Tag Archives: aging

Food and Health.

This won’t be an all-inclusive blog posting. To be all inclusive would require a novel, or at least novella, length blog post. People who have read earlier blog posts will know that I’m a fan of people eating healthy and not a huge fan of “fad diets”. The best healthy diet is the one you can adhere to.

As I’ve mentioned in other posts, and can be found online, diet and other lifestyle options can affect one’s chances of developing various chronic diseases. Though in this post I’ll be limiting myself to diet, and just a few things about it as well – and save other comments and suggestions for another time.

One piece of advice I can remember getting is to make sure one’s plate (ok, the food on one’s plate) is colorful as in having a lot of different colors. Granted in some cases (carrots and spinach) the colors don’t really indicate that they’re both high in the Vitamin A precursor Beta – Carotene, but both are (and have different profiles of how much of other healthy vitamins and fiber they have). Making sure that there are differently colored foods also means you’re likely to get other benefits. Both blueberries and cherries have a lot of antioxidants in them which can affect health. Though I think that we tend to look at their antioxidant effects too much at the expense of other effects they might have, such as on sugar absorption and metabolism. Never mind that blueberries and cherries also contain some fiber. There is growing evidence that blueberries can help prevent/treat type 2 diabetes. This doesn’t mean, however, that eating them replaces medications such as metformin, acarbose, rosiglitazone, and many others. Cherries may carry a similar benefit.  Tart cherries are touted to have anti-inflammatory effects and might help reduce the need for non steroidals in some people.

The fatty acids one eats can also affect health profoundly. The N-3 (also known as omega-3) fatty acids not only help protect against heart disease, but also seem to have a role in preventing depression and helping treat it as well. Though depression as an inflammatory mediated illness has gotten some press (though at the moment I don’t have a reference for that, and who hasn’t felt miserable when (s)he has a cold or the flu), it also avoids the fact that N-3 and N-6 fatty acids also get incorporated into cell walls, including nerve cells. This incorporation also affects the fluidity of the cell walls and therefore how well receptors work as well as how easily (or hard) nerve cells release neurotransmitters.

My advice, as always, is to try to avoid getting vitamins and such through supplements for a few reasons:

  1. In some cases they can do more harm than good (especially true of fat soluble vitamins). In one study, smokers that took vitamin A supplements had higher rates of lung cancer than those that didn’t.
  2. You might not be getting all the relevant forms of particular vitamins. For example, there are different forms of vitamin K, some promote clotting, others bone health.
  3. With a varied diet, one can get enough vitamins and antioxidants without supplements. You have to eat anyhow, even if you buy pills.

There are several times, however, where it might be worthwhile. For example:

  1. If you have had a gastric bypass, or a stomach resection for another reason, taking supplemental B12 is important so as to keep stores normal.
  2.  If you have a disease, or take a medication, that interferes with absorption of particular vitamins (Crohn’s and other diseases that affect the ileum can interfere with absorption of B12, anti ulcer mediations do the same.)

I’ve talked about diet before (The Pantry Prescription) so I won’t go into it today. I may do an updated version of  that post in the future.

Anyhow, here are some references to a few of the things I’ve mentioned today:

Coultrap, S. J., Bickford, P. C. & Browning, M. D. Blueberry-enriched diet ameliorates age-related declines in NMDA receptor-dependent LTP. Age (Dordr) 30, 263-272 (2008).

Ren, T., Zhu, J., Zhu, L. & Cheng, M. The Combination of Blueberry Juice and Probiotics Ameliorate Non-Alcoholic Steatohepatitis (NASH) by Affecting SREBP-1c/PNPLA-3 Pathway via PPAR-α. Nutrients 9, (2017).

Stull, A. J. Blueberries’ Impact on Insulin Resistance and Glucose Intolerance. Antioxidants (Basel) 5, (2016).

Lee, Y. M. et al. Dietary Anthocyanins against Obesity and Inflammation. Nutrients 9, (2017).

Mazaherioun, M. et al. Long Chain n-3 Fatty Acids Improve Depression Syndrome in Type 2 Diabetes Mellitus. Iran J Public Health 47, 575-583 (2018).

Masoumi, S. Z. et al. Effect of Citalopram in Combination with Omega-3 on Depression in Post-menopausal Women: A Triple Blind Randomized Controlled Trial. J Clin Diagn Res 10, QC01-QC05 (2016).

Grant, R. & Guest, J. Role of Omega-3 PUFAs in Neurobiological Health. Adv Neurobiol 12, 247-274 (2016).

Husted, K. S. & Bouzinova, E. V. The importance of n-6/n-3 fatty acids ratio in the major depressive disorder. Medicina (Kaunas) 52, 139-147 (2016).

