LiveLongAgeWell

Since cancer and heart disease are the number one and two causes of death in the U.S., I would love to report that taking vitamins will lower your risk, but several recent research reports cast doubts at least on vitamins C and E. Actually, these recent studies are part of a research trend showing that many vitamins—taken in pill form that is—have not been as effective as many had hoped for in preventing various diseases.

There is even the suggestion that taking some vitamin pills, particularly the B vitamin folic acid or vitamin E, might increase your chance for certain diseases, but the data is inconclusive and controversial, and further analysis is needed (and being done). Still, caution seems to be in order as far as taking vitamin pills.

At the recent American Association for Cancer Research “Frontiers in Cancer Prevention” meeting, the results of a 10-year long study were presented. This was a randomized clinical trial (the best type of research study), and it followed nearly 15,000 physicians. Some were given 400 IU of vitamin E every other day, some 500 mg. vitamin C every day, and others given placebo (dummy) pills. After a 10-year period the number of cancers was analyzed, and those who had taken the vitamins showed the same cancer rate as those who had taken the placebo. They also measured the rate of heart attack, heart failure, stroke, and angina, and again there was no benefit for the group that took the vitamins.

People who eat a diet full of fruits and vegetables seem to have a lower cancer risk, so it was hoped this long-term vitamin study would show similar benefits. Does this mean that vitamins have no benefit? No, but it does indicate that perhaps the only way to get the anti-cancer and heart-protective benefit, at least for these vitamins, is through your diet, and not through pills or supplements. Most likely there are many more substances in fruits and vegetables, particularly “phytochemicals“, that are more important for disease prevention than the vitamin content.

The status of vitamins in the medical literature will be unsettled for some time; for example, while vitamins C and E are falling out of favor, other vitamins such as D and B12, even in supplement form, are currently showing promise. And keep in mind that today we only considered if these vitamins help decrease the risk of cancer and heart disease; we haven’t touched on other diseases, such as cataracts, where vitamin supplements might be effective. I will discuss this in future posts and more completely in my book.

The trends though in vitamin research indicate this general recommendation: get your vitamins through a diet rich in a variety of fresh vegetables and fruits. Don’t rely on pills. As further vitamin research is released (a good study is underway on multivitamin pills), I will report it here.

Quick. What’s your guess? No points for you if you say the stuffing or the gravy, but if you guessed the turkey, not bad. If you said sweet potatoes, even better, but the award really goes to the cranberries! (for my Brazilian readers: cranberry is oxicoco). It’s ironic that I’ve been to many Thanksgiving dinners where people make fun of cranberries…but in fact it’s the part of the meal most bursting with healthy anti-oxidants.

Even before the Pilgrims arrived in 1620, North American Indians regarded cranberries as medicine. Later, sailors brought sacks of the vitamin C rich berries on voyages to prevent scurvy. And for generations, American folklore has regarded cranberry juice as prevention from urinary tract infections. Only recently has this been proven and the mechanism discovered: chemical tannins in cranberries called proanthocyanidins prevent the E. coli bacteria from adhering to the lining of the urinary tract, and if the bacteria doesn’t attach, they don’t infect.

Another area where cranberries act as a “natural Teflon” is in the mouth. The main cause of cavities is the bacteria Streptococcus mutans, and cranberries block this bacteria from attaching to the tooth surface and forming the “biofilm” necessary to make cavities and plaque. Blueberries have some anti-cavity activity also, but cranberries are much more potent.

More significant, cranberries are amazing little gems in the anti-oxidant world. On the scale of anti-oxidant activity of all foods, cranberries are almost at the very top, above chocolate, blueberries, red wine, coffee, and broccoli. Cranberries are simply one of the best foods we have, and there is a host of research that—like coffee but without the negatives—they can significantly raise our HDL (good) cholesterol levels. Cranberries are also beneficial for our stomach and gastrointestinal tract (again preventing adherence of various bacteria), and there is growing lab data that they might inhibit various cancers, particularly breast, brain, lung, skin, and prostate.

To prove these anti-cancer benefits in humans, more research is needed. Cranberries though are so wonderful that within the next few months I’ll revisit them and discuss the best ways to enjoy them (emphasizing limiting the sugar that often goes with cranberries).  But for now, just enjoy the cranberry sauce, and think that these little berries will be countering some of the bad heart effects of the gravy.

