1: Lifespan is a straightforward concept. It’s how long we will live.
“Lifespan deals with death, which is binary: we’re alive, and then we’re dead. It’s final,” Dr. Peter Attia writes in his book Outlive: The Science and Art of Longevity.
But before we die, sometimes many years before, “most people suffer through a period of decline,” Peter writes, that “is like dying in slow motion.”
Which is where “healthspan” comes into play. Healthspan is about how well we live. The period of our lives when we are free from disability or disease.
Lifespan is the number of years. Healthspan is the quality of our years.
2: Lifespan is captured by the horizontal or x-axis of the graph above.
Healthspan is displayed on the vertical or y-axis. It represents the sum total of our physical and cognitive functions.
“The black line represents the natural trajectory of our lives,” Peter writes. We “are born at time zero, and for purposes of our diagram, we’ll say your physical and cognitive health starts out at 100 percent.
“We remain relatively robust until about the fifth decade of life, at which point our cognitive and physical health will likely begin a gradual but steady decline, until we die (healthspan = zero) sometime in our sixties or early seventies.”
This was the natural course of life for human beings for many centuries, going as far back as hunter-gatherers, “provided they managed to avoid early death thanks to infectious disease or another calamity.”
In the last several hundred years, medicine has made dramatic leaps forward. Peter calls the predominant type of medicine practiced today “Medicine 2.0.” It began in the mid-1800s with the discovery of germ theory and later antibiotics. By emphasizing the scientific method of experimentation, it eradicated many deadly diseases.
Medicine 2.0, however, has proven much less effective in combating what Peter calls the Four Horsemen: Cancer, heart disease, neurodegenerative disease, and type 2 diabetes.
In the graph above, modern life is represented by the short-dashed line labeled “Med 2.0.”
We “will live a bit longer, thanks to the relative comfort and safety of our lives,” Peter writes. “But in midlife, we will gradually begin to feel some changes. We will lose a bit of our youthful strength and stamina. We might notice that we occasionally forget passwords, or the names of people we meet, or the names of actors in movies we watched long ago.
“Our friends and peers will begin to be diagnosed with cancer, cardiovascular disease, and related conditions like high blood pressure and diabetes or prediabetes. We will attend memorial services for friends from school.”
Then, our decline accelerates.
“Eventually, sometime around age seventy or seventy-five, give or take, our cognitive and physical capacities will diminish to roughly their halfway point (represented by the horizontal dotted line),” Peter writes.
He defines this stage as when we stop being able to do the things we want to do with ease. We are “constrained, and bad stuff starts to happen more frequently and with greater consequence. It’s one thing to break our femur in a skiing accident when we’re forty and still strong and resilient; it’s quite another to break it falling off a curb when we’re seventy-five and functioning at 25 percent of our capacity.”
At this stage, our risk of being diagnosed with a chronic disease also rises rapidly.
Which is where Medicine 2.0 kicks in. Our doctors “treat our heart disease, or cancer, or whatever else afflicts us, prolonging our lives by a few months, or years if we’re lucky. This is when the lifespan/healthspan curve flattens out horizontally to the right, representing this postponement of death.”
But where does this shift occur? After our healthspan has already been compromised.
“This means that we have delayed our death without significantly improving our quality of life—something at which Medicine 2.0 is quite adept.”
Peter calls this the “Marginal Decade” that most of us expect.
3: There is, however, another path forward. What Peter calls “Medicine 3.0.”
“Medicine 3.0 places a far greater emphasis on prevention than treatment,” he writes. It “pays far more attention to maintaining healthspan, the quality of life.”
The long-dashed line on the graph represents our ideal trajectory.
“This is what we want,” Peter writes. “Instead of beginning a slow decline in midlife, our overall healthspan stays the same or even improves into your fifties and beyond. We will be fitter and healthier at fifty-five and even sixty-five than we were at forty-five and will remain physically fit and cognitively sharp well into our seventies and eighties, and possibly beyond.
“We will seem like someone a decade younger than the age on our passport, or possibly two.”
The space under the curve represents our longer, better life: “more time being with our family, pursuing our passions, traveling, or continuing to do meaningful work,” Peter observes
When the decline does happen, it happens quickly but is relatively brief.
“Instead of a lousy Marginal Decade, we get to enjoy what feels more like a ‘Bonus Decade’—or decades—when we are thriving in every dimension,” he writes.
“While actual death is inevitable, this deterioration,” Peter notes, “is less so. Not everyone who dies in their eighties or nineties passes through the valleys of cognitive, physical, or emotional destruction on the way there.”
These declines are, in many cases, preventable: “I believe that they are largely optional, despite being their ever-increasing gravitational pull over time. . . Cognitive, physical, and even emotional deterioration can all be slowed and even reversed in some cases with the application of the proper tactics.”
One final point: What we do to improve our healthspan will almost always result in a longer lifespan.
Lifespan and healthspan are tightly entwined: If we “increase our muscle strength and improve our cardiorespiratory fitness,” Peter notes, “we have also reduced our risk of dying from all causes by a far greater magnitude than we could achieve by taking any cocktail of medications.”
Because Medicine 3.0 improves healthspan, lifespan benefits also follow.
Peter writes: “The next obvious question is: How do we accomplish this? How do we lengthen our lifespan while simultaneously extending our healthspan? How do we stave off death via the Horsemen while slowing or even reversing physical, cognitive, and emotional decline?”
More tomorrow!
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Reflection: How might I change my mindset regarding my health to focus more on prevention than treatment?
Action: Discuss with a colleague, friend, or family member.
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