Lifespan Versus Health Span

SPEAKER_01 0:05

We spend so much time asking how long we'll live. But there's a quieter, most honest question. Most of us never ask loud how well we live. Not just in final years, but all the years in between. And today's conversation is exactly about that. Welcome back to Healthy Mind, Healthy Life. I'm Yusuf, and this is the show where we have real conversations about what it means to take care of yourself, your mind, your body, and everything in between. I'm joined today by Dr. Gulnosh Sarafalashe, a board-certified dietrician who has spent her career caring for older adults and asking the questions most of medicine tends to escape. Not just how we survive aging, but how do we age well? She's the founder of Rari Academy and the creator of the Health Framework, a practical whole person model for what she calls health strands. Dr. Hulosh, welcome to the show.

SPEAKER_00 1:19

Thank you for having me, Yusuf.

SPEAKER_01 1:24

Before we get into the frameworks and all the wisdom packed into it, I'd love to start with you. Like, what was the moment in your clinical practice working with your patients that made you realize the way we usually talk about aging was missing something important?

SPEAKER_00 1:44

Yeah, so I've always been attracted to elders. And I think culturally that is a part of just my upbringing as well. But what I realized was that our culture sets us apart from our elders, where we can learn so much from them. And as I started to spend time with my patients, the more time I spent with them, I realized that health isn't just what you do, it's how we live. And people who understand that best are the ones who've actually lived the longest. So, you know, this um awareness kind of helped me in my personal life, and it has also helped me in my professional life.

SPEAKER_01 2:33

And you know, there's this cultural obsession with longevity right now, living to hundred, reverse aging, biohacking. And I wonder sometimes if all that noise is actually actually pulling us away from a more honest conversation. So you draw a clear line between lifespan and health span. For someone hearing the word for the very first time, what does that mean?

SPEAKER_00 3:01

Um, yeah, so health span is more, I believe, more important than our lifespan. We could live, you know, to be 90, 100 years old, but what if those last 15 to 20 years are actually spent being frail, being in uh dependent versus independent? And health span, you may not live as long, but every moment is meaningful and you are able to actively participate in life. And the way I approach care with my patients is I use something I call the health framework, where health is actually an acronym for how we have a healthy health span. So even though I'm a geriatrician, I'm also board certified in lifestyle medicine. And I spent a lot of my days, you know, talking to people in the most vulnerable states, sometimes people at the end of

Start With What Matters Most

SPEAKER_00 3:55

their lives. And what's most striking is that no one's really like talking about their cholesterol at the end of their life. And what I've noticed though is that when people get to the end of their life, what really is most important is how well they lived. They're not talking about numbers, they're not talking about their careers, they're not talking about um everything that they achieved, but they are talking about the experiences that they had and what mattered to them. In order to have a great life experience, you should be healthy inside and out, right? And and that's what I think health span is about. Not easing into death with frailty and dependence, but almost, I joke about this with my patients. I want to slam into the wall and die because I want to be active and independent the entire time.

SPEAKER_01 4:59

to how well do you want to live? I want to know what changes in the room. Like what are the things that open up for them.

SPEAKER_00 5:08

The first thing I always ask my patients is well, what matters to you about our interaction? I don't just give them medical advice, I don't just prescribe medications. The conversation always starts with what actually matters to you. Because within this health framework, the H stands for how we age. And within that, there are these five M's of geriatrics. And the first one is what matters to you. Um, and then the second one is your mindset, is your mindset either it's a medical mental disorder or it is your mindset about your health. And then we think about your medications, your medical problems, and finally mobility keeping you upright. So I approach the conversation that way, which I think people are taken aback often because they don't expect that. You know, mostly people go to the doctor and oh, here's your cholesterol numbers, here is your blood pressure, here's a pill, go home. And we're practicing reactive medicine rather than proactively being a part of our patients' lives and their health. And so once I understand what matters to them and we start to understand how they're aging independently, because we all age individually, um, there are genetic factors, but there are also psychosocial and environmental factors, then I can build a plan for

