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.

Whom Can You Best Trust For Good Health Advice?

I recently read a number of articles regarding patients who either second-guess or greatly mistrust their doctors.  Under such circumstances, this apparently increasing number of patients fail to adhere to their doctor's direction(s) and either do not fill prescriptions, take their prescriptions sparingly, or take action contrary to the doctor's advice.

This may not be surprising given the ubiquitous nature of health advice now available through various media outlets, including, TV, radio, print and internet, almost countless newsletters put forth by universities, government, non-profits and commercial entities, and a whole slew of unrelated websites. Scenarios often play out that patients consult such sources prior to the physician visit or immediately thereafter. With many patients feeling that their doctor hardly spends enough time with them, with visits often lasting between 6 and 15 minutes, and with the doctors on average interrupting patients within 26 seconds of explaining why they came in, it isn't surprising that patients are growing more suspicious and turning to alternative sources.

It that wise? The answer is both yes and no. It is wise to become an active participant in your health care and there is beenfit in reading up about your disorder and prescribed treatment. But second-guessing or ignoring your doctor's advice without informing him or her is not prudent. Relying on some alternative generic media source that isn't specifically aware of your medical history, gender, social and family history, lifestyle and diet, stressors, support system, etc. can be outright dangerous. When dealing with alternative practitioners, you could be believing and following the advice of a less qualified and educated person than your physician. Just because they give you the time, and show great compassion and understanding, doesn't make them more capable of helping you.

I'm not saying that there aren't alternatives to prescriptions and that sometimes one is actually better off with such alternatives.  What I am saying is that it's hard to know when you have come across such a viable alternative when such sources usually want to profit from their advice by selling you something (yes, it's true, physicians also profit from their advice, but they usually don't sell things). Even when they don't try to sell you something, the question remains are they strictly relying on science that has been properly vetted or are you just a guinea pig.  My experience is that many of these sources often overstep their boundaries and advocate for unproven or even sometimes repudiated solutions. Worse, they can load you up with a potentially dangerous combination of pills.

A friend of mine, whom I recently helped, was put on a total of ten dietary supplements, some multiple times a day, by a nutritionist for what he said was basically a history of constipation and a family history of diabetes. A thorough review of the supplements revealed that there was much overlap between the products, with some of the nutrients reaching levels more than 50 times the recommended dosages.  Nevertheless, my friend told me that the supplements had solved the constipation. As we continued to speak, he added that he was also taking aloe vela for the constipation, which turns out to have good scientific evidence to support its use for this indication. I explained that he could eliminate all the other products and take the aloe vela alone with some additional fluids to see if that worked for him.

By the way, it took me over 45 minutes to look up and review the ten products, and total the dosages due to the multiple takings, and over an hour to explain to my friend the pros and cons (more cons than pros) of taking the products he was on. The key point I eventually shared was that the risks of combining all these products was unknown and the benefits associated with some of the products were either limited or known to be worthless. The final analysis presented an unknown risk versus limited benefit, and therefore, logic dictated that he should stop taking the pills.

Obviously, you may not have a friend like me who can spend nearly two hours uncompensated reviewing your medical situation with a knowledge of both medicine and alternative medicine,and who can advise you without an agenda.

So what can you do?

I think it starts with finding the right physician, someone who has invested at least a modicum of time in understanding that the prescription pad is not always the first, best, or only solution. Find a physician you are unlikely to second guess and/or with whom you will not feel uncomfortable voicing your concerns. A good physician remains your best bet for getting good health advice as opposed to lots of other people prescribing untested, unregulated, and possibly dangerous alternatives. I know that it's not easy to find such a physician, but it's unlikely if not impossible if you don't look. So instead of spending hours on the internet reading every article you can find about what ails you, invest in a search for a physician with whom you can develop a more trustworthy relationship.

Physicians are not perfect. But at least they are regulated and monitored and if you want to improve your odds of getting good health advice, they are still your best bet.  As Mark Twain once quipped, "Don't take advice from a health book. You could die from a misprint." This advice equally applies to websites, TV doctors, and various other media and print sources. They almost always have a statement disclaiming any responsibility for what happens to you. When was the last time your doctor gave you such a disclaimer?

