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Longevity, as I define it, consists of three components:

• Lifespan: the number of years you live.

• Healthspan: the quality of your physical and mental health over those years.

• Emotional Health: purpose, fulfillment, relationships, regulated emotions, satisfaction, and presence.

A critical piece to extending lifespan and maintaining healthspan is delaying the onset of, or preventing entirely, The Four Horsemen*:

1. Atherosclerosis (stroke, heart attack, etc.)

2. Cancer

3. Neurodegenerative disease (dementia, Alzheimer's, etc.)

4. Metabolic disease (type 2 diabetes, non-alcoholic fatty liver disease, etc.)

* Listed in order of mortality rate, highest to lowest.

Combined, The Four Horsemen are responsible for killing 80% of people within industrialized nations. 

So, it’s no surprise that the rare individuals who blow past the average life expectancy and live with physical strength and mental sharpness into their 8th, 9th, and even 10th decades all share one trait:

They develop these diseases much later in life than the average person or, in rare cases, prevent them entirely.

Although the medical establishment has made incredible progress in the containment of infectious diseases that ravaged human populations for millennia, with the incredibly rapid development of a COVID-19 vaccine as evidence, we have made far less progress against The Four Horsemen.

The reason for this lack of progress is multifold. 

Aside from these diseases being incredibly complex, the current approach of the medical system is flawed in at least three ways that have contributed to the prevalence of the Horsemen diseases.

Understanding these three flaws will help you achieve two aims:

1. Enable you to take a proactive approach to your health and to engage in more well-informed discussions with your healthcare providers.

2. Inform lifestyle changes you can make today in order to (hopefully) decrease your likelihood of developing these diseases or at least push back the age at which they begin to plague you.

As a result, you will give yourself the chance of not just a longer life in the form of additional years, but a healthier life in the form of wit, strength, and vitality. 

Flaw #1: The medical system helps us live longer with disease, not delay or prevent it in the first place.

The Four Horsemen diseases work in a similar manner to Chinese water torture.

They are diseases of time exposure.

In other words, they slowly develop over decades and generally don’t take root in our bodies until, for the average person, sometime in our 5th to 7th decade. 

That is when the first diagnosis occurs which, far too often, coincides with the first intervention.

These diseases are not binary—you have it or you don’t—like the common cold.

Like the irregular drip that slowly drives a victim of Chinese water torture mad, these diseases compound in little increments over time.

How fast they compound in an individual is determined by behavioural, environmental, and genetic factors.

One does not suddenly drop dead of a heart attack at age 50.

The disease has been progressing in their arteries, possibly due to poor genetic luck or unhealthy behaviours like smoking, since the day they were born.

Exploring Flaw #1's Influence on Cardiovascular Disease

This flaw in the medical system is perfectly illustrated in how we handle the biggest killer in the world:

Cardiovascular disease. 

When your doctor is assessing your cardiovascular risk, they use a 10-year risk prediction time frame.

That means they are only concerned with your risk of an “event” (often resulting in death) over the next 10 years.

To determine your risk level, they plug your age, sex, lipid profile, and a few other stats into a model called the Framingham Risk Score which then spits out your 10-year cardiovascular risk.

A few problems with this approach:

• It only considers your 10-year risk. A 50-year-old should be concerned with their 30-to-40-year risk, not just their 10-year risk.

• If you’re under the age of 40, Framingham calculates your risk as zero. Remember, this is a disease of time exposure. Although it is unlikely to kill you in your 20s, 30s, and 40s, it is slowly progressing in your arteries. So why would we wait until your 10-year risk is concerning to do something about it?

Once your 10-year risk is high enough, intervention, generally in the form of a statin medication, is provided.

This is ridiculous.

It’s the equivalent of telling teenagers that it’s okay to smoke and then once they hit mid-life and have done enough damage to their lungs to put them on a fast track to lung cancer, helping them quit.

This approach to healthcare has resulted in Flaw #1: helping people live longer with disease, but not delaying or preventing it in the first place.

Once heart disease or cancer or Alzheimer’s have consumed your mind and body and your quality of life is shot, the medical system can help you to live longer through a series of medications and operations. 

But do you really want to live longer with a mind and body plagued by disease? 

Are the extra years worth it if you are unable to do the things you love?

If you can’t remember the faces and names of your children or spouse?

If you can’t move and take care of yourself?

Combatting Flaw #1: Take control, be proactive, and focus on prevention rather than treatment.

