The Science of Healthy Aging: Living Better, Not Just Longer

this program is a presentation of uctv for educational and non-commercial use only it is my great pleasure to introduce Ellen Hewes Ellen is one of the most loved faculty members of UCSF she hates it when I say things like this she tried to make me promise to make a very brief introduction to say something like here's Ellen but I'm going to toot her horn just a little bit Ellen had gotten a PhD in cell biology but despite that when she came to UCSF and got her MD and then her internal medicine residency she became enamored somehow with primary care with the kind of medicine where you connect with other people Ellen Ellen is a great lover I think maybe that's how I would describe her she has she loves everybody made her a little nervous there for a minute Ellen was one of the founders of one of the most prestigious parts of UCSF the Academy of medical educators she was also one of the really guiding forces and instigating forces that led to the development of the Osher Center for Integrative Medicine she was the first director of the osher Center when she couldn't look around and find somebody else to draft into that but she eventually found Susan falkman to do that Susan is just now about to retire Ellen was the Osher center's director of education for many years Ellen retired herself about a year ago most of us are still grieving that just a little bit but she does agree to come back now and then Ellen is a fabulous speaker she's getting nervous that I'm spinning up too much time and she's also my very good friend so here is Ellen thank you thank you thank you very much for coming out tonight this is actually a talk I've gotten the most out of myself personally in researching so I'm really excited to be able to share with you some information tonight about trying to live better not just longer so let's get started so I'm going to start actually with a little bit of background not just the definition of aging but what we're learning from a lot of the studies in the medical and scientific literature everything from studying people who successfully aged all the way down to test tube work with genes much of that work is actually being done here at UCSF so I'm really excited to be able to share that in this context of how that impacts what you and I should and maybe could benefit from in terms of aging gracefully as we grow older the last part of the talk will be condensing a lot of the information that I've been studying into ten basic recommendations for aging as successfully as possible so let's get started so aging despite the anti-aging industry is actually a natural non pathological process that affects all of us and in the United States our life expectancy is twice what it was of our grandparents at the turn of the century so an average child born today can expect to live to the late 70s the longest is in Japan and we're actually going to say something about some of the lessons we've learned from the Japanese who are so long-lived the shortest sadly is in Africa and Sierra Leone so you can see there's quite a huge difference in life expectancy depending upon where you're born and one in five Americans will be greater than 65 years old by 2030 so the population is definitely graying so how we learn about aging is a couple of different levels I think people naturally will be wanting to study looking at successful societies and there are some unique societies where people tend to live longer healthier lives there are several centenarians studies being done in this country and across the world studying people who've made it to a hundred and what is it that allows them to to be so successful we aren't so much going to be touching base about people who with accelerated aging or twin studies but those are also part of the information we learn about going through our lifespan much of the work we're going to talk about tonight is animal-based and lots of very interesting studies and then finally some very exciting work in terms of genes there may actually be some longevity genes which should have a great interest for anybody who's growing older so where are the societies where people live the longest and I mentioned already that Japan has one of the oldest and the island of Okinawa is supposedly the L the best place to be born if you want to live a long healthy life some of you may have seen this the blue zones are read about it it was actually highlighted on Dateline I think this last week and this is somebody who's written a book they've gone to these various places across the world and really sort of just looked at what were the factors that allowed the people to thrive to be healthy into their 80s 90s and even a hundred so Okinawa was one of them Crete in this country it was a place in Southern California where there's a large percentage of seventh-day adventists Costa Rica and they've added some other places as well throughout the night I'll be weaving in some information that this researcher has discovered and I mentioned centenarians studies there's one in Baltimore and there they're following greater than a hundred thousand people who are a hundred years or older in this country I mean and in fact the very old is the most rapidly increasing level of or a group of aging people now many of these people do lead healthy lifestyles about a third of them seem to just gracefully go through they don't get the same chronic diseases many people in our families have gotten their children live longer as well so there must be something and many of them do live healthy lifestyles but some don't so that's the big question is why you always read sometimes when