‘Live Well Longer Metrics That Matter For Longevity’ – Dr Owen Gallagher

Hello, my name is Dr Owen Gallagher, and this talk is called ‘Live Well Longer – Metrics That Matter For Longevity.’

Right now, I’d say everyone watching knows three important numbers. Probably their phone number, their bank balance, and maybe even some people know their Wi-Fi password. But how many of us know our Ferritin Level, our Testosterone Level, our Cholesterol Profile?

These are numbers that have a far greater impact on how we feel and how we age.

And so today, I want to talk about why those numbers matter, why symptoms often appear later than we think, and how better insight into our health can help us stay healthier for longer.

Most of the time, people think about longevity in terms of lifespan, i.e. how long we live. And in general, Ireland is doing very well. Our average life expectancy is 82 years according to the CSO, and that’s about eighth in Europe.

We’re still behind countries like Spain and Italy, but they have better weather, more olive oil, and they take an afternoon nap. So, we’re doing better without any of that.

But I want to bring our attention to another number, health span. The number of years you’re genuinely healthy, active, and independent

This is an important topic that Dr Farrell will put into more context later, but in Ireland, our healthy life expectancy is probably closer to 65. That means on average, people spend the last 17 to 18 years of their life living with illness, pain, or limitation.

That gap between when we stop being well and when we die is not inevitable. It’s largely determined by the choices we make and from my perspective, the signals we catch or miss along the way.

Everything we’re going to talk about today is about closing that gap. Not just living longer but living well for longer.

So, some inspiration for this talk came from research done here in Ireland by Professor Rose Anne Kenny at Trinity College Dublin. She leads a TILDA study, Ireland’s landmark study on ageing, which has tracked 8,000 Irish adults for 14 years. And she determined that only 20% of how you age is written in your genes. The other 80% is down to how you live.

But to have an honest conversation about health, we have to look at what actually threatens it. The four biggest causes of death in Ireland are Cancer at 30%. Cardiovascular Disease, which includes Heart Attacks, Strokes, and Heart Failure, at 28%. Lung Disease at 12% and rising, is dementia at 6%.

Together, these four account for the vast majority of deaths in this country and what they share almost without exception is that they develop quietly over years and decades with no symptoms at all. A person can have very high blood pressure for a decade and feel completely fine.

Arteries can be narrowing for years before we feel anything, and that’s both the challenge and the opportunity because protecting your heart, protecting your brain, reducing your risk of cancer, they’re not separate conversations.

The metrics that matter for one matter for all.

And so, when you look behind all those conditions, you find the same underlying drivers.

High Cholesterol, High Blood Pressure, High Blood Sugar, Obesity, Physical Inactivity, smoking, poor sleep, and chronic stress.

Of interest, the TILDA study also found that 45% of older adults have high cholesterol and don’t know it. 36% have high blood pressure and don’t know it. And it’s generally because nobody checks. There’s a gap in how we do healthcare in Ireland, and it’s exactly that gap that a service like UPMC’s health Screening aims to close.

So, let’s get on to the metrics themselves, and we’ll start with metabolic health, as it is the foundation on which everything else is built.

Your metabolism shapes your energy, your weight, your hormones, your mood, and your long-term disease risk of almost every chronic disease.

Weight

I’ll start with something that I’m genuinely excited about because it changes the conversation about weight.

Two people can weigh exactly the same but have completely different metabolic profiles, the same number on the scale but completely different health pictures. And that’s why we’ve invested in a new device called the Bod Pod. And it gives us three things that actually matter. Body fat percentage. And crucially, we can use this number to help determine where fat is stored in your body. For example, fat around the abdomen is a far stronger predictor of cardiovascular and metabolic risk than overall weight.

Lean Mass

And resting metabolic rate, how many calories your body burns just keeping you alive, which is an incredibly useful number for nutrition and recovery planning. The Bod Pod is also radiation-free, takes about 5 minutes, and really gives us a picture that the scales can’t.

Blood

From a blood-testing perspective, there are four metabolic markers I think we should know about.

First is your Liver Function. Your liver quietly performs over 500 jobs in your body, and it’s often the first place where metabolic dysfunction shows up. But a simple blood test can tell us a lot about how it’s coping, as liver stress is seen in the blood long before you feel anything.

