YOUR GUIDE TO HEALTHSPAN: TAKE CONTROL OF YOUR LONG-TERM HEALTH

Medically Reviewed by Dr. Rosmy Barrios

We all want to lead long, fulfilling lives. Yet a long life is not the same as a fulfilling one. Some people even dread the idea of having an extended lifespan if the extra time gets spent struggling with age-related concerns or battling lifestyle diseases.

What if we could optimize our health and vitality during those extra years? This is the concept of healthspan.

Healthspan is the course of life spent in good health, with minimal impact from chronic ailments or disabilities^[1]. This is arguably the best period of our lives, during which we feel at our best and most capable. It is often confused for healthy aging, yet healthspan is not limited to the later years of life. It is also not the same as a lifespan, which is the time spent alive.

A critical issue with the concept of healthspan is that health is not a clearly measurable variable indicating a good versus a bad well-being state. Instead, health changes dynamically throughout the lifespan. This variability makes it difficult to measure one's healthspan.^[2]

Researchers consider healthspan as a dynamic measure across the lifespan of various components of well-being:

• Physical: Maintaining a healthy body, free from chronic diseases and physical limitations
• Mental: Preserving good mental health, emotional stability, and cognitive function
• Cognitive: Maintaining optimal brain health, including memory, attention, and problem-solving abilities
• Social: Emphasizing the importance of social connections, relationships, and community.

Healthspan and Aging

Healthspan is closely connected to aging, as the two are interdependent. Though we all have a different health trajectory, there is a general downward trend with aging.

The aging process progresses with various biological changes that can impact our overall well-being. These changes include cellular damage and inflammation, which affect a cell's health and lower longevity by promoting telomere shortening.

The protective caps known as telomeres that are located at the ends of chromosomes, or gene segments, are important in the processes of tissue growth, cell division, and biological aging. With each cell division, telomeres gradually shorten. Chronic inflammation accelerates telomere shortening by increasing cellular stress.

Eventually, when telomeres become critically short, the cell enters a state of senescence or undergoes programmed cell death. This telomere shortening is a marker of biological aging. When a cell enters senescence, it produces more inflammation, changes shape, is less functional, and is at a higher risk for malignant mutation. These changes affect the healthspan and lifespan.^[3]

As we age, our healthspan gradually tapers off, and for many, it ends in older age. For example, someone may live to be 100 years old, yet as they age, they may spend the last 25 years of their life in poor health, making their healthspan roughly 75 years.

The Fries Hypothesis

This example highlights the concept of "compression of morbidity" (also known as the Fries hypothesis), emphasizing the importance of maximizing healthy years and minimizing years of illness^[4].

It aims to compress poor health towards the end of life, promoting a longer span of good health. This approach focuses on preventing or delaying the onset of chronic diseases and age-related conditions through healthy lifestyle choices and proactive healthcare.

Unfortunately, while healthcare improvements have lengthened the lifespan, the healthspan is shorter due to the increasing prevalence of chronic lifestyle diseases.

Our health span is realistically shorter than the years spent outside of advanced older age. For instance, the average American is said to fall ill up to 3 times a year on average^[5]. Assuming we spend 1-7 days (or longer) ill at home fending off the flu or something similar, this can knock six months to four years off the health span.

This estimate is in close agreement with the most current World Health Organization (WHO) statistics, suggesting that the average person can expect to live up to 66.1 years of their lives in good health.^[6]

To get an idea of your healthspan, healthspan calculators are available online. These consider various factors to give you an overall estimate of how long you can expect to live in good health.

Factors Influencing Healthspan

The factors that affect longevity, healthspan, and the aging process include genetics, lifestyle choices, and the environment.

While we cannot control our baseline genetic makeup, it can influence our susceptibility to specific age-related diseases and our life expectancy.

Scientists have discovered certain genes, known as longevity genes, that may play a role in determining an individual's health span. These genes are associated with an increased resistance to age-related diseases and maintaining good health as we age. They determine several biomarkers of aging, such as telomere length and the levels of certain hormones and proteins that may detract from or enhance longevity and health.

However, genetics is not the sole determinant of our healthspan. Our healthspans can be further impacted by environmental factors like pollution and lifestyle choices such as diet and exercise that can affect how our genes are expressed (epigenetics).

By understanding these factors and taking proactive measures to "compress morbidity" and harness the potential of longevity genes, we can work towards maximizing our healthspan and enjoy a longer, healthier life.

The Blue Zones and Longevity

Scientists are studying people in their 90s and 100s (nonagenarians and centenarians) from the Blue Zones to understand what contributes to their long lives.^[7]

The Blue Zones are regions of the world where people live significantly longer and healthier lives than the global average. These regions include Okinawa, Japan; Sardinia, Italy; Nicoya, Costa Rica; Ikaria, Greece; and Loma Linda, California.

Factors like education, income, and profession are not shared among these individuals and do not influence their longevity.

