Diet and Healthspan - Uncertain but High Value

[AnUser]

So I’ve been thinking quite a lot about the relationship between diet and healthspan. And I’ve come to the conclusion that it is a very uncertain field, meaning it’s hard to know whether there will be any benefits from healthy eating, calling into the question of the term healthy.

Outside of the effects of healthy eating of known risks established in clinical trials - like apoB concentrations and heart disease risk. I feel very uncertain. I personally have a low apoB from a junk diet but watching what type of dietary fat I eat, and pharmaceuticals like statins. So it’s not persuasive on this front.

But since the experts, intelligentsia, the elite, seem to congregate around healthy eating patterns. I feel like they probably know something I don’t, or they are also uncertain, but believe the expected value to be still good. I want to try eating healthily and see what happens.

What’s healthy eating?

It’s what people in an Apple Inc. Commercial eats - or in a future L.A suburb, think Spike Jonze’s Her from 2013 - basically unprocessed foods, a lot of vegetables, fruit, whole grains, and lean sources of protein. Dr. Walter Willett, the most cited nutritional scientist says the following:

“Be careful about going online, It’s very hard for someone not deeply into the science of nutrition to sort through all of the misinformation out there in the general media”

“It’s not too complicated. Most people are going to get their calories from carbohydrates, so it’s really important those are going to be healthy carbohydrates. Basically whole grains”.

“Second most us is going to get our diet calories from fats, so it’s important they are healthy fats like olive oil, canola oil, soybean oil”

“Of course plenty of fruits and vegetables, a wide variety is important”

“Protein sources, emphasizing plant protein sources like nuts, legumes, soy products, beans of course counted as legumes. Keeping red meat quite low if you want to have it at all. One serving a week perhaps, or if you like steak, maybe have it a few times a year or once a month. But not large amounts of red meat for sure. Modest amounts of poultry would be okay. Fish a couple times a week is a good idea because they are a major source of Omega-3 fatty acids which are essential.”

“Dairy products are not essential but if you like to have them, one serving a day is a good target to aim for preferably having it as yoghurt or some cheese you enjoy but not large amounts”

“Of course keeping sweets and especially sugar sweetened beverages on the low side”

It’s basically the quality of the foods that matter.

What effect does the sub-optimal diet have?

Negative effects on cardiovascular disease (struck out because low apoB/pharmaceuticals can take care of it IMO), type 2 diabetes, neurodegenerative diseases, lower quality of life due to type 2 diabetes and premature cognitive decline.

Adding physical activity, not smoking and avoiding alcohol, if we do all of these things right, we can add about 10 years of healthy life according to Dr. Willett, not life in a nursing home, but 10 years of healthy living.

What is our certainty?

In the 70’s it was guess work, but now we know a lot more based on large epidemiological studies following people for a long time.

Have some soy food.

Mastering the Art of Healthy Eating: Diet Tips and Nutrition Research | The Proof Podcast EP #266

Mastering the Art of Healthy Eating: Diet Tips and Nutrition Research | The Proof Podcast EP #266

What am I doing differently?

I am increasing my vegetable consumption, and fruits. With every meal is the plan. I am also swapping my carbohydrates from mostly refined grains to whole grains. I also am going to try to eat more beans and legumes.

Websites like https://www.myplate.gov/ will be of help to me.

What am I interested in when it comes to this topic?

If you know links between diet and cancer for example, although uncertain, that would be interesting to me. As I’ve said elsewhere I think heart disease “is a solved problem”. and I believe many others on the forum believe so as well, there are other topics for that.

[desertshores]

While I adhere to a moderately healthy diet myself, I think diets are probably overrated as long as one exercises and retains a respectable BMI.

As you can imagine at 82yrs old my progenitors didn’t have any information about what was healthy or not. They ate what was available. They were mainly farmers so they ate plenty of wholesome foods such as whole dairy products, beef, chicken, and pork.
On the downside, they ate plenty of bacon, baked bread, biscuits, and gravy. For dessert, they had pies, cake, and lots of other desserts with plenty of sugar.
My mother and my uncles lived into their 90s and were ambulatory to the end. One exception was an uncle who only lived to 85, but he was a functional alcoholic.

What was their secret? Maybe good genes, but they all worked their butts off during their lives and were not overweight.
They did not take any supplements.

