a state of existence that is arrived at slowly may be ... recede and old filings disintegrate ......

Art of Aging Gracefully Resource Fair April 25, 2013

Healthy Aging by Donald I Abrams, MD may not be

copied or reused without permission of UCSF Medical

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Healthy Aging

UCSF Osher Center for Integrative Medicine

Donald I. Abrams, MD

Chief, SFGH

Hematology/Oncology

April 2013

Aging

A state of existence that is arrived at slowly

May be defined as a series of disadvantaging events that normally occur in our bodies over time….

Wikipedia Definition

Ageing (British English) or aging (American English) is the accumulation of changes in a person over time.[1] Ageing in humans refers to a multidimensional process of physical, psychological, and social change. Some dimensions of ageing grow and expand over time, while others decline. Reaction time, for example, may slow with age, while knowledge of world events and wisdom may expand. Research shows that even late in life, potential exists for physical, mental, and social growth and development

Aging: Skin, Hair & Teeth

Skin’s dermal layer grows thinner and collagen fibers degrade causing loss of elasticity

50% have gray hair by 50 and most men over 60 are partially bald

Tooth enamel more prone to cracks

Gums recede and old filings disintegrate

Oral problems lead to poor nutrition

http://en.wikipedia.org/wiki/Human_body

http://en.wikipedia.org/wiki/Psychological

http://en.wikipedia.org/wiki/Social




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Aging: Eyes and Ears

Lens becomes less elastic after 40 and muscles controlling it weaken causing inability to focus on nearby objects

Cataracts common after 60 as proteins in lens oxidize and become opaque

Walls of ear canal become thinner and drier, while nerves and sensory cells die

Hearing declines 25% between 60-80; nearly 1/3 over 65 have hearing problems

Aging: Bones and Muscles

Both sexes suffer gradual loss of bone density after 50 as well as a deterioration of joint cartilage

Muscles lose size and weight in relation to the rest of the body

With dwindling muscle mass, body burns fewer calories at rest increasing tendency to gain fat

Aging: Heart and Lungs

Fatty deposits and scar tissue slowly accumulate in lining of blood vessels, reducing blood flow to vital organs

Blood pressure often increases

At ~55, proteins in lung become less elastic

Coupled with gradual stiffening of chest wall, lungs’ ability to transport oxygen ↓

Aging: GI and GU

Gastric juices & enzymes decrease by 60

Food moves more slowly through colon

Some nutrients absorbed less readily

Kidneys become less efficient with age

Bladder muscles weaken

1/3 seniors experience urinary incontinence

Prostate enlargement issues common




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Aging: Hormones and Sex

Reproductive hormones decline after 50; sharp drop for women; men more gradual

Effects range from mood changes to loss of bone and muscle strength

Menopause causes narrowing of vagina and thinning and drying of genital tissues; painful intercourse may precipitate loss of interest

Impotence not a symptom of male aging; less rigid erection and less forceful ejaculation

Aging: Brain and Nerves

Brain shrinks by 10% between 30 and 90

– Frontal lobes shrink 30% from 50-90

– Hippocampus shrinks 20% from 50-90

Neurons become less dense

Processing ability may wane, but attention and language should not suffer

“You may have the same size hard drive but the processing speed is slowing down”

Risk Factors for Cognitive Decline

apoE4 gene increases Alzheimer’s risk

Hypertension, diabetes and heart disease

Environmental exposure to lead

Smoking, alcohol, illicit drugs

Low education level

Lack of physical activity

Lack of social interaction

High stress levels




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Avoiding Cognitive Decline

Stay intellectually engaged

Remain physically active

Be socially active

Practice stress reduction

Avoid tobacco; moderate alcohol

Treat hypertension, diabetes, depression and elevated cholesterol

Use hearing aids or glasses as needed

Avoiding Cognitive Decline: Diet

Brain Threats

– Saturated fats

Meats, dairy and eggs

– Trans fats

Doughnuts and snack pastries

– Excess iron, copper and aluminum

Brain-Protecting Foods

– Nuts and seeds: rich in vitamin E

– Blueberries and grapes: anthocyanin antioxidants

– Sweet potatoes: Okinawan staple, β-carotene

– Green leafy vegetables: folate and safer iron

– Beans and chickpeas: B6, folate, Ca++, protein

– Vitamin B12

Theories of Aging

Free Radical Theory

– changes caused by free radical damage

Somatic Mutation Theory

– genetic mutations of DNA accumulate

Rate of Living Theory

– duration inversely related to energy expended

Theories of Aging

Error Catastrophe Theory

– error in synthesis of a protein sets off cascade

Cross-linkage Theory

– progressive cross-linking among structural protein

Telomere Theory

– Shortened telomeres prevent further cell division

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Newsweek Poll on Aging

801 Americans age 45 to 65 interviewed July 2001

Results published in special Fall/Winter 2001 edition “Living Longer, Living Better”

