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Extracts from an article to be found on the website of: The New Zealand Institute of Anti-Aging Medicine http://nziam.co.nz/ Even accepting the foreseen acceleration in scientific knowledge, it is still a fact that we are all going to die one day. That is not something to be afraid of as acceptance of death is a healthy thing. Everyone needs to come to terms with the fact that they are mortal. What most people are anxious to avoid is a long period of illness and incapacity in their latter years: “it’s not the dying I’m afraid of it’s the getting old”. It is important to maximise health so that you remain fit, active, healthy and happy for as long as possible. The Institute provides a complete approach to delay the onset of age-related decline through a comprehensive program. This will also help prevent the most common diseases: cancer, cardiovascular disease and diabetes. The five pillars of anti-aging are:
Have you ever been to visit a relative or friend who is in a rest or nursing home, where there is almost total silence? No conversation or social interplay, merely the passage of time until the next meal. It is heartbreaking but all too familiar. This is not the way caring for the elderly should be. It is easier to avoid being admitted to these facilities in the first place than it is trying to change the quality of care. By taking steps now to prevent the body’s gradual decline, we can all hope to keep active, independent and healthy - well into old age. The goal is to extend the years of good health and decrease or abolish the years of ill-health and dependence. Diets The other main starting point is to look at different areas of the world and see if the population there lives long and healthy lives. There are several populations that conform to this and the two most studied live in Okinawa (Japan) and in Greece. The diet attributed to producing these affects have been popularised as the Mediterranean and Okinawan diets. Of course, diet is probably only one factor of many. It is probable that genetics and lifestyle factors have a lot to do with how long you are going to live. Both of these diets are relatively high in carbohydrate, low in meat consumption and high in fish. Otherwise they are quite different. The Mediterranean diet contains a lot of pulses, tomatoes and olive oil, where the Okinawan diet contains soy products, cruciferous vegetables (e.g. broccoli, bok choy), rice - and even more fish. So where does the average western diet go so wrong? Carbohydrates Let’s start with carbohydrates. Currently, they have the reputation of being the bad, fattening part of our diet - witness the Atkins and South Beach diets. The crucial point with carbohydrates is how “refined” they are, or what is their “glycaemic index” (GI). What this means is how quickly they are digested and released into the bloodstream. If this happens quickly, then there is a rapid rise in blood sugar and so insulin is released to push the sugars into the cells. Not only does this increase the likelihood of obesity, it also makes your blood sugar drop quickly in an hour or two. But when the sugar rush is finished and there is no “slow-release” of other foods, then you feel hungry and eat a snack. If this happens repeatedly over many years, the body becomes increasingly resistant to insulin and you can develop “Metabolic syndrome” and type II diabetes. These are known to cause an increase in age-related cellular dysfunction, heart disease, strokes, kidney failure, and many, many more disease processes. It really is best not to get into that state in the first place. What about “complex carbohydrates”? These are usually found in natural state foods that have not undergone processing by food manufacturers. The nutrients are released more slowly and there is no sudden peak in sugar and insulin levels. You also feel full for longer. Examples of refined, high GI foods: White bread Sweets/lollies Carbonated drinks Short grain, white rice Some breakfast cereals (ricies, cornflakes, special K, especially anything with sugar coating or chocolate flavouring) Examples of unrefined, low GI foods Vegetables Nuts Pulses Wholemeal bread Cereals (granola/muesli, bran flakes, weetbix) Fats What about fats? Lots of research is currently being directed at this area. Many fats are being found to have therapeutic affects and previous “villains” are perhaps not so bad after all. Types of fats include Saturated (animal) fats Unsaturated fats which may be poly-unsaturated or mono-unsaturated. Trans-fatty acids Fats can affect the following areas: Blood cholesterol and lipid levels Blood pressure Inflammation Brain and nerve tissue function Development and behaviour in children Blood vessel flexibility It should be your aim to understand what fats are best avoided altogether, which can be