Second, your Sugars. First, a snapshot of your sugar right now, called your fasting glucose and your HBA1C, your blood sugar report card for the last 3 months. Together, these catch pre-diabetes, which can be reversed if you catch it early enough.

Third is Insulin, which you can think of as the body’s metabolic smoke alarm. It rises before blood sugar does, which means that elevated insulin can flag insulin resistance and pre-diabetes long before a standard test would show anything.

And fourth is Cortisol, your primary stress hormone. We need it, it gets us out of bed in the morning, but when it’s chronically elevated because of work pressure, poor sleep, never switching off, it drives weight gain, disrupts metabolism and accelerates ageing.

Heart Health 

Next is heart health, and as I said, cardiovascular disease is the second leading cause of death in Ireland overall. But once we reach 65, it becomes number one. Your cardiovascular risk is highly measurable and, in most cases, highly manageable if you know your numbers.

And I would start by checking your blood pressure, of course, with the target around 120 over 80. High blood pressure is one of the most common and most silent conditions in Ireland, and you can have it for years and feel absolutely fine. Resting heart rate, if you have a smartwatch or a wearable, you probably already have this number, and we’re aiming for around 60 beats per minute. A nice way to think about it is a heart that beats 10 fewer times a minute beats 5.2 million fewer times per year.

So that’s 5.2 million fewer beats of wear on your body’s most important muscle. A 12-lead ECG which checks the electrical rhythm of your heart and can detect conditions like atrial fibrillation and irregular heartbeat that significantly increases stroke risk and a full cholesterol panel that includes your LDL the kind of cholesterol that builds up in arteries and HDL the good cholesterol that clears it away but for those that want to go further particularly if your cholesterol is normal or you have a family history of heart disease, four advanced tests can reveal risk that the standard tests often miss.

So, the first one there is Apolipoprotein B (Apo B). So standard cholesterol measures the volume of cholesterol, and that’s like measuring how many passengers are in all of the cars on a motorway. But Apo B instead counts the total number of cars. And on the motorway of your arteries, the number of cars determines the risk of a pile-up, and so it gives us a much more precise picture of your cardiovascular risk.

Lipoprotein(a) or LPA is largely genetic, but about one in five people have elevated levels. High LPA is one of the most significant inherited risk factors for heart attack and stroke, and it does not appear on a routine blood panel, but you only need to test it once in your life to assess your risk. Homocysteine is a marker of inflammation that directly stresses our blood vessel walls, and high-sensitivity CRP (hsCRP) is a marker of chronic inflammation. Low-grade inflammation persisting silently in the body over years is now understood to be a major driver of heart disease, diabetes and dementia. So, hsCRP gives us a window into that process.

Next, I’m going to talk about your general health and vitality, and this section tends to resonate with many people because it touches on something almost everyone has experienced at some point: feeling tired all the time.

And in the clinic the first thing I want to establish is this tiredness a true deficiency or is it lifestyle related because the answer changes what we do about it and screening is how we find out.

So, the first is Vitamin D, which is almost universally low in Ireland. Our latitude and our weather mean we simply don’t get enough sunlight and so, the HSE recommends 15 micrograms daily for everyone from Halloween to St. Patrick’s Day, and some of us need it all year round.

Low Vitamin D can affect energy, mood, immunity, and bone health.

Vitamin B12, which is also essential for energy and how our nervous system functions. Low B12 causes fatigue, brain fog, low mood, and in time can lead to nerve problems and it’s more common than people think, particularly in older adults or those who eat a plant-based diet.

Ferritin is your iron storage marker. Standard blood tests check haemoglobin, which can often look normal even when your Ferritin is low and low Ferritin causes exhaustion, poor concentration, hair loss, and sometimes low mood.

Thyroid function, which includes your TSH, your T3, and your T4, regulates your entire metabolism, and when it’s underactive, everything slows. Your energy, digestion, mood, and weight. It is common but treatable. But it can go undetected if not checked.

Of course, closely linked to fatigue and vitality are hormones. And for men, testosterone is central to energy, motivation, strength, libido, and mood.

