Tag Archives: longevity

Upon Reaching The Century Mark, Eugene Shares His Keys To Longevity

We threw a birthday party  a few weeks ago in our Winghaven satellite office (O’Fallon, Missouri)  for our patient, Eugene.

In the back row are the wonderful staff of our Winghaven office (from left to right) my MA Jenny, sonographer Sandy, and nuclear medicine tech Robert. You can probably figure out the characters in the front row.

Eugene is the first patient of mine that I can recall celebrating a 100th birthday party. I mentioned him previously on this blog on a post about longevity, the art of living long and prosperously, which he had mastered.

He’s still doing remarkably well and his family shared this video of him dancing with his wife, Naomi (also our patient), at an earlier centennial birthday party.

Eugene told me that he met Naomi at a VFW dance when he was 85 years old and swept her off her feet.

The cake that Sandy had made for him features his love of dancing and swimming.

 

While we ate sandwiches and cake I asked him about his 100 years.

Wadlow standing next to his normal sized dad. Be sure to visit bucolic Alton, Illinois where you can stand next to a life-size statue of Robert Wadlow (who suffered from excess human growth hormone (pituitary gigantism) a disease which is now treatable which means that his claim to tallest man ever will likely never be challenged.

He was born and raised in Alton Illinois and went to high school with the  Alton Giant, Robert Wadlow. Depicted to the right next to his normal sized father, Wadlow was the tallest man in the world, reaching 8 ft, 11 inches.

Eugene graduated with a degree in chemistry and physics from Shurtleff University  then went on to get his masters and PhD degrees. He played in a 10 piece band in 1940.

During World War II he served as a navigator for an LST boat (which, he says, was nicknamed large slow target).

After tracking down his LST boat in Panama, he served in the Pacific and  at the Battle of Okinawa.

After retiring at age 65 he picked up running at the age of 65 and ran long distances frequently for 20 years.

I asked Eugene “To what do you attribute your longevity?”.

Here is his reply.

Happy Birthday To All Centenarians!

-ACP

Which Exercise Is Best For Heart Health: Swimming or Walking?

Reader Pat asked the skeptical cardiologist the following question:

Which would be the better heart healthy choice? Walking briskly 3 x week or swimming for 45 minutes 2-3 x a week?

Swimming is an attractive alternative to walking or running for many of my patients with arthritis because it is a lot easier on the load-bearing joints of the lower extremities.

To my surprise there is at least one study (from Australia) comparing swimming and walking that was published in the journal Metabolism in 2010.

The investigators randomly assigned 116 sedentary women aged 50-70 years to swimming or walking. Participants completed 3 sessions per week of moderate-intensity exercise under supervision for 6 months then unsupervised for 6 months.

Compared with walking, swimming improved body weight, body fat distribution and insulin resistance in the short term (6 months).

At 12 months swimmers had lost 1.1 kg more than walkers and had lower bad cholesterol levels.

It should be noted that these differences barely reached significance .

Types of Activities And The Intensity of Exercise

My general recommendations on exercise (see here) give examples of different aerobic physical activities and intensities.

These activities are considered Moderate Intensity

  • Walking briskly (3 miles per hour or faster, but not race-walking)
  • Water aerobics
  • Bicycling slower than 10 miles per hour
  • Tennis (doubles)
  • Ballroom dancing
  • General gardening Vigorous Intensity

These types of exercise are considered Vigorous Exercise

  • Racewalking, jogging, or running
  • Swimming laps
  • Tennis (singles)
  • Aerobic dancing
  • Bicycling 10 miles per hour or faster
  • Jumping rope
  • Heavy gardening (continuous digging or hoeing, with heart rate increases)
  • Hiking uphill or with a heavy backpack

As a rule of thumb, consider 1 minute of vigorous exercise equivalent to 2 minutes of moderate exercise and shoot for 150 minutes per week of moderate exercise or 75 minutes of vigorous exercise.

Of course one can swim laps at peak intensity or at a very slow, leisurely pace so swimming laps doesn’t always qualify as “vigorous” exercise. Likewise one can play singles tennis languorously and be at a moderate or lower intensity of exercise.

It is entirely possible that the swimmers were working at a higher intensity during their sessions than the walkers and that could be the explanation for the differences seen between the two groups.

