How to beat the big four diseases of ageing

As we live longer, it’s crucial to address the chronic illnesses that come with age. Photo / 123rf

We are living longer than ever before. In 1765, the average lifespan was just 38.8 years, and even by the start of the 1920s, still only 56. Then along came the vaccines: diphtheria, tetanus, whooping cough and tuberculosis. Today, life expectancy in the UK is 78.6 years for males and 82.6 years for females.

But longevity comes with a price: that of limping along with chronic health conditions. A report released last year from the Health Foundation reveals that almost one in five of us are projected to be living with a major illness by 2040, an increase of more than a third from today.

So what are these major illnesses likely to be? According to the experts, they tend to fall into related, but discrete camps. Longevity doctors now talk about the ‘Four Horsemen” of chronic disease – a phrase coined by Dr Peter Attia, the American author of the bestselling book Outlive: The Science and Art of Longevity.

These Horsemen are: heart disease, cancer, neurodegenerative diseases such as Alzheimer’s, and “foundational disease”, a spectrum including Type 2 diabetes and insulin resistance.

Sir Christopher Ball is an academic and the co-founder of the Oxford Longevity Project, a group of scientists who research living “better”, as well as for longer. He is 89 years old and still delivering lectures. “In the 20th century, much was made of the genetic link to disease – and it’s true that our genetics play a part,” says Sir Christopher.

“For example, I knew all my grandparents, and I’m lucky that none of them had cancer.” Bell was sadly still unable to avoid a series of heart attacks and triple bypass heart surgery at the age of 67 – but his response to this was to take up marathon running.

To a large extent, says Sir Christopher, our old-age health is in our hands – and we can absolutely reduce the risk of succumbing to chronic ill-health. “There’s an increasing recognition that we have the power to resist and slow the development of age-related conditions,” he says. “While our genes may load the gun, it’s our lifestyle and mindset that fires the trigger.”

Read on for the most common chronic conditions of old age – and what we can do about them.

The ‘Four Horsemen’ of chronic disease include heart disease, cancer, neurodegenerative diseases, and Type 2 diabetes. Photo / 123rf

Cancer

Cancer can strike at any age, but the older we get, the more likely it becomes. “The two most common cancers of old age are breast and prostate cancers,” says Dr Richard Siow, the director of Ageing Research at King’s College London. “As we age, our cellular mechanisms reduce the clearance of damage within our cells.”

The older we are, the more we suffer from a process called “oxidative stress,” where chemicals called “free radicals” cause damage to organs and tissues.

“We all have genes that we are born with, and these are switched on and off at different points during our life: this is called epigenetics,” says Siow. “As our cellular mechanisms fail, this has an impact on our epigenetic predisposition.” In other words, our genetic flaws are more likely to mean we progress to disease.

What can we do about it?

An unlucky few people are born with genetic conditions which vastly raise their risk of certain cancers: for example, the BRCA-gene mutation which can lead to breast, ovarian and prostate cancer. “However, in many other cases, the main causes are in our lifestyles and mindsets,” says Sir Christopher.

Dr Siow agrees. “We can mitigate our risk with lifestyle interventions,” he says. “For example, to cut the risk of lung cancer, stop smoking, vaping and avoid exposure to air pollutants.”

After smoking, obesity is the second biggest risk factor for cancer. The risk increases in line with how overweight you are, and for how long. Research indicates that about 20 per cent of cancers are caused by excess weight.

Cutting back on alcohol and eating fewer ultra-processed foods (more on which below) serve significantly to reduce the risk of cancer, as does attending screening programmes for cervical, breast and bowel cancer.

Heart disease

Age affects our cardiac health in various ways. “Our blood vessels become blocked by various fats and lipids, and they can harden: they don’t relax and expand as they used to and this drives up blood pressure,” says Dr Siow. “Our blood is thicker and more prone to clotting, and the heart itself contracts less.”

There is some cause for optimism. As regards heart disease at least, our health is improving. In marked contrast to the other Horsemen listed here, deaths from cardiovascular illnesses have actually been falling since the 1970s.

“We are now increasingly surviving heart attacks,” says Dr Siow. “Medical procedures such as bypasses and stents are hugely influential, as is the wide prescription of statins to keep cholesterol under control. The decline of smoking has also had a lot to do with improving cardiac health.”

What can we do about it?

Despite the good news above, heart disease remains the world’s largest killer, responsible for 17.9 million deaths each year.

