Category Archives: Aging

Post # 56 – What is Optimal Blood Pressure and How to Achieve it?

14 Sunday Aug 2016

Posted by in Aging, Causes of Death, Living to 120, Nutrition, Optimal Health, Optimal Nutrition, Reversing Chronic Diseases, Uncategorized

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First, a quick story and my own experience over the last six months.

For a number of years, I have had my blood pressure in tens (between 110 and 119) for Systolic and in the seventy’s for the Diastolic.  So, my typical BP measurement might be 112/74.

For the last couple of years, however, every time I visited a doctor or clinic, I noticed that it was in the high twenty’s or low thirty’s for Systolic (125 to 135 range) and low eighty’s for the Diastolic pressure. For example, I might see my as BP 128/82. Doctors always called it out as “normal” and I ignored it assuming that those were spurious readings.

About six months ago, I decided to get a BP monitor and started measuring my blood pressure frequently – like every day and even multiple times during a day.  I noticed that the higher readings I had seen during the last couple of years were actually true. I wanted to know if it was inevitable that my BP would be creeping up as I get older.  Or, could I do something about it?

And, so I decided to take a deeper dive into this topic of BP.

First, I asked my wellness doc if he had any ideas. He told me that it was nothing to worry about. When I insisted on understanding why my BP not stay in the tens for Systolic and seventy’s for diastolic, he told me that I was already eating a pretty clean vegetarian diet.  He suggested I could experiment with vegan diet and also suggested a couple of books to read.

Well after about six months of eating vegan (only plant based whole food, no eggs, no dairy, no meat) and daily monitoring my BP, it looks like my BP is nicely settling in the tens range for systolic and in the seventy’s range for diastolic and times even lower.

And, here is a quick synopsis of what I learned along the way about what is optimal BP and how to achieve it. You might find surprising some of  what I learned and am sharing here.

What is Optimal BP?

We have all heard that BP is the “silent killer”. That uncontrolled high BP can injure or kill you. According to American Heart Association website, possible health consequence can happen over time, if left untreated include:

  • Coronoary Heart Disease or CHD, i.e., damage to the heart and coronary arteries, including heart attack, heart disease, congestive heart failure, aortic dissection and atherosclerosis (fatty buildups in the arteries that cause them to harden)
  • Stroke
  • Kidney damage
  • Vision loss
  • Erectile dysfunction
  • Memory loss
  • Fluid in the lungs
  • Angina
  • Peripheral artery disease

I am sure you have also heard that BP less than 120/80 is considered “normal”.  120 – 139 for systolic or 80 to 89 for diastolic is considered pre-hypertension.  And, anything above those numbers is considered hypertension and your doc will say that you must do something to bring it in the lower ranges. NIH National, Heart, Lung, and Blood Institute website publishes this guidance:

Stages of High Blood Pressure in Adults

Stages Systolic
(top number)		 Diastolic
(bottom number)
Prehypertension 120–139 OR 80–89
High blood pressure Stage 1 140–159 OR 90–99
High blood pressure Stage 2 160 or higher OR 100 or higher

Well, where do these numbers come from?

As you may already know, if you have been reading these blog posts, that I am always suspect of the word “normal”.  I prefer talking about “optimal”.

 Updated Research on BP

In BMJ 2009, M R Law et al, published a very extensive meta-analysis study of 143 previously completed clinical trials on the use of BP lowering drugs. A meta-analysis study is a study of already published studies to assemble an overall conclusion. A key conclusion of this meta-analysis study was:

“The relative risk estimates of CHD events and stroke in the blood pressure difference trials were similar across all levels of blood pressure before treatment down to 110 mm Hg systolic and 70 mm Hg diastolic, below which there were too few data.”

Basically, from all previous studies they analyzed that the risk of all coronary heart disease and stoke continued to decrease as the BP were lowered to 110/70.  They could not tell if the trend would continue below 110/70, since there was not enough data available for cases below 110/70.

So, 110/70 is definitely better than 120/80 in reducing the risk of CHD and strokes.  Is 105/65 or other lower numbers better than 110/70, they could not prove it due to insufficient data.

Here is another conclusion:

“This, the largest meta-analysis of randomised trials of blood pressure reduction to date, shows that lowering systolic blood pressure by 10 mm Hg or diastolic blood pressure by 5 mm Hg using any of the main classes of blood pressure lowering drugs, reduces CHD events (fatal and non-fatal) by about a quarter and stroke by about a third, regardless of the presence or absence of vascular disease and of blood pressure before treatment, with no increase in non-vascular mortality. Heart failure is also reduced by about a quarter. Proportional disease reduction for a given blood pressure reduction independent of pretreatment blood pressure.”

Translated it means the risk of CHD and strokes decreases at the same rate no matter what the starting point is. So, when you lower your systolic BP from 140 to 130, or 130 to 120 or from 120 to 110, you decrease you risk by the same amount, of CHD by 25% and strokes by 33%.

The following example from the research paper illustrate this calculations.

“At age 60-69, the relative risk of stroke is 0.43 (57% decrease) for a 20 mm Hg decrease in systolic blood pressure. For a blood pressure decrease twice as great (40 mm Hg), the relative risk of 0.43 effectively applies twice (0.43×0.43, or 0.432), which is 0.18 (an 82% decrease).”

That is quite amazing, isn’t it?

Do you have to take meds to lower your blood pressure?

Short answer is: of course, not.

Michael Gregor, M.D. in his book, “How not to Die”, Chapter 7: How Not to Die from High Blood Pressure, very succinctly lays out who the villains and heroes are in the epic story of BP.

Gregor book

Villains are Sodium and all the foods that sneak sodium in the form of salt into our diet. Mechanism seems simple enough. Sodium causes water retention and body raises blood pressure to try to expel the excess retained water from the body.

There is a plethora of research that shows that if you lower your sodium intake to less than 500 mg a day, you can achieve a 110/70 BP.

Heroes are anti-oxidant, potassium and nitrate rich foods that provide antidote to sodium and the damage it does to the cardiovascular system. Adding the following foods to your diet will further lower or make it easier to bring it in the right range:

  • Rhubarb
  • Leafy green vegetables;, arugula, cilantro, butter leaf lettuce, Mesclun greens, beet greens, basil, oak leaf lettuce Swiss chard
  • Beets
  • Ground flaxseed
  • Whole Grains
  • Hibiscus Tea

Does the BP have to go up as we age?

Short answer is: NO.

Yes, the phenomenon of BP going up with age is what has been observed in “normal” situations. However, citing lots of existing research, Dr. Gregor demonstrates that the idea that BP has to go up as we age is a myth. With proper food intakes we can have a healthy BP for life.

Bottom line

There is extensive research available to establish that high Blood Pressure is indeed the silent killer it is made out to be. Consequences of high BP if left unchecked for extended period of time can cause many health issues beyond coronary heart disease and strokes.

120/80 may be considered “normal”, but is not actually optimal. Clear evidence exists that by lowering BP to 110/70, you can further reduce risks of CHD and stroke.  Further, benefits of lowering BP to less than 120/80 are significant.  There is not enough evidence at this time that numbers lower numbers than 110/70  further reduce the risks.

Meds are not the only means to lower BP. You can use lifestyle changes to lower BP to 110/70 or lower.

 Reducing sodium intake dramatically, lower than 500 mg per day, can lower the BP to 110/70.

