When Health Starts Determining the Size of Your Life

By Daniel Soule, Clinic Director, HormoneSynergy®

I had an experience recently that caught me completely off guard. It began at an afternoon drag show honoring Dolly Parton at a comedy club. People were having drinks, talking, finding their seats and waiting for the show to begin, and nothing unusual was happening. Yet as I looked around the room, I found myself becoming unexpectedly emotional.

The rest of the day was exactly the kind of day I hope to keep having as I get older. We drove through Oregon wine country for a tasting, had dinner, and later spent time under the night sky doing some astronomy. At nearly 62, I was struck by how much of it I could simply enjoy without thinking about whether my body would cooperate. I could walk where I wanted to walk, go where I wanted to go, and move through the day without planning around physical limitations. I felt deeply grateful for that, and at the same time, a sense of concern.

I have worked around preventive medicine long enough that aging is never entirely abstract to me. I think about the things that allow us to remain active, independent and engaged in our lives, and about how quickly those things can change. That day, surrounded by people simply enjoying themselves, I became unusually aware of approaching 62, of feeling well, and of how much I still want to do with my life. What I felt was mostly gratitude, but there was concern in it too, the kind that comes from knowing that health is precious and that much of what I hope to experience in the years ahead depends on protecting it as well as I reasonably can.

My thoughts moved naturally to my family and to people I have known for most of my life. At this age, health is no longer something I think about only in terms of laboratory values, cardiovascular risk or whether I am exercising enough. I see more clearly how it influences the freedom we have to travel, explore, remain independent, pursue new interests and continue participating in the lives we have built.

Watching the Differences Emerge

I think about people I went to high school with because, when we were young, most of us seemed physically capable of roughly the same things. We could stay out too late, eat badly, miss sleep, stop exercising for stretches of time and generally recover without giving the consequences much thought. Whatever differences existed in cardiovascular risk, metabolic health, bone density or physical conditioning were largely invisible because they had not yet begun shaping our daily lives.

More than four decades later, those differences have become much easier to see. People who were once indistinguishable from one another in terms of what they could physically do now live very different lives. Some friends are managing chronic disease, significant pain, loss of mobility or other limitations that influence where they travel, how far they walk and what they are comfortable agreeing to do. Their lives have not necessarily become unhappy or without meaning, but health has become one of the factors around which those lives increasingly have to be organized.

Then there are the people who remind me how much physical capacity can still be preserved. A physician friend of mine recently completed his fourth walk across the United States, this time at 70 years old. Another friend, someone I have known since the fourth and fifth grade, is finishing the Camino de Santiago tomorrow.

I romanticize walking the Camino. I want to experience it myself. I want to travel the world as I age, keep seeing places I have never seen, walk through cities I don't know, spend time under unfamiliar skies and continue saying yes to experiences that interest me. I have no illusion that walking the Camino is some kind of proof of superior health, but I understand what it represents to me. I want to know that I could do it if I decided to go.

I don't want my world to become smaller because I failed to take reasonable care of the body I need in order to move through it.

We tend to notice health when something hurts, when a laboratory result comes back abnormal or when a physician tells us something needs attention. We pay much less attention to the ordinary freedom good health provides because it usually announces itself by not interfering. You get on an airplane, spend a day walking through a city, carry your suitcase, climb a flight of stairs, work in the yard or accept an invitation without first having to calculate what your body will permit.

I appreciated my health when I was younger, but after 40 I began taking it much more seriously. I made more changes, became more deliberate about exercise and nutrition, paid closer attention to prevention and began thinking more carefully about what I wanted my health to look like decades later.

That does not mean I walk around imagining that everything is fine forever. Quite the opposite. I think about the next laboratory test. I think about the colonoscopy. I notice the occasional ache that wasn't there when I was 30. I understand that a completely unexpected event can change everything because I have already had one of those experiences. If it had not been for an observant neighbor at a critical moment in my own life, there is a very good chance I would not be here or writing this article.

