Aging Well: Parts That Matter

By Richard Laliberte, Amanda MacMillan & Nancy Kalish Prevention Magazine 1. Your Goal: Prevent a heart attack. Focus: The cardiovascular system By Richard Laliberte HOW YOU AGE Cholesterol levels shift HDL (good) cholesterol sweeps up LDL (bad) cholesterol and shunts it to the liver for removal. Without enough HDL, the bad stuff builds up, causing plaque. Plaque causes clots Plaque is a mix of fatty substances, including LDL cholesterol, which burrows into and inflames artery walls. When a plaque deposit bursts, the body’s healing mechanism produces a clot. This can obstruct the artery and cause a heart attack. Arteries become weak and stiff High blood pressure hardens flexible arteries, which strains the heart, rips open plaque deposits, and promotes blood vessel leaks that can cause an aneurysm or stroke. Blood vessels are lined with the same kind of tissue as your skin. “It’s just as important to keep your inner skin as beautiful as the visible skin,” says Lori Mosca, MD, PhD, an associate professor of medicine at Columbia University in New York City. “Instead of protecting it from the sun, you need to prevent damage from a poor diet or lack of exercise.” Blood can become “sticky” High blood sugar is like a soda spill on a countertop—it permits plaque-forming material to fasten more easily to artery walls. It’s also a symptom of diabetes, which doubles your risk of heart disease or stroke. Waist size expands Slowing metabolism leads to weight gain, which contributes to diabetes, high blood pressure, and high cholesterol. “Large waist size is the most important risk factor—it compounds all the others,” says Annabelle Volgman, MD, medical director of the Heart Center for Women at Rush University Medical Center in Chicago. YOUR STAY-YOUNG PLAN Keep moving “Physical activity reduces every controllable risk factor,” says Volgman. Just 10 minutes of cardiovascular exercise on most days can cut a sedentary person’s heart attack risk in half. Do intervals By boosting aerobic fitness and metabolism, twice-a-week interval training (short bursts of high-intensity exercise) for just 2 weeks can reduce heart risks by 20%, according to studies. Get started: Simply vary the pace of your daily walk for 2 minutes every 10. Monitor your markers Keep a copy of the blood work you have done during your annual physical and track changes over time. Make sure your numbers are always within these ranges: •  Cholesterol: LDL under 100 mg/dL; HDL above 50 •  Blood pressure: Below 120/80 mm Hg •  Fasting blood sugar: Less than 100 mg/dL •  Triglycerides: Less than 150 mg/dL Get “subclass” cholesterol tests If you have heart disease or are at risk, ask for a test called lipoprotein subfraction, which measures the size of your cholesterol particles. If your LDL particles are very small, they are better able to burrow into artery walls; despite normal or low cholesterol readings, you may need more aggressive monitoring and treatment. Test for inflammation Doctors now know that when LDL cholesterol damages the arterial wall, the artery becomes chronically inflamed, starting a cascade of events that may culminate in a heart attack. As part of this inflammatory response, your body produces a substance called C-reactive protein (CRP), which can be measured in a blood test. If you have normal cholesterol but a high level of CRP, you may need a more aggressive preventive plan (more intense monitoring of lipids). Screen out false positives Make sure to ask for the high-sensitivity test, which rules out other causes of inflammation, such as infection, injury, and arthritis. Brush your teeth, clean your arteries Cutting your risk of heart disease may be as easy as regularly flossing and brushing. Columbia University doctors have found that people whose mouths contain a high number of the bacteria that cause gum disease are more likely to have plaque-clogged arteries. Save every tooth Keep an eye out for gum recession. A recent study found that men ages 40 to 75 who had lost eight or more teeth because of gum disease had 57% higher risk of stroke than those who had lost less than eight. Get a baseline heart scan Prominent cardiologists recommend that women over age 50 who are postmenopausal and have any risk factors for coronary disease get a heart scan—several different technologies are available—to measure coronary artery calcium, which directly correlates to the total amount of plaque in your arteries. An early baseline enables your doctor to monitor signs