Anti-oxidant, potassium and nitrate rich foods provide antidote to sodium and the damage it does to the cardiovascular system. Adding the following foods to your diet will further lower or make it easier to bring it in the right range:

  1. Rhubarb
  2. Leafy green vegetables;, arugula, cilantro, butter leaf lettuce, Mesclun greens, beet greens, basil, oak leaf lettuce Swiss chard
  3. Beets
  4. Ground flaxseed
  5. Whole Grains
  6. Hibiscus Tea

AHA’s website offers a neat little tool for you to see how much BP you can expect to lower with different recommended lifestyle changes.

 

So there you have it, results of my experience and deep dive into this topic so far!

What are your thoughts on this subject?

Would love to hear from you and learn from you.

Please click on Comment to leave your comments or question so others can benefit from your input.

 

Post #53 – How to Optimize Your Immune System? –  Part III  – with Exercise

30 Monday May 2016

Posted by in Aging, Living to 120, Optimal Exercise, Optimal Health, Puposely Living, Vigor, Vitality, wellness, Yoga

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In Post #51, I discussed some basic terminology of the immune systems, how immune system works, and what kinds of issues happen when it does not work.

Things that are in our control to enhance our immunity and also so the immune system does not go haywire are the ones that you have heard about gazillions of time by now and are probably tired of hearing about: Nutrition, Exercise and Lifestyle.

In Post #52, we discussed how to boost your immune system with nutrition.   In this post, let’s focus on how and what type of Exercise can boost the immune system.

Impact of exercise on Immune systems

Quite a bit of research is available on how exercise impacts the immune system, although most of it is about impact of exercise on colds and flu. Based on the available research, here are some theories why exercise helps improve the immunity:

  • Physical activity may help flush bacteria out of the lungs and airways. This may reduce your chance of getting a cold, flu, or other airborne illness.
  • Exercise causes changes in antibodies and white blood cells (the body’s immune system cells that fight disease). These antibodies or white blood cells circulate more rapidly, so they could detect illnesses earlier than they might have before.
  • The brief rise in body temperature during and right after exercise may prevent bacteria from growing. This temperature rise may help the body fight infection more effectively. (This is similar to what happens when you have a fever.)
  • Exercise slows down the release of stress-related hormones. Some stress increases the chance of illness. Lower stress hormones may protect against illness.

Getting a little deeper into the subject, here are some findings from some specific studies:

  1. Exercise can provoke moderate acute elevations in IL-6 exerting anti-inflammatory effects
  2. Exercise increases numbers of Neutrophils, T and B lymphocytes, and NK cells – all key components of the immune system
  3. Exercise improves antigen specific T cell function for better protection from infectious agents and greater immunosurveillance
  4. Exercise enhances a variety of macrophage biology and capacities
  5. Exercise improves gut microbiota,  i.e., the bacteria collection in the gut

But how much exercise should you do?

We have all heard that exercise is good for you.  And, as this blog post is emphasizing, among other things, exercise also enhances the immune system. But how much exercise?

In this study, the researchers examined three groups of people: elite athletes, recreational athletes, and sedentary controls. Their results were kind of interesting:

  • The elite athletes had the most upper respiratory issues (66% got sick).
  • The couch potatoes were next (45% got sick).
  • The recreational athletes were the healthiest (22% got sick).

All kinds of other research has found the same thing, so exercise scientists tend to use a J-shaped curve to model the immune effects of exercise. It looks like this:

immunity vs exercise

So one thing is clear, moderate exercise is significantly better for you than no exercise at all. If you are sedentary, it does not seem to take much to get the benefits of improved immune system. For example, daily walking for one hour at a 60 to 65% maximum heart rate (computed as 220-your age) gets you near the optimal range in the above chart.

From the chart, it is clear that there is a point where the benefit of training stops and the negative effect of over-training on the immune system sets in. This literature review article, goes into much more specifics on the kind of exercise that produces the immune-suppressant, i.e., harmful, response:

  • Relatively long workouts (1.5 hours or more), especially without refueling during the workout.
  • A reasonably high intensity, but not excessively difficult (since you have to be able to keep it up for a while).
  • An inadequate recovery period between workouts.

Basically, the kind of grueling training elite athletes often go through preparing for a competition, such as running a marathon.

This article puts it slightly differently:

“No activity is worse than some, while too much may be worse than none at all. The ideal lies somewhere in between – though not necessarily in the middle, but rather smack dab in the “just enough” section. Can “just enough” be quantified? Perhaps it could be quantified using a battery of round-the-clock tests and measurements of anabolic and catabolic hormones, various serum concentrations, lactate build-up, cortisol, testosterone ratios, etc., but that would be expensive, unwieldy, and completely individualized. … If you want to avoid over-training, there are some grand, overarching principles to follow, but you’ll also want to pay attention to certain personal, entirely subjective cues.

That’s what my trainer and yoga teachers call “listening to your body”. There are days, when I am feeling physically ragged since I may not have slept well, or I may be catching a virus, or am feeling physically exhausted or whatever.   In such situations, I need to carefully “listen to my body” and either take it easier than usual or just totally skip the session.

Bottom Line

To optimize immune systems, exercise plays a critical role. It only takes a moderate amount of exercise to get the optimal benefit of exercise for improving immune system. For example any of these activities or some combination of these done daily would optimize the immune systems:

  1. walking for 1 hour at a pace of 60-65% of maximum heart rate of approximately 220 minus your age,
  2. An hour long yoga routine,
  3. A strength training session with body weight or light weights could do the trick

On the other hand, extended periods of over-training can compromise and may lead to sub-optimal immune system. It is more difficult to define over-training with objective measures and may depend upon many individual factors.  It is best to listen to your body and develop a subjective feel for what level of exercise may be “just right” for you for optimal immune system.

 

What are your thoughts on this subject?

Would love to hear from you and learn from you.

Please click on Comment to leave your comments or question so others can benefit from your input.

 

Post #50 – How to optimize your health by maximizing your telomeres?

21 Monday Mar 2016

Posted by in Aging, Life-Span, Living to 120, Nutrition, Optimal Health, Uncategorized

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What in the world is Telomeres? – you say

Well, if you have not heard of the word Telomeres, I will explain it here, since it is likely that you will be hearing about it more and more.  Especially, if you are interested in optimal health, living long and living health.

So, first here are some useful terms.

What is Telomere?

Telomeres are disposable buffers at the ends of chromosomes which are truncated during cell division. Their presence protects the genes before them on the chromosome from being truncated. During the process of each cell division, the telomere ends become shorter.

Hayflick Limit

An American scientist Leonard Hayflick established limits to cell replication what is now called Haflick Limit. The Hayflick limit is the number of times a normal human cell population will divide until cell division stops. Empirical evidence shows that the telomeres associated with each cell’s DNA will get slightly shorter with each new cell division until they shorten to a critical length.

Most cells will divide between 50 to 70 times before they cannot divide any more.

Role of Telomeres in Cellular Aging

As Hayflick first demonstrated, human cells have an inborn “counting mechanism” that tells them when to senesce, or stop dividing: Each time a cell replicates, the ends of each chromosome, i.e., telomeres, get shorter, and once the telomeres get too short, they trigger a “senescence program” that arrests the cell’s growth.

In short, telomeres represent body’s clock that determines our life-span and our health span.

Telomerase to the Rescue!

Telomerase is an enzyme that adds length back to the end of telomeres.  In a simple leap of logic, you can quickly figure that telomerase enzyme is an antidote to shortening of the telomeres.