Experiences like that have made it impossible for me to believe that health can be controlled completely. They have also made me less willing to use uncertainty as a reason not to influence the things that are still within reach.

What My Mother Taught Me About Starting Where You Are

My mother has influenced the way I think about this as well. At 79, she underwent triple bypass surgery. By any reasonable measure, that was a serious cardiovascular event arriving late in life, and it would have been easy to assume that whatever had happened over the previous decades had already determined the rest of the story.

She made changes afterward. I cannot prove which decision added which month or year to her life, and medicine rarely allows us that kind of certainty in an individual person, but I believe the changes she made after her bypass have helped extend her life and improve the years she has had since then. Watching her reinforced something I think preventive medicine sometimes communicates poorly: meaningful change does not lose its value simply because we wish it had started earlier.

People become active at 65. They stop smoking at 70. They begin treating blood pressure that was ignored for years. They rebuild strength after illness. They change the way they eat after a diagnosis. Sometimes a major health event becomes the reason someone finally begins paying attention, and sometimes people simply decide that they want the next decade to look different from the last one.

I find that much more useful than thinking of health as some lifelong scorecard in which every imperfect decision has already been tallied.

Taking Health Seriously Without Pretending We Control Everything

I have spent years paying attention to my own health. I exercise regularly, think about maintaining muscle, pay attention to body composition, nutrition, sleep and cardiovascular risk, and probably know more about preventive testing than I ever expected to know when I was younger. Working alongside Dr. Retzler has inevitably influenced the way I think about all of this. None of it means I have done everything correctly, and it certainly does not mean I believe a disciplined lifestyle protects anyone from every disease.

There are circumstances that make good health more difficult. Access to healthcare is not equal. Financial pressures are real. Work schedules, caregiving responsibilities, neighborhood safety, chronic illness and many other realities can complicate even basic health decisions. I don't think we should ignore any of that.

I also think we sometimes allow the complexity of health to obscure how much the simple things still matter. Walking is accessible to many people. Strength can be built without an expensive gym. Most of us know that smoking is harmful, that sleep matters, that highly processed food should not make up most of our diet and that years of inactivity eventually carry a price. None of this requires perfect circumstances or perfect behavior, and acknowledging barriers should not require us to pretend that ordinary choices have no effect.

I don't eat perfectly all the time, nor do I intend to. There are occasions when I eat food that I know is not particularly good for me, and I enjoy it. I feel comfortable doing that partly because it is not how I eat most of the time. If 90 percent of my choices support my health, the other 10 percent can belong to dinner with friends, travel, celebration or simply enjoying something because I want it. Taking health seriously has made those occasions easier for me to enjoy, not harder.

Preventive medicine is useful because some risks can be changed and because the opportunity to change them is often greatest before they begin interfering with daily life. Blood pressure and cardiovascular risk can be assessed and treated. Glucose abnormalities can be recognized. Bone loss can be measured. Sleep disorders can be diagnosed. Muscle and strength can be maintained or rebuilt. Smoking can be stopped, and physical activity can remain part of life long before mobility becomes difficult.

The American Heart Association's Life's Essential 8 framework is almost ordinary in this respect: nutrition, physical activity, nicotine exposure, sleep, weight, cholesterol, blood sugar and blood pressure. Much of cardiovascular prevention involves paying attention to ordinary things consistently over a long period rather than discovering a dramatic intervention later. The American Heart Association's Life's Essential 8 provides a useful overview of those factors.

Physical function deserves the same attention. The National Institute on Aging has long emphasized regular physical activity as part of maintaining strength, balance and independence with age. Its guidance on exercise and physical activity is far less exotic than much of what is now marketed under the banner of longevity. Preserving health over decades usually has far more to do with sustained habits and appropriate medical care than with whatever happens to be fashionable in longevity medicine at the moment.

