Posted by: drwbortz | July 15, 2010

Healthy Aging and the Oboe’s “A”

I can’t remember exactly, but it must have seemed very strange.  I was 4 or 5 years old when my parents took me to my first symphony orchestra concert at the Academy of Music in Philadelphia.

Leopold Stokowski was the conductor. 10 or 15 minutes before the music was to start, a hundred or so fellows in tuxedos and a few women in gowns started irregularly to meander onto the stage carrying a fiddle or horn. Eventually, they found a seat, usually next to someone with a similar instrument, and behind a shared music stand.

The sound on stage swelled to a mix of toots and arpeggios, everyone seemingly intent on contributing to the chaos. Cacophony is the right word for what was happening.  After all were seated the concertmaster stood up in front of the violins and all of a sudden the sound hushed- silence.  Then a forlorn single note emerged from somewhere in the middle of the orchestra. Virtually instantaneously, everyone was sounding the same note.  Amazing.

Almost immediately Stokowski walked onto the stage, with no baton, as was his habit.  The audience clapped, and soon the wonderful concert was underway.  Everyone seemed to be on the same page, the sound was glorious.  Not at all like that clamor before the oboe played its “A”.

Since then, I have seen this sequence repeated hundreds of times.  My early immersion into classical music has brought me a lifetime of high notes and rich sounds more entertaining than the Super Bowls I have witnessed.

My parents also steered me into my lifetime as a physician, an internist like my dad, with a shared special interest in aging.  This career has been similarly rewarding with thousands of intimate encounters of every possible description. I was in the life and death business, helping my patients die as late and as healthy as possible.

In this effort, I recognized early that aging was not a disease and thereby it is not susceptible to the operations and pills of the standard practice of medicine.  Aging is a life process, which requires a different conceptual framework to understand its workings.

One of the most important of these features is the absolutely central axiom of “use it or lose it.”  Any serious student of aging and every geriatrician each day sees the evidence of this axiom. Someone observed, “It’s not how old you are that matters, but instead it is how you are old.”  The How of aging is absolutely dependent on fitness, physical and psychological. A fit bone, or muscle, or heart, or brain will carry a person confidently and capably to a hundred years of age, our health warranty.

My 50 years as a physician, with a special interest in the issues of healthy aging, have been perfused with an insistence that exercise is a central concept of healthy aging.  The older a person becomes, the more important is the issue.

My friend Steve Blair wrote the central paper, “Physical Fitness and All-Cause Mortality” in the AMA Journal.  His work, done when he was lead researcher at the Cooper Aerobics Clinic in Dallas, showed a direct relationship between how long you will live and how fit you are.  I have quoted this article, hundreds of times.

Similarly I wrote a paper called “The Disuse Syndrome” in the Western Journal of Medicine in which I stated that six common conditions  all trace a major part of their causation to lack of fitness.  These are cardiovascular vulnerability, musculoskeletal fragility, metabolic instability (diabetes), immunologic susceptibility, depression, and precocious aging (frailty).

I pondered long why this impressive set of varied conditions all show the property of having lack of physical fitness as a major causative feature.  I suggested that exercise acts like a suit of armor insulating and protecting our body, from the assorted slings and arrows which disease hurls our way.

Just recently, however, I conceived of another way of thinking of the universal value of exercise, and that is to consider it as the oboe’s “A”, to which with all the organs and functions of the body tune themselves. The heart, the brain, the thyroid all hear the tone which fitness sounds. All harmonize in health.

Each of our hundred-trillion cells contains 30,000 genes switches which act as rheostats, all tuning in to a common signal.

The scientific word for this tuning is symmorphosis, an ugly word that I learned from Jared Diamond when I invited him to lecture here at Stanford University a few years ago. Symmorphosis proposes that the body structures and functions all react in a linked fashion, much as boats in the harbor behave according to the tide chart.  A moment’s reflection identifies that such linkage is not at all random, but imperative. If part of the body were to be listening to its chosen tuning, and all the others to a different note chaos would result. The toning of the fitness of the body responds as a rheostat to its signal setting, which is exercise.  A leg in a cast withers, a bored brain shrinks, a fallow artery narrows, but a loaded femur grows strong.  Use it or lose it is affirmed, like the orchestra getting the right signal.