Finally, another thought on the healthiest part of the Thanksgiving meal. Perhaps it’s really none of the foods at all, but rather the human connection we can make with the others at the table. Please consider that connection, that communion, and give thanks for that.  Connecting well with others is probably better than all the anti-oxidants in the world as a way to age well. So to all, especially my regular readers and subscribers, I thank you for reading, and have a wonderful Thanksgiving.

Last post I gave some background information on coffee, and today I am offering some practical pointers on how to maximize the health benefits of coffee. This is from my upcoming book How To Drop Dead Dancing In Your 90s: Live Long Age Well. If you have any thoughts or comments about coffee drinking and health, please leave a comment! In the meantime, I suggest you grab a cup and read on…

• Choose caffeinated coffee if you can, because it has greater health benefits as far as decreasing your risk of Parkinson’s disease and diabetes, and caffeine tends to increase your HDL (good) cholesterol. Decaffeinated coffee can raise your cholesterol level. If you cannot tolerate much caffeine, try caffeinated in the morning, and decaf later in the day. If that’s still too much caffeine, at least limit your decaf to one to two cups per day. If you drink decaf, buy high-quality, water-processed decaf that has been prepared through a filter (not the espresso style).

• The ideal healthy amount of caffeinated coffee is one to four cups per day, ideally two to three, spaced throughout the day to avoid caffeine rebound when the coffee jolt wears off.  If coffee keeps you up at night, try drinking earlier in the day before resorting to decaf. When you consider “bad health behaviors”, drinking more than four cups a day is not so bad, but if you drink a lot, you are more likely to become caffeine addicted (one of the easier addictions to beat if needed), and you need to keep an eye on your blood pressure. If you get jittery or notice heart palpitations, cut back.

• If you often drink “fancy” coffee drinks, think about the calories. If you order one of the über-marketed (whatever)-ccinos, you could ingesting over 500 calories in that one tasty drink. (Hint: be suspicious of any drink that has the ® symbol…it’s probably full of unhealthy calories.)  If you drink a ® coffee regularly, probably you have moved coffee from something healthy to something that could make you fat and harm your heart.

• Filtered coffee or percolated or instant is the healthiest. Less healthy is French press, boiled, and (unfortunately) the espresso types, because those styles, taken as an espresso, or mixed into a latte or cappuccino and into any number of other chic-ccinos, can increase your cholesterol. A coffee filter removes harmful chemicals that naturally are found in coffee (such as kahweol and cafestol), and espresso drinks are not filtered.  Of course once in a while it’s fine to drink espresso or lattes or cappuccinos, but for your basic coffee, remember that regular filtered coffee is healthiest. If you want to be both chic and healthy when you order, ask for a “Caffé Misto” or “Café au Lait” (filtered coffee with steamed milk). You can still use the French name, but the barista should make your drink with filtered coffee rather than the less-healthy espresso type.

• Coffee and osteoporosis: if you take enough calcium in your diet, 1000 to 1200 mg. per day, you probably don’t have to worry about coffee lowering your calcium level. But if you have a concern about bone thinning, take your coffee with milk or better, soy or skim milk, and if you have a serious issue, talk to your doctor. If you are pregnant or lactating, many doctors feel a cup of coffee is probably OK, but discuss with your physician.

• If you have high or borderline blood pressure, occasionally check your pressure after coffee. If you have coronary artery disease (narrowed blood vessels in the arteries of your heart), you should wait an hour after drinking coffee before doing significant exercise.

• For some reason I don’t understand, anti-oxidants have the nasty tendency to stain your teeth... nothing is perfect.  But be careful—coffee can ruin your smile, so swish water after drinking to avoid the un-sexy dark teeth look. Or chew a stick of sugar-free gum (especially good is gum with xylitol) after coffee to freshen your breath and keep your teeth white.

Occasionally I will post an excerpt from the draft of the book I am writing: How To Drop Dead Dancing In Your 90s: Live Long Age Well. Frequently people ask me about coffee: is it really good for you? is caffeinated OK?  So I chose to include this sample. Here is Part One from the coffee section of my upcoming book…

Antioxidant Rich…Drink It…Especially Caffeinated

It seems almost natural to think that all those great anti-oxidants are found only in colorful fruits and vegetables, so we might find it hard to believe that something so colorless and flat and black as coffee could be so healthy for you, but it is. If you drink caffeinated coffee, lose your guilt, because you are enjoying something that, it turns out, is really good for you, and as a bonus gives you a natural mental and physical boost. Coffee is full of anti-oxidants and there are many studies now that show coffee is almost a new super-food, with little downside. It doesn’t lead to ulcers, hypertension, or cancer. Quite the opposite is true. Recently an international research group rated the per-serving antioxidant content of foods and amazingly, coffee ranked higher on the list than either blueberries or red wine. In the American diet, coffee may be the #1 source of anti-oxidants.

