LiveLongAgeWell

You may think that getting older means becoming less happy, but various studies, including this new one just released at the American Psychological Association (APA) meeting in Toronto, show just the opposite: most people actually become happier as they get older. Good news, especially as the fastest growing population segment—in the U.S. at least—is people over age 85.

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.

Artificial Tanning Beds

Last month I covered sunscreens and sunless tanning lotions, and as a follow-up, there was a recent reclassification by the International Agency for Research on Cancer (IARC) that tanning beds should be raised to Group 1, that is, the highest risk level: “carcinogenic to humans”. While the artificial tanning bed industry has marketed their products as safer than the ultraviolet radiation from sunlight—and as not increasing the risk of melanoma (though they neglect to mention the increased risk of other forms of skin cancer)—the IARC reports a 75% greater risk of melanomas in people who start using tanning beds before the age of 30. Besides the cancer risks, while a tan might make you look better in the short run, in the long run you will end up more wrinkled. And though artificial tanning booths are dangerous, remember that sunless tanning lotions can be quite effective and safe.

Organic Food Not Worthwhile?

A headline from Reuters London caught my eye last week: “Organic food no healthier, study finds”. The author of the English study stated: “Our review indicates that there is currently no evidence to support the selection of organically over conventionally produced foods on the basis of nutritional superiority [italics mine].”  (Really, OK, maybe not proof, but no evidence at all?)

So a quick read might lead you to think it’s not worth the extra expense and trouble to seek out organic products. But this would be a false conclusion on at least two counts. First, the study only analyzed “nutritional content”; this is, what’s in the food, but most people choose organics because what’s NOT in them; i.e., pesticides and other organo-toxins (not addressed in this research). Second, if you look at what they consider “nutritional content”, you find they did not analyze antioxidant content, which is another reason to choose organic. While it’s true that there is not yet proof organics have a higher natural antioxidant content; for me, I’ll stick to organic products whenever I can. Unlikely any future research will find any health benefit whatsoever from eating foods with pesticides. It’s far more likely organic foods suffer less antioxidant loss during any processing, transport, and chemical additions.

Another Reason To Keep Your Cholesterol Below 200

If you know that your total cholesterol level is borderline or elevated, and you haven’t taken measures to change that, here’s another reason to take action. Published in the August Dementia and Geriatric Cognitive Disorders, researchers studied nearly 10,000 Northern California Kaiser Hospital members, and found that those who had total serum cholesterol levels over 200 mg/dL in their 40s, had a significantly great risk of dementia when they reached their 60s and 70s. The risk for either Alzheimer’s disease or vascular dementia was at least 50% percent greater in people with only mildly high levels—over 200. So take measures to keep your cholesterol in the normal range: whether it means a change in your diet and/or increased exercise, and if that doesn’t work, you should ask your doctor about possibly taking a “statin” drug to lower your lipid levels  (which—as logically follows from this study—have been shown may help prevent dementia.)

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.”

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

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.

I am trying to drink at least two cups of coffee these days. It helps wake me up and gives me a boost in the afternoon. Plus I enjoy it as a health drink—it’s full of antioxidants. Still, I find many people still carry (unnecessary) guilt about drinking coffee, so as new research about health and coffee comes forward, I will present it in this LLAW blog, be it positive or negative. The news, though, has been overwhelmingly favorable.

Here’s another report—this from the latest Journal of Alzheimer’s Disease—that should make coffee drinkers feel good, and if you don’t drink, you might consider it because this research is more confirmation that coffee seems to help keep your brain functioning well.

How does coffee help the brain? We don’t know but here are three theories: coffee decreases the risk of developing diabetes, which has been associated with dementia. Second, Alzheimer’s disease is marked by a build-up of “amyloid” plaques—basically sticky brain “junk” that blocks function—and caffeine apparently decreases the formation of these plaques. Finally, coffee’s antioxidant effect might be brain protective.

This Scandinavian study—part of the Finnish Cardiovascular Risk Factors, Aging and Dementia (CAIDE) Study—followed 1,400 men and women for more than 21 years, a very long time as research goes, and the result was that those who drank three to five cups per day were 65% less likely to develop dementia than those who didn’t drink coffee or drank less than two cups. The researchers tried to ensure that this difference between coffee drinkers and non-drinkers wasn’t the result of some other factor, for example, that the coffee drinker group had lower blood pressure or cholesterol than the non-drinking group.

Still, since this wasn’t a prospective clinical trial, the researchers can’t be certain that they looked at all factors involved. So there could be something else besides coffee that improved brain function. As a hypothetical example, maybe the coffee drinkers were a more sociable group, and they got out and mixed with more people and that’s what preserved their brains, not the coffee.

But this CAIDE study is one of several that have suggested drinking coffee is a very good way to preserve brain function, and for me, I’m sticking to my two or three cups of caffeinated coffee per day.

