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.

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.

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.

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”?  

Two high profile stroke victims highlight this trend among younger people.  Delaware attorney general Beau Biden suffered a stroke at age 41 last year.  His was classified as “mild” and he has made a good recovery.  Typically younger people recover better as they have retained more brain plasticity and have fewer co-morbidities to complicate their recovery.

 Less fortunate was rapper Nate Dogg who died this week from congested heart failure and complications from previous strokes.   He was only 41, but according to the LA Times and USA Today, he suffered from two previous strokes; the first at age 38 and the second the following year.  I certainly do not know all the details of his condition, but having a stroke puts you at significantly increased risk of having subsequent strokes.  It should be a wake-up call.

 How can you prevent a stroke?  Although there are several risk factors that you cannot change, such as family history, being African American or male[1], there are a number of risk factors that are modifiable.  A large case-control study evaluating the risk factors for stroke ahs identified 10 modifiable risk factors that are associated with 90% of stroke risk.  Of those modifiable risk factors, hypertension was the most important for all stroke types.[2]  In that study a history of hypertension was associated with a more than 2.5-fold increase in the risk for stroke.  The other risk factors included smoking, abdominal obesity, lack of regular physical exercise, diabetes, diet and alcohol intake, abnormal lipid profile, stress and depression.

 Not coincidentally, the risk factors for stroke and heart disease are the same; the relative importance of each risk factor varies for each disease.  And, the same lifestyle modifications that could reduce your risk of both heart disease and stroke also reduce your risk of diabetes and being obese, which further reduces your risk of having a vascular event.  It all boils down to modifying your lifestyle to avoid these debilitating chronic diseases, improve your quality of life and reduce your chance of dying prematurely.

 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)

Despite all of the tremendous medical advances of the last century, strategies to fight the viruses that cause seasonal flu and the common cold remain largely unchanged.    There are no cures for either which makes prevention all the more important.   Last year, we suffered through the first flu pandemic in 40 years courtesy of a new and very different flu virus named H1N1. Although there are thousands of fatalities attributed to the flu every year, getting a cold is usually less serious though still very unpleasant.    What are your options besides just rolling the dice and stockpiling Kleenex?

Most experts believe that viruses spread mainly by droplets made when infected people cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get sick by touching a surface, hand or object that has flu virus on it and then touching their own mouth, eyes or nose.[i]  Avoiding people who are sick, coughing or sneezing into your elbow rather than your hands and frequent hand washing are all effective staples to help you avoid getting sick or spreading the virus if your are sick.    What about hand sanitizers?

I am not a proponent of the ubiquitous hand sanitizer gels.  We seem to have become a germ-phobic society.  This is reinforced in the media with all of the TV segments showing us how many germs are on various surfaces we encounter everyday.  What is downplayed (or excluded) is that most of those strains are not disease causing strains.  Germs are everywhere, some essential and beneficial.  Several studies have correlated the lack of early childhood exposure to germs with an increased frequency of colds, allergies and autoimmune conditions later in life[ii]. Even the effectiveness of hand sanitizers has recently been called into question.  A new University of Virginia study found that hand sanitizers failed to “significantly reduce the frequency of infection from either the rhinovirus or the influenza virus”[iii].  

 So what can you do?  You may be able to help your immune system ward off infections with adequate rest, good nutrition and regular exercise:

• Sleep deprivation suppresses immune system function.  One study found that sleeping less than seven hours per night resulted in a three-fold increased susceptibility to cold viruses[iv]. 
• Eating real, high quality, natural foods are a great source for the vitamins and nutrients needed to prevent colds.  Get generous amounts of immune-boosting foods like green leafy vegetables, berries, apples, oranges, nuts, artichokes and beans.  Saturated fats and sugars contribute to a weaker immune system.
• Supplementing your diet with vitamin C & D, selenium and zinc is also essential for most individuals.  Vitamin D was found to be essential for immune cell activation[v].
• Even more so than nutrition, exercise has the capacity to protect and even enhance the immune response. Experimental studies have shown that a regular exercise program of brisk walking can bolster many defenses of the immune system, including the antibody response and the natural killer (T cell) response[vi].

[ii] Platts-Mills. Paradoxical Effect of Domestic Animals on Asthma and Allergic Sensitization. JAMA, 2002

[iii] Turner R, University of Virginia, 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC): Abstract V-444. Presented September 12, 2010.

[iv] Cohen S, et al. Sleep habits and susceptibility to the common cold. Archives of Internal Medicine. 2009;169:62

[v] Kongsbak, Martin, et al, “Vitamin D controls T cell antigen receptor signaling and activation of human T cells,” Nature Immunology 2010; 11: 344-349

[vi] Romeo J, Warnberg J, Pozo T, Marcos A. “Physical activity, immunity and infection”. Proc Nutr Soc. 2010 Aug;69(3):390-9. Epub 2010 Jun 23.

