Peter Attia, MD, has written an excellent book on how to keep ourselves from getting common chronic illnesses with aging. It’s Outlive: The Science & Art of Longevity, which offers a clear strategy to avoid these illnesses. He refers to those which kill the majority of Americans as the Four Horsemen. They are heart disease, cancer, neurogenerative disease, and type 2 diabetes (and related metabolic dysfunction).
He encourages the use of proactive tactics to keep us living well and longer in good health. It is not new to hear from a qualified medical expert that we need to prevent chronic illnesses before they can take hold. It may be a newer perspective to consider more testing to identify signs of these Four Horsemen much earlier in our lives so we
can change things that need to change.
For example, according to Dr. Attia, more than 29 percent of adults over age 65 have clinical type 2 diabetes. It is well understood in medical care that people with diabetes also have a much greater risk of also developing heart disease, cancer, and dementia.
One significant point of Dr. Attia’s message is that being proactive to avoid or successfully manage these chronic illnesses can help prevent all of them from developing or getting out of control. We have known for decades that preventing heart disease requires attention to what we eat, how we move, how we manage stress, and getting enough sleep. His book recommends essentially the same approach to overall chronic disease prevention.
Tactics to use
He identifies the following tactics: 1) developing an exercise plan that promotes peak aerobic cardiorespiratory performance, 2) finding the right meal plan that takes into consideration the quantity and quality of a person’s diet, 3) continuous glucose monitoring, and 4) getting enough quality sleep.
There is a disconnect between what most physicians do about preventing chronic illness and what Dr. Attia suggests. There is also a clash with what most insurance plans will cover. For many people, a visit to the doctor for a checkup may be prompted by symptoms: chest pain, unexplained weight gain or loss, dizziness, headaches, etc. By the time the older person gets an appointment and maybe gets some testing done, there can be confirmation that a chronic illness is already taking hold. Likewise, unless there is a symptom, the typical insurance, including Medicare, does not cover all of Dr. Attia’s suggested proactive, preventive testing that could optimize our health. Generally, our medical care tends to be reactive, not so focused on prevention. Insurance payments often control what a person gets by way of testing. When it’s optional, people resist paying out of pocket.
Glucose monitoring
Take the idea of continuous glucose monitoring, (blood sugar level) which Dr. Attia suggests. That means wearing a glucose monitor on your arm all the time. You can see if your blood sugar level is normal or not anytime. If you see it’s out of whack, you can adjust diet and other habits. Your typical physician is not going to prescribe such a device unless you have signs of a high risk for diabetes, pre-diabetes or related metabolic dysfunction. By the time such signs show up on your lab work, you are already on your way or you actually have diabetes. That is not what Dr. Attia means by prevention.
Simply put, you probably can’t even get a prescription for a continuous glucose monitoring device until you have diabetes. That’s the essence of our problem with preventive testing to help us avoid this particular, widespread chronic illness, type 2 diabetes. His book advocates for changes in insurance coverage for much testing he considers essential. He also advocates for the medical community to transform from being reactive to proactive about chronic illnesses. It’s not there yet.
What kind of old age do you want?
What we know about chronic illnesses and aging is that we don’t want to develop them and have a miserable time in our later years. There is no magic pill that lets us escape responsibility for our own health and longevity. To live long and well, we have to do the things most of us don’t want to do: get off the couch, stop eating processed food and too much food, find ways to address our stress, and sleep more. We can go along for awhile just not bothering to make changes because they are difficult. And there’s no instant reward for giving up that junk food. But the price we pay for not bothering is high. It can mean many years of declining health, lots of medications, constant doctor visits, and loss of independence.
The Takeaway: fend off the Four Horsemen
We do know how to prevent heart disease. That information has been around for a long time. What may not be totally clear is that the same good health habits that do protect our hearts also protect against the other three of the Four Horsemen. No, there is no immediate prize you get for starting something new, like a serious walking program. Increasing exercise is just one of those tactics for healthy aging. But you will likely notice when you do adopt even some of Dr. Attia’s advice, that you will feel more alive and energetic. Your body and mind will cooperate nicely with those great preventive strategies for healthy longevity. A long healthspan, not just a long lifespan is worth the effort!
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