LiveLongAgeWell

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.

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.

Anti-Aging Supplements

The American Medical Association AMA) has issued a report about hormones promoted on anti-aging websites. These include such products as Human Growth Hormone (HGH), DHEA, and testosterone, and they are sometimes available through online websites, or at many stay-young clinics around the world. HGH is one of the most popular, and the AMA states “evidence suggests long-term use can present more risks than benefits”. I agree. The research regarding this product, in particular, is turning more and more negative. I would be very suspicious of anything you take by mouth and especially injections, even of  “natural” products, that promise to keep you young.

Zinc Nasal Products and Loss Of Sense of Smell

Speaking of natural, one of the most popular over-the-counter products sold to prevent and treat the common cold is Zicam spray, and the active ingredient is the metal zinc. Here’s a glowing report from 2003 citing research showing that if you start Zicam within 48 hours of the onset of a cold, your symptoms can be cut by 50%. Now it turns out that the makers of Zicam have received over 800 reports of partial or complete loss of the sense of smell, often permanent. The company has settled 340 lawsuits regarding the product, and many more will be filed. Fortunately, the company has withdrawn many of their products from the market. “Natural” doesn’t mean effective, nor safe. Some of them are, but most probably are not, and like Zicam, can be found to be harmful years later when serious side effect reports roll in. Most are not regulated by the FDA. Buyer beware, even for “natural” over-the-counter products.

Vitamin D and Dieting

Here’s another possible benefit of what is currently the “hottest” vitamin, that is, vitamin D. (You can search on this blog to see the various recent reports.) The latest research, just presented at the Endocrine Society Annual Meeting in Washington, showed that people who had a higher vitamin D blood level before dieting lost a significantly greater amount of weight during their diets than people with lower vitamin D levels, and the higher the level, the greater the weight loss. This doesn’t prove that if you take vitamin D, you will lose weight. More research will be done to see if taking vitamin D supplements allows you to lose weight more successfully.  While there is no proof at this point, vitamin D in reasonable doses is considered safe, so if I was trying to lose weight, I would make sure I was getting enough of this vitamin, either through sunshine, diet (especially fatty fish, such as salmon), or supplements.

Have you been reading the reports in the news regarding (the newly discovered) health problems that can result from long-term inadequate sleep? In the past, many felt that regularly sleeping less than seven hours a night was no big problem, but now, research is showing that if, on a regular basis, we aren’t getting enough sleep, the bad effects go way beyond just looking and feeling tired.

The most recent report is about the association between high blood pressure and short sleep times. Previous research has suggested a link between inadequate sleep and diabetes, and even obesity. One reason may be that the human organism requires a minimum amount of sleep to reset and calibrate our internal hormonal system.

Scientists have discovered that—surprisingly—people who undersleep tend to get fat, and one way to keep at a good weight is to make sure you are getting enough sleep. Only with enough sleep will our body have good healthy responses to ghrelin and leptin.

Maybe they sound like new diseases: ghrelin and leptin…but, ghrelin is a hormone we all have that’s formed in the lining of the stomach, and after being secreted, it goes deep into the brain and excites the same mechanism that causes some people to become addicted to say, food or alcohol. The other one, leptin, is a hormone secreted by our fat cells (!) that puts the breaks on appetite by acting on our brain in the opposite fashion. You can only imagine that biotech drug companies are racing to find and sell a pill that acts like leptin.

Bottom line: if you don’t sleep enough, you tinker with this leptin/grhrelin balance in a bad way; the tendency is to get fat. Many of us suffer, at least occasionally, from sleep problems, and I’m briefly covering this issue so that if you are one of those sleep-poor people, well…let’s think about the problem in a more serious way, with more attention to fixing whatever are the underlying issues.

I’m curious if my readers are interested in hearing more about sleep, and about what happens if you don’t get enough, such as the effects on your blood pressure and heart (besides the diabetes and obesity issues). Leave a comment if you are, and if readers say they want,  I’ll write a more detailed report in the near future.

Over the last several years as more studies come out regarding vitamin supplementation and health, I have been decreasing the number and milligram “dose” of the vitamins I take. For example, I used to take vitamin E (as the more difficult to find, but more valuable “mixed tocopherol” form) 200 IU once per day, and now I take that same amount but three times a week. The one vitamin supplement though I recently added is vitamin D3, a single 1000 IU pill on most days.

Just this month another report about vitamin D and its possible “brain protective” effect appeared in the Journal of Alzheimer’s Disease. The author suggests people over 60 have their vitamin D level checked, and strongly consider vitamin D3 supplements or…get more sunshine.  This is not the first researcher to suggest vitamin D is “neuroprotective”. Earlier this year there was a large U.S. study showing that people with low vitamin D blood levels were more than twice as likely to have dementia as people with high blood levels. Of course, this doesn’t prove that taking vitamin D will cut your risk for dementia, but it seems likely, and for me, I think the potential benefits of daily 1000 IU of vitamin D3 far outweighs any risks.

I was surprised to see a report in the June American Journal of Medicine. The author examined health habits on over 15,000 adults over two different time periods: 1988 through 1994 and 2001 through 2006. The question was: are people practicing a healthier lifestyle now than they were 15 to 20 years ago? The answer is that currently, more people are doing worse when it comes to good health habits!

Yes, more people in the current study are obese (36 percent now vs. 28 percent in the older study), fewer people are exercising regularly (now 43%, and it was 53%), and even worse, the percentage of people who eat five or more servings of vegetables and fruits daily dropped from 42% to the current level of only 26%.

All this despite a flood of health information in the media, including blogs like this. Maybe people are becoming overloaded with health information and just… tune it out? Perhaps the constant flood of data, combined with contradictions from study to study, leads people to think: why bother? What do you think?

