May 27, 2025 • 34 mins
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We all want to live long and well—but how do we determine how many good years we have ahead?
In this episode of Live Long and Well with Dr. Bobby, we explore how to estimate both our total lifespan and the number of years we can expect to remain active and pain-free. Dr. Bobby reflects on personal experiences, emerging science, and time-tested frameworks to help you reframe your health trajectory with clarity and motivation. While we may not find exact answers, the tools and thought experiments shared in this conversation can shape the way we live now—and influence how we plan for the future.
We begin with why this topic matters, touching on personal stories of loss, aging milestones, and medical advancements. Then we move into three frameworks: how many years you might live (using tools from actuarial tables to cardiovascular risk calculators), how many of those years might be "good," and the wildcard of unpredictable events.
The simplest predictor comes from actuarial life tables, which estimate life expectancy by age and sex. A 55-year-old man today might expect to live to 79; a woman to 82. More advanced tools include the Framingham Risk Score, which factors in cholesterol, blood pressure, smoking status, and diabetes to estimate 10-year cardiovascular risk. Research suggests that sharing these risk scores can lead to behavior changes, as shown in this meta-analysis of 28 studies and preliminary evidence of outcome improvements.
On the genetics side, polygenic risk scores offer a glimpse into inherited risks, though they remain research tools for now (Nature study). More accessible are tests for specific genes like APOE4, which increases the risk of dementia (PubMed).
Beyond numbers, simple physical tests can offer insight. The Brazilian sit-stand test links mobility with mortality risk: fewer than 8 points doubles your six-year mortality risk. Grip strength, too, is a strong predictor of all-cause mortality across 17 countries (PubMed).
While biologic clocks based on DNA methylation are generating buzz, their utility remains limited due to variability between samples and testing methods (Nature Communications).
When it comes to estimating “good” years—those lived free from major pain or disability—the data are sparse. Some disease-specific tools (e.g., for MS or dementia progression) exist, but there’s no universal actuarial equivalent. However, we know muscle mass and aerobic capacity decline predictably with age—1–2% muscle loss per year and a 10% drop in aerobic fitness per decade (OUP Journal). Predicting your future function can begin with assessing how far you can walk, whether stairs leave you breathless, or how your weight and strength compare to a decade ago.
Finally, we can’t forget unpredictable events: the odds of a serious fall increase significantly after 65, and vision or hearing loss multiplies that risk (NCOA). Building physical resilience now can reduce these odds—see
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
We all want to live long and well, but how much time
do we actually have?
Are there ways to determine howlong we might live and how many
of those years will be goodones?
We may not find the fountain ofyouth, but perhaps we can
figure out how many good yearswe have ahead of us.
(00:24):
Hi, I'm Dr Bobby Du Bois andwelcome to Live Long and Well, a
podcast where we will talkabout what you can do to live as
long as possible and with asmuch energy and figure that you
(00:47):
wish.
Together, we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
I'm a physician, ironman,triathlete and have published
several hundred scientificstudies.
(01:09):
I'm honored to be your guide.
Welcome, dear listeners, toepisode 39.
How many good years do you haveleft?
Well, we all want to live longand well, but how much time do
(01:29):
we actually have Now?
Knowing that might influencewhen we retire, our savings to
get to retirement, our spendingnow, our spending in retirement
and the activities we mightenjoy now rather than waiting
until later?
Well, we don't know.
(01:50):
Many have talked about thisissue, about not knowing how
many good years or years we haveleft in there.
Say live every day like it'syour last, which generally
sounds like a good idea at somelevel.
There's also the weeks of lifecalendar.
(02:10):
That's gotten very popular4,000 weeks, which basically is
a bunch of boxes on a chart thatyou hang on the wall and you
check off the boxes as each weekgoes along and you get this
visual sense of ooh, I'm a thirdof the way through my life, I'm
half the way through my life.
Oops, I'm on the back end ofall of that.
(02:33):
That's gotten a lot ofpopularity.
Well, here's a thoughtexperiment before we dive into
data how long do you think youwill live?
Do you think you'll live to be75?
Do you think you'll live to be85?
Do you think you'll be one ofthose that might live to be 100?
How many of those years will begood years, meaning you're
(02:58):
functioning well, you're activeand you don't have pain to
contend with?
Do you think your good yearswill go until you're 65, 75
later?
Well, before we can get too far,we need to define good years.
Now, what I'm about to say toyou is a little bit, you know,
(03:18):
sort of tongue in cheek, becauseit doesn't apply to most of us,
but if your definition of goodyears is peak performance, for
most of us listening we're pastthat age in a number of regards.
If you want to be a world-classgymnast, as a girl or woman,
they tend to peak at ages 16 to22.
(03:40):
Mathematicians are reported todo their best work in their 20s,
and marathon runners seem to dobest in their late 20s and 30s.
Well, how about for the rest ofus?
Because obviously this is nothow we will probably judge good
years.
Now, over the course of the nexthalf hour, I may not be able to
(04:04):
give you the precise answer tohow long you're going to live
and how many of those will begood years.
Nobody can do that, but what Ihope I will do is provide a
framework or various ways tothink about it.
Motivate how you live your lifemight motivate changes in your
(04:25):
life, what you do, how you do itand how you might increase both
the number of years and thequality of those years.
Well, as always, I need toexplain to you why.
Why do I want to talk aboutthis topic, where's the
relevance in my life?
And then hopefully, it willring true for you.
(04:48):
My dad was a physician, workedvery hard and he got multiple
myeloma, which is a cancer ofthe blood forming elements in
your bone marrow, and he gotmyeloma at age 56 and he died
some years later.
I would say, looking at hisquality of life, his good years
ended at age 56.
(05:09):
Now I'm older than that now,and so I am mindful of my own
family history.
Recently, several friends outof nowhere had cancer diagnoses
one kidney cancer, one withprostate cancer and their lives
obviously changed a lot.
My listeners you give mewonderful feedback and comments.
(05:34):
Tell me, you know, when Iturned age 60 or when I turned
age 70, things seemed todeteriorate.
I seemed to be fine before that, but boy, a whole lot of things
seemed to go wrong, starting atthose ages, and so, therefore,
I started thinking about more ofthis topic, and there's so much
(05:55):
hype about these new biologicor epigenetic clocks due to
methylation of the DNA, and Iwanted to at least talk a little
bit about that, because peopleclaim this can help you
understand how long you mightlive.
