LiveLongAgeWell

Last post I explored how the most popular anti-aging website on the planet, RealAge.com (27 million visitors!), might not be your best source of medical information, as they are supported, handsomely, by several drug companies. Some of the content and marketing material might be biased towards taking medications when something simpler, like exercise (or just getting off the couch more) could be just as effective, cheaper, and without side effects.

Nicholas Kristof

I suggest you read a short piece by Nicholos Kristof, a New York Times columnist, from March 18 entitled “The Daily Me” (a popular piece; for several days the most emailed article from the Times). The gist was that as paper newspapers go bankrupt and disappear—today a major Chicago paper declared bankruptcy, and a week ago the largest Seattle paper went online only—we will get more of our news online. No shock; you might say, that’s fine, but research shows a problem, and it could adversely effect your medical news.

Mr. Kristof discusses research that as people gather their own news online, they predominantly visit sites with news and opinions that they already agree with…few people visit sites that present information or opinions that disagree with their current thinking. The long-term tendency then is for less broadly-informed people; individuals more polarized towards their pre-existing biases. This effect could as well pertain to medical news as we more and more get health information from blogs and sites that are most comfortable, and avoid conflicting opinions or difficult advice. Some of the most attractive sites are those developed with big corporate money. There, sometimes the information (even when written by an M.D.)  may be a rehashed press release—another piece in the marketing pie.

So be careful as you read medical news online. Take into consideration corporate “sponsors” or “partners” (look for the “about” page or similar). Check out sites that might not have sponsors or advertising, and strive to get more balanced medical news by always looking for fresh sources and a variety of input.

Finally, relating to medical experts, I suggest Kristof’s column from this week “Learning How to Think”. Here he notes how many media “experts” actually are not, and that the more famous the media expert, the more likely they are to be wrong! Absolutely fascinating.  It seems TV and the media in general seek out “experts” with strong convictions and black-and-white opinions. Great for sound bites and boosting viewership, but the less famous experts—less splashy and well-known—tend to explore the nuances of an issue (more boring), but are more likely to be right. Kristof covers financial experts who were so wrong about the current crisis, but, might this also apply to famous medical experts? Think about that next time you see a doctor endorsed by Oprah.

Several LLAW readers have told me they took the RealAge® online test, which is supposed to measure your biologic age. After you answer about 150 questions, it spits out your “real age”, and a number of health hints tailored to your answers.

Last week the New York Times created a stir when it revealed RealAge sells the data generated from visitors’ answers to various pharmaceutical company “partners”. If a site visitor had checked “Yes” to any number of  questions during the age test, then…expect to start getting emails from your new drug company partners! Sites like patientslikeme.com do the same.

I looked at RealAge® about a year ago (I’m suspicious of any website that is trademarked), and in taking the test, I noticed a number of questions geared towards signing me up and becoming their partner. For example, if I said “Yes” to questions like “Would I like to improve my overall health” or “Would I like to stay on top of the latest health research, etc.”  (Well, of course I do!! I’m writing a health care blog!!)

But still I felt squeamish about leaving so much personal personal health data—and financial information, like income—along with my email address, so I left the site. But many others have completed the test; something like 27 million! Wow.

If you are a RealAge® member, I urge you to read the Times article to see what’s happening with your personal information. Here are my favorite quotes from this article:

Pharmaceutical companies pay RealAge to compile test results of RealAge members and send them marketing messages by e-mail. The drug companies can even use RealAge answers to find people who show symptoms of a disease — and begin sending them messages about it even before the people have received a diagnosis from their doctors.

While few people would fill out a detailed questionnaire about their health and hand it over to a drug company looking for suggestions for new medications, that is essentially what RealAge is doing.

