Wednesday, December 12, 2018

Achy joints? It may be your diet.



One in four adults experience regular joint pain, and for those over 65, more than 50% have had their physician make a diagnosis of arthritis.  


Arthritis is the common vernacular for joint pain, a symptom found in hundreds of diseases.  But there are really two main groupings.


Traumatic arthritis results from a direct injury to the joint ligaments and cartilage. Healing of this injury then alters normal joint biomechanics leading to chronic discomfort.


Inflammatory arthritis is often just one aspect of a body-wide inflammatory process, rheumatoid arthritis and lupus, an autoimmune disease being two examples. Inflammation begins in the joint lining, or synovium, which then slowly destroys the joint cartilage.


Osteoarthritis, the “arthritis of aging”, has been assumed to be in the traumatic arthritis group, the result of years of  “wear and tear” on the joint cartilage. This presumption was supported by the observation that osteoarthritis was seven times more frequent in obese than in normal weight individuals. And was found more commonly in those who participated in soccer, competitive weight lifting, and elite level running, activities that increase joint stress .


However recent studies have identified low level synovial inflammation in what otherwise appeared to be classic osteoarthritis, suggesting a new possibility - our diet.


Studies of diseases as varied as cancer, diabetes, and heart disease had previously identified higher than expected blood levels of C-reactive protein, a specific finding in low level, chronic inflammation.  Many researchers have speculated that this inflammation is one of the factors involved in the development of these diseases. And now we have the same finding in many patients with osteoarthritis.


It turns out that diet can affect the level of C-reactive protein, and adopting a diet low in animal products and high in fruits and vegetables can lower this blood marker of inflammation.  Which suggests another addition to treating this common ailment.


We already know that a regular exercise routine decreases joint symptoms. A study following 6500 women for 12 years found that those who exercised regularly had far fewer complaints of joint pain than those who did not. Although it seems counter intuitive that a treatment for joint pain might be using them more, all the signs are pointing in that direction.


Adding a dedicated period of exercise into your daily routine is an easy first step. A non impact sport such as cycling, swimming, or water aerobics is preferable, but if that is more than you have the time for, a brisk daily walk will do.


You might consider losing weight. Even of you don’t think of yourself as obese, any weight you lose will lessen the stress on your hips and knees.


And now you have a third option. It makes sense to consider adopting a more anti inflammatory diet.  This would include eliminating all sugar. Substituting fish, whole grains, and vegetables for the red meat main course several times a week. And using healthy oils such as olive oil, avocado oil, canola oil in your food prep. You can find additional ideas in one of the many articles or books on the  Mediterranean diet.


It is possible your joint aches are just the tip of the iceberg, a symptom warning of a body wide inflammatory process, in which case this lifestyle change will continue to deliver additional health benefits as the years roll by.



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Thursday, November 29, 2018

The Fountain of Youth


Exercise regularly and you will maintain a stronger immune system, lower your risk of a heart attack, and have less chance of developing diabetes. And over time maintain a better memory and lower your odds of developing dementia.


But even with those positives, the aging process moves inexorably onward. It has been estimated that after our peak at age 30, we lose between 5 and 10% of our physical stamina every decade, and as the years pass, that is reflected in the fatigue we feel at the end of the day.


Loss of stamina is a combination of less muscle bulk (strength) combined with a decrease in the effectiveness of our cardiovascular system (aerobic capacity) in providing the oxygen our muscles need to function.


Regularly pushing the cardiovascular system (High Intensity Interval training - HIIT) and stressing the musculoskeletal system (weight or resistance training) can blunt the rate of decline. Just 30 minutes a day of either HIIT or working out at the gym can have a significant impact on your energy levels.


There is little question as to the mental lift you experience from taking charge of your health. But how much physiologic return do you get for that 30 minutes a day? And could you do better?


Investigators in Indiana (Ball State) located 28 men and women who had exercised regularly for 50 years. Most took up running in the health conscious 1970’s and then just stuck with it. They enjoyed it and made it part of their life. Most were recreational athletes (running, biking, swimming) and only a few actually exercised to be able to compete. On average, group members exercised 5 days (or 7 hours) a week.


