Compression of Morbidity: Vitality to the End

“Live long and prosper.” -Spock

“Live long and drop dead.” –Grok

Got your attention? (Thought so.) Sisson’s gone morbid, you say. Not exactly. Death is on the docket for today but more so the time leading up to death – (for some) a period of morbidity during which we experience major illness and impairment. We live, of course, with the prospect of our own mortality and how it will befall us, but we’re also emotional witnesses to that of our loved ones. I’ve lost many family and friends at this point in my life. Although I believe most had a good life, not many had what any of us would consider a “good death.”

I’d venture to say that most of us have known someone, perhaps even someone very close, who lived their last years with serious disease and debilitation. Perhaps they were in and out of the hospital, caught in continual throes of pain, rendered increasingly immobile and confined by physical weakness, stressed by the financial burden of their ongoing care, juggling medications and treatments whose side effects were almost as unbearable as the conditions they were meant to treat. Those final years may have offered the invaluable chance to be emotionally and cognitively present, to appreciate and reciprocate the love of family and friends, to bring individual and interpersonal business to a peaceful, meaningful closure. Maybe not. Either way, we can’t help but wish our loved ones could have lived out those years with less suffering, less hardship.

On the other hand, we’ve known people who, up until the day they died, lived active, independent lives wholly on their own terms. Old age obliged perhaps a slower rhythm but little constraint. There was a spirited, graceful older lady I knew growing up. Up until her last day, she lived (not far from us) in the house she’d raised her children in – staircases and all. She entertained her dozens of grandchildren and great-grandchildren there. She mowed her own yard. She biked around town every day. She kept one of the most beautiful gardens I’d ever seen and tended dozens of ferns (some thirty years old or more) in her sunny Victorian home. One spring morning while she was dusting a curio, she died of a massive, sudden heart attack. There’d never been evidence of heart disease or any other medical condition. She’d been fit as a fiddle, as they say, until the day when she literally dropped dead in front of that cabinet, duster still in hand. She was 89.

To be sure, it’s a shock when people die that way, but after the reality sinks in, there’s also a sense of gratitude, relief, even fortune that they had the life they wanted – up to the very last moment. Whatever the extent of our own grief, we take comfort in their quick passing. Given the choice, I sincerely hope to follow my old neighbor’s example.

We’d all like to live to a ripe old age. What a trip it must be to turn 100. However, I’d gladly give up those extra years, even decades, if it meant they were to be spent bedridden and miserable. Truth be told, I live the way I live not because I’m shooting for longevity. If I’m lucky enough to enjoy a long life, so be it. Rather, I live my life according to certain principles in order to push illness and markers of aging further and further down the road. Coined by James F. Fries, M.D., there’s a phrase for this: compression of morbidity. It’s the shortening of the period between the “first appearance of aging manifestations and chronic disease symptoms” and the end of life (PDF). In my book, that’s what it’s all about.

While statistics show that we’re generally living longer – some 78 years and 2 months according to the latest figures, the flip side is that other research shows we’re living fewer years disease free and more years with chronic and often debilitating disease. We congratulate ourselves in the developed world on our mortality-related statistics (e.g. life expectancy), but our morbidity picture is increasingly abysmal. As Eileen Crimmins, AARP Chair in Gerontology at the University of Southern California and co-author of the study examining morbidity and life span, observes, “There is substantial evidence that we have done little to date to eliminate or delay disease while we have prevented death from diseases. …At the same time, there have been substantial increases in the incidences of certain chronic diseases, specifically, diabetes.” In a short ten year span, we’ve lost on average a full year of healthy life (slightly more for women) – life without one or more of the major diseases that constitute the most common causes of death in the U.S.: cancer, diabetes, and cardiovascular disease. (I wonder what the picture would look like if you added other common chronic and debilitating conditions like Parkinson’s and Alzheimer’s.)

As this study showed, we also spend less of our life fully mobile. Just ten years ago, the average 20-year-old man would experience 3.8 years of his life with impaired functional mobility – “the ability to walk up ten steps, walk a quarter of a mile, stand or sit for 2 hours, and stand, bend or kneel without using special equipment.” Today that number is 5.8 years. Women fare even worse. Ten years ago, that number was 7.3 years and has since risen to 9.8 years. That’s almost ten years of one’s life without basic mobility. Yes, there’s much more to life than the ability to walk up stairs, but I can’t call this an ideal. We’re not talking about a freak accident here that couldn’t have been helped. This trend represents broad and gradual systemic decline – the kind of impairment that is almost always preventable by effective and consistent lifestyle intervention.

Call me callous (or not), but I think we’re shockingly blasé about the constraints people are routinely living with at the end of their lives. We’re physical beings, of course. I understand that bodies don’t last forever. Nonetheless, the fact that we’re losing so much ground in only a decade’s time should constitute a five-alarm fire.

For those who suffer in their final days or years, I’m grateful for the interventions of modern palliative medicine. Yet, it’s an uneasy contract. Do we accept the limitations, pain, and suffering of chronic disease more as a society when we have a “fix” to treat it? No one I know who’s dealt with a long decline has many good things to say about the treatments that spared them the worst of their suffering. They’re grateful, but they still traverse a long, hard road. These measures are better than the immediate alternative to be sure, but the commonality of their circumstances still begs a bigger question, I think.

For my part, I’m not going gently down that path of decrepitude. There’s no sense of surrender here. I’m not master of the universe, but I do have quite a bit to say about my own fate. I live every day of my Primal life as an affirmation of wholehearted, all-out living. Thriving, as it were. I’ll make my peace with my life and loved ones each day rather than wait until some compromised 13th hour. I’ll embrace every particle of discipline and self-respect to live a life that I know will support my well-being and independence today and in my later years. Let me live with the primal spirit of my ancestor kin and meet death (when it comes) with a vigor and vitality that confound the statistics and conventional resignation of our time. That, in my mind, would be the best resolution for a Primal life – and a good death.

Thoughts? Responses? Let me know what you think, and thanks for reading today, everyone.

TAGS:  Aging, Grok

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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139 thoughts on “Compression of Morbidity: Vitality to the End”

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  1. I couldn’t agree more. I would rather going out swiftly or with a bang than long and drawn out. My great grandfather was bedridden for about 10 years before he died. I too want to be like your neighbor, enjoying life up unto the last minute.

    1. Another thoughtful post from Mark. My wife and I love cruising the world, however, the average cruise passenger is far from inspirational. I’m 66 and in pretty good shape, sprinting, running and doing pullups and pushupa as well as my gym rings. It amazes me that the terrible, immobile, obese shape most Americans have degenerated to his accepted as normal.

      We all get old and somewhat disfunctional but decrepitation is the new norm.

    2. 10 years? This makes me feel so unbelievably blessed that I discovered the primal lifestyle at such a young age of just 22 years old.

      Living a vibrant life is what its all about. One must try their absolute best to cherish every moment as one never knows when it will end. Live primally and your chances of making it to 100 increase.

      Whats certain is that the quality of life is grand.

    3. “Let it be known in history that we chose to die on our feet, rather than live on our knees”

  2. Great post. Motivation to increase the amount of time I’m healthy (as opposed to just increase my lifespan) is my main reason for living Primally.

    I wonder, though, about the effect of improved diagnosis in those results. I haven’t read the article, but I wonder if the authors address this (btw, the link to the press release is missing the “h” at the beginning of “http”).

