Live Young, Think Young, Be Young: . . . At Any Age

Live Young,

Think Young,

Be Young,

… at Any Age

Donald Vickery, MD

Larry Matson, EdD

Carol Vickery, RN, MSN

Copyright © 2012 by Bull Publishing Company

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.

Published by Bull Publishing Company

P.O. Box 1377

Boulder, CO, USA 80306

www.bullpub.com

Library of Congress Cataloging-in-Publication Data

Vickery, Donald M.

  Live young, think young, be young : --at any age / Donald M. Vickery, Larry Matson, Carol Vickery. -- 1st ed.

    p. cm.

Summary: While there are plenty of books offering advice about how to age, none takes the crucial step back to challenge how people think about aging until now. The Aging Syndrome, the core idea in this book, explains the aging process by using three pillars: intrinsic aging, the aging process that no one understands; disuse, both physical and mental; and chronic disease processes, which begin in childhood or sometimes in the womb. Using practical steps and plain language, this volume is the only guide needed for developing a plan for growing older. By presenting a better way to think about aging, it reveals what everyone can do to live a longer life.

Includes bibliographical references and index.

ISBN 978-1-933503-97-4 (pbk.)

1. Aging--Physiological aspects. 2. Aging--Psychological aspects. 3. Nutrition. 4. Self-care, Health. I. Matson, Larry. II. Vickery, Carol. III. Title.

QP86.V52 2012

612.6′7--dc23

2012024132

Printed in the U.S.A.

First Edition

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Interior design and project management: Dovetail Publishing Services

Cover design and production: Shannon Bodie, Lightbourne, Inc.

DEDICATION

WE DEDICATE THIS BOOK to Don’s mother, Clarene Vickery, who at 94 years of age (as of October, 2012) continues to run the Parkwood School, a preschool in Vienna, VA, that she founded 56 years ago. Clarene is beloved by her family as well as many, many others who have been touched by her in some way. Her guidance, both spoken and unspoken, in raising children and in living life is a gift to all. Clarene is a wonderful example of what it means to live young, think young, and be young at any age and in the presence of any life circumstances. She has lived with three major chronic health conditions—diabetes, heart disease, and cancer—along with other significant health challenges. She has lost her husband and one of her children. She faces her challenges with courage and conviction, managing what she can control and accepting what she cannot. After a particularly hard day, she has said, this has not been such a good day, but maybe tomorrow will be better, and if not tomorrow, then the next day. Then she added, the hard days help us appreciate the good days even more.

So, to Mrs. Vickery, as she is known to her school children, and to many others out of the highest respect, we thank you first and foremost for Don and the love you showed him throughout his life, but we also thank you for the wisdom you have shared with so many others along the way. Your example for how to think, live and be every day, and how to age gracefully, is an inspiration to all who have known you, just as it has been the inspiration for the message of this book.

CONTENTS

FOREWORD: VISION—For a New Way of Thinking about Aging

PART I: WISDOM—To Know the Difference between Aging and the Aging Syndrome

Chapter   1 Speaking of Aging, Don’t

Chapter   2 Real Aging

Chapter   3 Lifespan and Life Expectancy

Chapter   4 Aging and Death

Chapter   5 Aging and Disease

Chapter   6 Aging and Evolution

Chapter   7 Adaptation to Disuse

Chapter   8 Calorie Restriction

PART II: KNOWLEDGE—To Understand the Disease Processes That Make Us Old

Chapter   9 Critical Concepts

Chapter 10 The Beginning of Disease Processes

Chapter 11 Acceleration of Disease Processes

Chapter 12 Constricted Circulation

Chapter 13 Metabolic Madness

Chapter 14 Insidious Inflammation

Chapter 15 The Root Causes

PART III: COURAGE—The Personal Plan to Change What Can Be Changed

Chapter 16 Courage to Change

Chapter 17 Building Your Personal Plan

Chapter 18 The Foolproof Plan for Self-Managing

Chapter 19 Take Your Body for a Spin

Chapter 20 Use Your Head

Chapter 21 Eat (and Drink) Like You Know What You’re Doing

Chapter 22 Give Yourself a Break

Chapter 23 Cop an Attitude … a Positive Attitude

Chapter 24 Know Your Environment … and What’s Getting into Your Body

Chapter 25 Pills and Potions

Chapter 26 Connecting the Dots

PART IV: RESILIENCE—To Accept What Can’t Be Changed

Chapter 27 From Acceptance to Resilience

AFTERWORD: SERENITY—Leaving This World a Little Better

Index

ACKNOWLEDGMENTS

WE ARE ESPECIALLY GRATEFUL to Jim Bull, Emily Sewell, and Claire Cameron of Bull Publishing for their steady and unremitting encouragement and guidance in walking us through the process of bringing this book to fruition. Their comments and suggestions played a vital role in transforming our rough drafts into the final manuscript. It’s hard to believe that there could be a finer group of people to work with or a more skilled team in the publishing industry. A special thanks to Kate Lorig for referring Don to Jim Bull and Bull Publishing in the first place.

