Kenneth L. Minaker, MD, FRCP(C), CSC(GM)

Chief, Geriatric Medicine Unit

Massachusetts General Hospital

Associate Professor of Medicine

Harvard Medical School

Improve Your Health … Extend Your Life

The Bottom Line• Aging as a process:

– Starts after growth/development

• Aging impacting function:– Starts after age 80

• Aging is here to stay:– Aging helps prevent cancer developing

• Aging can be modulated:– You can choose your path

Healthy Life Expectancy Rank Country HLE

1 Japan 75.0

3 Sweden 73.3

4 Switzerland 73.2

7 Italy 72.7

8 Australia 72.6

9 Spain 72.6

11 Canada 72.0

12 Norway 72.0

13 France 72.0

14 Germany 71.8

24 United Kingdom 70.6

25 Singapore 70.1

28 Slovenia 69.5

29 USA 69.3

We’re # 29!

• MYTH: Old people are all the same

Renal Function Changes: GFR

• MYTH: Old people are all the same

• REALITY: We are each of us more unique as we age

Renal Function Changes: GFR

• MYTH: Once you’re old, there is little benefit of treatment

• REALITY: The benefit of most therapies that help people is greater and more efficient in the elderly population.

Number Treated for 5 yr for Blood Pressure to prevent 1 stroke or MI

Older (>60 years old)

Younger

Morbidity and Mortality

Cerebrovascular

Coronary heart disease

46

68

168

184

• MYTH: Old Age starts at 65

• REALITY: While aging processes begin ~ age 30, limitation of function from aging (rather than disease) starts ~ age 80

• MYTH: The older you get, the sicker you get

• MYTH: The older you get, the sicker you get

• REALITY: While disability does increase with age, staying healthy longer is the biggest trend in late life over the past 20 yr

MF RoizenThe Real Age Makeover Harper Collins, 2004

• MYTH: The aging process can be defeated

• REALITY: The aging process can be deferred in its impact

Physiologic Reserves Already In Use

Increasing Age

PhysiologicReservesAvailable

“The Precipice”

• MYTH: Ponce De Leon was right, there is a fountain of youth, if we could only find it

• REALITY: Genetics, personal health choice, and illness management are the “potion” that has been found

Three Ways to Evaluate Positive Lifestyle Choices:

1. Direct evaluation of choices:– Anecdote– Groups– Communities

2. Incorporation of choices into daily life:– Lifestyle Programs

3. Scientific review and guideline development– Institute of Medicine of the National

Academies

If you are 45 years old and do all of these (rather than none) you will live longer.

(men- 7 years, women-11 years)

1. Sleeping 7-8 hours per night 2. Weight Control 3. Exercise 4. Limited Alcohol 5. Non-smoking 6. Eating Breakfast 7. Seldom Snacking

Lifestyle Choices for Health

Belloc et al

• Genetic

Health Factor ≥ 2 Years Younger

Age of parents at time of death

Both lived past age 85

MF RoizenThe Real Age Makeover Harper Collins, 2004

How to be Younger by 2 years or more from “The RealAge Makeover”

How to be Younger by 2 years or more from “The RealAge Makeover”

• Skin/DentalHealth Factor ≥ 2 Years Younger

Place your hand palm down on a table. Pinch the area between your thumb and your first finger for 5 seconds. See how many seconds it takes for your skin to go back to normal.

Immediately

Do you wash your hands and your food frequently?

Yes, almost always or always

Place a small strip of adhesive tape vertically on the middle of the forehead from scalp to between eyebrows. Move it to these three areas: the outside corners of the eyes, across the apple of each cheek, and above the upper lip. Press gently. Keep it there for a few seconds, then gently remove tape and evaluate the skins imprint for lines, flakiness, and dehydrated area.

Calendar age 30-40: tape is completely smooth; calendar age 40-50: tape is completely smooth, or flaky dead skin cells only but no lines; over calendar age 50 tape is completely smooth, flaky dead skin cells only but no lines, or small line on one area

Dental Disease None

MF RoizenThe Real Age Makeover Harper Collins, 2004

• Heart/Lungs/ExerciseHealth Factor ≥ 2 Years Younger

Maximum exercise capacity: peak kcals or METs achieved per minute for at least one minute of a 20-minute stamina activity

Men, 8.6 to 10.9 METs or 12-13.9 kcal/min; women, 8.1 to 9.9 METs or 1.6 to 11.9 kcal/min

Decrease in heart rate in the 2 minutes after max heart rate has been achieved by your most strenuous usual exercise

45 to 66 beats per minute decrease

Statin with or without surgery if over age 40 If you have other risk factors for arterial aging and are over age 40.

Perform a single-leg squat to test your knee strength and stability. Try to bend knee until your thigh is parallel with floor. Do not do this to the point of suffering significant pain.

No strain in knee

Blood pressure (systolic/diastolic, mm Hg) Less than 105/70; no heart disease

MF RoizenThe Real Age Makeover Harper Collins, 2004

How to be Younger by 2 years or more from “The RealAge Makeover”

• Brain/ BalanceHealth Factor ≥ 2 Years Younger

Look at the number 364-2872 for a 5 second count. Now look away and cover this spot. In 5 seconds write the number down. Five minutes later write the number on another sheet of paper. Now look at the numbers and pick the box that most closely fits

No mistakes

Do you have a positive outlook on life? Yes

Have someone take 2 pictures of you standing up, from both the front and side of your body. Draw a straight line on the photo (if you have a digital camera, you can do this on your computer, or just draw it on the photo with a ruler). In the frontal photo, it should be straight from your nose through the center of your body. In the side view, the line should be straight from the hole in your ear to the tip of your shoulder to your hip to your inner foot

Everything aligned

MF RoizenThe Real Age Makeover Harper Collins, 2004

How to be Younger by 2 years or more from “The RealAge Makeover”

• Social/ BehavioralHealth Factor ≥ 2 Years Younger

Use of cell or other phone to call friends regularly

Yes

Do you (or others) think you have a sense of humor, and to you often try to see the funny side of events?

