The Building Blocks to Better Aging

Welcome to the Living to 100 Club Podcast. Here's our host, Dr. Joseph Casciani.

Hello to everyone joining us today on our podcast. You're listening to one of our public episodes this month on the Living to 100 Club program, and I'm your host, Joe Casciani. Each week, our conversations educate and inspire, helping you get the best out of all the years we're given, regardless of what obstacles come our way. This Living to 100 Club podcast welcomes Dr. Michael Howard for an encore guest visit. Today's event is also the first of its kind here at OASIS, where we have a live audience in our studio for an engaging and interactive program. Welcome everyone to our podcast. I hope you'll be— have plenty of questions for our guest afterwards, so we'll be sure to reserve time at the end for Q&A. In today's program, we explore the many dimensions of successful aging, from stress management and resilience to happiness and good health. What does science tell us about the most successful strategies to longevity? What behaviors are the key factors in preventing and managing chronic illnesses? How do stress, anxiety, and depression contribute to sickness? Dr. Michael Howard is a behavior health practitioner and educator who presents on topics related to disease prevention, understanding longevity and aging, and other topics to scores of health professionals. First, a little more background. Dr. Howard is a clinical neuropsychologist, rehabilitation psychologist, and health psychologist. He's an internationally recognized researcher and speaker on aging and longevity, brain-behavior relationships, traumatic brain injury and concussion, dementia, stroke, addiction, and rehabilitation. During his 30-year career, Dr. Howard has had appointments to the psychiatry, neurology, and rehabilitation medicine faculties of 3 medical schools, headed neuropsychology and behavioral medicine departments, and directed programs for treating brain injury, dementia, addiction, psychiatric disorders, chronic pain, and other disabilities. Dr. Howard is the author of the book Living to Be 100: which was, as I've told Mike several times, the inspiration for me when I started my Living to 100 Club. I read Mike's book, Living to Be 100, and it created the seeds for my Living to 100 Club. So this is a hybrid program. We have Dr. Howard on a Zoom screen and we have a live audience here. So I'm gonna proceed as I usually do during my podcast. And then as I said, we'll have time for Q&A afterwards. So I just like to open by asking our guests to tell us a little bit about the journey that brought you to where you are today. Mike?

Oh, that's a long one. That's a long one. I was pre-med and then got accepted to med school and decided not to go. And a mentor of mine— I'd only taken 2 psych classes. I'd actually worked 3 years in a psychiatric hospital when I was in high school, in my first year of college. And worked on several different units there in this huge mental health operating hospital in Osawatomie, Kansas. And didn't really have much interest, I thought, in going into psychology, but then this one particular professor got me very interested, and I decided to get a PhD in psych instead, ended up specializing in neuropsychology. And since I trained back in the '70s, there weren't many neuropsychologists around then.

Sure.

I got to do a lot of different things. And, uh, got to be involved in lots of different sorts of things, from addiction to psychiatric stuff to brain damage to Alzheimer's units to traumatic brain injury programs and all that. And I do have attention deficit disorder, which probably kind of plays into that. I kind of like to do a bunch of different things. And back in the 1990s, from '89 to '96, I was in New Orleans doing a bunch of different things there. But I had a psychiatrist move in next door to me in my private practice office, and we got to be buds and, and Got very interested in positive psychology and instead of pathologies, more interested in normal development and aging in particular.

Sure.

And I turned 50 in '94, I turned 50. I got interested in aging 'cause I was getting old.

Mm-hmm. Yes.

And looking at myself here, God, yeah, I'm 79 years old. I'm an old guy. I'm an old dude here. I'll be 79 this year. And it was mostly that I got really interested in the research and spent a lot of time getting into aging and find as many aging studies as I could find and talking to people that were doing it and this. And, and it all sort of came, it all sort of just came together about then. And then, and then I went to work for Institute for Natural Resources that does continuing education stuff for health providers. So I just write 6-hour seminars and do all-day seminars on various topics, a number of which relate to aging and longevity. So I suppose that's a Yeah. Making a life into 6 sentences. That's probably it.

Yeah. Well, that's, it's a, it's a long journey. I can see that. A lot of highlights, a lot of achievements. Let's jump into the topic for today. Let's talk about aging and how does that make us more vulnerable to developing chronic illnesses? What's going on with our bodies?

Well, first of all, we were never supposed to live this long. Of course, our life expectancy in the United States alone has doubled since 1870. I mean, from going back to the 150,000 years we walked this planet, probably we spent 90, 95% of it as hunter-gatherers in the Stone Age. Probably the average life expectancy only be about 27 years because of a skewed left curve. So many kids died young and so many young people died of all sorts of things. So it, that brings life expectancy way down. Probably only 1 outta 10 made it to 60 years old. So the idea of coping with this idea of aging is a very recent phenomenon in, in human history. I mean, we lived about 39, 9 years in 1870, we live 76 now. We've, we've lost 3 years of life expectancy in the last— yeah, last couple years I saw that, which has to do with young people dying, not old people dying. Even though COVID-19 got a lot of old people, then it targeted, you know, folks like me, ancient folks like me, it went after. It's gone down a lot for what's happening to young people now, and infant mortality and pediatric mortality has gone up significantly to where we live now about 6 years shorter than the average high-income country that has incomes like we do. Our life expectancy is markedly shorter here. It's going down to 76 and the average, the top 16 high-income countries live 82 years. We're living 76. So we'll look at some, some of that. But the main reason is in your genetic code, you're built to die. We're genetically endowed to go through maturation, go through a development, up into the 20s, late teens or 20s, have a sort of a few, just a few years of at the maturational level, and then everything else is downhill because aging killer genes kick in then to kill us.