Investigators also identified a healthy peer group (also average age of 70 years) who were not regular exercisers, and a 3rd group of active, but not athletic, 30 year olds. They then tested all subjects to determine their aerobic (cardiovascular) capacity as well as taking a small sample of leg muscle tissue (a minor procedure).


The findings were even more impressive than had been expected.


First, the analysis of number of capillaries (need to deliver oxygen to the muscle fibers) and concentration of muscle cell enzymes (needed to process oxygen and glucose to provide energy for physical activity) in the muscles of the athletic seniors were identical to those of the 30 year old comparison group.


Even more astounding was the finding that the aerobic capacity (the measure of how much work a subject could do per minute), although slightly less than that of the 30 year old comparison group, was 40% better than their sedentary peers.  And using information in the medical literature, equivalent to the aerobic capacity of active adults 30 years their junior.


This study shows how effective regular aerobic exercise can be as a tool to blunting the effects of aging.  Instead of the inexorable 5 to 10% decrease per decade described in many articles on aging and human physiology, this group of regular exercisers slowed the rate of decline significantly. If you believe the data, to perhaps 3 or 4% per decade.


It may not be as easy as drinking the water of the fountain of youth, and not all of us have the inclination or time to take on this level of exercise commitment, but  if you did, it would appear that for an average of an hour of aerobic exercise a day (17,500 hours over 50 years) you gain an additional 30 years of robust exercise capacity. Or about 1 day for each hour invested. In my book, that’s a pretty good ROI (return on Investment).
References:

 https://www.nytimes.com/2018/11/21/well/move/regular-exercise-may-keep-your-body-30-years-younger.html
https://www.physiology.org/doi/abs/10.1152/japplphysiol.00174.2018
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Friday, November 2, 2018

New Year's Resolutions - Aging well


It’s the holiday season. Which means confronting that annual task of making your New Year’s resolutions.


We are all another year older, so it’s not unusual for aging to work its way into our deliberations.  How are we feeling? Are we doing all that we can to stay healthy and be ready for those trips and projects that we put off?


This year’s columns focused on strategies to decrease our odds of falling victim to the four major diseases of modern life  - heart disease, cancer, diabetes, and dementia. It seemed the ideal time for a summary in case you needed help jump starting the resolution planning.


And just like your IRA, making changes early, investing some energy in your 30s and 40s, leverages the benefits with greater rewards than you’ll get putting things off until that AARP invitation arrives in the mail. So for your first resolution - “No more procrastination”.


Smoking remains the number one cause of morbidity (illness) and mortality (death) in the US. If you are still taking an occasional puff, stopping smoking is an easy number two for the list.


Recent work suggests there is no completely risk free level of alcohol intake, and previous suggestions of a small health benefit from a drink a day were most likely wishful thinking. Health risks go up more quickly after that first drink, so moderation should be the goal.


Loss of your muscles accelerates with aging, but resistance exercise (lifting heavy objects) decreases the rate of loss.  


Stress your heart and you will not only decrease the risks of developing coronary artery disease, but you will be able to do more with those disappearing muscles.


Diet is a much more complex issue. Here are several common components in all healthy eating plans.


   - Get rid of sugar. More and more evidence indicates sugar is more harmful to your health than either salt or fats.


   - Replace red meat with fish, whole grains, and vegetable side dishes. Your microbiome will love the extra  fiber.


   -  Don’t skimp on protein. As we get older we need more, not less, protein. The inadequate daily protein intake of the elderly on limited incomes is a significant factor in their muscle loss.


   - Use more healthy oils -  olive oil, avocado oil, canola oil, walnut oil, flaxseed oil, or chia seed oil. Oily fish such as Salmon provide the especially healthy omega-3 fatty acids.


Social interaction is the final piece. Keep in touch with close friends. Go to church. Volunteer. Play bridge. These connections are important to keep your mind healthy and your spirits up.


So there you have it,  the secrets to not only living longer, but living better - aging well.  A healthy diet, regular exercise, no smoking, and alcohol in moderation.


