I love the reality that this graph makes us consider. Lifespan is how long we live, while healthspan is how well you live, free from disability or disease.

Diagram from Peter Attia, MD https://peterattiamd.com

We all want to live a long life and be in good health for the majority of it. Instead, the pattern that we see in Western society is declining health often at an early age. For many it can start in their 40’s and with it the gradual progression towards the onset of disease.

It may start as a diagnosis of high blood pressure or high cholesterol and daily medication to prevent further damage. We treat the symptom and extend our lifespan, instead of the cause and extending our healthspan.

Statistics show that by our mid-60’s, 80% of the population are on 2 prescription medications while 36% of the population are on 5 or more medications. Yes, our lifespan is now extended using these medications, but our quality of life is often diminished as we are no longer healthy.

This reduced quality of life can last for many years, 20+ or more, often occurring in our retirement years. Those years that we may have earmarked for things like travel, gardening, being with the grandkids or doing whatever we love and brings us joy.

Personally I am against this wait-and-see approach and I prefer a more proactive one. Doing what I can to prevent disease from starting earlier than it could and taking responsibility for my own health.

My aim is to move the black line on the graph (my healthspan) as close as I can towards the blue line (my lifespan). To delay the onset of disease for as long as I can in order to be disease free and have an improved quality of life. That however does not happen by default. It requires a target to aim for and focus to get there.

It doesn’t have to be a difficult or complicated plan to get there, but if you’re not aiming at anything, you will reach it every time. The work has to be done in advance in order to enjoy the benefits and fruits of good health as you age.

S.Jay Olshansky who studies the demographics of aging at the Univ of Illinois-Chicago says “We’re trying to attack heart disease, cancer, stroke and Alzheimer’s one disease at a time, as if somehow these diseases are all unrelated to each other, when in fact the underlying risk factor for almost everything that goes wrong with us as we grow older, both in terms of diseases we experience and the frailty and disability associated with it, is related to the underlying biological process of aging”.

If we want to prevent disease from occurring for as long as possible, where is the best place to start? What can we focus on that gives us the biggest payoff in terms of overall health. There is one key area that we need to be on top of and that’s our metabolic health.

Metabolism is being able to take in the nutrients from the food we eat and convert them to be used in the body. When this stops occurring efficiently, and if you meet 3 or more of these criteria you would be diagnosed with Metabolic Syndrome. This increases your risk for disease in cardiovascular, hormone and brain health.

High Blood Pressure> 130/85
High Triglycerides > 1.7 mmol/l
Low HDL cholesterol < 1.0 mmol/l for men or < 1.3 mmol/l for women
Fat around the middle - waist circumference > 94cm for men and 80cm for women
Elevated fasting glucose > 5.6 mmol/l

If no changes to diet and lifestyle are made at this stage the progression to insulin resistance, prediabetes and Type 2 diabetes will inevitably follow.

If you have recent blood work on hand, check your HbA1c, you want it to be 5.2% or less to be optimal. Anything higher than this is heading in the wrong direction and needs intervention. A level of 5.5% or higher is a loud alarm that damage has already been done to your heart, brain and liver. T2D is diagnosed when HbA1c (an average of your past 3 months blood glucose levels) has reached 6.5% or higher.

This change is slow and takes time to develop, typically 7-13 years so it’s entirely possible to make changes and reverse the progression. The longer you take to do this however, the more entrenched the pattern of dysfunction will become and the more damage will have been caused, that may or may not be reversible.

My clients often tell me when I start working with them that their blood sugar is within normal range and they have no problems. When we look at additional blood markers we often find that this is not true. Please take note of this. Insulin’s role is to keep your blood sugar in a healthy range and it can remain in this normal range during the 7-13 years whilst you may simultaneously develop insulin resistance and/or prediabetes. As it’s working to keep blood sugar in a normal range, insulin can be steadily increasing and if you’re not checking this blood marker you will be unaware of this.

When insulin is no longer able to regulate your blood sugar and it is now elevated, you have progressed a long way down the metabolic dysfunction pathway. Unfortunately, elevations in blood sugar usually happen after entrenched insulin resistance has been at play for quite some time.

Why is the default to wait for these dynamics to become so severe that they are “diagnosable” when they have already caused progressive damage?

Tracking your blood glucose level is not enough to give you a full picture of your metabolic health. Fasting glucose along with fasting insulin/c-peptide and HbA1c gives you a clearer indication of where you are along the path and what you need to do to get back on track.

The truth may be hard to hear.

If you just want to make moderate incremental changes in your diet and lifestyle, you’ll likely still have diabetes. You may slow its progression eg. choosing wholewheat bread instead of white, oatmeal instead of cereal, eating more fruit instead of biscuits, diet soda instead of regular.

Research shows you’ll still have cardiovascular risk, a shorter life and spend many of those years with debilitating disease with a reduced healthspan.

If you’re willing to make dramatic changes in your lifestyle all at once and sustain them with commitment for about 6 months and then stay on track with that lifestyle around 80% of the time, you can likely be free of Type 2 diabetes.

The old you and your choices and habits can lead you down this old path, or the proactive you can create a new path, new habits and a new you. You get to choose your healthspan. Now isn’t that a wonderful choice to be given.

What will you choose?