REAL AGE
Young Every Day
HEALTH HABITS TO KEEP YOU YOUNG
There are healthy habits that all of us can adopt to significantly reduce our rate of ageing. Whether it's getting enough sleep, eating breakfast, drinking alcohol in moderation, or walking the dog, some daily routines and overall life strategies can help us have longer, healthier, and younger lives. Learn to incorporate these habits into your daily life.
• Often it's the simple things that matter most in Age Reduction. You think you don't have time to sleep seven or eight hours a night? You don't have time not to. Your body needs time to rest and regenerate, and getting enough ZZZZZs will make your waking hours more productive. Getting a full night's sleep can reduce your RealAge by as much as three years.
Difficulty rating: Moderately easy to very difficult
• Once you've slept the whole night through, don't forget to start the day off right. Eating a low-fat, high-nutrient breakfast gives a power start to the day and helps keep you three years younger than those who never eat breakfast.
Difficulty rating: Moderately easy
• Do you like to have a drink now and then? Well, moderate drinking—that is, one-half to one drink a day for women and one or two drinks a day for men-—-may help you stay younger longer. A little alcohol can help your heart and arteries keep their spring. Moderate drinkers may gain as much as a 1.9-years-younger RealAge benefit, but drinking too much and too often can be dangerous, even life threatening. Indeed, heavy drinkers may have a RealAge that is three years older than that of nondrinkers.
Difficulty rating: Moderately easy (moderate alcohol consumption) to the most difficult (cutting back on excessive alcohol consumption)
• Fido owners, rejoice. People who own dogs actually stay younger longer. Think of your furry friend as an exercise-promoting stress-reducer. Sorry, cat owners, the greatest RealAge benefit of pet ownership has gone to the dogs: one year younger.
Difficulty rating: Moderate
Humans are creatures of habit—bad habits, more often than not. It is so easy to slide into unhealthy behaviors that can make us age faster than we should. Pressed for time, we skimp on sleep. Feeling guilty about last night's bowl of double-chocolate fudge ice cream, we skip breakfast. But we can learn good habits, too, even some that we can look forward to. Drinking alcohol in moderation—one-half to one drink a day for women and one or two drinks a day for men-—can help prevent arterial ageing. ('One drink' is 12 oz of beer, 4 oz of wine, or 1.5 oz of 80-proof liquor.) One of the best habits is walking the dog. Why? More exercise. As the torn-of-the-century physician William Osier said, "Walk your dog. Even if you don't have one."
Maintaining the quality of your life affects the quantity of your life: The better you take care of yourself, the younger you stay. How many times have you heard, 'Do everything in moderation' and 'Achieve balance in life'? Until recently, those sayings were more folklore than science. When it comes to ageing, research has confirmed that this commonsense folk wisdom is right. Let us now consider a few changes that are easy to do, simple to integrate into your life, and don't necessarily require the resolve that getting in shape or changing one's diet does.
Beauty Rest: Wake Up Younger in the Morning
I was the worst offender. When I was training to become a doctor, interns and residents were expected to survive without sleep. As I continued my career and had a family, I found myself getting busier and busier, with less and less time to do all the things I wanted to do. I just kept cutting down on the hours I slept, learning to rely on five hours a night or less. I didn't realize I was making my RealAge older. And I was making all my waking hours less productive.
Several studies have evaluated the long-term health effects of getting regular sleep. The data, drawn from reports from around the world, show that sleeping seven to eight hours a night provides protection against needless ageing. The best-known study on sleep patterns, the famous Alameda County, California, study, found that men who slept seven to eight hours a night and women who slept six to seven hours a night had a significantly lower mortality risk than those who did not. To translate that risk into RealAge terms, regular sleep patterns can make a three-year difference.
Our bodies aren't designed to accommodate the crazy schedules and hours that contemporary society demands of us. A hundred years ago, no one lived in a world lit by unnatural light. Life was largely shaped by the cycle of the day. Not so anymore. Our bodies [were created - my words - Keith Hunt] …. to adapt to the natural cycle of the day. Our natural rhythms follow this schedule, assisted by hormones, such as melatonin, serotonin, and Cortisol, that are secreted at different times of the day to push us through our sleep-to-wake cycle. For example, as it begins to get dark, our bodies begin to secrete melatonin, a hormone that increases drowsiness. As the sun starts to rise, the adrenal gland begins producing Cortisol, a hormone that gets us up and going. The less sleep we get and the less consistent we are about getting it, the more confused our body 'clocks' become and the more tired we are.
More than 20 percent of American adults find themselves dozing off at inappropriate moments or during quiet and sedentary activities-—-a sign that, on the whole, we aren't getting enough sleep. When I was an intern, I woke up at a dinner party at my professor's house with pie a la mode on my face. After a night on call, I had fallen asleep into the dessert. My date didn't wake me up, nor did anyone else. Most of us require at least six hours of sleep a night, usually between seven and eight hours. Sleeping more than nine hours a night regularly is too much for most of us and is often a sign of an underlying health problem. When we are younger, we need more sleep, and the quality of our sleep is better. As we age, the quality of our sleeping time diminishes. Our periods of 'slow-wave sleep'—the kind of sleep needed to ensure cognitive alertness and motor coordination-—decrease from 150 minutes a day to just 25.
Sleep deprivation lowers your performance at work and can adversely affect your moods, making you less attentive and, yes, grouchy. Also, sleepy people are at a greater risk of accidents, especially during periods of maximum sleepiness, such as the late afternoon or after midnight. As your body gets increasingly tired, your 'sleep latency window'—the time it takes to go from being bored to dead asleep—decreases from as much as three minutes to just thirty seconds. That is, the more sleep-deprived you are, the more likely it is for you to doze off at the wheel or otherwise to put yourself and others in a life-threatening situation.
(I KNOW I HAVE NEEDED 7 TO 8 HOURS OF SLEEP A NIGHT. IF I GET LESS I'M NOT IN GOOD FORM, MENTALLY OR PHYSICALLY - Keith Hunt)
What kind of habits ensure a good night's sleep? Sleep in a cool, darkroom.
If you find it hard to get to sleep, do something relaxing before going to bed— reading or watching TV—to calm you down. You can also drink a glass of milk or eat a banana or some other melatonin or serotonm containing food to help make you feel sleepy. If you need to rise early in the morning, skip late-night activities. The best sleep schedule is regular and one that is in sync with the natural rhythms of the day.
Sleep late on weekends to repay sleep debts. No, it's not a myth: You actually can catch up on restorative sleep, a specific type of sleep that we think is needed for normal brain functioning. And take a nap if you feel tired-—even twenty minutes can make you feel refreshed. Remember that naps do not make up for a good night's sleep, since you do not pass through all the stages of sleep that your body needs to feel refreshed to meet the day—-REM (rapid-eye movement) sleep and slow-wave sleep.
Do you have sleep problems? Illness or stress can disrupt the sleep pattern, making us sleep too much or not enough. For example, two common signs of clinical depression are waking up too early in the morning and sleeping an endless numbers of hours. Other diseases can disturb your sleep cycle, causing chronic sleepiness or fatigue. If you notice changes in your sleep cycle, talk to your doctor about possible causes. If you are under a lot of stress, try to find new ways of relaxing. For example, exercise may help. One study found that exercising in the early evening—walking, lifting weights, or any kind of workout—improved both the quantity and quality of sleep.
Although sleeping pills or alcohol might produce short-term sleep benefits, in the long run they disrupt sleep. Regular use of these substances can confuse your circadian rhythm (your internal clock), which means that you may then need a drug if you are to sleep at all. Occasional use is usually not a problem (for example, you can take melatonin supplements to help avoid jet lag during international flights), and there are times when you may feel you need sleeping pills. If so, talk to your doctor. Sleeping pills can be physically and psychologically addictive and may have long-term ageing effects. In fact, a recent study found that people who used sleeping pills more than fourteen days a month were 1.9 years older, and that those who took twenty-nine or more a month were 2.8 years older. It is a good idea to use sleeping pills for only a limited time or to abstain from them altogether.
(I FOUND WHEN I WAS NEAR 60 THAT I HAD INSOMNIA. I STILL DO. I HAVE BEEN TAKING SLEEPING PILLS FOR 12 YEAR [NOW IN 2022 IT IS 20 YEARS, AS I UPLOAD THIS] THEY HAVE NOT AGED ME, SO I WOULD HAVE TO DISAGREE HERE WITH THE AUTHOR. PEOPLE GUESS MY AGE AT ABOUT 50; I AM 71 - NEAR 72 - Keith Hunt)
The next time you think you can skimp on shut-eye, remember that sleep is one of the healthy habits that keep you young. Sleep helps strengthen your immune system, boosts your attention span, and dissipates excess stress that can damage your arteries, stomach, and immune system.
Don't Skip Breakfast: Starting the Day Off Right
When I was doing research for this book, I found that one of my favorite time-saving (and calorie-saving) schemes, skipping breakfast, was actually making my RealAge older. In fact, until I started researching the RealAge effect of different behaviors, I always skipped breakfast. And I congratulated myself for doing so, thinking I would not only save myself twenty minutes a day but also keep my weight down. I was wrong. Instead of saving myself time, I was spending time—making my RealAge as much as three years older. Studies have consistently shown that people who eat meals at regular intervals, particularly those who eat breakfast, stay younger longer. Indeed, non-breakfast-eaters have a mortality rate that is 1.3 to 1.5 times per year higher than those who eat breakfast regularly.
Breakfast is the first part of a daylong eating plan; it is better for us to eat several small meals throughout the day than one large meal at night. Eating breakfast helps our bodies metabolize food more efficiently and cuts down on the urge to snack between meals. Unhealthy snacking more than three days a week can increase your RealAge. Eating regularly helps break up long periods of fasting, meaning that our body doesn't have to gear up to digest a big meal after doing nothing for hours, which is not an efficient process. In addition, some researchers have hypothesized that we burn more fat during our waking hours, since we are more active. Thus, we may burn off our breakfast calories more effectively than we would an overstuffed, late-night dinner. That is still speculation.
Eating breakfast also makes your cardiovascular and immune systems younger. We don't know exactly why, but there are several theories. First, cereals contain lots of fiber, and fiber helps prevent arterial ageing by preventing lipid buildup. Fiber also helps decrease the risk of cancer. The average American eats 12 grams of fiber a day, but increasing your fiber intake to 25 grams per day can reduce arterial ageing and make your RealAge as much as three years younger. Second, cereals usually have vitamins added to them. During breakfast, we get many of the essential nutrients that we may not get for the rest of the day. This is even more important if you don't eat lots of fruits and vegetables during the day, or if you don't take supplements regularly. Other typical breakfast foods (fortified fruit juices, yogurt, and whole fruit) also contain essential nutrients, such as vitamins C and D and calcium.
So, specifically, what should you eat for breakfast? Cereals, fruits, juices, and low-fat dairy products like fat-free yogurt or skim milk. Choose a whole-grain cereal with no extra fat or sugar that just adds empty calories. Become a label reader and watch out for 'healthy' breakfast foods, including many brands of granola, that actually contain a lot of calories and fat. Drink plenty of juices—pure juice or fortified pure juice, not juice cocktails or blends that contain too much added sugar and less real juice. Whole fruits are even better than juice because they contain much desired fiber. Both are good sources of vitamin C and potassium. Eat whole-grain or multigrain toast; again, read the labels because many commercially manufactured breads contain added sugar, salt, and other ingredients that you may want to avoid. Instead of a pastry or a croissant, which are high in fat, choose an English muffin…. Fruit spreads are a good substitute for high-sugar and calorie-laden jams and jellies. In general, avoid breakfast foods high in saturated fats such as bacon and sausage [In God's food laws they should not be eaten period - Keith Hunt]. Omelets with salsa—no cheese—for a low-cholesterol, low-fat option. If you crave pancakes or waffles …. [Use only organic whole wheat flour - Keith Hunt]. Use chopped fruit with a sprinkle of powdered sugar on top instead of mounds of butter and syrup.
Remember, too, that 'donuts and coffee' is an absolutely empty breakfast - lots of calories, lots of artery-ageing fat, and no nutrition. Use breakfast time to stimulate your imagination: Try unconventional breakfast foods, such as chopped vegetables with a handful of low-fat whole-grain crackers, or a corn tortilla loaded with beans, lettuce, and tomato. Or make a fruit-juice smoothie in your blender. Add orange juice, ice, and any kind of fruit you want— bananas, berries, peaches, and mangoes. You can even add raw beets or tomatoes. If you own a juicer, you can make carrot or tomato juice mixed with celery, spinach, and other vegetables. It's a time-saving, nutrient rich, and fat-free way to begin the day.
If you are too busy to sit down to breakfast each morning, have a breakfast-on-the-go. Carry a small bag of cereal with you and munch on the cereal as you drive to work. Or pack a low-fat yogurt. Buy juice boxes with real juice— not 'juice drinks' or 'juice cocktails'—and carry them in your purse or briefcase. Keep plenty of fruit around, to start the day and to munch on between meals. Becoming a breakfast eater can make your RealAge as much as three years younger. And that's not even counting the RealAge benefits from all the vitamins; minerals; and other nutrients, such as carotenoids, flavonoids, and, of course, fiber you get from eating nutritious food.
Finally, breakfast can be an important social time. For many families, the weekend is a time for everyone to get together and talk about what happened during the week. Saturday and Sunday morning brunches are also a good time to see friends and to strengthen the social ties that help keep us younger.