There is excellent evidence coffee protects your liver from damage and decreases the risk of cirrhosis and gallstones, so especially if you do drink more alcohol—even wine or beer—than generally advised (one to two drinks per day), you should probably also drink a few cups of coffee daily (although cutting down on the alcohol would be better). A 2005 Japanese study showed that people who drank 3 or more cups of coffee per day had a 50% less risk of liver cancer, and there is evidence coffee drinkers also have a lower risk for colon cancer. Coffee can temporarily raise your blood pressure and heart rate, but does not lead to the disease of hypertension.

For diabetics and for those worried about becoming diabetic as they get older: coffee should be fine for you. While there is still some controversy, both decaf and caffeinated coffee seem to lower the chance of developing diabetes, though the protective effect is better with caffeinated coffee. Another advantage of caffeinated coffee is that while decaf can lead to an increase in both your total and LDL (bad) cholesterol,  caffeinated coffee will not; in fact, the caffeinated version is most likely good for your heart, as it tends to raise your HDL (good) cholesterol level.

Let’s talk about your brain on coffee. We all know that regular coffee will boost your energy level, temporarily at least, but more important, caffeinated coffee seems to have what is called a “neuroprotective effect”, and a number of studies have shown a 40-80% decreased risk of Parkinson’s disease in people who regularly drink more than one cup of (caffeinated, not decaf) coffee per day. However, if you are a post-menopausal woman who has been on estrogen therapy, this anti-Parkinson’s effect apparently does not hold for you.

All this is remarkable enough, but further studies now are suggesting that caffeinated coffee probably protects you from long-term memory loss, and even cuts your chance of developing Alzheimer’s disease. Researchers are now working to develop various coffee-related compounds that might result in treatments for Parkinson’s disease, alcoholism, alcoholic liver disease, and even depression.

On Monday…practical pointers on ways to maximize the health benefits of coffee.

Imagine—whether you’re currently 32 years old or 72—that you arrive into your 80s with a good mind and you are happy and active, but you develop a problem with a valve in your heart. So you go to a surgeon who tells you: “Sorry, you’re too old to have your heart fixed…” This is what many people have faced, in the past and even today, so it was good to read of two research studies presented at the recent American Heart Association meeting which gave the green light to needed surgery at any age.

Yes, even now it’s not uncommon that a surgeon can turn away an older individual who needs critical surgery. Instead of really fixing their problem, the patient gets some pills or other palliative treatment that really doesn’t solve their condition; just lets them limp along. This age discrimination is based on the belief that people in their 80s or 90s are just too fragile to survive or recover from major surgery, but this current research suggests that even some 90 year-olds can do just as well as much younger people.

These two studies analyzed the surgical records of nearly 10,000 elderly patients who underwent heart surgery in Florida and in the Northeastern U.S. The results were quite amazing; many of those who had surgery survived as long as individuals their age who did not have heart disease. The elderly took longer than younger people to recover (and as heart surgery is risky, some did not survive), but the large majority who successfully recovered later overwhelmingly reported a good quality of life. Of course, not all 80- or 90somethings are healthy enough for major surgery, but many are, and chronological age alone should not be a determinate of who is a surgical candidate. Further, while these two studies concerned heart operations, the results should also apply to other surgeries.

These studies are important for our society as the 75 and older age group is the fastest-growing segment of our population, and important for you because if you take care of yourself, you will also hopefully arrive at 80 then (sooner than you realize) your 90s, and you will want every option for the best treatments possible, even major surgery if needed. So no matter what our age is now (keep this in mind for ourselves or for our parents)—the research supports: end age bias in surgery!

Some day in the future you might want a second medical opinion, and the newest development in that realm is the online second opinion. Two prestigious medical centers now offer this service: one through Harvard-affiliated hospitals, and the other through the Cleveland Clinic.

Hopefully you’ll never need this service, but if sometime in the future you do and this post has “disappeared”, remember that you can retrieve archived posts through the “FIND IT” function on the right sidebar.

In general, it’s best to actually see, in the flesh, a physician at a medical center for a second opinion. Still, for whatever reason (such as you live too far away—or don’t know of any—eminent medical centers for your condition), you might want to consider these two options. They will also evaluate cases from outside the U.S., though records need to be translated into English…you might consider this for any friends or relatives living outside the U.S. who receive an ominous diagnosis.