The HEALTH Framework Explained

SPEAKER_00 6:28

them. And then I move into the energy piece. So health H for how we age, E is for energy. And this talks about um aging on a cellular level, but also on a disease-specific level that is energy dependent, and things like heart disease, metabolic disease, um, cancer, cognitive disorders, but then also how are we um affected by energy in a cellular way and how can we optimize that? Then we shift to activity and not necessarily like going to the gym, but what is our body able to do? And what do we want it to do? For instance, for me, I know that when I'm in my 70s, I'm in my mid-40s now, I want to be able to travel and I want to be able to lift a suitcase and put it in the overhead of an air airplane. And I want to be able to run across from one place to another. So, what would I physically need to be doing now in order to be able to do that then? Um, that plays into the conversation. And the L, this is the longevity part of the acronym, and everyone's like, oh, great, supplements, vitamins, but that's not at all what it's about. It's more about those pillars of lifestyle medicine that help us to thrive and live well. Of course, there are some supplements and vitamins that our body may need, and most of those we can get from our diet. We don't need to be taking handfuls of supplements every day. But there's no, there's no magic anti-aging hack. It is how we work in order to live a healthy life. You know, how much we put into our physical health, into ensuring we have a good night's sleep, ensuring that our mental health is as well, ensuring that we're abstaining from substances like alcohol and drugs, ensuring we have good social connections, you know, social isolation kills a person. It increases your risk of dementia. So ensuring that a person is connected to their environment is so important. And then finally, habits. So most habit books, well, I guess a better backup. So transformation is the next one. And as we age, we transform and we have to adapt to this transformation, correct? So if like I had both of my hips replaced about a year and a half ago, I was born with a congenital hip defect, but that try, you know, I had to adapt and learn new ways to move about. And rather than giving in, I learned to optimize what I needed to do and to succeed. So we transform, but then also transformation helps us in terms of completion. So not anti-aging, embracing aging, embracing the transformation and then completion. So how do we prepare for the next existence? And then last is our habits. So we know all of this. And then I try to understand a patient's habits and how we drift in life. So sometimes we drift because of life circumstances, and how do we incrementally reset? And that's our reset technique. We can sort of get back on track so that we can again um enjoy a better health span, a successful health span. That was loaded. I love that.

SPEAKER_01 9:52

Yeah, I love that because you know, health span is not about delaying the aging process, it's it is about moving through it without as much function, meaning, connection as possible. And that already feels like a different kind of aspiration.

SPEAKER_00 10:14

Yeah, um, I recently was talking to my sister about um one of my patients who've very healthy, like very healthy individual. And this patient and I became friends. And I was talking to my my sister, not giving her any specifics, but I said, you know, I've realized that the one thing this person needed was our friendship. And and I needed that too. And that that was the medicine that we exchanged between each other. And I learned so much from this person's knowledge and um being able to spend time with this person has given me so much insight and so much wisdom. And then I'm I'm hoping that um I've given them back some good advice and information about remaining healthy. But that is the other part of I think healthcare is not being reactive, but being proactive and getting ahead of things and really having that moment of introspection. Like, where do I need to be and what do I need to do to live the best life possible? And and sometimes medicine is not about pills or numbers, it's it's about more than that.

SPEAKER_01 11:33

The last letter in your framework is also an H that stands for habits. And I know for from your writing that you believe daily routines form what you call the invisible framework beneath everything else. But I think most of us know what we should be doing, like sleeping well, eating well, etc. etc. And we still don't do it consistently. So what do you think is actually getting in the way? And how do you approach that with your patients?

Motivation, Grief, And Real Change

SPEAKER_00 12:11

The way I approach that with my patients is again going back to what matters to you, what actually matters to you in your life. And once you ask that question, rather than giving them advice on, I need you to eat better, I need you to sleep better, we know all the things that we have to do, but where's our motivation come from to do the things that we need to do to reach our goals? And that's where the motivation, I think, comes from. So I had a patient, and then this person is long gone out of my practice, but came to me sad, depressed, had lost their spouse, and didn't know how to cook, didn't know how to take care of themselves. So their diabetes was out of control, their weight uh was very, very high. And was so sad. But their what mattered to them was just they wanted to feel better internally. They didn't want to suffer with the depression they were feeling for the loss of their spouse. They wanted to walk, they wanted a dog, and they couldn't have a dog because they could barely walk. They had arthritis. And once we had that conversation, I realized, okay, let's let's help you learn to cook for yourself and let's help you um get back into exercising. And I motivated them. So I said, you know, for the next three weeks, every time you go to the grocery store, call me. We're gonna shop together. Taught the patient how to read labels. And he would joke with me after a while and said, I'm the most annoying person at the grocery store because I'm the one everyone's waiting for to move on as I'm reading all these labels. But over a two-year period, they lost about 70 pounds and total transformation. Now, this person in their 70s. So it sometimes people are like, oh, it's it's too late for me. It's never too late. And they learned to cook for themselves, they started to get outside, ended up with a dog, and then, you know, was able to move on. So left the home that he was with with his spouse before she had passed away and moved away to be near his adult children and grandchildren so that he had more meaning in his life. But that I think was a successful transformation. And that's where this health framework took effect, where I started with that simple question what matters to you about your health? And when I ask that question, no one ever tells me I want to be unhealthy. They're coming to you for help. People come to the doctor for help, but we can't just offer advice without it truly being received internally, like truly being received and truly motivating a person based on what matters to them. So that's where I think the conversation shift helps me um have more success with my patients.

