It’s the dream for getting older:  stay healthy, don’t get decrepit, keep all your marbles, and have a good life.  The four horsemen of the anti-apocalypse.  Nobody can guarantee this, and if anyone does, don’t trust that person any farther than you can chuck him or her!  However:  You can give it your best shot, and it’s not that hard!  With some simple changes, you can achieve big results! 

Here to help with some good advice is Elizabeth Platz, Sc.D., M.P.H., an epidemiologist at Johns Hopkins, who does a lot of research on factors that raise and lower your risk of cancer and other health problems.  I interviewed her recently for the Prostate Cancer Foundation’s website.  These tips aren’t prostate cancer-specific, and they will help you to get and stay healthier – so you won’t just be another year older, but another year better! 

Are you ready to start fresh?  Now is the perfect time:  it’s the Chinese year of the Rat – the first in the 12-year rotation of zodiac signs, which means that this is a year of renewal.  Let’s see what we can do to feel better and look forward to a healthier, happier, more active life!  First…

Don’t bother looking for a quick fix.  There isn’t a magic pill or miracle supplement or treatment, no matter what they may say on TV and the internet.  Getting healthier can’t be achieved by anything hawked in an infomercial.  “For healthy living, for good well-being, for avoiding premature mortality,” says Platz, “the right things to do are the things you have to work at,” like eating right and getting exercise.  But take heart:  you can make big changes by doing lots of small things, if you do them steadily.  You can also live it up sometimes – eat that slab of birthday cake, or have pizza night – if, in general, you practice moderation most of the time.

Be active.  Good news!  This doesn’t mean that you must haunt the gym! One of the best things you can do for your health, says Platz, is easy:  avoid sitting all day.  “In the modern world, people tend to sit.”  We sit in the car.  We sit when we’re on our phones.  We sit at the computer.  “We have protracted periods of time where we’re just stationery.  Build intentional activity into your day.”  Get off the old tuchus!

This doesn’t mean you have to spend hours on the treadmill or elliptical; remember, we’re talking about small changes here:  Don’t park right next to the building; park farther out and walk a little longer.  Take the stairs instead of an elevator to go up one floor.  Set a timer and walk around your house.  Take the dog for an extra walk.  Just move around.

Focus on the “big three macros,” proteins, carbohydrates, and fats.  “Macromolecules” is a trendy word, but it describes something very basic: “these major, fundamental components of our diets,” says Platz.

            Protein:  “As we get older, we need more protein to help keep from losing muscle mass.”  How much?  This varies a lot; one study recommends 1.2 to 1.5 grams per kilogram of body weight; this could mean 123 grams for a 180-pound man; the minimum amount recommended by the U.S. government for the average 160-pound man is 56 grams.  Bottom line:  You need more protein than you think, and more than you’re probably getting.  Make a point of eating protein with every meal.  Instead of just having a piece of toast or some cereal for breakfast, for example, add some Greek yogurt (which is higher in protein) or an egg.   Protein doesn’t just come from meat; it’s in fish, beans, dairy products, eggs, and soy products, too.  It’s also in meal replacement drinks like Ensure and Boost, and in protein bars.

            Carbs: Again, moderation:  “Don’t overdo simple carbohydrates,” the kinds of sugars found in sweets, white bread, and even plain old potatoes:  yes, the humble potato, minding its own business and serving as a dietary staple to millions, now finds itself on the nutritional naughty list of “simple carbohydrates,” because it takes less energy to digest a spud than, say, a sweet potato, which is a more complex carb.  “Whole grains can be delicious,” notes Platz.  “They’re more than just what’s in whole-wheat bread” (which, admittedly, can taste like cardboard).  “Many grains can be mixed into your diet without a lot of effort.”  On the pasta aisle in the grocery store, check out faro – a nutty-tasting grain.  There’s also quinoa, barley, and bulgur, to name a few.

            Fats:  “Good fats are good for you.  Try cooking with olive oil instead of butter,” suggests Platz – who is quick to add:  “You don’t have to remove butter from your diet; olive oil just tastes good.”  And watch out for calorie-rich dressings, sauces, and gravy.  Again, this doesn’t mean don’t eat them; “just make sure it’s the right serving size – which is often more like a tablespoon, rather than a quarter-cup.”

Indeed, watch your portions.  One basic strategy to make sure you’re not getting more than you need:  use a measuring cup.  “Even when you’re eating something that’s healthier, make sure you’re not overdoing it from a calorie perspective.”  Those pesky calories add up, and this is how you gain weight: consuming more calories than you burn.