Ultimately, the best type of  exercise for heart health is the one you can do and  (hopefully) enjoy on a regular basis.

Antilanguorously Yours,

-ACP

N.B. Speaking of swimming. A year ago I wrote about longevity and featured Eugene, a 98 year old who could swim the length of a swimming pool underwater. Eugene turns 100 in 2 days.

US Health Care: Spending More But Getting Less Than Peer Countries Since 1980

Austin Frackt has a good article up at The incidental Economist discussing this graph:

life-spend

Why did the US become such an outlier; spending lots more per capita on health care but without demonstrable benefit?

A second graph shows how US longevity has not kept up with improvements noted in peer countrieslife-expectancy-1.jpg

Frakt touches on many of the proposed mechanisms for America’s divergence from the pack and the article is well worth a few minutes of your time.

Skeptically Yours,

-ACP

 

Dr. P’s Heart Nuts: Preventing Death In Multiple Ways

The skeptical cardiologist has finally prepared Dr. P’s Heart Nuts for distribution. IMG_8339The major stumbling block in preparing them was finding almonds which were raw (see here), but not gassed with proplyene oxide (see here), and which did not contain potentially toxic levels of cyanide (see here).

During this search I learned a lot about almonds and cyanide toxicity, and ended up using raw organic almonds from nuts.com, which come from Spain.

I’ll be giving out these packets (containing 15 grams of almonds, 15 grams of hazelnuts and 30 grams of walnuts) to my patients because there is really good scientific evidence that consuming 1/2 packet of these per day will reduce their risk of dying from heart attacks, strokes, and cancer.

IMG_7965The exact components are based on the landmark randomized trial of the Mediterranean diet, enhanced by either extra-virgin olive oil or nuts (PREDIMED, in which participants in the two Mediterranean-diet groups received either extra-virgin olive oil (approximately 1 liter per week) or 30g of mixed nuts per day (15g of walnuts, 7.5g of hazelnuts, and 7.5g of almonds) at no cost, and those in the control group received small nonfood gifts).

After 5 years, those on the Mediterranean diet had about a 30% lower rate of heart attack, stroke or cardiovascular death than the control group.

It’s fantastic to have a randomized trial (the strongest form of scientific evidence) supporting nuts, as it buttresses consistent (weaker, but easier to obtain), observational data.

Trademark

I applied for a trademark for my Heart Nuts, not because I plan to market them, but because I thought it would be interesting to possess a trademark of some kind.

The response from a lawyer at the federal trademark and patent office is hilariously full of mind-numbing and needlessly complicated legalese.

Heres one example:

"DISCLAIMER REQUIRED
Applicant must disclaim the wording “NUTS” because it merely describes an ingredient of applicant’s goods, and thus is an unregistrable component of the mark.  See 15 U.S.C. §§1052(e)(1), 1056(a); DuoProSS Meditech Corp. v. Inviro Med. Devices, Ltd., 695 F.3d 1247, 1251, 103 USPQ2d 1753, 1755 (Fed. Cir. 2012) (quoting In re Oppedahl & Larson LLP, 373 F.3d 1171, 1173, 71 USPQ2d 1370, 1371 (Fed. Cir. 2004)); TMEP §§1213, 1213.03(a).

The attached evidence from The American Heritage Dictionary of the English Language shows this wording means “[a]n indehiscent fruit having a single seed enclosed in a hard shell, such as an acorn or hazelnut”, or “[a]ny of various other usually edible seeds enclosed in a hard covering such as a seed coat or the stone of a drupe, as in a pine nut, peanut, almond, or walnut.”  Therefore, the wording merely describes applicant’s goods, in that they consist exclusively of nuts identified as hazelnuts, almonds, and walnuts.

An applicant may not claim exclusive rights to terms that others may need to use to describe their goods and/or services in the marketplace.  See Dena Corp. v. Belvedere Int’l, Inc., 950 F.2d 1555, 1560, 21 USPQ2d 1047, 1051 (Fed. Cir. 1991); In re Aug. Storck KG, 218 USPQ 823, 825 (TTAB 1983).  A disclaimer of unregistrable matter does not affect the appearance of the mark; that is, a disclaimer does not physically remove the disclaimed matter from the mark.  See Schwarzkopf v. John H. Breck, Inc., 340 F.2d 978, 978, 144 USPQ 433, 433 (C.C.P.A. 1965); TMEP §1213.

