No 48 - What can we do to live longer? A summary of longevity strategies

I became a doctor because I loved science, I enjoyed helping people and I thought that I might be able to make peoples live's better. I have never been someone who wanted to "save lives". I am not the "dramatic doctor" type.

My goal throughout medical school was always to be a T/O surgeon because I thought that helping people reduce their pain with an operation was probably one of the most efficient ways to improve peoples QOL and would be quite a fun job. Then I decided to switch to GP for a similar reason.

Being a GP, or a family doctor or a "Consultant in preventative medicine and chronic disease management" allows you to try and help many more people every day.

Most of the day to day work of a GP does not necessarily make a "statistically huge" difference in the average patients QOL (Quality of Life). But treating a rash, improving eczema, prescribing stronger analgesia can certainly improve QOL a bit and thats how I like to look at it.

However, when you look at what we can do to help a patient live longer .... it seems like we dont have many options and certainly nothing particularly new or revolutionary.

I have been reading and studying and listening to podcasts and lectures on a "good life" or "healthy life" or " long life" for a few years now and I thought I would try and summarise what I have found so far:

Practical advice for the general public on how to increase their healthy longevity:

1 The 80/20 rule - The Pareto Principle

I have put the Pareto Principle first because the most significant health benefits will be achieved with the simplest things. Some people will become obsessive about every last calorie, or which particular kind of HIIT training is optimal but these things probably won't make much of a difference. If more people started doing the simple things on this list then I am fairly sure that almost everyone would live longer and healthier.

2 The Serenity Prayer

This doesn't sound very medical or even evidence based but even the best made plans often go wrong. If you want to live a long and healthy life, you need to realise that life might be more complicated and there isn't always something you can control or change. You can be an organic fed, tour de france cyclist but you still might get hit by a bus and that is just life.

3 Victor frankl Man's Search for Meaning

Psycho-babble, wheres the evidence for this? Well, I doubt there is an RCT but there is plenty of anecdotal evidence that people who believe in something, who believe their life has a purpose, who choose to give their life meaning and focus on their "big why?", their "reason for living". Often do live longer and prove far more resilient than those who don't have a clearly thought out reason. Doesn't really seem to matter what that reason is, as long as it means a lot to you. It could be family, success, friends, business, charity or purely the desire to continue travelling and exploring the world. I've certainly witnessed old people who give up on their desire to live and then very shortly aftwards die, and I have witnessed patients go through horrendous upsets and trauma but who continue to smile and then go home. Its anecdotal, its psycho-babble, but its also something within your locus of control that may affect your longevity.

4 Have faith in something

Similar to point 3, I am not religious but there are plenty of stories and anecdotes in the literature that having a religious faith helps to give people meaning and resilience. Apparently, religious people also live longer. Obviously, there is confounding bias because of the fact that religious people tend to attend church, ceremonies, social gatherings and stay in contact with more people and therefore have a wider social network for help and support. So, my take away would be even if you have faith in a football team, at least go and celebrate that faith with like minded people. It might help.

5 Stoicism

The modern way to phrase this would probably be "resilience" or "looking after your mental health", but the philosophy of stoicism builds on points 2, 3 and 4. Life is unpredictable and you need to train yourself to be able to roll with the punches. If you can learn to control you desires, control your emotions and accept set backs and then continue to look for the joy in life then you will probably have what the Stoics call a "virtuous life" and may well live a healthier and longer life. Especially if you control the desires for pleasure, which come next...

6 Don't smoke

As per point 1 - the 80/20 rule, if you do the simple things, then they will make the biggest difference. There is no good reason to smoke. We know it increases your risk of dying from cancer, strokes, heart attacks, peripheral vascular disease, kidney disease, lung disease, heart disease and almost everything else. If you want to live a long life, then don't ever start smoking. If you already smoke, then wean yourself off either through the NHS quitting support, through Nicotiene replacement or through vaping.

7 Avoid alcohol and drugs

Stating the obvious again, but alcohol and most illegal drugs don't make you healthier. Most of them are essential toxins. In small doses, or in moderation they make you feel better and help you cope with life. In the long run they probably won't do you any physical good. No need to mention that alcohol rots your liver and brain, or that cocaine destroys your nose and heart. Everyone has seen the adverts and had the lectures. There is no acceptable "safe limit" to any of these "psycho-active substances" so, may as well keep them to an absolute minimum, or just accept that you are sacrificing healthy hours of your later life for some short term benefit now.

8 Walk

Same as the above. The evidence is that some exercise is better than none. Slow walking is what humans have evolved to do. Studies have shown its good for weight loss, back pain and mental health. There is no need to go mad in an expensive gym. Just going out for a walk every day is good enough. If you really want to push the boat out then go for a longer walk and build it up to make it longer and more challenging.

