Optimal Aging: Living to 100!

1. Optimal Aging: Living to 100! Barbara J. Steinberg, DDS Clinical Professor of Surgery Drexel University College of Medicine Philadelphia, Pa

2. The Number OneKiller of Men and Women:Heart Disease

3. > 82 million American adults are estimated to have 1 or more types of cardiovascular disease (1 in 3 people)2,200 Americans die of cardiovascular disease each day an average of 1 death every 39 seconds

4. Cardiovascular DiseaseRisk Factors • Smoking • Hypertension • Elevated cholesterol • Overweight / obesity • Physical inactivity • Diabetes • Family history • Age • Male Gender

5. Cardiovascular DiseaseOther factors that may affect risk • Stress • Oral contraceptives • Menopausal hormone therapy • Alcohol

6. Cardiovascular DiseaseBlood Pressure Classification (Adults 18 and over) Category Systolic Diastolic Normal <120 and <80 Prehypertension 120-139 or 80-89 Stage 1 Hypertension 140-159 or 90-99 Stage 2 Hypertension >159 or >99 Source: National Heart, Lung, and Blood Institute 2003

7. Under 200 Desirable 200-239 Borderline High 240 and above High Cardiovascular DiseaseClassification of Cholesterol Levels Total Cholesterol LDL Cholesterol Less than 100 Optimal 100-129 Near-optimal 130-159 Borderline High 160-189 High 190 and above Very High *LDL in very-high-risk people with CHD should be < 70

8. Under 40 Low Over 60 High *Optimal HDL should be > 50 for women Cardiovascular DiseaseClassification of Cholesterol Levels HDL Cholesterol Triglycerides Under 150 Optimal 150-199 Borderline high 200 and above High Source: NIH: May 2001

9. 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

10. Cardiovascular DiseaseRisk Factors • Waist measurement ≥ 35 inches for women and ≥ 40 inches for men  risk of heart disease • Overweight / obesity

11. Cardiovascular DiseaseRisk Factors • Father or brother had cardiac event < 55 yrs • Mother or sister had cardiac event < 65 yrs • Family history

12. Cardiovascular DiseaseEmerging Risk Factors • C-reactive protein (CRP) • C-reactive protein levels and risk of cardiovascular disease: • > 3 = high risk • 1 – 3 = average risk • < 1 = low risk

13. 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

14. Cardiovascular Disease Prevention and Treatment Lifestyle Changes Heart 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

15. Cardiovascular Disease Heart-Healthy Foods Fish • Omega-3 fatty acids • Herring • Sardines • Salmon • Atlantic or Pacific Mackerel • Trout • Halibut • Anchovies • Pacific Oysters • Eat at least 8oz./week

16. Cardiovascular Disease Role of Supplements • Consider omega-3 fatty acids in capsule form (fish oil) • 1-2 grams/day • DHA 400-800 mg • EPA 600-1200 mg

17. OBESITY Associated 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

18. 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

19. 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

20. 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

21. 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

22. 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 Medicine Published Online February 14, 2011

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

24. Inflammation • C-reactive protein level • Normal 0-1.0mg/dl • How to reduce inflammation • Exercise • Quit smoking • Heart healthy diet • Adequate sleep • Reduce stress

25. 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

26. 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

27. 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.

28. 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)

29. 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

30. 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.

31. 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

32. 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.

33. 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

34. 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 inactivity including excessive weight

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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)

41. 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.)

42. 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

43. 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

44. 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