Despite its benefits, far too many Americans are chronically sleep deprived.  We live in very stressful times.  One-third of Americans are losing sleep over the state of the U.S. economy and other personal financial concerns.[1]  According to the National Sleep Foundation, 20 percent of us get less than 6 hours sleep a night.  For many others, a good night’s sleep is increasingly losing out to the distractions and extremely hectic nature of our modern life. Some hard-charging professionals even shun regular sleep in deference to the philosophy “I’ll sleep when I am dead”.  Well it turns out that getting enough sleep, and other kinds of rest, just might postpone when your death occurs as well as increase the effectiveness and joyfulness of your life.

One way to think about the function of sleep is to compare it to another of our life-sustaining activities: eating. Hunger is a protective mechanism that has evolved to ensure that we consume the nutrients our bodies require to grow, repair tissues, and function properly.  Both eating and sleeping are regulated by powerful internal drives. Going without food produces the uncomfortable sensation of hunger, while going without sleep makes us feel overwhelmingly sleepy. And just as eating relieves hunger and ensures that we obtain the nutrients we need; sleeping relieves sleepiness and ensures that we obtain the sleep we need.

 Insufficient sleep may alter crucial hormone functions and energy expenditures.  A recent study found that a restriction in the amount of sleep time compromised the effectiveness of a reduced calorie diet for weight loss and reduction of metabolic risk factors.[2]  Another study found that sleep deprivation was associated with a two-fold risk of being obese in children and adults.  That research also suggested that those who slept less have a greater increase in body mass index and waist circumference over time and a greater chance of becoming obese over time.[3]  Obesity has, in turn, been linked to a variety of chronic and life-threatening diseases, including sleep apnea; a common disorder in which the upper airway is intermittently narrowed or blocked, disrupting sleep and breathing during sleep.  Researchers from the Sleep Heart Health Study found that sleep apnea doubled the risk for strokes in men, and increased the danger for women.[4]

 Physiologic studies suggest that a sleep deficit may put the body into a state of high alert, increasing the production of stress hormones and driving up blood pressure, a major risk factor for heart attacks and strokes. Moreover, people who are sleep-deprived have elevated levels of substances in the blood that indicate a heightened state of inflammation in the body, which has also emerged as a major risk factor for heart disease, stroke, cancer and diabetes.  Other studies have found that sleep influences the functioning of the lining inside blood vessels, which could explain why people are most prone to heart attacks and strokes during early morning hours.[5]  The strongest evidence seems to be linking sleep deprivation to an increased mortality risk.  Otherwise healthy people who do not get enough sleep or who shift their sleep schedules because of work, family or lifestyle appeared to be significantly more likely to die sooner.

 How much sleep is enough?  Generally, experts recommend seven to nine hours per night.  But, as it turns out there is no absolute number of hours. Everyone requires more or less sleep depending on a variety of factors including your individual makeup as well as your lifestyle. What counts is that you are getting enough sleep for your body and mind to be replenished, whether that is six, seven, or eight hours or more.

[2] Nedeltcheva A, Kilkus J, et al. “Insufficient Sleep Undermines Dietary Efforts to reduce Adiposity”.  Ann Int Med. October 5, 2010

vol. 153 no. 7 435-441

[3] Cappuccio F, et al. “Sleep Deprivation Doubles Risks Of Obesity In Both Children And Adults.” ScienceDaily 13 July 2006.

[4] Redline S, Yenokyan G, et al. Obstructive Sleep Apnea- Hypopnea and  Incident Stroke.  American Journal of Respiratory and Critical Care Medicine Vol 182. pp. 269-277, (2010)

[5] Wolfe B, Volzke H, et al. Relation of Self-reported Sleep Duration with Carotid Intima Media Thickness in a General Population Sample. Eur J Cardiovasc Prev Rehab. Volume 196, Issue 2, Pages 727-732 (February 2008)

Well, let’s look at the facts.  Last year over half a million Americans suffered adverse events due to prescription medications.[1]  Almost 100,000 people die yearly as a result of complications from pharmaceutical drugs.[2]  To be sure, the FDA is under pressure to approve drugs faster, and they undoubtedly are under-staffed to review the $2.5 trillion worth of foods, drugs and medical devices they are currently responsible to oversee.[3]  But ultimately, it is the American consumer that gets hurt; and the pharmaceutical industry that lines its pockets with billions of dollars in the process.