    1. It’s pretty hard to miss being sick and miserable even if you don’t have an official diagnosis.

      1. Unfortunately it seems like a lot of doctors seem to brush off decreased performance, mobility, etc. as “Well you’re old, it’s to be expected.” as opposed to seeing it as something to aggressively address with exercise and better nutrition…

        1. As a GP I can tell you that I would dearly love it if my patients were willing to tackle their issues with “exercise and better nutrition” but THEY DON’T LISTEN and if they listen, they still don’t comply. They want a pill. They don’t want to put forth the effort. I understand it’s hard work to stay in shape- I dedicate a fair amount of time and yes, money to it- but it’s absolutely worth it in my book. But try telling that to the average patient. They just don’t want any of it. Don’t blame the doctors!

        2. True, Emily — it’s definitely a two-way street. I’ve heard plenty of doctors complain about people who come in and just want a pill without further instructions, even in matters of life and death.

          I tend to forget about that when I’m here since pretty much anybody hanging around here is taking charge of their own health, but still. You’re right.

      2. I agree with you. My husband has felt sick for at least the past 5 years. Sure, he has heart disease, congestive heart failure, and type 2 diabetes, but so much of his “sick” feeling cannot be contributed to any one cause. It’s frustrating!

  3. Agreed.

    Many see middle age as a time of aging (when various ailments begin to manifest) as natural and inevitable, how often do you hear ‘it’s my age’ (and often from people only in their 40s).

    The biggest thing Primal has to get over is ‘it doesn’t have to be that way’. It isn’t natural, it’s pathological and mostly completely avoidable.

    1. I know what you mean. I hear friends, only in their early 30’s, blame their age for forgetfulness or health problems. It makes me feel quite strange when I am standing their listening to them talking this way (I am in my 40’s). These people often forget that I am actually older than they are 😛

      1. good point Kitty! we need to be careful what we say to ourselves about our selves – I am bad at this!

      2. LOL..that made me laugh.
        But it’s happened to me, too. Having a conversation with younger people and I get to hear about their health problems…it’s ironic.

        We live in a housing area and I see tons of people (young ones) huffing and puffing in their professional work-out clothing down the side walk with their arm weights and walk-man.
        And here I come in my 40’s sprinting down the street with my dog:)

      3. I know what you mean, Kittly. And the more they think about their forgetfulness or health problems (and blame it on their age) the more they’ll start experiencing those problems. This is a classic case of mind over matter!

    2. my experience? it starts in people’s 30s these days.

      it is common for my 31 yr old girlfriends to say ‘oh, well, you know, it’s aging!” or, if i pull a muscle or some such (rare, but still) “that’s because you’re aging! can’t do what you used to!”

      it’s so sad.

      1. My 25-year-old brother-in-law thinks it’s normal that he has lost significant mobility compared to when he was, say, 14. I tried to explain to him that it wasn’t normal…couldn’t make him listen (although I didn’t try ridiculously hard since it appeared he would have taken it as an insult).

  4. This has been on my mind all week. My grandmother is only 69 years old and takes enough pills everyday to stock a small pharmacy. She can’t get around very well and as a result, battles with depression. About three weeks ago, her doctor changed her depression medicine which ended up making her worse and last week she took a whole bottle of sleeping pills to try and commit suicide. In her “suicide note”, she said she just couldn’t handle being a burden on her family. She ended up living and is now staying with my parents until we can figure out what to do but it brought home the reality to me about living an all around healthy life and steering clear of excessive medical interventions when possible.

    1. I know someone in his *early 40s* who takes enough pills to stock a small pharmacy. Some of them are for asthma, but even that responds to changes in his lifestyle. In other words, if he takes better care of himself, he has fewer attacks and needs less medicine.

      1. Yeah, my ex has the same kind of asthma and he is in his 30’s. He has remarried and is now eating mostly processed food high in carbs and chemicals, and he has gotten worse. He has also aged about 20 years before my eyes.

  5. What a timely post. Not more than 10 minutes ago, I was talking about compression of morbidity with my sweetheart…yeah, I know…why was I talking to her about something like that? But, as she cares for her aging mother in a nursing home, our discussions often turn to how we never want to be in the same situation. We want to be going strong until the moment we keel over and die.

    We both believe that our lifestyle choices will go a long way in making that happen. While we’re not completely primal yet (we’re close), we do see the benefits of the primal lifestyle and we hope that those primal choices will help us live a long healthy life.

  6. Mark, great post today.

    I work in a hospital, and I see the effects of this morbidity on a daily basis. People rarely ever die of just one thing. I see patients here with a host ailments, multiple emergency room trips, life support, and heroic measures being used to save and prolong their life. What a life it is too. They go home, bedridden, on hosts of medications with invasive procedures, doctors appointments, and in home (or nursing home) care a necessity.

    I’d much rather be healthy right up until the day I “die of nothing”.

  7. Very well said. Sometimes people focus so much on “retirement” and don’t even bother living and relishing the moment.

  8. Love this post, and concur! I’ve thought this too as different family members pass, those that go suddenly opposed to those that suffer for what seems like eternity. The ones that suffer leave you with that feeling of despair, their sickness something you can only hope you do not have to endure. A heart attack while tending your favorite plants (doing what you love) definitely is the way I want to leave.

  9. My grandfather lived to be 95 and he had no health problems except for diabetes which he controlled with 1 pill and with his diet. For whatever reason, he hung himself last November. I think he was tired of living…if that makes sense.

    1. Some brave Ones are lucky to be able to carry through with that choice! I hope you are able to accept it without pain.

      1. Not sure I’d call it “brave” (since it would make sticking around to live “cowardly!”) but yes, it is an individual, personal choice. Hopefully it’s what he really wanted, at least.

  10. This is a timely post for me since I am watching the slow march toward death of my mother.

    She lives at the top of a steep hill and walked most everywhere up until a few years ago. She was still square dancing and could carry on a conversation while hiking up that hill at age 90. Now at 93 she is so weak she has to be pushed around in a wheelchair and has 24 hr. care. She probably has Alzheimer’s but still knows who I am. She has not been interested in anything and I mean anything for the last year or so. This is totally not like her.

    Probably around the age of 85 she started taking medicine for her heart. If she didn’t take it she would collapse on the floor. This medicine gave her another 5 good active years of life.

    Now here comes the problem. The only thing keeping her alive at this point is the heart medicine. She is not in a mental condition to make the choice of whether or not to take the meds and I don’t believe it is legal for anyone else to make that decision plus being a moral question.

    She always said she hoped she had a good death but this does not seem to be a good one or at least one she would have chosen.

    I think you all can figure out the dilemma in this scenario. Does one reject meds to give one another good 5 years with the chance that the same meds will give you a long drawn out exit? Or do you just go early? And, how can one make that decision anyway? Most of us choose life, no matter how compromised, if we have a choice.

    Sadly, I guess we don’t usually have a choice in how is is all going to end but do have some say in how we live.

    I will always have good memories of how my mom lived. I am sad about this last part and hope it will not leave a lasting impression of her with the family.

    1. Oh my gosh. It was hard enough to make that call with a family pet. I can’t even imagine having to make it with a parent. I was with my dad when he died at 78 last Summer. He had given up so long before that it almost felt like a blessing. There’s just really no easy way to part with a parent, is there?

