In medicine, knowing the right numbers can tell how healthy you really are; ranging from how well you are aging to your individual risk of developing diseases that could impact or shorten your life.  When it comes to your health, what you don’t know can really hurt you.  So, what are some of the key parameters to check?  To begin taking charge of your health there are a few tests I would recommend. While not an exhaustive list, these critical numbers can put you on the road to a healthier, longer life:

1.  Telomere length – Measuring telomere length tells you your biological age. Telomeres are the end caps on your chromosomes that protect the genetic material.  Telomeres are longer when you are young and gradually shorten as you age.  But at any given age, people who are healthier have longer telomeres than their unhealthy counterparts.  Short telomeres are linked with an increased risk of developing the chronic diseases associated with aging; such as cardiovascular disease, type-2 diabetes, cancer and dying from cancer.  Recent studies have shown that faster rates of telomere shortening are associated with dying prematurely.  The good news is that the rate of telomere shortening can be modified by changes in lifestyle.  There is even some evidence that telomeres can be lengthened by regular vigorous exercise and by a new supplement called TA65.  This supplement has been shown to activate the telomerase enzyme that builds and maintains telomeres.  It is the only commercially available telomerase activator found safe for people to consume.
2. Body fat percentage – Obesity and excess body fat are associated with poor health outcomes, greater risk for cardiovascular disease, type-2 diabetes, several cancers and cognitive decline.  Some advise maintaining a healthy weight but it the fat that is the problem.  Other measures such as BMI are notoriously inexact.  A healthy body fat percentage is different depending on age, but a generally between 18-22% for men and 20-26% for women.  If you are not able to get an accurate body fat percentage (calipers and home scales are typically inaccurate), using waist circumference and/or waist-to-hip ratios are reasonable alternatives.  The risk of premature death doubles for waist circumference over 40 inches for men and 35 inches for women. Interestingly, obese individuals have shorter telomeres than normal weight people.
3. Blood pressure – High blood pressure, or hypertension, has been called the silent killer because there may not be any symptoms until you have a heart attack or stroke.  In fact, the number one preventable risk factor for stroke is unrecognized high blood pressure.  Measuring your internal or central blood pressure is a more accurate reflection of your cardiovascular risk than the traditional cuff pressure measurements.  Until recently, this was only possible through an invasive procedure that was not practical for routine blood pressure measurement.  But using the non-invasive SphygmoCor Pulse Wave Analysis, you can get a central blood pressure measurement that is just as accurate.  Your blood pressure should be no higher than 120/80 and your central pulse pressure less than 50.
4. Blood sugar – To prevent diabetes, measuring only fasting blood sugar is not a sufficient screening tool.  Waiting until your fasting blood sugar is abnormal means you have had type-2 diabetes, pre-diabetes or insulin resistance for up to 10 years.  It is necessary to combine fasting glucose with hemoglobin A1C and fasting insulin to provide a broader perspective on how your body is handling or mishandling sugar.  Remember, nearly 70% of type-2 diabetes is preventable if caught early.
5. Cholesterol – Standard cholesterol tests measure total cholesterol, LDL and HDL but are not even as good as a flip of a coin to determine cardiovascular risk.  A more accurate barometer of risk from cholesterol is achieved by the VAP profile or LPP test that measures the cholesterol sub-particles for LDL and HDL as well as measuring inflammatory markers, homocysteine and C-reactive protein (CRP), that confer independent cardiovascular risk.
6. Intima Medial Thickness (IMT) – Rather than just assessing a risk factor, an IMT scan is a specialized ultrasound conducted on the carotid artery.  It effectively examines the state of cardiovascular disease itself – instead of looking at risk factors for the disease.  This 10-minute test can detect cardiovascular disease at its earliest stages.

 All of these tests and more are part of the in-depth assessments performed at Alternity Healthcare.   Call us for more information and to schedule your evaluation.  There is no better time than the present to find out exactly how healthy you really are; your life depends on it.

These statistics are based on BMI; a notoriously inaccurate measure of body composition.  After all, it isn’t really weight that people want to lose, it is body fat.  We have just become accustomed to equating excess weight with excess fat.  But the two can be radically different.  BMI does not adequately take lean muscle mass into account and routinely underestimates the body fat percentage of individuals.  And it is excess body fat, particularly the deep visceral belly fat that is associated with an increased risk of diabetes, cardiovascular disease, high blood pressure, metabolic syndrome, breast cancer, colorectal cancer, gallbladder issues, dementia and more.  As if that was not enough, preliminary research from Boston University researchers has found a “significant” link between visceral fat and lower total brain volume[4].

The research looked at 733 healthy individuals that were part of the Framingham Offspring cohort with an average age of 60.  Seventy percent of the participants were women.  Researchers looked at the potential associations of body mass index (BMI), waist circumference, waist-to-hip ratio, and abdominal fat with the total brain volume.  Abdominal fat was measured by CT scan and could differentiate the deep visceral fat from the subcutaneous fat just under the skin surface.  While there was an association with BMI and waist circumference, the real culprit was visceral fat.  Subcutaneous fat was not [significantly] associated with any adverse effect on the brain volume, whereas visceral fat was clearly associated with smaller brain volume.  Smaller brain volume is associated with poor cognitive function on testing and a greater risk of dementia on follow-up.

 What can you do to reduce your body fat? 

•  Make the decision to make a change.  Resolutions won’t cut it.  The vast majority only last a couple of months, at best.  This change is for your lifetime.
• Exercise regularly.  You need to do both strength/resistance and aerobic activity.  Interval training is the best and most effective method of combining both.
• Low Glycemic nutrition.  Balance is key:  adequate protein, healthy fats and fewer carbohydrates.  Excess sugars and processed carbohydrates are the real enemies.  Not dietary fats.  Avoid man made trans-fats but you need to eat healthy fats in order to lose body fat. 
• Eat smaller frequent meals throughout the day of natural, nutrient-dense whole foods
• Hormonal assessment.  Check your hormone levels to determine options for balancing your endocrine system.

