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The "most likely to kill or maim you" list

If you’re interested in increasing either your lifespan and/or your healthspan, you need to know what you’re up against. While early humans had to worry about a wild animal or famine taking them out, our modern world of protection and food abundance has led to a variety of other life-derailers.

Much of what an individual will face at a later age is related to his/her genes. So, if you have a family history of heart disease, it’s likely you are also at higher risk for heart disease.

But the good news is that, through many population and twin studies, we have learned that genes are not necessarily your destiny. In fact, one of the most fascinating things about our genetic code is that certain genes can be turned on or off. For example, exercise, intermittent fasting, and eating plants have all been shown to activate your “good” genes.

One thing we are not good about in medicine is preventing disease. We humans are a reactionary group—we often wait for the bad thing to happen and then try to fix it. But when it comes to health, if we wait until a heart attack, a cancer diagnosis, or Alzheimer’s we are too late in the game. Years of damage have already happened and have accumulated into a problem that will now have expensive drug after expensive drug thrown at it just to watch the person succumb to a life of disability before death. Yikes.

But before I digress into a 10-page haul on genetics and a rant on why we are so bad at preventative medicine, let’s have a look at what we’re up against—the top killers and cripplers that will try to prevent our future selves from living their best, healthiest, fulfilling lives.


Cardiovascular disease (CVD)

In people over 50-years-old, CVD still reigns as the reaper of death and disability (although cancer takes over as the lead from ages 60-69). Cardiovascular disease is a very broad term but it essentially covers a particular process: Over time, your miles and miles of blood vessels can get damaged (often by high blood pressure) causing the vessel walls to scar. These tiny scars lead to that vessel becoming stiff. A good blood vessel is pliable, meaning it can expand or contract depending on the amount of blood flowing through it. What’s more, these little rough, damaged areas in the vessels are good at accumulating sticky substances, such as cholesterol. The body tries to repair these areas and remove the sticky substances, but in doing so it can actually worsen the problem into calcified plaques that act like a beaver dam to the rush of blood moving through the vessels. If blood is suddenly blocked from getting to its destination, the destination tissue no longer receives oxygen and it will die. If this happens in the vessels bringing blood to the heart, you get a heart attack. If it happens in the vessels leading to the brain, you get a stroke. So really, doing things now to combat cardiovascular disease is good for your future heart and brain.

Surviving a heart attack or a stroke typically lead to disability. We have become pretty good at keeping people alive after these events with the use of blood-thinners, stents, and other medications. But this can often leave people with long-term disabilities such as shortness of breath when walking from their car to the store, or weakness to parts of the body, or decreasing mental ability and ultimately depression.

So, step 1 will be identifying your risk for CVD through family history, but also through biomarker tests, such as cholesterol levels and others. (More on biomarkers later). Step 2 will involve establishing a game plan to mitigate your risks as much as possible, while still living a happy, fulfilling life. And most importantly, you need to identify these risks and take-action while you are still in good health. Stop the enemy now and prevent or at least delay the war.



For many, this word brings dread and feelings of impending doom. All of us likely have a person that comes to mind when we hear that word. I have long been fascinated by cancer. I remember a 3-hour-drive with my mom when I was in medical school, during which I talked about cancer for the entire drive. I’m not alone, many physicians have spent their entire lives obsessed with figuring out why some of our cells suddenly start dividing out of control. And this process certainly deserves a “deep dive” at some point on this blog for those who also find it fascinating.

The problem in cancer is that the “off” switch on these cells is broken. Normal cells are programmed to divide (reproduce) but then to stop. Cancer cells either don’t get the “stop” memo or just ignore the memo. Further, the cancer cells that grow out of control have ways of evading our own immune system so that the body doesn’t recognize the cells as rogue. Many cells in our body develop mutations that could lead to them growing out of control, but our immune system (namely our Natural Killer Cells) identify them as defective and kill them. When such cells are able to fool the immune system, or when the immune system is week, uncontrolled cell growth can lead to cancer. Once the cancer has grown in its given position within the body, some of those growing cells escape into the lymph system and blood. This is when we have a big problem, because this family of out-of-control growing cells can now move into all areas of the body. We call this metastasis, and this is rarely survivable.

At least once in his term, most U.S. presidents announce something about the “war on cancer” and how we are close to seeing an end to cancer. The problem with such statements, is that there isn’t one war on cancer, there are hundreds of individual wars because we have found that each cancer seems to act independently, to some degree. One person with breast cancer may respond to a chemotherapeutic drug, while another one seems to be resistant.

We are unable to identify one “cause” of all cancers and we are unable to identify, as of now, a single, silver bullet to stop cancer. This can seem really daunting, and likely leads some people to say, “Forget it. I’m going to smoke and eat McDonald’s because something is going to kill me anyway.” But as we’ll discover, cancer can most certainly be prevented. And there are many ways to find cancer at its earliest stage (before metastasis) when it does develop so that curative treatment is possible.


Neurodegenerative disease

Neurodegenerative disease is an umbrella term that includes Alzheimer’s Disease, Amyotrophic Lateral Sclerosis (ALS or “Lou Gehrig’s Disease"), Parkinson’s Disease, and Lewy Body Dementia. If you live long enough, you’re likely to experience some sort of dementia. It’s normal to become more forgetful as you age and have trouble recalling certain words, but sometimes the nervous system succumbs to more than natural brain aging.

Alzheimer’s Disease is a complicated process. Once it is diagnosed, there is very little that can be done to reverse the disease. Many medications have been proposed to slow its progression but with minimal results. Other interventions, such as brain work (puzzles, balance exercises) and dietary changes have shown more promise than drugs for all neurodegenerative disease treatment.

We know that a huge genetic risk factor for developing Alzheimer’s is which version of the APOE gene a person has. The e4 version indicates the highest risk for developing Alzheimer’s, while the e2 version appears to offer protection against it. The actor Chris Hemsworth (Thor) made headlines recently when he revealed that he was tested and carries 2 copies of the e4 (bad) APOE gene, putting him at around an 8 to 12-fold risk of developing the disease. We’ll talk more about the decision to get such metrics for yourself when we talk about longevity biomarkers.



Not so much a disease, but rather a symptom of disease is falling down. This is one of the number one killers, but also a number one reason for a decrease in healthspan. The classic story is that an older person was doing pretty well until he/she fell. Weak muscles and bones and poor balance can lead to a fall. The weak bones will often break, requiring a prolonged period of sitting and possibly surgery. With weakened overall systems, this often leads to depression, mental decline, and ultimately to death.

Alright! Enough of looking at what might take us out. Before you can fight an enemy, you need to know the enemy. And we will get to know each of these enemies in further depth.

The good news about these pesky longevity enemies is that interventions to decrease the risk of one will decrease the risk of others, as well. Stay-tuned as we dive into all the ways you can not only reduce your risk of developing these diseases, but simultaneously increase your well-being into your later years.


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