    2. My husband just lost his 93-year-old grandmother 4 days ago. For the past 2 years she has been cared for by my mother-in-law after suffering a broken hip and just generally declining. While still in good health, she just became weaker but remained lucid (with quite the sense of humor) until the last few weeks. However, what a tender, intimate end: her eldest child and granddaughter caring for her as no one else could. We have all learned wonderful lessons about life and death by loving her through her end. I guess my point is that we all have roles to play through our births, lives, and deaths. It’s the relationships that matter most. Your mother may not have the end she wished for, but she does have a loving child to be there for her. That is a gift in itself for both of you. Bless your mother, you, and your family.

  11. This is a great post, Mark. It touches on an issue that’s pretty prominent in my life these days. Thanks for posting about it and writing about it so eloquently and effectively. I agree completely.

  12. My grandmother is 90 years old and while certainly not as spry as she once was, she still gets out meets few friends once in while. Loves having my kids come over even if they are mostly there for her tv ( small town and their grandparents do not have cable/sat lol) she has still more life these past 5 years than my cousin who died this year before her 45 birthday. My cousin had been overweight most of her life, and apparently suffered from a chromic illness which last diagnosis might not have been the correct diagnosis and the alternate was just as terminal. Either way our grandmother had more life in her years than she did in and out of hospitals, clinics etc. Her daughter is likely on her way to similar fate if she does not take care now, always been overweight, plus mental health issues.
    I tease my kids about living past 110 and being so darned onery they be almost desperate to have me keel over lol. My dad side of the family live some long lives and most were very onery as they aged.

  13. This subject is one I am more aware of now than ever before. I’m an orthopedic surgeon and I deal primarily with acute injuries in a hospital-based/ER setting.

    I am NOT going to dwindle away in a nursing home, demented and/or nonambulatory. There is no point to it and it’s a tragic way to end your years on earth. I will pay someone if I have to, to take me somewhere I’ve never been, and ski/big wave surf/motorcycle my way to a quick and adrenaline-infused end.

  14. Another thought-provoking and uplifting post. Thank you for that. My grandmother lived independently and vibrantly until 86. A couple hours before she died, she was gardening — pulling up a small tree by the roots, to be exact! Then she went inside, made some strong coffee, sat down, put her feet up, and went to sleep. That seems just perfect to me.

    1. That sounds just perfect to me too, with the possible exception of a glass of wine instead of coffee. But a good cup of coffee would work too.

      Wow! Pulling a tree out by the roots. Way to go!! Thanks for sharing that with us.

  15. Agree 100%. My husband talk about this all the time. It doesn’t matter how long we live, but the quality of life we live. That is why we GROK on.
    We both have family members that are constantly at the doctors and have limitations because of there health. They both just sit in front of the tv for hours in constant pain. It is sad to see.

  16. I’m a medical doctor who just went primal three months ago (I have never looked or felt better). I’ve been reading this site daily and felt compelled to write my first post on this topic. I can’t believe all the crap I learned during medical school about health. Acutally I should rephrase that, I mostly learned about disease, and very little about health and preventative medicine. Death is not the failure of our efforts as doctors, its an inevitable part of life. But in this society where Convential Wisdom rules, both doctors and their patients are trapped chasing chronic illness. I agree with Mark, I would give up decades of a bed-ridden life to enjoy more vitality and health. Luckily, by living primal I won’t have to choose as long as I stay away from “stupid things” (I forget what rule that is..). I do think that most doctors want a good quality of life for their patients, but that’s impossible to acheive if they are dead. So prolonging life becomes their goal, which then many times compromises the quality 🙁 It’s frustrating to say the least, especially because these chronic diseases are years in the making. Not to mention that many doctors themselves are unhealthy! I am just glad I discovered primal now, so I can share it with my friends and family and hopefully help them live healthy “aka disease/pill-free” lives.

    1. I am not sure where you practice medicine but I commend you on your choice to learn and apply wellness to yourself! NOW the million dollar question: How will you apply this knowledge and experience in your practice?

      1. I’m in Michigan, and actually I decided to become a pathologist which means I don’t see patients anymore. As a medical student I didn’t have great boundaries, I took home all their problems and worried about them constantly. Now I get to help by examing their tissues and making diagnoses. I diagnose a lot of cancer on a daily basis, it seems in younger and younger people. I found too that the time I did spend with patients as a medical student wasn’t enough to really counsel on lifestyle. And then they wouldn’t listen anyway, not surprising because convential wisdom doesn’t even work! Back then I was sleep deprived, had gained 20 lbs, and chronically stressed so I wouldn’t have listened to me either. But now that I’m primal, and sooooo grateful for discovering it while I’m still in my 20’s and can prevent chronic disease in myself, I tell everyone about it. Many family members ask me for medical advice, and lately I just refer them to MDA!

    2. I have a doctor who follows the Primal lifestyle and he helps those of his patients who are willing to listen to him. The others he still has no choice but to continue prescribing medications. But I feel truly lucky to have a doctor who understands health and nutrition and does not panic when I talk to them about eating primally; but actually tells me to eat a nice fatty breakfast of steak and eggs! Harmony’s question is a good one. Will you apply your new found knowledge in your medical practice?

    3. one down, a hundred thousand to go…well that was just a guess, how many medical doctors are there in this country anyhow?

        1. Hi Kitty, nice to meet you. I don’t think the medical profession will ever become obsolete, but since a significant amount of time and healthcare dollars are going towards these mostly preventable diseases, it makes sense to me that if the “demand” decreases, so will the “supply”. Of course there are plenty of conditions that require medical attention and there always will be a need for good competent doctors including pathologists like myself. But I personally would rather see fewer people needing medical attention for lifestyle-related chronic illnesses.

          I tried to reply under your actual comment below but for some reason I couldn’t, so this one is a little misplaced 🙂

      1. The medical/pharmaceutical industry is interesting…at this point its because of these diseases that we have jobs! Maybe that’s why there aren’t as many dollars in preventative health. But if having fewer doctors and health corporations is the natural outcome of our society becoming healthier and happier, I will gladly welcome that day with open arms. And then go back to school because being a doctor is the only job I’ve ever had 🙂

        1. Hi Shadia, I think that having doctors is still very impotant. I love my doctor because he does embrace the primal lifestyle and because he is a biochemist and can help with any deficiencies that crop up. But we still need doctors to diagnose diseases either way. Even though I have been primal for almost 12 months, and my blood count is great, 4 weeks ago I got this strange and frightening rash all around my eyes. Turns out that I am allergic to something in the air. It was that bad that I still needed the help of a little cortisol ointment to get rid of it.

  17. Great post. I know way to many people in their 40s and 50s who take a bevy of meds to “be healthy.” It’s especially sad when they are family members who I know could be helped by some lifestyle changes, but they are convinced that doctor knows best…
    For my part, if I could pick, I’d choose to have my parachute fail when skydiving at 105 years old!

  18. you know, above all else you’re just a really good writer. Good stuff!

    PS Althought you could’ve elaborated a bit more on how we as humans aren’t naturally predisposed to being sick/immobilized the last ‘X’ years of our lives. That only happens in modern/westernized societies, if I’m right.