As you can also guess things are probably not that simple.  They never are when it comes to human biology. But for this brief blog post, I will keep it simple.

So, with this premise of telomeres determining when cells say “uncle”.  And, Telomerase offering an antidote, race is on for researchers and entrepreneurs on many fronts.  Numerous questions are being asked and some have even been answered:

  • How do you measure telomeres inexpensively?
  • Do telomeres really correlate with one’s biological age?
  • Does telomere length account for life styles that have been known to determine one’s health span and lifespan?
  • What factors stimulate telomerase activity? Can we measure that?
  • What about the role of telomerase in cancer, where cell replication goes on without any limit?
  • And, so on and so on..

Some hard answers have emerged, well-rooted in hard science.  On the other hand, other answers are preliminary and people are making wild leaps of logic to get to the market first with commercial products and services.

Measuring Telomeres

Several companies now offer services to measure telomeres. For example, Titanovo, Inc., SpectraCell Laboratories, Telome Health, Inc.,  Telome Home.  Basically, you send them blood or swab and they will  send you your telomere measurements.

My experience

I recently got my telomeres measured by Titanovo, Inc.

I signed up online. They sent me a kit.  I swabbed inside of my cheeks and mailed it back.  I also filled in a lifestyle survey on their website they use to correlate the results with lifestyle.

Few weeks later, they posted my results on their website.  The following pictures represent result I received.  (You can click on these to enlarge and make them readable)

Titanovo profile 3-2016_Page_1

Titanovo profile 3-2016_Page_2

What do my results mean?

Here is my take away.  My relative telomere length is 0.62, which if you interpolate on one of the charts that means my telomere corresponds to a 48 year old male. 13 year younger biologically sound pretty good to me!

I reported my diet as vegetarian.  If I were to change my diet to vegan, according to the last chart, my telomere length could be 0.67. That represents an additional opportunity for 8% advantage in terms of biological age.  8% increase in lifestyle is pretty significant to me.

Since I just started experimenting with a vegan diet about 3 week ago, I will be interested in retesting the telomere length in a year to see if the results correspond to what Titanovo is forecasting.

Titanovo sells bundles of multiple kits, so people can play with their lifestyles choices and then see the impact, in say 3 months at a time.

Bottom Line

  • This area of telomere and measuring impact of lifestyle choices through measuring telomere is quite exciting.
  • A lot of research is going on in both gaining fundamental understanding as well designing interventions that could potentially defeat body’s lifespan clock.
  • Sound like pretty cool stuff to me, if this works as advertised.
  • I bet we will be hearing a lot about this topic, so stay tuned.

What is your perspective of this topic?

I would love to hear and learn from you.

Please click on the “Comments” link to share you thoughts.

 

 

 

 

 

Post #49 – What is the role of massage therapy in Optimal Health?

14 Sunday Feb 2016

Posted by in Aging, Optimal Health, Puposely Living, Quality of Life, Reversing Chronic Diseases, Stress, Uncategorized, wellness

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After so many years, my wife and I finally surrendered to the suggestions of our trainer and started getting massages at least once a month. He had been telling us how massage can be great for recovering from the stresses left over from hard workouts.  And, about six months ago, we decided to give it a shot and get massages on a regular basis.

So, I thought I will take some time to do some research into the role of massage therapy and share the research and our own experience in this blog post.

man_massage_table

What Is Massage Therapy?

Massage therapy dates back thousands of years. References to massage appear in ancient writings from China, Japan, India, and Egypt.

According to National Center of Complementary and Integrative Health (NCCIH) of the National Institute of Health (NIH) the term “massage therapy” includes many techniques and the type of massage given usually depends on specific need, physical condition and the expertise of the massage therapist.

In general, massage therapists work on muscle and other soft tissue to help you feel better.  The following massages you hear most about in the US:

In Swedish massage, the therapist uses long strokes, kneading, deep circular movements, vibration, and tapping.

Deep (tissue)massage technique uses slower, more-forceful strokes to target the deeper layers of muscle and connective tissue, commonly to help with muscle damage from injuries.

Sports massage combines techniques of Swedish massage and deep tissue massage to release chronic muscle tension. It is adapted to the needs of athletes.

Myofascial trigger point therapy focuses on trigger points—areas that are painful when pressed and are associated with pain elsewhere in the body. Examples of these are:

  • Accupressure – where therapist applies strong physical pressure on specific point on the body.
  • Reflexology – Similar to acupressure where pressure is applied to certain points on hands and feet.

But there are other massages that are not quite as common and are based on Indian medicine, Ayuerveda:

Marma-point Massage – where a therapist applies very gentle touch to some or all of the 107 different marma-points in the body to correct any imbalances in the body

Shirodhara – where warm oil is poured to the forehead

Abhyanga – oil massage is done by two people with synchronized movements

Massage therapy is sometimes done using essential oils as a form of aromatherapy.

Benefits of Massage

A lot of the scientific research on massage therapy is preliminary or conflicting, but much of the evidence points toward beneficial effects on pain and other symptoms associated with a number of different conditions. Much of the evidence suggests that these effects are short term and that people need to keep getting massages for the benefits to continue.

While more research is needed to confirm the benefits of massage, some studies have found massage may also be helpful for:

  • Anxiety
  • Digestive disorders
  • Fibromyalgia
  • Headaches
  • Insomnia related to stress
  • Myofascial pain syndrome
  • Soft tissue strains or injuries
  • Sports injuries
  • Temporomandibular joint pain

According to Arthritis Foundation  regular massage of muscles and joints, whether by a licensed therapist at a spa or by self-massage at home, can lead to a significant reduction in pain for people with arthritis, according to Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine, who’s conducted a number of studies on the benefits of massage, including on people with arthritis. In Field’s research and other recent studies on the effects of massage for arthritis symptoms, regular use of the simple therapy led to improvements in pain, stiffness, range of motion, hand grip strength and overall function of the joints.

In a study published in Science Translational Medicine by Dr. Mark A. Tarnoplsky et al found that a short, 10-minute Swedish-style massage session can reduce inflammation, which can help your muscles recover after a hard workout.

And, then of course, there are studies that attribute the benefits of massage just to receiving a dose of human touch that offers all sorts of healthy responses from lowering blood pressures, depression, improving immunity to oxytocin release for increased bonding response.

 What are the risks of Massage Therapy?

Massage therapy appears to have few risks when performed by a trained practitioner. However, massage therapists should take some precautions in people with certain health conditions. NCCIH recommend that:

  • In some cases, pregnant women should avoid massage therapy. Talk with your health care provider before getting a massage if you are pregnant.
  • People with some conditions such as bleeding disorders or low blood platelet counts should avoid having forceful and deep tissue massage. People who take anticoagulants (also known as blood thinners) also should avoid them. Massage should not be done in any potentially weak area of the skin, such as wounds.
  • Deep or intense pressure should not be used over an area where the patient has a tumor or cancer, unless approved by the patient’s health care provider.

Our Experience

Over the years, my wife and I have received massages during vacations etc.  We received several different Ayurvedic massages at the Ayurrvedic Institute in Albuquerque NM every day for a week of an intense detox and cleanse program called Panchakarma.  I have also received locally in Maryland Marma-Point massages.  And, now for the last six month, we are receiving massages once a month.

I described my experience of relieving migraine using acupressure in another blog post.

