Optimal Aging: Living to 100!

Barbara J. Steinberg, DDSClinical Professor of SurgeryDrexel University College of MedicinePhiladelphia, Pa

Barbara J. Steinberg, DDSClinical Professor of SurgeryDrexel University College of MedicinePhiladelphia, Pa

The Number OneKiller of Men and Women:

Heart Disease

> 82 million American adults are > 82 million American adults are estimated to have 1 or more types of estimated to have 1 or more types of cardiovascular disease (1 in 3 people)cardiovascular disease (1 in 3 people)

2,200 Americans die of cardiovascular 2,200 Americans die of cardiovascular disease each day an average of 1 disease each day an average of 1

death every 39 secondsdeath every 39 seconds

Cardiovascular DiseaseRisk Factors

• Smoking• Hypertension• Elevated cholesterol• Overweight / obesity• Physical inactivity• Diabetes• Family history• Age• Male Gender

Cardiovascular DiseaseOther factors that may affect risk

• Stress• Oral contraceptives• Menopausal hormone therapy• Alcohol

Cardiovascular DiseaseBlood Pressure Classification

(Adults 18 and over)

>99or>159Stage 2 Hypertension

90-99or140-159Stage 1 Hypertension

80-89or120-139Prehypertension

<80and<120Normal

DiastoliDiastolicc

SystolicSystolicCategory

Cardiovascular DiseaseClassification of Cholesterol Levels

Under 200 Desirable200-239 Borderline High240 and above High

Total Cholesterol

Less than 100 Optimal100-129 Near-optimal130-159 Borderline High160-189 High190 and above Very High*LDL in very-high-risk people with CHD should be < 70

LDL Cholesterol

Cardiovascular DiseaseClassification of Cholesterol Levels

Under 40 Low

Over 60 High*Optimal HDL should be > 50 for women

HDL Cholesterol

Under 150 Optimal150-199 Borderline high200 and above High

Triglycerides

Source: NIH: May 2001

Cardiovascular DiseaseRisk Factors

• Two-thirds of Americans are overweight or obese• Body Mass Index (BMI)

• 18.5 – 24.9 normal• 25 – 29.9 overweight• 30 or > obese

Overweight / obesity

Cardiovascular DiseaseRisk Factors

• Waist measurement ≥ 35 inches for women and ≥ 40 inches for men risk of heart disease

Overweight / obesity

Cardiovascular DiseaseRisk Factors

• Father or brother had cardiac event < 55 yrs• Mother or sister had cardiac event < 65 yrs

Family history

Cardiovascular DiseaseEmerging Risk Factors

• C-reactive protein levels and risk of cardiovascular disease:• > 3 = high risk• 1 – 3 = average risk• < 1 = low risk

C-reactive protein (CRP)

Symptoms of heart disease that may experienced

• Chest pain or discomfort• Atypical chest, stomach or abdominal pain• Nausea, vomiting, or dizziness• Extreme fatigue, weakness, and sleeplessness• Shortness of breath• Unexplained anxiety• Palpitations• Cold sweat• Paleness• Severe indigestion• Jaw, neck, or shoulder pain

Lifestyle ChangesHeart Healthy Eating Plan

• Low in saturated fat and cholesterol and moderate in total fat (20%-35% of calories)

• Limit saturated fat to < 10% calories (7% if possible) and trans fats to < 1%

• Limit salt and sodium < 2300 mg ~ 1tsp• 1500 mg

– ≥ 51 yrs. of age– African Americans– Hypertension– Diabetes Mellitus– Chronic Kidney disease

Cardiovascular Disease Prevention and Treatment

Cardiovascular DiseaseHeart-Healthy FoodsFish

– Omega-3 fatty acids• Herring• Sardines• Salmon• Atlantic or Pacific Mackerel• Trout• Halibut• Anchovies • Pacific Oysters

– Eat at least 8oz./week

Cardiovascular Disease

• Consider omega-3 fatty acids in capsule form (fish oil)

