LiveLongAgeWell

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.

Here are several excellent articles that may interest you… The first two cover recent LLAW topics (red meat and mind drugs), and these links will give you a totally different slant on each subject. The third article, and the shortest,  regards a totally different subject: creativity.

From The New Yorker, titled Brain Gain, is a long piece that first describes how college students are taking advantage of mind drugs (easily found on-campus) to ultra-perform. Then, in true New Yorker style, the author dives into several people at the forefront of cosmetic neurology, and the “transhumanist” movement (who believe we humans have the potential to live a very long time).

And if you are looking for even more motivation to cut down on your red and processed meat consumption, I suggest this relatively short article in the New York Times: Paying a Price for Loving Red Meat by Jane Brody.

I subscribe to an American Medical Association news feeder that every day sends me a digest of the latest medical news, and I have noticed for the last few months, the news is dominated by public health policy and health care economic reform in the United States.

So let me suggest a topic far away from those subjects… from a founder of the company IDEO, which helped design the Apple Computer.

Getting older is much more fun if you constantly keep your “creative juices” flowing, no matter your age; believe me, you will help keep your brain in good form, and this brief and entertaining piece from the IDEO group gives six hints to help us achieve that! Love it!

You probably have a friend, or perhaps a boss, like Bristol (name changed)….let me summarize Bristol—she’s very bright, but she consistently has a negative, pessimistic reaction to, well, seems like everything. I really like Bristol, but I’m constantly amazed: how can someone find something bad in almost every bit of news I give her? Now maybe I have an answer.

In the most recent issue of Veja (no link since it’s by subscription; only in Portuguese…most similar to Time magazine in the U.S.), there was an article of a British/Brazilian university study which identified a gene that appears to control optimism and pessimism. Several hundred people were put through DNA analysis along with a battery of psychological testing, and the results were clear: if a person has two “long” versions of this particular gene, they are prone to optimism, if they have the “short” gene version, they are much more likely to look at the world in a negative way, pessimistically.

This gene in question helps control transport of the neurotransmitter serotonin from nerve cell to nerve cell, and speaking generally, the more serotonin that travels the gap from nerve cell to nerve cell, the happier a person tends to be. It’s the basis for the most popular form of anti-depressants, SSRIs, otherwise known as “selective serotonin reuptake inhibitors”, which increase the amount of serotonin in that nerve gap, the synapse. So the people with the two long form genes have more serotonin available to bridge those nerve gaps, and probably look at the world in a more positive way.

With this gene information, I will try to be even more understanding with Bristol, or perhaps mention to her again the idea of seeing a physican to at least consider “up-regulating” her serotonin levels with medication. Of course, medication and the issue of behavior being genetic or environmental…all of these are hot and controversial topics. As science identifies more genes influencing more behavior types, I suspect the controversy will become even more intense, more polarized, as people debate how responsible individuals are for their own behaviors, and if  “problem” behaviors should be “fixed” with medication. What do you think?

Last Friday’s post was somewhat directed towards dense research (aging theory, anti-inflammatories, vitamin D, avoiding diabetes) so today, let’s go lighter, simpler, and to a topic that probably is more important than the heavy science issues, at least concerning your mind and memory.

I have a theory that much unnecessary (I might say, premature) aging occurs just because you think you should age in a certain way, at a certain rate. Maybe you observed such aging changes in your parents or contemporaneous friends, and now you feel this is how it should be for you too. But it doesn’t have to be. In many areas, if you really believe that you can maintain your abilities as you get older, you can. I’ve seen it many times. Certainly not in all aspects of aging, but it’s true in many: your mindset is most important. It’s not so complicated.

And this recent simple research from North Carolina State University, published in Experimental Aging Research, is directed towards that theory. Basically, two groups of older individuals were given memory tests to see how well their minds were functioning. Before and during the tests, half of them were essentially told (or in subtle ways reminded): “you are old”, and the other half were not biased with that rubbish at all…they just were allowed to do the memory tests.