(WHEN I WAS WORKING A FULL DAY JOB I ALWAYS ATE BREAK-FAST. I WAS MAINLY SATISFIED WITH A WHOLE GRAIN [NO SUGAR ADDED] CERIAL, ORGANIC MILK, HONEY, AND FRUIT ADDED - Keith Hunt)
Mixed Drinks: The Pros and Cons of Alcohol Consumption
In January 1996, the U.S. government, in announcing a revision of dietary guidelines, declared that the moderate intake of alcohol appeared to be beneficial to human health. The announcement was astounding. Clearly, we'd come a long way from Prohibition. After years of fighting alcohol consumption, the government was actually encourageing it. However, the government was careful to emphasize 'moderate.' That means one-half to one drink a day for women and one to two drinks a day for men—-nothing more.
The issue is clearly a delicate one. Alcohol can help you or harm you. Regular consumption of alcohol in small amounts helps prevent arterial ageing and heart attacks. Too much alcohol consumption can lead to alcoholism, liver disease, increased cancer rates, and increased risk of death from accidents during intoxication. Approximately 5 percent of all deaths can be attributed to the excessive consumption of alcohol, and the medical and social effects of drinking too much can be extremely severe. Around 100,000 Americans die every year of alcohol-related diseases, and 20 million Americans suffer problems related to alcohol addiction.
So, what's the right balance? Should you incorporate moderate drinking into your Age Reduction Plan? Or are you someone who can't drink in moderation and probably shouldn't drink at all?
First, the RealAge Age Reducing effect of alcohol consumption begins only when a person reaches the age at which the risk of cardiovascular disease increases—-after menopause for women and age forty to fifty for men. Second, the antiageing benefits apply only to some people. Therefore, you need to weigh your risks and decide whether alcohol consumption should be part of your Age Reduction Plan. You also need to determine if you can consume alcohol in moderate amounts, considering your own genetic and social risks of developing alcoholism, liver disease, or cancers.
The connection between alcohol and reduced arterial ageing—the so-called red wine factor—was first observed in France. The southern French, whose traditional diet is heavy in fatty cheeses, butter, and red meats, had surprisingly lower rates of cardiovascular disease than would have been predicted. The hypothesis that scientists came up with to explain this discrepancy was that all the red wine the French use to wash down their saturated fat-laden food was helping to protect their arteries from the buildup of fatty plaque. Mounting evidence now suggests that not just red wine but any alcoholic beverage helps protect us from arterial ageing. When it comes to Age Reduction, all alcoholic beverages seem to have the same effect: 4 ounces of wine is the same as one can of beer, which is the same as 1.5 ounces of 80-proof liquor. Moderate and regular consumption of alcohol reduces the risk of heart attack by as much as 30 percent, making your RealAge 1.9 years younger (see Table 10.2).
How does alcohol retard or reverse arterial ageing? No one knows the answer. Alcohol appears to prevent clotting by decreasing the rate of platelet aggregation, meaning that the platelets don't stick together as fast as they nor-
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Table 10.2
The RealAge Effect of Alcohol
For Men
Drinking one alcoholic drink a day
At age 35: 0.9 years younger
At age 55: 1.7 years younger
At age 70: 2.3 years younger.
Of drinking three to six alcoholic drinks a day
At age 35: 0.1 to 1.4 years older
At age 55: 0.2 to 5 years older
At age 70: 0.3 to 7.6 years older.
For Women
Drinking one alcoholic drink a day
At age 35: Probably none, as the benefits for women do not usually occur until after menopause.
At age 55: 1.8 years younger
At age 70: 2.2 years younger
Of drinking three to six alcoholic drinks a day
At age 35: 0.1 to 4 years older
At age 55: 0.2 to 5 years older
At age 70: 0.3 to 7.6 years older
......
mally would. Also, alcohol appears to prevent fat from oxidizing and, in this way, prevents it from forming plaques along the walls of the arteries. Alcohol promotes the health of the endothelium, the layer of cells lining your arteries that promotes proper blood flow. Although some may be better than others, all types of alcoholic beverages help reduce the level of atherosclerosis. All alcohol causes an increase in HDL (healthy) cholesterol levels. Red wine, presumably because of the presence of flavonoids in grape skins, may have other benefits as well. The flavonoids act as an antioxidant and free-radical scavenger, resulting in reduced arterial and immune system ageing.
What is the evidence that alcohol reduces arterial ageing and thereby the incidence of heart disease? The well-known Nurses Health Study, an analysis of the health habits of almost ninety thousand female nurses, found that those who drank three or more drinks a week (equivalent to one-half to one drink a day) had a 40 percent lower rate of nonfatal heart attacks and arterial disease than those who did not. Several corresponding studies of men found similar results. These studies also found that there was an ideal range of alcohol consumption. Women who had one-half to one drink a day and men who had one or two drinks a day were at a lower risk of coronary and arterial ageing, yet did not have a higher risk of ageing from liver disease or cancers, conditions that excess drinking can cause. Individuals who drank less than these limits were also at a higher risk of cardiovascular diseases, whereas those who drank more had significant increases in their RealAge because of cancers, liver disease, car accidents, and other accidents. Those in the low-to-moderate drinking range had the longest life expectancy, the fewest health problems, and the youngest RealAge at any calendar age.
Should you have a drink or two a night? That depends. Women should consume no more than one drink a night, and men should have no more than two. Why can women get the same antiageing effect from less alcohol? There are three reasons. First, women tend to be smaller, which affects the overall amount of alcohol they can tolerate at any time. Second, women have less alcohol dehydrogenase in the lining of their stomachs. This enzyme breaks down alcohol before it enters the bloodstream. Women thus tend to absorb more alcohol into their bloodstream per drink. Third, when you drink a lot, the enzyme that breaks down alcohol (cytochrome CYPE2A) increases. Unfortunately, this enzyme also breaks down hormones, such as oestrogen, that help protect women from heart disease.
People who are at a high risk of cardiovascular disease-—either because of a family history of heart attacks or because of signs of developing atherosclerosis—will get the most Age Reducing benefit from a drink a day. In contrast, people at risk of alcohol-related diseases should avoid alcohol altogether. Smokers and those with a family history of alcoholism, cirrhosis of the liver, hepatic cancer, or other alcohol-related illnesses are also strongly urged to avoid all alcohol consumption.
The liver is the principle site of metabolism of alcohol and as such remains at the highest risk of damage—and ageing—-from alcohol use. Liver scarring from the use of alcohol (cirrhosis) can cause considerable ageing. In some urban areas, it's the fourth leading cause of death for individuals age twenty-five to sixty-four. Cirrhosis of the liver (alcoholic hepatitis) can cause a person to age even faster than many types of cancers. Since cirrhosis of the liver causes irreversible structural damage, there are few treatment options for the disease once it reaches an advanced stage. Damage to the liver also appears to be related to an increased risk of cancer.
There are two theories about why excessive drinking causes cancer. The first and most widely held explanation is that the consumption of alcohol induces or increases the production of an enzyme that breaks down alcohol, the cytochrome we referred to above, called CYPE2A. This enzyme breaks down not only alcohol but also other foreign substances, often creating carcinogenic compounds in the process. That is why smokers, in particular, need to avoid drinking alcohol. The combination is deadly. The same enzyme that breaks down alcohol, (CYPE2A) and hence increases when you are drinking, also breaks down the nitrosarnines in cigarette smoke into a carcinogenic form. By stimulating the production of this enzyme, alcohol increases the risk of cancer from smoking. The RealAge effect can make someone as much as five to ten years older.
A second explanation for the higher incidence of cancer among heavy drinkers is that alcohol itself contains low levels of cancer-causing substances. The risk of throat and digestive-track cancers increases two to ten times among heavy drinkers, depending on the kind of cancer. Women in particular have to be careful: Those who drink too much are twice as likely to have uterine and cervical cancers, although, curiously, not breast cancers.
Excessive drinking can age you in other ways, too. Alcohol is fattening, and heavy drinkers tend to carry around more paunch and to look older. But that fat ages more than your looks. The impurities that are stored in the fat also increase your risk of cancer to that of someone five to ten years older. Finally, alcohol consumption impairs the absorption of crucial nutrients and vitamins, leading to nutritional deficiencies and even malnutrition. Alcohol consumption is associated with a decreased intake of thiamine, folate, iron, zinc, vitamin E, and vitamin C. It also decreases the efficiency of metabolism, particularly of the pancreas.
The best-known ageing effects from overconsumption of alcohol are accidents, both from automobiles and other causes. Never, ever, drink and drive. You put both yourself and others at risk. If you are out with friends, make sure to choose a designated driver or take a taxi home. And operating a boat, swimming, or putting yourself in other potentially risky situations while drinking can cause rapid ageing.
If you think that you drink too much, you probably do. If drinking is a problem for you, talk to your doctor about the possible medical risks, as well as strategies for quitting and getting younger. There are also many well-known clinics and organizations, such as Alcoholics Anonymous, that are extremely effective in helping break the addiction to alcohol. If you are a heavy drinker, the best RealAge plan for you is to quit drinking altogether. For people who regularly have a drink or two a night, the RealAge advantage is 1.9 years. For people who drink too much, the RealAge damage can be more than three years older.
A fun way to incorporate moderate drinking into your life—and one that is less likely to lead to overconsumption of alcohol—is to become a wine lover. By learning about different vintages and types of wine, you can have fun and lower your RealAge at the same time. The French weren't all wrong.
(IF YOU ARE NORMAL IN HEALTH, GOD'S WORD BACKS UP ALCOHOLIC DRINKING…BUT IN MODERATION - Keith Hunt)
Walk Your Dog: Even If You Don't Have One
When George S. died at age eighty-nine, his wife Joy, who was somewhat younger, found herself in a quandary. Although she was free to travel for the first time in years, her cocker spaniel Lucy kept her tied to home. Since George had been one of my patients for some time, Joy and I had become friends, and she often called me to ask about health and other related issues.
"Mike," she said, "I feel so torn. I adore Lucy, and she's one of my last ties to George. We picked her out together when she was a puppy, we named her, we housebroke her, and she nursed him right through to the end. The night he died, she lay curled on the bed next to him, offering comfort. But now I want to travel, and I feel guilty about leaving her. Do you think that I should get rid of her?"
"Let's see if we can find a way for you to keep Lucy but have some relief from the full-time demands," I told Joy. Part of the reason I felt she should keep Lucy is that owning a dog is good for you. Pet owners—particularly dog owners—stay younger longer. Indeed, the RealAge benefit is as much as one year younger and perhaps even more so during particularly stressful times.
Although one-third to one-half of all the households in the Enghsh-speaking world have pets, little research has been done on the effects of pets on health and ageing. Most of the medical literature on pets deals only with the negative aspects of pet ownership, such as allergies or the increased risk of disease. These issues should not be of concern to most people. Even if you are vulnerable to allergies or immune diseases, you might still be able to have a pet if you really want one. Talk to your doctor about the possible solutions.
Unfortunately, most studies on the benefits of animal ownership have not been rigorously controlled, and the results are often skewed. Since everyone involved in the research seems to enjoy animals, it is often difficult to be objective about the actual health benefits that pets may provide. Also, one needs to consider whether people who own animals are different in other respects from those who do not. Perhaps they are more social and less stressed, which is why they want pets in the first place. Finally, pet owners themselves are not all alike. Some clearly get enormous enjoyment out of their pets, whereas others see them as one more chore. To get a RealAge benefit from owning a pet, a person presumably should enjoy the pet. What this means is that you shouldn't get a pet just because it can make you younger, but that those of you who already own pets can take comfort in knowing that your animal companions make you younger.
(THOSE WHO DELIBERATELY WANT A PET [I HAD A DOG FOR 17 YEARS, A CAT FOR 5 YEARS {INHERITED IT FROM A FRIEND WHO DIED OF CANCER} AND I'VE HAD MY HORSE FOR 9 YEARS] DO GET EMOTIONAL HEALTH AND I BELIEVE PHYSICAL HEALTH ALSO. BUT YOU CAN STILL BE HEALTHY AND LIVE LONG IF YOU ARE NOT A "PET" PERSON - Keith Hunt)
A 1980 study on heart attack survivors found that the survival rate within one year of the heart attack was 94 percent for pet owners and only 72 percent for non-pet-owners. It didn't matter what kind of pet the person owned, either—dog, cat, bird, or iguana. Other confounding variables, such as different life circumstances, could not account for the benefit. In an expanded and more rigorous study, the results were similar. In fact, the survival rate for dog owners after a heart attack was even better. When translated into RealAge terms, the heart attack sufferers who owned dogs were as much as 3.25 years younger during their recovery period than those who did not own dogs. Other studies have found that pet owners have lower blood pressure and lower cholesterol levels. Also, pet owners seem to suffer fewer headaches, cold sores, and other chronic infections and to have a better overall sense of psychological well-being. It appears, too, that pet owners fare better during especially stressful times, suffering major life events less severely than those who don't own pets. Pet owners do not have as many bouts of depression and maintain better self-esteem.
Dog owners show a particular benefit. Why dogs and not cats? I spent a lot of time puzzling over this question. Since I do not own a dog or a cat, I had no personal experience on which to base an opinion. I assumed that all the walking that dog owners have to do might have something to do with the benefit, but the studies weren't clear about the reasons. Osier, one of the preeminent clinicians of the nineteenth century, observed that dog ownership boosted activity and exercise. After some ad hoc research of my own, I agree that the demands of dog ownership promote a healthier lifestyle. After speaking to some dog owners at a local park, I learned that dog ownership promotes other good habits in addition to extra exercise. Having a dog often means keeping a more regular schedule, including a more regular sleep schedule, that will accommodate the dog's need for regular walks. Also, dog owners who walk their dogs at the same park often form a social community, providing a support network for each other. All these factors can keep your RealAge younger.