In 1992 Congress passed the Prescription Drug User Fee Act, ostensibly to provide the FDA with desperately needed funds to make it more efficient.  The idea was to shift some of the cost of research involved in drug approvals to the pharmaceutical companies.   It essentially allows the drug makers to pay a fee to the FDA to approve their drugs.  This year, that user fee is estimated to be $920 million; nearly one third of the FDA budget![4]

Does that fee unduly influence FDA decisions?  It is hard to imagine that it wouldn’t.  The agency entrusted to regulate the pharmaceutical industry is now financially dependent on that same industry for funding.  Dr. David Graham, a senior drug safety researcher at the FDA who was pivotal in having Vioxx removed from the market was quoted as saying: “As currently configured, the FDA is not able to adequately protect the American public. It’s more interested in protecting the interests of industry. It views industry as its client, and the client is someone whose interest you represent. Unfortunately, that’s the way the FDA is currently structured.”[5]

Is there any evidence to back-up that claim?  Well, in the 40 years preceding the Prescription Drug User Fee Act, the FDA only recalled 8 medications it had previously approved.  Since 1992, that number is more than 22 drugs, and climbing.[6]  The latest drug casualty is Meridia, a weight loss drug pulled from the US market by its maker, Abbott Labs because it increases the risks for heart attacks, strokes and death.[7]  This isn’t the first weight loss drug to cause serious cardiovascular complications; remember Fen Phen and Redux?[8]  At least this time, the FDA eventually got it right by recommending Meridia’s removal from the US market.  It is troubling that European regulators banned it more than nine months ago.   What was the delay?  John Jenkins, MD, director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research, suggested we need more weight loss drugs, “We’re still very committed to working with (manufacturers) to help them to develop and gain approval of safe and effective drugs to help patients manage weight”[9]

Last month I reported on the cardiovascular issues resulting in tens of thousands of deaths attributed to the diabetes drug Avandia.  It was banned in Europe but remains available in the US, albeit with tighter restrictions.[10]   There was a concern that diabetics would have fewer medication choices.  Really?  Type-2 diabetes can largely be prevented and reversed through lifestyle modifications.  But that approach would hinder profits.

Theses are just a few of the drug problems we know about.  More are likely to be recalled under the current approval system, and many remain on the market with dubious scientific benefit.  They continue to be prescribed in large part due to the weight of the pharmaceutical industry’s marketing initiatives to both physicians and the general public.  That is not to say that all pharmaceutical drugs are harmful.  Quite the contrary, there are tremendous life-saving medications available when needed.  But, many of the chronic conditions for which they are prescribed are preventable.

You may not hear that from big-pharma’s advertising, because it is much more profitable to treat symptoms with expensive drugs than to make you aware of the range of natural alternatives to prevent illness. Eat real food, not processed foods laden with chemicals and preservatives. Avoid sugars, starches and processed grains.  Drink more water.  Take high quality nutritional supplements; unlike pharmaceutical drugs, there are no widespread reports of deaths from vitamins.[11]  Exercise vigorously and regularly; it is the fountain of youth.  Get enough sleep to recharge and revitalize yourself daily; 7-9 hours are needed.  Learn to manage stress, enjoy more of your life, and keep things in proper perspective.

 Help is there but you must seek it out and make a commitment to the lifestyle changes necessary.  How do you want to live your life 10, 20, 30 years or more from now?  You can’t wait until then to decide.  What you do now will determine whether you remain vital, healthy and engaged in your later years, or whether you will be frail, feeble and drooling on yourself in a nursing home waiting for someone to change your diaper.  Which is your future vision?

[2] Moore, Thomas J., AB; Cohen, Michael R., RPh, MS, ScD; Furberg, Curt D., MD, PhD., “Serious Adverse Drug Events Reported to the Food and Drug Admin.,” Arch Intern Med. 2007; 167(16): 1752-1759

[3] Gardiner, Harris, “The Safety Gap,” New York Times Magazine Nov. 2, 2008

[4] Zajac, Andrew, “Freeze? What Freeze? FDA in Line for Another Budget Boost,” Los Angeles Times Feb. 2, 2010

[5] Loudon, Manette, “The FDA Exposed: An Interview With Dr. David Graham, the Vioxx Whistleblower,” Organic Consumers Association Aug. 30, 2005

[6] Center for Drug Evaluation and Research Report to the Nation 2005: http://www.fda.gov/downloads/AboutFDA/CentersOffices/CDER/WhatWeDo/UCM078935.pdf

[7] James W, Caterson I, et al.  Effects of Sibutramine on Cardiovascular Outcomes in Overweight and Obese Subjects. N Engl J Med 2010; 363:905-917. Sept 2010. 

[8]Curfman G, Morrissey S, Drazen J.  Sibutramine – Another Flawed Diet Pill. N Engl J Med 2010; 363:972-974 Sept 2010.

[9] Abbott Withdraws Sibutramine from Market. http://www.medscape.com/viewarticle/730155

 [10] 47,000Deaths and Counting. http://alternityhealthcare.com/2010/09/25/47000-deaths-and-counting/

[11] “No Deaths from Vitamins, Minerals, Amino Acids or Herbs,” Orthomolecular Medicine News Service Jan. 19, 2010; http://www.orthomolecular.org