Longevity and Quality of Life - Lifestyle and Chronic Diseases - It is Time to Reflect on How We Live

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We live in strange times: 

"We have more scientists, more doctors, more therapists, more nutritionists, more gyms, more money than we ever had, and we're the sickest people we've ever been."   ...quote from the Internet             

With much better understanding of human biology, stellar advances in biomedical imaging and diagnostic techniques, and much increased health-related spending, one would expect that the average level of health and quality of life should show marked improvements.  This is not the case at all.

In the USA, a person expects to spend about 11 year or 14% of his/her life with disability. The situation is not much different in rest of the world.

Life expectancy has been increasing over the past 250 years, but no more. In the USA, since 2015, life expectancy has been decreasing despite the country outspending others in health care. Some sections of the UK society have seen a drop in longevity as well.  

What is happening is a complex interplay of human traits - put simply, from the point of view of biology humans are trapped in their evolutionary past unable to adapt/cope with the rapidly changing, technological world. Evolution works at a slow pace.  What we inherited from our ancestors half a million years ago still dominates our biology - it determines both our physical and mental needs.  The following two slides show the pillars of good physical and mental health.    

The seven items define our lifestyle and are absolutely essential for one's good physical and mental well-being.  Our ancestors thrived on plentiful availability of these and it is in this environment that  their (and our) biology evolved.  In the modern industrial world we do not enjoy any of our vital needs.  To make matters worse, we have concentrated on fixing the more visible physical health, largely ignoring mental well-being. Physical and mental health are deeply interconnected and, as the above slides show, we are largely responsible for the choices we make about our well-being.

While we do not have good/sufficient control on the quality of water we drink and the air we breath, it is largely our choice how much and what we eat, how and when we sleep and exercise, how we make friends with others in the society and the level of stress we subject ourselves to.  I have discussed, in my previous blogs, how our health and well being depends on sleep (1,2), outdoor air quality, water quality and diet (3,4,5) and refer these blogs for background reading.  Sustainable living and population control are intimately tied to our ability to create conditions conducive to ensuring life-long physical and mental well-being. 

Changing landscape of disability and disease:  Historically, the main cause of mortality in humans was infectious diseases (communicable diseases) carried by bacteria and viruses - responsible for over 50% deaths in the year 1900.  Since then, improved public health measures, vaccination and antibiotics have been effective in significantly reducing deaths due to infections resulting in a doubling of life-expectancy (from 40 to 80 years) in OECD countries.
However, over the past 50 years, diseases that are underpinned by poor lifestyle choices have rocketed in numbers and are now the major risk of mortality and morbidity - particularly in the rich countries.  Here, we are thinking of chronic diseases (non-communicable diseases) like type 2 diabetes (T2D), obesity, cardiovascular disease (CVD), cancers, dementia - particularly Alzheimer's disease (AD) - and many more.  Unlike infectious diseases, these chronic diseases do not kill you outright but make you ill and impair your quality of life for a number of years. 

There has also been a serious increase in the number of auto-immune diseases (AutoID) in the rich Western countries. Prevalence of food allergy in preschool children ranges from 5 to 10% in rich countries but remains ~ 1% in countries like Thailand.  New cases of type 1 diabetes in Finland is 62.3 for every 100,000 children, compared with 6.2 in Mexico and 0.5 in Pakistan.  Ulcerative colitis is two fold higher in Western Europe than in Eastern Europe.

In an AutoID  your immune system mistakes part of your body as foreign and sends out an army of fighter cells to attack them (AutoID is sometimes called the enemy within).  This causes inflammation in the system that affects your joints (rheumatoid arthritis), skin (psoriasis), glands (Addison's - hormone secretion by the adrenal glands and Grave's disease - overactive thyroid), organs (Type 1 Diabetes, MS - damage to protective nerve cell myelin sheath, IBD - Chrohn's disease & Ulcerative Colitis, Celiac disease or gluten intolerance), asthma and many more.  
The modern western diet rich in meat proteins, high in sugar and processed foods is suspected to be a major underlying cause of increasing incidence of AutoID. Other lifestyle factors like increased use of antiseptics and cleaning chemicals with excessive emphasis to hygiene removes low level exposure to common germs. The unprepared immune system then overreacts even to harmless substances with resulting increased incidences of allergies to nuts, pollen etc.  (But see also)  Such allergic reactions and other AutoIDs are almost unheard of in poorer countries.