What if the notes are flat or sharp? Disharmony and disease result.  A few years ago at Harvard Medical School, I was expounding on the use it or lose it theme and an audience member offered that they had heard another version of it, which is:”If who you are is what you do, when you don’t, you aren’t.” Clever and important .

Today I add my own kindred aphorism: “It’s never too late to start, but it is always too soon to stop.”

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Posted by: drwbortz | June 21, 2010

My Genes Made Me Do It … Wrong!!!

Recently, piles of new evidence indicate that the predictive power of genes simply isn’t as much hope as it is hype. The public has been swarmed with excited promotions of “personalized medicine” and its predictive power for potential disease. “For $500 we can tell you if you are going to become bald, or get cancer of your shoelace, etc.” Don’t believe it. The Supreme Court just shot down plans to sell gene prediction kits at Walgreens. The hucksters will have to wait awhile before they can peddle their pseudo-science.

What are genes anyway? Think of them as switches, as light switches for instance. Each of our trillions of cells contains around 30,000 genes which are arranged in meticulous fashion along our chromosomes inside the cell nucleus. These gene switches control our structure and function, and are thus immensely important to our health and well-being.

However, genes do not act independently, but instead operate in a fantastically-organized pattern, integrating vast amounts of information that each cell is constantly receiving from the environment. Oxygen, food, temperature, pressure, etc. all supply information to the genes. All cells have antennae on their surface called receptor sites, which transduce the constant stream of messages to the DNA of the gene, where they generate a specific response to the signal. Thus, the environment is constantly informing the cell of the state of its neighborhood.

Moreover these switches are not simply on or off but act as a rheostat, like a dimmer switch. So the response is exquisitely finely-tuned. It is now generally estimated that your ancestry, your genetic heritage, ordains 15% of your health status. Sure, genes matter, but not to the determinative degree that the gene-jockies might pretend. So it is not the cards that you are dealt that counts but how you play the hand. Both Newsweek and Time Magazine recently had cover stories proclaiming that “heredity is not destiny.”  So, it is you, not your genes, who is in charge.

Make the right choices.

Posted by: drwbortz | June 21, 2010

Challenging Nutritional Dogmas

One of the sacred cows of nutritional science is that breakfast is the most important meal of the day. All sorts of testimonials preach that, since overnight is the longest interval without calories, it is critical to fuel the furnace upon awakening.

I’m not so sure. As a lifetime student of food and enjoying eating as much as anyone I challenge the seeming certainty that breakfast is critical. One of my skepticisms streams from the fact that I am convinced that my stomach doesn’t wake up till later in the morning. I simply am not hungry when I first wake up.

Almost all of the pro-breakfast statements are anecdotal in type. Virtually none are based on scientific evidence. The claim that student test scores are higher in breakfast eaters or that breakfast is one of a long list of factors associated with longevity just doesn’t satisfy my desire to have well controlled, rigorous research supporting advocacy for breakfast. I am also cynical enough to believe that most of the breakfast preaching derives from the manufacturers of sugared cereals.

None of this is to say that I feel that the timing of the day’s calories doesn’t matter. In 1969 as a part of a large NIH-funded grant “The Effect of Diet on the Metabolism of Fat in Man,” I published a research paper in the journal Metabolism,” The Effect of Feeding Frequency on Diurnal Plasma Free Fatty Acids and Glucose Levels.”  Under strictly-controlled laboratory conditions I fed volunteers their liquid synthetic iso-caloric meals as one, three, and nine feedings. The “gorgers,” with only one big one meal, had markedly different blood fat and glucose levels than the “nibblers,” who had nine equal feedings. So timing does have an effect, but I still am not convinced of breakfast’s primacy.

