From Jan/Feb '99
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SUCCESSFUL AGING
Since antiquity, from ancient Egyptians to Ponce de Leon, people have sought ways to extend their life span. Even though there is no fountain of youth, you do have control over how you age. You can lengthen your life, preserve your function, and retain a glowing attractive appearance. Look around you at your friends and relatives -- can you see the difference in how people age? Some are crippled, wrinkled, and gray long before they should be. And then there are others who retain that sparkle of youth in the way they look, feel, and function into their eighties and nineties. The difference is not due to a stroke of luck, but rather in how they have taken care of their precious bodies over the years. Fortunately, it is never too late to start. Everyday I see broken bodies transformed into more radiant, active, agile, brighter people. The secret for successful aging is almost too simple to believe -- it is a healthy diet, moderate exercise, and clean habits. But the results are no less than a miracle.
The Aging Process
Chronologic and biologic aging begin at conception, however, declines in function become apparent shortly after sexual maturation. It makes sense that optimum health would be designed to occur at a time of maximum reproductive capacity, since this would optimize the chances of successful reproduction for our species. After those reproductive years we become less important to the species and with time, the body declines, health problems become increasingly more common, and survival is threatened. In spite of its disadvantages to us as individuals, aging is beneficial, and even necessary, at the species level, for example, to prevent overcrowding.
Living Longer, But Not Successfully
As the average life expectancy has increased over time, the maximum life span has remained unchanged at about 120 years for humans. With more people living longer there has been a higher prevalence of disability. While some individuals get healthier, most are getting sicker as they age. The proportion of our population over the age of 65 has increased from 4 percent in 1900 to about 13 percent currently. Increases in life expectancy during the last century can be attributed to improved sanitation, greater availability of food and shelter, and other public measures that reduced infant and childhood mortality. The advent of antibiotics reduced death, especially in the young. Smoking, lack of exercise and poor diet have been linked to 700,000 deaths in 1990 (JAMA 270:2207, 1993). Since the 1960s, increases in life expectancy among middle aged and older individuals can be attributed to alterations in diet and lifestyle.
Aging Gracefully
The aging process cannot be stopped, but increasing chronologic age does not have to mean increasing disability, and loss of independence. While it is true that there is a reduction of height, mobility, muscle and bone mass, hearing, vision, and mental functions, as well as graying of the hair and wrinkling of the skin as the years pass, the loss can be mitigated. We know this because of the worldwide geographic variation in the incidence of these losses, which indicates that these losses are due to diet, physical inactivity, and bad habits (smoking). My years in Hawaii taught me this lesson well. Downtown Waikiki I would see thousands of elderly Japanese tourists looking young and fit with smooth skin and a full head of dark hair into their eighties. Yet the Japanese decendents born in Hawaii and raised on kalua pig and McDonald’s Quarter Pounders were often fat, graying, bald, and wrinkled in their forties.
Diet and lifestyle changes to date have been shown to have the greatest effects on health, fitness, and life span. For example, exercise as simple as regular walking is associated with lower overall risk of dying. A study of 707 nonsmoking men found those who walked more than 2 miles per day had half the risk of dying as non walkers (N Engl J Med 338:94, 1998). People who exercise also tend to eat healthier diets higher in fruits and vegetables and smoke less often (Med Sci Sports Exerc 26:224, 1994).
Closing Down the Arteries
The high-fat, high-cholesterol diet enjoyed by most Americans closes down their arteries and robs them of their function through a disease process known as atherosclerosis. The resulting problems are named based upon the organ or tissue affected. The following are due to an insufficient blood supply that may develop gradually or suddenly.
These conditions of "old age" are entirely preventable and largely reversible by a healthy diet and lifestyle. Sometimes the judicious use of cholesterol lowering medications can be helpful.