Mm-hmm.

Now aging's built into our genetic code, but we don't die directly from that reason. Only about 30% of how long you're gonna live is your genetic code. 70% are lifestyle choices we make.

Lifestyle.

Across the board, but we are, we are born to die. It's built into our genetic code that, that we're gonna die. And as we age, a number of different things start to happen to our, to our bodily systems. There's the famous 9 molecular hallmarks of aging. It starts at the very, at the very cellular level. The cells begin to change. Your DNA gets damaged. Mitochondria don't function the way that they're supposed to after age 30. Matter of fact, pretty much everything After age 30 goes down.

Yeah.

And actually some begin in the early 20s, your lung function and things like that even begin to change then. And of course your maximum heart rate is 220 minus your age. That goes down every single year you go through your 20s, your cardiovascular system is starting to go down.

So this is, this is all normal aging as you're, as you're describing the normal aging process, decline of our cells, the biomarkers and all that. Shows upper aging. And then just, I just wanna highlight what Dr. Howard just said a minute ago. 30% of our longevity is due to our genetic makeup. 70% is due to our lifestyle factors. And to me, that's, that's a real eye-opener because that says 70% of our longevity is under our control as we learn more about healthy lifestyle. So, think about 70%, you know, contributing to how long we live, that's under our control. I, I think that's such an important point. Yeah, sorry to interrupt. Go ahead, Mike.

No, no, I like interrupting. It's okay. I like it. I remember I've got attention deficit.

That's fine.

The interruptions are kind of fun. We really live long by not dying. It sounds horrifically simplistic and reductionist, but we live long by not getting the diseases and illnesses that tend to shorten our lives and kill us. Very few of us die of old age. We die of age-related diseases that we get in relation to our body's aging, but our lifestyle choices impact on that to make us vulnerable to get the diseases that end up killing us. So to live long, you don't die, which means you basically either prevent, delay, or somehow manage top 10 cause of death really. Cuz 4 out of 5 of, of the 2.5 million Americans that die every year, 4 outta 5 will die of one of the top 10 cause of death.

Right.

Well, if you can delay or prevent or manage 'em once you get them, like if you get heart disease, like, mm-hmm, I've been an athlete my whole life and all that, and I've got a leaky aortic valve here. I just got a pacemaker put in because they found out with a Holter monitor I was running second-degree atrioventricular blocks at night and so forth. Aging is gonna catch up to the various bodily systems. In here, but medical management after age 75, the US is pretty good about that. We're not very good at the stuff that kills us before age 75.

Okay, that's important. Sure.

Yeah, that's the thing.

If we make it to 75, we've managed to avoid or delay or survive these other risk factors.

Give a nice hosanna to Medicare. Yeah, yeah, Medicare is a huge reason. Why we're living longer now than we did before. Because people have access to medical care in old age, which is when we're basically spending most of our health dollars, or things that hit us in old age.

Yeah.

A great deal. So our body systems all age, but not all of 'em kill us. I mean, your skin's gonna age. Look at mine. I mean, I don't, I can't, I look in the mirror, who is that guy?

You know? Yeah.

It's gonna get all of us, but your aging skin's not gonna kill you. Your aging digestive system's not gonna kill you, but your aging cardiovascular system is very likely to kill you. Your aging endocrine system, your aging immune systems, those are the things now that begin to threaten our lives, are those aging systems. So our bodies and brains age, but different systems are much more vulnerable to how long we're gonna live. You may not like your wrinkled skin, but it ain't likely to kill you unless you get a disease like malignant melanoma. It's not gonna, it's not gonna kill you. But your aging cardiovascular system is building up risk to your life and your endocrine system, your bones and your blood and your blood sugar control and the immune system going down as we age. All these things now make us vulnerable to age-related diseases that will end up killing us and shortening our lives.

Yeah. So 4 outta 5 deaths in the US are due to these chronic diseases, chronic conditions.

They're pretty much all, all, if you look at the top 10 cause of death, And, and you know, COVID-19 was number 3 the last 2 or 3 years. That's kind of an exception because this, of the pandemic, but heart disease, cancer, accidents now, and unfortunately accidents, the number 1 cause of that of course is overdoses. And that's opioid-related things, which is a huge American phenomena. These, these, these overdoses and they're usually due to chronic conditions too. Usually chronic pain is the reason why people start taking 'em. COPD, stroke, Alzheimer's disease, diabetes, kidney disease, suicide.

Mm-hmm.

And suicide, you would think, you know, that's an acute event. No, no way, sh— I did my master's thesis and original journal articles on suicide. Ron Maris, the great suicidologist, calls suicide a suicidal career. People build up to suicide over long periods of time. So all those things are chronic conditions. Every single one of them that begin often in our midlife and then begin to really manifest themselves as aging kicks in along with the risk factors for those as we get older. That's what ends up shortening our lives.

Yeah. What about anxiety and stress? Where do they fit in in terms of contributing to this chronic disease syndrome?

Well, hugely. That list of 10 things I just gave you Chronic stress is a risk factor for every single one of 'em.

Chronic stress.

Okay. It's not gotta go on your death certificate. Nobody's gonna die of chronic stress, but you're gonna die of diseases in which I think Robert Sapolsky, the great stress physiologist from Stanford, often says we all are gonna have the luxury of dying of a stress-related disease.

