by Siim Land
’Squaring the Curve’ describes the process by which you prolong your healthspan. Think of 2 lines plotted on a graph. Both start off at an equal level but in about 1/3 of the timeline, one of them starts to slowly decline. The other one maintains its heights and keeps going all the way until the last parts where it suddenly drops. That’s how you’d want to age as well – to sustain a stable level of vitality and health throughout all of your years, not just the youth and then have a sharp and quick descent. It might seem horrible but in terms of total suffering and well-being, it sure does beat the weaning process of aging gradually.
Figure 40 Squaring the Life Curve with Proactive Care
Most of the world is aging dysfunctionally – they’re constantly slipping downward with their health and physical condition – like tectonic plates sinking into molten mantle. With a proactive approach to longevity and personal healthcare, you can avoid that deterioration and postpone it quite remarkably.
Funny enough, hunter-gatherers and some longevity hotspots tend to follow the same trend. Old people maintain high levels of physical activity and youthfulness all the way into late elderhood and then they die quite suddenly. There’s nothing wrong with living like that as it’s a sign of health and vitality. It’s not even related to trying to live forever like a superhuman but simply improving the quality of life and extending healthspan. I’d prefer squaring the curve hard and quite rapidly rather than being subject to entropy throughout my entire life.
The Blue Zones
There are several of these regions across the globe called The Blue Zones where most of the population lives a very long life. The term was first coined by Dan Buettner in his 2005 National Geographic Magazine cover story „The Secrets of a Long Life“[253].
There are 5 Blue Zones: Okinawa in Japan, Sardinia in Italy, Nicoya in Costa Rica, Icaria in Greece, and the Seventh-Day Adventists in Loma Linda (California).
Figure 41 Longevity hotspots across the globe called The Blue Zones
These regions have the highest proportion of centenarians – people who live over 100 years old – they have less disease, increased longevity, and, in general, enjoy a good quality of life.
Given that these Blue Zones show up in a variety of locations across the entire globe, it’s safe to say that the biggest contributing factor to their long lifespan is the environment.
It’s epigenetics. ’EPI-’, meaning ’on top of’ or ’outside of’. Having certain genes plays only a minor role in determining your lifespan. A much more critical part is the environment in which those genes get expressed. Your environment is everything you get exposed to – the food you eat, the physical space, your natural surroundings, the thoughts and emotions you experience, the people you spend time with, and what overall interpretations are you making about all of it.
People in The Blue Zones are living in different geographical locations, they tend to eat different diets, they tend to follow different traditions but there are still a lot of things they have in common.
There are about 6 characteristics shared amongst these people that help them to live longer:
They eat a whole foods based diet with a variety of vegetables, fruit, fish, some meat, tubers, legumes, and whole grains.
They engage in moderate physical activity most of the day by working, gardening, spending time in nature, and walking.
They have lower levels of stress and less work which decreases their cortisol and slows down telomere shortening.
They stick to the circadian rhythms by following day and night cycles, getting a lot of exposure to natural sunlight, sleeping well at night, and having several naps throughout the day.
They have a strong sense of community as all of the people are actively engaged with their families and others around them.
They eat moderately and never too much because eating more would mean they’d have to work longer.
The diets of Blue Zones aren’t strict Paleo, vegan, or keto – they’re actually very balanced and include a wide variety of food groups. These people eat meat but they also eat vegetables. They eat bread but they also eat fish. They eat dairy but they also eat fruit. This creates a more robust intestinal flora, which supports the immune system and prevents disease. Therefore, it’s a good idea to mix up your diet every once in a while and rotate what you eat, especially if you’re doing restrictive diets like keto or vegan.
However, a balanced diet is an oxymoron and it’s not something you can quantify or prescribe to everyone – it’s a matter of context and the person who’s eating it. That’s why the recommendations prescribed in this book will be more effective and quantifiable.
Blue Zones don’t have a gym or treadmill parks – their exercise is integral to their day to day activities. These people move around at a low to moderate pace most of the day by walking around the household, riding a bike to check up on the neighbors, doing gardening to grow their own food, hiking in nature, throwing hay or whatever the situation demands. They’re not trying to burn their muscles or hit complete failure when lifting something – they’re moving less intensely but they’re doing it more frequently. It’s important to stay mobile and active throughout the day so your mitochondria could keep producing energy.
In fact, having an intense two-hour workout or a long bike run is still counterproductive if you sit in a sedentary position for the rest of the day. Frequency and total volume are much more important than maximum intensity when it comes to longevity.
The rationale in the Blue Zones is that eating more than you need requires more work and more stress. This problem is circumvented in the West because there’s an overabundance of everything – calories are so cheap that people literally have to come up with more ways of burning them off. Combine that with not moving enough and you’ll end up with the biggest obesity epidemic in history.
This same way of thinking in moderation applies to other areas of life as well – material possessions, working, sleeping, stress etc. The fact of the matter is that more is not necessarily better and you have to always keep in mind whether or not you need to have excess.
