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

Darth Vader BoxingI’m going to talk about the brain via an organ I know a little bit better: the prostate.

Bear with me.

Scientists have long known that, at autopsy, many men are found to have prostate cancer that never spread, never caused a problem, and never needed to be treated. They died with it, not of it. Why that is, is the subject of future posts, but trust me on this. Sometimes, diseases only show up at autopsy. People live a good long life and never show any signs of trouble, and yet, when they die, there it is under the microscope. For whatever reason, the disease never got out of hand. People died with it, not of it.

I did not know, until I interviewed Richard O’Brien, M.D., Ph.D., for an article for Breakthrough,  http://www.hopkinsmedicine.org/innovative/research/newsletter.html a publication of the Johns Hopkins Center for Innovative Medicine, that the same thing happens with Alzheimer’s. O’Brien, who was Chairman of Neurology at Johns Hopkins Bayview Medical Center, now Chairman of the Department of Neurology at Duke University School of Medicine, told me that some people, at autopsy, have Alzheimer’s pathology. They have the telltale brain plaques and protein tangles seen in Alzheimer’s disease – but they never develop any cognitive impairment. Other people have the exact same pathology, and they die of heartbreaking dementia. Why is this?

O’Brien sees opposing forces at work in the brains of people as they age. Think of the good Anakin Skywalker, still a part of the bad Darth Vader: a light-saber fight, now tilting toward the good side, now toward the dark side. Eventually, the good tips the balance, and Darth Vader dies on the good side, after having done a very helpful deed.

Well, in Alzheimer’s, the tipping point – the game-changer, the key factor that weights the scales toward dementia – seems to be ischemic disease. Stroke, or mini-stroke. “With a given amount of Alzheimer’s disease pathology in the brain,” O’Brien told me, “there are two forces at work. One is driving you to become demented, and the other is protecting you from being demented. The biggest force that we’ve found thus far is cerebrovascular disease.”

Note: This does not mean that every man who has had a stroke or who has cerebrovascular disease is going to get Alzheimer’s. That’s not what he’s saying at all. What it does suggest is that if a man has significant atherosclerosis, or if he has had a stroke, even if it’s asymptomatic – AND he has the plaques and tangles, that is a very powerful predictor that he will develop dementia.

The body has a limited capacity for what scientists call “insults.” Stroke is an insult. Plaques are an insult. Think of a boxer who can take a lot of punches, but he can only withstand so much. The brain has a tipping point, too. O’Brien believes that “either one of these alone isn’t enough, but the two existing together in the same brain are enough to tip you over.”

But there is very good news here:
Doctors are getting better at spotting and treating the risk factors that lead to stroke. In fact, two studies published last year found that the incidence of dementia has declined over the last 30 years. “The primary reason for that is the treatment of coexisting cardiovascular risk factors,” O’Brien said. He cautions that none of these treatments prevents the Alzheimer’s pathology from building up – but they “prevent it from becoming manifest. So you die with your plaques and tangles, but you’re still cognitively intact.”

So, what can you do to protect your brain? A huge one is exercise. The choices that we make today can help influence our risk of dementia later. In a report published in the Annals of Internal Medicine, scientists followed up on about 20,000 people who took part in treadmill testing in the 1960s as part of a cardiovascular study. Today, these people are in their eighties, nineties, or are deceased. “By searching the Medicare records for dementia diagnoses,” said O’Brien, the scientists “found that the people who had been in the fittest 30 percent of that group had a dementia rate that was half that of the other people in the cohort,” which confirms that “one of the side effects of regular exercise is a significant reduction in your risk of dementia.”

Another huge factor is cognitive reserve, and this is from education. It turns out that people who go to college tend to have more cognitive reserve than people who don’t. Note: I would imagine, although it hasn’t yet been proven, that if you haven’t been to college but you read and learn a lot, you are building up a cognitive reserve, as well. Learning a language or playing a musical instrument, doing research for your work, or singing in a choir – basically, anything that challenges your brain, as opposed to sitting on the couch and staring passively at the TV – all of these things have been shown to have beneficial effects on your ability to think, on the brain’s ability to make neural connections inside itself.

“All things being equal, people who go to college are much less likely to get demented,” O’Brien says, “people who are very fit are much less likely to get demented.” And there’s a third thing – “People with certain types of personality traits are less likely to get demented. Our latest data suggest that obesity is playing a similar role, too.” We already know (see my previous post on Low T) that fat, especially belly fat, changes your levels of hormones. What else does it do? Scientists are still figuring that out, but chances are good that obesity is not of great benefit to the brain.

Personality traits?
People who are positive and upbeat seem to have some protection from dementia. Again, why this is, is uncertain. It may be that people who are positive are more likely to educate themselves and exercise. They may also be more likely to do crossword puzzles or sign onto Luminosity, although O’Brien said he doesn’t think doing a puzzle here or there is enough by itself. One study published in the New England Journal of Medicine showed that people who did crossword puzzles had a lower rate of dementia than did people who spent a lot of time watching TV. But, O’Brien noted, this might be because the brains of people who choose to do crossword puzzles are very different from those of people who like to watch TV. “If you forced the people who are watching TV all the time to do crossword puzzles, would they have a lower incidence of dementia? I doubt it.”

Cognitive reserve is a very robust thing, according to O’Brien. “If you look at the neurons of people with high levels of cognitive reserve, they’re pretty resistant to the toxic effects of Alzheimer’s disease pathology. They actually have bigger neurons in the key areas of the brain. Their neurons are more healthy, even though there’s a lot of Alzheimer’s disease pathology.”

And finally, there is diet. O’Brien suspects that the Mediterranean diet might also have a significant effect on dementia, because it also has significant effects on cardiovascular health. “The data’s pretty clear that if you can prevent cerebrovascular disease, your chances of becoming demented are much lower.”

 

©Janet Farrar Worthington