 The key message is pretty clear.  How you take care of yourself now will determine how well you can maintain both your physical and cognitive prowess as you age.  This concept is not new.  Don’t wait until it is too late.  There is no time better than now to start living better.

It is now clear that significant cognitive decline is not an inevitable consequence of advanced age.  Several recent studies have demonstrated an association between eating a Mediterranean-style diet and slower cognitive decline in the elderly.[i]   A well-designed prospective study published last year in the American Journal of Nutrition analyzed data from a continuing study of 3,790 Chicago residents 65 and older that began in 1993. The researchers tested the subjects’ mental acuity at three-year intervals, and tracked their degree of adherence to the Mediterranean diet on a 55-point scale. High scores for adherence to the diet were associated with slower rates of cognitive decline, even after controlling for smoking, education, obesity, and hypertension.

Another study, presented at the American Academy of Neurology’s April 2010 meeting in Toronto, analyzed the diets of 712 New Yorkers.  MRI brain scans taken an average of 6 years later revealed brain infarcts in one third of the study participants.  Brain infarcts are small areas of dead brain tissue caused by silent strokes that may show no symptoms. Recent research has suggested that brain infarcts may be responsible for decreasing cognitive function as we age.  In this study, the group who most closely followed a Mediterranean-style diet was 36% less likely to have the damaging brain infarcts than the group who least followed the diet, and moderate followers were 21% less likely to have damage than the lowest-tier group.  A third study published in the February 2009 issue of Archives of Neurology found that eating a Mediterranean diet was possibly associated with a reduced risk of developing mild cognitive impairment (MCI) and of MCI advancing to Alzheimer’s disease.

Benefits of the Mediterranean diet may be due to the it’s positive impact on cholesterol levels, blood sugar levels, vascular health, or inflammation reduction; all of which have been linked with cognitive impairment. Is this proof positive that the Mediterranean diet can prevent stokes and dementia?  No. Although there is a lot of data suggesting beneficial effects of a Mediterranean diet on a number of chronic medical conditions, diet alone is not the only factor,.  Diet is but one component of a healthy lifestyle, and that includes regular exercise, prevention or treatment of diabetes, hypertension, high cholesterol, obesity—if they exist, and avoidance of smoking gives you your best chance to remain cognitively intact as you age.

Aging is a complex process with many contributing environmental and genetic factors.  While a person’s lifespan is not absolutely programmed into their genes, longevity is dependent on genetic mechanisms.  This means that a doctor can’t run a genetic test to see what age you will live to, but they can see how well or poorly you are aging on a genetic level.  The damage that we accumulate through our lives is reflected in certain areas of our genes, and these areas in turn shape the ability of our cells to continue to function.

These genetic keys to aging are called telomeres.  The word means “end part,” and telomeres form the end structure of every chromosome.  Telomeres have recently garnered increasing attention.  There are now thousands of articles published every year on telomeres where as recently as 1995 there were less than a hundred.  The popular press has been even more enthusiastic.  NBC’s Today show recently featured telomeres and hailed them as the secret to aging and ABC World News even called them a modern-day Fountain of Youth. 

Unfortunately, human biology does not work that easily.  There is no magic pill around the corner that will turn back the aging clock.  Telomere research is genuinely exciting and even revolutionary, but aging involves many factors which will prevent any silver bullet solutions.  

Telomeres are something like the plastic tips on the end of shoelaces.  DNA molecules are formed like an extension ladder that somebody has taken and twisted along the long axis so the uprights spiral around each other.  This is the famous “double helix” that James Watson, Francis Crick and Rosalind Franklin discovered in 1953.  Each side of the helix is a chain of sugars, while the rungs are pairs of complementary bases.  There are four bases that make the letters of the DNA alphabet: Adenine, Cytosine, Guanine and Thymine.  Adenine (A) always links to guanine (G) and cytosine (C) always links to thymine (T). 

This complementary pairing is what allows DNA to replicate, or to make new copies.  During replication, the DNA molecule is “unzipped” by enzymes.  This produces two half-strands of DNA, and each can be the template to build a new complete strand.  Every time one half-strand displays an A the opposite half of the rung must be a G.  The machinery of the cell works along the half-strand, adding the missing letters and creating two copies of the original DNA.

There is a quirk in this process, however.  The enzymes that add the new DNA bases to the growing chromosome go through a number of steps that require reading the existing strand so that they can correctly build the new bases.  Effectively, these enzymes are reading the old strand a few rungs ahead of where the new strand is being built.  This leads to the “end-replication problem,” where the old strand runs out of template rungs before the new strand is finished.  Telomeres are repeating sequences of TTAGGG that finish off each end of a chromosome.  When replication reaches these sequences, the last repeat is not rebuilt into the new strands. 

This preserves the meaningful genetic information but it also means every time that a cell divides, the telomeres get shorter.  When the telomeres in a cell get too short, then the cell dies. This limits a cell to somewhere in the range of 40 to 60 divisions in non-cancerous cells.  By looking at the length of the telomeres in a cell, therefore, scientists can tell if a cell can continue growing and dividing or if it’s near the end of its lifespan.  Looking at an average length of telomeres from a larger sample of cells, such as a blood sample, will tell you how well you are aging.  That is, long telomeres are directly reflective of years of healthy living, while short telomeres indicate accelerated aging. What such a test won’t do is tell you how long you have to live or what your remaining life expectancy is or what age you will live to. 

Some research studies using centenarians, that is, people at least 100 years old, offer the greatest demonstration of this.  Living to 100 used to be extraordinarily rare but the number of centenarians has increased greatly in the last 20 years.  In 1990, 37,306 Americans out of a population of 31 million were 100 or older.  As of December, 2010 that number had increased to almost 72,000 and it is estimated to exceed 600,000 Americans by 2050.