somebody is 108 and they say well it's that whiskey and that cigarette I've been smoking and you just go wait a second that doesn't fit with everything I've heard about how to you know make it to a hundred so what allows some of these people to live so long and this is I think the most exciting scientific finding in the last decade so there are some model organisms and they have found that there are some genes in each of these organisms that seem to affect how long the organism lives and that you if you can alter that gene you can actually increase or decrease their lifespan so you're not all going to become PhD scientists but Tetrahymena and yeast are you know very basic organisms this worm in the middle is something that I'm going to come back to with C elegans and one of the world's best researchers in ageing Cynthia Kenyon studies the lifespan of these worms and she found that there was a genetic pathway where if she altered it the worms lived twice as long just simple gene a single you know genes involving some things about how insulin works in the body fruit flies mice and this weird-lookin organism to the right than naked mole-rat that looks like a Halloween figure to me so let's go back so what are the theory old theories of aging where we just sort of wore out like an old car we'd end up looking like this in the junkyard our parts got worn out we didn't get the oil change even when we did it fine I just gave up the ghost but I think that wear and tear hypothesis is not the full picture and maybe not even part of the full picture so I'm going to briefly talk to you about some of the theories about why we do age one of them is oxidative stress calorie restriction telomeres which Liz Blackburn just got the Nobel Prize from from UCSF and then finally a little bit more specifically about these longevity genes so oxidative stress so when you buy your multivitamin that has an antioxidant this helps explain what that's about so in the body we need to be able to convert the food we eat into energy that our body can use and that's ATP and that occurs in these little organelles called mitochondria and every cell of our body and that's great we need the ATP to live but as a side effect of this process metabolism there are these sort of nasty actors reactive oxygen and nitrogen species that are not good and they actually can damage DNA and proteins and lead to the dysfunction of cells organs and ultimately the organism and so that's sort of the dark side of just having to be a person who needs energy to live so antioxidants are substances that people take to help counteract the reaction of these reactive oxygen and nitrogen species so that's one thing to think about look at these two monkeys they're the same age and the one on the left looks pretty you know reasonable the one on the right has been allowed to eat as much monkey chow as he wanted for his life no you know you just give monkey chow and they'll eat what they want well the one on the left was given 1/3 less than the amount of the one on the right and he's living a third longer and this has been something that's been observed in everything from these worms to very small organisms all the way up to the level of non-human primates and maybe even humans we're going to see more about it so animals who were given 1/3 less calories none of us wants to hear this live longer and they don't just live longer they live healthier they do not develop the same age-related diseases at the same rate they're less insulin resistant and this sort of makes sense insulin is the hormone you know that takes sugar that we get in our body into the cells the more sugar the more insulin and there's something not so good about having too much of either of those around and there's a slower decline in functional status now I need to make the point this is not eating disorder type calorie restriction this is healthy balanced nutrition just less of it that makes sense so this is not a you know an anorexic monkey this is a monkey who was given appropriately balanced nutrition just less of it than he or she would have normally eaten during the day and there's a whole bunch of people in the United States that have voluntarily chosen to do this they're members of something called the calorie restriction Society they've written a book called the longevity diet and they are putting their money on the fact that this research in younger I mean in other animals is going to apply to them as well so they eat about 30 to 40% fewer calories very balanced and there's actually now an ongoing observational study of people from this society who volunteered because it's very difficult to randomize people to this kind of a program although there is this study the calorie study comprehensive assessment of long-term effects of reducing energy of intake of energy that hat it's a two-year study and they've actually gotten people in New Orleans to agree to follow this lifestyle and the preliminary results are pretty remarkable at least in terms of insulin levels being lower and many other things that would be associated with aging the full two-year study is not yet out in print so we're going to have to wait awhile for this data to come through but there are lots of supporting other levels of evidence that indicate we probably are eating too much and we're probably eating too much of the wrong kinds of foods so why would this work well remember I just said that when you eat you have to make energy and transport it so maybe there's it's less oxidative stress for the cells maybe it also means your body has to make less insulin but there's also this new family of proteins some of you may have heard about called