These online services are not inexpensive, but if you or a loved-one has a life-threatening illness, it could be very worthwhile. The Cleveland Clinic charges $565, and the Harvard-affiliated site charges $495; more if they need to review X-rays or pathology specimens (for example a cancer biopsy done by your local doctor). Consult their individual sites for details and price information, and note that health insurance almost never covers this sort of second opinion. You can send your medical records either electronically or by mail.

Some of the situations where you might want to consider a second opinion:
• You have a rare or particularly life-threatening illness.
• Are unhappy with your care, or question the diagnosis or treatment recommended.
• Your doctor has recommended major surgery or some medical device implantation.
• You wonder if your HMO is offering the best treatment or is more interested in saving money.
• You live in a rural area and might not have access to first-rate care.

Generally if you seek out a second opinion, you want to go to a “center of excellence”, either in person or online, and both the centers mentioned here have good reputations, but of course there are no guarantees. Finally, considering the financial landscape of medicine today, you—or if you are shy, a trusted relative/friend/advocate—might ask the doctor about any financial or other conflict-of-interest in whatever treatment they are recommending, particularly if the doctor wants to implant a device, or enter you into a clinical trial.

Considering our current economic times, I will continue to regularly blog about research and ideas that hopefully will help us cope better. Previously I’ve addressed topics such as deep breathing, omega-3 supplements, and eating more fish (you are trying to eat more fish, aren’t you?)… as ways of cooling off our body’s stress response. Often we can’t control our outside stresses, but we can control how our body responds to those stresses, and that’s a big help.

This week at the American Heart Association’s meeting in New Orleans, a preventive cardiologist Dr. Michael Miller presented research showing how blood vessels respond differently to music we like, versus music that makes us feel anxious. Dr. Miller previously showed that laughter was good for the heart, since it seemed to relax our blood vessels and thus allow better blood flow. In the current study he found that when a group of volunteers were exposed to music they really liked, even their blood vessels relaxed, resulting in a 26% better blood flow. In contrast, music that made the test subjects feel anxious temporarily dropped their blood flow by 6%.

While Dr. Miller measured blood flow only in the arm, it’s likely that pleasant music would cause increased blood flow throughout the body, an effect that is good for the heart. (The opposite of what occurs in a person with high blood pressure where the vessels tend to be constricted and tight—not a heart-healthy process.) Dr. Miller didn’t discover the mechanism that made music open up vessels, but he suspects it has to do with the release of endorphins, chemicals released from deep in the brain which result in feelings of well-being.

One of the best ways to keep your brain functioning well as you get older is to frequently challenge it with new ideas, new activities….and even new types of music; music you might not initially like, but with a flexible brain, you learn over time to actually enjoy. Dr. Miller’s research suggests to me though that in times of stress—particularly if you already have high blood pressure or heart disease—one healthy way to chill out is to pro-actively seek out music that is most relaxing for you, and allow your blood vessels to open up and relax too.

Remember this for example next time you go to the dentist for some uncomfortable work, or on an airplane if flying stresses you. Be assertive; protect your heart as well as your mind…bring your iPod and put on whatever you most like, from hip-hop or rap to classical or christian contemporary, and let the blood flow. Don’t be shy; the research supports you.

In my last post I described how “belly fat” (medically known as visceral fat) is especially bad for health. It’s fat deep in our abdomen, wrapped around our internal organs—more dangerous than fat deposits elsewhere in our bodies. After that unappetizing thought… the holiday season is arriving, and so is the inevitable parade of diet books. Let’s look at the new bestseller Flat Belly Diet by Liz Vaccariello and Cynthia Sass from Prevention magazine.

The authors base their book principally on some Spanish research from 2007 presented in the journal Diabetes Care, which suggested that people who ate more MUFAs (Monosaturated Fatty Acids) lost more belly fat than people who ate the same number of calories but more saturated fats or carbohydrates.

MUFAs are an integral part of the excellent Mediterranean Diet. Common MUFAs include: olive oil; nuts and peanut butter; nut oils such as peanut and sesame oil; seeds such as sunflower and pumpkin; avocado; and perhaps dark chocolate.

