Live Long and Well with Dr. Bobby
Let's explore how you can Live Long and Well with six evidence based pillars: exercise, good sleep, proper nutrition, mind-body activities, exposure to heat/cold, and social relationships. I am a physician scientist, Ironman Triathlete, and have a passion for helping others achieve their best self.
Live Long and Well with Dr. Bobby
#39: How many good years do you have left?
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We all want to live long and well—but how do we determine how many good years we have ahead?
In this episode of Live Long and Well with Dr. Bobby, we explore how to estimate both our total lifespan and the number of years we can expect to remain active and pain-free. Dr. Bobby reflects on personal experiences, emerging science, and time-tested frameworks to help you reframe your health trajectory with clarity and motivation. While we may not find exact answers, the tools and thought experiments shared in this conversation can shape the way we live now—and influence how we plan for the future.
We begin with why this topic matters, touching on personal stories of loss, aging milestones, and medical advancements. Then we move into three frameworks: how many years you might live (using tools from actuarial tables to cardiovascular risk calculators), how many of those years might be "good," and the wildcard of unpredictable events.
The simplest predictor comes from actuarial life tables, which estimate life expectancy by age and sex. A 55-year-old man today might expect to live to 79; a woman to 82. More advanced tools include the Framingham Risk Score, which factors in cholesterol, blood pressure, smoking status, and diabetes to estimate 10-year cardiovascular risk. Research suggests that sharing these risk scores can lead to behavior changes, as shown in this meta-analysis of 28 studies and preliminary evidence of outcome improvements.
On the genetics side, polygenic risk scores offer a glimpse into inherited risks, though they remain research tools for now (Nature study). More accessible are tests for specific genes like APOE4, which increases the risk of dementia (PubMed).
Beyond numbers, simple physical tests can offer insight. The Brazilian sit-stand test links mobility with mortality risk: fewer than 8 points doubles your six-year mortality risk. Grip strength, too, is a strong predictor of all-cause mortality across 17 countries (PubMed).
While biologic clocks based on DNA methylation are generating buzz, their utility remains limited due to variability between samples and testing methods (Nature Communications).
When it comes to estimating “good” years—those lived free from major pain or disability—the data are sparse. Some disease-specific tools (e.g., for MS or dementia progression) exist, but there’s no universal actuarial equivalent. However, we know muscle mass and aerobic capacity decline predictably with age—1–2% muscle loss per year and a 10% drop in aerobic fitness per decade (OUP Journal). Predicting your future function can begin with assessing how far you can walk, whether stairs leave you breathless, or how your weight and strength compare to a decade ago.
Finally, we can’t forget unpredictable events: the odds of a serious fall increase significantly after 65, and vision or hearing loss multiplies that risk (NCOA). Building physical resilience now can reduce these odds—see
We all want to live long and well, but how much time do we actually have? Are there ways to determine how long we might live and how many of those years will be good ones? We may not find the fountain of youth, but perhaps we can figure out how many good years we have ahead of us. Hi, I'm Dr Bobby Du Bois and welcome to Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and figure that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. I'm a physician, ironman, triathlete and have published several hundred scientific studies. I'm honored to be your guide. Welcome, dear listeners, to episode 39. How many good years do you have left? Well, we all want to live long and well, but how much time do we actually have Now? Knowing that might influence when we retire, our savings to get to retirement, our spending now, our spending in retirement and the activities we might enjoy now rather than waiting until later? Well, we don't know. Many have talked about this issue, about not knowing how many good years or years we have left in there. Say live every day like it's your last, which generally sounds like a good idea at some level. There's also the weeks of life calendar. That's gotten very popular 4,000 weeks, which basically is a bunch of boxes on a chart that you hang on the wall and you check off the boxes as each week goes along and you get this visual sense of ooh, I'm a third of the way through my life, I'm half the way through my life. Oops, I'm on the back end of all of that. That's gotten a lot of popularity. Well, here's a thought experiment before we dive into data how long do you think you will live? Do you think you'll live to be 75? Do you think you'll live to be 85? Do you think you'll be one of those that might live to be 100? How many of those years will be good years, meaning you're functioning well, you're active and you don't have pain to contend with? Do you think your good years will go until you're 65, 75 later?
