LiveLongAgeWell

I am on break! (but not from working, just from entering posts)

Yes, I’ve been very busy recently with setting-up a medical company, and I  haven’t had the time recently to devote to my LLAW postings. (Since LLAW is a totally free blog—no charge ever to subscribers, and never any advertising—I don’t feel so guilty.)  I am of course keeping up with all the latest medical news, and when I have time again to devote to posts, they will again magically appear.

This article is dedicated to the many people who seem to get enough aerobic exercise, and eat a reasonable diet, but still have problems with excess fat. It will give you something else that might help your situation; something basic and super simple…

Have you observed that as far as general activity level is concerned, people tend to fall into one of two big categories: the people who tend to be “couch potatoes”, and those who are constantly moving? The first group just doesn’t seem to want to move much. They would rather wait for the elevator than take the stairs, even for one floor, and if they are sitting watching TV or at the computer, rather than jumping up and getting something they need from another room, they will call for help or at least just sit and wait until they have more motivation to actually get up and move.

Now the other group, we might call the “movers” or maybe “people who putter”, seem to be constantly moving, almost in a nervous way. But take a look at the body shapes of these two groups, and you might notice a pattern—the movers tend to be a lot trimmer than the people who don’t like to move. It makes a lot of sense, and now we have good scientific evidence that the movers are both thinner and healthier than the sedate group, but the reasons for this are a lot more complex than what you might think.

Studies comparing people in occupations requiring lots of sitting (such as bus drivers) with those who stand much of the day (for example train conductors), have shown a much higher rate of cardiovascular disease and fatal heart attack in those who sit most of the day.  Experimental studies have recently demonstrated that sitting a lot, even a few hours straight, lowers the activity of the enzyme lipoprotein lipase, which normally works to decrease the fat content in your blood. So even a few hours of sitting seems to alter your very fat metabolism.

A study of otherwise healthy men who became incapacitated and confined to bed rest showed that three weeks of bed rest had a bigger negative impact on their physical work capacity than 30 years of aging. Scientists (“inactivity physiologists”) are now more closely studying the physical changes during our “inactive” periods, but while we await more research, it seems clear that people who sit too much during the day face a host of problems, and to cut your risk of obesity, diabetes, and of heart attack, you need to, basically, “get off your butt” and move around more. For some people, even a good program of  regular aerobic exercise, combined with a reasonable diet, may not be enough to keep your weight under control if you sit much of the day.

•    Avoid sitting too long. You are at higher risk of serious metabolic problems if you spend hours watching TV or sitting in front of the computer at work or during your free time. As much as you can, just get up and walk or move around, if only for a minute or two at a time, that’s fine. If you can’t get up, at least shift in your chair regularly, and maybe shake/stretch your arms and legs occasionally. Try to change your mindset so that when you need something from another room, you see that as a good thing, not an irritation.

•    If you like video games, consider as an alternative to the standard (sitting) game something more active like the Nintendo Wii, which will get you up and moving, and allows you to play too. It’s great for both your body and your mind.

•    People who sit for long periods, for example on an airplane, suffer a higher risk of DVT or “deep vein thrombosis” a potentially life-threatening condition in which the blood stagnates in the deep veins in your legs to the point that a clot forms which breaks off and travels through to your lungs. Basic prevention involves getting up and moving around the plane occasionally, and flexing your calf muscles while seated to get the blood moving in your legs. Drinking water also helps to keep your blood from getting too thick and prone to clotting.

You may think that getting older means becoming less happy, but various studies, including this new one just released at the American Psychological Association (APA) meeting in Toronto, show just the opposite: most people actually become happier as they get older. Good news, especially as the fastest growing population segment—in the U.S. at least—is people over age 85.

This APA study from the University of California found two exceptions to the older=happier correlation. First are people dealing with dementia, and second are people stuck in a long-term stressful situation without escape, for example, a debilitating chronic disease.

Most of us, however, can look forward to greater happiness as we get older. The researchers felt that a main reason for that is that over time, we learn from experience what makes us stressed or unhappy, and we become better at avoiding or just ignoring those people or situations.

More from the APA Meeting

Two other interesting presentations at the APA …One a large Swedish study demonstrating that those adults who have a “strong social network” were 60% less likely to become demented over time.

