Pumping Irony

Craig Cox, EL’s managing editor and resident geezer, explores the joys and challenges of aging well.

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Generation Gap?

By Craig Cox / April 14, 2013

Here’s some good news for aging Baby Boomers: As bad as we may feel about our waistline, our cholesterol count, and our blood pressure, we’re actually healthier, as a group, than the generations chasing us.

That’s the conclusion of a study out of the Netherlands, reported in the current issue of the European Journal of Preventive Cardiology. Researchers looked at the metabolic health of 6,000 individuals in their 20s, 30s, 40s, and 50s over the course of 35 years and found that each successive generation had a higher prevalence of heart disease risk factors (weight, blood pressure, cholesterol levels) than the previous one. In the first batch of 30-somethings, for example, 40 percent were overweight. The 20-somethings at the time might have felt a big smug about that, but 10 years later, when they hit their 30s, more than half of them (52 percent to be exact) had ballooned into obesity land.

“The prevalence of obesity in our youngest generation of men and women at the mean age of 40 is similar to that of our oldest generation at the mean age of 55,” explained the study’s lead author, Gerben Hulsegge of the Dutch National Institute for Public Health and the Environment. “This means that this younger generation is 15 years ahead of the older generation and will be exposed to their obesity for a longer time.”

Being the competitive sort, I’m inclined to feel pretty good about this until it hits me that it’s a trend that could have serious public health implications. We’re not supposed to be stressing the healthcare system until we hit our 60s, 70s, and 80s. What happens when youngsters in their 40s and 50s start ringing up monstrous bills at hospitals and pharmacies for “old-folks” maladies like hypertension, diabetes, and heart disease? It can’t be good.

The basic culprit in all this, according to Hulsegge, is an epidemic of inactivity among young adults. That’s not too surprising, actually. We all slow down a bit as we age. And I can recall feeling pretty much immortal before I hit my 60s; no need to go out of my way to exercise or eat right, since I would always be a healthy and vigorous young man.

Unfortunately, reality eventually intervenes. And sometimes sooner than you might imagine. I can’t tell you how many stories I’ve read in recent years about athletic young people who woke up in their 30s to find they’d lost their edge — and put on some serious poundage.

If that’s not enough motivation to get off the couch, try imagining a bunch of smug Boomers comparing notes on their latest triathlon times and lamenting the sorry state of our young people’s health.

I know. Pretty disgusting. See you at the gym.

Don’t Worry, Start Moving

By Craig Cox / March 24, 2013

When a guy reaches advanced middle age, I suppose it’s natural to begin worrying about your longer-term health prospects. Little things begin to crop up occasionally that remind you of your mortality.

This is, of course, an excellent time to commit to a regular fitness regimen and take a close look at what you’re eating and all the things in your life that are causing undue stress. (It’s never too late. Really.) Mostly, we ignore this stuff and just do what we’ve always done because, well, it’s hard to change. And most of us just assume that if something serious crops up, we can just go to the doctor and get a prescription for some kind of pill that will make things all right again. Even if there’s nothing really wrong with us.

Here’s a case in point: As most of us know, heart disease is the number-one killer of Americans, and “bad” cholesterol, we’ve been told, is the primary cause of heart disease (though some have argued that cholesterol is getting a bad rap), so Big Pharma has developed a type of drug, called statins, that reduce all that “bad” cholesterol so we don’t have to change our eating habits or starting exercising.

And because everybody’s got to make a living, Big Pharma promotes the use of statins pretty much incessantly in TV commercials. Geezers like myself see these ads and get to wondering whether their old ticker is really as healthy as they think it is. So why not get over to the doctor and get a prescription? It’s a whole lot easier than working up a sweat at the gym or avoiding the drive-thru at McDonald’s.

Doctors are more than happy to oblige folks in these cases. A new study out of Cornell University showed that one in five people exposed to statin ads were likely to be using the drug — even though they were considered to be at a low risk for a heart attack.

I can’t fault the doctors, to be honest. People are paying good money for health insurance, and I suspect they expect to come away from every visit with something more tangible than a suggestion that they start working out and eating more kale. Besides, better safe than sorry, right?

Well, there’s actually a fair amount of debate around the cholesterol question and some real concerns about the side effects of statins. And, rather than worrying about your heart attack risks, I might suggest that you get up off the couch and move around a little. Twenty minutes of moderate exercise every day can make a world of difference, no matter how old you are. It might even help to regulate your appetite and quiet your cravings for fast food.

