Good general health article from the WP

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Joy . . . or Pain?

By Suz Redfearn

We all crave that mythic pill that eradicates wrinkles, diminishes our risk

of heart attack and averts dementia while ensuring that we live to be 99. A

hale, attractive, cheerful 99, that is.

Don't bet your life on it.

Despite the constant promotion of products claimed to extend life and

prolong vigor, nothing you can buy in a box, bottle or tube has been shown

to extend anything other than your credit card balance.

" There are clearly no pills or potions that have yet been established to

increase longevity, and in fact for many of such pills and potions out

there, there are real concerns about adverse effects, " said Hodes,

director of the National Institute on Aging (NIA).

You know the products he's talking about: human growth hormone,

testosterone, antioxidants and dietary supplements with several hyphens in

the name that (it's okay to admit it) you've begun to consider trying as the

signs of aging multiply.

" People spend a lot of money on one kind of anti-aging remedy or another,

and they have for thousands of years, " said Whitehouse, Case Western

Reserve University professor of neurology and biomedical ethics, who studies

age-related cognitive decline.

Alas, aging is still the fundamental fact of the life cycle, and the human

mortality rate remains 100 percent. But we can, if we're fortunate, exercise

some control over the timing of our death and what our life is like until

that day comes. Hodes says studies have shown that about 25 percent of how

we age is determined by genetics; the other 75 percent, by the environment.

Which is to say, by tending to our environment and what we do within it, we

can shift the odds of a longer and better life in our favor, at least a bit.

Of course, the best life practices won't prevent that proverbial bus from

running you down this afternoon, or some cruel cancer appearing on your

liver in September. But if those things don't intrude, there are a few key

lifestyle choices you can make that science has connected with long and

healthy tenure on this earth. And they are fairly well established to reduce

risk substantially for early onset of the diseases most likely to kill or

disable you: heart disease, stroke, diabetes, dementia and some cancers.

J. Fries, professor of medicine at Stanford University School of

Medicine, offers his " compression of morbidity " theory.

" By postponing the age at which chronic infirmity begins, " he wrote this

year in an issue paper from the Alliance for Health and the Future,

" disability and morbidity could be compressed into a shorter period of the

average human life span. "

When he first proposed the idea in 1980, he wrote, " I predicted a society in

which the majority of people could enjoy a long and vigorous life, with a

relatively brief terminal collapse at the end. " In other words, instead of

suffering progressive heart disease, physical disability and dementia for

the 20 years before your death, you can remain mostly healthy and vigorous

until, say, 83 and die of whatever disease finally gets you at 84 or 85.

His theory is holding up, he says: Since 1982, disability rates in the

United States have dropped 2 percent per year -- twice as fast as death

rates -- thanks to better screening, diagnosis and preventive drugs, as well

as to lifestyle shifts, especially the drop in the number of smokers. But

rising levels of obesity have offset some of the gains and threaten to shift

the numbers in the other direction.

How to further reduce disability and morbidity -- especially as they apply

to you? Below are nine simple (if difficult) suggestions you can adopt,

starting in the next half-hour, that science has linked to a longer,

healthier life, or to a reduced risk for deadly disease. If you feel you've

heard some of them before, don't blame us: Facts are stubborn things.

Reams of research suggest regular physical activity retards bodily decline,

though the precise mechanism by which it might do that remains a mystery.

Rigorous activity helps circulate blood throughout the body's tissues and

organs, delivering nourishment and removing impurities. Exercise also helps

maintain weight in a healthy range. Epidemiological studies associate a body

mass index of 27 or greater (27.8 for men and 27.3 for women) with increased

sickness and death.

Some good research connects aerobic capacity with living longer. A 2002

study in the New England Journal of Medicine looked at 6,213 men with and

without coronary artery disease. It showed a 12 percent improvement in

survival for every unit of metabolic capacity increased through endurance

training.

In a 1999 study in the Journal of the American Medical Association (JAMA),

low levels of fitness increased men's risk of death from cardiovascular

disease by about five times; overall risk of death from all causes increased

about three times.

Experts also know muscle strength and balance can help protect against falls

and related injuries that can compromise independence and, in the very old,

lead to death.

More definitive data on fitness's protective benefits on life span is

expected. NIA is developing a randomized trial to study how exercise affects

people's risk for disabilities. This will be the first direct test of its

kind to show " whether we can actually prevent decline in the living

community, " said Hodes.

