Microsoft word - 2_tuesday2_health&wellnesspresentationtextenglish_pr2010.doc

Dear ladies and gentlemen, Dear future young retirees,
You are approaching retirement and most certainly asking yourselves a number
of questions. The objective of this late morning seminar entitled “Health &
Wellness”, is to go over the more commonly asked questions regarding health
issues and bring attention to some of the lesser known concerns, hopefully to
help all live a more full and longer life.

Through the ages, man has sought to preserve his youth.
From Herodotus who mentions the water located in the land of the Ethiopians
granting youth and vitality to Ponce de Leon and his quest for the legendary
Fountain of Youth (actually he was looking for a cure for his own impotence),
there is record of man's frustrated attempts to preserve his youth. Since the
19th century, there have been sporadic attempts to attribute aging to one or
another endocrine defect.
Attempts have been made to reverse these changes with a variety of endocrine
therapies: Dehydroepiandrosterone (DHEA), human growth (HGH), estrogens,
androgens among others have been tried and are still promoted by a few
unscrupulous individuals as being the answer to this age old quest.
In actuality, the process of aging is complex and precludes simplistic
formulations.
There is an unavoidable programmed death of cells as we age. Although we do
not have a cure to avoid this entirely, there are measures that we can take in
our everyday lives and very exciting medical help coming in the near future to
assist us in forestalling many of the complications of aging. The following is not
meant to be a complete compendium on every aspect of aging, but will serve as a
foundation for emphasizing the basics and in some cases pointing out hopeful
new therapies soon to be available
In my 27 years of practice, I have learned much from my patients. I have noted
great differences in the aging process of certain persons allowing some to
remain youthful well into their older ages and others to age prematurely. It is
more than genetics in many instances and rather it is an attitude and zest for
life. What is their secret and what have I learned from these individuals?
Basically there are four common denominators that aging with grace seem to have: 1. HUMOR. These people are able to laugh at themselves, forgive, be patient, and find fun in everything they do. Curmudgeons do not age well. 2. DIET. The old adage that you are what you eat holds very true. They have learned portion control, what types of food are beneficial, and to listen to their body. You do not see many fat 80 year olds. 3. EXERCISE. They have kept their body fit, not necessarily with physical fitness exercises (but this is by all means good), but with active life styles such as gardening, golf, and other activities. I would include mental exercises such as continuing to learn new things and keep many interests and most particularly, to have a passion. Couch potatoes do not age with grace. 4. STAYING CONNECTED. As best possible being with friends, family and other socializing mechanisms are vital. One of the common complaints of older persons is: "all of my friends have died". The resilient ones are able to make new friends and develop new interests through a variety of ways: trekking clubs, chess or bridge clubs, Church, senior citizens organizations, retirement homes etc. MENOPAUSE is unavoidable but at the same time somewhat treatable. It is this therapy that has prompted heated debate over the past ten years. We know that estrogen replacement therapy (ERT) is available, but what does it do and is it safe? There are a number of benefits in using this therapy: it slows down osteoporosis by stimulating bone formation, assists helping the vasomotor symptoms of hot flashes, helps mucus membrane dryness, helps skin elasticity, mood improvement, helps with sleep disturbances, and assists with keeping high density cholesterol levels high.(This is a protection for prevention of heart disease and stroke). Unfortunately, concerns of breast cancer, uterine cancer and existing heart disease have made this an unpopular therapy. Non hormonal therapies such as exercise, mood elevators, soy products and others have their place in helping. It is thus advised to have regular gynaecological check-ups and learn self breast palpation. ANDROPAUSE is the male equivalent of the female menopause. After his early 20's, a man looses about 1% of his testosterone per year. By his mid 70's about 75% will have testosterone levels clinically in the hypogonad range. Symptoms of fatigue, muscular weakness, sexual dysfunction, diminished cognition, and development of the metabolic syndrome are common. If testicular cancer, prostate cancer and pituitary dysfunction are ruled out, testosterone therapy can be very helpful