The blogosphere is hopping with this controversy. You might be interested in checking out these blogs:

theblogthatatemanhattan.blogspot.com
CitizenVox.org
Ourbodiesourblog.org

Next: Dr. Oz, Oprah, medical experts

I chuckled to myself as I sat down to write this Part III of “mind drugs”, because I just read an article in today’s online New York Times about how caffeinated coffee—conclusively shown to be a performance enhancer in many sports—is the only supplement that truly enhances athletic performance that is not banned by anti-doping regulations. Caffeine is a mind drug as well as a body drug, but somehow—probably because it is ubiquitous, accepted everywhere—it would be too hard to regulate out of sports competitions, yet those who use it have a clear edge over those who do not.

In the post two days ago I addressed some safety concerns regarding mind drugs (known otherwise as “cognitive enhancers”), including the risk of addiction. Beyond safety issues, others object to cognitive enhancers because they are not “natural” for the brain, and further, that use is not moral as they give some people an unfair advantage.

The first issue regarding “natural” I don’t believe has credence. Much of what is done today in medicine—to people and by people—is not “natural”, and the pace of what is acceptable yet unnatural seems to be accelerating. I suspect only the most religiously orthodox today would protest contraceptive pills or condoms (not natural), though I know many who might be squeamish about Viagra or breast implants as unnatural, but they might well accept kidney transplants or in vitro fertilization; certainly far from natural. I think it’s very difficult to condemn anything in medicine today as unnatural.

The issue regarding morality and cognitive enhancers is a thornier topic, but it seems that over time, more mainstream scientists and doctors are saying yes, it’s fine for otherwise normal people to take a prescription drug that enhances one’s brain function temporarily by helping them think more clearly and delaying their need for sleep.

The moral question brings us back to coffee. Caffeine enhances calcium release from muscles, which allows those athletes who take it before competition (in pill form or as coffee) to run faster and longer—and as it also acts on the brain—with less sense of fatigue. Those who use it get at least a five percent performance boost over non-users.

Cognitive enhancers such as modafinal (Provigil), our model drug for this mini-series, likely improves the test-taking performance of those who take it before, say, a college-entrance exam, or a police qualification test (consider the comment from last post). There is no way to blood-test and know who took it versus those who did not. Is this mental-doping moral? Certainly it is less of an issue if everyone has equal chance to take an enhancer beforehand, but many would choose not to for a number of reasons: moral or fear of short term side effects or addiction or the possibility of long term brain damage. Modern medicine and advanced pharmaceuticals are presenting us ever more with these dilemmas, running faster than our answers.

Next….Indecisive Medical “Experts”, Dr. Oz, And Real Age®

A LLAW reader several days ago mentioned that it sounded like I advocated use of “mind drugs” to enhance mental performance (post: the new drug war…move over marijuana). I told her that I didn’t either advocate or vilify their use, but the subject deserves our consideration. All of us interested in potential advances in better aging will be increasingly exposed to—perhaps seduced by—the possibility that a prescription drug might boost mental performance and diminish the need or desire to sleep. Some have exclaimed: welcome…the age of cosmetic neurology is almost here!

In a recent journal Nature, seven prominent scientists argued that these drugs should be legal and more available for otherwise normal, healthy people who simply want a mental boost (“cognitive enhancement”). They stated

cognitive enhancement has much to offer individuals and society, and a proper societal response will involve making enhancements available while managing their risks.

Among those in-the-know, the main player in this field of pharmaceutical grade cognitive enhancements is modafinil (trade name Provigil). I haven’t taken it so I can’t speak from experience, but My Experience With Smart Drugs is a London journalist’s story about his use of the medication over several weeks. His report is glowingly positive. He wrote that he accomplished significantly more focused work while taking modafinil, and seemingly without side effects. He only stopped the drug after he became concerned about potential long-term brain damage.

