Health Talk: Healthy Aging
Hosted by Craig Stoltz
Washington Post Health Editor
Tuesday, April 18, 2 p.m. EDT
This week's health section focuses on preparing for a healthy seniorhood as early as possible. Learn about ways you can maintain a high quality of life into your golden years. On "Health Talk" with special host Lexie Verdon, our featured expert answered your questions and concerns about healthy aging.
William J. Evans, Ph.D. is the director of the Nutrition, Metabolism, and Exercise Laboratory in the Donald Reynolds Department of Geriatrics at the University of Arkansas for Medical Sciences and a research scientist in the Geriatric Rehabilitation, Education, and Clinical Center in the VA Medical Center. He is also currently a Professor of Geriatrics, Physiology, and Nutrition.
He co-authored "Biomarkers: The Ten Determinants of Aging You Can
Please read the transcript below.
Good afternoon. Today, we're looking at the issue of successful aging. It's never too early to start thinking about growing old.! From the day we're born, decisions about nutrition and lifestyle will impact our old age. So please send us your questions about how to have healthy senior years. Our guest today is William J. Evans, the director of the Nutrition, Metabolism, and Exercise Laboratory in the Donald Reynolds Department of Geriatrics at the University of Arkansas for Medical Sciences and a research scientist in the Geriatric Rehabilitation, Education and Clinical Center in the VA Medical Center. He also co-authored "Biomarkers: The Ten Determinants of Aging You Can Control." Dr. Evans, thank you for being with us.
Is heredity the main determinant for a healthy old age?
William Evans: Heredity is clearly very important. It most certainly determines your true "biogenic" potential for living a long life. However, how we live our lives will determine whether or not any of us will live to our true biogentic potential. For example, if you have a family history of heart disease, we know that low fat diets, exercise, and aggressive lowering of cholesterol can prevent a heart attack. This is very true of many chronic diseases that effect elderly people, like type 2 diabetes and high blood pressure. Not every one of us will live to be 120 years old, but we should all strive to live active, independent lives until we reach our individual biogentic potential.
Have you ever studied the effects of caring for an older person in aging a younger person? Unfortunately, after three years of caring for an uncaring mother in law, I find my mother bitter and generally less nice.
William Evans: We have not studied this in our laboratory, however it is an active area of research in other places. We do know that the health of the care givers is often compromised by the tremendous burden that often accompanies taking care of a loved one. This increased stress often causes a decrease in how your immune function works, making you more likely to get colds and the flu. You should make certain that you take care of yourself as well as your mother. Find outlets for yourself and enlist the help of other family members social services. But also important is to have some one to "blow off steam" too. Good luck.
Dr. Evans, obviously, we've all heart many times that we need to take care of our bodies. And our story in The Washington Post this morning makes clear that the aging process for some diseases such as osteoporosis can begin in childhood. But should people who are middle-aged feel like they missed the boat if they haven't been especially careful about their health?
William Evans: I think that one of the central messages of our research is that it is never too late for prevention. We have been able to get people as old as 100 years involved in a weight training program and have tripled their strength, improved their balance, and increased their overall activity level. This has the effect of reducing their risk of falling down. So even in this population, some degree of prevention works. Clearly, the earlier you start, the greater the effect. However, research shows that if you wait until you are past 70 years old to start an exercise program, you will still be able to significantly extend your life expectancy.
Mr. Evans: What are the preliminary signs of Alzheimer's? My dad is often forgetful and has, on occasion, gotten lost in areas with which he is quite familiar. My mom laughs it off and says its nothing but he won't go to see a physician. He's always been a person who enjoys kidding around but I am getting increasingly concerned. Thank you.
William Evans: Sometimes forgetfulness is a "personality" trait. I know it is for me. However, if the behavior of you dad has changed and he is much more likely to forget things, you should contact a Geriatrician (doctor who specialized in geriatric medicine) in your area. Remember, loss of cognitive function does not have to be a feature of aging.
The demographics all show that people are living longer now. But in some ways, when we talk about healthy aging, it's not so much living longer but living better. Can you describe how early intervention might help improve the quality of life when someone reaches his or her seventies or eighties?
William Evans: Yes. Our personal goal should be to live an active and vigorous life. Unfortunately for many of us the last years are often spent dependent on other for many aspects of personal care. We do know that for anyone, exercise programs can greatly increase functional capacity and independence. We know that one of the primary deficits that occurs with advance age is muscle weakness. By correcting this problem, many other age related factors may be improved.
Can you talk a little bit about your book and what the 10 biomarkers are that you believe help people control aging?
William Evans: My book, titled "Biomarkers: The ten determinants of aging that you can control" is published by Simon and Schuster and it is my hypothesis that these biological markers that have been thought to occur as a result of chronological age are, in fact a product of how we live our lives. These biomarkers include, muscle mass, strength, basal metabolic rate (how many calories you use at rest), aerobic capacity, blood pressure, insulin action (risk of diabetes), HDL to total cholesterol ration, bone density (risk of osteoporosis), and ability to control your body temperature (remember elderly people are much more likely to suffer from heat stroke and heat exhaustion).