Although we expect that aging equals dysfunction, centenarians tend to be healthier than the average person twenty years younger.  This makes sense in that you don’t live to be a hundred years old without being healthier than the average person when you are younger.  Two studies have shown that healthy centenarians have longer telomeres than ones that had conditions such as hypertension, congestive heart failure, myocardial infarction, peripheral vascular disease, dementia, cancer, stroke, chronic obstructive pulmonary disease, and diabetes.  These diseases may be stereotypically part of aging, but more importantly they all progressively cause damage to cellular machinery.  Finding that this progressive damage is reflected in telomeres is not surprising and it emphasizes how telomeres accurately reflect the difference between aging healthfully and aging poorly.

As mentioned earlier, building a new strand of DNA uses the old one as a template except when it gets to the end.  The question becomes, then, how are new telomeres created or old ones extended? An enzyme called telomerase provides the template and builds telomeres.  If a person has many active copies of the telomerase enzyme in their cells, then they will have longer telomeres.  By preventing premature shortening of telomeres, a high level of telomerase activity prevents premature cellular death.

While high levels of telomerase activity in normal cells is beneficial, it can turn problematic in cancer cells.  By itself, telomerase cannot cause a normal cell to turn cancerous.  When damage to other parts of the chromosomes accumulates, however, cells that have a lot of telomerase can avoid one of the mechanisms that kills diseased cells.  For this reason, some scientists are investigating telomerase inhibitors as a cancer treatment.

Most people, of course, will want to stimulate telomerase activity.  Right now there are no drugs that will do this but the good news is that the relationship between healthy living and telomere length goes both ways.  Healthy living can actually extend telomeres.  Improving telomerase activity or telomere length has been demonstrated by nutritional methods, reducing stress, increasing antioxidant activity, increasing physical activity, and smoking cessation. Specific nutrients that are important to telomere health include certain B vitamins, Vitamins A, C, D, and E, magnesium, zinc, and iron.

The B vitamin folate (B₉) is probably the most important vitamin for telomere preservation.  If there is not enough folate available in the cell, some or even all of the T bases in the TTAGGG sequence of a telomere can be replaced by a similar substance called uracil.  This will cause the telomers to be effectively truncated at the substitution site.  Low folate levels also make the construction of DNA strands more difficult and error-prone.  Folate is available in foods like green leafy vegetables like spinach or broccoli, beans and legumes, liver, and yeast. 

Vitamin B₁₂ catalyses reactions that are important in DNA maintenance, and women taking B₁₂ show longer telomeres than those that don’t.  B₁₂ is found in foods that come from animals, including fish, shellfish, meat, poultry, eggs, and milk.  Vegans and vegetarians are particularly susceptible to having a dietary shortage. 

Nicotinamide or niacin (Vitamin B₃) is needed for production of enzymes that regulate telomerase, so it is also very important for protecting telomere length.  B₃ also indirectly reduces the number of free radicals which can damage DNA in general.  It is found in animal foods like organ meats, fish, milk, and eggs and in plant foods such as avocados, dates, tomatoes, leafy vegetables, peanuts, and cereal grains.  Pregnant or nursing women may require higher doses of folate to ensure normal fetal neurological development. 

High normal levels of vitamins A and D in the blood are also associated with longer telomeres.  Both vitamins operate generally against inflammation, infection, and cancer genesis, thereby helping maintain telomere length.  Vitamin A is found in a wide variety of foods, especially liver, carrots, and broccoli and vitamin D is synthesized in the skin and found in fatty fish such as catfish and salmon.

Vitamins C and E are antioxidants that prevent DNA damage, including damage to telomeres.   Plants are the more prominent sources of vitamin C, especially colorful foods like rose hips, berries, peppers, and citrus fruit.  Vitamin E comes from nuts and nut oils, tomatoes, pumpkin, and sweet potatoes. 

Magnesium catalyzes a wide variety of enzymes involved in DNA repair and replication, as does zinc.  Adequate levels of both have been linked to increase telomere length.  Both are present in a wide variety of foods, although usually at low levels. 

Unlike all of these nutrients, iron is linked to shorter telomeres because excess iron can create free radicals which damage DNA.  While iron is vital in producing hemoglobin in red blood cells, too much can cause damage throughout the body. 

If all that sounds like a lot of difficult and particular dietary recommendations, remember that a generally healthy diet should help provide some of these nutrients in adequate amounts.  A modified Mediterranean diet of multiple small meals that is based mostly on plants and is low in high-glycemic carbohydrates like refined sugars and processed food is the basis for healthy living.  Such a diet will include good amounts of organic fruits and vegetables and also moderate amounts of lean meat, low-mercury fish, and poultry and also healthy monounsaturated fats.  Avoiding unhealthy ingredients like chemical additives, MSG, and artificial sweeteners and saturated fats will also help.  This type of diet will not only help maintain telomerase activity and telomere length, it will also have great impacts on cardiovascular health, metabolic syndrome and in helping prevent cancer.  Omega-3 fatty acid and antioxidants like green tea or grape polyphenols are also both generally healthy for many biological processes and specifically linked to longer telomeres.

Alternity Healthcare provides nutritional counseling to help you maintain such a healthy diet.  We can also provide high-accuracy nutritional profiling to find which nutrients you are receiving at healthy levels and which are missing and may require help from nutraceutical supplements to achieve optimal levels. 

Other things you can do to improve your telomeric health include reducing your exposure to oxidative stress that causes DNA damage.  This means reducing both psychological and physical or environmental stress.  Maintaining a healthy body composition without excess body fat is part of this, as is avoiding excess alcohol consumption and smoking.  Exercise, both aerobic exercise and resistance exercise, are also vital for both overall health and for telomere maintenance.

Telomeres are probably best thought of as the canaries in the coal mines of our cells.  They tell us not how long we have to live but how well we have been living.  Alternity Healthcare is proud to offer telomere testing to our patients so that we can use this knowledge to create a healthier road map for your continued life.