Need a few more specific resolutions?   


Eliminate sugar from your diet. I’d make this number three on your must do list. It will be a challenge.  Sugar is addicting and the first 2 weeks will be hard. But the health rewards are huge.


Cut your red meat portions in half, or better yet consider two meatless meals a week (fish can count as “meatless”)


Fifteen or twenty minutes of dedicated exercise a day. For the week, three days of resistance exercise and four days of vigorous walking or biking to the point you feel short of breath.


Happy New Year.

References (more references in topic specific blog posts - right column):

 https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.117.032047

https://www.nytimes.com/2018/09/03/well/live/preventing-muscle-loss-among-the-elderly.html

https://well.blogs.nytimes.com/2015/04/15/the-right-dose-of-exercise-for-a-longer-life/





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Saturday, September 29, 2018

Saving your brain


Over 5 million people in the United States currently suffer with dementia.  And if you are fortunate enough to live to age 85, it’s estimated your chances of exhibiting signs of dementia are at least one in four, and perhaps as high as one in two (50%).


These are alarming statistics but there is hope.  In a moment we’ll look at options that are estimated to cut your risk by a third.


Dementia refers to a set of symptoms (impaired decision making, misuse of language, and memory lapses) which can be found in a number of diseases.
Alzheimer’s is the most common cause, responsible for 60 to 70% of all  cases of dementia.


“Vascular dementia”, the result of diminished blood flow to the brain, comes in second with another third of the cases.


Prevention is the key to beating dementia as once symptoms develop, indicating the presence of ongoing damage, they are generally irreversible.
As you will see, options include many of the lifestyle changes that are common to other vascular or blood flow related diseases such as heart attacks and strokes. But to be effective they will need to be adopted in midlife.  


Diabetes and Blood Pressure Management


Diabetes, high blood pressure and obesity all contribute to premature aging of blood vessels. Whether it is preventing heart attacks, stroke (the major vessels to the brain), or vascular dementia (the small blood vessels), control of blood pressure and blood sugar levels are of unquestionable benefit.


Diet


Diet can have a powerful effect. And it is about both the negative effects of foods you should avoid as well as the positives of those you should add to your diet.


One study showed that those following a Mediterranean diet had less brain atrophy — an effect similar to 5 years of aging — than those who did not. And another that those who consumed two servings of green leafy vegetables a day had a rate of cognitive decline equivalent to someone 11 years younger.


And the foods to be avoided?  Red meat, butter, margarine, cheese, sweets, fried and processed foods, and empty sugar calories such as sodas.


Although it is not traditionally considered a “food”, alcohol in large amounts has been firmly linked to dementia, and even small amounts on a regular basis produce brain damage on neuroimaging studies.  This finding implies there is no “safe” level of intake for alcohol.


Social Engagement/Marriage


Having strong social networks as well as marriage are dementia protective.
Being a loner is associated with a number of poor health outcomes including cancer survival.  Why? Those in a relationship or with strong social networks tend to live healthier lifestyles.


Or perhaps being able to share worries moderates life’s stresses which are know to correlate with an increased risk of subsequent dementia.


Exercise


Last but not least is exercise. Of all the prevention options, this is the most powerful.


A group of 191 Swedish women, 38-60 years of age in 1968, were given an ergometer cycling test. When their mental status was valuated in 2010 (fourty years later), it was found that the women with high physical fitness at middle age were nearly 90% less likely to have developed dementia compared with the women who were only moderately fit.


Medications


Are there any medications of preventive value?


Vitamin E and Selenium, commonly suggested anti oxidants, have no protective benefit.


There is limited information on metformin, an insulin “sensitizer” and effective anti-aging medication in a mouse model.  Although it does diminish the incidence of dementia in diabetics (presumably via treatment of the diabetes itself) there is no solid evidence that it has a protective benefit for those with normal blood sugar metabolism.


But there is a glimmer of hope on the medication horizon. Smoking dope. The long term administration of THC, the main psychoactive ingredient in marijuana, ameliorates age related learning and memory deficits in elderly mice even though, paradoxically,  it impairs learning and memory in young mice.