There are many people to acknowledge with an undertaking of this magnitude. First, we had to decide, following Don’s passing, if we really could complete the book from Don’s drafts, outlines, and notes. Don’s dearest friends, Mike Friedman and Bob Reid, were instrumental in the decision to go forward. The four of us, Carol, Larry, Mike, and Bob, came to the conclusion together that Don’s vision of aging needed to be shared. We are grateful to Mike and Bob for their insights and encouragement in arriving at this decision.

Our gratitude also goes out to Steve and Carly Susan Wells whose support carried through the entire project. They were always there with whatever support we needed. Steve formulated most of the graphics, and Carly’s insights, support, and assistance in writing the final chapter of Don’s story were invaluable.

Thank you to Carol Reitz and Julie Wilson for their editing expertise and to Jonathan Peck of Dovetail Publishing Services for completing the graphics and handling the production process.

Thanks also to Don’s family—brother and sister-in-law Raymond and Ann Vickery, brothers Ken and Steve Vickery, and daughter Meredith Vickery for their reviews, encouragement, and suggestions as we worked through the various drafts, and son Andrew Vickery, for technical assistance. Finally a special thanks to Larry’s wife, Susie Matson, for her constant belief and encouragement over the months of writing and research required to weave the pieces together.

FOREWORD

VISION

For a New Way of Thinking about Aging

HOW MANY 35-YEAR-OLDS would take out a full-page ad in a major newspaper like The Washington Post? That’s exactly what Don Vickery did in 1979. Yes, in 1979 at age 35. The purpose: to admonish all of us for not taking greater responsibility for our own health. Don was a self-care visionary even at this early stage of his career. He knew that the best health care is what we do for ourselves—living a healthy lifestyle, taking care of acute problems, managing chronic disease, and being fully involved in our treatment decisions. Don’s journey into self-care began between 1971 and 1973, when he developed an algorithm-based triage system for the U.S. Army. By 1976, at age 32, he had coauthored his first book, Take Care of Yourself, which quickly became the standard self-care manual and is currently in its ninth printing. That book was followed by a guide for parents, Take Care of Your Child, and a lifestyle manual, Lifeplan, as well as numerous articles in medical journals. Don’s research showed that when individuals have good information, they make better decisions, are more satisfied with their care, and have better outcomes at lower costs. He has rightly been called the father of the self-care movement.

In 1992, Don fulfilled a long-time dream of starting a company, called Health Decisions, with the goal of reducing the demand for medical care by using nurses to counsel people in self-care—from acute problems to major medical decisions, from lifestyle changes to managing chronic disease. Don believed in the power of watchful waiting—the do nothing approach in which you observe the course of the condition and seek treatment if it doesn’t improve. He knew that most minor illnesses, and even many more serious conditions, follow a natural course in which our bodies heals themselves. But, in our impatience, we want to be treated now, even if it means enduring some risks and side effects.

Health Decisions was ahead of its time. Nurses helped people understand their conditions and provided both estimates of outcomes if the person did nothing or used self-care as well as the benefits and risks of other treatment options. When people were provided with this information and were encouraged to discuss their values and preferences, they often chose less invasive treatment options, perhaps watchful waiting. This led to fewer adverse effects, was less costly, and in the long run, often led to a better quality of life. What a novel approach—better health and lower costs at the same time. Most major health insurers now provide some type of telephone nurse support based on this model. Unfortunately, after a decade of helping people take charge of their health, economic realities forced the closing of Health Decisions in 2001.

Don returned to writing—in this case, a self-care book for boomers and seniors. He was working on a chapter on aging, obviously an important topic for anyone over age 50, but as he reviewed the science of aging, there was little that made sense and little consensus even among the experts. The field was burdened by conflict, controversy, and confusion, all perpetuated by a burgeoning anti-aging industry. Don realized that the real problem is not aging, but why we get old prematurely and what we can do about it. We confuse aging and old. We assume that old is the result of aging, but for the most part it’s not.

A new way of thinking about aging was clearly needed. Our current thinking was contributing to an almost universally negative view of aging along with a host of mistaken assumptions and beliefs about it. Misinformation was fostering a sense of helplessness, pessimism, and low expectations for the future. This was all contrary to Don’s core belief that if we take control of our health we can have a better quality of life at any age. A healthier, more positive vision of growing older was needed, one that involved doing more for ourselves and being less dependent on the medical system to take care of us. The self-care book was shelved and this one began.