  19. Good article, makes me think again about my long time idol Jack Lalane. He was sick with pneumonia for a week, but he lived for 96 years in the most tip top shape. As you discussed, he was primal in many ways, as he often said “If man made it, don’t eat it” and he only ate twice a day, which we call intermittent fasting.

    I’m really curious to see how long, healthy and happy we can truly live using a primal lifestyle from youth. Art Devany and his wife certainly seem to be going strong.

  20. I lost my dad on the 3rd when he decided dyalisis wasn’t for him. His choice was hard for me to accept. He chose to go on his own terms and I respected his wishes. I miss him terribly. He spared us and himself the agony of declining. His Alzheimer’s and kidney failure could have kept him suffering for years. I hope I may leave this world with the same courage and grace he exemplified. Peter Rose

    1. Wow Peter, I’m really sorry to hear that – my condolences.

      I hope the worst of the grief starts to subside soon so you can start focusing on the happy times and good memories.

  21. I’m a Kinesiologist at a wellness center for seniors. Time and time again I see seniors who are immobile, suffering, and still blaming someone or something else for their health problems. One of the biggest obstacles I have is convincing my patients to see that their health is in their hands. It’s frustrating when they don’t see that so much of their health is affected by their diet and activity level.

    Great post Mark. Thanks for the reminder and inspiration!

  22. “On the other hand, we’ve known people who, up until the day they died, lived active, independent lives wholly on their own terms. ”

    That was both of my grandmothers and my half-brother’s grandmother on his dad’s side. All tough old biddies to the end! 🙂

  23. I’ll gladly trade a somewhat shorter lifespan to go out in either a blaze of glory, or a lovely, final walk in the wood.

    The thought of being overly decrepit and dependent is too horrifying.

  24. A number of years ago, I met a 91-year-old man (at the gym!) who said that after he was finished exercising, he was going to help a friend who, although younger, wasn’t as able as he was. This gentleman said that he often did light housekeeping, ironing and grocery shopping for younger friends. Not only was this man taking responsibility for his own health, but he was helping others, which was probably also a factor in his longevity and upbeat attitude.

  25. My mom-in-law has been causing me to stop in my tracks lately with thoughts of this issue. She has lost more than 4 inches in height and has lost most feeling in her feet & lower legs to peripheral neuropathy. I can’t find a place in my brain to fit what is happening to her.

    I want to drag her outside to walk under the blue skies. I want to make her lift heavy things! I need HER to shout that she’s not going to give in to this!

    But I don’t know if each step that I encourage her to take is one more off the tally of steps she has left. The conflict between maintaining or increasing strength and furthering the physical damage to her nerves is a decision I can’t make for her.

    This is when we decide whether to go down or go down fighting. Do what you can today and appreciate the rain that falls on your head in the middle of a walk. It’s all beautiful.

  26. it is This Idea that motivates me to pay attention to my health Now. my elderly parents are in that phase of illness and it makes me so sad because I have been trying to influence them to exercise (they eat pretty well) but they are stubborn old norskis.

  27. This post comes into my life at just the right time. I found out today that my gramma is on her last leg so-to-speak. She has been suffering for years (arthritis, low blood count, black outs, lost mobility). As painful as it will be to lose her, it has been MUCH more painful to see her quality of life decline to the point of non-existent.

    While sorting through my grief I decided to take this experience as a lesson to take better care of myself. This article perfectly relates.

    I hope to be old like my gramma’s eldest sister- she’s 91, plays the xylaphone and drums in her church band, drives, spends summers at her cottage, and lives at home. What a life!

  28. Totally agree mark, as the klingons in star trek said, “die well”

  29. If we follow the money trail, nursing homes (and drug companies and doctors and…) have in their best interests to keep their residents alive – at any cost to the quality of their lives. I’d be curious to know the residency rate of nursing homes now as compared with prior decades.

  30. Mark, you’ve done it again! This was a very
    poignant post. As a young mother of three,
    trying to regain my health after three years of
    being unwell,I am deeply mindful of how my
    lifestyle and choices now will impact my family’s
    future. I have seen the grueling efforts my mother
    has invested in caring for my 82-year-old
    Grandmother who suffers from Parkinson’s.
    It has been brutal, but she has never complained.
    I want my children to have the freedom to live their own lives rather than having to care for
    a helpless parent. Thank you for reminding
    me to live each day well. I feel fortunate to
    have stumbled upon the Primal Blueprint. It is
    steadily renewing my physical and emotional

  31. This has been on my mind a lot lately. I have one remaining grandparent, my grandfather is 93 and recently had a health scare that landed him flat on his back in the hospital for several days. Before that he was relatively active, still driving, walking to the bingo games at his senior center and working in his machine shop. Even 4 days stationary in the hospital set back his mobility a TON. It took him a week before he could stand up to shave and several weeks before he could walk freely again. He’s back to maybe 70% of his old self (still can’t drive), but it’s been a hard road. This has made it very, very clear to me that staying active is a key to a healthy and enjoyable old age.

  32. Great post! I figure at age 45, I’m past what the primal world has expected me to live anyway. My only wish is to get my kids independent, after that, anything else is gravy.

  33. My father died at the young age of 75. He was killed in a logging accident! I hope to have such a good death someday.

  34. This, this my friend is what led me to Primal to begin with. Conventional medicine has utterly utterly failed in the quality of life issues which are ultimately all anyone cares about if you ask them.

    Like you I have seen many of those close to me go and I am convinced that the manner of our death has more to do with what’s going on between the ears than anything else. I damn well am going to leave the healthiest corpse possible be it tomorrow or 40 years from now.

  35. Life is not a journey to the grave
    With the intention of
    Arriving safely in a pretty
    And well preserved body,
    But rather to skid in broadside,
    Thoroughly used up,
    Totally worn out,
    And loudly proclaiming,

    Woo hoo !!!! What a ride!

  36. Gosh, this is sobering.

    I’ve never come across the term ‘compression of morbidity’ before.

    Recently I sat in a hospital waiting room with other people only slightly older than me. It was utterly depressing. I simply cannot contemplate ending up like that.

  37. My dad, 86 is in hospice. He has been dying for 11 years. He almost died on Iwo Jima with massive head injury but was patched up with a steel plate, cured for blindness and had a good life up until 2000 when he cancer cost him his tongue and larynx. Being fed through a tube into stomach he was less active and finally became immobile. In and out of hospital and conv. care homes past 2 years. 24 hr oxygen for years. Now in bed in family room. He says that the reason he is hanging on is so my mom gets income from his VA benifit and job retirement. Needs 24 hour watching. Us kids help out mom when we can. He should have died years ago but now is a challenge to keep quality of life up (what little there is) until he decides to die. To die in good health is a luxury few get. Modern medicine, keeping one alive while making one wish they were dead.

  38. Excellent piece! Mark, thank you for boldly writing what many of us think AND giving so many the forum to respond with their frustrations and concerns about loved ones.

    It seems in our society we view aging in negative terms and accept decrepitude as tne norm.

    As an aging woman who’s youth and bloom is behind her all I can say is–Like hell I am going to sit down and give up! I have worked hard to keep active and vibrant so that I can climb mountains when I want!

    We have to make a commitment to our health and well-being to the end!

    When the end comes I hope it is sudden and doing something exciting!

