SPECIAL FROM Next Avenue
By Denise Logeland
Most of the time, we should hold on to our wallets (and our dignity) when someone tells us we can look and feel younger — unless that someone is Dr. Daniel Neides, medical director of the Wellness Institute at the Cleveland Clinic.
Neides says “absolutely” we can undo some of the damage done to our bodies by neglect and the passage of time, and not just in the abstract terms of reducing disease risk. Neides believes we can shake off some of the very real ways that we feel age creeping up on us day to day.
Here are his answers to four common fiftysomething questions:
I used to be able to eat anything. Now I can’t have (onions/garlic/tomatoes/fill in the blank) or acid reflux kicks in and even wakes me up at night. Can I get back to enjoying any kind of food at any time of day?
We can absolutely reverse the symptoms that you just described by changing lifestyle.
The answer is not taking a proton pump inhibitor, like Prilosec, or an H2 blocker, like Zantac. That’s only minimizing the symptoms. We want to get to the root cause.
The major problem that we see with what we call the SAD, the Standard American Diet, is that it’s incredibly pro-inflammatory. We eat food that increases inflammation in the body and causes us to develop diseases — heart disease, vascular disease, dementia, depression. It’s just a recipe for disaster.
Our immune system is always on and always fighting. There’s collateral damage associated with this. Over time, we damage the lining of our arteries, the lining of our intestinal tract.
The first thing I do with patients who are looking to get back on track is develop an action plan that incorporates an anti-inflammatory diet. The most common one you’ve heard of is the Mediterranean diet: lean protein, little dairy, little sodium, no transfats and they typically will cook with olive oil.
By aggressively developing dietary habits that are anti-inflammatory in nature on a daily basis, you can reverse the damage that’s been done by the pro-inflammatory standard American diet.
What about sleep? Even when reflux doesn’t wake me, I don’t sleep like I used to and tend to wake up in the middle of the night. Can I ever expect to sleep again like I did in my 20s?
Yes. There’s a chemical in the brain called melatonin that decreases with age. Over the age of 50, we start to see a decline. And melatonin is responsible for how we maintain our circadian rhythm. For patients who are having sleep disruption, a supplement that’s often beneficial is melatonin.
I would want to make sure before recommending it, though, that there’s not an underlying problem causing sleep disruption. Is there an underlying mood disorder, for example?
Sleep disturbances are often correlated with a patient suffering from depression or dysthymia, which is basically having the blues but not clinical depression. We know that as we age, our risk for depression is higher. I would also want to check on whether sleep apnea is a problem.
Another thing to ask is whether patients are napping during the day. Often, it’s important to have a spouse or loved one in the appointment because the patient will say, “Yeah, occasionally I’ll close my eyes for 20 minutes.” And the loved one will say, “Are you kidding me? You nap for two hours every day.” That will have an impact on how we sleep at night.
I snore a lot, and a sleep study has shown that I do have apnea. I know there are serious risks that come with apnea, including higher stroke risk. But I don’t want to sleep with a CPAP (continuous positive air pressure) machine for decades to come. Can I do something on my own to get rid of sleep apnea?
The majority of patients who suffer from sleep apnea have a very specific body habitus: They are overweight and they tend to have a very thick neck. And then when you look in their mouth to view their airway, it tends to be narrower than in patients who are not overweight.
So one option we have is through weight loss, through diet and exercise. If we can get you to an ideal body weight, I think we will significantly impact or completely eliminate your sleep apnea.
A minority of patients with sleep apnea are not overweight. They might benefit from a surgery that removes the uvula and their tonsils if they’re still there.
I have achy, creaky joints. I know I can have my knees and other things replaced, and some of my friends have done that. But I don’t like the idea of invasive surgery or having something fake in my body. Can I rebuild the cartilage I’ve lost?
We can’t rebuild cartilage per se, but there are some options. One that I think has worked really well is glucosamine and chondroitin. That’s basically a synthetic version of the normal matrix that sits in the knee joint and prevents bone from rubbing on bone.
Another option is an injection called hyalgan. It’s taken from the cockscomb on the top of a rooster’s head, which is cartilage. It’s synthesized and turned into a gel, and we can offer patients injections, typically weekly injections for three to five weeks, depending on the severity.
Often, it can buy the patient six to 18 months of improvement in their mobility and quality of life. The majority of patients who have injections at some point will need joint replacement. But it could buy them time until they’re on Medicare or retired from a job.
The biggest thing you can do is exercise. Exercise is imperative to maintaining joint health.
If there’s already cartilage loss, what we’re looking to do is take the pressure off of the joint and have the muscles do the work. So we’re going to strengthen your quads and hamstrings and calves. With or without cartilage loss, it’s also important to get down to an ideal body weight. The less force you’re putting on your weight-bearing joints, the longer you’ll keep them.
Denise Logeland is a longtime business writer and editor whose beats have included the health care industry and financing for medical technology start-ups.