Longevity medicine – how to prevent disease and live longer
Humans are living longer than ever before. Life expectancy has more than doubled since 1900 due to major advances in healthcare, and in Malta we can now expect to live to 83 years of age. Yet 70 per cent of us are either overweight or obese and the average person is living one-fifth of their life with a chronic health condition.
Most people think of calling a doctor when they have a medical issue they wish to address, a reaction to a new symptom. In medical schools around the world, a reactive model of medicine is taught to future doctors – wait for a problem or symptom to arise and then investigate and treat if necessary. Little or no emphasis is placed on prevention and the role that lifestyle factors such as fitness, diet, sleep and stress response play in the role of the development of diseases.
“Lifestyle changes and early screening for disease and prescription medications when required will increase our healthspan and lifespan
I certainly didn’t leave medical school thinking that my patients had any control over the risk of getting diseases such as cancer, Alzheimer’s disease and mental health issues. In my mind, these diseases simply happened to people who would then become my future patients.
As I progressed in my career as a cancer interventionist, it was apparent that cancer was increasingly occurring in younger patients and in more aggressive forms. This has been shown in various studies across populations worldwide, especially ones that lead a western lifestyle, and the theory in the medical literature so far is that our lifestyles are playing a large part in this change.
While my work treating cancer patients, sometimes finding a cure, sometimes relieving symptoms towards the end of their life is hugely important, I realised there might be a better way to deal with cancer. It would be so much better if I could help my patients not get cancer and other diseases in the first place.
Longevity medicine is a novel approach to medicine − rather than wait for symptoms of diseases to appear to see a doctor, consultations with a longevity medicine specialist help patients prevent disease, optimise physical health, fitness and mental well-being. Consultations with a longevity medicine specialist are focused on increasing healthspan (how well you live free of disease) and lifespan (how long you live), and by preventing or delaying the chronic diseases of ageing.
When a chronic disease such as heart disease, cancer, diabetes or Alzheimer’s disease is diagnosed, changes causing that disease would have been happening slowly over the previous 10 to 20 years − doctors and patients would have missed the opportunity to prevent ill health.
Heart disease is a good example. Build-up of plaque in arteries all over your body start in people at a young age of 20-30 years old and only become apparent as a symptom sometimes 20 or more years later when the plaque causes critical narrowing or completely block an artery. In a significant number of people, the first presentation of heart disease is death.
Cancer is another example − in colorectal cancer, tumours develop from polyps which can be detected and easily treated at an early stage with screening tests before symptoms appear. When a patient is diagnosed with Alzheimer’s disease, changes in the brain would have been happening slowly for up to 20 years.
Maintaining aerobic fitness and muscle mass as we age reduces the risk of developing the diseases of ageing. Aerobic and resistance (weight) training are equally important in maintaining cardiac function, mobility, stability, insulin sensitivity, and brain health. Sleeping seven to eight hours a day increases life expectancy and decreases the risk of developing Alzheimer’s disease.
This is why a longevity medicine assessment includes measuring fitness parameters – like VO2 max, as well as strength and endurance; as well as other biomarker factors such as lipids, blood glucose levels, blood pressure and waist circumference.
A detailed history focuses on personal risk factors as well as family history of disease, and assessment of lifestyle factors such as exercise, diet and sleep. Blood test results and fitness parameters are analysed and a detailed lifestyle intervention programme with prescription medications, when clinically indicated, are prescribed with the aim of reducing, reverting or avoiding disease.
Cancer prevention and early screening are another important facet of longevity medicine – up to 40 per cent of cancers are preventable. While we focus on prevention, the fact is that approximately one in four of us will develop cancer at some point in our lives. All cancers have a better outcome when caught and treated early. Longevity medicine aims to offer a gold standard cancer screening service including novel approaches, for example, a cancer screening blood test which is able to detect cancer in up to 70 different sites before symptoms appear.
As we age, we all hope to maintain our independence, mobility, functionality, and overall well-being for as long as possible. Lifestyle changes and early screening for disease and prescription medications when required will increase our healthspan and lifespan and help us to live life to the fullest.
Philip Borg is a longevity medicine specialist as well as a consultant interventional radiologist and leads The Longevity Clinic at St James Hospital.