Massages that we receive from the same person every month are very therapeutic in that the therapist is getting to know our body. She is able to adjust her technique based on what our body needs. I am able to tell her any specific issue I may have. Usually these tend to be some stiff muscles that she could pay attention to.  During and after the massage, she is the one who tells me where the stiff muscles are.

Areas around my shoulders and neck are where I seem to burry my stresses and are getting more and more limber as a result of the massages.  I can definitely feel the result of my relaxed muscles in my yoga practice.

I have found Ayuervedic massages to be totally blissful. It blows me away how such gentle touches at the Marma-points or pouring of oil on third-eye can totally transport my body into a meditative state.

Bottom Line

Regular massage therapy definitely is valuable in creating and maintaining Optimal Health.  Repeating from the NCCIH website:

  • A lot of research on the effects of massage therapy has been carried out.
  • While often preliminary or conflicting, there is scientific evidence that massage may help with back pain and may improve quality of life for people with depression, cancer, and HIV/AIDS.
  • Massage therapy appears to have few risks if it is used appropriately and provided by a trained massage professional.

What do you think?

What are your experiences and knowledge of massages therapy?  

Please share your thought by clicking on “Leave A Comment” link.

I would love to learn and share with others what I learn from you?

 

 

Post #46 – What is Arthritis and what can you do about it?

16 Monday Nov 2015

Posted by in Aging, Bikram Yoga, Optimal Exercise, Optimal Health, Reversing Chronic Diseases, Vitality

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I often hear my contemporaries talk about pain in the knees, hands, shoulder, back. When I ask them what is going on, a common response is: “It is just arthritis.”  When I probe further about what kind of arthritis or what are they doing about it, I may get answers like:

  • No idea, have not talked to a doctor yet
  • Just have to live with it, I guess
  • Managing with pain meds
  • I could have surgery, but it is not that bad yet.

So, I thought I will go ahead and share what I have experienced and learned over the years on this topic

My ambition to run a marathon thwarted

Almost twenty years ago, I met Stu Mittleman, an ultra-distance running champion. He won the 1,000 Mile World Championship and set a new world record by running the distance (1 609.344 kilometers) in 11 days, 2 hours, 6 min. 6 sec. (Yes, that is right one thousand mile!). After winning that race, he got himself admitted to a graduate school to figure out how he did what he did.

With that knowledge and experience, he started teaching mere mortals how to run marathons.  When I met, I was so inspired, I signed up.

So, with his coaching program, I started building up my endurance. I ran my first 5K. And, then, my knees started hurting. He had no ideas on how to fix my knees.  So, I quit running.

Knees got worse over the next few years. I went to a Sports Medicine guy. He took a quick look at the X-ray of my knees and said, “Looks like arthritis. Do some physical therapy. When they are not good enough to do what you want to do, we can always go in and clean them up.”

So, what the heck is this Arthritis?

There are two excellent, very accessible resources for arthritis:  Arthritis Foundation and NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases.  Per the Arthritis Foundation website:

Arthritis is very common but is not well understood. Actually, “arthritis” is not a single disease; it is an informal way of referring to joint pain or joint disease. There are more than 100 different types of arthritis and related conditions. People of all ages, sexes and races can and do have arthritis, and it is the leading cause of disability in America. More than 50 million adults and 300,000 children have some type of arthritis. It is most common among women and occurs more frequently as people get older.

Common arthritis joint symptoms include swelling, pain, stiffness and decreased range of motion. Symptoms may come and go. They can be mild, moderate or severe. They may stay about the same for years, but may progress or get worse over time. Severe arthritis can result in chronic pain, inability to do daily activities and make it difficult to walk or climb stairs. Arthritis can cause permanent joint changes. These changes may be visible, such as knobby finger joints, but often the damage can only be seen on X-ray. Some types of arthritis also affect the heart, eyes, lungs, kidneys and skin as well as the joints.

There can be many underlying causes for swelling, inflammation, stiffness and pain in the joints. For example, Rheumatoid Arthritis, Lupus, Infectious Arthritis and Osteoarthritis can all cause these symptoms, but they are all very different diseases. It is very important to figure out with the help of a doctor what you are dealing with.

Osteo-arthritis is the most common type of arthritis. Per NIH website on Osteoarthritis:

Osteoarthritis (AH-stee-oh-ar-THREYE-tis) is the most common type of arthritis and is seen especially among older people. Sometimes it is called degenerative joint disease. Osteoarthritis mostly affects cartilage (KAR-til-uj), the hard but slippery tissue that covers the ends of bones where they meet to form a joint. Healthy cartilage allows bones to glide over one another. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, small deposits of bone—called osteophytes or bone spurs—may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain and damage.

Figure Showing a Healthy Knee

Knee without damage

Figure Showing Knee with Severe Osteoarthritis

Knee with damage

A doctor friend of mine told me that when doctors don’t know what the disease is, they call it osteoarthritis.  And, that is not far from the truth. If you eliminate, other diseases that might be causing inflammation, e.g., auto-immune diseases, it is osteo-arthritis.  Underlying disease causing damage to cartilage is not known at this point – if it is not one of the other specific diseases.

So, what can you do?

Well treatment can be quite different based on the type of arthritis or the condition that might be causing the joint issues.

However, in case of osteoarthritis, which is often the most common and age related, here are the treatment options, according to NIH:

  • Exercise
  • Weight control
  • Rest and relief from stress on joints
  • Nondrug pain relief techniques and alternative therapies
  • Medications to control pain
  • Surgery

Notice that exercise is on the top of the list. As soon as most people start to feel pain in the joints, guess what do they give up? Yep, exercise.  And, what do they need most to keep ostearthritis in check? Yep, exercise.

And, that is an interesting paradox I have seen played out again and again – including with my own mother.

Back to My Knee

Having learned the theory, I took on three things aggressively:

  1. Strength training to strengthen everything involved in functioning of my knee: quads, calves, hamstrings, and stabilizers muscles and ligaments.
  2. e-cises by Pete Egoscue to realign my knee since my knees were a little pronated and that was probably the reason why running aggravated my knees.
  3. Doing Bikram Yoga to help flush out any bone spurs or lose particles
  4. Started on supplement of Glucosamine Sulfate with Chondroitin and MSM that help rebuild the cartilage. See http://www.lifeextension.com/vitamins-supplements/item03157/glucosamine–chondroitin–msm#panelSupplements.

My goal was to be pain-free when I doing lunges with free weight, squats and single leg jump ropes. And, I am happy to say that I have been able to get there.

In my last X-ray, I still noticed some bone spur and what radiologist called “mild arthritis”.   I would really like to reverse that without any surgery. So, the chase is still on.

Bottomline

  1. If you have any stiffness, swelling, inflammation, or pain in the joints, it is important to get it checked out with the primary physician and if necessary with a Rheumatologist to first figure out what are you dealing with.
  2. If it is osteoarthritis, the following is a good list in order of priority:
    1. Exercise
    2. Weight control
    3. Rest and relief from stress on joints
    4. Nondrug pain relief techniques and alternative therapies
    5. Medications to control pain
    6. Surgery
  3. If it is other than osteoarthritis, use Arthritis Foundation and NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases  to study up and pursue your options.

I would love to hear your perspective on this topic.

What is your experience and knowledge from which I and others could learn?

#45 – Does Testosterone Replacement Therapy Increase Your Chances of Heart Attack?