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

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

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

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

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

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

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

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

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

Occasionally I will post an excerpt from the draft of the book I am writing: How To Drop Dead Dancing In Your 90s: Live Long Age Well. Frequently people ask me about coffee: is it really good for you? is caffeinated OK?  So I chose to include this sample. Here is Part One from the coffee section of my upcoming book…

Antioxidant Rich…Drink It…Especially Caffeinated

It seems almost natural to think that all those great anti-oxidants are found only in colorful fruits and vegetables, so we might find it hard to believe that something so colorless and flat and black as coffee could be so healthy for you, but it is. If you drink caffeinated coffee, lose your guilt, because you are enjoying something that, it turns out, is really good for you, and as a bonus gives you a natural mental and physical boost. Coffee is full of anti-oxidants and there are many studies now that show coffee is almost a new super-food, with little downside. It doesn’t lead to ulcers, hypertension, or cancer. Quite the opposite is true. Recently an international research group rated the per-serving antioxidant content of foods and amazingly, coffee ranked higher on the list than either blueberries or red wine. In the American diet, coffee may be the #1 source of anti-oxidants.

There is excellent evidence coffee protects your liver from damage and decreases the risk of cirrhosis and gallstones, so especially if you do drink more alcohol—even wine or beer—than generally advised (one to two drinks per day), you should probably also drink a few cups of coffee daily (although cutting down on the alcohol would be better). A 2005 Japanese study showed that people who drank 3 or more cups of coffee per day had a 50% less risk of liver cancer, and there is evidence coffee drinkers also have a lower risk for colon cancer. Coffee can temporarily raise your blood pressure and heart rate, but does not lead to the disease of hypertension.

For diabetics and for those worried about becoming diabetic as they get older: coffee should be fine for you. While there is still some controversy, both decaf and caffeinated coffee seem to lower the chance of developing diabetes, though the protective effect is better with caffeinated coffee. Another advantage of caffeinated coffee is that while decaf can lead to an increase in both your total and LDL (bad) cholesterol,  caffeinated coffee will not; in fact, the caffeinated version is most likely good for your heart, as it tends to raise your HDL (good) cholesterol level.

Let’s talk about your brain on coffee. We all know that regular coffee will boost your energy level, temporarily at least, but more important, caffeinated coffee seems to have what is called a “neuroprotective effect”, and a number of studies have shown a 40-80% decreased risk of Parkinson’s disease in people who regularly drink more than one cup of (caffeinated, not decaf) coffee per day. However, if you are a post-menopausal woman who has been on estrogen therapy, this anti-Parkinson’s effect apparently does not hold for you.

All this is remarkable enough, but further studies now are suggesting that caffeinated coffee probably protects you from long-term memory loss, and even cuts your chance of developing Alzheimer’s disease. Researchers are now working to develop various coffee-related compounds that might result in treatments for Parkinson’s disease, alcoholism, alcoholic liver disease, and even depression.

On Monday…practical pointers on ways to maximize the health benefits of coffee.

Recent medical research is suggesting that if you carry excess weight on your body, it’s the actual location of the extra fat that is most important. Most evidence suggests that “belly fat” (as opposed to hip, buttock, and thigh fat) is the worst kind. Fortunately, there are things you can do to cut your risks.

“Belly fat” is otherwise known as “visceral fat”, which means it is located deep in your abdomen, wrapped around your internal (visceral) organs, rather than just below the skin. Doctors describe people with belly or visceral fat as being “apple shaped” (versus those with hip fat, which gives a “pear shaped” appearance). It seems that the deep visceral belly fat—wrapped around our vital organs (not an appetizing thought in itself)— secretes toxic substances that especially leads to inflammation, diabetes, high blood pressure, and cardiovascular mortality.

And now we have strong evidence that people in their 40s who carry excess visceral fat are much more likely to develop dementia and Alzheimer’s disease when they are in their 70s.

Researchers in California in the 1960s and 70s began studying a group of more than 6000 people, measuring their abdominal girth to see what would happen to them over many years. This long-term study found that even people who were otherwise normal weight but had big bellies were 89% more likely than flat bellied people to eventually become senile from Alzheimer’s and all other causes. And those both overweight and with a big belly had a dementia risk over 200% greater than normal-weight people. Obese people (heavier than just “overweight”) had a risk factor of more than 300% (check this link for a great graphic and more details).

The mechanism for this belly fat-dementia risk is not known. It’s possible that the fat itself is not causing the dementia, but that some other mechanism is working that brings about both a big belly and dementia at the same time…but there is a good chance that if you do have a big belly, if you somehow fix your belly situation, you may well decrease your chances for dementia as you get older. This might be particularly important for people with a family history for dementia. You can’t change your family history, but you can fix a big belly.

Next post I’ll cover one possible remedy for the belly fat problem, and I can tell you now: it’s not liposuction…