of heart disease. Get a highly detailed picture Opt for the brand-new 64-slice CT scanner, which measures calcium and the amount of dangerous soft plaque in the arteries. Filled primarily with cholesterol, soft plaque is prone to rupture, resulting in a blood clot that can cause a heart attack. The Newest Heart Attack Fighters •  Eat more omega-3 fatty acids. They curb inflammation, lower blood pressure, and slow plaque growth. To get more, eat oily fish such as salmon at least twice a week and consider taking EPA and DHA supplements of 850 to 1,000 mg a day if you have heart disease. •  Take aspirin with a doctor’s okay. Low doses prevent clots that cause heart attacks, but regular use can cause stomach bleeding and increased stroke risk. “Whether you should take it depends on your age and family history,” says Mosca. •  Cut saturated fat even further. Artery-damaging fat should account for less than 10% of daily calories. Ideally, you should keep it below 7%. Be vigilant about reading food labels to avoid eating partially hydrogenated (trans) fats. •  Trim 200 calories a day after menopause. After 50, your metabolism slows about 5% a decade, so your body burns less energy even if you’re moderately active. Source: The American Heart Association’s new prevention guidelines for women Protect Your Heart Like the Mediterraneans Olive oil, leafy greens, whole grains, nuts, fruit, fish, red wine, tomatoes—their rich blend of antioxidants, phytochemicals, vitamins, and healthy fats cuts cardiovascular risks. Just 3 months of Mediterranean-style eating in one recent study improved blood sugar, blood pressure, and cholesterol in people at high risk of heart disease. The Mediterranean diet offers good sources of chromium, which may lower bad and raise good cholesterol as well as prevent insulin resistance (the hallmark of diabetes)—but it’s hard to get enough of the mineral from food. Best bet: Take a daily multivitamin with chromium. Quick tip Have a truffle for dessert: Eating a 30-calorie dark chocolate daily for 2 weeks will lower systolic blood pressure by 3 points and diastolic pressure by 2. 2. Your goal: Stay sharp. Focus: The Brain By Nancy Kalish HOW YOU AGE Your gray matter shrinks Neurons start diminishing in number and size, slightly reducing brain volume and your ability to recall details and facts with the quickness of your youth. Tangles and plaques destroy cells Tangles are fibers that develop inside neurons; plaques are a buildup of sticky proteins between neurons—both are thought to knot up and kill nerve cells. Having some tangles and plaques is normal, but developing too many is associated with Alzheimer’s disease. Free radical damage accumulates Inside brain cells, free radicals can damage DNA and interfere with energy-producing mitochondria, causing premature cell death. Connections between neurons diminish Levels of a neurotransmitter directly involved in memory, called acetylcholine, naturally decrease with age, reducing the brain’s ability to transport messages from one cell to another. Stress takes a toll Long periods of anxiety and worry may harm your brain, especially the hippocampus, a part responsible for memory. A Rush University Medical Center study that followed more than 1,200 people over 12 years found that those most easily stressed developed more cognitive impairment by the end of the study than other participants. High blood pressure and cholesterol starve cells LDL cholesterol can clog tiny capillaries in the brain, cutting off the blood that supplies oxygen, nutrients, and energizing glucose and increasing the risk of stroke. High blood pressure doubles your risk of Alzheimer’s. YOUR STAY-YOUNG PLAN Give your brain some quiet time Adequate sleep makes you smarter. New research from the sleep disorders program at Massachusetts General Hospital in Boston shows that sleep helps the brain bring together disparate pieces of information and interpret them correctly. Conversely, too little sleep leads to bad performance and mood disorders. Meditate Regular meditators’ brains exhibit high levels of gamma waves, associated with attention, working memory, and learning. Emory University researchers also discovered that when people begin meditating in middle age, they experience less loss of gray matter and attention levels when compared with those who do not meditate. Eat an apple a day Apples contain antioxidants that raise levels of acetylcholine, a neurotransmitter that’s essential to memory and tends to decline with age. They