When I reread the literature, it made a lot more sense. I called Joy and said, "I did some research on dogs, and not only is Lucy a good companion, but it's true that she keeps you younger. I think you should keep her and find a dog sitter-—someone you can count on to take care of her when you are away."
Do not get a dog unless you are prepared to take care of one. If you think it will be too much work or will add unwanted stress to your life, it probably will—and that's not fair to you or the dog.
Osier and others have attributed the advantages of pet ownership to physiologic benefits. This is where pet owners part ways with the data. Many pet owners claim that their pets give them an enormous psychological boost, something that in RealAge terms would make them much more than the one year younger attributed to dog walking. That may well be true. Most pet owners are extremely attached to their pets, and a high percentage of them find their relationship with their pets absolutely essential to their emotional well-being. Unfortunately, since no scientific data have accurately measured this relationship, we cannot calculate a RealAge benefit for these emotional factors. The only scientifically reliable information pertains to the physiologic benefits. All we can say is that, for animal lovers, one more thing pets give you besides love and affection is added youth. And that's a pretty hard gift to beat.
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R E A L A G E
Stress Reduction
HEALTHY MIND, YOUNGER PERSON
What's long been suspected has now been proven by scientific study: Emotional well-being helps you stay healthy and younger longer. Which emotional factors help keep you young? Which life events will cause age-promoting stress, and what can be done to offset the risk? Realize that the mind and body work together. Happiness and stress-free living will help keep your RealAge young.
• For years, having a type-A personality was seen as the cause of stress-induced illness. Now we know that stress-induced illness comes only from the things that stress you even if they don't seem to be the things that stress other people. Life events as different as the loss of a family member, moving to a new town, or financial troubles can all cause stress, but they have to be dealt with in different ways. Reducing stress in your life can give back thirty of the thirty-two years that major life events can take away.
Difficulty rating: Most difficult
• People who live with others, who have lots of friends, and who stay involved in social activities live longer, happier, healthier lives. During non-stressful times, living with three or more people or having many close friends can make you two years younger than those who don't have this support network. During extremely stressful times, it can keep you as
much as thirty years younger.
Difficulty rating: Moderately difficult
• Rich or poor, living beyond your means can be one of the most troubling day-to-day stresses. All that worrying about money can make you old. Learn how to plan your finances so you don't live beyond your means. Reducing financial stresses can reduce your RealAge by as much as eight years.
Difficulty rating: Moderately difficult
I bet you never knew school could make you younger! But the fact is, keeping your mind active helps keep your body young. Your mind is like a muscle: You need to exercise it. By using your brain, you can become more than 2.5 years younger.
Difficulty rating: Moderate
We often put off dealing with the emotional upsets in our lives, whether it's recovering from our parents' divorce when we were children or recovering from our own as adults. By not confronting these traumas, we often suffer needlessly, and it affects our health. If the social networks you have aren't enough to help you with the emotional conflicts you face, no matter what they are, seeking professional help through a psychiatrist, counsellor, or therapist can make your RealAge eight to sixteen years younger than it otherwise would be.
Difficulty rating: Most difficult
Feeling harried? Not enough hours in the day? Don't you sometimes wish that the phone would just stop ringing? Most Americans are stressed. There is nothing like a day of too many hassles to make you feel that you are ageing faster than you should. There is no doubt that too much stress does indeed age you. Stress is linked to ageing of both the arterial and immune systems. Also, people under stress are more likely to get into accidents or suffer other hazards that can cause them to age.
Stress is a normal part of life and can be good for us and necessary. However, too much stress turns normally useful bodily reactions into damageing overreactions. Stress overload can cause the brain to trigger an over-release or imbalance of 'stress hormones' that can lead to physiologic problems in the long run. Prolonged stress decreases our ability to control our cardiovascular responses, which increase blood pressure and age our arteries. The same neurotransmitter that keeps us alert and able to respond quickly in times of danger causes us to be overtaxed by the constant release of stress hormones. This constant excess actually decreases our ability to sense trouble, prevent accidents, and avoid confrontations. And stress suppresses the immune response, increasing our risk of catching infections or developing more serious diseases. In other words, stress stimulates many of the conditions that cause early ageing.
Almost all of us are juggling too many commitments that can cause age-inducing stress. You can prevent the needless ageing by learning to manage your day-to-day stresses and to develop safety networks that you can rely on when a major stress-inducing event occurs.
More than half of us will have a 'major life event'—a death, a divorce, a job loss or job change, an illness in the family, financial difficulties, relocation, involvement in a lawsuit, or other serious trauma—-within any one year. The occurrence of one major life event makes you about five RealAge years older during the time the event is going on and for at least one year (and probably two years) afterward. Two major life events in one year can raise your RealAge by as much as sixteen years, and three major life events in one year can increase your RealAge by more than thirty-two years for at least the following year. All of us have some stress in our lives, and during our lifetime, each of us will suffer a major life event at least once, if not many times. The question is not whether we will suffer stress but how we manage it.
The Nature of 'Stress'
What exactly is stress? How does it manifest physiologically? Stress is more than just the feeling that there's too much to do, too little time to do it, and too many hassles along the way. Stress is a very complex set of physiologic and psychological reactions. Dr. Hans Selye, one of the earliest researchers to study stress, defined it as 'the nonspecific response of the body to any demand made on it.' Simply put, stress is the body's reaction when it anticipates the need for extra energy. Almost anything can provoke this reaction: an injury, working under a deadline for a crazy boss, not sleeping enough, or not eating regular meals. Even laughing stresses the body.
Despite popular beliefs, stress is not purely mental; it is also physiologic. When we are stressed, our bodies release a flood of adrenaline, cortisone, and other stress hormones that induce physiologic changes. The heart pounds and blood pressure rises. Our rate of breathing increases, and we feel more alert. Blood races to the brain and heart and moves away from the kidneys, liver, stomach, and skin. Our blood sugar level rises, as do the amounts of fats and cholesterol in our bloodstream. The amount of clotting factors and platelets in the blood increases. All this is part of the 'fight-or-flight' response: The body is energizing itself for danger. The question is, how prolonged and damaging will our stress be?
Fleeting stress responses may be good for us. These survival responses cause us to jerk our hand off a burning pan or to jump aside when a car comes too close. These fleeting stresses do not age us. The problem arises when we
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The RealAge Effect of Stress
Major life events cause ageing. Twenty-eight percent of Americans undergo one major life event in any given year, 15 percent will undergo two, and 13 percent will have three or more.
A major life event consists of experiences such as the death or illness of a loved one (especially a spouse or a child), divorce, a major illness, moving to a new locale, being the target of a lawsuit, losing or beginning a job, and financial instabilities like bankruptcy.
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are in a constant fight-or-fllght state.
During chronic stress, our bodies are in a continuous state of siege. The same systems that help us when we are in danger by responding for the moment and then shutting back down are now in overdrive. Imagine a car. The more you rev the engine, the faster you use up the gas. With stress, the faster you rev your body, the more quickly you age. Physically, chronic stress alters the immune responses, causing a decrease in the production of beneficial T cells and B cells. Chronic stress also raises blood pressure.
Studies have shown that the relationship between stress and ageing are marked. A recent study published in the Journal of the American Medical Association found that stress was linked to increased levels of myocardial ischemia, reduced blood flow to the heart. Although doctors have long suspected that stress might cause a narrowing of the arteries, this study provided the first proof that stress also narrowed arteries acutely to the point of hazard. People who experienced a lot of stress also had more periods of ischemia and a correspondingly higher risk of heart attack or abnormal heart rhythms.
Not only does stress cause arterial ageing that increases blood pressure, but it also causes the release of neurotransmitters that elevate the heart rate, pushing blood pressure higher still. As you know, high blood pressure accelerates arterial ageing. Recent research at Johns Hopkins University indicated that people who score high on mental 'stress tests'-—not just the physical treadmill stress tests normally used to detect heart strain—-were more than twenty times more likely to develop heart and arterial diseases. Individuals who had 'hot' reactions—who were more likely to get agitated or frustrated by life events— had twenty times the rate of arterial ageing, as measured by the incidence of heart attacks and strokes, of people who had 'cool' reactions.
Stress doesn't just age your arterial system. As I mentioned, prolonged exposure to the neurotransmitters that your body releases during periods of stress can age the immune system as well. How do researchers measure this type of ageing? A study of health care workers found that those with especially stressful jobs had a lower level of antibody production than did those in less stressful positions. Furthermore, prolonged exposure to chronic stress depletes our bodies of important vitamins, such as vitamin C, vitamin D, and the B-complex vitamins, including folate. Stress also appears to increase our rate of bone loss, causing a depletion of bone density. Finally, overexposure to stress hormones, which at first heighten perceptiveness, can decrease perceptiveness over time, thus raising the risk of accidents and acts of violence—for example, the freeway confrontations called 'road rage.'
Different stresses affect people in different ways, and not everyone is stressed by the same things. Some doctors are the image of calmness when treating life-threatening traumas in the emergency room but become utterly flustered when tending to the daily tasks of running their offices. Some people love a good argument, and others will do anything to avoid one. Often type-A personalities, those who are always pushing themselves to run, run, run, become more stressed when they try to stop type-A behaviors. Relaxing or 'letting go' makes them anxious. The trick is to identify what stresses you and then develop strategies for avoiding stressful situations or, if they can't be avoided, figuring out how to handle them in ways that reduce your own stress levels.
Most stress is tied to the individual's perception of an event. One person might find skydiving exhilarating, whereas another may find it terrifying. Both feel stress from the event, but one feels good stress, called 'eustress' for the euphoric reaction; and the other, bad stress, or 'distress.' One person may love to go to parties, finding working the crowd or meeting new people fun and relaxing, but another person may find it nerve-racking. The level of stress we feel has a lot to do with our subjective interpretation of what is happening to us. One of the ways of changing our stress levels is to try to change our perception of an event.
I was in a major Chicago department store a few years ago on Christmas Eve. It was closing time, and my son and I were the last ones to get in line. It wasn't really a line-—-most shoppers were crowded around the register area, pushing and shoving. The salesperson was still ringing up sales an hour after the store had closed. When I finally reached the register, imagining what it would be like to spend the day heading off a surge of harried shoppers, I said to her, 'You must be glad this day's over. Talk about stressful.' The woman laughed and said, 'I love my job. In how many other jobs do you have people fighting over you?' I had to laugh, and I certainly admired her. She was in one of the most stress-inducing jobs ('point-of-service' jobs, such as cashiering during the Christmas rush, are among the most stressful), yet she didn't let the stress get to her. Rather than see the surge of customers as a negative stress, she considered it a positive situation: all these people fighting over her. Her ability to change her perception of the event meant that she did not age from that day's push, like she would have if she had found it stressful.
Measuring the Effects of Stress
The symptoms of stress fall into four categories: physical, mental, emotional, and behavioral.
Physical signs of stress include frequent headaches, trouble sleeping, sore and stiff muscles, nausea or upset stomach, diarrhea or constipation, a general sense of fatigue, and increased susceptibility to illness. Mental symptoms of stress include the inability to concentrate, confusion, and a lack of clarity. Also, stressed individuals are often indecisive and lose their sense of humor. On an emotional level, stress makes us anxious, nervous, and irritable. We may be quick to anger, impatient with others, or depressed. Behaviorsindicative of stress include fidgeting, pacing, or feeling that you can't sit still. On the other hand, you can also feel sluggish or avoid work because it seems too daunting.
There are two basic kinds of stress. The first is ongoing, low-level stress, such as job pressures or juggling work and children. Then there are those one-of-a-kind stresses that are harder to plan for—the death of a loved one, the sudden loss of a job, or a divorce. Although we know that both kinds of stress age us, it has been much easier for researchers to measure the ageing impact of the big one-time event because there are clear 'before' and 'after' periods to measure. It is clear, for example, that the death of a spouse has a significant RealAge impact. Widows and widowers have reduced levels of important immune system B and T cells, as well as low antibody production, for more than a year after the loss of their partners. And both widows and widowers are much more likely to suffer a major health event after such a loss. It is not uncommon for a person who has been married for a long time to die soon after his or her spouse dies, the death of one causing overnight ageing of the other.
Researchers have also been successful in measuring the impact of stress and increased ageing during and after natural disasters because there is a clear set of dates from which to detect changes in the rates of heart attacks and death. For example, demographic studies have shown that the rate of heart attacks (in particular, severe or fatal heart attacks) increases dramatically in the days after a major earthquake. And in the days after the bombings in the Gulf War, the heart attack rate surged in Israel. Although the studies didn't investigate the more general impact on ageing, we can presume a higher incidence of strokes and other ageing-related events as well. In another poignant example, a recent study published by the National Cancer Institute found that the psychological stress associated with the diagnosis of breast cancer caused the levels of immune cells, such as T cells and natural killer cells, to plummet, putting patients at an even greater risk. In these instances, it is clear that stress affects ageing. That is why we can say that one major life event can age you by as much as five years during the time it is going on and for at least one year (and probably longer) afterward.
In measuring long-term, ongoing stresses, researchers have had a harder time quantifying their impact on our ageing processes. Not because such stresses are any less real, but because there are no defined starting and stopping points. Furthermore, ongoing stresses seem to be open to a more subjective interpretation. Although everyone finds the death of a loved one stressful, not everyone finds the same aspects of family life or work life stressful. There is certainly evidence that ongoing low-level stresses make us older. For example, people who are severely dissatisfied with their jobs are also more likely to suffer heart attacks.
For these kinds of recurrent and chronic stresses, it is important to identify the things you find stressful. You must learn how to avoid them or how to plan for them in such a way that they won't stress you. For example, studies have indicated that most people have significant stress reactions the first time they speak in front of a crowd. Approximately 90 percent of the people who do a lot of public speaking become accustomed to it and no longer have stress responses. However, 10 percent still have that initial stress response no matter how much public speaking they do.