Weigh yourself.  As we get older, sadly, the weight we gain “tends to be fat,” says Platz, “at the same time as we are losing muscle mass.  Loss of muscle mass is particularly worrisome, and is linked to premature death.  It’s not just how much you weigh, but the proportion of lean mass – muscle and bone.”  What’s a good way to maintain and build muscle mass?  “Weight-bearing or resistance exercise.  Lifting weights.”

Weight-bearing exercise.  Again, this isn’t as hard as you may think.  Nobody’s suggesting that you need to bench press the weight of a Saint Bernard, or dead lift the equivalent of Dwayne “The Rock” Johnson.  “I’m talking about hand weights.  Light-weight weights.  You can even use your body weight,” by doing planks, push-ups, or yoga-type exercises.

An engaged brain functions better.  Thus, get a hearing aid if you need one.  “There is solid, very sound research showing that people who have greater hearing loss tend to have greater cognitive decline,” says Platz.  If you can’t hear, “your engagement with others tends to wane.  When your brain is no longer stimulated to the same extent, it’s associated with cognitive decline.”  This is the “use it or lose it” idea; if your brain isn’t actively engaged – if you’re not hearing conversation, or the TV, or the sounds of nature, or a sermon in church, or your friends and family members talking to you – those un-engaged brain cells can shut down.  Isolation is bad for the brain, and bad for your health in general.

So:  Stay activeVolunteer, play poker, meet friends for coffee, take a class.  Keep your brain working.  Talk to people.  That kind of engagement is good for your brain, and it prolongs life.  We are hard-wired to talk to other people, and to listen to them, and hey!  If we can help others while we’re doing it, it’s a win-win.  “You’ve accumulated wisdom, experience, and expertise, and if you can share that with others, including the next generation, so much the better.”  For more things you can do to prevent dementia and keep your brain engaged, see this post, and this one.

            Take care of your liver.  If you drink too much alcohol, or if you are overweight to the point where you are at risk of becoming pre-diabetic or diabetic, your liver can pay the price.  “Fatty liver disease is emerging as an epidemic in the U.S.,” says Platz.  If the liver is overloaded, it accumulates fat, becomes inflamed, and several things can happen:  the liver can develop fibrosis, or scar tissue, that may even lead to cirrhosis.  “If you feel like you’re starting to go down that path, now is the time to reassess your diet and lifestyle.  The best analogy is foie gras, where we force-feed ducks to create fatty liver and make good pâté.  When you accumulate fat in your liver, it’s the same thing that happens with those ducks.”

Make it your life’s mission not to fall.  The older you get, the harder it is to bounce back from a fall.  A toddler can face-plant and spring back up.  An older man can fall and break a bone, wind up in the hospital, and if he doesn’t push the physical therapy and exercise afterward, not ever fully recover all his flexibility and strength.  So, let’s do our best to avoid this scenario!  Here’s where yoga and some very simple exercises can help you maintain balance and flexibility.  “This needs to be a huge focus for men as they age,” says Platz.   It’s not so much about strength – again, nobody’s asking you to heft a giant barbell – as it is about stretching and working on your balance.  And, keep your bones strong:  make sure you get enough calcium.  Calcium doesn’t have to come from milk and cheese.  You can get it from leafy green vegetables, and some foods you might not expect – like sardines, and even tofu.  However:  “The recommended dietary allowances for men aged 51-70 are 1,000 mg a day of calcium; and for men age 71 and older, 1,200 mg.  A half-cup of raw broccoli has 21 mg.  But if you’re trying to get to 1,000 mg, you’d have to eat an awful lot of broccoli.”  In a perfect world, you would achieve dietary perfection by eating an exceptionally well-rounded diet.  Most of us don’t achieve that, and if you’re not getting enough calcium, you may need a supplement.  Don’t go overboard!  With dietary supplements, it’s not a case of, “if a little is good, more must be better.”  Just getting enough is fine.

Fasting?  Intermittent fasting, in various forms, has been in the news lately, and “some studies suggest there is a biological benefit.”  However, there is an easy way for you to take a break from food every day:  Cut out the late-night snacks.  “If you get the munchies at 10 at night, you’re basically having the calories of another meal.  Just not having food after dinner can make a big difference.  Sometimes, half the battle is simply recognizing what we’re eating.”  Are you eating more than you think?  An easy way to find out is to write it down, or use an app on your phone to record everything you eat.  Keeping a record – just for a few days, even – might make you think twice before saying yes to that late-night piece of pie.

