Perhaps you may not see yourself (yet…) as a practitioner of Preventative Medicine. However, on a personal level, how much do you think about what you’re doing now in preparation for how you want to function when you are an octogenarian? My initial motivation for exploring Medical Weight Management and Preventative Medicine were purely out of self-interest. I was almost 100lbs overweight and I struggled to get up from the floor when I got down to play with my 6-month-old son. How would I ever play with my grandkids when playing with my infant was such a struggle? I was terrified of my future after having watched both paternal grandparents die from complications of Type 2 Diabetes, and most particularly after my 65-year-old uncle took his own life as a result of misery from complications of DM2. I claimed I wanted to spend my retirement years traveling, but I had watched my grandparents and uncle have that same plan only to spend their retirement years dealing with chronic disease. My genetic crystal ball was showing me my future, and I wanted it to be different. Once I realized that preventing the development of DM2 in my 50’s and 60’s meant changing what I was doing in my 20’s and 30’s, my perspective shifted, and so did the way I discussed disease prevention with my patients.
This shift in perspective, working to prevent chronic disease, rather than waiting for it to set in before reacting, is what Peter Attia, MD presents as Medicine 3.0 in his newest book Outlive. If you haven’t read this book, I highly recommend it. He explains we live in the time of Medicine 2.0, where the standard is to “first do no harm” and react only once there is something to treat. However, in many ways this keeps us from acting until diseases are established and beyond the point of reversal. As a result, rather than live as along and healthy a life as possible before a very rapid decline and death, most of us will start a long and disease-filled decline starting in our 50’s and 60’s and the last several months to years of life will be filled with pain, suffering and little to no quality of life. When we see that patient or friend or family member who has worked hard their whole life only to die a few years after retirement, it should make us question what could have gone differently? Should we be intervening earlier in our lives, knowing that the process of aging is the natural consequence of continuing to live?
Undoubtedly when we think about our own “golden years”, most of us would like to envision being healthy and functional well into our 80’s and 90’s and then dying in our sleep from old age. However, this is not what we see happen. Instead, we see patients develop hypertension and dyslipidemia in their 50’s, heart disease or cancer in their 60’s and die in their 70’s having spent the final decade of their life weighed down by physical and cognitive decline. It doesn’t have to be this way, but changing this trajectory takes intention and active participation in one’s health starting decades earlier.
My favorite example Dr. Attia gives in his book is what he calls the Centenarian Decathalon. When he asks his patients in their 40’s and 50’s what they want to be able to do in their 70’s and 80’s. He provides them with a list to choose from that contains things like Getting off the floor with your own power, Lifting a grandchild, Hiking a mile on a hilly trail, or Lifting a 20-lb suitcase into an overhead compartment. Inevitably we all would like to be able to do these things as we age, right? This would mean we can care for ourselves and enjoy life. However, we know that we are going to lose 8-17% of our muscle strength with each passing decade and it will accelerate as more time passes. So being able to do a squat with a 30lb kettlebell (picking up a toddler) at age 40 isn’t enough. If you want to pick up that 30lb grandkid at age 80, you need to be able to squat with 50-55lbs at age 40 without hurting yourself. Lifting that 20lb suitcase overhead at age 80 means lifting 40lbs overhead now. As Dr. Attia frames it, by doing more now, you “armor yourself against the natural and precipitous decline in strength and aerobic capacity that you will undergo as you age”.
So if you have ever stopped to think “what am I doing now to make sure I have the golden years I envision?” or “what more could I being doing now so I don’t end up chronic diseases like heart disease, cancer, diabetes or Alzheimers?” then give Outlive a read or a listen. Even if it doesn’t change how you practice medicine with all of your patients, it may change the way you practice with some. It may even help you change the way you live now, so you can continue to live the best life possible for you as you age. When I’m 80 and shoving my carry-on in the overhead compartment as I travel to play with my grandkids, I hope to look over and see you there!
Dr. Sherri Thomas
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