Why We Live Longer Is More Important Than How Long We Live

I recently came across an article written by Michael Wolff that appeared in New York Magazine titled, "Mom, I Love You. I Also Wish You Were Dead. And I Expect You Do, Too." The gist of the article is that there is no good reason to live longer. The author paints a picture that living longer means a more painful, slow death.

It is a frightful article written by someone who is clearly in pain watching his mother suffer from a terminable illness. However, it is also just plain wrong. The fact that the author makes statements with reckless abandonment may be forgiven given his state of mind. But, I don't believe for one moment that what he has to say is true in most cases of extended longevity.  Why? Because the scientific facts speak otherwise.

A recent study from the Longevity Genes Project, launched by the Albert Einstein College of Medicine in New York City, supports my assertion. The results of the study, focused on near-centenarians, showed that the majority of  them were found to be "relaxed, friendly, conscientious and upbeat about life." Importantly, added the authors, "an easy laugh and an active social life were observed to be a group norm, while neuroticism was notably the exception. What's more, feelings were more commonly shared as they arose, rather than stifled and squelched." Not quite the doom and gloom reported by Mr. Wolff.

Mr. Wolff would have his readers believe that dementia strikes virtually everyone as we age. In fact, less than 50% of Americans over 85 develop dementia and about a quarter of all dementias are now directly linked to lifestyle, and thereby, may be preventable. What I think was missed by Michael is that why you live longer is as important as what that life looks like.

If you live longer only due to the miracles of modern science and technology, such a life may not be worth living. The goal is not to be alive at any cost, strapped to money machines that ka-ching with every passing moment. The reason to live longer is to enjoy more healthy years of life free of disability and pain.

A second recent study, that helps confirm healthy living can extend life even in the retirement years, demonstrates how to achieve such a life.  Led by Emily Nicklett, an assistant professor of social work at the University of Michigan School of Social Work, in Ann Arbor, the study, which was designed to explore the impact of exercise and nutrition together, found that women who were both the most physically active and the highest consumers of fruits and vegetables were eight times more likely to be alive after the study's five years of follow-up, compared to women who scored lowest on both counts.


There you have it. By living a healthy lifestyle, the women in the Michigan study avoided premature death and reported living quality lives. It's not surprising because exercise and good nutrition have been shown repeatedly to keep depression, dementia, falls, cancer, diabetes, heart disease, and stroke at bay for long periods of time.

The bottom line is we all eventually die and how we die is often unpredictable. But living a healthy lifestyle increases the probability of enjoying more good years. Michael Wolff ultimately misses the real point. If his mother had taken ill a number of years earlier, would the situation have been any less poignant and painful? Watching a parent suffer at any age is difficult for most children. Having a few more good years with the parent(s) before the process begins is a gift.

So if you want to live a longer, functional, and disease-free life, a word to the wise should be sufficient. Learn how to eat properly and get enough exercise to remain in good form and fitness. Michael Wolff may long for his mother's passing, but I long to keep my patients healthy and enjoying life for many more years because it beats the alternative.

Can You Grow Your Brain?

Does exercise lead to a better brain? According to an article in today's New York Times Magazine, it can.  In a recent blog, I discussed a number of studies that show that exercise can elevate mood and can have the same medicinal effect as antidepressants in treating mild to moderate depression. So you don't need to be a Rhodes Scholar to appreciate the therapeutic benefits of exercise.  However, we apparently do need a scholar by the name of Justin Rhodes to tell us why. Dr. Rhodes, a psychology professor at the University of Illinois conducted an interesting set of experiments with mice that showed that among four sets of mice, those who engaged in the most exercise saw an increase of new neurons or brain cells, even more than those who received the most mental stimulation.

The credit for this effect is partially given to something called B.D.N.F. When I first saw this acronym, I immediately thought that it stood for Brains Do Need Fun. Alas, it actually stands for the more mundane Brain Derived Neurotrophic Factor, which in layman's terms means it makes brains grow. I still like mine better because fun does make everything better, but it's still good to hear that we can potentially grow our brains. Scientists, however, believe that the growth from exercise in mice is not solely from  B.D.N.F, because they think that the process must include other complex biochemical processes and genetic cascades.

