The Lucky Years: How to Thrive in the Brave New World of Health (7 page)

It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.

—Sir William Osler

I
f I told you that you had to go to the doctor tomorrow to be closely examined and have a battery of tests—cholesterol, weight, blood sugar, liver and kidney function, metabolic health, cardiorespiratory fitness, blood count, cognitive function, perhaps even a DNA screening and check of your dental health—what would you do differently tonight besides brush your teeth for an extra minute? And what are you thinking about right now as you ponder this possibility? Are you nervous? Do you regret what you ate for breakfast or how you’ve lived your life this past year, maybe past several years? When you think about what you’ll look like ten or twenty years from now and how your health will be, what comes to mind? If that’s the hardest question to answer of all the ones I just gave you, you’re not alone.

In 2013, a fascinating report was published in the journal
Science
by three researchers from Harvard and the University of Virginia.
¹
One,
Daniel Gilbert, is a social psychologist well known for his research on such thought-provoking topics as what really makes us happy (not what you think), how we make decisions, and how well we predict what’s called our “hedonic reactions” to future events. In other words, he examines the psychology of our future self: what we think our emotional state will be further down the road.

Now, if I asked you to give me a fair assessment of how much you’ve changed over the past decade, what would you say? My guess, based on Gilbert’s results, is you’d admit to having changed a lot. But when asked about the next decade, you’re more likely to say that you won’t experience dramatic changes and that you’ve already become the person you want to be. That’s what Gilbert discovered when he and his colleagues measured the preferences, personalities, and values of more than 19,000 people between the ages of eighteen and sixty-eight. He asked them two things: how much they thought they had changed in the past ten years and how much they thought they
would
change in the next ten. Surprisingly, it didn’t matter how old his subjects were; the young, middle-aged, and older folks all believed they had changed a lot in the past but predicted that they wouldn’t change much in the future. Apparently, we regard the present as a “watershed moment” at which we have finally become the person we want to be for the rest of our lives. And this natural tendency has many practical consequences. Gilbert writes:

Time is a powerful force that transforms people’s preferences, reshapes their values, and alters their personalities, and we suspect that people generally underestimate the magnitude of those changes. In other words, people may believe that who they are today is pretty much who they will be tomorrow, despite the fact that it isn’t who they were yesterday. . . . [P]eople expect to change little in the future, despite knowing that they have changed a lot in the past, and . . . this tendency bedevils their decision-making. We call this tendency to underestimate the magnitude of future change the “end of history illusion.”

The end of history illusion states that the view of oneself shows no change going forward, and that one is only conscious of change in the past.

What I find interesting, and relevant to matters of health, is the following: “If people find it difficult to imagine the ways in which their traits, values, or preferences will change in the future, they may assume that such changes are unlikely. In short, people may confuse the difficulty of imagining personal change with the unlikelihood of change itself.”
²

Is this why it can be so hard for us to modify our behaviors to increase the chances of living longer and better? If seeing ourselves in the future is so difficult, then perhaps that’s why it can be such a challenge and chore to make changes today. Try telling a rambunctious teenager to cut back on his sugar consumption, a twenty-something to curb the drinking at singles parties, an overweight forty-something to start exercising after twenty-five years of inactivity and a penchant for soda and fast food, or a sixty-something to give up the cigarettes she’s smoked for four decades, and you can understand what I mean. The Gilbert research suggests that most of us believe we have attractive personalities, admirable values, and wise preferences. So given this state of affairs—having reached the “exalted state”—we might resist considering the possibility of change. We also like to believe that we know ourselves well, “and the possibility of future change may threaten that belief.” Gilbert and his colleagues nail it perfectly when they write: “In sum, people are motivated to think well of themselves and to feel secure in that understanding, and the end of history illusion may help them accomplish these goals.”

In the health realm, you can see how this kind of thinking can be a self-fulfilling prophecy: you don’t make the changes that you should make and wind up reacting to the health conditions that await you as a result of your inaction. This is also what sustains the “It can’t happen to me” mentality at any given time. We all make decisions that profoundly affect our future selves—from our daily habits to where we choose to live, what job we choose to have, whom we choose to marry, and even whether or not we choose to have children. But if we think that history is always ending today, then how can we make better decisions? How can we be motivated to make those necessary changes in our lives that make our futures better? According to Gilbert, we can blame the end of history illusion for our tendency to make decisions today that our future selves regret. I say, let’s be more aware of this phenomenon and use it to choose wisely in the Lucky Years so we can maximize our quality of life later with no regrets. And one way I think we can do that is to understand and accept that we are all mightily complex systems.

