Doctor’s Heart Series Chapter 9: Blueprint of Optimal Health and Longevity - Part 1
Inside tricks about preventing disease based on scientific studies
Caution : Long read !
Jonathan, the tortoise from Seychelles, was known for his longevity, having been born in 1832. He recently celebrated his 190th Birthday (yes, 190!). He resides on St. Helena Island, Atlantic Ocean(I never knew it existed!). Despite his old age, Jonathan continues to show vigor and vitality and is full of life. Scientists conducted experiments to uncover the secrets of his longevity. After several months of observation and testing, the researchers discovered that Jonathan's diet was rich in antioxidants, lived stress-free life, spending his days basking in the sun and taking long naps. The researchers gathered information to create a guide to longevity called the "Jonathan Protocol." The protocol outlines principles for healthy living, such as eating a balanced diet rich in antioxidants, managing stress, and staying active. The goal of the Jonathan Protocol is to help people live a long, healthy, and fulfilling life, just like Jonathan, the tortoise.
As in humans, Okinawan’s tend to live have longest lifespans on earth (especially females). The Okinawan lifestyle consumes a diet rich in fruits and vegetables and minimal meat and dairy. They also strongly emphasized exercise, staying active, a close-knit community, and strong social connections to keep them mentally and emotionally healthy. Despite the rapid modernization of their island, the people of Okinawa refused to abandon their traditions. They remained committed to living a healthy and balanced lifestyle, and as a result, they continued to enjoy long and fulfilling lives. Their story of longevity inspired people worldwide who came to Okinawa to learn about their secrets and incorporate them into their lives. Okinawa is a blue zone (one of the five zones in the world where most people have long lifespans) located on a small island in Japan.
Longevity…
Longevity is the capability to survive past the average age of death. The duration of human life (longevity) is influenced by genetics, the environment, and lifestyle. Longevity science as we know it catching up steam as scientific advances push the limits for human bodies to live longer and healthier. The importance of quality life is paramount compared to quantity, as most of us realize. I am trying to decode some things one needs to achieve optimal health. As we grow older, things change in our bodies, energy levels, physical tolerance, and mental clarity, and we become magnets to the chair (true, me included). After two decades of practicing medicine, the experience shows us that there are small changes powerful to prevent long-term disease. Prevention of disease is paramount in achieving optimal health and longevity.
Longevity is like Opera Symphony; just like all the instruments need to be in sync, the different parts of body physiology must be in sync for the performance. We understand what happens if the singing or the music goes into disarray; the program suffers, just as the body leads to disease over time. So we need the environment inside our bodies to create a perfect symphony.
Why Bicycle?…
Imagine a bicycle in motion symbolizing the human body from birth to death. Each wheel is five spokes in the back and five in the front, as shown in the picture. The front and rear wheels have to be balanced at all times to have that fruitful 100-mile journey (100 life years) without getting too many repairs, etc. The blood tests and blood pressure measurements must be in the optimal range for the body to self-heal and repair; attached are the 5 B’s, Blood sugar, Blood pressure, Blood cholesterol, Blood uric acid, and Blood vitamin D. The lifestyle factors mentioned above are essential to balance the wheel of longevity, 5 S’s include Sleep, Stress reduction, Superior nutrition, Social connections and Strength training, exercise, mindfulness, and breathing.
My focus is to work on disease prevention, what I learned as a practicing physician for over 2 decades working in different roles in hospitals, rehab, ICUs, nursing home, office, etc. Due to my recent health issues, I had the chance to reflect upon furthering my interest in studying prevention. The current research takes a decade or more to become mainstream medical practice. My blogging is to better understand the current trends of ever-changing medicine and make sense for me and everyone.
Blood Sugars…
Sugar consumption in the US and worldwide has increased significantly over the last decade. Globalization, technology, and ease of goods transfer to any part of the globe have created ultra-refined, easy-to-eat processed food. These foods with increasing excessive calories have flooded the market globally. This has catapulted us to excessive consumption, causing increased metabolic disease, including diabetes and elevated cholesterol. Blood sugars elevation is a silent problem; unless checked early, it can lead to more systemic issues; this is the most significant and existential threat to the human race currently, as we go into the food abundance world(where there is more sugar water flowing in our veins than the actual water). Where buying an apple costs more than a processed burger.
Blood sugar tests are available ubiquitously, especially during the yearly physical exam checking the following tests would reveal any abnormalities
Hba1c(hemoglobin A1c)
Glucose Tolerance test (Testing 0H, 1H, and 2 H blood test of Blood sugars after 75grams of sugary drink)
Triglycerides (which have been documented to be early manifestations of the future risk of Diabetes)
CGM(Continuous Glucose Monitor) if high risk or people consume excessive calories from carbohydrates. Glucose tolerance tests or CGM (continuous glucose monitor) are more accurate in monitoring sugars if prediabetic or Diabetic.