  39. I am currently in the USAF and it is amazing how many of my fellow “Airmen” are on physical profiles limiting them to do this or that. I am 36, have been CrossFitting for less than a year, and as paleo as possible for the last 3 months and I feel wonderful. It amuses me to be more mobile than the younger generations, while listening to the whining of those in my age range (my back, my knees, I can’t, etc…). I also wear Vibram’s, which are quite a shock to all, but I enjoy wearing them. According to the reg’s I need to wear socks with my “shoes” guess nobody thought of Vibram’s when the wrote the reg’s.
    For me being healthy and riding into the sunset is much better than the slow crawl I see many going for. I want to be able to run and play with my grandkids instead of sitting in a wheelchair taking who knows what for whatever is ailing me and watching them play. Granted that is still a number of years away for me, but I have found that my new way of life will help me get there.
    It is just amazing how the CW for 99% of Americans is that we need to be in pain and have a shelf full of drugs to help us live. I am slowly trying to turn my family around, they have at least 1 paleo meal a day and I get my kids outside as much as possible. But it is hard when everything they read says that you must eat grains to be healthy. But such is our fate…

  40. Yep. If I start to decay it’s straight to the extreme sports/war.

  41. What an important but too seldom discussed or understood subject. Your “I will not go quietly into the night” attitude is one that I embrace and try to live each day. After witnessing the long, slow, painful death of my mother, and now my grandmother (who just passed earlier this week), I have been re-evaluating what it means to “get old” and how one “thrives” not just “survives” after retirement.

    I look to my grandfather as the model. He lived to be 97 years old and lived independently until his last year. Although he was bedridden his last year, 96 years of independence is quite a run. In fact, I can still remember how even in his mid-90’s he would spring out of his chair when he heard “dinner is ready”. Still with a great appetite, he could move better than some people I know half that age.

    While he did not live a “Primal” lifestyle, he was always active. An athlete then coach in his younger years and an avid bowler well into his eighties, he was always on the move. Both him and my grandmother were of Italian descent and ate what what some call a “Mediterranean Diet” – lots of fresh vegetables, all kinds of meat and fish, cheeses, wines, and, yes, there were grain-based carbs, too. Another thing – he NEVER stressed over food or much of anything else.

    So, to sum it up, I guess the lesson from my grandfather on how to delay morbidity was “move more, stress less”. That’s a philosophy I can live with!

  42. What a great post! I have thought alot about this since starting the Primal diet.

    I have family members in both extremes, from extremely active, happy, healthy and fit to in-active, unhappy, and loaded with medication.

    I have always been interested in being healthy, especially since I found out that I had Crohns…. I have found that the better my diet and exercise routines are, the better I feel.

    I am not a strict Primal, but I definitely make 90% Primal choices and make every effort to stay active. I am in my late 30’s and thought I was doomed to be in pain when I woke up! But I haven’t had joint pain or much abdominal pain and almost no muscle pain.

    Sometimes I find it hard to stay motivated…. the diet can be alot of work, and expensive, and exercising every day is time consuming…. but then I think of how I want to try surfing this summer, and maybe rock climbing, and other stuff like that, and how I need to be strong and healthy and that helps me stay motivated…

    And of course MDA and it’s members are an indespensible support and motivator too!

  43. I love this! With all the fad diets/programs on the market, I’m only concerned with one thing: how can I live a long, healthy, active life? Not ‘what will help me lose the most weight’.
    This post brings to mind something my daughter said when she was about 5 years old. Her great, great grandma had just died at the age of 93. Breanna said, “Little Mama lived her whole life and didn’t even die ’till the very end.” Profound, I know.

  44. At 68, I’m active and vigorous — ran an 8-mile race last year, did leg presses (15X290, 10X310, 5X330) and thrusters with 50#, DL 3X10x110, BP 95# 3×2, and got a PR of 5X this morning, plus 70#KB swing 2X10, another PR). Cutting the carbs has made a difference, and action + diet = reduced morbidity. With luck, this old lady will avoid the deterioration I see in my male colleagues, some much younger than I.

  45. My beloved grandfather dropped dead in his son’s arms at the age of 99 after walking to his favorite bookstore. He never used a cane or had to wear Depends. He was pretty deaf, but he said that 99% of what people were saying was unimportant and uninteresting anyway. That’s the way to go!

  46. I hear ya! At 53 every move I make and step I take is geared toward health and flexibility. I took a ‘gentle’ yoga class at the gym one Saturday last month. Almost every person in there chose to use a chair for the entire hour rather than stand. Many of them were my age or younger…they just look so sick and tired of being sick and tired, you know? I just don’t understand why people seem to just ‘give up’?

    1. I used to think the same thing but after having spent years under a lot of emotional and psychological (and some physical) strain I also felt like giving up. I was basically ‘healthy’ but I was falling apart. I ended up with severe adrenal dysfuntion and was unable to walk up a flight of stairs without losing my breath. Some people can get this way simply due to stress, even if they are eating healthy (rice used to be the only thing I ate that was not primal). Luckily for me I just got depressed and stubborn to become the person I used to be. I became 100% primal (no 80-20% stuff) and am working very hard on reducing stress levels, and people from my life who were bringing me down. I am on the mend but it is a long and slow process. Some stress factors just cannot be so simply removed. I think that I did not give up simply because I am SO stubborn 😀

  47. This is quite an interesting topic Mark…

    I feel as if you’ve taken the red pill, but you are only illuminating us primal folk to the surface of the issue — hiding the milieu beneath the top soil.

    Agreed, wholeheartedly, that one should live life to it’s fullest.

    Secondly, be like the river. Take hits as they come and flow with them. Bend with constraints and you will live a happier life. (Or break them, rules are meant to be broken!).

    Ultimately, one has to question the underlying reasons to why there is such a decline in health.

    Grok would yell “Stop eating grains!” ect.

    The government yells “Eat the foot pyramid!”

    Except they are lying. I think they are lying.

    Obviously, at firsthand it is a food issue, and secondly a life-style issue. (Sitting on your ass all day is terrible, but if you eat primal you’ll most likely pass up on diabetes).

    Why then, with such staggering awareness, are things getting worse?

    That’s where the government and their true intentions come in.

    They admittedly put additives in our water to sedate us. They have done “secret” testing on cities previously (look up the bacteria bomb on san francisco).

    It might sound like a conspiracy theory, but I’m just begging the question…

    If we, the people, understand there’s an issue, then why does the government continue to falter?

    Masked agendas fuel this industrial curse.


    On a lighter note, here’s a funny blog-post that mentions a 60 year old man lifting 300 lbs.

    this is definitely not safe for work.

  48. I’m with you. There are too many people who just “give up” as they age. In the article from the Crossfit Journal by Mark Rippetoe called “Be alive, Be very alive” he says “Well, I don’t know about you, but I’m not interested in being 85 if I have to hire somebody to help me get up off the toilet.” I’m all about the quality of life I’m going to lead until the very end.

  49. Better to die a young man covered in blood than an old man covered in piss.
    ….Klingon Proverb

    (Nerd alert).

  50. I have to comment on this one just to say with everyone else: YES!

    I want to go out like my grandmother – at home after a normal day, falling asleep in my chair with a cup of hot chocolate and just never waking up. She was 93.

  51. I’ve actually had conversations with my parents about this issue. My Mother has Myeloma (I think that’s what it’s called) Cancer of the red blood cells. She wanted us Kids to know what she did and did not want done. For us it is all about living not merely surviving. Our society is so afraid of death they prolong the heartbeat and call it life.

