SOA Review of Literature on Maximizing Health Span

 

The Society of Actuaries Research Institute release a summary of several elements of a healthy (or unhealthy) lifestyle and their interventions and related these concepts to retirement aged populations. Lifestyle items in the report were:

1. Tobacco Use
2. Body Mass Increase
3. Metabolic Risks
4. Dietary Risks
5. Physical Activity
6. Screenings
7. Immunizations
8. Social Engagement
9. Cognitive and Mental Health
10. Emerging Evidence

Plus considerations were made for Aging in Place, Inequity, and the role of the Employer. 

Is Longevity Escape Velocity Science Fiction?

The Fountain of Youth.  The Holy Grail. The Philosopher's Stone. Humanity's quest for immortality features several legendary artifacts. 

Meanwhile, in the modern era, we have put computers in our pockets, go to space on a regular basis, can grow organs in a lab and machine based algorithms run many aspects of our lives. These advances sometimes make science fiction look more like prophesy. 

Is living into the 13th decade of life or beyond actually possible? Could it happen sooner than you think? Or is it just fantasy? Should we consider the cautionary tale of Icarus who flew too close to the sun? 

A new series called "Let's Talk Longevity" kicked of with a conversation (sort of debate) between Drs. Aubrey De Grey and Charles Brenner, centering around the possibility of achieving "Longevity Escape Velocity" (LEV).

De Grey's position imagines the possibility (50% chance in next few decades) of a "Methusalarity" a moment in which we begin to reverse some aspects of "aging" , primarily via "damage repair" at such a rate that we are able to repair damage in the body as fast as or faster than that damage is occurring. More concretely defined, it can be thought of as 20-30 years more of expected healthy life at age 60 when anti aging therapies begin.

Among the preamble to this definition, he calls out some important caveats:

1. "Aging" is primarily damage accrual
2. LEV requires "repairing damage" which is different than delaying or slowing damage

As a counterpoint, Dr. Brenner posits that the current approach to assessing the feasibility of  achieving LEV is "science fiction." The claims are 'unfalsifiable' and stretch known science beyond reasonable limits.

Cornerstones of Brenner's arguments are:

1. The age limit is genetically coded, optimized for reproductive health, and any "damage repair" mechanism would still come up against this hard limit.
2. The applications and effects of interventions face seemingly insurmountable challenges of "complexity" and furthermore any of the interventions De Grey has proposed have yet to demonstrate an extension of the genetic upper limit.

A recap of the dialogue is below.

Will Prescribing Vegetables Reduce Health Costs?

Recently, Tufts University published a research paper that looked at the effect of price incentives on health cost savings. (Paper: here).

This was brought to my attention via a new headline that read:

"“Prescribing” fruits and veggies would save $100 billion in medical costs" 

-Fast Company January 2021: LINK

$100 billion sure seems like a lot! And these are the kinds of statements that get my inner actuary all fired up.  Where did this number come from?  I will unpack this bit by bit (or maybe bite by bite?) and please allow me a few rants.

Death as a Dinner Guest

In the last post, we discussed Memento Mori - and how being conscious of mortality can motivate us to act and pursue a life of virtue.

In this post, I want to discuss death (and beyond?). 

The good news is that for many of us in the modern world, death is not something we see everyday. That is a wonderful world to live in. However, the less you encounter something, the more unfamiliar it becomes. We become afraid of things we don't know about or trust.

Let me be clear.  I am not talking about our innate fear of dying that helps us survive. To sense a threat and go to a fight or flight state is a very helpful feature of our programming. 

Instead, I am referring to fearing death as if it is the main monster in a slasher horror film.  It is something we recoil from, running away screaming when its shadow looms around us.

In our current times, we are battling a new monster like COVID-19, and death seems to be wreaking havoc among us in a Godzilla-esque fashion.

What I would like to entertain is a more neutral perspective. Can we come to a state of acceptance and perhaps even comfort with death? If so, then perhaps we can respond to it calmly and naturally. 

So, let's consider some alternative ideas of death:

Memento Mori or Memento Vivere?

I recently read an email from The Daily Stoic that challenged my current mindset.

Currently, my focus is on longevity - doing everything I can to maximize the chances I will get to live as long and as healthy as possible.

As a result, I am trying to make my decisions for the long run.

This is necessary in order to choose kale instead of Pringles.

But it may have a weakness. If we take long life as a given, then we (I) can be tempted to defer items to later point.

So does this mean I should eat the Pringles, because who knows if I’ll be around tomorrow?

Honestly? Maybe.

