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The Baby Boomer Tuneup
By Andrea Petersen, The Wall Street Journal
March 8, 2005
Researchers and doctors increasingly agree, however, that even modest changes in middle age and later can have a dramatic impact on health and longevity -- that people over 50 can benefit from what effectively amounts to a tuneup. A recent study funded by the National Institutes of Health, for example, showed that participants, who had a mean age of 51 and were at high risk of developing diabetes, were able to slash their risk by half through modest weight loss and exercise.
The problem is that while people over age 65 are less disabled and more spry than they used to be, there are signs that Americans in their 40s and 50s are actually less healthy today, according to an analysis of the annual National Health Interview Survey published last year in the journal Health Affairs. And with life expectancy on the rise -- it is now 78.2 years for a 50-year-old man and 82.1 years for a 50-year-old woman -- boomers could be faced with decades of ill-health if they don't make changes.
What follows is an effort to cut through the often-conflicting advice and come up with a list of relatively simple, concrete actions that people can undertake in middle age to help live a longer, healthier life. The advice is based on the growing body of research in this area, and on interviews with doctors, government officials and academics who specialize in it. They are in addition to the basic screenings that everyone over 50 should undergo -- regular cholesterol tests and colon-cancer screening, for example.
Some of the advice here highlights risk factors that often arise in middle age -- such as vitamin deficiencies, marital tension, even gum disease -- and can have a surprising impact on health. Others are efforts to simplify complex health guidelines -- on diet or exercise, for example -- into tasks that can be done reflexively, from the two vitamins that nearly every boomer should take to three key weight-bearing exercises that can be done anywhere.
Eat your spinach: Among all the research on fruits and vegetables, the evidence appears to be greatest for the benefits of green, leafy vegetables. Even far fewer servings than the government recommends can make a difference.
Research suggests that such vegetables can prevent age-related diseases, and even preserve cognitive function. A Harvard Medical School study released last summer found that women who ate eight servings or more a week of green, leafy vegetables such as spinach and romaine lettuce had the cognitive function of someone 1.7 years younger than women who ate three servings or fewer of the vegetables a week.
Scientists think that the reason fruits and vegetables are so beneficial is that they are high in antioxidants, substances that protect tissues from degrading. The government's recommendation for people to eat five to 13 servings of fruits and vegetables a day can seem pretty unattainable, but doctors say people will get benefits even from much lower amounts. "Going from two to three servings is much more important than going from seven to eight," says Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health.
Boost your B12, and your D: A variety of vitamins, minerals and nutrients are important for overall health, but we have particular trouble metabolizing B12 and D as we age. And many nutrition experts say boomers should take them in supplement form to avoid deficiencies.
A B12 deficiency can cause anemia and has also been linked to neurological problems. In a study published in the journal Neurology in 2001, those with low levels of B12 and folate (another B vitamin) had double the risk of developing Alzheimer's disease. Food sources for B12 include fish, eggs and milk and some fortified cereals. But Harvard's Dr. Willett says the form of B12 in a multivitamin is better absorbed than that from food. Be sure the brand you choose has 2.4 micrograms per day.
A multivitamin is also helpful for ensuring adequate intake of vitamin D; you need at least 1,000 international units per day. Aging skin has a tougher time absorbing vitamin D, which we largely get through sun exposure. While admonitions to wear hats and use sunscreen to prevent skin cancer are wise, that can also further limit our vitamin D. Vitamin D is essential for calcium absorption, bone health and muscle strength, and deficiency has also been linked to colon cancer. Fish is a source of vitamin D, but people can't get enough from food alone, Dr. Willett says.
Floss your teeth: Everyone knows dental hygiene is important for healthy teeth. But it is also important for your heart. A growing body of research shows a link between periodontal disease and stroke and heart disease.
In a study published last year in the journal Stroke, for example, those with severe periodontal disease (gum disease) had a 4.3 times greater risk of stroke than those with either mild or no periodontal disease. Scientists believe that infection in the mouth increases level of inflammation in the blood, which can help create blood clots that lead to strokes and heart attacks. Periodontal disease is most common in those older than 50.
The best prevention for periodontal disease is to brush and floss at least once a day and see a dentist for cleanings every six months, says Sally Cram, a periodontist in Washington, D.C., and a spokeswoman for the American Dental Association. It can be treated with intense cleanings and antibiotics.
Analyze your sleep: Increasingly, doctors are concerned that sleep apnea, a condition where people periodically stop breathing during sleep, leads to more than just some annoying snoring. In the past few years, research has linked it to high blood pressure, stroke and diabetes. Sleep apnea becomes more common during the late 40s and early 50s.
With age, muscle tone in the mouth diminishes, the tongue falls back to cover the windpipe more easily and the soft palate is looser. About one in five adults has at least mild sleep apnea, according to a 2003 article published in the Journal of the American Medical Association.