I am a huge believer in the benefits of exercise not only for mental health, but for heart health as well. Every study I've ever read supports that conclusion. However, I have my usual set of problems with these mice studies. First, it was done in mice, which means it is not necessarily extrapolatable to humans. In fact, scientists are unable to study similar affects in humans, although studies do show an increase in B.D.N.F levels after exercise.

Second,and more importantly, if exercise increases brain size and density, wouldn't professional  athletes have bigger, healthier, and more durable brains than the rest of us? I've yet to read or hear of a study that showed that athletes are smarter, develop less Alzheimer's, and in general have healthier brains than the rest of the population. Have you? Perhaps there is a threshold regarding the effects of exercise? Perhaps, when you start from zero and steadily increase, you experience heart and brain benefits up to a point, and then further increases lead to deterioration? That theory would be consistent with a couple of studies I've read that showed that professional athletes all develop some form of heart damage from their high levels of exertion.

Now please don't us this blog as an excuse to avoid exercise. It's not. The average person is no more likely to reach that turning point when exercise becomes potentially harmful than they are to grow their muscles "too big" in a gym. Professional athletes generally waive caution in pursuit of excellence, and most people will never get close to that level of endurance (nor should they).

Physical activity is the hallmark of health and longevity. All studied centenarian communities are predicated on constant physical activity. If that's not possible for you due to the nature of your work or other circumstances, then schedule, if possible, robust exercise for ideally 30 minutes a day. If you miss a day, ignore it and do better the next day  Even ten minutes of brisk activity a day was shown in one study to decrease heart attack risk by 50%. (Not a perfect study, but as you may have learned by now they never are, are they?) Minimally, get out of your chair every 55 minutes ans either take a walk, go up and down stairs, or do some jumping jacks.

Nevertheless, how do you know if your exercise is adequate for good heart and brain health? My rule includes singing. For endurance related aerobic exercise, try to get to the point where singing becomes difficult. Not where your singing becomes difficult for others, which may always be the case, but for you. By the way, if these words compel, you to start exercising or increase your level of exercise, please consult with your personal physician before doing so.

Ultimately, I can't tell you if the brain is figuratively or literally like a muscle that grows stronger with exercise, but I'm pretty sure that like a muscle, if you don't use it, you will lose it. 

I Just Don't Know

Today's blog has two parts and thought-trains.

Part 1

I typically don't read Glamour Magazine. However knowing my penchant for all things related to vitamins, my youngest daughter was delighted to share an article she came across in the magazine. The gist of the article were the responses from three experts to a question regarding the appropriateness of taking multivitamins after recent studies have suggested they may be harmful.

The first response came from a PhD who works at the Fred Hutchinson Cancer Research Center whose response was basically no, they are not needed. The second response came from a MD and professor of prevention at a Harvard teaching hospital who basically said no except in specific cases like folate during pregnancy shown to avoid birth defects. The third response came from Dr. Michael Roizen, the Chief Wellness Officer of the Cleveland Clinic who basically said yes because people don't eat good diets.

I was infuriated that he answered as he did. I met the man a little over a year ago when I visited the Cleveland Clinic in Ohio. The purposes of the trip was to explore partnership with him and the Clinic regarding my new prevention initiative. (For full disclosure, there were a number of subsequent conversations and correspondences after the trip as I vigorously pursued the opportunity. Eventually, however, I walked away because I found their terms of partnership to be highly lopsided.)

Notwithstanding, during the trip, I had an opportunity to speak to Dr. Roizen in privacy. During that time, which was relatively early in my auditing the field of prevention, I asked Dr. Roizen which dietary supplements he believed stood out among all others and that he would personally recommend for daily consumption. His list included baby aspirin, fish oil, probiotics, Vitamin D, and turmeric.

On the surface, it's not a bad list. Under the right set of circumstances, the first four have clear benefits. However, he did not know my medical history and therefore it was probably imprudent to him to make such specific recommendations, but then again I asked and he was happy to oblige. (Read more about this in part 2 of this blog.) 

For example, aspirin can prevent platelet aggregation (thereby decreasing blood clots) and some studies show some benefit in preventing colon cancer, but aspirin can also increase gastric bleeding and can lead to the development of macular degeneration. Given my history of gastric ulcer, aspirin is a tough choice.