– 1-2 grams/day• DHA 400-800 mg• EPA 600-1200 mg

Role of SupplementsRole of Supplements

OBESITYAssociated with:• Coronary artery disease• Hypertension• Stroke• Type-2 diabetes• Cancer (endometrial, breast, colon)• Sleep apnea• Osteoarthritis• health care costs• quality of life• risk of premature death

Fiber

• Benefits– Strongest in diabetes and heart disease where its

thought to improve cholesterol levels, blood pressure, inflammation and blood sugar levels

– May bind to toxins and move them out of body quicker– High fiber diets can promote weight loss making people

feel full

Dietary Fiber Intake and Mortality in the NIH-AARP Diet and Health Study

• Prospective cohort study included more than 388,000 adults ages 50-71– Diet assessed using a food–frequency

questionnaire at baseline (124 food items)– After 9 yrs. more than 31,000 of the participants

died as per national death records as to who died and cause of death

– Other risk factors taken into account• Weight• Education level • Smoking• Health Status

Dietary Fiber Intake and Mortality in the NIH-AARP Diet and Health Study

• Prospective cohort study included more than 388,000 adults ages 50-71 (con’t)

Results:– Dietary fiber intake lowered the risk of death from cardiovascular, infectious, and respiratory diseases by 24%-56% in men and by 34%-59% in women– Inverse association between dietary fiber intake and cancer death was observed in men but not in women

Dietary Fiber Intake and Mortality in the NIH-AARP Diet and Health Study

• Prospective cohort study included more than 388,000 adults ages 50-71

Results (con’t)– Dietary fiber from grains, but not from other sources, was significantly inversely related to total and cause specific death in both men and women

Dietary Fiber Intake and Mortality in the NIH-AARP Diet and Health Study

• Prospective cohort study included more than 388,000 adults ages 50-71

Conclusion: - Dietary fiber may reduce the risk of death

from cardiovascular, infectious and respiratory diseases

- Making fiber-rich food choices more often may provide significant health benefits

Y. Park, ScD; A.F. Subar, PhD; A. Hollenbeck, PhD, A. Schatzkin, MD

Archives of Internal MedicinePublished Online February 14, 2011

Inflammation

Related to: • Cardiovascular disease • Alzheimer’s disease• Cancers (colorectal, breast, prostate, and others)• Kidney disease• Lupus• Arthritis• Psoriasis• Periodontal disease

Inflammation

• C-reactive protein level– Normal 0-1.0mg/dl

• How to reduce inflammation– Exercise– Quit smoking– Heart healthy diet– Adequate sleep– Reduce stress

Vitamins

• A good multivitamin (MVI) is the best way to supplement a diet that may be lacking– People > 60 should consume a MVI even if they

eat a healthy diet because food is not digested as efficiently when we age

Vitamins

• Recommended: MVI that provides 100% of the Recommended Dietary Allowances (RDA) for essential nutrients established by the US Food and Nutrition Board of the National Academies / Institute of Medicine

• Calcium (At least 1200 mg/day recommended for adults 50 and over ) and vitamin-D supplements may also be needed

• Some evidence suggests that taking too many antioxidant supplements (i.e. vitamin C and E) might actually depress rather than enhance your immune system

Vitamin B12

• Vital for clear thinking, for nerves, RBC’s, to help develop genetic material in cells, and to prevent some forms of anemia.

• Present in almost all animal products– Milk, meat, fish, poultry, eggs, etc.

Vitamin B12

• As we age, we have a harder time extracting vitamin B12 from foods. B12 needs to be broken down and that process is less efficient as we age.– Taking a MVI will provide 2.0mcg of B12 (need

2.4 mcg a day)

Vitamin D

• Important for:– Calcium and phosphorous absorption– Helps prevent osteoporosis and other metabolic bone

diseases– Plays a role in preventing cancer (colon, breast,

ovarian, kidney, prostate)– Immune function– Brain function– Heart disease prevention– Diabetes prevention– Possible role in multiple sclerosis, lupus, irritable bowel

syndrome and Parkinson’s disease

Vitamin D• Obtained form 3 sources:

– Sunlight• Exposure 3 times / week for 10-15 minutes, no

sunscreen• As you age, your skin’s ability to convert UVB rays

into vitamin D , so it is almost impossible to get enough vitamin D from sun exposure

• If you live in northern states, from Oct. – Apr., the angle of the earth prevents UVB rays from making their way to the ground, so you can’t rely on sunlight for vitamin D during that time.

