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Why Metabolic Health Is the Key to Aging Well

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How do we live longer? Do we want to? It can be a mixed bag. Aging into our 80s and 90s conjures up images of repeat hospital visits, immobility, and a growing cluster of health problems. Age—in America, at least—seems to coincide with getting progressively less healthy. But there’s no reason why we can’t grow old like a Sardinian, who generally can live well for a long time, grow very old, and go quickly and painlessly when it’s time. It’s not something in the water in the Mediterranean—there are ways to get and stay healthy as we age over here, too. 

In his new book, Longevity…. Simplified, orthopedic surgeon Dr. Howard Luks lays out the science of achieving this lifestyle, and then goes into the hows. Luks shows that heart disease, type 2 diabetes, hypertension and dementia aren’t so much separate, discrete diseases, but different manifestations of a broader physical decline that attacks the body after years of poor mitochondrial health. Which all sounds pretty scary. But these aren’t inevitable problems, and their solutions are simple: We should eat healthier, we should be very active, we should sleep. 

Luks’s main revelation, that exercise doesn’t need to be hard, but constant, feels like a game-changer. After reading it, it feels also incredibly obvious. Shouldn’t we be moving most of the time? Most of the book is like that. GQ spoke with Dr. Luks about mitochondria, carbs, calorie deficits, the problem with Peloton culture, and why sleep is a cure-all.

GQ: You define longevity in terms of healthspan. How would you define each of those terms, and what’s it about?

Dr. Howard Luks: Longevity is much more than the number of years you live. It’s the quality of life during those years that’s important. For healthspan, we don’t want to live to 90 if we’re in the doctor’s office every other day, the ER every other month, on medications, frail. I’m trying, with my background in science, to draw those connections. I don’t want people to think they have hypertension, elevated cholesterol, type 2 diabetes. They have one problem, really, with a root cause: mitochondrial health.

These are things we can address. I talk about Gerald Shulman and his colleagues’ work, with thin college students of normal weight who are inactive and who have insulin resistance. (Insulin resistance is a predecessor to type 2 diabetes and metabolic syndrome, hypertension, heart disease, dementia and everything else.) 

We don’t want to wait until we manifest these downstream ramifications. We want to change our lifestyles earlier.

How does insulin resistance manifest in younger people? Are there symptoms, or are they markers for frailty down the line?

Insulin resistance won’t manifest itself physically in a college student. It’s lying silent. It’s 15 or 20 years before it manifests as type 2 diabetes. The researchers don’t give the “why” of insulin resistance: Is it inactivity, poor diet? The answer’s yes. Once these kids get more active, research shows their insulin resistance resolves itself. That’s the point. The earlier we get to these areas, the more easily they’re resolved.

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