How can that be? One of our many neurochemical pathways is the cannabinoid system.  As we age, this pathway, along with the others, becomes less active. In old animals, THC treatment restores the failing cannabinoid system activity, whereas it overactivated the normally functioning cannabinoid system of young animals.


So we once again see a theme that is common to many of the diseases of aging - an active lifestyle paired with a vegetarian leaning diet. But for the brain, we will add the importance of avoiding social isolation. Three lifestyle changes that you can add in small amounts to daily routines and will add years of benefit down the road.

 References:

https://www.amjmed.com/article/S0002-9343(18)30643-0/fulltext

 https://tandfonline.com/doi/abs/10.1080/1028415X.2017.1324357

 http://www.aginganddisease.org/EN/10.14336/AD.2017.0501

 https://www.ncbi.nlm.nih.gov/pubmed/26491085

 https://www.frontiersin.org/articles/10.3389/fnagi.2017.00183/full

https://www.nature.com/articles/nm.4311.epdf

 https://www.ncb i.nlm.nih.gov/pubmed/29263222

 https://www.bmj.com/content/361/bmj.k1675

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894933/

 https://jnnp.bmj.com/content/early/2017/10/30/jnnp-2017-316274

https://www.thelancet.com/commissions/dementia2017

 http://www.drmirkin.com/fitness/exercise-preserves-brain-function.html 

 http://www.health.harvard.edu/press_releases/regular-exercise-releases-brain-chemicals-key-for-memory-concentration-and-mental-sharpness

http://www.health.harvard.edu/press_releases/regular-exercise-releases-brain-chemicals-key-for-memory-concentration-and-mental-sharpness

 https://www.nytimes.com/2018/03/28/well/mind/fitness-in-midlife-may-help-fend-off-dementia.html

 https://www.nytimes.com/2017/10/04/well/move/for-your-brains-sake-keep-moving.html

https://www.bmj.com/content/361/bmj.k1675 Exercise no help once you have it.


http://www.drmirkin.com/morehealth/risk-for-dementia-goes-down-with-steps-to-prevent-heart-attacks.html

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Thursday, September 6, 2018

Use it or lose it….perhaps forever!


Regular exercise is essential to staying healthy. It maintains our muscle tone, keeps the arteries healthy (preventing strokes  and heart attacks), and minimizes the memory loss of aging. One of its less obvious, but no less important, effects is on insulin metabolism, reducing the risk of developing type 2 diabetes.

 Most of us assume we can take a break (often for vacation) from our regular exercise routine with no downside risk beyond a little extra effort to get back up to speed on our return to the gym.  But new work suggests the deconditioning effects of that break may not be completely reversible, especially as we get older.

 One study of middle aged adults (average age 35) confirmed this decrease in the body’s insulin sensitivity after just 2 weeks of slacking off on their daily exercise. This younger group returned to their baseline a few weeks after returning to their normal routine.

 A second study evaluated an older, pre diabetic population (average age 69). It again documented a decrease in insulin sensitivity that correlated with the reduction in activity, but then, surprisingly, went on to document an incomplete recovery.

 These two studies give new credence to the adage "use it or lose it" in that the loss of exercise related conditioning may not be completely reversible.

 But you do have several alternatives. Although you may not be able to stick with your full exercise routine, you should be able to maintain your conditioning with a more limited workout regimen.

 First, you can cut back on the level of exertion. It has documented that participants can actually improve strength and endurance exerting at only 55% to 85% of their personal maximum, a level that is just uncomfortable on a “perceived exertion” scale.

 But more importantly you can cut back on the duration of your sessions.

For aerobic conditioning (heart and lungs) you may have to push your level of discomfort as the trade off for time spent by using HIIT (high intensity interval training).  This will prevent deconditioning, and can in some instances actually improve aerobic fitness 10 times more quickly than moderate endurance training.

