Complementary and Alternative Medicine: Healthy Aging

so what is aging this is a definition a state of existence that are is arrived at slowly may be defined as a series of disadvantaging events that normally occur in our bodies over time and unfortunately I’m going to go into quite a bit of those disadvantaging events just to outline them for you if you haven’t already experienced in some of them yourself but of course Wikipedia is our current standard of how we get definition so I knew that if I didn’t share it with you that you would go home and google it yourself so this is the Wikipedia definition of Aging which G I think is a little complicated I won’t even try to read it I’ll let you look at it I don’t understand why they actually modified it to include this issue about deterioration but in any event this is a process that we are all living through let’s just turn to our organs and our systems one by one and see what the effect of aging is with regards to skin our dermal layer grows thinner and the collagen fibers degrade causing loss of elasticity of the skin 50% of us have gray hair by the age of 50 and most men over 60 are partially bald tooth enamel more prone to cracks your gums recede and old fillings disintegrate and these oral problems in the elderly often lead to poor nutrition with regards to eyes and ears our lens has become less elastic after 40 muscles controlling the lens weaken causing our inability to focus on nearby objects so ie reading glasses cataracts are common after age of 60 walls of the ear canal become thinner and dryer while nerves and sensory cells die hearing declines 25% between the ages of 60 and 80 and nearly 1 and 3 over the age of 65 have hearing problems bones and muscles both men and women we generally credit women with having the osteoporotic booms but happens to men as well after age 50 as well as deterioration of joint cartilage muscles lose size and weight in relation to the rest of the body and with the decrease in the muscle mass the body burns fewer calories because muscles are generally the furnace where we burn a lot of calories so this increases our tendency to gain fat fatty deposits and scar tissue slowly accumulate in the lining of the blood vessels reducing blood flow to vital organs as we all know the heart the brain the kidneys blood pressure often increases at age 55 the proteins in the lung become less elastic coupled with the gradual stiffening of the chest wall the lungs ability then to transport oxygen also decreases gastrointestinal and gastro genital urinary tract gastric juices and enzymes decreased by 60 food moves more slowly through the colon some nutrients are less readily absorbed kidneys become less efficient bladder muscles weaken one-third of seniors experience urinary incontinence and enlargement of the prostate causes many problems in aging men I know this litany of all this deterioration I’m giving it to you up front so that we can move on to some happy news afterwards reproductive hormones decline after 50 with that very sharp well known menopause for women and a more gradual decline in men that some are trying to call andropause just to give that sort of a syndrome these effects with the decline of these hormones rage from mood changes to loss of bone and muscle strength menopause is also caused menopause also causes changes in the vagina that may lead to painful intercourse precipitating a loss of interest with regards to aging in the men impotence itself is not actually a symptom of male aging however erections become less rigid and ejaculation less forceful and as a Harvard study showed so it must be true the men in the room will will cross their legs here with regards to the brain and nerves the brain reportedly shrinks by 10 percent between the ages of 30 and 90 the

frontal lobes shrink 30 percent after age 50 and the hippocampus responsible for memory decreases 20% neurons the nerves in the brain become less dense so processing ability wanes but attention and language should not suffer just by aging itself somebody said you may have the same size hard drive but the processing speed is slowing down that’s how we would define the cognitive effects of aging there are certain risk factors for cognitive decline or ie becoming dementia demented the a pony for gene increases the risk of Alzheimer’s disease some comorbid conditions such as high blood pressure diabetes or heart disease also increase the risk for cognitive decline exposure to lead smoking alcohol or use of other substances lower educational level interestingly lack of physical activity lack of social interaction and high stress levels and we’re going to go into all of these different issues in more detail and talk about how best to avoid cognitive decline but you’re all doing it here by staying intellectually engaged remaining physically active being socially active practising stress reduction avoiding out tobacco certainly and alcohol in moderation treating the diseases that may lead to decline in cognitive function high blood pressure diabetes depression and elevated cholesterol and again if you need them using hearing aids and glasses so what about aging why does it happen what causes the body to go through all of these different changes that we’re all so happy to wake up each morning to experience well one one of course free radicals are always blamed for everything oxygen you know likes to live pared oh – when you have a single oxygen that electron does damage to DNA and so many people thought aging is a process of free radical damage and oxidation or is it genetic mutations of DNA accumulate over time just through cells dividing and dividing an interesting theory the rate of living theory which I believe has been disproven is that your duration of life is inversely proportional to the amount of energy that you expend so hyperactive people tend to live shorter lives so that’s not