Aging: Life Is a verb, not a noun
Getting older is inevitable, growing up less so. Ask my wife; she will tell you immediately that growing up and maturity do not apply to me. What is aging?
Of the many definitions, I’ll mention just two: One is “the process of growing old and mature.” Or, a more biological definition, “aging is the endogenous and hereditary process of accumulative changes of molecular and cellular structures disrupting metabolism with the passage of time, resulting in deterioration and death. Aging occurs on both levels, of the whole organism as well as of individual cells”.
Aging is, by far, the leading cause of death; of the approximately 150,000 people who die each day, roughly 100,000 die of aging. In the developed countries, up to 90 percent of deaths are due to aging.
Everything and everybody is aging, or so it seems. In 2012, the average lifespan for the U.S. was 78.49 years, and for the world, it was was 67.59.
Still, for longevity, the U.S. ranks only 15th among the countries in the world. The highest is Monaco with 89.68 years, and at the bottom is Chad with 49. At the present time, the maximum lifespan for humans is approximately 120 years. The oldest documented human being was Jeanne Calment, a Frenchwoman who died in 1997 at age of 122 years and 164 days.
Centenarians are currently the fastest growing segment of the American population. While they number 70,000 in 2012, the American Census Bureau predicts that in 2050 we’ll have 600,000 in the US. Among centenarians, women are at a distinct advantage: 85 percent of centenarians are women. But if men can make it past 100, they are in general in better health.
Not everybody will get Alzheimer in very old age; only one third of centenarians have it, one third have some hearing and vision impairment (they might appear Alzheimerish, but they are not) and one third are completely normal and functional.
Is aging really a universal principle in nature? Maybe not. We know that most animals don’t die of aging. They are eaten or killed by other animals or humans. There are some animal species, like jellyfish, that never die. Some whales and turtles can survive more than 200 years. Many trees can survive over thousands of years.
In 2011, heart disease and cancer were the two leading causes of death in the U.S.: 590,000 for heart disease and 570,000 for cancer. Alzheimer’s was in sixth place, with 83,000 deaths. All three diseases are age-related — the older we get, the more of these three diseases we get.
Heart disease and Alzheimer’s disease increase steadily with age, but cancer is different. Up to age 90, the incidence of cancer is growing, but after 90, it starts to dip. If we look at death certificates of centenarians, we discover that most centenarians die of either heart failure or Alzheimer’s disease and very seldom of cancer.
What is the reason? In general, our immune system protects us against cancer and many other diseases, but with age, the immune system becomes weaker. Some studies suggest that the immune system in the very old is different. In advanced age, instead of progressively deteriorating, it reorganizes, and in many centenarians, it is actually augmenting.
Centenarians seem to be immunologic outliers. We do not know the precise mechanism of this phenomenon. Do some epigenetic switches get activated to protect the very old? Do very old people become more resistant to mutations?
Most diseases are closely connected to lifestyle, much more than to our genes: 80 percent is lifestyle, only 20 percent is genes. We cannot change our genes, but they can be switched on or off with our lifestyle. We are no longer powerless when facing chronic diseases of older age. From some animal studies, we have learned that activating or silencing just a few genes can significantly extend lifespan or protect us against certain diseases.
Recent studies of the human epigenome support the direct impact of lifestyle on our health. Once the National Epigenome Project is finished, we might be able to significantly extend the human lifespan.
The way we live matters the most. A healthy lifestyle can be achieved by following a few basic principles – not smoking, good nutrition, daily exercise, seven to eight hours of sleep, being socially connected with friends, family and community.
Spirituality matters: there is a biological value in prayer, no matter what your religion. If you are a non-believer, try meditation; it has the same biological value as prayer. Also, remaining active, at work or in retirement, helps to decelerate the aging process. Indeed, achieving old age is like a pedaling the bicycle: if you stop pedaling you’ll fall. Do not forget: life is a verb, not a noun.
What should we eat and how physically active should we be?
Nutrition first: eat lots of vegetable and fruits and fish (except talapia, which has too many omega 6 fatty acids). You don’t need to be a vegetarian; you still can eat meat but in moderation. Reduce your salt and fat intake (potato chips, nachos, fritos). Stay away from processed food, such as bologna. Drink lots of fluids, especially water, tea (green or black), coffee, and red wine in moderation.
Do not take vitamin supplements, especially the three vitamins A, C and E. The only vitamin where we have solid data that supplement helps is vitamin D. The best vitamin intake is in well-balanced nutrition. Eat fruits, but don’t drink fruit juices – oranges yes, orange juice no. Fruit juices have about 50 percent more sugar than fruits.
Avoid sugary soda drinks. All cancers are addicted to sugar. In a recent experiment, researchers compared cancer cell growth in culture alone versus culture with added sugar. Cancer cells grew much faster in the culture to which sugar had been added.
So try to limit the amount of sweets in your life. One more thing, eat slowly. It takes 20 minutes for the stomach to send a message to the brain that it is full. If we eat fast, we can consume lots of food in those first twenty minutes before we feel that we have eaten enough. Many fast eaters, mostly men, overeat. Slow down. Do not eat on the run.
Physical activity, like nutrition, has a numerous health benefits. It burns calories, prevents obesity, and reduces coronary disease, stroke, metabolic syndrome, type 2 diabetes, and depression. It also significantly contributes to the prevention of the four major cancers: colon, prostate, breast and lung. It also reduces arthritis and falls.
On a physiological level, physical activity boosts LDH (the “good cholesterol”), lowers triglicerides, increases testosterone, and slows down the shortening of telomeres at the end of the chromosomes, which are responsible for our longevity. If exercise were a pill, everybody should be on it.
We all would like to live a longer lifespan, not as severely disabled, mentally and physically, but fully functional to the end of our days. We should not die after months or even years of prolonged disabilities. In the near future, we might be able to compress morbidity to only a few weeks before we die.
Adding years to our lives is important, but even more important is adding life to our years. Extending longevity makes sense only if we can increase our healthy lifespan. It is no longer true that the older we get, the sicker we get. What is more true, the older we get, the healthier we have been.
Until we get epigenetic control for silencing or activating genes, getting older will remain hard work. Old age is no picnic, it is not for sissies. The number of changes, transitions and losses may be huge. The longer we live, the more we lose. We have to build resilience and be resourceful in finding healthy ways of coping with challenges when times get tough. We should strive to die young but as late as possible.
Dr. Ciril J. Godec is chief of the Department of Urology and Professor of Urology of Downstate Medical Center at Long Island College Hospital.
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