Until that study's findings appear, make sure you get the Surgeon General's

recommended 30 minutes of vigorous exercise daily. And read today's Lean

Plate Club column for thoughts about incorporating strength training into

your life.

Fifty years ago, 10 percent of Americans were obese. By 2000, 33 percent

were. The increase, most of it in the last 10 years, translates into

hundreds of thousands of deaths a year. Obesity is linked to type 2

diabetes, heart disease and 20 percent of all cancers.

The key to fighting obesity? Increase intake of fresh fruit, vegetables and

whole grains, dump the junk foods and sugary sodas, watch your body mass

index and cut portion sizes, say nutrition researchers. Of course, the most

important factor in weight control is balancing calories in and calories

out. (See " Exercise Daily, " above.)

Additionally, studies associate diets high in fiber and low in saturated fat

with longer, healthier lives. A recent UCLA study, presented July 13 at the

International Research Conference on Food, Nutrition, and Cancer, showed

that such diets also lower breast cancer risk and slow tumor cell growth.

Last fall a study in JAMA offered strong support for the Mediterranean diet,

based on grains, olive oil, vegetables, fruits and fish. The study followed

more than 2,300 healthy men and women ages 70 to 90 for 10 years; those who

combined such a diet with about 30 minutes of daily exercise, moderate

drinking and not smoking were more than 50 percent less likely to die from

any cause.

Can you go further? You've probably heard about promising research, in

animals and to some early degree in humans, about benefits of severe caloric

restriction -- say, cutting daily calories by about a third. Case Western

Reserve's Whitehouse said the results on smaller caloric-restriction studies

in humans have been stunning: Cholesterol levels, blood pressure and other

major risk factors for heart disease plummeted, along with risk factors for

diabetes. But this kind of diet is very hard to sustain, may compromise

nutrition and isn't proven yet.

Supplementing some vitamins and minerals is also critical as you age and

lose some of your ability to produce them or absorb them from foods,

according to the National Academy of Sciences (NAS). Vitamin B-12 helps

protect against anemia and neurological disorders; it's also been shown to

lower levels of the amino acid homocysteine, associated with risk of heart

disease, stroke, Alzheimer's disease, Parkinson's disease and osteoporosis.

Calcium helps protect against osteoporosis, colorectal cancer and

cardiovascular disease. It also helps lower blood pressure and cholesterol

levels. Recent evidence suggests that Vitamin D, a preserver of bone health,

may also help protect against breast, colon and prostate cancer.

Don't isolate yourself -- now or when you're older. Research has shown that

the more connected you are to a community -- be that your family, your

synagogue or your book group -- the longer you are likely to live. That

makes sense given our evolution from social pack animals whose survival

depended on being part of a group, said , professor of

geriatrics at Mt. Sinai School of Medicine in New York and president and CEO

of the International Longevity Center.

" Results in these studies seem to be related to the importance of intimate,

personal relationships, but there's more to it to that, " he added. " When

you're sick, having family or friends there to go and fetch your medicine is

also important. "

Heart disease is just one of the health risks that's reduced by spending

more time with others. A 2004 study of 6,861 Swedish men and women in the

journal Social Science and Medicine found that those who participated in the

highest number of social activities reported fewer cases of coronary heart

disease.

Having a spouse counts, too. A 2003 study of 7,524 women over age 64 in the

journal Psychosomatic Medicine associated both being married and having an

active social life with reduced risk of death.

Being with your flock also confers protective benefits. A 2004 study of

older adults in the journal Health Psychology found that those who attended

religious services more than once weekly had lower mortality and elevated

levels of interleukin-6 -- a substance produced by the body that can improve

response to infection and disease.

Make sure your buddies are in the mix, too. A recent Australian study, said

, showed that friends -- who are, after all, the people you choose to

associate with voluntarily -- were even more important to interact with

frequently than family.

If you drink a lot, you're reducing your odds for that longer and better

life you so richly deserve. But in recent years, much research has

demonstrated benefits, for many people, of drinking just a little bit.

A study in the New England Journal of Medicine earlier this year found that

one drink per day (equivalent to a 12-ounce beer, five ounces of wine or 1.5

ounces of liquor) may decrease the risk of cognitive decline in women. In

fact, among the participants, who were aged 70 to 81, moderate drinkers had

better cognitive scores than nondrinkers.

