Monday, May 26, 2014

Kayaking with Alligators and Other Calculated Risks

Jonathan Dickinson Park is a Florida State Park located in Martin County, Florida; the Loxahatchee River runs through it.

Last Friday, accompanied by my wife and another couple, I kayaked down the river to view pristine nature. Watching us from the sidelines were a number of alligators, with some appearing as large as ten feet long. One actually swam under my friend's kayak.

Stroking the water in my single kayak, I couldn't help but think what possessed me to go down a river surrounded by ferocious, life-altering creatures with my only defenses a paddle and a pocket-knife. Coupled with the knowledge that death had come to a young boy on this very same river from a similarly situated alligator only added to my puzzlement.

I am not a risk taker by nature, particularly when it comes to nature. True, I was a boy scout for three years, but supervised hikes in the woods was the extent of my trailblazing. Skydiving, motorcycle riding, hang-gliding, parachuting, bungee jumping etc. are simply not part of my repertoire and never have been. So what was I doing on that river? I was taking a calculated risk.

The Merriam Webster dictionary defines a calculated risk as "a hazard or chance of failure whose degree of probability has been estimated before some undertaking is entered upon." I think you will agree that boating down a river inhabited by alligators, one of which already killed someone, without any rescue in site in order to enjoy a unique patch of nature is by all means a calculated risk. Why did I do it and why should my adventure be of any concern to you?

Patients often told me that if they had to give up the foods they loved, there would be no reason to live. Clearly such people live to eat as opposed to eat to live. Even when faced with the risks of heart disease, cancer, stroke, diabetes, etc,, food means too much to them to give up. More importantly, they know there are no guarantees that if they actually gave up their pizza, cakes, burgers, french fries, milk-shakes, pasta, etc. that they would necessarily stay healthy or even live longer. For them, their calculated risk has their favorite foods trumping over potential health risks. 

Many people often make the same calculation about exercising regularly and managing their stresses more effectively. For example, if you spend one hour a day exercising for sixty years, you would have spent the equivalent of over three years of awake time (at an average of 17 hours a day) of your life exercising. It is estimated that people who exercise one hour a day, ignoring diet and other longevity factors, will on average live a few years longer. By some calculations, that seems like a wash. I say some, but not mine. 

When I think about the consequences of eating the right diet or staying physically active over the course of your life, I think in terms of both possible gains as well as losses. Although there are no guarantees that exercise will keep you alive longer, as Jim Fixx the runner proved by his passing, staying physically active has been clearly associated in every study I ever read with a healthier healthspan, the measurement of how long in life you feel well. So it's not just a matter of living longer, it's also about feeling better during the years you live. In addition, many studies also show that eating healthy when coupled with other healthy lifestyle choices is highly correlated with avoiding the chronic diseases often associated with aging. 

To eat what you want and to live a sedentary lifestyle is a calculated risk that you are free to take. It's your life after all. You may think that it is not as foolish as kayaking with alligators, but it's actually far worse given that millions of people have died prematurely from eating too much of the wrong foods while since the 1970s there are only twenty three recorded alligator deaths in the U.S. I prefer those odds. While alligators are a frightening topic and when they kill, they garner major headlines for the gruesomeness, the risk of dying early from an unhealthy lifestyle is far greater than death by alligator even when they are swimming nearby. So if you aren't brave (or stupid, depending on your perspective) enough to go kayaking with alligators, why do you keep eating the way you do? It's a calculated risk to eat unhealthy and the odds are not in your favor. 

Now that's something to chomp on (pun intended).

Friday, May 16, 2014

Is (The End of) Death Inevitable?

At a dinner party nearly two years ago, I made a passing comment about the inevitability of death. The host, an Israeli-Danish economics professor, took exception to my statement. He responded that one can only speak with certainty about what has happened, not what usually happens. At first blush, I thought he was either a wacko or was just being ornery. How could anyone assert that death was not a fact of life? How could anyone deny the inevitability of death?

After the dinner, I began to ponder his statement, and over the ensuing months gave it ever greater reflection. After reviewing the burgeoning body of research tackling anti-aging and longevity, I have reached my own conclusion. You may think I am also a bit looney, but please indulge me for a moment.

