Aging and Health: The future ain ’ t what it used to be. June 2, 2016 Mark C. Pettus M.D. FACP

1. Aging and Health: The future ain’t what it used to be. June 2, 2016 Mark C. Pettus M.D. FACP Director Medical Education and Population Health Berkshire Health Systems

2. Learning Objectives • Understand how the relationship between our genes and our • environment-lifestyle throughout our lives influences how long and • how well we live. • Examine current research that connects modern life with health • outcomes e.g. increased inflammation and insulin resistance. • Provide specific lifestyle strategies that can improve health and • improve quality of life i.e., reduce inflammation and insulin • resistance.

3. “The future ain’t what it used to be.” Yogi Berra

5. “Reality is an illusion, albeit a persistent one.” Albert Einstein

6. “It’s not what we don’t know that gets us into trouble, it’s what we know that ain’t so.” Will Rogers

7. There is nothing I can do about the DNA I inherited from mom and dad! Is it possible to improve the health of one’s DNA?

8. “I am more forgetful and tired because I am just getting old…” Opportunity !

9. 2015

11. Environment Lifestyle Life Epigenome Microbiome Consciousness Spirituality-Meaning

12. Disease (how things appear) Pre-diabetes, Diabetes, Obesity, Metabolic Syndrome, Heart Disease, Stroke, Depression, Autoimmunity, Alzheimer’s, Cancer, Fibromyalgia, Chronic fatigue ADDHD, GAD, PTSD, Autism spectrum Long-Latency Diseases Core Metabolic Imbalances (what drives them): Inflammation and oxidative stress Insulin Resistance Root Causes (what are their origins) Gene-Epigenome-Microbiome-Environment Nutrition Movement Stress Response Environmental toxins Sleep Social Connection Trauma Conflict Management Mindfulness Spirituality-Meaning in Work, Love, Play

13. Health as a byproduct of gene-environmental compatibility: Ancestral fine-tuning meets modern life!

14. Food is information. Food can increase or decrease inflammation and insulin resistance

15. Reduce carbohydrate-dense foods • Major contributor of obesity, insulin resistance, changes in blood lipids, inflammation, and alterations of the organisms in the human microbiome • A huge area of opportunity in individuals with increased belly fat, pre-diabetes or diabetes…these are health features of carbohydrate intolerance. • For most, sugar and refined, grain-based foods are problematic: eliminate and observe.

16. Higher Normal Fasting Glucose is Associated with Hippocampal Atrophy • 266 Cognitive healthy adults • Baseline fasting glucose • Baseline MRI scan to measure hippocampus • Repeat MRI at 4 years

18. Glucose Levels and Risk For Dementia • 2067 participants without dementia • Average age at baseline 76 years • Median follow-up 6.8 years • Baseline glucose • Cognitive assessment every 2 years

21. More quality fat sources • Pasture-raised eggs • Fatty fish e.g. salmon, sardines, anchovies, mackeral, trout • Grass-fed butter • Whole fat dairy, yogurt • Extra virgin olive oil • Extra virgin coconut oil • Avocados, olives • Nuts - almonds, macadamia, walnuts

22. Relative Intake of Macronutrients Impacts Risk of MCI or Dementia • Mayo Clinic study • 937 cognitively normal adults • Median age – 75.9 years • Follow-up averaged 3.7 years • Cognitive assessment at baseline and every 15 months • Food-frequency questionnaire at baseline

26. 447 healthy adults age 55- 80 in a community setting at risk for Alzheimer’s • Randomized Intervention included Mediterranean Diet with olive oil and nuts vs. standard low fat diet • Followed from 2003 – 2009 • Cognitive testing at regular intervals • Diminished decline in cognitive function in those on the dietary intervention

27. Investigated the diet-AD relations in a prospective study of 923 participants, ages 58 to 98 years, followed on average 4.5 years. Diet was assessed by a food frequency questionnaire. • Followed for 4.5 years • High adherence to the diet resulted in a 54% lower risk • Moderate adherence to the MIND diet put participants at 35% lower risk of developing the disease.

