Saturday, June 17, 2006

Back to School 2: Harvard Medical School Brains Tell Us How to Lead a Long, Healthy Life.(Rule one: Be a Woman.)

Dr. Anne Fabiny, Assistant Professor of Medicine, Harvard Medical School, and Director of Geriatrics Education at Beth Israel Deaconess Medical Center, takes the podium. Her scholarly interests are in geriatrics curriculum development and teaching. She is a member of the Academy at Harvard Medical School.

Dr. Fabiny shows us what we're up against on a large screen-- life expectancy tables at various ages from birth (74.7 years for boys, 79.9 for girls) to 100. A hundred-year-old can expect to live under a year. The chart shows that this writer, at age 68, has a life expectancy that makes me not a good bet to outlive a 15-year mortgage and leaves me many, many years years short of making it on stage as a 119-year-old comic.


For this long-in-the-tooth fellow, there is nothing but impeding doom in the tables. Looking at it, I can almost hear the softening, mournful tones of the diminuendo. Perhaps sensing a bit of a letdown in an audience knocking on the upper limits of the human life expectancy, Dr. Fabiny throws out a bone. “The good news is that the longer you live, the longer you live.”

Most of the audience is made up of physically superior, long-living women. Dr. Fabiny takes us through the aging process of a typical woman. At 45, her hair turns gray. At 53, she gets hot flashes. At 70, she gets high blood pressure. At 75 she has trouble climbing stairs. At 81 she starts falling. At 82, she has gotten rid of her husband, exercises, changed her meds and now golfs, travels and has a new boyfriend.

Women in the audience giggle.

“While we're waiting for David's pill, what can we do to help ourselves lead a longer, healthier life?” Dr. Fabini asked. “The importance of exercise cannot be overestimated. And by that, I mean regular exercise. If exercise were a pill, everybody would take it.”

She ticks off the benefits of regular exercise. “First of all, it retards the biological aging process. It is so good for our bodies that we should all get an exercise prescription from our doctor. Secondly, it enhances psychological function. It improves how we feel about ourselves, people in our lives, and the world at large.”

Dr. Fabini said the exercise should be of three main kinds: resistance training, cardiovascular endurance training, and balance training. Resistance training means working out with weights two to three days a week.

Older people should work into it slowly with “no ballistic movements. “Don't lift weights every day; you'll only hurt your muscles.”

Cardiovascular endurance training consists of weight-bearing activities such as walking. People forget that walking is a weight-bearing exercise and an excellent one, Dr. Fabini said.

She said the object is to increase the workload on the heart and lungs progressively. “In parking lots, park as far away as you can because every little bit of walking helps. Never use the escalator. Walk up the stairs instead. Avoid the remote control.”

Balance training can be done with very simple exercises: walking in a straight line, heel-to-toes, the task that police give to drivers to test for intoxication; balancing on one leg, swinging the second leg forward and backward; walking sideways, first one direction and then the other; and carrying small items at arm's length while walking. Dr. Fabini also recommends periodically rising from a chair on one leg, which builds both balance and strength.

Slim and clearly fit, Dr. Fabini demonstrates each balance exercise. Watching her doing walkovers, balancing on one leg, walking sideways back and forth exemplifies what this seminar is about: using our bodies thoughtfully and healthfully – and making them last longer than our ancestors could ever have imagined.

The sight of a Professor at the Harvard Medical School up there going through her paces, like a dance instructor or movement artist, is also an apt reminder that HMS is a temple of the body as well as of the mind.

The mind, oh yes; nearly forgot. Just a little memory lapse, or was it more than that? Most older people fear memory loss more than physical loss because it may indicate the onset of dementia which can eventually rob them of identity, self-respect, everything precious in life.

Dr. Fabini says that we can do much to prevent memory loss and it all revolves around regular exercise of the brain. By giving our brains a good workout as little as one day a week – reading, board games, dancing in a musical; anything that provides a good mental stretch -- we can reduce the risk of dementia. “And it is incremental,” she said.

More exercise? What a drag. How about something easy and less time-consuming and more modern, like a pill? If Dr. Sinclair (See previous post) can work on a pill to increase longevity and be taken seriously, what about a pill to prevent memory loss?

“Researchers are working on a memory-loss pill,” Dr. Fabini said. “Right now there are a number of randomized, double-blind, placebo-controlled trials going on.”

Randomized, double-blind, placebo-controlled.

That is academic language meaning that the research is serious. If the history of drug development is any guide, serious research into a memory-loss pill is likely to result in a memory-loss pill.

While waiting for such a pill, we might consider taking Ibuprofen. “There is some evidence to suggest that Ibuprofen helps prevent dementia,” Dr. Fabini said.