Hmm.

Because back, you know, in the Stone Age, we got all these infections and injuries that killed us.

Those stress.

Now we can die of these stress-related diseases, but we don't have to die so young from them if we manage stress better. Unfortunately, a lot of folks don't manage stress very well and it becomes a risk factor for anxiety and trauma disorders. And half of them will develop depressions. And these things of course become risk factors for the physiological illnesses that will end up killing us. You know, early deaths between 15 and 45, the biggest single risk factors for early deaths and disability then are mental disorders, not physical diseases.

So between age 40 and 50, did you say?

Well, up from 15, 15 to 40, once you hit puberty, from puberty up to about 45.

Okay. Okay.

It's mental. Look at the World Health Organization, its list of most disabling diseases. Then they're almost all mental disorders because there's bipolar disorder and schizophrenia and depression and things like this. They're, those are the things that disable and kill us then. And because of our lifestyle factors that go with them, they become a big risk for a lot of physiological diseases as well. Stress, when you, when you get, when you have a stress response, you know, when you go into the, your autonomic nervous system, you hitting the sympathetic part of your autonomic nervous system, which is designed to kind of save our lives, you know, when something's threat, like a getting attacked by a lion or somebody with a knife, 18 body systems change to help us survive the next 10 seconds or the next 20 seconds.

Wow.

And when your heart rate goes up then, and your blood sugar spikes up then, and your blood pressure spikes up then, your blood clotting factors go up and your immune system goes into high gear and all that All those other 14 of the things change. That's great when you're running away from somebody trying to stab you with a knife. But if that happens over and over and over, you can just see what's happened.

Yeah. We don't recover from it. Sure.

Becomes the bad stuff. The, the chronic, the acute stuff's good. The chronic stuff is bad. And that really is what gets us down the line, especially the immune, the immune system gets affected by it. We go into a hyperimmune response and an acute stress response. But as stress becomes chronic, we wear out the immune system and we go into immune suppression. And that's a huge— and then go into global, more systemic inflammation. And both of those things are just awful. You lose your targeted immune response, but you go into a global inflammatory response in the body that begins to damage all sorts of healthy systems. There's just— chronic stress is just a major killer. It's a major killer, major risk.

Yeah. Well, let's talk about prevention a little bit. I mean, let's talk about healthy behaviors. What can we do? How do we start engaging in these positive lifestyle behaviors? And so we can reduce, or as you said, avoid or delay the chronic illness. What are some of the recommendations for this healthy lifestyle?

Well, I am a firm believer of all the, all the aging studies I ever read. The one that probably is the most detailed and most tends to predict how long and how well we're gonna live is a study done right there in Southern California, the Longevity Project.

Mm-hmm.

And I'll hold this up cuz I don't have any vested interest in this thing at all. I've got two bookcases here full of stuff on aging, but if I had to buy one book on aging, I'd just buy this one. I'd read it cover to cover 5 times because it's the most detailed study of aging ever done.

That's by Terman.

That's the Longevity Project that Louis Terman's original 1,500 kids back in 1910, they're all dead. They followed them from birth to death, including death certificates, and did umpteen studies and interviews and follows on these people. They just collected so much data, it's almost hard to keep up with. Howard Friedman and Leslie Martin, they kind of, they run this thing now. And the thing that comes out of this is it's not so much what you do, as who you are. Your personality structure, our behavioral habits and our core beliefs we form in life become the things that begin to direct and control these health behaviors that we tend to do over time. Now, since personality change isn't easy, and although conscientiousness, that's kind of the personality factor that most predicts long life, and conscientious personality does tend to increase in most people over a lifetime. As we go from the 20s, 30s, 40s, and 50s, we tend to make more prudent decisions and have more impulse control and all that kind of stuff goes into it. But that personality style plays a giant role. So what do people with that personality style do? I think you have to begin, if somebody really wants to change their life habits, and as you and I both know, a very difficult thing to do.

Not easy to change behavior. We know that.

Yeah.

Woo.

I think you start with the 5 Fickle Fingers of Faith, what I call the 5 Fickle Fingers of Faith. It came out of a first study was back about 11, 12 years ago, but then a Public Library of Science one study was really brought this to the fore in the Harvard Physician Study. A number of studies have found this. If you just do 5 things regularly, not perfectly, but just, you know, pretty systemically and regularly in your life, You can add 13 to 16 healthy years, which most of us want. We, we don't want a lot long lifespan. We want a long healthspan. We want to have years when we're pretty healthy and we don't be sitting, you know, disabled in a wheelchair and really tore up at the end of life. Well, it happens, but we don't want that to happen. We wanna be healthy. So 13 to 16 healthy years you can come just by keeping a normal weight.

Mm-hmm.

Eating a fairly healthy plant-based diet. Exercising moderately and regularly, don't smoke, and don't drink to excess of alcohol. Now, this is not—

this is—

doesn't even have to have PhD in human physiology to figure this out. This is really pretty simple stuff. But in the Harvard Physician Study, only 1 to 3% of the American population do those 5 things regularly, and only 4 to 6% do 4 out of the 5 regularly. Now having good relationships, which is your biggest factor in happiness in the, in the happiness studies, having a good regular restful sleep, managing stress well, those are all really important. But the 5 Fickle Fingers of Fate physiologically predict so many of the chronic illnesses that end up disabling and killing us over life. And we simply choose not to do 'em in the American lifestyle.