SPEAKER_01 15:22

And you know, I think there is something really relieving about that because it's not about doing everything all at once. It is about finding the one thing that opens a door and try to do that. And once it is done, at least you have done something rather than sitting idle.

SPEAKER_00 15:44

Absolutely. And these small changes, you know, I I see my patients routinely, not when they're sick. I have these very routine scheduled visits, these are wellness visits, and when I see them, we celebrate the achievements and and how well they're doing. And and even the small achievements are are huge because they are so far. Um, so they they've gone so much further than they had ever in the past. And I think maybe that's where we've also gone um in the wrong direction with our patients, isn't we're not celebrating the great achievements. You know, they're coming in and rather than being like, oh, look, look what you've been able to do. Because our entire health is a journey. You know, we have ups, we have downs, we drift, like I talk about in the habit portion. And and what is our reset technique? How do we reset to get back on track? And that track doesn't need to be all or nothing. That track just needs to help us shift back to a place where the journey is meaningful, the journey feels successful,

Small Wins, Drift, And Resetting

SPEAKER_00 16:55

the journey doesn't feel overwhelming and like we lost, you know, because it it is, it is a journey. And yeah, and my patients have also taught me that too, because they have lived such long, meaningful lives, most of them who have come to me. And I always think, hey, you have to be a really tough person to become an old person. So yeah, I I remind them of that always too. I'm like, you know, you're pretty tough if you've made it this long. Let's just see how we can focus on really improving your health span now.

unknown 17:34

Dr.

SPEAKER_01 17:34

Gulosh, is there any way that our listeners can connect with you or learn more about your work?

SPEAKER_00 17:41

Sure. Yeah, I have a free blog. I write a blog called jerryacademy.com, G-E-R-I, Academy.com, and people from all over the world read it, but there are free blog posts on this health framework. And there I'm writing a book on the health framework. Um I'm just finished with the first draft, so it will be out probably in a couple of years. But um, I also wrote another book called Life, Love, and the In-Between, because you know, I do think physical health is important, but a lot of what we learn and how we cope and how we move through life has to come from the wisdom of our elders. And that book talks about that. So um there is there are links to purchase the book if anyone is interested in that. It's more of a memoir. And if anyone has specific questions, you know, you can message me through the blog. I do respond to um messages, questions, and we know you know there's a there's a problem as far as geriatric training goes. We're only training in the US, like 250 geriatricians a year. We need 30,000 by 2029. And we're only we only have about 7,000, and you know, they're retiring as well. So we're always going to have a deficit of geriatricians. And I was hoping that with this blog, offering something back could help people advocate for themselves and take some of this information to their doctors and say, hey, I've learned about this. What do you think? And and hopefully that will motivate people to um again focus on their health span rather than how long we live and stop listening to all the hype about anti-aging

Resources, Aging Wisdom, Closing CTA

SPEAKER_00 19:30

or all the strange biohacks, which you know, there's very little to no data behind.

SPEAKER_01 19:35

Yeah. Perfect. And to everyone listening, all these links are in the show notes, so just go and check those out. Dr. Is there any last message that you want to leave us with?

SPEAKER_00 19:48

Well, you know, I I think that aging happens, we should embrace it. I think we should live in the uh in between moments of life. Really don't keep looking towards the future um constantly because we're gonna miss what we have right this moment, right now. And and don't give up, you know. I I would say uh uh continue to reset as needed because uh if you don't achieve one goal, it doesn't necessarily mean that you failed, but you can continue at it.

SPEAKER_01 20:30

Thank you so much for coming. And you know, this was one of those conversations I'll keep thinking about long after we have stopped recording, and I'll I'll think about it, I'll I'll implement it, and you know, I'll also impart it to my parents, to my elders in the life. So thank you so much, Dr. Gulnosh.

SPEAKER_00 20:53

Absolutely a pleasure um being on your show.

SPEAKER_01 20:58

And to everyone listening. Your health is not just a medical checklist, it is a living thing, and it is never, never, never too late to tend it. If this episode meant something to you, share it with someone who needs to hear it today. We'll be back soon. Take care of yourself.