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Kenneth L. Minaker, MD, FRCP(C), CSC(GM) Chief, Geriatric Medicine Unit

Improve Your Health … Extend Your Life. Kenneth L. Minaker, MD, FRCP(C), CSC(GM) Chief, Geriatric Medicine Unit Massachusetts General Hospital Associate Professor of Medicine Harvard Medical School. The Bottom Line. Aging as a process: Starts after growth/development

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Kenneth L. Minaker, MD, FRCP(C), CSC(GM) Chief, Geriatric Medicine Unit

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  1. Improve Your Health … Extend Your Life Kenneth L. Minaker, MD, FRCP(C), CSC(GM) Chief, Geriatric Medicine Unit Massachusetts General Hospital Associate Professor of Medicine Harvard Medical School

  2. The Bottom Line • Aging as a process: • Starts after growth/development • Aging impacting function: • Starts after age 80 • Aging is here to stay: • Aging helps prevent cancer developing • Aging can be modulated: • You can choose your path

  3. Healthy Life Expectancy We’re # 29!

  4. MYTH: Old people are all the same

  5. Renal Function Changes: GFR

  6. MYTH: Old people are all the same • REALITY: We are each of us more unique as we age

  7. Renal Function Changes: GFR

  8. MYTH: Once you’re old, there is little benefit of treatment • REALITY: The benefit of most therapies that help people is greater and more efficient in the elderly population.

  9. Number Treated for 5 yr for Blood Pressure to prevent 1 stroke or MI

  10. MYTH: Old Age starts at 65 • REALITY: While aging processes begin ~ age 30, limitation of function from aging (rather than disease) starts ~ age 80

  11. MYTH: The older you get, the sicker you get

  12. MYTH: The older you get, the sicker you get • REALITY: While disability does increase with age, staying healthy longer is the biggest trend in late life over the past 20 yr

  13. MF RoizenThe Real Age Makeover Harper Collins, 2004

  14. MYTH: The aging process can be defeated • REALITY: The aging process can be deferred in its impact

  15. Physiologic Reserves Available Physiologic Reserves Already In Use Increasing Age “The Precipice”

  16. MYTH: Ponce De Leon was right, there is a fountain of youth, if we could only find it • REALITY: Genetics, personal health choice, and illness management are the “potion” that has been found

  17. Three Ways to Evaluate Positive Lifestyle Choices: 1. Direct evaluation of choices: • Anecdote • Groups • Communities 2. Incorporation of choices into daily life: • Lifestyle Programs 3. Scientific review and guideline development • Institute of Medicine of the National Academies

  18. Lifestyle Choices for Health • If you are 45 years old and do all of these (rather than none) you will live longer. • (men- 7 years, women-11 years) • 1. Sleeping 7-8 hours per night • 2. Weight Control • 3. Exercise • 4. Limited Alcohol • 5. Non-smoking • 6. Eating Breakfast • 7. Seldom Snacking Belloc et al

  19. How to be Younger by 2 years or more from “The RealAge Makeover” • Genetic MF RoizenThe Real Age Makeover Harper Collins, 2004

  20. How to be Younger by 2 years or more from “The RealAge Makeover” • Skin/Dental MF RoizenThe Real Age Makeover Harper Collins, 2004

  21. How to be Younger by 2 years or more from “The RealAge Makeover” • Heart/Lungs/Exercise MF RoizenThe Real Age Makeover Harper Collins, 2004

  22. How to be Younger by 2 years or more from “The RealAge Makeover” • Brain/ Balance MF RoizenThe Real Age Makeover Harper Collins, 2004

  23. How to be Younger by 2 years or more from “The RealAge Makeover” • Social/ Behavioral MF RoizenThe Real Age Makeover Harper Collins, 2004

  24. How to be Younger by 2 years or more from “The RealAge Makeover” • Diet MF RoizenThe Real Age Makeover Harper Collins, 2004

