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Time to Shape Up

I am so happy.  I’ve been writing for the Prostate Cancer Foundation for several months now; everything I’m writing is for men with prostate cancer and their families.  It’s right up my alley – telling men what they need to know, what their doctors might not tell them or may not even know, and most of all, doing my best to be upbeat because there is so much hope out there for men at every stage of this disease.  When the PCF says the website is a “go,” I will be able to tell you more, and share all that with you.

But here’s a preview: One story has me so fired up that I just want to give you the highlights.  It turns out that prostate cancer is a disease of inflammation, just like diabetes.  You know what inflammation is – when you skin your knee, and it gets all red and hot around the wound.  That’s your body’s way of attacking the germs, and in the case of a skinned knee, it’s a good thing.

Unfortunately, the same process gets triggered on a much smaller scale within your cells.  A lot of things can cause inflammation within the cells, including fried foods and even sexually transmitted diseases. Those are topics for another post.   

Fat can trigger inflammation, too. It turns out that people who are overweight tend to have higher glucose levels, higher insulin levels, and to produce cytokines – immune system boosters, which can encourage inflammation; sometimes inflammation is good, if it helps you fight off infection, but other times, it can put added stress on the body and perhaps tip the balance toward cancer,

healthy foodThe good news is that it is never too late to change your lifestyle – and to have this change instantly lower your cancer risk.  If you lose weight and start to exercise early in life, you may delay or even stop some of the processes that lead to prostate cancer.  If you lose weight, and if you exercise after you are diagnosed with cancer, you will certainly be in better shape for treatment.  You will also help lower your risk of having the cancer come back.  If you are battling cancer right now, losing weight and exercising may help deprive the cancer of some of the things it needs to thrive.

This is not just happening in prostate cancer.  Yale scientist Melinda Irwin, Ph.D., M.P.H., presenting her research at the big yearly meeting of the American Society of Clinical Oncology (ASCO) in Chicago, announced that she and colleagues found a “strong connection between exercise after (breast cancer) diagnosis and mortality.”  Even in women who had never really been active previously, starting regular exercise “seemed to show a great impact.” 

Irwin, an epidemiologist at the Yale School of Public Health, is probably not the favorite of the pharmaceutical industry; she has gone on record in the past pointing out that most large-scale drug trials don’t include a lifestyle component.  That’s because big Pharm “has no incentive to fund lifestyle behavioral interventions.  Why would they?  There’s no pill to take.”

And yet the connection between obesity and cancer keeps getting stronger.   ASCO, in a paper published in the online edition of the Journal of Clinical Oncology, has stated that being overweight “is associated with worsened prognosis after cancer diagnosis.”  It also said that if you are overweight and are diagnosed with cancer, chemotherapy or other treatment might not work as well; you may have more complications from treatment, may be more likely to have cancer develop somewhere else, and you have a higher risk of dying from cancer. 

ASCO estimates that as many as 84,000 cancer diagnoses each year are due to obesity, and that being overweight or obese is the cause of as much as 20 percent of all cancer-related deaths.  The National Cancer Institute has linked being overweight to “poorer outcomes in cancer patients,” and to raising the risk cancers including breast, colon, prostate, kidney, pancreas, esophagus, and gallbladder.

In a different study, European scientists just showed that having “central obesity” – fat in the belly, around the heart – makes you more likely to develop more aggressive prostate cancer.   The EPIC (for European Prospective Investigation into Cancer and Nutrition) study followed nearly 142,000 men from eight European countries for 14 years; the average age of the men when it began was 52.  Nearly 7,000 of those men were diagnosed with prostate cancer, and 934 of them died of it.  The scientists looked particularly at the men with the worst tumors.  They found there was a 14 percent greater risk of dying from prostate cancer for every 5-unit increase of Body Mass Index, and an 18 percent higher risk for every 10-centimeter (about four inches) increase in waist circumference. 

Having fat right around the waistline is already linked to Type 2 diabetes, high blood pressure, and heart disease; now, apparently, it is linked to cancer.  That’s because, unfortunately, fat in this particular location happens to surround organs, and it stresses them out.

walkingThe good news is, the risks go down as you shape up.  With every pound you lose, every bit of fat that you turn into muscle, your odds of being healthier go up.

Irwin has found that brisk walking lowered levels of two major biomarkers, insulin and “insulin-like growth factors” (IGF), in postmenopausal women who had survived breast cancer.  Both are linked to a higher risk of breast cancer.   She also has noted that breast cancer survivors who are obese have a 33 percent higher risk of having cancer return, or of dying from breast cancer, than other survivors do.

However, women who lost 6 percent of their weight through exercise and diet had a 30-percent decrease in levels of a protein associated with breast cancer, and women who exercised after being diagnosed with breast cancer had as much as a 40-percent lower risk of having the breast cancer return, and of dying.

