I think that I am not alone in having the firm conviction that I am going to live forever.

Of course, I know on an intellectual level that that is not the case, but on an emotional level it is difficult to believe in the possibility of my non-existence.

Living forever actually doesn’t sound that appealing. I imagine that after the first couple of centuries it could become quite tedious. But then, the idea of life coming to an end doesn´t appeal much either. As Spike Milligan said; “it’s not that I’m afraid of death; I just don’t want to be there when it happens.”

It seems to me, the best compromise for this dilemma, is to age gracefully, accept the limitations, but as far as possible remain active physically and mentally. The ideal is to compress all of the ill-health and disability to the very end of life. It should be not so much about the years in my life, but the life in my years.

But why do we age?

At first glance it looks like ageing as just an inevitable wearing out of the parts, like an old car that loses performance and rusts up; the simple laws of physics and chemistry at work. But in reality, it isn’t quite like that. Let me give you an example.

My neighbour has a dog that is 15 years old, blind with cataracts, crippled with arthritis and suffering heart failure. He is just an old dog. The same neighbour has a 15 year old son. He has 20/20 vision, his heart is in prime condition, and there is not a trace of arthritis in his joints. How is it that 15 years of ageing is so devastating in the dog, and leaves no mark upon the boy?

The point is, it is not just wear and tear that ages us. We are designed that way. We are programmed for obsolescence. There is clearly no biological reason why a dog could not age at the same rate as a human, or a human to age at the same rate as the bowhead whale which lives over 200 years, or the Greenland shark that can live for up to 400 years.

How can we combat this process?

This is my 8 point master plan for successful ageing:

1. About 25% of what determines how long and healthy a life you have is decided by your genes. So choose your parents carefully, make sure they come from good stock. Of course, we can’t choose our parents. But at least that leaves 75% of the determinants of your life expectancy that are modifiable, that we can do something about.

2. The next thing you must do if you haven’t already, is move to Marbella and live here. Spain has the 3rd highest life expectancy in the world and is expected to be at the top spot by 2040. Marbella as a town has one of the highest percentage green areas in Europe. The Mediterranean diet is generally considered the healthiest diet, air pollution is low, and we live in a relaxed, low stress, out-door life. And we have excellent doctors! Think about your home here as a sound investment in your health. 

3. Avoid long-standing stress. Short episodes of stress are fine and can be spurs to greater achievement. Unremitting stress is harmful, so is loneliness, depression, anxiety. These are all killers that can be as harmful as smoking. It is well known that married men have longer healthier lives than bachelors. On the other hand married women have shorter lives than single women, which will come as no surprise to some of our wives here!

Cultivate your friends, relationships and family. They are important to your health.

4. Don’t smoke: Giving up smoking is easy; I have done it hundreds of times!

If you are struggling to give up, there are medications that can help you.

If you can’t give up the nicotine, use e-cigarettes which are safer. The biggest killers: heart disease, stroke, lung disease and lung cancer are all linked to the hundreds of toxic substances in cigarettes.

5. Don’t drink too much. But what is too much? Traditionally, it is drinking anything more than your doctor.

There is some evidence that moderate amounts of red wine may be beneficial for heart disease and longevity because of the substance resveratrol in the skins of grapes. But there is dispute about what is a safe level. Some say that any amount of alcohol is harmful. I know that for many of you bon viveurs drinking wine is a great pleasure.

I think a middle road of 2 glasses a day of red wine is a reasonable compromise.

And if that seems rather little to you, you can just change your doctor!

6. Don’t eat too much. I realize it’s a bit late to tell you this after such an excellent lunch. Obesity and diabetes is rising rapidly in the developed world. Interestingly, it seems that among the elderly, being a little bit overweight may be beneficial so you could allow yourself a body mass index of 27 instead of 25. 

7. Exercise. It is clear that those that do no exercise and have a sedentary life have higher mortality. But interestingly, at the other end of the scale, the fitness fanatics actually do worse than the moderate exercisers. The key is to do exercise that is moderate, appropriate to your age and level of fitness and consistent. Half an hour a day or every other day of aerobic exercise that gets your heart going, but avoid heavy, bodybuilding weights. Balance exercises are important too. A major cause of mortality is from falls. Not from the fractured hip itself; that can be easily replaced, but from the complications afterwards, like pneumonia and deep vein thrombosis. Good balance prevents falls.