also contain quercetin, a flavonoid that protects brain cells against damage from free radicals. Take omega-3s Found in fish such as salmon, halibut, and sardines, omega-3 fatty acids are involved in nerve cell communication. Recent research shows that they help protect against the cell damage that leads to Alzheimer’s. Consider getting your omega-3s in pill form: Unlike whole fish, supplements have been found to be free of mercury and PCBs, according to analyses by Embrace fitness Exercise produces large quantities of brain-derived neurotrophic factor (BDNF), a protein that helps neurons survive and encourages the growth of new ones. “I call it Miracle-Gro for the brain,” says John Ratey, MD, a clinical associate professor of psychiatry at Harvard Medical School and author of the upcoming Spark: The Revolutionary New Science of Exercise and the Brain. “It helps the cells grow and makes them better and more resilient to future stresses.” Brains with more BDNF have a greater capacity for knowledge. To boost BDNF levels, Ratey recommends moderate- to high-intensity aerobic exercise, incorporating interval training. Other research shows that just walking brings substantial benefits. Best bet: Include a 10-minute speedwalk in your daily stroll. Add strength-training The latest research shows that muscle-building activities such as yoga and light-weight workouts increase production of IGF-1, another chemical essential to the growth of neurons. Stay connected The brain grows—even in old age—in response to pats, hugs, and other physical affection. Regular socializing also keeps your brain sharp by reducing cortisol, the destructive stress hormone. Last year, when scientists at Rush University performed postmortems on the brains of 89 seniors, they were surprised to find plaques and tangles associated with Alzheimer’s in several of the deceased, though none had experienced any of the disease’s telltale symptoms. When they researched the seniors’ social histories, they found the deceased all had one thing in common: tight relationships with many friends and family members. Dance the night away Hoofing with a partner, particularly the complex steps of dances like the tango, rumba, and samba, delivers a trifecta of brain protectors: social interaction, mental challenge, and physical exercise. In a McGill University study, seniors 62 and older who tangoed for 4 hours a week for 10 weeks improved their memories. Don’t like dancing? Go shopping at the mall with a friend, which offers the same trio of benefits. When you’re shopping, you’re socializing, figuring out the best bargains, and walking without even realizing you’re getting in a workout. Instant Brain Boost: Seek Novelty Your brain is a thrill seeker. New experiences stimulate the area that produces dopamine, a chemical involved in learning and memory. It also loves a brand-new workout. Studies show that doing new things builds brain mass and increases mental agility. The absence of novelty, however, causes dopamine-producing areas of the brain to shrink.To keep your brain lithe and strong, take up a language, hobby, sport, or musical instrument—any regular pastime that offers continual fresh challenge. Even if you’re not good at your new pursuit, you’ll still get the benefits. How Memory Experts Stay Sharp “I practice an instrument. I play the piano or guitar almost every day, which gets my mind moving in different ways than it does at work. Research shows that activities like this can keep one’s mind ‘young.'” —Tom Shea, PhD, 55, director of the University of Massachusetts Lowell Center for Cellular Neurobiology and Neurodegeneration Research. “I keep essentials in one spot. Do you forget where your grocery store is? No—because it doesn’t move around a lot. I always place my keys, wallet, and laptop in the same spot, so I always know where everything is.” —Stuart Zola, PhD, 60, director of the Yerkes National Primate Research Center at Emory University. “I do 20 minutes of yoga almost every morning. It clears my mind of distractions, which helps me focus, and has a definite positive impact on my memory.” —Russell Poldrack, PhD, 40, an associate professor of psychology at UCLA. “I deal with things immediately. I always return phone calls, pay bills, and answer e-mails right away, rather than trying to remember to do them days later. I also ‘off-load’ important info, such as phone numbers and appointments, to my PDA. That way, the only thing I need to remember is to check it.” —Aaron Nelson, PhD, 56, chief of psychology and neuropsychology at Brigham and Women’s Hospital in Boston and author of The Harvard Medical School Guide to Achieving Optimal Memory. 