Until recently, most user reports about modafinil have been positive, or at least neutral, with no significant side effects noted. Lately though, there has been somewhat of a backlash against the drug, and a National Institute on Drug Abuse study published in the March 18 Journal of the American Medical Association demonstrated, by using PET brain tomography scans, that modafinil increased brain dopamine levels. The conclusion was the drug carries a significant addiction risk, similar to cocaine. The authors noted, however “reports of modafinil abuse are rare and much less frequent than those for stimulant drugs” [such as Ritalin]. They also mentioned a significant blood pressure and heart rate increase with the drug.

But the big fear with modafinil is what was voiced by the London journalist: are there long-term deleterious brain effects? No one knows, especially since researchers are uncertain how the drug actually works, making the whole adventure rather more scary. Might it increase the risk of dementia and, by making thinking “easier” in the short term, thereby making the brain lazy and less creative?  (Brain function, similar to that for muscles, improves through synapse creation which is stimulated by mental effort.)

And indeed, could use prove to be physically or psychologically addicting?  From experience with other drugs, often serious side effects, such as addiction, only show up years later. Valium, for example—passed out almost indiscriminately during the 60s—only years later was discovered to be addictive, leaving a wake of angry patients who, after years of free use, were forced (to try) to wean off.

Next post…brief wrap-up on cognitive enhancement drugs.

We will return to prescription brain drugs later this week, as today we make a brief news diversion to a substance many people consider a mind drug: sugar. An interesting article appeared in the New York Times a couple days ago about how the food industry is recently trending from using High Fructose Corn Syrup (HFCS) as a primary sweetener, back to “natural” sucrose, that is, simply, sugar.

It’s interesting since HFCS has, over the past 30 years, crept into most all sweetened sodas, fruit juices, cookies and salad dressings and most every other food available in a bottle or a can. As it has silently and rather stealthily taken the place of sugar, many health experts have claimed that HFCS is a much less healthy replacement, and has been a major contribution to the U.S. obesity crisis. Food manufacturers, aware of their bottom line, substituted HFCS for sugar to boost their bottom line, as it was cheaper than real sugar. HFCS is easier to keep and transport, and extends the shelf life of many products, so it cut production costs, and initially few people seemed to care.

But more and more consumers have become alert to HFCS as a potential villain; the Times article mentions that Michelle Obama has pledged not to allow her children to consume it, certainly not good news for corn farmers. HFCS comes in various forms, but most commonly is chemically very similar to simple sugar (about 50% glucose and 50% fructose), though HFCS has slightly more fructose. HFCS is of course made from corn, but only after an extensive chemical process, this corn is magically transformed into…basically liquid sugar, but of course, it’s not exactly the same as the truly “natural” product.

If you want to wade into a big mess of a controversy, look into the various merits of HFCS vs. sugar. It’s hard to come to any good conclusion…is HFCS one of the reasons Americans have become so fat? Is fructose so much worse than sucrose for our livers? Does HFCS prevent us from feeling full? Does it lead to a rise in VLDL (the worst of the blood lipids)?

It’s hard to know what to make of the various arguments, and one reason is that many of the studies have been sponsored—sometimes indirectly so it’s difficult to know—by the sugar cane or beet or corn industries, and they can “buy” and release whatever research results they want. But here is what I have concluded so far: I would stick to simple sugar (sucrose) over HFCS whenever possible. Moreover, try to cut your sugar consumption as best you can, as those empty calories don’t do your body much good except provide a very temporary energy boost. The long term effects of sugar are for my book and later posts, but sugar does nothing good for your aging. There is intriguing research suggesting that sugar damages our skin proteins, and is one reason for diminished elasticity of our skin as we get older, and…premature wrinkling.

Move over marijuana. Bye-bye cocaine. See you later anabolic steroids…The world is entering a new drug war, and the first big shot was not fired in the streets of border town Mexico, but in the prominent medical journal Nature, and this report, like a bomb, has produced a flurry of counterattacks from both sides.