In summary:  Put the Iron Man competition on hold, and if you go to the gym, don’t aim for the Arnold Schwarzenegger look, go for something leaner and meaner.

8. Be vigilant of your health. Have your check-ups.  Check your blood pressure, your cholesterol, check for bowel cancer and so on. Don’t ignore even subtle signs, because they may be very significant. Most disease can be effectively treated if detected early enough.

So let’s say you do all of these things, you’ve got right genes, you follow the right lifestyle, how long could you hope to live for?

Since 1840 life expectancy has increased in a more or less straight line. Would anyone like to guess how much life expectancy will increase for each year that passes? It is almost 3 months. That is an astonishing 25% return on investment.

Spend a year of your life and you get an extra 3 months thrown in for free!

This linear increase shows no sign of slowing. No one knows for how long it can continue but it may be slowed or even regress by the increasing incidence of obesity and diabetes. Or we may reach the natural biological limit for our species.

The longest well-documented life is a French woman born in 1875 who lived 122 ½. That is pretty close to what is probably the natural biological limit for our species of about 125 years.

Let’s be honest, I don’t think than any of us have both the perfect genes and have lived the perfect life. We are not going to make it to 125 yrs.

What else could we do to get closer to that limit?

If you put mice on a severe calorie restricted diet, their lifespan can be increased by up to 50%. In human terms that would translate to an age of about 122 years.

There is some evidence that this will also work in humans, delaying age-related diseases like heart problems and possibly extending lifespan. However for many people living with that level of dietary restriction is such a miserable experience, would you want to prolong that life?

Is there anything we can do artificially to improve longevity?

If you go to Silicon Valley in the US, the medication of choice among the techies there is metformin. It’s a drug that has been used for decades to treat type 2 diabetes. It costs a couple of euros a month. 

What has got them so excited is a review in 2017 that found that diabetics who were taking metformin had lower all-cause mortality. They also had reduced cancer and cardiovascular disease and lived longer compared with those on other therapies.

Studies on mice given metformin showed they lived longer lives, were fitter, more active and performed better on tests for memory and learning. So this might be a way to reduce cancer, heart disease, maybe even treat Alzheimer’s disease.

The question is, should you take Metformin even if you are not diabetic?

The medical answer is; not yet. 

Not enough is known about true benefits that it can be recommended as an anti-ageing treatment. That will take years, and one of the reasons for that is that this drug’s patent has expired. That means any pharmaceutical company can make and sell it, and it is very cheap. Without the exclusivity of a patent, there is little money to be made to justify drug companies carrying out expensive trials.  However, some might argue “it is all very well saying ‘wait for definitive proof,’ but my clock is ticking!” 

My advice is to have a blood test to see if you have pre-diabetes, that is, a predisposition to develop diabetes in the future. 

If you have pre-diabetes then taking Metformin may well be justified anyway. 

If you don’t have pre-diabetes, and you are a gambling man, then talk to your doctor to weigh up the risks and possible benefits before joining the Silicon Valley techies.

What about the future? Surely science will eventually come up with some better answers.

The ageing process is programmed and partly controlled by genes like Klotho, which is named after one of the 3 Greek goddesses that spun the thread of life. Another similar gene is called INDY (an acronym for I’m Not Dead Yet). If the Klotho gene is overexpressed, then ageing is delayed and life extended. Conversely, if the gene is blocked then ageing accelerates. It may be possible one day to manipulate these genes and reprogram the ageing process.

If you take a Salamander and cut off one of its legs, it will regrow a fully functional new limb in a matter of weeks. This is because it has stem cells that can, when persuaded to do so, change into whatever type of tissue cell is needed and regenerate organs or body parts. Humans have a limited ability to regenerate: a shallow cut on the skin can heal without any scar. Cut out half of a person’s liver and the remainder will grow back to the original size. We also have stem cells, so the potential is there to regenerate any damaged organ or body part.

The idea of stem cell therapy has been around for decades, but despite all the hype, the results have been disappointing. There are very few successful applications. It turned out to be much harder to do than many people expected.

The biological principle however is clear and progress is being made. I have no doubt that at some time in the future it will be possible to regenerate any organ or body part that is aged or damaged, as needed. 

When that day comes, we may finally have realized the dream of humankind for thousands of years; immortality.