• Dark-skinned individuals do not readily absorb the UVB rays and therefore are at risk of vitamin D deficiency.

Vitamin D• Obtained form 3 sources:

– Dietary• Fish high in oil content

–Salmon–Herring–Mackerel–Oysters–Sardines–Shrimp

• Some cereals, juices, and milk fortified with vitamin D

Vitamin D• Supplements

– Vitamin D3 (cholecalciferol)• Stronger and more active than D2

• 1000 IU / day• 2000 IU/ day recommended for those at

risk for Vitamin D deficiency–Obesity–Osteoporosis–Limited sun exposure–Medications that nutrient absorption

in the GI tract.

Vitamin D

•Vitamin D deficiency is very common– 50% of women > 55 deficient– Test to determine concentration of vitamin D in

the blood• 25-hydroxy vitamin D (normal range 30 – 74

ng/ml)

People with levels of vitamin D have a 26% risk of death from any cause according to John Hopkins

researchers

Cancer• Almost in 1 in 2 Americans ~ 41% of the

population will be diagnosed with cancer in their lifetime

• 2nd most common cause of death in U.S.- accounts for 1 of every 4 deaths- Estimated that ~ 1/3 of the cancer deaths each year are due to poor nutrition, physical inactivityincluding excessive weight

Cancer• Lung cancer accounts for more deaths than

any other cancer in both men and women • 5yr. relative survivor rate for all cancers

diagnosed between 1999-2005 is 68% up from 50% in 1975-1977

Cancer

Reducing risk:• Stay away from tobacco• Stay at a healthy weight• Get moving with regular physical activity• Eat healthy with plenty of fruits and vegetables• Limit how much alcohol you drink (if you drink at all)• Protect your skin• Know yourself, your family history, and your risks• Have regular checkups and cancer screening tests

Alzheimer’s Disease (AD)

• Estimated 5.3 million Americans have AD– 1 in 8 people ≥ 65 yrs. – More common in women

• Projections: by 2030- 7.7 million people by 2050- 11-16 million people

Alzheimer’s Disease 10 Warning Signs

• Memory loss that disrupts daily life• Challenges in planning or solving problems• Difficulty completing familiar tasks at home, at

work or at leisure• Confusion with time and place• Trouble understanding visual images and

spatial relationships• New problems with words in speaking or

writing

Alzheimer’s Disease

10 Warning Signs (con’t)• Misplacing things and losing the ability to retrace

steps• Decreased or poor judgment• Withdrawal from work or social activities• Changes in mood and personality

Simple Lifestyle Measures May Help Maintain Cognition As We Age

• Control blood pressure, cholesterol, and blood sugar levels

• Quit smoking (smoking increases blood pressure)

• Stay physically active (e.g. dancing, tennis, bicycling, or any physical activity you enjoy)

Simple Lifestyle Measures May Help Maintain Cognition As We Age

• Stay mentally active– Exercise the mind with mental challenges as you

age (e.g. play chess, bridge, learn a new language, crosswords, games, reading, puzzles, etc.)

Simple Lifestyle Measures May Help Maintain Cognition As We Age

• Maintain a strong social network– Support system of family and friends– Stay socially connected and interact with people

Simple Lifestyle Measures May Help Maintain Cognition As We Age

• Manage your mood– Anxiety, worry, anger, and depression have been

linked with higher rates of cognitive impairment– May require professional help

Simple Lifestyle Measures May Help Maintain Cognition As We Age

• Avoid head injury– Take steps to prevent falls

• Get enough sleep– Short term memory improves when you get plenty

of sleep (at least 7 hours a night)

• Heart healthy diet– Whole grains and fatty fish are linked to production

of high density lipoproteins which are associated with the preservation of memory