Which leads to the next question: How can you reduce your level of stress? First I will discuss some simple, healthy habits that may help reduce stress. Then I will describe how to manage stress in relation to some of the bigger concerns-—your family and social relationships, your work, your finances, and your level of education.
General Habits That Reduce Stress
Let's begin with a few simple changes in physical habits. One of the best ways to reduce stress is to exercise. Think about it: Stress causes our bodies to build up extra energy, preparing them for fight or flight. Exercise burns energy and reduces our stress levels. Exercise metabolizes stress hormones in our blood and increases levels of our bodies' built-in anti-anxiety hormones, making us feel calmer. Exercise makes us more efficient and energetic, so we feel less overwhelmed by the stresses we do face. For example, just walking regularly can increase the level of beta-endorphins (hormones that help the body feel pleasure) in the brain, decrease anxiety and tension, and elevate one's mood. And exercise-—especially aerobic exercise—helps you divert energy from worrying and anxiety.
Relaxation techniques, biofeedback, and mental imagery also seem to reduce the effects of stress. Combination programs like yoga that include both body stretching and mind relaxation can be especially effective in easing emotional and physical tensions. One simple technique is visualization. Close your eyes, relax your muscles, and imagine yourself some place far away from the chaos around you. Imagine yourself on a beach or in a mountain meadow, feel the warmth of the sun on your skin, and let your muscles feel soft and heavy. Relax into them. Breathe deeply. Feel the tension dissipate.
A healthier diet and a regular schedule also help lower stress levels, making you younger in this way, too. Our favorite food vices—-sugar, salt, and caffeine— may actually elevate stress levels. So can cigarette smoking and excess alcohol. Focus, too, on getting enough sleep. Even though you think you don't have time for a full night's sleep, you will be much more productive if you are well rested. And the tasks at hand won't seem nearly so overwhelming.
One thing that many people find stressful is the sense that they don't have any control over a given situation, especially when they have many demands on their time. If that's happening to you, try to figure out what you can do to make yourself feel more in control. How can you make the situation work for you, instead of being controlled by everyone else's needs? At work, be more proactive in defining your responsibilities. If the boss talks to you only when something goes wrong, make a habit of frequently telling him or her what you've done right. It may change the tone of your interactions and make your job feel less stressful. Finally, if you believe that you have too many tasks to do at home, evaluate which ones are necessary and which ones aren't. See if you can develop a plan for simplifying your tasks. Or explain your frustrations to your family and ask if they can pitch in to help.
Now let's consider some simple changes in mental habits that help us manage everyday stress.
1. Learn to recognize the conditions that stress you and note your reactions to those conditions. Naming the problem is the first step toward solving it.
2. Try to think about the situation you find stressful from a different perspective. Is it really that bad? Is there another way of looking at the problem? Remember the saleswoman at Christmas. When people are putting too many demands on you, just imagine that they're fighting over you.
3. If you can't avoid a stress-producing situation, approach it in a calculated way, taking steps to avoid the stresses.
4. If a certain kind of event always makes you agitated, try to think of ways to change the context. What can you do to prepare for that event, so you don't have to go through the same old thing? If you find Thanksgiving at Aunt Thelma's stressful, don't go, or invite her to your place instead. Just because something's always been done a certain way doesn't mean you have to keep on doing it that way.
5. If certain individuals are causing you undue stress, whether it's your boss or your teenagers, stop for a moment and try to put yourself in their shoes. If they keep doing something that drives you crazy, ask yourself why they do it. What do they get out of it? By understanding their motivations and perspective, you will be better prepared to develop a strategy for reducing the stresses these individuals cause you.
6. Develop coping skills. Learn to take a time-out when you start to feel your anxiety rise.
7. If you find that interactions with a-particular person are stressing you, talk to that person about it. Don't be accusatory. Just let him or her know that a certain way of interacting is stressful to you. Maybe together you can develop a new way of interacting so you do not stress one another. An interaction that is stressful for one person is usually stressful for the other.
Social Networks: Ties for Life, or Laughing the Years Away with Friends
Although for years scientists discredited the effect of social factors on biological health, study after study has confirmed the importance of social connections. It has been shown repeatedly that the effect of interpersonal relationships on stress responses is not only psychological but also physiologic. These ties can actually affect the number of immune cells you have, which in turn can affect your resistance to disease and cancer. Social connections make your immune system younger and reduce stress.
As people age, their social relationships often change. In general, our social supports increase through our lives as we move into our fifties. Then, the neighborhood changes. Friends move away to warmer climates, our children grow up and start their own lives, and we experience 'empty-nest syndrome.' By the time we reach our sixties, our social networks have often begun to decrease. After a lifetime of looking forward to retirement, many people feel lonely and isolated once they no longer have a daily routine. It can be such a subtle change that they are not even aware that it's happening.
I have heard numerous stories from some of my older patients, who, after much consideration and worry, decided to sell the family house and move into a retirement community—not a nursing home, but a place that provides both apartments and nursing and other types of care if need be. The new residents go grumbling off to the 'old-age home,' complaining about being 'turned out to pasture.' Suddenly—and I have seen this happen many times—it's as if these individuals have gotten a new lease on life. Now, instead of being isolated, they have a whole social world around them, full of activities and new companions to share them with. One friend told me that after his ninety-year-old father moved into such a community, his father went from being the one who always complained his son never came to see him to being the one who was always too busy. 'Sorry, John,' he would tell his son, 'Friday's the day we go to the vineyards for a wine tasting. Saturday we're putting together the community newsletter, and Sunday Madeline's having a brunch. It'll have to be next week.' Moving out of an isolated house into a place where there is a social world really can make people younger.
Although, clearly, such places are not for everyone, and most of us are happy staying in our homes, I think the example is illustrative. It demonstrates in qualitative terms what we already know in quantitative terms—that having social connections in our lives makes us younger. Norman Cousins claimed that laughter could cure illness. In many ways, you can laugh yourself to youth. Being social isn't just frivolous, but vital to our health—and youth.
If you don't have many social contacts, think about building them. How? Invite your neighbor over for dinner. Use the telephone to stay in touch with people who live far away. In an Age Reduction double-dip, exercise with a friend. Learn to use e-mail to contact old friends and try chat groups on the Internet. The Internet is a way that people who are largely housebound can make themselves younger. My ninety-two-year-old father has a whole variety of people he talks to every day on the Web. It's one of the things that keeps his RealAge seventy-six years young!
No more strong, silent, types. Joining a group is one of the best ways to reduce stress. A church, volunteer organization, athletic team, community group, or social group—anything that gets you together with other people on a regular basis—can help make you younger. Nothing ages you like going through a major life event alone. Find people to talk to about your problems. Turn to your family and friends. Don't worry about worrying them; they will worry more if you don't tell them what is going on.
If you can't find people who seem to understand your problem, consider groups where you might find people who would understand. For example, a friend of mine became very stressed when his elderly mother developed Alzheimer's disease. Since the illness is remarkably unpredictable, his mother would behave erratically, at times intelligible but at other times incoherent. Sometimes she would be angry for no apparent reason, and other times she would simply start to cry. My friend found the unpredictability incredibly difficult to bear, yet he had to spend an enormous amount of time taking care of her. He also felt isolated; not only was he watching his mother decline, but most of his friends couldn't relate to his situation. His mother's doctor suggested that he go to a program offered by his hospital for relatives of Alzheimer's patients. There he learned what to expect from the disease. More important, he met other people who were dealing with the same situation. Together they could talk about how it felt to watch a parent slowly lose his or her identity. He found the group a great comfort, and it helped him get a different perspective on the disease. When his mother got suddenly angry, he knew that she wasn't angry with him; this was a manifestation of the disease. Learning not to take things she said personally reduced a lot of his anxiety and stress.
There are countless examples of the causal relationship between social ties and stress reduction—a combination that equals the promotion of youth. Learn to value your social relationships and do not sacrifice them to work or other obligations. And do not forget the most important social relationship: the person you choose to spend your life with……..
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TO BE CONTINUED
REAL AGE
STRESS REDUCTION continued
Avoiding the Money Blues: Financial Planning
Four of the ten most stressful events in our lives are tied to our finances. Declaring bankruptcy, losing a job, changing jobs, and not being able to pay the bills—-these financial woes can cause just as much stress as almost anything. They can also cause needless ageing. More to the point, financial upsets can trigger a series of other events that can age you as well, such as a divorce or a major depression.
Because Dennis M. was at high risk of arterial disease, he used to come to my office four times a year for checkups. At his checkup in mid-April, Dennis's blood pressure was through the roof. 'Dennis,' I asked, 'what's wrong? Your blood pressure's always been borderline.' He didn't answer. When I had him come back in two weeks just to double-check, his blood pressure was back to its normal reading. Curious.
The next year, his appointment was on April 15, and the same thing happened. 'Dennis,' I asked, 'what's going on?'
'I don't know,' he replied.
'Is something bothering you? Tax man got you down?' I asked, half jokingly.
'As a matter of fact, yes,' he said, and then went into a litany of financial
woes.
Dennis owned his own business and paid taxes quarterly. Like many of us, he hated to pay the government so much as a day early. He always skimped on his quarterly payments and then, come April 15, wham! He owed a fortune. Yet, as clever as he was at delaying, he never planned well for actually paying his taxes. So, when April 15 came, he often owed money he didn't have. The panic set in, and his blood pressure went sky high. What he knew was that tax time caused him endless worry. What he didn't know was that it was causing him needless ageing as well. The high blood pressure was ageing his arteries. No doubt it threw his immune system out of whack, too.
'Dennis,' I said, 'with the amount of worrying the IRS is putting you through, they're getting something much more precious than dollars. They're taking years off your life.' I convinced him to come up with a financial plan that worked as a medical plan, keeping him from undergoing the needless stress and rise in blood pressure, that could cause him to have a heart attack. Until I met Dennis, I had never thought that being a good doctor would mean I would have to be a good financial consultant, too.
Although financial blues seem to have nothing to do with your biologic age, the rate of ageing does correlate with financial stability. The data aren't precise enough to say with complete certainty, but we can assume that one of the reasons why people of higher socio-economic class have lower rates of ageing is that they have greater financial stability. One financial upset is less likely to derail them.
Work and Stress: Don't Let Work Age You
Work can be a source of fulfillment and enjoyment but also of anxiety, worry, and ... stress. No matter how much we like our jobs, we still face deadlines, demands, and problems that can stress us. In addition, there is almost no job that doesn't involve the frustrations of office politics and power plays.
The more control individuals believe they have over their jobs, the more likely they are to remain healthy longer. That is, job satisfaction helps keep you young. This is one reason why health improves as the level of income rises. In general, higher-paid jobs tend to provide people with more flexibility, independence, and choices over their work. If your job makes you unhappy or unfulfilled, think about what you can do to change that fact. It may mean looking around for a new job or working with your employer to improve your present working conditions.
As much as we grumble about our jobs, the loss of our jobs ages us more than working does. Losing a job can make your RealAge as much as five years older. Such a loss is especially significant for men who are in the middle or late stages of their careers, and for whom job layoffs and firings have an especially pernicious ageing effect. Most likely, this gender gap has to do with traditional social roles, in which men are taught to believe that their jobs are the most central parts of their identities. Men who have lost their jobs, and even those who have retired of their own free will, are more than twice as likely to have a major ageing event than are men who remain continuously employed. The goal is to have work that makes us younger. If your job makes you older, you are definitely being overworked and underpaid!
Young Minds: Become a Lifelong Learner
Here's something you probably never learned in school: Going to school makes you younger. People who are better educated tend to stay younger longer. In fact, those who don't have high school diplomas are 30 percent more likely to die prematurely than those who do. Mortality rates are lower still for those with some college education or higher. And a better-educated spouse makes you younger, too. Why?
No one knows for sure, but there are many possible explanations. There is no direct cause-and-effect relationship. Taking calculus doesn't make your arteries less likely to get clogged. And failing your junior high school English exam doesn't mean you are more likely to get diabetes. Rather, these kinds of statistics result from a whole set of conditions that relate to levels of education and the way education can affect a person's life trajectory. Some of these reasons are purely economic, because people with more education are more likely to have better-paying jobs and greater financial stability. Correspondingly, they often have a higher socioeconomic standing, less exposure to occupational risks, better access to health care, and a whole range of other benefits that help slow the rate of ageing. In contrast, people with lower levels of education are often poorer, have more dangerous and tedious jobs, live in areas where pollution levels are higher, and tend to follow more damaging health practices. The jobs that those with lower educational levels have may also expose them to greater environmental hazards.
There are differences in other ways as well. People without a high school education are eight times more likely to smoke and are more likely to be overweight, not to exercise, and not to make healthy food choices. Educational levels are used by researchers to gauge an entire social world, as opportunities, limitations, and social and health behaviors correlate with education.
The relationship between health, youth, and education is enormously complex, and no study will ever completely untangle the web. For one thing, the data are too imprecise. But despite the problems in correlating education with health, most of the studies try to adjust for confounding variables, such as income, social class, and social stresses. However, even when variables are accounted for, a higher level of education still procures a RealAge benefit. For example, we all probably know people with high levels of education who don't make a lot of money: Think of the person who has spent years training to be a classical musician or who is getting a doctorate in medieval history. People who do not make a lot of money but love what they do stay younger longer.
Why? No one knows exactly, but there are certain clues. One theory is that education increases access to information, including information about health. People who read more are also more likely to pay attention to the news; to think about their health; and to exercise, eat right, and avoid habits that can cause needless ageing.