72% believe they will live to be 80, 11% until 100

Current health rated excellent (22%), very good (31), good (27), fair (14), poor (6)

Death Rates at Different Ages

In North America and Europe, annual death rates:

– Among 15 year olds .05%

– Among 50 year olds 1.5%

– Among 105 year olds 50%

Rise in mortality mainly due to heart disease, cancer and stroke

– But eradicating these 3 would only add 15 years, half gain achieved during 20th century

Goal of Healthy Aging

DIE ‘YOUNG’ AS LATE AS POSSIBLE

Christiaan Barnard, M.D.

COMPRESSED MORBIDITY

Andrew Weil, M.D.

12-Point Program for Healthy Aging*

1. Eat an anti-inflammatory diet

Weil, Healthy Aging 2005




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Caloric Restriction & Aging

Caloric restriction is widely considered to be the most robust and reproducible way of extending health and longevity

Effects in mammals include:

– Lower insulin, increased insulin sensitivity

– Lower core body temperature

– Delayed onset of age-associated diseases

– Slower age-related decline in functional tests

For humans, drugs to mimic caloric restriction ?

My Standard Recommendations

Increase plant based foods

– Whole grains

– Fruits (deep pigment) and vegetables (cruciferous)

Decrease animal fats

– Eliminate dairy and red meat

– Poultry controversial

– Increase marine omega-3’s

Decrease refined carbohydrates

– Sugar, white flour, white rice

Season with garlic, ginger, onions, turmeric

Drink green tea and red wine

12-Point Program for Healthy Aging

2. Use dietary supplements wisely to support the body’s defenses and natural healing power

Photo by Susan Eisenberg

Potentially Useful Supplements

Multivitamin or Vitamins C, D3, and E (?)

Calcium/magnesium

Omega 3 fatty acids

Chondroitin sulfate and glucosamine

St. John’s wort

Valerian

Saw palmetto

Evening primrose/Black cohash/Red clover

Coenzyme Q-10

Ginkgo biloba

Zyflamend®

Resveratrol




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Medicinal Mushrooms

Photos by DIA on site at Fungi Perfecti (www.fungi.com)

Mushrooms and Aging

Useful properties of medicinal mushrooms

– Antioxidant

– Immunomodulatory

– Antiviral

– Anti-inflammatory

– Anti-neoplastic

– Aromatase inhibition


3. Use preventive medicine intelligently

– Know your risks of age-related disease

– Get appropriate diagnostic and screening tests and immunizations

– Treat problems (elevated blood pressure, elevated cholesterol) in their early stages

Where Drug Dollars Go

The five costliest classes of drugs accounted for two-thirds of the $181 billion spent on outpatient Rx for adults in 2004

– Cardiovascular $31.7 billion

– Hormones $24.5 billion

– Central Nervous System $23.7 billion

– Cholesterol-lowering $21.5 billion

– Psychotherapeutics $17.9 billion

AHRQ, DHHS from USA Today 3/12/07




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Newsweek Poll 2001

Drugs that lower blood pressure

– 45-54 22%

– 55-65 46%

Drugs that lower cholesterol

– 45-54 14%

– 55-65 27%

Antidepressants 15%

Viagra 4% men 1% women

HRT 37% women

But did you hear the one about the eunuchs in Kansas?

Fountain of Youth Hormones

Secretion of growth hormone falls 12% per decade after middle age

Estrogen abrupt and testosterone gradual declines

DHEA and DHEA(S) fall progressively after 30 and by 60 are < 50% levels of youth

“Neither DHEA nor low-dose testosterone replacement in elderly people has physiologically relevant beneficial effects…”

Nair et al NEJM 2006




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4. Get regular physical activity throughout life

Five Domains of Fitness

Posture changes begin as early as teens

Strength declines as muscle fibers decrease in size and number and supply of nerve stimulation and energy ↓

Balance deteriorates as muscles tighten and weaken and joints lose full ROM

Flexibility declines as connective tissue becomes less elastic

Endurance drops with ↓ flexibility, weakened muscles and stiffer lungs and blood vessels

Moffat and Lewis, Age-Defying Fitness

How Fit Are You?

Are you standing as straight and tall as you once did?

