LiveLongAgeWell

This article is dedicated to the many people who seem to get enough aerobic exercise, and eat a reasonable diet, but still have problems with excess fat. It will give you something else that might help your situation; something basic and super simple…

Have you observed that as far as general activity level is concerned, people tend to fall into one of two big categories: the people who tend to be “couch potatoes”, and those who are constantly moving? The first group just doesn’t seem to want to move much. They would rather wait for the elevator than take the stairs, even for one floor, and if they are sitting watching TV or at the computer, rather than jumping up and getting something they need from another room, they will call for help or at least just sit and wait until they have more motivation to actually get up and move.

Now the other group, we might call the “movers” or maybe “people who putter”, seem to be constantly moving, almost in a nervous way. But take a look at the body shapes of these two groups, and you might notice a pattern—the movers tend to be a lot trimmer than the people who don’t like to move. It makes a lot of sense, and now we have good scientific evidence that the movers are both thinner and healthier than the sedate group, but the reasons for this are a lot more complex than what you might think.

Studies comparing people in occupations requiring lots of sitting (such as bus drivers) with those who stand much of the day (for example train conductors), have shown a much higher rate of cardiovascular disease and fatal heart attack in those who sit most of the day.  Experimental studies have recently demonstrated that sitting a lot, even a few hours straight, lowers the activity of the enzyme lipoprotein lipase, which normally works to decrease the fat content in your blood. So even a few hours of sitting seems to alter your very fat metabolism.

A study of otherwise healthy men who became incapacitated and confined to bed rest showed that three weeks of bed rest had a bigger negative impact on their physical work capacity than 30 years of aging. Scientists (“inactivity physiologists”) are now more closely studying the physical changes during our “inactive” periods, but while we await more research, it seems clear that people who sit too much during the day face a host of problems, and to cut your risk of obesity, diabetes, and of heart attack, you need to, basically, “get off your butt” and move around more. For some people, even a good program of  regular aerobic exercise, combined with a reasonable diet, may not be enough to keep your weight under control if you sit much of the day.

•    Avoid sitting too long. You are at higher risk of serious metabolic problems if you spend hours watching TV or sitting in front of the computer at work or during your free time. As much as you can, just get up and walk or move around, if only for a minute or two at a time, that’s fine. If you can’t get up, at least shift in your chair regularly, and maybe shake/stretch your arms and legs occasionally. Try to change your mindset so that when you need something from another room, you see that as a good thing, not an irritation.

•    If you like video games, consider as an alternative to the standard (sitting) game something more active like the Nintendo Wii, which will get you up and moving, and allows you to play too. It’s great for both your body and your mind.

•    People who sit for long periods, for example on an airplane, suffer a higher risk of DVT or “deep vein thrombosis” a potentially life-threatening condition in which the blood stagnates in the deep veins in your legs to the point that a clot forms which breaks off and travels through to your lungs. Basic prevention involves getting up and moving around the plane occasionally, and flexing your calf muscles while seated to get the blood moving in your legs. Drinking water also helps to keep your blood from getting too thick and prone to clotting.

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We will return to prescription brain drugs later this week, as today we make a brief news diversion to a substance many people consider a mind drug: sugar. An interesting article appeared in the New York Times a couple days ago about how the food industry is recently trending from using High Fructose Corn Syrup (HFCS) as a primary sweetener, back to “natural” sucrose, that is, simply, sugar.

It’s interesting since HFCS has, over the past 30 years, crept into most all sweetened sodas, fruit juices, cookies and salad dressings and most every other food available in a bottle or a can. As it has silently and rather stealthily taken the place of sugar, many health experts have claimed that HFCS is a much less healthy replacement, and has been a major contribution to the U.S. obesity crisis. Food manufacturers, aware of their bottom line, substituted HFCS for sugar to boost their bottom line, as it was cheaper than real sugar. HFCS is easier to keep and transport, and extends the shelf life of many products, so it cut production costs, and initially few people seemed to care.

But more and more consumers have become alert to HFCS as a potential villain; the Times article mentions that Michelle Obama has pledged not to allow her children to consume it, certainly not good news for corn farmers. HFCS comes in various forms, but most commonly is chemically very similar to simple sugar (about 50% glucose and 50% fructose), though HFCS has slightly more fructose. HFCS is of course made from corn, but only after an extensive chemical process, this corn is magically transformed into…basically liquid sugar, but of course, it’s not exactly the same as the truly “natural” product.

If you want to wade into a big mess of a controversy, look into the various merits of HFCS vs. sugar. It’s hard to come to any good conclusion…is HFCS one of the reasons Americans have become so fat? Is fructose so much worse than sucrose for our livers? Does HFCS prevent us from feeling full? Does it lead to a rise in VLDL (the worst of the blood lipids)?

