In the news

Ignore those life expectancy numbers

Life expectancy is a number that is useful to actuaries who deal with population statistics, to healthcare planners and to the journalists who write about it. It has nothing to do with how long you will live. Life expectancy in the United States is more than eighty for women and somewhat less (seventy-six) for men. The not-so-good news is that life expectancy has decreased for two years in a row, the fall attributed to the rampant abuse of opioids. If drug-related deaths do not decrease this year and the flu season is worse than most years we can expect another decline, shattering a record that will provide much hand-wringing at all levels of government, in the halls of academia and in the media. The steady increase in drug-related deaths does demand our attention because it mostly affects those in mid-life, destroying families and ending productive careers. Perhaps the most frustrating aspect of the opioid problem is that these deaths are entirely preventable. Influenza deaths are also largely preventable. Although the influenza vaccine is far from perfect it does reduce mortality at both extremes of life, the very young and the very old, whose deaths are almost always due to secondary bacterial infection, not to the virus itself.

Although heart disease is still the leading cause of death in the United States, improvements in diagnosis and treatment have slowed its climb. Diabetes reportedly accounted for fewer than 80,000 deaths in 2015 but that is a misleading statistic. Type 2 diabetes now affects nearly ten percent of the population and contributes to heart disease and stroke, a fact that is not usually reflected in death certificates. Obesity is not listed as a cause of death in official records but it is a very important contributor to coronary artery disease and it is linked to more than a dozen cancers. Chronic lower respiratory disease, third on the list, is almost entirely the result of smoking.

As individuals it is within our power to postpone if not to avoid six of the seven leading causes of death: heart disease, cancer, lower respiratory disease, accidents (nearly half of which include drug/opioid victims), stroke and type 2 diabetes. Persons who maintain normal weight and do not smoke or use drugs don’t have to pay attention to life expectancy figures. Good habits will help you to exceed those numbers by a couple of decades.

 

In the news

 

Avoid false blood pressure readings

High blood pressure is the single most important factor in heart disease and it is a major factor in stroke. Another consequence is a significantly greater risk of dementia.  In the past a reading below 130/80 (systolic/diastolic) was considered normal; a reading above 140/90 was diagnostic of abnormally high blood pressure (hypertension).  The new guidelines lower those numbers so that nearly one-half (forty-six percent) of Americans are now considered to be hypertensive. According to the newest guidelines from the American College of Cardiology and the American Heart Association, persons whose blood pressure is 130/80 or more (either number) are considered to have high blood pressure. A blood pressure less than 120/80 is the new normal.

Taking one’s blood pressure is not as easy as it looks, even with the latest automatic devices, and falsely high readings are common. White coat hypertension results from anxiety and even physicians are not immune from this distortion. A few minutes of rest, both physical and and mental, are helpful. The check-in routine in most medical offices thwarts the process. Minor factors that each push the numbers up can lead to a false diagnosis of hypertension and unnecessary treatment. A cuff that is too small gives erroneously high readings; the arm should be on the same level as the heart and resting on a table, desk or the armrest of a chair; the legs should be uncrossed and both feet flat on the floor. The cuff should be placed on the bare arm, not over clothing. It helps to avoid caffeine and alcohol in the hours prior to the visit to the doctor’s office. Even when the measurement is done correctly the diagnosis of hypertension, unless other factors dictate otherwise, should await a second measurement on a different day.

There are numerous prescription medications that lower blood pressure but all of them have side effects and of course, are expensive. Persons with mild hypertension can almost always bring it back to normal with a few simple measures: losing a few pounds, lowering salt intake and increasing potassium intake by adding several servings of fruits and vegetables to the daily menu. For most people, taking the time for moderately intense exercise at least four days a week for about one hour is the most difficult step but it is perhaps the most effective.

Digital devices for home monitoring are inexpensive and are recommended in the new guidelines.

Exercise Tips

If you are not already exercising, consider that until the development of mechanized transportation and labor-saving devices, the average human burned 4 or 5 thousand calories a day in finding food and getting the chores done.