28. 6 servings of leafy greens/week • 2 servings fatty fish/week • 2-3 servings of berries/week • 3 servings whole grains/day • 2 servings of poultry/week • 5 servings nuts/week • 3-4 servings legumes-beans/week

29. Take care of your microbiome • An emerging major contributor to human health and disease • Be careful with antibiotics • Animal food sources given ABx • Prebiotics are critical: Fermentable plant-based fiber…most vegetables, legumes, beans in abundance • Probiotics for some

30. Sleep Hygiene • Loss of synchronicity as a major contributor to disease risk and diminished quality of life • Circadian genes • Sunlight during the day • Maximally darkened room for sleep • Consistent timing • Filter blue light after sundown (flux); orange lens glasses; incandescent a better quality light than fluorescent-cfu sources • Cooler temp – 64 to 65° • Obstructive sleep apnea under recognized • Relaxation techniques

32. Social Connection and Health • From an evolutionary biologic perspective we are born to bond: Mirror neurons • Reduced stress states • Improved coping and resiliency • Reductions in disease risk • Greater longevity and quality of life

33. Embracing the Moment You Are In: The Power of the Breath • Mindfulness practices powerfully proven to reduce disease risk • Epigenetic effects shown to reduce inflammation, improve insulin sensitivity • Improved mood, resilience, reduced anxiety • Improved performance, creativity and problem-solving capacity • MBSR, meditation, prayer, yoga, journaling, tai chi

34. Play Outdoors (and don’t be afraid of dirt) • Loss of circadian synchronicity associated with a host chronic health challenges and quality of life. • Full spectrum light exposure associated with a host of health benefits including improved mood, pain reduction, diminished inflammation, and greater health resiliency. • Connection between soil and human microbiome

35. Motion is the Lotion • Walk continuously • Be efficient with exercise dose-response e.g. small doses of HIT, functional resistance with emphasis on core. PAI-Physical Activity Intelligence • Dance to the music you love! • The Holy Grail from a disease risk-reduction perspective • Prolonged sitting is dangerous and not “undone” with regular exercise • Improved mood, resilience, less pain, less inflammation, improved insulin sensitivity, decreased anxiety

36. Exercise training increases the size of the hippocampus and improves memory • 120 older adults, 1 year, stretching vs. aerobic exercise • Measurement of hippocampal volume, BDNF and memory function at baseline, 6 months and 1 year

37. Exercise training increases the size of hippocampus and improves memory • After 1 year: • Exercisers had marked increase in BDNF • Exercisers showed substantial improvement in memory function

38. Exercise training increases the size of hippocampus and improves memory

39. Consider Organic for the Dirty Dozen and go to town with the Clean 15 Ewg.org

40. 10 individuals followed on personalized lifestyle intervention program • All had established mild AD or evidence of cognitive decline • Followed for 1-2 years • 9/10 with significant improvement

45. A Roadmap to Healthy Aging! • Whole foods nutrition with reductions in sugar, refined grain-based • flour, carbohydrate dense foods • More healthy fats e.g. olive oil, coconut oil, nuts, avocados, • butter, fatty fish, eggs (yolks are best) • Plant-based fermentable fiber and fermentable foods e.g. yogurt, kefir, sauerkraut, kimchi, etc. for the microbiome • Elimination trial e.g. gluten, grains • Dirty dozen-consider organic if able to reduce pesticide residues (ewg.org) • Liberal, sensibleoutdoor, full-spectrum light exposure • Motion is the lotion • Stress management e.g. yoga, tai chi, music, breath, meditation, journaling • Cultivate meaning in work, love and play. • Cultivate nurturing relationships-social connection • Laughter really is good medicine

46. “The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease.” Thomas A. Edison

47. www.thehealthedgepodcast.com

48. Grateful thanks!

49. Laughter Really is Good Medicine • Amazing capacity to reduce stress response • Social connection greatly enhanced • Lower markers of inflammation, pain, and anxiety • Enhanced secretory IgA production