consumed safely in moderation and which should be taken for health benefits. You should also be able to remember in which foods you can find these, and so buy produce that will keep you healthy, not increase the likelihood of disease. Cholesterol It is a gross over-simplification to say that cholesterol is “bad”. We need cholesterol to make a great many of the body’s hormones, without which life would be impossible. However, elevated levels of cholesterol in the blood are clearly linked to the development of cardiovascular disease, possibly increasing the risk of some cancers and worsens mortality figures. Conversely, lowering blood cholesterol decreases the risk of heart attacks, strokes and all cause mortality. This is clearly shown in people with raised cholesterol and increasing evidence points to this being the case in people with a “normal” cholesterol. A diet that is rich in saturated (animal fats) and cholesterol may have a detrimental effect on certain people’s lipid profile, whereas one that is high in good oils such as olive oil may improve it. This used to be a cornerstone of dietary advice, but this may not always hold true. High animal fat and protein diets with a very low carbohydrate intake, such as the “Atkins Diet” have now been studied in a bit more detail. Contrary to conventional wisdom, the levels of total cholesterol, HDL (good cholesterol), LDL (bad cholesterol) and triglycerides may actually improve! It is wise to monitor your lipid profile closely if you are going to adopt a strict Atkins or Ketogenic diet. In addition, there are other long-term effects of being on this kind of diet that are probably detrimental to health. Trans-fatty acids (TFA) These are the bad guys! Suffice it to say that they don’t really exist in natural foodstuffs. What is a TFA? It is the result of heating a vegetable oil in a certain way to make it change its structure. The reason that they exist is because they are remarkably stable, and therefore allow products that are manufactured with them a long shelf life. They are primarily found in baked goods, biscuits, margarines and ready-meals. Multiple excellent studies have shown them to be highly detrimental. Many countries stipulate that products containing TFAs must have this clearly labeled. This is currently not the case in New Zealand. The give away is usually on the labeling when “hydrogenated vegetable oil” or just “vegetable oil” is present on baked goods. Try to avoid if at all possible, and even press for change in the legislation as they can be hard to spot. New York has just become the first city to ban trans-fatty acids! Poly-unsaturated fatty acids (PUFA) These can either be omega-3 (n-3) or omega-6 (n-6). Omega-3 oils are found in cold water fish and are generally accepted to be good for you. For vegetarians, flaxseed oil is a good source of omega-3 oils. The beneficial effects of n-3 oils are primarily on the cardiovascular system. They help with:
Salmon Tuna Mackerel Herring Sard ines Hoki Be aware that the larger the fish, the higher up the food chain it is, and therefore the greater the risk of mercury contamination. It is good to consume fish that is either harvested in a sustainable way, or is not under pressure from over-fishing. Small pelagic fish (sardines, anchovies and herring) are abundant, low risk for mercury toxicity and cheap. In contrast, most tuna populations are on the verge of collapse (with the exception of skipjack tuna), and they are expensive and have significant mercury contamination. Omega-6 oils are found in other vegetable oils such as canola, sunflower and margarines. Our current western diet is overweight in omega-6 oils. It is estimated that for optimal health, a ratio of n-6 to n-3 oil intake, should be no more than 6:1 and probably as low as 3:1. Most people consume foods with a ratio of 50:1. This is thought to be “pro-inflammatory”. The type of chemical messengers that the body uses to create inflammation are formed from n-6 oils. The messengers that are “anti-inflammatory” are formed from n-3 oils. Often the oils used in bought foods contain hydrogenated vegetable oils. These have partially altered to be more saturated (see TFAs) and are more stable. Recent research suggests that these could be positively harmful. Mono-unsaturated fats (MUFA) Olive oil is an omega-9 MUFA. This should be your primary source of fat. I recommend you use olive oil as your cooking oil and also for salad dressings. There is good evidence to support the health benefits of olive oil, particularly if it is cold pressed extra-virgin (this means there are no chemical processes used to help extract it that may alter its structure). It is a rich source of phytonutrients and anti-oxidants. Olive oil can: • decrease your risk of heart disease • improve your cholesterol and blood lipid profile • decrease inflammation • help