Some basic facts about exercise:

Your body is designed to be moderately active almost every day.

“Exercise” doesn’t only mean the things we do at the fitness center.

It is absolutely impossible to become musclebound.

The benefits of exercise include much more than losing weight or                                        avoiding a heart attack.

No one is too old to exercise.

Almost no one is too sick to exercise.

Using about 500 calories per week is not an ordeal and it will result in the loss of about one pound per week if they are not replaced with food.

 

Area Presentations

Upcoming presentations in the San Diego area this winter are scheduled for the Osher Lifelong Learning Center at Cal State San Marcos (www.csusm.edu/olli) and at the OASIS Adult Learning Center (www.oasisnet.org). Dates, times and locations are posted on their websites.

Scheduled presentations include: Being a kid in the Stone Age, Ten ways to prevent dementia and Alzheimer’s disease, Ten ways to prevent cancer, How to prevent blindness as you age, Health benefits of wine and chocolate, and more. We’ll keep you posted.

If you are looking for a speaker for your organization there are more than sixty-five PowerPoint presentations listed at http://www.stoneagedoc.com.

In the news

A better shingles vaccine

Herpes zoster, known as shingles, is a very late complication of chickenpox, a disease that was common when today’s seniors were kids but that is now almost nonexistent because of the chickenpox vaccine. Shingles begins when the chickenpox virus that has lain dormant within nerves of the spinal cord emerges because of an aging or compromised immune system. It begins with an itchy or tingling sensation, usually on one side of the chest or abdomen. Over several hours the pain increases and a rash appears in the form of small blisters that may form an angry red cluster. After about a week the rash begins to disappear but some patients have pain in the area that can last for years. When the rash involves the face it may result in eye damage, even loss of vision.

If an antiviral drug is taken during the first twenty-four hours the attack may be halted but vaccines are now available that can prevent the disease or at least modify it considerably. The first of these was released in 2006. Although it prevented the disease in only a little more than fifty percent of patients it did make the disease milder in most recipients.  A new vaccine, Shingrix, was approved in October 2017. It is almost twice as effective as the older vaccine but it requires two doses, two to six months apart. Side effects such as pain, redness and swelling at the injection site may occur and some persons experience headache, fatigue and generalized muscle pain. These short-lived and generally mild symptoms must be counterbalanced against the risk of severe, long-lasting pain and occasional blindness that occur with shingles. It’s estimated that about one out of three people over the age of sixty will develop shingles; for those over the age of eighty-five the risk is more than fifty percent.

Persons over the age of sixty should be vaccinated even if they received the earlier vaccine and even if they have had shingles in the past. The new vaccine, in addition to being ninety percent effective, provides protection for at least nine years.

Some pharmacies expect to start receiving the new vaccine in December but it will probably not be available until January or February in most areas.  Most private insurance plans cover the cost of the vaccine and so does Medicare Part D. Some plans may require payment by the patient.

Only about thirty percent of eligible persons received the old vaccine. Shingles is a debilitating illness that no one should endure, especially in the golden years.

The Osteoporosis Cocktail – bottoms up!

Calcium is important for strong bones and the prevention of osteoporosis but it’s only a start. Important bone-building nutrients include protein, magnesium, boron, omega-3 fats, vitamins A, C, K and D as well as trace minerals such as copper, manganese, zinc and others.

The good news is that almost all these nutrients are present in a diet that includes whole grains, fruits, vegetables and fish. The bad news is that only four percent (!) of Americans get the recommended amount of all these nutrients every single day AND also get a moderate amount of bone-building exercise at least four times a week. That’s why  a daily multivitamin/multimineral is good insurance, especially for older persons.

Osteoporosis is not inevitable just because we get older but it seems that way because it’s so common. It simply doesn’t happen even among the oldest modern-day hunter-gatherers.

 

 

October 27, 2017

Area Presentations

Keeping your wits: how to avoid dementia and Alzheimer’s disease, Wednesday November 15, 3:00 p.m. Encinitas Library.

