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

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

More from the APA Meeting

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

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

“Sham” Vertebral Procedure and the Placebo Effect

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

Up to 90 percent of the visible skin changes commonly attributed
to aging are caused by sun exposure.

11 Hints…What You Can Do

1. If you are very concerned about the potential toxicity of sunscreens, consult this summary from the Environmental Working Group, a non-profit consumer “watchdog” organization that has issued a list of what they consider recommended and relatively safe products. One problem is that you probably won’t find many of their recommended ones at your local drugstore, but you can probably find most online.

2.If you are not so concerned about theoretical chemical risks, you can consult this short list of American Academy of Dermatology (AAD) “recognized” products (while not as cautious as the EWG list, the AAD is still quite a careful group). One brand from their list I particularly like is Aveeno, which you will be able to find locally. Aveeno makes high-quality products that are not terribly expensive.

3. The last several years has seen release of several products that have longer-lasting, stablilized UVA protection (as well as the more standard UVB protection), and Mexoxyl and Helioplex are two components to look for. Helioplex seems to be the superior product, and of those brands with Helioplex, I like the Neutrogena brand, particularly Neutrogena Ulta-Sheer SPF 70 with Helioplex. It’s what I use. Some researchers have claimed that since these chemicals are partially absorbed into the bloodstream, that they might have an estrogen, hormonal-type effect internally. Talk to your physician if you are concerned about possible hormonal effects,  and you may not want to use one that is absorbed, on children.

4. If you want a sunscreen that is not absorbed, find a zinc oxide or titanium dioxide product (and see EWG report above), though these often leave the skin with an unattractive white cast.

5. It is probably best to avoid spray and powder sunscreens that have (ultra-small) nano-particles which might be inhaled.

6. Besides using a broad-spectrum UVA/UVB product, buy at least a SPF 30, and use enough of it! Shockingly, you need to use a “shot-glass” amount, about 1 oz. (1/3 of a typical 3 oz. tube) for your entire body, if you want to get the advertised SPF factor. Bottom line: use more than you think you should.

7. Apply 30 minutes before going in the sun to allow it to absorb.

8. Sunscreens lose potency over time. Look at the expiration date when you buy or use, and throw away any product at 3 years.

9. Reapply after going in the water, after significant sweating, and about every 2 or 3 hours. Even “waterproof” sunscreens come off after 40 minutes in the water, so if you are a water person, look for “very waterproof” which should give double water protection.

10. Don’t forget to apply to areas commonly forgotten such as: the entire surface of the ear (I can’t count how many ear skin cancers I excised and re-constructed when I was in California), any bald spots, the tops of your feet….and use a lip-sunscreen too (lip cancer is common)!

11. Avoid the sun during peak times, 10 am to 3 pm, wear a hat and don’t forget quality sunglasses to protect your eyes from cataracts! (a subject for a future post…)

Next: self-tanning products.

Last post I presented evidence that the act of chewing gum can temporarily improve short-term memory and test-taking performance (click to read).

These brain benefits are based on relatively new research, including functional MRI scans, but other well established research has demonstrated that chewing gum can improve your oral health; the condition of your teeth and gums. If you have healthy gums and good oral health, you are less likely to get sick.

People with poor dental nutrition, meaning untreated cavities and inflamed gums, are more likely to suffer from cardiovascular disease. The current thinking is that some heart and blood vessel disease, including atherosclerosis, is an inflammatory process, and if your gums and teeth are not in top condition—meaning they are chronically infected—your oral tissues will be slowly leaking toxic, infectious products into your bloodstream. These toxins then are slowly irritating, inflaming the walls of your blood vessels and leading to more vessel damage and making you more prone to heart attacks and strokes.

As an otolaryngologist, I saw tens of thousands of mouths over 25 years, and usually I got a fantastic clue as to how healthy someone was just by looking at their teeth and gums. Not always, but usually, if the gums were in good shape, so was the person, and if the person had bad oral hygiene, their body was not in such great shape either.

Saliva is a good thing; in general the more the better. One of the causes of chronic gum infection and inflammation is dry mouth. Typically the more saliva you make, the healthier your mouth, and one reason chewing gum is healthy is because it stimulates saliva production. Saliva dilutes the acidic environment in your mouth that follows a meal—it washes away and neutralizes the acid and food particles that lead to chronic infection and dental plaque. The calcium and phosphate in saliva can strengthen your dental enamel. Further, low-grade gum irritation makes you more prone to diabetes, and if you already have diabetes, gum infection will make your blood sugar more difficult to control. Finally, a dry mouth makes bad breath more likely.

Even the normally conservative American Dental Association has endorsed certain chewing gums, and you can see which those are by clicking here. They typically contain tooth-friendly sugars like xylitol or sorbitol. The recommended “dose” is that you chew for up to 20 minutes after a meal. It’s particularly a good idea after you eat out—for example after lunch at work—and don’t brush until hours later.

Look for a gum with “Whitening” on the label. They cost more than regular gums, but are worth it. The only side effect I can think of is the act of chewing gum can in some people strain the TMJs (temporo-mandibular joints), so watch for any pain in front of your ears, and discuss any concerns with your dentist. Otherwise, give gum a try. It’s cheaper than most all medications, and a lot safer. It potentially can improve your oral health, your general health, your mental health, and your social life…as we get older, breath becomes more of an issue, and whatever we can do to combat bad breath and allow people to come physically closer, the better.

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’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.

Last week there was a report about patients receiving too much radiation (excessive risk for the benefit received) from a new and already popular X-ray. That study is the subject of the next post. Today as background let’s just look at one article that appeared in late 2007 in a top medical journal, The New England Journal of Medicine titled “Computed Tomography — An Increasing Source of Radiation Exposure”.