At HormoneSynergy®, much of what we do comes from this same philosophy. We look at cardiovascular risk, metabolic health, body composition, bone density, cognition and other areas because changes in these systems frequently begin before someone considers themselves sick. The purpose is not to turn a healthy person into a patient preoccupied with every number. It is to identify meaningful risk while there is still an opportunity to respond to it.

What I Actually Want From Longevity

There is another side to this that I think about quite a bit. Longevity has become an industry, and there is an increasingly strange culture around optimizing every measurable aspect of human biology. Meals become calculations, sleep becomes a score, exercise becomes data and laboratory values become something to continually improve. A person can become so occupied with preparing for a healthier future that health itself begins consuming the present.

My interest in prevention is not about making health the only interesting thing in my life. In many ways, the opposite has happened. I have been returning to interests that have nothing to do with medicine. Astronomy has become important to me again. I find myself thinking more about spirituality, reading and listening to Alan Watts, spending more time with the questions that have fascinated me for years and thinking about places in the world I still want to see.

Maintaining muscle, cardiovascular health and mobility matter to me because they support independence and the ability to keep doing those things. Preventive testing matters because I would rather know about a meaningful problem while I still have options than discover it only after it has already changed my life.

My physician friend walking across the country at 70, my childhood friend finishing the Camino and my mother making meaningful changes after a triple bypass at 79 represent very different versions of what continues to be possible as we age. None of their stories promises anything about what will happen to me or anyone else, but they remind me that age itself does not determine the boundaries of a life nearly as neatly as we sometimes assume.

Watching people I have known for decades age has made the other side of that reality just as visible. At 25, cardiovascular disease was something I understood intellectually. At 62, I know people living with it. The same is true of diabetes, joint disease, loss of strength, cognitive decline and the gradual accumulation of medical problems that can alter what someone is physically able to do. Seeing those changes among people you have known since childhood is very different from reading about population risk in a medical journal.

I think that was what I carried into the comedy club that evening. Some of what I saw around me concerned me, because after years in this work it would be dishonest to say otherwise. More than anything, though, I became aware of my own health and how fortunate I felt to be there at 62, going out for the evening and participating in something simply because I wanted to be there.

I did not leave thinking I was healthier or better than anyone else in the room. I left thinking about how much I still want from my own life and how dependent so much of it will be on the body carrying me through it.

I want to travel. I want to walk the Camino. I want to keep discovering the night sky. I want to continue exploring the spiritual questions that interest me, spend time with people I care about and remain open to interests I have not even discovered yet. I want to enjoy the occasional meal that has absolutely nothing to do with optimal nutrition and not feel guilty about it because most of the time I am doing the things that support the life I want.

I know that none of those efforts guarantees anything. A laboratory result can surprise me. A colonoscopy can find something I did not expect. An accident can change a life in an instant. Aging itself will eventually ask things of my body that I cannot negotiate away.

What I can do is give myself as much opportunity as possible. I can exercise, maintain muscle, pay attention to cardiovascular and metabolic health, eat well most of the time, sleep, keep learning, stay engaged with the world and use medicine appropriately rather than waiting for disease to force the conversation.

When I think about the Camino now, I am not using it as a metaphor for someone else's healthy aging. I really do want to walk it. Whether I ultimately do is almost beside the point. What matters to me is arriving at the opportunity with a body capable of saying yes.

At 62, I consider myself fortunate to be in the best health of my life. I also understand more clearly than I ever have how precious and temporary that can be. Taking care of it is not about proving anything to anyone else. It is about protecting as much of the life ahead of me as I reasonably can.

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HormoneSynergy® Clinic in Lake Oswego, Oregon focuses on evidence-based preventive longevity medicine, including cardiovascular risk assessment, body composition, bone health, cognitive assessment and comprehensive physician-guided evaluation.

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This article is educational and is not intended to diagnose, treat or replace individualized medical care. Health outcomes are influenced by genetics, environment, illness, injury and many other factors in addition to modifiable health behaviors. Discuss personal risks and preventive strategies with your healthcare professional.