These findings join others showing that consuming one drink every other day

to two a day may lower risk of heart attack, stroke and peripheral arterial

disease. Heart attack risk saw the greatest reduction -- 30 percent. Over

all, moderate drinkers die later than do nondrinkers or heavy drinkers, and

they develop less disability than the general population.

The mechanism for such protective effects is not clear. But scientists know

that moderate alcohol intake reduces blood clotting and blood pressure while

raising good HDL cholesterol, thus improving the overall cholesterol

profile. However, the American Cancer Society recommends restricting alcohol

or abstaining, noting that even moderate drinking may increase the risk of

several cancers. For women, findings from some 50 studies suggest alcohol

consumption is tied to a higher risk of breast cancer. One drink a day

appears to increase risk by 10 percent.

If, like 40 million Americans, you're still smoking despite all the

warnings, our finger-wagging won't likely stop you. The following data won't

either, but here they are anyway: Tobacco use is the largest cause of

premature death in the United States and the largest cause of disability.

Smoking causes 90 percent of lung cancer cases and much of the cancer of the

mouth, throat and esophagus. It can also lead to sudden cardiac death,

emphysema and chronic bronchitis, while increasing bone loss and

osteoporosis. There's also impotence, vision loss, a bad cough, icky teeth

and lousy breath.

For all the damage smoking does, the body bounces back fairly quickly once a

smoker tosses the butts. According to the American Cancer Society, three

months after quitting, lung function improves by 30 percent. Within a year,

quitters lower their risk of heart disease by half. Within five years, risk

of stroke drops to that of a lifelong nonsmoker. Within 15 years, risk of

heart disease does the same.

" There are no health benefits to smoking, " said Reuben, chief of the

division of geriatrics at the University of California, Los Angeles (UCLA).

" The only benefits lie in quitting. "

We know, we know: Quitting smoking is one of the toughest acts in the

personal health business.

If you're ready to try again, or just considering it, you can find help at

the " How to Quit " site of the Centers for Disease Control and Prevention (

http://www.cdc.gov/tobacco/how2quit.htm ), the " Guide for Quitting Smoking "

of the American Cancer Society ( http://www.cancer.org , click on " quitting

smoking, " then click on " kick the habit, " then on " quitting smoking " ) or the

National Cancer Institute's site ( http://www.smokefree.gov ).

Ever thought about volunteering at a local school? Finally learning to speak

Portuguese? Plowing all the way through " Finnegan's Wake " ? If living long

and well is your goal, it may be time to act. A growing body of research

suggests that keeping your brain engaged on challenging tasks appears to

help stave off cognitive decline, dementia and Alzheimer's disease. All

three of these can lead to premature death and a poor quality of life.

The NIA conducted a seminal study in this area, published in 2002 in JAMA.

Researchers divided 2,800 healthy seniors into three groups: One practiced

strategies for remembering lists of words and details in stories. The second

worked on reasoning skills, detecting patterns in information and using them

to solve problems. The third group tried to boost processing speed by

practicing such tasks as looking up telephone numbers, reading directions on

prescriptions and responding to traffic signals. Each group showed improved

cognitive ability, compared with baseline, at the end of the 10-week

training and again two years later. A control group that received no

training experienced no such improvement.

But after you challenge your brain with, say, a word puzzle, it's important

to go out and have fun. A 2003 New England Journal of Medicine study linked

participation in leisure activities like playing musical instruments,

dancing, reading and playing board games with a reduced risk of dementia

among 75-year-olds. Researchers theorized that such activities stimulate

pleasure-oriented neurotransmitters, forming new connections in the brain.

Likewise, a three-decade-long study published in 2003 in the ls of

Internal Medicine examined 678 Catholic nuns, ages 75 to 107. Researchers

found that those who regularly engaged in games and crosswords were more

likely to remain mentally alert until death. Nuns who performed more menial

tasks, such as housekeeping or kitchen work, did not tend to live as long.

According to Bob Gleeson, medical director of Northwestern Mutual Life

Insurance Co. and author of " What Healthy People Know and the 7 Things They

Do to Stay Healthy and Live Long " (Classic Day Publishing, 2005), most of us

are born with the genetic wherewithal to live to 85. The challenge, he says,

is to prevent premature disease from taking us down before that.