  25. Foods for Health • 1. Tea, green 1-6 cups • 2. Coffee ? • 3. Fish 2-3 times/week • 4. Cooked Tomatoes 10 servings/week • 5. Fiber > 25 gm/day • 6. Nuts > 5 oz/week • 7. Chocolate dark • 8. Saturated fat < 10% total calories/day < 1/3 of all fat intake • 9. Fruit > 4 Servings/day • 10. Alcohol 1.5 oz/day- women 3 oz/day-men Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

  26. Macronutrient Intake as % of Energy • Fat 20-25 • Carbohydrate 45-65 • Added sugars <25% • Protein 10-35

  27. Lifestyle Recommendations • Exercise 60 minutes per day of moderately intense exercise (walking 3 mph)

  28. Elements for Health • 1. Potassium > 4,700 mg/day • 2. Sodium < 1,200 mg/day • 3. Water 3.7 liters/day men • 2.7 liters/day women • 4. Calcium > 1,200 mg/day • 5. Selenium 55 ug/day • 6. Magnesium 320 mg/day-women 420 mg/day-men • 7. Chromium 30 ug/day • 8. Copper 900 ug/day • 9. Iron 8 mg/day • 10. Manganese 2.3 mg/day • 11. Phosphorus 700 mg/day • 12. Zinc 11 mg/day Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

  29. Potassium Intake > 4700 mg/day • The main intracellular cation affects nerve, muscle and vascular tone • Good food sources include fruits, vegetables, leafy greens, vine fruits and root vegetables • Currently Americans consume much less potassium than these guidelines • Decreased potassium intake is associated with high blood pressure, kidney stones and thin bones Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

  30. Sodium (1,200mg/day) • Combined with chloride and known as salt • Salt maintains body fluid volume and particulate concentration for all metabolism • Current intake greatly exceeds the need • Most salt is added to food during processing • Excess causes high blood pressure and swelling Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

  31. Time (hrs) to excrete 50% of a sodium load vs. age: young (hatched), old (solid) Geriatric Nephrology and Urology 4:145-151, 1995 Delayed sodium excretion in normal aging Fish LC, Murphy DJ, Elahi D, Minaker KL

  32. Water Intake per day Men- 3.7 liters Women 2.7 liters • Water is the solvent for all biochemical reactions and comprises 60% of your body weight • Water absorbs heat, maintains vascular volume, and provides a way for materials to move in and out of your body • Water requirements can vary widely depending on heat and exercise levels. With sweating and exercise you can lose 1-2 liters per hour • Sources: % of intake drinking water 35-54 beverages 49-63 food 19-25 Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

  33. Total Water AI Summary, Ages 51+ Years Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

  34. Protection of Hyperosmolality (Y vs. O)

  35. Vitamins for Health • 1. Vitamin D 600-2000 IU/day • 2. Folic acid 400 ug/day • 3. Multi-vitamin 3/week if intake < 1,200 calories (Keep Vitamin A levels low < 2,500 IU) • 4. Vitamin E 200- 400 iu/day • 5. Vitamin A 625 ug men 500 ug women • 6. Vitamin B6 1.7 mg/day • 7. Vitamin B12 2.4 ug/day • 8. Biotin 30 ug/day • 9. Vitamin C 90 mg/day • 10. Vitamin K 120 ug/day • 11. Niacin 15 mg/day • 12. Riboflavin (B2) 1.3 mg/day • 13. Thiamin (B1) 1.2 mg/day Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

  36. Vitamins for Health- New Insights • Vitamin D helps bone, muscle and anticancer systems in our body • The current hint is for high normal levels • Antioxidants are good but how much is far from clear: • Risk of high doses: • Vitamin A- association with lung cancer • Vitamin C- association with CAD • Vitamin E- association with heart failure • Folate, B12, B6- association with stroke, heart attack • If you eat a good diet (> 1200 cal/day) aside from Vitamin D you are likely getting the basic requirements. • In general a single multivitamin per day seems reasonable (70% of Boston Seniors are taking them)

  37. Medicines for Health • 1. ASA 162 mg/day Dietary Reference IntakesThe National Academies Press, 2005Minaker et al

  38. END Special thanks to: Whole Foods Market Tara Minaker, RD, LDN Research Dietitian Metabolic Phenotyping Core/Nutrition of the MGH Clinical Research Center, a member of the Harvard Catalyst CTSC

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