And you said 1 to 3% of the population engages in these 5 practices? 1 to 3%. So 1 out of 100, 3 out of 100 people. So good weight, diet, smoking, exercise.

If you think of the 2 things that people think, weight, diet, and exercise, and weight, that's original little triangle here. Although diet is more of a factor in weight than exercise. It, for most people, body weight, diet, and exercise, and then smoking and drinking. I mean, it's done. This isn't hard stuff really.

Yeah.

But when you, wherever you think, 73% of us are now overweight or obese. Probably only about anywhere from 12 to 14% of the population eat a regular healthy diet. Only about 16 to 22% exercise regularly. We still have about 14% of people that smoke regularly. And a lot of people in the population still drink to excess that aren't necessarily alcoholics or alcohol addicts, but they're binge drinkers or drink to excess on a regular basis. So you can see, just add the numbers up.

How do you define, how do you define the drinking to excess? More than 2 drinks a day?

Yeah, that's for a man. For a woman, it's probably more than 1 drink a day. If you look at what the data—

more than 1, sure.

I'll tell you, dude, drinking's tough, Joe. Drinking's tough. I probably, you know, I ran 3 addiction units and I, I've got a lot of stuff on alcohol and light to moderate drinking. Even the most recent studies tell us even a drink a day probably is giving you brain impairment. When it goes on every, every single day. I mean, yeah, there doesn't appear to be really a fairly healthy level of that. Everybody's different, of course. We have different genetic makeups, and sure, some people can do it and some people can't. But for the average person, probably even a drink a day, it may be somewhat helping your cardiovascular system, but it also may be impairing your brain and making it more likely you may have age-related brain issues. It's Drinking's, drinking's tricky stuff. It's very tricky stuff. What a, what the healthy level is, is, is kind of tricky.

Yeah.

And then diet, we're talking about, you just know, even though the longest lived person ever, Jean-Louis Calment.

Yeah. Yeah.

Smoked for 100 years.

I mean, yeah.

A third of a pack a day.

There's always exceptions, right? I mean, there's always, there's always an exception.

Sure.

Sure. And talk about diet a little bit. Talk about the healthy diet, plant-based. Vegetables, fruit.

It's real easy, folks. You just, you start to, with probably for brain-based diet, it's called the MIND diet, the MIND diet developed by a nutritionist up in Chicago. And that's simply a meld together of the DASH and the Mediterranean diet.

Mm-hmm.

Which simply means you're eating a lot of plant-based foods, maybe some chicken and fish tossed in there, some low-fat dairy products. But you're not eating whole fat dairy products. You're not eating processed or red meats a great deal. You're not eating the butters out there and all that sort of thing. It's really pretty simple stuff when you get down to lowering the refined carbohydrates and the saturated fats, raising the unsaturated fats and the more complex carbohydrates and the protein sources coming from not red meats usually, or, or from a really whole fat dairy products. It's pretty, pretty simple.

Mm-hmm.

Typical model, you know.

So the MIND, M-I-N-D, that's the combination of the DASH and Mediterranean.

Yeah. Look it up on Google. It's real, real easy to find.

Sure, sure.

Okay. A guy named Goodarsa Dhaney, a few years ago at Harvard School of Public Health, they came up with 12 things Americans do that shorten their lives.

Hmm.

10 of them were diet related and all 12 or one of the 5 Fickle Fingers of Fate.

Wow.

It all gets back to the same stuff. I know it sounds so simplistic. Yeah. It all narrows down to the same things. But if you look at Godard's DNA study up there, what they looked at in terms of the things we did that tend to kill us, every single one of 'em is one of the 5 Fickle Fingers of Fate, and 10 of them are diet related. It just, because you know, the drinking will be diet related. Okay. Your body weight is in there. Exercise is in there, but But basically most of them are diet related. And I think when it gets down to it, of all the things we do, probably chronic stress and diet may play a bigger role in what's, in what's really taken our, our lives down than, than anything else.

Yeah.

You, when you really look at, if you wanna narrow things down to a couple of things to look at, it's how we manage and what we eat. You kind of are what you eat. The, the old saying probably has some validity to it.

Yeah. Well, okay, this is eye-opening, obviously, information. So the next question is, how do we change our behavior? We, we get a lot of good information, right? We learn more. There's, you know, reports, there's news, there's internet, there's so much good information out there, and yet it's hard to adopt the change, right? How do you, how do you engage in some healthy behaviors?

I think it comes down to making a an actual plan. And I'm a big believer in written plans. When I worked with people in weight loss and smoking cessation and stuff like that, a written plan that you write down, that you basically put down the goals. I like the SMART acronym that goes with it. They gotta be specific, they gotta be meaningful and manageable. You have to be able to achieve those goals. They have to really be time-oriented and they have to relate to the real things in your life. And yeah, I know, and I have a, a real kind of rule of three. Now this is my own particular bias. There's no science behind this. When I worked with people for years and years, I found it's hard for people to work on more than 3 things at a time. I mean, you're just doing 3 is a lot. You start throwing 5, 6, 7 things at people, it's just, and 1 or 2, but 3 probably is about the most that you can kind of get to. But for example, when you get to powerful addictions like smoking cessation, There's a really good number of studies that tell us that 40% of people that smoke don't even have the desire to quit. They just do it even though they know it's killing them. Mm-hmm. They know that, did 89% of them know it's gonna kill them, that it's gonna not have a good end of life, you know, and so forth. It's gonna be awful. They still smoke. About 35% know it's bad for 'em and they wanna quit and they say, I'm gonna quit in the next 6 months. But then 6 months later, what do they say? I'm gonna quit in the next 6 months.

