Healthy ageing: Why lifestyle matters and where does longevity medicine fit in

When people think of the word ‘longevity’, their minds might turn to the Bryan Johnsons of this world; obsessively ‘biohacking’ with hundreds of supplements and whatever the newest wonder anti-ageing drug of the moment is, pedantic tracking of every variable and a life abundant in restrictive rules and sorely lacking any spontaneous joy. 

Most women I meet might react to this with anything from mild amusement to abject horror, but a common theme I hear is; ‘that is definitely not for me’.  We’re just trying to get through the day, progress at work, keep children alive, fed and thriving and get through our endless to do-lists; the pursuit of living forever not featuring on it at all.  But here is why I think we need to reframe ‘longevity’ for women’s health….

Currently, many women will spend the last decade of their life in poor health.  Although we live an average of 10 years longer than men, for many, there is little ‘life’ in those years.  Instead, they are plagued by chronic disease, disability, dependence and frailty.

Healthy ageing means different things to different people, but I imagine the reality described above is quite different to how most of us would imagine our ideal old age.  Whilst we may not be motivated by living forever, we do want to be independent, clear of mind, and strong of body in our last years.  If you have children, you might be motivated by the desire to still be around and well enough to look out for them and any future grandchildren.  You may relish the opportunity for a second career or igniting an old one disrupted by your motherhood years.  Or simply the desire to maintain hobbies and passions right until the very end. 

But many of us aren’t striding decisively towards these goals.  Doing so requires a conscious effort, started as early and as consistently as we can.  And contrary to what social media will have you believe, the largest gains to be made in this, come not from wonder drugs, supplements or IV drips, but from the fundamental foundational blocks of healthy ageing: lifestyle and preventative medicine practiced well.  Together with the emerging specialty of evidenced-based longevity medicine, we should be able to ensure that our last years are what we hope for.

Lifestyle medicine

This is the concept of optimising our lifestyles to prevent and reverse disease and consists of the following pillars: optimal nutrition, exercise, sleep, emotional wellbeing and the avoidance of harmful substances.  Whilst I will go into each of these in more detail in future articles in a nutshell we’re talking about:

Nutrition:

Your diet should ideally consist of whole, unprocessed, plant predominant foods, low in saturated fats and with moderate high-quality protein.

Exercise:

Movement is crucial and if we want to harness its longevity potential, we should be aiming for a varied portfolio to counteract our otherwise sedentary lives. So, exercise to challenge and improve not only our aerobic capacities, but also our strength, flexibility and balance.

Sleep:

An integral aspect of our biological ecosystem, the importance of which modern life has undervalued for so long.  We know that lack of sleep is associated with heart disease, obesity and poorer mental health and more, so optimizing our ability to achieve optimal quality and quantity of sleep (most of the time), is fundamental to health.

Emotional wellbeing:

This encompasses our ability to manage stress that we know has a huge but often ignored impact on our physical health, mental health and resilience and the strength of our social connections, which is emerging as an important factor for optimizing healthspan.  Loneliness and social isolation are both known to be risk factors for worse cardiovascular and brain health.

Avoiding harmful substances:

I doubt I have to tell anyone that smoking and drugs aren’t good for you, but many people underestimate the negative impact of alcohol to our metabolic, brain and cardiovascular health, as well as our cancer risk.  In addition to these, whilst less under our direct control, it’s also important for us to be mindful of (although no need to panic about) environmental pollutants, including endocrine disruptors, which evidence increasingly show have negative implications for human health.

Preventative medicine

This is the practice of using healthcare measures to prevent or delay the onset of disease or to detect disease at an early enough stage to stop the development of complications.

This involves regular health and cancer screening and interventions including:

1.      Lifestyle measures as detailed above

2.      Vaccinations, for example the HPV vaccine for cervical cancer.

3.      Medication (where lifestyle is not appropriate or insufficient), for example to control blood pressure and cholesterol.

4.      Surgery when needed, for example the removal of benign colorectal polyps or precancerous skin changes to reduce the risk of cancer

Longevity medicine

This new area of medicine will focus not only on delaying the onset of disease, but preventing and reversing ageing and the chronic diseases associated with it.  In time, we hope our healthcare systems will move from having to focus on caring for people when they are already unwell, to care that ensures people stay well: sickcare to healthcare.

It is easy to see that at its core, longevity medicine will have some overlap with preventative medicine, including lifestyle.  But it also aims to go further by redefining the way we assess health.  Whilst conventional medicine uses organ specific models of disease (cardiovascular, gastroenterology, gynaecology etc), based on our understanding of how these systems should work, longevity medicine will identify common mechanisms for dysfunction at a deeper level, using new biomarkers and targeted personalized treatments to correct them. 

Figure 1: Hallmarks of ageing: targets for new longevity treatments

For women in particular, the field will I hope explore the impact of reproductive ageing on our longevity.  Currently, the bulk of the evidence we have for the use of menopausal hormone therapy involves its use in managing only symptoms and bone health, however there are many unanswered questions as to its potential role in also expanding our healthspan through improved brain, cardiovascular and metabolic health.

However, it would be wrong to assume that the only way to target these hallmarks of ageing is with new longevity treatments.  Lifestyle measures can also target these hallmarks and so for now, remains an equally important intervention.

Take aways:

Longevity medicine is an exciting development that has the potential to completely overhaul the way we think about ageing and the diseases associated with it and I look forward to keeping you up to date with the evidenced-based developments in the field in the ‘Matriarchy’ section. 

However, it is so important that we all understand that preventative medicine, including lifestyle, currently remain the fundamental building blocks to healthspan and longevity. There isn’t yet a single gerotherapeutic agent or supplement that can take the place of these. 

So, the next time you see an influencer waxing lyrical about a new wonder supplement and you have that rising feeling of FOMO, wondering whether to just go ahead and splurge, ask yourself whether you have truly covered all your lifestyle and preventative bases.  Without these, no matter what you put on top, your foundations for healthy ageing will be fragile.

External resources:

American college of lifestyle medicine: Patient Resources

British society of lifestyle medicine: What is Lifestyle Medicine

National University of Singapore: Centre for healthy longevity