Kobayashi, M. et al. Dietary n-3 Polyunsaturated Fatty Acids in Late Pregnancy and Postpartum Depressive Symptom among Japanese Women. Front Psychiatry 8, 241 (2017).

Levant, B. & Healy-Stoffel, M. N-3 (Omega-3) Fatty Acids: Effects on Brain Dopamine Systems and Potential Role in the Etiology and Treatment of Neuropsychiatric Disorders. CNS Neurol Disord Drug Targets (2018).

Pusceddu, M. M., Kelly, P., Stanton, C., Cryan, J. F. & Dinan, T. G. N-3 Polyunsaturated Fatty Acids through the Lifespan: Implication for Psychopathology. Int J Neuropsychopharmacol 19, (2016).

 

What’s the Secret to Longevity? Lessons from “Blue Zones” Worldwide – MPR

What’s the Secret to Longevity? Lessons from “Blue Zones” Worldwide – MPR.

I found this article interesting, although  it’s a few years old. I don’t know how the life span compares to communities surrounding the ones listed. The things each community does or has do sound a lot like the health advice given to patients to stay healthy and each community has things in common with each other.

The things that likely make a “blue zone” a blue zone are as follows:

1) They maintain a healthy plant based diet. With the exception of Seventh Day Adventists who don’t eat meat at all, meat is only eaten either in moderation or very rarely. In Okinawa people grow their own food, which also means they’re outside walking, bending, exercising, etc.

2) Exercise is done. It can be physical work, it can be walking. Current recommendations are for 2.5 hours of exercise a week (this works out to roughly 20-30 minutes daily).

3) People are part of  the community. Some have made the claim that regular church going helps you live longer. Given that there’s no empiric evidence for a higher power, it’s more likely the social contacts, the sense of belonging or being part of something greater than oneself that help maintain emotional health. I won’t ponder more about this at the moment. At this point I’m planning a post talking more about this because it deserves a post of it’s own (or two).

Of note, I haven’t been too active blogging here the past couple of years and am planning on becoming more active in doing so. I am considering adding another blog where I talk about self care things people can do to helps stay healthy and keep this blog to talk more about medicine itself, and  talk about specific illnesses. Let me know which (an additional blog about staying healthy/self care issues + this one or an “all in one” blog) you think would work better.

Better Sleep May Be Incredibly Important to Alzheimer’s Risk

Better Sleep May Be Incredibly Important to Alzheimer’s Risk.

Sleep disturbances are common. Sometimes patients have come in with sleep problems that are clearly related to temporal issues (such as stressors like a death in the family, work stress, etc).

It is the people that come in with chronic issues which I think are challenging. Some patients have come on while on medications chronically to help with sleep. One concern is that they end up being too dependent on medications to sleep. When seeing things like this, it makes me wonder if patients on sleep medications chronically are altering their sleep architecture enough that it still puts them at risk for things.

Some sleep issues, such as obstructive sleep apnea, do put one at risk for things like high blood pressure, irregular heart rhythms, etc. luckily for that things like weight loss, CPAP machines, etc can help without the use of medications. This article does make the case for getting good sleep regularly!

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.

Stroke

In this post I’ll be talking about Strokes (also known as Cerebral Vascular accidents). It is the fifth leading cause of death in the United States.  It also is a major cause of disability and in terms of treatment, missed work, etc costs an estimated $34 billion dollars a year in the U.S. alone. Although the risk for stroke rises as we age, according to the CDC website 34% of strokes were in people younger than 65.

There are two kinds of stroke. One is hemorrhagic, meaning that is caused by bleeding. The other is ischemic, meaning that it is caused by a a blockage in a blood vessel. The symptoms, however are determined by the location and size of the stroke. Symptoms include: Facial Droop, double vision, confusion, garbled speech, limb weakness (especially if it occurs on one side of the body), numbness, and headaches.

It is important that if one suspects he or she is having a stroke that medical care be obtained quickly. There is a 3 hour window of opportunity from the start of symptoms that ischemic strokes can optimally be treated with clot dissolving medications. More than three hours after the start of symptom and the likely hood of poor outcomes increases – and the riskier it is to use medications to try and unblock arteries.

An acronym used to keep in mind regarding stroke is the word FAST (Face – is the face symmetrical: is one side drooping? Arms – weakness in one arm. Speech – is it normal? Time – call 911 immediately if it seems someone’s having a stroke).

Ischemic strokes are the most common. Based on symptoms one can’t tell if a stroke is ischemic or hemorrhagic, so it’s better to get to a hospital quickly. At this point in time there may be fewer acute treatments to stop hemorrhagic strokes, but even then supportive treatment is available.

Sometimes symptoms resolve quickly (within a few minutes). This is called a Transient Ischemic Attack, or TIA. This should not be ignored because people who have had a TIA are at increased for having a major/bigger stroke.