necessarily true the air catastrophe theory is synthesis of proteins sets off a cascade that damages cells and cause cell death and then across linkage theory which is popular among people who promote chelation therapy suggests that there is progressive cross-linking among structural proteins of the cells which causes organ decline and death now you know I like to be evidence-based as much as possible but I told you I am NOT a gerontologist so I don’t have real expertise in aging beyond my own experience and my learning about how to prevent cancer and cancer recurrence but I did find actually cleaning my house recently a July 2001 and Newsweek the results were published in a special fall winter 2001 edition of Newsweek called living longer living better in this poll of really a small number of 801 Americans aged 45 to 65 three-quarters thought that they would live to be 80 and 11% thought that they would make it to 100 half rated their current health is excellent or very good and the other half were somewhat below then now in looking at death rates at different ages in North America and Europe the annual death rates among 15 year-olds are very low five per thousand among 50 year olds it’s increased three hundred fold so that the death rate is one point five four hundred among people who are 105 years old the annual death rate is 50% so one out of two of those are not going to make it the increase is mainly due to mortality from heart disease cancer and Stroke eradicating these three problems would only add 15 years of life which is half of the gain that we achieved in the 20th century when the lifespan lengthened 30 years it’s very dramatic improvement in the lifespan in the 20th century alone because people that are 80 even if they don’t get cancer will soon die of something else so what are the goals of healthy aging Christiaan Barnard the one who invented the heart transplant said died young as

late as possible Andrew Weil who’s sort of one of my gurus said that the goal of healthy aging should be compressed morbidity and if you think about it it means live a healthy active life for as long as you can and then at the end before the end have everything compress your morbidity which is you know not doing well should not be strung out over a long period of time but compressed so let me just disclose that with all of my career over the past 25 years in 2002 I became a fellow in the program and integrative medicine at the University of Arizona which is Andrew Wiles program and I did an online distance learning fellowship in integrative medicine and that’s how I learned much of what I when I talking about tonight and I became friends with Andrew and I really loved his book healthy aging I don’t know if people have read it but it is in the bibliography that I’ve given you and what I’m going to do now is really much the remainder of this discussion is going to be looking at the 12 points everything is always 12 I don’t know you know why there anyway tan isn’t good enough I don’t know yeah but Andy gives a 12 point program for healthy aging and fortunately the number one is really my number one two and again taking this back to cancer I think everybody appreciates that 30% of malignancies around the world are related to tobacco but what people don’t know is that 30 to 40 percent are related to what we eat and what we don’t eat and in our body we have a lot of ongoing inflammation what is inflammation if you get a cut or surgery then when you’re healing you get heat and warmth and redness and that ultimately leads to healing but that process is inflammation we have that ongoing in our body because of damage through free radicals through buildup of cholesterol and that inflammation is not leading to healthy repair of tissues but actually to damage of tissues and so Andy’s advice is to eat an anti-inflammatory diet and this is the advice that I give with all the patients that I see in consultation at the Osher Center in it and it’s definitely consistent with the guidelines from the American Cancer Society now I know aging is not just living life without cancer but for an oncologist healthy aging that’s how I would define it and the American Cancer Society guidelines start out the guidelines for nutrition and exercise actually start out by talking about weight and if you haven’t noticed weight is a big problem in our country today largely I think due to increased utilization of corn as a sweetener so the recommendation here is to maintain a healthy weight throughout life if your weight has to fluctuate it should be in an 11 pound range that is unless you’re overweight unless your body mass index is above 25 then your safest to get down to where you’re not of 25 and then maintain that healthy weight throughout your life but avoid excessive weight gain and loss and even before talking about nutrition the American Cancer Society guidelines say adopt a physically active lifestyle and suggest that adults should have at least 30 minutes of moderate to vigorous activity on five or more days a week 45 to 60 minutes is better and I’ll show you in a little bit how difficult that is for us to do that is a big change and recently I saw a CNN statistic that only 6% of Americans abide by that suggestion consume a healthy diet with an emphasis on plant plant sources we should eat five to nine servings of fruits and vegetables a day and that’s fruits and vegetables if you’re going to eat that many vegetables a day you have to start in the morning it’s just an American sort of ism that we should eat eggs and bacon and toast or donuts and coffee and orange juice for breakfast if you want to be healthy you start when you wake up and start eating correctly whole grains in preference to refined grains should be used and the consumption of processed and red meats in particular should be limited or avoided with regards to alcohol for healthy aging and for decrease in cancer risk men can have perhaps two drinks a day and women one women at risk for breast cancer are

