Monday, November 5, 2018

Nutrition – One of The 7 Keys to Healthy Aging

“If We Could Give Every Individual The Right Amount Of Nourishment And Exercise – Not Too Much And Not Too Little – We Would Have Found The Safest Way To Health,” Hippocrates.
 Two thousand four hundred years ago and it is still the best advice.
Your agenda is health and longevity. This means most of us have to modify our lifestyles. That is the goal. If lifestyles are changed to include appropriate eating patterns and appropriate food intake along with exercise, better sleep, no tobacco and less stress, then health and wellness will follow and persist. This means many fewer chronic illnesses and a longer lifespan. But it is very important to modify lifestyles for the long term, not just a few weeks or months.
A good place to begin is with nutrition and for that a good starting point is to understand and follow the Mediterranean Diet. It consists of extensive fresh vegetables and fruit each day plus regular servings of nuts, seeds and beans along with whole grains such as whole wheat, oats and brown rice, olive oil and fish with a topping of wine but limited meat and very little added sugar. This is widely considered to be a sound, healthy diet. As a general rule it is food prepared “from scratch” in the kitchen, not processed food from the manufacturers nor prepared foods from the corner deli or fast food place.

There are some specifics that should be noted.
Cover your plate with two thirds vegetables and only one third with meat or fish. Make the veggies the major part of the meal. Fresh and local when possible and organic whenever available. Fix them simply such as steaming, stir frying or baking. Fresh vegetables need little seasonings although some herbs are both flavorful and healthy additions. Dark greens should be a frequent part of the meal – spinach, kale, collards, dandelion greens, arugula and Swiss chard are good examples. Spinach, arugula and dandelion make a wonderful salad; toss it with olive oil and balsamic vinegar and perhaps top it with a few slivers of carrot plus some cucumber slices and cherry tomatoes. Consider steaming or stir frying the others.
Fruits are important. Eat a wide variety of types and colors, preferably local and fresh although frozen is fine. Avoid canned fruits as they invariably have added sugar. Berries like strawberries, blueberries, blackberries, raspberries and cherries are high in polyphenols that are valuable for many metabolic processes and especially good for the brain.
Whole grains means just that and not refined white flour as found in most breads, packaged foods such as most cereals, pasta, cakes, pies, cookies, and yes even pizza. Refined white flour has essentially no nutritional value so it is essential to avoid all of these, with perhaps a rare treat or two. It follows that trips to the fast food outlet are verboten. Fats are fine in moderation and indeed are essential. Get them from olive oil, avocados, nuts and seeds and from fin fish. Avoid trans fats. Keep omega 6 fatty acids to a minimum; they are found in many commercially baked goods.
It is critical to avoid sugar. This is difficult since we have been trained to desire sweet tastes and sugar of various types is added to many packaged foods, sodas, yogurts and of course ice cream. The limit per day is 25 grams for women and 37 grams for men. To put this in perspective, a can of soda has the full complement of sugar for a man and is well over that for a woman. One more reason to avoid fast foods. When you buy cheese avoid ones with food colors; real cheese has natural color. Yogurt is very healthy but most brands add fruit, flavoring and a lot of sugar. Look to also see that the cultures are “live;” many are not and essentially all flavored yogurts and those with sugar added have no live cultures.
Fish are high in omega 3 fatty acids – the good fats. You need them and can’t create them in your body so it must come from your foods. Most beef comes from animals that have been placed in small pens for months and fed a diet of grains like corn and soybeans so as to fatten them up. But this fat is mostly omega 6 fatty acids which is pro inflammatory. Unfortunately, the USDA labels the fattest beef as “prime.” Beef from cattle that have been grazed their entire life have minimal omega 6s and do have omega 3 fatty acids but the amount pales compared that found in salmon, mackerel or sardines. Another important point – find meats that do not have additives, either on the range, the feed lots or added after butchering. Antibiotics, growth hormone, nitrites and other additives are likely adverse to your gut health.
Chickens are usually raised in buildings so that they never see the light of day before slaughter but do have antibiotics in their feed and may be stimulated with hormones to grow larger. Look instead for poultry from farms that use no additives and let the chickens fun free. And with all meats avoid these that have added liquid “to retain moisture.” Get real chicken and real beef, lamb or pork, additive free and pasture grazed.
Buying organic vegetables and fruits and grass-fed meats are more expensive for sure. But the health benefits outweigh the costs.