Although the biggest causes of death worldwide are cardiovascular, infectious, and cancer-related, the push for new pharmaceuticals from many companies will not be cures for those top three killers, but will focus on three other areas: appetite/weight control, sleep, and memory. Some experts believe that in ten years, we will be able to, with the right drugs (if we can afford), fine-tune our weight, exact sleep duration, and memory functions as easily as we now tune-out commercials on our digital video Tivos.

In the drug underground—somewhere in that murky space between the legal and the actionable—a quiet revolution has been brewing in the use of so-called “smart drugs”. In the past few decades doctors have used amphetamine derivatives, like the ever-more popular Ritalin, to treat the ever-more established diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). But Ritalin was just one of the first to tinker with attention and wakefulness, and in 1998, the first good drug treatment for narcolepsy (the uncontrollable desire to fall asleep at most any time) was released.

Modafinil (commercially known as Provigil) proved to be a wonderful advance for narcoleptics, and, as often happens with new drugs with brain effects, it was tested illegally in the underground of clubs and college campuses, and found to be very effective in keeping even normal people awake and functioning seemingly at a high level for long periods of time. The American military, which long relied on amphetamine-type drugs, soon adopted modafinil as the drug of choice for special op soldiers who needed to stay awake for days at a time. Many college students found modafinil as an especially effective study aid, and one survey estimated that on some U.S. campuses, 25% of students have used modafinil or similar.

But the use of this drug in many cases has been, at best, “off-label”; that is, used for problems not FDA approved, or illegal, especially by students who obtain pills diverted from friends with legitimate prescriptions. And a growing controversy: should these drugs, especially Provigil, be released for general use, to be taken by anyone who wants an extra edge? Advocates claim it’s safe, non-addicting, and that wider release would be good for society.

This call for liberalization of mind-enhancing drugs such as Provigil has been a minority opinion, considered highly questionable by the majority of experts who fear wider release would result in abuse, brain damage, addiction, or injustice (the argument is only the well-off could afford regular use, and the rich already enjoy many advantages). So imagine the uproar when seven high power scientists from Harvard, Stanford, and the Universities of Oxford, California, and Pennsylvania published this recent report in Nature saying, basically, free these drugs for wider use…it’s our right, and will be good, even advance, mankind. The article is very readable; you may or not agree with it, but I suggest it to you. Next week, more on mind drugs.

I received a number of calls and emails regarding my recent post on Botox, so here’s a brief update regarding two issues.

First regarding the cost. In the U.S. an average Botox treatment runs about $300 to $400 for “one treatment area” (in Brazil, about R$ 400), so before you agree to being injected, ask the doctor how many “areas” she wants to treat, and what will be the total cost. You might be able to negotiate that a bit, particularly for more than one area. Don’t be shy about asking. Many plastic surgeons are negotiating charges these days.

Expect to pay more in big cities and on the East Coast, but I wouldn’t make my choice based on price, but on the qualifications and experience of the plastic surgeon or dermatologist. And while you may have heard of “Botox parties” (most common in California)…personally, I would run away from any doctor who participated in such an event. Injecting “the most potent toxin known to man” is not a trivial medical procedure; it carries risks and you want it done in a relatively sterile environment, with the doctor paying attention only to you, not to a crowd and with an eye on his marketing presence.

The second Botox issue is that a new type of Botulinum toxin should be FDA approved this year; a decision is expected by mid-April.  Apparently the new form (brand name Reloxin, and already available in Europe as Dysport), has several potential advantages over the current Botox made by the Allergan Corporation.

The cost to your doctor for each vial of Reloxin will be lower than the cost of Botox, so the cost to the patient should be less. And while the new form is also, like Botox, a form of Botulinum toxin A—and very similar to the standard Botox—Reloxin contains less “protein load” so it is thought patients might form less antibodies to this new toxin, and so the beneficial effect might last longer. And the onset of action is said to be somewhat faster, though this is probably no big advantage.

