Navigating the Longevity Science Echo Chamber

Longevity Science in the Media: A Formula for Overwhelm

The media spin and hype around medical news are pervasive, confusing, and often contradictory, but add to it the rising popularity and social media presence of “Longevity Science” and it can be overwhelming.

Why are some of the newest tests so controversial, not covered by insurance, and “not ready for prime time”? How do you tell a real Longevity scientist or physician from an “influencer”, blogger, or supplement pusher?

As a patient who’s interested in and willing to dedicate themselves to leading a healthy longevity lifestyle, how do we navigate the hype and who do we believe?

The Back and Forth of Nutritional Science in the Media

Why is nutritional science so back and forth? — eggs are good, eggs are bad! (Remember the old Lewis Black routine?)

We can look to nutritional science as indicative of some of the problematic ways medicine, science, and media create a convergence that confuses, obfuscates, and frustrates our best intentions.

Nutritional science has suffered from several flaws, some intrinsic to the field, but mostly from problems with association studies that are “peer-reviewed” and in actuality, observational rather than causal. These observational studies when referred to as evidence are considered to be “low-quality”. For example, there was a recent study that found that Intermittent Fasting (IF), which basically refers to keeping your eating window to eight hours a day, was associated with a 90% higher cardiovascular mortality. Really?

A more careful review of the study revealed it was not an actual study but a retrospective “peek” at eating habits from 5,000 people remembering over several years what they ate for two days out of the year, and recording it months after the fact. It was not built as a study to look at eating times where people would have had to write down exactly when they ate in real-time. It wasn’t a prospective study where similar groups were randomly assigned to different eating windows and then followed for several years to see what happened. The survey data is quite unreliable, the findings aren’t even presented, published, or peer-reviewed yet, and there may be numerous alternative explanations for the data, for example, having to do with perhaps older or sicker people tending to have dinner earlier… and maybe this group goes to bed earlier? Who knows?

The majority of the Intermittent Fasting literature published prior shows that in randomized studies, it is beneficial or at least neutral to eat over 8-10 hours and fast 12-14 hours vs. eating over 12-14 hours. This is a great example of the mainstream media jumping to conclusions, and looking for the media splash. The backlash and critiques to the Intermittent Fasting study in question were swift (see resources below).

The literature is full of these types of misrepresentations. But think about the human diet and how complex it is. Can we lock people up in a metabolic ward for ten years and control their calories, food quality, eating times, exercise output, how they prepare their food, and where it is purchased? That is the only way we could really test one thing at a time… (eggs vs. no eggs, high saturated fat vs. moderate saturated fat, etc.) while keeping the rest of the diet AND lifestyle exactly the same for all test subjects. It is not possible.

Another problem in the nutrition field is categorizing foods. For example, when someone responds that they ate 6 ounces of “meat”, do they mean a hot dog, a fatty piece of prime rib, or a pasture-raised bison burger? Those are not the same foods nutritionally, yet often they will get lumped together. Yes, there were studies that purported to show that red meat “caused” colon cancer, heart attacks, or diabetes but we actually still don’t know for sure if that’s the case. More thoughtful analysis says it probably isn’t. In fact, the recommendation to lower meat consumption was backtracked recently.

When you consider that most of America eats poor-quality agricultural feedlot meat or cured meats, and that meat consumption is often combined with habits like consuming fries, beer, and overall higher caloric and saturated fat loads, we might think we are analyzing meat, we are actually analyzing a whole lifestyle. There is no randomized prospective trial looking specifically at grass-fed, small-portion, high-nutrient quality meat over ten years vs. fish or beans as protein, with everything else controlled. While it is possible that a dinner of 3-4 ounces of red meat of high quality combined with 2-3 vegetables is healthier than a diet high in rice, beans, and nuts, which carry a significant glycemic load (carbohydrates or sugars), we just don’t know. And the truth is we likely won’t know and will continue to work from observational studies, not real studies, for a long time. Without an advanced degree in statistics and access to original medical literature, these press reports feel jarring, and their advice will tend to flip-flop if you wait long enough.

New Medical Tests: Professional Medical Guidance is Key

New imaging tests and lab tests become available each year. In longevity clinics in particular patients are accessing advanced tests like whole-body MRIs to screen for cancer, VO2 max tests to look at fitness levels, and blood tests that show our “biological” age.