sirtuins I just want to take a couple of slides to show you what these are so sirtuins are the products of genes that get triggered when somebody's not eating as many calories and I've got the resveratrol in that beautiful glass of Cabernet there for a reason because resveratrol is a substance that triggers the production of these sirtuin type proteins and when they gave res very very high doses of resveratrol to chubbie mice really bet you know mice that were unhealthy they actually started to appear younger they started to live longer they started to have less of the metabolic problems associated with obesity so everybody's thinking hmmm this might be you know a really good thing to research and a great thing to consider starting a company for and sure enough that happened David Sinclair at Harvard started something called search for Masuda khals to research resveratrol and resveratrol like substances that will help trigger these special proteins that seem to be good for the obese mice and may be good for many other things including cancer obesity diabetes let alone aging in general and just another large pharmaceutical company felt the potential in this field was large enough that they paid a fairly large amount of money in 2008 to purchase Souris so now it is part of this larger conglomerate so we're going to so we've talked a little bit about proteins a little bit about genes let's talk a little bit about aging at the cellular level any of you have ever been in a laboratory I've seen petri dishes and know that when people try to grow cells fresh cells on a petri dish in the they actually unless they undergo a certain kind of transformation die after a certain period of time and there seems to be about 50 cell division seems to be about the time that the cells don't get can't continue to divide in culture and it was called the hayflick limit again actually Leonard hayflick worked here at UCSF and why might that be well that leads us to the story of telomeres that I'm sure some of you heard about with the recent Nobel Prize awarding telomeres are like the ends of chromosomes and as genes divide and chromosomes have to divide they tend to get a little bit frayed a little bit shortened with stress or with age so you want your telomeres to be protective protecting the ends of your chromosomes so these are again DNA protein complexes which stabilize the ends of chromosomes they shorten their shorter in people that are older their shorter in people with disease and their shorter in people who are undergoing chronic stress and they lengthen which is kind of interesting you can actually show that they can get healthier or longer in response to good things like healthy lifestyles stress management so this is going to be an area I think that many many people are interested in looking at product in the next five years you're going to go to your primary care doctor and you're going to get your telomere length estimated and then you're going to go on a drug or do a lifestyle thing and a couple months later six months later whatever you may get your telomeres checked again as a measure of how well you're doing and and the health related benefits to what you've what changes you've made yeah oh I'm sorry Proceedings of the National Academy of Science it's one of the most prestigious sorry I we it was too long to type in but that's a great article this is an amazing article so this was also done here locally with Liz Blackburn in collaboration with Dean Ornish many of you are aware has done huge work with you know lifestyle modification particularly a very low-fat diet so this was 31 men who had low grade low risk prostate cancer and as you know prostate cancer in some men grows very very slowly and if you're first diagnosed with a low-grade cancer many men actually choose what we call watchful waiting because having immediate surgery or treatment doesn't always impact their lives in a positive way so this was 31 men with low risk cancer who were followed followed this Ornish lifestyle program that involved exercise the low-fat diet stress reduction and a little bit of yoga and they did this for three months and then they did some of you may not be familiar with this but this green and red kind of sparkly picture at the top are what are called gene arrays so they were able to check the genes that were active before the men started the program and afterwards and what they found in just three months of a lifestyle change 500 or more genes were either turned on or turned off in a health healthy direction meaning genes that were controlling tumor formation oxidative stress and inflammation all of which are bad were down regulated less active after the program and others that we believe are more health promoting were stimulated so this was pretty mind-boggling that in three months you could see this kind of genetic change with just making lifestyle change the bottom graph shows you also their telomere length we had no idea that the telomeres could change in such a short period of time we don't know whether this could happen in a month because the study hasn't been done yet but at least at 3 months the very positive message here is you make a lifestyle change you change your genes in a very short period of time so I just want to finish this part about the basic science by saying at a conference I went to recently at Harvard there are probably three or four or five other longevity pathways not just the insulin one not just the sirtuin one and there are feelings that maybe each of these is cross communicating with each other so although they haven't reached the popular press yet I think we're just at the beginning of a very