrant in our eighties and early to mid-nineties.  Is that reasonable? Does it really make a difference what we think? It turns out yes. As gleaned from my extensive readings about centenarians, in most cases, the centenarians, and even super centenarians (over 110), expected to live long with many expecting to living even longer than they actually did. Attitude really does matter. It's not enough to simply expect to live long. Lifestyle and genetics play a role, but hoping to die by a certain age has consequences. 

Did You Ever Get An A?

Here's another, perhaps more pertinent, analogy.  Remember those school days you may wish to forget? Do you recall ever studying for a test in the hope of getting an A? If so, did you study 'just enough' to get an A or did you study all the material in the hope that would get you an A. Unless you are one of those geniuses of whom my children always claim never have to study to get an A, I posit that you reviewed all the material in an exhaustive fashion in the hope that you had done enough to get such A. Trying to do 'just enough' to get an A is highly unlikely to work because it isn't a complete approach. The same applies to healthy longevity.  If you simply aim to live to age ninety, you are assuming that unhealthy behaviors that may prevent you from living past ninety will also not impact your health pre-ninety. They will, and aiming for ninety is being shortsighted. 

The Facts About Longevity

So let's go back to the premise of the two articles that claimed that dying at an older age has serious drawbacks. The facts are that such conclusions are simply inaccurate. According to research conducted at the New England Centenarian Study (NECS) affiliated with Boston University, "90% of all of the centenarians [they studied] were still independently functioning at the average age of 93 years. Somehow, despite the presence of diseases, people who become centenarians don’t die from those diseases, but rather they are able to deal with them much better than other people and remain independently functioning more than 30 years beyond the age of 60." 

Compression of Morbidity

Furthermore, the NECS research reveals that when compared to controls, "nonagenarians (subjects in their nineties), centenarians (ages 100-104), semi-supercentenarians (ages 105-109) and supercentenarians(ages 110+)...had...progressively shorter periods of their lives spent with age-related diseases, from 17.9% of their lives in the controls, to 9.4% in the nonagenarians, down to 5.2% in the supercentenarians. In other words, the longer they lived, the less they suffered from disease. These findings support the "Compression of Morbidity" hypothesis.  

What is that, you ask? In 1980, a Stanford researcher named James Fries proposed the “Compression of Morbidity” hypothesis which states that as one approaches the limit of human life span, they must compress the time that they develop diseases towards the very end of their life and he proposed that people around the age of 100 do this. Although the NECS research shows that 43% of centenarians may suffer from age related illnesses before age eighty, and 42% suffered between eighty and one-hundred, most of the suffering was compressed to the last few years of life. Got it? The longer you live, the more healthy years you enjoy.

What that means for you is that the real reason to want to aim to live to one-hundred is that you will experience a far more pleasant eighties and early nineties, one mostly free of debilities and difficulties, if you succeed.

The Longer You Live, The Healthier You've Been 

Although it is true that living past your late nineties seems to require good genes (more in future blog), living to your mid-nineties is also a function of the lifestyle choices you make.  So the next time someone asks you how long you want to live, I hope you say "as long as possible" and mean it. Aiming beyond and high when it comes to longevity, like in the racing and school analogies, is the way to go.