summarize this "In his later years, Richard Overton liked to take the edge off his
days with a shot of bourbon and a few puffs of a Tampa Sweet cigar, lit
directly from the gas stove in his home in Austin, Texas. He insisted that he
never inhaled—word to the wise. Mr. Overton, as he was known, was born
during the Theodore Roosevelt administration and died in late 2018 at the
age of 112.
Not to be outdone, British World War I veteran Henry Allingham
attributed his own 113-year lifespan to “cigarettes, whiskey, and wild, wild
women.” It’s a shame he never met the adventurous Frenchwoman Jeanne
Calment, who once joked, “I’ve only ever had one wrinkle, and I’m sitting on
it.” She rode her bicycle until she was 100 and kept smoking until the age of
117. Perhaps she shouldn’t have quit, because she died five years later at 122,
making her the oldest person ever to have lived.
Mildred Bowers, at a comparatively youthful 106, preferred beer,
cracking open a cold one every day at 4 p.m. sharp—it’s five o’clock
somewhere, right? Theresa Rowley of Grand Rapids, Michigan, credited her
daily Diet Coke for helping her live to the age of 104, while Ruth Benjamin
of Illinois said the key to reaching her 109th birthday was her daily dose of
bacon. “And potatoes, some way,” she added. They were all youngsters
compared with Emma Morano of Italy, who consumed three eggs a day, two
of them raw, up until her death at age 117.
If we were epidemiologists from Saturn and all we had to go on was
articles about centenarians in publications like USA Today and Good
Housekeeping, we might conclude that the secret to extreme longevity is the
breakfast special at Denny’s, washed down with Jim Beam and a good cigar.
And perhaps this is so. Another possibility is that these celebrity centenarians
are messing with the rest of us. We cannot be certain, because the relevant
experiment cannot be done, as much as I’d like to open JAMA and see the
title “Do Cream-Filled Chocolate Doughnuts Extend Lifespan? A
Randomized Clinical Trial.”
—
We yearn for there to be some sort of “secret” to living a longer, healthier,
happier life. That desire drives our obsession with knowing the special habits
and rituals of those who live longest. We are fascinated by people like
Madame Calment, who seem to have escaped the gravitational pull of
mortality, despite having smoked or done other naughty things throughout
their lives. Was it the bike riding that saved her? Or was it something else,
such as the pound of chocolate that she purportedly consumed each week?
More broadly, it’s worth asking: What do healthy centenarians actually
have in common? And, more importantly, what can we learn from them—if
anything? Do they really live longer because of their idiosyncratic behaviors,
like drinking whiskey, or despite them? Is there some other common factor
that explains their extreme longevity, or is it simply luck?
More rigorous research into large groups of centenarians has cast (further)
doubt on the notion that “healthy” behaviors, which I can’t resist putting into
scare quotes, are required to attain extreme longevity. According to results
from a large study of Ashkenazi Jewish centenarians, run by Nir Barzilai at
the Albert Einstein College of Medicine in the Bronx, centenarians are no
more health-conscious than the rest of us. They may actually be worse: a
large proportion of the nearly five hundred subjects in the Einstein study
drank alcohol and smoked, in some cases for decades. If anything, the
centenarian males in the study were less likely to have exercised regularly at
age seventy than age-matched controls. And many were overweight. So much
for healthy lifestyles.
Could the centenarians merely be lucky? Certainly, their age alone makes
them extreme statistical outliers. As of 2021, there were just under 100,000
centenarians in the United States, according to the Census Bureau. And
although their number has increased by nearly 50 percent in just two decades,
the over-one-hundred age group still represents only about 0.03 percent of the
population, or about 1 out of every 3,333 of us.
After ten decades of age, the air gets pretty thin, pretty quickly. Those
who live to their 110th birthday qualify for the ultra-elite cadre of
“supercentenarians,” the world’s smallest age group, with only about three
hundred members worldwide at any given time (although the number
fluctuates). Just to give you a sense of how exclusive this club is, for every
supercentenarian in the world at this writing, there are about nine billionaires.
Yet nobody has come close to Madame Calment’s record. The nextlongest-lived person ever recorded, Pennsylvania native Sarah Knauss, was a
mere 119 when she died in 1999. Since then, the world’s oldest person has
rarely exceeded the age of 117, and she is almost always female. While some
individuals have claimed extremely lengthy lifespans, of 140 years or more,
Calment remains the only person ever to be verified as having lived past 120,
leading some researchers to speculate that that may represent the upper limit
of human lifespan, programmed into our genes.
We are interested in a slightly different question: Why are some people
able to just blow past the eighty-year mark, which represents the finish line
for most of the rest of us? Could their exceptional longevity—and exceptional
healthspan—be primarily a function of their genes?
Studies of Scandinavian twins have found that genes may be responsible
for only about 20 to 30 percent of the overall variation in human lifespan.
The catch is that the older you get, the more genes start to matter. For
centenarians, they seem to matter a lot. Being the sister of a centenarian
makes you eight times more likely to reach that age yourself, while brothers
of centenarians are seventeen times as likely to celebrate their hundredth
birthday, according to data from the one-thousand-subject New England
Centenarian Study, which has been tracking extremely long-lived individuals
since 1995 (although because these subjects grew up in the same families,
with presumably similar lifestyles and habits, this finding could be due to
some environmental factors as well). If you don’t happen to have centenarian
siblings, the next best option is to choose long-lived parents.
This is part of why I place so much importance on taking a detailed
family history from my patients: I need to know when your relatives died and
why. What are your likely “icebergs,” genetically speaking? And if you do
happen to have centenarians in your family tree, let me offer my
congratulations. Such genes are, after all, a form of inherited luck. But in my
family, you were doing well if you made it to retirement age. So if you’re like
me, and most people reading this book, your genes aren’t likely to take you
very far. Why should we even bother with this line of inquiry?