safest having one alcoholic drink a week alcohol promotes estrogen estrogen for certainly breast cancer is something that often fuels the progression of the disease so that’s why it’s not a sexist thing it’s a physiologic reason that women should have less now these are not telling everybody to go out and drink alcohol if you don’t drink that’s even better as we discussed with regards to cockpit cognition for people again the don’t have breast cancer phytoestrogens seem to be very helpful particularly men aging men phytoestrogens from soy and flaxseed are good for the prostate the beneficial effect of phytoestrogens on the breast is probably during development Asian women in Asia have a much lower rate of breast cancer than women in the United States and when Asian women moved to the United States their risk of breast cancer increases because they’re eating a diet that is not as good as what they were having before cruciferous vegetables those that grow in the shape of a cross the flowers broccoli cauliflower Brussels sprouts cabbage and kale are very rich in indole-3 carbinol this is a substance that’s very chemo preventive very antioxidants and oncologists are actually looking at it as a possible intravenous chemotherapy utak agent because it’s so potent and that’s why I eat broccoli two or three times a day personally it’s also encapsulated now in dall 3 carbonyl but I believe it’s best for us to get these nutrients through eating the whole food as opposed to taking things in capsules whenever possible however since not everybody is going to eat salmon black cod albacore tuna herring or mackerel each day I think omega-6 omega-3 fatty acid supplementation is necessary but in the meantime I do recommend that people eat foods which I mentioned those Coldwater fish that have omega-3 and the plant source of omega-3 would be flaxseed garlic ginger and tumeric are excellent spices they lower cholesterol they lower blood pressure they also probably have some anti-cancer activity turmeric at the American Society of Clinical Oncology meeting last year was heavily promoted as a potential anti-cancer agent vitamin d3 the sunshine vitamin also comes from these cold water fish if you put dried mushrooms outside they can also create vitamin d3 even though they don’t appear to be alive to us d-3 however is something those of us that live in the San Francisco with the fog probably also need to supplement with the capsule but we’ll talk more about supplements in a while as well things to avoid again too much alcohol trans fats which are present in all those processed baked goods and no longer in kentucky fried chicken but grilled or broiled meats may produce toxic heterocyclic amines which in and of themselves may be causing cancer so my my standard recommendations to my patients and my friends are again as the American Cancer Society recommends to increase plant-based foods whole grains fruits particularly heavily pigmented fruits we can’t say enough about blueberries and suddenly pomegranates are becoming very popular as well and vegetables particularly cruciferous vegetables numerous times during the course of the day decrease animal fats now I didn’t mention my my feeling about dairy but I’m not a proponent of dairy and I recommend that I think dairy is a major allergen and cause of inflammation in most of us many races African Asian Jews don’t have the machinery to digest either the sugars or the proteins in dairy and I think what it does is it sets up a chronic inflammatory response it’s associated with prostate cancer ovarian cancer lymphoma I think there’s a big Lobby in this country to promote dairy again Asians don’t use a lot of dairy they live long their bones are fine there are other ways to get calcium poultry Andy while if you read his book he believes that eggs and chicken and poultry are high in a kind of stoic acid which is a precursor to prostaglandins which are inflammatory you know I think if we eat free-range poultry without hormones and antibiotics and pesticides that were probably okay despite that and I feel badly telling people to eliminate dairy refined sugar and red

meat so I feel like if I’m gonna get get away with that I have to allow people a little chicken every once in a while I do believe that white foods white milk white sugar white flour white rice except for basmati and jasmine because those have a better glycemic index are not good we tend to eat heavily processed food in this country it doesn’t have nutritional value causes a lot of insulin and insulin like growth factor to be released those are pro-inflammatory and they also increase cell division particularly of malignant cells so people must have heard by now of PET scans that’s the latest technology we’re using to locate tumors in patients with cancer a PET scan is basically we inject radio labeled glucose or sugar into the body and weak out the areas where the radioactivity is most concentrated because the tumor loves sugar so why feed cancer sugar and we don’t need sugar either because with that increase when you eat refined sugar of insulin and insulin like growth factor you overshoot your own blood sugar goes low and you feel fatigued and a little depressed and the only way to bring it back up again is to eat more sugar so most people are on this up-and-down roller coaster all day long of energy and mood and if you eliminate refined sugar your mood and your energy levels stabilize again I mentioned seasonings and I drink green and red green tea is great antioxidant the polyphenols have good chemo prevention they prevent a lot of different cancers and red wine is probably the reason that the French get away with eating their poor diet which is against all the guidelines I’ve given because red wine has resveratrol which we think is a very