LiveLongAgeWell

The H1N1 (swine) flu pandemic is dangerous, yes, but also fascinating as a study of how different countries are responding and how theories change quickly. Here in Brazil, where it is winter and prime flu season, the massive city São Paulo has pretty much closed down all schools for the next two weeks, affecting over 6 million students. And just a few weeks ago, public health officials were theorizing that obesity alone appeared to be a major risk factor for developing a serious case, or of dying of the influenza.

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.

Today I’m posting a chapter from my  book-in-progress: How To Drop Dead Dancing In Your 90s….here is Part I of GREENS!

Kale. Collards. Mustard Greens. Beet Greens. Dandelion Greens. Swiss Chard. Spinach. All “greens”, and, except for spinach, they are foreign to most American diets. Despite having a taste that many might also regard as foreign—too strong, even bitter—to increase your odds of dancing into your 90s you should move beyond salad and the more conventional vegetables and start adding these more exotic  “greens” into your routine.

Taste bud research suggests some people are genetically programmed to despise the taste of greens, and if that includes you, try making an extra effort, because these are the vegetable superstars. Some nutritionists feel they have more value per calorie than any other food.
Perhaps greens have such a distinctive taste because they are so primitive. Unchanged for thousands of years, originally from Asia and Africa, hearty and easy-to-grow kale was among the first vegetables brought by the colonists to the New World. Later, American slaves popularized collards, and greens became part of “soul food”. Unfortunately they were often considered throwaways—vegetables for poor people—until scientists discovered that they were actually so nutritionally rich, and now greens are enjoying a renaissance.

They are full of fiber and low in calories, bursting with vitamins A and C, iron, calcium and various other minerals, and those mysterious “phytochemicals” such as lutein and the more impressively named zeaxanthin; these are the most exciting components in greens, the substances that protect our cells from cancer, age-related vision problems, and maybe dementia. An extra benefit: many American diets are deficient in vitamin K, and greens are the absolute best natural source for this vitamin.

Like most vegetables, adding greens to your diet will help keep your cardiovascular system healthy, and lower your risk of stroke. But greens are much more potent—studies suggest that a green-rich diet is associated with a significantly lower risk of lung, breast, ovary, colon, and bladder cancer. Most research indicates about a 20 to 50 percent lower risk of these cancers in people who eat lots of greens. The mechanism seems to be that the phytochemicals trigger a genetic signal that stimulates the activity of detoxifying enzymes in our liver, so carcinogens are neutralized before doing damage.

Scientists (and drug companies) are working furiously to treat osteoporosis, and along with the importance of calcium and vitamin D, vitamin K is a new star for keeping our bones strong. The Framingham Heart Study showed that those with the highest vitamin K intake had a 65% decreased risk of hip fractures! If true, eating a good amount of greens certainly is a much cheaper and safer and perhaps a more effective way, compared with medications, to lower your risk of disabling bone fractures. And, as we will discuss further in the PROTECT chapter, greens intake probably dramatically cut the risk of cataracts and macular degeneration (the most common form of age-related vision loss).

Next: Greens, Part II

At the end of this post I’ll tell you how you can be considered to enter the study…

If you follow LLAW, you might know that my “favorite supplements” are, currently, fish oil tablets and vitamin D. In various posts I have detailed all sorts of possible benefits from these two supplements, and note that you can get both through natural sources (such as small doses of sunshine, or salmon) as well as from pills (and generally, natural sources are the better option).

The problem is that various other supplements have been heralded in the past as being wonderful and great for a variety of problems, especially for cutting the risk of cancer and cardiovascular disease. But then when really well-designed research studies are done, the supplements often fail to show a good effect, and sometimes they even result in more harm than good.

Vitamin E, folic acid, selenium, and beta-carotene all fall into this category, like Michael Jackson, of “fallen super-stars”, and, who knows, in five years we might be saying the same thing about vitamin D or fish oil (though I doubt it). The type of study that needs to be done—to see if vitamin D and fish oil are really any good—is a double-blind, randomized, prospective clinical trial. This sort of study is not commonly done as it’s expensive and it takes years to see the results.

Such a study starts with a large group of people, preferably many thousands, and splits them up into equal groups, that is, groups that are equally healthy or unhealthy, and then the researchers give some of them an active pill, for example, vitamin D, and the other group a fake pill, a placebo, and then a few years later compare the two groups to see how they did. Best if neither the people taking the drug nor the researchers know who is taking what (“double-blind”), and only break the “code” at the end of the experiment.

But most studies on vitamins and supplements are not like this; instead, they are “retrospective”…the researchers look at the health of different groups of people and look backwards in time (retrospectively) and see what they were taking or doing or eating, and try to deduce if a particular behavior or vitamin or whatever was responsible for the good or bad effect. But this research method leaves a lot to be desired, and it’s one reason you read a study that comes out stating that such-and-such is great, then a year later, you read the opposite. The problem could well be that either study, or both, was poorly-designed, and unless you really dig into an article to see if the study was prospective, double-blind, etc, you don’t know which research to better believe.