The ‘memento mori’ mindset is not a new one. I hadn’t realized that there was a whole genre of artwork that has the nearness of death as a theme. “Vanitas” paintings had skulls somewhere in the background, along with elements like hour glasses for time and flowers for life.

The Hungry Brain by Stephan Guyenet - Discussion Questions

It's hard to know what to trust these days, but I found Guyenet's text to be the standard for honesty and humility. He clearly lays out what we know and what we don't.  If a discovery has had reinforcements, he says so, if it is still awaiting further proof, he admits that as well.  He tips his hat to fellow and even competing researchers, acknowledging their texts and papers in every chapter.

Not only is the text reliable, it is useful and quite illuminating as to why there is an obesity epidemic and why it is so dang hard to fight it. The text is rich with insights, and the discussion questions will be focused on reactions or actions you might consider from each insight.

By the way, Stephan runs the website Red Pen Reviews, which rates texts on their scientific accuracy.

Without further delay, let's explore some reflections on the ideas presented in this text.

1. A tough question off the bat - how do you feel when you see a really obese person?  Do you believe they are fat because of their own choices? Is weight loss to you as simple as calories in vs.calories out? Do you feel like your own weight is totally in your control? 
2. Fat and sugar are often demonized as evil. In the story about the African tribe that has ties to our earliest ancestors, we see dietary actions like eating the equivalent of bacon grease soup and drinking a liter of honey and they do not struggle with obesity. What are the key factors that contribute to the bad reputation of fat an sugar in western, affluent society?
3. There is a scene in the movie The Matrix where a character is eating a steak. This is in contrast to his usual diet is a tasteless gruel of nutrients. To continue to eat the steak, he has to give up freedom and knowledge and betray his friends. Talk about the alluring power of food. One recommendation that comes from the scientific research is to simplify your diet, making it a bit more bland, and a bit more predictable. Do you think this is practical? What barriers would you have to overcome to achieve this?
4. There are two main notions in the book that challenge the idea of control and free will. First, is the concept that our brain is making decisions before we are aware of it. Second, is the idea that there is a control mechanism hardwired between our stomach and our brain stem that regulates our consumption. These mechanics don't help us in our food rich environment, but we may able to change our eating habits in ways that reinforce our bodies innate ability to know when to stop eating and how to feel full. Do you find it illuminating or frustrating to learn that there are unconscious processes involved in eating? Does this give you new ideas on how to approach your meals?
5. We are well aware of the common ailments of obesity - heart attacks, diabetes, etc. But had you ever considered brain damage to be one?  How does adding this potential ailment to the list change your perspective on food and diet and even obesity treatment?
6. We know smoking is bad for us, drinking excessively is bad for us, and the western diet of hyper palatable foods is not doing us any favors. Yet, you or someone you know is likely choosing immediate pleasure at the cost of long term health. Knowledge may not be enough. What sort of things will help move the dial? Would you be willing to take pills or undergo surgery to alter your inner compass?
7. Surprise, surprise, two major elements that contribute to weight gain and food consumption have nothing to do with what or how much you are eating. Namely, stress and sleep. Does it feel overwhelming or helpful to have to have a more holistic mindset towards health?

Lifespan by David Sinclair - Discussion Topics

I am not going to do classic book reviews on this blog. Any book already has plenty of reader's opinions and frankly I am not always qualified to critique some of the scientific claims that an author may present. I'll defer to the masses and the experts for those thoughts.

What I will do is offer some discussion questions that I think are worthwhile for the longevity community.

1. A central idea to Sinclair's book is that there is a singular cause for aging, namely loss of 'information.'  Do you find his claim convincing or simply convenient? How so?
2. Is the pursuit of a singular aging cause worthwhile, or are we better off tackling it in a multi faceted approach?
3. Which of Sinclair's research findings to you find the most exciting? Most terrifying?
4. In the legend of Prometheus, stealing fire from the gods brought him eternal torture. Sinclair presents some potential consequences to 'curing' aging - are we ready for a world in which aging stops? 
5. Are you ready to start taking a pill that prevents aging? What if it only slows it down? 
6. Suppose a pill that prevents aging is available, should it be mandatory, similar to vaccination?
7. When do you think you are going to die? What would it take to change that expectation?

Contemplating Longevity Part 4: Mechanistic Theories of Aging

At the time of this writing, COVID-19 has the globe in a state of uncertainty as the virus spreads and we await a treatment.

But there is another condition that is 100% fatal that also has no known cure (yet). Aging.

For the community of scientists who view aging as a disease, a lot of the focus is on the pieces and parts that make us who we are.

To date, there has not been a discovery singular item that explicitly causes or delays aging. The thing is, it seems to be a bit of a game of whack a mole.