Don had always been fascinated with the idea of heuristics. Heuristics is probably a new term for most—it refers to a simpler way, a shortcut, in thinking about and solving a complex problem. The algorithms for Take Care of Yourself and Take Care of Your Child are examples of heuristics for understanding and managing symptoms. But no issue Don had tackled was quite as complex as aging. He searched for a simpler way to understand what makes us old and how we can stay young.

In the end, the brilliance of this book is the combination of two heuristic tools—a new one that he called the Aging Syndrome to explain why we get old, and an old one, the Serenity Prayer, to explain what we can do about it. They fit together perfectly.

First, develop wisdom to know the difference between what we can and can’t change about getting old. We can change the Aging Syndrome; we can’t change aging.

Second, use courage to change what we can change (the root causes of the Aging Syndrome) with a strategy to accomplish the change (self-managing).

Third, accept what we cannot change (aging and other stuff that happens in life for no apparent reason). This results in a new mindset about growing older and a plan to control how fast it happens.

Don lived what he taught—he had an active, informed, and involved lifestyle, despite being diagnosed with rheumatoid arthritis in his early 40s and living on and off with crippling pain for nearly a quarter of a century. The disease influenced how he experienced life every day, and it gave him a unique view of aging. He would say, I’ve been young and old, young and old, young and old, again and again as the disease waxed and waned. He also said, I will not claim that mine is a unique experience, or that it has provided me with some secret approach to staying young. I will say, however, that it has provided insights into the difficulty of taking advantage of what science has to offer. And, more than anything else, it has burned the essential rules of dealing with getting old into my mind.

This story should have a happy ending. After all, it is a more optimistic view of growing older. It shows us that we have a lot of control over how we age and the quality of life we live. It begins with a new mindset about aging and growing older, and then provides a new way of thinking about the factors that contribute to growing old. Don’s story is a story of life, and we never know how life is going to unfold. We can do the best we can, but things still happen that we don’t anticipate and have no control over. Life can change instantly, as in serious accidents that we hear about almost daily. Acceptance of these events is part of the process of building resilience. For Don, life changed rather abruptly in the spring of 2008. It wasn’t an accident, but a disease—an aggressive form of lung cancer that began to spread rapidly. Because Don had never smoked, there was no explanation for the cancer. Don passed away on November 22, 2008, at the young age of 64. He left behind a large legacy and this book is a big part of it. The Afterword at the end of the book continues Don’s story and includes some lessons that we learned from him during his last six months—on accepting our own mortality and preparing for the end. No one knows how his or her life will end, but we know how we can make the most of our lives for as long as we do live. Live Young, Think Young, Be Young … at Any Age shows us the path.

PART

I

WISDOM

To Know the Difference between

Aging and the Aging Syndrome

What we don’t understand is largely the result of the

vocabulary we use and the assumptions that we make.

—Albert Einstein

WISDOM—THE ABILITY TO MAKE sound decisions and judgments based on knowledge, experience, common sense, and insight accumulated over a lifetime. It seems logical that wisdom should increase with age. We do become older and wiser, don’t we? In some ways yes, in other ways no. The wisdom we have is based on the life we have lived—the unique knowledge and experience that each of us has accumulated. We’re all wise in some aspects of life, ignorant in others. But wisdom becomes increasingly challenging as the pace of life accelerates and becomes more distracting, and as we become increasingly specialized in our careers. The result is that wisdom is often lacking in many areas. One of these areas is our ability to take care of ourselves, to self-manage the changes that occur in our bodies and minds as we get older.

We all become more experienced with aging as the years go by, but experience alone doesn’t foster any greater insights into the aging process or the wisdom to grow old with strength, vitality, and grace. Our culture is enthralled with youth and winning, which makes aging the adversary and getting older seem like losing. The result is the booming anti-aging industry built on the promise of youth. Henry David Thoreau once said, It is a characteristic of wisdom not to do desperate things. The growing use of unproven anti-aging pills and potions is a sure sign of desperation—and a lack of wisdom.

Why is wisdom in such short supply when it comes to growing older? Many factors contribute, but a poor understanding of aging tops the list. Most of us are convinced that aging is responsible for most of the problems that become more common as we get older. We know that everything ages, so it’s easy to assume that aging is the cause, at least after age 50. Unfortunately, the belief that aging is our greatest adversary is wrong for one simple but powerful reason: We don’t know what aging is. Even the true experts, the research gerontologists, tell us that it remains a mystery. Science is usually the bastion of truth, but the research on aging struggles to make sense of a quagmire of competing theories and complex biochemical mechanisms, with little consensus or clarity. The research is fascinating but, quite frankly, not very helpful. With each breakthrough, scientists tell us that they’re getting closer to finding the holy grail of aging and that a true anti-aging drug is on the horizon, but it will take time and money. They’re still working on fruit flies, yeast, and worms—a far cry from humans.

