Older Athletes Have a Strikingly Young Fitness Age – The New York Times

Older Athletes Have a Strikingly Young Fitness Age – The New York Times.

For me this is an exiting and interesting story.  As I have said in earlier posts, exercise is important.  This just reinforces the notion that exercise, even if started later in life, does help health.  I won’t wax poetic about how exercise is a “veritable fountain of youth” as I try to avoid being overly dramatic with health care claims.

Surviving Old Age (AKA: Aging Well, part two)

One of my first posts in this blog was titled “Aging Well”. In that post I wrote mostly about staying healthy and how to (hopefully) age well and arrive at being an older adult being relatively healthy. In this post I’m  going to talk about things to think about or do once you get there  – and perhaps people to think about family members that are older. For the purposes of this post, the definition of older is 65 and above, despite the line that “65 is the new 40”.

Initially I would like to summarize a bit of what I said in the first post:

1) Be active! Both socially and physically (more on this later).
2) Control as best you can the health problems you do have.
3) Keep mentally active as well. Whether it’s taking adult education classes, daily crossword puzzles or playing cards with people often, do it!
4) Use a healthy eating pattern. For a fuller summary, go here to see the original post: aging well

For he remainder of this post I’ll talk about other things worth doing.

Firstly, if you haven’t already, sign a health care proxy form, and give copies to your primary care physician as well as a friend/relative. You may never need to use it but it is important to have if you develop a health issue that prevents you from making decisions about health care.  I have seen too many people admitted to the hospital with dementia that is so advanced that they were unable to make competent decisions for themselves in any capacity and did not have any family or friends who could speak on their behalf (legally I think family is given precedence over friends unless noted in the health care proxy or other similar legal document). There is a form called “five wishes” that not only, once filled out and properly signed, acts as a health care proxy but also gives your health care proxy and physicians more knowledge about your wishes regarding your wishes/goals/etc should you not be able to speak for yourself. Find the link here : aging with dignity – five wishes 

Secondly, take a good look at your finances. Long term care is expensive and if you have a lot of assets, such as owning your own home, medicare/medicaid might not pay for living in a nursing home should that be what you need. Long term care at home might also be out of your reach. Hence it is important to talk to a financial planner or lawyer with experience in elder affairs or elder law respectively. If you have a disorder like dementia , it’s even more important to do this because you’re more than likely to need someone to make decisions for you at some point.

Elder abuse is also a concern, especially if there are cognitive or  severe mental health issues. This also makes it important to have someone to talk to or know where to go (for more information, go here: National Center on Elder Abuse ).

Thirdly, as I mention above and in my earlier post, be socially active. This is potentially helpful in a number of ways. one is that people are social animals. There are likely multiple benefits to mental and cognitive health by having a lot of social interaction. Also, being part of a community means there are people who could be called upon to help with food shopping, transportation to and from doctors offices (among other things), and so forth if you happen to be unable to do these things yourself – even temporarily such as due to an illness.

Motion is Medicine

If there was a medication that you could take that would help reduce weight, reduce the chances of developing disorders such as diabetes, dementia, and  osteoporosis, I think most people would take it. If the side effects of this medication (even in the absence of dementia, depression, fatigue, etc) were a better mood, a better ability to concentrate, less fatigue, even more people would probably clamor to take it.

There is such a medication: exercise. Some medical societies, such as the American College of Sports Medicine state that “exercise is medicine”. The current recommendations for the minimum amount of exercise is 150 minutes a week of moderate exercise. This comes out to 20 minutes 7 days a week or 30 minutes 5 days a week. Walking is an example of moderate exercise often used to give people an idea of what the effort level of moderate exercise is. One should be walking slowly enough that one could talk and not be out of breath, but fast enough that one couldn’t sing. When my patients state they can’t find the time to do 20 minutes a day, I encourage them to find 10 minute periods through the day to walk. Obviously for some forms of exercise (swimming, playing a game of basketball, etc), this would be impractical to do.

Some research indicates that exercise has an anti-inflammatory effect in the body. Other research seems to indicate increased sensitivity to insulin, increases in various other hormones (or decreases in others), it is likely the mechanism for the beneficial effect of exercise is due to more than one pathway. That is to say that rather than, say deceased inflammation is the cause for improved mood or a decreased risk of dementia, it is likely that improved insulin sensitivity, anti inflammatory effects, etc all act in concert to improve health in people who exercise regularly. When talking with my own patients I tend  to avoid talking about why it works  and prefer to talk about the kinds of exercising they could/should be doing.