Another of my nutritional skepticisms involves carbo-loading before an athletic event. Since we all originally came out of Africa we should look at our Paleolithic ancestors to see if they sat down for a hearty breakfast before they went out for a 20-mile hunting jaunt.  It seems more likely that hunger, maybe even bordering on starvation, was their more likely nutritional situation.

Our bodies are extremely smart in choosing the calories they need and stored fat is a magnificent fuel , as it fulfills this need for energy, when it is not present in excess.  Our ancestors preferred fatty meat because of its caloric density. Irven De Vore wrote, ”They eat as much as much meat as they can catch, and as much carbohydrate as they need.”  It would be unwise for our metabolism to flaunt this preference.

Besides, I have now run 40 marathons most of them on an empty stomach, like the bushmen.  Fat is stored amply within muscle fibers and is the predominant endurance fuel.  Even the brain can use fat as ketone bodies for energy.

One of the truisms of my life is to trust the wisdom of the body. When it is not hungry, I don’t see why I should sit down and gorge calories when the stomach says, I’m not hungry.

My usual breakfast of a glass of orange juice and a cup of coffee surely excommunicates me from the food establishment , but having written dozens of scientific papers and having run 40 consecutive annual marathons gives me confidence that my insights may be right after all.

Posted by: drwbortz | May 21, 2010

What is Your Age Gauge?

In my book Dare to be 100, published 14 years ago, I proposed a very simple test that first assesses what your body does, and secondly, why.

I suggested that there are three primary physical tasks which a human organism pursues.  It moves, it thinks, and it makes love.  It is true, of course, that the body does other things.  It eats, breaths, and excretes, but these functions pretty much act as support systems to the basic three above.

In my Dare book I wrote that of the first task, movement.  No one can dispute the fundamental role of movement that nature has assigned our bodies.  Most of our energy is focused on getting our mass moved from one place to another.  Our muscles and bones are part of the drive train that enables our body to move.  Meanwhile, our circulatory, nervous, and digestive systems also serve mobility. Movement is a central theme in all of nature, and it is no less so with us, although we seem to be failing in this job, due to our relatively recent cultural laziness.

The second task is cognition. We honor ourselves with the label “sapiens”.  It is our distinction.  Other creatures outperform us in virtually all other categories of life, but intelligence is our crowning glory.  The body’s mechanics ensure that under all sorts of challenge — hot, cold, infection, starvation, extreme exertion — the brain is protected first, then the other organs get what’s left over.

Third, sex.  Many biologists would claim reproduction is the only purpose for all of nature, that each of us is only a temporary organization of flesh or plant stuff, the duty of which is to transmit genetic information down through time.  I identify sex in a much less-restrictive manner, proposing that it transcends the mere reproductive element. To me, our sexuality is one of the major life-quality issues, not confined at all to the early phases of life.  Famous gerontologist Alex Comfort made perhaps his greatest contribution by emphasizing the Joy of Sex as we grow older.  Sex is renewal, engagement, self-esteem, staying awake in life, sense preserving and extending.  It provides a richness that lasts a lifetime. Comfort wrote “Aging abolishes neither the need nor the capacity for sexual experiences.”

Having validated the fact that movement, thought, and sensual engagement represent the core activities of a vital life, the Age Gauge proceeds.  You accumulate one point a day when you walk a mile, one point when you read a book, and one point when you make love.  One point per category is the maximum allotment.  If you walk two miles, or read two books, or make love twice, one point per day is all you get for each.  Each category has equivalents: swimming or biking or square dancing, et cetera count as well.  Similarly, writing a letter, or playing a musical instrument, doing your computer work, or doing crossword puzzles all contribute a point .

Equivalents for making love are harder to propose, but they invariably involve putting your sensual self in action.  These three activities provide a potential 3-point day and a 21-point week.  It is important to recognize that these points are not age sensitive.  The Age Gauge applies if you are 30 or 80.  As life proceeds, one might find the weekly total points sagging, although they shouldn’t.  If you focus on the three S’s of successful aging — strong, smart, and sexy —the point total evolves naturally.

