The Longevity Book: Live stronger. Live better. The art of ageing well.

Today, in the Western world, diseases that were a dire threat since people have been keeping written records have been virtually eradicated. Illnesses that killed kings and queens don’t trouble us at all. The tiny blip of history in which we are currently living is the only one in which fear of contracting smallpox doesn’t govern our daily activities. And the reason we are granted this good fortune is because regular people and doctors alike got curious about how we could live better, investigated their environments, and then applied what they learned so that we could all become healthier.

That is why longevity is, in many ways, a modern phenomenon. The fascinating thing is that we have almost exactly the same DNA as the people who preceded us, but we get to live a lot longer. Genetically speaking, even in ancient Rome, a person who managed to get the right nutrition and get enough sleep and steer clear of diseases and wars and lions and gladiators could have made it all the way to a ripe old age. But the environment of ancient Rome made celebrating your eightieth birthday a pretty impossible goal to achieve. And, in fact, so did most environments of most places, until the twentieth century.

TRIGGERING IMMUNITY

For millennia, smallpox (#litres_trial_promo) was public enemy number one. It was recorded in the ancient medical literature of Persia, India, and China and has been noted on the remains of Egyptian mummies. Smallpox is even (#litres_trial_promo) thought to have contributed to the first decline of the Roman Empire. When the Crusaders marched over the continent, smallpox marched home with them. And later, when Europe caught discovery fever and sent explorers and emissaries sailing over the seas to the new lands to the West, smallpox hitched a ride.

In England and in the new American colonies, the death toll was enormous. A bad case of smallpox meant a 60 per cent chance of death. By the eighteenth century in England, 400,000 people a year (#litres_trial_promo) were dying of smallpox, and there was no cure (#litres_trial_promo) in sight.

But in countries like China, Turkey, and Africa – which had been suffering the ravages of smallpox for eons – a traditional “folk” treatment was helping to stem the tide. In China, a process called inoculation (#litres_trial_promo) had developed as early as 1100, when it was observed that those who survived smallpox became resistant to the disease. Healers began inserting smallpox-infected needles into otherwise healthy people to deliberately make them sick. This treatment not only helped people survive their case of smallpox, but granted them immunity from future exposure.

Turkish tradesmen had attempted to tell the Europeans about this process, but in England, they weren’t buying it. Variolation (#litres_trial_promo) needed a champion in order to be accepted by Western medicine, and it found one in a woman named Lady Mary Montagu (#litres_trial_promo), the wife of England’s ambassador to Turkey.

In 1715, Lady Montagu travelled with her husband to Constantinople, and her visit changed the world. In Turkey, Lady Montagu learned about the local method of managing smallpox.

“There is a set of old women who make it their business to perform the operation every autumn”, she wrote. “The old woman comes with a nut-shell full of the matter of the best sort of smallpox, and asks what veins you please to have opened … She immediately rips open that you offer her with a large needle … and puts into the vein as much venom as can lie upon the head of her needle.”

Lady Montagu had an intimate relationship with smallpox. It had killed her brother, and it had left her face badly scarred, a daily reminder of what could happen to her children if they contracted the disease. She wanted to do whatever she could to protect them.

First, she had her young son inoculated by the embassy doctor. Then she brought the procedure back to England and had the same physician inoculate her young daughter in front of an audience of court doctors. Eventually the procedure became widely accepted – a precursor to our modern-day vaccinations.

FIGHTING AN INVISIBLE ENEMY

The first breakthrough in extending the human life span was learning to recognize what was invisible: the microbes that swarm around us – in the air, on our skin, in our food – and have the potential to make us sick. Bacteria and viruses are both types of microbes, invisible to our eyes without a microscope and easily transmitted from organism to organism or via food, water, or air. Basically, everywhere you go, everything you eat, everyone you touch, there they are. Microbes.

Bacteria are tiny one-celled living organisms that have a remarkable ability to flourish in inhospitable conditions, from the iciest regions on earth to the hottest vents beneath the ocean floor. Some bacteria are pathogenic, or capable of causing disease, and have the potential to make us very sick; bacteria cause illnesses like cholera, tuberculosis, and gonorrhea. Many harmful bacteria can be killed simply by washing your hands with soap and warm water. But before the middle of the 1800s, people only washed their hands when they looked dirty – not because they suspected that an invisible bacterial army could really ruin their day.

Until the modern era, in the war between humans and microbes, the microbes were winning. In order to push the limits of life expectancy, doctors first had to understand that much of human illness could be traced to the bacteria and viruses that creep onto and into our bodies. To create medicines that killed germs and saved lives, they had to see what had been unseen.

And once they figured out all of that, there was another battle to win: they had to convince people that they were right.

