Month: June 2023

Our Healthspan is limited by 4 Major Age-Related Diseases. In this article we learn what these 4 diseases are, and how we’re escaping from them.

---

Medicine may seem complex (and it really is, when explored in detail), but this doesn’t mean we can’t get a plane view of what’s going on, and how to use this knowledge to our advantage. Indeed, the ICD (International Classification of Diseases), the world reference to date, created and published by the WHO (World Health Organisation), lists more that 55 000 diseases. However, make no mistake, this complexity is unnecessary to most of us, we need to focus on the fundamentals: if you want to optimise for healthspan (that is, the number of years you’ll live in good mental and physical health), and unless you have some specific/rare/particular condition, you need to pay attention to only 4 chronic diseases, which I have called “The 4 Angels of Death”.

Now, the fascinating part is that these 4 Angels of Death play a different game with each one of us. That is, they start in different positions, and come for us at different speeds. It’s like a huge life-long Pacman game. And if we’re good enough, just like in Pacman, we can escape from our ennemies, and get to the next level … So our job is first to study them in general, and then allocate our efforts and resources escape from them efficiently. Indeed, out of the 4 Angels of Death, our strategy is to always focus on and avoid the one who is closest to us, and moving the faster in our direction. There’s no point in spending too much energy on the ones who are far away, we need to fight the one who is actively threatening us the most.

So let’s start by listing our 4 ennemies. For each one of them, I’m giving some preventive measures which allow us to avoid these diseases. This is very complex, so I’m barely scratching the surface of this, and by the way I’m not a doctor, but the only reason I’m doing this is to send a message of self-responsibility and hope. We’re not powerless in the face of these diseases, we have tools to fight back and escape them.

Metabolic Disorder

In a nutshell, Metabolic Disorder is a cluster of diseases which have all in common the fact that your body can’t properly manage energy anymore. That means it can’t store it properly, can’t process it properly, or use it properly. Most of the time, it’s diabetes type 2 (your body can’t control the glucose levels in your blood), but also other conditions such as hyperinsulinemia (too much insulin in your blood), fatty liver disease, insulin resistance, etc.

I’m starting with this disease, because most of the time, people don’t die from it, but it is in some sort a very favourable “bedrock” for all the other chronic diseases. So avoiding it is a great strategic move.

Some examples of how to avoid this category of diseases:

– optimise your glucose levels

– optimise your BMI (Body Mass Index)

– physical activity (but not any activity, more in a future blog post)

Cardiovascular and Artherosclerotic Diseases

This is the number 1 cause of death. Everyone has had a friend, or a family member, who died of heart attack, or stroke. This is not coming from anywhere, each one of us may have a hereditary predisposition, but this is totally avoidable with the right preventive measures (more of it in a future blog post).

This category of diseases starts attacking our arteries decades before any symptom appear. Some examples on how to avoid cardiovascular diseases :

– sequencing our DNA to find out if we have a mutation which significantly increases our risks, called LP(a). If we have it, we have to aggressively reduce our LDL (Low Density Lipo-Protein, common called Bad Cholesterol).

-monitoring the general health of our arteries (for example using a Computer Coronary Tomography Angiography – CCTA).

– regular lab tests to monitor our LDL, HDL, ApoB, triglycerides (a bit technical, will come back in a future blog post). These results have to be be interpreted by a doctor, but you don’t have to wait to feel sick to do them.

– adapting one’s diet depending on the results of the 2 aspects aforementioned.

Cancer

If Cardiovascular Diseases is the number 1 cause, then Cancer is definitely number 2. Everyone knows what cancer is, no need to further explain it, however I think it’s important to mention some less-known facts about this disease:

– it’s not a disease, but a cluster of many diseases, each cancer is different, and this is also one of the reasons why it’s so difficult to treat it

– we all have cancers all the time, which is not a problem most of the time, it’s just that our immune system is so efficient at addressing cancer cells we are not even aware of them

– despite huge amounts of money and R&D effort poured into cancer, we still haven’t found strong treatments to fight it, especially when it is metastasized (which means that the cancer cells are not in one place anymore, but have moved basically everywhere else in your body).

