Chapter 2
Aging Really Is the Leading Cause of Death
Even so, that still left me with a manuscript with a four-digit page count. I had to come up with something to meet the publisher’s requirements for printing. The problem was that I didn’t have any chaff I could separate from the wheat. Far too many well-known doctors recycle content from their earlier work to cash in all over again. I try to do the opposite and include only new material, which is why throughout the text I refer you to parts of my previous books where I addressed relevant concepts. So the only way I could think of to reach the target page count was to transform How Not to Age into a fully audiovisual experience.
You’ll see video links popping up throughout the text. My team and I produced hundreds of video bites, each about five minutes long, to cover the hundreds of thousands of words’ worth of information I had to cut from the manuscript. Don’t worry: all practical takeaways are also included in the text. I just want no one to take my word at face value. I strive to justify every single recommendation precisely. Unfortunately, there wasn’t always enough space, so you may want to follow the links to dive deeper into the supporting data, even though I provide the basic conclusions in the book.
Aging Really Is the Leading Cause of Death
Presumably, no one dies of old age. According to one study based on more than 42 000 consecutive autopsies, centenarians had succumbed to diseases in 100 percent of the cases examined. Although all had seemed healthy until shortly before their deaths, even to their doctors, none died “of old age.” They died of diseases, mostly heart attacks. Similar results were found in another series of autopsies of people over 100 and over 85, an age group referred to in the medical literature as the “oldest old.”
If age kills through disease, why wasn’t How Not to Die the only longevity book you needed? In it, I examined what you can do to prevent, arrest, and reverse each of our 15 leading causes of death, starting with heart disease, which isn’t just the number one killer among centenarians, but in the population as a whole. In the United States, every year since 1900, heart disease has been the leading cause of death, except 1918, when the flu pandemic claimed the most lives. (As I explain in more detail in How to Survive a Pandemic, Covid only made it to third place.) For most of this century, heart disease has been the leading cause of death and disability worldwide, and it’s expected to remain so in the coming decades. But is that really true?
Since age is the biggest risk factor for most of our deadly diseases, one could argue that people actually die primarily from old age. In age-related conditions such as heart disease, cancer, stroke, and dementia, mortality rates rise exponentially. Yes, within the same age group, high cholesterol can increase the risk of heart disease twentyfold, but an 80-year-old woman may have a heart attack risk 500 times higher than someone in their mid-20s. A plant-based diet lowers the risk of dementia threefold, yet the difference in dementia rates between those over 85 and those under 65 is 1 to 300. We focus on factors like cholesterol because it’s a modifiable risk factor, but what if we could also modify the rate of aging?
Instead of, as we currently do, addressing individual degenerative diseases in piecemeal fashion, we could focus on slowing the aging process itself. I still remember, as a little nerd, planning to cure cancer when I grew up. But even if all forms of cancer were eliminated, average life expectancy in the United States would rise by only about three years. Why? Because if you escape cancer, you’re merely postponing death by heart attack or stroke. If one age-related disease doesn’t kill us, another one will. Instead of playing “Whack-a-Mole!” and fighting each disease one at a time, we could slow the aging process and solve all these problems at once.
Imagine an intervention that not only reduces your risk for the biggest killers, but also for arthritis, dementia, osteoporosis, Parkinson’s, and sensory impairments. Even if we could slow the aging process by only seven years so that, for example, the average 65-year-old woman had the health profile and disease risk of today’s 58-year-old woman, we could expect to cut overall risk of death, frailty, and disability in half (since that risk roughly doubles about every seven years).
That’s why I wrote How Not to Age.
Is getting old a disease?
For decades, one of the most contentious questions in gerontology has been whether aging itself should be considered a disease. Getting old is natural, sure—but so is an infection, and there we’re talking about a disease. The aging process is universal. Yes, but everyone catches a cold. If you’re interested: in my video see.nf/agingdisease I go into the debate in more detail. Does it matter what you call it? If we call a rose by another name, it wilts just as quickly. If getting old were classified as a disease, it would lead to more funding for its study, as recently occurred with the classification of obesity as a disease.
You’d think the pharmaceutical industry would invest in a drug that would certainly be a blockbuster. But why spend money on research when it can spend it on advertising for all the anti-aging products without proven effects that it already sells? Many of the leading supplement lines are owned by pharmaceutical companies. They are the ones selling “pharmaceutical cosmeceuticals” and “skin creams that reverse the aging process.” The drugmaker Sanofi even partnered with Coca-Cola to develop a “beauty drink.” They’re already making a fortune exploiting the public’s gullibility and desperate yearning for anti-aging products. Why waste more money proving that something really works?
Healthy and Spry
When a group of people were asked the question How long do you want to live? and offered 85, 120, 150 years, or forever as possible answers, about two thirds said they’d most like to make it to 85. But when the question was phrased differently—How long would you like to live with guaranteed mental and physical health?—the most common answer was: forever. It’s not just about how long we live, but how well. That’s embodied in the Greek myth of Tithonus, to whom Zeus granted eternal life but not eternal youth, so he shriveled more and more with age and began to babble without stopping (before finally turning into a cicada).
Longevity is indeed a Pyrrhic victory if the extra years are accompanied by relentless decline. Only about 18 percent of people can be said to “age successfully.” Studies have found that the prevalence of multimorbidity—that is, the simultaneous presence of multiple chronic diseases—among older people ranges between 55 and 98 percent. By 85, more than 90 percent have at least one disease, but on average about four. And just as 85 percent of cancer patients tend to overestimate their odds of survival, the same is true for people with other chronic diseases. People with heart failure or chronic obstructive lung diseases such as emphysema were surveyed. It turned out that their probability of dying in the following year was three times greater than they themselves had estimated. 96 percent of all outpatient dialysis patients thought they would probably still be alive in five years, yet almost half died within two years.