To sum up, people who lose weight and exercise can improve their odds of not dying from cancer significantly. 

©Janet Farrar Worthington

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How to Age Well, Part 2

This is the second part of a series on aging well. – Janet

It all makes sense, but sometimes we need to hear this stuff anyway.  Eat right, get vaccinated, and get some sun, because Vitamin D protects your body and helps prevent cancer.  This is from How to Age Well, Part 1.   Part 2 is about how we all need to get off the couch, mentally as well as physically.

Jeremy Walston, M.D., a gerontologist at Johns Hopkins, co-directs the Biology of Frailty Program and is co-principal investigator of the Older American Independence Center.  He has spent his career studying how we age.  In addition to many studies on specific aspects of aging, he has looked at what healthy older people have in common — at what they eat and don’t eat, and how they live – and has come up with some practical tips.  I recently interviewed Walston for Breakthrough, the magazine for the Johns Hopkins Center for Innovative Medicine.

Here’s more of what he had to say:

Keep Moving

exercise“Stay active as long as possible,” says Walston.  “Don’t sit for long periods of time, especially in the late afternoon or evening.  Studies show that those are low-activity times for many people, so it’s good to try to boost your activity during those times.”  Go for a walk after dinner.  Walking is good; in fact, you should walk a lot, or do some aerobic activity – there’s plenty to choose from. 

Just a few examples include taking a Zumba or Jazzercise class, riding a bike, swimming or doing water aerobics, hiking, jogging, or dancing.  In addition to getting cardiovascular exercise, “it’s also important to do exercises that help you stay flexible, that help your balance and gait, and that help strengthen your muscles.  Don’t forget your shoulders,” which are important for maintaining core body strength and higher levels of function.  And if you have an “orthopedic issue,” like knee or hip trouble, address it.  “It is essential to maintain your mobility as long as possible.”  This may mean that you need a knee or hip replacement – but it also could be something as simple as starting to use a cane.

However, while you’re staying active: 

Don’t Fall

balanceThe body literally takes a hit when you fall.  Many older people, who otherwise have been doing pretty well, take a turn for the worse after a fall.  Just being laid up for a few days, or even longer, can be difficult for the elderly because they tend to lose strength quickly. 

The best way not to fall is to be aware of the risk, and do your best to prevent it, says Walston.  “Things that can make you fall include not watching your medication; vision problems; weakness in the lower extremities; and balance and gait problems.” 

One huge risk factor is easy to fix:  “low lighting and a cluttered living area.”  Make sure your rooms are well lit – that you not only have enough lamps or ceiling lights, but that the bulbs are high-powered enough so you can see where you’re going.  And go after the clutter.  It doesn’t take much – maybe a stack of books or magazines that slips over, or a puzzle left by a grandchild on the floor – to make a walkway treacherous. 

Sometimes, you’re so used to looking at clutter that you don’t see it.  This is why Walston recommends bringing in an independent party – a friend or relative who is not used to your home, who can see potential trouble spots you haven’t noticed.

You can lower the odds of falling, as well, by working on your balance.  Tai Chi is a great way to do this, and many community centers offer classes (another bonus: taking a class helps you stay connected – see below).  Weights and exercises can also help your legs get stronger. 

Keep your mind active, too

puzzle“Cognitive risk factors include diabetes, elevated lipids, and high blood pressure,” says Walston.  Medications can keep all of these problems in check.  Even if you are currently being treated for these, it’s good to go the doctor for “tune-ups” every so often, to make sure you’re still on the right dosage.   

But other things can affect how well you’re thinking and functioning, too, and they may not be what you’d expect:

Poor hearing:  If you don’t feel connected, you may tend to withdraw from the conversation, smiling politely, not engaging, because you don’t know what people are saying.  This is bad.  “Get a hearing aid if you need one.”  It won’t just help your hearing; it will help your brain.

Personal note: I find this especially poignant.  There’s a feedback loop between our brain and the world.  We need stimulation to keep our brain going.  If we withdraw and isolate ourselves, we don’t get that feedback, and this hurts us mentally.  If all you need to do to help stop this from happening is get a dang hearing aid, swallow your pride and go get one!  Do it for your brain.

Physical inactivity:  Being active affects every part of your body.  It helps your heart work better, helps your lungs get more air, strengthens your muscles, and helps your brain work better.  Many studies have shown that older adults who are active are less likely to get dementia and Alzheimer’s. 

Depression:  If you are depressed, you are going to be withdrawn, you may not eat or sleep very well, and you may not get enough exercise.  All of these can affect your cognitive skills. 

Addressing all of these risk factors is good “cognitive protection,” says Walston.  And one of the most important ways to protect your brain is to stay active is to “interact with others more frequently.”  Stay connected.  Talking to people — volunteering, interacting with others in church, clubs, or other groups, being around family or friends – is good medicine. 

This is the second part of a series on aging well. To read part one click here. 