She also says that the supplement Gingko Biloba may be helpful in the amount of 180 mg a day. “One important study of Gingko Biloba use found clinically significant prevention of dementia,” Dr. Fabini said.

A growing number of books, videos, Internet sites, and special classes promote a sort of mental aerobics claiming to improve memory, sharpen thinking, and prevent or delay dementia. Many of the programs focus on techniques for improving memory and concentration, such as paying closer attention (if it doesn't go in, it won't be there to be recalled), associating words and images with visual images, repeating information aloud, and breaking information into smaller pieces.

Research shows that such techniques can be effective. A recent study in the Journal of the American Medical Association of people 65 and older found that 26% performed better on memory tests after 10 sessions in memory techniques. Ability to process information quicker and solve problems increased even more.

However, many researchers on memory and cognition distinguish between short-term training to improve memory or reasoning skills and ongoing mental activities that regularly stimulate the brain. They say that the latter is what matters most in slowing down overall cognitive decline and perhaps heading off dementia.

To that end, Lawrence Katz, a Duke University author and scientist, has developed “neurobic” exercises involving doing routine activities in new ways (e.g. writing with your non-dominant hand). The idea is to get the brain off autopilot and put it to work.

The harder the brain has to work, the better it can perform and the longer it can do so, according to studies. A study published by the New England Journal of Medicine in 2003 concluded that people who frequently read, play board games, and play a musical instrument or dance, have a reduced risk of dementia. As is the body, the brain is like a racehorse: it has to be exercised – or it loses function.

Afterwards, the faculty presenters take questions. Asked if more vigorous exercise is more beneficial than a moderate exercise like walking, Dr. Fabini said: “Brisk is always better. The more you work your heart the better. Exercise, exercise, exercise.”

Diet supplements are a huge, multi-billion-dollar industry in the U.S. Slick color magazines on life extension are packed with ads for longevity supplements and scientific-sounding articles implying that the supplements work.

Asked if there any supplements on the market that increase longevity, Dr. Sinclair said flatly, “Don't buy any of them. You're better off saving your money.”

Why do women live longer than men? Three learned professors at Harvard Medical School appeared baffled by the question from the floor. While the three looked around at each other, with no one volunteering to have a go at the question, there was a slightly awkward moment.

Finally, the chairman of the event, Dr. Lipsitz, spoke in a non-too-confident voice: “It may have something to do with genetic differences. Or it may be a result of their greater social connectedness than men, which is a known benign factor in preventing diseases. But the truth is that we have no sure answer as to why women live longer than men. Medicine is a bit embarrassed that we do not know.”

Ah, the perfect crowning touch to a stimulating and informative seminar -- a front row seat at the public self-humbling of three learned professors at the Harvard Medical School. They fessed up to not knowing something that every woman in the audience knows in her bones: that women live longer because they have to for the sake of the species.

Rationale: The typical man left alone can't take care of himself never mind look after others and nurture the healing needed for society to carry on; the typical woman does both with her eyes closed. Source: my wife. And if you don't believe her, ask any woman on the street.

This untested observation will not be published soon in Nature, though it probably should be. Comparative studies of male and female physiology offer lots of evidence that we males are truly the weaker sex. We appear to carry inherent vulnerabilites in our genetic and hormonal make-up not present in our girlfriends, wives, and daughters. Which makes sense, since they are the ones we rely on to save the species.

Male weakness begins in the womb where male embryos outnumber female fetuses but suffer more miscarriages. Boys who manage to get born start out life behind the survival eight ball and stay there their entire lives. A baby boy is more likely than a baby girl to have a defect at birth and is three to four times more likely to have a developmental disorder such as autism or dyslexia.

In the teen years, more boys than girls commit suicide and die violent deaths before reaching adulthood. As adults, men get coronary heart disease a decade earlier than women and are twice as likely to die from it. For men, the news from cancer is almost as bad.

The same is true for common infections. Of the ten most common infections, men are more likely that women to have serious bouts with seven of them. Compared to my wife's, my immune system is a pushover for marauding microbian invaders.

And speaking of marriage, men have a hard time surviving without it. Compared to single men, married men are healthier, better adjusted, make more money, and live several years longer. Women yearn for marriage but are often better off physically and emotionally without the responsibilities (and, sadly, that's what marriage is for most women) of a husband. Merry widows are not the stuff of fiction, but of reality.

Besides coming out of this wonderful seminar with your brain synapses snapping, a lucky attendee can also scoop up free materials from the National Institutes of Health. The materials are up to date, highly informative, and based on the best available research. With so much health information today dubious, authoritative information like this is a treasure. You can believe it and you can act on it.