01 Sunday Nov 2015

Posted by in Aging, Optimal Health, Supplements

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Ever since I learned about testosterone and Testosterone replacement therapy (TRT) and had personal experience I have looked for opportunities to publicize this.

On September 7, 2015, I published on this blog post #43: What is the role of Testosterone Replacement Therapy for Optimal Health? There I discussed the downside and upside of undergoing TRT  for men.

Well, at least two men that I know of, inspired by these conversations and the blog post went to their doctors, got their testosterone (T) levels checked and found that their clinical conditions were correlated with the very low T levels.  However, on both cases their doctors told them they would not recommend TRT since it would increase their chances of heart attack.

When I learned of this, I decided to research this notion of increased chances of heart attack with TRT and hence this blog post.

An article was published in Journal of American Medical Association September 2013 issue: Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310(17):1829-36.  The conclusion of the research was:

“Among a cohort of men in the VA health care system who underwent coronary angiography and had a low serum testosterone level, the use of testosterone therapy was associated with increased risk of adverse outcomes. These findings may inform the discussion about the potential risks of testosterone therapy.”

Basically, they looked at the historical patient data on the computers (not patient charts) for those who had heart health issues (they had undergone angiography) and had low-T.  Researchers then compared the mortality results of those who had undergone TRT against those who had not.  Based on their statistical analysis of this data, they presented the above conclusion.

Media picked up this story and ran with it. Of course, adding all kinds of media color on these results. If you Google the title of this article, you will see many media stories.

And, of course, medical malpractice lawyers picked up the story and started to put together class action law suits against doctors and practices.

Prospect of the Malpractice law suits will scare the dickens out of any doctor, who is not expert in TRT.  No wonder, the two men that I referred to above got the response they got from their doctors.

Of course, you know that there are at least three sides to every story. So, here are the three sides of this story.

RESPONSE FROM FDA

Here is the most recent word from the FDA on this topic as a result of the study and the various Advisory Committee Meetings (See http://www.fda.gov/drugs/drugsafety/ucm436259.htm for full text):

“Testosterone is FDA-approved as replacement therapy only for men who have low testosterone levels due to disorders of the testicles, pituitary gland, or brain that cause a condition called hypogonadism. Examples of these disorders include failure of the testicles to produce testosterone because of genetic problems, or damage from chemotherapy or infection. However, FDA has become aware that testosterone is being used extensively in attempts to relieve symptoms in men who have low testosterone for no apparent reason other than aging. The benefits and safety of this use have not been established… Based on our findings, we are requiring labeling changes for all prescription testosterone products to reflect the possible increased risk of heart attacks and strokes associated with testosterone use. Health care professionals should make patients aware of this possible risk when deciding whether to start or continue a patient on testosterone therapy…

RESPONSE FROM Urology Care Foundation

The official foundation of the American Urological Association (specialists who you would normally consult for TRT had the following response (See http://www.urologyhealth.org/patient-magazine/magazine-archives/2014/summer-2014/testosterone-replacement-therapy-is-it-right-for-you for full response)

“On January 31, 2014, the Food and Drug Administration (FDA) stated they would study the risk of heart attack, stroke and death in men taking testosterone replacement therapy (TRT). This was after two recent studies suggested that TRT raises the risk of heart attack in men.

The American Urological Association (AUA) has followed these reports closely. The AUA notes there are also conflicting studies suggesting TRT may lower heart attack risk. More studies need to be done to be certain whether and how TRT changes men’s risk of heart attack.

The AUA is also concerned about misuse of TRT. You should not take testosterone for non-medical reasons, such as bodybuilding, preventing aging changes or performance enhancement. Men should not take TRT if they have normal testosterone levels or if their testosterone levels have not been tested. If you have normal testosterone levels, using TRT will not help your health problems.”

RESPONESE FROM Life Extension Foundation

Life Extension Foundation is generally at the cutting edge of evidence-based recommendations for supplements and therapies for optimal health that might not yet be in the mainstream. Here is summary of their take on the controversy: (See the full article at http://www.lifeextension.com/magazine/2014/3/response-to-media-reports-associating-testosterone-treatment-with-greater-heart-attack-risk/page-01)

The age-related decline of men’s testosterone levels is inevitable.

Unless aging men replace their diminishing testosterone, they could succumb to any of the numerous health problems linked to low testosterone levels: frailty, muscle loss, weight gain, impaired cognition, fatigue, loss of self-confidence, depression, declining bone health, increased risk of type II diabetes, stroke, and cardiovascular disease.

A number of studies show that testosterone replacement therapy improves multiple measures of men’s vitality, especially related to cardio-metabolic health.

Therefore, on November 5, 2013, we were startled to see media headlines like “Testosterone Treatments Linked to Heart Risks.”

This headline and others like it were prompted by a retrospective, observational study in the September 5, 2013, issue of the Journal of the American Medical Association (JAMA). The study suggests testosterone therapy may increase risk of death and certain cardiovascular events.5

There are several significant shortcomings in the study’s design and methodology, and the results conflict with an existing body of research showing that low testosterone increases a man’s risk of heart problems:

  • Woefully inadequate Testosterone Replacement (T should be over 550 ng/dL to accrue benefits)
  • Failure To Account For Impact Of Estrogen (To much Estrogen can increase heart attack/stroke risk)
  • Significant Difference In Baseline Testosterone Levels Between Groups (hard to reach the right conclusion)
  • Achieving Higher Testosterone Levels Has Clear Cardiovascular Benefits (Again total T should be over 550 ng/dL to accrue benefits0
  • Additional Studies Demonstrate The Benefits Of Maintaining Higher Testosterone Levels (See the articles for cited research that has shown higher T actually lowers the risk of heart attack/stroke)
  • Study Conflicts with Previous Research
  • Retrospective Observational Study – Unmeasured Confounding Or Hidden Bias Might Exist
  • Unnatural Forms Of Testosterone Used By 1/3 Of Subjects (Proper form is bio-identical testosterone gel to maintain even levels as opposed to injection which promote peaks and valleys)

So, there you have it at least three sides of this story.

BOTTOMLINE

Are you sufficiently confused, yet?  Here is what I would recommend as a bottom line:

  • Talk to a specialist who knows what he/she is doing. Not just your primary physician.
  • Read the life extension article in full. For optimal health through “non-mainstream methods”, I constantly find that I have to show up at the doctor’s office armed with information.
  • Doctors often rather prescribe meds for individual symptoms than get to the root cause.  To avoid prospect of litigation, they also have to engage in defensive medicine.
  • Know your numbers and their implications: Total Testosterone, Free Testosterone, DHEA, Estradiol, LH, FSH.
  • Your numbers should correlate with your health issue for TRT to be effective or advised.
  • Ask for testosterone in the form of gel from a compounding pharmacy. That is the right therapy and is much cheaper.

Your thoughts?

I would love to hear from you, learn and share with others what I learn.

Post #43 – What is the role of Testosterone Replacement Therapy for Optimal Health?

07 Monday Sep 2015

Posted by in Aging, Lean Mass, Optimal Health, Percent Body Fat, Supplements, Vigor, Vitality

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“Are you tired? Have you lost your edge, you sense of vitality, your ‘mojo’? Does sex feel like work, or maybe it does not work out any more? Is your mood blah? Have you put on a gut even though you don’t seem to be eating any more than your ever did? May be it is your age. Or maybe just maybe, you have a medical condition called low testosterone, or, as I prefer to call it low T.”