Speaker 1:Well, before we can get too far, we need to define good years. Now, what I'm about to say to you is a little bit, you know, sort of tongue in cheek, because it doesn't apply to most of us, but if your definition of good years is peak performance, for most of us listening we're past that age in a number of regards. If you want to be a world-class gymnast, as a girl or woman, they tend to peak at ages 16 to 22. Mathematicians are reported to do their best work in their 20s, and marathon runners seem to do best in their late 20s and 30s. Well, how about for the rest of us? Because obviously this is not how we will probably judge good years.
Speaker 1:Now, over the course of the next half hour, I may not be able to give you the precise answer to how long you're going to live and how many of those will be good years. Nobody can do that, but what I hope I will do is provide a framework or various ways to think about it. Motivate how you live your life might motivate changes in your life, what you do, how you do it and how you might increase both the number of years and the quality of those years. Well, as always, I need to explain to you why. Why do I want to talk about this topic, where's the relevance in my life? And then hopefully, it will ring true for you.
Speaker 1:My dad was a physician, worked very hard and he got multiple myeloma, which is a cancer of the blood forming elements in your bone marrow, and he got myeloma at age 56 and he died some years later. I would say, looking at his quality of life, his good years ended at age 56. Now I'm older than that now, and so I am mindful of my own family history. Recently, several friends out of nowhere had cancer diagnoses one kidney cancer, one with prostate cancer and their lives obviously changed a lot. My listeners you give me wonderful feedback and comments. Tell me, you know, when I turned age 60 or when I turned age 70, things seemed to deteriorate. I seemed to be fine before that, but boy, a whole lot of things seemed to go wrong, starting at those ages, and so, therefore, I started thinking about more of this topic, and there's so much hype about these new biologic or epigenetic clocks due to methylation of the DNA, and I wanted to at least talk a little bit about that, because people claim this can help you understand how long you might live. I'm probably going to do a whole separate episode on this topic. Let me know if you'd like it, but I will touch on it briefly today. So let's look at what we know and don't know, since how many good years we have left is a critical life question, and it's been around for thousands of years and probably will be around for another few thousand years.
Speaker 1:Before we dive into the information, I have two requests. Number of you have texted me through the podcast app. Unfortunately, although I get your texts, many of you want an answer and are upset that I don't give an answer. But I can't. The way you submit them doesn't allow me. Those services don't allow me. By all means, go to my website, drbobbilivelongandwellcom. You can message me through there. Then I'll be able to respond back to you, because I really, really do want to do that. My other request please share this podcast with others, not just this podcast episode. Please share this podcast with others, not just this podcast episode, but the Live Long and Well with Dr Bobby. As I've mentioned many times that you know, I have no financial part of this. I only want to help you. So the more people that get the podcast, the more people I can help.
Speaker 1:Okay, let's dive in. How might we think about this topic? What I'd like to do is put together a framework. First one is how many years of life, not how many good years, but how many years of life do we have ahead of us? Now? This may range from something very simple, like actuarial tables, to something complex, like risk equations, and we'll talk through those. Some of these are well understood, been around for hundreds of years as approaches, and some are new and as yet unproven. Next, we'll explore a framework for well, how many good years and by my definition of good years is you can be active, you're pain-free, you don't have any really disabling symptoms this is much tougher to predict, as we'll talk about. And then, thirdly, the impossible to predict the unpredictable accidents and injuries. We can't ignore these wild card events, although, obviously, because they're unpredictable, we can't predict them.