Mental Dysfunction
Loss of mental function is commonly seen among aging Americans. A diet high in fat and cholesterol has been shown to increase the risk for premature loss of mental function (Ann Neurol 42:776, 1997). This may be due to small strokes or more subtle decreases in blood supply to brain tissue. More severe and rapid loss of mental function occurs with Alzheimer’s disease. Aluminum toxicity in susceptible people is the cause of this disease. (Gerontology 11:16, 1997). Much of the aluminum enters the body in our food from pots, pans, cans, and additives. The use of antiperspirants has been linked with the systemic accumulation of aluminium and an increased risk of Alzheimer's disease. (Mol Med Today 4:107, 1998). This occurs because the active ingredient in antiperspirants is aluminum chloride, which is inadvertently sprayed into the nose where it enters the brain through the olfactory lobes (stalks of the brain). (Plain deodorants do not contain aluminum chloride).
The best way to prevent and/or slow the progress of Alzheimer’s dementia is to eat a healthy diet and avoid inhaling or ingesting Aluminum. Gingko biloba is an herb that has been shown to improve mental performance and the social functioning in people with Alzheimer’s disease (JAMA 278:1327, 1997). Aluminum can be removed from the body by chelation with substances like desferrioxamine, preventing further damage to the brain and slowing the progress of the disease (J Toxicol Environ Health 48:667, 1996).
Weakening the Bones
The average American diet, which is high in protein and low in fruits and vegetables, generates a large amount of acid (mainly sulfuric and phosphoric acids) which must be buffered by active resorption of the bones (J Nutr 128:1051, 1998). The dissolved bone is then excreted by the kidney into the urine. Muscle foods (beef, chickens, fish, shrimp, etc.) and eggs are the highest generators of acid for the body. The addition of alkaline foods, which are fruits and vegetables reverses the loss of calcium and the dissolution of the bone. Bone may then be rebuilt, and eventually changes that lead to osteoporosis are reversed.
Crippling Arthritis
The most common form of arthritis is known as osteoarthritis, also referred to as degenerative arthritis, which is supposed to be a result of normal natural aging. In the United States, this form of crippling arthritis is seen in x-rays of the hands of over 70% of people age 65 years and older. However, this same disease is comparatively rare in African and Asian countries, where people physically labor to survive (Br J Rheumatol 24:321, 1985). How can that be? Osteoarthritis is said to be due to wear and tear on the joints, so why is it less common among hard working people of underdeveloped countries? Nor does it explain why with light use, the hands of women often become twisted and deformed with age.
Osteoarthritis develops when damage to the joints exceeds the capacity of the cartilage materials to make repairs; the result is the joint surfaces become eroded. The rich American diet lays the foundation for osteoarthritis. Toxins come from the foods we eat. Animal studies have shown that an unhealthy diet fails to provide adequate antioxidants to destroy the free radicals that form, that damage the joint tissues (J Orthop Res 8:731, 1990).
Poor circulation may play a major role in joint deterioration. The severity of osteoarthritis is found to correlate with risk factors for coronary artery disease in people (J Cardiovasc Risk 3:529, 1996). No surprise, the diet and lifestyle that leads to one degenerative disease also enhances the development of others. Cholesterol added to the diet of experimental animals increases the incidence of osteoarthritis (Pathol Microbiol (Basel) 43:265, 1975). This disturbance in circulation that affects the joints occurs at the level of small blood vessels such as the capillaries, and causes inflammation and destruction (Sem Arthritis Rheum 12:11, 1982).
Kidney Loss
The high protein content of the American diet places wear and tear on the kidney tissues. The result is that the average American loses about one-fourth of their kidney function by age of 70 years (N Engl J Med 307:652, 1982). This does not cause a problem for most people unless they have lost kidney tissue from other causes, because it only requires one-third of the kidney mass to clear all wastes from the body.
Outward Signs of Aging
Our skin and hair are among our most telling signs of aging. Poor circulation to the skin causes it to lose its normal elasticity and to become wrinkled. Cigarette smoking further compromises circulation and provides products toxic to the skin (Ann Intern Med 114:840, 1991). Heavy smokers are nearly five times more likely to be wrinkled than nonsmokers. Combined with heavy sun exposure, heavy smokers are 12 times more likely to be wrinkled. Aging of the skin by excess sun exposure results in coarseness, wrinkling, pigmentation, exposed blood vessels (telangiectasias), precancerous lesions (actinic keratosis) and cancers.