Once Reloxin is released, for me personally, I wouldn’t run out and be one of my doctor’s first patients. Reloxin is said to spread in the tissues more than Botox, and the concentration of Reloxin is different than Botox, and for any new procedure, there is a “learning curve” for your doctor while she or he gets acquainted with the nuances of the new medicine. I’ll give another update when the drug is released. Some cosmetic experts are expecting “price wars”, but for sure, expect to see lots of new ads…

Next post….pills people are taking to boost brain power!

Last Sunday I thoroughly enjoyed a dinner of the national dish of Brazil, feijoada (fehz-waada), so I was happy to see that this week the New York Times featured black beans (the principal component of feijoada), as the topic for its Recipes for Health series.

You probably know that legumes—which includes black beans as well as the color spectrum of others such as navy, red, pinto, and white—are healthy, but my guess is you don’t know how great they really are, and that the black variety is the healthiest of the lot. Some of the benefits of black beans:

1.    They are full of fiber, which naturally lowers your cholesterol absorption and production. High fiber diets have been linked with lower heart attack and stroke risk.
2.    Beans are also loaded with the best type of carbohydrates, the complex type, which are slowly absorbed and provide your body with long-lasting energy without the spikes in blood sugar seen with many carbs.  Beans are especially good for those with sugar control issues, and recently, blood sugar spikes have been implicated in long-term memory decline.
3.    Surprisingly, beans and particularly black beans are full of the same antioxidants, anthocyanins, that are found in grapes. Recent research has shown the darker the bean, the higher the antioxidant content. Black beans actually contain about the same anthocyanin content, weight-for-weight, as grapes and cranberries.
4.    They are low in calories and almost completely fat-free.
5.    Especially for a fruit/vegetable, they are full of protein…one cup provides about a third of your daily protein needs.
6.    Beans have high iron content, and are full of the wonderful trace element molybdenum, as well as heart-healthy folate (a B vitamin) and magnesium.
7.    Black beans likely have anti-cancer properties.
8.    They store well for long periods of time, and are cheap.

The downsides to beans are that they take some time to prepare and cook…the healthiest way is to cook them yourself rather than using canned beans (interestingly, in Brazil, you cannot even find or buy canned beans), and beans tend to cause gas (despite that they are considered beneficial for most people’s gastrointestinal tracts). Pre-soaking the raw hard beans in water for at least six hours makes them easier to cook and also decreases the gas problem. Then simmering beans can take an hour or two, but if cooked in a pressure cooker, it goes down to 30 minutes.

The Times mini-series details several black bean recipes, including basic simmered beans, black bean soup with spinach, and a healthy alternative to traditional fat-filled refried beans.

Real Brazilian feijoada is another matter entirely, and what’s in it depends on the region you live. The one I had last week had black beans mixed with various types of pork and sausages, potatoes, cabbage, squash, and collard greens. Here is one recipe from foodbuzz if you want to experiment. You can even find feijoada made only with chicken, or without meat, although those would not be considered true feijoadas by most (carnivorous) Brazilians.

But if you don’t want to spend the time making feijoada, try at least basic black beans from scratch. It will be worth the effort in taste and nutrition, and the more you can divorce yourself from canned food, the better! (But if you really don’t have the time or inclination to make from scratch, canned low-sodium black beans are an OK substitute.)

All in all, I would wager that black beans are the least expensive super-food we have, and these days, that is something to consider.

Based on last week’s survey results, rather than every week sending out two email updates to subscribers, I will send out one to two weekly based on the content. And as always,  three fresh posts will magically appear on the LLAW website itself every week.

I am sure that this study will not put an end to the controversies comparing various types of diets, but recent research published in the New England Journal of Medicine—coming from the Harvard School of Public Health—strongly suggests that, to achieve weight loss, it really doesn’t matter what type of diet you adopt…the important point is that you significantly reduce your caloric intake.