I'm probably going to do awhole separate episode on this
(06:16):
topic.
Let me know if you'd like it,but I will touch on it briefly
today.
So let's look at what we knowand don't know, since how many
good years we have left is acritical life question, and it's
been around for thousands ofyears and probably will be
(06:37):
around for another few thousandyears.
Before we dive into theinformation, I have two requests
.
Number of you have texted methrough the podcast app.
Unfortunately, although I getyour texts, many of you want an
answer and are upset that Idon't give an answer.
(06:59):
But I can't.
The way you submit them doesn'tallow me.
Those services don't allow me.
By all means, go to my website,drbobbilivelongandwellcom.
You can message me throughthere.
Then I'll be able to respondback to you, because I really,
really do want to do that.
My other request please sharethis podcast with others, not
(07:22):
just this podcast episode.
Please share this podcast withothers, not just this podcast
episode, but the Live Long andWell with Dr Bobby.
As I've mentioned many timesthat you know, I have no
financial part of this.
I only want to help you.
So the more people that get thepodcast, the more people I can
help.
Okay, let's dive in.
How might we think about thistopic?
(07:45):
What I'd like to do is puttogether a framework.
First one is how many years oflife, not how many good years,
but how many years of life do wehave ahead of us?
Now?
This may range from somethingvery simple, like actuarial
tables, to something complex,like risk equations, and we'll
(08:05):
talk through those.
Some of these are wellunderstood, been around for
hundreds of years as approaches,and some are new and as yet
unproven.
Next, we'll explore a frameworkfor well, how many good years
and by my definition of goodyears is you can be active,
(08:26):
you're pain-free, you don't haveany really disabling symptoms
this is much tougher to predict,as we'll talk about.
And then, thirdly, theimpossible to predict the
unpredictable accidents andinjuries.
We can't ignore these wild cardevents, although, obviously,
(08:47):
because they're unpredictable,we can't predict them.
Underlying everything we talkabout is the nature versus
nurture question.
You know, is it determined bymy genetics how long I will live
and how many good years, or isit the environment and what I've
done?
Well, clearly, with the sixpillars?
(09:10):
I believe that exercise andsleep and nutrition, and
exposure to heat and cold, andmind-body harmony and social
relationships will affect ournumber of years and the quality
of those years.
But at some level this doescome down to genetics.
It appears that when you'retalking about people who live a
(09:34):
very long time, say they live tobe 100, perhaps a lot of that
has to do with nature, notnurture.
But for most of us who may notlive to be 100, obviously what
we do and how we do it makes abig, big difference.
But it's going to be a blend,one back of the envelope
(09:54):
approach to this.
Look at your family how old didthey live before they died?
How functional were they beforethey started to deteriorate and
have problems physically,mentally and otherwise?
All right, let's begin with howmany years we have, how long
(10:17):
are you likely to live?
And I'm going to walk throughfour approaches and give you
action items that you might wantto try.
Well, the oldest approach isactuarial tables.
These are tables that give youthe probability of how long
you'll live based upon your age.
Now, we might think this issomething relatively recent, but
(10:41):
it was discovered recent.
But it was discovered 450 yearsago, or 400 years ago by James
Haley.
Now, james Haley wasn't famousfor the actuarial approach.
Of course he did come up withit.
He's known mostly for Haley'sComet, but he in fact put
together the first life tableand in its simplest version it's
(11:04):
broken out by age, and men andwomen, and it basically says how
many years you will survive.
And this is a populationaverage, doesn't apply to you
per se, but it's better thannothing in terms of prediction.
So what do life tables tell us?
Well, today, in the UnitedStates, your survival at birth.
(11:27):
So, at birth, boys, men, willlive to be the age of 73.
Women, at birth, will live, onaverage, to age 79.
Now, that doesn't soundparticularly old.
But also realize that a lot ofpeople die, maybe in childhood,
(11:47):
maybe with a motor vehicleaccident, maybe with suicide,
maybe overdose.
So the older you are, a lot ofthose people are not in the
table.
And so what's remaining?
You tend to live longer.
So, in contrast, if you were toask the question of these
tables, well, I'm age 55.
(12:09):
What's my expected survival, onaverage, from an actuarial
standpoint?
For men it's 79.
So not the 73 at birth, up to79.
And women it's up to 82.
So these are numbers you'veprobably heard people throwing
around, because typically peopleare looking at it in this
fashion.
So the longer you live, thelonger you are likely to live.
(12:34):
My expected survival is about16 years, or I am expected to
live till age 84, based uponlife tables.
What's the action item here?
The action item here is in theshow notes.
I will have links to all ofthese various things.
Go to a link to an actuarialtable, look where you are on it
(13:01):
and see what that tells you.
Is this how long you'reactually going to live?
No, maybe it is, maybe it isn't, but it's a starting point, all
right.
Approach number two to how manyyears you have left, there are
clinical equations.
So the actuarial table ispretty much just age and sex
(13:22):
based.
Clinical equations say well,what about some of my known risk
factors for heart disease andknown diseases that might affect
heart disease?
So going back about 25 years,there was a huge and important
study, the Framingham HeartStudy, and it came up with a
(13:43):
risk score, a calculator.
Now this has been improved uponover years and I have a link in
the show notes that you can dothe calculation yourself and it
basically asks you to put inyour age, your sex, your race,
your blood pressure, what yourcholesterol levels are, whether
(14:06):
you have diabetes, whetheryou're a smoker.
And when I plugged in my data,my 10-year risk is about 4.7% of
having a major cardiac eventand death.
So you might look at it.
You might be at 5%, you mightbe at 10%, but this is another
(14:27):
way to begin to get a handle.
Looking specifically atcardiovascular disease.
This doesn't look at othercauses, action item here.
Go to the link in the shownotes, see where you are and you
can look at your actuarialnumber.
You can look at your numberbased upon cardiovascular risk.
Now you'll have two differentnumbers to look at.
(14:51):
Okay, there is an expandedcardiovascular risk equation.
Sadly, it's not something youcan do yourself, but the concept
is let's take the same clinicalfactors, like I talked about,
but let's fold in your geneticbackground.