potent antioxidant and maybe something that’s associated with longevity with regards to milk I I put this up and you know not everything comes from Harvard we saw their research on penis size but the School of School of Public Health dairy recommendations should you get calcium from milk when most people in the United States think of calcium they immediately think of milk but should this be so milk is actually one of many sources of calcium and there are some important reasons why milk may not be the best source for everyone these include as I mentioned lactose-intolerant high saturated fat possible increased risk of prostate possible increased risk of ovarian cancer this this comes from the Harvard School of Public Health website which really I liked better the comments on milk sucks calm but I think this is a little less sort of compared conspiracy theory and paranoid than within milk sucks now there is some evidence that caloric restriction does promote longevity in animals if you restrict the caloric intake of animals very severely they have lower insulin and increased sensitivity to insulin their core body temperature lowers there you have a delayed onset of age associated diseases and the age-related decline in functional tests is slower so we don’t want to restrict our calories to 1,500 calories a day which would be sort of a comparable to promote longevity so now scientists are looking for drugs that can mimic caloric restriction and again this is where resveratrol in red wine and also mind you red grapes may be having its effect in being a mimicker of caloric restriction the second point I know I spent a lot of point a lot of time on 0.1 but I’m a big old Adelle Davis you are what you eat believer and you know nutrition is really important when you go into the supermarket now there are so many things there that are not food you know we need Whole Foods and so I’ll stop talking about food now so and a second point is you dietary supplements wisely to support the body’s defenses and natural healing power this is a photograph taken by a high school friend of mine Susan Eisenberg who wrote a book called don’t call us we’ll call you about women construction workers because she was a electrician Foreman at building skyscrapers in Boston and she wrote this book about experiences of a woman construction worker in the 70s and 80s now she has lupus and thyroid cancer and so she’s a poet now writing slightly dark poetry but she also is a photographer and she finds this cemetery

in Boston where she takes her pills and her supplements and she sort of creates art and this is a chess game if you will with her conventional medicines versus her supplements and you know I think it makes a statement there so with regards to aging potentially useful supplements and and these are somewhat controversial I still think a little vitamin C maybe two to five hundred I’m not a big high dose vitamin C person because most of it you’re just going to pee out similarly I don’t recommend any B vitamins because all they do is tint your urine that orange yellow color because you’re just peeing them out you don’t need them if you eat well I mentioned vitamin d3 which is cholecalciferol not heard though Calcifer all I take a thousand international units a day it helps with absorption of calcium and because I don’t do dairy you need to absorb calcium from other sources and I take 400 international units of a a day and that’s a with mixed tocopherols not just a particular tocopherol because if you just take one you may block absorption of the others which are necessary so vitamin E has been somewhat controversial the medical literature likes to only publish the negative results of studies with vitamins because they’re sort of a little anti vitamin not to sound too paranoid or conspiracy theory but they published recently an article that vitamin E leads to immortality’ and what they did they took people who were on the verge of dying and they gave them high doses of vitamin E and they died you know and then so you know I don’t know I mentioned omega-3 fatty acids from fish you know that’s i personally don’t take fish oil because i find that a little unpleasant but i take a capsule of omega-3 don’t get omega 3 6 9 because we don’t want the 6 & 9 that’s pro-inflammatory we want the Omega threes also you know as clean as possible without contaminants of course and I take it the second thing I put in my stomach in the morning after my mushroom extract because if you eat and then take your omega-3s you’re gonna have fish burps and that’s very unpleasant but if you take your omega-3s and then eat on top of it you won’t get that unpleasant symptom and you’ll be more prone to take it every day for people who have joint issues I think there is good enough evidence that chondroitin sulfate and glucosamine may be useful for men who have prostate hyperplasia symptoms we did a study at the Osher Center showing that saw palmetto didn’t work and it was published in the major medical journal but it was in men with moderate to severe BPH benign prostatic hyperplasia it’s not recommended for that it’s recommended for people with mild BPH so that’s why it didn’t work so you know I still think it’s worth looking at st John’s wort which is useful for depression needs to be carefully taken because of its potential to interact with prescription drugs it’s broken down in the liver by the same pathway which breaks down many prescription drugs can cause an increase in the dose or a decrease in the level of the prescription drugs leading to either ineffectiveness or toxicity so very important always to tell your doctor if you’re taking st. John’s work valerian is something for sleep relaxes melatonin also may be useful for sleep for symptoms of menopause again black cohosh recently published a big article that it doesn’t work for some women it does so you know everything that’s