9 Enjoy Nature

If you are going to go for a walk, you may as well go to a park or green space and have a look at some trees. Plenty of studies have reported that seeing trees makes you feel calmer, happier and improves your mood. Again, its probably evolutionary. Even if you live in a tower block, in most Western cities you should be able to go for a walk and find somewhere with some trees.

10 A simple diet - eat meat, fat and vegetables and not too much carbs

There is not a lot to say about this. Diet is complicated. There are not that many good studies because its hard to do good experiments on humans. We evolved to eat everything but if you try to eat what your great-grandparents would have eaten about 100 years ago. Thats probably what will keep us the healthiest. Smaller portions of meat and vegetables, limited processed food, plenty of vitamins and minerals and as little sugar and carb as possible.

11 Fast

Lots of people have written about fasting. We would have evolved during times of feast and famine. Poor harvests, bad hunts, cold winters - all of these times until very recently would have left us hungry. People who fast regularly seem to live longer. This is certainly true in animal studies and seems to be true in humans. Some people have even taken this to extreme and have been calorie restricting themselves to 1500 calories a day for decades. It wouldn't be my lifestyle choice but apparently these people are living long and healthy lives. I prefer to just do 5:2, or 16/8 or fast for a few days every now and again.

12 Do Something Hard

This principle links together a few things mentioned earlier. People who regularly take on "hard challenges" that they might fail or push them outside of their comfort zone report being more resilient. This principle also applies to doing hard things like: exercising more; eating more vegatbles; resisting chocolate or a beer. Some people have even recommended that as a lifestyle, every year they design a new challenge to push themselves beyond what they have ever done before and this gives them meaning, a goal, something to work towards and a sense of accomplishment. All of which will improve your mental health and life.

13 Have friends or family

People with good social support tend to be happier, more resilient and live longer. This one is fairly straight forward to say but harder to do. This one is especially important for men who tend to not form many close friendships and tend to rely on their wives/ partners for social interactions that aren't work related. Try to have a hobby that keeps you social or just make the effort with old friends.

14 Laugh and Joy

Laughter is the best medicine. Its an old cliche for a reason. It works. If you are having a bad day find something or someone that makes you laugh. Fastest way to cheer yourself up and reduce your stress levels. Same with joy. It makes you feel good for a reason, so try to do things that bring you joy. Why would you want to live a "grey life" without laughter and joy?

15 Find Mentors

Like anything in life, its easier to learn how to do something with a bit of help. This can be Instagram, Youtube, Authors, Podcasters, family members, teachers, friends or the bloke down the pub. I have listed a few "resources" below who i think are helping me to live a healthier and hopefully, longer life.

16 The Drive by Peter Attia - https://www.youtube.com/c/peterattiamd

Dr Attia is obsessed with longevity and speaks to many of the world leaders in the field. Even if you are sceptical that Youtubers can be EBM, even if you approach it with scepticism and go and look up all their sources, at least this will give you ideas to go away and think about.

17 The Fat Emporer - https://www.youtube.com/c/IvorCumminsScience

Similar to Dr Attia, Ivor Cummins is obsessed with preventing metabolic syndrome and heart disease. Again, even if you disagree with getting health advice from a non-doctor youtuber, its still hypothesis generating.

18 Fast 800 https://amzn.to/3rO4Un1

Dr Moseley has done his research and his book is wonderfully written. Most of the science on healthy diet and fasting can be digested easily by anyone who reads this.

19 Lifespan by David Sinclair https://amzn.to/3EDcqsC

A far more detailed account of the evidence beyond longevity strategies.

20 - Medical Interventions

Lastly, things a doctor can do to help you live longer. The first things are obvious - treat any illness that is currently going to kill you if we dont treat it. So things like insulin for type 1 diabetics, or antibiotics for children with sepsis or levothyroxine for severely hypothyroid patients. Thats the easy stuff.

The preventative measures are far more difficult because controlloing human behviour is near impossible and following people up for thier life time is expensive and long! But we know that most people who take metformin will live longer due to its anti-inflammatory effects, anti-cancer effects and blood sugar lowering actions.

Rapamycin - looks like it might prolong the lives of animals in studies by down regulating their immune systems. It may well work for humans as well but the studies are not there yet to recommend it to “healthy people”.

Lastly, doctors can do what they are trained to do and examine you and investigate you on a more regular basis. Some of this is called preventative medicine, or check ups or screening. There are numerous screening programmes for various cancers, for high blood pressure and diabetes. Do these medical interventions prolong your life? Currently, evidence would suggest that regularly visiting a doctor and having lots of screening tests probably doesn't make you live much longer on average (obviously a small number of people do benefit hugely!). But we are trying to find better tests, and better strategies so this may well change.

Thanks for reading. If you have any suggestions to add to the list or amend then please let me know.

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