“The main message is not to wait for something to happen in your 50s and 60s before addressing your heart health,” says Dr Siow. “Make sure you drink less alcohol, become more physically active. You don’t have to be an Olympian: use the stairs, go out into open spaces: walking a hundred metres or one metre is better than no metres at all.”

Diet is also key. There has long been evidence of the cardiac health benefits of the Mediterranean diet: rich in lean meats, fruit and vegetables, olive oil, and pulses, as well as an avoidance of foods high in saturated fat, sugar and salt.

Stress can also be a factor, according to Ruth Goss from British Heart Foundation. “Stress on its own will not cause heart disease, but it can lead to unhealthy behaviours such as comfort food, smoking and drinking too much,” she says.

It’s also vital to manage conditions which can lead to heart attacks and strokes: cholesterol, high blood pressure, and diabetes: so make sure you attend your routine GP appointments.

Heart disease deaths have been falling since the 1970s thanks to medical advancements. Photo / 123rf

Diabetes and other metabolic disorders

Type 2 diabetes (the type most often acquired later in life) may sound benign, but that is far from the truth. “Type 2 diabetes is characterised by a high rate of vascular complications and subsequent disability, frequent hospital admissions, and increased institutionalisation,” says the charity Diabetes UK.

People with poorly treated Type 2 diabetes can go on to suffer serious problems with their vision, kidney functions and even the loss of limbs.

Type 2 diabetes is the most common metabolic heart condition in older people. New figures from the charity show that 4.3 million people are now living with a diagnosis of diabetes in the UK (90 per cent of these being Type 2) and that 2.4 million people are at high risk of developing Type 2 diabetes in the UK.

Sir Christopher calls this condition “’diabesity’, and, indeed, Type 2 diabetes is largely linked to physical inactivity, poor diet and weight gain.

“Diabetes is a problem on its own but it also can also lead to conditions such as heart disease and dementia,” says Dr Siow.

What can we do about it?

“We all know about obesity, and we can choose to avoid it,” says Sir Christopher. Hence, diet is key when looking to avoid Type 2 diabetes.

An ever-growing body of research is redefining what “healthy eating” actually means. Instead of focusing on calories, experts are now paying attention to how processed our foods are – the extent to which they have been altered from their original state, as well as peppered with additives and emulsifiers. Avoiding ultra-processed foods (or UPFs) is now an accepted part of the healthy eating equation.

“Scientists are now concentrating more on the role of the microbiome,” says Dr Siow. The microbiome refers to the collection of bacteria, fungi, viruses that live in our gut.

Dr Siow continued “However, it is true that more evidence is needed. What is clear is that we need to eat less, and particularly reduce our intake of carbohydrates.”

Dementia

While we are fighting diseases such as heart disease and cancer: the fuse has been lit on another time bomb: that of cognitive issues such as dementia and Alzheimer’s – overwhelmingly diseases of old age.

“Dementia is closely linked to depression,” says Dr Siow. “Diabetes and cardiovascular disease also increase cognitive decline. There’s a lot of research but we don’t have good interventions yet.”

Last year saw the launch of two new drugs: lecanemab and donanemab. These were hailed as breakthroughs because of their role in potentially clearing out amyloid, a protein that aggregates on neurons and stops the brain from working properly, causing dementia.

However, there is still concern about the side effects related to these drugs, and they are not widely available.

What can you do about it?

In 2020, the Lancet Commission on Dementia found that 12 “modifiable risks” could lower the number of dementia cases by 40 per cent. These included hypertension (high blood pressure), hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact. Other studies have shown the importance of refreshing sleep.

“As we don’t yet have good interventions for dementia, it’s vital to mitigate our risk via lifestyle changes, especially as cognitive decline leads to physical frailty,” says Dr Siow.

He sees a future in digital “wearables” for people to monitor in their own homes, alerting them to signs of cognitive decline: this is particularly important, as all current interventions rely on early diagnosis. It’s also known that simple acts such as wearing a hearing aid can keep a person socially engaged for longer, potentially reducing their risk of dementia.

For Sir Christopher, mindset and emotional health are key to staying sharper for longer. “Happiness is a choice,” he says. “Make a reason to be happy: the sources of joy are service of others, creativity, and pursuit of mastery, through learning.”

In taming all the Horsemen, Sir Christopher’s conclusions have one common theme. “Your illness is not the business of the doctors – they are merely your consultants,” he says. “In the end, it’s up to an individual to take the lead. The responsibility for a life of healthy longevity lies with you. You are the biggest player.”