Healthspan and Lifespan
These words seem to be abuzz these days. Many people may wish to live a long, fulfilling life, hoping for a robust lifespan. An important term that has been most recently circulated is living a long, HEALTHY life. A life in which one is not dependent on the care of others, in which they can remain spontaneous, spry, and aware of their surroundings and with whom they are interacting. A life where the day to day is not filled with doctor’s appointments. A life that is long, and filled with health. This is the desire for healthspan.
Within the last year, Netflix released two documentaries that followed people’s lives, trying to understand how certain health behaviors impact health both in the short-term, but also in the long-term.
As a direct care triple board certified endocrinologist that actively focuses care on a comprehensive approach to cardiometabolic care and healthspan in my clinic at Summon Health, I received many texts from patients, as well as family members, telling me to watch these series. They know how passionate I am about optimizing lifestyle as much as possible to summon our own health and minimize the number, or the doses of medicines that we may need to rely on. Once I had received over 20 texts about these series, I decided it was time to watch them.
So please continue reading below for my take on two of these recent documentaries.
Live to 100: Secrets of the Blue Zones
Description
This documentary followed National Geographic correspondent Dan Buettner to the areas of the world with the highest concentration of centenarians, individuals living past 100 years old. These areas are:
Okinawa, Japan
Sardinia, Italy
Loma Linda, California
Ikaria, Greece
Nicoya, Costa Rica
He interviewed octogenarians, nonagenarians, and centenarians in each of these locations about their life habits to see if there were commonalities in these ‘ingredients’ with which to best ensure a ‘recipe’ of living past 100 years old.
There were, indeed, 4 common ingredients that emerged. The first - eating plants. In each locale, the primary source of nutrition was from fresh ingredients harvested from the land - sweet potato, olives, vegetables, grapes, beans, and squash, to highlight some. The second - movement. The key to this was that the centenarians weren’t relying on going to the gym or trainers to get them moving. Rather, it was in their daily living that there was constant movement. For example - gardening relied frequently on squatting and then standing up. Going to church require walking up hill and up stairs. Pickleball teams and a community rec center were other examples. Whatever it was, avoiding sedentarism and opting for movement was a crucial ingredient to longevity. A third ingredient is having purpose - as in what moves you, what inspires you, what drives you to be the best you? Having a well defined purpose brings hope to the anticipation of the next day. And the fourth ingredient was having a supportive community. As humans, we are social beings. We are not meant to experience this world in isolation, or try to process emotions or experiences in solitude at all times. Creating and engaging in social activities with individuals who you have chosen as ‘your tribe’ was a common key element to longevity.
My Take
Nutrition is such a low hanging fruit (pardon the pun) that it is absolutely necessary that a conversation about health and longevity has to involve understanding the importance of nutrition quality. A variety of nutrition fads may come and go, but the importance of whole foods (real foods that are void of ultra-processing and do not have fats, sugars, or salts added to it) can not be understated in addition to making sure that plants have a stronghold in everyday nutrition. Consuming a variety of plants in ones diet contributes to a healthy, diverse gut microbiome which has many links to health. The food source of these healthy gut bacteria is fiber, therefore, any nutrition pattern needs to make sure to include whole food fiber sources.
Movement is a simple intervention that humans like to overcomplicate and then make up excuses as to why they are too busy to engage. I’ve done it. Yet, the brilliance of this documentary was in the demonstration that the movement of these centenarians was not because of the fancy gyms they had memberships to. In fact, many of the places featured were in remote areas void of gyms. Their movement came from daily, consistent movement - tending to their home gardens several hours a day (constant squatting and standing), or daily walking up their village’s steep sidewalks to get to their place of worship. What was clear is that they were the opposite of sedentary during the day. This was perhaps my biggest revelation from the documentary.
Purpose in life proves to be an important ingredient that comes up in several of these centenarian communities. Finding their motivation that gets them up in the morning, gets them out the door, and looking forward to the coming day. Having a sense of ‘why’ and believing in its importance is something we can all learn to pause for and re-evaluate what they are for ourselves. And then live this purpose on a day to day basis.