Try to get more sleep.  Most of us don’t get enough sleep, or don’t sleep well.  There are some simple things you can do for better “sleep hygiene,” including not being on your phone or the computer right before going to bed; the blue light these devices produce messes up your body’s clock.  Drinking caffeine or alcohol too late in the day can affect your sleep, as well.  Herbal tea, with lavender or chamomile, or other natural remedies can help; so can taking melatonin, a hormone your body naturally produces.  We make less melatonin as we get older; ask your doctor about taking an over-the counter melatonin supplement.   Also:  “Many men tend to snore as they get older.  If your partner tells you that you’re snoring, maybe you should do something about it.  Losing weight can help.”  If it’s severe, talk to your doctor.

 

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington

 

Two recent studies bring good news for those of us who either don’t have a lot of time to exercise, or just don’t like it and don’t want to spend an hour working out: bursts of cardiovascular activity matter. A lot.

For those of us who are getting older (which, unless you’re dead or cryopreserved, or both, is everybody), nothing is better at delaying aging than exercise, say Mayo Clinic investigators, who recently published a very interesting study in the journal, Cell Metabolism.  In other words, there is no magic bullet pill or thing you can eat that will do as much as exercise to keep you living longer and healthier.

Well, we kind of knew that. But the really good news here – especially for those of us who don’t just have scads of time or willpower to spend at the gym – is that it doesn’t have to be for a huge chunk of time every day.

The Mayo researchers didn’t just look at the things we usually think of with exercise – weight loss, better endurance, muscle mass vs. fat, maybe improvements in mood or functioning. Instead, they looked at the effects of exercise in younger and older adults at the molecular level. Particularly, they were interested in the effects on the mitochondria – the battery packs that produce energy in our cells.

The study’s volunteers – 36 men and 36 women in two age groups: young (18-30) and “older” (age 65-80) – were healthy but sedentary. They underwent tests to establish baseline levels for their aerobic fitness, blood sugar, and the gene activity and health of the mitochondria in their muscle cells. Then they were randomly assigned either to a control group (no exercise) or one of three different exercise programs: high-intensity interval biking (pedaling hard for four minutes, resting for three, and repeating three more times); vigorous strength training with weights; and a combined program of light weights and exercise bike-riding (at a moderate pace for 30 minutes, a few times a week).

After 12 weeks, all the participants had repeat lab tests. As you may expect, everybody who exercised had better fitness and blood sugar levels. The people who did weights gained more muscle mass, and the people who did interval training had better endurance.

But the really significant changes were invisible to the naked eye. In the under-30 people who did the interval training – the vigorous bike-riding for four minutes, four times – 274 genes showed increased activity; those who did the more moderate exercise had changes in 170 genes, and the weight-lifters had changes in 74 genes.

Think that’s exciting? Well, it is, but it’s not nearly as exciting as what happened to the seniors who did the interval training: nearly 400 genes showed higher activity, compared with 33 genes in the weight-lifting group and a sad 19 genes in the people who just did the moderate exercise. The oldsters who did the bursts of exercise had healthier mitochondria, too.

What do we take away from this study? That you’re never too old to benefit from exercise, for one thing. And for another, just because you’re older doesn’t mean you are past the point of vigorous exercise – especially if it’s just for a few minutes at a time.

If you aren’t already exercising, you should talk to your doctor to make sure it’s okay. Then, if you’re cleared for takeoff, don’t be like that guy at the gym who’s reading a book or watching the TV on the wall and cycling about one mile a minute, pedaling so slowly that if he were on a regular bike, he would fall over because he’d have no momentum. That barely even counts, and I see people like this at the gym all the time. They have no problem carrying on a full conversation, either; they certainly aren’t short of breath.

Now, how can you apply this to your own life? If you ride a bike or use a treadmill, the timer is your friend. You don’t have to program anything; you can just increase the speed to a comfortable running level, and lower it to a brisk walking level. Do it for one minute. If you can’t do it for a minute, start with 30 seconds of running or pedaling harder, then work your way up. My favorite thing to do on the treadmill is walk at a brisk pace for a minute and a half, then run for a minute, then walk for a minute and a half, then run for a minute, etc., for 20 minutes. When I started, my speeds for walking and running were pretty pokey. Then one day, I was running at my customary pace and I thought, “Hmm. I can go faster,” so I did. I was walking at my customary pace, and I thought, “I can go faster,” so I did. You will be amazed at how much better you get over time.