The hallmarks of health advice in recent years have been: eat a varied diet that is rich in fruits and vegetables and low in fat, get plenty of exercise and maintain an appropriate weight. Does that vary at all by age? In other words, if you are working to improve your health and perhaps starting sometime after those opportune teenage years, will the regimen be different depending on your age?
William Evans: Most of the advice is still very pertinent for older people, particularly eating a varied diet. However, for many older people, eating a very low fat diet may result in weight loss. Weight loss for an older person who does not need to lose weight is a risk factor for premature death. For many elderly people, a diet rich in nutrients is important and a shift away from saturated fats to mono-unsaturated fats (olive oil, for example) is important.
For those older people who find weight loss very difficult, our research shows that reducing fat intake to about 20% of total calories (without having to count calories) coupled with a two to three days a week of exercise can cause healthy weigh loss.
Can you elaborate a bit on the question of exercise. As we age is there a difference in the need for aerobic exercise vs. strength training? Are there any guidelines for people to know how much they should be getting of each?
William Evans: Aerobic exercise has been demonstrated to increase life expectancy by reducing the risk of heart disease, diabetes, high blood pressure, and certain types of cancer. This is exercise such as walking, running, biking, swimming.
However our research has demonstrated that the only way to bring back muscle that you have lost is by strength training. This involved lifting a weight or using a machine that provides resistance. The weight should "fatigue" your muscle after only 10 lifts. If you can lift a weight 20 times it is much too light. Intensity of the exercise is the most important factor to produce result. We have been able to demonstrated that strength training increases muscle mass and strength, increases bone density, stimulates how many calories your body burns up every day, increased over all activity levels and has many other important and positive effects.
One outstanding resource on information about exercise for elderly people is a booklet and video that is available from the National Institute on Aging. If you are interested the cost is only $7.00 and you should send it to NIAIC, Dept. F, P.O. Box 8057, Gaithersburg MD 20898-8057. If all you want is the 100 page booklet, it is free.
I know that some experts advise older people to begin taking vitamin supplements because of difficulties in getting all the nutrients from food as the body ages. Can you talk a bit about what kinds of vitamins are important for seniors to take?
William Evans: We know that for many elderly people who do not require as many calories to maintain their body weight as when they were young, supplements may be of real benefit.
I recommend the use of a vitamin E supplement. It has been demonstrated to improve your glucose tolerance and boost how your immune system works, and you cannot get enough in your diet. The amounts that have been used are between 400 and 800 international units per day. The current recommendations for calcium intake of 1200mg per day may be too high for many women to get only in their diets. A calcium supplement and vitamin D may also be very beneficial. I would also recommend a multi-vitamin.
Obviously as we age, the risk of disease increases. We have all read quite a bit about the need for mammograms, Pap smears, fecal occult and PSA testing to help detect cancer. And many people get their blood pressure and cholesterol checked regularly. But our story this morning, also mentioned the issue of thyroid testing. Why is that important?
William Evans: Good question:
Thyroid function may be somewhat impaired in older people. This may lead to either a speeding up or a slowing down of your metabolism (the total number of calories that you use every day). As I indicated earlier, involuntary weight loss is a risk factor for older people. If your metabolism slows down, you may be gaining weight. The test if very simple and involves only a blood sample.
Takoma Park, MD:
What are your suggestions for exercise for my 81 year old mother who has rheumatoid(sp?) arthritis in her knees and hands? Any continued movement brings about pain and swelling and she is already on high doses of prednisone. Also, she goes to about 4 different doctors who never seem to keep track as to what each other is doing let alone prescribing. Should she be seeing a geriatric specialist who can oversee everyone? Thanks for your time.
These are two really important issues. When people get older, it is more difficult to do the things that health officials advise. How can family and friends help and what advice do you give to people trying to do such exercise. Beyond that, would you talk briefly about the advantages and perhaps disadvantages of switching from a family physician or internist to a geriatrician, and when that might be appropriate.
William Evans: I think that it is very important for many elderly people who have a number of chronic diseases to see a geriatrician. A very important function of a geriatrician is that he/she views the whole picture and very often, the first thing they will do, is greatly reduce the total number of medications that elderly people are too often prescribed. This so-called "poly-pharmacy" is one of the most important causes of balance problems, falls, depression, and altered appetite. I recommend that anyone over the age of 60 who begins to have multiple problems visit a geriatrician.
A very nice research study was performed by Dr. Ronenn Roubenouff and the USDA Human Nutrition Research Center on Aging at Tufts University. His research team examined the effects of high intensity strength training on older patients with rheumatoid arthritis. They found that, first of all, these patient were much weaker and had much lower muscle mass than "age-matched" controls. They also found that the exercise program was extraordinarily successful in improving strength and function and, importantly, the number of flare-ups of their disease and they decreased their reliance on prednisone.
We also know that many elderly people have serious and painful arthritis. Exercise should not hurt. We always attempt to exercise our subjects in a range of motion of their joints that is free of pain. This may start out to be a very limited range, but it always increases.
Dr. Evans, this has been very interesting and helpful. Thank you so much for being with us. And thank you all for participating. Join us again next week.
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