With the recent progress of science and medicine, we should become more proactive regarding our health.
Health is our most valuable asset. This is not a novelty, and it will probably never change. We may forget it sometimes, but a few days of flu always come as a reminder that when our body doesn’t feel right, everything else becomes less important. Most of us share the same goal: living disease-free for as long as possible. Doctors and scientists had so far contributed to this goal by helping us improve our understanding of diseases and their treatments. We learned to cure some types of cancer, to do a heart transplant, and we overcame the most deadly epidemics. But, is this approach the most optimal to extend human lifespan and health-span, and how did we get to focusing mainly on curing a disease instead of preventing it?
Ancient civilizations believed that the human body is constituted of four fluids whose balance was necessary for a healthy life. Doctors employed different practices not only to restore but also to maintain this balance. For example, fasting was used in V century b.C. by Hippocrates for therapeutic and health purposes. Curing diseases went hand in hand with their prevention.
Over the course of history, scientists started focusing on finding a cure for diseases as a way to extend human longevity. In the 20th century we discovered the antibiotics, we learned how to remove an appendix, how to cure some types of cancer, and much more. It enabled us to extend the life expectancy from 46 years in 1950 to 71 years in 2015. Paradoxically, the same principle that was driving modern medicine towards finding a cure for different diseases in an increasingly more performant and safer way had a major side effect: it gave people the idea that healthcare was all about treating diseases and that the art of not getting sick in the first place was less relevant.
Health started to be perceived as a dualistic state: either I am lucky enough to be “healthy” and feel good, or I am sick and I need a cure for my disease. Pr. David Sinclair referred to Jay Olshansky in his book “Lifespan” who expertly described today’s health practices: “The way doctors treat illness today is simple, as soon as a disease appears, attack the disease as if nothing else is present, beat the disease down, and once you succeed, push the patient out the door until he or she faces the next challenge; then beat that one down. Repeat until failure.”.
The problem with the modern health approach is that fighting one disease will not significantly increase human life- and health-span. David Sinclair explains in Lifespan:” if we could stop all cardiovascular disease every single case, all at once we wouldn’t add many years to the average lifespan; the gain would be just 1.5 years”. This clearly shows that our current vision of healthcare is not going to contribute significantly towards better quality and duration of our lives. For centuries, this approach helped us to fight against viruses and early causes of deaths, but as the receding US life expectancy testifies, we need a new approach.
So it appears that the “curing” mentality cannot extend our health-span and life-span anymore. What is left? The preventive approach. We have to understand that the first step towards living a long and healthy life is to take back the control of and responsibility for our health. We already know the big principles of a healthy lifestyle. For nutrition (even if right now the nutrition war is more active than ever) we know that putting an emphasis on whole foods, vegetables, fruits, seeds, nuts, spices promotes good health. We know how sleep is important. We know the importance of exercising. We also know we should pay attention to our mental health. But we can do better.
The broad outlines of a healthy lifestyle are not enough
The public space witnessed a major increase in health-related debates over the last decades. The consequences of this were more funding for research and major breakthroughs, but also an emergence of a large number of non-specialists that give health advice hiding under the mass of health-related content. The general advice for a healthy life represents a big step towards better health, but they lack one crucial component: personalization.
Health guidelines are created to benefit the majority of people, but it doesn’t mean that they benefit everyone or in the same way. They are still a good place to start, but given the tremendous amount of them what happens very often is that people put a lot of time and energy into things that eventually don’t have a big positive impact on them. Regarding health, and generally, in life, you always want to adopt the Pareto Principle approach. For health, it translates into 80% of the health benefits you experience should come from 20% of your efforts and things you do to achieve them. This actually means a lot. Personalized health management could enable everyone to take the right approach to maximize positive outcomes without being lost in the ocean of health advice.
Health is a complex system that relies on countless parameters and having to search how to optimize each of them can be overwhelming. That’s why personalization could be a major breakthrough. If you know yourself, you will know which parameter to work on to get a game-changing outcome. You may think: that sounds good, but there’s nothing new here; why and how can I change something?
What is new?
Giving a risk factor for a disease to someone is not an easy task. Even harder is giving a general health review that provides an individual with actionable insights for the prevention of conditions she/he is at higher risk of contracting. But in the last decade, the dramatic improvements in our ability to sequence the human genome changed everything. With fast and affordable sequencing we entered a new era. We can now understand the genetic component of many diseases, and we can link certain gene variants to increased risks for certain diseases. We can also create ultra-personalized nutrition plans that understand better our deficiencies and fix them.