It’s hard to know what to make of the various arguments, and one reason is that many of the studies have been sponsored—sometimes indirectly so it’s difficult to know—by the sugar cane or beet or corn industries, and they can “buy” and release whatever research results they want. But here is what I have concluded so far: I would stick to simple sugar (sucrose) over HFCS whenever possible. Moreover, try to cut your sugar consumption as best you can, as those empty calories don’t do your body much good except provide a very temporary energy boost. The long term effects of sugar are for my book and later posts, but sugar does nothing good for your aging. There is intriguing research suggesting that sugar damages our skin proteins, and is one reason for diminished elasticity of our skin as we get older, and…premature wrinkling.

We are now (hard to believe) weeks after the New Year…yet many LLAW readers are still asking about diet and weight loss, so today I am highlighting an important recent report from the British Medical Journal. This was a so-called meta-analysis, which is a kind of super-statistical study that examines a large number of other studies done on one subject. A good meta-analysis like this one looks at how each sub-study was done, discards the sub-par research (not uncommon), and come to a grand conclusion after summing the best of the studies.

The goal of this meta-analysis was to determine: is the Mediterranean diet really as good as it’s supposed to be? Does it cut disease and make people healthier? The conclusion, after assembling over 1.5 million subjects, was that yes, the Mediterranean diet really does lead to a drop in the death rate and can help you avoid chronic nasty diseases such as Alzheimer’s.

The Mediterranean diet is also a tasty one, one that you can stick to for life, and for your life. It’s not a six-week or year-long program. It’s best forever. Named after the traditional diet of countries surrounding the Mediterranean Sea (traditionally with some of the lowest incidences of heart disease), here it is:

1. Most of your fats come from Olive Oil, and secondarily, Canola Oil (rather than butter or other oils).
2. Eat Nuts, but no more than handful per day (since they are high in calories); peanut butter, cereals, and seeds are great.
3. Lots of Fish, at least several times per week.
4. Minimal red meat, preferably a few times per month.
5. Lots of Fruits, Vegetables, Whole Grains, and Legumes. For dessert, choose fresh fruits over the typical processed sugar products.
6. Red Wine in moderation (unless you have a problem with or sensitivity to alcohol).

This is not such a difficult diet to adhere to, for one reason because it’s relatively high in fat. This fat though comes from vegetable sources (such as olives), so they are healthy monosaturated fats, rather than the saturated fats from animal sources.

The result of the BMJ meta-analysis was that those who stuck to this diet had a significant decrease in early death from all causes, and specifically a decreased risk of dying from cancer and heart disease, along with a modest (13%) diminished risk of Parkinson’s disease and Alzheimer’s.

Finally, one recent Spanish study concluded that if you stick to a Mediterranean diet, you are much less likely to be part of the group which gained an average 7.5 pounds (3.4 kilos) over a ten-year period. (Unfortunately, many young Mediterraneans have moved away from their traditional healthy diet to a Western diet full of more processed foods and saturated fats, and the rate of obesity in these countries has jumped alarmingly.)

If someone were to ask me to name the worst cancer, I would say cancer of the pancreas. This cancer has received much media attention recently. Patrick Swayze is now fighting it, and it killed Luciano Pavarotti and Professor Randy Pausch (author of The Last Lecture).  Even the president of the American Medical Association died of pancreatic cancer last year.

The survival statistics are grim: after diagnosis, only about 25% of the afflicted live even one year, only 5% survive five years. It is so deadly because this cancer is typically diagnosed late, after it has spread, and surgery in those cases won’t cure. While there is hope that new and experimental drugs will work better, standard chemotherapy usually gives disappointing results. It also tends to be one of the most painful cancers. Victims often quickly lose lots of weight and become yellow with jaundice.

The pancreas—which produces digestive juices and hormones involved in food metabolism—is buried deep in the abdomen below and behind the stomach, and this deep location masks symptoms until it has spread beyond the pancreas. The liver, close by, is a prime target. Clearly, it’s a disease you want to avoid, and fortunately medical researchers have identified some measures you can take to significantly cut your risk:

1.    Don’t smoke. Smokers suffer a two to five times risk of getting pancreatic cancer. But if you smoke and quit, after five to ten years of not smoking, your risk goes down to that of a non-smoker.

2.    Eat lots of fruits and vegetables, especially dark green and highly colored ones. These vegetables contain more cancer-inhibiting phytonutrients. Think tomatoes (high in lycopene), soy, broccoli, blueberries, carrots, cranberries, and many others. In general the darker, richer, more vibrant color the better!

3.    A diet high in legumes and whole grains seems to cut the risk. One reason may be because these foods help fill you up and keep you from getting obese.

4.    Avoid obesity! Especially central, or abdominal obesity is thought to be a risk factor for pancreatic cancer. If you are overweight, work on numbers 2 and 3 above, and as a minimum for exercise, start moving and walking more. For example, take the stairs rather than the elevator, and park your car farther from the store entrance so you are forced to walk more.

5.    Minimize your red meat consumption, especially processed meat. It may be the high level of iron or the fat in red meat are the carcinogenic components, and for processed meats (non-fresh meat), the high sodium and nitrates might be the problem. Also, meats cooked at high temperature, and charred or grilled meats are especially believed to be loaded with cancer-causing substances.