This is similar to the kind of exercise our ancient ancestors got. I’m not talking about grandpa or even great-grandpa, but way back to the hunter-gatherer days. They didn’t go out jogging for the heck of it, and they certainly didn’t spin or do Zumba – but what they did do was put on bursts of speed when they had to, so they could bring down the animal they were hunting. Thus, I think that at some level, we are hard-wired to do this. Try it. Start small – just a few minutes total, at first – and see how you do.

This brings us to the next study, published in the Journal of the American Heart Association.

Scientists from the National Cancer Institute and Duke University looked at records of nearly 5,000 people over age 40 from the National Health and Nutrition Examination Survey from 2003-2006, and followed them for more than six years; during that period, there were 700 deaths. Then they looked at the amount of time those people who died had spent in moderate-to-vigorous physical activity (MVPA).

They found that all MVPA counted: even if it was just a few minutes here and there. It all went toward the daily total.

This is huge, because it goes against all the guilt-inducing exercise recommendations we have been treated to for decades. The conventional medical wisdom has been that exercise only counts if it’s sustained – for 20 or 30 minutes, or more. And the worst result of this is that many people have thought, “Well, I don’t have much time today, so I’ll just have to try to get in a good workout tomorrow,” or the next day, or next week.

Au contraire, say the results of this study: All exercise contributes to helping you not die. “For about 30 years, guidelines have suggested that moderate-to-vigorous activity could provide health benefits,” said the study’s senior author, William E. Kraus, M.D., of Duke University School of Medicine,” but only if you sustained the activity for 10 minutes or more. That flies in the face of public health recommendations, like taking the stairs instead of the elevator, and parking farther from your destination. Those don’t take 10 minutes, so why were they recommended?”

Why, indeed? Because every little bit helps. In this study, Kraus and colleagues at the National Cancer Institute found that the length of each period of exercise was not related to the overall benefit of living longer. Five minutes of jogging counts. Five minutes of riding an exercise bike counts.  Or five minutes of swimming a couple laps, or whatever.

The participants in the survey wore an accelerometer (similar to a Fitbit or the activity tracker on a smart phone) for up to a week. Looking at the data, the researchers looked at the people in two groups: those who had bouts of MVPA for about five minutes at a time, and those who exercised for longer than 10 minutes at a time.

People who got about an hour a day of MVPA – not an hour at a time, mind you, but an hour of little bits of exercise here and there, all added up – were half as likely to die. Those who got 100 minutes of exercise a day cut their risk of dying even more, by about 75 percent. Again, it was the total time they spent moving, not how long at a time they exercised, that mattered.

In this study, there was no distinction between intentional exercise and just plain old physical activity, like walking up a flight of stairs, or vacuuming the floor, or running to catch a bus.

“Despite the historical notion that physical activity needs to be performed for a minimum duration to elicit meaningful health benefits,” Kraus and colleagues reported, “we provide novel evidence that sporadic and bouted MVPA are similarly associated with substantially reduced mortality.”

In other words, it’s all good.

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

 © Janet Farrar Worthington

 

Hey, guys: If you think exercise is just about pumping iron and getting big traps, six-pack abs and “gun show” biceps, your prostate would like to disagree.

To your prostate, how ripped or shredded you are is not nearly as important as your cardiovascular health.

Now, you may be wondering, why should the prostate even care about cardiovascular exercise? Here’s a very good reason: exercise can lower your risk of getting lethal prostate cancer, or of having cancer come back if it’s already been treated.

Epidemiologist June M. Chan, Sc.D., an expert on lifestyle and cancer, heads a research program at the University of California San Francisco that seeks fixable risk factors for prostate cancer progression – things in your lifestyle that you can change to lower your odds of dying of prostate cancer. I recently interviewed her for the Prostate Cancer Foundation’s website.

In previous work, Chan and colleagues were the first to show that vigorous exercise (such as jogging or bicycling) after diagnosis was associated with a reduced risk of prostate cancer death in men with localized disease. “We observed that three or more hours a week of vigorous activity, as opposed to less than one hour a week, was associated with an approximately 60 percent reduction in the risk of dying of prostate cancer.” Chan and colleagues observed similar results among 1,455 men in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). These findings suggest that “engaging in relatively vigorous physical activity and/or having higher cardiorespiratory fitness may protect against prostate cancer progression.”

