How do I live longer? Here are 10 ways backed by evidence

Patients often come to me seeking advice about what they can do to live longer. The number of things that have been proven to extend life, however, remains shockingly small. What follows are things that have enough support in the scientific literature that I generally recommend them (though the strength of the evidence varies even with these):

  1. Take simvastatin (brand name Zocor). That is, if you have coronary artery disease. (This is one of those drugs that doctors joke should be put in our water supply.) A landmark trial called the 4S Study (click on the “Look Inside” button to read the article) showed that people with heart disease who take simvastatin will reduce their risk of dying from any cause by 30% (relative risk).
  2. Take ACE inhibitors if you have heart failure. Though we’ve known for decades ACE inhibitors make such patients live longer, studies also show a shocking number of such patients aren’t taking them. (This is the other drug that doctors joke should be put in our water supply.)
  3. Wear oxygen if your PaO2 (partial pressure of oxygen in your blood) is below 55 mmHg, as in severe emphysema. Lots of people want to wear oxygen for lots of reasons, but the only good reason to do so is if you PaO2 is below 55. And then you should do it not so much because it will make you feel better (it may do so, interestingly, by improving your energy, but strangely not by making you feel less short of breath), but because it will prolong your life.
  4. Get annual Pap smears (and mammograms). The interval for screening Pap smears isn’t the same for all women, but it too increases the likelihood of living longer. So does mammography (though the age at which to begin screening mammograms remains controversial).
  5. Get screening colonoscopies. Like Pap smears, how often you should get one varies depending on your baseline risk, but it too has been shown to decrease the likelihood of death. Screening exercise treadmill tests, on the other hand, the most frequently requested screening test, has been shown in otherwise low-risk individuals not to increase lifespan and should be avoided: the risk of false positives (that is, the test says you have coronary disease when you don’t) in low-risk individuals is higher than the likelihood of true positives (this turns out to be especially true for women) and only exposes patients to unnecessary invasive testing like cardiac catheterizations, which have very real risks.
  6. Exercise. Most of us already know that exercise makes us healthier. Some may also believe it makes us live longer. Those who do are probably right, though it depends on who’s doing the exercising. Statistically speaking, middle-aged men who exercise will live longer than middle-aged men who don’t. Statistically speaking, elderly women will also live longer than elderly women who don’t. Middle-aged women probably will live longer than middle-aged women who don’t. Elderly men, interestingly, won’t live longer than elderly men who don’t.
  7. Assume responsibility. In both elderly men and women, however, simply being made to feel a sense of responsibility has been found not only to improve daily functioning but also to increase lifespan. In a study of nursing home patients by researchers Ellen Langer and Judith Rodin, residents on one floor were given a plant for which they themselves were expected to care (the experimental group) while residents on another floor were given a plant for which their nurses would care (the control group). After three weeks, 93 percent of residents in the experimental group showed an overall improvement in socialization, alertness, and general function; in contrast, for 71 percent of residents in the control group functioning actually declined. And in a follow-up study eighteen months later, half as many of the residents who’d received plants for which they were expected to care by themselves had died as the residents who’d been given plants for which their nurses cared.
  8. Learn to be optimistic. A former resident of mine, Hilary Tindle, just recently published a book, Up: How Positive Outlook Can Transform Our Health and Aging, summarizing the research on optimism and aging, which shows that optimists live longer than pessimists. For a discussion about how to become more optimistic, see my own book, The Undefeated Mind, chapter 4.
  9. Train yourself to view aging as a positive. Studies show that people who have positive self-perceptions of aging have a strong will to live and that having a strong will to live actually seems to increase longevity.
  10. Be happy.  So much easier said than done, of course. Happiness, however, doesn’t seem just correlated with longevity. It actually seems to cause it.

Alex Lickerman is an internal medicine physician at the University of Chicago who blogs at Happiness in this World.  He is the author of The Undefeated Mind: On the Science of Constructing an Indestructible Self.

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  • Eve Harris

    Please review the evidence when it comes to cancer screening before you make these claims! Mortality benefits are notoriously elusive. You are citing research that is more than 20 years old!