Such accounting represents the physical self.  But all of us immediately recognize that the physical self without meaning is a hollow venture. The biology of being human is necessary but insufficient.  Individually, we must provide the reason for living on our own.  No one can define our personal meaning of life for us.  When I search this challenge for myself I hearken back to Grandpa Bortz’s exhortation, “Make yourself necessary.”  I’m sure when I was 8 or 9 years old this really meant, “Scat, don’t bother me.”  But now, at age 80 the advisory is much more portentous.

Albert Einstein’s observation applies, “From the standpoint of daily life, there is one thing we do know that man is here for the sake of other men — above all,  for those upon whose smile and well-being our own happiness depends and also for the countless unknown souls with whose fate we are concerned by a bond of sympathy. Many times a day I realize how my own outer and inner life is built upon the labors of my fellow man, both living and dead, and how earnestly I must exert myself in order to give in return as much as I have received.”

To accommodate the necessity of having a vital meaning in life, the Age Gauge provides an extra two points per day for being necessary.  These two points combined with the other three make potential 5-point days and 35-point weeks.  As you survey your weekly point totals, the Age Gauge provides a useful prediction of your chance of living to your potential 100-year lifespan.

So here’s a guide to how to interpret your Age Gauge results, on a points-per-week basis, to determine your chances of living to be 100 years old.  Numbers are in Age-Gauge points.

The Age Gauge

Points Per Week

Chance of Living to 100

Rate of Aging

% Likelihood of 100
0 – 5 You are dead now. Gone. 0
6 – 12 Lucky to make another 10. You’re sinking fast. 1
13 – 19 Slim.  70 is a more likely goal. Modest down drift. 5
20 – 25 You have a chance. Average. 20
26 – 30 A long, full life is likely. Gains offset loses. 60
31 – 34 Your daily daring predicts success. Slight. 80
35 A sure bet. You size all your moments. Minimal. 100

.

Whatever your point total and your current age, never forget Bortz’s Law: “It is never too late to start but it is always too soon to stop”.

Posted by: drwbortz | May 17, 2010

Does the obesity bulge affect the universe?

I just heard on StarDate on NPR that the diameter of our largest planet cousin Jupiter is growing because of an assortment of gravitational effects which are accumulating more debris around its midriff.

I can’t help but wonder if the same is happening here on home Earth with our collective midriffs continuing to bulge.  I wonder if it may be distorting the gravitational force of our planet.  We may no longer have a concentric circumference, but one with a lump on it.  We may no longer be a sphere at our equator, but one with a bulge around its belly.

Lets see: if there are 6 billion people on earth, 20% of whom are overweight and the average overweight is 25 pounds, this calculates out to 15,000,000 tons of extra weight due to human obesity.

What would you think of the possibility that this may be affecting galactic events?  One of my favorite sayings from the poet Francis Thompson is, “Thou canst not stir a flower without troubling of a star.”

Who knows what effect fat Earth has on the rest of the universe?

Don’t let this concern keep you awake tonight.

Posted by: drwbortz | May 11, 2010

The Epidemic of Pre-Disease

Now we have pre-cancer, pre-hypertension, pre-dementia, and particularly pre-diabetes.

When I was in medical school, 50 years ago, we were taught that diabetes was a disease caused by lack of insulin, resulting in high levels of blood sugar, and the diagnostic symptoms of excessive thirst and hunger and weight loss. Then, enterprising physicians seeking more rigor in making the diagnosis proposed that the disease of diabetes could be confirmed when the first morning blood level was over 125 mg/dl.

This diagnostic label was widely encoded, but more recently became amplified by the addition of the term pre-diabetes, which is employed when the morning sugar level was not yet 125 (mg) but was over 100. So pre-diabetes screening was proposed to identify those unsuspecting persons whose borderline test results predicted that, although they didn’t officially have diabetes, they were at increased risk of developing it.

I have personally contributed to this practice by proposing the term pre-pre-diabetes in my book “Diabetes Danger”, suggesting that those 200 million Americans who were unfit and overweight are in the progressive pipeline leading to diabetes, but are not as yet officially coded in standard nomenclature.

