February 12, 2008

Diabetes Does Not Preclude a Long Life

Today's news contained a report about a study of centenarians which came up with the cheering news that neither diabetes or obesity prevents people from living to be 100.

Here's the original AP News Release:

Reaching 100 Is Easier Than Suspected

What fascinated me was the way that newspapers headlined this story. In keeping with the media's unending need to demonize diabetes and obesity, this same story ran with headlines like these:

Men Who Maintain Healthy Habits Lead Much Longer Lives

Key to longer life may lie in keeping fit from the age of 70, says study

In fact, the studies cited did not say that. The researchers admitted that genes appear to account for 25% of the likelihood of longterm survival. Many centenarians come from long-lived families. And the data about the relationship of risk factors and aging applies only to men. Women are much more likely to live to be old no matter what their health issues might be.

But here's where the reporting of this story gets interesting. Most of the news reports based on the AP story left out a graph the AP had prepared to accompany the article, though the graph did appear in my wonderful small town daily paper, The Greenfield Recorder.

These other media reports merely noted that men without any of these risk factors--which was translated into "men with a healthy lifestyle" had a 54% chance of living to be 90 and those with all the risk factors--translated into "an unhealthy lifestyle" had a 4% chance of living that long. These reports left out the information about the extent to which each factor decreased the risk of a 70 year old man's living to be 90.

Here's the chart:



What it appears to show is that:
  • Being sedentary decreases 70 year old men's chances of living to 90 by 10%.
  • Being obese decreases 70 year old men's chances of living to 90 by 10%
  • Diabetes (which probably means an A1c > 7%) decreased 70 year old men's chances of living to 90 by 4%.
  • Smoking decreases a 70 year old men's chances of living to 90 by 3%


A combination of factors appears to have a stronger impact on survival than the factors on their own.

Why is this good news? Because you can eliminate high blood pressure and high blood sugar by lowering your carbohydrate intake significantly, and, if that doesn't get the job done, by adding one or two carefully chosen drugs.

You can deal with the problem of being sedentary by taking a 30 minute walk every day. There's a lot of research that seems to find that this is all you need to do to make a difference in your health. Heroic exercise, such as lifting heavy weights and running, is, in fact, more likely to cause the kinds of joint and tendon injuries that will render you sedentary as you get older than is walking.

You can stop smoking.

That leaves one last factor that is harder to deal with especially as you get older, which is obesity. Since several studies based on NIH NHANES data have made it clear that losing weight for any reason after age 70--including dieting--appears to increase your chances of dying, I'm not certain that it is a good idea to diet aggressively at that age.

But even so if you are male and you address the other factors, you've improved your chances of living another 20 years from 4% to 44% which is not all that much worse than those lucky people--most of whom have the good genes which kept them from obese--who have that 54% chance of long term survival.

The one thing missing in these statistics is data about how many of these men survived in the kind of shape you'd want to survive in. A different NIH-funded study published this past October found that fully 34.4% of people who 90 or over had dementia and one in 7 over the age of 70.

One in Seven Americans Age 71 and Older Has Some Type of Dementia, NIH-Funded Study Estimates

Living a decade or two with dementia can be a fate worse than death, and the more healthy you are otherwise, the more likely that is to happen. Furthermore, many otherwise healthy people in their 90s are deaf or have lost their vision thanks to age-related macular deterioration.

And of course, there's one last problem with living to be very old that seems to be the hardest to deal with for the people I've seen live through their 90s: their friends are not as lucky and die. Living on when your closest friends and relatives--including children--are all gone can be difficult.

Personally, I think the focus should not be on long life as much as on quality life. I don't want to live into my 90s if it means being deaf, blind or demented, nor would I want to outlive all the people I love, particularly my kids.

But if you have been burdened by the belief that a diagnosis of diabetes means you are going to die much younger than normal, these statistics should cheer you up.

I recently got an email from someone complaining about her 80 year old father's refusal to do anything about his diabetes. I also have gotten mail about 90 year olds who insist on eating too much carbohydrate. I find these reports extremely comforting. You better believe that if I make it to 80 I'm going to eat whatever I please.

No one in my family who has made it through their 90s has done it in any kind of shape I'd like to be in, so a nice swift heart attack at 89 seems to me to be a lot better option than a painful cancer--especially since chemotherapy in people in their 80s almost always leads to dementia--or a series of strokes.

Everyone dies of something, and a massive heart attack is probably the most merciful of all the alternatives. And after I've done what I can do to improve my chances, I'm not going to obsess about long life. Instead, I'm going to make sure that I spend the days allotted to me in such a way that when it is time to go I'm ready, having done what I came here to do, seen what I came here to see, and loved who I came here to love.

7 comments:

Radcliffe said...

I really love your ability to look beyond the numbers.

Radcliffe at Radcliffe's Weight Journal

Red Sphynx said...

Jenny,

Good post! Thanks especially for the graph.

Take a look at that graph again. I think that the the five factors in the gray box are to be taken singly. That is, the marginal effects are to be compared against 'No factors'. So decrease (in those making it to their 90's) for obesity is 54-32 = 22%, diabetes is 54 - 28 = 26% and smoking is 54 - 25 = 29%. (Realize too that these data are drawn from male physicians, not the general population.)

There's an interesting (and free) editorial that accompanies the studies.
http://archinte.ama-assn.org/cgi/content/full/168/3/262

Adam Becker Sr

Goober said...

Great post!

It lifted me up a little bit--especially the last paragraph or so.

nonegiven said...

I like it. Try to stay healthy until things really start going downhill.
When things get really bad eat pizza, ice cream and bon-bons on the couch with a stack of favorite DVDs, drink enough to dull the pain and start smoking again. Check.

Bernard said...

Jenny

Nice writeup about this article, though I think diabetes decreases your chances by more than 4%.

I'm really coming to the realization that reducing carbs is key in a number of ways. Trouble is that they taste so good!

Jenny said...

Bernard,

The key thing to remember is that this study only investigated the impact of diabetes on living for 20 more years. And in older men.

The impact of living with it for the 60 years it takes to get to the age 70 when the study began is something else indeed.

I'm with you on the carbs. I put a lot of time into helping people understand their impact, but though I do my best to keep my carb input down, I eat my share. And when I do I take the blood sugar hit.

On my death bed I hope my last thought is not going to be, "Damn I wish I'd eaten more pastry!"

Anonymous said...

"Everyone dies of something, and a massive heart attack is probably the most merciful of all the alternatives. And after I've done what I can do to improve my chances, I'm not going to obsess about long life. Instead, I'm going to make sure that I spend the days allotted to me in such a way that when it is time to go I'm ready, having done what I came here to do, seen what I came here to see, and loved who I came here to love."


I'm with you here. I've always said If I was given a choice I would rather go fast with a heart attack than a slow painful death from cancer.