LiveLongAgeWell

We are now (hard to believe) weeks after the New Year…yet many LLAW readers are still asking about diet and weight loss, so today I am highlighting an important recent report from the British Medical Journal. This was a so-called meta-analysis, which is a kind of super-statistical study that examines a large number of other studies done on one subject. A good meta-analysis like this one looks at how each sub-study was done, discards the sub-par research (not uncommon), and come to a grand conclusion after summing the best of the studies.

The goal of this meta-analysis was to determine: is the Mediterranean diet really as good as it’s supposed to be? Does it cut disease and make people healthier? The conclusion, after assembling over 1.5 million subjects, was that yes, the Mediterranean diet really does lead to a drop in the death rate and can help you avoid chronic nasty diseases such as Alzheimer’s.

The Mediterranean diet is also a tasty one, one that you can stick to for life, and for your life. It’s not a six-week or year-long program. It’s best forever. Named after the traditional diet of countries surrounding the Mediterranean Sea (traditionally with some of the lowest incidences of heart disease), here it is:

1. Most of your fats come from Olive Oil, and secondarily, Canola Oil (rather than butter or other oils).
2. Eat Nuts, but no more than handful per day (since they are high in calories); peanut butter, cereals, and seeds are great.
3. Lots of Fish, at least several times per week.
4. Minimal red meat, preferably a few times per month.
5. Lots of Fruits, Vegetables, Whole Grains, and Legumes. For dessert, choose fresh fruits over the typical processed sugar products.
6. Red Wine in moderation (unless you have a problem with or sensitivity to alcohol).

This is not such a difficult diet to adhere to, for one reason because it’s relatively high in fat. This fat though comes from vegetable sources (such as olives), so they are healthy monosaturated fats, rather than the saturated fats from animal sources.

The result of the BMJ meta-analysis was that those who stuck to this diet had a significant decrease in early death from all causes, and specifically a decreased risk of dying from cancer and heart disease, along with a modest (13%) diminished risk of Parkinson’s disease and Alzheimer’s.

Finally, one recent Spanish study concluded that if you stick to a Mediterranean diet, you are much less likely to be part of the group which gained an average 7.5 pounds (3.4 kilos) over a ten-year period. (Unfortunately, many young Mediterraneans have moved away from their traditional healthy diet to a Western diet full of more processed foods and saturated fats, and the rate of obesity in these countries has jumped alarmingly.)

It was a striking, almost metaphorical, image on TV today. The outgoing vice-president seemed disabled, in a wheelchair due to a back injury. The new president, young and vigorous. Best wishes to him! Our inauguration edition is dedicated to you, that you too keep your back young and healthy.

In my Friday post I discussed unnecessary tonsil surgeries from the view of a tonsillectomy patient as well as a surgeon. Today let’s consider back and spine operations. Many health care experts, and even a number of orthopedic surgeons, believe many people who undergo back operations would be better served without surgery; and being treated instead with more conservative measures such as physical therapy, or just patience.

Most back pain will go away on its own without any treatment at all. Fortunately, in many ways—maybe more often than you might imagine—the body heals itself. Sometimes, probably frequently, we muck up and complicate natural healing—causing more harm than good—with surgery. It’s a fine line, and a really good surgeon, who is first looking out for the needs of his or her patient, has the judgment to know when to cut and when to wait.

Particularly in some areas of medicine financial pressures can cloud the surgeon’s judgment, and we can use back surgery as an example. Medical device companies, huge profit machines, need orthopedic surgeons to use their products over the competition’s. These companies hire practicing doctors as “consultants” who can be paid tens or hundreds of thousands of dollars yearly to “help develop” and promote their particular brand. The patient is rarely aware of this arrangement.

The Wall Street Journal several days ago reported on a prominent spine surgeon and faculty member of the University of Wisconsin who earned 19 million dollars over five years from device maker Medtronic. This is an extreme example, but you might be interested to know that the medical device salespeople are OFTEN present in the operating room when an orthopedic surgeon operates, offering advice and assistance on using their products.

