20 is the New 40

In 2021, why do we accept reductions in our quality of life?

Photo by NeONBRAND on Unsplash

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20 is the new 40.

                For decades, we have said the opposite. 50 is the new 30. 60 is the new 40. To some extent, this has been true. Medical advances have reduced suffering and mortality, increased life expectancies, and improved health and quality of life in old age. But we have now begun to trend in the opposite direction.

                Life expectancy has actually begun to decrease in the United States.

                It was declining before the COVID-19 pandemic and continued declining during the pandemic.

                While most of the gains in health and quality of life in the last 50 years have been due to medical progress, most of the losses in health have been due to lifestyle factors. Poor nutrition, lack of sleep, lack of exercise, lack of sunlight, sedentariness. There is only so much that medical science can do to overcome these. There is a limit to what a pill can solve. You cannot take a pill to cure back or joint pain (more on that later).

20 is Actually the New 40:

                In 2018, a shocking report came out from the Heritage Foundation revealing a startling statistic: 71% of Americans aged 18-24 are not fit enough to serve in the military. While physical fitness is not the only driver of that number, poor fitness and the health conditions caused by poor fitness are the primary drivers.

                This should startle Americans. 18-24-year-olds are supposed to be in the prime of their life, at the height of their physical fitness. And yet a majority of this age demographic is too unhealthy to serve in the military.

                One might ask whether this 71% figure is actually a function of overly-high standards, rather than objective lack of fitness. But the fitness standards for military service are not reasonably – or even particularly – high. Each branch has lowered its standards in the past. The basic fitness standards for military service are not an athletic benchmark signifying high performance. Rather they are minimum standard to indicate basic fitness.

                If you are a healthy 20-year-old, you should not have trouble meeting these standards. A healthy 25-year-old man should be able to do 4 pullups and run 3 miles in less than 28 minutes.

                Some will quibble with me, but we have been defining health downwards for years to the point at which we have lost sight of what a healthy human body should reasonably be capable of based on millennia of evolution.

Obesity:

                The elephant in the room is obesity. While not the only factor, obesity is the primary driver of poor health in America. According to the CDC, 42% of Americans are obese. While attempts to remove the social stigma around fat are admirable, encouraging unhealthy lifestyle choices is not. By all means, let us stop moralizing over fitness and nutrition. Let us stop shaming people for poor choices. Let us stop fetishizing aesthetics (six-pack abs, etc.).

                But let us be perfectly clear about the disastrous health consequences of obesity and the damage done by poor lifestyle choices.

                Instead of telling people to lose weight so they look better, we should be telling people to lose weight for their health. We should tell people that if they would like to reduce their risk of diabetes, heart disease, cancer, Alzheimer’s, back pain, arthritis, depression, all-cause-mortality, death from COVID-19, and many other diseases or conditions that can cause mortality and suffering, they should avoid obesity.

                Most doctors do tell people to lose weight for health reasons, not because they want their patients to compete in Mr. Universe. But this advice often gets conflated with mainstream fitness advice which tends to focus on aesthetics. I realize, too, that plenty of nutritionists and coaches out there are focused on health. And yet most people who tell me they want to lose weight do not say that because they want to get healthier. And they are representative of the mainstream view.

                Exercise, sleep, and nutrition are not important because they make you look good. They are important because they actually improve almost every existing quality-of-life metric.

COVID-19:

                Something else needs to be said (and has, but not loudly enough). Obesity was one of the primary drivers of America’s (and the West’s) COVID-19 outcome. 78% of those admitted to the ICU with COVID during the pandemic were obese. Obesity and age were the two most important risk factors. Nations without widespread obesity had dramatically lower death rates from COVID-19.

                This is not meant to shame anyone. Forget shaming people. This is about being realistic and looking at the data with clear eyes. This is about the least-talked about, but highly-important interventions people could have made to fight the pandemic: exercise, nutrition, sleep, and weight loss. No substitute for a vaccine by any stretch. But losing 20lbs just might have made the difference for some people hospitalized with COVID-19.

                Even daily walks outdoors provide a significant level of protection against COVID. Getting 150 minutes per week of aerobic exercise made a dramatic difference in rates of hospitalization and death for people who tested positive for COVID-19.