prevent obesity and metabolic syndrome Other sources of MUFAs are nuts and avocados. Protein Should make up approximately 30% of your total calorie intake. It is preferable to get this from non-animal sources such as beans and pulses, fish or dairy produce but some meat intake is not detrimental to health. Try to use lean cuts of meats, which will allow you to get your protein without consuming extra saturated fats. Phytonutrients A diet rich in plant foods has been associated with good health and long life. There are strong associations with a decreased risk of cancers, heart disease, blood pressure, neurodegenerative diseases and diabetes/metabolic syndrome. Lots of these benefits were thought to be due to the anti-oxidant content of fruits and vegetables. Recent studies have therefore looked at taking these antioxidants and supplementing them individually to people, then measuring whether the health benefits follow. The results have largely been disappointing. It seems likely that the mechanisms for these health benefits are far more complicated. It is probable that these factors act in concert and in combination, and probably modulate cell-signaling pathways and growth factors. More sophisticated supplements will be developed as a greater understanding of these components evolves. For now, it is best to try and consume as many fruit and vegetables in your diet as you can tolerate. Uncooked or lightly steamed vegetables are usually better as the phytochemicals can be de-activated by prolonged cooking. Two exceptions to this rule are tomatoes and carrots – both these are significantly better for you when cooked! Superfoods Following on from the phytonutrient section, there are certain things that I would encourage everyone to include in their diet. Berries Dark berries contain massive amounts of anti-oxidants and are packed with the flavanoid subclasses: anthocyanidins and flavanols. Fish Deep sea cold water fish from a renewable resource at least a couple of times per week. Farmed fish may not have any benefit as the oils depend on a natural diet and cold waters. Flaxseed oil (FSO) Ground flaxseeds are the best, sprinkled over foods or cereals. If you use FSO then ensure it has some of the husk/seed is left in as this has the lignan secoisolariciresinol diglycoside (SDG) which is an essential component for its beneficial effect. Olive Oil A rich source of n-9 FA which have anti-inflammatory, lipid modifying and anti-platelet effects. Nuts Contain LCFAs, anti-oxidants and trace elements. Brazil nuts are the best source of selenium. Dark chocolate Try to buy with a minimum cocoa content of 70%, contains the flavanoid procyanadin with powerful anti-oxidant effects. Green tea Contains a flavanol, epigallocatechin-3-gallate (EGCG), which can inhibit metalloproteinases, and acts as a potent anti-oxidant among several possible other mechanisms. Populations that consume high volumes of green tea have a lower incidence of many cancers and heat disease. Also prevents age and UV related skin damage. Black tea Particularly Oolong, has high levels of polyphenols, catechins and isoflavins. Mostly inactivated by the addition of milk or when consumed with dairy products. Red wine and grapes Particularly the cultivars grown in cooler climates such as Pinot Noir, which contain high quantities of resveratrol, a substance that has similar effects at a cellular level to a calorie restricted diet. The methods used in Sardinia and Southwest France help preserve the polyphenol content. Resveratrol has been shown to increase the lifespan of yeasts, fruit flies and worms in a similar fashion to caloric restriction. Also contains other flavans, anthocyanins, quercetin, myricetin and kaempferol which have beneficial effects on lipid profile, oxidative stress profile, inflammation and platelet function. In moderation! Tomatoes Contain lycopene which is particularly effective against prostate cancer and probably has general anti-cancer and a cardiac protective effects as well. The anti-inflammatory effect is also of benefit in rheumatoid arthritis. Activity is increased by 6 times when cooked. Cruciferous vegetables Bok choy, broccoli, cauliflower and Brussels sprouts. Best of all are broccoli sprouts: 1 sprout has the same quantity of sulforophane as a whole head of broccoli. Thought to be potent anti-cancer agents, particularly for breast cancer. Miso soup and soy products Good source of phyto-oestrogens, that may have a role in breast cancer prevention if introduced into the diet early in life. Proven to improve the appearance of age and sun damaged skin. Recent reports suggest that one component is particularly effective at decreasing abdominal fat and therefore the risk of metabolic syndrome and type II diabetes. Garlic and onions Contain allium that has been shown to be protective in stomach, colorectal and