Next time. Uh-huh. So what's this telling us?

75% of people who have bad behavioral habits don't make a significant attempt to stop those behavioral habits. About 25% do, and only about 5% succeed in maintaining that over time. So I'm an optimistic guy, really. I mean, I've heard you, I am really in my terms of my personal life.

Yeah.

But the fact is, this is extremely difficult. My personal physician's a close, long friend of mine. We ran programs together. We go to lunch every month and I just had lunch with him.

What he tells me all the time, he said, Mike, you're a psychologist.

How can I get people to stop their bad behavioral habits? Well, with a great deal of difficulty. Because a habit is built into our brains in terms of powerful procedural memories we learn to do over and over and over and over again. Unless you set up plans and really go into this and measure it and have it down on paper and go step by step to do it, it's horrifically difficult to change a lot of our behavioral habits. We fall back into 'em because they're habits.

Mm-hmm.

They direct so much of our lives. We don't wanna admit this most of the time, but procedural memories for the habits we develop direct so much of what we do. The brain simply wants to repeat things that are success and do them over and over and over and over and over and over again. And it's, it's very difficult. You gotta set up those good plans with the good goals that are reachable. Keep up on 'em every single week. Go over 'em with people, have other people involved. Great. Your family members, other people doing it. If you're trying to lose weight or something like that, if other people are doing it, it's easier.

Support. Sure.

But it's just horrifically difficult to change unhealthy behaviors to healthy behaviors. And I think if you look at our population, the evidence is right there.

Yeah, yeah, it's hard. So I, I talk about setting small goals, small steps. I call them turtle steps. Yeah. Not big goals, not, you know, lose 25 pounds in the next 2 months. I wanna, I wanna change my behavior tomorrow. What am I gonna do different tomorrow that I'm not doing today? Or what did I do today that I didn't do last week? And being aware of those small increments. And that's where we start to build a little bit of confidence, right? We make that progress, we have some success. And that confidence helps us to continue on that road.

Absolutely. Short-term goals leading to long-term goals.

Short-term goals.

Yeah.

Yeah. They're achievable in the amount of time you wanna do it. You're absolutely right. I mean, there's no question about it.

Yeah. Yeah. I talk a lot about, you know, successful aging and we get hit with these challenges and, you know, we hit the potholes on the road and it's all about resilience and getting back up on our feet and, you know, how can we, You know, we get knocked down, can we get back up? And how do we stay motivated? How do we stay positive? How do we stay inspired about moving? So let's talk about resilience a little bit. I know you've written a lot about this. So resilience, a, a trait that's innate and you know, it, it's just something that we're born with, or can we become more resilient? Can we be taught to be more resilient? Help us understand that a little bit, Mike.

It is massively more learned skill set than it is built into us. Yes, our personality plays a role, of course, there's genes, there's genetic risk involved in it, of course. But resilience basically is a set of stress management skills, skills that you've learned and practiced over time to manage the kind of challenges and stressors out there in the environment that are gonna continue to confront us. So unless you're basically confronted with these, and have to learn the management techniques to manage them, it never becomes a skillset. You're not born with this. You have to learn it over time, which means you have to do something that's not all that pleasant. You have to be confronted with things sometimes that are challenges for you.

Mm-hmm.

And you've got to somehow learn to cope with them. And, and hopefully you're in situations for most of the time you succeed, but some of the time you may fail.

Sure.

And learning from those failures over time, so you become a good stress manager. Over, over time. As I'm sure you're aware, and most of the people are out there listening right now, over the last 10 to 30 years, especially the last 10 years, the overall level of resilience in young people, in children, adolescents, and young adults, has markedly declined as the levels of anxiety, depression, and trauma disorders have all skyrocketed in this—

I didn't know that.

Because they're kind of inversely proportional to each other. If your skill set to manage stressors becomes better and better and better and better, then you're gonna be able to manage things in life well and not be overwhelmed to the point that you become anxious or depressed or traumatized or things like this. So it's, it's probably your biggest buffer that you can build. Now, all of us are gonna be overwhelmed at some time. And if you just look at the, the two guys sitting in the flight deck of Flight 1549 that took off from LaGuardia and ended up in the Hudson River, the so-called Miracle on the Hudson, the Chesley Sullenberger and Jeffrey Skiles, the two folks up there. In 3.5 minutes, these folks showed you a tremendous amount of resilient coping skill, but they were overwhelmed for 20 or 30 seconds when they first had that bird strike. They just sat there stunned. All of us get overwhelmed at certain times. People that have developed resilience coping skills are able to pull themselves back up, make an initial really important decision. And this is probably, if you wanna talk about the single biggest key to stress management, Here's your first decision. What can I control and what can I not control? I mean, it goes back to the Serenity Prayer, goes back to the Greeks. I mean, this goes way, way back. Goes back to Epictetus, the Greek Stoic philosopher that said the key to happiness is to not waste a whole lot of worry about stuff you can't control, is to worry about stuff you can control, accept what you can't and worry about what you can. It's amazing though, how much we tend as humans, to worry and stress ourselves out about things we don't have a lot of control over. If you look at the American Psychological Association's Stress in America survey and look at the top 10 or 12 things people say they're stressed themselves out about, about 10 of them are things they have no direct control over. Like the next presidential election or—

Sure. Foreign policy. Yeah.

Country going down the tubes or something like that.