Is walking up a flight of stairs a strain at times?

Are you getting up from a chair more slowly?

Is it harder to look left & right when backing up?

Do you get stiff with prolonged sitting?

Is standing on one leg to put on a shoe difficult?

Do you trip or lose your balance more easily?

Does walking or jogging a distance take longer?

Moffat and Lewis, Age-Defying Fitness

Healing Power of a Brisk Walk

Weight control: regular exercise allows for easier weight loss and decreased likelihood to regain

Mental health: physical activity can be as effective as psychotherapy, relaxation and meditation for stress and depression

Heart health: lower blood pressure and increase in HDL cholesterol




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Difficult Behaviors to Adopt

Exercising enough 48%

Limiting sugar or sweets 38%

Limiting red meat/fatty food 32%

Eating enough fruits/veggies 31%

Limiting salt/sodium 22%

Giving up tobacco 21%

Limiting alcohol 7%

Newsweek Poll 2001


5. Get adequate rest and sleep

Integrative Aspects of Sleep

Sleep hygiene

regular bedtime

avoid alcohol

limit activity in bedroom appropriate lighting

no eating immediately prior to bed

evaluate meds for sleep interference

Brief naps

Consider melatonin or botanicals

Herbs for Insomnia

Valerian: strongest evidence, appears safe

Kava: not recommended in view of hepatotoxicity

St. John’s wort: worrisome cytochrome P450 issues

German chamomile: may inhibit CYP3A4

Hops: anecdotal and historical evidence

Lavender: oil inhalation as aromatherapy

Passionflower: often combined with valerian

Lemon Balm: increases “calmness”

Block, Int Cancer Therapies, 2004




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6. Learn and practice methods of stress protection

Stress and the Body

With all that we know about how stress aggravates cardiovascular disease, promotes viral infections, exacerbates metabolic diseases, halts reproduction, and regulates the normal function of virtually every cell in the body, why would cancer cells somehow be exempt?

Cole NCI Cancer Bulletin 2006

How Do You Reduce Stress?

Watch TV, read, music 83%

Talk to someone 75%

Exercise, sports, walk 68%

Ignore it 48%

Go shopping 37%

Meditate 37%

Have a drink or cigarette 24%

Newsweek Poll 2001


7. Exercise your mind as well as your body




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8. Maintain social and intellectual connections as you go through life


9. Be flexible in mind and body: learn to adapt to losses and let go of behaviors no longer appropriate for your age

Principles of Attitudinal Healing

Choose Peace!

If you are involved in a tug-of-war, if you let go of the rope you are no longer

Practice forgiveness

When someone comes to you with anger, recognize it as underlying fear and return love

Fear of our own mortality underlies most of our fears

The Value of Humor

Study of 54,000 Norwegian followed 7 yrs

Participants filled out survey on how easy they found humor and its importance

The greater the role humor played, the greater the chance of survival over the 7 yrs

– Top quarter 35% more likely to be alive than the lower quarter

– In 2015 with cancer dx at baseline, a great sense of humor cut chance of dying by 70%

“Humor works like a shock absorber in a car”

Sven Svebak, American Psychosomatic Society, 2007




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10. Think about and try to discover for yourself the benefits of aging

Benefits of Aging

Gift of time...

– to be creative and enjoy other’s creativity

– spend time with family

– enjoy Nature

Freedom Senior discounts


11. Do not deny the reality of aging or put energy into trying to stop it. Use the experience of aging as a stimulus for spiritual awakening and growth


12. Keep an ongoing record of the lessons you learn, the wisdom you gain, and the values you hold.

At critical points in your life. Read this over, add to it, revise it, and share it with people you care about.




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The Bottom Line?

All of this research holds a fairly obvious lesson.

Life itself is lethal, and the things that make it sweet make it more lethal.

Chances are that by starving and castrating ourselves, we really could secure some extra years.

But most of us would gladly trade a lonely decade of stubborn survival for a richer middle age.

Our bodies are designed to last only so long.

But with care and maintenance, they’ll live out their warranties in style.

Cowley, Newsweek, 2001

Happy Aging!

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Healthy Aging

Chief, Hematology-Oncology

San Francisco General Hospital

Professor of Clinical Medicine

Integrative Oncology

UCSF Osher Center for Integrative Medicine

1545 Divisadero, St 4th Floor

San Francisco, CA 94115

Phone: (415) 353-7720

www.osher.center.edu

Donald I. Abrams, MD

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a state of existence that is arrived at slowly may be ... recede and old filings disintegrate ......

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