Posts Tagged ‘longevity’
Let’s hear it for potato chips
It must be the summer as the level of science has dropped, but the level of important information has remained at an all time high. We now have an article that included 120,877 men and women who were all healthcare professionals. They were followed for up to 20 years. The participants in this study gained an average of 3.35 pounds every four years. This number correlates with our general medical belief that people gain an average of 10 pounds a decade.
Published in the N Engl J Med 2011; 364:2392-2404 this study proved once and for all that eating potato chips causes obesity. This is followed in second place by eating potatoes or fries. The best foods to eat are yogurt and nuts. It should also not be a surprise that drinking sugar sweetened beverages of any kind wasn’t such a good idea either. No calorie soda seems to be ok. I told you not to super size it.
One of the most surprising findings was that it doesn’t seem to matter what type of dairy products you eat. There was no apparent difference between fat, low fat and no fat milk and other products so I guess we can go back to milk that tastes like milk. At least my cappuccino will taste better.
This article also sheds light on the eternal foolishness of low carb, high carb, no carb, low fat, etc. etc. that is the fodder of every magazine in this country except the National Review. (Unless they are discussing what Ronald Regan ate for breakfast) Here it is, the unblemished truth directly from the paper: “changes in the consumption of refined or processed foods and liquid carbohydrates or alcohol (OH NO) were positively associated with weight gain, whereas changes in the consumption of unprocessed foods such as whole grains, fruits, nuts and vegetables were inversely associated with weight gain.”
If you eat the way we eat now you, are doomed to gain weight. If you eat like we did in 1776, you are set. I wonder where Veal Parmesan fits in. This is probably the reason the Italians who live in Italy have never heard of it.
I have more good news. As I have blogged before, watching TV will kill you. That is unless you watch it standing up and while doing something (like exercising) and not eating potato chips and drinking soda. It may be as bad as smoking but not quite. This of course does not relate to watching anything with Oprah in it, which is allowed at all times and gets a free pass.
Speaking of smoking, when you stop, it does seem to cause an initial weight gain but then is responsible for little change after. The benefits of not smoking clearly outweigh the risks of smoking even if you gain weight.
Either good or bad is the news that 50 to 100 kcal of energy either way is enough to cause a weight gain or loss over time. This probably accounts for the constant refrain that I and most physicians hear, which is that I eat nothing and can’t lose weight.
Let’s summarize. I know you have heard it before but it seems to be the best way to lose weight. Get some exercise daily. The more you do, the less you will weigh. Eat as much non processed food as possible. We might have to go back to cooking. Don’t smoke. Don’t watch TV. Live long and prosper.
Maybe Brooke Shields had it right (Part 2)
I love people who put their money were their mouth is. Literally! On March 3, 2011, The New York Times published a long article about David Murdock. This article was written by Frank Bruni who was for years the Times restaurant critic. Most people will not know who David Murdock is, but it seems he is very wealthy and on Forbes list of the 400 wealthiest Americans at No.130 with an estimated net worth of $2.7 billion. He owns a pack of companies, most notably Dole Foods.
He believes in eating a certain way, the way he has been eating for over thirty years. It consists of — I know you know – fruits and vegetables. His protein comes from fish, egg whites, beans and nuts; no alcohol, sugar or salt. Haven’t I heard this before? Jack LaLanne’s biggest contribution lately was the Juice-a-matic to liquefy anything that was a fruit or vegetable. V-8 is not a substitute.
Jack, however, did not build a $500 million North Carolina Research Campus to prove his contention that eating the right variety and amount of fruits and vegetables will result in living for a much longer time. This is the proper time to tell you that he also exercises, both cardiovascular and weight training. He is also paying for a 50,000 patient study to find markers of longevity that may be present early on when the disease strikes years later.
None of this is particularly new or original. It is being done on a much greater scale than ever before, however. Will it answer the vexing question of does it matter? Most doctors believe – and I will be the first to tell you that just because we believe something doesn’t make it right – that it’s not what we eat, it’s how much. Even the Federal Government came out with that fantastic piece of nutrition advice in their Nutrition position paper this year. It is buried in the middle of the paper, but nonetheless, is a big step forward for the Feds.
Murdock’s father lived into his 90’s. His mother died young. It’s not really how long you live but how well you function into old age and that is predicated on how flexible you are and how much you exercise; Yoga, Tai Chi, weight training and walking all help to tone and keep vital muscle, which allows for better functioning of the body as it ages. In the 23 years that I have practiced medicine in Florida, one recurring observation I have is that if a patient came to Florida sick, they did not miraculously improve; however, if a patient came still healthy enough to exercise, then they often looked and acted much younger than their actual age. I have many patients, both men and women, who are in their 90’s and look as if they are in their 70’s.