Here are a few interesting points about back and spine surgery:

• Back pain is the second most common pain complaint (headache being first), and is the number one cause of work-related disability.
• The number of spinal surgeries has surged over the past several decades; from the early 90s to the early 00s, back surgeries in the Medicare age group rose almost four times. It’s not clear that this surge in surgeries has resulted in more happy patients.
• The surgeries carry risks and not all patients’ symptoms are cured by surgery.  A study last year showed that in patients with sciatica (pain shooting down the leg), 95% were better after one year whether or not they had surgery (though those who had surgery tended to have pain relief more quickly, but the final result was the same).
• Even sophisticated X-rays can be misleading. An MRI can show one problem such as a herniated disc, but the patient’s symptoms might be coming from another problem not seen on the X-ray.
• Of course some back surgeries are necessary, and if you are ever faced with spine or back problems and surgery is considered, consider seeking out an opinion from a surgeon member of the Association For Ethics In Spine Surgery. This group is committed to eliminating the influence of the device manufacturers, and making surgical judgments based purely on the needs of the patient.

When doctors talk to each other about the reason a patient needs surgery, they use the term “indication”. So one doctor might say to another: “What was the indication for that guy you just ‘did’ (operated on)?”  Because to put a patient through an operation, or even a minor procedure, a surgeon should have the patient’s best interest as the primary concern, and the collective benefits of surgery or procedure should outweigh the sum of the risks. Any operation needs at least one valid “indication”, one medically justifiable reason to put the patient through the pain, expense, inconvenience, and risks of a procedure.

So the joke goes something like this: two surgeons are talking about a patient who they think had an unnecessary operation by some other surgeon and the first surgeon says to the second: “What do you think the indication was for that guy’s surgery?”…second surgeon: “Probably the patient had a Blue Cross card and a heartbeat!” (A Blue Cross card means he had good insurance.) In effect, the surgery was done more for the doctor’s financial profit than to benefit the patient. Sadly, this happens. Moreover, it’s often difficult for the patient to know he had unnecessary surgery, particularly if the doctor came across as very knowledgeable and was personable.

When I was about ten years old, it seems like nearly every kid—myself included—had their tonsils out, and the indication often was: good insurance and a heart beat. Many of us probably didn’t need our tonsils out, but it was the custom, and parents rarely complained.

Years later when I myself was doing tonsillectomies on other children, I took the procedure very seriously. Occasionally I would have a parent come in with their child and—perhaps because they remembered back to their own childhood—they would say: “My daughter has had a few tonsils infections and I want you to take out her tonsils”. In many of these cases, their child didn’t really need a tonsillectomy (it wasn’t “indicated”). They hadn’t had enough problems to justify the risks, expense, discomfort, and pain of surgery. They were better off being managed medically; with other, more conservative measures.

I would tell the parent: “These days we have strict criteria about who gets their tonsils out, and I think we should try more conservative treatment before we even think about surgery.” Still, some parents would persist and say: “No, I really want her tonsils out. When I was a child, I had mine out, and I did fine.” At that point then I would either suggest they go for a second opinion or I would say: “You know, tonsil surgery has risks, and the biggest risk is severe bleeding. There’s even a risk of bleeding to death. Back when I was a kid they did about a million tonsillectomies a year in the U.S., and about a thousand of those kids died every year from bleeding. And you know what’s most sad? Most of those kids really didn’t need their tonsils out in the first place.”

On Monday’s post I’ll relate all this to back surgery.

There’s a good chance many of you will be traveling and spending time with relatives during the coming days, giving you a great opportunity to make a last minute gift. It’s something inexpensive, valuable, and doesn’t even require shopping.

I was inspired by several recent reports showing that computer use by middle-aged and older people—either for general web searching or strategic video games—is good for the brain. It only makes sense, and hence the booming industry devoted to computer games and programs for baby boomers (and older) to keep brains young and flexible.

