Hip fracture is an iconic bugaboo of old age. It is a chronic condition in the sense that its complications, such as Depression, blood clots and pneumonia often extend long beyond the healing process.
Predisposing factors include old age and associated risk factors like osteoporosis, sarcopenia (loss of muscle mass and strength), poor vision, poor balance and hazards in the home.
FALLING is the usual agency that produces the fracture. At the risk of being ostracized, I will point out that thousands of injuries sustained by walking or tripping over dogs (and cats) occur every year.
In my small “hilltop” group of friends, there was 1 fatality, 1 shoulder fracture-dislocation, 1 hip fracture, and 0 acknowledgements of animal causation. Members of the family are immune to blame.
Treatment of hip fracture involves surgery with pins, or the more cost-effective Hip replacement. PREVENTION is critical. Osteoporosis must be prevented by exercise, Calcium, vitamin D, and avoidance of certain medication like Corticosteroids.
Balance should be developed by exercises. Vision problems, such as cataracts,should be corrected. Muscle mass should be preserved by diet and exercise, and the home cleared of throw-rugs and obstacles removed.
Just yesterday, a friend wearing socks (reducing friction?) fell down some stairs after stepping over a dog-gate. She is scheduled to have her elbow pinned. Have I mentioned SLEEP, DIET and EXERCISE RECENTLY?
Every year, as millions of people around the world forge new resolutions to eat healthier and lose weight, US News & World Report releases a conveniently timed ranking of the best diets. A panel of experts in obesity, nutrition, diabetes, heart disease, and food psychology rigorously rate each of 39 diets on seven criteria:
- Likelihood of losing significant weight in the first 12 months
- Likelihood of losing significant weight over two years or more
- Effectiveness for preventing diabetes (or as a maintenance diet)
- Effectiveness for preventing heart disease (or for reducing risk for heart patients)
- How easy it is to follow
- Nutritional completeness
- Health risks (like malnourishment, too-rapid weight loss, or specific nutrient deficiencies)
1. Mediterranean diet
Emphasis on fruits, veggies, whole grains, olive oil, beans, nuts, legumes, fish and other seafood. Eggs, cheese, and yogurt can be eaten in moderation. Keep red meats and sugar as treats.
2. DASH (dietary approaches to stop hypertension) diet — TIE
Eat lots of fruits, veggies, lean protein, whole grains, and low-fat dairy. Avoid saturated fats and sugar.
2. Flexitarian diet — TIE
Be a vegetarian most of the time. Swap in beans, peas, or eggs for meats, and consume plenty of fruits, veggies, and whole grains. You can look up more details because there’s actually a full meal plan involving breakfast, lunch, dinner, and two snacks to add up to a total 1500 calories per day. But feel free to also just swap in flexitarian meals ad hoc.
4. Weight Watchers
The first actual paid program on the list, WW uses a points system to guide dieters towards foods lower in sugar, saturated fat, and overall calories while consuming slightly more protein. There are a variety of paid WW plans, with the lowest being about $20 per month.
5. Mayo Clinic diet — TIE
A two-part system, with part one (‘Lose it!’) involving adding a healthy breakfast (i.e. fruits, veggies, whole grains, healthy fats) plus 30 minutes of exercise per day. You’re not allowed to eat while watching TV or consume sugar except what’s naturally found in fruit. Meat is only allowed in limited quantities, as is full-fat dairy. The second phase (‘Live it!’) is basically the first phase but with more flexibility. You aren’t realistically going to cut out sugar forever, and the Mayo Clinic diet acknowledges that. So the long term plan involves lots of whole grains, fruits, veggies, and healthy fats. Less saturated fats and sugar.
One of my previous posts, “bad breath”, was so well received that I am emboldened to deal briefly with another important, if politically incorrect, topic; Constipation.
I have anemia, and take regular IRON, which produces constipation. A high fiber diet solved it. My bones have also been thinning over the years into Osteopenia, a deficiency of Calcium. I Increased my calcium intake with some CALCIUM citrate powder, and developed one of the worst episodes of Constipation I have ever had, in spite of my high fiber diet.