While there is no single secret to longevity, researchers found that their lifestyle habits prove to contribute substantially. These lifestyle factors overlap with those known to influence well-being, lifespan, and healthspan. Many individuals do not smoke, are not obese, and handle stress well, which lowers their odds of acquiring common age-related conditions like hypertension and heart disease.

These individuals also possessed several additional genes associated with longevity that are not present in many.

Healthspan Beyond the Basics

While the Blue Zones teach us about the wonders of maintaining a healthy lifestyle for promoting healthspan, there are additional factors to consider in our pursuit of health longevity.

Regular Checkups, Screenings, and Vaccinations

These are vital components of preventive medicine and play a crucial role in promoting healthspan.

• Regular checkups with healthcare professionals can detect health issues early for timely treatment.
• Screenings for cancer, heart disease, and chronic diseases identify risks for prevention.
• Vaccinations prevent infections and diseases for better health and longevity.

Addressing Chronic Conditions

Managing existing chronic conditions is crucial in optimizing healthspan. This demands an all-around approach that includes regular monitoring, medication adherence, lifestyle modifications, and self-care. By effectively managing conditions, individuals can improve their health.

Supplements and Emerging Technologies

Supplements and emerging technologies for healthy aging are under ongoing research.

A balanced diet is usually best, but some supplements may support healthspan. Caution and consulting with professionals for evidence-based use and dosage are crucial.

Emerging technologies like gene therapy, stem cell therapy, and precision medicine can potentially enhance healthspan. Ongoing research may provide new opportunities for health and longevity.

Personalized Healthspan

Healthcare is becoming more individualized as a result of technological advancements. This includes personalized healthspan, where individuals can use data from biomarkers and genetic testing to tailor their lifestyle, diets, and medical treatments.

Biomarkers, such as telomere length, insulin sensitivity, and inflammation markers, serve as measurable indicators of biological age and overall health. These biomarkers provide valuable insights into the aging process and overall health. They can track progress and identify areas that require attention. By utilizing biomarker data, individuals can personalize interventions, adjust lifestyle choices, and optimize their healthspan.

To ensure the best results, seeking professional guidance from healthcare providers is important for personalized guidance based on individual biology.

Precision medicine is an emerging field that has the potential to revolutionize healthcare and improve individuals' health. In the future, better diagnostic tools and more information on biomarkers will pave the way for the standardization of precision medicine.

Emerging Frontiers in Healthspan Research

As our understanding of aging and healthspan continue to evolve, so do the frontiers of research and technology. There are many exciting possibilities for the future.

Some of the most promising research areas for improving healthspan include:

• Exploration of biomarkers of aging and their role in healthspan.
• Continued research on the impact of lifestyle choices and environmental factors on healthspan.
• Integration of precision medicine and personalized healthspan into mainstream healthcare.
• Development of more effective medications and supplements capable of delaying the aging process and extending longevity.
• Advancements in therapies that can change our gene expression and facilitate tissue regeneration.

Cutting-edge therapies under development may reduce the time we spend struggling with age-related ailments and extend our healthspans. A few of these are discussed below.

Senolytics and senotherapeutics target and eliminate senescent cells, which have stopped dividing and are associated with aging and age-related diseases. These medicines can block inflammation produced by senescent cells and eliminate them from the body, potentially lengthening healthspan and slowing the onset of age-related diseases.^[8]

Calorie restriction mimetics are compounds that mimic the effects of calorie restriction, which has been shown to extend lifespan and healthspan in various animal studies. These compounds influence insulin signaling, the mTOR pathway (nutrient-sensing and growth regulation), SIRT-1 pathway (energy production and metabolism), and AMPK (energy efficiency pathway). These may have the potential to improve healthspan without the need for strict dietary changes.^[9]

Gene therapy involves modifying or replacing genes to treat or prevent diseases. In the context of healthspan, gene therapy may hold promise for targeting specific genes associated with aging and age-related diseases. For example, gene therapy targeting TERT and APOE are currently undergoing clinical testing. These may help prevent telomere shortening, cancer mutations, or gene-related Alzheimer's Disease changes.^[10]

Stem cell therapy involves employing stem cells to repair damaged tissues and organs. This emerging technology can potentially improve healthspan by repairing age-related damage and promoting healthy aging.^[11]

Bioartificial organs, enriched by gene and stem cell technology, will surpass organ transplantation. These combine re-engineered biologic tissues with synthetic components to provide fully functioning organs that can treat late-stage disease and organ failure. Bioartificial kidneys and hearts are already close to being widely available^[12].

Conclusion

Healthspan is the period of life over which one remains in good health, unaffected by chronic diseases and disabilities. While genetics play a role in our healthspan, lifestyle choices and environmental factors also significantly impact it. By making better choices and staying informed about emerging health research and technology, we can extend our healthspan and live longer, healthier lives.

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