I summarize the Flat Belly Diet book:

1.    Eat four— 400 calorie meals per day, 1600 calories total (for a woman); meals spaced 4 hours apart
2.    Eat a MUFA with each meal

They describe a four-day “Jumpstart” followed by a four-week “Eating Plan”, and claim you don’t really have to exercise to slim your belly. The online program at FlatBellyDiet.com screams: “91% Success Rate! Target Belly Fat….NO exercise required!”. It’s interesting the book and website overwhelmingly targets women, but it’s the men who generally need more help with belly fat problems. But many more women than men buy diet books…

Flat Belly Diet is strong on marketing hype, though it scores good points emphasizing MUFAs. However the research on MUFAs leading to a special loss of abdominal fat is preliminary, controversial, and based on relatively few subjects (there were only 11 “volunteers” in the main study). Nevertheless, some people only attempt a dietary change with a glitzy book filled with recipes and a “plan”, so if that’s you, maybe this book is worth looking at.

But if you are really serious about affecting a more long-term change in your diet, and don’t care about glitz and bling, I would recommend a more thoughtful and scientific book: Michael Pollan’s In Defense of Food. It’s cheaper and a much better value than the flashy Belly book. I love how Pollan puts forward three basic laws of a good diet: “Eat food. Not too much. Mostly plants.” He emphasizes avoiding processed foods and sticking to foods “your grandmother would recognize”. Simple advice—lacking the high production value in many diet books today—is often the best.

Recent medical research is suggesting that if you carry excess weight on your body, it’s the actual location of the extra fat that is most important. Most evidence suggests that “belly fat” (as opposed to hip, buttock, and thigh fat) is the worst kind. Fortunately, there are things you can do to cut your risks.

“Belly fat” is otherwise known as “visceral fat”, which means it is located deep in your abdomen, wrapped around your internal (visceral) organs, rather than just below the skin. Doctors describe people with belly or visceral fat as being “apple shaped” (versus those with hip fat, which gives a “pear shaped” appearance). It seems that the deep visceral belly fat—wrapped around our vital organs (not an appetizing thought in itself)— secretes toxic substances that especially leads to inflammation, diabetes, high blood pressure, and cardiovascular mortality.

And now we have strong evidence that people in their 40s who carry excess visceral fat are much more likely to develop dementia and Alzheimer’s disease when they are in their 70s.

Researchers in California in the 1960s and 70s began studying a group of more than 6000 people, measuring their abdominal girth to see what would happen to them over many years. This long-term study found that even people who were otherwise normal weight but had big bellies were 89% more likely than flat bellied people to eventually become senile from Alzheimer’s and all other causes. And those both overweight and with a big belly had a dementia risk over 200% greater than normal-weight people. Obese people (heavier than just “overweight”) had a risk factor of more than 300% (check this link for a great graphic and more details).

The mechanism for this belly fat-dementia risk is not known. It’s possible that the fat itself is not causing the dementia, but that some other mechanism is working that brings about both a big belly and dementia at the same time…but there is a good chance that if you do have a big belly, if you somehow fix your belly situation, you may well decrease your chances for dementia as you get older. This might be particularly important for people with a family history for dementia. You can’t change your family history, but you can fix a big belly.

Next post I’ll cover one possible remedy for the belly fat problem, and I can tell you now: it’s not liposuction…

Most people know that being overweight or obese contributes to the risk of heart disease and diabetes, but probably many don’t realize that being obese increases your risk of various cancers also. It’s a topic we will visit in future posts, but today I want to mention a recent study which demonstrates one way normal-weight women benefit from vigorous activity…they markedly cut their breast cancer risk.

It is a startling statistic, but one out of eight women will develop breast cancer during their lifetime (one out of 100 breast cancer cases occur in men), so anything that decreases this risk is welcome. And while the media tends to focus on risk factors we can’t control such as genes and family history, this study from the National Cancer Institute describes one relatively simple action women can take.

Beginning in 1987, the researchers studied over 32,000 post-menopausal women and found that women who engaged in regular vigorous activity or vigorous exercise had about a 30% reduction in the risk of breast cancer. Interestingly, this effect was seen only in slim and normal-weight women; obese women did not show the same good effect from strong exercise (though obese women would cut their risk by losing weight).

The type of activity that led to the decreased cancer risk included heavy housework such as washing windows, scrubbing floors, or digging outside. But don’t fear if you don’t want to do—or don’t have time for—heavy housework, because women who engaged in strenuous sports or vigorous exercise such as running, serious tennis, and fast dancing enjoyed the same benefit. Light housework such as washing clothes, basic gardening, or mild exercise didn’t seem to have the strong protective effect.

So especially if you have a higher-than-average risk of breast cancer, for example due to family history, keep vigorous activity in mind. (For an excellent current reference on breast cancer, check out this pdf from the American Cancer Society.) For Monday: how both men and women can cut their risk of another common and feared affliction, Alzheimer’s disease.