One of my recent blogs dealt with fish oil at length, so just to summarize, its not the panacea everyone has made it out to be and given the option, eating fish like Wild Alaskan Salmon beats it hands-down.

Another one of my blogs dealt with probiotics and an extensive body of research supports my assertion that probiotics have no benefit if you have a generally healthy gut. They can be beneficial when taking antibiotics and when dealing with inflammation of the bowels, but they are not useful routinely.

Many people are apparently (I say apparently because no one knows for sure) Vitamin D deficient because of lack of sun exposure. However, treating anything on presumption, I believe is a mistake. First of all, many foods are fortified with Vitamin D so even though one does not get much sun exposure one is not necessarily deficient. Second, it is easy enough to check for a Vitamin D deficiency and by doing so the result will indicate if you there is a need to supplement and also how much should be taken.

So viewed in their entirety, the first four suggestions from Dr. Roizen were not outlandish as they generally do not cause harm (except for aspirin.) and may be beneficial at times. Tumeric, however, is another story.

Dr. Roizen told me that tumeric prevents Alzheimer's and is good for brain health. Based on Dr. Roizen's suggestion that day (and my hearing him repeat the same advice a few days later on the Retirement  Living TV channel), I naively purchased tumeric and began to add it regularly to my food.

Unfortunately, the highly staining substance turned my teeth bright yellow.  After this disconcerting turn of events, I began intensively researching tumeric and discovered two disturbing facts. First, tumeric has little validated science to support its use for the indications Dr. Roizen asserted. Second, I discovered that in the absence of a black pepper called piperine, tumeric is very poorly absorbed by normal ingestion and so adding it to my food was an effort in futility, except if turning my teeth yellow was my endgame. (By the way, I had to go to a dentist to get rid of the stain.)

Despite these five recommendations, I should have been even more wary of Dr. Roizen's advice when he also practically whispered to me, as to share a well-kept secret, that a certain statin drug had also been shown to decrease the development of Alzheimer's. The whispering should have been the giveaway. All statins are now widely accepted to have no efficacy for such purposes, but I suppose he was depending on some source of information to make his claim.

So now you know why it was disturbing for me to read about Dr. Roizen confidently disseminating advice about multivitamins.

Part 2

After reading Dr. Roizen's comments, I became curious about his background and read his bio available online. I find his credentials to be excellent.  I started thinking why a person like him would spew out what I believe is basically worthless, if not harmful advice, with such certainty. I also started thinking about Dr. Oz, a close friend of Dr. Roizen, (they've authored a number of books together and Dr. Roizen is an adviser to the Dr. Oz Show). Like Roizen, Oz's credentials are also top-notch.

Why, I asked myself, are such erudite men propagating such apparently bad advice about dietary supplements?  Why were they either ignoring or reaching different conclusions that I do from the numerous studies now widely available that show the dangers of dietary supplementation?

So let's assume for a moment that I am reaching the more valid conclusions. If so, what causes them to support the industry? Your first instinct may be to say money, but I dismiss money as the main motivator because I suspect they have already accumulated enough to live quite comfortably and I don't believe that for such distinguished and successful clinicians, it is the end to end all.

So what's the answer? I thought back to a recent episode of The Dr. Oz Show. The guest was a cryptographer (hand-writing expert). As part of the show, the expert analyzed a writing sample from Dr. Oz. His conclusion based on how Dr. Oz forms a wide-open at the bottom scripted 's.' was that this demonstrates that Dr. Oz is very susceptible to the opinion of others. Basically, he concluded that Dr. Oz's popularity stems from his genuine desire to please others. I think most people would agree that this is a pretty good trait to possess.

Let me preface my next comments by stating I have basically no training in psychotherapy. All that follows is conjecture. If you are interested, allow me to speculate why I think this trait of wanting to please others can be problematic especially for physicians in the limelight.

Most physicians are highly intelligent and possess a great deal of accumulated knowledge. Patients know this and expect doctors to be able to routinely answer their questions. However, the body of clinical knowledge, which continues to grow daily, is already far beyond anyone's grasp and that is why there are many specialties and sub-specialties in medicine.