Yet, we continue to ascribe our declining abilities and health problems to aging because it’s the easiest explanation and it excuses any personal responsibility. Our beliefs are reinforced by doctors who tell us that our new diagnosis is a disease of aging or that our symptoms are just part of aging. And, of course, most of the information we hear about aging comes from a range of anti-aging experts whose businesses depend on aging being the problem and their product the answer.

The result of all of this is a distorted mindset about aging that makes us believe we are helpless to do much about it. We expect to go downhill as we get older—to lose abilities, to get stiff and fat and weak, to take more pills to control diseases, to have a poorer quality of life, and so on. Part I of this book examines the roots of this mindset—our mistaken assumptions and beliefs about how and why we grow old. The title is Wisdom because it is about building the wisdom to know what is real about aging and what is not. The first chapter introduces the Aging Syndrome, a new way of thinking about how and why we grow old the way we do. The Aging Syndrome is a combination of factors that we control and that have been proven to cause the problems that we associate with getting old. It removes the notion of inevitability and the feeling of helplessness. Later chapters on real aging (the mysterious process), lifespan and life expectancy, death, disease, evolution, adaptation to disuse, and the practice of caloric restriction (the only proven anti-aging approach) address the fallacies of our current mindset and the clarity that results when we think in terms of the Aging Syndrome.

The bottom line: If we want to change how we age, we have to change how we think about aging. We’re in no way denying aging or saying that you won’t get old. What we are saying is that the mysterious aging process is a relatively minor factor until the ninth or tenth decade. The Aging Syndrome explains why we get old in our 50s, 60s, and 70s. We can stay as young as possible for as long as possible if we self-manage the factors that contribute to the Aging Syndrome. This will compress the impact of real aging into the last decade of life.

Think of older folks you’ve met who are vibrant, active, and energetic. They show us what is possible. Wisdom is the foundation. It begins with letting go of our current mindset about aging, then letting go of our low expectations for the future. Part I will open your mind to a new way of thinking about growing older and the possibilities that go with it. We ask you to proceed with high expectations.

CHAPTER

1

Speaking of Aging—Don’t

A New Way to Think about What

Really Makes Us Old

How old would you be if you didn’t know how old you are?

—Satchel Paige

DO YOU THINK ABOUT HOW YOU ARE AGING? Are you concerned about getting old? What is your vision of old? Is it like that of most people—frail, shrunken, slow, unstable, declining vision and hearing, loss of abilities, and so on? More important, what is your vision of you "getting old"? Is it what you are experiencing right now—weight gain, lack of energy, loss of strength, stiffness, aches and pains, high blood pressure, medications, inability to do activities you used to enjoy?

Why does all of this happen? Most of us say aging without giving it a second thought. What do you believe about aging? Which of the following statements do you believe?

Aging is our greatest adversary as we grow older.

Aging determines how long we live.

Aging steals our youth; it makes us old and feeble.

Aging causes chronic diseases, like heart disease, high blood pressure, and diabetes.

Aging is largely a matter of genes and luck.

How we age is largely out of our control.

Science will determine the cause of aging, and this will lead to the discovery of drugs that will keep us young.

How many of these statements do you think are true? Most of us believe they are all true, at least to some degree. Unfortunately, none of them is true for one simple reason: We honestly do not know what aging really is. Oh, we can define it, such as everything that happens with the passage of time, but what is it really? Scientists have been studying aging for decades. They’ve come up with many theories, but there is no consensus and none of the theories can account for the changes that occur in our body and mind as we get older. And, with all of this research, we still have no way to measure the aging process. We don’t know what to measure.

Why do we have so many distorted beliefs about aging? That part is simple: It’s because we hear so much about aging and we see the ravages of old age all around us. You will probably hear more about aging than any other topic over your lifetime, and we’re not in the habit of critically evaluating any of this information. We just assume it’s true. Aging is such an easy explanation for problems we develop as we get older. When the doctor tells us that our high blood pressure or type 2 diabetes is due to aging, we accept it and start taking our pills. We have such undying faith in science and medicine. When we hear that scientists have made another discovery about aging, we believe that they really are closing in on a pill to keep us young. When we hear doctors tell us that hormone therapy is the answer or when entrepreneurs tell us that a new supplement is an anti-aging miracle, we want to try the treatments because they just may work. As we experience stiffness, aches and pains, or trouble sleeping, the drug industry tells us that it’s all due to aging and that medication is the answer. We believe aging is the cause, so we buy over-the-counter drugs or ask the doctor for prescriptions to help us feel better, sleep better, perform better, and so on. All of this reinforces our mistaken assumptions about the mysterious process of aging that is going on in all of us. How could anyone develop a healthy mindset about aging amid such a sea of confusion and competing interests?