If applicant does not provide the required disclaimer, the USPTO may refuse to register the entire mark.  SeeIn re Stereotaxis Inc., 429 F.3d 1039, 1040-41, 77 USPQ2d 1087, 1088-89 (Fed. Cir. 2005); TMEP §1213.01(b).

Applicant should submit a disclaimer in the following standardized format:

No claim is made to the exclusive right to use “NUTS” apart from the mark as shown."

I’ve gotten dozens of emails from trademark attorneys offering to help me respond to the denial of my trademark request. Is this a conspiracy amongst lawyers to gin up business?

Nuts Reduce Mortality From Lots of Different Diseases

The most recent examination of observational data performed a meta-analysis of 20 prospective studies of nut consumption and risk of cardiovascular disease, total cancer, and all-cause and cause-specific mortality in adult populations published up to July 19, 2016.

It found that for every 28 grams/day increase in nut intake, risk was reduced by:

29% for coronary heart disease

7% for stroke (not significant)

21% for cardiovascular disease

15% for cancer

22% for all-cause mortality

Surprisingly, death from diseases, other than heart disease or cancer, were also significantly reduced:

52% for respiratory disease

35% for neurodenerative disease

75% for infectious disease

74% for kidney disease

The authors concluded:

If the associations are causal, an estimated 4.4 million premature deaths in the America, Europe, Southeast Asia, and Western Pacific would be attributable to a nut intake below 20 grams per day in 2013.

If everybody consumed Dr. P’s Heart Nuts, we could save 4.4 million lives!

Meditativeterraneanly Yours,

-ACP

If you’re curious about why nuts are so healthy, check out this recent meta-analysis, a discussion of possible mechanisms of the health benefits of nuts complete with references:

Nuts are good sources of unsaturated fatty acids, protein, fiber, vitamin E, potassium, magnesium, and phytochemicals. Intervention studies have shown that nut consumption reduces total cholesterol, low-density lipoprotein cholesterol, and the ratio of low- to high-density lipoprotein cholesterol, and ratio of total to high-density lipoprotein cholesterol, apolipoprotein B, and triglyceride levels in a dose–response manner [4, 65]. In addition, studies have shown reduced endothelial dysfunction [8], lipid peroxidation [7], and insulin resistance [6, 66] with a higher intake of nuts. Oxidative damage and insulin resistance are important pathogenic drivers of cancer [67, 68] and a number of specific causes of death [69]. Nuts and seeds and particularly walnuts, pecans, and sunflower seeds have a high antioxidant content [70], and could prevent cancer by reducing oxidative DNA damage [9], cell proliferation [71, 72], inflammation [73, 74], and circulating insulin-like growth factor 1 concentrations [75] and by inducing apoptosis [71], suppressing angiogenesis [76], and altering the gut microbiota [77]. Although nuts are high in total fat, they have been associated with lower weight gain [78, 79, 80] and lower risk of overweight and obesity [79] in observational studies and some randomized controlled trials [80].

Longevity: Lifespan, Healthspan and Swimming Underwater At Age 98

img_7056
Eugene and Naomi.

The skeptical cardiologist has a few nonagenarian patients who seemingly defy the ravages of aging and remain vibrant and active into their late 90’s.

Eugene, for example, still ballroom
dances regularly with his wife, Naomi and swims underwater significant distances.

In this video, recorded when he was 97, you can see him swim the length of a swimming pool underwater

As life expectancy at birth has increased  from 35 years in 1900 to over 80 years now, we see more and more individuals reaching their nineties. Ongoing research seeks to further extend our lifespan.

But just as important as increasing lifespan is increasing healthspan, the portion of the life span during which function is sufficient to maintain autonomy, control, independence, productivity and well-being.

Eugene is an example of someone with a long lifespan and healthspan and this is what we truly seek, the combination of living well and living long.

Peter Attila writes that lifespan is driven by how long one can avoid the onset of diseases caused by atherosclerosis such heart attacks and strokes (see my  discussions on subclinical atherosclerosis here), cancer and neurodegenerative disease.