The second one sounds obvious, yet is something frequently ignored—that many people who seem to be getting mentally slower are really not; it’s just that their hearing has slowly dropped, making them seem dim-witted. Be aware that many older folks are embarrassed to admit a hearing problem, so keep this in mind regarding your own family. If you notice someone losing sharpness over time, one of the first things to test is hearing.

“Sham” Vertebral Procedure and the Placebo Effect

The best possible research study is a “double-blind clinical trial”, and a typical trial like this involves splitting up a group of people into two equal groups, and giving one group an active drug, and the other group an inactive drug (placebo) and then comparing the outcome of the two groups over time. Unfortunately, since these studies are expensive and time-consuming, a majority of research studies are not true clinical trials, and surgical clinical trials involving placebo, or “sham” surgery, is exceedingly rare.

Sham surgery is complex in many ways; you can imagine trying to convince one half of a study group that they really had surgery, when in fact they had nothing more than an incision made, or an anesthetic shot given, rather than a full operation.

So I can’t recall the last time I read about a sham surgery clinical trial, but one was just completed by a team from Australia, Britain, and the U.S. The goal was to learn if vertebroplasty, a common back procedure (to decrease pain in vertebral fracture patients) was actually effective, or the improvement seen was just a placebo effect.

The researchers performed the full procedure on one half of the patients, involving an anesthetic shot and injecting bone cement into the fractured vertebra. The 50% of patients who had the sham procedure had the anesthetic shot but no cement was placed. To add realism to the sham group, the doctors had the cement in the room to give the same smell sensation as the real procedure.

The result was that the sham surgery group did just as well, with just as much improvement, as the ones who had the full procedure. For more details, look at this full summary in the New York Times. And if you have doubts about the efficacy of a procedure or operation your doctor suggests, you might ask “what clinical trials have been done, if any, to show this procedure is effective?” Your doc will be surprised, but should be able to answer.

Finally….it seems a number of research papers in the past decade have been “ghostwritten” by medical marketing companies rather than doctors. (This is probably no surprise to most doctors, but I suspect it might be for the general public.) In these cases the drug company hires a marketing company to write a paper with a positive spin on whatever they are selling or wanting to sell. Note that if the research did not turn out in their favor, they just wouldn’t publish it.

After the marketing writer finishes his favorable report, the doctor(s) may just look the paper over and make a few changes, but often the report is tailor-made to suit the drug company. Amazing how medicine has changed over the years, and how doctors can be bought off. Supposedly this practice, now exposed, will stop, but I doubt it.

Artificial Tanning Beds

Last month I covered sunscreens and sunless tanning lotions, and as a follow-up, there was a recent reclassification by the International Agency for Research on Cancer (IARC) that tanning beds should be raised to Group 1, that is, the highest risk level: “carcinogenic to humans”. While the artificial tanning bed industry has marketed their products as safer than the ultraviolet radiation from sunlight—and as not increasing the risk of melanoma (though they neglect to mention the increased risk of other forms of skin cancer)—the IARC reports a 75% greater risk of melanomas in people who start using tanning beds before the age of 30. Besides the cancer risks, while a tan might make you look better in the short run, in the long run you will end up more wrinkled. And though artificial tanning booths are dangerous, remember that sunless tanning lotions can be quite effective and safe.

Organic Food Not Worthwhile?

A headline from Reuters London caught my eye last week: “Organic food no healthier, study finds”. The author of the English study stated: “Our review indicates that there is currently no evidence to support the selection of organically over conventionally produced foods on the basis of nutritional superiority [italics mine].”  (Really, OK, maybe not proof, but no evidence at all?)

So a quick read might lead you to think it’s not worth the extra expense and trouble to seek out organic products. But this would be a false conclusion on at least two counts. First, the study only analyzed “nutritional content”; this is, what’s in the food, but most people choose organics because what’s NOT in them; i.e., pesticides and other organo-toxins (not addressed in this research). Second, if you look at what they consider “nutritional content”, you find they did not analyze antioxidant content, which is another reason to choose organic. While it’s true that there is not yet proof organics have a higher natural antioxidant content; for me, I’ll stick to organic products whenever I can. Unlikely any future research will find any health benefit whatsoever from eating foods with pesticides. It’s far more likely organic foods suffer less antioxidant loss during any processing, transport, and chemical additions.