Another reason appears to be education itself. Mental acuity is something that diminishes with age. However, the variation from one person to another is tremendous. Some people lose that acuity rapidly; others retain a rapier wit and an ability for clever repartee until the day they die. Indeed, it is hard to talk about averages because so many people defy the trends. The object of RealAge is to learn how to be one of those whose mental acuity doesn't diminish. Education seems to play an important role in achieving this goal.
Education, either through formal or informal methods, is one of the things that keeps your mind in shape. It makes sense, too. For example, the jobs that require high levels of education are often the ones that provide stimulation and variety. They are jobs in which you keep learning while you're working.
What does this mean for you? Keeping your mind engaged will keep you young. Chances are, if you are reading this book, you are already doing just that. You have a curiosity about your life. Chances are, too, that you are somewhere past school age. So, the question remains, How can you make education a part of your adult life?
No matter who you are, there are many ways of ensuring that your mind is active and young. First, it's never too late to go back to school. Don't let your calendar age stop you. Not all of us had the opportunity to go to college when we were eighteen. Even if you do have a degree, you may have developed other interests since you were twenty-one. I had a neighbor who obtained her bachelor's degree at age eighty-one. When I asked her what she was going to do next, she told me, 'I'm thinking about getting a Ph.D.' She's the best example of what RealAge is all about: someone who takes advantage of the disparity between her calendar age and RealAge to do the things she's always wanted to do.
Consider taking a class in something you're interested in, whether it's philosophy or computers. It doesn't have to be academic. A crafts class at a local community center will help broaden your horizons. Creating lifetime learning doesn't mean you have to love school. There are many ways of stimulating your mind that don't require getting grades: going to museums, reading, taking trips, developing new interests. If you have an interest in something, explore it. Or, as I like to say, stay young because of it!
(I WILL SAY A BIG AMEN TO ALL OF THAT! KEEP YOUR MIND ACTIVE. READ BOOKS, STUDY FROM THIS WEBSITE, DO CROSS-WORD PUZZLES, FIND A HOBBY THAT CHALLENGES YOUR MIND, KEEP UP ON THE NEWS NEAR AND FAR, WATCH DOCUMENTARY PROGRAMS, BUY DVDs FROM "THE TEACHING COMPANY" [THEY HAVE COURSES ON JUST ABOUT EVERYTHING]. WATCH TRUE LIFE MOVIES, AND LET YOUR MIND KINDA BE THERE, WITH THE TRUE EVENTS AND SCENES.
WRITE ABOUT THINGS IF YOU LIKE WRITING. VOLUNTEER FOR THIS GROUP OR THAT GROUP. JUST DO ANYTHING THAT WILL KEEP YOUR MIND ACTIVE AND LEARNING ALL THE TIME - Keith Hunt)
Confronting Your Personal History: Recovering from Severe Emotional Traumas
Each year half of us will experience a major life event A family member may be sick or die, someone may sue you, or you may lose your job. You may have financial worries or be forced to move. Your marriage may fall apart. You may be one of nearly 20 million Americans who has severe clinical depression. Or you may have experienced some trauma in childhood that still affects you (for example, the effect of being a child whose parents become divorced).
I have talked a lot about what you can do to protect yourself during these tough times, strategies for managing stress and emotional hardship. Nevertheless, what if it's just too much? What should you do when it all seems overwhelming? Or if you have a particular problem that is difficult to talk about even with friends and family members? These topics warrant far more in-depth discussion than I can properly provide in this book. However, there are numerous books devoted entirely to each one of these issues, and you should start with those for guidance.
Do not hesitate to seek professional help. A therapist, psychologist, minister, counsellor, or psychiatrist can provide guidance and insight. For years, a stigma was associated with seeking professional help. This attitude hurt everyone. Everyone can benefit from being emotionally healthy, and everyone has life experiences that affect his or her emotional well-being. Thankfully, the past ten to fifteen years have seen a marked shift in the way we view mental health. Seeking professional help has become increasingly accepted.
Mental health is very tricky. Often a person going through a particular crisis denies having a problem. That is why those who live with alcoholics are much more likely to see the problem than the alcoholics themselves. Some mental and emotional states have a biological component as well as a psychological one. For example, the variations of a clinical depression are defined by the chemical changes that occur in hormones in the brain. Medications can help these conditions. So can psychotherapy ('talk therapy'). Often the two work best in combination. Emotional events can trigger a biological reaction, and although a pill can change the biochemistry of the brain, it does little to change the emotional stresses that may have triggered the depression in the first place.
Depression
Depression is one of the most prevalent diseases. However, because depression is a disease that can be subtle, it often goes undiagnosed. The causes of. depression can be physiologic and/or psychological. Although we tend to think of depression as a mental and emotional problem, many depressions actually have underlying organic causes. For example, people who are diagnosed with clinical depression frequently have low levels of the hormone serotonin in the brain, indicating a biological origin for what seems to be a psychological condition. Furthermore, there are almost always physiological symptoms, including sluggishness; sleeplessness; loss of appetite; a general sense of helplessness or uselessness; and, at times, suicidal tendencies.
Depression is common in people as they age. More to the point, it is also a disease that can lead to unnecessary ageing. It often affects women in menopause; both men and women who have recently retired; and anyone who has suffered a major ageing event, such as a heart attack or diagnosis of cancer. Sometimes the trigger can be biological, sometimes psychological. But for whatever reason, depression happens.
What is the relationship between depression and ageing? For starters, depression is tied to an increased rate of arterial and cardiovascular ageing. A 1994 study found that women who had depression had lower bone density, presumably from increased levels of the hormone Cortisol, which is found in the blood of depressed people. In addition to causing ageing directly, the symptoms of depression—lethargy, sluggishness, a sense that nothing in the world matters—-lead to behaviors that can accelerate ageing. Depressed people are less likely to exercise, to eat a healthy diet, or to make any effort toward healthy living at all.
Women are more prone to depression than men, although no one knows why. Hypotheses run the gamut. Some researchers believe that women face greater discrimination and often have to juggle more social roles. Others see the disparity as stemming from biological, largely hormonal, differences. About 10 percent of women, suffer from depression during pregnancy, and many have the classic 'postpartum depression' after giving birth. Also women tend to have a higher incidence of hypothyroidism, which is also associated with depression.
Medications can trigger depressions. In addition, depression can be a symptom of other diseases. Individuals who are recovering from heart attacks and strokes are known to be especially prone to depression. Social stresses, such as the death of a loved one or a divorce, can bring on depression, too.
Treatment for depression is highly effective within just a few months of its initiation. Although treatment can prevent accelerated ageing, the biggest problem is that many depressed people are often unable to seek help on their own. If you suspect that someone you care about is depressed, find out more about the condition and see if you can get help for him or her.
Unfortunately, your primary care physician is generally not the best person to detect depression. The symptoms are subtle, and because depression was largely misunderstood until the mid-1980s, many doctors were not trained to recognize the disease. One recent study found that family doctors detected depression in only about 35 percent of the cases. Thus, if you suspect that you or someone you care about might be suffering from depression, seek specialized help. Psychiatrists, psychologists, and licensed therapists are all trained to recognize the symptoms of depression and are able to provide many possible types of treatment.
Other types of emotional distress do not have an organic component at all, but that doesn't mean they aren't true problems. For example, children who experience physical or sexual abuse can suffer the repercussions well into adulthood. And the effects can be psychological and physiologic.
Emotional well-being correlates with physical well-being, which means that if you are emotionally healthy, you stay younger longer. A mental health professional can help you develop strategies for dealing with stress and emotional traumas. Just like a financial planner can help you arrange your finances, a therapist can help you evaluate the situations that cause you stress and develop strategies for avoiding or diffusing them. Sometimes stress can be very subtle and difficult to identify. More and more, we are coming to understand that the health of the mind and the health of the body are interrelated. Do not neglect one for the other. Taking care of yourself—both physically and mentally—-will help keep you young for a long, long time.
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TO BE CONTINUED
REAL AGE -- The Right Medicine
The Youngest Patient
HOW THE RIGHT MEDICINE CAN KEEP YOU YOUNG
The whole point of RealAge is to keep you out of the doctor's office. Yet, now and again, all of us need to visit the doctor. Learning how to obtain the best possible care will keep your RealAge younger. Those who patrol their own health, learn how to manage a chronic condition, get regular checkups, and demand high-quality care can have a RealAge as much as nine years younger than those who do not. Evaluate your family disease history and your genetic risks. Knowing which diseases you may be predisposed to develop can help you counteract those conditions before they begin. If you do develop a chronic medical condition, properly managing the illness can save you from much of the ageing that it can cause. Being a savvy patient will help make you a younger patient.
• The best person to monitor your health is you. You know your own body better than your doctor ever will. You know if it aches, if something isn't working right, or if something has changed. Even if it's just a subtle change. Patrolling your health can reduce your RealAge by as much as nine years.
Difficulty rating: Moderately difficult
• How long did your parents live? How long did your grandparents live? And do the lengths of their life spans help predict the length of yours?'' What is the correlation between heredity and longevity? Learn how to evaluate your inherited biological risks.
Difficulty rating: Moderate
• Mixing and matching prescriptions or taking medicines erratically or beyond the prescribed time can age you. Taking too many drugs can make you as much as 4 and 1/2 years older. However, don't stop taking a medicine without consulting your doctor first. Deciding not to take necessary medicines can make you more than 1 year older.
Difficulty rating: Moderately easy
• Eighty percent of us will have a chronic illness at some time in our lives. Diseases such as diabetes, arthritis, heart disease, kidney disease, and asthma are common, and all increase the rate at which we age. In most instances, learning to manage that disease properly means that you will be able to live healthily in spite of it. Depending on the condition, proper management can reduce the ageing effect of a chronic illness by 80 percent and, in some cases, even more.
Difficulty rating: Moderately difficult
By reading this book you have learned what you can do to keep as far away from the doctor's office as possible. But every now and again, all of us need to visit the doctor. Keeping a clean bill of health helps us stay young, and detecting and managing new conditions in the early stages are the best ways to prevent the ageing the conditions can cause. Learn to patrol your own health, looking for any early warning signs that something is amiss. Evaluate your family history, so you know what diseases you may be genetically predisposed to develop. By knowing your risks, you are in the best position to counteract them. Carefully monitoring any chronic conditions that do exist can save you years of unnecessary ageing.
Patrolling Your Health: Learning How to Be a Member of the Age Police
I met Nathan R. on the way to the operating room. I was his anesthesiologist. He had a small tumor on a nerve just below his skull near his ear: a potentially deadly condition if not caught in time. Lucky for him, it was discovered early—and because of bis own persistence.
Nathan was fifty-five when he began to notice that his hearing wasn't quite right and that his equilibrium was off. He noticed dizziness and vertigo when he stood up suddenly. He kept having the sensation that he was going to faint, particularly whenever he did anything energetic. He went to one doctor after another. The doctors ran him through all the tests they thought appropriate, but couldn't find anything wrong.
Just because they couldn't find anything wrong didn't mean that something wasn't wrong. Nathan, who was feeling worse and worse, kept persisting. After going to several specialized clinics and seven different doctors, Nathan finally went to a doctor who took another MRI (magnetic resonance image-ing) scan, a kind of three-dimensional X ray, of Nathan's brain. At first the doctor, just like all the others, said that he couldn't find anything wrong.
Nathan was so insistent that something was wrong that the doctor went back over the images again, showing Nathan exactly what doctors look for when reading an MRI. Explaining to him how to read the images, pointing to the different lobes of the brain pictured on the screen, the doctor began to study the image very carefully. Nathan asked lots of questions. Suddenly, the doctor finally spotted it. A small bump on a nerve, a telltale tumor. 'It's so small that I can't believe I even saw it,' the doctor told me when he called me to do the anesthesia. Normally brain tumors aren't detected until they are well over 1 centimeter; Nathan's was one-third that size. Two days later, Nathan went into surgery.
'You're one heck of a lucky guy,' I told Nathan in the recovery room as he came out of anesthesia. The tumor that was removed proved to be fast-growing—and cancerous. It might well have killed Nathan in a matter of months had it not been discovered, but because it was discovered early enough, Nathan suffered virtually no consequences. After a few weeks of recovery, he went right back to life as usual. Since he already exercised, ate right, and took care of himself, his RealAge was more than ten years younger than his chronological age, around forty-five. The only side effect of the surgery was some hearing loss in one ear. It's not much, considering the danger he had barely escaped.
Although Nathan was indeed lucky, he had created his own luck. He was enough in tune with his body to know when something was amiss and to take it seriously. Nathan was saved by his own persistence and savvy.
It's a great story. One that makes us feel good. But it raises the question: If something small and vague began to affect you and lasted several weeks, would you see a doctor to find out what was wrong? Or would you hope that it would go away by itself or just try to live with it?
Stop and ask yourself: Are you healthy? Compared with the health of others your age, would you rank your health as excellent, good, fair, or poor? If you say 'excellent' or 'good,' then your RealAge is probably a bit younger than calculated. If you say 'poor,' then your RealAge is a bit older. Studies show that most people can assess the general state of their own health relatively accurately. That is, when something's not right with our bodies, most of us know it. One study found that those who ranked their overall health as poor were as much as twenty times more likely to die in the next year as those who ranked their health as good. This finding is not surprising. If you are sick, chances are that you already know it. However, this statistic held true even for people who didn't know that they had anything wrong with them; they just had a sense that their general health was not very good. Furthermore, at least seven studies, including the recent report of the Baltimore Longitudinal Ageing Study, have shown that this result is consistently true: patients who suspect that something is wrong, even though their physicians have diagnosed them as being disease-free, are generally right: something is wrong.