                Vitamin D deficiency was also a driver of COVID-19 mortality. We should have socially distanced outside at the beach and at the park, not inside our homes. Especially since outdoor transmission was vanishingly rare.

                And yet, instead of following the science of human health and modifying their behavior in order to protect themselves against complications from contracting COVID-19, 42% of Americans gained weight in 2020. I do not say this to shame anyone who did gain weight during the pandemic. Most people probably did not know that diet and exercise had a prophylactic effect. The only people who deserve shame are those who encouraged this anti-scientific trend by closing parks and beaches and telling people to stay in their homes and not to go outside.

                By increasing the amount of time Americans spend indoors looking at screens, and the rates of obesity and drug addiction in the U.S., COVID-19 contributed to the collective problem of early-onset aging among relatively young people.

Defining Aging Down:

                One gets a collective sense of apathy today from young Americans regarding their physical health. Many seem to say, “I should go to the gym more” in resignation, rather than in resolution. Many young people simply accept that sarcopenia and middle-aged weight gain will inevitably set in earlier and earlier – perhaps beginning around college graduation. Given the astounding weight gain by American college students (especially in their first year – the Freshmen 5 is now the Freshman 25), it is not as if they are starting from a point of excellent physical health.

                This apathy should not cause anyone to feel shame (unless they can use that shame constructively to drive them to improve their own health), rather it should be a cause for sadness. Early resignation to a true reduction in quality of life is a sad thing.

                1 in 10 Americans are diabetic and 1 in 3 are prediabetic. Some are traveling towards an early grave, their way marked by foot ulcers and pain. We should offer them compassion, and we should do what we can to save them, but we should also work to save others who are not yet at that point. Acceptance is not the proper answer.

                Combatting the obesity epidemic is not about high-mindedness regarding “correct” exercise and nutrition. It is about saving the lives and health of millions of people who might otherwise suffer and die.

                We should not resign ourselves to aging earlier and earlier. We should not resign ourselves to 20 being the new 40 because that makes 40 the new 60 and 60 the new 80. I do not want to live forever. But neither do I want an early death following years of pain and suffering. Neither do you, I would guess.

Musculoskeletal Pain:

                Up to 80% of Americans experience back pain during their lives. Many people seem to think this is also the inevitable result of aging, rather than lifestyle. If we add the numerous knee injuries, joint and foot injuries, we can understand why ~20% of Americans suffered from chronic pain in 2016.

                To some, the answer is surgery. However, given the complications, expense, invasiveness, and long-term prognosis of surgery, we should not desire to live in a society in which the average person begins having surgery in their teens or 20s.

                Earlier, I mentioned that many people instinctively reach for painkillers when they experience musculoskeletal pain. While painkillers can relieve pain, I cannot fathom why anyone would believe a pill could solve a musculoskeletal injury. It is a physical problem. Not a chemical problem. The most advanced chemical engineering in the world cannot create a chemical that constructs a bridge.

                I realize that people reach for the painkiller because they do not understand the pain or the injury and they just want to forget about both. But a painkiller cannot fix the underlying problem. And quite often, neither can rest. The vast majority of musculoskeletal pain experienced by young and middle-aged Americans is eminently fixable. The solution is not rest, but movement.

                Pain is a signal from the body that something is wrong. To fix the pain, you have to fix what is wrong. The problem is usually caused by two things: lack of movement, and improper movement. The solution is proper movement.

                This is something of a simplification, but in the category of improper movement, I include “too much, too fast, or too soon.” In other words, putting your body through something it is not ready to do:

-          Lift an object beyond your strength

-          Run more frequently and for longer than you are capable of

-          Etc.

                In the category of proper movement, I include:

-          Physical therapy

-          Stretching

-          Soft tissue work

-          Massage to restore range of motion

-          Dynamic stretching and mobility drills

-          Retraining proper movement patterns

-          Mobilizations

-          Etc.

                Musculoskeletal pain is another area in which I see a collective shrug as millions of people resign themselves to something that will harm their quality of life. It makes me sad to hear someone say that they will suffer from a lifetime of low-back pain as the inevitable result of lifting heavy boxes, when - if they learned to lift those boxes correctly, the way their body evolved to lift heavy objects – they would be spared. Phrases like, “everybody has back pain,” “running hurts your knees,” “lifting weights hurts your joints,” and “I can’t have good posture because I sit all day for my job,” are all sad.

