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In last month’s article I discussed the New England Centenarian Study (NECS) being conducted at the Boston University School of Medicine under the direction of Dr. Thomas Perls. According to an overview and history provided on the website of NECS http://www.bumc.bu.edu/centenarian/overview/, the study began in 1995 and included all centenarians living within eight towns in the Boston area. Since then it has expanded to enroll individuals from throughout the United States and other countries.
I reported viewing a CNN-TV segment about NECS in which a woman in the study emphasized the importance of resilience in her life and being able to “come back from great disappointments and hurts and truly, truly be alive.” She observed, “True maturity is living in peace with that which you cannot change.” Others spoke of the importance of connections with others and finding purpose for one’s life.
As noted on its website, a goal of the NECS project is to understand those lifestyle factors that contribute to “a model of aging well.” The factors that they identified resonated with ideas I have expressed in previous writings, including “therapeutic lifestyle changes” (TLCs) in my November and December, 2011 articles. Given the number of responses I received to my March article, I decided to devote this month’s theme to the NECS research findings and Perls’ observations. I hope this article will serve as a catalyst to reflect upon steps we can take to lead more fulfilling, longer, and healthier lives.
Life Expectancy Calendar
Perls has a website www.livingto100.com that features a life expectancy calculator. The calculator actually considers a number of variables to help estimate how long the person providing the information will live. In a recent interview with Sara Dabney Tisdale of U.S. News & World Report, Perls offered this description of the calculator:
The calculator takes into account the things people are doing right and wrong in terms of maximizing their healthy years. Your smoking habits, your body mass index, whether you’re a man or a woman and whether you have high blood pressure, heart disease or diabetes—there’s really good evidence to estimate the impact each has on your life expectancy. For other things, like flossing your teeth, I had to estimate the effect. But it’s a fact that a person with gingivitis has an increased risk of heart disease.
I was somewhat surprised that flossing was mentioned as a factor in life expectancy. However, in an interview with Dr. Sanjay Gupta published on CNN.com, Perls further explained this link. “Not flossing your teeth invariably leads to inflamed gums. Chronic inflammation leads to the release of inflammatory substances into the bloodstream that can clog the arteries.”
And to think that the main reason I floss each day is to prevent tooth decay and gum disease, which, of course, is very significant in its own right! Little did I realize that flossing might also be adding months or years to my life. Flossing now takes on even more importance for me.
Perls emphasized that the life expectancy calculator is an educational tool to encourage people to recognize “what they could do differently to not only live longer but to live a larger chunk of time in good health.” He added, “We’ve come up with a saying: ‘The older you get, the healthier you’ve been.’ It’s an optimistic and positive view of aging, one that I hope is very enabling.”
Adopting a Healthier Lifestyle
The more I examine the kinds of research findings cited by Perls, the more convinced I am that while genes certainly play an important role in longevity and health, of greater importance is the lifestyle we adopt—and unlike the genes we inherit, we do have control over our lifestyle practices. The impact of lifestyle is supported by studies conducted of identical twins reared apart. From these studies, NECS estimates that 70-80% of longevity is rooted in environmental factors and 20-30% in genes. NECS notes a study of Seventh Day Adventists at Loma Linda University “who as a group have perhaps the longest life expectancy in the United States, 88 years for men, 89 years for women.”
An obvious question is what attributes do Seventh Day Adventists share that contribute to their longevity. The answer advanced by NECS is the particular lifestyle to which they subscribe, a lifestyle required in great part by their religious beliefs. “They tend to be vegetarian, they don’t smoke, they regularly exercise, and they spend a lot of time with their families and with their religion.” NECS observes that the habits of many Americans are in sharp contrast to those of the Seventh Day Adventists, “for example, excessive meat consumption, lack of exercise, smoking, etc., and thus, it is not surprising that the average American has the genes to reach their mid-80s, they just need to take very good care of themselves with proper lifestyle choices.” Instead, NECS reports that on average, Americans in general die 8-10 years younger than the Seventh Day Adventist. I realize such a comparison is based on placing all other groups in the United States together, but the conclusion reached by NECS is still worth serious consideration.
I believe there is overwhelming evidence to indicate that by engaging in particular daily actions we will achieve a higher probability of living not only a longer life, but as importantly, a life filled with improved health. It is for this reason that psychologists and other mental health and health care professionals have increasingly turned their attention to identifying and encouraging people to adopt activities associated with enhanced physical and emotional well-being. Let’s look at what these activities entail.
Tisdale posed the following question to Perls: “What factors are most important to achieving maximum lifespan and better health in old age?” Perls’ answer provides guideposts for living a longer, healthier life. He answered:
“I have an acronym: AGEING, spelled the British way. ‘A’ is for attitude. Centenarians are optimistic, and they tend to be funny. I think that those personality characteristics translate into being able to manage stress well. They don’t internalize stress; they seem to be able to let go.” As I read these words I was immediately reminded of the centenarian whose quote I used in last month’s article and at the beginning of this article, “True maturity is living in peace with that which you cannot change.” I realize for many people that view is easier said than done, but it is an outlook towards which we should strive if we are to lessen stress, regrets, and frustration. It is an outlook that has guided my work with my patients.