Big influences are in play:  Medical advances have been tremendously successful in keeping us alive but are ineffective in preventing one from contracting one or more of the chronic diseases.  For example, if one has a heart attack or a stroke, the hospital will make sure that in majority of cases the patient survives but he/she rarely recovers sufficiently to lead a proper active life for many years afterwords.  Obesity is another good example where the obese person tries repeatedly to lose weight - unsuccessfully - but suffers long term physical and mental distress with a higher probability of contracting one or more chronic diseases.  
Ironically, this situation has been extremely beneficial for many industries like the pharmaceutical, weight watchers, Big Food and many more.  Food business was worth 5.75 trillion dollars in 2017 (up from 2 trillion dollars in 1992) ~300% increase in USA alone - the US population only increased by 28.2% during this period.  The pharmaceutical industry sales worldwide have grown from 390 billion US dollars in 2001 to 1205 billion US dollars in 2018. Some businesses, like Big Food, have really benefited from the surge in chronic diseases in the past 50 years and it is in their interest to maintain the status quo of people making poor lifestyle choices and maintaining their revenue stream.  Similarly, pharmaceutical companies have valuable customers who are chronically ill and need medication on a long-term basis. Money generously spent in advertisements and lobbying ensures that people continue to buy their products, and rules and regulations are not made too punitive.
In a perverse way, the mantra for business appears to be - first profit by making them ill, then profit by selling cure for the illness.

How one defends against such powerful influences is not easy.  You have to educate yourself and make individual decisions of taking the responsibility of your health in your own hands - decide how you can deliver the pillars of good health to foster your health and of those around you.  Take guidance from people/communities who enjoy good health and longevity.  I discuss this in the next section.  

'Blue Zones', Sustainable Living and Longevity:

It used to be fashionable to attribute the rise in some chronic diseases to the increased longevity during the past 100 years - essentially, chronic diseases are diseases of old age, and as people are living longer we see greater incidence of chronic diseases.  In fact, type 2 diabetes (T2D) was known as adult onset diabetes - only people over the age of about 50 years would get it.  This is not the case anymore.  These days, young people of all ages, contract T2D. Something has changed.

Then there are pockets of people, communities dotted around the world where there is a disproportionate number of centenarians - people who live beyond the age of 100 years.  In these regions - called the 'blue zones' - older people lead active healthy life free from chronic diseases.  Genetics is not the reason for their extraordinary health and longevity, because the same people, when they move to the Western countries and adopt the prevailing lifestyle, start to lose their good health very quickly and suffer from chronic diseases no different than the indigenous population.  

In all blue-zones, people achieve and maintain their good health and quality of life into their 80s, 90s and beyond through common elements of lifestyle, diet, exercise and outlook.  Such blue-zones have been studied in diverse places like Okinawa (Japan), Sardinia (Italy), Costa Rica and Greece. The most extensively studied longevity oasis is in Southern California, Loma Linda - 65 miles east of Los Angeles, the second largest city in America - home of the Seventh-day Adventists where people can expect to live to beyond 100 years with a 10 times greater probability than an average American. It is well documented (1, 2, 3, 4) that people of Loma Linda owe their longevity to their 'simple' life style inspired by their religious beliefs fostering close community relations, active lifestyle and exclusively unprocessed diet. 

I leave this blog with a slide showing the typical diet of a Loma Linda centenarian:

Final Word:  Writing this blog was a unique experience - particularly the brief discussion of the blue-zones.  It reminded me of my upbringing in a small town at the foothill of the Himalayas.  As strict vegetarians, our diet was not very different from the Loma-Linda diet.  Until 1955, there was no electricity in the town and we slept from about 9 pm to 6 am, walked one and half miles to school and played cricket all afternoon.  The air was clean as they were less than 10 motor cars or seriously polluting industries.  There was a lot of community feeling among neighbours and stress was virtually unknown. We never ever took supplements and only ate seasonal fruits and vegetables. My parents lived long healthy lives of 86 and 90 years with no chronic disease and zero disability days.  Sadly, the town has changed a lot - mostly for the worse for health, but everybody says that much progress has been seen in the past 60 years!