3. Your goal: Be active for life. Focus: Bones and joints HOW YOU AGE Bones get thin After bone mass peaks around age 30, you start to lose 1 to 2% of bone a year; the pace accelerates to 3 or 4% annually in the first 5 to 7 years after menopause, when declining estrogen offers less protection against cells called osteoclasts that break down bone. This puts you at high risk of both osteoporosis and fractures, its most serious consequences. Muscle fibers shorten and weaken Around age 40, muscles start shrinking and losing energy-producing mitochondria in their cells. Weakened, poorly nourished muscles have lower aerobic capacity and absorb sugar from the bloodstream less efficiently, making bone-building exercise difficult. Joints lose their cushions Synovial fluid, which lubricates the protective cartilage in knee, hip, and other joints, begins to dry. Cartilage then erodes and frays, a precursor to arthritis. Wear and tear takes a toll About 26% of women get arthritis, compared with only 17% of men. Reason: Muscles attached to wider pelvises exert additional stress on knees that, over time, exacerbates cartilage damage. YOUR STAY-YOUNG PLAN Do weight-bearing exercise Walking, dancing, stair-climbing, skiing—any activity that forces your skeleton to support your weight speeds the work of bone-building osteoblast cells. Just a half hour of brisk walking boosted two measures of bone growth in one recent study. But avoid high-impact moves such as running or jumping if you already have osteoporosis or you risk fractures. Practice tai chi Postmenopausal women who’ve practiced the slow, graceful movements of this exercise for years have denser bones—and even beginners slow bone loss as soon as they start, according to a recent research review at Harvard. Strengthen and tone your muscles The stronger you are, the less likely you’ll be injured in a fall. What’s more, lifting weights as little as twice a week reverses loss of mitochondria, giving you and your muscles extra energy, according to a recent study at the Buck Institute for Age Research in Novato, CA. A 16-week strength-training program has also been shown to cut arthritis pain by 43%. Bonus benefit: Muscle workouts boost your metabolic rate as much as 15%, so you burn more calories even when you’re inactive. Target your quadriceps People with strong thighs have less cartilage damage and pain in their knees from osteoarthritis, according to a preliminary study. Mayo Clinic researchers say toned quads reduce lateral kneecap motion that speeds cartilage wear. Make sure also to strengthen your hamstrings at the backs of your thighs so you don’t create muscle imbalance. Get enough calcium The mineral is the main component of bone, and women need at least 1,000 mg a day—1,200 after menopause. Yet 78% of us don’t get enough, especially after age 50, when adult intake averages just 674 mg a day. Eat calcium-rich dairy foods and consider taking two 500 mg supplements a day. “Take doses separately—for example, one at breakfast and one at dinner,” says Kimberly Templeton, MD, an associate professor of orthopaedic surgery at the University of Kansas Medical Center. “The body can absorb only about 500 mg at a time.” Additional food sources include fat-free milk, which provides a third of the daily value for calcium, and spinach, which delivers 12% of the DV for calcium and also contains vitamin C, a collagen builder that improves calcium absorption. Supplement with vitamin D It helps calcium enter the bloodstream and fuse to bone, but half of women aren’t getting the 200 IU recommended before menopause—much less the 400 IU you should get after age 50. What’s more, many experts think the current recommendation is too low, prompting the National Osteoporosis Foundation to raise its recommendation to 800 to 1,000 IU of D a day for women age 50 and older. One fast food fix: 3.5 ounces of salmon provides 90% of the DV for vitamin D, contains bone-building calcium, and is rich in omega-3 fatty acids, which reduce inflammation linked to rheumatoid arthritis. Stay ahead of arthritis pain with massage and acupuncture The two natural treatments are known to ease pain in the 46 million sufferers of the disease, two-thirds of whom are women, with none of the potentially serious gastrointestinal side effects caused by NSAIDs. Recent studies have shown that stimulation of pressure