Yes

Orgasms Men- 200-300, Women-satisfied with quality and quantity

Decision latitude in your job Great; can prioritize and choose own tasks

Current intellectual activity Keep mind active by learning new things every week in formal or informal ways.

MF RoizenThe Real Age Makeover Harper Collins, 2004

How to be Younger by 2 years or more from “The RealAge Makeover”

• DietHealth Factor ≥ 2 Years Younger

Do you avoid simple sugars Yes, almost always or always

Have you increased the IQ of your kitchen? By 15 to 30 IQ points

Fish, excluding shellfish (servings per week) More than 2 servings

Servings of cooked tomatoes (ex: tomato sauce, pizza, spaghetti with marinara sauce) eaten per week)

Men, more than 10 servings/wk

Nuts eaten per week 3-4 ounces

Folate or folic acid, a B vitamin (amount in food and supplements)

More than 700 µg/day

Amount of saturated and trans fat in diet Less than 20gm a day

MF RoizenThe Real Age Makeover Harper Collins, 2004

How to be Younger by 2 years or more from “The RealAge Makeover”

Foods for Health

1. Tea, green 1-6 cups 2. Coffee ? 3. Fish 2-3 times/week 4. Cooked Tomatoes 10 servings/week 5. Fiber > 25 gm/day 6. Nuts > 5 oz/week 7. Chocolate dark 8. Saturated fat < 10% total

calories/day < 1/3 of all fat intake

9. Fruit > 4 Servings/day 10. Alcohol 1.5 oz/day- women

3 oz/day-men

Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

Macronutrient Intake as % of Energy

• Fat 20-25

• Carbohydrate 45-65– Added sugars <25%

• Protein 10-35

Lifestyle Recommendations

• Exercise 60 minutes per day of moderately intense exercise (walking 3 mph)

Elements for Health

1. Potassium > 4,700 mg/day 2. Sodium < 1,200 mg/day 3. Water 3.7 liters/day men 2.7 liters/day women 4. Calcium > 1,200 mg/day 5. Selenium 55 ug/day 6. Magnesium 320 mg/day-women

420 mg/day-men 7. Chromium 30 ug/day 8. Copper 900 ug/day 9. Iron 8 mg/day 10. Manganese 2.3 mg/day 11. Phosphorus 700 mg/day 12. Zinc 11 mg/day

Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

Potassium Intake > 4700 mg/day

1. The main intracellular cation affects nerve, muscle and vascular tone

2. Good food sources include fruits, vegetables, leafy greens, vine fruits and root vegetables

3. Currently Americans consume much less potassium than these guidelines

4. Decreased potassium intake is associated with high blood pressure, kidney stones and thin bones

Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

Sodium (1,200mg/day)

1. Combined with chloride and known as salt

2. Salt maintains body fluid volume and particulate concentration for all metabolism

3. Current intake greatly exceeds the need

4. Most salt is added to food during processing

5. Excess causes high blood pressure and swelling

Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

Time (hrs) to excrete 50% of a sodium load vs. age: young (hatched), old (solid)

Geriatric Nephrology and Urology 4:145-151, 1995Delayed sodium excretion in normal agingFish LC, Murphy DJ, Elahi D, Minaker KL

Water Intake per day Men- 3.7 liters Women 2.7 liters

1. Water is the solvent for all biochemical reactions and comprises 60% of your body weight

2. Water absorbs heat, maintains vascular volume, and provides a way for materials to move in and out of your body

3. Water requirements can vary widely depending on heat and exercise levels. With sweating and exercise you can lose 1-2 liters per hour

4. Sources: % of intake drinking water 35-54beverages 49-63

food 19-25

Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

Total Water AI Summary, Ages 51+ Years

Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

Protection of Hyperosmolality (Y vs. O)

Vitamins for Health

1. Vitamin D 600-2000 IU/day

2. Folic acid 400 ug/day

3. Multi-vitamin 3/week if intake < 1,200 calories

(Keep Vitamin A levels low < 2,500 IU)

4. Vitamin E 200- 400 iu/day

5. Vitamin A 625 ug men 500 ug women

6. Vitamin B6 1.7 mg/day

7. Vitamin B12 2.4 ug/day

8. Biotin 30 ug/day

9. Vitamin C 90 mg/day

10. Vitamin K 120 ug/day

11. Niacin 15 mg/day

12. Riboflavin (B2) 1.3 mg/day

13. Thiamin (B1) 1.2 mg/day

Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

Vitamins for Health- New Insights

• Vitamin D helps bone, muscle and anticancer systems in our body– The current hint is for high normal levels

• Antioxidants are good but how much is far from clear: – Risk of high doses:

• Vitamin A- association with lung cancer• Vitamin C- association with CAD• Vitamin E- association with heart failure• Folate, B12, B6- association with stroke, heart attack

• If you eat a good diet (> 1200 cal/day) aside from Vitamin D you are likely getting the basic requirements.

• In general a single multivitamin per day seems reasonable (70% of Boston Seniors are taking them)

Medicines for Health

1. ASA 162 mg/day

Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

END

Special thanks to:

Whole Foods Market

Tara Minaker, RD, LDNResearch DietitianMetabolic Phenotyping Core/Nutrition of the MGH Clinical Research Center, a member of the Harvard Catalyst CTSC