very exciting period in science that's going to have a great impact on how we age so I think it's just really going to be the tip of the iceberg and this was just one way to say it is a complicated exciting process and I don't expect you to I'm not even going to go through this all but I think there are many many different things that affect how we age at a cellular and organismal level and I think we're going to know a lot more in the next five to ten years so what does this all mean to you what does all this basic science mean to you and I think the truth is nobody yet has discovered a way to reverse aging that's I think everyone would love to can't I keep the wisdom that I have now and go back to the body of that 25 year old who could do more oh boy that would be wonderful so we don't yet have a way to reverse aging but some of the data I'm going to present to you in this next part of the talk says there is a huge amount we can each be doing to make ourselves healthier and live better not just longer so I love that these two quotes there's the concept of dying young as late as possible because you really do you'd like to be functioning and active and mentally aware and then you know get your illness and go quickly would be my wish so that's also the concept of compressed morbidity so that you don't you know you don't have a ten-year slow decline and are really not the quality of life that you would like so I just want to say a word about the anti-aging industry there are huge amounts and I don't this is a picture that I always get in the United Airlines magazine no this is some he's dr. life I don't know him personally but he underwent you know one of these anti-aging programs and he looks pretty wonderful as a result the sad part is many of these programs support healthy lifestyle great but they also do a lot of hormone replacement and their belief is that as these hormones drop as you age you should just supplement them and you'll do fine there's really no data to support this these Fountain of Youth claims and there may actually be some dangers associated with replacing some of these hormones so I just don't want to say you have to have a skeptical attitude when you read some of these ads but there are actually many excellent guides to aging available and I think these three are three that I would highly recommend Andrew Weil wrote this book back in 2002 and it's breathtaking I read it again to prepare for this talk and in 2002 he was already talking about telomeres and the different sorts of scientific basis for what I'm going to say so and there are a fair number of websites also that will help you have any of you tried or gone to the one called real age calm okay so let me tell you what that's about this was based on some of my Croy's and dr. Rosen's findings and it brings together all of the things that I'm going to be talking about what you do is you sit at the computer and it'll say okay what's your blood pressure what's your weight how BIG's your waist you know how much exercise do you get and they put these all into a formula and they give you what they consider to be your functional age not your biological age some of you may have seen on Oprah you know people have come in and said had this test done and they're 50 but they're really 66 by functional status than they get religion and go do a lifestyle thing and then they're now 48 I mean it actually for whatever it is I think it's a really good thing to let people know that what they do in their life really has an impact on their health and that there are people who are 65 who are functioning at the level of a 40 a year old because luck you know good lifestyle whatever so these are good websites to visit and so one of the other pockets sorry I'm sorry it's if you just dr. Michael Roizen and if you just look at it under you staying young you can get it on Amazon so this is another really positive piece of information which surprised me what really determines your health because many of us feel like oh I just got mom's genes I'm going to be fat the rest of my life there's diabetes in my family why care and genes are clearly really important but in some studies when they've looked at what are the various contributors genes are really about a third of our health and look at this behavior is more influential forty percent of your health may be attributable to the things you choose to do for your health clearly you want to be in a healthy environment you'd like to have social contact we'll talk more about that at the end and having good health care would certainly be helpful but the biggest slice of this pie is behavior so even though it's kind of hard once in a while to get up off the couch it is really in the power of every single one of us to have a huge impact on our own health and maybe the health of our families so I just wanted to briefly say why I think changing your lifestyle changes your genes remember we just talked about those prostate cancer patients well there's a whole new field called epigenetics and we used to think you know the genetic code you know gets transmitted from generation to generation well what they found is that what we do in our lifetime impacts the our genetic material in a way that's not just dependent on the sequence but on how the chromatin is packaged how it's modified and those changes are very very profound so here again I don't want to spend too much time on it but we're now understanding at a sort of test-tube level why is it at getting up and exercising why is it that eating a healthy diet may actually have such a profound effect on your genes so as we understand those mechanisms I hope it's an inspiration