We cannot answer the question “Is the type of food that you eat important?” yet. The mice may help, but for the present generation, I would advise eating less and as someone once said, “an apple a day keeps the doctor away.”
However, we maybe closing in on why exercise helps you live longer, and that is the next blog.
Maybe Brooke Shields Had It Right (Part 1)
There have been several articles in The New York Times recently that I would like to comment on. They both relate to living longer. Neither discusses how we are going to pay for it when some of us get there, but they discuss aspects of exercise and eating.
Recently, on January 23rd, Jack LaLanne died at age 96, at his home, of respiratory problems. He had heart valve surgery in December 2009 and had trouble since that point. He was a prime example of the concept of exercise and eating properly, and one of my personal heroes. He exercised several hours everyday and ate a very rigid diet which avoided all processed foods and consisted mainly of fruits, vegetables and fish. He apparently ate two meals a day breakfast and dinner. He is reported to drink moderately, consuming one glass of wine a day. He was from French ancestry after all.
Without a doubt the man was in excellent shape and continued with prodigious stunts every birthday. These stunts included 1,000 jumping jacks and 1,000 chin ups in 1 hour and 22 minutes at age 45, and at age 80, he was handcuffed and shackled while pulling 80 people in 80 boats 1.5 miles in the Long Beach harbor. Go ahead and try it. I urge you to look him up on YouTube and see how you can do a complete set of exercises with a simple chair and a broom stick.
Jack LaLanne’s brother died at age 97 and never exercised. As a teenager, Brooke Shields famously cooed “nothing comes between me and my Calvin’s.” She was talking about his jeans, and I’m talking about your genes. Although it is somewhat fatalistic, your general health is related to your genes and then what you do with them. If you want to live like Jack LaLanne, do it. His brother did not and lived as long. It’s almost like an experiment.
Why do people die? Many have illness, but some die of the proverbial “old age.” What is old age? Can “old age” be combated? Can we find the “Fountain of Youth” that is supposedly here in Florida? (Please dear G-D not in Orlando) To put it most simply “old age” is the process where our cells stop dividing to replace cells that die, and the reason cells die is that their power plants or mitochondria stop functioning. The race is on to figure out how to keep mitochondria functioning, and in turn, prolong life. This is one of the postulated benefits of antioxidants.
On March 2, 2011, The New York Times published an article by Gretchen Reynolds who is one of the health writers for the Times. This article details another article that was published in the Proceedings of the National Academy of Sciences the week before the Times article was published. The article detailed an experiment with mice. Although mice are not humans, we can manipulate the genes of mice and produce strains that will do anything to the animal. Mice serve as a surrogate for humans, and many of our drugs are tested on mice in early development. In this case, the mice were bred to lack a primary mitochondrial repair system and so they died earlier than mice that do not have this defect.
The experiment consisted of one group of the genetically altered mice who exercised on that famous wheel for the human equivalent of a 6.2 mile run three times a week. The other group of mice got no exercise. None of the exercise mice died of natural causes the first year, whereas all the non exercised mice died the first year. They didn’t look very good either. The protein PGC-1alpha was increased in the exercising mice, and they repaired their mitochondria in spite of not having the proper genetic pathway.
It seems that exercise just might help us live longer by repairing the mitochondria at the cellular level, or some people may just have it like Jack’s brother. One of the responses to the article in the Times was, “where do I get a wheel?”
What about the diet part? That’s next.
Stay in school…and live longer
The concept of “data mining” lives on. What is data mining? It is the use of large data bases to identify items of interest using data collected for a study to prove a different hypothesis. In the past it has provided some interesting concepts, but in general, the medical public follows the findings with a wink and a shrug. Sometimes the issues are studied in their own right to prove the hypothesis in a second study devoted to the new issue. It is important to understand that a study can only prove or disprove what it set out to do. Other identified effects or findings are not proved by what is known as Ad Hoc analysis.
Just such a finding was published this week in the Journal of the American College of Cardiology. (J Am Coll Cardiol 2011; 57:138-46) The article is titled Association of mortality with years of education in patients with ST-segment elevation myocardial infacrtion treated with fibrinolysis. It includes a detailed data review that occurred using the GUSTO III data.
Let me back up a moment and review some ancient history. In the mid 1990’s, the preferred method of handling a myocardial infarction was not angioplasty like it is today. We used to infuse a drug known as a fibrinolytic to “dissolve” the clot and re-open the artery. These studies had thousands of patients, and an enormous amount of ink went into the heralding of one drug over another. They were world wide trials and eventually led to PCI vs. Fibrinolysis, and fibrinolysis lost, ergo, the current dictum of 90 minute door to balloon time. In other words, if you come to a hospital, the expectation is that we will have opened your heart artery by 90 minutes. This is so powerful an assumption that even transportation to another hospital for angioplasty is favored over fibrinolysis.