Another Reason To Keep Your Cholesterol Below 200

If you know that your total cholesterol level is borderline or elevated, and you haven’t taken measures to change that, here’s another reason to take action. Published in the August Dementia and Geriatric Cognitive Disorders, researchers studied nearly 10,000 Northern California Kaiser Hospital members, and found that those who had total serum cholesterol levels over 200 mg/dL in their 40s, had a significantly great risk of dementia when they reached their 60s and 70s. The risk for either Alzheimer’s disease or vascular dementia was at least 50% percent greater in people with only mildly high levels—over 200. So take measures to keep your cholesterol in the normal range: whether it means a change in your diet and/or increased exercise, and if that doesn’t work, you should ask your doctor about possibly taking a “statin” drug to lower your lipid levels  (which—as logically follows from this study—have been shown may help prevent dementia.)

The H1N1 (swine) flu pandemic is dangerous, yes, but also fascinating as a study of how different countries are responding and how theories change quickly. Here in Brazil, where it is winter and prime flu season, the massive city São Paulo has pretty much closed down all schools for the next two weeks, affecting over 6 million students. And just a few weeks ago, public health officials were theorizing that obesity alone appeared to be a major risk factor for developing a serious case, or of dying of the influenza.

Many of the people with H1N1 in ICUs seem to be obese, and the United States—with the epidemic of obesity affecting, amazingly, about 34 percent of the population—has had a much higher death rate than Japan, for example, with less than 2% of the population obese.

Now, the U.S. Center for Disease Control has decided that obesity, on its own, doesn’t seem to be a risk factor. Still it’s worth remembering that fat cells, especially those deep in the abdomen, secrete substances that cause a chronic state of low-level of inflammation in the body, and as a result, obesity depresses your immune system making you more susceptible to most any infection, or even cancer.

So if you are living in the summer now but have worries about flu in the upcoming seasons, you would do well to get yourself in shape and try to lose as much fat as possible to keep your immune system functioning well. If you smoke, have a plan to quit before the fall. Besides that, you can markedly cut your risk of flu by three simple measures: keeping at least a meter (3 feet) away from anyone sick, washing your hands multiple times during the day (especially after you touch surfaces in public areas), and avoid touching your nose, eyes, or mouth, because that’s how you infect yourself.

Know that these influenza viruses, fortunately, don’t penetrate through your skin, and if you remember to always wash your hands well before touching your face, you are much less likely to become infected.

OK, now another way to keep healthy and fit—eat your “greens”…Here is Part II, How to eat greens! (last week was background information):

•    When you try greens and don’t love the taste right away, consider that kale, the king of the greens, contains about 10 times more of that fantastic anti-oxidant lutein as does broccoli. The high fiber content in greens will help you control your weight, your cholesterol, as well as your blood sugar. If you have a family history or particular concerns with breast, ovarian, or colon cancer, you should eat some greens every day. If you smoke, daily greens might give you some protection from the carcinogens in cigarettes. So these truly are superstar vegetables, and you can develop a taste for them.

•    Kale is probably the healthiest of the bunch, but collards are excellent as well, and the flavor tends to be a bit smoother. The plants harvested during cooler weather may taste better, and look for smaller leaves. Spinach is a green, and a good way to start, but you should venture forth and experiment with the more potent ones. You might slowly add bits of raw kale into your daily salad, or add finely-cut collards to soup. Kale comes in different colors and varieties. Mustard greens have somewhat of a spicy, racy taste. Over a few months try them all and see which you like the best.

•    When preparing, cut out any tough stems, and to make life easy, try frozen greens or find bags of pre-washed, cut greens. You can lightly sauté them in olive oil, and try adding lemon, pine nuts, and some red pepper flakes. Look at the DDD appendix for more hints on finding recipes. One note for those on blood thinning medication: the high vitamin K content in greens could interfere with your medication, but rather than avoiding greens, research suggests greens might help protect you from the bone-thinning effects of those medications, so discuss with your physician.

Today I’m posting a chapter from my  book-in-progress: How To Drop Dead Dancing In Your 90s….here is Part I of GREENS!