prostate cancer. Tumeric Highly exciting compound that we will be hearing a lot more about in the future. Has been shown in the lab to kill cancer cells, repair many forms of genetic damage and assist cells resist aging processes. Protects against photo-aging of the skin. Chillies The active component in chillies is called capsaicin. Early research shows it may help prevent cancer formation and skin aging. Populations that consume large amounts of chillies have a lower incidence of stomach and colon cancer. Nutrigenomics Certain diets appear not to be harmful to certain people. For example in one person a diet high in salt will produce a dangerous rise in blood pressure, but not affect another. Some people can drink as much as they like and never get liver cirrhosis whereas most people will get sick over a period of several years. We are slowly getting an understanding of why this should be. The DNA we are born with produces the genetic coding that gives someone blue eyes or blond hair. It also codes for all the different enzymes – enzymes that digest, absorb, detoxify and process foods. Consequently some food groups that would be harmful to most people can be harmless to others. Foods that are beneficial to some may not be to others. It is exactly the same for processing prescription drugs as well. People can get significant, and occasionally severe, side effects; or sometimes no beneficial effect at all. In the coming years, we will see genetic testing to see what dietary components are of benefit to the individual, rather than to a population as a whole – this is called nutrigenomics. Aging Stroke Dementia Alzheimer’s disease If you find the prospect of these disease processes terrifying, then you are not alone. Most surveys suggest it is the loss of brain function, and therefore one’s character, memory, ability to interact with friends and family and to be able to look after oneself, that scares people most about getting old. Unfortunately there is no cure for these problems yet, and although new developments are making inroads, it is unlikely that there will be anytime soon. However, maintaining a fit and healthy brain will guard against these problems. Regular mental agility exercises and taking a combination of supplements specifically designed to increase your brain function reserves will give you the best chance. It’s a bit like building up a reserve of muscle. Even if you lose 50% of your calf muscle, you can still straighten your ankle. If you keep your brain fit and active it can withstand a bigger insult before any particular function is lost. This has been clearly shown on a group of nuns who kindly allowed their brains to be inspected after their death. The nuns who did regular mental exercise e.g. crosswords, read books etc, had far better mental capacity scores than those who did not. What was also exciting was comparing the brains of nuns who had Alzheimer’s. A brain that has Alzheimer’s has “tangles” in it. The worse the Alzheimer’s; the more tangles. In nuns who kept their brains fit, the microscopic damage of Alzheimer’s was far worse than expected i.e. the mental fitness and reserves built up by regular use protected against the effects of Alzheimer’s. Gingko has also been proven to be beneficial in the treatment of Alzheimer’s, and a number of other new “smart-drugs” have recently come on the market that have been shown to increase the level of functioning in Alzheimer’s sufferers. Most strokes and the other most common form of dementia are primarily due to vascular disease. What happens is the same process as that which causes heart disease: the blood vessels supplying the brain get increasingly thickened and furred up so the supply of oxygen and nutrients to the brain is decreased. Often a blood vessel gets completely blocked. If it is a large one a full-blown stroke can occur with a resulting loss of function. The kind of stroke depends on which area of the brain is affected e.g. being unable to move an arm or leg, or being unable to speak. If tiny vessels are involved then there may be no noticeable effect, but as this happens over and over again, the amount of functioning brain matter decreases, resulting in dementia. Decreasing the risk of strokes is incredibly important. Tight blood pressure control, lowering raised cholesterol and helping keep the blood a little thinner – in at risk individuals - are all crucial. What else can we do? Well, there are a variety of supplements that have very promising results in clinical trials, all of which we have included in our brain health supplement. How is exercise good for you? Cardiovascular disease Most of the research published about the health benefits of exercise are on its effects on cardiovascular disease. At the core of the problem of cardiovascular disease is dysfunction in the cells that line your blood vessels. An