Why I Closed MDPrevent

Please read the article I wrote for The Atlantic magazine at http://www.theatlantic.com/health/archive/2014/01/why-i-had-to-close-my-preventive-healthcare-clinic/282929/

Can Dr. Oz Be Trusted?

On an episode of The Dr. Oz Show this week, one of Oz's guests endorsed several name brand products.  I found that odd because of the following statement I found today on Dr. Oz's website www.droz.com.

link: http://www.doctoroz.com/blog/mehmet-oz-md/my-name-profit-not-anymore (here's the link)

Under the heading of  "My Name for Profit? Not Anymore. by Mehmet Oz, MD," it reads

"I am not and have never been a paid spokesperson for any particular brand, supplement or product. I’ve even decided to no longer use brand names on The Doctor Oz Show."
  
Not only were brand name products specifically displayed and discussed on the show this week, here is a list of some of them from his website:

http://www.doctoroz.com/videos/packaged-food-shopping-list

Frozen Food Meal
Helen’s Kitchen Fiesta Black Bean Burrito Bowl

Soup
Amy’s Organic Light in Sodium Lentil Vegetable

Energy Drink
GT’S Synergy Gingerberry Kombucha Tea

Vitalicious Vitabrownie Deep & Velvety Chocolate

So you may say these are food products, not dietary supplements. Has he endorsed any brand name pills? Yes. On another episode this very week titled, Whole-Body Anti-Aging Guide 2014, he displays specific brand name pills from companies like Life Extension Foundation (LEF) and Swanson. One pill product called Lipowheat was recommended to remove facial wrinkles. (There were several other products also endorsed.) Now why would Oz specifically recommend a product from a company like LEF? Could it be because they sell his book on their website? Or because they have written very positive stories about him and his wife in their magazine? Is helping Dr. Oz market his brand or sell his book a type of compensation for his endorsements? Would that make him a paid spokesperson, which he claims he has never been?

(Below are relevant links supporting my assertions:

http://www.lef.org/magazine/mag2008/sep2008_Dr-Mehmet-Oz_01.htm

http://www.lef.org/magazine/mag2011/aug2011_Lisa-Oz-The-Power-of-Healthy-Transformation_01.htm

http://www.lef.org/news/LefDailyNews.htm?NewsID=20939&Section=NUTRITION

http://www.lef.org/search/?q=mehmet)

I thought Oz's words above that "he would no longer use brand names" were perfectly clear. Am I missing something? You tell me. Can he be trusted?

The Pill Pushing Dr. Oz: His New Diet; Melatonin and DGL Licorice for Heartburn

I truly thought I was done critiquing the good Dr. Oz, but here I go again.  Looking for something to watch as I mounted my elliptical, I fancied upon his show yesterday titled Dr. Oz's Two-Week Rapid Weight-Loss Diet. Now don't even get me going on the concepts of "rapid weight loss" and "diet," let alone something meaningful and lasting that is suppose to happen in two weeks. (See my previous blog on "Stop The Weight Loss Madness.") But the show started innocently enough with Dr Oz telling the audience that if they cut out all dairy (other than Greek yogurt), all bread and wheat based products (yes, that includes pasta), all sugar (including all alcohol), all artificial sweeteners, and all coffee, they could lose on average nine pounds over two weeks like his audience did. Now who can argue that cutting out many of the foods that cause weight gain may result in weight loss? I can't. (I'm not a fan of these quick weight loss schemes and a recent study shows the more often you try a new way to lose weight, the harder it gets. http://care.diabetesjournals.org/content/36/1/34.full) I think its disingenuous for Oz to claim that its something new or easily doable. Changing one's diet is at the crux of successful weight loss and it's just a big tease to throw this out at people. Either way, if he stopped with his diet suggestions, all would have been fine.

But of course, my pill-pushing friend couldn't help himself. After discussing this "new" diet, he recommended that people take a multivitamin and probiotics. Why? Just to play it safe. Are lean protein like fish and chicken, unlimited (that's his words) vegetables, nuts, Greek yogurt, fruits, unsweetened almond milk, and flaxseed not a good enough source of vitamins (other than Vitamin D)? If so, why should everyone take a multivitamin? From my perspective, it's because he's a pill-meister; a pill pimp, a pill-monger. You get the point, he's addicted to pushing pills. Could it be because the pill companies advertise on his show and websites? I don't know nor do I care. I just wish he would stop confusing people. Of course, he didn't describe the potency and bacterial strains that the probiotics should contain, which can make a difference between a complete waste of money for everyone versus some possible effect for some people.  Should you take 100 million or ten billion? Two strains or ten? Which strains? What's the point of making a recommendation without being specific and explaining why? (See my blogs about probiotics.)