So stop worrying and start moving. It could prevent a heart attack. Without any drugs.

The Heart of the Matter

By Craig Cox / March 3, 2013

Last week, the venerable New England Journal of Medicine published the results of a study showing that your diet can have as significant an effect on your risk of cardiovascular disease as any prescription drug. The response from the medical industry was immediate. The New York Times called it “a watershed moment in the field of nutrition.” Neil J. Stone, MD, former chair of the American Heart Association’s nutrition committee, said, “This is the start of where we need to go with nutritional clinical trials.”

I have no medical training or credentials whatsoever, and all I could think was, Duh! In the world of alternative and integrative medicine, diet has always been seen as a key ingredient in a healthy lifestyle. I’d say it’s about time conventional medicine got a clue.

For the past 50 years, doctors have been pushing surgery and pharmaceuticals as the only way to prevent heart attacks and strokes. And when they did talk about diet, they preached the gospel of low-fat foods, despite numerous studies showing the nutritional value of healthy fats. (Check out “A Big Fat Mistake” for more on this.) So it’s hard to understand why a single study from the University of Barcelona, involving about 7,500 people, would have such an impact on the industry.

But, according to Dr. Daniel J. Rader, a heart disease specialist at the University of Pennsylvania, the Barcelona study tested the Mediterranean diet hypothesis in a way it had never been tested before. “Given the importance of diets and given the decades of dietary recommendations we have given to people, you would think we would have had more dietary studies with hard endpoints to get at these questions,” Rader told the Times. The best of these earlier studies looked only at intermediate markers of risk, like cholesterol levels (the results of which, it turns out, were mostly misinterpreted).

I might also suggest that there’s little incentive for researchers to turn their attention to dietary changes, when pharmaceutical remedies are far more lucrative. And I have to say that I’m not optimistic that organizations like the American Heart Association are going to change their views on this anytime soon. As Alice Lichtenstein, lead author of AHA’s dietary guidelines, told the Times, “We definitively need to test plausible diets, within the context of what is available and consumed in the U.S., that could lower the risk of heart disease.”

But when asked whether she thought a study of vegan diets and their effect on heart disease might be in the offing, Lichtenstein was not optimistic. “Given the high cost of conducting a long-term diet study, we have to think about what is feasible for the majority of the U.S. population,” she said. “From past experience, we know it is highly unlikely people are going to make radical changes in their diet and stick with those changes long term.”

Not exactly a ringing endorsement of the Barcelona study.

In fact, the medical industry is far behind the curve when it comes to nutrition and its impact on health. Michael Lauer, MD, director of the division of cardiovascular sciences at the National Heart, Lung and Blood Institute, says it reminds him of where heart attack research was 50 years ago, when victims were placed on bed rest and given lidocaine and nitroglycerin — a treatment regimen that tended to shorten, rather than lengthen, life spans.

The good news is that we don’t have to wait for Western medicine to catch up with functional medicine pioneers like Mark Hyman, Frank Lipman and others, who long ago began helping people regain their health through dietary and lifestyle changes. All we need to do is to educate ourselves about this approach, shift our eating habits and wean ourselves from a medical model that I fear is destined to forever be surprised by the obvious.

Numbers Game

By Craig Cox / July 1, 2012

Last week I had an interesting conversation with a registered dietitian, who was kind enough to take a look at the results of the lab tests I mentioned a while back. The upshot was that the numbers suggested I was at risk of heart disease and metabolic syndrome, my sex hormones were out of balance, and I was overstressed, deficient in vitamin D, maybe had some thyroid and digestive issues.

Other than that, however, I am fit as a fiddle.

Actually, the conversation began with my dietitian congratulating me for living such a healthy lifestyle, which got me to wondering what she might say to a client who wasn’t exercising every day, getting plenty of sunshine, and eating pretty well. I understand that there’s always room for improvement, and that these consultations are designed to push you a smidgen closer to optimally healthy choices, but I gotta say that, as much as I appreciate the fact that my employer wants to help us all be optimally healthy, I’m not one to respond very readily to numbers-based metrics.