Community harkens on the fact that humans are inherently social beings. It is not natural to exist in the world in isolation. In fact, there are many studies that loneliness is a risk factor for several diseases, as well as a risk factor for death. Seeking out other individuals who confirm your purpose, who elevate your energy, and with whom you can share joys and tribulations is a very important part of health. In fact, this comes up as one of the pillars of Lifestyle Medicine, which is social engagement. We need to have our clan with whom we make the time to meet and who create an important role for prolonging healthspan.
You are What You Eat: The Twin Experiment
Description
This was another Netflix documentary that now took 21 identical twins and randomized them to either a vegan diet or an omnivore diet to examine changes in cardiometabolic, gastrointestinal, and cognitive health. This experiment was intriguing because whenever doing human studies, dna differences between people can account for a lot of the variability. When using IDENTICAL twins - this genetic variability is accounted for as the DNA between both are the same.
In this experiment, the first 4 weeks each twin was provided with the healthy versions of the diet they had been assigned (so, healthy vegan vs. healthy omnivore) through meals being delivered to their house. Then, the last 4 weeks of the study, each twin was responsible for making their own food, within the diet they were assigned. I should also mention that they did have trainers that gave them exercises to do, aiming to build muscle.
Both before the nutrition intervention and at the end, each twin had blood sugar and cholesterol drawn, body composition measures done (looking at muscle mass and percent body fat and visceral adipose tissue), had cognitive tests administered, as well as microbiome (gut bacteria) assessed.
Results
At the end of the study, the results showed that the twins that were randomized to the vegan diet had lower LDL cholesterol levels, lower fasting insulin levels, lost more weight, and had more reductions in visceral adipose tissue. The twins randomized to the omnivore diet only saw a benefit in increased muscle mass in comparison to their identical twin on the vegan diet.
My Take
It is not surprising to me that several of the blood measures showed a significantly favorable response for the twin randomized to the vegan diet. This is yet another demonstration, now in humans who share the same DNA, that food quality and a nutrition pattern that highlights increased fiber and lower saturated fat, helps lower plaque forming cholesterol and improves insulin sensitivity. I discuss often with my patients how the root of insulin resistance is a combination of BOTH increased saturated fat as well as ultra-refined carbohydrates. So, by increasing vegetables, legumes, whole grains, and fruits - individuals are naturally increasing fiber and complex carbohydrates and by eliminating animal products, they significantly decrease the largest source of saturated fat in the Standard American Diet and insulin resistance and cholesterol profiles measurably improve.
Yet, the results were also not as impactful as I would have anticipated, and certainly not as impactful as I have seen with the patients I work with in my practice. Thiis is why I believe this is true. It is not enough to just follow the basic ‘rule’ of a nutrition pattern. For example, just by going vegan does not mean that everything vegan is healthy. In fact, I stress to many of my patients who are interested in being more plant-based, that there are plenty of plant-based food options available. However, the goal is not to have plant-based junk food, no! Instead, the focus is on incorporating whole food vegan foods into the day to day nutrition. And this is where my gripe with the documentary is. I feel there was a lot of time focused on vegan meats and cheeses. And while I appreciate and respect the angle that was taken for an environmental and animal rights perspective, as a physician and being as my focus is on health, these vegan meats and cheeses are not much healthier than the animal based alternatives. And so I would not expect there to be dramatic improvements in health numbers if processed vegan alternatives to animal products are consistently used in the diet.
Understanding the quality of nutrition and why a certain nutrition pattern (high fiber low saturated fat) is important needs to be part of the training when individuals are adopting new eating patterns. Once people understand this premise, they make much healthier choices grocery shopping or when ordering food at restaurants. And this consistent application of knowledge results in dramatic improvements in cardiometabolic health measures, such as blood pressure, fasting blood sugars, and LDL cholesterol.
With both documentaries, the most obvious detail that was confirmed was that healthy plant-based eating is a necessary ingredient for health. Additionally, including constant and consistent movement (or, avoiding being mostly sedentary) as well as feeling a purpose in life and having a community of individuals with whom to socialize are crucial pieces as well. Beyond my passion for cardiometabolic health, it is the lifestyle medicine component that I recognized as being an essential part of the medical visit and one that is so often overlooked due to lack of time. However, this comprehensive lifestyle approach to living as healthy as possible for as long as possible(healthspan and lifespan) is the revolutionary medical care that I have created for individuals and one in which I am committed to working on for myself and with each of my patients in my medical practice at Summon Health.
