You have been a cancer surgeon. What made you turn your attention to the science of longevity? Isn’t that something for tech billionaires who have been throwing their money at the problem of ageing?
It’s a problem that affects all of us, so I don’t think the participation of wealthy investors is mutually exclusive to my personal and clinical interest. I prefer to manage my own risk and take matters into my own hands rather than wait and hope for a technological breakthrough which may or may not happen. Currently, virtually all investments in this problem focus on molecules, which I believe only represent a fraction of the tools we have at our disposal to live longer — and more importantly, better — lives.
In your book, you’ve spoken of why we need to move from Medicine 2.0, which was about antibiotics and vaccines, to Medicine 3.0 which focuses on prevention. Why do you think prevention hasn’t got the attention it deserves?
As I see it, three problems contribute to the lack of attention toward prevention. First, prevention doesn’t fit well within the framework of Med 2.0, which essentially follows the pattern of diagnosis, then prescription. This works well for treatment of certain existing diseases, but the ‘diagnosis’ can be very elusive when it comes to prevention. Second, at least in the US, financial incentives, whether for research and development or for healthcare providers, are all geared toward disease treatment rather than prevention. Third, physicians are not trained in the tools to prevent disease, such as exercise and nutrition, or even the ways to use medications, such as lipid-lowering drugs, to prevent heart disease decades before it takes hold.
Ideally, we should be eating healthy and working out but if we could do only one thing — diet or exercise — what would you choose?
Choosing is impossible since both are so vital. However, in terms of quantified benefit, a lot of exercise will do more good than a very strict diet. Consider that having type 2 diabetes increases your risk of all-cause mortality (death from any cause) by approximately 40%. Now consider that being unfit (low VO2 max) or having low muscle mass or low strength is associated with a 200-300% increase in all-cause mortality. So, when viewed through this lens, it’s hard to find a behaviour that has a greater impact on your life than exercise.
What do you think is wrong with the modern diet and how can we fix it?
Evolution and our genes solved a problem — that of avoiding starvation — that is very different from the problems we face today. That evolutionary system worked very well until about 100 years ago, at which point food started becoming much more energy-dense (and palatable) and much cheaper to produce and transport. So now, instead of a problem of too little, we have too much, especially with regard to highly processed foods laden with salt and sugar. It’s staggering how calorie-dense these foods can be, and avoiding them is one of the clearest ways to avoid the pitfalls of a modern diet.
Indians have a higher risk of heart disease and Type 2 diabetes. Can we really overcome genetics by changing our lifestyle?
Absolutely. Type 2 diabetes is a very modern phenomenon. It was virtually unheard of 100 years ago, despite the fact that human genetics have not changed much over millennia. This tells us that the disease is not genetically predetermined (though different people do indeed have a different level or degree of genetic susceptibility) and that something else must explain the sudden rise in its prevalence. So, what’s changed? We eat much more, especially low-nutrient, high-calorie foods. We move and exercise much less. We sleep less, and we are possibly under more stress. All of these factors play a role and probably in that order. So, if we want to go back to a time when fewer than 1% of the population had diabetes, we have to change our lifestyle to counteract these unhealthy trends.
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n the final chapter, you’ve spoken about your struggles with emotional health. Coming out with those details must have been tough so why did you choose to share that with readers?
It was very difficult and uncomfortable to write about such a personal topic, but my hope and belief is that by doing so, others who read it will be more open to exploring their own emotional health. Their issues may be different from mine, but the most important first step is recognising that a problem exists (which can be very hard). The second step — having the belief that with enough hard work, the problems can be addressed — might be even harder. But ultimately, to paraphrase Esther Perel, what is the point of living longer, if you can’t do so in harmony with those around you?
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2023-07-29 22:30:00Z
CBMinwFodHRwczovL20udGltZXNvZmluZGlhLmNvbS9ob21lL3N1bmRheS10aW1lcy9jYW50LXdhaXQtZm9yLXdlYWx0aHktdG8taGFjay1hZ2Vpbmctd2UtYWxyZWFkeS1oYXZlLXRvb2xzLXRvLWxpdmUtbG9uZ2VyLWRyLXBldGVyLWF0dGlhL2FydGljbGVzaG93LzEwMjIzNjk0MS5jbXPSAaMBaHR0cHM6Ly9tLnRpbWVzb2ZpbmRpYS5jb20vaG9tZS9zdW5kYXktdGltZXMvY2FudC13YWl0LWZvci13ZWFsdGh5LXRvLWhhY2stYWdlaW5nLXdlLWFscmVhZHktaGF2ZS10b29scy10by1saXZlLWxvbmdlci1kci1wZXRlci1hdHRpYS9hbXBfYXJ0aWNsZXNob3cvMTAyMjM2OTQxLmNtcw
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