Car analogies are useful tools for explaining the function and longevity of the human body.  Everyone knows that the better you treat your car, the longer it will last.  However, despite utmost care, if the car is regularly used, at some point, the engine will need to be rebuilt, the tires replaced, the exterior retouched, etc. A car functions based on the quality of its fuel and replacing actual fuel with non-combustible liquids means the car can't function (except for electric cars, a scientific breakthrough in its own right).  Humans similarly need the right care and fuel to function.

However, car buffs will tell you that even though most cars are useable for at most a couple of decades, there are cars out there that are nearly a hundred years old and there are plenty of cars still functioning after many decades.  Yes, they need extra-special maintenance, but their useability is extendable indefinitely with continued care. Cars, like humans, also require the interoperability of multiple parts to be useful. Without a steering wheel, you can't meaningfully use the car even if you have a wonderful engine. Similarly, humans need their hearts, brains, livers, etc. to all function in unison and the failure of one is the failure of all.

Of course, cars analogies are of limited utility because the human body is far more complicated.
Unlike cars, replacing human parts is still a challenge. Yes, we can transplant some parts like hearts and livers, when they are even available, but parts like brains and thyroids still remain beyond our abilities. In fact, the human body is so complicated that many metabolic processes, parts of the microbiome (the bacteria, good and bad, that share our body space), and both human and microbiome genes and their related proteins have yet to be either fully understood or even identified. Even worse, when the body malfunctions like with auto-immune diseases and cancer, we are still mostly defenseless.

Nevertheless, what is unknown is ripe for the finding, analyzing and manipulating.  When smallpox was killing hundreds of millions of people, I am sure many wondered if a solution would ever be found. It was and the disease and the plague it caused are now mostly history. When the HIV virus was first discovered, the prognosis was sure death. Today, many live with the diagnosis due to effective interventions.

That is why I now believe that the difference between life and death is only a matter of undiscovered science. This means that the end of death as humans now understand it (another essay in its own right) will require scientific advances and breakthroughs that are only a matter of time. No one can tell you exactly when these life-altering discoveries will be made, but I suspect it will happen sooner than expected.  Why?  Because of the three "Ps": (Scientific) Progress, People and Purse.

Real progress is being made. Research into understanding what causes death is accelerating.  Universities across the U.S., Europe, Asia, and Israel are actively engaged in finding the root causes of death and related processes that accelerate and impede it.  Research into fruit-flies, worms, rodents and monkeys have already identified a number of gene variants whose presence and/or manipulation has been proven to extend life by as much as five times (in worms). Human gene studies have already identified multiple gene variants associated with super-centenarians, those aged above 110. Scientists recently created the first living semi-synthetic organism made from synthetic base pairs after long believing such a feat was impossible. As our ability to identify genes and proteins grows, so does the possibility for targeted gene therapies to control their actions. The accelerating progress to date offers the great promise of much more to come.

The solution to death will require great effort and that will require people capable of mustering such effort. Last year, Google announced the formation of a new company called CALICO, for California Life Company and hired Arthur Levinson, the former CEO and current Chairman of the pioneering Genentech, arguably one of the most successful and innovative biotechnology companies of all times. He is also Chairman of Apple, another technology bellwether. Levinson has begun assembling a team of leading scientists including recently adding Cynthia Kenyon, the UCSF molecular biologist and biogerontologist who has done the groundbreaking research into worm life extension. Not to be outdone, Craig Venter, the biologist and entrepreneur credited for winning the race to sequence the entire human genome, announced this year the formation of Human Longevity, a company dedicated to life extension. Human Longevity announced that it would first target cancer by collaborating with a UC San Diego Moores Cancer Center to sequence the genomes of between 40,000 to 100,000 cancer patients a year in order to find gene patterns amenable to novel gene therapies.

People like Aubrey de Grey, of the SENS Research Foundation, a non-profit funding work at universities across the world and at its own Research Center in Mountain View, CA,. have been getting much airtime about funding life extension by giving TED talks, writing extensively and circulating widely. Ray Kurzweil, the prolific writer, inventor, scientist, Google director of engineering, and futurist purports that the melding of humans and technology, what he calls the Singularity, will by itself propagate life indefinitely into a new era of Transhumanism, a perspective that argues that humans will enter a new stage of existence by using technology to greatly enhance intellectual, physical, and psychological capacities.  Of course, life and death as we know them today would be redefined under this scenario. Think beyond bionics and The Six Million Dollar Man and implanted circuitry and the current TV show Intelligence. Think nano- or even the much smaller femto-technology. Think semi-synthetic humans.