Testosterone is the primary male sex hormone, or androgen.  Circulating levels of testosterone increase at the time of puberty and peak in early adulthood for men.  Testosterone is responsible for men looking like men and feeling like men.  Following that peak is a gradual but steady decline in testosterone levels beginning in the mid-30’s. Declining testosterone levels cause a variety of symptoms including loss of muscle mass and strength, increased belly fat, impaired brain function, disrupted sleep, loss of libido, impaired sexual function and general fatigue.  But, because the loss of testosterone is gradual these symptoms typically occur little by little, and the impact on a man’s life may not be felt until his 40’s, 50’s or later.  This is sometimes referred to as andropause, or the male menopause.  This gradual decline in vitality, function and quality of life is too often attributed to “just getting old” when in reality, many of those symptoms can be reversed with proper treatment.

It is readily apparent to most that testosterone plays a crucial role in male sexual function. Sexual potency peaks along with the raging hormones of a teenager.  Similarly, testosterone is essential for building and maintaining muscle mass, youthful energy and strength.  Considering testosterone therapy to improve the way you look, feel and perform would be good enough for many.  In fact, testosterone therapy has resulted in improved libido and erectile function in middle aged men.[i]  However, recent scientific evidence has demonstrated significant adverse health implications for men with low and declining testosterone levels.  Numerous studies have now established a strong association between low testosterone and depression, metabolic syndrome, type-2 diabetes, osteoporosis and cardiovascular disease.  In one study men with low testosterone had a nearly 50% increase in mortality over a seven year period.[ii]   An unmistakable link has also been established between erectile dysfunction and the development of cardiovascular disease.

Several studies have shown that restoring testosterone to more youthful levels in middle-aged men improved insulin-sensitivity, reduced serum cholesterol, fat mass, waist circumference and inflammatory bio-markers associated with heart disease, diabetes, and metabolic syndrome.  One study concluded that “that testosterone treatment in men has potentially beneficial effects on virtually all of the coronary risk factors, as well as an independent anti-plaque forming action.”  In men with heart failure, testosterone therapy also improved functional capacity, or the ability to perform physical activity without constraint.[iii]

So why aren’t more men getting testosterone therapy?  Many physicians do not recognize the symptoms of low testosterone as a treatable condition. Traditionally, physicians have been reluctant to prescribe testosterone therapy in large part out of a misguided fear of increasing prostate cancer risk.  Recent evidence has called that conventional paradigm into question.  A large meta-analysis out of Harvard University[iv], as well as a collaborative review of 18 prospective studies[v] concluded that no significant association existed between higher testosterone levels and prostate cancer risk.  Conversely, studies have shown an increased risk of prostate cancer and aggressive prostate cancer in men with low testosterone levels.  In a group of middle-aged men treated with testosterone and followed for more than 5 years, there was no increase in the incidence of prostate cancer and PSA levels remained stable.[vi] 

 What is the bottom line?  Any man over 40 or 50 that feels off his game, run down or is experiencing any of the symptoms of low testosterone should have a thorough evaluation looking for cardiovascular disease, pre-diabetes, and osteoporosis among others.  I recommend seeking out a physician experienced in preventive health and hormone therapy for men.  At Alternity Healthcare, we utilize comprehensive evaluations and state-of-the-art diagnostics to form the basis of an individual preventive health program.  Rather than narrowly focusing on just your hormone levels, our comprehensive programs will expose your total health picture and help you to achieve renewed, long-term health and vitality.   

Although numerous studies have demonstrated substantial health benefits from physical exercise, there is debate about the optimal type, duration and intensity to achieve the most favorable result.  When you mention exercise to most people, it congers up images of tedious endurance training; that is, traditional “cardio” that many exercise gurus tell you to do.  But recent scientific studies are pointing to another, more efficient option to strengthen your heart, improve lung function and overall fitness.  Shorter bursts of vigorous exercise benefits heart health as much as tedious endurance training.

A small study done at McMaster University in Canada compared healthy men and women riding stationary bikes.  Some exercised five days per week doing 40-60 minutes of moderate-intensity cycling.  Others did four to six sets of 30-second sprints on the bike allowing 4-5 minutes of recovery between sets; with a total exercise time of 15-25 minutes just three days a week.  After six weeks, the researchers found that the intense sprint interval training improved the structure and function of arteries as much as traditional, longer endurance exercise.

A larger study, following 13,000 people for 15 years in the Harvard Health study found that people live longer if they do vigorous exercise, but not if they only do light or moderate exercise.[1]   Another study looking at the cardiovascular benefits of exercise in people following coronary artery bypass surgery (CABG) found that higher intensity interval training improved aerobic capacity (VO₂) significantly better than moderate intensity continuous training.  In fact, the study data showed that the 4 week improvement in VO₂ in the interval training group was greater than that achieved in the moderate continuous training group after 6 months.^[2]

What is VO₂?  There are a number of parameters that can be measured to assess your overall cardiovascular health but the one of the best is your aerobic capacity, otherwise known as your VO₂ max.  Measuring VO₂ max reveals how well your lungs can get oxygen into your blood, how efficiently your heart can pump that blood to your organs and exercising muscles and how well those muscles can utilize the oxygen for energy production.  The more oxygen your body can use, the better your body works.

Mitochondria are the power plants where fuel is burned, energy is produced and harmful free radicals are neutralized.  The number of mitochondria that you have in your cells determines your performance capacity.  But that number is not fixed.  There are several complex pathways that lead to an increased number of mitochondria.  The best known and most effective way to produce more mitochondria is with exercise.^[3]   Mitochondrial production increases in direct proportion to the amount of physical activity performed.^{[4] [5]}

I have previously reviewed in detail three nutritional supplements, Resveratrol, Alpha Lipoic Acid and L-arginine, which have been shown to augment mitochondrial production and thereby improve oxygen consumption.  Quercetin, a compound found in berries, onions grapes and red wine can also improve VO₂.  A study using elite cyclists demonstrated a 4% increase in VO2 over a six week trial [6], and a similar increase in healthy but untrained individuals given quercetin supplements over seven days.