  52. I take care of myself not because I want to live forever, but because I want to enjoy the years I’ve got.

  53. I play racquetball with a 90 year-old man who’s been married 70 years! He has a wonderful upbeat attitude that makes him a pleasure to be around. He can’t move like he used to but he’s up for the game!

  54. I’m sorry, but isn’t anyone seeing how arrogant and insensitive this post is? As an occupational therapist, I work people with disabilities from birth to death. (Two positions- one with children birth-three and one at a skilled nursing facility.) I have been following the diet, am interested in living a balanced healthy life. However, to insist that it’s better to be dead than disabled is ableist, ageist, and naive. Persons with disabilities can and do live meaningful, productive lives. Get over yourself Mark.

    1. I agree of course that people with disabilities can have great lives. Plenty of people enjoy themselves regardless of age and physical limitations. I have several physically disabled relatives myself.

      But I would still say that decisions about one’s personal standards for what constitutes a sufficiently high quality of life are just that, personal.

      It’s an individual thing. I don’t think I’ve seen anyone here speaking for anyone but themselves on that front, although I have seen (quite reasonable) sympathy for relatives and friends in bad shape.

      People will also revise their attitudes based on their experiences once they get to the point of disability. For example, initially Christopher Reeve thought perhaps it would be better if they “let him go”, but changed his mind.

      I do think it’s important that we all focus on making the most of our situation rather than giving up too easily when we do start showing signs of age, though.

      1. I agree with the gist of Mark’s post — but that’s just for myself. I’ve always been averse to traditional medicine and do well with alternatives, but not everyone goes for that.

        Both my parents are in their 80s and experiencing disabilities, they’re being treated in a rehab center. I would never want to go through what they’re going through. Yet — I think this is what they want. My mother strongly desired hip replacement surgery and was willing to go through the physical therapy afterward to have a better quality of life. No one talked her into it, something deep in her wanted the chance for improvement. My father has also had numerous health issues but only recently began a cognitive decline: up until a few months ago he was sharp, interested in the world, enjoying his grandchildren. Yes he suffered a lot, but he had a will to live and go on.

        I don’t know what the answer is, all I can think recently is that if someone has a will to live it’s important to respect that and help them as much as possible (I think this is distinct from the issue of prolonging people’s suffering through life support when they’re barely hanging on).

        There are mysteries here, who knows why someone still wants to be alive even if they’re not “optimal.” It’s not what I envision for myself, but clearly the will to live and enjoy life is deep-rooted and stronger than judgments of whether it’s worth it. I especially think that people need to be treated with dignity no matter how poorly they seem to be doing, we need to respect the life force within them that keeps them going.

  55. What a great post!! I live my life like a do (primally) despite the eye rollings of my husband and others, because I believe it will help me live a BETTER life. Not necessarily longer. But healthier. And surely active until the very end. Or, at least that is my goal.

    We have been living with my in-laws while we close on our house (having moved across several states), and my in-laws are the ‘typical’ older folks (and seriously, they’re not that old – 65 and 63) who take a ton of meds and hobble around and sit and complain about diabetes and bad genes and what we (the kids) have to look forward to when we get old. It is appalling and so SO depressing!! I NEVER want to live like that. And their lifestyle – full of carbs, starch, sugar, no activity, and 8 hours of nightly TV watching after dinner (just to name a few things) are what I think has led to this demise.

    At least I have to hope that there IS hope. And the Primal Blueprint has given me hope so now living primally is the only way I can feel like I’m living the best life I can. And I’m so much happier and healthier for it!!

  56. Wow. Awesome post. I’ve been hoping someone would cover this in greater detail.

    I remember reading awhile back (not sure where) that hunter-gatherers that are lucky enough to escape child mortality, accidents, and infectious diseases to make it to old age generally have a very compressed morbidity at the end of their lives, generally just a few days on average.

  57. This reminded me of a quote from On the Road by Jack Kerouac

    “I shambled after as I’ve been doing all my life after people who interest me, because the only people for me are the mad ones, the ones who are mad to live, mad to talk, mad to be saved, desirous of everything at the same time, the ones that never yawn or say a commonplace thing, but burn, burn, burn like fabulous yellow roman candles exploding like spiders across the stars and in the middle you see the blue centerlight pop and everybody goes ‘Awww!'”

  58. At the ripe young age of 63.5 years I discovered MDA via a local radio interview with Mark in Charleston, WV. My Doc was ready to put me on insulin due to my progressive Type II diabetes. I have regained my health and my life over these past 6 months. Lost 50+ lbs. Eliminated 2 oral diabetic Rx’s plus my cholesterol meds and 1/2 of my blood pressure meds (still working on the other half.) More energy, lots of compliments from those that know me and greatly motivated to dig in a little deeper. Couldn’t do even one pushup when I started and only a few squats. Recently took a 13 mile hike by myself in the woods during a snowfall and it was exhilirating. Let’s roll, time is wasting. Thanks for your work Mark and all of you who offer such great posts.

  59. there’s no gurantee for any of this stuff. Your DNA may have already determined your future. Live the best life you can and don’t let the experts tell you what you should be doing. I like the Scott Tinley philosophy.(fUCK IT THIS IS WHAT I LIKE TO DO) Cheers

  60. Ha ha I like it too! With the women in my family they seem to have the longevity gene..I enjoyed many years with great grandmothers on my mother’s side, they were in their 90’s when they passed on. I lost one grandmother in the last few years in her 80’s a long and painful path due to MS. One of my grandmothers still cuts her own lawn, has a boyfriend, and travels. I am going to be 38. These women are an inspiration, they worked hard, raised families, stayed active and some even enjoyed themselves!
    My English Bulldog Koko just died a few weeks ago, during her afternoon nap. She was fine and happy in the morning, we ran out to do a few errands, when we came back, she was snuggled in her bed by the front door with her chewy bone under her chin, dead. Peacefully, in her sleep. RIP Kokomo Kissabull Aguiar, that’s how I want to go….

  61. i think modern medicine does not prolong life.
    it just lengthens (the process of dying)


  62. I’m another reader who could not agree more with you.

    I work as a medical transcriptionist. I don’t agree with a lot of what conventional medicine does, but it’s how I make my living.

    I have transcribed lots and lots and lots of reports for people who spend the last years, even decades, of their lives in some form of nursing home, very debilitated, and often going back-and-forth between the nursing home and the emergency room.

    Frequently these people cannot walk, can’t talk, and can’t recognize their loved ones anymore. The light’s on (just barely), but you’d be hard put to say that anyone’s really home.

    Oh, yeah, and one of the hospitals for which I transcribe is a teaching hospital, and they’re still teaching them the garbage about the cholesterol theory of heart disease.

    No doubt some of the patients are even more demented because of statin drugs, but we won’t even get into that right now.

    Anyway, I really enjoy your blog. I am also impressed by the respectful way in which you interect with your readers.

  63. once again so timely–i was happy to ride my mtn bike up a very steep grade tonight as I usually don’t get up that thing without stopping until about 6 weeks deeper into the spring riding season and I was talking with another rider up there about how many more springs would I be able to do this? he said he’d seen a guy who looked to be about 60 heading up this hill. i’m 49 this spring. i wanna ride that steep section as long as I can and climb lotsa crags and then settle into yoga, gardening and biking around town and then go out like that old lady, oh yeah!