Stopping the Calcium leaves me with the osteopenia worry, but was a great relief. Many other medications can cause constipation. Ask your Pharmacist for a list.` Hypothyroidism, and a variety of autoimmune, intestinal and neurological conditions have constipation as a symptom.
As I struggled with something that should be automatic, I worried about possibly pushing out a hernia, ballooning out one of my colonic diverticula, or developing hemorrhoids. These are all complications of constipation, not to mention the big waste of time. Regularity is much to be desired.
If you have regular SLEEP and EXERCISE a low Calorie density, high fiber diet, and are not taking a lot of drugs and supplements, you most likely don’t have constipation. If you have constipation, you might consider examining your sleep, diet, exercise and medications. If you don’t want to change your habits and medication, try METAMUCIL and drink lots of WATER.
Old age is an inevitable condition if you are lucky enough to live a long life. Middle aged people say it begins at 70 years of age. According to an Elysium survey of people 40 and older, the average American FEELS old for the first time at age 47 years.
In the distant past, 50 was CONSIDERED to be old. The generally better conditions and Medicine of modern times keeps extending LIFESPAN, if not always HEALTHSPAN. Old age is certainly a Condition, and it is for sure Chronic, thereby qualifying for inclusion, but is it a Disease?
It is not considered a disease by the authorities, and so it doesn’t gather research funds like it should. What exactly IS old age? Being 88 Years old, and a physician, I feel qualified to comment. Old age is a collection of past accidents and sports injuries plus complications of past illnesses engrafted on a gradually deteriorating body.
Where does Obesity and Metabolic syndrome fit in this rubric? The Plague of our time fits in the disease category. It is definitely preventable, although with difficulty. Please search past postings for more information on this topic.
In what way does the body gradually deteriorate? Any organized, non-random high information structure gradually becomes more disordered, and “worn away” with the passage of TIME, the destroyer. Entropy (disorder) gradually increases, in the absence of corrective energy input.
Even rocks and mountains eventually erode, given enough time. One of the most interesting characteristics of life is that it maintains its integrity for an inordinate amount of time, given its complexity and furious dynamism.
Every day our DNA sustains thousands of molecular ruptures from high energy radiation and other stressors. Proofreading and repair mechanisms are employed, at high energy cost, to repair these breaks. This corrective is especially efficient when we are young and vigorous; In our youth, our reproductive years, growth and repair predominate. Gradually, growth ceases, repair mechanisms age, and we become old.
Our Darwinian “warranty” expires. We are left with an aging body, unimportant to evolution. We are long on experience and short on future. But we still have a marvelous metabolism at our disposal, depending on our lifestyle. There are a number of metabolic pathways which affect aging, 2 of which have been more studied.
The mTOR pathway is most attuned to youth, senses nutrients and gears up for ANABOLISM, or growth. If you have not been careful to tailor your food intake to suit your decreasing requirements, your efficient metabolism stores it away for a rainy day, around your belly and in your arteries, a bad effect from an essential mechanism. Antagonistic Pleiotropy is the name for a body mechanism that can be good for one function (or age) and bad for another.
The Sirtuin system is also important in aging, and has a variety of housekeeping functions, including mitochondrial maintenance. It is activated by exercise. The cells of our bodies change with aging. In old tissues, there are less stem cells and other young, functional units. There are more damaged, dysfunctional “zombie” cells that don’t do much but promote inflammation, and hence more inflammatory cells accumulate.
Controlling the mTOR System and promoting the sirtuins help increase apoptosis and get rid of dysfunctional cells, including cancer. DOCTORS SHOULD PRESCRIBE EXERCISE, as well as SLEEP AND DIET, like they do medicine, and maybe we wouldn’t need so many pills. We might also feel better into old age.
Disease, Metabolic syndrome, Entropy, DNA, Metabolism, Apoptosis, Zombie cells
Dietary patterns with a higher proinflammatory potential were associated with higher CVD risk. Reducing the inflammatory potential of the diet may potentially provide an effective strategy for CVD prevention.
