So you want to live longer?

Here is a story on possibly the newest anti-aging fad: resveratrol. It's found in red grapes and other foods. In lab animals it has been shown to switch on a set of enzymes called sirtuins that are associated with anti-inflammatory and anti-neoplastic processes. Sirtuins apparently extend life in worms, flies and rats. The mechanism is thought to be that similar to the calorie-restriction theory of life-prolongation. This theory says that low-grade starvation stimulates the body to switch from reproduction (in which a body's resources are ultimately directed to offspring) to preservation (in which the body's resources are directed at the self). Hence, a longer life, as counterintuitive as it sounds. I should say, however, that there is no evidence in humans that this is the case. The calorie-restriction diet fad and resveratrol supplements have not been around long enough to know if they have any significant effects and a clinical trial measuring longevity would probably take several decades. If you consider the risks minimal compared to the potential benefit, you might just hedge your bet and do it anyway, which is the only rational explanation for why someone would willingly starve themselves. Furthermore, I am not sure if CR would really make a significant difference compared to simply following your doctor's advice, which is, eat lots of fruits and vegetables and get exercise. Only recently with all the media attention around obesity and diabetes has the American mainstream really started to take these doctor's orders to heart. (Incidentally, high gas prices may be the biggest boon to healthy aging as it will discourage dependence on the car).

Calorie-restriction diets are pretty controversial in the medical community. The obvious concern is the risk of malnutrition - but that could be lessened with supplements, if you think that is a good way to get nutrition (I don't). Another concern is that CR is really just anorexia - or possibly some other disorder - in masquerade. CR people, like anorexics, are obsessive about calorie counting; in fact their entire daily routines can revolve around it. Anorexia is a very complex disease that involves psychosocial factors and possibly organic brain disease. Many anorexics are very functional, educated, smart individuals. They can be very good at rationalizing their self-destructive behavior. CR, if a flavor of anorexia, would not simply be a rationalization of chronic self-starvation, it would be a pseudo-medical and pseudo-scientific theory defending anorexia as a healthy lifestyle choice.

Another element I find amusing about the anti-aging community is that it is almost entirely composed of young and youngish people who probably have very little contact with elderly folks. I have quite a bit of contact with older people. One thing that is fairly consistent is that old people don't talk about wanting to live longer. You just don't see 85 year-olds talking to you about the latest and greatest fad to keep them young and healthy. My theory about that is simple: old people get tired of living. And this is hard to foresee when you are fit, healthy, functional, and have life changes to look forward to when you are in your 20s, 30s and 40s.

One thing I enjoy most about my older patients is talking to them about how they view the quality of their lives. If they are happy, then what are their secrets? If they are not, then what when wrong? I hear a lot of the same answers.

The secret to aging well is pretty simple: keeping a good sense of humor; being passionate about something; and having meaningful personal relationships. If an 80 year-old has got those three or just two of three, then chances are, they are pretty happy with their life, regardless of their medical problems. This brings to mind an 81 year-old gentleman I met while in Burns, Oregon that had a smile and energy of someone more than half his age. We like to think that it just genes; but this guy also had the magical trifecta: he was always telling jokes and laughing, he played bluegrass guitar and fiddle very well several times a week, he had a large family close by in town and many friends with whom he played music.

How about those who don't do so well as they age? Invariably these are people who don't have any interests or hobbies (dispassionate); people who are unable to deal with stress well (lack humor); people who have a weak social support system (few nearby friends/family). People think that you are prone to get depressed as you age simply because your body and mind break down. We know quite well, however, that how one perceives pain and disability plays a very large role in the meaning of the pain or disability. In other words, a depressed individual is more likely to attribute more significance to their knee pain than is someone who is not depressed. A person who throws out their back at work as opposed to working in the yard is much more likely to see the doctor for a disability claim, and there is very good data that shows people who claim disability for an injury recover much more slowly than those who do not, regardless of the severity of the disability. So my point is, that we deteriorate as we age, but what that means to us - will it become a disability that impairs our sense of well-being or not - is very much a matter of how many of those protective factors (passion, humor, relations) we have in our lives.

Nevertheless, even the happy 81 year-old I mentioned conceded that life is getting long. He is happy, but life has a very different meaning for him now than it did 50 years ago. Back then he had a series of life-changes to look forward to: graduating from school, perhaps college, getting married, having children, buying a first home, developing a career. But at 81 all the big life-changing events have happened.

The tragic thing about aging is that our mental and physical functioning will decline, at varying rates, as we approach death. Ideally that decline should be short and fast; the worse case perhaps is Alzheimer's dementia, where the decline is insidiously slow and protracted, and involves not simply ending up in wheelchair but in loosing your mind and identity. The goal of simply extending life I think misses the point, and that is not about how long to live, but about how quickly to die. One could be the most devout CR dieter for many decades and eke out another five years of life. But eventually that person will die and it will be the same process as any one else: cancer, infection, heart attack, dementia, and maybe trauma. It maybe swift or interminable, but the death is the same.