So starts the book Testosterone for Life, by Abraham Morgentaler, M.D., Associate Clinical Professor at Harvard Medical School.

Testosterone for Life

In my previous blogs, I mentioned how early last year, for the first time in my life, I did a comprehensive blood tests. I got these tests done through Life Extension Foundation. These test included all basic hormones.

Only two items showed up not within the “Reference Ranges”: A1c and Free Testosterone. With respect to the LabCorp’s reference rages, my Hemoglobin A1c value of 5.8 was too high (reference range 4.8 to 5.6), even though my fasting Glucose was 91, well within the reference range.

On the other hand, my Free Testosterone value of 5.5 was too low (Reference Range 7.2 to 24.0), while Total Testosterone, DHEA-Sulfate and Estradiol where all within the reference rage.

Now I was quite familiar with A1c, even though I expected it to be normal since my fasting glucose has always been stable around 90 during all my wellness tests.

But Testosterone I did not know anything about. So, I hit the books. The above referenced book by Dr. Morgentaler was one of the first authoritative books I read on the subject. Male Hormone Restoration is another good source. There are also many papers on this subject on NIH Pubmed, for example: The benefits and risks of testosterone replacement therapy: a review.

One of the guidance that Dr. Morgentaler and others practitioners offer is that not all low Testosterone (or Low-T) cases need to be treated. Physicians must examine low-T blood test measurements and correlate with the clinical symptoms. List of symptoms looks the same as at the top of this post for this condition called Hypogonadism:

  • Are you tired?
  • Have you lost your edge, you sense of vitality, your ‘mojo’?
  • Do you have no or low libido (desire for sex)?
  • Do you have erectile dysfunction?
  • Is your mood blah?
  • Have you put on a gut even though you don’t seem to be eating any more than your ever did?
  • Do you have difficulty building muscle mass, bone mass or gaining strength even with workouts and right nutrition?

So per recommendation of practitioners, if some combination of above symptoms exists along with low-T, boosting testosterone may be in order.

I could answer yes to several of the questions above. I had also noticed that fat loss and muscle gain had also plateaued in spite of my continued regime of workouts and nutrition. In fact, in the book, The Life Plan, Jeffry S. Life, M.D., describes how at one point in life low-T became an impediment to maintaining his body composition.

The life plan

I immediately researched and added some supplements to my regime: Miraforte from Life Extension and Male Rejuvenator from Xtend-life. Over the following six months I noticed my Free Testosterone improve as much as 70%. However, my A1c even to increase.

Concerned with trend of my A1c, about six months ago, I started working with Benjamin Gonzalez, M.D. who specializes in functional medicine and hormone replacement therapy (HRT).

After reviewing my tests, conditions and efforts, Dr. Gonzalez started prescribing Testosterone Replacement Therapy (TRT).  In fact, he like many researchers, believes that optimal testosterone levels should be on the high end of the range, close to what men in their 20s will have. This can be a source of slowing down or reversing many age related issues.

The only known downside of TRT is that it is that the supplementation is not recommended if you have enlarged prostates – although that risk is still not proven in the research. 

The treatment involved once a day regime of DHEA supplements as pills and bio-identical testosterone applied as topical cream on wrists. It took about six weeks, before the impact of TRT became apparent. I started noticing that:

  • My daily energy level and “mojo” is up
  • Sexual performance is much better
  • Libido is much improved
  • My fat loss and muscle gain has resumed.

Just last week, I did a set of follow up tests and review with Dr. G. – about six months since starting TRT and coincidental with my 61st birthday. Free Testosterone, DHEA-Sulfate and Estradiol levels are now actually higher than the high end of respective reference ranges.   As a result, Dr. G. has advised, backing down somewhat the daily amount of testosterone.

Fortunately, my wife has also chosen to undergo HRT at the same time I did to balance and optimize her own hormones.  She is also experiencing very positive results.  So, we are well matched in energy and libido.  How lucky for me!

Having gone further up, my hemoglobin A1c is back down to 5.8, but I don’t have enough data points to see if the improvement in A1c is correlated to testosterone levels. So, getting my A1c down is still an active chase for me.

In the past couple of months, I have been talking to my friends and family, especially those over 50 to get their Testosterone levels checked and pursue treatments the levels are low and they have symptoms of hypogonadism.

To bring this issue to light, many researcher have been popularizing the term Andropause, which is like menopause for women.  However, for most men, the decline of testosterone is very gradual starting in their 30s and is not a sudden event as for most women.

So, how about you? Have you had any experience with hormone replacement?

What was your experience?

I would love to hear, so I can and others learn from your knowledge and experience.

Post #41 – So, how to measure how close to optimal is your health? Or, how quickly are you aging?

19 Sunday Jul 2015

Posted by in Aging, Dying, Life-Span, Living to 120, Mental Health, Nutrition, Optimal Exercise, Puposely Living, Vitality, wellness

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“How old are you?” someone asks. Number of years since birth is the generally the answer – that is your Chronological Age or CA.

But how hold do you feel? How old do you act? How old do you look? That is your Biological Age or BA.

Wouldn’t it be nice to actually be able to measure your biological age?

CA and BA is the difference between being 40 year old and going on 60. Or, may be being 60 year old and going on 40.

Wouldn’t it be more useful to have a single number like BA, than understanding individual factors like your total cholesterol, HDL, A1c, VO2 Max, etc?

Recently, in the media there has been a buzz about a recent research published by scientists led by Duke University School of Medicine about measuring biological age. For example, see the article in WSJ: How Quickly Are You Growing Old?

Now there are a quite a few websites, where you answer a bunch of question and they will tell you, your biological age as compared to your chronological age.

For example, here are three such sites, I tried (my CA is 60.9 years):

http://www.biological-age.com/ calculated my biological age as 36

https://www.sharecare.com told me my BA was 53.6.

http://www.growyouthful.com/gettestinfo.php said my BA was 46.

Each of the sites followed up with advice and helpful hints on what I could start or stop doing to further increase my expected health and lifespan.

Unfortunately, none of these websites show exactly what they do with the information you provide and how they arrive at the number they call Biological Age.

But this recent study, “Quantification of biological aging in young adults”, by Daniel W. Belsky et al, is very rigorous treatment of this subject and gives you all the details behind the curtain. And, for me, these details are not only fascinating but actually quite useful to understand what matters for biological age to start diverging from chronological age. In other words, what slows down or speed up aging.

The study calculated the aging rate of 954 men and women—taking various measurements of their bodies’ health—when they were each 26, 32 and 38 in chronological years. By analyzing how these measures changed over time, the researchers were able to see who aged faster and who slower than normal.

To measure the pace of biological aging, which the study defined as the declining integrity of multiple organ systems, the researchers relied on 18 separate biomarkers, summarized in figure below.

These ranged from common measures such as HDL-cholesterol levels and mean arterial blood pressure to more obscure ones like the length of telomeres—the protective caps on the ends of chromosomes that shorten with age.

Go on in Years

Chronological age of all participants was 38 years. However, researchers found that the biological ages varied from 26 years to 60 years.

For measuring how fast people aged, they calculated aging over 12 years. About 30 percent aged biologically one year for every calendar year. There were those who aged as much as 3 years for every calendar year. And, there were four members of the group who aged not at all or actually got biologically younger during the 12 year period.