    • Alex Lickerman

      I agree that morality benefits are notoriously elusive, but just because evidence is old doesn’t mean it’s invalid. Can you point me to papers that convincingly argue to the contrary?

      • Eve Harris

        AHRQ, October 2008
        “population screening programs *between the ages of 50 and 75* years using any of the following 3 regimens will be approximately equally effective in life-years gained, assuming 100% adherence to the same regimen for that period:8 1) annual high-sensitivity fecal occult blood testing, 2) sigmoidoscopy every 5 years combined with high-sensitivity fecal occult blood testing every 3 years, and 3) screening colonoscopy at intervals of 10 years.

        • Alex Lickerman

          Yes, but this statement confirms there is a survival benefit to screening for colon cancer. (This statement is, however, still controversial: some authorities will argue the survival benefit one gains from fecal occult blood testing is accrued because positive tests are followed up with colonoscopy.)

      • Sleeperagent

        Morality?? Mortality, perhaps

        • Alex Lickerman

          Whoops, yes, thank you. Mortality, not morality.

    • Guest

      They keep changing the “rules” so frequently, it’s hard to know what to believe. The “Choosing Wisely” campaign especially has thrown a spanner in the works of all those who’ve been trying to convince us for years that we need all these annual screening tests.

      If you don’t like the medical guidelines for healthy living today, just wait a few months and they’ll put out new ones.

      • Alex Lickerman

        The guidelines change as the evidence changes. It’s frustrating for everyone, doctors and patients alike, but what better option is there but to revise them as new evidence dictates?

  • Jean Oliver

    Of course a doctor is going to include medical interventions (in the form of pharmaceuticals and cancer screenings) in his list of ways to improve longevity, and even put them as the top 5. I am glad, however, that he did include exercise and optimism on his list but am rather disappointed that there was no mention of diet. Anyone who is familiar with the literature on the “Blue Zones”, where citizens typically live to an advanced age without normal age-related degenerative conditions, knows that most of those benefits are gained through what that population eats as well as how they live their lives in respect to daily activity, social ties, etc. And I agree with Eve Harris: cancer screenings (in most cases) may reduce the cause of death for that particular cancer but in most cases do not reduce deaths from all cause mortalities. In other words, you will die at the same age, just from a different cause. So those screenings may do nothing to improve your overall longevity. If we focused more on lifestyle, we could perhaps prevent those conditions that would require this doctor’s first 5 recommendations. People who never develop high cholesterol, emphysema, diabetes, etc. would never require statins or other “maintenance” drugs, thus eliminating the need for the first 3 things on his list. And diet and exercise would go a long way in lowering the risk of cancer and, if not eliminate the need for screenings, at least focus them on those who will really benefit (higher risk) or move to a longer interval between screenings.

  • usvietnamvet

    I simply don’t understand this desire to live longer. If I could live longer as if I were in my 30′s I might think about it but living longer in my 70′s, 80′s and 90′s….NO THANKS.

    • http://drpauldorio.com Paul Dorio

      But that’s exactly the unsaid point — to live HEALTHIER longer. Perhaps it should be stated as such but come on, who wants to live into their 100s bed-ridden like Grandpa George?

  • Chiked

    I stopped reading after the first one. Cholesterol is NOT responsible for heart attacks. Inflammation is. When will the medical profession stop selling out to pharmaceutical companies?

    • Guest

      Take drugs and get prodded. Yuck, no thank you. My goal is exercise, moderation, and avoid docs like the plague. After the kids are fully vaccinated they will do the same.

  • Peter Hall

    Oh dear! Perhaps I should not be surprised that a doctor turns to drugs for the top two recommendations for extending life, but it is still disappointing when the most effective and obvious one is left out completely.
    The American diet is high calorie and low nutrition which is why most Americans are overweight and undernourished and prone to illness. A nutritrarian diet has been shown to reduce weight and dramatically reduce disease including reversing type 2 diabetes. Please read Joel Fuhrman M.D.s books ‘Eat To Live’ and ‘Super Immunity’.
    Vegans almost never get cancer or heart disease and long-term vegans live about 13 years longer than average. Since I adopted a nutritarian diet two years ago I have lost 24lbs and feel 10 years younger – and I never go hungry.