Speaker 1:Underlying everything we talk about is the nature versus nurture question. You know, is it determined by my genetics how long I will live and how many good years, or is it the environment and what I've done? Well, clearly, with the six pillars? I believe that exercise and sleep and nutrition, and exposure to heat and cold, and mind-body harmony and social relationships will affect our number of years and the quality of those years. But at some level this does come down to genetics. It appears that when you're talking about people who live a very long time, say they live to be 100, perhaps a lot of that has to do with nature, not nurture. But for most of us who may not live to be 100, obviously what we do and how we do it makes a big, big difference.
Speaker 1:But it's going to be a blend, one back of the envelope approach to this. Look at your family how old did they live before they died? How functional were they before they started to deteriorate and have problems physically, mentally and otherwise? All right, let's begin with how many years we have, how long are you likely to live? And I'm going to walk through four approaches and give you action items that you might want to try.
Speaker 1:Well, the oldest approach is actuarial tables. These are tables that give you the probability of how long you'll live based upon your age. Now, we might think this is something relatively recent, but it was discovered recent. But it was discovered 450 years ago, or 400 years ago by James Haley. Now, james Haley wasn't famous for the actuarial approach. Of course he did come up with it. He's known mostly for Haley's Comet, but he in fact put together the first life table and in its simplest version it's broken out by age, and men and women, and it basically says how many years you will survive. And this is a population average, doesn't apply to you per se, but it's better than nothing in terms of prediction. So what do life tables tell us?
Speaker 1:Well, today, in the United States, your survival at birth. So, at birth, boys, men, will live to be the age of 73. Women, at birth, will live, on average, to age 79. Now, that doesn't sound particularly old. But also realize that a lot of people die, maybe in childhood, maybe with a motor vehicle accident, maybe with suicide, maybe overdose. So the older you are, a lot of those people are not in the table. And so what's remaining? You tend to live longer. So, in contrast, if you were to ask the question of these tables, well, I'm age 55. What's my expected survival, on average, from an actuarial standpoint? For men it's 79. So not the 73 at birth, up to 79. And women it's up to 82. So these are numbers you've probably heard people throwing around, because typically people are looking at it in this fashion. So the longer you live, the longer you are likely to live. My expected survival is about 16 years, or I am expected to live till age 84, based upon life tables.
Speaker 1:What's the action item here? The action item here is in the show notes. I will have links to all of these various things. Go to a link to an actuarial table, look where you are on it and see what that tells you. Is this how long you're actually going to live? No, maybe it is, maybe it isn't, but it's a starting point, all right.
Speaker 1:Approach number two to how many years you have left, there are clinical equations. So the actuarial table is pretty much just age and sex based. Clinical equations say well, what about some of my known risk factors for heart disease and known diseases that might affect heart disease? So going back about 25 years, there was a huge and important study, the Framingham Heart Study, and it came up with a risk score, a calculator. Now this has been improved upon over years and I have a link in the show notes that you can do the calculation yourself and it basically asks you to put in your age, your sex, your race, your blood pressure, what your cholesterol levels are, whether you have diabetes, whether you're a smoker. And when I plugged in my data, my 10-year risk is about 4.7% of having a major cardiac event and death. So you might look at it. You might be at 5%, you might be at 10%, but this is another way to begin to get a handle.
Speaker 1:Looking specifically at cardiovascular disease. This doesn't look at other causes, action item here. Go to the link in the show notes, see where you are and you can look at your actuarial number. You can look at your number based upon cardiovascular risk. Now you'll have two different numbers to look at.
Speaker 1:Okay, there is an expanded cardiovascular risk equation. Sadly, it's not something you can do yourself, but the concept is let's take the same clinical factors, like I talked about, but let's fold in your genetic background. It's called a polygenic risk score, and so this was done in large research settings and it really kind of wrestles with the nature versus nurture because it's blending some of those risk factors with some of your genetics based upon your ancestors. Again, you can't do this yourself, but it's an interesting thing and maybe at some point it will be available. It's an interesting thing and maybe at some point it will be available.