Such pre-disease linguistic devices are intended to alert persons with no actual symptoms, but who are securely headed in the direction of the full blown disease, that something is amiss. This early knowledge is like a blinking red warning light.

Yet in my view, the proposition of early detection has been substantially subverted by the pharmaceutical industry, which floods our channels with their promotional tidbits. “Maybe you don’t have X or Y or Z , but we encourage you to consult your physician so that he or she can prescribe our trusty medicine to manage your pre-disease.” Aligned with this practice is that of the tech-testing folks encouraging tests, MRIs, scans, blood tests, etc. to see whether you quietly are really at risk of a pre-sickness. Dr. Clifton Meador wrote an article in the “New England Journal of Medicine” 16 years ago in which he explored the phenomenon of “the last well person” for whom voluminous testing only showed that everything was perfect, whereas the rest of us all have some trigger to alert that something may be wrong or going to be wrong. This concept then reveals that the rest of the 300 million of us are sick or pre-sick. And we better get our act together to find out what’s wrong quickly.

Eminent psychiatrist, Dr. Thomas Szasz has published a collection of essays under the term the “Medicalization of Everyday Life” in which he details the application of medical diagnostic labels to everyday occurrences. A freckle becomes the dermatologist’s good friend. The tension headache prompts a head scan, $1,000 work-up. A skipped heart beat demands a Holter monitor and a cardiologist.

The medicalization of America, in which every citizen has been converted into a patient, has been widely identified as one of the major escalators of health-care costs. Repair is the leit motif of the medical system. This presumes that our medicine’s diagnostic competence to reach out to what might be repaired through drugs and surgery is so compelling that we have a responsibility to attend to the freckles, heart skips and stresses ASAP. As the medical-screening door swings open to invite everyone in, a crowd develops, and expenses soar. But what if we are all at risk, as in my pre-pre-diabetes category? You can’t propose tracking and treating all of us for a disease that hasn’t yet happened, or can you?

As an alternative, I propose the proposition of prevention. What if all the preconditions listed above could be averted reliably, safely and cheaply with simple self-care, which doesn’t require any tests or therapies to guide the effort?

In my view, this is precisely what we must have, if we are not get healthier before we bankrupt the health care system. With the appropriate non-medicalized counter-strategies, instead of pills, scalpels, MRIs and statins, I suggest to Washington that we must establish a health lobby to offset the sickness lobby. We need physical exercise, a reasonable diet, parks and trails, and ways to alleviate stress.

What if these non-drug therapies are safer, more effective, and are more appropriate to our health needs than the medicalizing sirens that are abusing us by their alarm tactics?

Anybody up for such an idea?

Posted by: drwbortz | May 4, 2010

Marathon Meditations at Age 80

On Monday, April 19, 2010 I ran the Boston Marathon.

40 years and 40 consecutive annual marathons later I crossed the finish line in Copley Square, Boston.

What a difference.  The first time it took me five hours and five minutes to finish.  I finished in silence.  This last time it took 7 ½ hours, and I finished to the cheers of a thousand Patriot’s Day celebrants with flash bulbs popping.

The first time I hadn’t the slightest idea what the effort entailed, and I was in tears.  The last time I was a grizzled vet, who knew that the back spasm that I encountered at 24 miles was only a minor annoyance and nothing to halt the run.  So I finished with a big smile.

Not bad for an 80-year-old. I was beaten by 30,000 other runners including an 83 year-old woman. The winner, a Kenyan, broke the course record in 2 hours, five minutes. He could have lapped me twice.

The first time I was beaten by only 800 other runners, and I was only among the last runners.

The first run was done because my physician father, who was my alpha/omega figure for 39 years, died abruptly, and I was devastated.  But I was smart enough to know that running was a fabulous treatment for depression.

I’m a terrible runner. The iconic image of the runner is the fleet-of-foot whippet with wings on his shoes.  My image is of a slogger with army boots on. Yet being a Walter-Mitty-type athlete, my father’s death quickly spurred entry into the only world-class athletic event to which an ordinary Joe could aspire.