Most diet research involves short-term studies and a relatively small number of participants (or have many more participants of one sex like the Israeli study mentioned below), but this Harvard study went on for two years, and involved 811 participants, and each of those was randomly assigned to one of four diets:

* Low-fat, average protein: 20% of calories from fat, 15% of calories from protein, 65% of calories from carbohydrate
* Low-fat, high-protein: 20% fat, 25% protein, 55% carbohydrate
* High-fat, average protein: 40% fat, 15% protein, 45% carbohydrate
* High-fat, high-protein: 40% fat, 25% protein, 35% carbohydrate

All of the diets encouraged lots of fruits and vegetables, the participants were encouraged to do 90 minutes of moderate exercise weekly, and all underwent first individual, then later in the study, group weight-reduction counseling. All participants were encouraged to cut about 750 calories from their previous diet, but all people during the study ate at least 1200 calories per day.

The results: people in all four diet types lost an average of 13 pounds (5.9 kg.) after the first six months, and then after about a year, most people slowly gained back some of their original weight, but at two years, all four diet groups were about nine pounds (4 kg.) less than their original weights.

One important differentiating point was that those people who faithfully continued attending group-counseling sessions over the two years lost an average of 22 pounds (10 kg.) rather than nine pounds!

Now while this seems to be a good study, it isn’t perfect; for example, the study group was 62% female rather than the ideal 50%.  And an Israeli study published last year in the same journal showed that people who followed a low-carbohydrate diet for two years had a larger weight loss than those who followed a low-fat diet, but this study consisted mostly of men (86%), and the study was partially funded by the Atkins Foundation (which advocates a low-carbohydrate diet).

Without doubt, the diet wars will continue, and I will not be surprised if I report within the next two years a different large controlled study with completely different results. Still, I think we can take away a couple lessons: first, that cutting calories is the most critical factor in any diet. Daily calorie counting might well be worthwhile to make sure you keep to your daily goal. You could take this approach: choose whatever diet (Atkins, Ornish, Mediterranean, etc.) you can stick to! (Consult with your physician, and you might have to experiment with several to see which you can really follow.) Second, it’s likely that if you consistently work with group support or counseling while you diet, you will have better results.

Next post: a nutritious recipe idea from Brazil, whether you are dieting or not!

I’ve always been interested in people who seem to “turn gray” (their hair that is), but otherwise seem to age well. For example, my own brother developed the salt-and-pepper look in his twenties, and now, in his late 50s, he has mostly gray hair but his skin still looks great…and I’m sure he doesn’t use any facial creams whatsoever. He took up marathon running at age 56, now runs at least six marathons per year, and at the finish of each one, he’s not very worn out…he could run much further if the race demanded.

And I, with much less gray hair…I’m sure right now there’s no way I could finish a marathon. In general I haven’t noticed any correlation between gray hair and aging of the skin, or internal aging…what has been your experience in that realm, for yourself or by observing others?

You might be interested in this article in the New York Times, which discusses that studies show no correlation between gray hair and aging of the skin or, more important, with lifespan. Gray hair seems to be just a characteristic found on a gene and has nothing to do with aging in general. Don’t let that stop you from tinting your hair (in a quality and safe way) if you want, and we’ll cover that sometime later in this blog, or in my book…

Another thing I find interesting is that here in Brazil most everyone knows his or her blood type, whereas in the United States, many people don’t know. And here’s a good reason to be blood-type aware: your chance of getting pancreatic cancer (unfortunately one of the deadliest and most difficult to detect early), is much higher with certain blood types.

A recent report in the Journal of the National Cancer Institute showed that those with blood type O appear to have the lowest risk, and if you have are type A, you have a 32 percent higher risk than a type O individual. If you are type AB, you run a 51 percent higher risk, and type B, a 72 percent higher risk.

Some hints for avoiding pancreatic cancer I covered in a previous post, and certainly if you are type O, you still could develop this cancer, but if you have type A, AB, or B blood, I would pay particular attention over the years to the latest research in detection and prevention. Hopefully this new blood type research will lead to fresh ways to prevent and treat this killer.