LIVE LONG OR LIVE WELL?

THE PHYSICAL-HEALTH TIME BOMB

There are four key lessons that you can instil in your child for a brighter future: don’t put weight on, make exercise a part of your lifestyle, don’t smoke and don’t drink hazardously. These are the essential building blocks for physical and mental wellbeing. Beyond these, there’s not much you can control in your child’s life

We are living longer. But how do you ensure your child not only lives long, but lives well?

Englishwoman Sadie Cox turned 100 in March this year. You may have seen stories about her on the news. Of course, there’s nothing that newsworthy about getting to 100 these days. Your chances of living long enough to receive a letter from the President have never been higher.

What astonished many, however, was how young Sadie looked. Inevitably, a picture was posted online, and it went viral. But those looking for the recipe to eternal life were disappointed. Sadie said she hadn’t done much sport since netball at school. It seemed the real secret was in her genes: her sisters, Anita and Sylvia, were 97 and 94, respectively, at the time.

Which makes the recent report from the influential Nuffield Council on Bioethics all the more important. The report said that it was “morally permissible” for parents in future to be allowed to alter the genes of their babies. This is not a purely theoretical consideration. Gene-editing techniques exist already. Advocates say they can prevent children inheriting devastating diseases; critics claim they will inevitably lead to a breed of genetically-improved supermen and women who will look down on the rest of us Untermensch (literally, ‘under man’ or the common man). There is no right answer, but the geneediting debate is happening now, and couples planning on starting a family in the next few years may find that basic decisions about the physical health of their children end up pushing hitherto untested frontiers of science and ethics.

A foretaste of the intense debate aroused by such profound decisions is with us now, with the argument about whether children should be allowed to access medical treatment to change their gender or prevent puberty. While the numbers concerned remain tiny, the figures are growing as awareness of treatment spreads. It is a sensitive topic, inflammatory to some, but to all of us a reminder of the increasing extent to which the physical bodies we are born with do not dictate who we are. Parents of tomorrow will have to consider both genes and gender as never before.

Parents today, by contrast, are faced with a far more straightforward task: deploying the available science to ensure their offspring live long and well.

“Basically, if you look at the last century, far fewer people now die of infectious disease, thanks to sanitation, vaccination and antibiotics,” says David Oliver, Britain’s former National Clinical Director for Older People’s Services. “And we’re much better at the heroic end of things — heart-attack treatment and things like that.”

That means the biggest killers today are lifestyle related: stroke, heart disease, common cancers, and respiratory disease. The World Health Organisation has shown that half of all preventable disease for people over 50 in western countries is common to four lifestyle choices. The first is sitting on your backside.

“Being sedentary is actively bad for you,” says Oliver, and is one reason why parents of children of all ages should be wary of screen time, which is almost always static. The other three big no-nos, Oliver says, are “excess alcohol, smoking, and obesity. If you want a longer, healthier life, well, you can’t account for accidents. Sh*t happens. But to maximise your chances: don’t put weight on, make exercise a part of your lifestyle, don’t smoke and don’t drink hazardously.”

That’s it, parents! That’s all you can control to give your children the best chances of long and healthy life. Those four things. And they don’t just affect your physical ability. “They account for dementias, too,” says Oliver. “You are likely to get dementia far more in people who are overweight, smoke etc. The same risk factors come through again and again.”

Like many health professionals, Oliver despairs of what he describes as “an obesity epidemic”. Your weight is overwhelmingly about diet, he says, and we seem to insist on getting it wrong. There’s no point doing 20 minutes on a treadmill, then rewarding yourself with a doughnut: the calories consumed will far outweigh the calories burned.

When I was worked as a newspaper’s comment editor, the most impassioned article I published was from Ian McColl, who was professor of surgery at Guy’s Hospital in London until his retirement. He was incensed that an obesity epidemic was threatening to “kill more than the influenza epidemic of 1919”, and its simple cure was being ignored. “The answer is smaller portions, and food that satisfies,” he wrote, before resorting to capital letters for his payoff: “EAT LESS and LIVE!” A healthy diet Parental example is critical. “Kids value different things according to how they see others value it — that’s how they learn,” says Tali Sharot, a cognitive neuroscientist at UCL. “The best way to teach your kids not to have bad habits is not to have those bad habits yourself. I would not smoke or have my children watch me smoke. They don’t see me eating candy.”