In most cases, these tests are not FDA-approved at this time for the purposes they are being used. They still can be highly accurate, sensitive, and specific and they also might be very reproducible (get the same results if run 2 or 3 times separately). With the right professional guidance they might change our behavior, as in causing us to alter our exercise programming, change our supplementation or diet, or undergo additional testing that we might not have done.

In one sense, a lot of our best medical tests today started out as experimental. For example, there was a “first” CT scan series, with no data to compare back to an era before CT was available and no proof that CT scans would save lives over the subsequent ten years. Likewise, some of the newly available tests will eventually stand the test of time and will be proven to be useful and save lives, suffering, and probably a lot of medical expense.

One example is the biological age test that can tell us that physiologically, in one aspect, we look more like an average 50-year-old than an average 60-year-old. That’s not a written guarantee that we will live ten years longer than everyone else our age but provides a benchmark for us to experiment by perhaps altering our sleep patterns or diet and rechecking the direction of our aging down the line.

Despite best intentions, these tests can sometimes be anxiety-provoking, and disappointing, and prompt further more invasive testing. This is why it’s important to keep in mind that it makes a difference when these tests are administered by a quality lab or imaging clinic and then interpreted by a skilled physician who can explain the test and blend the results with information already available about the patient. People interested in this level of testing should seek guidance from a physician who is familiar with the patient as well as the test’s potential and limits and be able to translate the results compassionately and accurately.

Not all of us are willing to wait the 17-30 years it can take for a new medical technology to go through all the vetting and long-term follow-up, and many of the companies developing these tests do not have the $500 million it takes to usher a test or technology from idea and rollout to full FDA approval. Yet we, as physicians, have to be smart about selecting the right tests for the right person at the right time, and not overstating their certainty.

Medical Science vs. Media Hype: Consult a Reliable Physician

There are many supplement companies, salespeople, bloggers, and apps that have hopped onto the “longevity” train. Even the New York Times has run articles like “Exercise Snacks for Longevity” or “How Long Can We Live?” (see below).

While we at Hudson Valley Longevity Medicine cannot give you a blanket statement about all longevity books, supplements, and programs, we can advise that you read broadly, look for longer, more thoughtful, and analytical books and articles that quote the medical literature, and avoid obvious “sales” pitches for specific products, foods, or programs.

What we know so far is that there is no “secret” to longevity at this point. What we do know is that the quality and quantity of our sleep, our mental health, our diet, and our movement matter quite a bit. So do things like our management of light exposure, our involvement with family and friends, and having purpose late into our life.

At Hudson Valley Longevity Medicine, we are careful and analytical about the data we collect and are always educating our patients about the limitations of what we know and how to responsibly use the information. Patient education is our main goal and our passion. We feel that part of our job is to take you out of the echo chamber and give you the guidance and care needed to confidently select a health optimization path specifically suited to you and your lifestyle.

Resources

Not-so Serious Resources

Lewis Black On America’s Obsession With Health: YouTube – https://www.youtube.com/watch?v=DxgITv5yaPI

More Serious Resources

A study says intermittent fasting is making people drop dead. Oh, come on: STAT – https://www.statnews.com/2024/03/19/intermittent-fasting-study-heart-risk/

Meat’s Bad for You! No, It’s Not! How Experts See Different Things in the Data: New York Times –  https://www.nytimes.com/2019/10/01/upshot/health-risks-meat-experts.html

No need to cut back on eating red meat, new research finds: silive.com – https://www.silive.com/news/2019/10/no-need-to-cut-back-on-eating-red-meat-new-research-finds.html

Opinion: The latest flip-flop on red meat uses best science in place of best guesses: Los Angeles Times – https://www.latimes.com/opinion/story/2019-10-09/red-meat-diet-nutrition-guidelines

How Long Can We Live?: New York Times – https://www.nytimes.com/2021/04/28/magazine/human-lifespan.html

Is 30 Minutes of Exercise a Day Enough?: New York Times – https://www.nytimes.com/2022/04/06/well/move/30-minutes-exercise.html

Photos by: Alexandr Podvalny & Louis Reed