It's called a polygenic riskscore, and so this was done in
(15:12):
large research settings and itreally kind of wrestles with the
nature versus nurture becauseit's blending some of those risk
factors with some of yourgenetics based upon your
ancestors.
Again, you can't do thisyourself, but it's an
interesting thing and maybe atsome point it will be available.
(15:34):
It's an interesting thing andmaybe at some point it will be
available.
Now, all of these predictionapproaches that I've talked
about so far, they're imperfect,they're not going to give you
the exact answer, but one of theside benefits is it might drive
change.
There was a meta-analysis, asummary of 28 studies where they
(15:55):
shared this type of riskinformation with each person.
Sometimes they shared it,sometimes they didn't share it
and asked the question did itlead to changes in behavior that
might alter your risk?
And the answer was, in general,yes, in general.
(16:16):
Yes, there's even a study nowit's not yet published, but it's
been talked about where theyshowed that sharing this
information reduced events whenthe cardiovascular risk score
was shared, so there was lesslikelihood of heart attack,
stroke and death.
Now I've talked a lot just nowabout cardiovascular disease and
(16:37):
that's an area where we reallyhave a lot of data which
actually does a pretty good jobof predictions.
In the area of cancer and otherdiseases.
There are risk equations thatpeople have put together and it
does show some people are athigher risk, some people are not
at higher risk, but they're notvery precise.
(16:58):
They're not really ready for usto use in any meaningful way,
which is too bad, but that's thereality.
Well, there are a couple ofother ways of doing this
clinically and there are someblood tests for certain diseases
.
So you may have heard about theAPOE4 gene.
(17:19):
There are different forms ofthe APOE gene.
You could have the E2, the E3,the E4.
The E4 is the one that'sassociated with a risk increased
risk of dementia.
Now you may have no copies ofthe gene.
You may have one copy.
You may have two copies.
The more copies of that, thehigher risk of dementia and the
(17:43):
earlier onset of thatdeterioration seems to occur.
So if you have two copies of it, you may have a 60% risk of
dementia.
Now it doesn't mean you have100%.
There are a lot of otherfactors that will weigh in.
I looked at my APOE4 resultswhen I did 23 and me the genetic
(18:06):
testing.
There are various ways that youmight be able to get this test
if it's of interest to you.
I have a whole episode onwhether you should do large
panels of testing because offalse positives and things.
You might listen to that ifyou're interested, but this is
something that is available thatfor some people might be
(18:27):
helpful.
Okay, so those are clinical andactuarial approaches.
Here's number three.
There are various physical testsphysical strength tests,
physical agility tests that canhelp predict mortality.
Again, this is not perfect, butit's moving from an actuarial
(18:47):
table, which is everybody, tosomething that's more specific
to you.
So one is called the Braziliansit-stand test and basically you
get five points for how youstand up from sitting on the
ground and you get five pointsup to five points as you then
(19:08):
move from standing back to theground and each aspect of it you
can lose points.
So if you're sitting on theground and you can't just get up
on your own, you have to use ahand or two hands, or a hand and
a knee or two knees.
Each of those points of supportyou lose a point and for each
(19:31):
point you lose there appears tobe a 20% increase in mortality
looking over the next six years.
So if you have less than eightpoints, again 10 is perfect.
If it's less than eight points,you have a doubling of
mortality in the next six years.
If you have less than fourpoints, then you have a
(19:53):
five-fold mortality risk.
My score is about nine to 10.
I can do it without holdinganything or touching the ground.
I'm a little wobbly and you dolose half a point for being
wobbly.
So that's one thing you can do.
Another is something simple.
It's grip strength and it was alarge study of 17 countries and
(20:16):
looked at four-year follow-upand they had 142,000 people and
you might be able to, andtypically what you do is you
squeeze this device and itmeasures how many pounds or
kilograms of force, and for me,I can do about 100 pounds of
(20:36):
grip strength, and for differentfolks, obviously, the number is
going to be less, the number isgoing to be more.
But each five kilogramreduction in that amount
compared to your peers, which isabout 11 or so pounds, there's
a 15% increase in mortality.
(20:58):
So again, here's another wayyou could test yourself and get
some inkling about whether yourlifespan is compared to others.
Okay, so here's an action item.
You can do one of these testsor both of these tests.
The Brazilian sit-stand takesno equipment.
I'll have a link to a YouTubevideo not mine but somebody
(21:22):
else's which can show youexactly how to do it.
It's fun, share it with yourfamily, share it with your
friends.
You can then work on doing itbetter with some practice and
some strength work.
There's various other tests.
I'm not going to go throughOne's called the HANG test.
It's just like a pull-up whereyou hold on the VO2 max testing.
There may be various otherthings.
(21:43):
Now, with the physical testing,we have a chicken or egg
problem.
Is it that the weaknesses orthe imbalances cause early death
through falls or other things,or is it a reflection on the
fact your body is justdeteriorating and it may be
(22:07):
associated with earlier death,but it may not be causative.
Why does it matter?
Well, it matters because ifit's causative and we can
improve those things, we canimprove our grip strength, we
can do better on the sit-standtest.
That might lower our mortality.
We don't have data.
(22:28):
Looking at this, I tend tothink, looking more broadly at
the exercise literature, that infact, working on this could be
beneficial.
But again, this is my opinion,based upon my understanding of
literature not specific to thesethings.
Okay, the fourth and final areaof figuring out how many years
(22:51):
you have left are calledbiologic clocks or epigenetic
clocks, and I again may do anepisode on this.
If you're interested, let meknow.
So there's a concept ofchronologic age that's based
upon how many years old you are,and then there's what's called
(23:12):
biologic age.
So it's possible that you are60 years old but your heart
looks like and functions like a40-year-old or an 80-year-old.
Similarly, other parts of yourbody may function similarly or
not to your chronologic age, andthis could be very exciting if
(23:32):
in fact, it could predict deathand disease.
There's one called the HealthOctoTool.
The University of Washingtondeveloped this and basically
they looked at known diagnosesthat you might have in 13 body
systems and then they add thisup in some unique way and then
(23:53):
they come up with your biologicage.