6.    Floss your teeth! Yes, it is thought that those with bad oral hygiene, gum inflammation, and periodontal disease have a higher level of inflammatory substances in their body, and these can spark a pancreas cancer. Men with periodontal disease have a 64% higher risk!

7.    Make sure you are getting enough vitamin D. Vitamin D deficiency is common world-wide, and studies have suggested those who get adequate vitamin D cut their risk of pancreatic cancer by 50%. For more on vitamin D, I recommend this article from the Harvard School of Public Health.

In future posts, I will discuss each of these hints in more detail, but in the meantime, the above is food for thought…and make that food highly colored vegetables!

I’ve seen several stories in the media recently regarding the average holiday season weight gain, and the various reports claim from one to ten pounds. I was curious about why such a wide range, and decided to look at the research. I found that probably the more accurate weight gain is closer to one pound than ten. However—and this is important whenever evaluating how good the research is—it’s good to know: who were the group of people (“subjects”) that the researchers studied to reach their conclusions?

When I read some of these studies on holiday weight gain, the researchers in the most prominent studies seemingly did not look at a cross-section of average Americans. In one highly quoted study the subjects were 94 Oklahoma college students, studied only over the short Thanksgiving holiday; not much of a time period. And since the students knew they were being monitored for a weight gain study, they may well have moderated their normal eating habits to not look “bad” when weighed at the end. Whatever, the result was an average gain of only one pound (0.5 kg).

The other highly quoted study recruited 200 people from the campus at the National Institutes of Health (NIH) in Bethesda, Maryland. Only in the detail of the study do you see that 88% of the subjects worked at the NIH. I suspect this group was not representative of typical Americans; they were probably (hopefully) more health conscious—they worked at the National Institutes of Health! The conclusion again was an average gain of only one pound. They followed the subjects longer, into the next fall, and found, disturbingly, that the weight people gained during the holidays was usually not lost later in the year.

So you can see that the subjects studied in each of these reports were not typical Americans. Many studies, including important ones testing for possible side effects in new drugs, are done by recruiting otherwise healthy college students, and the results might not apply to the average older person who might actually need that drug someday. Medical centers often recruit students for their studies because the hospitals are located on campuses and it’s easy to find willing student subjects, especially if they can earn a few dollars  participating.

Enough today about studies….now what can you do to prevent your own weight gain this year-end? Look at this link from the Cleveland Clinic: 8 Steps to Surviving Holiday Weight Gain. My favorite of their hints: don’t forget to keep up aerobic activity during the holidays, and never go to a party hungry! Next week I’ll post my take on the 12 Best And Worst Beverages For Weight Loss.

A main goal of this blog is to give you practical hints so you can live healthier and longer, but just as important is to give you information so you can live happier. There doesn’t seem to be too much point trying to live a super-long life if you aren’t reasonably happy. Now especially during these tough economic times, when I find information on ways you can increase your level of happiness, I will pass it along…

Earlier this year (before I started this LLAW blog), two reputable research reports appeared regarding, first, how quitting smoking, and then how obesity could be “contagious”. Yes, a team of researchers—from Harvard and UC San Diego—concluded that you are significantly more likely to lose or gain weight or quit smoking if you become aware of friends or relatives who recently lost or gained weight, or quit smoking, even if they live across the country. Just knowing about others who have changed in these ways seems to profoundly influence your own behavior. The influence of your friends spreads almost like a social virus, in a seemingly contagious manner.

Just last week the same researchers showed a similar type of effect with happiness: if you become aware of friends or even neighbors (who aren’t friends but just acquaintances), then YOU are more likely to also become happier. The effect is greater if these people actually are your friends, and the closer they live to you the greater the effect. There seems to be a larger effect from people your own gender who become happy. More surprising is that they found even “third degree” friends had some influence on your own happiness, meaning if a friend of one of your friend’s friends switched to becoming happy for some reason, then their happiness in a small way rubbed off onto you. If true, this truly speaks of an amazing strength of social networks.

When these researchers earlier this year released their studies on contagious obesity and smoking behavior, other scientists seemed to be surprised, but generally supportive that it all made sense. But this current study on happiness—even though it came from good institutions—has raised more skepticism.  Some have said that perhaps there is something in the statistical analysis that has lead to erroneous conclusions, particularly since they concluded that if your next-door friend suddenly became happy, that the effect on you was greater than if your own spouse became happy.

I suspect it will take a couple years for the various social scientists to argue all this out. Typically what happens when a study is controversial is that either another group of scientists will be able to repeat the first study and confirm the findings, or will conclude with their new research that the first study was wrong, or only partially right.

In the meantime however, we might take the conclusions of this happiness study at face value, and to maximize our own happiness, try to form bonds with people, or at least become aware of others who are doing positive things with their lives. It just might just rub off on us.

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…