Perls continued, “The ‘G’ is for genetics. If people in your family have passed away in their 60s and 70s, alarm bells should be going off: You, more than other people, need to pay attention to prevention and screening.” In considering this comment I thought of several people I have known whose parents and grandparents had died at a relatively young age, especially of heart disease. Rather than feeling depressed or helpless by the thought that the medical history of their family implied that they also were predestined to have a short life, they became proactive and adopted a lifestyle to counteract heart disease. One man told me when he was about 60 years old that both his father and grandfather had died of heart problems before they were 50. He was especially diligent in maintaining a healthy diet and weight and exercising on a regular basis. He said, “I know that heart problems run in my family. I also know I can lessen the risk factors.” He remained healthy until his late-80s, succumbing eventually to cancer.
Next is Perls’ meaning for the letter “E,” which represents exercise. “I say people should exercise five times a week, 30 minutes a day.” He also advocates realistic strength training 2-3 times per week. I continue to hear from people that they just don’t have time to exercise, that they are so busy with work and other responsibilities. Yet, if you were told that you could do something five times a week for 30 minutes that would increase your life expectancy and improve your health, wouldn’t you want to build that into your schedule?
Although most people would answer that question in the affirmative, they fail to set aside time for this 30-minute activity. I have suggested to my patients that if it helps them to get started, they begin with 10-15 minutes of exercise each day, perhaps just taking a walk around the block, and slowly increase their time to a half-hour. I am reminded of a man in his late 40s who worked 60 hours a week and could not find time to exercise. He also did not monitor his diet, often eating high calorie, fatty foods. He had a heart attack, which brought a sense of mortality to the forefront of his life. In response, he initiated a regular exercise and diet regimen recommended by his cardiologist and reduced the number of hours he worked. He remarked, “If someone had told me that I could make these kinds of lifestyle changes prior to my heart attack, I would have said that it would be impossible to do. But, when you are faced with a life or death situation, you find it is possible to live a healthier life. It took a heart attack to wake me up.”
Perls noted that “I” represents “interest, and that has to do with exercising your brain.” In his interview for CNN.com he explained, “Participate in new and difficult cognitive activities (puzzles, brain teasers, learning a musical instrument or language). This is strength training for your brain which can delay memory loss and perhaps, if you are predisposed to it, Alzheimer’s disease.” I do not believe that Perls is suggesting that these brain exercises can prevent Alzheimer’s disease. Rather, just as physical exercise helps to maintain physical health, it is important for all of us to engage in activities that keep our minds as sharp as possible.
In the CNN-TV segment about centenarians, they highlighted one man who still played gin rummy on a regular basis. He remained alert as he memorized all of the cards that had been played in each hand. I would guess that to accomplish this feat when one is 100 years old suggests the presence of good “memory” genes. But, if we did not regularly use these genes, how good would they remain? And even if we were not blessed with the impressive genes that this man possessed, I believe it still makes eminent sense to strengthen and maintain the genes with which we were born.
“N” is for nutrition. “The goal should be a healthy weight.” The word “healthy” should be underscored since it implies that such a weight is a result of eating a well-balanced diet and that there not be major fluctuations in our weight. We are all aware of the “obesity epidemic” in both children and adults that exists in the United States and other countries. Unfortunately, maintaining a healthy diet is difficult for many people to achieve. However, there may be some hope in the future. Perhaps as a result of public awareness and protest, even fast food establishments are beginning to offer healthier choices on their menu as people become knowledgeable about the very high calories and lack of nutritious value of some food items and appreciate that being overweight represents a major risk factor for heart problems and other diseases.
And finally, Perls offered a strong opinion in describing the meaning of the letter “G,” which represents “Get rid of smoking, and get rid of antiaging quackery. I’m a very outspoken critic of the antiaging industry, especially growth hormone, which I think is really quite dangerous.” I wouldn’t be surprised if Perls received some negative feedback from some manufacturers of antiaging products.
A Concluding Comment
In the CNN.com interview Perls was asked, “Is it safe to assume someone will live longer simply because they eat healthy, exercise, and are relatively in good health?” He responded:
It is certainly safe to say that those behaviors and good health status will improve not only your life expectancy, but also help you live more of your life in good health, compressing the time you are not doing well toward the very end of your life. Most people with good health habits, appropriate health screening and if need be, interventions, should be able to live to their mid-80s, much of that time independently.
Perls was also asked if it is ever too late for people to begin making changes to extend their life. His answer was simple and direct. “Absolutely not. Changes you make today could immediately extend your life.”
I would only add that to insure that these recommended changes in lifestyle not appear daunting and beyond our reach, we begin slowly and realistically. It is important to maximize the probability of early success since one success typically leads to another. The goal is to remain motivated to engage in activities that increase the probability of longevity and health. To do so, we can certainly benefit from understanding the lifestyle and attitude of centenarians who have achieved such a goal.