in restoring to an extent these maladies. Drawbacks are: HDL levels fall, sleep apnea can worsen, red blood cell levels can rise to problematic levels and there is always the possibility of stimulating existing malignant prostate cells. It is advised to visit the urologist for prostate cancer screening and eventual erectile dysfunction issues. VlTAMlN D deficiency is one of the hottest subjects in medicine and not only for the aging patient, but young alike. It is now recognized that many of us suffer from the lack of Vitamin D because of a decrease in sun exposure (this is how our bodies make Vitamin D), and besides cold water fish, it is not found in much abundance in our foods. Deficiency in this vitamin has been linked with coronary artery disease, prostate cancer, breast cancer, and colon cancer, as well as bone loss. Replacing this can obviate many of these problems and I strongly recommend that all take this unless there is a reason not to do so. I would recommend 2,000 units of the D3 per day. Better even: walk daily under the sun. HYPOTHYROIDISM especially in elderly females is insidious and can cause weakness, confusion, and depression. THE METABOLlC SYNDROME consists of those individuals who have truncal obesity, low HDL levels, high triglycerides, elevated glucose, hypertension, and ultimately atherosclerosis and diabetes. Although this syndrome is all too common in younger patients, it increases with age and weight gain. In the elderly, many reasons contribute to instability and falls. Both neurologic (pertaining to the brain and nerves) and non neurologic (pertaining to muscles, bones, and joints) affect one's stability. Physiologically 2/3 of our body weight is centered in the upper body, thus making us inherently unstable. The more we weigh, the more unstable we become. By age 85, 80% have a gait disturbance. Muscle especially in the quadriceps of our legs and gluteus muscles in our hips remain vital in allowing us to maintain balance. It is imperative that we keep active by using these muscles. Simple activities such as walking, climbing stairs, biking, or even getting out of a chair can preserve these muscles to a large extent. When it is apparent that muscle tone alone is insufficient to prevent falls, the use of a cane or walker can be of great benefit in keeping within the confines of our center of gravity. Remember, the best treatment for a broken hip is prevention. Few other terms strike fear in patients and families more than the term dementia. Becoming synonymous in the general population with dementia is the term Alzheimer's disease, which is in fact only one specific form of dementia. First we must define the term dementia. It is impairment in memory accompanied by one other cognitive function (APHASIA, a disturbance in language, A PRAXIA, an inability to execute motor skills in the absence of weakness impairment, AGNOSIA, disturbance of visual processing, and lastly the inability to use ABSTRACT REASONING. All of this should be severe enough to interfere with daily functions and independence. The major dementia syndromes are: 1. REVERSIBLE FORMS: Metabolic etiologies such as hypothyroidism, B12 and Folate deficiency, electrolyte imbalances such as low sodium, low calcium, renal and liver dysfunction. Certain acute infections as well as chronic infections such as HIV. Depression is sometimes confused with dementia. Neoplasms of the brain and certain pressure build ups in the brain can cause dementia. Drugs such as sedatives, pain medication, and antidepressants account for a number of patients each year thought to be demented. 2. ALZHEIMER DISEASE (AD) accounts for some 60% of dementias, which translates into some 8 million cases of dementia in Europe and in the US . With the aging population, this number is projected to quadruple in the next 50 years! 3. PARKINSON DISEASE is associated with a 6 fold increase in dementia. This is a dementia that is somewhat related to Alzheimer Disease but the pathology differs somewhat. About 10% of dementias are of this type (also known as Lewy body dementia). 4. VASCULAR DEMENTIA accounts for another 10-25% of dementias and is found most commonly in hypertensive patients, diabetics and Afro-Americans. 