  64. My father turns 72 this year. He has spent all of his life doing 50 laps of an olympic sized swimming pool each day, going for long walks, riding a push bike, and runs a marathon once a week. He has only just started to complain that his legs are starting to feel stiff and sore after one of his runs.

  65. This year I will be luckily enough to help celebrate the 100th birthday of an amazing lady who still lives alone in her own home, cares for herself and still has all her wits about her. She is Amazing.
    On the other hand, my uncle developed Alzeheimers in his 50’s and has spent nearly 20 years in a secure unit for late stage Alzheimers patients. He is gone, simply a body housing the mind of a newborn baby. He only lives because he has a swallow reflex and they continue to feed him. The doctors say he could live for many more years (If living is what you call it).
    My point….. Is that I guess you just never know what you are going to get in life.
    Im really looking forward to that Party!

  66. Great post, thanks.
    Since starting to live primally last summer, I keep noticing how much time people around me spend talking about their illnesses and those of folks they know. It’s so depressing! More and more, I stay out of the conversation and just think about something else, something life affirming – like the nice, juicy steak I’ll cook for dinner with a tomato salad sideplate, or walking the dog in the New Forest. Also, when anyone asks me, I tell them, “I’m growing younger!” and that is my belief. Living primally is fun and makes me feel good! Grok on!

  67. Three years ago, at age 47, I could barely move, locked in a body wracked with rheumatoid arthritis. Then the celiac diagnosis. Tried the standard near western pseudo gluten free route and stopped getting worse.. not better, but no worse after a nearly daily decline that had me preparing for the inevitable. Switched to paleo and within forty eight hours went from a morning gel time of two or more hours to being able to literally hit the ground running. I still have a long row to hoe as to healing and recovery but now I have another few days to move in a positive direction.
    I read a quote the other day. “I do not eat really healthy to make myself live longer….I eat healthy to have quality of life while I am here on the planet.”
    I found this to be so profound. There are consequences to our choices. I used to always see that as such a heavy handed negative. Now I see the consequences as one of the most positive as to the impact it can have on our quality of life. Now, if I can only get my loved ones to pay more attention.

  68. My grandparents have been going through this for several years now. It’s taken a harsh toll on my mother to have to care for them and watch them suffer for nearly a decade. And they’re no happier for it. They can’t have anything they want, and every day is another set of humiliations. I don’t want to touch any nerves here, but on top of all that, I can’t even imagine how much of other people’s money has been wasted in prolonging my grandparents’ suffering.

    I spoke with my mother yesterday about it. We both said that we would never follow them down this road, but maybe that’s easier to say when you’re healthy and not staring death in the face.

  69. Absolutely agree. I’ve seen both sides up close in my family. The cost of my mother’s thirty year slow dying with Type2 diabetes, both emotionally and financially is a very unpleasant picture. When my grok-like dad dies, now 90, it will have been having enjoyed a physically active, healthy life, and next to nothing in insurance and related health costs. While it may seem callous to reduce this to $$, the fact is we are each paying for health costs related to obesity and poor diet generally. But the bottom line is my mother did not enjoy those years of decline, and that is really a terrible testament to any life.

  70. I’ve seen both sides in my family. Most immediatly, my mother spent 30 years declining due to obesity caused T2 diabetes; years she did not enjoy life, nor have the energy to do much with here children and grandchildren. The costs were great physically, mentally, financially. My Grok-like dad, 90 now, has rarely had a sick day, remains active, and enjoys life fully. He volunteers at a nursing home where most of the people are younger than he by ten or more years. When he dies, it will have cost the insurance he carries, almost nothing. It may seem callous to reduce this to $$, but we all pay for the diet and obesity related
    health problems. But the saddest part is that life is only half lived when illness dominates.

    1. Sorry for the duplication, my computer wigged out and I thought it didn’t post.

  71. As a primal Crossfitter I am hoping to be the tough old gramma who is still around to do Wod’s with my grandkids!
    I lost my dad when I was 17 and I am determined to be around for a very long time for my kids and show them that life is meant to be LIVED!
    love the comments by everyone, Grok on!

  72. I”m in my late 20’s been diagnosed with renal failure 4 years ago. Yes 4 years ago it was a death sentence, but after 1 year on dialysis and a lot of muscle loss, I started researching food and exercise. I’m not 100% primal more the 80-20 rule. And it works for me. I’ve also started Kettlebell this year and saw my strength go up. I sometimes forget I have renal failure since I”m healthier then before renal failure where I ran, and ate “healthy”.
    It frustrates me when dialysis patients a few years old or younger then me, come to treatment and complain why me. I haven’t asked why me in over 3 years. And I don’t take all the normal drugs that renal patients have. I have normal blood pressure and I feel great. I try to talk to patients about exercise as a start, but it falls on deaf ears.
    I know something related to renal failure will be my end, but I’m enjoying the ride. And people have lived high quality lives for 30+ years on dialysis.
    If you do get some disease learn to manage it and you can still live a high quality life, it will only bring you down if you let it and don’t educate yourself.

  73. My grandmother died at 93 a few weeks ago–she experienced that slow, long decline into morbidity and immobility that you describe. She lost all of her faculties one by one, starting with her physical vitality, then her immune system, and finally her mind. She was in and out of the hospital constantly for 2 years, and by the end she had had so many small strokes and serious infections that we’re not sure she remembered who her son (my dad) was, and was unable to speak. We are quite sure, however, that she was miserable and in pain. That was pretty obvious.

    She wasn’t Grandma anymore for a long time. She was a shrunken wisp of her formal self. I can say that it was a relief when she finally died. There was a picture of her at her funeral that was taken when I was younger (she was perhaps 75, 80 at the most), and I cried my eyes out when I looked at it, because I was so sad and angry that the memories I have of her from the last several years weren’t really her. That old woman with lively eyes and a sarcastic smile, who used to bake Christmas cookies with me every year, who lived through the Depression and saved everything to the point of obsession, who took care of me when I was small and walked herself to church 6 days a week, every week of her adult life, died a long time ago. Her body just didn’t know when to stop breathing.

    I sincerely hope I have the wherewithal to end my own life if I am ever in a situation similar, before I am too weakened to do it. But the best thing to hope for is that death comes swiftly and unexpectedly for me, and I never have to go through the kind of death my grandmother didn’t deserve.

  74. I’m with Carly on this one. Aged 26 I experienced an injury to my spinal cord. I’ve had my backside cleaned by others, remained immobile for many months (unable to move from the neck down), and in 24/7 excruciating pain. Should I have come home with my shield or on it?

    I’m 47 now and still in 24/7 pain, unable to walk unassisted and all the other health implications that come with spinal cord injury. Sometimes when I read MDA I do so with a shield of armour to protect me from the oh so macho approach to living.

    Even with all my neurological health problems I still have a zest for life. Perhaps this is why many hang on with their meds… because life isn’t just for those who are physically fit.

    It’s true; everyone has to decide how much ‘decrepitude’ they’ll tolerate. Sadly, some of us have to face that choice through no fault of their own from a very early age. I’m grateful for big pharma, the medical profession and the paleo/primal way. Hell! I’m thankful I can feed myself.