But then the organizers changed the rules, and created the qualifying times, which effectively excluded me.  Except that a group of medical doctors under Ron Lawrence’s leadership found an exemption for doctors, because of our support services for the runners.

Shamelessly, I accepted my entry number, color-coded to identify my outlier category, and I finished.

At the end of the first run I swore that I would never again submit to the tortures of this 26-mile test.  But just like childbirth, as soon as it was done, I searched for next year’s opportunity.  And the searching has led to runs in Athens, the original marathon, Dublin, New York, Australia, Beijing, Boston again, maybe 10 times, and Big Sur, California –my favorite.  Despite its hills, its scenery is spectacular.

So this marathon story is my highly personal odyssey of a life journey.  It has virtually become my religion. Exploring it has many important derivative aspects.  I’ve learned the thermodynamics of  exercise, the anthropology of running, and mostly about its health benefits.  As a geriatrician, the insight provided by these decades of commitment has defined a new way of looking at growing older.

Aging’s principal pathology is frailty which is not a defined disease but is of immense importance.  Its cause is to be found principally in lack of exercise.  Physical activity of any type from walking to marathon running is the preventive and treatment of frailty. It is cheap, safe and effective. What other remedy can make these claims?

I’m already planning marathon, 2011.

Posted by: drwbortz | April 30, 2010

Elephants and Ripples

Most television qualifies as spam, but once in a while there is a redemptive moment.  Such was the case last week, when PBS showed its special, “The Buddah,” by producer-director David Grubin.  Like many people I had a college course on the world’s comparative religions. This generated in me a positive perspective about Buddhism.  Its faith is possessed by 6% of the world’s population (Christianity is 31% Islam 20%.)

This college intro gave background for the travel experiences in which we toured Buddhist lands, including several weeks in Ladakh, the last refuge of Tibetan Buddhism, Japan, with our sojourn ending in Nepal.  In these experiences, we saw Buddhism firsthand. Its current practitioners, the persons who practice Buddhism daily, exhibit a characteristic life which represents their fundamental philosophy of generosity, suffering and patience. My most intimate encounters with Buddhism were during these travels, most specifically to the Everest base camp in the Himalayas. Our glorious guides, cooks, and porters were the Sherpas, who were practicing Buddhists.  We slept, climbed, and sweated with them, clearly the most wonderful collection of people with whom I have ever been connected. Great memories endure, but that was 30 years ago.

These memories were clearly recounted by the TV show, which was beautifully produced and executed.  It brought back the endearing caring that defines the practicing Buddhists.  The TV special told of the youth who was born to a rich Hindu king father in southern India and raised in splendor and isolation. His father sought to insulate him from the pains of the world.  He married and had a son, but then left the palace and confronted sickness, aging, and death for the first time.  He reflected deeply and renounced his luxury and family.  He went on to explore, and founded a religion.

This Buddhism is congenial to me. It is almost exclusively a moral, ethical philosophy, generous and caring. It lacks an authority figure.

However this reassertion of the fundamental beliefs and personal devotions recalled my aversion to their adoption of personal reincarnation as a core belief.  The notion that our earthly deeds, when accumulated, serve to guide our souls into a future life just couldn’t make it with me.  Rebirth in another life, in whatever shape or spirit simply stretched my imagination too far.  The TV special made prominent mention of this reincarnation tenet.

Recently however, I have been busy re-evaluating my own personal sense of life beyond death. As much as we inevitably reject the notion of personal oblivion after death, we seek alternatives, most of which we have identified in the standard religious explanations, which Thomas Szasz and Sam Harris hold accountable for the traditional religions. Explaining the afterlife is a standard obligation of classical religions.  Buddhism has its own reach.

I am immensely contented with Irv Yalom’s notion of ripples that he proposes in his fine book, “Staring at the Sun.” In it he allows that, at death, our molecules and atoms merge with the infinite dust from which we arose.  In his book, “The Fifth Miracle,” Paul Davies allows that all our bodies contain one atom of carbon from every milligram of dead organic material that is more than a thousand years old.  Deriving from this calculation is the implication that we are, each of us, host to a billion or so atoms that once belonged to Buddha or the tree under which Buddha once sat.