There are some very interesting treatment for cancer (most of them still in clinical trials), most of them related to monoclonal antibodies and/or gene therapies, but for now, the best strategy we have at hand is to:

– keep our immune system as healthy as possible

– screen for cancer on a regular basis, through MRI and a new disruptive test called GRAIL, which detects more than 50 cancers from a simple blood sample

Neuro-degenerative diseases

This category of diseases encompasses Dementia and Alzheimer. It’s not the death of our bodies, but of our minds. There is a lot of mystery around this disease, and we don’t really understand it well. It seems to be caused (or at least associated with) high levels of 2 proteins in our brains, called “amyloid beta” and “tau”.

Different mechanisms are explored for neuro-degenerative diseases, but what is important to know for our purpose of maximising healthspan is that:

– there’s a mutation called APOE, which multiplies by around 10 the likelihood to suffer from neuro-degenerative diseases. A simple DNA sequencing test can identify that.

-possible routes towards neuro-degenerative diseases are: either through metabolic disorder (because your neurons don’t process glucose as they should), either arthero-sclerotic (because your neurons are not properly provided with the necessary nutriens, which cannot properly travel through your clogged arteries), either cognitive (in short, improper brain stimulation/no purposeful in life/insufficient social interaction).

What you can do to prevent neuro-degenerative diseases:

– fulfil your life with meaningful social interactions.

– stimulate your brain through intellectually challenging activites.

– optimise your physical health against artherosclerosis and metabolic disorder.

---

This article may seem depressing, but on the one hand, understanding the rules of the game we’re playing will allow us to resist longer, and an amount of 20 or 30 additional years of healthy life is an absolute win in itself. On the other hand, by extending our healthspan, and staying alive as long as possible, we increase the probability of getting cured from these diseases thanks to new discoveries and breakthroughs coming in the next decades. We have a plan here!

If you want to reach a Healthspan of 100+ years, you definitely need to play with a Continuous Glucose Monitor (CGM) at least a couple of times in your life. Read below to understand what it is and why it is so important. I’m not a doctor (and I assume you’re not either), so I’m over-simplifying the complexity of the human body to explain everything.

---

The CGM

A CGM looks like a small white coin (see below on my arm).

The one I’ve chosen is called Frestyle Libre 3 from Abott Technologies (I have absolutely no stake, no hidden interest whatsoever in this company), it costs roughly $75. It lasts exactly 14 days from the moment you install it on your arm until it expires and you have to take it out and throw it. Its job is to measure the concentration of glucose in your blood every minute.

The role of Glucose in your Body

In a nutshell, Glucose is the fuel of your cells. When you eat, your digestive system breaks down food into different components, and glucose is sent into your bloodstream. If there’s too little of it, your cells don’t have enough energy. When there’s too much of it, serious and dramatic consequences may occur (such as loss of vision, kidney damage, etc …). So your body has an efficient lever to maintain your glucose level under control, a hormone produced by your pancreas, called insulin. Insulin may be considered as “the hormone of abundance”, because when you’re eating more than your body needs (abundance), the production of insulin will tell your body to store that additional glucose in your cells (mostly fat cells, liver and muscle cells).

So what?

You eat sugar, it flows into your bloodstream, then insulin tells your cells to absorb it, end of the story, so far so good right? Well, not quite, and this is where things get tricky and interesting!

During your first decades of life, this glucose / insulin system works perfectly, fine-tuning your glucose levels 24/24 and 7/7 to keep you healthy. However, as you grow older, your cells may become resistant to insulin, so that your pancreas needs to produce more and more insulin to keep your glucose levels within the desired limits, which is called “insulin resistance”. Most of the time, this happens because of decades of excessive quantities of sugar you ingest, associated with glucose spikes in your blood, which generates insulin spikes to compensate. Eventually, this vicious circle of your pancreas producing more and more insulin, and your cells becoming more and more resistant to insulin, ends up into diabetes (or more generally metabolic disorder), which means your body just can’t control glucose in your blood anymore.

If you want to live long and healthy, you want to avoid this at all costs. Metabolic disorder is the “foundation” of all the chronic diseases, which means that people suffering from this will have a skyrocketing probability of suffering from every other age-related major chronic disease (neuro-degenerative, cancer & cardio-vascular).