Inflammation plays an important role in cardiovascular disease (CVD) development. Diet modulates inflammation; however, it remains unknown whether dietary patterns with higher inflammatory potential are associated with long-term CVD risk.
The number of older people, including those living with dementia, is rising, as younger age mortality declines. However, the age-specific incidence of dementia has fallen in many countries, probably because of improvements in education, nutrition, health care, and lifestyle changes.
Overall, a growing body of evidence supports the nine potentially modifiable risk factors for dementia modelled by the 2017 Lancet Commission on dementia prevention, intervention, and care: less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact.
We now add three more risk factors for dementia with newer, convincing evidence. These factors are excessive alcohol consumption, traumatic brain injury, and air pollution. We have completed new reviews and meta-analyses and incorporated these into an updated 12 risk factor life-course model of dementia prevention. Together the 12 modifiable risk factors account for around 40% of worldwide dementias, which consequently could theoretically be prevented or delayed.
The potential for prevention is high and might be higher in low-income and middle-income countries (LMIC) where more dementias occur. Our new life-course model and evidence synthesis has paramount worldwide policy implications. It is never too early and never too late in the life course for dementia prevention. Early-life (younger than 45 years) risks, such as less education, affect cognitive reserve; midlife (45–65 years), and later-life (older than 65 years) risk factors influence reserve and triggering of neuropathological developments.
Culture, poverty, and inequality are key drivers of the need for change. Individuals who are most deprived need these changes the most and will derive the highest benefit.
Lancet’s 2017 Metanalysis mentions 9 Dementia risk factors. The 2020 Paper adds 3 additional factors. TRAUMATIC BRAIN INJURY, ALCOHOLISM, and AIR POLLUTION.
The inclusion of Trauma, with a 3% weighting, may be due to the increased awareness of TBE stemming from football injuries. The preventable 12 Factors are still in the minority. 60% of the factors are not preventable, since they are Genetically determined.
LESS EDUCATION, HEARING LOSS and SOCIAL ISOLATION, 3 of the original 9 factors,all lead to less brain stimulation, and can be unified under the idea of COGNITIVE RESERVE. If a person starts with less Cognition, it is reasonable to think he would be Demented sooner.
Together, less education, hearing loss, and social isolation account for almost Half of the correctable conditions. SMOKING is one of those things which impact almost every human disorder. It is amazing that cigarettes are still manufactured. In fact, their use is actually Increasing,especially the Far East, where they probably account for much of the escalating problem with Dementia in that region.
Our favorite causes, Sleep, Diet, and Exercise, apparently play only a minor role in Dementia. Sleep is completely dismissed in this report. The fact that both Sleeping less than the Ideal 7-8 hours, and more than that amount is thought to correlate with health problems is probably the main reason for the omission.
My own opinion is that people who are in poor health may need more sleep, and therefore sleep longer. My own sleep is interrupted 3-5 times per night, so it is not surprising that I need an hour extra to feel rested. Any less than 9-10 hours, and I need a nap, which in my opinion is a sign of insufficient nighttime sleep. Poor sleep may be a factor in metabolic syndrome, often leading to DIABETES, OBESITY, and HYPERTENSION, which are factors in Dementia, mentioned in the article as bit players.
PHYSICAL INACTIVITY is mentioned as a minor factor in Dementia, but exercise, studied as a treatment of dementia, was found to improve only strength. Diet is not mentioned, but does contribute to OBESITY, which is a minor factor. Dementia is a great emotional and economic burden, afflicting many otherwise happy families with misfortune.
The Lancet metanalysis is admirable. But don’t forget the healthy lifestyle emphasizing Sleep Diet and Exercise; and exercise includes cognitive exercise. Anything we can do to avoid dementia is worthwhile. –
ABDOMINAL (VISCERAL) FAT KILLS. The following post tells you how, and suggests what you might do to prevent this scourge, which is gradually becoming an epidemic in America.