The most important thing for living over 100 is to optimize your environment. Naturally, we can’t all go live on the sunny coast of Costa Rica, but what we can do is follow these best practices of longevity and improve our surroundings to the best of our ability. First, you have to start off with taking care of your own health and stress. Then that vitality will begin to ripple further beyond onto others around you as well and it becomes a feedback loop of happier people creating more happier people and eventually, you may start living in a Blue Zone yourself.
Why Does Muscle Promote Longevity?
As mentioned already, more muscle and strength is a much greater predictor for longevity than just aerobic exercise. But why is that?
Resistance training can counter-act age-related sarcopenia. The worst thing about losing muscle with age is that you’ll keep the fat. Sarcopenia decreases the number of functional muscle fibers and proteins in your body while accumulating excessive intra- and extracellular lipids underneath the skin[254]. That’s why people who do strength training and have more muscle tend to look healthier and are physically active even at an older age.
Figure 42 Healthy Muscle VS Sarcopenia
The best benefit of increased muscle mass is that it improves your insulin sensitivity[255], which will protect against diabetes, promotes glucose tolerance, and enables the person to eat more calories without getting fat. Skeletal muscle acts like a huge sponge for glucose and it comprises the majority of whole-body glucose uptake. That’s why training and having more muscle can be preventative for insulin resistance.
To build muscle, the body has to have a reason for doing so. This entails applying mechanical stress that would stimulate muscle protein synthesis (MPS) and the mTOR pathway. Mild distress on the muscle preserves its mitochondrial function, which will prevent the age-related sarcopenia. It’s another hormetic adaptation that prolongs lifespan. Muscle mit
ohormesis is thought to promote longevity because of repressing insulin signaling[256].
There is a hypothesis called Uncoupling to Survive, which suggests that increased mitochondrial uncoupling and thus increased energy expenditure might increase longevity by preventing the formation of reactive oxygen species (ROS)[257]. Expression of uncoupling protein 1 (UCP1) in skeletal muscle mitochondria increases lifespan considerably[258]. UCP1 or Thermogenin is an uncoupling protein found in the mitochondria of brown adipose tissue that’s used to generate heat through non-shivering thermogenesis.
Fasting and resistance training promote UCP1, which in turn increases heat-shock proteins and lipid metabolism. Increased skeletal muscle uncoupling doesn’t seem to reduce oxidative stress in muscle cells but actually increases endogenous antioxidant defence systems and redox signaling.
Figure 43 UCP1 results from beta-oxidation, which produces more heat and promotes longevity
There’s evidence that skeletal muscle acts similarly to an endocrine organ, just like the adipose tissue does. Muscle cells (myocytes) produce certain cytokines called myokines that fight inflammation and maintain healthy physiological functioning[259]. That’s another potential mechanism by which muscle uncoupling protects against chronic diseases. Being fit and muscular also enables the person to maintain a slightly lower resting heart rate and blood sugar, by reducing inflammation levels and burning off visceral fat.
Muscle mass, essentially, is like a solid pension fund that is associated with increased longevity, healthy aging, greater healthspan, and improved physical well-being throughout your entire life.
Unfortunately, not only are you more prone to losing lean muscle as you age but it also becomes increasingly more difficult to build it. As you get older, entropy begins to catch up and makes it harder for you to maintain fitness. For instance, rates of sarcopenia are often similar to the declines in growth hormone, testosterone, and other anabolic hormones (See Figure 44). All of those factors contribute to building and maintaining muscle, which is why you want to optimize your lifestyle.
Figure 44 Decline in Growth Hormone with age
In my opinion, part of the reason old people lose their muscle and anabolism is that they’ve become sedentary. What you don’t use you’ll lose, especially strength and muscle. Those who are squaring the curve with a proactive approach to fitness and health will most likely be able to maintain more of their youthfulness whereas those who’ve simply given up will inevitably slip off into a gradual downward spiral of deterioration.
When looking at your family members who haven’t made the healthiest dietary choices you may indeed become depressed and want to postpone aging as much as possible. However, this should be encouraging and motivating because you don’t necessarily have to suffer from the negative side-effects of aging with the right lifestyle habits.
What it should also tell you is that to increase your lifespan as well as your healthspan, you’d want to start working on it TODAY. It’s a proactive process that requires an active approach.
What Kind of Muscle Benefits Longevity
As with everything related to the body, not all muscle tissue is created equally. There are several nuances to having more lean mass and not all of it is necessarily better.
In fact, it’s thought that strength, not muscle mass per se, is associated with mortality[260]. Although losing muscle is a contributor to increased atrophy in old age, the elderly and obese people tend to have less strength and force production than healthier ones[261]. Maintaining muscle mass alone has not been shown to be enough to prevent loss of muscle strength, which suggests that muscle quality is equally as important for longevity.
Factors that underpin muscle quality include insulin sensitivity, motor unit control, body composition, metabolic status, aerobic capacity, fibrosis, and neural activation. All of them determine how well your muscle functions as well as the rate of decline with age.