Why we age is one of the most compelling questions we face. No one knows the answer or even how to define the process, but there are plenty of theories. Every day it seems a new study emerges to take a stab at what, how, and why we wear and tear over time to the point we can no longer replenish our cells, keep up with our biological housecleaning, and stave off degenerative illnesses. In a 2015 study, for example, research led by German scientists found that a certain area of the cell, the so-called endoplasmic reticulum, loses its powers in advanced age and this results in proteins not being able to mature properly.
³
At the same time, another area of the cell, the cytosol, accumulates the waste of oxidative damage. Although this interplay was previously unknown and now opens up a new understanding of aging, it doesn’t tell the whole story. Nothing really will, because aging is not predicated on a single pathway.

Aging entails an opaque and exceedingly complex intertwining of different biological pathways. And the biological processes that underpin
the illnesses of aging, from heart disease to cancer, vary enormously. However, the greatest driver of all—despite the wide spectrum of diseases and their inherent, unique mechanisms—is aging itself. Or, I should say,
old age
.

We do know that certain switches in the body turn on or off to effect changes that result in aging, especially once we’ve reached reproductive maturity in adulthood. In a recent discovery, scientists from Northwestern University found that a single genetic switch that exists in all animals, humans included, gets activated at some point after sexual maturity that essentially turns off a cell stress response that protects vital proteins.
⁴
Now if we can figure out how to turn this switch back on and protect our aging cells by boosting their ability to resist stress, we can keep our cells’ quality control systems optimal and acting young.

We also know that changes to DNA—mutations—can lead to diseases such as dementia and cancer. Part of the programming that directs aging and dying lies in our genes, so we have to start looking at modulating genes—turning off the “die” or “age” switches—to extend life and increase not just the life span, but also the length of a healthy life. In worms, scientists can tweak certain genes and push the immortality button a little while longer. Why can’t we learn to do that in humans?

While we tend to think of aging as a universal process of becoming increasingly less fertile, weaker, and vulnerable to illness, that’s actually a gross misunderstanding, at least when you consider the aging process in species other than our own. It turns out that the phenomenon of aging shows an astounding diversity of strange patterns. This was recently demonstrated in a compelling 2014 paper written by researchers from a consortium of institutions including the University of Southern Denmark; the Max Planck Institute for Demographic Research in Rostock, Germany; the University of Queensland in Australia; and the University of Amsterdam in Holland, and published in the prestigious scientific journal
Nature
.
⁵
The authors describe how they studied aging in species ranging from lions, killer whales, baboons, lice, lizards, and nematodes to seaweed, oak trees, water fleas, frogs, and hermit crabs. The species included eleven mammals, twelve other vertebrates, ten invertebrates, twelve plants, and one algae.

For several species, the scientists documented what you’d expect to see with age: an increased risk of death, or mortality. In fact, most mammals, including killer whales and humans, as well as some invertebrates including water fleas, follow this pattern. But get this: some species’ mortality
decreases
as they age. In other words, their chance of dying
declines with age
. And in some wild instances, mortality drops to virtually (and, obviously, theoretically) zero all the way up to death! Just who on this planet can do that? For desert tortoises and many plant species, both of which experience the highest mortality as juveniles, their mortality steadily dwindles as they age.

Amazingly, there are also species whose mortality remains relatively constant and unaffected by the aging process. They grow neither weaker nor stronger over time. This is most striking in the small freshwater animal
Hydra magnipapillata
, which has continuously low mortality. This creature can in fact be housed in lab conditions that render it effectively immortal. Some experts have calculated that 5 percent of the hydra population could still be alive after fourteen hundred years if they are kept in a certain environment that doesn’t age them in a normal sense of the word. I know, this sounds like science fiction. But so did the thought of reversing aging in mice by hooking them up to younger comrades.

Scanning electron micrograph of the mouth and five tentacles of a freshwater
Hydra magnipapillata
. This species can practically live forever, at least relative to us.

Several species of plants and animals exhibit remarkably little change in mortality throughout their life spans. Examples include the plants rhododendrons, viburnums, and armed saltbushes; animals such as the hermit crab, common lizard, and red-legged frog; sea-dwelling life-forms oarweed (a type of kelp), red abalone, and the coral red gorgonian; and a few birds with some curious-sounding names such as the great tit and collared flycatcher.

If we were to look at the fertility patterns of the forty-six species these researchers studied, we’d find some surprising divergences from common beliefs about aging. Our fertility is high during a relatively short period of life, flanked by long periods of infertility before and after that window of time. The same pattern also occurs in other mammals such as killer whales, chimpanzees, and chamois, a goat-antelope species native to mountains in Europe, and in birds such as sparrow hawks. But some species actually become
more
fertile with age. Such a phenomenon is especially common in plants like the agave and in rare mountain plants. On the contrary, the nematode worm
Caenorhabditis elegans
is practically born super fertile and then very quickly loses its ability to reproduce.