Clearly, people that stay physically active throughout life reap substantial benefits from exercise.  But what about those getting a late start?  Can beginning an exercise program at any age make up for years of sedentary living?  The short answer is a resounding “yes”.

A study spanning 35 years in Sweden strongly suggests that starting to exercise at or after 50 years old is better than never starting at all.  Another British study traced men over 18 years, at an average age of 63.  This study revealed a strong link between exercise and survival.  A third study from Norway found that men who were physically fit enjoyed substantial protection from cardiovascular disease and early death.   Not to be outdone, a study of American veterans followed men over 25 years and noted a 38% lower mortality in men who were physically fit.  Just as important was the finding that men who were unfit at the start and improved their fitness had a 35% lower mortality than those who remained unfit.

So, improving your fitness level strengthens your heart, improves your vascular system, enhances lung function, reduces your risk for a myriad of chronic diseases and ultimately protects against premature death.  But exercise alone is not sufficient.  It should be part of an overall adoption of healthy lifestyle habits:  eating more fruits and vegetables, avoiding processed foods and added sweeteners, not carrying around excess body fat, not smoking, getting more sleep and managing stress.  If you are over 50 you should have a thorough medical evaluation prior to beginning an exercise program and seek guidance from an experienced trainer or exercise physiologist.  At Alternity Healthcare, we perform an extensive evaluation including VO₂ testing on all of our new patients.

 It is never too late or too early to start exercising.  You will feel better, look better and live better.  You could then spread the word to your children and younger friends who have become distressingly inactive, overweight and lazy.  Remember, leading by example is most effective.

What are added sugars? 

Added sugars included table sugar, brown sugar, high-fructose corn syrup (HFCS), honey, molasses, brown rice syrup, agave syrup and other caloric sweeteners in prepared and processed foods — for instance, in soft drinks, iced tea, candy, pastries, cookies and canned fruits.  These added sugars provide no nutritional value.  Some may find it surprising that honey is included here, but honey has 35% more calories per tablespoon than table sugar. 

Extent of the epidemic

Americans now consume over 100 pounds of added sugars per person per year; more than a 50% increase from 30 years ago.  This is equivalent to 22 teaspoons per day!  It is also nearly three times higher than the level found not to “conclusively demonstrate a hazard to the general public.”[1]   So how much of any substance can be consumed before it goes from harmless to toxic?  It is generally accepted that a glass of red wine may have certain health benefits, but we all know the problems that drinking too much can bring.  It is hard not to blame added sugars for the obesity and diabetes epidemics we now face in this country.  In 1980, approximately one in seven Americans was obese and almost 6 million were diabetic.  Thirty years later, coinciding with increased sugar consumption, one in three Americans are obese and more than 14 million are diabetic.

Throughout our history, there has been a suspicious but not incontrovertible association between sugar consumption and disease.  From the late 19^th and early 20^th centuries there was a very notable increase in sugar consumption as the candy and soft-drink industries grew, along with a parallel increase in diabetes incidence and deaths.  

Is it just the calories?

Conventional recommendations from the Department of Agriculture or the American Heart Association[2] advise reducing sugar intake because of the excess empty calories; that is, the lack of any vitamins, minerals, protein, or fiber, that leads to weight gain and related diseases like diabetes.  High-fructose corn syrup has become one of the most vilified food additives but a growing number of nutrition researchers believe that there is little difference between HFCS and refined sugar, at least with respect to how they are metabolized in your body.  The evidence that HFCS consumption uniquely increases the risk of weight gain is very weak.[3]  HFCS is not used extensively outside the US but obesity rates are increasing worldwide.

Refined sugar (sucrose) is made up of two different sugar molecules, glucose and fructose in a 50-50 mixture.  Other carbohydrates, such as bread, potatoes and pasta break down to glucose.  That is, bread that does not contain HFCS.  Glucose is metabolized and used for energy by all cells in your body.  HFCS is 45% glucose and 55% fructose.  There is also fructose that occurs naturally in fruits, but the absorption rate of the sugar is blunted by the fruit’s fiber content.  Anywhere fructose is found in nature, there is always fiber present.  Fructose is metabolized by the liver and when present in sufficient quantities will be converted into fat.  The speed with which fructose arrives in the liver also influences the rate of conversion to fat.  This is a critical point, since soft drinks are by far the biggest culprits for the glut of sugar consumed, and the fastest way to absorb sugar.   In the 1950′s a typical soda contained 10 ounces; now we have 44 ounce Big-Gulps.  The more sugar consumed, the more insulin your body needs to produce to try and manage it.  In the presence of high insulin levels, more of your calories are stored as fat, creating a vicious cycle that ultimately leads to insulin resistance and fat accumulation in the liver.  And, what has become the most common form of liver disease, non-alcoholic fatty liver (NAFLD), has been linked to an increased consumption of fructose.[4]

Another hormone, leptin, is the satiety hormone.  It sends the signal to your brain to stop eating.  Its effects are essentially disabled in people with insulin resistance.  When leptin isn’t being released, or the signals not processed the way it’s supposed to–as happens in insulin-resistance–your brain doesn’t know you’ve already had enough to eat.  It thinks you’re starving, so you just eat more.  You end up in a vicious cycle of consumption and then disease.  In many obese individuals, leptin resistance contributes to thier difficulty in losing weight.

Sugars, lipids and hypertension

A study published last year looked at the relationship of added sugars to blood lipid levels.  Researchers compared the diets and blood profiles of over 6100 adults from the National Health and Nutrition Examination Survey.  Even after controlling for other variables including body mass index (BMI), physical activity, and total energy expenditures, the results showed that participants consuming the least amount of added sugars had higher HDL (good) cholesterol, lower triglycerides and lower LDL (bad) cholesterol.  The researchers concluded that there was an important association between increased sugar consumption and cardiovascular risk factors.  In another recent study, consumption of sugar-sweetened beverages was associated with significantly elevated blood pressure and increased BMI[5]

What does it all mean? 