So,  materially we are reincarnated in a molecular sense.  I find more personal satisfaction in aggregating Yalom’s notion of ripples, which places emphasis on the energies which have come before us, rather than their material concretions.  It comforts me to presume that any goodness that I generate may, in effect, be a resonance of what the Buddha and other great teachers taught. All of us are the recipients of previous matter and of previous energy.  We are their re-incarnation.

Let us make the best of it.

I’ve always had a substantial interest in anthropology as a pillar of trying to understand what it means to be human.  I actually met my wife at Harvard summer school, where in 1949 I was attending my first formal course on this topic. This interest festered and lay somewhat dormant during my training years, which were fixated on learning clinical medicine and biochemical research, and thirty years of medical practice at the Palo Alto Medical Clinic and Stanford University Medical Center.

But the opportunity in 1980 to take an extended sabbatical leave from my patient care duties was delicious.  Accordingly, Ruth Anne and I strapped our backpacks on and left JFK on October 1, 1980, and headed directly east to Dakar, Senegal, where three days later, she celebrated her 50th birthday in a never to be forgotten brilliant fishermen’s village on the shore. The locals joined in the chorus. From there a month’s trekking down the west coast of Africa to the awful city of Lagos, Nigeria, the absolute cesspool of humanity, where fortunately we had a medical contact.

We saw a lot.  I had an interest in voodoo medicine, which I saw at first hand, in West Africa.  Then the flight to Nairobi, where I had obtained an unenthusiastic invitation from Richard Leakey to hang around his famous laboratory.  “What does a medical doctor know about old bones?”  His father, Louis and mother Mary were the archetypic anthropologists.  Yet enthusiasm and funds are a good recommendation, so I settled into my pattern of four days a week in Leakey’s library for research study, and three days a week to visit the game parks, Kilimanjaro, Rwanda , Masai Mara, Amboselli, etc.  We brought three of our four children over for long visits to indulge the extraordinary lessons which Africa presents.  It was a fabulous “roots” experience.  Digging in the dust of the Olduvai Gorge, and surveying the shorelines near where Lucy was unearthed reshaped our lives in a way to which only our previous Himalayan adventures could compare.

While in Africa I had three personal ambitions.  First was to explore the frequency and practice of voodoo folk medicine.  Second was to survey the role of older people in the hunter-gatherer culture. And third, to seek the evidence of the physical activity pattern of our old, old ancestors.  It is the last of these three ambitions that held the most promise for exposition. I scrounged enough insights in the Nairobi library to generate sufficient material for a major paper, which I subsequently wrote in the Journal of Human Evolution entitled “Physical Exercise as an Evolutionary Force.”

The library in Nairobi was like Valhalla to the world’s anthropologists. It was where their gathering place, and I had the opportunity to exchange ideas with them on the formative elements of our species.  While the anthropologists were very interested in territoriality, aggression, on nutritional habits, etc. I suggested that maybe  physical exercise was another contributing feature to the formation of our species.  The paper, (of which I’m very proud,) derived from this speculation, and said that our early ancestors left the jungle canopy, where our chimpanzee cousins remain, about 5 million years or so ago.  Our great, great great, grand-daddies and grand-mas went out on the Serengeti, where they adapted an upright stance and a persistence hunting way of life.  This led to a host of gene expression events, such as loss of body hair and a prodigious capacity to sweat.  Among other things, it also gave birth to the growth of the human brain from its chimp size of 500 cc to our current size of 1100 cc.  Interestingly, the Neanderthals who lived between Lucy and us had even bigger brains than ours, but they were also more physically active.  Domestication leads to smaller brains and other adaptive degradations. BDNF ( brain derived neurotrophic factor), is elevated by exercise.

The high mobility habit of our ancestors was re-suggested recently in an article in  Nature by David Lieberman of Harvard University and Dennis Bramble from the University of Utah, who seem to have been aware of my similar work of twenty years previously.