  75. When I turned 40 I started getting what I called “Old-guy-itis” and I realized that I wasn’t necessarily getting old, I was just out of shape. But getting in shape again had to be different than when I was 20 and could just start running every day and call it good. I got really inspired by Cross-fit, and loved that whole functional fitness idea. The main challenge for me was restoring flexibility and elasticity of my joints, ligaments, and building strength for my whole body. I love PBF and appreciate how you have such holistic approach to being alive. Thanks Mark!

  76. My grandfather used to say he was going to get shot by a 21 year old jealous husband when he was 95. He was a dynamo till 89. Almost no pills his whole life.

  77. Oh, if only my sweet husband had lived long enough to read these posts! We tried so hard to live a “healthy” lifestyle (according to USDA guidelines). How wrong we were. I’ve been Paleo for two months and am feeling great! I am no longer depressed, my joints don’t ache anymore, my acid reflux is gone and I’ve dropped 14 pounds from my 5 foot frame. I’m never hungry since I eat all I want of nutritious, tasty proteins and vegetables. The most difficult part of this lifestyle is not irritating the hell out of your friends who don’t yet understand! “-)

  78. “Is life so dear, or peace so sweet, as to be purchased at the price of chains and slavery? Forbid it, Almighty God! I know not what course others may take; but as for me, give me liberty or give me death!”

  79. In Japanese sword fighting Kendo you have to be at least 46 before you can attempt to achieve the highest level 8th Dan. See here these fantastic athletes compete
    Some are in their 70’s and 80’s

    Or see the 10th dan master Mochida Moriji Hanshi her in action at age 76.
    These old guys move so fast. Sometimes a fight lasts 1 second and you have to see it in slow motion to see what happened. Functional fitness and vitality to the end!!

  80. Wow, thank you for this. I was just saying last night that I’d rather live a great life to 55 than a disease-ridden one to 85.
    My husband is an emergency physician, and this topic is so important, and yet one many people won’t discuss. I can’t even explain the brutalities that happen to elderly patients in the ED all in the name of “doing everything possible.” Our entire society needs a reality check on this issue.

  81. I been a subscriber to the daily apple for only a short time. However, discussion like this have convinced me how different this group is from some of the other “fitness” sites I have seen. I would like to share the following: I am 62 years old. I have been exercising vigourously (weights, running, biking walking) since I was a child. I have never stopped, through college, professional school up to the present. I have seen my contemporaries age before my eyes, with chronic self inflicted illness over the years. My own health and vigor have always been enough motivation for me to continue with this life style. Two years ago my wife and I took custody of our then 5 year old and 18 month old grand sons from their drug addict parents. I now firmly believe that “providence” guided me along this path. I will continue with the primal life because I have a duty to these two little ones to be as healthy and strong as possilbe for as long as I can. I want to teach them about living and dying in the best possible way. We owe this to them and to each other. To all of you keep up the good fight, you may never know who else will benefit from what you do for yourself.

  82. Thanks Mark,

    That couldn’t be summed up any better, good work. Thaks to you from Australia.

  83. Mark – in my opinion, your finest post ever. Years of thought went into this one, and it’s evident. Thanks for writing it!

  84. Do Not Go Gentle Into That Good Night by Dylan Thomas

    Do not go gentle into that good night,
    Old age should burn and rave at close of day;
    Rage, rage against the dying of the light.

    Though wise men at their end know dark is right,
    Because their words had forked no lightning they
    Do not go gentle into that good night.

    Good men, the last wave by, crying how bright
    Their frail deeds might have danced in a green bay,
    Rage, rage against the dying of the light.

    Wild men who caught and sang the sun in flight,
    And learn, too late, they grieved it on its way,
    Do not go gentle into that good night.

    Grave men, near death, who see with blinding sight
    Blind eyes could blaze like meteors and be gay,
    Rage, rage against the dying of the light.

    And you, my father, there on that sad height,
    Curse, bless, me now with your fierce tears, I pray.
    Do not go gentle into that good night.
    Rage, rage against the dying of the light.

  85. I’m with you, Mark…I would rather live a shorter amount of years (and be healthy) than live to 100 and be infirm and sick for the last 20 years of my life. On a side note, I think that age is all in the mind. Some people are active and healthy until they drop dead because they don’t think that their age should dictate the state of their health!

  86. New concept :
    Period of Mobidity…

    I’m proud to say that my great grandmom died at 102 and she was fortunate enough to have known her great great grand daughter… Born in 1895 She led an active life – agrarian commercially and did sewing, cooking like other women of that time. I always knew her to be crippled and immobile.. She suffered from arthritis and otherwise healthy she used to shuffle around with her walking stick, over the years that declined into pushing wheel chair, then sedentary in her bedroom most of the day… She died peacefully in her bed in 1998.

    Is living long whilst enjoying uncomplicated health a thing of the past?

  87. Very beautiful and inspiring….I fell in a manhole in 1998 , thanks to sleazy employers with no regard for human life ( they faked the top to look functional) I was left spinning in the wind… body nerve damage…. and 4 slams to the back of the head….workman’s comp MD’s ” WOW’ you should be dead!”….prayer, nutrition and self-rehab (hideously painful) and 7 years later I was no crazier than I was before the accident and looked great (except for the horrible scar where my left shin had been crushed)….since this incident and subsequent miraculous recovery….I am determined not to ever be debilitated again…..I already did my time there…..your blog is always inspiring and keeps me on track….I always get questions on how I can look so young for my age…and when I explain the eating, supplements, and exercise they usually say it’s not worth it….soooo many people want magic….when common sense is really so easy when it’s habitual

  88. Certainly, poor health habits (obesity, lack of activity) combined with effective emergency medical treatment (they’ll get you through that first heart attack!) contribute to the problem of extended senescence. So do falling per capita murder rates and automobile fatality rates (about half of what they were three decades ago). The reduction in the smoking rate is an another odd contributor to this problem: Smoking is correlated with some very specific and very fatal diseases, like lung cancer, that kill people before they become infirmed.

    In mice and monkeys, caloric reduction and improved diets seem to have more effect on health than longevity: While researchers may be disappointed that recent experiments have shown that CR and/or improved diets don’t appear to be a “magic bullet” for primates, it does suggest that maintaining a good diet, and a good body weight, are likely to leave people disease-free longer.

    Also, if projects like Google Calico (Cynthia Kenyon, Ray Kurzweil, etc.) are able to invent that “magic bullet” to slow, stop, or reverse aging, we’ll all be better off if we are in better shape when we begin the new therapy.

  89. A poem by Roger McGough…..

    Let me die a youngman’s death
    not a clean and inbetween
    the sheets holywater death
    not a famous-last-words
    peaceful out of breath death

    When I’m 73
    and in constant good tumour
    may I be mown down at dawn
    by a bright red sports car
    on my way home
    from an allnight party

    Or when I’m 91
    with silver hair
    and sitting in a barber’s chair
    may rival gangsters
    with hamfisted tommyguns burst in
    and give me a short back and insides

    Or when I’m 104
    and banned from the Cavern
    may my mistress
    catching me in bed with her daughter
    and fearing for her son
    cut me up into little pieces
    and throw away every piece but one

    Let me die a youngman’s death
    not a free from sin tiptoe in
    candle wax and waning death
    not a curtains drawn by angels borne
    ‘what a nice way to go’ death