[AnUser]

The diet studies have shown that people that eat this way tend to be healthier. It would include your cohort and earlier if not based on it. There are always exceptions, but there is surely a trend that those to eat more vegetables, fruit, whole grains, etc, tend live healthier and longer lives.

From The Tree of Life (2011). Did the people in the 50’s and 60’s live healthier on average based on these factors?

[arugula]

This three part series might be of interest.

How long do health influencers live? Episode 1 of 3.

How long do health influencers live? Episode 1 of 3.

[Ericross2]

Diet is complex: I’ve been a vegetarian, a brief vegan, an “Atkins”, a Mediterranean, a keto, a carnivore, and a sad SAD heavy person throughout much of my life. Virtually none worked for me no matter how hard I tired. For me: being lean/ muscular is the first step to longevity since I don’t see many old fat guys. So now I’m low carb but heavy protein, combined with heavy exercise.

I’ve been going on the assumption that “too much” protein is probably bad for longevity, but that muscle/connective tissue building /maintenance is required to keep healthy (as is some level of growth/regrowth or things aren’t repaired). So I eat a diet that is probably too much protein for longevity, but hope to counter this with Rapamycin and just being healthy in general. But I’m also concerned about healthspan and moving fluidly into my 80s (I’m 52) so a diet that helps me with this would be better. I’ve picked a diet I can adhere to longterm and helps me stay leaner (but I am not a tribalist about it and don’t care if you want it or don’t want to be on my diet). I’m also worried that higher LDL will lead to higher CVD risks, so I’m thinking of trying to supplement with something like Nattokinase which could cut plaques (and thus CVD risk).

High protein: good for health, bad for longevity

High LDL: mixed for health, bad for CVD.

Here’s a research article I just saw which is a study of 113,000 Koreans with a median age of 53, published this year of their mortality versus meat consumption (90% red); they really get into the specific different types of meat. It basically says less (red) meat means lower CVD (although high non-processed meat didn’t seem to be a major risk). Processed meat was bad in general. But the differences were closer than I would have expected.

I get that if I eat vegetarian I’ll probably have lower CVD risk (although this study suggests the risk is more miinor than I had expected). But will this really be better for longevity?— is higher protein better for other risks? I’m trying to figure out if I eat healthy whole foods, low carbs, and a lot of (clean) meat, will my risk really be only CVD which may be alleviated through plaque reduction and then I may end up with better risk factors in other areas (such as cancer, immunity, Alzheimer’s, etc). So my combo may end up ahead. I assume if I’m healthy metabolically, there’s less of a chance I die of some of these other issues like kidney failure, etc. Also an object at rest etc. so the more I exercise the better off I’ll be (assuming I’m not a muscle-bound romance novel cover model).

Total and cause-specific mortality associated with meat intake in a large cohort study in Korea - PMC.

Participants were 113,568 adults with dietary data at recruitment (2004–2013) of the Health Examinees-Gem (HEXA-G) study, a prospective cohort study conducted in 8 regions of Korea. Participants were followed until 31 December 2020. Total, red, white, and organ meat intake were computed based on a 106-item questionnaire. Multivariable Cox proportional hazard models were implemented using the lowest quintile of meat intake as the reference category.

Findings

For 1,205,236 person-years, 3,454 deaths were recorded. High intake of processed red meat was positively associated with all-cause mortality [men: hazard ratio (HR) 1.21, 95% confidence interval (95% CI) 1.07–1.37; women: HR 1.32, 95% CI 1.12–1.56]. Increased risk of all-cause mortality (HR 1.21, 95% CI 1.05–1.39) and cancer mortality (HR 1.24, 95% CI 1.03–1.50) was observed in women with high intake of organ meat. Moderate intake of pork belly was associated with reduced risk of all-cause mortality in men (HR 0.76, 95% CI 0.62–0.93) and women (HR 0.83, 95% 0.69–0.98) but high intake was associated with increased risk of CVD mortality in women (HR 1.84, 95% CI 1.20–2.82). Low beef intake decreased the risk of CVD mortality in men (HR 0.58, 95% CI 0.40–0.84), but roasted pork increased cancer mortality in women (HR 1.26, 95% CI 1.05–1.52).