The other and what's received alot more attention and for some
people a lot of excitement, isbased on blood testing or tissue
testing and that's looking atchanges in the DNA, and they
look at, often, methylation,which I don't need to go into
the chemistry or biochemistry ofthis.
(24:15):
My take on these biologicclocks, especially the ones that
are based on methylation andblood and tissue samples, is
they're not ready for prime time.
If you do two different testson the same day in the same
person, you're going to get twodifferent answers.
If you use the same test in thesame person on different days
(24:36):
or even different times of day,you're going to get different
answers and different tissuesalso have different answers.
So I believe this could be veryexciting in the future.
I think it's a wonderful way tobegin to look at research
interventions, but for everydaypersonal use, I don't see that
(24:57):
we're there yet.
Okay, now we're going to switchto how many good years you have,
and for this purpose I'm goingto say that good years are.
You can remain active,pain-free and without any
particularly problematicsymptoms.
There are data the actuarialtables, the equations, blood
(25:22):
tests that do an interesting jobon predicting how many years
you have left.
It is much more challenging tosay I'm 50 years old, I'm in
pretty good health, but am Igoing to have 10 more good years
of health?
Am I going to have 20?
This is an area which obviouslywe all want to know, but
(25:46):
unfortunately the data reallyaren't there Now.
For some diseases there areprediction tools that suggest
how your disease might progress.
So, for example, multiplesclerosis a bunch of different
studies.
Multiple sclerosis tends to getbetter, get worse, but
gradually it gets worse overtime and there are ways to
(26:09):
predict how that progressionmight occur.
There's similar tools that lookat dementia Is my cognitive
ability going to fall quickly orslowly?
Similarly, kidney disease andmovement towards kidney failure.
There's some predictionequations.
Now there are lots ofquestionnaires out there that
(26:31):
can look at our physicalfunctioning, like the SF-36 that
was developed at RAND manyyears ago.
They can assess our physicalfunction, how active we are and
all those kinds of things.
Unfortunately, they don'tpredict what's going to happen
in the next one year, five yearsor 10 years, and there is no
actuarial equivalent really thatcan predict number of good
(26:54):
years.
Okay, well, I want to give yousomething to think about.
I can't just say, well, sorry,there's nothing.
So I think there are two waysto think through this.
First is there are changes thatare going to happen to almost
all of us, and we've talkedabout these.
So as you get above age 30, youare going to lose 1% to 2% of
(27:18):
muscle mass each year, whichmeans our strength is going to
typically fall year in year out.
Also, our aerobic fitness isgoing to tend to deteriorate.
It does, in almost everyone,probably 10% loss of our fitness
each decade, and when you getto be about 70, you may lose 20%
(27:42):
per decade.
So do some predictions foryourself.
If you can lift a 40-poundsuitcase up into the overhead
bin, you might not be able to doeven 30 pounds in 10 to 20
years.
If you can run a mile in 10minutes now, well, another
(28:05):
decade or so, you'll be lucky torun at 11 or 12 minute pace.
I've certainly noticed my speedhas really fallen over the
years.
So here is an action item foryou.
So here is an action item foryou, because things will tend to
become less muscle and lessaerobic fitness.
(28:26):
Redouble our efforts towardsstrength training and our
aerobic work.
You can look at episode 2 andepisode 38 on exercise and get
some ideas about what to do, andepisode 38 on exercise and get
some ideas about what to do.
Okay, so the first is justgenerally looking at how our
bodies change muscle-wise andaerobic-wise over time.
(28:47):
The second is to take a morepersonal view.
So there are known causes ofdisability in the United States
and the most common causes ofdisability are low back pain,
arthritis, more generally, heartdisease, like heart failure.
About a quarter of us will getheart failure and that means
(29:10):
we're going to be short ofbreath when we try to do stuff.
Depression is also a big partof disability.
So one thing you can do is takestock of your own well-being.
Do you have any of theseproblems?
Because these might help youproject forward in time.
How far can you walk?
Do you get short of breath whenyou climb stairs?
(29:33):
What is your weight likeBasically?
Look at where you are and thatmight give you a sense of where
things might head.
Also, look at your family.
How did they age?
Where were they at differentages and time?
Okay, so we've talked about acouple of aspects of how many
(29:54):
good years, but then there's thewild card, the risk that bad
things happen without warning,the unpredictable.
Now there are some very rareevents, like what's likely here,
you're going to be killed bylightning Well, that's about a
one in a million.
What's likely you're going todie from a shark attack?
(30:18):
Well, that's about one in fourmillion.
So these are rare things, notlikely to affect many of us, but
something you can keep in mind.
Then there are uncommon events,not rare events, but uncommon.
So bike accidents leading todeath there were about 1,400 of
them in 2023, which isn't a hugenumber, but it increased by 50%
(30:42):
in the past 10 years.
Motor vehicle accident deathsthere's about a one in a hundred
chance per year that that couldhappen.
So these are kind of wildcardevents.
Now there are some that aremore common, and they become
more common as we get older.
For folks 65 and older, there isa one in four chance each year
(31:07):
of having a fall, a major fall,and there are about 38,000
deaths in the United States eachyear that are related to a fall
.
And if you've fallen once in afairly major way, that doubles
your risk of another fall.
If you have visual problems,that doubles your risk of a fall
.
If you have hearing loss, ittriples your risk of a fall,
(31:31):
although a lot of that risk goesaway if you get a hearing aid.
Okay, what's your action itemhere?
Action item here is buildresilience into your life to
avoid falls.
My episode number 34 onresilience and strong bones may
be something to look at.
(31:53):
Okay, concluding thoughts no, wecan't fully predict how many
years ahead and how many goodyears, but I gave you some
action items that you might tryout.
Some of these calculations andphysical tests the epigenetic
clocks may be exciting for thefuture.
I just don't think we're ready.
There are opportunities tochange, to improve, and maybe
(32:17):
doing some of these assessmentsmight motivate you towards that.
Now, my daughter, rachel, isvery interested in astrology and
I looked at astrology and tarotcards and palm reading to see.
Well, maybe this could help usin predicting how many years or
how many good years.
Well, unfortunately, I didn'tfind any data to test how good
(32:42):
they were.
Let me end with what I mightview as a positive view of this.
We're all going to get olderand some things are going to get
worse, but in some cases somethings get better.