Following are ten tips on healthy aging from one NIH booklet:

1.Eat a balanced diet, including five helpings of fruits and vegetables a day.
2.Exercise regularly (check with a doctor before starting an exercise program if you have any chronic illnesses).
3.Get regular health check-ups.
4.Stop smoking (it's never too late to quit).
5.Practice safety habits at home to prevent falls and fractures. Always wear your seatbelt in a car.
6.Stay in contact with family and friends. Stay active through work, play, and community.
7.Avoid overexposure to the sun and the cold.
8.Use moderation if you drink alcohol. When you drink, let someone else drive.
9.Keep personal and financial records in order to simplify budgeting and investing. Plan longterm housing and money needs.
10.Keep a positive attitude toward life. Do things that make you happy.

These tips are admittedly simple and most of us have heard of them before, but they are based on years of research gathered by the National Institutes of Health. Every word has been chosen carefully and is backed up by science, real science not pseudoscience.

In personal health, doing the little things like those above can have a huge influence on how long you stay vertical and viable.

To the ten tips above, I would add two:
1.Refuse to take yourself seriously.
2.See humor everywhere and laugh out loud a lot.

RED FLAG! The last two tips are not, repeat, NOT from the National Institutes of Health, are NOT endorsed by Harvard Medical School, and have NOT been scientifically proven in controlled trials.

So long and keep moving.

 E-Books by George Pollock

"State Kid: Hero of Literacy" is fiction based on his  real-life experiences  growing up in foster homes; "Last Laughs," is the true story of how five foster kids (he and four younger siblings) found their way in life and each other. "Killers: Surprises in a Maximum Security Prison," is the story of the author being locked up for 23 hours with killers in a maximum security prison;  "I, Cadaver" is about the author's postmortem adventures and mischief in the anatomy lab at UMass Medical School. “A Beautiful Story” demonstrates the art and process of creative writing as a 16-year-old boy goes all out to write a story good enough to get him into an exclusive college -- on full scholarship; and "A Long, Happy, Healthy Life," which is about how to live the title every single day.

Monday, June 12, 2006

Back to School: I Become a Student at the Harvard Medical School

The seminar at the Harvard Medical School is free and open to the public. It is entitled, “Aging Well: Finding Keys to a Longer, Healthier Life.” The moderator and two presenters are professors at Harvard Medical School.

So, having a pulse, I get to go to Harvard. So much for Ivy League standards.

The moderator is Lewis A. Lipsitz, MD, director of the HMS Division on Aging and Chief of the Gerontology Division, Beth Israel Deaconess Medical Center. Dr. Lipsitz' research focuses on falls and syncope in the elderly, blood pressure regulation, orthostatic hypertension, and clinical geriatric syndromes.

This geriatric guy and his wife have a front row seat, thanks to a prevalent but under-appreciated and understudied phobia called Front Row Syndrome. Sufferers are afraid to sit in the front row; they will do so only at gunpoint. An apprehensive wife, obviously in the early stages of the disorder, has to be coaxed into the empty front row.

Why does no one care about FRS?

Dr. Lewis says the purpose of the seminar is to bring a “little bit of medical school to the public.” The full house of mostly older people will hear the same information and research findings on aging and human longevity that medical students are getting, and from the same professors.

“Aging used to be viewed as a long period of decline,” Dr. Lewis says, “leading to death. But now we recognize that for many people, aging is actually a period of vitality, of self-actualization. It can be a positive thing in which people maintain a high quality of life until the day they die.”

Dr. Lewis said that one simple fact of demography overshadows all else in aging and health care today: people are living longer and 13% of the population – those 65 and over -- “consume most of our medical resources.”

Presenting first is David Sinclair, PhD, of the HMS Department of Pathology. Dr. Sinclair's research focuses on finding small molecules and genes that can delay or prevent diseases caused by aging. He has recently published major new findings in the prestigious journal Nature, describing a “master regulatory gene” and extending lifespan in lower organisms. He is founder of SIRTRIS Pharmaceuticals, a company seeking to develop drugs to combat diseases of aging such as cancer and diabetes.

Dr. Sinclair is boyish, with a full head of light brown hair, looking far too young to be a professor at Harvard Medical School and a leading researcher in the field of aging and longevity. He apologizes for the Australian accent he has not been able to shake despite several years in Boston.

He begins by saying that human beings today face a barrier of 100 years of age, mainly because of the death toll taken by major chronic diseases such as cancer, heart disease, and stroke.

“Is there an underlying cause of each disease?”

There is a perception, Dr. Sinclair said, that “when a few of us get it, it's an illness; when disease occurs in more than 50% of the population, it is part of aging.” But the fact is, Dr. Sinclair said, we can do a lot to delay aging. “Within 15 years we will have a pill that will slow down the processes of diseases.”