Although there isn’t anything that can be done about some risk factors such as age, there are many things one can do to reduce the risk of having a stroke:

1) Control your blood pressure if you have high blood pressure.

2) Lower your cholesterol if you have high cholesterol.

3) Control your diabetes if you are diabetic.

4) If you smoke, stop. If you don’t smoke, don’t ever start.

5) if you have an irregular heart rate, talk to your doctor about whether you need to be on blood thinners as certain irregular heart rhythms increase your risk of ischemic strokes.

6) Exercise (this will help with numbers 1-3 above)

Aging Well

I think that when most people think of aging well, they think of what adults do to become healthy older people. Another line of thinking, which I happen to like, is that successful aging starts  in childhood (may be even in utero) as many things that occur in childhood can affect health as adults. Think of people whose mothers had rubella while pregnant with them. For those of us old enough to have gotten chicken pox rather than the vaccine, we’re at risk for shingles as adults. Severe iodine deficiency can lead to hypothyroidism and developmental delay (a more politically correct term for mental retardation). Growing up bilingual seems to protect against developing dementia, as well as having other beneficial effects on growing brains. The list goes on.

Though many people associate older age with disability and frailty, it doesn’t necessarily have to be that way. One thing I was taught throughout my training is that the older old (people in their 80’s and 90’s) are healthier than those in their 60s. At first this might sound counter intuitive. However, if one considers that those who are sickest die sooner, then it makes sense. The person whose only health issue is well controlled diabetes or well controlled hypertension is much more likely to reach his or her 80s than one who is overweight, diabetic with a glyco-hemoglobin of, for example, 9.5%, high cholesterol and has poorly controlled hypertension.

However, as I am assuming most if not all people reading this are adults, and as a time machine that would let people go back and vaccinate themselves against chicken pox, or somehow convince their parents to make them grow up bilingually (unless they did already)does not exist, I will limit myself to what an adult can do to age successfully. Nothing is guaranteed to prevent illness or frailty but what I suggest below does seem to help protect from or delay such things.

1. Stay Active. Our ancestors did not sit in cubicles all day earning enough money to buy food. They had to do any one of the following to get food: hunt animals, gather food, tend/harvest crops in the field or herd cattle/sheep etc. Only in the past few millennia was it possible for farmers to support a population where everyone didn’t need to be involved with procuring food/housing/etc. Not that getting food was a 24/7 job, but took more physical effort than driving to a supermarket. Even then people walked or rode horses to get places on land. Now it seems like to go more than 50 feet people drive their cars. Our bodies were made to be used. We should all be taking at least 10,000 steps a day (this comes out to walking approximately 5 miles/day).

2) Avoid bad behaviors. By this I mean, don’t do things that can shorten your life. Avoid smoking (not only is it bad for your lungs and increased your risk of lung cancer and of COPD, it raises your risk of bladder cancer, kidney cancer, esophageal cancer, raises your blood pressure and risk of heart disease). Drink in moderation (no more than 1 drink/day). Avoid any street drugs and sharing needles.  If you are sexually active and not in a monogamous relationship, use condoms. Having a discussion about your partners(‘) HIV status isn’t a bad idea either.

Don’t forget to embrace good behaviors. By this I mean not just those things I mention above and below, but also keeping any chronic diseases you have under control as best you can.

3) Be part of a community. Whether it’s a church (or synagogue or mosque), club for a hobby you enjoy, volunteering or any other activity that regularly gets you out with people, do something where you interact with people. The more positively the activity affects your community, the better. Humans are a social species. It helps keep your mind active if you remain part of a community.

4) Watch your diet. Eat healthy. What constitutes a healthy diet could (and likely will) take up a whole other blog post or two. Eat more vegetables. Cut back on meat – processed and otherwise. Eat more fish. Don’t drink to excess.

5) Be curious and educate yourself throughout your lifetime. Whether it’s people with more neural connections that end up in college and graduate school (and that is what makes people with college degrees less likely to develop dementia) or whether the education helps the neural connections stay healthy isn’t known. It could also be that the more educated someone is the more likely it is they will maintain doing healthy behaviors. In any case,  your brain is like a muscle, use it or loose it. If you have the time and inclination, learn another language. Take up a new hobby. Take a course in something you don’t know anything about. Take a refresher course in Italian (or spanish, or multivariable calculus, whatever floats your boat). If it’s another language, try and get good enough you can go to a foreign country where that is the official language and use that without having to speak English.

6) I realize not everyone has as much money as Warren Buffet or Donald Trump, but watch your financial health as best you can. If you retire, you don’t want to have to choose between a co-pay for medication or rent +/- food. If you can afford it, consider getting long term care insurance. If you need long term care, it can mean the difference between being at home with help or needed to go into a nursing home (policies are different, some might pay for nursing home stays as well).

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