Arthur Brooks wrote a bookcalled Strength to Strength and
in it he talks about twodifferent types of intelligence
(33:04):
fluid intelligence andcrystallized intelligence.
Fluid intelligence is theability to solve new problems
you know the Nobel Prize winnersor even just solving new
problems in your life.
This is a skill, anintelligence that tends to be in
your 20s and begins todeteriorate over time after that
(33:28):
.
But then, as we get older, weget something called
crystallized intelligence, andthat's the ability to tap into
our accumulated knowledge,skills and experiences, the
ability to synthesize and say ah, I see what's going on here.
That tends to improve with age.
(33:50):
So, although maybe our musclesare decreasing, our crystallized
intelligence is getting better.
Ultimately, do what you can,enjoy what you can and realize
some bad stuff out of nowherecould happen.
I truly hope that you can livelong and well and that we will
(34:11):
be together on this podcast formany, many years to come.
Thanks so much for listening toLive Long and Well with Dr
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten, if you want to continue
(34:32):
this journey or want to receivemy newsletter on practical and
scientific ways to improve yourhealth and longevity, please
visit me atdrbobbilivelongandwellcom.
That's, doctor, as in D-R Bobby.
Live long and wellcom.
We all want to live long and well, but how much time
do we actually have?
Are there ways to determine howlong we might live and how many
of those years will be goodones?
We may not find the fountain ofyouth, but perhaps we can
figure out how many good yearswe have ahead of us.
(00:24):
Hi, I'm Dr Bobby Du Bois andwelcome to Live Long and Well, a
podcast where we will talkabout what you can do to live as
long as possible and with asmuch energy and figure that you
(00:47):
wish.
Together, we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
I'm a physician, ironman,triathlete and have published
several hundred scientificstudies.
(01:09):
I'm honored to be your guide.
Welcome, dear listeners, toepisode 39.
How many good years do you haveleft?
Well, we all want to live longand well, but how much time do
(01:29):
we actually have Now?
Knowing that might influencewhen we retire, our savings to
get to retirement, our spendingnow, our spending in retirement
and the activities we mightenjoy now rather than waiting
until later?
Well, we don't know.
(01:50):
Many have talked about thisissue, about not knowing how
many good years or years we haveleft in there.
Say live every day like it'syour last, which generally
sounds like a good idea at somelevel.
There's also the weeks of lifecalendar.
(02:10):
That's gotten very popular4,000 weeks, which basically is
a bunch of boxes on a chart thatyou hang on the wall and you
check off the boxes as each weekgoes along and you get this
visual sense of ooh, I'm a thirdof the way through my life, I'm
half the way through my life.
Oops, I'm on the back end ofall of that.
(02:33):
That's gotten a lot ofpopularity.
Well, here's a thoughtexperiment before we dive into
data how long do you think youwill live?
Do you think you'll live to be75?
Do you think you'll live to be85?
Do you think you'll be one ofthose that might live to be 100?
How many of those years will begood years, meaning you're
(02:58):
functioning well, you're activeand you don't have pain to
contend with?
Do you think your good yearswill go until you're 65, 75
later?
Well, before we can get too far,we need to define good years.
Now, what I'm about to say toyou is a little bit, you know,
(03:18):
sort of tongue in cheek, becauseit doesn't apply to most of us,
but if your definition of goodyears is peak performance, for
most of us listening we're pastthat age in a number of regards.
If you want to be a world-classgymnast, as a girl or woman,
they tend to peak at ages 16 to22.
(03:40):
Mathematicians are reported todo their best work in their 20s,
and marathon runners seem to dobest in their late 20s and 30s.
Well, how about for the rest ofus?
Because obviously this is nothow we will probably judge good
years.
Now, over the course of the nexthalf hour, I may not be able to
(04:04):
give you the precise answer tohow long you're going to live
and how many of those will begood years.
Nobody can do that, but what Ihope I will do is provide a
framework or various ways tothink about it.
Motivate how you live your lifemight motivate changes in your
(04:25):
life, what you do, how you do itand how you might increase both
the number of years and thequality of those years.
Well, as always, I need toexplain to you why.
Why do I want to talk aboutthis topic, where's the
relevance in my life?
And then hopefully, it willring true for you.
(04:48):
My dad was a physician, workedvery hard and he got multiple
myeloma, which is a cancer ofthe blood forming elements in
your bone marrow, and he gotmyeloma at age 56 and he died
some years later.
I would say, looking at hisquality of life, his good years
ended at age 56.
(05:09):
Now I'm older than that now,and so I am mindful of my own
family history.
Recently, several friends outof nowhere had cancer diagnoses
one kidney cancer, one withprostate cancer and their lives
obviously changed a lot.
My listeners you give mewonderful feedback and comments.
(05:34):
Tell me, you know, when Iturned age 60 or when I turned
age 70, things seemed todeteriorate.
I seemed to be fine before that, but boy, a whole lot of things
seemed to go wrong, starting atthose ages, and so, therefore,
I started thinking about more ofthis topic, and there's so much
(05:55):
hype about these new biologicor epigenetic clocks due to
methylation of the DNA, and Iwanted to at least talk a little
bit about that, because peopleclaim this can help you
understand how long you mightlive.
I'm probably going to do awhole separate episode on this
(06:16):
topic.
Let me know if you'd like it,but I will touch on it briefly
today.
So let's look at what we knowand don't know, since how many
good years we have left is acritical life question, and it's
been around for thousands ofyears and probably will be
(06:37):
around for another few thousandyears.
Before we dive into theinformation, I have two requests
.
Number of you have texted methrough the podcast app.
Unfortunately, although I getyour texts, many of you want an
answer and are upset that Idon't give an answer.
(06:59):
But I can't.
The way you submit them doesn'tallow me.
Those services don't allow me.
By all means, go to my website,drbobbilivelongandwellcom.
You can message me throughthere.
Then I'll be able to respondback to you, because I really,
really do want to do that.
My other request please sharethis podcast with others, not
(07:22):
just this podcast episode.
Please share this podcast withothers, not just this podcast
episode, but the Live Long andWell with Dr Bobby.
As I've mentioned many timesthat you know, I have no
financial part of this.
I only want to help you.
So the more people that get thepodcast, the more people I can
help.