Conclusion

There was increased risk of all-cause mortality associated with intake of processed red meat in men and women, increased risk of all-cause and cancer mortality with intake of organ meat in women, and increased risk of cancer mortality with intake of roasted pork intake in women. High intake of pork belly increased the risk of CVD mortality in women, but moderate intake was inversely associated with mortality from all-causes in both men and women.

[scta123]

I think eating well or eating for health can be achieved not in one single way. There are many ways but there are some things to avoid and keep in mind. My personal view is to avoid processed food (mostly because it is caloric dense, usually too much fat or sugar and there is a good chance there are some trans-unsaturated fatty acids or HFCS included) and trying to eat less SFA, enough vegetables and legumes for dietary fibre and the rest is just mixing and matching. Some days I eat something sweet, some days I don’t. I believe in moderation and eating what you like is also important for happiness and mental health. I have no food that I would say no to in moderation if I really like it. I also believe that some CR is necessary for health and longevity as it forces our body to work more efficiently. I also believe lean and strong body is what is most important. I believe that lifestyle and eating is just one point in lifestyle and lifestyle as a whole is far more important than medical interventions. For example high LDL-C (or apoB for that matter) is mostly (if there is no case of genetics) driven by lifestyle. We know what reduces it and what drives it higher. Stress, mental health, anxiety, depression they all have a great impact on our overall health and wellbeing. And in this mechanistic cartesian world we try to understand the details, but forget that the sum is usually more than the just total of all parts.

[Brimstone]

To me the problem is in the definition. Define “healthy eating”. For every vegetarian, vegan, carnivore, low carb, high carb, low protein, high protein, person out there I can dig up no less than a dozen studies that show they aren’t eating “healthy”. I had relatives that lived on a Pennsylvania Dutch diet…they mixed days of high fat, high sugars and high protein, they fed on lard, funnel cakes, Coke, smoking and drinking and they all lived well into their 80’s and were “healthy”. Like @desertshores there were no supplements in sight. Then again, I can point to friends of mine who lived the same way and are on 8 different meds to keep the damage they’ve done in check. To me, healthy eating is what keeps me happy and keeps my blood markers in check. I disagree vehemently that there is a “healthy eating” menu that is a one size fits all. Even saying fruits and vegetables are part of a “healthy diet” is contradicted by people who eat none and are “healthy”.

As for “healthspan”? Define that as well. Is that having parents with heart diseases and you avoiding it? Is that having one thing like high cholesterol that can be controlled on meds but no other problems? Is that being fully cognizant as you age even is you have sarcopenia? Is that having no diseases whatsoever…ever? Again, I think healthspan is individual to everyone, not just a flat umbrella term.

I’m not trying to be critical of the question or your concerns, quite the opposite. I’m trying to say that if we judge our diet by a study on a Korean population we’re missing the mark. We should be judging it based on what our body tells us. You are your clinical study with an N of 1…being the only N that matters. We have no idea what confounding factors were involved with any study, but we do with us…and we can measure us…and see results with us. We’re the perfect study.

I think the real question we should be asking is what is a healthy acceptable diet for us that leads to a healthspan we are happy with. Just my two cents.

[AnUser]

I defined healthy eating in the first post, based on what the most cited nutritional scientist says, which is also consistent with other experts from different countries. That there are exceptions is expected, everyone’s heard of someone’s grandma that smoked a gazillion cigarettes, drunk a lot of whiskey and lived to 90. Healthspan is how long someone lives in good health, like not having to be in a nursing home, but able to live normally and in a good way.

I disagree that we should be living as n=1 because we can’t look that far into the future, our best bet is to look at those who’ve already lived and died and try to find statistical correlations, of course compiled and delivered to us by experts.

[Brimstone]

Thoroughly respect your opinion and I appreciate your point of view. I guess what I’m saying is that correlation is not cause and effect and studies based on questionnaires are fraught with human error and guesswork. As an N of 1 I may not be able to look that far into the future, but if I can control my “now” I may be able to control my future.

Thank you for your perspective, it’s why I truly love these forums.

[AnUser]

The real N=1 is deciding your uncertainty in the result and multiplying it by the value.

10 years healthy benefit, with 60% certainty is 6 years of expected healthy living, is it worth it to be eating more vegetables, fruits, etc? If you really trust the Science™ you will judge it to be a larger expected benefit. It’s up to you, or you might be a full skeptic and have 0% certainty, deriving no value from this. This is the only way I can eat healthy without thinking “correlation is not causation” and abandoning it.