5. FRONTAL-TEMPORAL DEMENTIA is characterized by atrophy of the frontal and temporal lobes and is familial in up to 40% of the cases. Because of the frequency and therapeutic opportunities that exist in the AD and Parkinson Dementia, special consideration will be given. We know that AD is characterized pathologically by protein depositions in the brain called Amyloid protein. Neurofibrillary tangles in the brain accompany these deposits. Once these plaques have formed, inflammation and programmed death of brain cells follow. Until recently we did not have a good test to identify this disease. We now have a PETscan with a contrast (FDDNP) that binds to these plaques and can identify this disease. Hence we have a marker of following this. Current therapies are intended to delay the progress of the syndrome (not cure the disease) and hopefully improve the patient's symptoms. These act by assisting in the preservation of the neurotransmitter Dopamine across brain cells. These medicines do nothing, however, to halt the progression of cell death. We can definitely help ourselves avoid this disease! Weight control is vital. Females who have an excess ""belly fat" in the less than 50 age group have a 7fold increase in AD. Males with the same problem under the age of 50 have 4fold increases. The reason is the metabolic syndrome and the insulin increase that stimulates the production of the Amyloid and Tau proteins. The message is to reduce . Eating 5-9 fruits and vegetables daily delivers antioxidants to protect brain cells. Moderate alcohol intake (females 1 drink and males 2 drinks daily) has been shown to reduce the cognitive decline in AD. Regular exercise (30 minutes of walking daily) reduces AD in up to 60%. In the Netherland study, patients taking Statins had a 43% less incidence of AD compared to their age matched controls. It is thought that cholesterol is a precursor to the amyloid protein. Folic acid may have a beneficial effect on cognitive function, but other B vitamin therapy is not effective. Other therapies that are NOT effective are: NSAI, Ginkgo, and antipsychotics. Now the exciting part!! New therapies are in the near future to act directly on the amyloid deposits that are the damaging substances to the brain. Hence, instead of merely delaying the progression of the disease, we may have a cure! Even more compelling is the fact that we may have a clue to the etiology of the dementias of Parkinson Disease. It is thought that a neuropathogen, probably a virus enters the nose through inhalation or stomach through ingestion decades before clinical dementia occurs. Though no immediate symptoms occur, problems with olfaction (sense of smell) because of penetration to the olfactory nerve and or dyspepsia (problems with digestion) and constipation begin to occur because of penetration of the gastric lining into the nerve bundle of the stomach known as Meissner's plexus. Over the ensuing decades, this virus propagates along the Vagus nerve and causes other symptoms such as cardiac arrhythmias. Once the pathogen enters the Pons portion of the brain, REM sleep disorders and violent dreams may follow. The end result is involvement of the Substantia Nigra portion of the brain. Dementia at this point, decades after the inciting event, now is underway. So what does this mean? if identified at an early time, therapy, perhaps antivirals/ could be used to rid the body of this potential devastating illness. It is reasonable that a vaccine may indeed be possible. 1. Adult Vaccines: After checking with your physician, the following vaccines are indicated for most adults: SHINGLES VACCINE is indicated for those over the age 60 and is safe and effective in preventing this painful disease. TDP (tetanus, diphtheria, and pertussis) should be given before age 65 and then a booster every 10 years. FLU VACCINE is indicated annually for those over 65, or who have a chronic disease such as heart, lung, or diabetes. PNEUMONIA VACCINE should be given after the age of 65 and repeated 5 years later. 2. Age Related Macular Degeneration (ARMD) is increased by smoking, alcoholism, family history, coronary artery disease, high cholesterol diet. Zinc containing foods (lean meat, whole grains, cereals, seafood and dried beans) are most helpful in prevention. Zinc oxide 80 mg. two times a day is beneficial. Antioxidant vitamins C, E, and beta Carotene are beneficial (the food sources of these such as fruits and vegetables are far better than supplements). There are ongoing trials showing the benefit of Luteins (found in tomatoes) and omega 3 fatty acids (fish oil). 3. Good Oral hygiene is fundamental, Floss your teeth! There is good evidence that inflammation plays a major role in both stroke and heart attack. Good oral hygiene has been shown to decrease the risk of both of these maladies. 4. Fish Oil has many health benefits including heart health, lowering of triglycerides and eye protection. One gram 3 times daily confers protection against a host of health problems. 5. For every 1 % reduction in cholesterol, there is a 2% reduction in the incidence of coronary artery disease. Statin therapy has been a modern day miracle. These drugs are to heart disease and stroke what antibiotics were to infection 60 years ago! 6. Stress reduction is so vital to one's overall health. We know that mental turmoil leads to a host of illnesses including heart attacks, strokes, susceptibility to infections and perhaps even cancer by interfering with our immune system. It is thus vital to seek help for problems in your life that go overlooked, but can have such devastating effects. 