Now, exactly why is this? That’s what Chan and colleagues are hoping to figure out. “We have a number of studies here at UCSF examining lifestyle and prostate cancer,” she says. “One trial is for men on Active Surveillance, and our main goal is to look at changes in prostate tissue.” Investigators are comparing prostate biopsy samples taken at diagnosis and again after a 16-week period in which men are randomly assigned either to continue their usual activities or to take part in a personalized exercise program that is designed to increase their cardiopulmonary fitness. The researchers also are measuring chemical processes involving circulation and metabolism, looking for specific differences in the two groups.

In this study, Chan is not as interested in studying the men who are already exercising a lot. “We anticipated that the biggest benefits would be observed in individuals who are relatively sedentary and who adopt moderate exercise. If men are already highly fit, they’re probably already exercising several hours a week, and we thought it would be harder to ask them to do more or spend more time, so that we could observe a relative change in fitness,” she says. “Our main goal is to increase the fitness levels gradually through a walking program in men who are at low to intermediate levels of fitness at the beginning of the study.”

The idea here is that even moderate exercise can help lower the risk of lethal prostate cancer. We’re talking about the kind of exercise that almost everyone can do. It is “purposely scaled to be relative to someone’s baseline fitness, and we are choosing men who are low- to moderate-fit,” Chan notes. Men in this study start out just by walking, and then walking faster, and then escalating – literally – to walking uphill.

The men aren’t going flat-out, like someone in a high-intensity workout. They’re just doing a little more than they could, and after they get used to that, they do a little bit more – slowly building up their fitness.

Chan speculates that the tissue samples in the exercise group will show changes in indicators of angiogenesis (cancer’s ability to build a scaffolding of blood vessels and other infrastructure so it can grow and move beyond the prostate); in inflammatory processes; in insulin and insulin-like growth factor signaling; in androgen receptor signaling pathways; and in oxidative stress mechanisms. “Biochemically, exercise could help deter metastasis of the tumor by changing the environment for the cancer” – in effect, spraying fire retardant on the tumor. Not necessarily extinguishing the flame altogether, but making it burn slower, and helping the body set up fire breaks to keep the cancer confined to its current location.

Making Prostate Cancer Fat and Happy

“Prostate cancer may be the most common cancer where exercise, used like a drug, can confer an increase in survival,” says medical oncologist Jonathan Simons, M.D., CEO of the Prostate Cancer Foundation. “There is no form of treatment that has this effect, and certainly not one as beneficial to the entire body as exercise.”

It may be, Simons adds, that what exercise does – just as it improves blood flow in the arteries – is give cancer a better blood supply that keeps it happy where it is, “so the tumor has no motivation to leave.” So basically, exercise makes cancer feel like it’s at a nice hotel, with free cable TV, continental breakfast, and a pool. It’s content to stay there indefinitely, ordering room service. “When tumors are stressed” – when they’re in a bad neighborhood, in effect – “they have genes that are programmed to help them survive by getting them to crawl away to someplace that better serves their needs.”

One of those genes, Simons found in research at Johns Hopkins, not only pipes in more blood to supply the tumor; it gets rid of waste products – the cancer cells’ sewage, in effect. “When tumors try to turn on blood vessel growth to get more nutrients, they also build their own plumbing for both intake and waste disposal. Angiogenesis is not just about getting oxygen and food – glucose and protein – to the cancer. It’s getting rid of byproducts, too. That kicks off a genetic program so the cancers can relocate” – start to spread.

But giving the cancer a better blood flow might subvert the cancer’s need to boost its own blood supply. It just may be that exercise makes cancer, rather than head for the door, sit back in the recliner and reach for the remote. A contrary notion, isn’t it – that in order to turn your prostate cancer into a couch potato, your best chance is not to be one yourself?

This doesn’t mean, of course, that men who exercise are immune to prostate cancer. “There are very fit athletes who have had forms of prostate cancer that are so aggressive, so genetically mutated, that have proved fatal,” notes Simons. However, those men are at one end of the spectrum of prostate cancer. There are many thousands of men at the other end or in the middle, for whom exercise may make a real difference. “What if you have a Gleason 8 cancer, you had surgery, your PSA was undetectable, and now it’s starting to creep up. And what if you could exercise and delay its colonizing in your bones by eight or nine years, because you so shifted the chemistry in your body that the cancer cells just sat there? That’s a very abstract concept, one that’s still not widely appreciated. But if we could get even three times as many men right now exercising, we could change the overall survival of the disease.” And if scientists like Chan can figure out precisely why this is happening, it may lead to development of new treatments that could make exercise even more effective in deterring the return or spread of prostate cancer.