Think for a moment of those older folks you know who are truly computer-proficient. Most likely they also have active, flexible, competent minds and attitudes.

I’m not suggesting you buy some anti-aging brain program. Rather, for your relatives who already have a computer but don’t know its potential, show them how to really use it. Plenty of adults own computers, but their competence level is stuck at email. Maybe they manage some basic (aol usually) navigation, but using it as the wonderful people-connecting, information gathering, brain-expanding tool that it is, doesn’t happen. They may lack computer savviness, but often it’s a lack of confidence; some even think they might break something.

Now since you, dear blog reader, likely have a decent command of computers, I suggest the gift of your knowledge and time. Gift wrap a small card granting a couple hours of your undivided attention as computer tutor. Set a time and do it. Collect your patience, sit with them preferably at their own computer, and have them first demonstrate what they can do. Then, again patiently, help them expand.

Find topics that interest them and see that they can search and bookmark (you might bookmark LiveLongAgeWell, which has plenty of interesting, safe links on the sidebar). Or show them how to find recipes, or poetry, or sport scores, or shop, or pay bills. Demonstrate that many books can be found online, free.

Check their software versions and anti-virus software, and see they know how to update. Since there are online financial predators, check their firewalls. Teach them how to stay safe, not to click on suspicious links, and about phishing. If they are more adventuresome, demonstrate social networking—help them connect with lost friends. There is so much to learn that this gift can be renewed for many occasions over many years…You can’t do it all at once.

Not only will all this be good for the brain, but will help them keep current and yes, younger, as computer-competence becomes ever more necessary to connect with modern life.

Imagine if print newspapers and magazines go the way of film cameras, and most reading goes online—those who are computer-comfortable will be way ahead.  And for people who become disabled or home bound, those who can navigate a computer will still have much of the world available. So consider this gift, this year. I’ve done it. It can work for you as well as for your student, and might even make the two of you closer…Next post Monday…Happy Holidays!

About the time the Berlin Wall fell in 1989, several Berlin universities joined with several U.S. institutions and launched the Berlin Aging Study (BASE), with the goal of closely following, over many years, a group of more than 500 men and women aged 70 to over 100 years old. Over time this group has been put through extensive testing to asses their physical and mental health and their social and economic well-being. While the “subjects” in BASE were Berliners only, most likely the results generalize across cultures. The ultimate purpose of BASE is to find keys to aging better, and the study is ongoing.

Here are some of the results to date…which gives encouragement that when we hit middle age and beyond, our lives should continue to be happy and satisfying:

1. On average, the people in the study felt about 13 years younger than their actual age, and felt that they looked about 10 years younger than they actually were.

2. The men believed they looked younger than the women, by about 4 years. (I wonder if the men in this study might be well, slightly delusional, because in the U.S., it seems like the women take better care of themselves, and look younger. I’m really curious what the LLAW readers think about this. Please leave a comment with your opinion!)

3. Most in the group had a high level of satisfaction with their own aging; they weren’t depressed or discouraged about being older.

4. Some people, seemingly those in the best health, seemed to feel even younger as they got older.

5. Finally, referring back to “self-perceived age” discussed in Monday’s post: when BASE studied various groups of older people of the same age and physical health, the ones who just felt younger had better vitality, health, and longevity than those who felt their “real” age. Thinking and feeling younger seemed to give people more resilience to face the challenges of getting older.

I recently read two examples in the New York Times of older people doing amazing things (and from their pictures, they look pretty good too). First, a 73 year-old who 50 years ago played college basketball. He recently started community college in Tennessee, tried out for the college team again, and yes, he’s on the team and doing well as college basketball’s oldest player.

Second story was the 100th birthday celebration at Carnegie Hall for the composer Elliot Carter. Since turning 90, he’s published over 40 compositions; six in the past year alone. James Levine, the music director of the Boston Symphony Orchestra says about Elliot Carter “He’s still writing at the top of his form…every time he writes a piece he has new ideas he’s trying.”