This mindset affects our attitude about aging and our expectations for the future. It shapes how we interpret events in our life and the information we read or hear about aging. When we have trouble doing something or when we get fat, feel weak, notice stiffness, or have aches and pains, we think we’re getting old. We expect to slow down, get weaker, do less for ourselves, take more medications, and so on. We accept it and go on hoping for the best.

At this point you’re probably thinking to yourself, OK, I get the point about aging and anti-aging, but you’re not trying to say that aging is not real, are you? Of course not. We all know that aging happens. No one questions that there is an unchangeable, mysterious process going on in every living organism that ultimately limits its lifespan. We know aging exists, but that’s about all we can count on. The fact that it is real, however, provides the thread of legitimacy that makes us buy into all of these unfounded assumptions. But—it’s only a thread.

KEY INSIGHT

The key issue about aging is not whether it exists or not, but what we attribute to it.

In this chapter, we present a new way of understanding how and why our body and mind get old. It’s called the Aging Syndrome. Our current concept of aging as an unchangeable, negative march toward feebleness is part of it, but actually a surprisingly small part. There are many other factors that contribute, and when we evaluate their impact, we see that agingactually plays a very minor role in how our bodies and minds change over time. We call these other factors root causes.

Our current mindset places the focus almost entirely on aging and distracts us from these root causes. Most important, these root causes are things we can control—as opposed to aging, which we cannot control. When we begin to think in terms of the Aging Syndrome, our focus changes to what we can control. This nurtures a new wisdom about aging that allows us to separate truth from fiction so that we know how to stay in the game right up to the end.

Even Science Confuses Beliefs and Knowledge

The term real or biological aging is used to distinguish the unchangeable process from other factors, such as disease and environmental, that can also weaken our body and make us old. But, what is real aging beyond an unchangeable, mysterious process? We turn to science for answers to such questions. Unfortunately, with aging, we’re met with disappointment: a lot of theory but few answers—in other words, a lot of beliefs but little true knowledge. There is an enormous gap between what science believes about real aging and what has been proven about real aging.

There’s a big difference between beliefs and knowledge. Beliefs are powerful whether they are true or not. They are true to the believer, and they lead to assumptions that become accepted as knowledge. With time, they become ingrained in our subconsciousness. A big part of this book is about questioning our long-held assumptions and beliefs about aging. These assumptions prevent us from taking a more active role in self-managing the process of growing older.

Those in the anti-aging industry depend on false assumptions to sell their anti-aging products. When we think about aging, it is usually in terms of the changes that occur—gray hair, thin skin, age spots, wrinkles, frailty, loss of height, slowing down, vision and hearing difficulties, urinary problems, and so on. We don’t think about why these changes occur because we assume aging is the cause. We take aging for granted. We don’t think about the process, just the results. That’s why it’s so important to understand the difference between what science merely believes and what it knows about aging. We can accept aging, but at the same time acknowledge that we know very little about it, especially the role it plays in the changes that we associate with getting old. Therefore, the first step in changing our mindset about growing old is letting go of aging as a cause of anything.

Don’t Confuse Real or Biological Age With Real or Biological Aging

The two are very different, just like age and aging. Real age is a fun way to estimate the impact of our lifestyle, environment, and other risk factors on our longevity. For example, research suggests that someone who has smoked his entire adult life will die an average of 8 years earlier than someone who has never smoked. Hence, a lifelong smoker’s real age is 8 years older than his actual age. This is an inexact science, but it can show us the effect of our behaviors and exposures in a way that we can all understand. We value life more than anything, so when we see that our excess weight, lack of physical activity, and uncontrolled high blood pressure are making us 10 years older than we really are, it can be a powerful message … but it says nothing about aging.

It’s Not about Aging—It’s about Old

Of the many definitions of aging, the simplest and most useful is: the process of growing old or maturing. This definition is useful because it gives us a new perspective. We see that understanding old or maturing is far more important than understanding any theory of aging.

KEY INSIGHT

Understanding how we get old is the key to leaving the confusion of aging behind and getting on with discovering what we can do to stay young.

The words old and maturing have very different connotations. Old is mostly negative—slow, weak, frail, wrinkles, and so on. It makes you think that nothing good happens with old age—a bad assumption. There are actually a number of positive things that happen with older age, including the benefits of more experience, better problem-solving skills, a greater sense of optimism, being less judgmental and less emotionally involved in things. Older folks often have a better understanding of the world around them and are not as bothered by little things. And, we hope, they have earned at least a little wisdom.

Maturing, on the other hand, is generally seen in a positive light, mainly in relation to growth and development. But, maturation doesn’t stop when we reach adulthood. We mature throughout life as we grow in wisdom, experience, and serenity. We’ll use maturing for the positive effects of increasing age and growing old for the negative aspects. Our goal thus becomes pretty simple—slow down, stop, or even reverse the growing old parts, while embracing the maturing parts.