THE REVOLUTIONARY IDEA OF WASHING YOUR HANDS

In mid-nineteenth-century Europe, one in two hundred women who had a baby did not survive the year after giving birth. It was basically taken for granted that after childbirth, a lot of women would catch something called puerperal fever (#litres_trial_promo), an infection of the reproductive organs that often leads to death.

One physician wanted to know why. In 1860, Ignaz Philipp Semmelweis, a doctor at a Viennese hospital, noted that in the hospital’s two delivery rooms, the rates of infection were skewed. Women in the delivery room where medical students assisted births were three times more likely to come down with puerperal fever than the women in the delivery room staffed by midwives.

Though the chief of his hospital urged him to leave the matter alone, Dr Semmelweis wanted to investigate the discrepency. Why were so many women and babies dying? Why did more women survive when their babies were delivered by midwife?

Dr Semmelweis figured out that while the midwives did have better training and more experience than the students, skill wasn’t the only reason the patients survived. Remember, nobody understood how germs spread yet. The medical students weren’t thinking twice about where they were before they stepped into the room to help deliver babies. But Dr Semmelweis noted where they were: in class, dissecting diseased cadavers. That’s right. The students would go straight from the dissection room to the delivery room without washing their hands. They were transmitting bacteria, and ultimately, infection.

LONGEVITY VOCABULARY

• LIFE EXPECTANCY: How long you can be expected to live if you are born in a certain time and in a certain environment

• LIFE SPAN: How long an individual actually lives

• MAXIMUM LIFE SPAN: The longest recorded life span for the species (122.5 years for a human female)

• HEALTH SPAN: The healthy years of your life

• LONGEVITY: How long you can live

• STRONGEVITY: How strong you are over the course of your long life

When Dr Semmelweis instructed students to wash their hands before each examination, the maternal and infant mortality rates (#litres_trial_promo) from puerperal fever dropped sharply. Once one of the top causes of postpartum infection, this disease is now barely seen in the developed world.

Dr Semmelweis is credited with introducing the idea of antisepsis (#litres_trial_promo): sanitizing your hands and keeping surfaces free of germs. His discovery changed our entire understanding of germs and illness. This was a crucial shift for the human life span, because it gave more women and more children a fighting chance at survival. Dr Semmelweis’s investigation is the reason why there are signs in public toilets around the world today reminding people to wash their hands.

Another breakthrough for the human life span was the introduction of antibiotic drugs like penicillin. Before the mid-twentieth century, simply trimming your rose garden could be a dangerous pastime. The discovery of antibiotics changed the way people lived their lives. As researchers beat back the bacteria, children, young adults, and women (#litres_trial_promo) were all afforded a better chance of living longer. After penicillin was invented, the human life span jumped another ten years.

As more people aged, the ratio of what was killing us shifted from infectious diseases to the illnesses that accompany ageing, like heart disease. By the 1950s, as people started living through infections and making it to their seventies in record numbers, cardiovascular diseases became the number one killer (#litres_trial_promo) in the country for men and women. It is still the number one killer today, partially because the technological advances that increased life expectancy also led to modern conveniences that can undermine it: innovations like processed foods and devices that enable us to live sedentary lifestyles.

WHEN LIFE GOT LONGER (#litres_trial_promo)

HOW WE GOT HEART SMART

Until the middle of the twentieth century, the causes of heart disease were an utter mystery to the medical community. Most theories were based on speculation; there was not enough meaningful data to provide any real insight into how to prevent the disease that was killing so many people in Western societies. Then in 1948, in the United States, the National Heart Institute (a part of the NIH) launched a study that is still recognized as one of the most important medical accomplishments of the era: the Framingham Heart Study (#litres_trial_promo). More than five thousand men and women between the ages of thirty and sixty-two from the town of Framingham, Massachusetts were selected to participate in the longitudinal study, which assessed the health of these individuals every two years over the course of several decades. (The study is still running; in 1971, another group of more than five thousand participants enrolled, the children of the original group; in 2002, the grandchildren of the original group signed up.) Through tracking such a large sample of participants over time, researchers learned that the common denominators of heart disease included high blood pressure, smoking, and high cholesterol levels. A model for later longitudinal studies, the Framingham study gave doctors a way (#litres_trial_promo) to identify possible heart disease candidates and to develop preventative measures. It was also the first major study that included women (#litres_trial_promo), an important qualification that we will discuss in more detail later.

