I recently turned 60. To help celebrate the occasion, friends organized a surprise party. After the festivities, there came a time to reflect, and I came to an uncomfortable conclusion: I am closer to that period in life when my energy and powers will diminish and I will lose my independence. At age 60, the organs of the body gradually begin to fail and the first hints of age-related disease begin to appear.
I hardly notice my aging on a day-to-day basis. When I look in the mirror each morning, my face and white beard seem the same as the day before. But in photographs from the 1970s, my beard is completely black. On closer inspection, I notice other changes in my body: more aches and pains, less resilience, less vigor. And my memory may not be quite what it used to be. At the same time, despite the evidence, some part of me feels unchanged. In fact, I feel the same as when I was 6.
Some years ago I went to my 25th high school reunion. I had not seen most of my classmates since our graduation in 1959. A few were just as I remembered them, hardly changed at all. Others looked so aged that I could barely find points of coincidence with the pictures of them I had in my head. Why the difference? Why are some individuals so outwardly altered by time and others not? Or, in other words, why is there often a discrepancy between chronological age and biological age?
I believe the answer has to do with complex interactions of genetics and environment. I also believe, on the basis of evidence I have reviewed, we actually have control over some of those factors.
I do not subscribe to the view that aging suddenly overtakes us at some point in life, whether at 60 or some other milestone. I meet researchers, physicians and others who believe that we are born, grow rapidly to maturity, and then coast along on a more or less comfortable plateau until we begin to decline. They call the period of decline senescence and consider it distinct and apart from what came before.
I find it more useful to think of aging as a continuous and necessary process of change that begins at conception. Wherever you are on the continuum, it is important to learn how to live in appropriate ways in order to maximize health and happiness. That should be an essential goal for all of us. What is appropriate when you are in your 20s is likely not going to be appropriate in your 50s.
We can mask the outward signs of the process or try to keep up old routines in spite of it, but we cannot change the fact that we are all moving toward physical change. The best we can do—and it is a lot—is to accept the inevitability of aging and try to adapt to it, to be in the best health we can at any age. To my mind the denial of aging and the attempt to fight it are counterproductive, a failure to understand and accept an important aspect of our existence. Such attitudes are major obstacles to aging gracefully.
Which brings me to the subject of antiaging medicine.
The Antiaging Business
Antiaging medicine is nothing new. What is remarkable, though, is its growth into an organized field, with journals, annual meetings and a concerted attempt by leaders to have it recognized as a legitimate specialty of orthodox medicine.
There are at present no effective antiaging medicines. Yet the field keeps expanding. Currently, popular practices include live-cell therapy (injecting the fetal cells of animals into human beings), caloric restriction (drastically limiting the number of calories a body takes in) and hormone therapy (to restore hormones to levels found in younger people).
My bottom line for now is that these theoretical breakthroughs serve only as distractions from what’s important—namely, learning to accept the inevitability of aging, understanding its challenges and promises, and knowing how to keep minds and bodies as healthy as possible while moving through life’s successive stages.
To age gracefully means to let nature take its course while doing everything in our power to delay the onset of age-related disease. Or, in other words, to live as long and as well as possible, then have a rapid decline at the end of life.
In the following pages, I will share some of my recommendations for what you can do to experience healthy aging. They are not intended to help you grow younger, to extend life beyond its reasonable limits or to make it easier for you to deny the fact of aging. The goal is to adapt to the changes that time brings and to arrive at old age with minimal deficits and discomforts—in technical terms, to compress morbidity. I hope that you will discover and enjoy the benefits that aging can bring: wisdom, depth of character, the smoothing out of what is rough and harsh, the evaporation of what is inconsequential and the concentration of true worth.
An Ounce of Prevention
Taking care of the body means different things at different stages in life. For example, accidents are major causes of death and disability in people in their teens and 20s, often the result of thoughtless or reckless behavior, such as riding motorcycles without helmets, diving headfirst into murky bodies of water and using drugs and alcohol unwisely.