Speaker 1:Now, all of these prediction approaches that I've talked about so far, they're imperfect, they're not going to give you the exact answer, but one of the side benefits is it might drive change. There was a meta-analysis, a summary of 28 studies where they shared this type of risk information with each person. Sometimes they shared it, sometimes they didn't share it and asked the question did it lead to changes in behavior that might alter your risk? And the answer was, in general, yes, in general. Yes, there's even a study now it's not yet published, but it's been talked about where they showed that sharing this information reduced events when the cardiovascular risk score was shared, so there was less likelihood of heart attack, stroke and death.
Speaker 1:Now I've talked a lot just now about cardiovascular disease and that's an area where we really have a lot of data which actually does a pretty good job of predictions. In the area of cancer and other diseases. There are risk equations that people have put together and it does show some people are at higher risk, some people are not at higher risk, but they're not very precise. They're not really ready for us to use in any meaningful way, which is too bad, but that's the reality. Well, there are a couple of other ways of doing this clinically and there are some blood tests for certain diseases.
Speaker 1:So you may have heard about the APOE4 gene. There are different forms of the APOE gene. You could have the E2, the E3, the E4. The E4 is the one that's associated with a risk increased risk of dementia. Now you may have no copies of the gene. You may have one copy. You may have two copies. The more copies of that, the higher risk of dementia and the earlier onset of that deterioration seems to occur. So if you have two copies of it, you may have a 60% risk of dementia. Now it doesn't mean you have 100%. There are a lot of other factors that will weigh in. I looked at my APOE4 results when I did 23 and me the genetic testing.
Speaker 1:There are various ways that you might be able to get this test if it's of interest to you. I have a whole episode on whether you should do large panels of testing because of false positives and things. You might listen to that if you're interested, but this is something that is available that for some people might be helpful. Okay, so those are clinical and actuarial approaches. Here's number three.
Speaker 1:There are various physical tests physical strength tests, physical agility tests that can help predict mortality. Again, this is not perfect, but it's moving from an actuarial table, which is everybody, to something that's more specific to you. So one is called the Brazilian sit-stand test and basically you get five points for how you stand up from sitting on the ground and you get five points up to five points as you then move from standing back to the ground and each aspect of it you can lose points. So if you're sitting on the ground and you can't just get up on your own, you have to use a hand or two hands, or a hand and a knee or two knees. Each of those points of support you lose a point and for each point you lose there appears to be a 20% increase in mortality looking over the next six years. So if you have less than eight points, again 10 is perfect. If it's less than eight points, you have a doubling of mortality in the next six years. If you have less than four points, then you have a five-fold mortality risk.
Speaker 1:My score is about nine to 10. I can do it without holding anything or touching the ground. I'm a little wobbly and you do lose half a point for being wobbly. So that's one thing you can do. Another is something simple. It's grip strength and it was a large study of 17 countries and looked at four-year follow-up and they had 142,000 people and you might be able to, and typically what you do is you squeeze this device and it measures how many pounds or kilograms of force, and for me, I can do about 100 pounds of grip strength, and for different folks, obviously, the number is going to be less, the number is going to be more. But each five kilogram reduction in that amount compared to your peers, which is about 11 or so pounds, there's a 15% increase in mortality. So again, here's another way you could test yourself and get some inkling about whether your lifespan is compared to others.
Speaker 1:Okay, so here's an action item. You can do one of these tests or both of these tests. The Brazilian sit-stand takes no equipment. I'll have a link to a YouTube video not mine but somebody else's which can show you exactly how to do it. It's fun, share it with your family, share it with your friends. You can then work on doing it better with some practice and some strength work. There's various other tests. I'm not going to go through One's called the HANG test. It's just like a pull-up where you hold on the VO2 max testing.