Okay, let's dive in.
How might we think about thistopic?
(07:45):
What I'd like to do is puttogether a framework.
First one is how many years oflife, not how many good years,
but how many years of life do wehave ahead of us?
Now?
This may range from somethingvery simple, like actuarial
tables, to something complex,like risk equations, and we'll
(08:05):
talk through those.
Some of these are wellunderstood, been around for
hundreds of years as approaches,and some are new and as yet
unproven.
Next, we'll explore a frameworkfor well, how many good years
and by my definition of goodyears is you can be active,
(08:26):
you're pain-free, you don't haveany really disabling symptoms
this is much tougher to predict,as we'll talk about.
And then, thirdly, theimpossible to predict the
unpredictable accidents andinjuries.
We can't ignore these wild cardevents, although, obviously,
(08:47):
because they're unpredictable,we can't predict them.
Underlying everything we talkabout is the nature versus
nurture question.
You know, is it determined bymy genetics how long I will live
and how many good years, or isit the environment and what I've
done?
Well, clearly, with the sixpillars?
(09:10):
I believe that exercise andsleep and nutrition, and
exposure to heat and cold, andmind-body harmony and social
relationships will affect ournumber of years and the quality
of those years.
But at some level this doescome down to genetics.
It appears that when you'retalking about people who live a
(09:34):
very long time, say they live tobe 100, perhaps a lot of that
has to do with nature, notnurture.
But for most of us who may notlive to be 100, obviously what
we do and how we do it makes abig, big difference.
But it's going to be a blend,one back of the envelope
(09:54):
approach to this.
Look at your family how old didthey live before they died?
How functional were they beforethey started to deteriorate and
have problems physically,mentally and otherwise?
All right, let's begin with howmany years we have, how long
(10:17):
are you likely to live?
And I'm going to walk throughfour approaches and give you
action items that you might wantto try.
Well, the oldest approach isactuarial tables.
These are tables that give youthe probability of how long
you'll live based upon your age.
Now, we might think this issomething relatively recent, but
(10:41):
it was discovered recent.
But it was discovered 450 yearsago, or 400 years ago by James
Haley.
Now, james Haley wasn't famousfor the actuarial approach.
Of course he did come up withit.
He's known mostly for Haley'sComet, but he in fact put
together the first life tableand in its simplest version it's
(11:04):
broken out by age, and men andwomen, and it basically says how
many years you will survive.
And this is a populationaverage, doesn't apply to you
per se, but it's better thannothing in terms of prediction.
So what do life tables tell us?
Well, today, in the UnitedStates, your survival at birth.
(11:27):
So, at birth, boys, men, willlive to be the age of 73.
Women, at birth, will live, onaverage, to age 79.
Now, that doesn't soundparticularly old.
But also realize that a lot ofpeople die, maybe in childhood,
(11:47):
maybe with a motor vehicleaccident, maybe with suicide,
maybe overdose.
So the older you are, a lot ofthose people are not in the
table.
And so what's remaining?
You tend to live longer.
So, in contrast, if you were toask the question of these
tables, well, I'm age 55.
(12:09):
What's my expected survival, onaverage, from an actuarial
standpoint?
For men it's 79.
So not the 73 at birth, up to79.
And women it's up to 82.
So these are numbers you'veprobably heard people throwing
around, because typically peopleare looking at it in this
fashion.
So the longer you live, thelonger you are likely to live.
(12:34):
My expected survival is about16 years, or I am expected to
live till age 84, based uponlife tables.
What's the action item here?
The action item here is in theshow notes.
I will have links to all ofthese various things.
Go to a link to an actuarialtable, look where you are on it
(13:01):
and see what that tells you.
Is this how long you'reactually going to live?
No, maybe it is, maybe it isn't, but it's a starting point, all
right.
Approach number two to how manyyears you have left, there are
clinical equations.
So the actuarial table ispretty much just age and sex
(13:22):
based.
Clinical equations say well,what about some of my known risk
factors for heart disease andknown diseases that might affect
heart disease?
So going back about 25 years,there was a huge and important
study, the Framingham HeartStudy, and it came up with a
(13:43):
risk score, a calculator.
Now this has been improved uponover years and I have a link in
the show notes that you can dothe calculation yourself and it
basically asks you to put inyour age, your sex, your race,
your blood pressure, what yourcholesterol levels are, whether
(14:06):
you have diabetes, whetheryou're a smoker.
And when I plugged in my data,my 10-year risk is about 4.7% of
having a major cardiac eventand death.
So you might look at it.
You might be at 5%, you mightbe at 10%, but this is another
(14:27):
way to begin to get a handle.
Looking specifically atcardiovascular disease.
This doesn't look at othercauses, action item here.
Go to the link in the shownotes, see where you are and you
can look at your actuarialnumber.
You can look at your numberbased upon cardiovascular risk.
Now you'll have two differentnumbers to look at.
(14:51):
Okay, there is an expandedcardiovascular risk equation.
Sadly, it's not something youcan do yourself, but the concept
is let's take the same clinicalfactors, like I talked about,
but let's fold in your geneticbackground.
It's called a polygenic riskscore, and so this was done in
(15:12):
large research settings and itreally kind of wrestles with the
nature versus nurture becauseit's blending some of those risk
factors with some of yourgenetics based upon your
ancestors.
Again, you can't do thisyourself, but it's an
interesting thing and maybe atsome point it will be available.
(15:34):
It's an interesting thing andmaybe at some point it will be
available.
Now, all of these predictionapproaches that I've talked
about so far, they're imperfect,they're not going to give you
the exact answer, but one of theside benefits is it might drive
change.
There was a meta-analysis, asummary of 28 studies where they
(15:55):
shared this type of riskinformation with each person.
Sometimes they shared it,sometimes they didn't share it
and asked the question did itlead to changes in behavior that
might alter your risk?
And the answer was, in general,yes, in general.
(16:16):
Yes, there's even a study nowit's not yet published, but it's
been talked about where theyshowed that sharing this
information reduced events whenthe cardiovascular risk score
was shared, so there was lesslikelihood of heart attack,
stroke and death.
Now I've talked a lot just nowabout cardiovascular disease and
(16:37):
that's an area where we reallyhave a lot of data which
actually does a pretty good jobof predictions.