Some diets have taken the link between eating less and long life to extremes. For more than 75 years, research has shown that mice and rats which were fed around a third less than control subjects, lived up to twice as long. In monkeys, the link between starving and long life is, however, associated only with adults. “Caloric restriction appears to have some effect on life expectancy — but it’s a pretty dismal life,” says David Sinclair, Director of the International Longevity Centre. “Much better to focus on the same old advice: plenty of fruit and veg, not too much booze.” Sally Beare, a nutritional therapist and author of The

Live Longer Diet, studied five populations around the world that were celebrated for their longevity. She found common factors in their diets. These are her conclusions:

Go organic. I believe that the vast amount of pesticides in our food must contribute to poor health.

Lots of fruit and veg. Especially veg, which are a rich source of nutrients.

Free-range meat. It’s leaner, and the fats present are higher in “good” monounsaturated omega-3 fat (also present in fish, flax seeds and walnuts). Vegetable proteins in the form of nuts and beans. Fermented foods. From kimchi to probiotic yoghurts, get the good bacteria in your gut. Eat food straight out of the soil for the same reason, or maybe give it a very quick wash. Herbs, not salt. For seasoning. Water and wine. Organic red, in moderation. Sardinia in Italy is a longevity hotspot — and the island’s Cannonau wine is delicious.

Mother to two adolescents, Beare is keenly aware of the difficulties of practising what she preaches.

Her 12-year-old son, in particular, is resistant to her advice. “His favourite foods are pizza, bacon and crisps,” she says. “But I try not to nag him too much, as I don’t want him to rebel against healthy eating. What I do instead is try to get as much goodness into him as I can. If you keep putting nutritious foods, fruit and veg on the table, for most children, some of it will go in and hopefully become habit forming.”

Move to improve

The importance of really ingraining good habits is clear. Studies show that children at school are pretty active. But afterwards, in adulthood, time spent exercising really drops off. That’s where the problem is. Despite all that running around the playground, exercise is not hardwired into their lifestyles. It’s a problem likely to get worse.

“Life is too easy,” says David Sinclair. “And most innovation is about making our lives even easier — it’s about not going up and down steps, not going to the shops, it’s all about us not doing physical activity.” Those with children in their 20s might remind them that skeletal muscle loss — a key factor in older-age, life-limiting frailty — begins at 30. Regular exercise that promotes balance and challenges frailty is beneficial at any age.

And the rewards for starting our children on the right track have never been bigger. “Being healthy and active allows you to prevent decline and decay,” says David Oliver. “And if you can do that, then over 75 is typically one of life’s most contented ages.”

That is why, even as life expectancy (LE) continues to edge up (by 2030, LE in Ireland is predicted to be around 84 for men, and 87 for women; up from 78 and 83 today) what doctors really think hardest about is healthy life expectancy (HLE). That’s the age you reach before you become dependent. The length of time after retirement that you can cut your own toenails; can wash and dress yourself. And there is a huge discrepancy in HLE.

In London’s Tower Hamlets, traditionally a deprived area, residents can expect an average of only six-and-a-half years of healthy life once they reach 65; those in upmarket Richmond, just across London, can expect 14-and-a-half years of good health. More and more, the real goal is not extending life, but compressing ill-health right to the very end. Because there is a natural limit to life, known as the Hayflick limit, which governs how long human cells can divide. No matter how medicine advances, human bodies are believed to have an expiry date of around 125 years .

That’s as things stand. But the reality for our children is that the natural limits of human bodies will no longer necessarily constrain them. Already, we are seeing human beings augmented by physical implants. For a long time, the most controversial thing about the double-amputee Oscar Pistorius was that he was granted permission to run in the (able-bodied) Olympics, prompting debate about whether his prosthetic blades conferred him an unfair advantage. We are living at the dawn of the cyborg age.

“Vast numbers will be queuing up to get arms and legs replaced, and upgraded, and we will have to accept that,” says futurologist Ian Pearson. “We will have to be wary of them looking down on the rest of us. They may feel they have a natural right to rule the world. We have to hope there is still a general belief is the intrinsic worth in flesh and blood.”