Gas prices. Uh-huh. Yeah.

Yeah. That you worry about things you don't have control over. So where's resilient people? Do is they tend to, I think Jesse Sullenberger says this in his book, what resilient people do is they tend to focus energy on things that they can do something about and not on things you can't do anything about and develop a skillset to do it. So when the next stressor comes along, you now have a skillset you can adapt to that stressor. And guess what? When you start doing that effectively, people develop a core belief system we call optimism. You see, Optimism isn't so much you think, oh gee, I'm gonna marry the most perfect person and get rich and live on the beach. It's, I've handled the bad crap that happened to me before. So the next time it rains crap on my head, I'll probably figure out some way to do it. So I'll make it through. Resilience is tied to optimism.

Sure.

Because optimistic people don't believe it's all gonna be great. They believe they're gonna handle the bad crap so the rest of it'll turn out all right. That's what they, without that skillset, You can't believe it. So we're in an age, we're not everybody of course, but we're in an age of the helicopter parenting and the bulldozer parenting and things like this where for reasons that are kind of complicated back in the '90s and around then, a lot of parents developed the core belief that a child should never fail, that failure was horrible, and we had to stop kids from failing. Well, the truth is the evidence is powerful that control failures, as long as kids are confronted with stressors that they can manage most of the time, a failure every once in a while, when you're encouraged to learn from it, is in fact strengthening.

It's not weak. Sure.

For over time. But a belief system is a lot of people. So we have, you know, clearing the way for kids, you know, it's basically, it's an old saying, but you know, what you wanna do is prepare the child for the road, not the road for the child.

That's right.

And unfortunately we've done a lot of preparing, basically, uh, fix the road instead of the kid. And we're seeing a lot of the, of the aspects of that now and hugely spiking levels of depression and anxiety in teenagers, for example, over the last 10, 15 years. Now, yeah, the smartphones and social media and stuff have played, Instagrams and TikToks all play a role in this, but kids aren't as geared to be able to deal with stressors as they were 20 or 30 years ago. Even using some of the same instruments to measure it, there's a really significant difference. And for the price for it, let me show you something here. This is a JAMA, the General American Medical Association study, looking at life expectancy. And notice what's happening with us there towards the end compared to other high-income countries. Our life expectancy is going down, not because of what's happening in people over the age of 75, but what's happening to young people in terms of going back to infant mortality. And more anxiety and depression in kids a great deal, developing problems early on. The issues with more suicide, higher levels of overdoses, it just goes, it gets complicated. But it's younger people really that are really bringing down our overall life expectancy now. Typically it's what's happening to them, not what's happening to people over age 75.

Yeah. Yeah. So we're always being tested about our resilience and about this grit and determination to make it over those challenges. I mean, I talk about people who had strokes or maybe a fall and a hip fracture. And I had a lot of experience in nursing homes where some people would say, I'm done, I throw their hands up and I can't do it anymore. And other people would say, okay, if I dig deep, I'm going to, you know, go to rehab, I'm going to fight and work through this. So, it is that optimistic, determined, motivated point of view that's going to make all the difference. And I think that's to me the key to successful aging, no matter, 'cause we're always gonna hit the bumps, we're always gonna hit the challenges, but can we stay positive even going through them? That's—

Conscientious personality folks, that's one of the reasons why they live long in that longevity project that they do is they basically develop that kind of optimistic, they work on things they can control. They've got this kind of Goldilocks zone, stuff they worry about. The people that don't worry about anything don't tend to live long. Because they make a lot of, you know, they got a lump in my breast. So what? It'll be all right. They just don't worry about anything. The people worry all the time, die young. It's the people really in the middle that worry, but worry about stuff they have control over, are the ones that tend to have those long, those long life expectancies.

Yeah. Good. Thanks for that. That's very helpful. One more point I'd like to bring up. There's, you know, the saying, what we think about, we bring about. Be it till you see it. Adopting a certain belief that we are a certain way and that's how it changes us. I think the term is cognitive embodiment. I don't know if you're familiar with that term, but what are your thoughts about that? Can we just kind of put ourselves in this new identity, new frame of mind, and eventually we are there rather than always struggling?

Well, again, our personalities tend to form in usually in the teen years, sometimes in the early 20s, we develop our sort of overall behavioral habits and core beliefs that are gonna be part of who we are for the rest of our lives. That becomes something that tends to— most of the studies now tell us, if you look at the Five Factor Theory of Personality, the Five Factor Model, it tends to stay with us over our lives until we get to be older age compared to our peers. Now, conscientious increase some, neuroticism may go down. You know, there's some evolving changes in there, But we kind of are who we are. So changing somebody's personality at that point in time, I, I'm a person, I'm a believer in cognitive embodiment or embodied cognition, or it's, it's sometimes called, that's my biopsychosocial way that I look at things. Our brains basically work because we're responding to what's going on in our bodies and respond to what's going on in the outside world. And integrating those two things is what our brain's trying to do. Most of the time. And the patterns, the procedures we develop to do that, that become our personality habits, become the things that put us at more or less risk for having long, healthy lives over time. And it's changing those things, as we've talked about before, changing those things becomes something you have to work on one little step at a time to get you there. You're just not gonna become all of a sudden more conscientious.

No, it's not gonna happen overnight, but you know, we're gonna redefine ourselves so many times after right, years of being a certain way. Maybe we worked as an accountant or a homemaker or a writer or whatever, and now we're looking at a new lifestyle, a new way to exist, and, you know, a new journey, redefining ourselves, and we're reinventing ourselves in many ways. So this kind of, um, be it till you see it is part of the, part of the journey, I think.