If you want to live longer without disease, you must be proactive. Act as early as possible.

You’re too late if the first intervention begins when the disease is already established.

You must siege war on The Four Horsemen before they build momentum.

The lifestyle changes required to drive down disease risk are nothing new.

Ensure adequate sleep, eat healthy whole foods, don’t eat too much, perform a well-rounded exercise routine, manage stress, and spend time with those you love.

Your role in the medical system is to learn to be the captain of your own ship. Do not delegate that responsibility to your doctor.

Screen early and aggressively, get second opinions, follow up, ask questions, seek clarification, and perform your own research and self-education.

Flaw #2: The medical system treats diseases as entirely separate and distinct issues.

Poor metabolic health, having type 2 diabetes, for example, increases your risk for heart disease, cancer, and Alzheimer’s.

Conversely, improving your metabolic health will reduce your risk of these same diseases.

Yet this is not recognized or addressed in the current medical system.

In his book Outlive, Dr. Peter Attia suggests thinking about this through the lens of disease-specific prevention and general prevention.

Disease-specific prevention includes the actions we can take to prevent specific diseases.

For example, scheduling regular colonoscopies will help to detect cancer early and prevent its spread, and targeting specific lipoproteins (cholesterol) such as ApoB will help reduce cardiovascular risk.

General prevention strategies attack two or more of the Horsemen at once.

The best example is metabolic health. Maintaining healthy metabolic function through diet, exercise, and sleep will reduce your disease risk across the board.

In fact, regular exercise that builds strength and improves endurance is the most powerful general prevention “drug” there is.

Combatting Flaw #2: Understand your family history, screen aggressively, and strive for excellent metabolic health.

Gather a comprehensive family history. How did your relatives die? At what age? What lifestyles did they lead? Understanding your family history will help you decide where to first place your focus in the next step…

Screen aggressively. Blood tests, colonoscopies, mammograms, pap smears, testicular self-examination, MRIs, prostate-specific antigen (PSA) blood tests, and so on. The whole works.

Fun? No.

Worth not dying young? Yes.

Strive for excellent metabolic health. For most people, this is achievable through lifestyle factors.

Nothing new here.

Exercise and move every day. Train for strength and endurance. Eat whole foods. Don’t eat too much. Avoid junk food and alcohol. Get enough sleep. Manage stress.

Flaw #3: The medical system relies far too heavily on the wrong tactics.

The current medical system relies almost entirely on administering procedures and medications to disease-ridden individuals.

Neither of these are inherently bad, but they should be the second line of defense.

The primary tactics we deploy should be exercise, nutrition, sleep, and emotional health.

These proactive and preventative practices, when properly implemented, drastically reduce the likelihood we will need procedures and medications downline.

Debunking the “natural” claim

The fact that something is natural does not imply it is healthy.

Nor does something being synthetic imply it is unhealthy. 

Cyanide can be found in nature and so can deadly poison secreted by venomous snakes. I guarantee that you want neither of those compounds in your system.

Vitamin D supplements, hepatitis vaccinations, and cholesterol-lowering drugs are all made synthetically. Many people will benefit from having these compounds in their system.

Takeaway: Do not avoid pharmaceutical drugs because they are not “natural.”

If you and your doctor decide to implement a supplement, drug, or hormone to optimize your health, that is perfectly fine.

Supplements and drugs, such as lipid-lowering medications, can be essential to a long and healthy life.

Combatting Flaw #3: Do your own research and analysis, perform individualized risk assessments, and confront problems head-on. 

Your doctor is no longer the coach and the quarterback.

You must work with them as a team to ensure you are deploying the right tactics to achieve the goal of living longer while preserving your quality of life.

To do so, you must be well-informed and medically literate enough to ask questions and engage in productive discussion. 

Your health is too high stakes to be passive. Be a well-informed participant. 

Every action you take, including the option of doing nothing, carries a risk.

For every major decision, you must consider a risk vs. reward vs. cost analysis that is uniquely tailored to you.

And when a problem arises, no matter how scary or unsettling it may be, you must confront it with bold action.

You cannot afford to ignore an issue until it’s too late.

These flaws and their solutions are by no means comprehensive.

But as the Pareto principle states, 80% of outcomes stem from 20% of inputs. Focus on the small minority of important actions that yield the vast majority of positive results and you’ll be in a pretty good place.

Help your loved ones—If you found this newsletter valuable, please share it with others who would benefit from reading it.

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Much love,

Jack Dixon