and something of hope to you but we are not leading very healthy lifestyles this was a survey of over 150,000 US adults and only 3% said they could answer yes to each of these things that they didn't smoke they were a healthy weight they ate their five fruits and veggies a day and they exercised regularly I mean this should be the bottom line basic health prescription that you should be getting from your physician and that you should be incorporating into your life and that's if only 3 percent of us is doing it that's not a very positive finding so we're not going to focus on all the unhealthy behaviors that you know about but I clearly need to list them smoking drinking using drugs risky behavior is all not good but I would like to focus on the positive aspects of what you can do for your health in addition to getting rid of some of these unhealthy behaviors so here's my 10 recommendations and we're just going to start going from 1 to 10 maintain a healthy weight nobody who walks the streets or rides a bus is going to be surprised that two-thirds of us are overweight a third of us are obese a third of a million US adults are believed to die prematurely because of obesity-related disease and it's not surprising we evolved at a time when there wasn't a whole lot of you know there wasn't a McDonald's down the block so if you didn't if you and your ancestors were not hardwired to eat when there was food to have a really healthy appetite and to hold on to those calories as fat you and I wouldn't be here today so sometimes people call them the thrifty genes and there are certainly some families that don't have them my family has it in spades where you know it's you over eat you under exercise and there you are you're packing it away you know in places you don't want to so and on top of it in the last 10 20 30 years we are consuming huge numbers of extra calories than our grandparents did and sadly we need fewer calories as we age I've mentioned in one other talk I think it was a year or two ago as we age we naturally lose muscle mass even if you're pretty active and muscles the most metabolically active tissue so the bad news is let's say you're 20 I'm just going to make up a number and you need 2000 calories to maintain your weight by the time you're 30 maybe you only need 1800 calories by the time you're 50 maybe you really only need 1700 calories so you're fighting this sort of battle of needing fewer calories as you age because you're naturally losing muscle mass so all of these things together have added into an obesity epidemic and truthfully I think one of the major culprits is portion size many of you who saw supersize me saw the effects of you know taking the extra sized Big Mac for just even a period of a month so here are some strategies so actually let me before I go on with the specific strategies the Okinawans that in the Blue Zones they say a little affirmation before each meal it's called the 80% rule and they before they sit down and eat a meal 80% full they stop or at least intend to stop when they're 80% full not you know Thanksgiving dinner type you know roll yourself out so they actually are aware and as a result and maybe other cultural things they eat on average a thousand calories less per adult than we do in this country so yeah okay yes yes no not necessarily a very good question so let me repeat it in the calorie restriction you know the people that are choosing to follow that some certainly weight loss is a side effect of doing that kind of a program but many of them were not obese and that was not their original intention they will lose weight and you will lose excess body fat by following that regimen but they're doing it with the goal of hopefully having a healthier longer life well that's a good question yeah that would be a little bit more complicated because you'd have to really really make sure you had healthy adequate nutrition really really good balance so you weren't you know going solo that you weren't getting essential nutrients okay so let me so what are some strategies there's some restaurants in San Francisco that will serve you a half portion so if I found what I can't remember which one it was but I said okay would you just serve me half of it and bring the rest in a doggie bag because I'm the kind of where I was raised I don't know about you eat your you know everything on the plate and it's a nice night I've had a glass of red wine oh that extra piece of bread looks great and I end up eating more than I need to so upfront I know that if I'm given half a half an entree I'm going to probably feel satisfied so splitting entrees is a great idea smaller plates this is fascinating they you know if you ever been to buffets and you get this little tiny thing and you think they're being cheap they're not they're helping you with your health if you go from an 8 you know a 10-inch plate to an 8 inch plate you eat 1/3 less when you're not told ahead of time that this is an experiment on calorie restriction so at the buffet you get the small plate you feel like you you know you're filling it up you may go back for seconds but you instinctively many people will eat less so there have been a couple of experiments where they've literally gone into families and just replaced the plate size and it's made a difference in terms of weight loss and then these final things are for people who really can't manage to understand portions these are actually pretty remarkable and if you just used like this plate down to the left for a week you'd be astounded at what a portion of meat really is it's like this miniscule little thing in a cup the difference between this and the plates that are just