But it starts to decline from our mid-30s onwards. FSH molecule, a key hormone that tracks transitions as a woman goes through peri-menopause and menopause. And these hormonal transitions have a profound effect on overall well-being, metabolism, sleep, and our mood.

Something that’s not tested often in our routine health checks is your functional fitness. So that’s how your body actually performs, and it’s one of the strongest predictors of how long and how well you’ll live.

The first test I’m going to talk about is VO2 Max. That’s the maximum amount of oxygen your body can use during exercise. It’s the gold standard of cardiovascular fitness. Until recently, only athletes had it tested, but we now have a sensor in our clinic that measures it quickly and comfortably, so everybody can find that number. Research has shown that low cardiovascular fitness can predict early death as effectively as obesity, smoking, or diabetes in some studies.

Without training, our VO2 max declines by up to 10% per decade after the age of 30. But it is trainable at any age with zone 2 cardio. That’s exercise at a conversational pace. The most effective way to improve that number.

We test it in the clinic with a small handheld device that takes about 30 seconds and tells us a lot. There was a landmark study published in The Lancet in 2015 that found that for every 5-kilogram reduction in grip strength, there was a 16% increase in all-cause mortality.

This is something that you can test yourself at home. So, the next time you’re in the gym, or you pass a pull-up bar in the park, if you hang from the bar, arms relaxed, feet off the ground, and see how long you can hold on comfortably, because in this simple test, you’re measuring your grip strength, your shoulder mobility, your upper body endurance, and your overall physical reserves. If you last under 10 seconds, it’s probably worth more practice, but if you’re getting into the 60- to 90-second range, that’s very good.

How effectively we breathe can be assessed in the clinic using lung spirometry. And we have two numbers here that we look at. your FEV1, which measures how open your airways are, and FVC, which measures how much air your lungs can fully hold and empty. And spirometry can help us detect lung conditions like COPD, asthma, smoking-related disease, often before you have any symptoms.

And so to wrap up, the metrics that we’ve covered today span metabolic health, heart health, vitality, fitness, and lung function. None of them requires you to be sick to be tested. They’re about understanding your baseline and catching silent risks early so you can make informed decisions about your health.

At UPMC Sports Surgery Clinic, our new health screening service brings all this together in one place and more.

We offer guidance on what your results mean and what to do next because that’s often the harder part. So, if you’re interested, please see our email address on the screen. If you have a question or you’d like to book in and maybe to finish this week, if you pick one metric you don’t know, whether it’s your blood pressure, your resting heart rate, or your hang test time, and see how you can improve it, and that will start you off on your journey to living well longer.

Number one, if they have symptoms, they should go to their GP and get checked. But if they’ve no symptoms and they’re high-risk family history, I’d probably do a blood test in your 40s just to get a baseline level. With the number if it’s less than 1.5, you’re probably good then screening every two or three years again if you don’t have any symptoms. And then I think maybe as you reach your 50s, you probably should get it more routinely again based on a number every two or three years.

Okay. What were the symptoms then as well? probably just to recap on symptoms as well, that yes for prostate I suppose the common one is getting up at night to pee kind of one was in the realm of normal but if you’re getting up two three times a night it’s bothering your sleep it can be an early sign then when you’re trying to go to the bathroom maybe some difficulty starting or difficulty in the flow of urine or again any pelvic pain that’s new it’s worth getting checked okay thank you someone else here is asking do you offer MRIs as part of health screening, but the MRIs aren’t part of the standard screen, but on the day of your visit, you get a full head to toe exam,

So, if there is any abnormalities or you know when we’re talking, if you have any particular worries, we can refer you for MRIs, but also any imaging like chest X-ray, CT, cardiac echo, and we can refer them as a priority to the Sport Surgery Clinic where they do the imaging.

Yeah. Again, it might depend on the level, any mild changes.

You probably could do it every 12 months, but if it was particularly high and you’re trying to, you know, change your diet, increase your exercise, it’s probably going to be 3months before you see any changes. And of course, cholesterol is only one part of it. At the clinic, we do your blood pressure, we do your ECG, we gointo your family history, and that’s probably more of a comprehensive risk assessment of your cardiac risk.