evidence-based because it’s a randomized placebo-controlled clinical trial doesn’t necessarily mean that it might not work for one individual coq10 is something that protects mitochondria anybody who has a family history of cardiovascular disease any of my patients who get radiation around the heart I think it’s good to take coq10 Andy while suggest that anybody taking a statin that statins can sometimes damage mitochondria and that he claims that one of the drug companies actually has patented a combination statin coq10 because anybody taking statins should be on Supplemental Co Q 10 ginkgo is the one that helps us remember things but you have to take it three times a day and I could never remember so one of my favorite botanical combinations is zai flammond remember Vioxx that cox-2 inhibitor that got removed because people were having cardiac events well this is I phlegm and is a 10 herb cox-2 inhibitor that has oregano basil ginger turmeric green tea

you know 10 different herbs it’s a slower onset of an effect but I get when I take a flume and when I start to get something like what Ellen had with her knee I having pain I would take xylem and it might not be on the first day but on the second day not only is that better but all these other aches and pains that I didn’t realize I had are gone it’s it’s a good agent and I recommend zyf lemon I mentioned mushrooms I’m a big believer in medicinal mushrooms again I like traditional Chinese medicine and much of traditional Chinese medicine utilizes medicinal mushrooms this is reishi Ling G which is in Chinese medicine what’s taken for immortality this is shiitake black mushrooms which are also immune modulatory and perhaps have anti tumour antiviral activity these are maitake which are also potent mushrooms the is harissa or lion’s mane which is good for nerve for people who have neuropathic damage from diabetes or chemotherapy or HIV I often suggest this this is a the website that I go to and refer my patients to to get mushrooms for medicinal purposes I think with regards to aging some useful properties of medicinal mushrooms include antioxidant immunomodulatory antiviral anti-inflammatory antineoplastic and also for women it may that some of these mushrooms may inhibit aromatase which is what produces estrogen and is good for women with the breast cancer that’s estrogen receptor-positive moving on to the third point Andrew Weil says use preventive medicine intelligently know that the risks that you have for a specific age-related disease and get the appropriate diagnostic and screening tests and immunizations treat problems such as elevated blood pressure elevated cholesterol in their early stages and he means treat problems with conventional therapies as well as using complementary therapies because what integrative medicine is what we practice at the Osher Center is a thoughtful and rational combination of conventional and complementary therapies creating something that’s really patient-centered and in a relationship based medical practice so just with regards to where we spend our money on drugs the five costly is classes of drugs accounted for two-thirds of the 181 billion dollars spent on outpatient treatment for adults in 2004 and the the largest group were cardiovascular drugs followed by hormones which include estrogen replacement central nervous system which includes pain medicines cholesterol-lowering drugs as a group were the four most expensive and cyclo therapeutics which are antidepressants antipsychotics and sleep medications were the fifth in 2001 it was reported that in the 45 to 50 year old group about a quarter were taking blood pressure lowering drugs but by the next decade almost half were drugs that were lowering cholesterol were also frequently used and again this was pre nine-one-one antidepressants only in 15% and viagra only in 4% of men but I don’t know 911 to maybe have changed our world hormone replacement therapy only present in were present in 37 percent of women and I suppose that would be decreased now from all that we know about those risks testosterone in men certainly got a lot of increased usage over the past decades testosterone used to be available as only a pill which would damage the liver it then became injectable but subsequently testosterone became available as first a patch and then a gel and it became more widely used and this whole disease or syndrome of andropause was basically invented I believe by the drug companies that were making testosterone replacement so that they could increase sales of testosterone as a potential Fountain of Youth hormone so you know I am concerned a little bit about the use of testosterone in older men just like estrogen turned out not to be a good idea hormone replacement therapy and women because it could potentially fuel tumors now in addition to the sex

hormones there’s also growth hormone which is promoted as a Fountain of Youth hormone because secretion of this hormone falls off 12% per decade after we reach middle age now I mentioned that estrogen has the abrupt and testosterone the gradual declines a precursor to testosterone and estrogen is dehydroepiandrosterone and sulfated form and these also fall progressively after the age of 30 and by 60 are 50% lower than they were when we were younger now recently the New England Journal of Medicine did a placebo control trial of DHEA which is available over-the-counter at your drugstore as something for you know Fountain of Youth and they showed that neither DHEA nor low-dose testosterone replacement in elderly people has physiologically relevant beneficial effects so it didn’t do anything for bone density for body fat for actual hormones for mood it did for some patients there was an increase in quality of life which is very subjective but otherwise there were really no benefits I think a healthier way to stay young as opposed to taking hormones is to get