There is much you can do to prevent illness, including having a complete physical exam and regular checkups. But there are two specific points of preventive health care that I feel need emphasis:
Don’t smoke. Tobacco addiction is the single greatest cause of preventable illness. Exposure to tobacco smoke not only increases the odds of developing many kinds of cancer but also raises the risks of cardiovascular and respiratory diseases. Inhalation of vaporized nicotine is as addictive as the smoking of crack cocaine or crystal methamphetamine. Almost all cases of tobacco addiction begin in the teenage years or earlier; therefore, I address this message to young readers. Do not experiment with smoking: the chance of becoming addicted is too great, and this is one of the hardest of all addictions to break.
Watch your weight. Morbid obesity, sometimes defined as being 50 kg or more above your “normal” weight, is incompatible with healthy aging because it increases the risk of a number of age-related diseases, including cardiovascular disease, Type 2 diabetes and osteoarthritis. Ordinary obesity—weighing at least 20% more than you should—correlates with milder forms of these diseases as well as with increased incidence of postmenopausal breast cancer and cancer of the uterus, colon, kidney and esophagus.
It should be obvious by now that diets don’t work, except in the short term. By definition, diets are regimens that eventually end, and when people go off them the weight that was lost is almost always regained. I am going to urge you to follow a diet that I believe can increase the probability of healthy aging, but I hesitate even to call it a diet. It is absolutely not intended as a weight-loss program, nor is it an eating plan to stay on for a limited period of time. Rather, it is the nutritional component of a healthy lifestyle. I like to call it the Anti-Inflammatory Diet.
The word inflammation suggests “fire within,” a graphic if inaccurate image. Normal inflammation is the healing system’s response to localized injury and attack. It is confined to that location, serves a purpose and ends when the problem is resolved. Abnormal inflammation extends beyond its appointed limits in space and time; it does not end when the problem is resolved. The inflammatory process unleashes some of the immune system’s most sophisticated weaponry, including enzymes that can rupture cell walls and digest vital components of cells and tissues. When inflammation targets normal tissues, when it just won’t quit, it is abnormal and promotes disease rather than healing. Abnormal inflammation has been linked to a wide range of diseases, including cancer, coronary heart disease and the autoimmune diseases—Type 1 diabetes, multiple sclerosis, rheumatic fever, rheumatoid arthritis and systemic lupus.
I believe without question that diet influences inflammation. The food choices we make can determine whether we are in a proinflammatory state or in an anti-inflammatory one. The anti-inflammatory diet offers specific recommendations for foods to include and foods to avoid.
It is probably possible to lead an inactive life and still experience healthy aging, but it isn’t likely. Almost all the healthy seniors I know were physically active throughout life, and many of them still are. They walk, dance, play golf, swim, lift weights, do yoga and Tai Chi.
Of course, it is possible to get too much physical activity, not just because overactivity raises the possibility of damaging joints, muscles and bones, but also because of the possible adverse effects on body composition, the nervous system and reproductive and immune function. Knees are especially vulnerable, and surgical methods for repairing them are less than ideal. Repeated concussive injuries, as in football and soccer, may be associated with cognitive impairment in later life. That said, far more people in our culture err on the side of getting too little physical activity than too much.
Walking, if you do it vigorously enough, is the overall best exercise for regular aerobic activity. It requires no equipment, everyone knows how to do it and it carries the lowest risk of injury. The human body is designed to walk. You can walk in parks or shopping malls or in your neighborhood. To get maximum benefit from walking, aim for 45 minutes a day, an average of five days a week.
Rest and Sleep
In addition to adequate and proper physical activity, the human body needs adequate and proper rest and sleep. Most children and young adults have no problem getting them. Older people often do.
The few memories I can retrieve of nursery school and kindergarten are of afternoon naps after milk (which I didn’t like) and cookies (which I did), curled up on a blanket on the floor of a classroom, often in a patch of sunlight coming through a window. It was so easy then to nap and wake up refreshed. I’ve had to relearn that process in my 60s—without the cookies.
One change I notice is that I get sleepy earlier than I used to, sometimes by 8:30 or 9 if I am having a quiet evening at home. I don’t want to go to bed that early, because if I do, I’ll get too much sleep or wake up when it’s still dark. Sleep experts call this “advancement of the sleep phase” and note that it is a common experience of older people.
So, here is my advice about rest and sleep for healthy aging:
Rest is important. Make time for daily periods when you can be passive, without stimulation, doing nothing.