So starting early next year Harvard University is going to be doing one of the prospective clinical trials with vitamin D and fish oil (they are calling this the VITAL study). The research will study the subjects for five years into the future (prospective) and see how they all do. In 2016, then, we should know if fish oil and/or vitamin D are good for decreasing the risk of stroke, heart disease, or cancer—the three diseases the research is studying. Now even this is not going to be a perfect study, as it relies on people self-reporting their health via questionnaire (at times inaccurate), and while the researchers try to disguise the placebo pills, some people will try to figure out what they’re taking, try to outguess the researchers, and/or will take extra vitamin D or fish oil or other agents on the side, or not take the pills as they promised to if they think they are placebo.

But still, this study is probably the best we’ll get, and is better than any retrospective study. Here’s your chance to be a part of it… Harvard is now recruiting potential “subjects”. If you are interested in participating, or just want to read more details about this study, click here.

Last week I presented some of the issues surrounding sunscreens and today I’ll give some practical hints. Unfortunately, there is still no sunscreen available that is even close to perfect; they all have potential issues regarding how well they block both UVA and UVB, how long they are effective, and how safe they are (particularly regarding absorption into the bloodstream). Still, protecting yourself from excessive sunlight is critical, not only to help protect from the number one cancer of all—skin cancer—but to avoid early aging. Consider this quote from the U.S. Environmental Protection Agency’s excellent pdf fact-sheet “The Burning Facts”:

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.

I have a regular disagreement with a doctor friend of mine. I tell him that most research supports that people who drink a little alcohol each day live longer, and he says no, sorry, that can’t be… (or if he’s in a good mood, he might concede: “yes, but only if it’s red wine”). And I always respond: no, actually, even people who drink a little gin or vodka or whatever each day live longer and with less risk of early death. It’s always the same argument.

So I was happy to see this recent publication of a large, impartial research project (part of the U.S. Health and Retirement Study) from a reliable institution; the University of California San Francisco, which followed 12,519 adults age 55 and over during a four year period with one question: who was more likely to die—of any cause—during the four-year period—those who didn’t drink any alcohol, those who drank “moderately” (one drink per day), or those who drank “heavily” (three or more drinks per day).

They found that people who had one drink per day enjoyed a 28 percent lower risk of dying during the four-year period. The researchers controlled for other factors like race, smoking, obesity, socioeconomic status and so forth to make sure that what made the difference was only the alcohol intake, and not some other factor(s), like that people who could afford a little alcohol each day also were thinner, or had better diets, or wore their seatbelts more, etc.

The study further concluded that people who drank three or more drinks per day increased their risk of dying during the four years by 11%. Those who drank just a little bit—averaging one drink per week—did not show a lower death risk like those who had one drink a day. In this study, the people who drank a little bit, or we might say moderately (one drink per day),  survived the best.

Alcohol and health though is a complex and controversial topic, and it brings out lots of passion and guilt, fear, danger…all of that, in doctors as well as in the general public. Floating around is the concern regarding addiction, and for all of us, that needs to be considered.

If you care to read more about this, and how cancer risk compares with heart risk and alcohol, I suggest you might start with this recent WebMD article.

Now I’ll ask my doctor friend—the one with whom I argue this issue—and see what he thinks about this UC San Francisco study. I suspect he won’t believe it. If you remind me, I’ll tell you what he says.

ps….yes, Buzz the poodle is better

I noticed an interesting research report a few days ago, a Spanish university study showing that THC—the active ingredient in marijuana—had an effect in killing brain cancer cells. And since brain cancer is one of the worst, any good news is worth a look. Senator Ted Kennedy is fighting this disease right now.

The Spanish study focused initially on mice with artificially induced brain cancers, and THC introduced into the tumors caused the cancer cells to basically consume themselves to death (a process called autophagy), and apparently left the normal cells intact. The researchers then tried the treatment on two human brain cancer patients, with supposedly good results (however, if the patients had actually been cured or put into remission, that would have been huge medical news).

There were reports about THC being effective against brain cancer in 2004 and there have been sporadic positive reports that THC may promote brain neurogenesis (growing new brain cells), and could even help fight Alzheimer’s disease. It seems that many of these studies though haven’t been replicated, which is essential in testing any potential medical advance. Many times one medical study can be flawed in any number of ways.

I suspect though that over the past decade, in the United States at least, it would have been politically difficult to get funding—let along publish—for any study that might show a benefit from THC or cannabis. Let’s hope that now, going forward, objective research can be carried out in what we might call politically sensitive areas (stem cell research comes to mind). Only then can we can learn, for example, if these early studies showing positive effects of THC on the brain are valid or not.

We have heard nutritional experts for years saying: “eat less meat, especially less red and processed meat” A week ago a large study from the National Cancer Institute was published, and the results should wake-up those of us who eat (probably too much) red meat. The study strongly suggested we have a higher cancer and cardiovascular disease risk, and, bottom line, may die sooner. Fortunately, there are some measures meat eaters can take to minimize the risk and damage (and there is very good news for “white” meat eaters). First let’s look at the cold hard numbers, then, let’s try to get some balance on the issue.