Because we are probing a more relevant question: Can we, through our
behaviors, somehow reap the same benefits that centenarians get for “free” via
their genes? Or to put it more technically, can we mimic the centenarians’
phenotype, the physical traits that enable them to resist disease and survive for
so long, even if we lack their genotype? Is it possible to outlive our own life
expectancy if we are smart and strategic and deliberate about it?
If the answer to this question is yes, as I believe it is, then understanding
the inner workings of these actuarial lottery winners—how they achieve their
extreme longevity—is a worthwhile endeavor that can inform our strategy.
—
When I first became interested in longevity, my greatest fear was that we
would somehow figure out how to delay death without also extending the
healthy period of people’s lives, à la Tithonus (and à la Medicine 2.0). My
mistake was to assume that this was already the fate of the very long-lived,
and that all of them are essentially condemned to spend their extra years in a
nursing home or under other long-term care.
A deeper look at the data from multiple large centenarian studies
worldwide reveals a more hopeful picture. It’s true that many centenarians
exist in a somewhat fragile state: The overall mortality rate for Americans
ages 100 and older is a staggering 36 percent, meaning that if Grandma is
101, she has about a one-in-three chance of dying in the next twelve months.
Death is knocking at her door. Digging further, we find that many of the
oldest old die from pneumonia and other opportunistic infections, and that a
few centenarians, such as Madame Calment, really do die of what used to be
called old age. But the vast majority still succumb to diseases of aging—the
Horsemen—just like the rest of us.
The crucial distinction, the essential distinction, is that they tend to
develop these diseases much later in life than the rest of us—if they develop
them at all. We’re not talking about two or three or even five years later; we’re
talking decades. According to research by Thomas Perls of Boston University
and his colleagues, who run the New England Centenarian Study, one in five
people in the general population will have received some type of cancer
diagnosis by age seventy-two. Among centenarians, that one-in-five threshold
is not reached until age one hundred, nearly three decades later. Similarly,
one-quarter of the general population will have been diagnosed with clinically
apparent cardiovascular disease by age seventy-five; among centenarians, that
prevalence is reached only at age ninety-two. The same pattern holds for bone
loss, or osteoporosis, which strikes centenarians sixteen years later than
average, as well as for stroke, dementia, and hypertension: centenarians
succumb to these conditions much later, if at all.
Their longevity is not merely a function of delaying disease. These people
also often defy the stereotype of old age as a period of misery and decline.
Perls, Barzilai, and other researchers have observed that centenarians tend to
be in pretty good health overall—which, again, is not what most people
expect. This doesn’t mean that everyone who lives that long will be playing
golf and jumping out of airplanes, but Perls’s ninety-five-and-older study
subjects scored very well on standard assessments of cognitive function and
ability to perform those tasks of daily living we mentioned in chapter 3, such
as cooking meals and clipping their own toenails, a seemingly simple job that
becomes monumentally challenging in older age.
Curiously, despite the fact that female centenarians outnumber males by at
least four to one, the men generally scored higher on both cognitive and
functional tests. This might seem paradoxical at first, since women clearly live
longer than men, on average. Perls believes there is a kind of selection
process at work, because men are more susceptible to heart attacks and
strokes beginning in middle age, while women delay their vulnerability by a
decade or two and die less often from these conditions.
This tends to weed the frailer individuals out of the male population, so
that only those men who are in relatively robust health even make it to their
hundredth birthday, while women tend to be able to survive for longer with
age-related disease and disability. Perls describes this as “a double-edged
sword,” in that women live longer but tend to be in poorer health. “The men
tend to be in better shape,” he has said. (The authors didn’t measure this, but
my hunch is that it may have something to do with men having more muscle
mass, on average, which is highly correlated to longer lifespan and better
function, as we’ll discuss further in the chapters on exercise.)
But even if they are not in such great shape in their eleventh decade, these
individuals have already enjoyed many extra years of healthy life compared
with the rest of the population. Their healthspan, as well as their lifespan, has
been extraordinarily long. What’s even more surprising is that Perls’s group
has also found that the supercentenarians and the “semisupercentenarians”
(ages 105 to 109) actually tend to be in even better health than garden-variety
hundred-year-olds. These are the super survivors, and at those advanced ages,
lifespan and healthspan are pretty much the same. As Perls and his colleagues
put it in a paper title, “The Older You Get, the Healthier You Have Been.”
In mathematical terms, the centenarians’ genes have bought them a phase
shift in time—that is, their entire lifespan and healthspan curve has been
shifted a decade or two (or three!) to the right. Not only do they live longer,
but these are people who have been healthier than their peers, and
biologically younger than them, for virtually their entire lives. When they
were sixty, their coronary arteries were as healthy as those of thirty-five-yearolds. At eighty-five, they likely looked and felt and functioned as if they were
in their sixties. They seemed like people a generation younger than the age on
their driver’s license. This is the effect that we are seeking to mimic.
Think back to the notion of the Marginal Decade and Bonus Decade that
we introduced in chapter 3, and the graph of lifespan versus healthspan.
Because Medicine 2.0 often drags out lifespan in the context of low
healthspan, it lengthens the window of morbidity, the period of disease and
disability at the end of life. People are sicker for longer before they die. Their
Marginal Decade is spent largely as a patient. When centenarians die, in
contrast, they have generally (though not always) been sick and/or disabled
for a much shorter period of time than people who die two or three decades
earlier. This is called compression of morbidity, and it basically means
shrinking or shortening the period of decline at the end of life and
lengthening the period of healthy life, or healthspan."