inflammatory process begins, abetted by a high LDL cholesterol, that causes thickening of the blood vessel itself, furring up of the lumen and an inability for the vessel to relax and dilate. The pathology of these processes is extremely complicated and still being clarified. Exercise, however, seems to reduce the incidence of all the contributing factors. Sedentary people have a 20-50% increased risk of developing high blood pressure compared to active people and a nearly 7 times greater risk of developing heart disease! Aerobic fitness Aerobic fitness refers to the body’s ability to transport and use oxygen during prolonged exertion (brisk walking, running, swimming, cycling etc). This exercise has been conclusively shown to reduce the risk of developing heart disease and also for preventing further heart problems in people who already have heart disease. The amount of exercise required to produce a reduction in risk is relatively small – perhaps 700-1000 kcal/week – 1 hour moderate walking five days a week. Health benefits (lower blood pressure, pulse, lipids) are probably derived from even less exercise in previously sedentary people. The more exercise performed, however, the greater the benefit gained: for each 1000kcal of exercise it is estimated a mortality benefit of 20% is achieved. This means that a progressive and incremental training program is best. While some exercise can help, more is better. The Harvard Alumni Health Study found that men who burned between 2,100 calories per week reduced their risk of heart disease by 10% but those that burned over 4,200 reduced it by 19%. After that the risk reduction seemed to plateau. The risks associated with exercise are minimal even in the elderly and those with established heart disease (2 fatalities per 1.5 million patient-hours of exercise), provided you start slow and build up gradually. It is recommended you speak to your doctor before starting an exercise program. Anaerobic fitness Anaerobic fitness refers to the body’s ability to produce energy without the use of oxygen and is also referred to as strength or resistance exercise. Results from the ongoing study looking at health professionals in the US show that as little as 30 minutes of anaerobic exercise reduced the risk of having a heart attack. Aerobic fitness is best achieved by getting a supervised program in a gym. It is important to have a program that does not cause injury and does not stress the joints and tendons. Injury will require extensive time for healing, which takes longer and longer as we age, and is counterproductive to maintaining health. It is better to do a slightly lighter program all the time than to go for broke. Metabolic syndrome (MS) This condition has been discussed elsewhere but in brief it is an increasingly common health problem characterised by central obesity, high cholesterol, pre-diabetes or diabetes and high blood pressure. The reasons exercise is beneficial for the MS are virtually identical to that discussed above. There are several other mechanisms as well. Part of the problem with the MS is the excess of fat around the middle. Not only is that under the skin (spare tyre) but it is also inside the abdominal cavity and inside the organs like the liver. Recently it has been discovered that it is this fat that is mostly to blame for the changes associated with the MS. Externally people can look fine: not overweight, no significant increase in their waist to hip measurement ratio, yet if they have an MRI scan one can reveal significant build up of intra-abdominal fat. This is becoming increasingly common even among SE Asian and Asian populations. This fat is only really treatable with the modification of dietary intake and exercise. A sedentary lifestyle is probably one of the major causes of metabolic syndrome and cardiovascular disease and is increasingly being recognised as a major risk factor to be actively sought and modified. Simply reducing your calorific intake won’t fix the problem, The body merely thinks it is going through lean times and goes into “starvation mode” conserving energy in the most efficient manner it can. Primarily, this means breaking down muscle (not good) and preserving fat for the long winter ahead (also not good). A well structured exercise and nutritional programme can work wonders for people. Type 2 Diabetes Better diabetic control can be achieved through exercise. It is well documented that improving one’s physique – more muscle and less fat – can improve your diabetic control. In some people with type II diabetes or pre-diabetes that are significantly overweight, merely losing weight and increasing muscle mass has completely reversed their diabetes. Even in people who are not overweight, decreasing intra-abdominal fat (see above) and increasing muscle can either remove the need for medication or decrease