regular physical therapy physical activity excuse me throughout life exercise again a recent Newsweek cover story suggested that exercise improves body composition in bone keeping it mineralized keeping muscles tone and decreasing fat it enhances the cholesterol profile improves glucose and insulin sensitivity reduces blood pressure improves the tone of our autonomic nervous system reduces inflammation and improves cardiac function so even modest improvements in fitness in people who previously were not fit at all are associated with large improvements in their health status people who went from being unfit to being fit over a five-year period had a 44% reduction in the relative risk of death from any cause compared to people who remain inactive so this is important and overlooked proven primary prevention of cardiovascular disease diabetes osteoporosis breast cancer colon cancer functional decline and Falls among the elderly a book that recently came out called age defying Fitness describes five domains of fitness posture strength balance flexibility and endurance and you can see there the effects of aging in all of them and we need to remain fit and active and work in all of these domains so how fit are you are you standing as straight and tall as you once did is walking up a flight of stairs a strain at times are you getting up from a chair more slowly is it harder to look left and right when backing up no who doesn’t have that one really do you get stiff with prolonged sitting is standing on one leg to put on a shoe difficult do you trip or lose balance more easily those walking or jogging a distance take longer so think about your fitness this is that surveyed again from Newsweek where I was somewhat shocked when people were asked which are the most difficult healthful behaviors for you to adopt giving up tobacco was rated by 21% no I used to smoke and I I thought that was pretty difficult exercising enough forty eight percent that was listed as the number one how many people in this room exercised to the level as recommended raise your hand well so not so bad maybe it looked like forty percent so that’s pretty good oh don’t because these are my two dogs that both left me on January 4th of this year but they were both put down on January 4th but a new puppy is coming from their lineage on May 26th so so it’ll be – and Lilly this time instead of Byron and Shelley so get adequate rest and sleep and before I put this talk together I had not yet read healthy night no is that the name of the book it’s in your the book by Reuben diamond that’s in the it’s a wonderful wonderful book oh there it is hell healing night it’s all about the healing benefits of sleep dreams and healthful awakening deep sleep stage 3 & 4 characterized by the theta and Delta slow wave activity decrease with age men under 25 spend 20

percent of their total sleep time in deep sleep by 35 only 5% is deep sleep with a 75 percent decline in their human growth hormone because growth hormone is put out during deep sleep by 50 most men have lost the capacity to experience deep sleep and produce only negligible human growth hormone but elevated cortisol which is a bad hormone that damages our immune system on average interestingly women get more deep sleep per night than men 70 minutes compared to 40 minutes is this linked to the fact that women have a longer lifespan and some in his book he also suggests this may be adaptive because of women and child raising and the fact that they need to be up more with child than husband and so maybe that’s why they ultimately get more deep sleep there’s a widespread belief today that sleep quantity and quality normally diminish with age but it may be the other way around that is we prematurely aged as a result of chronically poor sleep recent research suggests that the common signs of what we consider normal aging may in fact be symptoms of chronic sleep deprivation so I thought that was really interesting sleep problems among the elderly are less related to age per se and more to lifestyle and he in this book writes a description of Thomas Alva Edison that makes him sound like a speed freak that this man Thomas Edison who invented the light bulb was so driven and stressed and always wanted to be working and went through wives and divorces in there and he invented the light bulb so he can continue to work all the time and Reuben diamond says that much of the problem with our society today is we have too much lan light at night and he suggests that what we need to do is return twilight to our lives so now at home at about this time I start because they have dimmer switches in every room returning a little Twilight and dimming the lights and I don’t walk into the bathroom right before I go to bed and have bright lights blaring at me because he’s right you know here I’m saying we should eat as close to nature and primitive man we should also live in the cycle of the environment in which we exist long-term impact of overly driven lifestyle use of excessive use of sleeping pills and substances and also medications that interfere with our body’s own production of melatonin including aspirin and nonsteroidals beta blockers and diuretics that every hypertensive takes and benzodiazepines ativan valium etc so what are the integrative aspects of sleep we should have a regular bedtime with no eating immediately prior to bed I don’t eat for I don’t go to lie down if I’ve eaten within two hours I try to stay up avoiding alcohol right before bed limiting activity in the bedroom you can figure out whatever you want from that appropriate lighting as just mentioned they evaluate medications that might be useful and then for elderly people brief naps may be useful melatonin again which our body produces in our pineal gland to let us know it’s night time is also available as a supplement the dose people take when I take a 3 milligram dose of