                A quick word on sitting. Our society has developed an excessive sitting fetish. I find this a perfect example of resignation to poor quality of life. When you actually stop and think about how much of our lives we spend in this one position, it is really shocking. Especially when you realize that for most of human evolution, humans did not spend long periods of time in that position.

                Some people seem to think I limit my sitting (I prefer standing, squatting, kneeling, lying on the floor, etc.), in order to prove a point or because it sounds “hard.” (While sitting sounds “easy.”) The exact opposite is true. Life is easier when I sit less. Reducing sitting has materially improved my quality of life. Years of too much sitting has had profound negative effects on my body, which I am only now beginning to recover from.

                If you are reading this, and you take my word for it, and you begin to reduce your sitting to 2 hours a day or less (over a long period of time), you will thank me when you are 90 years old.

The Saddest Bit:

                The saddest bit is that all this is preventable. But instead of making the simple changes that could reverse early-onset-aging, we define health downward. The human body (including yours), evolved to be able to do much more than we typically realize. It did not evolve for a life of sitting at a computer screen. Neither did the human brain.

                Problems arise when we do too much of what we are not evolved to do and too little of what we evolved to do. If you use a machine for a function that it was not designed to perform, you usually break it. If you do not use it for the function it was designed to perform, you may eventually lose the use of it. But if you use a machine the way it was designed, to perform the function for which it was designed (assuming it was designed and built well), it will last a long time and function effectively.

                The human body was designed to be capable of walking several miles every single day. It was designed to be able to lift heavy objects, climb, carry loads, and spend long periods of time in squatting or hanging positions. If we use our bodies properly, starting at an early age, squatting deeply, climbing stairs, lifting a box, or walking 5 miles should all still be easy tasks at age 45.

Reversing Our Definition of Easy:

                Though it seems counterintuitive today, more movement and proper nutrition will actually make life easier and better, even if they sound “hard.”

                The late and great novelist Terry Pratchett understood this concept (he had a way of always seeing the world differently from everybody else). The protagonist in his novel Moving Pictures is a wizard in training at the Unseen University. He is one of two individuals in the entire university to use the university gym. The faculty of the Unseen University are renowned for their laziness. Yet Pratchett tells the reader that Victor (the protagonist) is the laziest one. Because he is the one who realizes he will expend less effort in life if he minimizes his non-propulsive weight (fat) and maximizes his propulsive weight (muscle).

                Simply accepting that 20 is the new 40 means showing apathy towards the onset of aging earlier and earlier. Admitting it is the first step towards treatment.

                Some will respond to me by saying, “I don’t want to live forever.” To which I would respond in turn that I am not talking about lifespan. I am talking about healthspan. You may not want to live forever (I certainly do not), but I would bet that you also do not want pain and reduction in your material quality of life during the years you do live.

                Aging and dying are not the same. Some level of aging is inevitable, but much less than is commonly understood. Rather than slowdown being the result of aging, aging is the result of slowing down. If you move less, you will age faster and you will begin to lose the ability to move. If you move, you age slower or even reverse aging (to some extent).

                Some think exercising and moving means fighting a losing battle against aging. The opposite is true. Instead, early-onset aging is the unnatural and entirely preventable result of lack of movement.

                Let me emphasize this: the causal relationship is flipped. Lack of movement causes aging to begin far earlier than it should. Slowing down should not start at age 22. The human body should be capable of vigorous movement at age 22, or 32, or even 42.

                In Japan, it is common to sleep on mats on the floor. Japanese people tend to be some of the longest-lived and longest-functioning people in the world. At 100 years old, many of them can still get up and down off the floor unaided. This is not due to a lifetime of difficult yoga sessions. It is the result of years of living in ways that are compatible with the human body, instead of ways that destroy it.

                If you want to be able to get up and down off the floor in old age, make sure you spend time getting up and down off the floor throughout your life.

                20 may be the new 40 in America today, but it does not have to be. And it turns out the solution is easier and more comfortable than most of us imagine. It boils down to moving more, sitting less, eating nutritious foods, sleeping 8 hours a night, and going outside.

In 2021, we have higher standards of living and greater material prosperity than ever before in human history. We have the tools to have a greater quality of life, with longer healthspans, than ever before. Why should we resign ourselves to material reductions in quality of life?