Is there anything that you can eat? Yes, dark chocolate, preferably 85% cocoa or more. It is inherently healthy. So is coffee. It is not only OK but healthy to have alcohol in moderation.
You are eating not just for yourself but also for the bacteria in your intestines – the gut microbiota (microbiome.) The 100 trillion of them need nourishment so that they can help maintain your immune system, your intestinal lining cells and so that they can produce various nutrients that your cells in various organs use for energy. Their “food” is the fiber that your intestinal enzymes cannot digest but which the bacteria love. The best sources are in vegetables and fruits. Consume inadequate fiber and the “good” bacteria are starved. If meanwhile, you eat sugar, refined white flour or too much alcohol, you will be feeding the “bad” bacteria with detrimental results. That, of course, is a common combination in the standard American diet but it leads to increased intestinal permeability (“leaky gut”), local and systemic inflammation, passage of toxins into the bloodstream and the induction of a variety of complex chronic illnesses. So, treat those bacteria well. The foods like veggies with their high fiber content that benefit the gut microbiota are called prebiotics. Foods that include bacteria and yeasts that are known to be healthy are called probiotics and are found in many foods like live culture yogurts, live culture Kefir, non-pasteurized sauerkraut, kim chi and other fermented foods. Have some regularly.
To recapitulate – aggressively avoid added sugars; eat lots of veggies of a wide range of colors including dark green leafies; include only whole grains and not too much. You need good fats as found in olive oil, nuts and seed, and lots of fish. Dairy, eggs and poultry are best if it comes from grass fed animals. Same for beef, pork and lamb in limited quantities. Include some wine and plenty of water. Be sure to include plenty of fiber foods and probiotic foods as well. Local, fresh and organic are preferable.
This combination will keep you healthy and keep your intestinal bacteria happy as well. When they are happy, you will be healthier
A final word comes again from Hippocrates; “All disease begins in the gut.” 

Still the best advice only now we begin to understand just why he was correct.

Next post – Keep moving!

Friday, October 5, 2018

Review of Longevity Decoded

Longevity Decoded by Dr. Stephen Schimpff is an engaging discourse on the issues facing seniors today.  The title itself draws the reader into a personal search for ways to age gracefully.  

And it is a tone of lightness and good humor employed by Dr. Schimpff that immediately underscores his central thesis for healthy aging:  a positive attitude; calm acceptance of one’s mortality; and “living in the moment.”

In presenting a common-sense, practical prescription for the aging process, Dr. Schimpff details medical information – including recent medical breakthroughs – with clarity and incisiveness.  His “seven keys” are punctuated with suggestions and tips for the senior.  In one section, he outlines the major elements of the “Mediterranean diet”; in another he notes ways to improve and maintain one’s balance.

Above all, Dr. Schimpff seems to be urging seniors to embrace life toward the end of achieving a sense of mental, emotional, and physical well-being.

Reviewed by Frank Haight, retired pubic school teacher

Friday, September 21, 2018

Normal Aging – A Steady Loss of Organ and Process Function

The percentage of the population that will be “elderly” is rising fairly dramatically. In 1900 only four percent of the population was over 65 and only one percent over 75. By 1950 it was eight and three percent, respectively. By 2000 it was thirteen and five percent and now it’s about fourteen and six percent. By 2030 it will be substantially more again.

There are many different concepts about aging but for our purposes we’ll consider aging gracefully or perhaps aging wisely. Most people would prefer to have a long life with the proviso that it is with good health while having some element of fun along the way. That will be the theme of these articles.
Older individuals have multiple age related impairments and they tend to have multiple chronic illnesses. The care of these illnesses is all too often far from ideal. America has the resources but healthcare delivery is dysfunctional at best. And of course we know that health care costs are very high. One of the keys is really good comprehensive primary care which all too many Americans just do not have. The other key is lifestyle modifications; I’ll deal with the latter in some detail in the articles to follow. 

As we age, sort of like a car, “old parts wear out.” Most organ functions decline by about one percent per year. Of course there is great variation in this but that is a pretty good average. The decline starts at about age forty and probably much earlier and continues throughout life. Fortunately most of our organs have a huge redundancy and so we can afford these declines without any level of illness. But at some point the decline may get to the point where we have a functional impairment that can be serious.