Healthspan,  Attila writes, is about preserving three elements of life as long as possible:

  1. Brain—namely, how long can you preserve cognition and executive function

  2. Body—specifically, how long can you maintain muscle mass, functional strength, flexibility, and freedom from pain

  3. “Spirit”—how robust is your social support network and your sense of purpose.

Problems with the body result in frailty, recognized as a major cause of disability and related falls, hospitalizations and death in the elderly.

The single best tool for warding off frailty appears to be physical exercise.

img_7051
Eugene and Noami tripping the light fantastic in our exam room

So, if you want to life a long life with lots of quality years at the
end of that life be like Eugene: swim and dance with your loved ones. Keep moving, stretch and exercise in some manner regularly.

Gerontologically Yours,

-ACP

Running For Longevity: From A-Punk to Aba Daba Honeymoon

About two years ago I wrote about a study that found that any amount of leisure-time running was associated with a lower risk of cardiovascular disease which  made me reconsider my usual advice to patients on exercise:

As part of a prospective longitudinal cohort study at the Cooper Clinic in Dallas, Texas, Lee, et al. looked at data from a group of 55,137 adults on whom they had information on running or jogging activity during the previous 3 months.
Those individuals who described themselves as having done any running in the last 3 months had a 30% lower risk of all-cause mortality and a 45% lower cardiovascular mortality.

Amazingly, it didn’t matter how much you ran.

Those who ran <51 minutes per week did just as well as those who ran >176 minutes per week.

At the time I felt the study was not definitive, but food for thought. Evidently, it got me thinking so much that I began running regularly (despite my previous dislike of running).

Music and the Tempo of Running

During my runs I listen to music on my iPhone, either through Apple Music or songs that I have purchased.

Today, after deciding Leonard Cohen’s Live in Dublin (although awesome, and one of the best live albums I’ve ever heard) was not motivating enough, I hit the first song on my iPhone: A-punk by Vampire Weekend.

A-Punk is one of my favorite songs released in the last decade. It’s very upbeat.. perfect for a running accompaniment. The opening guitar riff is simple, fast and catchy. It’s simple enough that I can play it on guitar but, so fast that my fingers fatigue quickly.  The bridge portion features a wonderfully fast and complicated bass line with punchy drums and an overlying synth flute melody. You can watch a video of it here:

As I ran I realized that the tempo of A-Punk was perfectly suited to my preferred running speed of 6.1 MPH. You’re probably wondering what the tempo of A-Punk is. It’s likely that the only time song tempo comes up in general conversation is when talking about CPR and the need to compress the sternum at 100 beats per minute, the alleged tempo of The Bee Gees Stayin’ Alive (it’s actually 104 BPM.)

A-Punk’s tempo turned out to be 175 BPM. If you are not inclined to count the actual beats in a minute to determine the tempo of a song, you can enter the song into this site to get the number or download a smart phone app for the purpose.

Oddly enough, the next song on my alphabetical listing of songs, Hoagy Carmichael’s version of Aba Daba Honeymoon, also had a screen-shot-2016-10-02-at-8-45-44-amtempo (174 BPM) perfectly suited to my running speed. (The song after that was my old band Whistling Cadaver attempting to play the medley at the end of Abbey Road at our 30 year high school reunion in 2002-not good for running to, but immensely entertaining).

Monetizing Music For Running

Having observed that the tempo of certain songs matched perfectly to my running tempo, I wondered if there were any advantages to selecting such songs. Would I run faster or longer or with less discomfort or less injuries?

The web site run2rhythm would certainly like me to believe that screen-shot-2016-10-02-at-9-45-42-amrunning to the right tempo song will improve my performance. This site claims that “the wrong musical playlists can be detrimental to your training as they will not provide any synchronization between the body, the music and the mind. The body is almost always out of sync with the music.”

screen-shot-2016-10-02-at-9-03-39-amRun2rhythm provides a chart of the BPM that corresponds to different running speeds and sells playlists starting at $3.99 corresponding to specific tempos. These are playlists by unknown artists created for run2rhythm and the samples were not inspiring to me.

Here’s an example:screen-shot-2016-10-02-at-9-05-39-am

 

 

Is Music a Legal Drug For Athletes?

It turns out that there is a body of scientific literature related to music and exercise, and the vast majority of it seems to come from one man,  Dr Costas Karageorghis at Brunel University in London, an expert on the effects of music on exercise.  In his 2010 book, Inside Sport Psychology, he claims that listening to music while running can boost performance by up to 15%.