The Great Mistake—Confusing Age for Aging

Because we use the number of years we have lived as the measure of how old we are, it’s easy to let our subconscious substitute aging for age. This leads to another damaging assumption—that weakness and feebleness, or aging, progress in a straight line in concert with age. Unfortunately, the number of years we have lived is a poor indicator of how we feel and function—in other words, how old we are in terms of health and biology. Think of your last high school class reunion, especially if you’ve had at least a 30th reunion. With each reunion, you see more variation in how old classmates appear. By the 30th it becomes a challenge to recognize some folks, while others seem to have hardly changed. It’s clear that people vary greatly in the rate at which they get old. Is this due to variations in the immutable aging process? Hardly. Remember that none of these changes has been conclusively linked to any particular theory of aging. We call this the missing link in aging research. Besides, it would be impossible to tell anyway because we have no way to measure aging. One thing we do know, however, is that the number of years we have lived, our numeric age, is not very useful as a measure of aging or biological age.

Another area of confusion between age and aging concerns the risk of chronic disease. Aging is consistently mentioned as a risk factor for most chronic diseases simply because they become more common with increasing age. It makes sense that older age is associated with a greater chance of developing a disease simply because there is more time for the disease to develop no matter what the cause. Age is a measure of time and is, in fact, a perfect risk factor (see box)—straightforward, easily measured, and on a continuum from low to high, or lower probability to higher probability. Aging, on the other hand, cannot be a risk factor because it has none of these characteristics. We’ll come back to this in Part II when we talk about chronic disease, but for now the key point is that risk factors tell us nothing about why things happen. They only predict the likelihood that they will occur. Do you ever think of age as a cause of anything?

It’s easy to assume that age and aging go hand in hand. But, when we exchange aging for age in our minds, it changes our thinking. We begin to believe that aging is a real cause of disease. This change has a dramatic effect on our mindset about getting older because we identify so strongly with our age. When we hear that most people are overweight at 40, have a chronic disease by 50, and take multiple prescriptions by 60, and then when we see it in real life, our mindset is confirmed—we’re getting old. When we see people who seem older than they really are at our reunions, we attribute it to variation in the aging process—yet another flawed assumption.

Risk Factors

Risk factors are conditions or characteristics that help us predict events, such as a diagnosis or a heart attack. They tell us nothing about what caused the event to occur. We all know that high blood pressure and high cholesterol levels are risk factors for heart disease. This means only that people with these conditions are more likely to be diagnosed with heart disease. It does not mean that high blood pressure or high cholesterol levels cause heart disease. Consider another risk factor for heart disease—family history. If your father had a heart attack at age 47, your risk for having a heart attack is increased, but this says nothing about what would actually cause the heart attack. It could be a defective gene you inherited, a diet you learned from your father, a psychological trait, or any number of other factors that you and your father have in common.

KEY INSIGHT

Believing that the evidence that supports age as a risk factor also supports aging as a cause is one of the biggest mistakes in our thinking about aging.

We’re going to change your thinking about what makes other people seem older than they really are, and what makes you older than you want to be. Satchel Paige pitched in the big leagues into his 50s. Most baseball players are old at 40. What was different about Paige? His mindset about aging, which led him to ask How old would you be if you didn’t know how old you are? It’s a good question. He really believed that he was younger than he was—and he performed that way too.

Old Is Not a Function of Age

The idea that our body and brain can be old at 40 or young at 70 reflects the central theme of this book—that each of us has a lot to say about how and when we get old. There is a long list of changes that occur in every structure and function of our body as we age (see Tables 2.1 and 2.2 in next chapter). These changes are so common that age is often used to predict them. They’re accepted as normal aging. At middle age, the list includes overweight, stiffness, poor stamina, low back pain, high blood pressure, and high cholesterol. At older ages, the list includes frailty, debilitation, dependency, and advanced disease. However, age alone does not dictate any of these changes.

Lab results and physical findings typical of older people can be seen in young folks, and vice versa—findings associated with a younger age can be observed at older ages. Some change is inevitable, but the time frame is far from inevitable. Age-related changes vary tremendously from person to person. Genes play a role, but so do many environmental and lifestyle factors (i.e., root causes). As we’ll see in the coming chapters, there is a lot more to growing old than aging, or age. The key question shifts from What is aging? to What makes us old? This change in thinking takes us from debating a mysterious concept with no real application to addressing our universal challenge—slowing down the process of getting old.

KEY INSIGHT

We do not have to settle for a future predicted by our numeric age.

Did your vision of old or getting old at the beginning of the chapter fit the usual picture? We can change this mindset if we begin to think differently about why we get this way. Think about people you know who are exceptions—vibrant, active, and energetic at older ages. They need to be our models for getting older. Most of these folks are unique in two ways: (1) how they view growing older, and (2) how they manage their lives. Most importantly, they show us what is possible. The rest, who are the norm, show us what is inevitable if we don’t change our thinking and our expectations, and if we don’t manage our behaviors and exposures in our everyday lives.

