The Virtue of Being Short

If you've ever had a tall man stand in front of you at a concert, blocking your view, and wished that he would have a heart attack, the odds were against you.

Tall men are less likely to develop heart disease than are short men, according to research published last week in The New England Journal of Medicine. In a study of more than 200,000 people, every 2.5 inches of height meant a 13.5 percent lower likelihood of coronary artery disease.

Unsure how or why this result came to be, the researchers are grappling for explanations. So are journalists and health-conscious news readers, and experts asked to comment on the findings: "In a sense," the director of cardiovascular sciences at the National Heart, Lung, and Blood Institute Michael Lauer told The New York Times, evoking Ian Malcolm, "we are nature’s random experiments."

In another sense, we know a lot about cultivating long life and vigorous hearts. The international team of researchers suggest that the findings may be due to smaller people having smaller-caliber arteries that could be more easily clogged—but then immediately dismiss the idea because no such association was found in females, whose coronary arteries are smaller de facto. Shorter people do have higher likelihoods of having high cholesterol and triglyceride levels in their blood, but the researchers say that can only account for a small fraction of the heart disease. They conclude in the journal article, "A majority of the relationship is likely to be determined by shared biologic processes that determine achieved height and atherosclerosis development."

So the question seems to be, should everyone get taller? How best to go about the enlargement? Would it work to simply lengthen one's bones? Or, more practically, should I inject my mildly short kid with $50,000 hormones? Actually, before that, are taller people really better off?

In his 1995 song "I Wish," Antoine Roundtree (Skee-Lo) wished he was a little bit taller. He was five-foot-eight, which is only an inch below average in the United States—but it would be culturally insensitive to impugn his candor outside of its subcultural context, the especially tall baller community. The sentiment struck a chord outside of those circles, too. According to writer Brian Palmer at Slate, who may or may not know Skee-Lo, most of the people he knows would love to be taller:

Most people I know would love to be taller. Parents with slow-growing children often ask pediatricians for growth hormone to save their kids the indignity of being short. I get it. Tall people—particularly tall men—earn more money and are held in higher esteem than their shorter colleagues. Tall people also have higher IQs and a wider selection of mates.

In the last two centuries, the average height of the Dutch population has increased by almost eight inches. While this heart-disease study was making news last week, so were behavioral biologists at the London School of Hygiene and Tropical Medicine, trying to explain why Dutch people have rapidly overtaken Americans as the tallest people on the planet. These researchers found that tall Dutch men are more likely to have children than their shorter counterparts. Either because they are more attractive to women or simply more virile, the tall men are disproportionately breeding. In the United States, this is not so.

Some epidemiologists have argued that the skyrocketing of the Dutch was due to access to dairy and meat products, but Americans have just as much access and have grown instead ever rounder while the Dutch, Norwegians, and Swedes have surpassed us vertically. Instead, lead researcher Gert Stulp explained in Science, human sexual selection seems to be at play. Taller Dutch men produce more offspring than do average and shorter Dutch men, while in the U.S., average-height men and short women are the most productive.

Which may or may not be desirable, depending on your want for children and aversion to wasting seed. The point was that while being tall can suggest evolutionary advantage in some places, it doesn't in others. And reproductive viability does not mean longevity. Compared with the taller northern Europeans, the shorter southern Europeans have lower rates of cardiac death. Swedish and Norwegian people are more than twice as likely as Spanish and Portuguese people (who are, on average, five inches shorter) to die from heart disease. In 2013 researchers at Albert Einstein College of Medicine published a study of 144,701 women that "confirm[ed] the positive association of height with risk of all cancers." Another large study found increased risk of several cancers in tall men and women, and that taller people have higher rates of mortality from cancers. Palmer calls the fact that tall people die younger "an immutable physical reality."

Over the decades, Americans have fallen further and further down the global rankings in life expectancy, now holding down a solid 36th place. The tall Dutch have perennially outlived Americans, but since 1970 no one has supplanted a very short country in the top spot: Japan.

The people of Japan's Okinawan islands live the longest lives in the world. They have about seven times the rate of centenarians as do other industrialized countries, and the lowest rates of cancer and heart disease in the world—and they are even shorter than the mainland Japanese. The average Okinawan man is four-feet, nine-inches tall.

So the question seems to be, should everyone get shorter? How best to go about the shrinkage? Would it work to simply remove one's feet? But if you can't run, or even walk, would that outweigh the benefit of being shorter? Or, more practically, should I not lament my shortness or inject my mildly short kid with $50,000 hormones?

Okinawans also appear to forfeit their imperviousness to disease when they move to mainland Japan or the United States. On the islands they eat a low-calorie diet rich in vegetables and grains. They drink tea and antioxidant-laden rice liquor called awamori and lead active, socially connected lives. They eat primarily monounsaturated and polyunsaturated fats with few high-saturated-fat animal products, apart from fish.

Research on this type of caloric restriction (not calorie counting, but just eating less) has consistently shown dramatic benefit to longevity. Innumerable animal studies have found that larger animals within the same species show accelerated aging, note researchers Thomas Samaras and Harold Elrick. They proposed in 2002:

Rapid developments in genetic engineering are likely to lead to substantial increases in the height of future generations. Health and longevity are strongly affected by socioeconomic status, relative weight, regular exercise, and various health practices. However, animal and human data suggest that larger body size independently reduces longevity. Therefore, the promotion of greater height and lean body mass in our children needs to be objectively evaluated by the medical profession before it becomes the norm.

They refer to growth-hormone injections, to body building, and to a societal aversion to short stature—rooted in the historical implication that shortness meant malnourishment, illness, and poverty. Last week's heart-disease study is far from another reason to want to be taller. A forward-thinking, health-conscious Skee-Lo might have wished to be a little bit shorter. When a tall person blocks your view of a concert, allow them their privileged vantage with a laugh. Death will come for them.