The study found that those older people who were subtly told: “we are young researchers doing memory tests on you old people” did much worse on the tests than the older people who just took the test without any such biased and unnecessary comments. So as you, and we, all get older, we will be subjected to such biases and comments (be ready so you can reject them), and if you just believe in yourself, you’ll do much better…

I could only find a short abstract of the study (I couldn’t get access to the full report), so I suggest you read the following press release from North Carolina State University, which sums up the details of the study very nicely:

Thinking your memory will get worse as you get older may actually be a self-fulfilling prophecy. Researchers at North Carolina State University have found that senior citizens who think older people should perform poorly on tests of memory actually score much worse than seniors who do not buy in to negative stereotypes about aging and memory loss.

In a study published earlier this month, psychology professor Dr. Tom Hess and a team of researchers from NC State show that older adults’ ability to remember suffers when negative stereotypes are “activated” in a given situation. “For example, older adults will perform more poorly on a memory test if they are told that older folks do poorly on that particular type of memory test,” Hess says. Memory also suffers if senior citizens believe they are being “stigmatized,” meaning that others are looking down on them because of their age.

“Such situations may be a part of older adults’ everyday experience,” Hess says, “such as being concerned about what others think of them at work having a negative effect on their performance – and thus potentially reinforcing the negative stereotypes.” However, Hess adds, “The positive flip side of this is that those who do not feel stigmatized, or those in situations where more positive views of aging are activated, exhibit significantly higher levels of memory performance.” In other words, if you are confident that aging will not ravage your memory, you are more likely to perform well on memory-related tasks.

The study also found a couple of factors that influenced the extent to which negative stereotypes influence older adults. For example, the researchers found that adults between the ages of 60 and 70 suffered more when these negative stereotypes were activated than seniors who were between the ages of 71 and 82. However, the 71-82 age group performed worse when they felt stigmatized.

Finally, the study found that negative effects were strongest for those older adults with the highest levels of education. “We interpret this as being consistent with the idea that those who value their ability to remember things most are the most likely to be sensitive to the negative implications of stereotypes, and thus are most likely to exhibit the problems associated with the stereotype.”

Continuing the theme of last Friday’s post “do married people live longer?”, today a light and simple idea for couples looking for ways to keep their relationships fresh. A healthy, low-stress primary relationship goes a long way to keeping you physically healthy. First though, since many LLAW readers are outside the U.S., let me define “date night”.

“Date night” is a pre-set “date” time, typically one evening per week, that couples—often who have been together for some years—use to re-ignite or at least help maintain some fun and passion in their relationship. The two don’t have to be actually married, but the common theme is that the partners are often so busy with their independent work and home lives that without this pre-arranged time, they might not get out of the house alone together for fun and entertainment.

Researchers have found however that “date night” for many couples can be, every week, every time… pretty much the same…out to the same restaurants or movie theaters or with the same group of friends. Now some recent studies, based on neurotransmitters, suggests a better way to approach “date night”.

These days neuropsychologists look at either brain scanning or brain chemistry to try to explain and understand human emotions, and love and passion are prime targets for research. Already widely known is that couples’ relationships shift over the first several years, and the original excitement and passion is usually replaced by a (hopefully) still loving connection, but typically the newness and passion cools over time.

The neurochemical explanation is that when we are first in love, the brain is flooded with the neurotransmitters dopamine and norepinephrine, the same transmitters that fill our brains when we engage in new activities and adventures that are exciting, or daring, maybe a bit risky. Working with that data, a social psychologist from the State University of New York devised a number of experiments with couples in various situations.

He found that one big key to keeping a relationship exciting and the good neurochemicals flowing is to inject novelty and challenge into shared activites. Make an active effort to avoid the same places or the same people each week. Shake it up as much as you can. Rather than Chinese food, pick Moroccan, rather than biking in the park, try rafting or hiking on new trails, rather than hooking up with the couple from work, invite that new lesbian couple for drinks or dinner. Take risks, shake it up, constantly. Some things will work out, others will fail and that’s a good thing. It shows you’re willing to live a bit on the edge, and that helps keep your brain chemistry in good working condition. When you experience novelty in outside activities, the right neurotransmitters will keep flowing, and you’ll probably continue to see newness in your partner too.

Monday’s post will be “Date night success for married people”…
but today let’s examine one pearl of “conventional wisdom”: that married people live longer and are healthier than single people.