  • Alex Lickerman

    Again, this link argues for particular screening guidelines. It doesn’t address the evidence that suggests screening in this way improves the likelihood of survival.

    • Eve Harris

      MANY primary sources are cited in these guidelines, which are the most user-friendly resource, after all…I’m trying to spread GOOD information more than I’m trying to argue with you :)

      • Alex Lickerman

        Ah. Fair enough.

  • elizabeth52

    Interesting article that makes some good points, but I disagree with annual pap tests and mammograms. The evidence against annual pap testing is clear: it provides no additional benefit, it amounts to serious over-screening that simply pushes up the risk of a false positive and potentially harmful excess biopsies and over-treatment.

    I’d agree though that women should be “offered” (not ordered or coerced) 5 HPV primary tests at ages 30,35,40,50 and 60 or given the option of HPV self-testing with the Delphi Screener, and the roughly 5% who are HPV+ and at risk of cervical cancer. should be offered a 5 yearly pap test. (until they clear the virus)

    This is the new Dutch program, it’ll save more lives and take most women out of pap testing and harms way.

    As I low risk woman I declined pap testing more than 30 years ago, I was content to accept my near zero risk of cervix cancer rather than a 77% lifetime risk of referral for colposcopy/biopsy with our program. I now know I’d be HPV- and cannot benefit from pap testing.

    Mammograms, I’ve declined this test and removed myself from the screening register. I think it’s unfair (to put it politely) to women to simply recommend breast screening. Women should be provided with real information – like the brochure prepared by the Nordic Cochrane Institute, an independent medical research group, on the risks and benefits of mammograms. (it’s at their website and has been translated into lots of different languages)

    The evidence is concerning: about 50% of screen detected breast cancers are over-diagnosed, the fall in the death rate is mostly about better treatments, not screening. Also, Professor Michael Baum, UK breast cancer surgeon and amazing advocate for informed consent, has an article in the BMJ (2013) that says the risks of screening exceed any benefit when you include women who die from heart attacks and lung cancer after treatments, including radiotherapy and chemo.

    So annual pap testing – gulp, might as well head over to day procedure and donate some of your healthy cervix right now.
    Mammograms – annual is a horrifying thought, but before women agree to 2 yearly from 50 to 70, they should consider the evidence and make up their own mind. I think it’s now hard to argue that mammograms will extend your life.

    Colonoscopies: most polyps never turn into invasive cancer, only about 3% progress and there are risks with the procedure. (serious risks, like perforation and infection) I’m looking forward to the results of a randomized controlled trial being conducted by Dr Gil Welch and his team at Dartmouth, comparing the FOBT with the colonoscopy.
    I’ll probably decline the colonoscopy, but have had a FOBT after doing a lot of reading. Cervical cancer was always rare and in natural decline, I would always be cautious accepting much risk at all to cover a rare cancer. Bowel and breast cancer are much more likely, but screening, in my opinion, still needs to be approached with caution.

    I agree with most of your points though, I think we can extend our lives (or improve the odds) by keeping our weight down, exercising regularly, staying connected to the world…maybe some late study, my mother joined a gym at age 62 and still attends three times a week plus a yoga class at age 81) keeping stress levels down, limit alcohol, no smoking, a decent diet…it’s almost going back to basics.

    I think too many people rely on screening, it’s false reassurance in most cases. I recall one woman proudly telling me she never misses her pap test while lighting a cigarette, she’d been trained to believe that was the most important healthcare decision and that cervical cancer was a huge threat…little did she know that lung cancer poses a MUCH greater threat to her life. I believe we make the best decisions when we have all of the evidence…informed decisions.

    • Alex Lickerman

      Your points are well-taken. I’ve amended my recommendation on the Paps.

  • querywoman

    Vegetarians in a certain part of India are supposed to be sickly and lack longevity. The mythical Garden of Eden diet lacked Vitamin B12.

  • querywoman

    Use public transportation instead of transporting yourself in your own metal and vinyl tube. The social activity seems to increase longevity.

  • http://drpauldorio.com Paul Dorio

    Personally, I would have written the “top ten” in reverse order. And the first three really need to be put into another category.

  • Ken Leebow

    Disappointing information – one large step backward for doc advise.