the dose of medication significantly. The aim here is to lose fat with aerobic exercise and increase muscle with resistance exercises. Muscles have receptors on them that take up glucose from the blood stream. In diabetes there is an excess of glucose in the blood stream (high blood sugar) and a relative resistance of these receptors to glucose. The more muscle you have, the more receptors you have to take up that glucose. The more exercise you do, the more the receptors need to take up to feed the muscle, and the less resistance they develop. Osteoporosis This is the term applied to the thinning and weakening of the bones as people age. When we get old we are more likely to fall. When the elderly (and not so elderly) fall over they break things – most commonly their wrists and hips. People who fall and break their hip have a nearly 50% mortality rate in the next six months. This extraordinary figure represents the associated illnesses in someone of that age but primarily it is a reflection of the loss of ability to bounce back from significant injuries. A huge amount of money spent every year on the prevention and treatment of osteoporosis each year. It is clear that trying to reverse established osteoporosis is extremely difficult. Preventing it is relatively straightforward. A diet rich in calcium, vitamin D and plenty of exercise will do the trick in most people. The kind of exercise you need to prevent exercise is anything that produces a stress on the bone. Running for lower limbs and resistance exercises for upper and lower limbs are best. The time to start is now. Waiting until you are in the at risk groups (post-menopausal women, elderly men) means it is too late. If you act now, you can build up a reserve of bone mass, which can be maintained as you age. Unfortunately, impact can exacerbate degenerative changes in the joints (osteoarthritis) so a structured approach is best. Falls In conjunction with preventing osteoporosis is preventing the falls themselves. A preventative approach is again best: - Strength - Flexibility - Balance All play a role, and exercises targeted to all of these areas are necessary. Brain, mood and cognition If we exercise, our thoughts are clearer. Why, has never really been clearly elucidated but is generally accepted that mental function and learning are improved with physical activity. Personally I have found studying for examinations much more productive if interspersed with regular breaks for light physical activity and one proper run. There is a decline in cognitive function with age. This is partially due to the effects of cerebrovascular disease (see above) but also a product of the deterioration of intra-cellular processes. We know exercise will help prevent the first of these problems. It is likely that it will also help the second. Exercise produces an increase in the number of free radicals and reactive oxygen species that cause cellular damage, but also increases the amount of compensatory mechanisms to counter them. By producing frequent minor stresses through exercise, you are able to up regulate the defences and prevent the damage that accumulates over the years. Secondly, somehow the plasticity and ability to prevent degeneration is enhanced by exercise, decreasing the amount of decay that is normally seen in aging neurological tissue. This may be due to some neurotropic factors: Obesity (Silver Spring). 2006 Mar;14(3):345-56. Neurobiology of exercise There is also a direct relationship between depression and exercise. People who are feeling down do not have the impetus to exercise – after all, what’s the point – and conversely people who exercise are less likely to develop depression. Exercise causes the release of various neurotransmitters such as dopamine, serotonin and endorphins which make you feel good. There is a clear association between recovery from periods of depression and partaking in regular exercise. Mr Richard Evatt Practice Manager. r.evatt@nziam.co.nz -------------------------------------------------------------------------------- Mr Marc King Anti-Aging Consultant, Personal Trainer. m.king@nziam.co.nz -------------------------------------------------------------------------------- Dr Mark Izzard Surgical Oncologist. mbbs fracs m.izzard@nziam.co.nz -------------------------------------------------------------------------------- Dr Mark Gray Dermatologist, Pathologist. mbchb frcpc frcpa m.gray@nziam.co.nz -------------------------------------------------------------------------------- Dr Charles Tweed Anti-Aging Specialist. mbbs frcs facem c.tweed@nziam.co.nz -------------------------------------------------------------------------------- PO Box 33 1208, Takapuna 398 Lake Road, Takapuna, Auckland, New Zealand Telephone 09 4867111 Facsimile 09 4867133 info@nziam.co.nz |
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