The fasting glucose levels associated with the lowest mortality were 80–94 mg/dL regardless of sex and age. Prediabetes (100–125 mg/dL) was associated with higher mortality. The associations of hyperglycemia with mortality were stronger at younger ages. - Association between fasting glucose and all-cause mortality according to sex and age: a prospective cohort study in Korea
I believe the Asian counterparts are much more at risk for heart disease, and sudden cardiac death probably stems from early prediabetes and diabetes in this population. Based on this study, the younger generation, less than 50 yrs with prediabetes have a higher risk for morbidity and mortality. Lifestyle interventions in this age group has maximum impact.
Once diagnosed with diabetes, keeping the blood sugars below 140 mg /dl has shown to improve with complications(eye disease, kidney disease, skin disease etc), thus improving longevity in these patients. Many studies are looking at Diabetes and Longevity. In the UKPDS Study results showed that tight glucose control reduced the risk of cardiovascular disease and death. ADVANCE Study results showed that tight glucose control decreased the risk of major cardiovascular events.
Blood Pressure Elevation (Hypertension)…
Hypertension is highly prevalent in the adult population in the United States, especially among persons older than 60 years of age, and affects approximately 1 billion adults worldwide.
Blood pressure is the pressure of blood pushing against the walls of your arteries. Arteries carry blood from your heart to other parts of the body. Blood pressure normally rises and falls throughout the day. Elevated blood pressure also called Hypertension is a condition increased pressure in the arteries leading to various effects on the organs causing undue effects heart disease, Stroke, Kidney disease etc.
Several clinical trials that have investigated the relationship between blood pressure and longevity, some of them listed below :
Systolic Blood Pressure Intervention Trial (SPRINT) - This large, multi-center trial found that intensive blood pressure control reduced the risk of cardiovascular disease, heart attack, and stroke, as well as improving overall longevity. See below!
ACCORD Study (Action to Control Cardiovascular Risk in Diabetes) - This study investigated the effects of intensive blood pressure control on cardiovascular disease and mortality in people with type 2 diabetes. The results showed that intensive blood pressure control was associated with a lower risk of cardiovascular disease and death.
UK Prospective Diabetes Study (UKPDS) - This study investigated the effects of tight blood pressure control in people with type 2 diabetes. The results showed that tight blood pressure control reduced the risk of cardiovascular disease, kidney disease, and death.
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) - This large, multi-center trial compared different antihypertensive medications in terms of their effects on blood pressure control and cardiovascular disease. The results showed that several classes of antihypertensive medications were effective in reducing blood pressure and reducing the risk of cardiovascular disease.
Identifying elevated blood pressure itself is an essential step toward optimal health. Lifestyle factors ( low salt, exercise, stress reduction, etc.) are the cornerstone in the initial treatment of hypertension. Blood pressure is easily managed by medications with the least side effects. However, overall untreated blood pressure or hypertension has consequences, so check with your doctor and get treated if your blood pressure is persistently high, as mentioned above. The systolic blood pressure, or the upper number, must average 120 mm of hg (with a range of + or - 10 ), and the diastolic blood pressure, or a bottom number of less than 80 mm of hg.
Home blood pressure monitors can be purchased after checking authenticity of machines from the website Validatebp.org.
Uric Acid…
Elevated uric acid, also called Hyperuricemia, occurs when there’s too much uric acid in the blood. Uric acid is mainly formed by the breakdown of purines (cellular material) and may result from increased production of uric acid, decreased excretion of uric acid, or both. Alcohol, especially beer (yeast), Meat (game meats, meat organs like liver, etc.), and High fructose corn syrup has extra purine content. The latest research sheds light on high uric acid levels causing not just gout (commonly arthritis of the foot) but are also associated with health conditions such as heart disease, elevated blood pressure, Diabetes, and kidney disease.
Uric acid can be measured in routine blood work; ideally, the goal should range from 4 to 6 mg/dl. People with severely elevated above 8 mg/dl need medication management with allopurinol or Febuxostat. Thus consuming low-purine foods helps to decrease the levels. However, maintaining a healthy lifestyle, such as regular exercise, a healthy diet, and a healthy weight, can help regulate uric acid levels and reduce the risk of hypertension.
Clinical studies have shown a correlation between elevated uric acid levels and an increased risk of hypertension. Dr. Johnson, published in JAMA, has studied extensively lowering Uric acid levels and improving high blood pressure. Another study showed high serum uric acid is related to the risk of MI(Myocardial Infarction) and all-cause mortality, as depicted below.
Vitamin D and Sunlight…
Please check out my previous blog for a detail explanation; Sun exposure is a natural and effective way to produce vitamin D, which is essential for overall health and well-being. Some potential health benefits of adequate sun exposure and vitamin D include:
Bone health: Vitamin D helps to regulate the metabolism of calcium and phosphorus, which are essential for building and maintaining strong bones.
Immune function: Vitamin D plays a role in regulating the immune system and may help reduce the risk of certain infections and autoimmune diseases.