For doctors in the limelight, however, they work hard to create a persona of all-knowing. They want to be viewed as saviors of sorts, able to help both small and wide audiences alike. They never want to disappoint by saying I don't know or I'm not sure.

This realization has caused me to think about my own approach. Until a few weeks ago, I grew more confident in my assertions and more provocative in my conclusions. Then a funny thing happened which I wrote about in another blog. During one of my lectures, an audience member challenged my statements virtually one by one. This forced me to recalibrate and make sure that everything I was saying was defensible. I think my conclusions were generally accurate, but generally was no longer good enough.  I realized after that talk that I was falling into the same trap that I think many before me have fallen into.  I realized that because almost nothing in regards to science can be said with absolute certainty, that it is not fair for someone who can get up and comfortably speak to an audience to assert otherwise.  A speaker should not be expected to always please his or her audience out of expediency if it is the truth that the audience needs and wants.

I believe that many of the doctors like Hyman, Oz, Roizen, etc, say what they say not because it will make them even more money; rather, because it will make their audiences like them more as they offer simple solutions to complicated problems. Some problems require the audience to work hard to accomplish effective solutions and promising quick fixes may be dangerous and inappropriate.

I promise to keep Mark Twain's words close to heart whenever I speak and write. Twain said "it's not what you know that gets you into trouble, it's what you know for sure that does."  Accordingly, as I continue to learn more about dietary supplements, I will work hard to report the facts (if they can be called as much), not my biases. I promise to answer "I just don't know" when that is the most appropriate answer. I think my patients and audiences deserve no less. What do you think?

Would You Want To Know Early?

A new test developed by Eli Lily & Co. that detects the presence of proteins in the brain that are related to Alzheimer's disease was approved Friday by the Food and Drug Administration.  Previously, Alzheimer's was only definitively diagnosed after death, through autopsy of the brain.

Before I get to the test, let me start with a note of positivity. Many people think that dementia is an inevitable result of aging. This is not true. Dementia only affects 1 out of 8 people above the age of 65 and only 3 out of 7 above the age of 85. That means that more than half of the people who live past the age of 85 do not develop dementia.That's important to remember! Also, while Alzheimer's is currently not effectively treatable, other forms of dementia representing about a quarter of dementia cases may have effective treatments and a number of other conditions which may resemble Alzheimer's may also be treatable.

So it would seem that this test would be well received.

However, the new test is stirring a bit of controversy primarily because there are no good treatments for Alzheimer's and therefore some question the value of early diagnosis. Others, including doctors, believe that early diagnosis is valuable because it will give people time to plan out their lives. Also, because the diagnosis of Alzheimer's is often made on general subjective clinical findings and not specific objective findings like blood results or other diagnostic tests, this new test allows for the first time for definitive diagnosis.

I agree with those who think the test is a valuable addition to doctors' diagnostic arsenal in identifying and battling this horrific disease. Early diagnosis will also allow researchers to develop more effective treatments for the disease and maybe some day to find a cure. As Alzheimer's is a lethal disease which strips people of most cognitive ability before denying life, I agree with many others that it would be prudent to give one ample time to arrange his or her affairs. In this case, Alzheimer's is unfortunately no different than wanting to know you have terminal cancer as soon as possible.

Also, definitive diagnosis may be of utmost importance because there are several disease that present like dementia such as delirium, and there are several forms of dementia including one called vascular dementia (muti-infarct dementia). Unlike Alzheimer's, vascular dementia is treatable and more importantly, it is not necessarily a progressive disease.

More excitingly, although a precise link has not been identified between Alzheimer's and lifestyle, scientists grow more confident that such a relationship exists.  For vascular dementia, the link is absolute. The same principles that apply to heart health, apply to this disease which consists of mini-strokes that destroy small parts of the brain in a cumulative fashion. This progressive destruction ultimately fully robs one of cognitive ability and other key brain functions. The major take-away is therefore, protect your heart, protect your head. Eating properly, staying physically active, managing stress, and getting 7-8 hours of sleep per night reduces the development and progression of these vascular events that mirror heart attacks.