Bone: not so boring, Friday November 17, 10:00 a.m. at Escondido Senior Center. Register at OASIS Adult Learning Center (www.oasisnet.org)

In the news

            Have you had your flu shot yet? If you think that you might get the flu anyway you may be right! The vaccine is rarely 100 percent effective but that’s not the point. What we do know is that persons who receive the influenza vaccine, especially seniors, are much less likely to be hospitalized with a complication.

Most people who die during an influenza epidemic don’t succumb to the virus but to secondary infection, such as that caused by Staphylococcus bacteria, many strains of which are now resistant to several antibiotics. And the last place you want to be is in the hospital where antibiotic-resistant bacteria are most likely to occur.

And you can’t get the flu from the vaccine! It’s made from a killed virus. But you might get the flu in the couple of weeks that it takes for the vaccine to protect you. So don’t wait!

Lifestyle

Dieting Guidelines

You’ve probably heard that by using a smaller dinner plate it will appear that there is more food there and you will eat less. The reverse is also true. If a plate is bigger and you fill it yourself you’ll put more on it – and you’ll probably clean your plate!

Some ingenious researchers with a sense of humor went a little further. They offered Philadelphia moviegoers fresh popcorn in either a medium-sized bowl or a large one. (There is no such thing as a “small” popcorn bowl in a movie theater.) The large-bowl folks ate 45.3 percent more popcorn than those who had a medium-sized bowl. But the sadistic researchers went a step further. They did the same thing with stale popcorn – and the people with large bowls ate 33.6 percent more than the medium-bowl subjects.

Even persons who should know better can fall into the trap. When a group of 85 nutrition experts were invited to an ice cream social, they were given either a small bowl or a small scoop or a large bowl or a large scoop, and were told to serve themselves. If they had a large bowl they took (and ate) 31 percent more ice cream. Those who used a large scoop gave themselves 14.5 percent more, whether they had a small or large bowl.

Take a look at your mealtime habits and ask yourself if you can make a few changes to take advantage of this nutritional illusion!

 

 

October 9, 2017

Area Presentations

Upcoming presentations in the San Diego area are scheduled for the Osher Lifelong Learning Center at Cal State San Marcos (www.csusm.edu/olli) and at the OASIS Adult Learning Center (www.oasisnet.org). Dates, times and locations are posted on their websites. Titles include Health benefits of wine and chocolate, Keeping your wits: 10 ways to prevent dementia and Alzheimer’s disease, Probiotics: feeding the germs that keep us well, Bone: anything but boring, Being a kid in the Stone Age.

In the news

            Hepatitis A: everyone should get the vaccine because you can never know when you will be exposed to the virus. It could be at the beach, at a fancy restaurant or when having dinner at the home of a friend or relative. Salt water, even lots of it, won’t kill or dilute the virus if there is a sewage spill and the authorities might not even know about it the day you go for a swim. Persons who are infected can spread the disease before they have obvious symptoms and not everyone is a scrupulous hand-washer.

The hepatitis A vaccine is extremely effective, protection lasts for a lifestyle and side effects are rare. It’s not cheap but neither is a hospital stay.

Lifestyle

Dieting Guidelines

Consider the first three letters of the word diet. That should serve as a reminder that purposeful starvation or even marked calorie restriction are not normal human behaviors. Before the modern era such events did occur and humans developed the capacity to tolerate prolonged hunger. True famine was extremely rare.

In order to avoid the body’s reaction to starvation, such as slowing of the metabolism, cravings or the urge to become inactive, don’t cut back too much on calories. By lowering portion sizes to about 75% of what you usually eat and by having small, calorie-sparse snacks between meals, you can easily cut about 500 calories from your daily intake. If you do that consistently you will lose about one pound per week. Another pound should melt away if you exercise at least one hour about 4 times a week.

 

In the news

Home Genetic tests

The explosion in the field of genetics has brought the inevitable commercialization of genetic tests that can be done in the privacy of one’s home and the results are sent back directly to the individual. That means that neither your family physician nor a trained geneticist are available to help you interpret the findings. For some tests that doesn’t matter but for an ever-growing number it does.