Data published last year from the large Sleep Heart Health Study showed that even participants with mild sleep apnea had an increased incidence of glucose intolerance and insulin resistance, conditions that lead to diabetes.
Sleep apnea is diagnosed by a physical examination of the mouth and an overnight sleep study that measures how frequently a patient stops breathing. Treatments include a special mask worn during sleep, surgery to shorten the uvula and dental devices.
Pump iron: The benefits of strength training to maintain muscle as we age are well-documented. But it is increasingly clear that strength training has benefits for the heart as well, and one new effort has boiled training down to simple exercises that you can do in the home or office.
Strength training -- or resistance training -- involves controlled exercise using weights or the force of gravity to strengthen muscles. Muscle mass begins to decrease by about 5% per decade after the age of 40, so strength training is vital to prevent a host of problems, including sarcopenia, a loss of muscle mass and strength that puts people at risk for falls and thus lethal hip fractures.
But new research also shows that strength training has surprising benefits for the heart, reducing levels of homocysteine, a blood marker that can indicate risk for heart attacks and strokes. In one 2003 study by researchers at the University of Virginia in Charlottesville, six months of resistance training, three times per week, cut homocysteine levels by more than 5%. Those who didn't train saw a 6% rise in homocysteine levels.
This doesn't mean you need to start doing bench presses at the gym. The International Longevity Center, a New York-based nonprofit, is promoting three simple exercises that provide the benefits of resistance training without requiring fancy equipment.
Walk the dog: Aerobic exercise not only reduces blood pressure and the risk of cardiovascular disease, but it also helps preserve cognitive function. A study published last year in JAMA showed that women aged 70 to 81 years old who were most active experienced less cognitive decline that women who were less active. The Centers for Disease Control and Prevention recommends at least 30 minutes of moderate activity most days of the week. But leading doctors, including Wojtek Chodzko-Zajko, head of the department of kinesiology and community health at the University of Illinois at Urbana-Champaign, say those 30 minutes don't have to be all at once: A quick walk with the dog, a couple of trips up the stairs and a few laps around the mall over the course of the day add up.
Kiss your spouse, and call your college rooomate: Middle age is a time when relationships can be rocky as people deal with empty nests, elderly parents and their own looming retirement, according to psychiatrists. So it can be particularly valuable to maintain strong relationships and an active sex life, which research has shown to have benefits for health and longevity.
"The decade between 50 and 60 is a period of major turbulence," says Arthur L. Kovacs, a psychologist in Santa Monica, Calif. "Death becomes a more constant companion and this leads to a kind of stocktaking."
A study published in 1997 that followed 918 Welsh men over a decade showed those who had the highest frequency of orgasms had half the risk of death during a 10-year period than those with the lowest frequency.
Friendships are important, too. A study published in Lancet that followed 1,200 people in Stockholm, Sweden, for three years, showed that those with a limited social network had a 60% increased risk of developing dementia.
Check your skin: The risk of skin cancer soars during midlife, but new techniques are making it possible to diagnose skin cancer earlier and treat patients with less pain and scarring.
The average age of onset of melanoma, the most deadly form, is 50. The average age of onset for other skin cancers is 60, says Andrew J. Kaufman, assistant clinical professor of medicine at the University of California, Los Angeles.
One new technique, dubbed dermascopy, uses a magnifying instrument and an oil placed on the skin that allows light to penetrate the skin's surface. Since the doctor is better able to see if the spot has characteristics of cancer, it may allow for earlier diagnosis. It can also eliminate some unnecessary biopsies. The American Cancer Society recommends that everyone 40 and older get a yearly body check from a doctor.
Brush up on French verbs. Or play the cello. Or go dancing. There is now strong evidence to support the common-sense belief that stimulating activities can help us stay mentally sharp as we age.
The ability to act on new information, to multitask and to retrieve information from memory all gradually decline beginning in one's 20s. But it becomes more noticeable after the age of 40, says Molly V. Wagster, program director of the neuropsychology of aging branch at the National Institute on Aging.
In a 2003 study published in the New England Journal of Medicine, those who most frequently read, played board games, played musical instruments or danced had a 63% reduction in the risk of dementia. In a 2002 study following 801 Catholic nuns and priests, an increase in the level of cognitive activity was associated with a 33% reduction in the risk of developing Alzheimer's disease.
Get screened for depression: There are specific risk factors for depression at midlife, say mental-health experts, and the signs aren't always easy to spot, particularly in men.
The good news is that the risk of depression overall goes down after you hit 40. The dark cloud is that, for men, suicide rates rise after 40. Women also face a slight increased risk of suicide around menopause, says Douglas G. Jacobs, associate clinical professor of psychiatry at Harvard Medical School. "Any time you have hormonal changes, it is going to affect mood," Dr. Jacobs says.
Symptoms of depression include difficulty sleeping, weight change and feelings of worthlessness. But in some people, especially men, depression may manifest itself with fatigue, irritability and a lack of productivity at work. Those with symptoms should consult their doctors.
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