Obesity, altered blood lipids, hypertension and insulin resistance adds up to metabolic syndrome; one of, if not the major risk factor for heart disease and diabetes.  While it hasn’t been conclusively determined what initially causes metabolic syndrome or what the initial event is in the insulin resistance cascade, there seems to be a remarkably strong correlation between liver fat and insulin resistance.[6]   Insulin resistance, obesity and metabolic syndrome are also closely associated with an increased risk of cancer.[7] 

If sugar consumption leads to insulin resistance, and insulin resistance is one of the fundamental underlying defects in cancer, as it is in type-2 diabetes and heart disease, then it seems to follow that excessive sugar consumption may cause cancer.  Even if the final scientific conclusions are not in, isn’t the association enough to make you rethink how much sugar you are willing to consume?

In 2010, nearly 1.6 million newly diagnosed cancer cases and more than 500,000 cancer deaths were expected in the US.  Cancer is the second leading cause of death in the US, exceeded only by cardiovascular disease.  Approximately 1 in every 4 deaths is attributable to cancer.[1]  But nearly 340,000 cancer cases in the United States could be prevented each year by adopting a healthier lifestyle, according to the World Cancer Research Fund (WCRF)[2].  In addition, a third of cancers can be cured through early detection and treatment. 

What is it about a healthier lifestyle that can help prevent cancer?  New research has uncovered an association between telomere length and cancer risk.  People who have white blood cells (leukocytes) with shorter telomeres may be at a higher risk of developing cancer, especially aggressive cancers that are more likely to kill.  Telomeres are the “shoelace ends” that cap and protect your chromosomes and naturally get shorter as you age.  Researchers measured leukocyte telomere length in 787 individuals who did not have cancer then followed them for ten years.[3]   Those with the shortest telomere length had more than triple the risk of developing cancer, and those in the middle group had twice the risk compared to those with the longest telomere length.  Those in the short telomere group also had a higher risk of dying from their malignancy than those with longer telomeres.

There is a mounting body of evidence linking short telomeres to a higher risk for a variety of cancers.  Studies have found shortened telomeres in breast cancer cells[4], bladder cancer cells[5], oral cavity cells[6] and colon cancer cells[7].  An Italian study found that individuals with the longest telomeres were ten times less likely to develop cancer than those with shorter telomeres.[8]

How does that fit in with a healthy lifestyle?  Following a Mediterranean diet can significantly reduce cancer risk.  A study published last year showed that by eating five servings of fruits and vegetables you could reduce your cancer risk by 6-11%.[9]   Eating a plant based diet has been shown to increase the activity of telomerase, the enzyme that repairs and rebuilds telomeres by 30%, resulting in improved telomere maintenance.[10]  

Regular vigorous exercise also activates the telomerase enzyme.[11]  Not surprisingly, exercise has been shown to reduce cancer risk and cancer mortality in men and women.

Women who engaged in more than 7 hours per week of moderate-to-vigorous exercise for the last 10 years were 16% less likely to develop breast cancer than those who were inactive.[12] And vigorous exercise for 20 minutes per day, 5 day per week significantly reduced the risk of fatal prostate cancer in men[13]

Obesity carries an enhanced risk for numerous cancers and obese adults have shorter telomeres than their normal-weight counterparts.[14]  We have known for decades that smoking increases your risk for cancer.  We now know that smoking accelerates telomere shortening.[15]  In fact, obesity and smoking are states of heightened oxidative stress, which increases the rate of telomere erosion per replication, and increases inflammation.[16]

Besides exercising, eating better and maintaining a healthy body weight, vitamin supplements offer additional protection for your telomeres. Daily intake of vitamin D in the 4000 – 8000 IU range was associated with a substantial reduction in the risk for breast cancer, colon cancer, multiple sclerosis and diabetes.[17]  Higher blood levels of vitamin D are associated with longer telomeres.[18]  Resveratrol[19] and just taking a multivitamin resulted in longer telomeres in women.[20]

You have the power to alter your biological aging clock by the choices you make in how you eat and live.  The same choices will lower your risk of most chronic diseases, including cancer.  Isn’t this what we call a “no-brainer”?  

 The word “mojo” has origins in African language and refers to magic or voodoo to generate luck and power. In the early 20^th century, it still referred to a source of vigor, energy, sexual potency and power, particularly for men. More recently, it has been expanded to mean power or influence of any kind.  An entire Austin Powers movie was devoted to his lost mojo and his desperate search to find it. He ultimately discovers his mojo is within, and that he had access to it all along.

 As we age, our capacity for physical exertion, as measured by maximal oxygen consumption, declines 10-15% per decade after age 20.  This is primarily due to relative physical inactivity and accumulation of body fat.   And, the average American gains 1 lb of fat every year between ages 30 to 60, and loses ½ lb of muscle.  This age-related deterioration in muscle mass, muscular strength and aerobic fitness correlates with the loss of independence in later life.  What can be done to recapture the feeling of your youth?  It’s simple; nothing that we do for ourselves to attain and maintain optimal health is more important than regular vigorous exercise. 

 Improving cardiorespiratory fitness is associated with lower risk of heart attack, stroke, and premature death.[1]  Resistance exercise retards the insidious age-related loss of muscle mass and strength that can lead to frailty.  Exercise helps you stand taller, feel more confident, sleep better, manage stress more effectively, manage your weight and boost libido. Walking speed has been correlated with survival among older adults.[2]

 Exercise has been called the closest thing we have to a fountain of youth.  It turns out that at the cellular level, exercise improves telomere maintenance by increasing the activity of the enzyme telomerase that builds and repairs telomeres.[3]  Telomeres are the part of your chromosomes that control aging.  They represent your biological clock.  When you are young your telomeres are longer and progressively shorten with age.  But the rate at which that shortening occurs is directly influenced by lifestyle choices.  So at any age, healthier individuals have longer telomeres than their unhealthy counterparts. There is also another way that exercise improves your health and keeps you young, and it has to do with something called mitochondria.  The latest evidence demonstrates that telomere dysfunction (shortening) impairs the production and function of mitochondria.[4] 

 Mitochondria are the power plants where fuel is burned, energy is produced and harmful free radicals are neutralized.  The number of mitochondria that you have in your cells determines your performance capacity.  But that number is not fixed.  While the process of synthesizing new mitochondria is complex, there are several pathways that have just recently been described.  The best known and most effective way to produce more mitochondria is with exercise.[5]  

 Mitochondrial production increases in direct proportion to the amount of physical activity performed.[6] [7] It is controlled by stimulating the master regulator of mitochondrial biogenesis known as PCG-1 alpha.  In addition to directly increasing the activity of PGC-1 alpha, exercise also stimulates the production of three intermediary factors.  Each of those intermediaries also directly stimulates the production of mitochondria, and they can be stimulated by nutritional interventions.  