Kale. Collards. Mustard Greens. Beet Greens. Dandelion Greens. Swiss Chard. Spinach. All “greens”, and, except for spinach, they are foreign to most American diets. Despite having a taste that many might also regard as foreign—too strong, even bitter—to increase your odds of dancing into your 90s you should move beyond salad and the more conventional vegetables and start adding these more exotic  “greens” into your routine.

Taste bud research suggests some people are genetically programmed to despise the taste of greens, and if that includes you, try making an extra effort, because these are the vegetable superstars. Some nutritionists feel they have more value per calorie than any other food.
Perhaps greens have such a distinctive taste because they are so primitive. Unchanged for thousands of years, originally from Asia and Africa, hearty and easy-to-grow kale was among the first vegetables brought by the colonists to the New World. Later, American slaves popularized collards, and greens became part of “soul food”. Unfortunately they were often considered throwaways—vegetables for poor people—until scientists discovered that they were actually so nutritionally rich, and now greens are enjoying a renaissance.

They are full of fiber and low in calories, bursting with vitamins A and C, iron, calcium and various other minerals, and those mysterious “phytochemicals” such as lutein and the more impressively named zeaxanthin; these are the most exciting components in greens, the substances that protect our cells from cancer, age-related vision problems, and maybe dementia. An extra benefit: many American diets are deficient in vitamin K, and greens are the absolute best natural source for this vitamin.

Like most vegetables, adding greens to your diet will help keep your cardiovascular system healthy, and lower your risk of stroke. But greens are much more potent—studies suggest that a green-rich diet is associated with a significantly lower risk of lung, breast, ovary, colon, and bladder cancer. Most research indicates about a 20 to 50 percent lower risk of these cancers in people who eat lots of greens. The mechanism seems to be that the phytochemicals trigger a genetic signal that stimulates the activity of detoxifying enzymes in our liver, so carcinogens are neutralized before doing damage.

Scientists (and drug companies) are working furiously to treat osteoporosis, and along with the importance of calcium and vitamin D, vitamin K is a new star for keeping our bones strong. The Framingham Heart Study showed that those with the highest vitamin K intake had a 65% decreased risk of hip fractures! If true, eating a good amount of greens certainly is a much cheaper and safer and perhaps a more effective way, compared with medications, to lower your risk of disabling bone fractures. And, as we will discuss further in the PROTECT chapter, greens intake probably dramatically cut the risk of cataracts and macular degeneration (the most common form of age-related vision loss).

Next: Greens, Part II

For those of you with dreams of life extension, there was good news last week. It has been known for many years (since the 1930s), from fruit fly, worm, and mice studies, that long-term calorie restriction extends  life spans in many of these animals. Some mice, who from birth have been fed 30% fewer calories than normal mice, have had their life spans increased by up to 30- or 40%. But before you go on a radical diet (or worse, put your kids on such a diet), be aware that many strains of mice and rats do WORSE on such a diet. Still, the fact that many animals aged so much better has tickled the fancy of anti-aging researchers.

A big step up from rodent studies, and before human trials, is primate research. Monkey studies are very expensive to carry out, and life span research, as you might imagine, take many years to complete. Still, twenty years ago, a long-term rhesus study was started at the University of Wisconsin, and now there are preliminary results supporting the value of calorie restriction in suppressing diseases. The rate of tumors and cardiovascular disease was cut by half for the calorie-restricted monkeys, and none of the these monkeys developed any signs of diabetes (which affected about 40% of the normally-fed monkeys). Further, the calorie-restricted monkeys had less muscle and brain shrinkage, and also looked younger than the normally-fed group.

Identical ages; one on right fed long-term low calorie diet.

Since these monkeys normally live about 27 years (and up to 40 in some cases), this 20-year-old study is only about half-way completed, and life span comparisons will take some time yet. But (and here’s your chance again to be part of a research study if you live in the Eastern United States), the so-called CALERIE study is beginning in several U.S. medical centers, which attempts to see if a 25% reduced calorie diet (of course nutritionally balanced) will show positive changes in humans.

Scientists don’t know why calorie-restriction diets might work. Of course if we have lower cholesterol levels, lower blood pressure, fewer cancers, less diabetes and so forth, it’s not so hard to imagine a longer life span, but other factors are also suspected. It is thought that semi-starvation shuts off some of our genes that are directed towards reproduction, and turns on genes that promote better maintenance of our current bodies (our organism senses there is not enough food to share with other, new people, so to best preserve the species, our bodies work harder to preserve our own bodies).