In the future, if and when a doctor suggests to me some sort of CT (computed tomography) X-ray, I will say: Studies show that some CTs expose people to lots of radiation, so how does this CT rate, and how good is the CT facility you’re sending me to? If my doctor doesn’t know, I will question the radiologist at the X-ray facility before I schedule the test. I will want to know how their equipment rates with other institutions on radiation exposure, and what steps they take to protect patients from unnecessary exposure.

This might be shocking, but it’s true: from a single typical CT study you will receive about the same dose of radiation as an atomic bomb survivor who was one to two miles from ground zero at Hiroshima.

Those Japanese survivors received approximately a 3000 millirem radiation dose, and for a typical CT study—depending on where it is done, the type of scan, the age of the patient, and other factors—a person will receive from 1000 to 10,000 millirems of radiation. And here we are not talking about exotic scans, just normal CT studies ordered every day in emergency rooms and doctors’ offices by the thousands for complaints ranging from headache to chest pain to bellyache.

Excess radiation exposure—studied long-term in Hiroshima/Nagasaki survivors and radiation workers in the nuclear industry—has shown an increased risk for most types of cancer. Shockingly, a recent survey revealed that 53% of radiologists and 91% of emergency room doctors did not believe that CT scans increased the lifetime risk of cancer. But these scans can and they do. 75% of these doctors seriously underestimated the radiation dose from CT scanning. When I have spoken privately to radiologist friends about the issue of radiation from CT scans, they say yes, they are concerned, but seem to be hoping for the best; they really don’t want to think that their tests might increase anyone’s chance of cancer.

Despite that hope, it’s estimated up to 2% of cancers in the U.S. today are secondary to irradiation damage from CT scans, leading to 3 million excess cancer cases in the next 20 to 30 years in the U.S. alone. And while perhaps the increased risk from only one scan might be relatively small, many people undergo multiple scans over their lifetime, and the risk is cumulative. Disturbingly, children are much—up to 10 times—more sensitive to the cancer-inducing effects of radiation.

Next…ideas how to avoid unnecessary medical irradiation.

Triggered by a lack of sunshine and shortened days, SAD people suffer a depression often marked by a combination of fatigue, weight change (typically weight gain), social withdrawal, increased sleep time, loss of concentration and libido, and feelings of hopelessness. It can be so severe that some consider suicide. It’s a serious disorder that demands care, and if you or someone you know might be affected, therapy is usually highly effective.

To help prevent SAD and to treat mild cases, push yourself to get outside each day (in the midday sun if possible), and increase aerobic exercise in the winter months…it may be enough just to take a brisk 30 minute walk outside each day. Avoid areas of your house that are dark. Try to sit and work by the window, keep the blinds up, and the lights on more than usual (bright white fluorescent light bulbs are best). Socializing more each day seems to help.

If your case is more severe or not helped by simple measures, talk to your physician. First line therapy includes (no shock) “light therapy”, but there is a special light that’s recommended, used in a particular way each day for at least 30 minutes, usually in the morning. Tanning bed lights are a bad idea, and you can’t depend on regular fluorescent lights if you have significant SAD; you need the right light. A SAD therapy light may emit from 2500 to 10,000 lux, whereas a typical home light fixture might give off only 100 to 200 lux. Adequate ones costs over $100, but it’s a good investment, and cheaper than other treatments such as antidepressants (ask your doctor about ones that won’t have a sedative side-effect) and psychotherapy. Some people need a combination of these treatments to shake them out of SAD. Many need to start their therapy each fall and continue to late spring.

I admit that right now I’m in Brazil, and it’s about 30 degrees (centigrade, about 86 F.) It’s the middle of summer, and I don’t think anyone here suffers from SAD (unless they have “reverse SAD”, a subject for a later blog.)

So, to my friends and readers up north, I’d recommend—if you can swing it—a trip down here or somewhere south to avoid SAD next year. You might ask your accountant: if you get a doctor’s prescription, could such a trip be tax-deductible? But if you’re ever planning to run for political office, don’t even think about it…

Next week’s edition of the New Yorker magazine (available online now) has an article by Jerome Groopman, M.D. regarding his adventures in trying to stop his head noises. Much of the discussion revolves around soldiers in Afghanistan and Iraq, and how gunfire and explosions have turned hearing loss and tinnitus into the number one cause of disability claims for these soldiers. Apparently, they are not using earplugs consistently, and in many cases (like body armor) the military hasn’t provided adequate protection.

But it’s not only soldiers who suffer life-long hearing loss and ringing. It also commonly arises from noise at work, and from listening to iPods at too high of a volume. As a general rule for iPod use (and for most other portable music players), if you put the volume at 80% of maximum, don’t listen for more than 90 minutes a day. At 100% volume, you will suffer inner ear damage after only 5 minutes of exposure! In general, try to limit your iPod to 70% or less of maximum volume.

If you regularly go to loud clubs or concerts, avoid future hearing loss and ringing by investing in a set of good earplugs with an adequate Noise Reduction Rating.   Consult this article for much more data about safe earplug use, including a table of recommended loudness x listening time.

So your best defense to avoid the irritation of tinnitus is prevention. Minimize—beginning when you are young but it’s never too late to start—unnecessary exposure to loud noise. But if you already have ringing, get an appointment with an otolaryngologist (ear-nose-throat specialist) and get a hearing test to find out what’s the cause and what can be done to treat it. If you want more detail, check out this guide to ear ringing.