Though I encourage people to do weight bearing exercises such as walking, jogging, basketball, etc, I also realize that there needs to be some accommodation. For someone who’s morbidly obese or has severe arthritis that limits, at least initially, how much they can walk I might suggest stationary bicycles, water aerobics or something like tai chi (which is a weight bearing exercise, but because one isn’t jumping around as much as with things like basketball) the stress on joints is lower. I also realize that if someone doesn’t like a particular form of exercise, that person’s less likely to do that than a form of exercise they enjoy doing. Prescribing exercise isn’t a “one size fits all” solution to promoting health.

For people who’ve read many of my earlier posts, have probably noticed that I’ve focused less on medication and more on lifestyle issues such as diet. This post is no different. Many of the most common diseases I see in the office are most commonly caused by, for lack of a better word, poor lifestyle choices.By this I mean having a poor (read “western”) diet and not exercising enough. Once one has hypertension, type two diabetes, obesity, etc, lifestyle changes might not be enough to totally reverse  or cure a particular problem in a specific patient. However even if one needs an antihypertensive, diet and exercise don’t become less important.

The Pantry Prescription

With this blog post, I realize I run the risk of sounding like one of those people that touts a new food every day or month (drink pomegranate  juice for it’s high anti-oxidant content. You’ll live to 100!! it’s the next superfood!!!!). As I’ve pointed out, when evaluating health claims for foods/pills/etc it’s probably better to evaluate the claims as how they relate to endpoints such as decreased risk for disease, death, etc. rather than take something just because it’s a good antioxidant or has other reputed health benefits.

Anyhow, if someone were to ask me what kinds of foods should I eat/have handy, here are a few things I’d probably suggest. It is not an exhaustive list by any means. Of course if one has allergies to any of these foods, then they shouldn’t be on that person’s list of foods to have:

#1) Olive Oil. This makes my list because of the health benefits associated with intake. There is an inverse relationship with olive oil intake and the risk of dementia (that is, the more you take, the lower your risk of developing dementia). I has a lot of anti-oxidants in it as well as healthy fats. It’s good for heart health as well. It is important to mention that it’s important to use it IN PLACE of other fats, not just add it to a bad diet. That is, use olive oil in place of animal fats, coconut oil and other saturated fats.

#2) Canola oil. It’s high in Omega-3 fatty acids which are associated with lower risk of death due to heart disease, dementia, etc.  It has a higher flash point than olive oil so can be used to cook at higher temperatures (and has a less strong taste which can be important with some foods).

#3) Flax seed/flax seed oil/ground flax. Flaxseed is also a good source of omega-3 fatty acids. However these are medium chain omega-3 fatty acids (as opposed to the long chain omega-3 fatty acids which are found in fish. It is the longer omega-3 fatty acids which have been shown to have health benefits). Not all of the fatty acids are converted to long chain omega-3 fatty acids in the body, but any little bit helps, and any that takes the place of fully saturated fatty acids or trans fatty acids is a good thing. Fish such as tuna, salmon, and sardines, to name a few, are better sources for long chain omega-3 fatty acids.

#4) Legumes, any combination of them you might want (legumes include peanuts, lentils, any type of bean). In combination with a cereal (e.g. rice or wheat) will provide all the essential amino acids (make up a “complete protein”). The health benefits get even better if it’s a whole grain you pair the legumes with.

#5) Tree nuts such as almonds, walnuts, cashews, etc. Though relatively high in calories – they  tend to be high in fats – they are healthy. They contain some fiber. The fats they have tend to be the healthier types of fats and tend to be high in fat soluble antioxidants. Using a handful of nuts such as almonds to stave off hunger pains can help keep someone from consuming even more calories at dinner due to hunger. And they’re better for you than sugary/starchy foods such as crackers.

#6) Eat many different fruits and vegetables. The greater the variety the better. One study showed that blueberry intake reduced the chance of developing diabetes by 40 % (however this is only one study. Whether this is close to the “real number” blueberry intake reduces risk would be determined by looking at/doing more studies). Other fruit intake also reduced risk of certain diseases, for example,  apple intake is associated with a lower risk of developing emphysema.  Rather than relying on one “super food” or whatever fruit is the fad of the day, having a variety of fruits is probably better. Each fruit and vegetable has a different mixture of antioxidants and phytochemicals. The different phytochemicals probably have different affinities for different tissues (this is my supposition here. I have no proof to back it up other than a feeling it might be the case) and by having a variety of foods, it’s likely that more parts of the body will be protected.

#7)  A variety of spices. I would put turmeric high on the list of spices to have as it appears that the curcumin (a substance found in turmeric) is a rather potent anti oxidant and anti inflammatory agent. However, I would make the same argument about spices that I make about fruits and vegetables above. The greater the variety the better.

Notice I have not put on the list meat, poultry, milk or other sources of animal protein.I wouldn’t say avoid them, unless you have a  particular cultural or moral stand on eating animal products. I only mention fish because of the healthy fatty acids some fish contain. Limiting the amount of meat one has is important for maintaining health.  However the amounts of each, frequency of using these in diet is a topic for another time.