 

 

Some questions from the audience

MBI Member 1: I have Sanitas insurance. I understand that you don’t work with them. Can I ask why not, and do you work with any other insurances?

Dr Crichton-Smith: I do work directly with the international insurances like Axa-PPP, BUPA and so on, and arrange direct billing with them. I don’t work directly with Sanitas or other Spanish health insurances. The reason for that is that unfortunately they pay their doctors relatively little. The only way to make a living with them is to have a high volume of patients, and see them very quickly. That is not how I like to practice Medicine, so I choose not work with them.

MBI Member 2: I was rather surprised that you advised against strength-building exercises. I was involved in a charity with Arnold Schwarzenegger (who, by the way is an excellent person and does a lot of charity work) to promote strength-building exercises in the elderly which improves their functional capacity, posture and self-confidence.

Dr Crichton-Smith: I completely agree with you. Strength-building exercise is very important. What I mean to say is that I recommend, for example, low weights and high repetitions over the very heavy weights that are used to develop bulky muscles in body-builders. That kind of gym work, especially as you get older, risks injuries and maybe other side effects.

MBI Member 3: The hormones that bodybuilders take can affect the heart….

Dr Crichton-Smith: Yes, the use of anabolic steroid for building muscle has many adverse effects including on the heart. It is not recommended.

MBI Member 4: How much do you drink, if that is not too personal a question?

Dr Crichton-Smith: I drink less than 2 units of wine a day. 

MBI Member 4: Do you think that drinking more will significantly affect life expectancy?

Dr Crichton-Smith: It seems that susceptibility to the effects of alcohol, and also cigarettes, varies from person to person. For example, Winston Churchill drank heavily and smoked cigars and lived into his 90s. Even Jeanne Calment, that 122 year old, smoked and drank alcohol to a modest degree. But of course, you may not find out what your own susceptibility is until it is too late, so it is sensible not make any assumptions.

(Note: genetic studies may be able in the future to predict vulnerability or resistance to the effects of substances like alcohol or tobacco in a given individual).

MBI Member 1: I had a check-up recently, they told me my liver would make a fine foie gras paté, and they found that I have high ferritin levels on my blood test. My doctor recommends me to have blood taken out of me every so often to keep the ferritin levels down. Can you explain what that is about?

Dr Crichton-Smith: Have you been diagnosed with haemachromatosis?

MBI Member 1: I don’t know, just high ferritin levels I think.

Dr Crichton-Smith: There are different causes for elevated ferritin levels, one of which is an excessive amount of iron stores in the body. It sounds like you may have haemachromatosis. This is a disorder of iron metabolism where the body tends to accumulate iron. The treatment is venesection or periodically removing about 500ml of blood from a vein. This forces the body to manufacture new red blood cells and haemoglobin and in the process use up the accumulated iron deposited in the tissues.

MBI Member 1: What effect does this condition have? What organ does it affect?

Dr Crichton-Smith: The iron is deposited in many organs and can cause damage especially in the liver, but also the heart, pancreas… However, the real problems occur in patients who don’t know they have the condition and are not treated. The treatment of removing blood is very effective at avoiding the damage to organs if it is started early enough.

MBI Member 6: How would you know if you have it? What symptoms are there?

Dr Crichton-Smith: The classical symptoms are “bronze diabetes”. That is, a person develops diabetes because of damage to the pancreas and has a bronzed appearance to the skin, like a deep sun tan. But there can be many other symptoms.

MBI Member 4: If you had cancer what treatment would you have. Chemotherapy? Immunotherapy?

Dr Crichton-Smith: It really depends on the type of cancer, the staging, if it has spread and so on. For example with prostate cancer now there are so many treatment options for a range of different situations. It is a complicated area, and I would take advice from my oncologist first as to what is the most appropriate treatment for my condition.

MBI Member 7: You seem to be quite open-minded as a doctor, perhaps open to alternative treatments. I wondered what your attitude would be, if you had cancer, say, to the use of hashish for treating your disease?

Dr Crichton-Smith: I have no training in so-called alternative or complementary medicine. In fact I don’t make any distinction between that and conventional medicine. The principle is that any treatment should be based on at least some good evidence that it is effective and safe. So I would consider receiving or prescribing any treatment, conventional or otherwise, as long you could demonstrate there was good science to back it up.