HIIT requires an all out effort for 30 to 60 seconds followed by a minute of recovery. Repeat five sets - three times a week. Although it may sound like more than you might want to take on, numerous studies have shown HIIT to be more acceptable to participants than slower (and longer) aerobic routines. And best of all,  you can maintain your aerobic fitness with just 3 ten minute sessions a week.

 Then we have muscle tone/strength.

 Here the “aha” studies have shown that you can decrease the weights you are using, pushing just 70% of a personal one-time maximum for 30 repetitions, the point at which your muscles begin to fatigue).

 And more recently “slow lifting” with each rep performed in a slow and more deliberate way rather provides equal benefit to fast repetitions. So a slow set of 30 repetitions will get you almost the same benefit as the dreaded “set of 3” that make up the traditional gym routine.

 So there you have it. Take that vacation. Commit to 3 HIIT sessions a week (you can do them anywhere). And if you have access to a weight machine, add in several sets using modest weight to the point of muscle fatigue.

Then you will be ready to settle right back into your regular gym routine when you get home.



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Sunday, August 12, 2018

Don't forget your morning flax.


More than a hundred studies have shown that eating more fruits and vegetables decreases your odds of a heart attack, stroke, cancer, and early death. And the more vegetables you eat, the more pronounced the benefit.


What is the mysterious health factor associated with vegetables? It could be the simple fact that as we fill up with low fat vegetables we eat less red meat. Or maybe it is the plant antioxidants protecting us from the pesticides and other harmful chemicals in our environment.  The answer, it appears, is much less glamorous - it is the extra fiber.


Fiber is the structural skeleton of all fruits, vegetables, nuts, and beans. Fiber is a carbohydrate (a starch) but unlike flour and other dietary carbohydrates, it is impervious to our digestive enzymes. And as a result this fiber passes unchanged into our colon where it is digested as a source of energy by our microbiome (the millions of resident bacteria).


There are 2 kinds of fiber.


Insoluble fiber absorbs water but won’t dissolve in it. Put a teaspoon of bran in a glass of water and you can see for yourself.  The “bulk” of the indigestible fiber in our diet resistants digestion by the microbiome, passing through the colon unchanged. Its benefit is in keeping our stool bulky, helping maintain regular elimination.


Soluble fiber, on the other hand, will dissolve in water and is a “food” used by the microbiome.  Various fatty acids formed as a byproduct of this bacterial metabolism are absorbed into the bloodstream and are thought to be the real reason dietary fiber is so beneficial to our health.


These fatty acids appear to affect various metabolic processes.  For example, aiding in the control of blood sugar levels (diabetes) and helping to lower blood cholesterol and fat levels. Other fatty acids make it only as far as the colon lining cells where they are used by the cells themselves and thus keep the lining of our colon healthy.


Put mice on a low fiber diet and their colon lining cells shrink in size and produce less mucus. A thinning of the mucus barrier lining the colon in turn allows bacteria closer contact with the lining cells themselves. This triggers an inflammatory response as our immune system works to  “protect” us from an invasion of foreign bacteria.


It has been speculated that this ongoing inflammation may play a role in the development of colon cancer. And may be the explanation of the association of a high fiber diet with a decrease in colon cancer risk.


Chronic colon inflammation may also play a role in other inflammatory conditions such as arthritis and asthma, as well as interfering with normal sugar metabolism (diabetes) and also how we store excess dietary calories. It appears to shunt these extra calories directly into fat cell storage contributing to obesity.


By providing energy to the colon bacteria, soluble fiber keeps our microbiome (those millions of bacterial factories in the colon) healthy and productive.


When mice are put on a low fiber diet, the total bacterial population quickly drops to a tenth of its pre-diet size along with experiencing a significant decrease in bacterial diversity. The result? Fewer and possibly less efficient factories to produce those helpful fatty acids.


Thus soluble fiber has two benefits. It provides the raw materials for fatty acid production and is a source of energy to keep the bacterial production facilities open and available.


What are your options to tap into fibers’ benefits?  Increasing the amount of fruit and vegetables in your daily diet is the easiest start. This will not only add additional fiber but indirectly decrease the amount of red meat.  