Hearing decline begins at about age 25 but is not noticed until much later.  Many will need reading glasses by age 40 even though having excellent vision for years; cataracts will occur later.  Balance, often not noticed until later, starts its inevitable decline early as well. Meanwhile internal organs including heart, lungs and kidneys are slowly declining and so too is brain function, especially cognition. 

This normal aging process of old parts wearing out is universal, is progressive, and is irreversible, at least as we know of it today. Let’s use bone mineral density (BMD) as an example. BMD is easily measured to demonstrate the sturdiness of our bones – how strong they are. We start out in life with cartilage rather than bones but as we grow as toddlers, then as children, then as teenagers, calcium and other minerals along with a protein-collagen matrix are laid down in our bones and they become increasingly strong reaching a peak at around the age of twenty. Once that age and that peak are reached it can’t go up any further – that’s it. Then there is a plateau and at about age forty it starts to decline at the one percent per year rate.   Since women tend to live longer than men, in total more women than men will have a fracture at some point in their lives. We might just say that is one of the risks of living longer.
At age twenty men’s bone mineral density is, on average, higher than women’s. Nevertheless for women as for men the decline is about one percent per year. Menopause changes this; the rate of loss increases to perhaps three percent per year for a few years and then returns again to the one percent average decline until reaching osteopenia and then osteoporosis. There are three important points to be made here. If we live long enough, our bone mineral density will decline to a level where if we fall a bone fracture becomes more likely. Since women start at a lower level and because they have this increased loss of BMD during menopause they’ll reach that fracture threshold in life earlier than men.

Cognitive function is another example; our brain loses some of its abilities as we age.   This loss of cognitive function over time should not be confused with the disease Alzheimer’s. Nearly everyone who lives long enough will suffer from some cognitive decline but only some will develop the disease known as Alzheimer’s. As with BMD, we reach our peak cognitive function around age twenty; it plateaus for about ten years and then starts the slow decline. Given the great redundancy in our brains, it is not noticeable for some time. [Figure modified from Science Magazine] Eventually we reach a functional threshold where our cognitive function begins to impair our ability. This becomes more apparent when an older person is engaged in highly technical activity, in very fast paced activities, or in stressful situations (emotional, physical or health related). Those challenges to cognition are less apparent when in highly familiar situations. 
Muscle mass and strength decline in a similar fashion resulting in sarcopenia. Most people lose perhaps 30% of their muscle mass between ages 50 and 70. [Figure modified from the Buck Institute] Individuals that exercise find it takes more effort to maintain their muscle mass and strength but regular exercise and good nutrition have a significant beneficial impact.

This loss of about 1% per year is normal. In the following post, I will look at some of the proposed mechanisms for the aging process and then turn to how to overcome them.

Praise for Dr Schimpff

The craft of science writing requires skills that are arguably the most underestimated and misunderstood in the media world. Dumbing down all too often gets mistaken for clarity. Showmanship frequently masks a poor presentation of scientific issues. Factoids are paraded in lieu of ideas. Answers are marketed at the expense of searching questions. By contrast, Steve Schimpff provides a fine combination of enlightenment and reading satisfaction. As a medical scientist he brings his readers encyclopedic knowledge of his subject. As a teacher and as a medical ambassador to other disciplines he's learned how to explain medical breakthroughs without unnecessary jargon. As an advisor to policymakers he's acquired the knack of cutting directly to the practical effects, showing how advances in medical science affect the big lifestyle and economic questions that concern us all. But Schimpff's greatest strength as a writer is that he's a physician through and through, caring above all for the person. His engaging conversational style, insights and fascinating treasury of cutting-edge information leave both lay readers and medical professionals turning his pages. In his hands the impact of new medical technologies and discoveries becomes an engrossing story about what lies ahead for us in the 21st century: as healthy people, as patients of all ages, as children, as parents, as taxpayers, as both consumers and providers of health services. There can be few greater stories than the adventure of what awaits our minds, bodies, budgets, lifespans and societies as new technologies change our world. Schimpff tells it with passion, vision, sweep, intelligence and an urgency that none of us can ignore.

-- N.J. Slabbert, science writer, co-author of Innovation, The Key to Prosperity: Technology & America's Role in the 21st Century Global Economy (with Aris Melissaratos, director of technology enterprise at the John Hopkins University).