BOTTOMLINE:

Finding one’s Biological Age is a fascinating concept and can be very useful in optimizing health and life span. However, this is not an exact science just yet, although good strides are being made in research.

However, if you want to focus on living optimally, you can focus on changing your lifestyle to optimize the basic 18 or so biomarkers used in this study. Most of these can be impacted by lifestyle choices. Only 20% depend upon genetics.

Proper food, hydration, exercise, supplements and medical care are the key methods to managing these primary biomarkers.

Websites that compute biological ages also suggest additional actionable items that seem to strongly correlate to optimal health span and life span. These include:

  1. Optimal sleep (7 to 9 hours)
  2. Reduced stress (meditation, perspective management)
  3. Reduced exposure to toxins (organic food, reduced use of chemicals, clean water)
  4. Increased social contact (having friends, family, living with a life partner)
  5. Purposeful living (satisfying work, hobbies, social endeavors)

What is your take on this subject?

Please feel free to leave comment to share your perspective.

Post #40 – How much Sun exposure should you have for Optimal Health?

08 Monday Jun 2015

Posted by in Aging, Optimal Health, Supplements

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A couple of weeks ago my wife and I took a vacation in the Exuma Islands in the Bahamas to celebrate our 30th wedding anniversary. Now everyone knows what Bahamas Islands have plenty of: Water and the Sun. Lounging on the beach and swimming in the ocean with all shades of turquoise, we definitely got plenty of both water and the Sun. Case in point, this picture of me!

IMG_2995

And, that got me thinking: So, how much Sun exposure one should have for optimal health?

On the positive side, we know that being in the Sun is very therapeutic. It cheers us up. Both because it is good for our disposition and it is a major source of Vitamin D.

On the other hand, we have all heard of skin cancer, eye damage and hypersensitivity that excessive exposure to sun can cause.

So, how do we balance the two for Optimal Health?

First, how much Sun do we need for daily dose of Vitamin D?

Most of the “experts” sort of punt this question saying that there isn’t one recommendation for everyone. This is because the amount of time you need to spend in the sun for your skin to make enough vitamin D depends on a number of factors. These include your skin type (how dark your skin is or how easily you get sunburnt), the time of year and what time of day it is.

In the Northern Hemisphere, (e.g., US, Canada) short daily periods of sun exposure without sunscreen during the summer months (April to October) are enough for most people to make enough vitamin D. Evidence suggests that the most effective time of day for vitamin D production is between 11am and 3pm.

A short period of time in the sun means just a few minutes – evidence suggests that about 10 to 15 minutes is enough for most lighter-skinned people – and is less than the time it takes you to start going red or burn.

The larger the area of skin that is exposed to sunlight, the more chance there is of making enough vitamin D before you start to burn. People with darker skin will need to spend longer in the sun to produce the same amount of vitamin D.

In the Northern Hemisphere, our skin isn’t able to make vitamin D from winter sunlight (November to March) as the sunlight hasn’t got enough UVB (ultraviolet B) radiation. During the winter, we get vitamin D from our body’s stores and from food sources. Hence great emphasis on Vitamin D supplements in the US and other countries in the Northern Hemisphere located at higher latitudes.

How much sun before you do damage to the Skin?

Now on to how much sun is needed to produce sun damage to the skin. Here also the clear answer is: It depends.

In research, often the measurement of damage used is the amount of UV radiation needed to cause erythema – the red flushing of the skin caused by exposure to sunlight. The theory is that more the erythema, the greater is the likelihood of damage and cancer.

Because of the variables of geography and seasons, and variations in how an individual reacts to sunlight, it isn’t possible to come up with hard and fast rules – but here are some useful guidelines.

Avoid the midday sun

The time when the skin makes most Vitamin D is when it’s exposed to the midday summer sun – but that’s the time the skin is most easily damaged.

However, redness can occur in only eight minutes in a mid-day sun.

So in peak summer times from 10 am to 3pm, you should use protection against the sun; shade, hats, clothing, sunglasses and sunscreen.

But earlier in the day and later in the afternoon, for a similar period of sun exposure and vitamin D manufacture, you get much less skin damage.

During the summer months in the Southern states in the US, for example, 10 to 15 minutes of unprotected sun exposure of the face, arms and hands before 10am or after 3pm, three to four times a week, will give you enough Vitamin D without skin damage.

But this may not be enough in Northern part of the US or Canada, especially in winter. You’ll need longer periods of exposure or more flesh exposed to the sun.

Longer for dark skins

Note that the figures only apply to fair skinned people. People with very dark skin need around six times more exposure to UV radiation to produce as much vitamin D as someone with fair skin. These people may need sunlight exposure during peak times – i.e. the middle of the day – especially in the Northern states in the winter months.

On the other hand people with darker skins are less likely to get skin damage because of greater amounts of pigment in their skin. Even though they are still susceptible to getting skin cancer.

Bottom Line

Based on what I just learned, for Optimal Health, I am going to stick to my Vitamin D supplements to get sufficient Vitamin D, year-round and heed to the following recommendation I found on the Skin Cancer Foundation website:

Q: I’m going to the Caribbean this winter. Are there any special precautions I need to take to protect myself from the sun?

A: (By Neil Sadick, MD, FAAD, FAACS, FACP, FACPh) When the days get colder and the nights get longer many people enjoy a vacation to a warm place like the Caribbean, to catch some sun and “recharge their batteries.” Typical winter vacation regions are located close to the equator, with little distinction between the seasons and high temperatures year-round. The sunny weather in these regions is accompanied by strong ultraviolet (UV) radiation, as the sun’s rays hit the earth at a more direct angle and aren’t as well-absorbed by the atmosphere.

Furthermore, these sunny days tend to be long, sometimes with substantial amounts of UV until early evening. The ability to travel from a winter season to a sunny vacation spot in just a few hours is a great comfort in modern times, but also a heavy burden for the skin. Current studies now show that sun-filled vacations and sunburns play a key role in the development of melanoma, the most dangerous form of skin cancer.

Intermittent, intense sun exposure, the kind you are likely to receive on a sun-drenched winter vacation (the sort that often leads to sunburn), is associated with a much higher melanoma risk than regular, everyday sun exposure. Suffering one or more blistering sunburns in childhood or adolescence, or five or more by any age, more than doubles a person’s lifetime chances of developing melanoma. Important precautions that protect you from the sun on your vacation include shade, sun-protective clothing, and sunscreen, as well as sensibly limiting your sun exposure in general.

The sunscreen you use should have a sun protection factor of at least 30 and sufficiently block UVA as well as UVB rays. (Look for “broad spectrum” or “multi-spectrum” protection.) If you’ll be vacationing near the water, a water-resistant or very water-resistant sunscreen formula is recommended. Apply approximately one ounce of sunscreen (two tablespoons) to the whole body, and reapply every two hours or immediately after activities such as swimming, sweating, or rubbing/wiping.

Loose-fitting, long-sleeved shirts and long pants made from tightly woven fabrics offer the best protection from the sun’s UV rays. You may want to look for clothes that have a UPF (ultraviolet protection factor) label of 30+; a shirt with a UPF of 30, for example, will let just 1/30th of the sun’s UV radiation reach your skin. High-UPF athletic gear may be particularly helpful, since such clothes are meant to keep you cool and comfortable, no matter how hot the weather gets.