 Resveratrol, a compound found in red wine, has been associated with anti-cancer activity, cardioprotective activity, antioxidant and anti-inflammatory activity, anti-viral activity and anti-neurodegenerative activity.[8] [9] [10]  Resveratrol, in addition to PGC-1 alpha, activates a class of genes called sirtuins that improve the efficiency of metabolism, reduce cellular stress and promote cellular survival.  It also results in increased production of nitric oxide (NO).

 Nitric oxide is produced by a layer of cells lining blood vessel walls and regulates the flow of blood to tissues.  When released, it causes the blood vessels to relax and expand, increasing blood flow and oxygen to tissues.  NO is necessary for a man to achieve an erection and is the pathway affected by medications like Viagra.  NO has recently been found to directly regulate the oxygen supply to mitochondria.[11]  NO is produced from the amino acid, L-arginine.  There are a number of animal and human studies documenting the beneficial effects following L-arginine supplementation.[12]  Those benefits are attributed to the increase in NO production.  The effectiveness of L-arginine can be enhanced by the addition of alpha-ketoglutaric acid (AKG).  AKG is more bioavailable. It’s faster acting and extends NO production, giving you a longer-lasting effect.

 Alpha Lipoic Acid (ALA) increases energy expenditures, improves insulin sensitivity, and reduces appetite.[13]  It functions by activating an enzyme (AMPK) that regulates cellular metabolism.  AMPK is the “fuel sensor” enzyme for the body and is the pathway through which ALA increases mitochondrial biogenesis.  A controlled release version has been tested and found to be safe in diabetics, and significantly improved measures of glucose control.[14]

 What’s the bottom line?  We all know, or at least have heard that exercise is good for your health.  Here you have a pretty detailed road map to the underlying cellular mechanisms that demonstrate what exercise does for your body.   Additionally, you see that directed nutritional interventions can activate one or more of the same pathways as exercise leading to the same beneficial effects.  Does that not mean that you should forgo exercise in favor of just taking those supplements?  No. The nutritional cocktail described should be taken in conjunction with a regular exercise program.  It is an adjunct to maximize the production of mitochondria and increase energy reserves.  

 Why should you bother?  More efficient energy production, increased exercise performance, reduced body fat, improves sexual performance, reduced inflammation and oxidative stress, and a lowered risk of developing one of the chronic diseases associated with aging.  The potential payback is huge and will impact every aspect of your health and well being.  You’ll look better, feel better and enjoy life more.  You may even get back your swagger.  So what are you waiting for?

[2] Studenski S, et al. Gait Speed and Survival in older adults. JAMA 2011; 303: 50-58

[3] Physical Exercise Prevents Cellular Senescence in Circulating Leukocytes and in the Vessel Wall.  Circulation 2009 Nov 30.

[4] Sahin E, Colla S, Liesa M, et al. Telomere Dysfunction Induces Metabolic and Mitochondrial Compromise. Nature. Feb 2011; 470: 359-65

[5] Reznick RM, Shulman G. The role of AMP-activated protein kinase in mitochondrial biogenesis. J Physiol 2006; 574:33-39

[6] Baar K, Wende AR, Jones T, et al. Adaptations os skeletal muscle to exercise: rapid increase in transcriptional coactivator PGC-1. FASEB J 2002; 16:1879-86

[7] Coffey VG, Hawley JA. The molecular basis of training adaptation. Sports Med 2007; 37:737-763

[8] Baur J, Sinclair D. Therapeutic potential of resveratrol: the in vivo evidence. Nat Rev Drug Discov 2006; 5:493-506

[9] Harikumar K, Aggarwal B. Resveratrol: A multitargeted agent for age-associated chronic diseases. Cell Cycle 2008; 7:1-18

[10] Orallo F. Trans-resveratrol: a magical elixir of eternal youth? Curr Med Chem 2008; 15:1887-98

[11] Clementi E, Nisoli E. Nitric oxide and mitochondrial biogenesis: a key to ong term regulation of cellular metabolism. Comp Biochem Physiol A Mol Integra Physiol 2005; 142:102-110

[12] Preli R, Klein K, Herrington D. Vascular effects of dietary L-arginine supplementation. Atherosclerosis 2002; 162:1-15

[13] Xue B, Khan B. AMPK integrates nutrient and hormonal signals to regulate food intake and energy balance through effects in the hypothalamus and peripheral tissues. J Physiol 2006; 574:73-83

[14] Evans JL, Heyman CJ, et al. Pharmacokinetics, tolerability and fructosamine-lowering effect of a novel, controlled-release formulation of alpha lipoic acid. Endocr Pract 2002; 8:29-35

 For years, medical researchers have studied centenarians; those one hundred years or older, to identify clues to longer life.  What seems clear is that longevity is not merely a chance event dependent on good genes, although longevity does run in families.[1]   A landmark Swedish study of identical and fraternal twins reared separately has provided much of the data regarding the relative influences of nature versus nurture in the components of aging.  Generally it is agreed that genes only account for approximately 20-30% and environment 70-80%.  This idea is supported by a study of Seventh Day Adventists at Loma Linda University who as a group have perhaps the longest average life expectancy in the United States, 88 years for men and 89 years for women. The main attributes that these individuals have in common is that their religion for the most part asks that they make very good lifestyle choices. That is, they tend to be vegetarian, they don’t smoke, they regularly exercise and they spend a lot of time with their families and with their religion. Many Americans do the opposite and thus it is not surprising that on average, Americans die 8-10 years sooner.