Outside of living the healthiest life possible per the kind of steps

outlined in this article, the best way to do that, he argues, is to know

which diseases you may have a higher risk for, discuss those with your

doctor and schedule the appropriate screening tests for them.

There is no magic list of screens (yet) precisely tailored to your age,

family history, environment and lifestyle. You've got to develop that with

your doctor. For instance, does osteoporosis, the bone-thinning disease, run

in your family? Your doctor may order a bone-density test, which the U.S.

Preventive Services Task Force recommends for women 60 and older who are at

increased risk; he may ascertain that you're getting enough calcium and

weight-bearing exercise. At increased risk for heart disease or stroke? You

and your doctor may want to discuss complementing lifestyle measures such as

diet and exercise with statins -- cholesterol-lowering drugs -- or

anticoagulants.

Want to have a sense of your risks before you consult your doctor? Some

online tools can help you guesstimate your risk for diseases including heart

attack, cancer and diabetes. See, for example:

· The National Heart, Lung, and Blood Institute's risk calculator,

http://www.nhlbi.nih.gov/guidelines/cholesterol (click on " 10-year risk

calculator " ).

· The American Diabetes Association risk calculator,

http://www.diabetes.org/diabetesphd (click on Personal Health Decisions).

· The Harvard Center for Cancer Prevention risk calculator,

http://www.yourdiseaserisk.harvard.edu/ (includes risk calculator for

cancer, diabetes, heart disease, osteoporosis and stroke).

There's a widespread notion that stress can age you. But until recently, no

one's been able to prove that, or show why.

Then last year, researchers from the University of California, San

Francisco, published research in the Proceedings of the National Academy of

Sciences showing that chronic stress speeds the collapse of the ends of gene

bundles inside cells, hastening the body's physical breakdown. Researchers

measured the lengths of telomeres--the caps at the ends of chromosomes, the

molecules that hold genes. In 39 women ages 20 to 50 who had been

experiencing long-term stress tied to their care of a child with a serious

chronic illness, researchers found shorter telomeres than in a control group

of women whose children were healthy.

The takeaway? Say experts, try to manage the stress in your environment. And

find better ways to manage your response to that stress through exercise,

meditation and relaxation. Controlled studies have tied meditation to lower

blood pressure. A study this spring in the American Journal of Cardiology

that followed 202 people over several years found lower rates of death from

cardiovascular disease and cancer in those who practiced meditation.

Moderate and high-intensity exercise has also been found helpful in

relieving stress.

And get enough sleep. Studies show that averaging less than seven to eight

hours of sleep a night increases the level of the stress hormone cortisol

and interferes with normal metabolism.

Some research suggests that happy people live longer. That may sound like

good news, but if people could simply make themselves happy as easily as

they can modify their diets and take 30-minute walks, well, therapists would

be out of business, the self-help industry would collapse and Dr. Phil would

just be another loud bald guy who should lose some weight.

Still, the data are compelling.

In one study in last year's Archives of General Psychiatry, researchers

gauged the level of optimism and pessimism in 999 Dutch men and women aged

65 to 85, then followed them for nine years. The upshot? The optimists had

one-quarter the risk of cardiac death compared with their more pessimistic

counterparts. The higher their level of optimism, the more robust their

protection. The study also showed that optimistic people had lower death

from all causes over nine years.

Other research suggests optimism has a protective effect on the immune

system and helps ward off depression.

All right, if you're the cheerful and optimistic type, you've once again

lowered your risk of early death. But what if you're not naturally sunny?

Seligman is the preeminent researcher in this often-ignored niche of

psychology, and his book " Authentic Happiness: Using the New Positive

Psychology to Realize Your Potential for Lasting Fulfillment " (Free Press,

2002) provides a how-to guide. According to Seligman, you can experience

happiness by absorbing yourself in your job or a hobby and spending time

serving others.

British economist Layard, author of " Happiness: Lessons from a New

Science " (Penguin Press, 2005), agrees: Becoming happy and optimistic, he

says, is essentially taking control of your emotions instead of letting them

control you.

" It's a matter of how you organize your attention, " said Layard. " You focus

on the good parts of yourself and you look forward instead of looking back. "

And, presumably, have more " forward " to look at than you otherwise might.

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