Gray hair, baldness, and wrinkles are reliable signs that a man is at increased risk of suffering from a heart attack (Am Heart J 130:1003, 1995). Gray hair indicates the susceptibility to heart attacks with a similar strength to that of smoking and the presence of diabetes. In women, graying showed a similar but weaker effect. The importance of baldness and graying is found in younger and older men. The male hormone, dihydrotestosterone, is the main agent responsible for baldness and may be an important reason men have more heart disease than women. The high-fat, low-fiber, meat-laden American diet is the cause of elevated dihydrotestosterone levels, and baldness in genetically susceptible men.
Not only is graying a sign of more heart disease, but it also is associated with more bone loss. When the majority of a person’s hair was gray by the age of 40 years, then the bone density was reduced by 7% to 8% in the hip (femoral neck and trochanter), and 4% in the total body when compared with those not prematurely gray (J Clin Endocrinol Metab 82:3580, 1997). The common findings of bone loss, heart disease, graying, baldness, and premature wrinkling point to common denominators of a high-fat diet, lack of exercise, and unhealthy lifestyle (damage from excess sunlight and cigarette smoking). Stop these behaviors and you will slow, and reverse, the aging processes inside and outside. The occurrence of precancerous lesions, known as actinic keratosis, in sun damaged skin can be reduced by more than two-thirds when the fat in the diet is reduced from 40% to 21% (N Engl J Med 330:1272, 1994).
Calorie Restriction
Restricting the food intake of mice and rats of all ages to a level 20 to 40 percent below which the animals would voluntarily consume, markedly slows the aging processes. They live up to 50 % longer, have fewer diseases associated with aging, and their tissues are maintained in a more youthful state. Alterations in the way the body metabolizes carbohydrates may underlie this mechanism for anti-aging.
Prolonged life from calorie restriction has an adaptive advantage for species survival. When calorie intake is excessive, physiological priorities are set for body growth and reproduction rather than endurance and longevity. The converse occurs when food is in short supply in order to increase the probability that sufficient individuals will survive to restore the population when conditions improve. In other words, during famine or drought, to avoid extinction, reproduction is curtailed and aging is slowed to postpone the end of reproductive years until food is again available. Overall the body improves its defenses from environmental stresses.
The effect of calorie intake in people may be the same. Ultimate height and weight of an individual is determined by their calorie intake. The amount of calories consumed during adolescent growth plays a determining role in eventual adult height, and a person’s current calorie intake determines body fatness (weight). Men of a height of 5 ft. 9 in. (175.3 cm) or less live 7.46 years longer than men of at least 6 ft. (182.9 cm). Men weighing less than 140 lb. (63.6 kg) live 7.72 years longer than those weighing more than 200 lb. (90.9 kg) (Bull World Health Organ 70:259, 1992. So bigger is not necessarily better, as believed by most Americans.
Diet and Lifestyle are the Key to Successful Aging
The main problem with calorie restriction is that it hurts to be hungry and it can be accomplished for a long time by only a very few stoic people. There is a way to reduce your calorie intake and to avoid hunger and that is to eat a low-fat, high-carbohydrate diet of unprocessed plant foods. In a classic study published in 1987 in the American Journal of Clinical Nutrition, subjects were fed diets for 2 weeks, each containing 15-20%, 30-35%,, or 45-50% fat. The diets were similar in appearance and palatability but differed in the amount of high-fat ingredients used. Spontaneous energy intake was 2087, 2353, and 2714 calories on the low-, medium-, and high-fat diets, respectively. Therefore, without being hungry and without any effort you can restrict your calories with a lower fat diet.
That very same diet, when based around starches with the addition of fresh fruits and vegetables, minimizes the intake of toxins such as fat, salt, animal protein, cholesterol and free radicals; and maximizes the intake of nutrients, antioxidants, and other phytochemicals that keep your body younger looking, feeling great, and fully functional. It is not unreasonable to expect that the average person’s life can be expanded by 5-10 more useful years (Proc Natl Acad Sci USA 78:7124, 1981). Now the average life expectancy for men is 72.5 years and for women 79.3 years in the United States. This would bring us over the present average life expectancy of Japanese men of 79.5 years and women of 82.5 years, as we switch more towards a plant-based, oriental-type diet.