Perhaps the most intriguing persona in the longevity field is entrepreneur Laura Deming.  Admitted into MIT at the age of 14, child prodigy Deming, now 19, dropped out to found Longevity VC, a venture capital firm focused on identifying and funding research into life extension. Deming began researching longevity at the age of 12 in Cynthia Kenyon's UCSF lab.  With an early start into the field, Deming offers real promise. However, even great people usually need resources.

Scientific research is often expensive. To have any real hope for sooner than later anti-aging breakthroughs, purses must open and they have.  On the government front, the National Institute of Aging has been spending wisely. Recently, it announced a ten million dollar grant to University of Rochester, Albert Einstein College of Medicine and Harvard to fund such research. Craig Venter is purported to have raised fifty million for his venture, and Ms. Deming is funded to some extent by Peter Thiel, one of the co-founders of Paypal and a successful hedge fund manager.  Although Google has not publicly announced its investment in CALICO, it is estimated to be in the tens of millions.  By my estimates that easily places the current investment north of 100 million dollars. That may not be the billions needed, but its a good start.

So given the progress, people, and purse now engaged in the search for immortality, do you think that (the end of) death is inevitable? Maybe the economics professor was on to something...

Thursday, May 8, 2014

When Is Vitamin D A Real Worry?

On March 14, 2014, I wrote a blog titled Vitamin D and Breast Cancer: Are they married or just acquaintances? The blog explained why study results that showed a relationship between low Vitamin D levels and a poor breast cancer prognosis were misleading by suggesting that raising vitamin D levels would change the course of the disease.

Last week, a new study reported that in men diagnosed with prostate cancer, the lower their vitamin D level, the worse their prognosis. As with the breast cancer study, this study implied that if men loaded up on Vitamin D, they would improve their survivability from their cancer.

This was not surprising. Hardly a week goes by without some new study showing a relationship between Vitamin D and some disease. So what's the answer? Should you raise your vitamin D levels to levels above 50 nanograms per milliliter (ng/ml) as many Vitamin D proponents claim is needed to protect yourself against cancer, osteoporosis, falls. etc.?

I say no. 

The body of evidence is becoming very clear that Vitamin D is more a disease marker than disease causer. That means that your vitamin D level indicates the severity of a disease like cancer as opposed to controlling the severity.

Although vitamin D is commonly called a vitamin, it is not actually a vitamin in the strict sense, as it can be synthesized by exposure to sunlight. It can also be consumed like other vitamins through foods like wild Salmon, certain portabello mushrooms, and almond milk (to which it is added).  Vitamin D is an essential nutrient, which means that your body cannot function without it.  However, there is a growing consensus that as long as your Vitamin D blood level is above 20 ng/ml, you have enough.

When a doctor tests your blood and finds that your level is low, it may mean one of two things. First, you may not be naturally producing and/or consuming enough Vitamin D. Anything below 20 ng/ml should be immediately addressed by either prudently increasing sun exposure, eating more foods with Vitamin D or taking a 1,000 mg supplement.  Above that level, the evidence suggests it's safe.

However, if your Vitamin D level is below 20 ng/ml, there may be a second more nefarious reason for the deficiency. You may have an illness that you are unaware of.  This merits further careful evaluation by your doctor. A low level may indicate an as yet undetected cancer that requires prompt attention.

When my older brother, z"l, battled against kidney and prostate cancer, his Vitamin D level went below 10 ng/ml.  I asked his doctors to try to increase it thinking that somehow that would make a difference. They did; it didn't.  That's because his Vitamin D level was simply telling us how sick he was and within a few weeks he passed.

So the next time you see a headline about the association between Vitamin D and some disease, please remember that although Vitamin D is essential to healthy human functioning, your Vitamin D blood level is one of many indicators on your health dashboard.  Therefore, low levels are typically neither a cause of disease (other than rickets/osteomalacia that happen at very low levels) nor make the disease more severe as so many studies would have you believe.

So have your doctor check your Vitamin D levels at least once every couple of years, but be satisfied if it stays above 20 ng/ml. Think of Vitamin D as your Dashboard Vitamin.