points, either manually or with acupuncture needles, prompts the nervous system to release chemicals that mask pain. Drink pomegranate juice In lab tests done at Case Western Reserve University and reported in the Journal of Nutrition, extract from the fruit lowered levels of an inflammatory chemical called interleukin-1B, which is released during arthritis flare-ups, as well as enzymes that erode cartilage. When to Get a Bone Scan Bones don’t let on that they’re weak—until they break. That’s why you should get a bone mineral density test such as a dual energy x-ray absorptiometry (DXA) if you meet these criteria from the National Osteoporosis Foundation: •  You’re postmenopausal, have a fractured bone, or have any risk factor for osteoporosis—you are thin, are small-framed, exercise very little, don’t get enough calcium and vitamin D, smoke cigarettes, or have recently quit smoking after many years. •  You’re 65 or older—even if you don’t have a fracture or any other risk factors. A Flat Belly: Good for Your Bones Your body’s main source of strength and stability is your core—also referred to as your torso, trunk, or midsection—which includes all the muscles of your abdomen, lower back, and hips. Any bone- and muscle-building routine you follow should include core exercises. A strong midsection will: •  Keep you moving. Toned core muscles provide support to joints, enabling them to handle mild strains and stresses that lead to injuries. •  Prevent back problems. Trunk muscles sheathe your spine, shoring up weak points, like compressed or frayed disks, that can cause debilitating pain and reduce mobility. •  Improve balance and posture. A solid core helps prevent falls. Creaky Knees? Try Glucosamine and Chondroitin Many researchers think this combination reduces inflammation and boosts hydration of joint cartilage. A review of 15 studies found that these supplements improve mobility. The largest trial so far found that 1,500 mg of glucosamine combined with 1,200 mg of chondroitin (a component of cartilage) safely relieves moderate to severe knee pain. If you have diabetes, first check with your doctor: Glucosamine can affect glucose metabolism and may interfere with medication. You can also try ginger and turmeric supplements, which contain anti-inflammatory compounds. Quick Tip: Add Milk to Coffee The bone-building benefits of calcium and vitamin D in a tablespoon of low-fat milk offset the impact of caffeine, which causes bones to excrete calcium—about 2 mg of calcium per cup, according to the National Institutes of Health. 4. Your goal: Look younger. Focus: Skin By Amanda MacMillan HOW YOU AGE Cell turnover slows Through the natural exfoliation process, your skin sheds dead cells as younger ones, generated deep in the epidermis (skin’s top layer), migrate upward to replace them. In young, healthy skin, cells take about 28 days to reach the surface and flake off 12 days later. As you age, renewal slows: New cells aren’t produced as quickly, and old ones hang on longer. Free radicals attack The body is assaulted by unstable oxygen molecules—called free radicals—from pollution, stress, cigarette smoke, and the sun. Over many years, this causes cell irregularities, including discoloration and cancer. Collagen breaks down. After age 40, the body typically slows down the rate it produces collagen, a mesh of protein that, together with elastin, helps keep your skin plump and elastic. When collagen degrades and is not replaced at the same rate, the outer skin loses volume and settles into creases and wrinkles. Skin dries out Your cells lose moisture faster after 40, as estrogen production and thyroid function—both of which affect sweat glands—slow down. YOUR STAY-YOUNG PLAN Cover up – but not all the time Avoid overexposure to the sun. Stay in the shade between 10 AM and 2 PM, when UV rays are strongest, and wear a wide-brimmed hat and clothing that covers much of your body. Get adequate sleep They don’t call it beauty sleep for nothing. Skin cells regenerate more quickly when you snooze. Dark circles under the eyes are the immediate consequences of losing just a few hours of restorative sleep. Prolonged sleep deprivation can lead to dry, dull skin all over the body. Moisturize at night The temperature of your skin rises slightly when you’re asleep, helping it absorb creams and lotions. Anti-aging potions may also work better because they’re not competing with makeup or sun exposure. Try a bedtime-specific cream such as ROC Retinol Correxion Deep Wrinkle