In the area of cancer and otherdiseases.
There are risk equations thatpeople have put together and it
does show some people are athigher risk, some people are not
at higher risk, but they're notvery precise.
(16:58):
They're not really ready for usto use in any meaningful way,
which is too bad, but that's thereality.
Well, there are a couple ofother ways of doing this
clinically and there are someblood tests for certain diseases
.
So you may have heard about theAPOE4 gene.
(17:19):
There are different forms ofthe APOE gene.
You could have the E2, the E3,the E4.
The E4 is the one that'sassociated with a risk increased
risk of dementia.
Now you may have no copies ofthe gene.
You may have one copy.
You may have two copies.
The more copies of that, thehigher risk of dementia and the
(17:43):
earlier onset of thatdeterioration seems to occur.
So if you have two copies of it, you may have a 60% risk of
dementia.
Now it doesn't mean you have100%.
There are a lot of otherfactors that will weigh in.
I looked at my APOE4 resultswhen I did 23 and me the genetic
(18:06):
testing.
There are various ways that youmight be able to get this test
if it's of interest to you.
I have a whole episode onwhether you should do large
panels of testing because offalse positives and things.
You might listen to that ifyou're interested, but this is
something that is available thatfor some people might be
(18:27):
helpful.
Okay, so those are clinical andactuarial approaches.
Here's number three.
There are various physical testsphysical strength tests,
physical agility tests that canhelp predict mortality.
Again, this is not perfect, butit's moving from an actuarial
(18:47):
table, which is everybody, tosomething that's more specific
to you.
So one is called the Braziliansit-stand test and basically you
get five points for how youstand up from sitting on the
ground and you get five pointsup to five points as you then
(19:08):
move from standing back to theground and each aspect of it you
can lose points.
So if you're sitting on theground and you can't just get up
on your own, you have to use ahand or two hands, or a hand and
a knee or two knees.
Each of those points of supportyou lose a point and for each
(19:31):
point you lose there appears tobe a 20% increase in mortality
looking over the next six years.
So if you have less than eightpoints, again 10 is perfect.
If it's less than eight points,you have a doubling of
mortality in the next six years.
If you have less than fourpoints, then you have a
(19:53):
five-fold mortality risk.
My score is about nine to 10.
I can do it without holdinganything or touching the ground.
I'm a little wobbly and you dolose half a point for being
wobbly.
So that's one thing you can do.
Another is something simple.
It's grip strength and it was alarge study of 17 countries and
(20:16):
looked at four-year follow-upand they had 142,000 people and
you might be able to, andtypically what you do is you
squeeze this device and itmeasures how many pounds or
kilograms of force, and for me,I can do about 100 pounds of
(20:36):
grip strength, and for differentfolks, obviously, the number is
going to be less, the number isgoing to be more.
But each five kilogramreduction in that amount
compared to your peers, which isabout 11 or so pounds, there's
a 15% increase in mortality.
(20:58):
So again, here's another wayyou could test yourself and get
some inkling about whether yourlifespan is compared to others.
Okay, so here's an action item.
You can do one of these testsor both of these tests.
The Brazilian sit-stand takesno equipment.
I'll have a link to a YouTubevideo not mine but somebody
(21:22):
else's which can show youexactly how to do it.
It's fun, share it with yourfamily, share it with your
friends.
You can then work on doing itbetter with some practice and
some strength work.
There's various other tests.
I'm not going to go throughOne's called the HANG test.
It's just like a pull-up whereyou hold on the VO2 max testing.
There may be various otherthings.
(21:43):
Now, with the physical testing,we have a chicken or egg
problem.
Is it that the weaknesses orthe imbalances cause early death
through falls or other things,or is it a reflection on the
fact your body is justdeteriorating and it may be
(22:07):
associated with earlier death,but it may not be causative.
Why does it matter?
Well, it matters because ifit's causative and we can
improve those things, we canimprove our grip strength, we
can do better on the sit-standtest.
That might lower our mortality.
We don't have data.
(22:28):
Looking at this, I tend tothink, looking more broadly at
the exercise literature, that infact, working on this could be
beneficial.
But again, this is my opinion,based upon my understanding of
literature not specific to thesethings.
Okay, the fourth and final areaof figuring out how many years
(22:51):
you have left are calledbiologic clocks or epigenetic
clocks, and I again may do anepisode on this.
If you're interested, let meknow.
So there's a concept ofchronologic age that's based
upon how many years old you are,and then there's what's called
(23:12):
biologic age.
So it's possible that you are60 years old but your heart
looks like and functions like a40-year-old or an 80-year-old.
Similarly, other parts of yourbody may function similarly or
not to your chronologic age, andthis could be very exciting if
(23:32):
in fact, it could predict deathand disease.
There's one called the HealthOctoTool.
The University of Washingtondeveloped this and basically
they looked at known diagnosesthat you might have in 13 body
systems and then they add thisup in some unique way and then
(23:53):
they come up with your biologicage.
The other and what's received alot more attention and for some
people a lot of excitement, isbased on blood testing or tissue
testing and that's looking atchanges in the DNA, and they
look at, often, methylation,which I don't need to go into
the chemistry or biochemistry ofthis.
(24:15):
My take on these biologicclocks, especially the ones that
are based on methylation andblood and tissue samples, is
they're not ready for prime time.
If you do two different testson the same day in the same
person, you're going to get twodifferent answers.
If you use the same test in thesame person on different days
(24:36):
or even different times of day,you're going to get different
answers and different tissuesalso have different answers.
So I believe this could be veryexciting in the future.
I think it's a wonderful way tobegin to look at research
interventions, but for everydaypersonal use, I don't see that
(24:57):
we're there yet.
Okay, now we're going to switchto how many good years you have,
and for this purpose I'm goingto say that good years are.
You can remain active,pain-free and without any
particularly problematicsymptoms.
There are data the actuarialtables, the equations, blood
(25:22):
tests that do an interesting jobon predicting how many years
you have left.
It is much more challenging tosay I'm 50 years old, I'm in
pretty good health, but am Igoing to have 10 more good years
of health?
Am I going to have 20?
This is an area which obviouslywe all want to know, but
(25:46):
unfortunately the data reallyaren't there Now.