How much does patrolling your own health affect your RealAge? It is difficult to quantify exactly. If you spot an early cancer and have it removed before it has a chance to metastasize, you may save yourself ten, twenty, even thirty years of RealAge ageing.
The health care industry has undergone tremendous changes in the past decade. Health maintenance organizations (HMOs) and budget cutbacks have made time and costs extremely important considerations in the practice of medicine. Most doctors have considerably less time to spend with their patients than they did just a decade ago. Hence, doctors have less time to get a 'feel' for their patients before they diagnose them. In addition, the changing nature of the insurance industry, and of the health care industry itself, means there is less chance that you will see just one doctor all the time. Many news reports lament the 'sorry state of health care.' But the news isn't all bad. We now have better facilities, better treatments, and better diagnostic tools, which means that the best possible care is better than it's ever been. The trick is to get that care for yourself.
How do you do that? By being a proactive patient.
First find a doctor you like and trust. Choose someone who is competent, conscientious, and attentive to you and your problems. Your primary care physician should make you feel comfortable. (If you don't feel comfortable, find someone else.) Also, he or she should listen to you and be able to explain clearly what is going on with your body. Ask friends, neighbors, or pharmacists about the doctors they use and consider listings, such as the 'top physicians' guides. Also, you might want to find out where your doctor went to medical school and how well he or she did there. For example, membership in Alpha Omega Alpha indicates that your doctor graduated in the top of his or her class. Many HMOs or health service networks have services that provide information about their physicians. If a particular condition runs in your family, consider getting a specialist physician who is board certified in that field.
Second, get regular checkups. A clean bill of health provides a baseline for how you are when everything is 'normal.' Then, if something does arise, you have a better framework for knowing what is wrong and when it started to go wrong. In addition, the more information your doctor has about you when you are healthy, the easier it will be for him or her to know when you are sick. If, you, like Nathan, sense that something is wrong but your doctor doesn't find anything, don't be afraid to ask your doctor, 'What does this test tell you?' or 'What does this number mean?' And don't forget this one: 'Is there anything else that it could be? Something we're not thinking about?' Part of your doctor's job is to explain to you exactly what is going on inside your body. If you don't understand what's ailing you, you won't be prepared to take the best care of yourself. Also, don't hesitate to get a second opinion. Or a third or fourth. If the second opinion agrees with the first, you can relax and feel more comfortable about the diagnosis you have been given. If the opinions differ, you will have a chance to compare them and to reconsider your options.
Remember, modern medicine can't cure everything. Although we are discovering more about the ways our bodies work every day, many aspects of human biology remain elusive. It may take time for a condition to manifest itself in such a way that it can be diagnosed. But the more aware of your body you are, the more likely you will be to catch a serious illness in its early stages.
How can you be a better patient when you do go to the doctor? By being prepared and informed. Write down questions before you go so you won't forget any important points. If you've noticed a particular problem, write down your symptoms. Make a copy to give your doctor. If you are going to see the doctor for a condition that is chronic, keep a log. If you have a pain that comes and goes, note when it comes and how long it lasts. Keep track of the foods you eat, the activities you perform, and anything else that seems relevant. Write down all the medicines, including herbs and vitamins, that you take and their dosages. The more information your doctor has, the better he or she will be able to help you.
Even if a symptom seems too minor to be mentioned, don't treat it yourself. Tell your doctor. Some conditions manifest in very odd ways. When something hasn't felt right for a while, it's probably not all in your head.
Don't be afraid to do your own research. Go to the library and look up a basic medical textbook or use the Internet to find information on whatever ails you. A number of health-information Web sites are run by major medical centers, and hundreds more are sponsored by organizations of varying credibility. Perhaps you will stumble across a description of exactly what you are experiencing but haven't been able to put into words. On the other hand, don't be a gullible reader: Not everything you read is true, especially information that doesn't come from well-respected research institutions or hospitals. But as you learn more about your health, you will also learn how to distinguish what's likely to be true from what's likely to be rubbish.
A final reason that people stay away from the doctor is cost. Health care is expensive, and not all of us can afford health insurance. This issue is clearly too complicated to discuss here. However, do not ignore a health problem to save a few dollars. The longer you wait to seek proper health care, the more likely the condition will worsen. Not only will it be more expensive to treat in the long run, but you will also be more likely to have experienced the ageing and illness that the condition can cause. Prevention is almost always the cheapest health care option.
It's All in the Genes? The Impact of Family Heredity
At the beginning of the book, I pointed out that more than 70 percent of ageing can be linked to behavior and other environmental factors, meaning that you exert enormous power over how you will age. But what about the other 30 percent? Exactly how should you view your genetic inheritance? And how can you avoid the ageing associated with it?
Although many studies have investigated the family history of disease in relation to the onset of disease, only three major studies have correlated overall longevity trends between parents and their children. The Framingham Study, the Termite Study, and the Alameda County Study looked at the ages of parental death to determine if they predicted the longevity of the offspring. Did the two correlate? Yes, but mimanally. Each study showed a minor relationship. The Framingham Study, the most comprehensive of the three, found about a 6 percent correlation between the ages of the parents at the time of their deaths and the longevity of the offspring, meaning that many other factors affect longevity as well. If both your parents lived past age seventy-five, then the odds that you will live past seventy-five increase to some extent. But to what extent?
If both your parents died before age seventy-five, your RealAge will be as much as 4.2 years older if you are a man and as much as 3.5 years older if you are a woman. If both your parents lived past age seventy-five, then your RealAge will be 4.2 years younger if you are man and 3.5 years younger if you are a woman. If no first-degree relative (parent, brother, or sister) had breast, colon, or ovarian cancer diagnosed early, you are an additional 0.2 to 11 years younger, depending on the disease, than if your siblings or parents had those diagnoses. Some genetic conditions, such as being a carrier of the BRCA-1 breast cancer gene, can make your RealAge as much as 17 years older. This is one of the instances in which genetics can make a big difference.
When you calculate the role of family history, remember that many factors complicate the issue. What, for example, was the cause of death? If a parent dies at age forty in an accident, it provides little information about how long you will live, since that parent didn't die of biologic causes. If a parent dies at age forty of breast cancer, it may mean that you have an increased risk of developing the disease. The genetic predisposition is not always negative, either. For example, in many instances, we inherit a gene from our parents that can actually help us live longer. Some people have a gene that boosts HDL (healthy) cholesterol levels. Because they have high they are often diagnosed as having a cholesterol problem. But the diagnosis is wrong. This gene is a trump. All that HDL cholesterol helps prevent arterial ageing to such an extent that the gene gives carriers a RealAge benefit of as much as twenty-six years! Remember, too, that just because there is a familial tendency for a certain kind of ageing does not mean that that kind of ageing is genetically; inherited. For example, a family history of heart attacks may or may not be genetically coded.
In general, you should review your family history for three conditions: (1) a history of cardiovascular disease; (2) a history of a particular type of cancer, such as breast cancer or colon cancer; and (3) a history of rare genetic illnesses, such as Huntington's disease, Parkinson's disease, multiple sclerosis, or even Alzheimer's disease. If you know of more than one case of these diseases on one side of the family, you may have a genetic predisposition to that condition. The first step in determining whether there might be a family history of an illness is to count the number of occurrences of that condition. Then determine how these individuals are related to each other and to you. Everyone must be related by blood, not marriage.
A family history of a certain disease does not necessarily mean that you are genetically predisposed to develop that condition. It indicates a possibility, not a certainty. Even if a genetic illness does run in the family, there is no way of knowing if you have inherited the disease gene (or genes). In most instances, your odds of inheriting any condition are less than 50 percent. Even if you have inherited a predisposition for a specific biological condition that can cause ageing, you may very well not do those things that trigger the onset of the disease.
For example, it is known that certain people have an inherited predisposition to develop Type II diabetes. On the other hand, almost 90 percent of those who are diagnosed with the disease are also excessively overweight. Many do not exercise, and a large percentage smoke. When a person is genetically predisposed to develop the disease, environmental factors, such as weight gain, lack of exercise, and smoking, can trigger the disease. A slim and fit person may well have the genetic predisposition but never know it because the conditions that trigger the disease never occur. Indeed, taking care to protect your 'youth' is the very best disease management. Living in a youthful manner can offset the genetic predisposition before a disease develops at all.
Cardiovascular ageing is another example. As doctors have begun targeting high-risk patients (those who have a long family history of arterial disease and ageing), they have seen the onset of premature ageing diminish. By exercising, eating a low-fat diet, taking an aspirin a day, and taking folate regularly, anyone—-no matter what his or her inherited risk—can reduce the rate of arterial ageing. If a risk factor applies to you, you will want to do what you can to offset it. For example, if you are a man and your father, grandfather, and great-grandfather died of heart attacks before age fifty, you will want to pay extra special attention to preventing arterial ageing, not allowing the conditions that would make you the next heart attack victim.
Pill Popping: Too Much Medicine and Mixing
Medicines Can Cause Ageing
It happens all the time: One doctor prescribes a medicine for a patient without knowing that another doctor has prescribed another medicine for that same person. Somehow the information isn't communicated—the patient either forgets to tell the doctor what he or she is taking or tells the doctor the wrong name for the medication (something that is easy to do). The result can be a potentially life-threatening drug combination. Mixing drugs, taking medicines beyond their prescribed time, or taking them erratically can be hard on your body-—and make you older. Be an informed patient; ask your doctors why you should be on any drug they prescribe and be sure to tell them what you are already taking, even simple things like aspirin, over-the-counter drugs, vitamins, and supplements. Many patients forget to mention these over-the-counter drugs and supplements, thinking that because they can be bought by anyone, they must be harmless. This is not true. Don't forget to mention recent vaccinations you've had and antibiotics you've taken.
Statistics show that people who take too many pills without proper supervision have a RealAge as much as 4 and 1/2 years older. But the fact that taking more pills makes your RealAge older doesn't mean you shouldn't take any medications. It's important to take the medicines you need and to take them as instructed. Not taking necessary drugs-—or not taking them correctly—can make you more than one year older.
When Sue C, one of my wife's good friends, phoned, she was in a near panic about her mother.
'Mike,' she said, 'Mom's blood pressure is completely out of control. Sometimes it's at 150/80; at other times it's as high as 220/150. She's on all this medication to control it, and she's good about taking them, but she gets a lot of side effects. Headaches that completely incapacitate her. It seems like the medicine is just making things worse.'
'Sue,' I said, 'if her blood pressure's as high as you say it is, it could be life threatening. How soon can you get her here?' 'Right away,' she responded.
Sue brought her mother, June D., to my office. Sue was right June's blood pressure was 220/150—-so high that it was a medical emergency.
'June,' I said, after examining her, 'if we can't bring your blood pressure down in the next four hours, I'm checking you into the hospital. Your blood pressure is off the charts.'
'I can't understand why. I'm on five different medicines to bring my blood pressure down.'
'Well, that may be the problem. Drugs can often interact, causing an unintended effect. Tell me everything you're on.'
She listed-the five medications that she took regularly.
I was puzzled. There were two drugs on the list that could cause a negative drug reaction when taken together. However, her symptoms—extremely high blood pressure and severe headaches—were not the ones that this interaction should have caused. I asked her, 'Are you sure that you've told me everything you're taking? What about vitamins, over-the-counter drugs, food supplements, herbal remedies, or herbal teas?'
'Oh, I didn't even think of that. I'm taking several vitamins and three kinds of herbal pills. Two of them I read helped prevent headaches, and one is supposed to clear my sinuses. But they're natural. They can't hurt me, can they?' Then she told me what they were.
'Bingo,' I said. 'We've found the culprit.' The herbal remedy she was taking to alleviate her sinus symptoms interacted with one of her medications, causing both her terrible headaches and her erratic blood pressure. She was playing around with an explosive mixture that could cause a heart attack or a stroke. 'First, we are going to do something to bring your blood pressure down,' I told her. 'Then I want you to go home and throw away that bottle of herbs.'
'I'm so surprised. I thought these supplements were harmless,' June said.
'That's exactly the problem,' I replied. 'Natural remedies seem so innocuous, but when mixed with the wrong medicine, they can be dangerous.'
I gave June some medication to bring her blood pressure down immediately. I told her to take the drugs exactly as instructed. Then I cut her blood pressure medications to just three, to eliminate the possible interactions. The new medication worked. Within a week her blood pressure was close to normal, ranging from 110/70 to 130/90. Her body adjusted to the medicine, and she started to feel great.
Then the second phone call came. It was Sue again. 'Mike, Mom's been feeling super on her new blood pressure routine. In fact, she feels so good that she told me this morning that she thought she would stop taking her medicine. I just wanted to double-check with you to make sure it's okay.'
'You're kidding me!' I cried, not believing that I hadn't gotten my point across. 'Going off that medicine so suddenly could put tremendous stress on her heart or the blood vessels in her brain. She could have a stroke or heart attack. Give me her phone number because I want to call her right now.'
Luckily, I got June just in time. And I did something I rarely do: I yelled at a patient. I scolded her for putting herself in a possibly life-threatening situation, and I told her, in no uncertain terms, that she had to take her pills right away.
Although the proportions vary from locale to locale, on average more than 15 percent of all hospital admissions are due to the improper use of prescribed medications and to adverse interactions between drugs or drugs and supplements. In fact, one study calculated that, in 1994, Americans spent $73 billion oil prescription drugs, but that the costs that were due to adverse effects exceeded $100 billion. Hard to believe, isn't it? Does this mean we should quit prescribing—or taking—drugs? No. Drugs have saved a lot of dollars and years of life by controlling illness and preventing ageing. It just means we all need to be more attentive to the problem of mixing drugs with other drugs and supplements.