OBESITY is an energy imbalance problem. MORE CALORIES ARE CONSUMED THAN ARE NEEDED AND CAN BE UTILIZED. A Good quality Diet, with lots of natural (rather than processed) foods, especially vegetables and fruits, have lots of FIBER that takes up space and makes you feel full.
Fiber also feeds the MICROBIOME. If the foods are DIVERSE, the microbiome will also be diverse and help utilize the calories you eat. A healthy Microbiome also contributes to your health by manufacturing neurotransmitters, vitamins, and other factors that are just starting to be appreciated. Diet QUALITY, as well as quantity, is important.
EXERCISE is critical for more than utilizing calories. It increases ADIPONECTIN which guides fat to fat stores where they belong, rather than to the liver, and IRISIN which favors the production of BROWN FAT, thus utilizing energy. The opposite of exercise, the SEDENTARY LIFESTYLE, is now considered a disease system in itself.
Lack of SLEEP favors obesity in a number of ways; at the very least, you can’t eat while asleep. Abdominal fat contains INFLAMMATORY cells which go directly to the Liver via the hepatic portal system to cause metabolic disruption. Insulin sensitivity falls, blood sugar, LDL and triglycerides rise. DIABETES and the METABOLIC SYNDROME result.
The excessive weight also causes back, hip and knee problems which contribute to the 10% increase in overall medical costs due to Obesity.
We have no photographs, abdominal, navel-level girth measurements, CTs, BMIs or death certificates to prove it, but it is highly unlikely that Paleolithic Humans suffered from excessive abdominal fat. They had no refrigerators, deliciously packaged snacks, sugary, fructose-containing soft drinks and candy, nor did they have cave-lighting to extend their daylight eating hours and disrupt their diurnal rhythm.
They had to walk or run long distances to obtain their meagre food supplies, which tired them out so that they most likely had a good night’s sleep. SLEEP, DIET and EXERCISE are built into our Metabolism by Darwinian Evolution. Paleolithic humans didn’t live long lives and succumb to cancer and heart disease.
They died most often by violence, which made Blood clotting a survival benefit, rather than the Risk factor for stroke and heart attacks that coagulation is to us now. It is not all our fault that OBESITY is steadily increasing over the last few decades.
CAPITALISM is driven to provide us with ever increasingly available and tasty food. Both consumers and purveyors scream when even the most logical political check on OVEREATING is legislated: Taxing of sugary, fructose-containing, nutritionless soft drinks was tried in Philadelphia to a chorus of complaints. To my knowledge the tax has survived, reduced sugary drink consumption, and was helpful in reducing the weight of Philadelphia residents. Not many cities were brave enough to follow suit.
GENETIC Influences can also conspire against weight control. The FTO gene, while relatively infrequent does have an influence, as shown in twin studies. And there seems to be a SET POINT in weight that makes it difficult to take off the pounds and keep them off. 2 years after almost all diets, the weight has returned. Eating HABITS, once established are hard to change.
BARIATRIC SURGERY has been shown to help Obesity, as well as Metabolic syndrome and Diabetes .I hope it will survive the test of time. Weight gain is easier to PREVENT than it is to treat. Somehow, society must get to the children, and keep them from gaining weight in the first place. Even children are now becoming obese.
INTERMITTENT FASTING can help contain Obesity. My own version is TIME-RESTRICTED EATING. I limit my eating to 6 hours a day, from Noon (usually 1PM) until 6PM. This has resulted in a modest weight loss from 142 pounds to 137 pounds. My son lost some 30 pounds in a 30 day, 1000 calorie “crash” diet to fend off advised Back Surgery. He exercised a lot of SELF CONTROL both to lose the weight, and to keep it off.
Unfortunately, Self Control is in short supply in our present SOCIETY OF EXCESS. Good luck in your quest, if you choose to embark on weight reduction. And good luck with your health if you don’t. I recommend “the secret life of fat” by Sylvia Tara in either case. Also, search for intermittent fasting in DWWR.