Is it ever too late to start to exercise? No!

In other trials, including one funded by Movember, Chan and colleagues from around the globe are studying the benefit of aerobic exercise and also strength training in men with castrate-resistant prostate cancer, to see if these interventions can help men at a later stage of cancer live longer. “There are data in men with advanced disease also suggesting that exercise may impart not only quality of life but also clinical benefits” she says.

Body Size and Prostate Cancer

Prostate cancer loves fat. Fat increases inflammation in the body, lowers insulin resistance, and just generally makes a more inviting environment for prostate cancer.

But exercise burns fat. And this, in turn, lowers your body mass index (BMI).   “Increasing evidence suggests that being overweight, either before or at the time of diagnosis with prostate cancer, is strongly associated with the risk of cancer progression and of dying from prostate cancer,” says Chan. “For example, among 2,546 men diagnosed with localized prostate cancer in the Physicians’ Health Study, a one-unit increase in BMI before cancer diagnosis was associated with about a 10-percent increase in a man’s risk of dying of prostate cancer.”

BMI calculators are available on the internet, but briefly, if you are at a healthy weight, your BMI is between 19 and 24.9 kg/m2.  In the Physicians’ Health Study, having a BMI of 30 kg/ m2 or greater “was associated with a nearly twofold increased risk of prostate cancer death,” notes Chan. Further, “a meta-analysis of six studies in prostate cancer patients reported that a 5 kg/m2 increase in BMI raised the risk of dying of prostate cancer by 20 percent, and of biochemical recurrence (having the PSA start to rise again after treatment) by 21 percent.”

 More of this story and much more about prostate cancer are on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.” The PCF is funding the research that is going to cure this disease, and they have a new movement called MANy Versus Cancer that aims to crowd-fund the cure, and also empower men to find out their risks and determine the best treatment. As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

 ©Janet Farrar Worthington

 

What weird quirk of human nature makes us more excited about a cure than prevention?  Imagine the headlines:  “Cure for Dementia!”  Wouldn’t you want to be one of the lucky ones to have bought stock in that company?

I have a friend who’s a dental hygienist, and you couldn’t pay me to do her job: Nobody wants to go to the dentist, nobody wants to hear about all the things they’re not doing to protect their teeth and not get gum disease. 

Nobody wants to be preached at.  We all know we need to floss our teeth*, and brush twice a day.  It’s pretty simple.  But how many people don’t floss, except maybe right before they go to the dentist?  How many of us have lied through our teeth, so to speak, and vehemently denied doing this? 

Dude, all they have to do is start poking around in there, and when they see plaque and your gums bleed at the drop of a hat, they know.  How many of us say, “I hate going to the dentist,” and then pay big money to have fillings and root canals, or worse, to get bad teeth pulled and get dentures.

Well, it’s the same thing happening here, except instead of losing your teeth, you could lose your memory, and your ability to think right. 

This story appeared in the news last week.  It didn’t make nearly as big of a splash as I thought it should:  “Exercising in Mid-Life Prevents Dementia.” 

Prevents dementia!  If you’ve ever watched a loved one struggle with dementia or Alzheimer’s, you know that this is hell on all sides. 

But this! This is really wonderful news:  Some basic lifestyle choices can delay or even prevent this from happening. 

Can you imagine if some drug company had developed a magic pill, something you take in your 40s and 50s, that prevents dementia?  People would be saying, “Sign me up!”

exerciseThis is better than a pill.  Also, it’s free!  The good news from this story is that – like many things we’ve talked about in this blog – every little thing you do makes a difference.  You don’t even need to lift weights or buy a gym membership.  You get points for walking the dog.  Just keep moving!  Any activity is good! 

An Australian researcher, Cassandra Szoeke, Ph.D., and colleagues just published these findings in the American Journal of Geriatric Psychiatry.   They followed nearly 400 women, aged 45 to 55, for more than 20 years, and gave them periodic memory tests; the women learned 10 unrelated words, and then tried to remember them 30 minutes later.

The investigators looked at everything – diet, education, marital status, employment, children, smoking, mood, physical activity, Body Mass Index, blood pressure, cholesterol, hormone levels, etc.   Although younger age and better education (this goes with the “cognitive reservoir” that seems to protect against Alzheimer’s that we talked about in this post) were linked to a better baseline test, the one factor that proved most powerful in determining who didn’t get dementia was regular physical activity

Note: In these posts, I talked about weight loss and smoking, and exercise as a way of not dying of cancer.  This isn’t even about big-effort activity.  You don’t have to jog, or pump iron, or do some extreme sport to keep your brain working. 