For the rest of Alzheimer's, there is a 60% correlation between Alzheimer's and high blood pressure. The presence of diabetes and depression versus diabetes alone doubles the relative risk for developing dementia. These findings demonstrate the relationship between Alzheimer's and other diseases related to lifestyle.

So even though today doctors and scientists do not know with certainty how to prevent and treat Alzheimer's, it would seem prudent to live your life in such a healthy manner as to decrease the risk of vascular dementia and maybe even Alzheimer's itself.

If you know someone who has early clear symptoms of short-term memory loss, you should consult with a doctor and consider this test. In the interim, let's all hope and pray that a breakthrough discovery for this disease will come soon.

Cures For Alzheimer's Unfortunately Simply Don't Exist - Yet!

Without a doubt, except for cancer, no diagnosis strikes more fear in people's hearts than Alzheimer's. It not only robs memory, but it is also a terminal illness. As far as Alzheimer's diagnosis goes, although there are now some elaborate diagnostic test for it involving injecting dye, etc., most patients are still diagnosed empirically-which means by presenting evidence and ruling out other conditions and causes of memory loss and/or dementia such as mini-strokes, etc.

Given the severity of the disease,  it is not surprising that people so diagnosed as well as their loved ones are often desperately searching for news of a cure.  The current prescription medications available offer little solace and do little to slow disease progression.

I read a recent article about a man duped by a broadcast he watched that presented coconut oil as one such cure. A doctor on the Dr. Oz show offered hyperbaric oxygen therapy as yet another cure. Dr. Mark Hyman told me personally that he has cured Alzheimer's among his patients. I'm not sure there is anything more cruel that handing out false but fleeting hope to hurting people. Today, there simply are no cures for Alzheimer's.

However, there has been progress on the Alzheimer's research front. As discussed, diagnosis has improved.  A new animal model has been developed that may prove useful in someday finding a cure. Scientists now better understand how the disease spreads. There is reason for long term hope.

There are some known supplements that seem to have efficacy in cognition decline. As you know, I am not a fan of supplements in general but the science offers some support for these two. Bacopa for cognition and Huperzine A specifically for Alzheimer's.  Are they cures?  Absolutely not. May they provide some short term relief? Possibly. Their safety profile is not well known so I would only purchase them from a USP or Consumer Lab certified lab. Bacopa is recommended at 150 mg daily. Huperzine A dosages have ranged from 60 to 400 micrograms daily. I would not start these supplements unless under the supervision of a physician.

Do not take either drug if you are pregnant.

Concerns about Bacopa include:

1. Don't take if you have allergies to any member of the Scrophulariaceae (figwort) family. 

2. Adverse effects for bacopa may include drowsiness, palpitations, nausea, indigestion, increased bowel movements, abdominal pain, dry mouth, thirst, muscle fatigue, and fatigue.

3. Do not take with drugs or herbs that are metabolized by cytochrome P450 enzymes. 

4. Take under close medical supervision if you have a thyroid disorders, as bacopa may increase thyroid hormone levels.

 5. Take under close medical supervision if you take calcium channel blockers, due to the potential for additive effects. 

6. Take under close medical supervision if you are taking sedatives, due to the potential for additive effects.

Concerns about Huperzine A include:

1. Don't take if you have allergies to any member of the Lycopodium family.

2. May produce mild-to-moderate nausea and mild and transient ankle edema and insomnia.Close medical supervision is required if taking other acetylcholine inhibitors. May also cause temporary dizziness, sweating, vomiting, diarrhea, dizziness, anorexia, cramps, bradycardia, rash, skin hives, slurred speech, insomnia, excitability, hyperactivity, vision blurring, ankle edema, breathing problems, tightness in the throat or chest, or chest pain.

3. Close medical supervision is required if taking other acetylcholine inhibitors, as adverse effects are potentially additive, in patients with liver disease, as huperzine A appears to undergo hepatic metabolism,in patients with vertigo, as huperzine has been shown to cause dizziness in clinical trials, in patients with asthma, as huperzine A may cause breathing problems and in patients with renal disease, because of the renal excretion of the drug.

As you can read above, these supplements, like prescription medications, have some concerning side effects. So please only use them under close medical supervision.

In the meanwhile, let's all pray for an early cure for this devastating disease we all know as Alzheimer's.