In all animals, he said, aging is slowed down by an extreme diet known as calorie restriction. “I tried it for about a week and gave up. You're hungry all the time. It was too tough for me.” But he emphasized that severe calorie restriction works in all laboratory animals, from worms to rats.

A gerontologist who did pioneering research showing that a low-calorie diet could prolong life and increase vigor was Dr. Roy Walford. His most famous subject was himself.

For the last 30 years of his life, Dr. Walford adhered to a diet of about 1,600 calories a day, far below the 2,000 to 2,800 calories recommended. Eating mostly fruits, vegetables, fish, and lean meat, he kept his weight at about 130 pounds. He stood 5-foot-9.

Dr. Walford experienced major health benefits: lower blood pressure, reduced blood sugar, better cholesterol, more energy and greater zest for life. In research with other people, he demonstrated similar results.

“His work really established the sub-caloric diet as a valid way of increasing longevity,” said Dr. Jonathan Braun, the chairman of pathology and laboratory medicine at the David Geffen School of Medicine at U.C.L.A.

In 1991, Dr. Walford's restricted-calorie diet was put to the test on a national scale when he become one of eight researchers to seal themselves in Biosphere 2, a three-acre self-contained greenhouse in the Arizona desert. Shortly after shutting themselves in, they discovered that they were short of food.

With food scarce, Dr. Walford put the group on a severely restricted diet. When the door of Biosphere 2 was opened two years later, the group emerged with drastic weight loss and improved health.

But the restricted diet could not save Dr. Walford from amyotrophic lateral sclerosis, or Lou Gehrig's disease. He died of the disease in the spring of 2004 at the age of 79, victim of the greatest barrier to human longevity today – chronic disease.

“Life expectancy and life span are not the same,”Dr. Sinclair said. “Life expectancy is the number of years a new baby can expect to live. In 1900, life expectancy was 47 years. Today it is 77.4 years. Life span is the number of years a human being is capable of living. Some say that is 100. Over the last few decades, this number has been creeping upward.

"Maybe this is good, maybe it's not so good. What we should all want is for life expectancy to perfectly match life span. That means we would all live happily to the fullest [the maximum human life span] and then drop dead.”

People are surprised to learn that much of Dr. Sinclair's research centers on simple yeast cells. “Yeasts are organisms who have a life,” he said. “They take nourishment, find mates, reproduce, and have a life span.”

In short, he said, yeast have the essential characteristics found in the animal kingdom, plus a short life span, which makes them suitable for the study of the aging process; the shorter the lifespan studied, the faster answers can come.
Every animal has an intimate relationship with food and this is true of simple organisms like yeast, Dr. Sinclair said.

If yeast have enough food, "they are happy, want to grow fast and want to reproduce. If food is scarce, the yeast become stressed and undergo bodily changes to protect themselves. They pull back from reproducing. Their actions seem to be saying, 'Why reproduce if the offspring are just going to die?'”

This defensive action seems intended to reduce damage to the body, Dr. Sinclair said. It also slows the metabolic rate which has the effect of shifting the body down to slow motion.

“What appears to be happening is that the body is being tricked and mounts defenses,” Dr. Sinclair said. “A car doesn't fix a scratch, but we do. We have little cellular mechanics that spring into action during times of stress and fix us.”

In 1990, the first longevity gene was discovered in a worm. It was a single gene. “That told us that aging can be regulated and that a single gene is the master regulator,” Dr. Sinclair said. The process starts with the diet, which activates the master regulator gene, which changes metabolism and slows the aging process, Dr. Sincalir explained.

When Dr. Sinclair and his team applied severe calorie restriction to yeast, the organism reacted just this way. He and his team found that a single gene, the master regulator, is the engine of the process. The name of the gene is Sir2. Dr. Sinclair reported this remarkable finding in the May 2003 issue of Nature.

Another important finding from Dr. Sinclair's lab quickly followed. Having learned about the controlling role of Sir2 in the aging process in yeast, the scientists searched for a means to activate the master regulator gene without first nearly starving an organism to death.

They succeeded in finding the means in a specific molecule. But where they found the molecule came as something of a shock. They found it in, of all things, red wine.

“I almost fell out of the chair,” Dr. Sinclair said.

The molecule, resveratrol, extends the lifespan of lower organisms by activating an anti-aging pathway. This finding was also reported in Nature, August 2003. Since then, Dr. Sinclair has been introducing resveratrol to a variety of lab organisms and has found that it significantly extends the lifespan of every organism. It doubles the lifespan of yeast, for example.

“We were very sad when those old yeast finally died,” Dr. Sinclair said.

What next?

“The goal now is to design drugs to slow down the aging process.” Dr. Sinclair smiled coyly. “I have a scoop for you, something that hasn't been published but will be soon. Almost certainly this will work in a person.”

So long and keep moving.