Fortunately this “marriage” benefit is not so rigid, as it allows for unmarried couples too; just living as a couple, or at least living with another person, is said to help you live longer. The reasons are uncertain. It could be that close daily social interaction itself is good for our hearts and brains, or that when we live with another person we are less likely to engage in damaging behaviors like laying on the couch all day or drinking too much or smoking. Probably it’s a combination of various things.

There is also good evidence that living with a pet is better than living alone. (I suspect it’s better to live with a pet than with another human with whom you don’t get along. I believe the stress from a nasty human relationship is worse than any benefit….yes, dogs and cats can be our best friends…)

Armed with the conventional wisdom then, I found this Psychology Today blog post very interesting. Written by a University of California psychologist, she argues that the basic research (the RAND study)—the foundation of the accepted dogma that marriage protects you—is biased and not true.

Dr. DePaulo’s examined the RAND study along with even longer-term data, and found that the most scientifically correct conclusion is: what is best for your health is not singleness or the married state, but consistency… that you either STAY married or STAY single.

She says the other studies had it wrong in their conclusion that people who were “single” died sooner. The reason lies in the RAND definition of “single”. They defined single as anyone who was not married at the time of the research. This means that their “single” group included not only people who had never married, but anyone who was also divorced, separated, or widowed. And there is plenty of data—and I saw this many times in my medical career—that people (especially men) who are divorced, separated, or widowed suffer more medical problems.

So the major study showing that being married was healthier than singlehood used a definition of “single” that included an less-healthy mix of separated, divorced, and widowed people. Another longer-term study of single vs. married, the Terman Life-Cycle Study which began collecting data in 1921, found that either consistent marriage or consistent singleness was the best for health.

I recommend you check out the Psychology Today blog, and if you have an opinion, email me or leave a comment. I am not against being in a couple; far from it, but I think we should, like this UC professor, look at the potential medical benefits more honestly. Next…one hint how to stay coupled.

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.

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.

Several people from last week’s survey (if you didn’t fill it out, you still can on the site), suggested I address more of the psychological issues of aging well. So today let’s cover one small but I think important psychological aspect of aging, an attitude you might be carrying but not be aware of. It’s something artificial, a mind-set that will cut your potential and cause you to age faster.

About when I turned 30, I started to hear some of my similarly-aged friends say things like: “I’m too old to try that” or “Oh no, I can’t do that, I’m too old”. It was like they hit the magic age of 30 or so, and they realized some discrete, all-of-a-sudden drop in their ability to handle certain tasks or enjoy some activities or sports they used to easily engage in, or in their ability to interact with younger people anymore.

That was a strange concept for me, because as I grew up, I don’t recall anyone in my family ever saying—including my grandfather who at age 90 started going to the golf driving range—anything like that. My grandfather it seemed was always open to most any new adventure or activity no matter what his age. Maybe he lived in some perpetual state of denial, but up until he died suddenly at age 94, he was mentally and physically healthy, active, and always seemed happy. I also observed that characteristic in my best-aging older patients…the ones who seemed happiest also seemed the most open to new activities and ideas…they didn’t let their chronological age inhibit them.

It seems to be almost a self-fulfilling prophecy: those who think or believe that their age limits them from doing something they might want to do, find that indeed, they “can’t”, and worse, this sets in motion a pattern of inability and inaction. Since they “couldn’t” do whatever anymore (say something as simple as enjoying themselves and staying late at an absolutely fun party), that “confirmed” or justified they were really getting older, and they began to limit themselves more and more, aging themselves ever more quickly and prematurely.

Some people don’t necessarily think they can’t do something anymore, but that they shouldn’t do it at “their age”. For example, I have heard sixty-year olds say they don’t think they should be friends with people in their thirties. To me, that seems slightly crazy and certainly counterproductive. I think whatever age you are, you should be happy to have good friends across the entire age spectrum if you can, and each of you can teach and enrich the lives of the others.

So listen to your inner voice and see if this is a factor in your life, or someone close to you. Maybe it’s something learned from your parents, but if you are aware, you can un-learn, and realize that at most any age, you really have the potential to do what you want, and you should.