In one of the most famous lines in American literature – uttered by Nick Romano in Willard Motley’s long-forgotten novel Knock on any Door – the advice is to “Live fast, die young, and leave a good-looking corpse.”
A number of rock singers and others have heeded this advice, although the state of their corpses has often fallen short of the mark.
In the opposite corner stands Rheumatologist and Stanford University Professor Dr James Fries who more than 40 years ago coined the term ‘compression of morbidity’, meaning to minimise the duration of chronic disease suffering before death, the aim being to improve the quality of our older years. For budget watchers such as politicians this wise advice also relates strongly to the subject of health costs.
Although compression of morbidity has now become a key goal of healthy ageing and longevity it may be easier to express than to achieve, unless appropriate strategies are put into place.
The evidence emerging from research in recent decades shows that while pharmaceuticals are an important factor they are not the whole answer, with the issue of lifestyle being increasingly recognised as a crucial factor.
Enter, the evidence based discipline called Lifestyle Medicine, which now has an established following throughout the world. Locally we have the Australasian Society of Lifestyle Medicine.
Two major health issues are related closely to healthy ageing, sarcopenia, which is the toll of time on muscle strength, and the prevention or delaying of early dementia.
The former has both metabolic and musculoskeletal implications that can impact on morbidity, mortality rates and quality of life. Regarding dementia, there is a huge amount of research going on to find pharmaceutical solutions, but in the meantime much can be achieved with lifestyle changes.
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There is a strong overlap between lifestyle changes needed for prevention of both sarcopenia and cognitive impairment with ageing.
For prevention of dementia the Lancet Commission on Dementia Prevention in 2017 cited nine causes for dementia -
- Less education
- Hypertension
- Hearing impairment
- Smoking
- Obesity
- Depression
- Physical inactivity
- Diabetes
- Infrequent social contact
A further three were added in 2020 -
- Excess alcohol
- Head injury
- Air pollution
Modifying these 12 risk factors will prevent or delay up to 40% of dementia cases.
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Preventing sarcopenia with lifestyle measures will overlap significantly with these measures, particularly by addressing blood pressure and weight control, diabetes prevention, physical inactivity, depression, social contact and alcohol overuse.
Diet and exercise are crucial to addressing these health issues.
As regards diet the evidence favours the Mediterranean Diet, but it has been added to by combining with the Dietary Approaches to Stop Hypertension (DASH) diet to form the MIND diet.
Here are the 10 foods the MIND diet encourages:
- Green, leafy vegetables: Aim for six or more servings per week. This includes kale, spinach, cooked greens and salads.
- All other vegetables: Try to eat another vegetable in addition to the green leafy vegetables at least once a day. It is best to choose non-starchy vegetables because they have a lot of nutrients with a low number of calories.
- Berries: Eat berries at least twice a week. Although the published research only includes strawberries, you should also consume other berries like blueberries, raspberries, and blackberries for their antioxidant benefits.
- Nuts: Try to get five servings of nuts [unsalted] or more each week. The creators of the MIND diet don’t specify what kind of nuts to consume, but it is probably best to vary the type of nuts you eat to obtain a variety of nutrients.
- Olive oil: Use olive oil as your main cooking oil.
- Whole grains: Aim for at least three servings daily. Choose whole grains like oatmeal, quinoa, brown rice, whole-wheat pasta and 100% whole-wheat bread.
- Fish: Eat fish at least once a week. It is best to choose fatty fish like salmon [NorDocs shares the concerns raised in recent times about the factory farming of salmon in Tasmania], sardines, trout, tuna and mackerel for their high amounts of omega-3 fatty acids.
- Beans: Include beans in at least four meals every week. This includes all beans, lentils and soybeans.
- Poultry: Try to eat chicken or turkey at least twice a week. Note that fried chicken is not encouraged on the MIND diet.
- Wine: Aim for no more than one glass daily. Both red and white wine may benefit the brain. However, much research has focused on the red wine compound resveratrol, which may help protect against Alzheimer’s disease.
The MIND diet recommends limiting the following five foods:
- Butter and margarine: Try to eat less than 1 tablespoon (about 14 grams) daily. Instead, try using olive oil as your primary cooking fat, and dipping your bread in olive oil with herbs.
- Cheese: The MIND diet recommends limiting your cheese consumption to less than once per week.
- Red meat: Aim for no more than three servings each week. This includes all beef, pork, lamb and products made from these meats.
- Fried food: The MIND diet highly discourages fried food, especially the kind from fast-food restaurants. Limit your consumption to less than once per week.
- Pastries and sweets: This includes most of the processed junk food and desserts you can think of. Ice cream, cookies, brownies, snack cakes, donuts, candy and more. Try to limit these to no more than four times a week.
As regards exercise for prevention of dementia and sarcopenia a combination of aerobic and resistance training is needed.
As regards sarcopenia and increasing physical activity the benefits are significant for building up muscle whilst increasing metabolism.
To quote from Nutrients 2020 June 12 (6) 1755…
‘Although adherence to the Mediterranean Diet may be beneficial to prevent frailty and sarcopenia in older adults, there has been great variability in the populations studied. The ethnic differences in populations and how they might modify the components of the Mediterranean Diet could have an impact on the results. Furthermore, more studies need to evaluate the impact of the Mediterranean Diet on incident sarcopenia, while there is mounting evidence to support the hypothesis that the Mediterranean Diet preserves muscle mass and some physical function in aging populations.’Butter and margarine: Try to eat less than 1 tablespoon (about 14 grams) daily. Instead, try using olive oil as your primary cooking fat, and dipping your bread in olive oil with herbs.
- Cheese: The MIND diet recommends limiting your cheese consumption to less than once per week.
- Red meat: Aim for no more than three servings each week. This includes all beef, pork, lamb and products made from these meats.
- Fried food: The MIND diet highly discourages fried food, especially the kind from fast-food restaurants. Limit your consumption to less than once per week.
- Pastries and sweets: This includes most of the processed junk food and desserts you can think of. Ice cream, cookies, brownies, snack cakes, donuts, candy and more. Try to limit these to no more than four times a week.
When it comes to exercise to prevent sarcopenia referral to an Exercise Physiologist is helpful. To begin managing the situation they will start by doing some measurements to assess the degree of muscle loss.
The main tests are grip strength, 5x sit-to-stand test and gait speed. More sophisticated testing for measuring lean muscle mass uses DEXA technology which is certainly used for research. But simpler assessment is usually all that is needed for most cases. They will then devise appropriate aerobic and resistance training exercises personalised to the patient’s needs and abilities.
In summary the key to preventing dementia, sarcopenia and to the overall compression of morbidity is to address lifestyle issues, and the earlier in life one starts the better. However, it is never too late.