KEY INSIGHT

Our real age can be much younger than our numeric age. We control our own unique probability of getting old by managing the factors that make us old.

The Aging Syndrome Is What Makes Us Old

The most common changes that occur with increasing age involve shrinking, weakening, and stiffening. These problems often result from diminishing stimulation. When not used, the body begins to decay, to weaken, and to break down. The core concept of old is weakness, not only of the body but of the mind as well. The most important goal for anyone who wants to stay young is to be strong, physically and mentally.

So, what causes us to become mentally and physically weak? Not aging, at least not in the way we usually think of it. If only it was that simple. We’d like to believe the anti-aging folks—just take a collection of anti-aging supplements. Unfortunately, getting old—that is, mentally and physically weak—is a more complex process. The truth is that a lot of little things interact to cause our body to weaken and begin breaking down and to allow chronic disease to develop and progress. That’s why we call this process the Aging Syndrome.

KEY INSIGHT

A syndrome is a collection of signs and symptoms of disordered function that occur together and form a logical picture of an abnormal condition. In the Aging Syndrome, the abnormal condition is the acceleration of growing old.

What Is the Aging Syndrome?

The Aging Syndrome can be defined as the signs and symptoms of being old, categorized by the processes that produced them. These processes are the result of ten primary underlying factors, the ones we call root causes. When you read about their individual effects in Part II, you will see that they cause most of the changes we commonly attribute to aging. Together their effects cause us to age faster than we should.

There are several advantages to thinking in terms of the Aging Syndrome. First, it explains the missing link—the gap that exists between the theories of aging and the changes that we define as old. We may want to believe that observations in worms and yeast also apply to humans, but that’s really quite a stretch. The Aging Syndrome shows us how ten key behaviors and exposures do result in the changes we associate with getting old. Second, it takes the mystery out of aging and makes it less of a distraction. It provides the wisdom we need to interpret the latest discoveries about aging and to see through the most recent fountain-of-youth product being hyped on the radio or the Internet. Finally, the Aging Syndrome shows us that growing old has many causes, both known and unknown, and it helps us realize that we have lots of control over some and little or no control over others. It emphasizes the importance of knowing the difference between the two. And, it gives us a plan for focusing our efforts on what we have the most control over and what has the greatest impact. That plan is the focus of Part III.

Description of the Aging Syndrome

Figure 1.1 shows the components of the Aging Syndrome. There are three pillars of the syndrome—the three major factors that cause us to grow old:

1. Disuse—When we don’t use our body and brain enough, they get weak—that is, old. It’s the use it or lose it law of the biology of adaptation. We can use our body and brain to our advantage to reverse our weaknesses.

2. Chronic disease—Disease processes begin long before there is a diagnosis, but our doctors and health care system pay little attention until the diagnosis is made, at which time considerable aging has already taken place.

3. Real Aging—This is the mysterious unchangeable process that we don’t know much about, except that it is minor compared to the other two. The Aging Syndrome teaches us to accept aging and then move on to more important challenges—reversing disuse and slowing chronic disease.

Figure 1.1 The Aging Syndrome: Interacting root causes lead to megacause conditions that accelerate disease processes leading to disease damage. This combines with disability from disuse, real aging, and things we have no control over to cause the Aging Syndrome.

The big issue with these three pillars of growing old is the time and energy we devote to them. How much attention do you pay to each of them? Most of us think more about aging than the other two, which is why we call it the great distraction. In the Aging Syndrome mindset, we divert our attention away from aging and focus on disuse and disease. Disuse is the most powerful category for most of us because it not only causes problems on its own but also contributes to nearly every chronic disease process. Still, we ignore disuse even though we know we should not. We underestimate its power, and we associate it with exercise and all the bad things that go with it—discomfort, injuries, bad experiences, looking foolish, and so forth. Muscle and brain cells must be used or they wither away. They are not regularly replaced like most other cell types. Disuse of these cells leads to physical and mental weakness and accounts for a large part of getting old.

Chronic disease is the most misunderstood part of the Aging Syndrome. We ignore it as well, but at least for good reason: We don’t know why we should pay more attention to it. However, this is changing as more factors (root causes) are associated with various diseases at earlier and earlier stages. The question of cause has created chaos in the understanding of chronic disease. It was much easier to rely on aging as the cause. But, when you see high blood pressure and diabetes occurring at younger and younger ages, even in adolescents, can we really believe that these conditions are caused by aging? An expanding body of research demonstrates a multitude of relationships among causes and diseases (Figures 1.2 and 1.3). In the Aging Syndrome, we simplify disease processes by focusing our attention on the three megacause conditions that are the links between root causes and chronic diseases.