At the time that the Framingham study began, treatments for age-related diseases were mainly aimed at easing the symptoms (#litres_trial_promo) and making the patient comfortable, not actually curing the disease. But in the 1950s, doctors gained new ground in surgery. Insights gleaned from surgeons in World War II allowed surgical procedures to become more specialized. Doctors better understood (#litres_trial_promo) and had better access to diagnostic tools, anaesthesia, and blood transfusions. And the widespread availability of antibiotics made high-risk surgeries safer. Surgeons were more confident than ever, and their first order of business was the heart.

By the 1960s, heart transplant (#litres_trial_promo) surgery was on its way. In the middle of the decade, a chimpanzee’s heart was put into a man. In the late 1960s, the first human heart was transplanted (#litres_trial_promo). Revolutionary techniques like these, along with the rise of coronary care units, the treatment of high blood pressure, and the improved medical response to coronary disease, were part of the West’s response to the threat that cardiovascular disease represented.

Between 1950 and the end of the twentieth century, although cardiovascular disease was still the number one killer of men and women, the number of such deaths dropped by half (#litres_trial_promo). At the same time, the study of cellular biology became more sophisticated. Better diagnostics and therapies stemmed from discoveries in biochemistry and physiology, such as the ultrasound and the CAT scan. Each development offered doctors and scientists the opportunity to utilize more sophisticated information about the human body. And as a result, in the West, human life expectancy got longer (#litres_trial_promo).

For human beings today, life may be getting longer still. We are starting to develop a much deeper understanding of the causes of many age-related diseases, how to treat their symptoms, and how to prevent some of these illnesses in the first place. Tests now exist that can screen for and accurately diagnose cancer and other chronic conditions before they progress to a fatal stage. Numerous medications are widely available to manage hypertension. And, just as we all now take it for granted that washing our hands is essential to limiting the spread of germs, there aren’t many people alive today who aren’t aware of the fact that smoking is bad for you.

It wasn’t an accident or a random mutation of our genes that bought us these extra years of holidays, vacations, birthdays, and anniversaries. These bonus years are the result of developing a better understanding of the world we live in and the dangers that are present. They are the result of the efforts of countless individuals striving at universities, hospitals, and other learning centres, all asking “why” every day. The knowledge we have gained over the past 150 years has allowed us to casually refer to our forties as “midlife” – and to be 100 per cent correct.

PLEASE TRY THIS AT HOME

Many doctors say that compliance is the hardest part of keeping people healthy – they can tell us to treat our bodies better or prescribe medications, but they can’t make us adhere to their advice.

Over the past several decades, public health officials have been working to raise awareness that habits like smoking, not getting enough exercise, and eating junk foods are unhealthy. Despite their efforts, nearly 20 per cent of American and UK adults still smoke (#litres_trial_promo). Nearly 70 per cent of adults are obese (#litres_trial_promo) or overweight. Less than 40 per cent eat the recommended (#litres_trial_promo) five servings of fruit or vegetables every day. These are all indicators that more people still need to hear, understand, and implement the message about making healthy choices.

The reality is that for a large percentage of Westerners, choices are limited. Cost, access to healthy foods, and education are real issues that perpetuate the obesity crisis. Many families subsist on fast food or processed foods, both of which are high in unhealthy fats and salt as well as loaded with hidden sugars and preservatives. One of our greatest challenges as a society and as individuals is turning education into action, and helping individuals remove the obstacles that make unhealthy choices cheaper and more accessible than healthy choices.

The bottom line is that our lifestyles affect our risk factors for disease. If our life expectancy numbers don’t continue to climb, and the next generation’s life expectancy is lower than that of their parents, it is going to be the result of what they have learned at home.

THE COSTS OF THE SILVER TSUNAMI

The ability to live longer, to spend more years on this planet and more time with our families and loved ones, is an amazing opportunity. But just as with any opportunity we seize, there are also consequences.

For the first time in history, there are now more people over the age of sixty-five (#litres_trial_promo) than under the age of five living on this planet. Researchers call this phenomenon the silver tsunami.

The silver tsunami makes ageing a pertinent topic for every person, no matter when his or her birthday is. For most of human history, as we now know, people didn’t live to be very old, so young children tipped the scale of the population – there were always more kids around than old people. But all that is about to change, and it is imperative that we consider what the impact will be on a social and economic level so that we can figure out how best to navigate the coming tide.

The first wave of the incoming tsunami will be made up of baby boomers, who were arguably the first generation to fully benefit from all the advances of modern medicine. Everyone else will be a part of subsequent waves. And as even more sophisticated medical technologies emerge, science will likely push the boundaries of life expectancy once again. All that longevity comes at a price. Healthy adults will retire later, which means that the people we vote into government will have to reconsider retirement ages and benefits, and people who run businesses will have to change the way they staff their companies. Traditional hierarchies may be overturned. Many older people may find themselves taking lower-level positions, reporting to people who are actually their junior in age but their senior in authority.