According to Szoeke: “Regular exercise of any type, from walking the dog to mountain climbing, emerged as the Number One protective factor against memory loss.”  Also, she continues:  “The effect of exercise is cumulative.  How much and how often you do over the course of your life adds up.”

walkingEvery little bit helps.  What if you didn’t start at age 40?  That’s okay!  Even if you start at 50, “you can make up for lost time.”  I’m going to add my two cents here and say that at any age, doing something is better than nothing, and if you can do your brain a tiny favor every time you move around, then do it.  Don’t cop out and say, “Well, I’m too old to start now, I’m toast.”  No, you’re not.  Conversely, “I’m way younger than 40, I’ve got plenty of time,” is just a terrible attitude.  You’ve got an even better chance of making a difference in your lifetime health!  

After exercise, the other things that proved to be strong protectors against memory loss were having normal blood pressure and having a high level of “good” cholesterol. 

One neat thing about this study, funded by the National Health and Medical Research Council and the Alzheimer’s Association, is that a lot of studies of memory loss start over age 60.  This is because the risk of dementia doubles every five years over age 65. 

The other:  There’s no prescription here for what you do, how hard you work out or how fast you run or walk.  The researchers found that it didn’t matter what people did, just that they did something.  The key is just daily exercise.  Seven days a week. 

“Start now,” says Szoeke, because if you wait, you will disadvantage your health.” 

*Note:  It turns out that dentists have been recommending flossing for a century without having done scientific studies to prove that it works.  Oops.  However, flossing does make your gums stronger and healthier, and removes food that otherwise might remain stuck between your teeth indefinitely, so it is a good thing to do.

©Janet Farrar Worthington

 It’s Really Hard to Lose Weight, and Now You’ve Just Depressed Me

I get it.  It is really hard to lose weight, and I would have depressed myself, too – except I know it can be done.  I am shaping up, myself, and I’m seeing results.  My kids got me to start going to the gym a few years ago.  Then I stopped doing weights and started running, but although I enjoyed it, I got plantar fasciitis and was hobbling around every morning when I got out of bed. 

Then my daughter sent me a link to this great website called Bodybuilding.com.  After doing just weights, and then switching to just cardio, I have finally figured out that it’s better to do both.  (I also want to state publicly that my daughter tried to tell me this, years ago, but I didn’t get it.  I do now.)

None of this is as hard as you might think.  Here’s the routine I have been doing:  http://www.bodybuilding.com/fun/randy29.htm

I don’t even do all of it!  It starts with crunches.  I don’t do them.  I go to my local YMCA, and frankly, the floor is gross.  They have mats you can use, but they’re gross, too.  I don’t want to be on them.  This is not your fancy clientele, as evidenced by the sign over the water fountain telling people not to spit in it.  Sometimes people don’t read the sign, that’s all I’m going to say. 

There are 12 exercises, and before you think, “oh, Lord, how long will that take,” let me reassure you that each one just takes a few minutes.  And again – I don’t do them all!  It’s not that bad. 

barbellI start with the “barbell bench press.”  I do 40 pounds.  Don’t laugh; it used to be 30.  That’s okay.  If 40 gets easy, I will move up to 50.  Baby steps, people.  Then I do the dumbbell shoulder press.  I do 12 pounds each; again, you could laugh at the girly lack of weight, but it used to be 10 pounds.  One-arm dumbbell row, 25 pounds; it used to be 15.  Wide-grip lat pulldown:  I do 50 pounds.  It used to be 40.  Seated cable rows: I do 40 pounds.  That hasn’t changed, but I was doing it wrong at first, and now that I’m doing it right, that’s a good weight for me.  Barbell curl:  I don’t do it, but I do the dumbbell curls instead; 15 pounds, used to be 10.  Triceps pushdown:  I do 45 pounds.  I used to do 40.  Barbell full squat:  The pole that holds the barbells weighs 45 pounds; I add 50 to that.  Leg extensions: I do 50 pounds; used to do 30 when I started.  Lying leg curls: I do 50 pounds.  I don’t like them, so I often don’t do them.  And that’s okay, because I’m doing the other stuff.

treadmillThen I do 20 minutes on the treadmill; I used to run, now I walk briskly.  I also have a Chocolate Lab who is insane, and I take her for long walks, too.  Combining both the weights and the walking really has made a huge difference for me.    