From Theory to Practice: Flatten the curve!

Now that you know how important it is to keep your glucose levels within a normal range, let’s get from theory to practice! So ideally, you want a fasting glucose level between 60 and 99 mg/dl (in the morning when you wake up, before having breakfast), and during the day, a glucose level as flat as possible. When you eat, depending on your diet, the glucose level will rise, then insulin will bring it back down, but you want small rather than ample variation around the mean.

Each individual will react differently to different foods, so this is why a CGM is essential, you can’t rely on how an average person reacts to a specific food. You need your own user’s manual!

So you have 14 days with a CGM on the back of your arm, this is the one time in your life you can eat the most delicious but unreasonably unhealthy food, just to see how your glucose levels spike (or not). Try everything, junk food, sugar, cake, soda, you name it. Let’s roll baby!

My personal use case

I’ve been wearing my firs CGM for 4 days now, and I’ve tried around 30 different foods, and here’s some examples of what I’ve learned about myself:

– fast-food skyrockets my glucose levels, I mean really crazy, above 230 mg/dl (which is huge), I’ve tested a Quick Giant + a big Coca-Cola + nuggets + lots of ketchup and mayonnaise. Yummy, so delicious, what a pitty!

– those delicious Liegeois with whipped cram send my glucose level to the sky also

– curiously, Taboulet Oriental (Tabbouleh) and Corn also triggered a spike, even more so than a that delicous but super-sugary chocolate “Toblerone”

– orange jus, fruits, potatoes, and pasta seem to be well tolerated, generating no spike of glucose

– 1h of moderate effort like jogging does not seem to influence my glucose

I’ll still test: different types of alcohol, and also sleep deprivation to see how it affects my body’s ability to control blood glucose. It seems from some studies that on average, sleep deprivation reduces your body’s ability to control glucose by as much as 40%. I can’t wait to test this!

Watch out for prediabetes

In addition to helping you understand what food to avoid, a CGM may also teach you something even more important, which is what your diabetes profile is. Oh boy could you have a big surprise (read below)! Diabetes is when your body can’t deal with glucose, because the insulin is either not produced in enough quantity, either because your cells don’t respond to it anymore :

– a glucose level of <100 mg/dl is OK

– a glucose level of 100 – 125 mg/dl means you may be prediabetic.

– a glucose level >125 mg/dl means you have diabetes

Knowing a couple of things related to prediabetes are of essence for your healthspan:

– prediabetes is most of the time asymptomatic, you don’t know it, you don’t feel it – until it is too late!

– prediabetics have an order of magnitude of 5 years of delay between their prediabetic condition and “type 2” diabetes. This is 5 years they won’t event be aware of, because as explained below, this is asymptomatic.

– this condition is extremely common, 80 million americans have it (out of 330 million roughly), which is almost 25%!

Prediabetes: if I may have it, you may have it!

Now, I’ve kept the most interesting part for the end of this article: during my first 4 days of CGM usage, my device has consistently measured a glucose level above 100 mg/dl, with variations between 100 and 200 mg/dl, and most of the values being around 110 mg/dl. If you’re carefully read what I’ve written above, you should understand that this means that I may be prediabetic.

I thought of myself as being almost perfectly healthy, and I invest a great deal of time and effort into staying into shape: I don’t drink, don’t smoke, I’m not overweight, I eat healthy (or so I think), I sleep well, I’m not stressed, I practice sports 5 times / week, etc …

It’s true that I have one diabetes “type 2” case in my family, but I thought it was because of a lack of care.

I have to do additional exams, before I consider this as a certainty, but my takeaway here for you is double:

1. if I have prediabetes, you may have it, don’t sleep on it before it is too late. Remember that 1 in 4 people have it.

2. detected and acted upon early, prediabetes is reversible. Don’t waste your time, don’t act like like an ostrich hiding its head in the sand, and hoping for the best.

Because I do care so much about your short and long term health, I want to ask 2 questions: Are you going to look elsewhere and hope for the best when it comes to your diabetes profile? Or are you going to start finding out as much as possible about your body by ordering a CGM today?