Improve Your Health … Extend Your Life
Kenneth L. Minaker, MD, FRCP(C), CSC(GM)
Chief, Geriatric Medicine Unit
Massachusetts General Hospital
Associate Professor of Medicine
Harvard Medical School
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
We’re # 29!
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
• 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 Younger
years old)
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 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
“The Precipice”
Physiologic
Reserves
Available
Physiologic Reserves
Already In Use
Increasing Age
• 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
Lifestyle Choices for Health
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.
2.
3.
4.
5.
6.
7.
Sleeping 7-8 hours per night
Weight Control
Exercise
Limited Alcohol
Non-smoking
Eating Breakfast
Seldom Snacking
Belloc et al
How to be Younger by 2 years or more from
“The RealAge Makeover”
• Genetic
Health Factor
Age of parents at time of
death
≥ 2 Years
Younger
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 Disease
None
MF Roizen
The Real Age Makeover
Harper Collins, 2004
How to be Younger by 2 years or more from
“The RealAge Makeover”
• 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 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 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 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 Everything aligned
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
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
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 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 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 Roizen
The Real Age Makeover
Harper Collins, 2004
Foods for Health
Dietary Reference Intakes
The National Academies
Press, 2005
Minaker et al
1.
2.
3.
4.
5.
6.
7.
8.
Tea, green
Coffee
Fish
Cooked Tomatoes
Fiber
Nuts
Chocolate
Saturated fat
9. Fruit
10. Alcohol
1-6 cups
?
2-3 times/week
10 servings/week
> 25 gm/day
> 5 oz/week
dark
< 10% total calories/day
< 1/3 of all fat intake
> 4 Servings/day
1.5 oz/day- women
3 oz/day-men
Macronutrient Intake as % of Energy
• Fat
• Carbohydrate
– Added sugars
• Protein
20-25
45-65
<25%
10-35
Lifestyle Recommendations
• Exercise 60 minutes per day
of moderately intense
exercise (walking 3 mph)
Elements for Health
Dietary Reference Intakes
The National Academies
Press, 2005
Minaker et al
1.
2.
3.
Potassium
Sodium
Water
4.
5.
6.
Calcium
Selenium
Magnesium
7.
8.
9.
10.
11.
12.
Chromium
Copper
Iron
Manganese
Phosphorus
Zinc
> 4,700 mg/day
< 1,200 mg/day
3.7 liters/day men
2.7 liters/day women
> 1,200 mg/day
55 ug/day
320 mg/day-women
420 mg/day-men
30 ug/day
900 ug/day
8 mg/day
2.3 mg/day
700 mg/day
11 mg/day
Potassium Intake > 4700 mg/day
Dietary Reference
Intakes
The National
Academies
Press, 2005
Minaker et al
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
Sodium (1,200mg/day)
Dietary Reference
Intakes
The National
Academies
Press, 2005
Minaker et al
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
Time (hrs) to excrete 50% of a sodium load vs. age:
young (hatched), old (solid)
Geriatric Nephrology and Urology 4:145-151, 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
Dietary Reference
depending on heat and exercise levels.
Intakes
The National
With sweating and exercise you can lose
Academies
Press, 2005
1-2 liters per hour
Minaker et al
4. Sources:
% of intake
drinking water 35-54
beverages
49-63
food
19-25
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
Dietary Reference Intakes
The National Academies
Press, 2005
Minaker et al
1.
2.
3.
Vitamin D
Folic acid
Multi-vitamin
4.
5.
Vitamin E
Vitamin A
6.
7.
8.
9.
10.
11.
12.
13.
Vitamin B6
Vitamin B12
Biotin
Vitamin C
Vitamin K
Niacin
Riboflavin (B2)
Thiamin (B1)
600-2000 IU/day
400 ug/day
3/week if intake
< 1,200 calories
(Keep Vitamin A levels low
< 2,500 IU)
200- 400 iu/day
625 ug men
500 ug women
1.7 mg/day
2.4 ug/day
30 ug/day
90 mg/day
120 ug/day
15 mg/day
1.3 mg/day
1.2 mg/day
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 Intakes
The National Academies
Press, 2005
Minaker et al
END
Special thanks to:
Tara Minaker, RD, LDN
Research Dietitian
Metabolic Phenotyping Core/Nutrition of the MGH Clinical
Research Center, a member of the Harvard Catalyst CTSC
Whole Foods Market