 But is a longer life worth living if you become frail, demented and dependent?  The vast majority would answer unequivocally, “no”.  Interestingly, studies of centenarians have uncovered some surprising facts.  The New England Centenarian Study dispelled the misconception that the older you get, the sicker you become.[2]  Lead author, Thomas Perls says, “the older you get, the health­ier you’ve been.”   In other words, peo­ple who demon­strate excep­tional longevity tend to have had a life­long his­tory of good health.  Indeed, peo­ple who die in their 70s or 80s are plagued by degen­er­a­tive ill­nesses in the years before their death; in con­trast, Perls has found that nearly two thirds of cen­te­nar­i­ans either delay the onset of dis­eases such as heart dis­ease, stroke, and diabetes—or escape them alto­gether. Plus, a sub­stan­tial pro­por­tion of cen­te­nar­i­ans who sur­vive such age-related ill­nesses do so with­out devel­op­ing phys­i­cal dis­abil­i­ties, enabling them to remain socially, men­tally, and phys­i­cally active. 

 It is apparent that living to 100 confers an important advantage in years of healthy living.  Not all centenarians are identical but there are a number of common characteristics:

• Few centenarians are obese. In the case of men, they are nearly always lean.
• Substantial smoking history is rare.
• Centenarians are better able to handle stress than the majority of people.
• Nearly 1 in 5 centenarians had no significant changes in their thinking abilities disproving the expectation by many that all centenarians would be demented.[3]
• Alzheimer’s disease was not inevitable.  Some centenarians had very healthy appearing brains with neuropathological study.[4]
• Many centenarian women have a history of bearing children after the age of 35 years and even 40 years, suggesting optimal hormone balance plays a role.

Biologically, telomere length correlates with years of healthy living.[5]  Telomeres are part of your chromosome that acts as a biologic clock.  As you age, and each time your cells divide, your telomeres get shorter.  When they get too short, your cells stop dividing and die.  This is the biological basis of aging.[6]  But if the enzyme telomerase is activated, it can repair and build telomeres, slowing the aging of your cells.  In a study of centenarians, those classified as healthy (being physically functionally independent without hypertension, heart failure, heart attacks, peripheral vascular disease, dementia, cancer, stroke, chronic obstructive lung disease and diabetes) had significantly longer telomeres than their unhealthy peers.[7] Obese individuals have shorter telomeres than their same age counterparts, and obesity increases the risk for several degenerative diseases and premature death.  Chronic perceived stress can shorten lifespan and increase your risk of degenerative disease associated with aging.[8]

How can you get longer telomeres?  A healthy plant-based diet combined with regular physical activity has been shown to increase telomerase activity by 30%.[9]  Fish oil supplements[10] and regular multivitamin use have both been associated with improved telomere maintenance.  Regular, vigorous exercise activates the telomerase enzyme, improves cardiorespiratory fitness and reduces the risk of several degenerative diseases.  In one study, sedentary individuals had telomere shortening equivalent to 10 additional years of aging compared to those performing an average of 28 minutes per day of physical activity.[11] 

It seems more than coincidental that the same healthy lifestyle choices that are common among healthy centenarians are the same choices that preserve telomere length on a biological level.   But what can improve your odds of making sustainable lifestyle choices?  It is not just disease-risk modification or the fear of death.  It is the joy of living; and living well.  Pleasure, joy and freedom beat out willpower, deprivation and austerity.   Devel­op­ing healthy habits and a pos­i­tive atti­tude towards life while we’re young, though chal­leng­ing at times, can set us up to be happy, healthy, and inde­pen­dent in old age.  Although many of us do not think about it until we are old, aging well isn’t just a project for the elderly. It’s some­thing we need to work toward our entire lives.  Why not start living better today?

[2] Perls TT, Bochen K, Freeman M, Alpert L, Silver MH. The New England Centenarian Study: validity of reported age and prevalence of centenarians in an eight town sample. Age and Ageing.1999;28(2):193-197

[3] Silver, M.H., Jilinskaia, E., Perls, T.T. Cognitive functional status of age-confirmed centenarians in a population-based study. Journal of Gerontology, Psychol Sci 2001;56B:P134-P140

[4] Silver MH, Newell K, Brady C, Hedley-Whyte ET, Perls TT. Distinguishing between neurodegenerative disease and disease-free aging: correlating neuropsychological evaluations and neuropathological studies in centenarians. Psychosomatic Medicine 2002;64:493-501.

[5] Njajou, O. T. et al. Association between telomere length, specific causes of death, and years of healthy life in health, aging, and body composition, a population-based cohort study. J. Gerontol. A 64, 860–864 (2009).

[6] Mikhelson, VM, Gamalei IA, “Telomere shortening is the main mechanism of natural and radiation aging” Radiats. Biol. Radioecol. June 2010;50(3):269-75

[7] Terry D, Nolan V, Anderson S, et al. Association of longer telomeres and better health in centenarians. Journal of Gerontology: Biological Sciences 2008 63A:8:809-812

[8] Epel, E. S. et al. Accelerated telomere shortening in response to life stress. Proc. Natl Acad.Sci. USA 101, 17312–17315 (2004).

[9] Ornish D, Lin J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol. 2008;9(11): 1048-1057

[10] Farzenah-Far R, et al, “Association of Marine Omega-3 Fatty Acid Levels With Telomeric Aging in Patients With Coronary Heart Disease” JAMA. 2010;303(3):250-257 (doi:10.1001/jama.2009.2008)

[11] Cherkas L, et al. The Association between Physical Activity in Leisure Time and Leukocyte Telomere Length.  Arch Int Med 2008; 168 (2)