Living to be a ‘healthy 100’: Maimonides specialist tells all
Recently my wife and I were invited to celebrate the 100th Birthday party of one of my patients. She was one of my first patients shortly after we moved from Minnesota to New York. I performed surgery on her more than thirty years ago (it was not for cancer). After surgery, I have seen her from time to time, and I am always surprised to see how healthy and fit she is. She still lives alone in her house in Brooklyn Heights, she has no help from a home attendant or any other help, she is completely independent. She still works as a volunteer in a soup kitchen, walks about thirty blocks every day, meets with some younger friends daily either at home or in church, and a few times a year she goes to Atlantic City, since she likes to gamble. She eats everything, most frequently Italian – lots of vegetables, fruits, a moderate amount of red meat, cheese and pasta. When I first saw her as a patient, we went over lifestyle, and I advised her that drinking red wine goes well with Italian food. For the past thirty years she has religiously followed my advice – she always has one glass of red wine with dinner.
Why is she so healthy at her advanced age? She has no diabetes, her blood pressure is well controlled with medication, she never had cancer, and her cholesterol is low. She uses glasses but no hearing aids. Her memory is excellent. She still has her own teeth. She never smoked. She was never obese. All her life she worked hard, endured some tough times, raised three sons and was working in catering business with her husband. When I asked her what’s the secret of her healthy aging she replied, ‘There is nothing secret in my life, it’s your attitude”.
We now know that lifestyle is closely related to longevity and diseases of old age, especially cancer and cardiovascular disease. Epidemiologists tell us that approximately 60% of cancers are preventable with a healthy lifestyle. It matters what and how much we eat, how physically active we are, how many hours we sleep and, especially, whether or not we smoke. She is active in her church and still many friends and acquaintances.
Nutrition. There is no special diet to bring us to very old age. Eat slowly. Have some vegetables and fruits every day. Chicken and fish you can eat as much as you like, but be moderate with red meat. Reduce carbohydrates (breads, pasta, sweets) and, to a lesser degree, saturated fats (bacon and other greasy foods). Most cancers are addicted to sugar. At the University of Alabama, researchers compared cancer cell cultures grown with and without glucose. Where glucose was added, the cancer cells grew three times faster. Moderation in carbohydrate intake is thus an important tool in cancer prevention. It is also good preventive strategy for obesity, cardiovascular disease and diabetes. What should we drink? Water, of course, is the best. Drink when you are thirsty, but don’t force yourself to drink when you are not. Limit drinking sodas and fruit juices (too much sugar) and whole milk (too much saturated fat). Skim milk is fine. Good drinks are regular coffee and tea, especially green tea, which have lots of antioxidants. Decaffeinated coffee and tea lose most of their antioxidants during the process of decaffeination. A moderate amount of alcohol is healthy, especially red wine that has lots of resveratrol, a powerful antioxidant, but if you don’t drink or cannot drink in moderation, you don’t need to start. I do not advise vitamins; the best vitamin is healthy nutrition.
Physical activity. We don’t need to go to the gym every day, but there are ways we can incorporate more physical activity in our daily life: using the stairway instead of the elevator (up to five flights) or taking a 15 minute walk during lunch time. One does not need to dedicate half an hour to physical activity in one session; small segments of 5 to 10 minutes count as much as one uninterrupted activity of 30 minutes.
Sleeping. Most of us are chronically sleep deficient. Sleep experts suggest that 7 to 8 hours sleep is ideal, 6 hours is a minimum and 9 hours is too much (as we would remain sluggish the whole day). Chronic sleep deprivation weakens our immune system and can lead to cancer, diabetes, high blood pressure and cardiovascular disease.
My patient seems to follow the above suggestions without really knowing the physiology behind it; this is true for many centenarians around the country. Numbering 53,364 in 2010, centenarians are the fastest growing segment of today’s population in US. The oldest well-documented living human being was Jeanne Calment, a Frenchwoman who died in 1997 at age 122 years and 164 days. Many other elderly people have claimed very old age, but under close scrutiny, their claims could not be documented. Indeed, in recent years, we have increased the average lifespan, but have not increased the maximum human lifespan. Is this our biological limit? Maybe, the autopsy data shows that the oldest among us, the super-centenarians, aged 110 and up, mostly die of heart failure and brain failure (Alzheimer’s); many simply die in their sleep.
For years we have successfully replaced some body parts with transplants (kidney, heart, lung, liver, pancreas, intestines etc.) or with prosthetic devices (hip and knee replacement, breast and penile implants, etc.) and functionality returns, at least temporarily and sometimes for a few decades. So far, a brain transplant has not been done in a human (although it has been done successfully in monkeys, dogs and rats). Some would call the transplants phase “the car stage” of repair of the human body. There are some cars around which have been running for over 100 years, although some parts of the engine have had to be replaced with new ones. The human body is much more complex than the most advanced car engine. Although transplants and implants don’t prolong life significantly, they very much improve the quality of our life.
Most of our cells regenerate throughout our life, some very often (skin, GI tract) and some very much less frequently (skeletal muscle, heart and brain). Most of our cells are programmed to mature and die (apoptosis) after a certain number (approximately 70) of divisions. But not stem cells, which can renew themselves indefinitely and convert themselves into any one of the body’s more than 200 cell types, depending upon the environment or organ into which they are delivered. We could live much longer if we could bring stem cells into failing organs to replace dying cells, especially of the heart and brain. Initial data from animal studies show that this may be possible. Rather than treating a failing heart with a transplant, we may be able to just deliver some stem cells into the heart and it will regenerate itself. The same could be true for the brain. In the not so distant future, if some organs in our body would be failing due to old age, we could just regenerate them with a periodic supply of stem cells, and the human body could last additional decades or even longer. This sounds like science fiction, but many research labs around the world are moving in this direction.
Prolonging our biological life does not make much sense if we do not preserve our human dignity, our mental capacity. Today Alzheimer’s disease is rampant in older age. Let’s hope that it will be possible in the near future to regenerate our dying brain cells with stem cells. We will still all die eventually – maybe due to environmental disaster, cancer, some new unknown pathogen, nuclear war, etc., but not of aging. Aging need no longer remain the biggest killer of our species, as it is today, especially in the developed world.
So get ready: aging might eventually become a curable disease. We can remain productive and healthy until something kills us, but that should not be aging. So, what do we have right now to fight aging: our lifestyle choices. We should optimize lifestyle and augment our health the best we can and hope that science, especially basic science, will catch up with us. My centenarian patient is still in good shape and she is ready to celebrate many more birthday parties.
—Ciril J. Godec, MD,
Deputy Director, Division of Urology
Residency Program Director for Urology
Maimonides Medical Center
Professor of Urology,
Downstate Medical School
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