Yeah, I think all the data supports that. I think that's right.

Yeah, yeah, good, good. Well, great conversation. We have some time here. I'd like to open it up to question and answer or comments from our audience. We have several people out here and open to any comments or questions. We covered a lot of territory, a lot of it on the surface. We can talk for hours on so many of these topics, but anybody have any thoughts?

I wonder— I'm just a work in progress here. I'm not—

we all are.

I think I'm just trying to keep up with what data data tells us out there. And yeah, that's evolved. That's an evolving thing.

Yeah, sure, sure.

Science isn't a body of knowledge.

It's a way to look at the world and getting data.

And that keeps changing over time.

Yeah.

And that's a frustration with a lot of people. Like, hey, you were telling us 10 years ago you're supposed to eat this stuff. Yeah. Well, that's what science is. I mean, we just, we just move on.

Yeah.

I'm just trying to—

we like it to be static, but we can't. It's not, it's not gonna work that way. Yeah. Any thoughts or questions for Dr. Howard? Yes.

So I was thinking about the 5 rules.

Yes.

And if you live your life that way, however, your parents have had dementia. Is there a genetic cause that you can't avoid even though you've lived a healthy lifestyle?

Sure.

Yeah, it's a good question, but remember, dementia is not a disease or an illness. It's, it's a condition. Dementia means something in your brain is screwed up to the point that you can't live on your own anymore. That, that's really what the definition of dementia is. What we tend to think about dementia, of course, are the neurodegenerative dementias like Alzheimer's disease and dementia with Lewy bodies and vascular dementia and frontotemporal dementias and all those things I worked with over the years. And there are different risks for those. For example, one horrific dementia you can get, Huntington's disease, is a pure genetic disorder. You get from one bad allele of one gene, the IT15 gene, and you're down the tubes. If you live to your 30s and 40s, you're gonna get it no matter what. There's a very rare form of Alzheimer's disease, only about 1 out of every 100 people that get it. That's due to, to a genetic anomaly on one of 3 different genes, and you'll get an early onset type.

But that's familiar.

Alzheimer's, for example, is about 50 to 60% genetic of the kind most people get called late onset sporadic Alzheimer's, but it's about 40 to 50% Lifestyle. So it's a combination of both. While Alzheimer's has genetic component to it, it's called sporadic cuz it doesn't tend to run in families. So just because your mom got it or your aunt got it or your brother got it, that doesn't necessarily increase the chance that you will get it because there's at least 25 to 30 genes involved in the risk to get Alzheimer's disease. The biggest one is called the Apolipoprotein E gene. That's about 25% of your total risk. But even if you have the two baddest alleles called the epsilon-4 alleles of that gene, that's only 25% of your risk to get it. And people that have both bad genes there never get— live in their 90s and never get Alzheimer's. So there's a multiple bunch of factors that determine your risk to get Alzheimer's. I'll tell you something, the 5 fickle fingers of fate are right there among the 12 major risk factors to get Alzheimer's disease. Keeping your brain busy, getting good sleep. There's a lots of, lots of other factors involved in it, but keeping a, a good body weight, having eaten, eaten a good diet, exercising regularly, don't smoke, don't drink to excess. They significantly lower the risk that you will get Alzheimer's disease. And that's about two-thirds of the people that get dementia as you get older will get Alzheimer's. There's another 55 neurodegenerative dementias, but the most common is, is Alzheimer's disease. And again, just because you've had relatives that got it doesn't mean you're going to get it. Typically the symptoms don't begin until your late 60s into the 70s. Most people are diagnosed in the 70s and 80s, and they don't have significant family history of it. So we can't genetically test you for it because again, no one gene causes it. If you have that early onset type that runs in families, we could test for that gene and know if you got it. But But most of, most Alzheimer's disease is again, 97% of cases are sporadic. They don't tend to run in families. So just because a family member got it doesn't massively increase the chance that you will get it.

Okay.

Well, thank you. Okay.

Yeah, no problem. That's a pretty easy one. I've dealt with that for a lot of years.

Yeah.

Thank you for that.

It's not that those aren't scary, because they are. There's 55 neurodegenerative dementias. We have no cures for any of them.

Right.

No treatments that stop any of them. Once you get them, it's over.

You've seen the, um, the Lancet Commission on Preventable Dementia, correct? 40% of the dementias around the world are due to modifiable risk factors.

Absolutely.

60% due to the organic brain pathology like Alzheimer's or Lewy body, 60%, but 40% are due to these risk factors that can be modified, can be prevented, can be reversible. We don't think about dementia being reversible, but there are a lot of these types that are, I mean, not Alzheimer's, I mean, you know, not the ones that he talked about. Those are due to organic, you know, the pathology in the brain, but there's a number of the conditions that are preventable, reversible.

Well, there are kind of 4 categories of dementias. Yeah. Some are reversible. I mean, you know, if you, if you're gonna get, you get some kind of brain infection, you clear up the infection, messed up and couldn't do anything. You treat the infection, goes away. Certain medications that older people take. A lot of the people we, when I was on the dementia screening team in the VA, a lot of the, the people who came in were on 6, 7, 8 medications.

Yeah.

We had some PharmD people I put on the, on the, the screening team there, and they were able to find, change their meds. And their cognition improved significantly.

Stress and depression also can mimic dementia.