It is interesting to note that the problem of drug interactions has gotten worse. The Food and Drag Administration (FDA), in an attempt to lower drug costs to consumers and to make medications more readily available, has increased the number of medications available without prescription. Drugs that just a few years ago required a prescription are now available over the counter, including such popular medicines as fepcid (famotidine), Tagamet (cimetidine), nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin), Rogaine (minoxidil), Imodium Ooperamide), and nicotine chewing gum. Make sure to ask your doctor about these drugs, since they can have substantial adverse effects when mixed with various prescription drugs, herbs, or supplements.
The problem with drug interactions is partly the fault of doctors. The classic stereotype of the hurried doctor with incomprehensible handwriting is not far off: Prescriptions can be hard to read, and doctors and patients do not always communicate effectively. Doctors frequently think that they are explaining things clearly but use technical terms and jargon that patients don't understand. Several years ago, a patient wrote on her basic information form that she had undergone a hysterectomy. When I asked her about it, she told me she had her tonsils out when she was six! I knew then that we were miscommunicating. Patients are often afraid to ask if they don't understand something, or they forget to ask, mainly because they are not feeling well or because being in a doctor's office can be a nerve-racking experience.
Remember, the best patients are informed patients. Do not hesitate to ask your doctor about medication that he or she has prescribed. In addition, ask about interactions with over-the-counter drags or herbal remedies you take regularly. Don't feel self-conscious about taking up the doctor's time. You and your doctor should be partners in preserving your youth and health. If there is something you forgot to ask while you were at the doctor's office, call your doctor back. Or ask your pharmacist when you get your prescription filled. Pharmacists know about each drug and can help advise you on your overall medication. Use your doctor and your pharmacist as cross-checks for each other for one may catch something the other one doesn't. Because the channels of information are different, one may have recently learned something the other doesn't yet know. And, besides, the pharmacist who fills your prescriptions may be aware of medications you are taking that are prescribed by another physician.
Becoming a 'home pharmacist' is a surefire way to get older. Once you have used a drug for what it was prescribed for and no longer need that drug, throw away the remaining pills. Pills can change their composition if allowed to sit around too long. Also, by getting rid of extra bottles, you reduce the risk that you or the people you live with will take the wrong pill accidentally. Prescription medications should not be used for anything other than what they were prescribed for. Never assume that because something was good for one condition, it would be good for another. Don't take two pills when the instructions advise one; just because one is good doesn't mean that two will be better.
And never go off a drug just because you are feeling better. If you are prescribed antibiotics, for example, it is very important that you take the entire amount prescribed. Do not stop after just a couple of days because you feel better. This is an exceedingly common and potentially very dangerous mistake because the illness often comes back quickly and in a more virulent form. Because the bacteria causing the disease have already been exposed to the antibiotic, they often develop resistance to it, and the drug no longer works effectively.
Similarly, people who take blood pressure medicine often quit taking it the minute their blood pressure dips into the normal range. Going off blood pressure medicine can be extremely dangerous—even life threatening. Stopping suddenly can cause rebound tachycardia and hypertension, a condition in which your heart rate and blood pressure suddenly rise to levels higher than they were before you started taking the medication. These changes can put enormous strain on your arteries and can trigger a heart attack or stroke. Even if they don't they cause significant arterial ageing.
Remember, doctors need feedback. They can't know that a drug is causing a side effect unless you tell them. Hormone-replacement therapy is a perfect example. Approximately 50 percent of women who quit taking hormone-replacement therapy do so without telling their doctors. The treatment is a tricky one: Different women react differently to different doses and combinations, so often the dose needs to be adjusted until one is found that works. However, by working with her doctor, a woman can usually find the right dosage for her.
Two common side effects of various drugs that can be difficult to discuss with a doctor are impotence and loss of sexual desire. Several blood pressure medicines and depression medications, such as Prozac, have these side effects, as do other medications. Even though patients don't mention impotence and the lack of sexual desire to me often, I try to search tactfully for the occurrence of these conditions. Male patients say impotence makes them feel and act older. Female patients also report changes in libido from various medications. Impotence and the lack of sexual desire are extremely frequent, but they are treatable conditions. If you notice that a medication is affecting you in this way, talk to your doctor. Don't be embarrassed. Usually, a different medicine can be prescribed.
In summary, how can you keep your medications from ageing you?
Keep your drug regimen simple. Ask your doctor if you can reduce the number of medications you take. One study showed taking twenty-three or more pills a day can make a person as much as 4 years older than taking four or fewer pills a day. The more pills you take, the greater the potential for an adverse drug interaction that can cause you to age unnecessarily.
Here are some simple steps for making sure that you get the RealAge benefit associated with taking medications.
Develop a good relationship with your primary care doctor.
Make sure that you keep him or her updated on everything you're taking.
Keep a list of medicines and dosages that you take either regularly or occasionally and bring it with you when you visit any doctor, drop-in clinic, or emergency room.
Choose a pharmacist you can trust and develop a long-term relationship with him or her. Your pharmacist will also have a record of all the drugs you are on or have been on and can warn you about possible drug interactions. (Although many HMOs now provide pharmaceuticals by mail, I prefer the old-fashioned drugstore with a new-fashioned computer, one where the pharmacist both knows the patient and has an up-to-the-minute record of his or her medication history.)
Now, of course, we must turn to the larger question: What if you have one of those conditions—-heart disease, arthritis, kidney malfunction—-that require a lot of medicines and a lot of medical care? How can you prevent the ageing effects of chronic illnesses?
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TO BE CONTINUED
REAL AGE……
Chronic Disease - Learning to Live with it
As much as this book is about preventing the kinds of chronic conditions that cause us to age-—heart disease, cancer, arthritis, Alzheimer's—the fact is that almost 80 percent of us will have a chronic condition at some point in our lives. So the question remains, "What happens if you get a chronic illness? How are you to treat it? How can you prevent its ageing effects?
For starters, a chronic disease does not mean that life is over. It is not time to call it quits. Life can and will go on. Every day we learn more about such diseases and more about staving off their effects. Such a diagnosis does not mean that you are now 'old,' but it does signal an important shift: You will have to learn how to live with the disease's 'chronicness,' and with the fact that it is a presence in your life, a presence that cannot be ignored without ill effect. Almost without exception, a diagnosis of chronic disease also signals that it's time to take your youth seriously. If you are diagnosed as having a chronic and potentially debilitating illness, you will have to learn how to live healthily—and youthfully-—-in spite of it.
Although having a chronic condition like diabetes or arthritis can age us, how we manage that disease can make an enormous difference. For example, if diabetes is not managed properly, a diabetic can age at twice the expected rate; he or she will experience almost two years of biological ageing for each passing calendar year. However, careful management of the disease can reduce the ageing effect by over 50 percent, and by as much as 80 percent. For Type II diabetes (non-insulin-dependent diabetes), proper management can make manifestations of the disease virtually disappear, leaving no significant ageing effect. Similarly, the ageing effect of heart disease can be retarded by as much as 70 percent with proper vigilance, and if the disease is diagnosed before significant structural damage occurs, the ageing it causes can even be reversed. We see similar benefits of disease management for everything from kidney disease to neurologic disorders to thyroid problems to cancer. No matter what ails you, the ageing damage that a chronic condition causes is always, always improved by proper management.
In fact, we should stop thinking about most of these conditions as diseases and start thinking about them as physical states of ageing. States that accelerate the speed of ageing. States that you can, at least, partly control. I do not like the term chronic disease. With the exception of a few contagious illnesses (HTV infection, for example), most of the chronic conditions that affect us as we age are not diseases in the way we generally think of the term—that is, as infectious diseases. Nor are they usually inheritable genetic diseases, in the sense that the problem has to do with something structurally wrong with us from the time we were born. Rather, these conditions are examples of the body beginning to come undone as a result of ageing. The image of a machine wearing down its parts is apt. These conditions—heart disease, kidney disease, endocrine malfunction—are what we mean by ageing. Yet, and this is important, these conditions also accelerate the rate at which other parts of us age, too. By managing such conditions, we can control, in large part, the degree to which they will age us.
What should you do if you are suddenly afflicted with heart disease, arthritis, or another age-accelerating condition? First, do not despair. Instead, confront the situation head on. Develop a plan. You will need to understand the disease in and out and how it might affect and age you. Find a doctor who can work with you to develop a plan for disease management (It matters less whether your doctor is a generalist or a specialist; what is important is that he or she is knowledgeable about the condition and caring toward you). Read up on the condition yourself. Ask lots of questions. The more you know and understand, the better prepared you will be to fight the effects of the condition. Talk to your doctor about developing a well-rounded strategy for disease management, including diet, medications, exercise, stress reduction, and daily planning.
In general, managing a chronic condition means not just focusing on the condition itself, but treating your whole body with extra care. Those who suffer from almost every kind of chronic disease will want to pay extra special attention to retard or reverse more general ageing processes throughout the body. Eating a proper diet, exercising, managing your weight, and avoiding cigarettes and excess alcohol become key components of ageing management for almost all chronic diseases. All the things that can induce ageing when you are healthy become amplified by a chronic condition. Whereas your body may have once been able to handle long working days, no breakfasts, not enough exercise, or drinking too much, the condition you now have will make the margin for error much lower, because your body won't tolerate as much abuse.
Let's consider diabetes, for example. Diabetes is the sixth leading cause of death in this country, and the leading cause of blindness, not to mention one of the most significant causes of premature ageing. But it needn't be.
There are two types of diabetes, Type I and Type II. Although they have different causes, the two types have largely the same effect: high levels of sugar in the blood. Diabetes, if not treated properly, can cause arterial ageing; blindness; kidney failure; liver damage; and, in advanced stages, limb loss and heart failure. However, by keeping blood sugar within the levels of people who don't suffer the disease—by managing diet, insulin, and exercise—diabetics can avoid much of the ageing that high blood sugar causes. A diabetic can control the ecosystem, as it were, of his or her body in such a way that the disease has little impact. However, doing so requires a lot of attention and commitment. Not just once in a while, but every single day.
Type I diabetes-—sometimes called juvenile diabetes because the disease often begins in childhood—occurs when the body quits making insulin, the hormone necessary to metabolize sugar in your food and to regulate glucose levels in your blood. Patients with this type of diabetes generally inject artificial insulin that substitutes for the natural insulin their bodies should produce. Carefully monitoring blood sugar and making sure to balance diet, exercise, and insulin levels, in such a way as to keep glucose levels within a normal range is a way of preventing damage.
Type II diabetes, or adult-onset diabetes, usually develops when a person is over forty, often older. It occurs when the cells in the body become insensitive to insulin. The insulin receptors on the outside of each cell no longer react to the insulin molecule that signals the cell to break down glucose. Hence, blood glucose levels remain high. Type II diabetes occurs most often in people who are overweight; although the reasons are unclear, excess weight seems to impede the body's ability to metabolize sugar properly. Type II diabetes affects about 10 to 15 percent of adults over age fifty-five but is more prevalent among some population groups than others, confirming a generic component. For example, African-Americans, particularly African-American women, are much more susceptible to the disease. Indeed, one out of four African Americans over age fifty-five has Type II diabetes. Among certain Native American populations, the prevalence can be as high as 80 percent. However, in many cases, the disease is triggered by a combination of genetic predisposition and lifestyle choices. Some 90 percent of the people who develop Type II diabetes are considerably overweight, and most of these people also do not exercise or have proper diets, both of which further exacerbate the condition. If you 'live young,' you will have less chance of developing the disease, no matter what genes you have.
Diabetic patients who take charge of their condition, vigilantly keeping their blood sugar levels within normal ranges, experience little premature ageing. Patients who lose excess weight, begin exercising, and eat balanced diets that are carefully calibrated to their diabetic condition can reverse the ageing effects of the disease altogether, suffering no more ageing than their disease-free peers. Think of it this way: The diabetic's body can no longer create the conditions it needs for healthy existence all on its own. However, it is possible for the diabetic to create an environment inside the body that keeps him or her in an equally healthy state.
Although not all chronic diseases can be managed in the same way, many other types of diseases are similar to diabetes in the way that they should be treated. Thyroid disease, kidney disease, any endocrine disease, and many gastrointestinal diseases are analogous. The most important element in controlling the effects of these conditions is constant vigilance. Diabetics and most others who have chronic diseases have to monitor their condition each and every day.
Although not all chronic conditions can be managed as well as diabetes, all chronic conditions can be managed so they do not do as much damage—or cause as much ageing—as they would if left untended. Even Alzheimer's disease, a condition with few effective treatments, can be managed in ways that slow the ageing that the disease can cause. For example, studies have found that Alzheimer's patients who participate in clinical trials-—and hence are provided with high-quality medical care and better support systems—are half as likely to end up in nursing homes within the same period as Alzheimer's patients who do not participate in such trials. Better disease management does not stop the disease but helps stave off its most ruinous effects.
Those who have a chronic condition should ask themselves: Can this condition make me more prone to other kinds of chronic conditions? For example, people who have arthritis may be less likely to exercise, and for an obvious reason: It hurts. However, modest exercise relieves the symptoms of many types of arthritis. Furthermore, not exercising may cause the sudden appearance of arterial disease-—arterial disease that had been staved off because of exercise. That is, the response to one chronic illness (lack of exercise because of arthritis) may bring about another chronic illness (arterial disease).