Realistically, a calorie-restricted diet on a long-term basis is not easy to maintain, so many biotech researchers are trying to mimic this semi-starvation effect through medication. Many of the efforts involve resveratrol, an “anti-aging” component found in red wine. This sort of medication would have an incredible market potential as you can imagine, and I believe that within ten years we will a FDA-approved pill we can take that will replicate this semi-starved state.

But for now, I think anyone interested in trying a severely calorie-restricted diet should talk to their regular physician, as well as to an endocrinologist and a nutritionist to see if it’s a good idea, as there are risks. These potential, yet unknown risks and a constant feeling of deprivation might not be worth it, and you might well wait for more human trial results or some proven pill to be released. Failing that, there are studies showing that periodic short fasts—by stressing your body much as exercise stresses your muscles, yet makes you stronger—might offer some of the same benefits. It may be that some form of alternate-day fasting may be as good as full-time calorie restriction. Again, talk it over with your doctors, and if you decide to try something like this, get regular blood tests and physical exam monitoring to see how you are doing.

Finally…..I want to mention to my subscribers that only about 1/2 of the LLAW posts are sent out (I know there is too much mail)…but if you care to read other posts, on other topics, you need to go the the LLAW website itself. Thanks for your interest.

I have always been impressed how often a bad string of ill health starts with a fall. For many older people, a fall, especially one resulting in a broken hip, can lead to a cascade of problems: surgery, a long period of diminished mobility and further loss of bone and muscle strength, then sometimes complications like blood clots and pneumonia, and even a tendency towards mental decline if measures are not taken to reverse this course.

And falls in younger people are not great either. For the physically active, sprained ankles are the number one sports injury. In the U.S. alone, about 8 million people suffer such an injury, and, alarmingly, about 30 to 80 percent of those people will go on to re-sprain either the same ankle or the other.

One common factor leading to falls in both younger, and especially older folds, is a diminished sense of balance, so no matter what your age—whether you want to avoid a sprained ankle that would crimp your exercise routine or a broken hip that could lead to much worse problems—I recommend you look at this simple, yet elegant 3 minute video about balance training imbedded in this New York Times health blog article. While the video shows several different simple exercises you can do to strengthen your ankles and improve your sense of balance, the take-away basic exercise is this (from the article): “Stand on one leg. Try not to wobble. Hold for one minute. Repeat.”  (Try it; it might be tougher than you suspect.)

You can progress towards more difficult exercises from that basic one, such as crossing your arms while balancing on one leg, then closing your eyes, then trying it on an unstable, softer surface such as foam or a pillow. The more difficult ones will do more to strengthen your brain’s balance circuitry, which is especially important as we get into middle-age and beyond (if doesn’t apply to you, think about your parents).

Make sure you do any of these exercises close to a wall or a table or column or something to steady yourself if needed, and do it away from sharp or breakable objects. Check with your doctor especially if you have had a recent injury. You might even start a routine of doing the basic balance exercise while brushing or flossing your teeth…it’s a way to incorporate several beneficial health behaviors at the same time, and beginning a routine like that will make you much more likely to be consistent with the activity, and consistency is one key to success. Consider a Post-It reminder note on your bathroom mirror, until the activity becomes a habit!

A New Risk Factor For H1N1 (swine flu) Infection

An interesting risk factor has emerged regarding those who get severely ill or die from H1N1 flu: obesity. It seems that a large majority of those ending up in intensive care units worldwide are overweight, and the more overweight, the higher the risk of more severe complications. This story of course is still unfolding, but it’s a very curious finding so far, and may be the reason that Japan, for example, with a very low prevalence of obesity, has had ZERO deaths with over 2000 H1N1 cases confirmed. The U.S., with a huge, growing prevalence of obesity, has a much higher death rate. For more, including theories why, click here. Another good reason to keep your weight under control, and not only for this infection…excess fat cells secrete substances that impair your general immune system, leaving the obese more prone to infections, as well as cancer.

Here in LLAW we’ve recently covered sunscreens, and that the sun is responsible for a majority of the changes in our skin that we normally blame on aging. It’s not our age, but the amount of sun exposure we’ve accumulated over the years that gives us most of our wrinkles.