For example, my VLDL-3 cholesterol reading was 10 milligrams/deciliter. The optimal reading is less than 10. So, if my number was 9, I’m assuming it would not be a “strong predictor of heart disease.” My cortisol (stress hormone) level was measured at 17.8, which according to the original lab report is well within the healthy parameters (6.2 – 19.4), but according to my dietitian falls outside the “optimal functioning values” established by an e-book called Consumer’s Guide to Interpreting Laboratory Testing. Same goes for my vitamin D levels, which at 46 nanograms/milliliter falls well within the guidelines set by the lab (32–100) but are “lower than optimal” according to my dietitian.

There are other similar curiosities, but I won’t bore you with the details. My point is that these numbers are simply numbers, and they can be interpreted in various ways. Indeed, some physicians argue that these sorts of direct-to-consumer lab tests should never be used for a diagnosis. As J. Edward Hill, MD, a former chairman of the American Medical Association, told the New York Times a few years ago, ”’The first thing I try to teach medical students is that about 90 percent of diagnoses can be made accurately by taking a good history and good physical exam. When you do testing, it is to confirm your suspicions.”

I’m not saying these tests can’t be instructive. I’m pretty convinced that I’m dealing with a certain amount of inflammation on a regular basis, and my prostate certainly ain’t what it used to be. Plus, it’s entirely possible that I’m carrying more stress than I’d like to admit. But I’m not going stress myself further by worrying about having a heart attack this week or next. In fact, I’m not going to worry about a thing as long as I feel as good as I feel today.

I can see a few changes I can make to my diet and exercise regimen, and there might even be a supplement or two that would do me some good, but overall I feel like I’m on the right path, no matter what the numbers say. If I keel over from cardiac arrest tomorrow on my way to work, feel free to have a good laugh on me. I’d be laughing too.

What’s the Score?

By Craig Cox / June 17, 2012

It’s an article of faith among consumers of conventional medicine — especially those who are soldiering on through advanced middle age — that you should always know what’s going on in your body. It’s called preventive medicine, an approach that gained popularity in the ’70s and continues to be favored by the medical establishment today, despite the fact that it has led to an onslaught of questionable screenings and tests (see PSA, mammograms) that have driven healthcare costs through the roof. I’m not a big fan of this approach, because I think these tests often produce faulty results, and even when the results are accurate, the cure may often be more harmful than the cause.

That said, I completely understand why most folks are so inclined to agree to these tests. The results are pretty interesting — though not in the way you might expect.

Awhile back, I was asked by one of my editorial colleagues to participate in a lab test as part of an upcoming feature article. (I’m representing the geezer segment of the population in this piece.) So I had some blood drawn at a nearby lab, and last week I found myself poring over the results with a lot more curiosity (and confusion) than I would have predicted.

The good news is that I seem to be pretty healthy — at least based on the majority of my lab results. Plenty of vitamin D, low cortisol levels, and glucose, sodium, potassium, chloride, calcium, protein and DHEA all landing where they’re supposed to land. The bad news is that it’s pretty likely that I’m going to have a heart attack.

That’s the problem with these lab tests: One or two measurements can make it seem like you’re on death’s doorstep. In my case, I appear to have “borderline” high cholesterol (238, when it should be below 200). But, digging a little deeper, I discover that what’s pushing that score up is my LDL count (149), which is considered a risk factor for developing arteriosclerosis. My HDL, or “good” cholesterol is right where it ought to be, as is my VLDL (“bad” cholesterol) levels.

Then there’s my C-Reactive Protein (or CRP), which weighed in at 4.12 milligrams/liter, slightly over the 3 mg/L that indicates a high risk for a “future cardiovascular event.” This gets me to thinking about all the people on my dad’s side of the family who had heart attacks, until I notice something in the fine print accompanying my test results: “There are other conditions that can raise CRP levels, including exercise and weight training. . . . The general aging process can also increase CRP levels.” I’m old and my morning workout involves lifting weights, so maybe that had something to do with it. Which gets me to wondering how exercising and weight lifting can contribute to heart disease.

But, wait. Maybe it doesn’t. A little more digging and I notice that, among the recommendations for reducing CRP levels is “30 minutes of exercise daily” along with weight training.

Thankfully, I get to talk with someone who can explain all this to me. That should be interesting.

No Excuses

By Craig Cox / November 11, 2009

My father died 30 years ago
today, so some of my siblings and I (along with my daughter) will be marking
the occasion later this afternoon at a tiny cemetery in Becker, Minn., where he
and my mother are buried – along with a large contingent of the Cox clan
(including my grandfather and great-grandfather).
There will be much reminiscing about our childhood years, I’m sure, and I
expect we’ll raise a few glasses of Grain Belt in his honor.