Muscle quality is closely connected with muscle strength and power. With age, you tend to see a progressive decrease of type IIb fibers also known as fast twitch muscle fibers. Part of this may be because of disuse and sedentism but another reason is probably due to pure atrophy of lean tissue.
Therefore, having simply bulkier muscles like a bodybuilder may not necessarily correlate with increased longevity and lifespan. Even though you may exhibit higher insulin sensitivity and growth hormone, the body will still wean off because of the excess weight it has to carry. A good example is cardiomegaly (enlarged heart) where the heart can’t pump out enough force and thus compensates for it by growing larger. That’s why some athletes often die prematurely - their heart has to work extra hard to sustain its large size. Bodybuilders who take steroids to build muscle also tend to have larger hearts than regular people.
The key is to have quality muscle that’s able to carry heavier loads and protect itself against muscle dystrophy. Being able to exert more force with less muscle size indicates higher muscle quality and mitochondrial density.
Grip strength is a simple and inexpensive measure of overall muscular strength. Low grip strength is associated with all-cause mortality, cardiovascular events, myocardial infarction, and stroke. It’s thought to be a stronger predictor of dying than systolic blood pressure[262].
A recent UK study on over 400 000 participants tested the association between grip strength, obesity, and mortality[263]. It was found that a stronger grip was associated with an 8% decreased risk of mortality. Adiposity measurements were inconsistent with mortality but a BMI over 35 and abdominal obesity were strong predictors of mortality, independent of grip strength. Therefore, even if you are a strong-but-fat person with good grip strength, it’s not justified nor optimal to be obese. Not fat shaming, just doing what’s best for you…
It's suggested that overall grip strength may act as a biomarker of aging across the entire lifespan[264]. That’s why some old men who have done physical labor all their lives tend to be quite healthy and robust even without going to the gym. Strong hands require you to be working and lifting things on a consistent basis. Old farmers in The Blue Zones also tend to have good grip strength despite their smaller physiques. Farm work requires much more forearms than biceps and triceps like you’d train at the gym.
Grip strength is the ability to use your hands to hold onto something and not give in under heavy load. It signifies enduring through and not letting go. Those people who have stronger grips may live longer just because of possessing this notion of grasping on and refusing to die.
Another potential indicator of muscle quality is leg strength. In 2011, researchers found that leg strength was one of the most important factors for determining physical function and mortality[265]. The link was purely based on strength and longevity regardless of the amount of muscle mass.
What are the best exercises for building grip and leg strength? Compound lifts like squats, deadlifts, barbell rows, and bench press are the best ones for developing full-body strength and muscle. More on this in Chapter Seven.
Furthermore, resistance training increases bone mass and lowers the risk of osteoporosis, which a lot of people suffer from. Elderly folks who don’t exercise and have lost their muscle are prone to hip fractures and joint pains just because of lacking bone density. In fact, one of the causes for dying is that they get an injury or they fall on the ground and they get hospitalized or die altogether.
Fortunately, it’s never too late to start working out. It’s been shown that elderly sedentary people can gain more than 50% strength after 6 weeks of resistance training. They even had to workout only 2-3 times per week with about 70-80% of maximal strength[266]. Age is not an excuse to not train or be un-fit.
Lifting weights and bodybuilding are actually incredible for injury prevention and rehabilitation. Strength training’s been found to be more effective in treating painful muscles and mobility issues[267]. On the flip side, things like Pilates do not seem to improve symptoms of back pain or functionality[268].
Compared to aerobic exercise, strength-based resistance training protects against aging a lot more. It’s been found that strength training can have a lot of the same health benefits as cardio, such as reduced chronic inflammation and improved cardiovascular health[269].
A recent meta-analysis found that resistance training is more effective than cardio for fat loss as well as overall health[270]. In addition to that, both high intensity and resistance exercise tend to suppress your appetite a lot more than low-intensity cardio. That’s another hidden contributing factor for longevity – you’ll subconsciously eat less because of working out smarter.
In conclusion, strength and resistance training are the best exercises for anti-aging. It not only maintains functionality of the body but also builds lean muscle tissue, which will postpone age-related diseases, protects against deterioration, prevents sarcopenia, and combats entropy.
A lot of research shows that muscle mass should be considered a vital sign of health and aging. Low muscle mass is associated with several negative health conditions. Just exercising or doing a lot of cardio isn’t necessarily better because you may end up losing lean tissue. The NET benefit of excessive aerobic work isn’t better than focusing primarily on resistance exercise.
Endurance and Cardio
However, there are still some benefits to doing endurance-based exercise and cardio. To protect yourself against aging and disease, you’d want to maintain aerobic fitness regardless of your physique goals.
Aerobic capacity, which is your maximal ability to use oxygen during physical activity, tends to decline after the age of 50[271]. Having more aerobic capacity helps muscles to use oxygen more efficiently, which will improve physical performance.