So somewhat bemused that he was up to his old tricks, I hoped he was done, but expected no such outcome. He did not disappoint.

The third segment on the show was about natural ways to treat heartburn. For that, he recommended 3 mg of melatonin each night for 4 weeks and a herb called DGL licorice, which he recommended before every meal. Unfamiliar with either of these recommendation and always willing to explore alternatives to prescription pills, I went to work to try and validate his assertions.

Let's start with the DGL licorice. The only double-blind randomized controlled study appears to have been done in 1973 (http://www.ncbi.nlm.nih.gov/pubmed/4584640) and showed no benefit over placebo. I also searched the naturalstandard.com database, which gave it a letter grade of "D," which means there is "negative scientific evidence"-- the evidence stacks against its effectiveness. It just doesn't work.

For melatonin, which is naturally produced by both your pineal gland and in your gut, and is also a by-product of sun exposure to your skin and associated with Vitamin D production, there was one small study that involved only sixty people that showed some benefit. However, the study used more than a 50% larger dose of 5 mg versus the 3 mg he recommended. (http://www.ncbi.nlm.nih.gov/pubmed/17426465?dopt=Abstract.)  I couldn't find a study at 3 mg. Nevertheless, one study should never form the basis of a recommendation. Studies are often flawed and that's why good science requires validation. That's how naturalstandard.com grades different substances; it bases the grade on the body of evidence. It gave melatonin a "C" for effectiveness against gastrointestinal issues such as heartburn, which means the science is inconclusive. Besides, the explanation Oz offered for why he thinks melatonin even works on heartburn was not consistent with the human scientific literature. It's believed to be a completely different mechanism, unrelated to the pyloric sphincter he claimed was involved.

Finally, as melatonin is often used as a sleep aid, taking such a pill when you don't have a sleep problem, can alter your sleep.

It's very clear to me that Dr. Oz has little regard for making recommendations without proper vetting. If you know someone foolish enough to take advice from this man in regards to supplements, please show him or her this blog and the several dozen others I've written that point out the danger of such advice.

Shame on you, Dr. Oz, again.

A Final Word (At Least For Now) On Eating Healthy

As I get ready to hang up my stethoscope again, and ponder the over one-thousand conversations I've had with patients and others over the past three years about eating for health, one theme repeatedly comes to mind: despite their belief to the contrary, most people don't truly understand what it means to eat healthy. They are also confused about the value of eating healthy when the diet still includes plenty of unhealthy foods. Healthy foods, no matter how much you eat, do not neutralize the ill effects of unhealthy foods.

As a service to all, here is a brief synopsis of the elements of a healthy diet. It's little technical at first, but I get down to a basic list at the end.

First, let's take a quick look at what are called the essential nutrients, of which there are six categories, that all humans basically need to survive. By essential, we mean that the human body cannot produce these on its own without outside help.

There are:
13 essential vitamins

• Vitamin A
• Vitamin C
• Vitamin D
• Vitamin E
• Vitamin K
• Vitamin B1 (thiamine)
• Vitamin B2 (riboflavin)
• Vitamin B3 (niacin)
• Pantothenic acid
• Biotin
• Vitamin B6
• Vitamin B12
• Folate (folic acid)

Vitamins are grouped into two categories:

• Fat-soluble vitamins are stored in the body's fatty tissue. The four fat-soluble vitamins are vitamins A, D, E, and K.
• There are nine water-soluble vitamins. The body must use water-soluble vitamins right away. Any left over water-soluble vitamins leave the body through the urine. Vitamin B12 is the only water-soluble vitamin that can be stored in the liver for many years.

There are 15 give or take essential minerals. There are also trace minerals not listed here.