1. Scientist will find something that looks a cause of aging. 
2. Then they try to interrupt that thing and see what happens. 
3. Maybe they stop the phenomena successfully, but aging still continues. Or aging may slow in some cases but not others.
4. Go back to 1.

What sort of things have they found along the way? How well do we understand our machinery?

A Longevity Virus?

As an intermission to all the COVID-19 news, let's take a moment to consider the beneficial role of viruses in our longevity.

In the movie The Matrix Agent Smith calls humanity a virus.

He might have been more accurate to say humanity wouldn't be the same without viruses.

Contemplating Longevity Part 3: Evolution Based Theories of Aging

What was the first moment you realized you were getting older?

A memory for me was when I went into the training room at college after basketball practice. As a freshman, I wondered what all these guys were doing laying down on training tables, sitting in ice baths, and having things wrapped and taped. Four years later, I found myself appreciating the services of the trainers to soothe aching joints and muscles.

Now, the grind of competitive athletics certainly introduces some wear and tear, but even for non-athletes the progression of age seems inescapable.

There is a Norse myth that tells of Thor wrestling an old woman named Elli. The harder he struggles, the stronger she seems. Eventually, even mighty Thor submits, and finds out that this elderly woman is 'old age' herself.

Aging is not a uniquely human experience, although some organisms age in dramatically different ways. The naked mole rat, tortoises, redwood trees and the 'immortal' hydra come to mind.

Humans have made remarkable gains in life expectancy. More people are living for more years. But the rate of aging, think of the point in life we see wrinkles and gray hairs appear, has not changed very much at all. Why is that?


The scientists that are looking under the hood have a few ideas. From studying other creatures, and looking at various unique versions of homo sapiens, we are starting to build a knowledge base that can give us some insights.

From this knowledge we are starting to show that in some cases we can slow down or delay the aging process. At the very least, we get a better understanding of things that can speed it up (which most of us want to avoid).

It is important to note that there is not one universal theory of aging, rather there is a universe of aging theories.  In some ways we are like the blind priests holding different parts of the elephant.

Let's take a quick tour through the aging universe and see what's out there.

Contemplating Longevity Part 2: To Infinity and Beyond

In Part 1, we considered how gains in childhood mortality affect the calculation of life expectancy, as well as how birth conditions influence your odds of living to an old age.

Now, let's look at some interesting things at the other end of the age spectrum.

First, let's visit the "mortality plateau".  This is not an actual rock formation (at least I couldn't find one, the closest I got was the "Death Canyon Shelf")

What I am referring to is an intriguing phenomena at old ages.

Contemplating Longevity Part 1: The Importance of Starting Strong

Like every fire begins with a spark, every life has a starting point.

For now, let's define our starting point as birth. And let's also consider the first few years.

I want to look at this from two directions.

First, from a measurement perspective. You may hear news headlines about movements in life expectancy.  Fluctuations from one year to the next are usually fairly small.  But if you look back a few decades, the gains have been huge in several countries.

It may seem counter intuitive, but a lot of that lift over the past few decades has not been a function of life extension at older ages.  Instead, longevity will go up, sometimes dramatically, when more little humans survive their first few years.

Second, do your birth circumstances predict your longevity?  To what extent? And if they do, is there anything you can do about it?

Grab your marshmallows and graham crackers and let's cozy up to the fire and contemplate longevity!

Is Death Random or Predictable?

Another way to ask this is: is it more like a casino game or a battery?

Let's visit each position.

A Study of a Study: Lifestyle Changes Add 14 Years your Life

The news headlines come out:

But what does this actually mean?

Where do these claims come from?

There are many studies that have headlines like this.

Let's unpack this a bit, it's a bit of a ride!

Living to 100 Conference 2020

The Society of Actuaries put together this event every 3 years.
livingto100.soa.org/



For media coverage see below:

Tips on Moving More in an Office

The following seven tips can help you get moving in cubicle world.

Ongoing Reviews of Mindfulness and Meditation Apps

 

There are a bunch of meditation apps out there, and plent of people have their reviews posted on Apple Store or Google Play. However, for a quick intro to each one, you can take a look at my own experience.

Eat Your Numbers

Link to an article I wrote for contingencies magazine.

Eat Your Numbers

Assumptions and Approaches

When it come to living longer, there are many studies and claims about what works and what doesn't. From my actuarial background, I've developed some layers of scrutiny by which I view the world.

Prologue

"And the winner of the Workable Innovations for Living Longer Contest is Longevity Assistant by Nate Worrell."

So begins the journey into the development phase of Longevity Assistant.  But the adventure started earlier.