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 RankCountryHLE 1Japan75.0 3Sweden73.3 4Switzerland73.2 7Italy72.7 8Australia72.6 9Spain Canada Norway France Germany United Kingdom Singapore Slovenia USA69.3 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

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

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

MF Roizen The 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 Physiologic Reserves Available “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 Roizen The Real Age Makeover Harper Collins, 2004 How to be Younger by 2 years or more from “The RealAge Makeover”

Skin/Dental Health 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 DiseaseNone MF Roizen The Real Age Makeover Harper Collins, 2004

Heart/Lungs/Exercise Health 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 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 40If 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 Roizen The Real Age Makeover Harper Collins, 2004 How to be Younger by 2 years or more from “The RealAge Makeover”

Brain/ Balance Health Factor≥ 2 Years Younger Look at the number 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 Roizen The Real Age Makeover Harper Collins, 2004 How to be Younger by 2 years or more from “The RealAge Makeover”

Social/ Behavioral Health 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 OrgasmsMen , Women-satisfied with quality and quantity Decision latitude in your jobGreat; can prioritize and choose own tasks Current intellectual activityKeep mind active by learning new things every week in formal or informal ways. MF Roizen The Real Age Makeover Harper Collins, 2004 How to be Younger by 2 years or more from “The RealAge Makeover”

Diet Health Factor≥ 2 Years Younger Do you avoid simple sugarsYes, 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 week3-4 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 dietLess than 20gm a day MF Roizen The Real Age Makeover Harper Collins, 2004 How to be Younger by 2 years or more from “The RealAge Makeover”

Foods for Health 1. Tea, green1-6 cups 2.Coffee? 3. Fish2-3 times/week 4.Cooked Tomatoes10 servings/week 5. Fiber> 25 gm/day 6. Nuts> 5 oz/week 7. Chocolatedark 8.Saturated fat< 10% total calories/day < 1/3 of all fat intake 9.Fruit > 4 Servings/day 10.Alcohol1.5 oz/day- women 3 oz/day-men Dietary Reference Intakes The National Academies Press, 2005 Minaker et al

Macronutrient Intake as % of Energy Fat Carbohydrate –Added sugars<25% Protein10-35

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. Water3.7 liters/day men 2.7 liters/day women 4.Calcium > 1,200 mg/day 5. Selenium55 ug/day 6. Magnesium 320 mg/day-women 420 mg/day-men 7. Chromium30 ug/day 8.Copper900 ug/day 9. Iron8 mg/day 10.Manganese2.3 mg/day 11. Phosphorus700 mg/day 12. Zinc11 mg/day Dietary Reference Intakes The National Academies Press, 2005 Minaker 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 Intakes The National Academies Press, 2005 Minaker 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 Intakes The National Academies Press, 2005 Minaker et al

Time (hrs) to excrete 50% of a sodium load vs. age: young (hatched), old (solid) Geriatric Nephrology and Urology 4: , 1995 Delayed sodium excretion in normal aging Fish 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 beverages49-63 food19-25 Dietary Reference Intakes The National Academies Press, 2005 Minaker et al

Total Water AI Summary, Ages 51+ Years Dietary Reference Intakes The National Academies Press, 2005 Minaker et al

Protection of Hyperosmolality (Y vs. O)

Vitamins for Health 1. Vitamin D IU/day 2. Folic acid400 ug/day 3. Multi-vitamin3/week if intake < 1,200 calories (Keep Vitamin A levels low < 2,500 IU) 4. Vitamin E iu/day 5. Vitamin A625 ug men 500 ug women 6. Vitamin B61.7 mg/day 7. Vitamin B122.4 ug/day 8. Biotin30 ug/day 9. Vitamin C90 mg/day 10. Vitamin K120 ug/day 11. Niacin15 mg/day 12. Riboflavin (B2)1.3 mg/day 13.Thiamin (B1)1.2 mg/day Dietary Reference Intakes The National Academies Press, 2005 Minaker 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. ASA162 mg/day Dietary Reference Intakes The National Academies Press, 2005 Minaker et al

END Special thanks to: Whole Foods Market Tara Minaker, RD, LDN Research Dietitian Metabolic Phenotyping Core/Nutrition of the MGH Clinical Research Center, a member of the Harvard Catalyst CTSC