With this newfound knowledge and technology, scientists can study the parameters influencing the appearance of disease and the effects of the preventive approach either by changes in lifestyle habits (exercise, nutrition, etc.), or by early medication to delay the appearance of the disease.
Why is it a major difference?
Dr. Peter Attia, a Longevity specialist explains in his reversed engineered approach to human longevity that “after 40 years old, a non-smoker, a non-suicidal person has 80% of chances to die from one of 3 types of diseases: Cancer, Cardiovascular disease, neurodegenerative disease, and accidents”. So to reach your longevity goal, the approach is quite straightforward. We have to understand what is the most probable cause that is going to put an end to our life and address it as the earliest possible in a preventive way. The recent progress of science and technology is making this approach to health and longevity more and more relevant. Although the idea of Benjamin Franklin that “an ounce of prevention is worth a pound of cure” is not new, it’s the first time that this approach can actually be a game-changer on a large scale.
How to use that?
The idea is “know yourself to be able to choose for yourself”. If you can have precise information regarding your health risks, you will be able to develop a holistic vision of your health. For example, if you are at high risk of contracting cardiovascular diseases, you will want to pay extra attention to monitor your heart. If you are at high risk for diabetes, you will want to monitor your blood glucose, if you are at high risk for Alzheimer's, you will pay extra attention and work to prevent it and detect it in its silent phase.
The new range of information can also help you figure out your optimal nutrition (metabolism of vitamins, supplements to take, etc.). This new approach is helping you focus on what is important for you and not the general guidelines made to fit the majority of people.
Limitations of this approach
The prices are still high
Every new approach comes with its limitations. Here, even if the prices of DNA sequencing and analyzing have decreased a lot over the past decade, we are still talking of hundreds of dollars to get yours tested and analyzed. Then, if you want to get actionable insights you can either consult a longevity specialist that will create a plan suited for your goals and your characteristics or try to find online what you could do to optimize your health regarding your risks. The first option is still very costly, and having such a specialist to help you is clearly not possible for everyone. The latter requires a lot of time, and it is not the most reliable.
The psychological aspect of this approach is a challenge
The psychological aspect of this approach shouldn’t be neglected. How would you feel is you knew you had the gene variant APOE4 giving you roughly 80% of developing Alzheimer's? Or if you had higher chances of developing breast cancer? This kind of information are not always easy to digest and they would require adequate support and counseling. It doesn’t mean however that the whole approach is bad. What we have to understand is that this is not really new information, it’s rather a precision. We all already know we are going to die sooner or later. In Europe, we can expect to live 80 years. We also know that it’s most likely a disease that is going to kill us. So now we can either run from the thought of our finite existence or try to maximize it and be able to go hiking with our grandchildren. What this approach shows, is that it’s up to us. As Pr. David Sinclair wrote in his book “Lifespan”: “There are steps we can take right now to live much longer and much healthier lives. There are things we can do to slow, stop, and even reverse aspects of aging”.
How precise is the information?
When you get information regarding your risks, it’s normal to be concerned about the validity of that information. Some diseases are well understood today, and insights on these are usually accurate. But understanding the risk factor or disease is a medical field rapidly evolving. With this approach, the best we can do is optimizing health based on the current state of the science. Our understanding of health and disease is in constant evolution, and treatments of today may not be those of tomorrow. But that’s just the best we can do today, and it’s already very good.
Lifestyle and habit changes
This whole approach relies on preventing rather than curing a health condition. The first step is understanding your body. Then comes the time of action. What could you do to minimize your risk and extend your health-span? This will be very different from a person to the other, but the common point is that some changes will have to be made. And as we know, lifestyle changes can be hard to stick to. The whole value of such an approach relies on its ability to make people stick to habits that will help them live longer. Without that, the effect of it won’t be game-changing. The real revolution lies in combining the hard science of understanding your body and your risks with the soft science of making you follow a plan suited for your longevity. Hard science without real-life changes has little value, so does habit trackers without hard science to back them.
At first, thinking about health can be overwhelming. The biggest challenge the new actors of Longevity will have is to find the perfect tradeoff between the precision of the actionable and the feasibility of them. These actors will have to become a trusted source of truth in a world relying on complex parameters. Then they will have to suggest the next steps to help the user improve his condition and monitor his risks.
Becoming more proactive regarding health makes sense now more than ever before. Science and technology together can bring a new era in healthcare. It is now time for innovations that work on bringing the new hard science of risk factors and disease prevention along with the psychological aspect of habit change and lifestyle management to change how we approach our health and longevity.