Reversing Skin Aging:
Estrogen therapy (HRT) has been demonstrated in some studies to increase skin thickness, reduce dryness of skin and hair, and prevent atrophy (Theropie 51:67, 1996). This amounts to smoother, less wrinkled skin. HRT does not seem to do much for the wrinkled skin of smokers (Maturitas 29:75, 1998). HRT exerts a beneficial effect on the skin by slowing the process of skin slackness that follows menopause.
A Vitamin A derivative cream called tretinoin, and sold as Retin-A, is very effective at reversing skin aging with reduction in wrinkling and removal of dark, irregular skin pigmentations (J Am Acad Dermatol 26:215, 1992). An effective and safe formula contains 0.05% tretinoin as a cream.
Alpha hydroxy acids, "wrinkle creams," improve facial skin tone and fine wrinkling with application to the skin, and can be bought without prescription in "anti-aging" moisturizing lotions and face creams.
Deep chemical peels can improve damage from sun exposure and changes with aging
Botulism toxin injections into the muscles under the wrinkled skin paralyzes the nerves to the skin causing the skin to relax and the wrinkles to disappear, and lasts about 6 months (Plast Reconstr Surg 94:94, 1994). This technique is especially useful for wrinkling of the forehead and crows feet about the eyes.
Precancerous and cancerous lesions can be removed by an anticancer drug (5-fluorouracil, Efudex), by liquid nitrogen, and by taking the top layers of the skin off by using laser energy.
Plastic surgery can smooth out wrinkled skin by mechanically stretching it across the skull. Baggy skin under the eyes and the chin can be cut away leaving a more attractive and youthful appearance.
ANTI-AGING POTIONS
Concoctions and mixtures of organic and inorganic origin have been offered to retard aging for hundreds of years. Normal aging is the sum of many mechanisms operating at the molecular, tissue, and organ levels. Several hundred genes are involved in the aging process. Therefore, it is extremely unlikely that a single intervention could reverse all aging processes, and substantially prolong life span.
Melatonin
Melatonin is involved in mood, sleep, sexual behavior, reproduction, immunological functions, and circadian rhythm. It also delays aging by acting as a free radical scavenger, cleaning up free radicals (Biochem Pharmacol 56:1265, 1998). Peak levels occur during normal sleep hours. With aging there is a definite decline in night time melatonin levels. Mice fed melatonin at night in their water bottles live significantly longer than controls (Proc Natl Acad Sci USA 91:787 1994).
Garlic
Garlic has been shown in rats to prevent atrophy of the brain and thus may have an anti-aging effect (Exp Gerontol 32:149, 1997).
DHEA
DHEA is an abbreviation for dehydroepiandrosterone, a hormone made in the adrenal glands. Levels fall dramatically with age from 3470 ng/ml in men of age 20 to 24 to 670 ng/ml in men over 70 years. In women levels fall from 2470 ng/ml to 450 ng/ml (J Clin Endocrinol Metab 59:551, 1984). The hormone can have effects both like testosterone (androgenic) and estrogen (estrogenic). High levels may protect against breast cancer in premenopausal women, but may increase the risk in postmenopausal women (Cancer Res 55:4870, 1995). Muscle strength has been found to increase with DHEA (Biol Psychiatry 30:371, 1991). However, there is too little data to conclude DHEA will greatly effect the illnesses associated with aging. As monkeys age their levels of DHEA decrease. Calorie restriction, which extends the life span of rodents and retards aging in laboratory animals, slows the decline of DHEA levels.
Antioxidants
As we age we are exposed to oxidative damage from free radicals from our food and from the normal metabolism that sustains life. Free radicals are highly active substances that damage proteins and DNA. The body has several mechanisms for detoxifying free radicals including enzymes (superoxide dysmutase, catalase, and glutathionine) and vitamins (E, C, and beta carotine). Many people interpret these findings to mean they should take supplements of antioxidants, but a safer and more effective approach would be foods. Increased consumption of fruits and vegetables has been proven to increase the antioxidant capacity of the human body (Am J Clin Nutr 68:1081, 1998).
From Jan/Feb '99
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Back Issues of Newsletter