If you’re simply curious about your ancestry there isn’t much that needs interpretation. Tests that promise to reveal your risks of diseases such as breast cancer or Alzheimer’s disease are much more complicated. Some tests determine if you are a carrier of a disease such as cystic fibrosis but even that condition is associated with several genes, not just one.

One of the pitfalls of genetic testing, even that which is done in a highly sophisticated laboratory, is that it won’t help you to change your lifestyle so that you can avoid it. Before you take an in-home test, discuss it with your doctor. You might save some anxiety as well as money.

Lifestyle

Exercise: it doesn’t have to be all at once.

For persons who have a job and a family, time is precious and devoting an hour or so to walking, jogging or a trip to the gym is just not likely except on the weekend, if then. Two points to keep in mind are that all physical activity is beneficial and it doesn’t have to be done all at once. After all, that’s how your great-grandparents avoided becoming obese. In the early 20th century the rate of obesity in the United States was five percent! Many lived on farms with few labor-saving devices and city folks walked almost everywhere. Their tools and home appliances were powered by hand.

If you’re a walker you can split it into one 15-30-minute session during lunch break and another right after work. You don’t need to sweat, just raise your heart rate. For resistance exercise you can keep light dumbbells or elastic bands handy at your place of business, maybe even share them with a couple of coworkers. Even if you don’t grunt, groan and sweat, that activity will increase blood flow to your muscles and heart. If you want to you can have a heavier workout on the weekend.

Retired? Not only do you not have the excuse of too little time, you’re at the age when physical activity really matters. The vast majority of 60-year-olds are overweight and about one third (!) are diabetic or prediabetic. Losing just a few pounds and keeping them off will help you to avoid the nasty complications (blindness, kidney failure, amputation) that make type 2 diabetes the ruination of a happy retirement.

 

Health Wisdom from the Stone Age, Volume One, an e-book, became available at www.amazon.com on July 4th, 2017. Enter Health Wisdom from the Stone Age in the search box.

This five-volume series is an anthology based on my weekly column, The Stone Age Doc that has been published in the Reading (PA) Eagle since 2005.

In the news…

Good news for coffee drinkers. A couple of cups a day, regular or decaf, may slightly lower the risk of type 2 diabetes, stroke, heart disease and Alzheimer’s disease as well as several different types of cancer. Isn’t it nice to know that something that tastes good can actually be good for us?

A few years ago some studies associated coffee drinking with cancer. More comprehensive and better research has shown just the opposite.

The antioxidants in coffee probably contribute to this list of benefits. For those who don’t get much in the way of fruits and vegetables, coffee is the major source of antioxidants. And then there’s chocolate…

Lifestyle

The Internet is a great source of information – and misinformation. In order to avoid the latter, stick to trusted sites like http://www.mayoclinic.org/disease-conditions or http://www.webmd.com. Tufts Medical School, Harvard Medical School and the University of California at Berkeley also have quality sites where non-professionals can find useful information. Most sites whose URL ends in edu are associated with universities and medical schools. Their newsletters are informative and reliable.  I no longer recommend PubMed, the site of the National Library of Medicine, having found published articles there from “medical” journals of dubious worth. In one recent search I found that one of the authors of numerous papers in one particular field has had his medical license revoked in several states because he falsified research. His son and co-author has no medical degree and was fined $10,000 for practicing medicine without a license. Some scientific-sounding journals are set up by charlatans pushing products.

Objective and reliable information on supplements is available at http://www.consumerlab.com, which does not accept advertising.

Area Presentations

Upcoming presentations in the San Diego area this fall are scheduled for the Osher Lifelong Learning Center at Cal State San Marcos (www.csusm.edu/olli) and at the OASIS Adult Learning Center (www.oasisnet.org). Dates, times and locations are posted on their websites.

A day in the life of a Renaissance physician will be presented at the Escondido Senior Center on Monday, July 17th at 1:00 p.m.

If you are looking for a speaker for your organization there are more than sixty PowerPoint presentations listed at http://www.stoneagedoc.com.

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If you have a question, or a suggestion for a future topic, let us know at drphil@stoneagedoc.com.