• Calcium (Ca)
• Chloride (Cl⁻)
• Chromium (Cr)^[5]
• Cobalt (Co) (as part of Vitamin B₁₂)
• Copper (Cu)
  Main article: Copper in health
• Iodine (I)
• Iron (Fe)
• Magnesium (Mg)
• Manganese (Mn)
• Molybdenum (Mo)
• Phosphorus (P)
• Potassium (K)
• Selenium (Se)
• Sodium (Na)
• Zinc (Zn)

There are 9 essential amino acids

• histidine, 
• isoleucine, 
• leucine, 
• lysine, 
• methionine, 
• phenylalanine, 
• threonine,  
• tryptophan
• valine.

2 essential fatty acids

• alpha linolenic acid
• linoleic acid

water
air

Some also think that choline, once thought a vitamin, is also an essential nutrient.

There are also other amino acids and fatty acids, and many other compounds in foods, such as antioxidants, enzymes, etc. that are metabolically active but are not essential to the diet as the human body can function without them.

Okay, so what are you supposed to do with all this detail. Nothing really other than eat foods that contain them.

For example, 11 of the vitamins can be obtained from eating fruits and vegetables.

One, vitamin D, can be made by sun exposure or found in foods like unsweetened almond milk.

The other Vitamin, B12, can be found in fish, chicken and meat. I'll come back to these later.

The minerals can be found in vegetables, fruits, nuts, beans whole grains, and seeds.

The amino acids and choline can be found in nuts, whole grains, beans, eggs, fish, chicken and meat.

The fatty acids, or their derivatives, can be found in seeds like chia and flax, as well as healthy wild fish like Alaskan Salmon.

So what does a healthy diet look like?

It contains daily raw fruits and vegetables, fresh or frozen. Fruits must include berries, banana, citrus, apples, and melons. Other fruits are optional. Vegetables must contain leafy green vegetables, collards, onions, tomatoes, carrots, onions, garlic, and mushrooms.
It contains raw whole nuts (includes pecans, almonds, pistachio, Brazil nuts, and macadamia- at least twenty a day except for Brazil nuts-limit to two a day), cooked beans (limit soybean but some okay), raw seeds (chia and flax best, but limit), and minimally processed whole grains like steel cut oatmeal with no preservatives nor genetically modified grains (non-GMO).
It contains wild fatty fish like wild salmon, herring, sardines, cod, halibut, etc. (3-4 times a week)
It contains free range chicken once a week, free range eggs twice a week, and lean antibiotic meat every other week as a side dish.
It includes dark chocolate(for the polyphenols) of at least 70% cacao with less than 5 grams of sugar per serving with a serving size equal to at least a third of the bar.
It contains unsweetened almond milk.
A very little olive or safflower oil.
It contains sun exposure and at least 50 ounces of fluids a day.
Of course, even a good thing in excess is harmful. So eat these foods in moderation, eat mindfully, and remember what the Okinawans say before every meal: Hora Hachi Bu (eat until your 80% full)


A healthy diet does not contain dairy of any kind (after infancy), yogurt included, and definitely not dairy that contains added hormones such as Bovine Recombinant Growth Hormone (which is part of all non-organic dairy), artificial sweeteners or added sugars, processed breads with added sugar, pastas whole grain or otherwise, ketchup with high fructose corn syrup (most), chips, processed snacks, pretzels, crackers, cold cut meats, processed meats, processed cereals like Cheerios and Kashi made from genetically modified grains (also don't be fooled by the label Organic: read the label and watch for added sugar greater than 4 grams per serving-if so, avoid), sweetened drinks or bottled fruit juices, health bars, protein touring products -- including bars, drinks, shakes or any other product touting protein, any supplements (unless prescribed by a knowledgeable physician), any multivitamins (unless pregnant), fried foods, burnt or charred foods, any food with partially hydrogenated on its ingredient list (even if label states no trans-fats), non-sun dried fruit (even if sun-dried eat in moderation), no foods or drinks whatsoever with preservatives added including nitrates and sulfites in particular, too many smoothies even if all raw ingredients--too many calories involved, farm-raised fish, especially tilapia and salmon, more than once a week tuna, non-organic apples, corn or potatoes, movie theater and microwave popcorn, too many oils including coconut, olive, sunflower, and safflower oils, too many starchy vegetables, candies with sugar and chemicals, foods with added dyes, non-organic soy-based products, and more food than you need to live-which is not really all that much after you meet the essential requirements. 

I hope this information has been helpful and I wish you all Bon Appetite. If you have any questions, please feel free to write me at steven.charlap.md@mdprevent.net for at least the next six months.