If you listen to dermatologists, they will say something like: “there’s no such thing as a safe tan”. Meaning, all tans, while they might make you look good, are manifestations of damage to your skin’s DNA. From a wrinkle- and cancer-prevention standpoint, a pale complexion, while not considered the most attractive, is certainly the most “healthy”.  I have several dermatologist friends who are really serious about the sun issue. They practice what they preach, and I have never seen them with a tan.  But, for me, I’ll take a bit of sun, a bit of that risk. Still, it’s nice to know there’s a decent alternative—self-tanning—something people are moving to as a way of avoiding the risk and damage altogether. Are self-tanners safe?…

In the last few years the cosmetic industry has developed products that won’t turn you a sickly shade of orange.  By blending the tanning chemical DHA (dihydroxyacetone) into a blend of moisturizers, and stabilizing the chemical release, most people can now get acceptably good results. And the active component DHA does truly appear to be safe. It’s derived from glycerin, is not absorbed into the bloodstream, and only works on the outmost layer of the epidermis of the skin. The brownish color is result of a chemical reaction between DHA and the proteins in your skin cells, and, since your dead outer skin cells are constantly shed off, the “tan” also sheds off within a few days to a week.

DHA has been around for 30 years in various cosmetics, and as far as I can find has never been found to be toxic or carcinogenic. While you might hear about other products, such as tyrosine, DHA is the only component that appears to be safe and effective. Certainly avoid any pill that promises to make you tan; these are all dangerous. (And don’t believe that some tanning beds are OK; none of them are safe sun alternatives.)

Sunless-tanning hints:

1. check out products from Jergens (the Natural Glow line, various products for different skin tones) and L’Oreal Sublime Glow Daily Moisturizer. If you like the more “chic” brands, try one made by Clarins.

2. consult the list of products approved by the Skin Cancer Foundation.

3. you might have to experiment with several to see which one works best for you. When you first use one, don’t use it on your face; find an out-of-the-way spot to check the result and to make sure you aren’t allergic.

4. first wash and gently exfoliate your skin before applying, so that your skin is a smooth surface to uniformly pick up the product.

5. use fairly generously, as you would sunscreen, but avoid too much around your elbows, hands, and tops of the feet. Here your skin is thicker and you might get more pigment change. If certain areas turn out too dark, you can partially reverse the process with a bit of hydrogen peroxide or even whitening toothpaste rubbed-in as needed.

6. wash your palms right away, and if you use on your face, don’t forget to apply to your ears.

7. remember you still need to use sunscreen if you get out into the sun! Neither the “sunless tan” or the product themselves will protect your skin from sun damage. However, there are new products that combine 15-30 SPF sunscreen into the self-tanners.

I suggest you try one of these products, particularly if you are worried about the damage you get from even a mild tan, or about possible toxic effects from sunscreens themselves. None of these DHA products out now are perfect, but most people can find one that works quite well.  And on the horizon, being developed in Australia, are self-tanners that work by stimulating our skin’s melanin. If they are shown to be safe (I wouldn’t be the first to use them), they will be a remarkable leap forward in sunless tanning.

Several weeks ago I detailed some problems with the common over-the-counter pain reliever acetaminophen (otherwise known as paracetamol, and the biggest U.S. brand name is Tylenol). The issue is that this medication, even in what many consumers feel is a safe dose, can lead to permanent liver damage.

Just today there was a big FDA meeting in Maryland, and a number of  recommendations were made (likely to be accepted by the full FDA) which will soon limit your choices for OTC and prescription pain relievers. The committees voted to limit the maximum pill size from 500 to 325 milligrams for acetaminophen, and lower the accepted maximum daily dose to well under the current 4000 milligrams. Further—and significant for many people in chronic pain—it looks like Percocet and Vicodin, two exceedingly popular drugs that mix acetaminophen with a stronger narcotic, will be banned. Read more details here

Normally I publish a post on Monday or Tuesday, and again later in the week. This week has been particularly busy for me, so…sunless tanning, part III of the sunscreen series, will be posted later in the week rather than today. In the meantime, if you are lucky enough to have sun where you are, I suggest you put on a good sunscreen and get outside!