melatonin I get very depressed weird dreams and groggy the next day so now I’ve learned to bite that 3 milligram tablet in quarters and just put a quarter of it under my tongue so 0.75 milligrams under the tongue is probably a better way to go and I do a lot of international intercontinental traveling and I do use melatonin to put my body into night when I arrive someplace for the first few nights that I’m there other but nickels that people might use for insomnia are listed here the strongest evidence for valerian kava kava is felt to maybe be to hepatotoxic to the liver st. John’s wort I mentioned German chamomile seems very benign a wonderful thing to take but that also may interfere with the enzyme system responsible for breaking down many of our normal prescription drugs hops which is in beer lavender not to take it as a pill but lavender oil as an aromatherapy has been shown to be very calming passionflower is often combined with valerian and lemon balm is also used to increase calmness point number six learn and practice methods of stress

protection even better than reduction isn’t it to protect ourselves from stress with all that we know about how stress aggravates cardiovascular disease promotes viral infections exacerbates metabolic disease halts reproduction and regulates the normal function of virtually every cell in the body why would cancer cells somehow be exempt this is from the Journal of the the National Cancer Institute bulletin last month when it was reported that stress does increase metastasis in cancer cells does not cause cancer per se but increases the spread because stress is basically increased epinephrine which kills lymphocytes the building block cells of the immune system and it’s increased cortisol cortisone steroid corticosteroids which are also immunosuppressant so Newsweek 2001 how do you reduce stress I couldn’t believe watching TV reading and music or clumped together when I gave this presentation in Africa and one of my colleagues says where is sex I said oh that’s a good question so I guess it’s not there but other ways that people reduce stress is by ignoring it going shopping 37% meditate and 24% have a drink or a cigarette so a little maladaptive but there are other ways to reduce stress yoga tai chi mind-body intervention many of which we offer at the Osher Center hypnotherapy biofeedback meditation imagery and visualization breathwork spiritual healing and prayer music and art therapy and then if you want to do body body certainly massage therapy is a way to eliminate and relieve stress exercise your mind as well as your body and things that one can do learn a foreign language learn how to use a computer a DVD or one of these fancy mp3 players change the operating system of your computer yeah that’s about a keeps you keeps your mind that’s what Andy recommended that one read do crossword puzzles I don’t know about Sudoku because I haven’t figured out how to do that yet senior hostel programs or good ways to exercise your mind and attending this institute maintain social and intellectual connections as you go through life this is my little subgroup of my fellowship class you know I will tell you that these I went to for the first time I life I did jury duty in 2002 and I came home and I said I want to go to law school and I got to look like oh really in it and then I went to telluride mushroom festival and I heard Andrew Weil talking about his fellowship in integrative medicine I said that’s what I want to do and I realized that I wanted to be a student again because I was at an age you know above 50 where I just didn’t know how long I was going to be able to retain new facts and I always loved being a student you know when I was in high school college medical school it was fun and I’ve been a teacher for so long I just wanted to take tests and have homework and I did it for two year and I loved it and it allowed me to also have new social connections my classmates you know I still am in touch the one over my shoulder just sent me an e-mail today so you know that’s important when you get to be a certain age you forget that you can still you know maintain new friendships 0.9 be flexible in mind and body learned to adopt to loss adapt to losses and let go of behaviors no longer appropriate for your age and in this for this I I really turned to my dear friend Jerry Jam Polsky and his wife Diane Surrency own this is at their house in Hawaii and this is my friend David who was just a house guest this week but this is from when we went to Hawaii last month David 60 Diane slightly older and Jerry is now over 80 and Jerry and Diane developed the Centers for attitudinal healing which were originally designed for families of children with life-threatening illnesses and Jerry wrote a book called love is letting go of fear and we in the AIDS program in the mid 80s required Jerry and Diane to come give us group therapy because we were suffering from a lot of grief that we didn’t know how to name and they taught us lessons to each week we had to write down a lesson and these are lessons that I remembered and actually when I saw Jerry and Diane I showed them this slide and they said you forgot one thing and I added that that’s the third bullet and they said very good that you remembered for those four lessons the most important I think is choose peace and that is your late coming here you’re

