Telomeres Are Cool

I am fascinated by telomeres. Telomeres aren’t some sort of underwater television or talking mirrors. Telomeres are caps on the ends of your DNA, your genes. They shorten with age. Eventually they are gone and so are we. As they shorten we become more vulnerable to disease and generally poor health. With advancing age, our immune systems do not work as well. We do not really understand why that is. One newly discovered clue is that individuals with shorter telomeres are more vulnerable to infections. There is now basic sciences evidence that telomeres protect against cell degeneration, chromosomal damage and the transformation of healthy cells into cancerous ones. Although we are still just starting to learn about telomeres, we already know that chronic lung disease, high blood pressure, Alzheimer’s Disease, coronary artery disease, transient ischemic attacks (threatened strokes), angina, diabetes, HIV, lupus and depression are all linked to short telomeres or compromised telomere function. These findings do not indicate that all ill health and aging are really some sort of “telomere disease”. In a way, telomere numbers look increasingly like the answer to the question “how healthy am I?”. Taking it a step further ,leading us to practical and effective action, measuring telomere length appears to be the way to answer the bottom line question that interests us all “If I do that will I be healthier?”. There are many tests which give us a sense of the risk of specific threats to our health. Cholesterol measurement gives us a far from perfect indication about our risk of dying from a heart attack. Blood sugar measurements and blood pressure can also give us some idea about specific health diseases. A very big HOWEVER though is that these individual measurements are as weak as they are strong. They are so narrow and specific that even when they are very good at telling us about specific risks, they are relatively worthless as measurements of overall health. For example, very a low cholesterol is associated with lowered risk of heart attack but also higher risk of violent death - accidents and suicide. You are more than a disease or collection of health problems. Measuring telomeres is not really useful as far as predicting specific disease risks, at least not yet. At some point (soon?) incorporating telomere numbers should give us a much more accurate impression of just how worried to be about a person’s health generally and specifically. There are people with high cholesterol or a high blood sugar for example...

The Wisdom Of Effective Annual Health Screening

A recent article in the NY Times caught my eye. I couldn’t have agreed more, and also less. Titled “Let’s (Not) Get Physicals”, it was a reflection on the problems with conventional routine physical exams. http://www.nytimes.com/2012/06/03/sunday-review/lets-not-get-physicals.html?pagewanted=all The time-honored tradition has been for a thoughtful patient to see her/his doctor for an annual exam. The article discussed several of the screening tests that have been the foundation of the annual exam routine. Many of these have been shown to be ineffective. Ineffective screening tests are worse than just a waste of time and money, as they lead to other needless tests and procedures. The procedures, the next steps looking to identify or treat the “disease” that is not there or does not need to be treated, usually create their own problems. The end result is that the patient has been harmed by this well-intentioned effort. Bear in mind that dumping procedural screenings is nothing new. Annual chest Xrays, anyone? We used to do that not so terribly long ago. That was the agreeing part. My disagreement is based on the definition of what is done. From my experience it is certain that an appropriately directed annual health assessment is wise. That is true, even excluding the simple technology of a couple of blood tests. I see people every day who are so vitamin deficient that it shows up in simple blood tests from a conventional lab. But forgetting that, dumping all the post 19th century technology, there is ample, easily accessed and useful evidence of what needs to be changed to better a person’s health. Taking to patients about how they feel, what they eat, their exercise patterns, how they are managing the stress of their lives, etc., tells me a lot. With that information, I can help them improve the quality of their day to day lives and avoid developing the most common diseases in our society (e.g., heart disease and diabetes). The risks of talking to a patient, looking over a three day diet record, reviewing his/her use of supplements/medications and conducting a simple physical exam are close to nothing. Another shadow, looming over this discussion, is that doctors know that patients don’t change their habits. You can never get them (you) to change their diet or exercise. They won’t work to learn how to manage stress better. Docs know that. As you know very well, docs are wrong. A child can learn to read and write without any help. but...

Running and Longevity

Newly released data, collected over nearly 40 years, indicate that runners live 5-6 years longer than other people. I like this but also have some doubts. I began running as a 12 year old, and after a few more months of surgical recovery, hope to resume this life-long habit. I love it. My work as medical staff at marathons and as Medical Director of the Santa Rosa Marathon are the confluence of my interests. Just like this study shows, I am certain that running, and more broadly, being physically active, are crucially important to any person’s health and wellbeing. Now for the doubts. Five to six years is a huge difference. The study has a number of flaws, unfairly visible with close to two generations of hindsight. Why “unfairly”? Well, any long-term study will have significant problems. There is too much we don’t know, including unknown and then unobserved variables. So, weakness are inevitable. Too much criticism is also unfair, because of course the reason to do research is to learn what we don’t know. We can’t expect researchers to know what no one knew when they began. So, my advice is to take these findings with a grain of salt. Running is great. However, exercise in any form is great and there are excellent reasons, theoretically, scientifically and understood by those with experience, why other forms of exercise are also essential and sometimes preferable. As my father died of a heart attack at age 47, can I attribute my 10 additional years (SO FAR) to my running? Sure, but only in part. My diet has been excellent, way better than his was, for the last 40 years. That influence, other elements of my exercise regimen and many other factors for sure play their parts. So, run if you want to run, but exercise, you must. While you are at it, adding in the other good stuff will help you live better, not just longer....