In media articles on the topic he is often quoted as saying “Music is a legal drug for athletes.”

However, in a 2012 review article he is more circumspect, concluding:

Music is now rarely viewed in a manner akin to the ‘vitamin model’ described by Sloboda (2008) wherein one can ascribe immutable effects to a specific musical selection for all listeners and at all times. The beneficial consequences of music use stem from an interaction between elements of the musical stimulus itself and factors relating to the traits and experiences of the listener, and aspects of the exercise environment and task. In particular, the role of music is dependent on when it is introduced in relation to the task and the intensity of the exercise undertaken. In closing, the evidence presented in this review demonstrates that music has a consistent and measurable effect on the psychological state and behaviour of exercise participants

Creating Your Own Tempo Playlist

The research on music and exercise suggests that songs with inspirational themes (apparently, “Gonna Fly Now,” the Rocky theme, is the most popular workout song of all time) are more effective performance enhancers. Also, self-selection of songs works better.

For me, running while listening allows me to focus on nuances of instrumentation, timing  and lyrics that otherwise I would not pay attention to. It is essential, then, to have songs that are worthy of such close listening.

I wondered if anyone has compiled lists of songs of a certain BPM that were originals and good songs.  Sure enough, the folks at jog.fm have exactly such a function.  My search for songs with tempo of 175 BPM yielded A-Punk and hundreds of other songs, screen-shot-2016-10-02-at-10-10-58-amincluding some I like (thumbs down for Footloose and Wonderwall (which is really 1/2 of 175 BPM or  88 BPM), thumbs up for Dancing With Myself).

You will note that my preferred tempo of 175 BPM corresponds to a much faster running speed than my preferred 6.1 MPH. This may have to do with my short legs or my running style. It makes sense to count the number of steps you take per minute at your optimal speed rather than rely on charts or averages.

Achieving the Right Dose of Exercise

Whatever you listen to while running, walking, cycling or hopping, hopefully it will assist you to achieve the dose of exercise per week that results in improved cardiovascular outcomes.

This chart from recent European guidelines on lifestyle for prevention of disease describes different intensities of aerobic exercise:

screen-shot-2016-10-01-at-10-18-34-am
If you engage in vigorous exercise such as running or jogging, cycling fast or singles tennis, you only need to achieve 75 minutes per week. Moderate exercise such as walking or elliptical work-outs requires 150 minutes/week.

As a result of switching to running, I’ve cut down my total exercise time per week by half leaving me more time to create music!

Readers – feel free to share your favorite workout songs and let me know what tempo works best for you.

Synchronously Yours,

-ACP

Yikes! This is a silly video. I’m not sure I can run to the song anymore.

 

 

Jamón Ibérico and The Mediterranean Diet

The skeptical cardiologist recently spent a week in the Basque region of Spain intensively researching dietary and lifestyle choices of this unique area.

Spain borders the Mediterranean and is often included in those countries that are considered to be the source of the Mediterranean diet (MD) which I recommend to my patients.

For a good summary of the Mediterranean “diet pyramid” check out this 1995 article.

The definition of the MD varies, often based on what  bias the definer has for particular foods or macronutrients, but initially was considered to be the food patterns typical of Crete, much of the rest of Greece and southern Italy in the early 1960s. The reason for choosing this time era and geography was based on:

  • very high adult life expectancy with very low rates of coronary heart disease, certain cancers and diet-related chronic disease
  • Data suggested common characteristics of  food availability and dietary intake
  • Epidemiological studies throughout the world on populations with similar dietary patterns suggested a benefit

The diet is closely tied to traditional areas of olive cultivation in the Mediterranean region.

The MD of the early 1960s had the following characteristics:

  • an abundance of plant foods (fruit, vegetables, breads, other forms of cereals, potatoes, beans, nuts and seeds)
  • minimally processed, seasonally fresh and locally grown foods
  • fresh fruit as the typical daily dessert
  • sweets containing concentrated sugar or honey consumed a few time per week
  • olive oil as the principal source of fat
  • dairy products (principally cheese and yogurt and full fat) consumed in low to moderate amounts
  • fish and poultry consumed in low to moderate amounts
  • zero to four eggs consumed weekly
  • red meat consumed in low amounts
  • wine consumed in low to moderate amounts, normally with meals

I stayed in a small beach town, Deba, in Spain which is half way between Bilbao (famous for its Guggenheim museum) and San Sebastian. There were very few non-Spanish tourists in Deba so  presumably the dietary and lifestyle choices I observed are representative of current Basque choices although likely different from the early 1960s.