The data for this study was collected from October 13, 1995 to January 13, 1997 and included 15,059 patients. Patients were then excluded if the country provided <500 patients and if no level of education was identified. This left a total of 11,326 subjects.
The levels of education broke down as follows: 19.8% had 7 years of school, 61.6% had completed high school, 14.4% had 12 to 16 years of education and 4.4% had greater than 16 years. Most doctors have 20 years: 12 in school, 4 in college and 4 in medical school. This does not include post graduate training. (I have 7 years.)
The worst marker for mortality after an ST elevation myocardial infarction is age. After matching up all of the other variables, the second worst marker is years of education. If you have less education, you are more likely to die. Overall, one year mortality with <8 years of education was 17.5%; with >12-16 years, mortality was 4.9%; and with >16 years, mortality was 3.5% across the nations studied. If you stay in school forever, you might not die, at least from a myocardial infarction.
Now, it is not the level of education which provides the benefit, but it seems to be a surrogate marker of other variables — for instance, more treatment of other predisposing conditions such as hypertension and hyperlipidemia. Perhaps, better life style, less smoking, or better eating habits. No one really knows because the data was not obtained at study entry. Moreover, it was best illustrated in the countries of United Kingdom, Germany and Sweden who had a very significant pValue of<0.0001. We, in the United States, had a pValue of 0.0233, which is not significant. Our mortality with >16 years of education was 4.2%.
Interesting, but it may not apply anymore. We no longer use fibrinolysis in this manner. I am sure that out there in wonk land someone is doing the analysis, as you read this, as to what angioplasty in today’s medical care does to mortality.
My only advice is to stay in school.
Blue Zones
Let’s talk about longevity from a scientific point of view. First of all, what is the optimal lifespan of the human organism? Depending on whom you read, it is probably somewhere between 120 to 125 years. Old Testament biblical longevity is probably not possible for many reasons.
As in many other cases when it comes to questions such as these we tend to look for natural history to clarify the situation.
Are there places on this planet where people live longer than average lifespans? Well, as it turns out if we look around the planet there are multiple areas where human beings reach the age of 100 with surprising regularity. These areas are the so-called Blue Zones. So, where are these so-called Blue Zones? They are Okinawa in Japan, Arzana in Sardinia, Vilcabamba in Ecuador, the Hunza Valley in Pakistan, Abkhazia in the Caucusus, the Nicoya Peninsula of Costa Rica, Icaria in Greece and Loma Linda in California.
As you can readily see these places are scattered throughout the planet so that race, ethnicity, geography (mountains, valleys, coastal, etc.), altitude, latitude and longitude do not seem to matter. It was thought for a while that genes did matter since many of these places are closed societies but Southern California is a mixture of many ethnic groups and gene pools and is a melting pot of cultures.
So what conclusions can we draw from these Blue Zones? What do they have in common? Well, as it turns out that while you are looking at the diversity between these groups you can find some interesting similarities. For instance, in Sardinia the diet obviously contains a moderate amount of alcohol whereas among the Seventh-day Adventists in California there is no alcohol consumption. Some of these areas include diets that are heavy in legumes, others in whole grain, others in soy and fish and still others in nuts and berries.
Enough of what these cultures are not. What do they have in common? What can we learn from them? Well, as it turns out, they all tend to have a very low body mass index which means they are thin. In general, they also live in less polluted, cleaner environments and have a healthy diet of whole foods which are fresh and without preservatives consisting of predominantly vegetables, fruits, whole-grain and fish. They use very few chemicals except occasionally salt to preserve their foods and their diets are very low in animal fat and fats in general. They are not vegetarians. They do eat some meat and poultry as well as fish. In addition, their lives are filled with strenuous physical activity. They do not go to the gym and work out for hours a day. This activity is part of their lifestyle. They tend to walk many miles a day even if they’re primary occupation does not require significant physical effort.
Lastly they have very strong social ties to their family and the community at large and this seems to support them psychologically and eliminate a great deal of stress in their lives.
The obvious last question here is not where to move but how to structure our environment to mimic these Blue Zones. We can start by eating a more healthy diet filled with fresh fruits and vegetables as well as whole grains and fish. We can follow that with a more active lifestyle, and indeed, we may have to go to the gym if not take up gardening or new long-term outdoor project that requires some physical effort on our part. Lastly, we need to reconnect with our family and community in a positive, supportive and mutually beneficial way.
None of these concepts that I’ve outlined above are complicated or novel, and they are fairly obvious. So why do we keep looking for the next pill or potion or quick fix when the answer is right in front of our noses? My wife always said that I was the master of the obvious. The challenge is how to incorporate these changes into our lives in a consistent and meaningful way in a society that is wired 24/7 with a microsecond half life to ideas and trends. Good luck!
To read future blog posts by Dr. Charles Russo, visit the Jim Moran Heart & Vascular Center Blog.
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