For apoB reduction my certainty is 99% so the value is godlike for me.

[desertshores]

People on diets of all kinds may live long.
The people in the youtube video that lived to be over 90 did not stress exercise.
I personally look to exercise first and diet second.
I am looking for a study that gives some info on how important genetics are.
While “Plant Chompers” used mostly celebrities advocating for one diet or lifestyle over others there are many exceptions to the “normal” diets when it comes to longevity.
My own dietary intake over my lifetime has not been that great. Only after I retired did I start to take more interest in my diet.
The jury is still out on the long-term anti-aging effects of such things as intermittent fasting and time-restricted eating.

“Susannah Mushatt Jones, an Alabama-born 116-year-old woman who resided in Brooklyn, revealed that daily diet consisted of morning bacon and eggs, fruit for lunch, and the classic meat, potatoes, and vegetables for dinner. However, her niece said at the time, “She’ll eat bacon all day long.” The world’s second-oldest verified living person, a 118-year-old French nun named Lucile Randon or Sister André, does her one better and admits to eating chocolate every morning.”

What the World's Oldest People Eat in a Day

[JuanDaw]

As Tanaka says, the “secret to a long life is doing the things that you like. Eating the things I like, doing the things I like. I’ve been able to enjoy each and every day.”

[AnUser]

It’s probably possible to eat a healthy diet that you like.

[Joseph_Lavelle]

Pleasure in food is important but I have found that what I like to eat, what I crave, what foods I find pleasurable is changable. The more and longer I eat whole food (and more variety of vegetables), and eat little added sugar or fat, the more I crave the healthy stuff. Now I find that the texture of foods (crunchy in particular) is the most important attribute. After adding spices (pepper, garlic, red pepper, etc) to my meals to get more phytonutrients, I now find the mixture of flavors draws my attention to my food (and away from my smartphone).

[AnUser]

It’s also not realistic to go 100% healthy diet. Swapping carbohydrates to mostly whole grains seems relatively easy. Eating fruit with dinner is easy. So is having a salad on the side.

[Joseph_Lavelle]

Not all at once, I agree. The key is doing better over time. 100% healthy is a good long, long term goal. Today I will do better than yesterday.

[AnUser]

I’m not sure everyone will share that long-term goal of 100% healthy diet, as we all differ in our assessment of the science, risks and benefits. Someone who is 60% sure or someone who is 90% will care more, or less. As there is a difference in expected benefit. There is surely a drawback eating 100% healthy, as it isn’t as palatable, pleasurable, etc.

[Joseph_Lavelle]

Of course everyone gets to set their own goals. My point was that the foods that give pleasure can shift toward healthier foods. I assume it is similar to why I enjoy exercising….I’ve been doing it for a long time. It gives me pleasure. Someone starting from scratch might feel differently at first.

[jakexb]

Peter Attia has mentioned this many times… basically for all the focus on diet, very few well-constructed nutrition studies have shown more than a tiny, maybe not even significant, effect on lifespan. The ones that do usually have to do with one thing: which foods are less bad for you when you eat TOO MANY calories?

If you stay under your total caloric needs, basically every thing gets used and there are very few things (excluding truly bad stuff like trans fats) that are going to give you problems. But if you go over your caloric needs, now your body has to figure out how to dispose of this stuff and some things are worse than others.

[scta123]

I totally agree that a moderate CR is necessary in any diet as it forces our body to be as efficient as possible and as every cell has to fight for calories…

Few days ago I stumbled upon this article below, when researching polypil vs. other strategies to reduce ASCVD and found two interesting articles one titled exercise is the real polypil and this that proposes polymeal could be as effective as polypil (which is more popular on this forum as a form of combining lipid reduction, hypertension and blood sugar controlling medicines with low dose aspirin).

The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%… ingredients of the Polymeal were taken from the literature. The evidence based recipe included wine, fish, dark chocolate, fruits, vegetables, garlic, and almonds. Data from the Framingham heart study and the Framingham offspring study were used to build life tables to model the benefits of the Polymeal in the general population from age 50, assuming multiplicative correlations.

The Polymeal: a more natural, safer, and probably tastier (than the Polypill)...