I have also changed what I eat.  This has been difficult, because God help me, I love comfort food.  I grew up in the South, and when I go to South Carolina to visit my family, I gravitate to fried chicken, fried okra, fried catfish… notice a theme here?  Fried foods are very bad, as we talked about in a previous post.  Also, sweet tea is the house wine in the South.  I am drinking it straight, without the cup of sugar in each gallon.  My relatives are still speaking to me.

More concerning for me, is where my body likes to store fat.  I don’t have junk in the trunk, or thunder thighs.  Instead, my body wants to put on fat right in the tummy, where it causes the heart to work hardest.  It’s not much, but it’s more than I want.

I’m eating food that is better for me, and in return, I actually feel better for it.

You may find a diet that is perfect for you, and if that’s the case, more power to you.  I have found that slow and steady wins the race. 

Here’s my best tip: Every single little thing you do makes a tiny difference.  Have mustard instead of mayo.  If you get a sandwich, skip the cheese.  Get it on whole-grain bread. 

Don’t get chips with it.  If you say, “No way, I’m getting chips,” of course that is your right, and it’s your life.  How about maybe you get the small size instead of the “sharing size?”  At least there are fewer chips in there.  You’ve got to start somewhere.

Chicken has fewer calories than beef. 

Drink only water or something with no calories, like unsweetened tea.  Avoid soda like the plague.  Alcohol has a lot of calories.  You could start to lose weight right away if you just cut back on that.  Watch out for juice; it has a lot more calories than you think.  Eat a piece of fruit instead.  If you go to Starbucks, get a Refresher, which only has about 35 calories, instead of a Frappucino.  Don’t rely on diet drinks; that’s a whole ‘nother blog post, but they still make your body crave sweet things, and this does bad things to your insulin receptors. 

Make the effort to limit processed food.  Yes, when you’re tired and you just want to eat something fast, it’s a pain to cook from scratch.  I know this.  I have never been one to make a bunch of meals ahead of time, so I can’t recommend that approach, although a lot of people do it.  But it’s not that hard to get a piece of chicken and cook it.  You can buy frozen brown rice and microwave it; it takes three minutes.  Or cut up that chicken and stick it on top of a store-bought salad mix, then add a simple vinaigrette dressing.   

Fast food is bad.  Now, you may say, “But I have no choice, I’m on the road, I can’t carry food all the time.”  Keeping in mind that you actually could carry granola bars and fruit, I’ll say, “Okay, then watch your calories.”  McDonald’s posts the calories right on the sign.  If you just have to have a burger, limit your portion size, as the doctors say.  Get one of their original small hamburgers, not a cheeseburger.  Get a small fry instead of a large.  For God’s sake, don’t get a soda.  Your insulin receptors will thank you. It’s not great, and I wish you would do something else, but at least you will save hundreds of calories right there.  (I will note here that some nutritionists would say I’m being a traitor to the cause:  “Eek! Fast food burgers and fries are evil!  Shun them!  Get a salad instead.”  But a lot of people feel that when their doctor gives them a diet, it’s “my way or the highway,” and if they leave the highway once, they might as well just stay off-road.  I am hoping you will stay on the road for the long haul.)

Speaking of salads: Salads are good, but if you load them up with a creamy ranch dressing, lots of cheese and croutons, maybe some ham or bacon for good measure, with a big side of bread and butter, you are defeating your purpose.

Take the stairs. 

Don’t drive circles around the parking lot looking for that lazy spot right in front of the store.  Park farther away from the store and walk. 

When you start to exercise, don’t start with heavy weights.  Work up to it.  Don’t get on the treadmill, run fast and then poop out after two minutes.  Start by walking slowly.  In my opinion, it’s better to walk slowly for 20 minutes than speed-walk for five.  If you don’t have access to a treadmill, set a timer and walk for 20 minutes, at any speed you choose.  Anything you do is more than you would accomplish by just sitting still.  Trying means a lot.

Don’t get discouraged.  The worst thing you can do is try something, decide it’s too hard, then quit because you just know it’s never going to happen, and that you’re a loser, or whatever you might say to yourself.  You’re not a loser because you’re trying.  No judgment, only encouragement.  You are making the effort. 

Baby steps.

This lifestyle we have – I’m including myself here, because I’m fighting it, too – has got to change. 

We can do this.

©Janet Farrar Worthington

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

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