Ask your doctor if there are any hidden symptoms you should be looking for. Heart attack victims, for example, often suffer bouts of serious depression in their recovery period. Although it is unclear what the exact cause-and-effect relationship is—Does the heart attack cause a biologic depression? Do depressed people have more heart attacks? Or is having a heart attack simply depressing?—it is clear that those who are recuperating from heart attacks need to be aware of this possible condition. Depression can undermine a recovery program, making it difficult for a heart attack sufferer to get the energy to change eating habits or begin an exercise program, all the things that speed recovery faster and help offset ageing. Luckily, in most instances, depression can be successfully treated.
No matter what disease you have, beware of its emotional effects. It is frightening and disheartening to be diagnosed as having a chronic condition. After a lifetime of thinking of yourself as a healthy person, all of a sudden you have to reevaluate your self-image. Don't think that you have to go it alone. It is not uncommon for someone who is diagnosed as having a chronic condition to hide the news from loved ones, not wanting them to worry. But doing so leaves the ill person feeling isolated, and those around the sick person always sense that something is wrong because such a diagnosis changes a person's behaviour. I have seen this reaction innumerable times in my patients: Being told that you will have a condition for the rest of your life, a condition that may affect the quality and length of your life, generally makes a person reflect on the larger importance of his or her life.
If you are diagnosed as having a chronic condition, use your social networks. Talk to people who are close to you about your fears and worries. You will find that the people who care about you will want to help. They will help keep you on track, urging you to stay on the special diet or joining you in your new exercise routine. Do not hesitate to seek professional help from a therapist or counsellor if you feel overwhelmed by the news. To ward off the ageing effects of a chronic illness, you need to be prepared in both body and mind.
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TO BE CONTINUED
REAL AGE …
Young for the Rest of Your Life
LIVING AS YOUNG AT SEVENTY AS YOU DID AT FORTY-FOUR
The book is over, but the rest of your life is about to begin. How will you choose to live it? You now know what your RealAge is and have essential information to make informed choices about your health and ageing. You know what factors accelerate ageing and what factors slow it down? Evaluate your health behaviors and lifestyle. What will you do to 'age-proof' yourself? You can reduce the rate of ageing. In the end, the choice is up to you.
Each winter my ninety-two-year-old father leaves his home in upstate New York to spend the winter months in Arizona, living in a community of other retirees, the youngest of them in their mid-seventies. When I began writing this book, I sent him drafts of the chapters. He began sharing what he had learned with his friends. More and more of them developed an interest.
They formed the equivalent of a Great Books club, in which they'd get together and read selections, finding out what each of them could do to stay young longer. They started taking vitamins and eating more fruits and vegetables, incorporating new 'get-young' strategies as new sections of the book arrived. After reading about exercise, they jumped to action. The whole group of twenty-five—not one with a calendar age less than seventy-five—raided the local WalMart, buying out the entire supply of two-to-fifteen-pound free weights (much to the amazement of the twenty-two-year-old salesclerk who looked on, open-mouthed, as twenty-five retirees in jogging shoes departed, barbells in hand). They hired a personal trainer to show them how to lift the weights correctly and to guide them through a fitness routine. Now they lift weights three days a week, go mall-walking another three days a week, and meet for 'happy hour' every evening to have a drink and spend time with their new 'young' friends. They egg each other on to get younger, celebrating each other's successes.
They have a blast. Each day they're getting younger and having fun doing it. My father's so busy I sometimes have problems tracking him down: He's out on the town. He frequently goes to New York City and travels by himself. He knows more about the Internet than I do. He's got friends, social engagements, and freedom, and there's no stopping him. People always say to me, 'He's amazing. To think, at his age.'
Sure, he's amazing, but not because of his age. Being young at ninety is something we can all strive to achieve. My dad's RealAge is seventy-six and getting younger. Enjoying our-old age with vigor and energy should be the rule, not the exception.
At the beginning of this book, I said, 'Health is like money.' At first the comparison sounds crass: How can you equate money with something as precious as life? But how can you not? Money as money isn't worth a dime. Money is only as valuable as what it buys. Money is really about potential. It provides possibilities, choices, and freedom. It also allows you to place a value on your choices and to make decisions: Likewise, the RealAge payoff isn't youth itself but the possibilities that youth provides.
The RealAge system teaches you how to; buy time. It allows you to understand what your biologic potential is. The younger your RealAge, the more possibilities, choices, and freedom you will have to do what you want with your life. The younger your RealAge, the more time you will have to spend with your friends and family, to develop new interests, and to do whatever it is that makes you enjoy life. Don't let ill health keep you from being who you want to be. RealAge gives you a currency for health. It helps you place a value on your health decisions, so you can protect what is truly priceless: your life. As life expectancy has increased dramatically in the past century, especially in the past thirty years, medical researchers have been faced with a major ethical dilemma: Are we extending the quantity of life at the expense of the quality of life? With expensive life-support machines and new technologies that can keep people alive longer and longer, doctors have worried that perhaps all this effort has only extended suffering, making patients endure painful diseases longer, living out their final years in misery. But this is not true. New studies show that most Americans can expect to live long lives (that is, to the national averages) without major illness or disability. However, there is enormous variation within the population. When studies have examined those who live the longest with the greatest mobility and independence, they have found that individuals at the top of the curve tended to make the same behavioral choices: They exercise, eat a diet low in saturated fats, don't smoke, take the right amount of vitamins, and do many of the other forty or so things described in this book. Even at the end of their lives, these people had less illness and for a shorter time than those who didn't make these choices; the period of decline tended to be compressed and lessened. In these same studies, those who had the most illness and incapacitation didn't adopt these healthy behaviors—-and they got older faster. They had shorter life expectancies and spent more time in hospitals and doctors' offices.
Clearly, there are no sound statistical measures of 'quality of life.' It is a subjective indicator. Some people are always happy no matter what; others are never happy. However, by looking at the data, we can draw certain conclusions. A person who is healthy has a better quality of life than if he or she needs to be under strict medical supervision. Also, a person who is mobile, lives independently, and is disease-free has a better quality of life than if he or she were hospitalized. Those aren't giant leaps of logic.
Before you even picked up this book, you were probably aware of all kinds of behavioral choices that were 'good' for you. But did you adopt those behaviors? I hope this book has helped you view your health in a new light. Rather than seeing these decisions as the prevention of disease, I hope you now see them as being about the prevention of ageing. Thinking about 'disease prevention'—the classic way preventive medicine has modelled itself—-is disheartening. Perhaps it's to daunting a project or its benefits seem too far off. Moreover, we think of disease in black-or-white terms: You're either sick or you're not. However, this description doesn't fit the reality of human health. Most of the 'old-age' diseases are not actually diseases as much as manifestations of the ageing process itself.
RealAge is a way of understanding that everything you do—from walking the dog to brushing your teeth-—-affects your rate of ageing. Adopting healthy habits means not just that you prevent disease, but that you live longer-—and younger. By living the RealAge plan, you increase the length of that part of your life that's vigorous and productive.
When I think about why I became a doctor in the first place, I realize that my decision can be summed up in one word: prevention. I never wanted to cure people after they were already ill; I wanted to help them avoid illness in the first place. Life is too much fun to spend time being sick. (In fact, I always think of my specialty, anesthesiology, as being all about prevention: Anesthesia prevents the shock reaction that the trauma of an operation can cause.) Yet, until now, prevention has been thought of in terms of far-off, negative goals. 'I won't eat fatty foods today, so I won't have a heart attack thirty years from now.' But prevention isn't a negative goal but a positive one. Preventing illness is gaining health. And the payoff is not thirty years in the future, but right now.
If you've made it this far through this book, you know in tangible and practical terms how you can prevent and even reverse ageing. So where should you start?
. First, write down your RealAge. Look at that number. Are you happy with it? Or would you like to make it younger? What will you do to change it?
. Second, review your Age Reduction Plan. What choices can you make to make your RealAge younger? Are they practical choices for you? In light of what you've read, are you willing to make choices that two hundred pages ago you wouldn't have made?
• Third, establish priorities. Consider how and when you want to add new Age Reduction strategies to your life. Set realistic goals and decide what steps you can take to meet them. What are the quick-and-easy strategies you can adopt for getting younger with hardly any effort? What are the anti-aging strategies that require more work? How will you integrate them into your life?
• Fourth, start small. Don't overwhelm yourself by trying to do too much at once. Begin with the 'quick fixes,' integrating new Age Reduction practices slowly, especially if they are in the 'most difficult' category. After all, you're in this for the long run. It's more important that you stick with your Age Reduction Plan than that you do every possible Age Reduction step right away, only to give them all up after a few weeks or months.
• Fifth, reevaluate. Often. Review your Age Reduction Plan every few months. Is it time to add a new strategy? I have patients who add one new anti-aging practice to their life every year—a kind of New Year's resolution.
. Sixth, don't give up. Getting younger is not that hard. A few simple choices can help make you five to seven years younger in just a few months. Other choices can help reduce your RealAge by as much as twenty-five years. Most of the benefits can be achieved by making simple choices that do not take much time or effort, just some practice.
. Seventh, you are never too old to start getting young. It doesn't matter if you're a lifelong smoker, if you've had a heart attack, or if you've suffered any number of other conditions. You can undo much of the ageing that you have already incurred by making changes now. Our bodies are remarkably resilient, and it is within your power to undo years' worth of unnecessary ageing. In their report of the MacArthur ageing studies, Jack Rowe and Robert Kahn wrote: 'There is increasing evidence of the remarkable capacity to recover lost function.' Yes, you can get young again.
. Eighth, the most important, celebrate successes. Reward yourself for becoming younger. Whether you decide to throw yourself a 'year-younger party' or to treat yourself to a massage after a month of daily workouts, you need to congratulate yourself for getting younger. (Don't forget to celebrate the year-younger successes of those around you, too. By encouraging people who are close to you to get younger, you are giving yourself a gift. You are helping those you care about to stay young with you.)
Think of RealAge planning like retirement planning. Most of us spend time in our forties and fifties making investments and setting up a pension fund or an individual retirement account, planning for that day when we no longer have to go to the office. RealAge is retirement planning for your body, an age-insurance plan. As I said in Chapter 1, your RealAge is a calculation of your net present value. It is a way of calculating how old your body really is. The choices you make affect that value. You build value by building youth.
Last fall, my friend Simon called me. He was the first person I convinced to stop smoking using the RealAge concept. 'Mike,' he shouted exuberantly into the phone, 'I'm a grandfather!' At age sixty-two (and RealAge fifty-seven), he had lived to see the birth of his first grandson. It was nothing short of a miracle.
Thirteen years earlier, when Simon was barely able to walk and in need of a dangerous operation, none of us—not his family, not me, and not Simon-— would have believed that he'd live to see the day when he'd become a grandfather. Much less, live to see that day as an energetic, physically fit, and young grandfather. 'Simon,' I laughed, 'you're not old enough to be a grandfather.'
Simon made choices that not only saved his life, but that gave him back his life. Thirteen years ago he couldn't walk across a room without pain. Now he's playing tennis and challenging me to squash matches. He's tackled some of the toughest challenges in Age Reduction: cessation of smoking, exercising, and eating a more healthful diet. He's done it slowly—adding bit by bit. Each year, he reevaluates his anti-aging plan, integrating new choices and behaviors. He's living younger now than he did thirteen years ago. The payoff has been huge. He's seen his kids get married, he's traveled, he's enjoying his life. He even retired early, so he could have more fun. (Now, he's feeling so young that he's been threatening to come out of retirement!)
In my practice, and even in my own life, I see that RealAge motivates people to change their behaviors and to choose youth. I see how my patients have stopped smoking, lost weight, and made choices that helped them stay young. I see how it has helped me learn to eat a healthier diet and be more balanced in my exercise regimen. RealAge has encouraged my father to start lifting weights and helped my wife to start taking her calcium regularly. RealAge helps us to place a value on our daily choices—choices that are easy to overlook but that help us stay young. (Every time I take the stairs instead of the elevator, I remember that it is helping me to stay younger. Every time I choose an apple instead of a cookie, I think that, too.) I hope that RealAge helps motivate you. By lowering your RealAge, you are buying time to do more and be more, to enjoy life like you've always wanted. What could be more promising than that? Stay young—for the rest of your life.
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THE END
AND I CAN TRULY SAY THAT FROM AGE 14, WHEN I BOUGHT THE CHARLES ATLAS HEALTH AND STRENGTH COURSE [STILL OBTAINABLE ON THE INTERNET] AND HAVE FOLLOWED A GOOD PART OF IT ALL MY LIFE, IT HAS PAID OFF IN A BIG WAY. I'M 72 COME SEPTEMBER 11, 2014, AND PEOPLE GUESS MY AGE AT ABOUT 50-52. FULL RETIREMENT IS NOT EVEN IN MY THOUGHTS OR DREAMS. I WORK PART-TIME AS CARETAKER FOR A COMMUNITY CENTER; I STILL TEACH MUSIC; I SWIM TWICE A WEEK; I WORK-OUT WITH BAR-BELLS 3 TIMES A WEEK; I DO SOME CHARLES ATLAS EXERCISES REGULARLY; I RIDE MY HORSE LIKE I'M STILL 40 YEARS OLD; I WATCH MY WEIGHT AND EAT A GOOD HEALTHY DIET.
MY DAD KEPT HIMSELF PRETTY FIT AND ATE A HEALTHY DIET. HE LIVED TO BE TWO MONTHS SHORT OF 94. AND IF HE HAD LOST HIS BIG BELLY IN HIS 70s HE WOULD HAVE LIVED TO BE AT LEAST 100 AS HE WISHED.
SO IF YOUR NOT "WITH IT" THEN WHAT I'VE SAID AND WHAT YOU HAVE READ FROM THIS BOOK, I HOPE WILL ENCOURAGE YOU TO INDEED GET WITH IT….. TO GROW YOUNGER AS YOU GET OLDER.
Keith Hunt
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