I guess the only good news from this is that if YOU choose to live a reasonably healthy life (in short: eat a good diet, exercise and keep your weight under control), you will  look better and better as you get older compared with the growing number of people who are all also getting older, but who aren’t taking care of themselves like you are.

I was surprised and slightly amused to see acai (properly spelled, with accents açaí, and pronounced ah-saa-EE), the blue Amazonian berry, so heavily promoted as a weight loss aid—and a frequent subject of spam emails—because here in Brazil, where it comes from, acai is more likely seen as something that will make you fat, not thin. Still, acai as a supplement has become a huge industry in the United States, with a marketing frenzy spurred by high-powered endorsers like Dr. Oz and Oprah. What’s the truth….will it help make you thin, or fat, or neither?

I initially heard of this “healthiest fruit in the world” —a reputation it carries in Brazil—on my first trip here in 2001, and since it was exotically blue, tasty, and apparently full of antioxidants, I have eaten it frequently. Acai is a grape-sized fruit from an Amazonian palm tree (another part of the same tree is sold as “palm hearts”), usually sold in frozen packs of blue pulp. Typically it is prepared as a thick smoothie, mixed with banana and the sweet caffeine-rich syrup of another Amazonian berry, guaraná. It’s fashionable to cover the whole bowl with granola.

Acai indeed has the reputation as being mysteriously healthy, full of antioxidants, and the science indicates that it is, but exactly how heavily it’s loaded with antioxidants is controversial. Some studies indicate a medium level, some higher; it depends on which “system” of oxidation in the body or test tube is being tested. It seems likely though that the basic antioxidant content is quite high, somewhere around that of a blueberry.

Interestingly, the value of antioxidants in the body is a hot topic now…are they helpful or could they be in some cases harmful? A recent study regarding vitamins C and E and exercise suggest that antioxidants, at least as pill supplements, might actually weaken our own body’s natural system of mopping up oxidative damage, and antioxidant pills might weaken these defenses. So a new theory is that these supplements might make our own natural antioxidant systems lazy, and in the long run, lead to more oxidative damage, more aging.

But it is much too soon to reach any conclusions; almost certainly, other studies with different formulations of vitamin E, different dose schedules, etc, will give different results. Most scientists seem to agree however that the antioxidants you consume in foods like tea, red wine, colorful vegetables, legumes, coffee, chocolate, etc, are beneficial as far as cutting risk of heart disease, some cancers, and possibly dementia.

Back to acai. Besides whatever natural antioxidants it contains, it is full of the best form of (monosaturated) fatty acids, similar to olive oil, and has lots of fiber. But as a weight loss aid? No proof at all, and no good evidence either. Don’t waste your money. Acai in body creams as a wrinkle reducer? Again, no evidence; better to spend your money on a visit to a dermatologist, a prescription for topical retinoic acid, and a good sunscreen. Still, I’ll continue to eat my acai mixed with banana and guarana, but I’ll rely on the gym and lots of walking to keep my weight in line…certainly not acai, green tea, or any supplement.

One of the hottest topics in medical research regarding aging is that many problems—from some cancers to atherosclerosis to Alzheimer’s disease and even some aspects of aging itself—can be in part caused by inflammation, which we might describe as a low-grade infection in the body over many years. This chronic irritation gradually results in damage to various organs such as the brain and the lining of our blood vessels, and might be one of the major factors in determining who among us will lose our mental capacity as we get older…the more the chronic inflammation, the greater the long-term damage, the higher the risk for dementia.

So for the past several years at least, the conventional wisdom has been that drugs that decrease inflammation also lower the risk of dementia, and much hope has been directed towards the non-steroidal anti-inflammatory drugs (NSAIDs) such as over-the-counter ibuprofen and naproxen (U.S. trade names like Aleve, Advil, Motrin).

Indeed, it was almost exactly one year ago that the esteemed journal Neurology published a huge study of veterans (about 250,000 people) over the age of 55, and found that during a five-year period, NSAID use appeared to lower the risk of developing Alzheimer’s by 24-40%. Considering the grand theory of inflammation, this all made sense. But now a University of Washington study, spanning 12 years, showed the opposite result—those who used NSAIDs most heavily (which, we would think, should markedly cut the inflammatory effect), had a 66% higher risk of developing Alzheimer’s than those who didn’t use NSAIDs.

The authors of this new study suspect the reason for this contradiction is that the earlier research studied younger people, and the latest study looked at people over 75. So perhaps NSAIDs only have the protective effect for younger people, and if you are above 75, NSAIDs markedly raise your risk? Is it perhaps that NSAID use by younger people delays the onset of Alzheimer’s, but ultimately raises the risk? This is still a very messy and complex topic, which won’t be resolved soon. What is certain is that much new research will come out over the next decade, and maybe by then the issue will be resolved.

The news about vitamin D just keeps getting better and better. In fact, it’s hard to find much news that is negative about this vitamin. The latest work comes from studying Costa Rican children with asthma, and those with the lowest vitamin D levels had a much higher risk of severe asthma.

Want to avoid diabetes? (who doesn’t?)  It seems likely that most cases of diabetes in people 65 or older are preventable… it’s not just fate, or family history. Nine out of ten cases can be avoided if you “live right”. According to a recent report in The Annals of Internal Medicine, people who follow some basic health principles regarding diet and exercise have a 89% lower risk of developing diabetes.

Here’s how to do it…see the details in MedPageToday, and of course, consult your physician for your specific situation:

1. above average physical activity
2. healthy diet regarding fat and fiber intake
3. don’t smoke, or have quit 20 or more years ago
4. light to moderate alcohol use, vs. not drinking at all
5. avoiding obesity
6. keeping your waist under 34.6 inches (88cm) for women, and under 36.2 inches (92 cm.) for men

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.

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!