Thursday, November 27, 2014 Kislev 5, 5775

Reversing Your River of Time

September 4, 2013 By:
Carol Saline, Inside Magazine Feature
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My grandmother lived to be 93. I never once heard her complain about looking or feeling old — her generation was too busy surviving to worry about aging. Her daughter — my mother — had no shortage of vanity and teetered around on high heels until she broke a hip in her 80s. Though she hated her wrinkles, she never considered any kind of cosmetic surgery. And when she played golf, it was for companionship, not for fitness or exercise. For my generation, though, graceful aging has become an anachronism. I probably could have financed several trips around the world — first class, no less — with what I have spent trying to keep Father Time locked in the closet.

Granted, this is not exactly a new phenomenon. Cleopatra was bathing in milk to preserve her skin 2,000 years ago, and Ponce de Leon only discovered Florida 500 years ago because he was searching for the Fountain of Youth. But they were outliers compared to the hordes battling the clock today. In the last 20 years, anti-aging has grown from a piddling share of the economy to a $210 billion-a-year industry. The American Academy of Anti-Aging Medicine (A4M) was founded in the early 1990s with 12 members; currently, it has 26,000, 85 percent of them board-certified physicians. Last year, with the economy still recovering from The Great Recession, 14.6 million people still found the wherewithal to have some kind of cosmetic procedure.

Dr. Robert Goldman, a leader in the anti-aging world and vice president of A4M, pins the phenomenon on a few simple factors. “We now have a large middle class with a longer lifespan than ever before,” he says. “They have the income and the leisure time to devote to looking and feeling young and a media dominated by pop culture that bombards them with anti-aging messages. The boomer generation doesn’t want to grow old like their parents did.” Consequently, 50 has become the new 40 and so on up through the decades. There is an increased realization that you might be able to get away with a lot of bodily abuse in the first half of the game of life, but, like a losing football team, you need a new strategy for the second half, one based on science and not hype. Permafrost is a reality; perma-youth is a fantasy.

We’d all like to die young as old as possible, but can we really add years to the life we have been given? Mainstream medicine believes that we are born with a genetic expiration date. However, you can’t separate length of life from lifestyle. Bad choices like smoking, immoderate drinking, poor eating habits and a couch potato existence will certainly shorten your days on the planet. On the other hand, advances in science and technology suggest you might be able to extend the warranty. Think of it as better aging versus longer living. For the last 50 years, the Baltimore Longitudinal Study of Aging has been examining normal aging in thousands of adults in an attempt to differentiate the biological effects of normal aging from factors like disease, poverty and lack of education. They’ve learned a great deal, such as the fact that aging is a gradual process, and that it takes place much more slowly than the phases of growth and development. Although we all age differently and even our individual body parts fail at different rates, there are some changes everyone can expect: hearing loss (which comes earlier and faster in men); the need for reading glasses; bone loss; a decrease in metabolism (you don’t burn calories as fast, so you need less food-derived energy); the quality of your sleep; and a slower sexual response (not necessarily a big issue unless you’ve got to catch a train).

Sadly, research has not confirmed any specific therapies to conquer aging. The Baltimore study comes down hard against fads like high doses of antioxidants and supplemental hormones like DHEA, growth hormone and the currently popular testosterone additives, unless they are used to correct true clinical deficiencies. There was lots of excitement when scientists discovered that resveratrol, the chemical in red wine, might be a potent anti-aging force. Lab studies with rats suggest that resveratrol regulates the life and death cycle of cells and aids in damage control. But you should still wait to start ordering cases of Bordeaux until more research is done. By contrast, there is wide agreement that some supplements are worthwhile, particularly vitamin D, which, among other things, is a powerful immune booster. A4M’s Goldman touts daily doses of vitamin C, selenium and a multivitamin. He also recommends lots of hydration — with age, your kidneys are less able to keep enough water in your body.

That said, the trend is toward less supplementation and better eating. The National Osteoporosis Foundation recommends getting your calcium from food, not a pill. And Fox News’ Dr. Mike Cirigliano, a Penn internist, says if you want to live to the end of your genetic life, then be sure to get enough sleep, watch your weight, reduce your stress and eat healthy foods. He’s a big fan of the whole foods concept, especially vegetables in the cruciferous family like kale, broccoli and cauliflower.

What you eat apparently does more than affect the formation of plaque that leads to heart disease. A recent study by researchers at the University of Pennsylvania found that diet and lifestyle play a role in combating Alzheimer’s disease, particularly in people who are genetically vulnerable.

It’s a no-brainer that obesity is a factor in lifespan because it contributes to heart disease, diabetes, etc. But weight isn’t just a matter of where the needle on the scale stops. Body composition can be more dangerous for older adults than too many pounds. Pay attention to your BMI (body mass index) and how your fat is distributed, specifically what size belt you need. Fat around the waist (an apple-shaped body) is a greater health risk than fat around the hips (a pear-shaped body).