Night Cream (evening formulas are often richer than daytime formulas but don’t contain SPF), and slather dry feet, hands, and nails with a rich, hydrating cream or petroleum jelly. Drink more water Downing six to eight glasses of water each day helps skin stay elastic and supple, says Doris J. Day, MD, a clinical assistant professor of dermatology at New York University Medical Center. “When the skin is adequately hydrated, it looks healthier and more vibrant, and makes some wrinkles less visible.” De-stress Stress—both internal and external—makes the body’s defense mechanisms work overtime and deprives skin of moisture, leaving it drier and more vulnerable to irritants and allergens. Unwind during the day with quick periods of meditation or focused breathing—and do a quick exercise DVD (kickboxing?) after work. Just be sure to pick a mindful activity during which you are tuned in to your body and not distracted by your blasting iPod. Do cardio “Think of the flush on your face after a good workout: That’s a sign that your skin’s getting the oxygen and nutrients it needs,” says Audrey Kunin, MD, a Kansas City, MO-based dermatologist and author of The Dermadoctor Skinstruction Manual. A good sweat flushes impurities from pores while you’re burning calories and keeping off extra pounds that could put unnecessary strain on the skin. Before you work out, make sure you’re well-hydrated, and use extra moisturizer, particularly in the drier, colder months. Try yoga “Stretching tones and conditions the muscles and firms up the skin they’re attached to,” says Hema Sundaram, MD, a Washington, DC-area dermatologist and cosmetic surgeon. Backward -bending poses such as the fish, camel, and cobra can counter gravity’s pull when done regularly, while the forward-bending child, bowing sun salutation, and headstand poses encourage a rich supply of blood to the face. And the more you can truly relax your facial muscles, the less you’re contributing to future crow’s feet, frown lines, and wrinkles. Eat antioxidants If skin’s biggest enemies are free radicals, its best friends are the vitamins and minerals that neutralize the volatile and destructive molecules. Eating lots of antioxidants—five to eight servings of fruits and vegetables a day—can combat cellular damage caused by free radicals. Sip green tea People who do so regularly have less sun-related skin damage than those who don’t, according to Dartmouth Medical School researchers. The tonic, which contains the powerful antioxidant EGCG, can be used as a topical ingredient as well. (Ask your dermatologist about Replenix, available in doctor’s offices). 3 Essential Wrinkle Fighters 1. Retinols A derivative of vitamin A, retinol helps “unglue” dead skin cells, accelerating their removal and stimulating new growth. Its ability to improve mottled pigmentation, fine lines and wrinkles, skin texture, and skin tone and color has been well documented. Start with an over-the-counter retinol, using a small amount a few nights a week. If you experience good results, consider moving up to a prescription-strength formula. 2. AHAs Alternating a retinol cream with an alpha hydroxy acid—another exfoliant that attracts moisture to the skin—can renew your skin with fewer side effects, like peeling and redness. Use an AHA formula the nights you’re not using a retinol; both can increase sun sensitivity so are best applied before bed. Ask your dermatologist for specific product suggestions. AHAs consist of these five acid types: •  Glycolic acid, from sugarcane •  Lactic acid, from milk •  Malic acid, from apples and pears •  Citric acid, from lemons and oranges •  Tartaric acid, from grapes 3. Peptides These molecules contain a high content of hydroxyproline, the building block of collagen. Researchers believe they function as messengers in the skin, repairing broken collagen and elastin connections between the dermis and the epidermis. Look for algae and copper peptides; both have been well studied. Drugstore Wrinkle Fix Olay Regenerist’s serum, day cream, and night cream regimen (all of which contain peptides) was the top-rated performer in Consumer Reports’ 2007 antiwrinkle study. In a 12-week trial of 23 patients ages 30 to 70, the bargain combo beat out a $300-plus French line and seven other favorites, reducing fine lines by just under 10%. Quick Tip COME ON, SMILE! When older women flash a broad smile, they’re perceived even by younger people as more youthful and appealing, according to a study published in Psychology and Aging.