Speaker 1:There may be various other things. Now, with the physical testing, we have a chicken or egg problem. Is it that the weaknesses or the imbalances cause early death through falls or other things, or is it a reflection on the fact your body is just deteriorating and it may be associated with earlier death, but it may not be causative. Why does it matter? Well, it matters because if it's causative and we can improve those things, we can improve our grip strength, we can do better on the sit-stand test. That might lower our mortality. We don't have data. Looking at this, I tend to think, looking more broadly at the exercise literature, that in fact, working on this could be beneficial. But again, this is my opinion, based upon my understanding of literature not specific to these things.
Speaker 1:Okay, the fourth and final area of figuring out how many years you have left are called biologic clocks or epigenetic clocks, and I again may do an episode on this. If you're interested, let me know. So there's a concept of chronologic age that's based upon how many years old you are, and then there's what's called biologic age. So it's possible that you are 60 years old but your heart looks like and functions like a 40-year-old or an 80-year-old. Similarly, other parts of your body may function similarly or not to your chronologic age, and this could be very exciting if in fact, it could predict death and disease. There's one called the Health OctoTool. The University of Washington developed this and basically they looked at known diagnoses that you might have in 13 body systems and then they add this up in some unique way and then they come up with your biologic age.
Speaker 1:The other and what's received a lot more attention and for some people a lot of excitement, is based on blood testing or tissue testing and that's looking at changes in the DNA, and they look at, often, methylation, which I don't need to go into the chemistry or biochemistry of this. My take on these biologic clocks, especially the ones that are based on methylation and blood and tissue samples, is they're not ready for prime time. If you do two different tests on the same day in the same person, you're going to get two different answers. If you use the same test in the same person on different days or even different times of day, you're going to get different answers and different tissues also have different answers. So I believe this could be very exciting in the future. I think it's a wonderful way to begin to look at research interventions, but for everyday personal use, I don't see that we're there yet.
Speaker 1:Okay, now we're going to switch to how many good years you have, and for this purpose I'm going to say that good years are. You can remain active, pain-free and without any particularly problematic symptoms. There are data the actuarial tables, the equations, blood tests that do an interesting job on predicting how many years you have left. It is much more challenging to say I'm 50 years old, I'm in pretty good health, but am I going to have 10 more good years of health? Am I going to have 20? This is an area which obviously we all want to know, but unfortunately the data really aren't there Now.
Speaker 1:For some diseases there are prediction tools that suggest how your disease might progress. So, for example, multiple sclerosis a bunch of different studies. Multiple sclerosis tends to get better, get worse, but gradually it gets worse over time and there are ways to predict how that progression might occur. There's similar tools that look at dementia Is my cognitive ability going to fall quickly or slowly? Similarly, kidney disease and movement towards kidney failure. There's some prediction equations. Now there are lots of questionnaires out there that can look at our physical functioning, like the SF-36 that was developed at RAND many years ago. They can assess our physical function, how active we are and all those kinds of things. Unfortunately, they don't predict what's going to happen in the next one year, five years or 10 years, and there is no actuarial equivalent really that can predict number of good years.
Speaker 1:Okay, well, I want to give you something to think about. I can't just say, well, sorry, there's nothing. So I think there are two ways to think through this. First is there are changes that are going to happen to almost all of us, and we've talked about these. So as you get above age 30, you are going to lose 1% to 2% of muscle mass each year, which means our strength is going to typically fall year in year out. Also, our aerobic fitness is going to tend to deteriorate. It does, in almost everyone, probably 10% loss of our fitness each decade, and when you get to be about 70, you may lose 20% per decade. So do some predictions for yourself. If you can lift a 40-pound suitcase up into the overhead bin, you might not be able to do even 30 pounds in 10 to 20 years. If you can run a mile in 10 minutes now, well, another decade or so, you'll be lucky to run at 11 or 12 minute pace. I've certainly noticed my speed has really fallen over the years. So here is an action item for you. So here is an action item for you, because things will tend to become less muscle and less aerobic fitness. Redouble our efforts towards strength training and our aerobic work. You can look at episode 2 and episode 38 on exercise and get some ideas about what to do, and episode 38 on exercise and get some ideas about what to do.
