Medicine 3.0: A focus on longevity and healthspan
By Dr. Anusha Khan
These days, you can’t go past a few scrolls on social media platforms without being hit with “wellness ads” about “the latest and greatest anti-aging avenues” or “anti-aging secrets" that are evidently almost always being claimed to be “kept from you” or something that the health industry “doesn’t want you to know about”. Let’s make one thing clear - when we are talking about longevity, we are setting ourselves apart from the “wellness industry”, where "anti-aging” products, “toxic foods that are killing you”, expensive tests that provide no real applicable value, and endless lists of “supplements” promising you a fountain of youth, run rampant. Instead, longevity and healthspan are main principles of a mind-shift in how we approach medicine/healthcare in today’s world: call it Medicine 3.0. A proactive approach to health rather than the norm, which is reactive. Its foundation is evidence-based and evidence-informed framework of medicine, which is used to personalize preventative care to help patients live longer and more importantly, live healthier.
Longevity simply means, years lived. Health span, on the other hand, means how WELL you live - meaning quality of life. After all, who wants to live past 100 and have the last several decades of their life be miserable and fraught with frailty, disease and loss of independence? (the answer is: no one). In order to maximize longevity and healthspan, one has to take an engaging and proactive approach to staving off chronic conditions that threaten our years and quality of life. This means aggressively investing in optimizing your metabolic and physical health now, so that you can reap the rewards in the 6th, 7th, 8th or even the 9th decade of life. This is where the Medicine 3.0 approach comes in.
Currently, most of U.S. is practicing Medicine 2.0. This type of care involves seeking care only when you are sick. Or when the disease has already occurred. When cognitive decline has already begun, when diabetes has taken root, when cholesterol is rampant in the vessels of your heart or when cancer has already taken a hold. This is reactive care. Trying to take action when the damage has already started or occurred. And even though some, if not most, of these conditions still have a chance of reversal, or at the very list, can be kept from progressing - Medicine 2.0 approach is to throw the proverbial “kitchen sick” at you to rescue you from the later stages of illness, prolonging life that is riddled with frailty. When keeping you from needing to be rescued would be a much better approach, in the first place.
Modern medicine has allowed us to be able to put stents in arteries to keep patients from dying after a massive heart attack - but the loss of cardiac function after that heart attack would have been prevented if the beginning of that blockage was found earlier and acted upon - staving off that heart attack in the first place.
Wonderful medications such as insulin and oral antiglycemic medications can help keep blood sugars from reaching dangerous levels but the damage to the blood vessels that high sugars caused, which then result in peripheral vascular disease, would have been prevented if trending blood sugars over time helped to realize the impending path to diabetes the patient was on before, the “lab value turned red”. Just because a lab result is “normal”, doesn’t mean you have a “clean bill of health”. Trending metabolic data can help discern the path you are on - if you were told the path you are on will lead to diabetes even though currently your HbA1c level is technically “normal" - would you remain on that path or do something to change the trajectory so you never approach the destination of diabetes to begin with? It’s similar to if you were told the road that you are on has a broken bridge 3 miles ahead; would you look for a detour or continue down the road and meet your inevitable demise?
We now have genetic and cognitive testing which can help discern risks of dementia and help measure baseline cognitive function, which can aid in picking up signs of even the mildest cognitive decline if or when it begins. This can be invaluable information to help formulate a plan to keep the condition from progressing. But in the current system, the loss of cognition is only realized and acted upon when it has progressed enough to be noticeable by family members and is well on its way to dementia.
You catch the drift. A focus on longevity and healthspan is an endeavor that requires a heavy investment in mitigation and prevention of chronic disease.
The idea is simple. Take a car for example: you can extend your car’s life and use of it for as long as possible, IF you take good care of it. You change the oil, rotate tires, change out the belts, don’t let it sit idle, and aren’t harsh with it with your driving. You have not only improved its longevity but more importantly, you’ve improved its quality (healthspan). The car will last much longer than with a person who does none of those things for it. In fact, it’ll break down, requiring work which would likely cost way more than it’s worth. And it’ll continue to be unpredictable and unreliable.
Similarly, having a doctor who helps keep a check on your metabolic health, helps you build muscle mass and strength, helps you work on stability and flexibility, helps you with exercising cognition while prioritizing sleep, helps screen for cancers early, and helps keep a tight control on blood sugar and blood pressures - will result in improving your longevity and healthspan, well into your marginal decade (the last decade of one’s life). THAT’s the Medicine 3.0 mindset.
It’s the approach that results in the difference between continuing to be an active participant in your life as you age versus living out your last few decades in assisted-living facilities or nursing homes.
As a prominent figure in the applied science of longevity states: “if you want to be a kick-ass 80 year old, you can’t afford to be average when you’re 50.” -Peter Attia MD
Whether you like it or not, your physical and metabolic fitness WILL decline with age. The idea is to build “health reserves” as early as possible - so you can fall back on it. It’s like if you learned to shoot an arrow at 100 yards, shooting at 50 yards will be a piece of cake. Think of it this way - when you make a dedicated and heavy investment in your physical, mental and metabolic health as early as possible, you are starting out at “level 100”, when you really just need to perform at “level 50” as you get older. But if you’re currently at “50” or worse “30” - which many Americans are - and it’s a fact that your metabolic/physical/cognitive health WILL decline as you age- is it any wonder why we see the last several decades of life spent in frailty, loss of independence and in misery.
Much like saving money as early as possible for retirement — you can only draw from it as much as you’ve been able to save. The larger the account - the more comfortable life will be. Much like that car - the better maintained, the less its susceptible to age-related breakdowns.
So while the wellness industry will continue to make expensive false promises of fountains of youth, and the healthcare system will continue to focus on the end-stage of conditions, fraught with frailty - you now know there’s a better more practical approach to health. It’s shifting the focus from trying to extend life once disease has already occurred. Instead, it's about investing major effort to help you live longer without disease and frailty.