Finally, a hat with a brim at least 3” all the way around and UV-blocking sunglasses will also help protect the vulnerable skin on your head, face, neck, and tops of the shoulders. Sensible sun behavior means avoiding tanning and burning as well as seeking the shade between 10 AM and 4 PM (and especially between noon and 2 PM, when the sun’s rays are strongest).

What are your thoughts on this topic?

I would love to learn from you and share that knowledge with others.

Post #33 – What can you do to maintain optimal health of your brain? Or, How my sons got me playing video games?

18 Sunday Jan 2015

Posted by in Aging, Living to 120, Mental Health, Optimal Health, Vitality

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In most of my past blogs, I have talked about maintaining optimal physical health – staying physically fit, keeping all chronic diseases such as diabetes, arthritis, high blood pressure, cardiovascular issues and such at bay. Also, I have talked about developing, building and maintaining lean mass, strength, balance and flexibility.

But, what about the brain? How to keep brain in top shape as we age, while keeping Alzheimer disease and dementia far away from ourselves? What is in our control that we can do?

After all, living to 120 (or to whatever your target is), without full cognitive faculties won’t be much fun.

Researching this topic, I found that National Institute of Health (NIH), National Institute of Aging, has a very good chapter “The Changing Brain in Healthy Aging” in their publication “Alzheimer’s Disease: Unraveling the Mystery”. The following is excerpt from that chapter.

As a person gets older, changes occur in all parts of the body, including the brain:

  • Certain parts of the brain shrink, especially, the prefrontal cortex (an area at the front of the frontal lobe) and the hippocampus. Both areas are important to learning, memory, planning, and other complex mental activities.
  • ­Changes in neurons and neurotransmitters affect communication between neurons. In certain brain regions, communication between neurons can be reduced because white matter (myelin covered axons) is degraded or lost.
  • ­Changes in the brain’s blood vessels occur. Blood flow can be reduced because arteries narrow and less growth of new capillaries occurs.
  • ­In some people, structures called plaques and tangles develop outside of and inside neurons, respectively, although in much smaller amounts than in Alzheimer Disease
  • ­Damage by free radicals increases – free radicals are a kind of molecule that reacts easily with other molecules­
  • Inflammation increases  – inflammation is the complex process that occurs when the body responds to an injury, disease, or abnormal situation.

What effects does aging have on mental function in healthy older people?

Some people may notice a modest decline in their ability to learn new things and retrieve information, such as remembering names. ­They may perform worse on complex tasks of attention, learning, and memory than would a younger person.

However, if given enough time to perform the task, the scores of healthy people in their 70s and 80s are often similar to those of young adults. In fact, as they age, adults often improve in other cognitive areas, such as vocabulary and other forms of verbal knowledge.

It also appears that additional brain regions can be activated in older adults during cognitive tasks, such as taking a memory test. Researchers do not fully understand why this happens, but one idea is that the brain engages mechanisms to compensate for difficulties that certain regions may be having.

For example, the brain may recruit alternate brain networks in order to perform a task. Th­ese findings have led many scientists to believe that major declines in mental abilities are not inevitable as people age. Growing evidence of the adaptive (what scientists call “plastic”) capabilities of the older brain provide hope that people may be able to do things to sustain good brain function as they age. A variety of interacting factors, such as lifestyle, overall health, environment, and genetics also may play a role.

Another question that scientists are asking is why some people remain cognitively healthy as they get older while others develop cognitive impairment or dementia. Th­e concept of “cognitive reserve” may provide some insights.

Cognitive reserve refers to the brain’s ability to operate effectively even when some function is disrupted. It also refers to the amount of damage that the brain can sustain before changes in cognition are evident. People vary in the cognitive reserve they have, and this variability may be because of differences in genetics, education, occupation, lifestyle, leisure activities, or other life experiences.

Th­ese factors could provide a certain amount of tolerance and ability to adapt to change and damage that occurs during aging. At some point, depending on a person’s cognitive reserve and unique mix of genetics, environment, and life experiences, the balance may tip in favor of a disease process that will ultimately lead to dementia.

For another person, with a different reserve and a different mix of genetics, environment, and life experiences, the balance may result in no apparent decline in cognitive function with age.

Scientists are increasingly interested in the influence of all these factors on brain health, and studies are revealing some clues about actions people can take that may help preserve healthy brain aging. Fortunately, these actions also benefit a person’s overall health. Th­ey include:

  1. ­Controlling risk factors for chronic disease, such as heart disease and diabetes (for example, keeping blood cholesterol and blood pressure at healthy levels and maintaining a healthy weight) ­
  2. Enjoying regular exercise and physical activity ­
  3. Eating a healthy diet that includes plenty of vegetables and fruits
  4. ­Engaging in intellectually stimulating activities, and
  5. Maintaining close social ties with family, friends, and community

So, actions 1, 2 and 3 suggested by NIH NIA are the same as for keeping physical body fit and in good order. That is a good news!

But there are also additional actions 4 and 5 one can take, that are good to keep brain fit and in good order.

Piano Lessons at 60:

To increase my intellectually stimulating activities, as I was turning 60, I decided to start taking piano lessons. I have been very left brain focused on my intellectual pursuits – STEM or Science Technology, Engineering and Math education. So, I figured, it is high time I did something to develop my underused right brain. And, there is a lot of evidence in research of the benefits of learning music on the brain.

For the last six months, I have been finding piano lessons very pleasurable and at the same time very intellectually and physically demanding. One half-hour lesson a week and daily practice of half hour to an hour, is what it takes for me learn and get comfortable with a piano piece my teacher introduces in the lesson. Initially it was just one piece from the “techniques book”, for the last few weeks, there is an additional piece from a popular “songs book”. All this piano playing got be doing something good for my brain, since week after week, it seems that I am learning with my brain and in my muscles new stuff.

How my sons got me playing video games:

Until now, I have completely resisted playing video games.

For Christmas, our twin sons, Daniel and Justin, gave us a present of family membership to Lumosity. Lumosity exploits research to-date in neuroplasticity. Research has found that certain types of activities may impact the brain more than others. It’s believed that as an activity is repeated, the brain tends to fall back on the same set of existing neural pathways. To continue changing, the brain must be exposed to novel, adaptive experiences that challenge it to work in new ways.

Drawing on this idea, Lumosity is designed to give each person a set of exercises that challenge their cognitive abilities.

Lumosity “games” are based on a combination of common neuropsychological and cognitive tasks, many of which have been used in research for decades, and new tasks designed by an in-house science team. Working with experienced game designers, Lumosity neuroscientists have transformed these tasks into over 40 challenging, adaptive games.

Lumosity’s game-based training program is designed to expose your brain to gradually increasing levels of challenges, adapting game difficulty to your individual ability level. As your scores increase, you may encounter new or more difficult games. Modeled from the concept of a physical personal trainer, Lumosity pushes you to operate at the limits of your abilities and stay challenged.

They also report measures of your performance, so you can see how you are improving in speed, memory, attention, flexibility and problem solving and how you compare with others in your age bracket. A metric called LPI is a consolidated metric of these five factors. Also, you can use a test called Baseline Test to see how the scores translate to other situations you don’t play in the games.

I have been playing these games for two weeks now. It is definitely fascinating, how various skills of speed, memory, attention, flexibility and problem solving improving. With this rate of progress, who knows, I may get good enough to play some video games against Justin and Daniel!

What are your thoughts on this subject of keeping brain fit and in optimal shape?

What strategies or techniques do you use to keep you brain fit?

Please leave a comment in the blog; I would love to hear from you.