I found the Basque people in Deba to be welcoming and joyful and European statistics show the Basque to be among the most satisfied with their overall life and job conditions.

Interestingly, the  life expectancy of the Basque population in  2000 in years was  75.8 for men and 83.8 for women, and by  2011 it had increased to 79.3 and 86.1, respectively. The Basque women live longer than women in any other country in Europe.

Walking around the squares of Deba I observed two activities which I would ordinarily have presumed would result in a low life expectancy: lots of cigarette smoking and lots of Jamón consumption.

hanginghamsHam was everywhere in Deba, from the supermarkets to the cafes. A typical appetizer choice was a plate full of Jamón Ibérico. Most of the pintxos (Basque-style tapas) we saw consisted of Jamon on bread.

From  jamon.com (dedicated to the fine art of ham):

jamon“Picture paper-thin strips of dark red ham like petals ringing a hand painted plate. Imagine big honest hams curing in the mountain air. Picture individual hams resting on stands in family kitchens throughout Spain with a long slim knife at hand for any and all to slice a treat.

In Spain, Jamón is hospitality. Jamón is Spain. Of all the European hams, jamón from Spain is the Gold Standard.”

Jamón, dry-cured ham, has been eaten in Spain and other Mediterranean countries since ancient times. There are basically two kinds: hams from rustic and free range  pigs (Iberia, Corsican or Cinta Senese) and hams from intensively-reared white pigs (Serrano, Parma, Bayonne).

Both hams involve a moderate salting and a ripening period of 7-14 months for white pigs and over 20 months for Iberian hams.

When they are finished curing, they have an incredibly complex taste,  distinct marbling, a deep red color and an intense ham flavor.

The most sought after ham is Jamón Ibérico de Bellota: a sub category of Jamón Ibérico” where the pigs are free to roam the meadows of the ‘dehesa’. During the autumn prior to their sacrifice, they are encouraged to gorge on acorns (bellotas) from the holm oak and cork trees, sometimes gaining as much as a kilo of weight a day.”

Health Consequences of Eating Jamón Ibérico.

A 100 g serving of Jamon Iberico contains 375 calories, 200 of them from fat. Of the total 22 grams of fat, 6.5 grams is saturated, 2 grams polyunsaturated, and 13 grams monounsaturated . There are 43 grams of protein and a lot of sodium ( 1.1 grams).

If we follow most current nutritional guidelines we would be advised to avoid Jamon because it is a considered a processed meat and it contains lots of salt and saturated fat.

Despite eating lots of Jamon,  however, the Spanish and Basque do very well in terms of longevity and rates of heart disease.

joxeancider
Our Basque host, Joxean, pouring cider from a giant wooden barrel at a “sagardotegi” or Basque cider house after yelling “Txotx”. See here (http://www.euskoguide.com/food-drink-basque-country/sagardotegi-sidreria-cider-house/)

The Basque good health could be related to any number of factors. They consume lots of fresh fish caught in nearby ports and prepared with lots of garlic and olive oil. (I had the best monkfish of my life in a cider house in the hills near Deba). Fish and olive oil are clearly beneficial dietary components.

They also drink alcohol in varied forms, including locally sourced apple cider, beer and fine local wines from Rioja.

moreflyschThey are active and they have long stretches of beautiful coastline to hike (including this geopark), some of the best surfing beaches in the world, and hills for cycling.

Ultimately, a healthy lifestyle consists of enjoyable and sustainable exercise and an enjoyable, sustainable  and palatable diet composed of  a combination of foods (mostly plants) , interacting in myriad unmeasurable ways. Focusing on specific fat (other than industrially produced trans fats) or sodium content is not a particularly useful approach.

I think Jamon can be considered part of a healthy Mediterranean diet when consumed in moderation and when combined with an active physical lifestyle. It makes a wonderful addition to anyone’s diet.

Jamónly yours,

-ACP