 

The Prevention Prescription, part 3

In my previous two posts I’ve written about different kinds of prevention (eg, primary, secondary, etc as well as vaccination which is a form of primary prevention). In this post I am going to talk about a couple of different things relating to prevention.

The first is that there are preventative measures which sometimes fall into more than one category. By this I mean that if we counsel someone to change their diet and exercise more because they’ve had a heart attack, give them aspirin, a statin, etc. that we’re engaging in tertiary prevention. However if they are on their way to becoming diabetic but because of the change in diet and increase the amount of exercise they do, and therefore lower their risk of Diabetes Mellitus, then one could argue that’s primary prevention (or secondary if they have metabolic syndrome…).

I’m a firm believer in using medication to lower cholesterol, blood pressure, etc when and if appropriate. However, I think we give short shrift to diet, exercise and sleeping enough as preventative measures to prevent or delay multiple medical problems.  Even if someone needs to be on medication, lifestyle changes are important to keep up. Exercise and diet do not become less important just because someone’s started medication. One recent study published in the New England Journal of Medicine comparing intensive lifestyle changes+usual care as compared to usual care did not reduce death. However there was evidence for a better quality of life and less need for medication, at least early on. There is a lot of evidence that enough exercise and good dietary practices can prevent and delay Diabetes. And for those that are cost conscious, a half an hour a day of walking is a lot cheaper than most medications!

There is a push by some physicians to actually prescribe exercise the same way we prescribe medications. Books have even been published on the matter!!

Four of the best things to do for your health.

Correlation between smoking and lung cancer in...

Correlation between smoking and lung cancer in US males, showing a 20-year time lag between increased smoking rates and increased incidence of lung cancer. (Photo credit: Wikipedia)

Four of the best things to do for your health.

1) Don’t start smoking. Stop smoking if you’ve already started.

 If someone asked you to pick up a habit that increased the risk of all of the following (and would cost you roughly $33-77 dollars a week depending on where you live, brand, etc), would you do so? Here are some of the things that smoking increases the risk of: lung cancer, colon cancer, bladder cancer, esophageal cancer, kidney cancer, pancreatic cancer, cervical cancer, vascular disease including aortic aneurysms and strokes. It increases the risk of fractures in post menopausal women. It increases the risk of low birth weights in infants. There is an increased chance of developing cataracts. For men in their 30s and 40s, it increases the risk of erectile dysfunction by 50%.

According to the CDC, smoking contributes to 443,000 deaths annually in the U.S.

2) maintain a healthy weight.

obesity raises the risk of multiple diseases: Diabetes Mellitus – type 2, high blood pressure, colon cancer (though the mechanism isn’t known how). It increases the risk of breast cancer (adipose tissue has an enzyme that converts testosterone to estrogen), osteoarthritis and more. There are no easy ways of doing this. At its simplest it means taking in the same amount of calories you expend. Granted if you’re overweight, you need to expend more calories than you take in.

3) Exercise

On top of helping maintain a healthy weight, excercise has many beneficial effects. Exercising reduces the risk of alzheimer’s disease, some cancers, it can improve mood, helps reduce blood pressure and can help prevent and treat diseases such as type 2 diabetes.  The suggested minimum is 150 minutes of moderate physical activity a week, which comes out to approximately 20 minutes a day. It can be something as simple as walking. The what of exercise (what kind) is less important than the regularity of actually getting exercise.

4) Have a healthy diet.

Potential health benefits of apple consumption...

Potential health benefits of apple consumption. (See Wikipedia:Apple#Health_benefits). Model: Mikael Häggström. To discuss image, please see Template talk:Häggström diagrams (Photo credit: Wikipedia)

Diet is the mainstay treatment in a lot of diseases. Whether it’s DM-2, high cholesterol, coronary heart disease (even if you’re on medication for any of these, maintaining an appropriate, healthy diet becomes no less important). In one study coming out of Lydon, France (known as the Lydon Study), people who were put onstandard treatment and who were switched to mediterranean diet with N-3 fatty acid supplementation (as opposed to just the  standard treatment) decrease their mortality after a heart attach by 66% (their mortality went from 17% down to 10%). This was independent of weight loss, decrease in cholesterol, etc. A dietary/lifestyle program promoted by Dr. Ornish which uses lifestyle changes, exercise and a vegetarian low fat diet (10-20% of calories from fat rather than the 20-30 used in the AHA step II diet) has been shown to reverse Coronary Heart Disease and is covered by medicare. A mediterranean style diet is also associated with decreased death from heart disease, a decreased risk of certain cancers as well as a decreased risk of dementia. At this point I won’t go into a huge discussion about diet (I’m likely to blog more about this in the future on multiple occasions).