Trends in Aging Well

By Marilyn L. Pinsky

Gastroenterology specialist Isaac Kalvaria stands with his son Hylton Kalvaria.

I had a far-ranging conversation with a doctor who looks at the aging process from the perspective of “trends.”

Isaac Kalvaria is a gastroenterology specialist retired from full-time practice who now does second opinion consulting and treats indigent patients at Sarasota Memorial Hospital in Florida. His ideas on aging well are grounded both in science and from his own experience as a physician. Most important, he provides specifics for what we can do to control our own aging process.

I think you’ll find his ideas as exciting as I did.

Q: Dr. Kalvaria, what is the premise of “trends in aging?”

A: With regard to health, the most powerful piece of information you have is your family history. Armed with that, you can intervene in your own lifestyle early on. The knowledge that my father died at 45 of a heart attack prompted me to study my risk factors and proactively make the necessary changes to reduce the chance of the same outcome. This requires a recognition of trends in individual health and the power of early interventions to improve outcomes. This “self-auditing” of trends is not restricted to health. These include monitoring our cognitive state, financial situation, physical activity and social lives. Continually auditing each of these areas can identify trends that are either positive or negative and can be proactively amplified or adjusted to improve outcomes.

Q: What led you to this approach?

A: As a doctor, my concern was always with the negative trends, which can lead to major health issues if not identified early and reversed. A progressive gain in weight needs to be reversed before it becomes a major health issue. A weight gain of five pounds may not be something to be concerned about, but a weight gain of 25 pounds becomes both a physical and psychological problem. The real message here is to be proactive vs. reactive. Ideally, if one wants to have a real impact on future health and happiness, we would be aware of this in our 20s and 30s, but the problem with self-auditing and making meaningful changes at a young age is that there is less sense of relevance and urgency.

I consult with young people who have gastrointestinal problems and urge them to change their lifestyles as well as their family’s lifestyles. The younger the age at which changes are made, the greater the benefit for lifelong health. This might involve a change of diet, increasing exercise levels, improving sleep quality and avoiding harmful habits such as smoking, alcohol and recreational drug use.

Q: Physically, I understand there are things we can do to stay healthy. But what about cognitively? That seems to be out of our control.

A: Yes, we all have a particular fear of dementia, particularly Alzheimer’s. However, there are some very early signs which suggest the beginning of cognitive impairment, such as behavioral changes. Other more subtle signs are constantly being discovered. Early intervention can make a big difference in the quality of life. The Bredesen Protocol is one such program.  This begins with a simple evaluation consisting of a set of blood tests, including tests for heavy metals and mold, and a cognitive assessment that can be taken online. The protocol involves a healthy plant-based diet, modest frequent exercise, maintaining a healthy body weight, stress management, optimizing sleep quality, sun exposure, socialization and a sensible diet, including limitation of sugar intake and appropriate supplements. Being curious and open to constant learning is also very important. I encourage people to establish with a good general practitioner no later than their 40s and have annual lab tests, again looking for trends that can be improved with simple interventions.

Q: How do you feel about supplements and do you take any yourself?

A: I’m a believer in supplement use, but only after a careful assessment of good evidence-based data. Vitamin D, for example, has recently been identified as a very important vitamin for maintaining general health as well as perhaps reducing the risk of Alzheimer’s dementia. Vitamin D dose should be adjusted to achieve an optimal blood level of 50-60 ng/ml. Another useful supplement is Omega-3 fatty acids, derived from cold water fish. I also take a general-purpose multivitamin. Low-dose aspirin is very controversial, and recommendations should be individualized. Other supplements may be important based on individual needs.

Q: For people who want to tweak their aging process, what type of medical professional should they seek out?

A: They may want to consider finding a primary care physician or internist who has an interest in functional or naturopathic medicine or, at the very least, is open to alternative therapeutic approaches. I use both an Eastern and Western medicine approach in my practice. In functional medicine, we look for the root cause of a problem. Important factors which may have an influence on health include the type of birth (vaginal or cesarean section), whether breastfed or not, growing up with a pet, and growing up in a city or rural environment. These factors have a great bearing on the intestinal bacterial population called the microbiome. We have 100 trillion cells in our body and of those, 50-70 trillion are bacteria in our gut. The microbiome is affected predominantly by diet, environment and geographical location. There is a dramatic difference in the composition of the microbiome between individuals living in developed countries compared to developing countries, the latter showing a more diverse and overall healthier pattern. Interestingly, there is even a difference in the microbiome between heavy and thin individuals, perhaps suggesting opportunities for weight control by adjusting the microbiome.

Q: I’ve heard a bit about Blue Zones, where people live longer. Could you explain?

A: The Blue Zones are those areas of the world where people live vigorously and healthily into their late 90s and 100s and pass away suddenly or after a short illness. People in those zones have been studied to see what commonalities they share that would account for those healthy outcomes. The zones are Okinawa in Japan, Loma Linda in California (mostly Seventh Day Adventists), Ikaria in Greece, a region in Sardinia, Italy, and the Nicoya Peninsula in Costa Rica. Though geographically diverse, they have the following things in common: there is active socialization within their own community, people are in constant movement without necessarily doing a formal exercise program, they live on mostly a plant-based diet, they stop eating when they’re 80% full, they have a sense of purpose in their lives, they drink alcohol in moderation, they are non smokers, they each have a way to downshift and shed stress, there is a sense of belonging, their culture puts family first (a sense of commitment) and they have a social circle that supports healthy lifestyles.

Q: How can people achieve those outcomes who don’t live in those communities?

A: In reviewing these blue zones, in addition to the diverse geographic locations, there are many differences in lifestyle, particularly diet, so there is not a “one size fits all.” This provides opportunities for a more diverse diet within sensible parameters. However, the most important common factor is surrounding oneself with a group of like-minded friends who provide support in both good and bad times. The love of music can be a shared experience, and acquiring a pet can be very therapeutic. Avoiding social isolation in older age groups is critically important.

Q: Any final words of advice for healthy aging?

A: Identifying trends and then amplifying the good ones and reversing the bad ones is perhaps the most important general piece of advice. It is not easy to change a diet you have become accustomed to for years, but if you identify bad dietary habits, start to change those today. Slow and steady changes are much easier to adopt and maintain than drastic interventions.

Likewise, friends can support a healthy lifestyle or not — smokers tend to associate with smokers and alcoholics with alcoholics. Surround yourself with like-minded individuals who are motivated to stay healthy. Try to identify and treat anxiety and depression, which can be very detrimental to health and avoid situations and individuals who induce anger, which is a very psychologically and physically damaging state. Get the many facets of your life in order, including organizing your finances, preparing your living wills, and, if appropriate, your trusts. Try to leave a legacy beyond financial, to include happy and healthy descendants.

None of us knows what tomorrow brings, so we have to assume the best day of one’s life is today. To remain youthful and age well, we need to remain inquisitive and have a sense of awe about this life we are living, and be aware that by self-auditing, we can make changes today which will benefit us tomorrow.