For some diseases there areprediction tools that suggest
how your disease might progress.
So, for example, multiplesclerosis a bunch of different
studies.
Multiple sclerosis tends to getbetter, get worse, but
gradually it gets worse overtime and there are ways to
(26:09):
predict how that progressionmight occur.
There's similar tools that lookat dementia Is my cognitive
ability going to fall quickly orslowly?
Similarly, kidney disease andmovement towards kidney failure.
There's some predictionequations.
Now there are lots ofquestionnaires out there that
(26:31):
can look at our physicalfunctioning, like the SF-36 that
was developed at RAND manyyears ago.
They can assess our physicalfunction, how active we are and
all those kinds of things.
Unfortunately, they don'tpredict what's going to happen
in the next one year, five yearsor 10 years, and there is no
actuarial equivalent really thatcan predict number of good
(26:54):
years.
Okay, well, I want to give yousomething to think about.
I can't just say, well, sorry,there's nothing.
So I think there are two waysto think through this.
First is there are changes thatare going to happen to almost
all of us, and we've talkedabout these.
So as you get above age 30, youare going to lose 1% to 2% of
(27:18):
muscle mass each year, whichmeans our strength is going to
typically fall year in year out.
Also, our aerobic fitness isgoing to tend to deteriorate.
It does, in almost everyone,probably 10% loss of our fitness
each decade, and when you getto be about 70, you may lose 20%
(27:42):
per decade.
So do some predictions foryourself.
If you can lift a 40-poundsuitcase up into the overhead
bin, you might not be able to doeven 30 pounds in 10 to 20
years.
If you can run a mile in 10minutes now, well, another
(28:05):
decade or so, you'll be lucky torun at 11 or 12 minute pace.
I've certainly noticed my speedhas really fallen over the
years.
So here is an action item foryou.
So here is an action item foryou, because things will tend to
become less muscle and lessaerobic fitness.
(28:26):
Redouble our efforts towardsstrength training and our
aerobic work.
You can look at episode 2 andepisode 38 on exercise and get
some ideas about what to do, andepisode 38 on exercise and get
some ideas about what to do.
Okay, so the first is justgenerally looking at how our
bodies change muscle-wise andaerobic-wise over time.
(28:47):
The second is to take a morepersonal view.
So there are known causes ofdisability in the United States
and the most common causes ofdisability are low back pain,
arthritis, more generally, heartdisease, like heart failure.
About a quarter of us will getheart failure and that means
(29:10):
we're going to be short ofbreath when we try to do stuff.
Depression is also a big partof disability.
So one thing you can do is takestock of your own well-being.
Do you have any of theseproblems?
Because these might help youproject forward in time.
How far can you walk?
Do you get short of breath whenyou climb stairs?
(29:33):
What is your weight likeBasically?
Look at where you are and thatmight give you a sense of where
things might head.
Also, look at your family.
How did they age?
Where were they at differentages and time?
Okay, so we've talked about acouple of aspects of how many
(29:54):
good years, but then there's thewild card, the risk that bad
things happen without warning,the unpredictable.
Now there are some very rareevents, like what's likely here,
you're going to be killed bylightning Well, that's about a
one in a million.
What's likely you're going todie from a shark attack?
(30:18):
Well, that's about one in fourmillion.
So these are rare things, notlikely to affect many of us, but
something you can keep in mind.
Then there are uncommon events,not rare events, but uncommon.
So bike accidents leading todeath there were about 1,400 of
them in 2023, which isn't a hugenumber, but it increased by 50%
(30:42):
in the past 10 years.
Motor vehicle accident deathsthere's about a one in a hundred
chance per year that that couldhappen.
So these are kind of wildcardevents.
Now there are some that aremore common, and they become
more common as we get older.
For folks 65 and older, there isa one in four chance each year
(31:07):
of having a fall, a major fall,and there are about 38,000
deaths in the United States eachyear that are related to a fall
.
And if you've fallen once in afairly major way, that doubles
your risk of another fall.
If you have visual problems,that doubles your risk of a fall
.
If you have hearing loss, ittriples your risk of a fall,
(31:31):
although a lot of that risk goesaway if you get a hearing aid.
Okay, what's your action itemhere?
Action item here is buildresilience into your life to
avoid falls.
My episode number 34 onresilience and strong bones may
be something to look at.
(31:53):
Okay, concluding thoughts no, wecan't fully predict how many
years ahead and how many goodyears, but I gave you some
action items that you might tryout.
Some of these calculations andphysical tests the epigenetic
clocks may be exciting for thefuture.
I just don't think we're ready.
There are opportunities tochange, to improve, and maybe
(32:17):
doing some of these assessmentsmight motivate you towards that.
Now, my daughter, rachel, isvery interested in astrology and
I looked at astrology and tarotcards and palm reading to see.
Well, maybe this could help usin predicting how many years or
how many good years.
Well, unfortunately, I didn'tfind any data to test how good
(32:42):
they were.
Let me end with what I mightview as a positive view of this.
We're all going to get olderand some things are going to get
worse, but in some cases somethings get better.
Arthur Brooks wrote a bookcalled Strength to Strength and
in it he talks about twodifferent types of intelligence
(33:04):
fluid intelligence andcrystallized intelligence.
Fluid intelligence is theability to solve new problems
you know the Nobel Prize winnersor even just solving new
problems in your life.
This is a skill, anintelligence that tends to be in
your 20s and begins todeteriorate over time after that
(33:28):
.
But then, as we get older, weget something called
crystallized intelligence, andthat's the ability to tap into
our accumulated knowledge,skills and experiences, the
ability to synthesize and say ah, I see what's going on here.
That tends to improve with age.
(33:50):
So, although maybe our musclesare decreasing, our crystallized
intelligence is getting better.
Ultimately, do what you can,enjoy what you can and realize
some bad stuff out of nowherecould happen.
I truly hope that you can livelong and well and that we will
(34:11):
be together on this podcast formany, many years to come.
Thanks so much for listening toLive Long and Well with Dr
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten, if you want to continue
(34:32):
this journey or want to receivemy newsletter on practical and
scientific ways to improve yourhealth and longevity, please
visit me atdrbobbilivelongandwellcom.
That's, doctor, as in D-R Bobby.
Live long and wellcom.
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