As my birthday looms ahead this weekend, and the distance I’ve circled around the sun keeps lengthening like a shadow, I thought I would summarize four of the more important studies that have been published on longevity. Unlike other things that have been touted for long life such as resveratrol, high dose antioxidants, human growth hormone, and plasma from young people’s blood, these lifestyle interventions are cheap, mostly proven to help, and can’t be stuffed into a crappy pill for Huberman or Oz to sell us.
I fully realize that even when we do (almost) everything right, medical illnesses and events can still occur at random. But these are solid, peer-reviewed studies that have shown how we might reduce our chance of cardiovascular death over the next decade by 50-60%.
HALE (Healthy Ageing: a Longitudinal study in Europe)
This study published in JAMA in 2004 analyzed the effects of 4 main variables on mortality rates in about 2,300 European 70-90 year olds who:
Over a 10-year follow-up period, the separate variables were associated with the following all-cause mortality risk reductions:
And when the data were broken down by specific diseases that caused death in this 10 year study, similar numbers were seen for reducing mortality from coronary heart disease, cardiovascular diseases, and cancer specifically.
Combining all four healthy factors lowered the all-cause mortality rate by 65%.(Overlapping buckets prevents this from adding up mathematically to 117%, or else we would have discovered the fountain of youth.)
Lifestyle studies are by definition tough to hold up as incontrovertible truths since there are so many variables in our lives that can confound simple cause and effect conclusions. But finding the same associations in additional studies, with significant risk reduction percentages, keeps lending credence.
I think it is important to point out that “moderate alcohol use” only stands out as a benefit when compared with heavy alcohol use; not when compared to no drinking in the first place. Alcohol and health is kind of a minefield, but suffice it to say that drinking too much alcohol contributes to accidents, injuries, liver disease, high blood pressure, and various cancers. However, limited or moderate alcohol use may provide certain health benefits for adults, such as possible reduced risk of coronary artery disease, although this has not been definitively proven. I wrote a deep dive about alcohol a couple years ago, and UpToDate has a good patient education run down if you’d like to go through the weeds.]
Take home points - The HALE study found that a healthy diet (like Mediterranean), not drinking to excess, staying physically active, and not smoking reduced death by 65% over ten years in the older people studied.
You can still make a big dent in your mortality risk at an older age.
ARIC - Atherosclerosis Risk in Communities Study
This study published in The American Journal of Medicine in 2007 examined a middle-aged cohort to determine the frequency of adopting a healthy lifestyle defined as:
Of 15,708 participants aged 45-64, 8.5% already had these 4 healthy habits at baseline.
Another 8.4% newly adopted a healthy lifestyle within the first 6 years of the study beginning.
Compared to those who did not change, those who newly adopted a healthy lifestyle had:
The authors conclude: “In this study, we found that a midlife switch to a healthy lifestyle that includes a diet of at least 5 daily fruits and vegetables, exercise, maintaining a healthy weight, and not smoking results in a substantial reduction in mortality and cardiovascular disease over the subsequent 4 years.”
You can still make a big dent in your mortality risk at a middle age.
Health Professionals Follow-up Study
This prospective study published in Circulation in 2006 followed 42,847 middle-aged and older men from the Health Professionals Follow-up Study for 16 years.
It found that men who adhered to five low-risk lifestyle factors (guess!):
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not smoking
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healthy body mass index
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regular exercise
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moderate alcohol intake
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a healthy diet
…had an 87% lower risk of coronary heart disease (CHD) compared to men who did not adhere to any of these factors.
The study estimated that 62% of CHD events in this cohort could have been prevented through better adherence to these five lifestyle practices. Even among men taking medications for hypertension or high cholesterol, 57% of CHD events may have been preventable with a low-risk lifestyle. Additionally, men who adopted two or more additional low-risk lifestyle factors during the follow-up period still had a 27% lower risk of CHD compared to those who did not make such changes.
Take home: You can make an even bigger dent in your mortality risk during middle and older age by sticking to improvements over longer time horizons, above and beyond what medications can do for you… and even adopting two out of five factors ain’t bad.
Nurses’ Health Study
This study in the New England Journal of Medicine followed 84,129 women from the Nurses' Health Study for 14 years to investigate the combined effect of lifestyle factors on the risk of coronary heart disease.
Women were defined as low-risk if they had the following characteristics (just 3% of the population hit all 5):
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not smoking
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maintaining a healthy body mass index
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moderate alcohol consumption
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regular physical activity
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a diet rich in fiber, marine omega-3 fatty acids, folate, high polyunsaturated to saturated fat ratio, and low in trans fat and glycemic load (these are all built into diets like the Mediterranean)
These low-risk women had an 83% reduced risk of coronary events compared to all other women.
The study estimated that 82% of coronary events over these 14 years could be attributed to the lack of adherence to this low-risk lifestyle pattern.
(Nota bene - In case you missed my mini-podcast entitled “Examining Room Jawn # 1 - Food Sequencing,” I did touch on how we can better approach the sequence of foods we eat off our plates to blunt glycemic index and promote better nutrient absorption. This episode rocketed past Dr. Huberman on Apple Podcasts to the #1 spot last week, and people started unsubscribing from his highly profitable show in droves. Many found a new home at Examined. (If only this were true, ha!)
Conclusion
Chances are it’s not too late to work on some healthier behaviors in the quest for a longer life and good health span. They say that the best time to plant your cherry, apple, and fig trees was 20 years ago. The second best time is today. Who knows what the future holds. But even if the fates are ultimately unkind to us, eating well, exercising, going easy on alcohol, not smoking, and keeping weight down usually makes us feel better along the way. Studies find consistent correlations between these lifestyle factors and better health, and while correlation does not equal causation, I think we can agree that a randomized controlled clinical trial should not be a purity test for every intuitive and obvious truth we glean from decent studies.
Best of luck, go for some if not all of these lifestyle factors if you can, and cheers to healthy stuff you can’t cram into a pill :)
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In lieu of birthday gifts, please consider a free try of my primary care jawn called Examined, available on Substack.
😆👍