While you are working to diversify your diet, consider adding a tablespoon of flax meal (in applesauce) to your morning vitamin routine, or to your breakfast smoothie. We know this simple step works as diabetics taking a tablespoon of flax meal a day dropped their fasting blood sugars and a subgroup with high blood pressure also experienced a drop in their average readings.


A single change as you take action to improve your health. A small step, but in an important direction. Then in the late afternoon you can add a snack on a couple raw carrots or broccoli as you make dinner.

http://www.drmirkin.com/nutrition/how-soluble-fiber-promotes-good-gut-bacteria.html

https://www.nytimes.com/2018/01/01/science/food-fiber-microbiome-inflammation.html

Added after publication:

 https://nutritionfacts.org/video/benefits-of-flax-seeds-for-inflammation/
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Monday, July 2, 2018

Eat your way to a healthier, longer life.


The expression “you are what you eat” was coined in the late 1800s and  implied that one’s state of mind was influenced by their diet . An advertisement in 1923 upped the ante when it suggested that “"ninety percent of the diseases known to man are caused by cheap foodstuffs.”

Last year a more rigorous scientific approach published in the Journal of the American Medical Association (https://jamanetwork.com/journals/jama/fullarticle/2608221) concluded that fully half of the 700,000 annual deaths from heart disease, stroke (which along with cancer are 2 of the 3 leading causes of death), and diabetes are a direct result of poor dietary habits.

The analysis found that a deficiency of healthy foods contributed as much to a poor health outcome as did an excess of unhealthy foods. Let’s take a look at the 10 diet changes they suggest would have the biggest impact.

Salt was at the top of the list of things to avoid. If you are looking for one single dietary change to improve your health, take the salt shaker off the dinner table along with cutting recipe recommendations for salt in half. It will take a couple weeks to adapt to this change, but you will soon realize how much unneeded salt is added to restaurant meals and those processed foods you are buying at the grocery store.

Sugar, especially in sodas, was number two.  Along with salt, sugar is the one additive that takes a 2 week commitment to break what is a real taste addiction for many.

Processed meats, which are high in both salt and fat, were high on the “to be avoided” list.

And finally, as you might have suspected, red meat rounded out the 4 items to be avoided.

Now let’s switch to the foods that are often in short supply in our diets and, if increased, would have a positive impact on our health.

Fish, with its omega-3 fatty acids provides a great alternative to red meat. A win-win diet change, decreasing red meat while adding the omega-3s.

Also expected we tend to scrimp on our daily intake of fruits, vegetables, and whole grains. When you cut down on red meat, these offer great alternatives to assure you don’t leave the table hungry.
Fats, of course, made the list.  A separate study published last month, re-emphasized the cardiovascular disease (CVD) risks of “trans” as well as saturated fats. The study quoted from prior papers indicating that merely replacing dietary saturated fats with polyunsaturated vegetable oil reduced CVD by 30%.

Nuts, loaded with unsaturated (good) fats, were the final “must add” with a strong association with good outcomes. When you get that urge for a few chips and doritos between meals, a hand-full of nuts is a healthy alternative to get you to your next meal.

Another study indicated  that adding just five tablespoons of olive oil or 30 g  (a handful) of unsalted nuts to a conventional Mediterranean diet provided a 30% reduction in the risk of CVD mortality compared with simply lowering saturated fat intake alone.

So that rounds out ten changes to consider in your daily diet.

If you have been reading my columns the past year, this study confirms the  major themes of prior articles.

- Less sugar. More and more the evidence indicates it is more harmful to your health than either salt or fats.

- Less red meat.  And replace it with an increase in whole grain and vegetable side dishes. Both changes support a healthier microbiome with all its benefits.

- Less saturated and more poly-unsaturated fats. Cook with unsaturated vegetable oil (or olive oil).  Get a jar of unsalted nuts for snacks. They are the answer to killing that urge to snack.

- And finally, the more you can do cook a meal yourself, avoiding restaurant and processed foods from the store, the more successful you will be in limiting your weekly intake of salt, sugar, and harmful saturated fats.
https://academic.oup.com/eurheartj/article/39/17/1503/4987029

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