This concept of “trying new ideas”—always being willing to experiment—not sticking to a rigid self, is one great secret to exceptional aging.

This quiz is to get you thinking about your different “ages”, as my Friday post will be about some encouraging results from the Berlin Aging Study. Like all quizzes here on the LLAW blog, there’s no pressure and no one checks the answers; it’s only to spark some thought.

When someone asks “how old are you?”, you probably think about your chronologic age (after perhaps first considering: should I even tell this person, and if so, should I lie?) But this quiz is about your five different ages:

1.    What’s your chronologic age? The easy one, your real age. The only age you can’t control, it just ticks upward, but the good news is that the rest of your ages you have lots of control over.

Regarding lying about your actual age, I think it’s generally not a good strategy. If you take care of yourself well, you hopefully won’t be shy about telling. If you don’t want to say, better to deflect the question than lie. Besides, forcing yourself to be honest is a great stimulus to take good care of yourself!

2.    What’s your physiologic age? How well is your body functioning? You might be 32 and have the physiology of a 45 year-old or 75 and have the inner works of a 59 year-old. So take a guess—where do you think you are at?

Your goal of course is to have a physiologic age no greater than your real age. Fortunately, this is more controlled by how you live your life than by your genes.

3.    Your apparent age? Assuming other people don’t know your real age, it’s how old someone thinks you are when they see how you look and act. It’s a complex issue involving not only how you look, but how you talk and walk and how you are dressed and much more…

You have lots of control over this age, but typically, it’s hard to know what people are thinking.  Most people won’t tell you, and if they do, they could be lying either up or down. (An embarrassing situation I have experienced is when a proud older person asked “how old do you think I am?”, and I guessed too high. Next time when someone asks this awful question, you might consider, as I have, well…adjusting what you say.)

4.    Your self-perceived age? In your own mind, and when you look in the mirror, the age you feel or think you are.

Often changes day to day of course, but in general, as we will see from the Berlin Aging Study, it’s healthy to think of yourself as younger than your chronologic age. So don’t worry if you don’t “feel your age”. It’s a good thing.

5.    Your desired or fantasy age? The age you’d like to be if you could choose. Nice if it’s approximately your real age, and again, if you do a really good job with yourself, it just might be.

Funny that when you’re very young, usually it’s more than your real age, then sometime in your twenties, when you feel the sting of responsibility, you want to be younger.

Now next time someone asks you your age, you might be a little snappy and say “which age are you referring to exactly?”. Or, if you really feel the need to fudge your actual chronologic age, try picking one of your other ages, like your fantasy age, and watch their reaction!

First, I want to welcome new readers to LiveLongAgeWell (LLAW)! I have been slowly informing people about LLAW, but still there are many Internet users who are new to blogs. I hope you use this site as a health resource, and find it useful enough to bookmark and return often.

Generally three times a week—on Monday, Wednesday, and Friday—I will add new “posts”, with various hints, health information, and news items all geared towards helping you age better. I cover physical and mental health, but also news and hints to help you look healthier, and hopefully younger too! If you are new to LLAW, you might read my initial welcome post of September 29 to get a better idea of my goals. The “Pages”, found on the right sidebar, includes a “Core Principles” page which covers my basic philosophy about how to age well.

To make LLAW a “Bookmark-able” health resource, I have added to the sidebar a number of useful links to make finding health information on the web easier for you. Check out the various headings and click on a few. If you want to do your own online medical research, read daily medical news items, find up-to-date nutrition or dietary supplement guides, or information on the latest good skin products, you should find it all there, and more.

Finally, especially if you are new to blogs, I encourage you to make use of the “Comments” tag that you will see at the end of each post. To keep each post a reasonable length, I can’t cover everything about a topic, and if there is information you want to share, please do, and help make this site a more valuable resource for us all.