Yeah, absolutely. Oh, when it's severe enough. Oh yeah, absolutely. Severe depression can make people basically just nonfunctional.

Yeah. Pseudodementia we used to call it. Yeah.

Oh yeah.

Other questions?

That was an old term for it. You're right. Yeah.

Okay.

My, is, is it ever too late to adopt the Five Little Fingers? No, it's never too late. It's great if you've done it since you were a kid. But the fact is we have data that show even people in their 50s, 60s, even in the 70s, if you change lifestyle factors, you can give you more healthy years to life and lower the risk that you will get these things that are going to disable and kill us. It's never too late really to start those things. Never.

Good answer. Thank you. Yes.

I have a kind of funny question. I was reading an article this morning and it says that old people tend to develop a special kind of smell or odor that young people do not have. And what they said that it's because of omega-7 or something. I wanna see if it is true.

Sure. Did you hear that, Mike?

Yeah, I did. It's possible because of sweat glands and things like this and odors that people have can change somewhat with aging because you are changing the biochemistry and sometimes the fatty acids are involved in that because they're involved in secretions like that. And I knew, I didn't read it to specific omega-7s, but I wouldn't be surprised that it said something like that. But yeah, yeah, there, there are olfactory changes that you can smell oftentimes in folks that they get older. Other factors do that too, but I mean, there, there can actually be body, body smells that are, that are different. Yes.

Hmm. Wow. Okay. Well, looks like we're about to wrap up, but let me ask you, what's the takeaway for our audience? What would you hope our listeners remember from our talk?

Well, it's gonna sound like a broken record, but I think when you, when you start thinking about if you want to have a long, healthy life, if, if that's a goal, you gotta start thinking about first the 5 Fickle Fingers of Fate because they're the things that probably impact it. I think also I would pay attention to relationships. Study after study tells us that people going back to the Alameda study, that the people that had good relationships and the people who had good social support systems around and so forth live remarkably longer than people that didn't. Loneliness and social isolation becoming a bigger problem in the US now than it was before. It's no, no joke. That's some important stuff. Regular restful sleep, developing good stress management skills, I think, and those 5 Fickle Fingers of Fate. If you look at those 8 things, people, now here's the thing. When I looked at all these, I've got 24 centenarian studies, God knows how many aging studies, little stuff up here. The people that tend to have the longest, healthiest, and even happiest lives tend to be people that cluster a number of different lifestyle factors that are positive for outcomes in the same person. It's the whole's kind of greater than the sum of its parts. Most of people, I found 16 lifestyle factors in that little book, you know, that, that I did that you, that you read. And, and the most, the centenarians that I interviewed had 9, 10, 11, 12 of those things in their lifestyle. It's not just 1 or 2 or 3 things. It's that conscientious personality style that has all these characteristics with it, but you have to start somewhere. So if you're gonna start somewhere, those 5 Pickle Fingers of Fate are a great place to start. And then you could throw in relationships and stress management and sleep, you know, along with it. But that's a really, really good, good place to start.

Well, that's great. Great advice. Great information. Great encouragement. Great inspiration. I think we all know that we can do things that can improve our lives, help us live longer. And this is just another affirmation of that.

So many different ways that we, we can enjoy life. I mean, I'm 79. I know I haven't got many years left. I mean, I know that, but I don't sit around and worry about it every day. You try to, you live every day that you can. You have your short-term goals, your things you like to do that, that you're working on throughout your life. And once you develop a pattern of doing this, it stays with you as you get older. And, uh, I don't mind being 79 at all. Yeah, doesn't bother me. Matter of fact, in a way, I kind of feel more sorry for kids being born in the world now than when I was. I, I had a much easier life as a child, adolescent, and a young adult than most folks do now. Not nearly as complicated and not with all the things that impact children.

Yeah, I agree. There's a lot of forces today that, uh, young adults, children need to go through. But oh boy, the important thing is we, um, you know, we have our years ahead of us and we can celebrate. We embrace our senior years, enjoy our opening doors, and what else can we look at and what other doors can we open. There's a lot of opportunity out there. That's, that's what's encouraging to me.

You change goals, you change goals. You know, the things I did 30 years ago I can't do now, so I do different stuff.

You find interest in different areas and you know, there's things that we still can do and new things. Sure. Well, Dr. Howard, it looks like we're out of time for today, but I just wanna remind the listeners who are listening to visit my website, livingto100.club, sign up for my email list and download a free copy of my 9 tips to make living longer enjoyable. You also see an option to contact me with your questions and comments. I welcome your feedback. So Mike, thanks so much for being a guest on our show today. For those who might wanna contact you, how could they do that?

Mehowardphd@yahoo.com. M-E-H-O-W-A-R-D-P-H-D at yahoo.com. I usually manage to answer, to answer most of them when they come in, if I can, if there's any kind of valid information I can give them. I have no problem with I don't know either. Okay, it's never been a problem for me. M-E-H-O-W-A-R-D-P-H-D at Michael Eugene Howard, PhD, the M-E. Yeah, yeah, at Yahoo, at Yahoo, right?

No, .com. Okay, well, thanks again, and thanks to all of our listeners for tuning in. Hope to see you next time.

Great.

Hi, this is Suzanne Newman, host of the Answers for Elders podcast and radio show. We are the North Star that guides you through the complicated journey of senior care with trusted experts in money, law, living solutions, and more. So join us on this station, your favorite podcast channel, or just go to answersforelders.com. Meet the wayshowers who will help your journey go a lot easier.