Cardiovascular health: Some studies suggest adequate vitamin D levels help reduce cardiovascular disease risk by improving blood pressure control and reducing inflammation.
Mental health: Vitamin D has been shown to positively impact mood and cognitive function and may help reduce the risk of depression and dementia.
Cancer: Some studies have suggested that adequate vitamin D levels may help to reduce the risk of certain types of cancer, such as colon, breast, and prostate cancer.
Sun exposure is a natural and effective way to produce vitamin D. However, it's essential to be mindful of the potential risks of excessive sun exposure, such as skin damage and skin cancer. It's also important to consider that sun exposure may only be possible or practical for some, especially during winter or for those living in high latitudes or areas with significant cloud cover. Hence taking Vitamin D supplementation or eating vitamin D-rich foods during this time to keep the levels in the optimal range.
Cholesterol…
Cholesterol is a waxy substance found in blood and body needs cholesterol to build healthy cells. However, high cholesterol levels can increase risk of heart disease by developing fatty deposits in the blood vessels. Eventually, these deposits grow, making it difficult for enough blood to flow through your arteries. Sometimes, those deposits can break suddenly and form a clot that causes a heart attack or stroke. High cholesterol can be inherited, but it's often the result of unhealthy lifestyle choices, which make it preventable and treatable. A healthy diet, regular exercise and sometimes medication can help reduce high cholesterol.
There are different kind of Cholesterol particles namely HDL and Non HDL ( LDL, IDL, VLDL). High Density Lipoprotein is considered good cholesterol and higher the number better cholesterol metabolism. However Elevated non HDL - Increases risk for Heart disease. In one study West of Scotland Coronary Prevention Study (WOSCOPS) demonstrated that treatment with pravastatin, a drug that lowers cholesterol levels, reduced the risk of cardiovascular disease and improved survival in men with elevated non-HDL cholesterol levels. The Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial also found that reducing elevated non-HDL cholesterol levels through the use of rosuvastatin was associated with a reduced risk of cardiovascular disease and improved survival.
Apo B Lipoprotein / Apo A 1 Lipoprotein ratio
The ApoB-containing lipoprotein (Cholesterol) particles attach to LDL, VLDL, and chylomicrons promote clogging in the arteries. There have been several clinical trials that have investigated the relationship between the Apolipoprotein B/Apolipoprotein A1 (Apo B/Apo A1) ratio and mortality.
One large study, the Framingham Heart Study, found that individuals with high Apo B/Apo A1 ratios had a higher risk of death from cardiovascular disease and all causes, compared to individuals with low Apo B/Apo A1 ratios. Another study, the Multi-Ethnic Study of Atherosclerosis (MESA), found that individuals with high Apo B/Apo A1 ratios had a higher risk of death from cardiovascular disease, compared to individuals with low Apo B/Apo A1 ratios. Several other clinical trials have also found a positive association between the Apo B/Apo A1 ratio and mortality, particularly from cardiovascular disease.
Check for Lipid panel and Apo B / Apo A1 ratio(<0.7), Lipid panel delineates Non HDL and HDL. Ideally the lower Non HDL ( <130) or higher HDL (>40) the better the cholesterol status and lower risk for cardiovascular disease. This can be achieved by Lifestyle factors of healthy eating, superior nutrition, exercise etc.
Conclusion…
Healthy aging is something every human aspires to. Based on the current situation with Pandemics, Environmental issues, Increasing cancer rates changing ecosystems, Immigration has changed how we live. A century ago, we lived an average life span of the 40s-50s. We have witnessed people living longer and healthier with all the scientific and technological advances. The data we have currently has helped many people find treatments and cures. Even a decade ago, Stage 4 cancer patients were dying months to a year compared to now, people live years, especially Breast and Colon cancer (a recent report of the patient at Johns Hopkins Medical center showed complete remission of cancer with the advent of Immunotherapy). In the last century, we have come a long way in tackling infectious diseases and vaccinations. However, the problems with noncommunicable diseases and poor lifestyle choices, and greater inequality than ever have caused more morbidity. We have come a long way from 100 years ago, Average lifespan touching 80 in the developed world and the ’70s in the developing world. Heart disease, Cancer, Dementia, and Infectious disease are the top killers currently.
Like Jonathan the tortoise or people in Okinawa, we must work towards balancing a better lifestyle and maintaining good health, yearly physical checkups, avoiding long-term complications, and maintaining optimal health and longevity. My Sincere efforts to understand the mechanism of healthy aging and thus help individuals to make decisions for a healthier, disease-free future.
Balancing of bicycle is paramount in shaping longevity and a disease-free state.
Part 2… to be continued
Suman Manchireddy MD FACP FHM, Internal Medicine, Leesburg, VA.
Email : Care@ReliantMD.com
Disclaimer: This is purely informational and educational purposes only, seek medical advise prior to starting any testing or treatment regimen. The data presented here is researched extensively and has been condensed for a broader audience.