How ‘perfect’ do we have to be to age well?

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The hunt for a longer, healthier life has become a multibillion-dollar industry, as researchers experiment with drugs and supplements, examine exercise regimes and diets as well as the lifestyles of those who live the longest.

The ones who have raged with vitality against the dying of their life’s light have often raised as many questions as they have provided answers on longevity.

What does it take to age well? Credit: Getty

Frenchwoman Jeanne Calment, who reputedly lived to 122 and claimed her breasts remained as firm as “two little apples”, ate half a kilo of chocolate a week as well as drinking a glass of port each evening. British World War I veteran Henry Allingham suggested he had made it to 113 thanks to “cigarettes, whisky, and wild, wild women”. US World War II veteran Richard Overton, who lived to 112, once said that one secret to his long life was smoking cigars and drinking whisky, as he often did on the porch of his Austin home.

These centenarians are not poster children for the longevity secrets of sugar, tobacco and hard liquor. Rather, they are genetic anomalies.

And, sadly for the rest of us, these same approaches are more likely to hasten the end of our life, or at the very least, our health span.

“Centenarians live longer because they get chronic diseases 20 to 30 years later than everybody else,” says Dr Peter Attia, the author of the New York Times non-fiction bestseller, Outlive. “Now their genes do that for them. [But] we’re going to have to use medicine, nutrition, sleep, exercise, etc to delay the onset of those chronic diseases.”

So, how perfect do we have to be to do that? And how much room is there to have fun in our lives without compromising our health?

“I guess it depends on what you consider fun,” Attia tells me. “Say my definition of fun is heroin and cocaine, then there’s probably not a lot of room for fun because I think those risks are pretty high. Or if a person says, ‘my idea of fun is never exercising’, then it’s going to be really hard.”

But Attia insists we don’t have to be pristine to extend our health span.

To monk or not to monk?

“I certainly don’t consider myself a monk when it comes to food,” says Attia, who adds that alcohol, for instance, is not good for us at any dose. “But does that mean we should never, ever consume it? My view is if it gives you pleasure, it gives me pleasure.”

He limits his favourite drinks – tequila and red wine – to four a week and tries not to drink within three hours of bedtime, so it doesn’t disrupt his sleep. He adopts the same attitude of moderation towards chocolate or other foods that we enjoy.

“I am no longer a dogmatic advocate of any particular way of eating,” he writes, adding that the idea there is one perfect diet that works best for everyone is “absolutely incorrect”. Rather, he focuses on whether we are under or over-nourished, under or adequately muscled; and metabolically healthy or not.

What he is “monk-like” about is exercise, which includes endurance, strength, stability work and pushing his Vo2Max, recommending that we move more than the bare minimum of the physical activity guidelines.

“If a person wants to add a decade to their life, they’re going to have to do more than see the doctor and take their blood pressure and cholesterol medicine,” he says, clarifying that those things still matter.

Along with physical activity, getting good sleep and nutrition, doing more may mean taking risks, something that he and others pursuing longevity and health span are willing to do to varying degrees.

We need to do more than the bare minimum, but do we need to be ‘perfect’?Credit: Getty

The longevity gamble

Harvard-based Australian biologist David Sinclair, a leading voice in anti-ageing research and lifespan extension, takes NAD+ booster supplement NMN, as well as resveratrol (which is weakly linked with reduced inflammation and risk of dementia) and metformin (which improves cardiometabolic health and increases lifespan – at least in mice). Stanford neuroscientist Andrew Huberman, whose popular podcast explores longevity and health optimisation, also takes NMN (which theoretically boosts energy production and supports cellular repair, but comes with safety concerns), while podcaster Joe Rogan injects testosterone and takes peptides, which advocates believe can boost growth hormone.

Yet there is a lack of good evidence in humans for most of these approaches. There are also questions around dosing and the interactions between different drugs.

Attia, who takes the medicine rapamycin, which might improve immune function, thinks about risk through the lens of investment. You could do nothing with your money and take no risk, or you could be sitting in Las Vegas gambling taking enormous risks, with enormous potential reward. There is, of course, a spectrum in between.

“I think where you want to be on the spectrum is where you have the highest expected return, not the highest potential return. And I think the same is true in health, although it’s more difficult to quantify,” Attia says.

That means considering the risk versus the expected return. He asks his patients whether they understand how a drug or supplement works; do they have a nutritional deficit or believe that “super normal” levels offer some benefit; is there a biomarker to track if it’s working; is there robust human data and if not, is there data across different species that demonstrates safety and efficacy. Finally, is it prescription-based or is it completely unregulated?

Dr Rosilene Ribeiro, a postdoctoral research fellow at the University of Sydney’s Charles Perkins Centre, is more risk-averse than Attia. “I would not recommend taking medication that has not been thoroughly tested and approved for human consumption,” she says, adding that some of these drugs may inhibit our bodies’ ability to absorb nutrients and can “interact with our diet in unknown ways”.

“Rapamycin has also been shown to affect immune function and cause adverse effects such as anaemia, leukopenia [low white blood cell count], elevated blood pressure and cholesterol,” she says.

And although we are unlikely to ever attain it (and who would want to if it makes our life miserable?), Ribeiro believes we should strive towards lifestyle perfection. “While genetics and environmental factors also play a significant role in our health and lifespan, lifestyle is one of the only factors we can generally control,” she says. “I would recommend that [people] focus their efforts there rather than taking medications with unknown side effects.”

When thinking about how we approach risk and perfection in our pursuit of living well for longer, Attia believes one final question is worth considering.

After years of constantly tinkering and experimenting with different approaches to maximise his longevity and thinking of it as an engineering problem to be solved, he had a realisation:

“Longevity is meaningless if your life sucks. Or if your relationships suck. None of it matters if your wife hates you. None of it matters if you are a shitty father … all these need to be addressed if your life is to be worth prolonging – because the most important ingredient in the longevity equation is the why. Why do we want to live longer? For what? For whom?”

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