Speaker 1:Okay, so the first is just generally looking at how our bodies change muscle-wise and aerobic-wise over time. The second is to take a more personal view. So there are known causes of disability in the United States and the most common causes of disability are low back pain, arthritis, more generally, heart disease, like heart failure. About a quarter of us will get heart failure and that means we're going to be short of breath when we try to do stuff. Depression is also a big part of disability. So one thing you can do is take stock of your own well-being. Do you have any of these problems? Because these might help you project forward in time. How far can you walk? Do you get short of breath when you climb stairs? What is your weight like Basically? Look at where you are and that might give you a sense of where things might head. Also, look at your family. How did they age? Where were they at different ages and time?
Speaker 1:Okay, so we've talked about a couple of aspects of how many good years, but then there's the wild card, the risk that bad things happen without warning, the unpredictable. Now there are some very rare events, like what's likely here, you're going to be killed by lightning Well, that's about a one in a million. What's likely you're going to die from a shark attack? Well, that's about one in four million. So these are rare things, not likely to affect many of us, but something you can keep in mind. Then there are uncommon events, not rare events, but uncommon. So bike accidents leading to death there were about 1,400 of them in 2023, which isn't a huge number, but it increased by 50% in the past 10 years. Motor vehicle accident deaths there's about a one in a hundred chance per year that that could happen. So these are kind of wildcard events. Now there are some that are more common, and they become more common as we get older.
Speaker 1:For folks 65 and older, there is a one in four chance each year of having a fall, a major fall, and there are about 38,000 deaths in the United States each year that are related to a fall. And if you've fallen once in a fairly major way, that doubles your risk of another fall. If you have visual problems, that doubles your risk of a fall. If you have hearing loss, it triples your risk of a fall, although a lot of that risk goes away if you get a hearing aid. Okay, what's your action item here? Action item here is build resilience into your life to avoid falls. My episode number 34 on resilience and strong bones may be something to look at.
Speaker 1:Okay, concluding thoughts no, we can't fully predict how many years ahead and how many good years, but I gave you some action items that you might try out. Some of these calculations and physical tests the epigenetic clocks may be exciting for the future. I just don't think we're ready. There are opportunities to change, to improve, and maybe doing some of these assessments might motivate you towards that. Now, my daughter, rachel, is very interested in astrology and I looked at astrology and tarot cards and palm reading to see. Well, maybe this could help us in predicting how many years or how many good years. Well, unfortunately, I didn't find any data to test how good they were.
Speaker 1:Let me end with what I might view as a positive view of this. We're all going to get older and some things are going to get worse, but in some cases some things get better. Arthur Brooks wrote a book called Strength to Strength and in it he talks about two different types of intelligence fluid intelligence and crystallized intelligence. Fluid intelligence is the ability to solve new problems you know the Nobel Prize winners or even just solving new problems in your life. This is a skill, an intelligence that tends to be in your 20s and begins to deteriorate over time after that. But then, as we get older, we get something called crystallized intelligence, and that's the ability to tap into our accumulated knowledge, skills and experiences, the ability to synthesize and say ah, I see what's going on here. That tends to improve with age. So, although maybe our muscles are decreasing, our crystallized intelligence is getting better.
Speaker 1:Ultimately, do what you can, enjoy what you can and realize some bad stuff out of nowhere could happen. I truly hope that you can live long and well and that we will be together on this podcast for many, many years to come. Thanks so much for listening to Live Long and Well with Dr Bobby. If you liked this episode, please provide a review on Apple or Spotify or wherever you listen, if you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at drbobbilivelongandwellcom. That's, doctor, as in D-R Bobby. Live long and wellcom.