Real aging will probably turn out to be a combination of many processes that are indistinguishable from what we call disease processes. But, at this stage, we just don’t know. What we do know is that we pay too much attention to aging. Why worry about something we can’t do anything about? In the coming chapters we’ll give you more reasons to ignore aging and to change your focus to the megacause conditions.

Figure 1.2 Chronic disease as presented in the media—too general to be of any use.

The Three Megacauses

Megacauses are the major pathological (disease-producing) processes that result from root cause behaviors and exposures. They show us how diseases develop over the years, eventually reaching the diagnostic threshold when they are finally recognized by the medical system. The period leading up to the diagnosis is vital because this is when significant damage is being done below the radar, and it is the time when we have the most control over the process (Figure 1.4).

Figure 1.3 Chronic disease in the media, the next step—specific relationships and interactions result in chaos.

Figure 1.4 Chronic Disease and the Aging Syndrome: root causes lead to a few megacauses, which lead to many diagnoses.

The three megacause conditions—constricted circulation, metabolic madness, and insidious inflammation—play a role in the majority of health and medical issues we will face in our lifetimes. Constricted circulation is easiest to recognize. It has to do with the health of our blood vessels—the buildup of plaque (atherosclerosis) and the stiffening of vessel walls (hypertension). Our circulatory system becomes increasingly constricted and unable to deliver an optimal supply of blood to our cells. Constricted circulation is directly responsible for most heart disease, strokes, and peripheral vascular disease, but it also contributes to every other disease process through its impact on blood flow.

Metabolic madness relates to the changes that occur in our metabolism as a result of overeating, fat accumulation, and inactivity. It begins with muscle cells shrinking and becoming resistant to insulin as a result of disuse. This causes our body to release more insulin, pushing our excess calories into fat cells for storage. Expanding fat cells, especially in the upper body, begin to secrete numerous substances that play havoc with our metabolism and appetite. Obesity, the metabolic syndrome, and type 2 diabetes are the hallmarks of metabolic madness.

The third megacause, insidious inflammation, is the rising star of the megacause world. We’re all familiar with the signs of normal inflammation—redness, heat, swelling, and pain. It’s our immune system coming to our defense, initiating a healing response. What we’re less familiar with is the chronic, low-grade, silent inflammation that takes place in tissues all over our body in response to abnormal substances or conditions. Many doctors and scientists now believe that virtually every known illness is associated with persistent inflammation. The three megacauses interact with one another, compounding their impact and further accelerating disease processes.

The Ten Root Causes

Few abnormal conditions ever have a single cause, and that is never truer than with the three megacause conditions. Multiple factors contribute to plaque buildup, stiffening blood vessels, fat accumulation, insulin resistance, and chronic inflammation. We use the term root causes because they are the source of not only most chronic diseases but also accelerated aging. The ten root causes are listed in Table 1.1.

These factors play varying roles in each of our lives. Some have a greater impact than others, but all are important because they interact in subtle but powerful ways. Physical and mental disuse are universally important. Sufficient use is absolutely vital for maintaining physical and mental functioning. When muscle and brain cells are not stimulated regularly, they begin to shut down. Adaptation to disuse is relentless in its impact on vitality and disease. In contrast, if you don’t smoke and never associate with smokers, then tobacco isn’t a factor. Similarly, if you don’t drink alcohol or if you use it only moderately, alcohol isn’t much of an issue. The food and drinks we consume, the stress we’re confronted with, the environmental factors we’re exposed to, the medications and herbal supplements we take, our attitude about life and aging, and the emotions we feel all play varying roles in the developing megacauses. Together, they can make us grow old slowly or quickly.

Table 1.1 The Ten Key Root Causes of the Aging Syndrome

1. Physical disuse

2. Mental disuse

3. Poor diet and nutrition (eating habits)

4. Tobacco exposure (secondhand smoke)

5. Excessive alcohol

6. Stress

7. Environmental exposures

8. Negative attitude and emotions

9. Overuse of medications and herbs

10. Genes

In discussing the ten root causes, we will focus on changing what can be changed to reverse the megacauses in order to shift the odds of a long, healthy life in our favor. However, we will all experience injuries and illnesses and losses along the way that can have lasting effects. We have to learn to accept what we have no control over and make the best of any situation. That’s where acceptance and resilience come in. If we are not able to accept such situations, the resulting emotions will make us age faster than we would like.

Genes are unique in that some aspects of them are changeable, while others are not. Our understanding of genes is changing, but we know that they are not static. They can be turned on and off with various stimuli, including the other root causes. This can work for us or against us. We all have a unique set of genes, or genotype, that increases the likelihood of some problems and reduces the chances of others. Sometimes, no matter what we do, our genetic makeup can set