7. The combination of the antiplatelet drug Plavix and the gastric productive drugs in the class of Proton Pump inhibitors ( Nexium, Protonix, Prilosec, Aciphex, Prevacid, Zegrid, and Omeprazole) should not be used. The reason is that the latter drug increases the degradation of the Plavix through revving up the liver enzyme system that breaks the Plavix down. The end result can be an increase in stent thrombosis and heart attacks and strokes. 8. Screening of cancer reflex - Colonoscopy is also advised for colon cancer screening by the gastroenterologist. - Inspection of your skin by the dermatologist is helpful in diagnosing melanoma or skin cancer. ▬ 1. Tomato contains lycocopene which is a very powerful antioxidant and source of Vitamin C. They are useful in combating cancer of the prostate, colon cancer and combating infections such as viruses that cause the common cold. ▬ 2. Spinach is loaded with iron, Folic acid and Luten. These lower homocystine levels in blood that can cause coronary artery disease. These also fight age related macular degeneration and there is some evidence that Folic acid can be effective in our battle against dementia. ▬ 3. Red Wine raises our HDL levels, and contains strong antioxidants that inhibit the production of endothelin 1 (a peptide that contributes to hardened arteries). Resveratrol is a substance derived from the skins of grapes and is felt to have both anticancer and anti infection properties. ▬ 4. Almonds & nuts contain mono and poly unsaturatedfats. As such, HDL levels are raised and LDL (bad cholesterol) levels are lowered. Almonds can trigger a process known as apoptosis (a process that cancer cells kill themselves). Nuts contain Vitamin E and thus assist in preserving skin, blood vessels, assist in helping fibrocystic disease in women and prostate cancer in men. One caution is that they contain 150 calories per ounce. Eat hands full not cups full. Caution must be used as nut allergies are one of the most common allergies in children and can be deadly. If you have diverticulosis, use caution, as these can cause a flare-up of diverticulitis. ▬ 5. Broccoli is high in Vitamin E and C. It is thought to be useful in assisting against breast and gastrointestinal cancers. If broccoli is not to your liking, brussel sprouts, cabbage, cauliflower and bok choy are also quite healthful. ▬ 6. Oats are high in soluble fiber. These fibers absorb water and expand, thus causing a feeling of fullness. They also help with digestion and elimination. Unfortunately there is no convincing data that oats do anything to ward off colon cancer. Oats do interfere with the absorption of cholesterol and thus lower these levels. ▬ 7. Fish are high in omega 3 Fatty Acids which help to lower LDL cholesterol, protect the brain and decrease clot formation, thus protecting against deadly emboli, heart attacks and strokes. ▬ 8. Garlic has been espoused as a health food for years. It is its odor that makes it so beneficial. (Not by having people avoid breathing in our faces) It contains a sulfide that lowers triglycerides and raises HDL levels. Garlic has antibacterial and anti fungal properties and can block certain parasites such as malaria in developing countries. In the lab, it is felt that garlic has certain tumor blocking abilities. ▬ 9. Green Tea is loaded with polyphenols that are felt to prevent blood vessel growth to tumors. In China there is a low level of cardiac death and GI cancers. ▬ 10. Blueberries are the Swiss Army Knife of the fruit and vegetable kingdom. Pint for pint they provide the best antioxidants known. They are thought to be of value in preventing coronary artery, disease, certain infections and neoplasms and lastly help promote brain power. 11. Nori, the Japanese Sea weed provides a very high content of vitamins especially Vit A. 12. Olive Oil, colza oil are high in HDL cholesterol & prevent cardiovascular disease. Do not forget the value of drinking plenty of water (1.5 L/day) as well as fruit juice especially if it is consumed immediately after preparation ƒ 4 common denominators to age with grace ƒ Humor, diet, exercise & staying connected ƒ Metabolic concerns ƒ Gait disturbances ƒ Dementia syndromes ƒ Pearls ƒ 12 Foods for life To live in good health after 60 is up to a certain extent determined by you. It is my hope that the above will help with your understanding of certain aging phenomena and motivate you to do those things over which you have control to improve your life. In so doing you will certainly add more life to your years and perhaps more years to your life. Dr Sekander Rao Gasca Medical Services UNOG

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