Medical Compass: What does it take to be a healthy centenarian?
By David Dunaief, M.D.
On Sunday, former U.S. President Jimmy Carter celebrated his 99th birthday. While he is currently in hospice care, most of his last decade, he has been healthy and active.
Living into your 90s is becoming more common. According to the National Institutes of Health, those in the U.S. who were more than 90 years old increased by 2.5 times over a 30-year period from 1980 to 2010 (1). This group is among what researchers refer to as the “oldest-old,” which includes those aged 85 and older.
What do they all have in common, other than age? According to one study, they tend to have fewer chronic medical conditions or diseases. Because of this, they tend to have greater physical functioning and mental acuity, along with a better quality of life (2).
In a study of centenarians, genetics played a significant role. Characteristics of this group were that they tended to be healthy and then die rapidly, without prolonged suffering (3). In other words, they grew old “gracefully,” staying mobile and mentally alert.
Factors that predict one’s ability to reach this exclusive club may involve both genetics and lifestyle choices. Let’s look at the research.
How important is exercise?
We’re repeatedly nudged to exercise. Why? Results of one study with over 55,000 participants from ages 18 to 100 showed that five-to-ten minutes of daily running, regardless of the pace, can significantly impact our life span by decreasing cardiovascular and all-cause mortality (4).
Amazingly, even if participants ran fewer than six miles a week at a pace slower than 10-minute miles, and even if they ran only one to two days a week, there was still a decrease in mortality compared to nonrunners. Those who ran for this very limited amount of time and modest pace potentially added three years to their life span.
An accompanying editorial to this study noted that more than 50 percent of people in the United States do not meet the current recommendation of at least 30 minutes of moderate exercise per day (5).
A study presented at the European Society of Cardiology Congress in 2022 found that those 85 and older reduced the risk of all-cause mortality 40 percent by walking just 60 minutes a week at a pace that qualified as physical activity, not even exercise (6).
Does reducing animal protein consumption help?
A long-standing dietary paradigm has been that we need to eat sufficient animal protein. However, many are questioning the value of this, especially as it relates to longevity.
In an observational study of 7,000 participants from ages 50 to 65, results show that those who ate a high-protein diet with greater than 20 percent of their calories from protein had a had a 75 percent increase in overall mortality, a four-times increased risk of cancer mortality, and a four-times increased risk of dying from diabetes during the following 18 years (7).
However, this did not hold true if the protein source was plants. In fact, a high-protein plant diet may reduce the risks, not increase them. The reason, according to the authors, is that animal protein may increase insulin growth factor-1 and growth hormones that have detrimental effects on the body.
The Adventists Health Study 2 trial reinforced these findings. It looked at Seventh-day Adventists, a group that emphasizes a plant-based diet, and found that those who ate animal protein once a week or less had a significantly reduced risk of dying over the next six years compared to those who were more frequent meat eaters (8). This was an observational trial with over 73,000 participants and a median age of 57 years old.
What effect does systemic inflammation have?
In the Whitehall II study, a specific marker for inflammation was measured, interleukin-6. The study showed that higher levels did not bode well for participants’ healthy longevity (9). If participants had elevated IL-6 (>2.0 ng/L) at both baseline and at the end of the 10-year follow-up period, their probability of healthy aging decreased by almost half.
The good news is that inflammation can be improved significantly with lifestyle changes.
The takeaway from this study is that IL-6 is a relatively common biomarker for inflammation. It can be measured with a simple blood test offered by most major laboratories. This study involved 3,044 participants over the age of 35 who did not have a stroke, heart attack or cancer at the beginning of the study.
The bottom line is that, although genetics are important for longevity, so too are lifestyle choices. A small amount of exercise and consuming more plant protein than animal protein can contribute to a substantial increase in healthy life span. IL-6 may be a useful marker for inflammation, which could help predict healthy or unhealthy outcomes. Your doctor can test to see if you have an elevated IL-6. If you do, lifestyle modifications may be able to reduce these levels.
References:
(1) nia.nih.gov. (2) J Am Geriatr Soc. 2009;57:432-440. (3) Future of Genomic Medicine (FoGM) VII. Presented March 7, 2014. (4) J Am Coll Cardiol. 2014;64:472-481. (5) J Am Coll Cardiol. 2014;64:482-484. (6) European Society of Cardiology Congress, Aug. 28, 2022. (7) Cell Metab. 2014;19:407-417. (8) JAMA Intern Med. 2013;173:1230-1238. (9) CMAJ. 2013;185:E763-E770.
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.