The researchers studied over 500,000 people during a ten-year period, 1995-2005. All of them completed an extensive dietary questionnaire diet (I suggest you take a glance at this almost unbelievable survey form [pdf]). The study also analyzed the individuals’ health habits (like smoking and exercise) and diseases, and at the end of the ten year period, the main question was: did eating red meat significantly raise the risk of death from cancer and heart disease? The answer was a clear yes.

Shockingly, men who ate the most red meat had a 31% increased risk of dying from any disease during the ten-year period compared to men who ate very little red meat. For women, the numbers were even worse: a 36% higher risk of dying for those who ate the most. Most of the deaths were due to a higher rate of cancer and cardiovascular disease in the heavy meat group.  Those eating the most processed meats (like sausages, hot dogs, bologna) showed, for men, a 16% higher risk of dying during the ten-year period, and again, worse for women at a 25% higher risk.

One issue that complicates the data is that those who ate lots of red meat were also more likely to smoke, and on the other side, those who ate less meat were more likely to eat more fruits, grains, and vegetables. While the researchers tried to factor those issues out of the study—and only examine the difference in meat consumption—it’s impossible to separate out the various other factors.

The possibility exists, for example, that it’s not so much the heavy meat consumption that’s responsible for the increased deaths, but the lack of fruits, vegetables, grains, and the increased cigarette use in the heavy meat group. Most likely it’s a combination of factors: more red meat and less of the good things in the diet, and probably the minimal-meat eaters were tuned in to many other healthy habits than were the heavy-meat eaters. Maybe the serious carnivores were more likely to eat things like fast food, or French fries… The bottom line is that it’s very difficult to study only the difference between those who ate lots of meat and those that did not, and this study didn’t do that either.

Next post I’ll write briefly about “white” meat, and list a number of ways red meat-eaters can minimize their risks. Humans evolved—rather successfully—as omnivores, eating many types of animals and plants. It’s a contentious issue. I have heard people say, in effect, I don’t care if I die sooner; I want to enjoy eating meat. And, since the risk of death for each of us is 100%, it’s a question we need to answer for ourselves, not only for meat, but in many aspects of our lives.

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

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

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

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

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

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

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

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

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

I’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.

A recent Canadian study cast doubt on the efficacy of colonoscopy, but there are measures you can take to improve your odds of getting a good test.

Colonoscopy, while certainly not a fun procedure, is recommended as a cancer screening test on all adults beginning at age 50, and for younger people with risk factors (for example a positive family history). Colorectal cancer is the third leading cause of cancer deaths in the U.S. You have a 1 in 19 chance of developing colorectal cancer during your lifetime! Fortunately though, if this cancer is caught early the five-year cure rate is over 90%, so screening and early detection is well worthwhile.

Colonoscopy involves using a flexible endoscope to visualize the entire (5 ft/ 1.5 m) colon, looking for polyps or growths that might be cancerous. Most intestinal cancers begin within colon polyps, and it takes from 5 to 10 years for a polyp (one that is so predisposed) to turn into a cancer. A colonoscopist should biopsy or remove any polyps or growths that looks suspicious. Hopefully suspicious polyps are removed before they have the chance to become cancerous.

While there are other screening methods for colorectal cancer (such as virtual colonoscopy, various x-ray studies, fecal blood and DNA tests), colonoscopy is still considered the “gold standard” —a highly accurate test. So it was surprising when a recent report appeared in the Annals of Internal Medicine casting doubt on the reliability of colonoscopy. This Canadian study showed that many potential cancers were missed, particularly on the right side of the colon, the farthest away and most difficult part of the colon to visualize during a colonoscopy. And an earlier study last year suggested that the more difficult-to-see flat lesions are more likely to turn into cancers than polyps.

One problem with colonoscopy is that, despite a pre-procedure “prep” (a cleanout of the colon of any fecal material using oral laxatives and maybe enemas), many patients still have some residual feces in the colon which can hide some lesions—flat growths in particular. Another issue arising from the Canadian study, is that about a third of the colonoscopies there were not done by gastrointestinal endoscopic specialists; rather, they were done by internists or family practitioners who likely do not have the same skill as a specialist.

You can take some measures to try to get a good colonoscopy for yourself when that time comes:

1.    Ensure you are getting the study done by a trained gastrointestinal endoscopic specialist, someone who does a high volume of colonoscopies every year. You might consult this patient guide from the American Society of Gastrointestinal Endoscopy. And for myself, I would only have the study done in a hospital or outpatient facility (rather than a doctor’s office) so I could be properly monitored and sedated.
2.    Be compulsive about doing the pre-colonoscopy prep. Even though it is inconvenient to clear out your colon, it is vital so the colonoscopist can get a good look at the walls of your colon, rather than, well….something else! Tell your doctor on your pre-procedure consultation that you want a safe but adequate cleanout so he can do a good job.
3.    Also on your pre-colonoscopy consultation, or on the day of the colonoscopy itself, you might consider something I would do myself: mention to your colonoscopist that you have read that some polyps can be missed on the right side of the colon, or if the procedure is hurried….that sort of comment will be remembered by your doctor, and she or he might just make an extra effort to be careful and complete.