He made his living
delivering that golden elixir to bars and restaurants in St. Paul, an occupation
that earned him a barrel chest and arms like steel. (I remember returning from
Air Force basic training feeling pretty buff and foolishly challenging him to
an arm-wrestling match at the dining room table. It was over before I could
contemplate the true depths of my delusion.) He was strong, but somehow sickly
at the same time.

That barrel chest loomed
over an even larger belly (he fought weight issues for much of his adult life),
and he suffered from ulcers and other digestive ailments. His love of fried
foods and sweets was legendary around our house, and we all learned how to
smoke cigarettes and drink beer by observing him.

Of course, back in the ’40s
and ’50s none of us knew the dangers of smoking – much less the insidious
threats posed by greasy foods, refined carbs, a sedentary lifestyle and chronic
stress (Dad was a hall-of-fame worrier). So, when he landed in the hospital
with a heart attack at the age of 52, we were all shocked. And when cancer
claimed him eight years later, we all felt he’d been stolen from us.

So I was thinking about Dad
this morning while doing my morning zazen.
And later while sweating through a half hour of push-ups, planks and kettlebell
moves. He really didn’t know any better. I don’t have that excuse.

Fate or Fitness?

By Craig Cox / June 25, 2008

Russert: No guarantees

I was back in the gym last night for a pretty rigorous, fast-paced workout: 10 miles on the bike (average heart rate of 114) and a good half-hour of upper body and (a little) ab work on the machines. Worked up a pretty good sweat. Felt pretty good about myself.

Then, this morning, I stumbled across a piece in The New York Times that was trying to explain the sudden heart attack that killed NBC political guru Tim Russert, a guy who had apparently shown no symptoms of heart disease and then simply keeled over and died at his desk.
As Denise Grady explains, Russert’s death has raised serious questions about the efficacy of heart disease treatment options. The 58-year-old Russert was taking drugs to lower his blood pressure and cholesterol, rode an exercise bike regularly, had annual stress tests and was doing his best to lose weight. All these behaviors seemed to be working; according to his doctor, Russert had about a 5 percent chance of dying of a heart attack in the next 10 years.
So much for those odds….

Now, of course, anyone who’s been seeing their doctor regularly and who’s been doing what they think they should be doing to prevent cardiac arrest is going to start wondering whether they’re just wasting their time and ought to just get back to eating donuts and fried chicken like they used to do because they like donuts and fried chicken a lot more than they like to exercise. I mean, a lot of good all that stuff did Tim Russert, right?

Doctors like to point out in cases like this that medicine is not an exact science; you can do everything your doctor tells you to do to stay healthy and you’re still going to die at some point — maybe tomorrow, even if you’ve got important stuff to do. There are no guarantees.
Every one of my father’s siblings suffered a heart attack at some point in their lives. Most of them died. A couple of them, like my dad, survived the heart attack and succumbed later to cancer.

So, I’m pretty well-versed in this whole heart disease thing. And even though none of my siblings have keeled over from myocardial infarction yet, we’re not taking anything for granted. We’ve all given up smoking (except my little brother, who’s just stubborn) and everybody seems to be getting at least a little exercise from time to time, and we all know a lot more about healthy eating than my dad did back in the ’50s.

A friend of mine likes to point out that you can eat well, get plenty of exercise, live a low-stress lifestyle … and then get hit by a bus while crossing the street to get to your yoga class. And she’s right. There are no guarantees. Maybe Russert would’ve died five years ago if he hadn’t started exercising and taking drugs to lower his blood pressure, etc. Or maybe not.

My grandfather lived to be 93 and he smoked a cigar everyday and liked to drink whiskey and favored rocking chairs over exercise bikes.
So, you never know.
I’m about a year younger than Russert was at his death, and I’m doing everything I can to keep myself vertical for the long haul. But, it’s not really about avoiding the Grim Reaper, who we all know lurks around every corner and can maybe pluck us out of this earthly realm pretty much whenever he chooses (who really knows?). It’s about feeling good right here, right now.
After all, that’s all we’ve got, isn’t it?

Pumping Irony

Recently in heart disease Category

Generation Gap?

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Don’t Worry, Start Moving

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The Heart of the Matter

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Numbers Game

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What’s the Score?

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No Excuses

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Fate or Fitness?

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