Our primitive exercise pattern has much to tell us about our current condition.  In 2005 the International Journal of Obesity presented a paper by workers at Columbia University and  Verona University Medical School.   These workers calculated that our primitive ancestors had an exercise program that was roughly 160% of ours, and that we, today, would need to add a 12-mile walk to catch up .

The medical implications of this downgrading of our physical activity pattern is regularly apparent in our obesity statistics, as well as in many of the other components of the Disuse Syndrome, of which I will write later. The CDC projects that our current generation of youngsters is the first in the history of our country who may not live as long as their parents.  Therefore, despite spending huge amounts of money and having incredibly more information, we are living less healthy lives with a shortened life expectation. We are now zoo animals, and therefore must be very carefully tended.  We were born free, but we are now degrading our physically active pedigree. This has little to do with the medical system but has only to do with our culture, which has seduced us by way of electricity and the wheel.

We need to rediscover our legs, which have enabled our survival, until now.

Posted by: drwbortz | April 14, 2010

Gateway to Next Medicine

In May of last year I gave a talk in Philadelphia at the annual meeting of the American College of Physicians to a couple hundred doctors.  My title was “Geriatrics: the Gateway to Next Medicine.”  A moment’s reflection reveals the essence of the title.  Since geriatrics describes the medical care of older people, the nature of aging is a critical domain in medicine.

Many unthinking, uninformed persons consider aging to be a disease, and it appears as such a category in numerous medical texts. But aging isn’t a disease at all. Stars age, canyons age, redwoods age. Are they diseased? If it is a disease then what kind of disease is it?  Since it is universal, including biology, it is certainly not confined to living things.

Where can we look for a unifying definition of aging?  Good question. What are the components of the definitions of this universal canon?  They are matter, energy and time.  All are involved in a requisite definition of aging.  I submit that the definition of aging is the effect of an energy flow on matter over time. There is an explicit statement given to us by the physicists of just such a unifying statement, which is known as the Second law of Thermodynamics.  This seemingly obscure and seemingly arcane formulation is said by British historian C. P. Snow to be a pillar of knowledge.   Snow wrote, “Not knowing the Second Law of Thermodynamics is like never having read a work of Shakespeare.”  Is his poetic indictment, he states that the First Law asserts that energy changes in its distribution but that its sum is constant. The Second Law of Thermodynamics has to do with the flow of energy. There are many nominated definitions. But they all encompass this notion that energy flow is unidirectional, just as is time.

Energy, such as that life generating gift from the sun, going from a hot source to an energy sink, dictates the imperative of the uni-directionality of flow. This is known in the trade as entropy.  20 years ago I wrote a paper in the Journal of Experimental Gerontology entitled “Aging as Entropy.”  Every human life, every life, starts at conception as a highly vigorous, highly ordered active entity, which over the course of a lifetime decays to disorder, to increasing degradation. The rate of this decay, this aging, depends on which species undergoes this, but all do regardless of what the immortalists may claim.  Too low order and organization leads eventually to defective function culminating in the ultimate entropic event which in living creatures goes by the name of death, or in inanimate objects, by the name of junk.

So the study of aging for a geriatrician yields first principles from which all else derives.  If aging is entropy, a unidirectional biophysical process to which there is no exception, then pills, potions, fountains, sheep glands, and prayers are irrelevant. Aging is not a disease and as such is not susceptible to cure.  It is life, and life, by definition, is a fatal condition.

My father, a geriatrican away ahead of his time in the 1930s, when asked, “Doctor Bortz, how do you stop aging?” replied with great insight, “I’m not interested in arrested development.”  So, the topic of my lecture to the American College of Physicians,” Geriatrics as a Gateway to Next Medicine,” is richly informed by these thermodynamic imperatives.  Its compass demands a different approach.  Instead of the component emphasis of current medicine, geriatrics demands a system approach.  Instead of an episodic snapshot understanding of the human lifespan, as presently conceived, a process emphasis is demanded.  Instead of a fixation on repair as the primary task of medicine it needs to redirect its energies to prevention.

Geriatrics is the gateway to Next Medicine.

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