©Janet Farrar Worthington

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How to Age Well: Part 1

Quality of life is the key:  our goal shouldn’t be just to live to a ripe old age.  No one wants to be old and decrepit (or decrepit at any age, frankly).  But old and healthy – now that’s an exciting goal.

Jeremy Walston, M.D., a gerontologist at Johns Hopkins, co-directs the Biology of Frailty Program and is co-principal investigator of the Older American Independence Center.  He has spent his career studying how we age.  In addition to many studies on specific aspects of aging, he has looked at what healthy older people have in common — at what they eat and don’t eat, and how they live – and has come up with some practical tips.  I recently interviewed Walston for Breakthrough, the magazine for the Johns Hopkins Center for Innovative Medicine.

The secrets of healthy aging, he has found, aren’t so secret after all.  The best “fountain of youth” we have right now are some common-sense building blocks that can help everyone, at every age, live better.

Nutrition:  Make Every Bite Count

If you do it right, just about everything you eat can help your body.  This doesn’t mean you have to have an ascetic diet of nuts and berries, or be a food martyr who never eats birthday cake, macaroni and cheese, or a BLT with chips and a pickle.  But comfort foods and flat-out junk should be the exception, not the rule, and you should make most of your dietary choices good ones. 

Now, what does this mean?

Eat Fresh Fruits and Veggies

healthy food“Fresh fruits and vegetables are very important,” says Walston, “particularly ones that are rich in potassium.”  High-potassium fruits and veggies – including bananas, oranges, strawberries; dried fruits, like raisins, apricots, and prunes; spinach, tomatoes, avocados, beans and peas, and potatoes – are the best way for you to get potassium.  Potassium is also found in dairy products, in whole grains, meat, and fish.

Here’s some of what potassium-rich foods can do for you:  Blood pressure:  When you get your blood pressure tested, you’re told it’s one number over another one.  That number on the top is systolic blood pressure, and potassium can lower it by several points.  Heart: Potassium helps your heart beat, which happens about 100,000 times a day.  It can help regulate the heart rhythm, too.  Cholesterol:  Potassium, by itself, is not a designated cholesterol-lowering agent; however, if you are eating foods rich in potassium, this means you’re not loading up on saturated fat.  Just eating this good food instead of junk can lower your cholesterol.

Fresh fruits and vegetables are also are anti-inflammatory.  This is very important, because inflammation has been linked to many diseases, including several forms of cancer.  When you eat these healthy foods, don’t blow it, Walston adds:  “Don’t add salt and don’t overcook them.”

Get More Protein

Protein is increasingly important; we need it more now than we did when we were younger.  “Protein helps muscles function better, and it is also important to help maintain muscle mass.”  True, you can get protein from a cheesesteak sandwich, but it’s better to “choose high-quality protein that is low in fat,” says Walston.  Salmon, for example, is a great source of protein; so are chicken, lean beef and pork, eggs, beans, soy, and low-fat dairy products like yogurt.   “We need about 30 grams of protein at a sitting to stimulate muscle growth optimally,” and the best time to take in protein is after exercise; this helps the muscles recover and grow.  “You can also get it from a protein shake or energy bar.”

Get Plenty of Vitamin D

Vitamin D helps keep your bones strong.  It also helps keep your muscles, heart, brain and immune system healthy, and can help prevent cancer.  Having low levels of Vitamin D is bad: A study published in the Archives of Internal Medicine found that people with the lowest levels of Vitamin D had more then twice the risk of dying from heart disease and other causes, compared to those with the highest levels.  The researchers listed “decreased outdoor activity” as one reason that people can become deficient in Vitamin D.  You can get it in milk, oily fish, mushrooms, eggs, and meat.  You can also take a supplement.  The National Institutes of Health recommends 600 IU (international units) of Vitamin D a day if you’re under 70, and 800 IU a day if you’re over 70.

sunshineAnd get some sun:  “Your body needs direct sunlight exposure to activate the vitamin D.”  A pretty amazing reaction happens when the sun hits your skin: the UV-B rays activates vitamin D into a form that your body can use best.  You don’t need to bask in the sun for hours; just a few minutes – 20 or so – a couple of times a week  is plenty of time to gain this benefit.

Get your shots

Lower your risk of getting the flu, or pneumonia, or shingles by getting a shot.  Many pharmacies, grocery stores, and big-box stores like Walmart and Target offer these shots at a low cost.  Take them up on it.  The risks of getting one of these illnesses far outweigh the inconvenience and minor expense of a vaccine.   

Coming up next:  Part 2:  Keep Moving, Don’t Fall, and Keep Your Mind Active.

©Janet Farrar Worthington

Regular disclaimer: This is a blog. It is not an encyclopedia article or a research paper published in a peer-reviewed journal. If a relevant publication is involved in the story, I mention it. Otherwise, don’t look for a lot of citations, especially if I’m quoting from a medical professional.

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