Naps are good. Try to get into the habit of napping: 10 minutes to 20 minutes in the afternoon, preferably lying down in a darkened room.
To minimize early waking, try to postpone the evening meal until after dusk and schedule some kind of stimulating activity in the early evening.
If your mind is too active when you get into bed, you will not be able to fall asleep, no matter how tired you are. It is good to know one or more relaxation techniques that can help you disengage from thoughts. More on those later.
Life is stressful and always has been. Eliminating stress entirely is not an option. If there are discrete sources of stress in your life—a relationship, a job, a health problem—you can and should take action to try to mitigate them. But my experience is that we all are subject to a kind of conservation law of stress. If stress recedes in one area, it seems to increase in another. Get your finances in order, and your relationship sours. Get your relationship together, and the kids cause you grief.
Whatever objective stress you have to deal with, you can learn to activate the so-called relaxation response, a shift within the autonomic nervous system from sympathetic dominance (the fight-or-flight response) to parasympathetic dominance (the heart rate slows, blood pressure falls and metabolism and immunity are optimal). You can evoke the relaxation response in many ways: by working on your breathing, practicing yoga, taking biofeedback training, floating in water or stroking a cat or dog that you love.
Thoughts, Emotions and Attitudes
Your thoughts, emotions and attitudes are key determinants of how you age. The most common forms of emotional imbalance—depression and anxiety—are so prevalent that they can properly be called epidemic. They affect people of all ages, including a large percentage of the elderly. Doctors manage them with antidepressants and antianxiety agents—the key word here being “manage.” These drugs suppress depression and anxiety; they do not cure them or get to their roots.
Cognitive behavioral therapy, or cbt, has become popular only in recent years. It traces its remote origins in part to the teachings of a Greek philosopher, Epictetus, a former slave who developed a science of happiness. Perhaps the best-known expression of Epictetus’ philosophy is the Serenity Prayer, attributed to the Protestant theologian Reinhold Niebuhr and adopted by Alcoholics Anonymous: “God, grant me the Serenity to accept the things I cannot change, Courage to change the things I can, and Wisdom to know the difference.”
Five hundred years ago, the Buddha taught his followers that unhappiness derives from the incessant habits of judging every experience as pleasant, unpleasant or neutral and of trying to hold on to the pleasant ones while shunning the unpleasant.
One of the tenets of the integrative medicine that I practice is that health and illness involve more than the physical body. Good medicine must address the whole person: body, mind and spirit. My aim is to call attention to our unchanging essence—the part of us that remains the same no matter how much our appearance changes.
I consider it important for both doctors and patients to know how to assess spiritual health. Today there is a minor trend in medical education to offer some instruction in this area. More often than not, however, it is offered as an elective, and often it is linked to teaching about death and dying. At its best, it makes medical students aware of this other dimension of human life and gives them tools to help patients know their strengths and weaknesses, whether or not they have life-threatening illnesses.
One way to promote spiritual well-being is through the writing of an ethical will. An ordinary will or last testament mainly concerns the disposition of your material possessions at death. An ethical will has to do with nonmaterial gifts: the values and life lessons that you wish to leave to others.
In many cultures, elders, sages and saints have saved some of their pithiest teachings for students and disciples gathered at their deathbeds. Hindu saints, Zen masters and Jewish rabbis have been particularly good at this sort of thing; many of their final words have been written down for posterity. Jewish ethical wills almost 1,000 years old are preserved, and the practice of writing them appears to go back at least 1,000 years before that.
I can think of no better way to close this article than to recommend that you undertake the composition of an ethical will. No matter how old you are, it will make you take stock of your life experience and distill from it the values and wisdom you have gained. You can then put the document aside, read it over as the years pass and revise it from time to time as you see fit. It can be a wonderful gift to leave to your family at the end of your life, but I think its primary importance is what it can give you in the midst of life.
Aging brings rewards as well as challenges. And to age gracefully requires that we stop denying the fact of aging and learn and practice what we have to do to keep our bodies and minds in good working order through all phases of life. The first step toward aging gracefully is to look at the process squarely and honestly and understand it for what it is. My hope is that I have helped you to do just that. Autor: Andrew Weil