David Rubenstein, having interviewed some of the most interesting and powerful people in the world—including presidents, athletes, CEOs, and entrepreneurs—notes that conversations "almost always end up talking about how they're living and how much they think about trying to live better". Now, David Rubenstein is trying to make sense of "the mountain of new information available and the ambitious efforts underway to tackle the biggest health obstacles" related to longevity. The core issue facing humanity today is a paradox: while life expectancy has dramatically increased, "staying alive doesn't guarantee staying healthy".
Since the early 20th century, the average human lived just 32 years. Since then, life expectancy has more than doubled. In 1850, life expectancy in the U.S. was 38; today, it is 76. This increase is a "remarkable achievement," reflecting an interaction between the environment and genes, with experts believing the average age could potentially reach 90 in wealthy countries. However, this longevity comes with a significant cost: "longevity without health is, if not valuable".
The critical measure today is the health span—the healthy years of life—which is about ten years less globally than the lifespan. David Rubenstein highlights that in the U.S., the divide is the largest at 12.4 years. While the U.S. lifespan is 78, the health span is only till about 66. David Rubenstein frames this divide as a "problem for individuals, societies and economies", questioning whether we have "systems in place for long term care" as the number of older people grows.
For thousands of years, humans have "dreamed of extending life". The scientific mission to slow and reverse aging began with studies on yeast in an MIT lab in the 1990s, where a single gene, CO2, was identified in mutant yeast cells that lived longer than expected. This discovery led to the identification of the sirtuins, a whole family of genes that repair DNA in the nucleus of the cell, regulate metabolism, and control stress responses.
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Crucially, sirtuins require a cofactor called NAD to be activated. NAD has multiple roles, including activating these sirtuins (proteins that can keep you young) and benefitting mitochondria—the "powerhouse that makes energy for the cell cells". The problem is that NAD levels fall as humans get older. Researchers "think that raising any D levels is critical" and "resets the rate of aging to the slower rate". This belief led to the development of products designed to raise NAD levels in humans, which a professor interviewed by David Rubenstein turned into a business. However, the effectiveness of NAD+ boosting supplements in humans is still unproven. Many experts remain "highly skeptical," noting that much of the supporting science is limited to animal models.
David Rubenstein inquires about the practical steps for viewers, noting that most people are seeking answers on "how to be healthier and ultimately how to live longer". Experts agree that while genes play a protective role—if a first-degree relative lived past 100, the likelihood of living past 90 is more than 90%—for most people, longevity is "all about lifestyle": 93% lifestyle, 7% genetics.
David Rubenstein’s guests outline several essential interventions:
• Diet: The closest thing to a healthy diet is the Mediterranean diet. Sugar is "the enemy" of longevity, driving the pathways that cause aging, meaning people should avoid fruit juice, cereals, and tropical fruits. Red meat is acceptable in moderation and infrequently, preferably organic.
• Fasting: Fasting is "excellent for you" and acts as the "sleeping of your metabolism," allowing the body to repair and activate autophagy, a mechanism that gets rid of cellular "junk". The easiest way to incorporate it is to restrict eating to an eight-hour period (e.g., noon to 8 p.m.) with no calories in between.
• Exercise: Exercise is the "strongest evidence that we have" for longevity and is arguably the "best anti-aging medicine" for the next decade. It is critical to lift "heavyweights" to prevent the loss of muscle mass and maintain balance, which is vital to prevent fatal falls.
• Relationships: Close relationships are the number one predictive factor for longevity. David Rubenstein confirms that the "deep, loving relationship[s]" you have with your spouse, children, or friends are what extend your lifespan.
Studies show that adopting just eight healthy habits could add up to 24 years to a person's life. Based on known lifestyle interventions, most people could expect to live to 95 in good health today "without any drugs or any supplements".
The demographic shift towards longer lives is creating an economic impact that David Rubenstein’s experts are closely monitoring. They point out that systems like Social Security in the U.S. were created 100 years ago and have not been updated, making them vulnerable to insolvency. Social Security reform is deemed a key priority for governments, with solutions including raising the retirement age (as Denmark plans to do to 70 by 2040). The workplace is also facing a new challenge with a "five generation workforce" that requires companies to create "more age inclusive strategies" for skilling and upskilling.
The goal of this extended health span is the "longevity dividend," which is calculated to be $36 trillion a year globally. Centenarians experience a "contraction of morbidity," being healthy for 30 years longer than most people and sick for very little time at the end of their lives.
Ultimately, David Rubenstein concludes, the power is "in your hand". The decisions made today will determine the outcome of the "last 20 or 30 years of life". The key, he advises, is to focus on "living healthier. The living longer is a side effect".