stuck in traffic you know we’ll still be here so you miss five minutes you can get yourself all riled up you can get your adrenaline and epinephrine going you can kill your lymphocytes or you can just say choose peace you know and just just choose peace if you’re involved in a tug of war with the nurse on the intensive care unit or you know whatever or one of your students if you let go of the rope you’re no longer involved I mean it doesn’t mean be passive and you know don’t ever do anything it just means you can escalate like that or you can practice forgiveness which is the one that I forgot not because I don’t but because I just didn’t remember when someone who when someone when someone comes to you with anger recognize it as underlying fear and return love and that’s very useful for me in encountering patients who were want to blame somebody for their disease you know they’re frightened so I don’t return anger you can do that but then that’s the tug-of-war but if you return love you totally disarm people and then one that’s really potent for me fear of our own mortality underlies most of our fears I know I get that from my parents because from my birth to my second birthday three out of four of my grandparents died my mother lost her mother and father can you imagine from my birth to my second birthday and so she not enough that she’s a typical Jewish mother but she vibrated all of this fear of loss of people that you know we love and fear of mortality into me that I think is what you know got me interested in my field which is first cancer than HIV and now cancer again because you know just trying to get a grip on my personal but recognizing that fear of our own mortality underlines most of our fears also allows us in a way to go back to number one and choose peace also I think humor is something I believe in maybe you could tell but there was recently a study that was published of a group that I don’t often think of as it’s so humorous particularly but Norwegians who are maybe they are followed for seven years I’m sorry I don’t mean to offend anybody though please don’t have the ambassador write me a letter but participants filled out a survey on how easy they found humor and its importance and the greater the role that humor played the greater the chance of survival over the next seven years the people who were the most humorous in the top quarter have were 35% more likely to be alive than the lowest quarter and in the 2015 patients with a cancer diagnosis at baseline a greater sense of humor reduced the chance of dying by 70% they say humor works like a shock absorber in a car allowing us to you know without getting all addled coming to the end of our 12-point program think about and try to discover for yourself the benefits of aging and this PowerPoint demonstrates some things that we venerate that are old Stradivarius –is red wine cheese’s redwood trees what about old people why do we put them away why do we hide them in Okinawa where Andrew Weil goes a lot when they have celebrations and parades the elder of the village or the or the neighborhood is paraded in front of everyone to start the whole thing because they’re venerated we need to get into that space where we appreciate age and we venerate it there are benefits of Aging we get experience and wisdom we have the gift of time to be creative and enjoy others creativity spend time with family enjoy nature freedom senior discounts the last movie I went to the Queen yes right here at kabuki they gave me my first ever I have it still in my in my pocket it was one of those times well do you do you really want to do this or not you know but for 2 bucks you know really in July I’m gonna go to Hilda’s birthday Hildy’s gonna be 90 in Kansas City this is her daughter and her daughter and her daughter so that’s four generations and I think that’s another benefit of aging that you can see your family grow and you can experience the love and support of your family do not deny the reality of Aging or put energy and trying to stop it use the experience of aging as a stimulus for spiritual awakening in growth too many of us in our society are trying to reverse the aging process by taking pills by having facelifts by doing tummy tucks by trying to do anything to say that we’re not aging we are and we need to appreciate

aging as a fact of life and something that’s very important and very beautiful Andy ends his book by saying something that was very important I 8 III was in an assisted living facility before he broke his hip recently and he was writing still for their monthly newsletter and I didn’t want I didn’t think he could cope with the whole book healthy aging but the last chapter was about something that Andy calls the ethical will which he says is based in Judaism and basically instead of just be queefing the people to come after you material items you should keep a little diary or a little manuscript which bequeaths to your successors what you learned in your life and how to best cope it’s called an ethical will and there’s a great example of his own in the last few pages of the book and I really think that that’s a great gift I did ask my father – why don’t you write about this for the folks but he didn’t get a chance to he’s now in a different place with his wife and he doesn’t write for the newsletter anymore so the bottom line of this as summarized in that Newsweek article all of this research holds a fairly obvious lesson life itself is lethal and the things that make it sweet make it more lethal chances are that by starving and castrating ourselves I didn’t I didn’t tell you about castration but we can talk about it we really could secure some extra years but most of us would gladly trade a lonely decade of stubborn survival for a richer middle life middle-aged our bodies are designed to last only so long but with care and maintenance they’ll live out their warranties in style so thank you I just want to invite all of you who haven’t been we have some brochures in the back and some brochures in the front to the Osher Center where we’re celebrating our 10th anniversary this year the clinic’s only been in action for five years we have massage therapists traditional Chinese medicine practitioners mind body providers well family practice integrative oncologist physical therapist personal trainers many many things that people can take advantage of and I wish you all healthy aging