If there is one thing on everyone’s list for healthy aging, it’s exercise. Havertown orthopedist Dr. Nicholas DiNubile, author of the best seller, Framework, says, “Exercise is the closest thing we have to the fountain of youth. It can change the quality of aging.” He considers exercise a medicine and cautions it’s important to get the right amount — neither too much nor too little. According to DiNubile, there are three areas that should be targeted. Strength training is essential because by age 30, we begin to lose 3 to 5 percent of muscle mass with each succeeding decade (a condition known as sarcopenia), and bone mass erodes as well. While the bad news is that bone and muscle loss is inevitable, the good news is that you can manage the rate and, to some degree, even reverse the damage. DiNubile says a program to maintain muscle mass could include Pilates, free weights or machines at least twice a week. “Your muscles don’t know the difference,” he points out, so pick your poison. Cardiovascular training is absolutely necessary to maintain heart health, and don’t kid yourself that a casual stroll will do the job. DiNubile recommends at least 30 minutes three times a week of jogging, swimming, brisk walking or biking or aerobics.

What’s most often neglected is attention to balance, agility and flexibility — none of which are addressed in the gym. As we age, our neural connections don’t fire as rapidly. Think of it like a gradual downgrade from cable to dial-up. Nor does our internal GPS respond as quickly, which is one reason why so many older adults fall. If you aren’t stretching every day, you can expect to lose your flexibility, period. Yoga and t’ai chi are good for improving balance, but you can do something as simple as standing daily for 30 to 60 seconds on one straight leg with the other leg raised knee-high; when you master this, move on to doing it with your eyes closed, then standing on a pillow. Good luck!

I’ve rarely heard anyone say, “I look younger than I feel.” The hard truth is that by middle age, there is already a disconnect between what we see in the mirror and how we feel inside — along with an increasing unwillingness to accept that disparity. Advances in technology have catapulted cosmetic surgery from the realm of the rich and famous to an option for just about anybody with a few extra bucks for a Botox injection. No longer do people hide the fact they’ve had a little work done. They actually boast about it and recommend their surgeon to anyone interested. Bolstering the affordability of non-surgical cosmetic procedures is a cultural shift in the acceptance that wanting to look younger is perfectly OK. Could you imagine 20 years ago, sitting at home watching a TV show like the long-running FX series, Nip/Tuck, or that a news personality like Greta Van Susteren would splash her “before” and “after” face lift pictures on the Internet?

Skin is the very first organ to show signs of aging, so a good skin care regimen implemented before the bloom is off those rosy cheeks is just about the best and cheapest gift you can give yourself. Not using daily sunblock is a sure-fire road to wrinkles. “Sunscreens won’t prevent aging,” says Center City dermatologist Sandy Ehrlich, “but they will prevent accelerated aging such as brown spots, and they’ll help maintain elasticity.” Clinical aesthetician Jane Marie D’Amato, who literally saves people’s skin at the medical/dental collaborative Deme, notes that SPF 30 is the new SPF 15 for normal sunscreen use. When you’re spending time on the tennis court or at the beach, she recommends choosing a product that contains titanium or zinc oxide for maximum protection. In addition to sunscreen, her must-do minimum for skin care includes an antioxidant cream or serum containing vitamin C to fight the environmental assaults on your skin that are lurking everywhere, as well as an exfoliant — either a prescription retinoid like Retin A or a retinal over-the-counter product. “A little self-acceptance wouldn’t hurt either,” she adds.

If you decide to go the cosmetic surgery route, don’t expect to turn back the clock and look like you did when you could dance until dawn. “The best patients,” says Wayne-based plastic surgeon Dr. Kevin Cross, “are people who say, ‘I’m not 20 and I don’t want to look like 20. I just want a more youthful version of me.’ ” Fortunately, that no longer requires a face lift; there are now lots of less invasive options. “Facial aging changes the surface of the skin,” Cross explains. What was once smooth and luminous becomes crèpey and splattered with brown spots. For that problem, he suggests some kind of resurfacing. Depending on the damage and how long you are willing to hide from the world, that could be a light peel, a light laser like Fraxel or a deep surgical procedure that can take six to eight weeks of recovery.

Cross advises that if you’re bothered by wrinkles, crow’s feet, and sagging and loose skin, try Botox. Years ago, the standard cosmetic surgery pulled and tightened the skin. Today, the goal is to restore volume and add structure to what gravity has destroyed. There are all kinds of injectable fillers like Restylane and Sculptra that do a great job of plumping up the face. Expect fillers to last anywhere from six months to a year, depending on your basic anatomy. “We are also starting to see some radio frequency devices that will tighten the neck,” Cross says. How and when to indulge is up to you, but Cross notes that the trend is to have small, regular touch-ups rather than wait until you need a major overhaul.

No matter what you do, the harsh reality is that aging is as inevitable as death and taxes. Take heart in the knowledge that, while you can’t avoid it, you can postpone the deadline. Although there is no guarantee that a healthy lifestyle, exercise and good nutrition will add years to your life, you can be damn sure they will add life to your years!

Carol Saline is the chief medical correspondent for Inside. This article originally appeared in Inside Magazine, a Jewish Exponent publication.

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