marked with you know don't put more protein than this is that you can still stack a whole lot of food on those other plates this it's going to show you because it's like a little cup fascinating the things that are helping people ok we're going to not have time to go through a great great detail every one of them but I just want to touch the surface so exercise no brainer 60% of us don't exercise regularly 25% are couch potatoes and we burn 800 fewer calories a day than our grandparents did at the turn of the century and that's pretty astounding given that a pound of fat is 3,600 calories it's not going to take a whole lot of days of eating 800 calories more or not extra the combination of eating and not exercising so you all probably are aware that the National recommendation minimal recommendation for moving every day is about 30 minutes of moderate-intensity exercise let me translate that for you most of the time people say that's brisk walking so that's not walking you know like down in the mall that is clip walking 3 to 4 miles an hour so if any of you remember Stan alive from the Bee Gees I am NOT going to subject you to my version of stayin alive but that is a hundred beats a minute and that's the pace you should be walking for your broad a moderate intensity brisk walking so high you know so that's that's it's not sauntering so this is the minimum you should be doing and that the problem is everybody's got 24/7 stresses how the heck do you get to the gym to do this and a lot of us just don't have the luxury of getting there so the key that I see is you have to integrate it into your life and be creative about it park further away take the stairs get off a stop early walk on breaks I in fact when I semi-retired had the option of continuing to pay for a very expensive parking permit that would get me just to the one office or I could pay 1/3 as much and park ten blocks away up a big hill well I chose because I'm cheap and also I knew if I didn't if I didn't have that built in so now I guarantee that I have to walk 10 blocks down and 10 blocks back to my car every time I go into work that I just knew that if I didn't do that I might not get as many steps in trying to exercise with friends if that's something that helps you work with a personal trainer if the resources are there set a goal when I turned 60 I decided I wanted to go a very long backpacking trip so that whole year I every time I felt like a couch potato I just could I knew that I would feel horrible on the trail if I didn't go out and exercise sure enough I finished this long backpacking trip I turned into a couch potato again so you know so I found out that the only way for me to stay consistently motivated is to plan a backpacking trip that's long every summer and no I'm serious for me that's what works so if it's for you to walk you know a half marathon with your kids or to do the AIDS walk or to do something if setting a goal helps you do it and getting a pedometer for those of you or a data driven is great they're available pretty cheaply the recommendation is 10,000 steps a day and when they put pedometers on people they found that they actually walked a mile more the equivalent of 2,000 steps for a day and they actually did lose a little bit of weight so whatever you can do to make exercise a positive integrated part of your life the better and it's never too late this was a study of really elderly almost 8,000 older women and they looked at them over 12 years certainly those that were really active and stayed active did great those who were couch potatoes and didn't get off the couch did the worst they had a higher level of mortality but anybody who then got you know inspired who'd been not active but then shifted to the active mode had the same mortality as the people that had been active their whole life and sadly the people who had been pretty active but then got less so they had the same mortality of people that just had never exercised so this is kind of use it or lose it but the good message here is it's never too late ok stay mentally active so we the whole theory used to be your brain is optimized at about age 25 to 27 and it's downhill from there you don't make any more neurons no more connections to bad and that the data is really different now we now know that you can make new neurons and it's like anything you have to exercise it to help that process happen so learning something new picking up a new musical instrument that you wish you'd studied you know when you were younger playing video games you know staying a part of your bridge group anything that keeps you doing Sudoku doing the crossword puzzle anything that keeps you mentally active and I just want to share with you this was a fabulous woman I met when I was backpacking last summer Lynne she's 75 and she read this talk and has been living it she was has been very active her whole life had actually breast cancer and it was on some drugs that were really difficult for her to manage for another cancer but it hasn't kept her from getting out and doing the things she loves the most which is backpacking with her husband and at the age of 68 she took up the cello you know I'm going come on to the end she's just they she said it I'm not quite as good I'm sure as if I'd taken it up at age nine but she now has a group that she plays with so it's just when I asked her permission to talk about her I just I was so inspired when I met her and said you're really a poster child for staying active both physically and mentally and there are actually now brain fitness programs if any of you seen these when you've been in if you look at the KQED you know pledge drives they're often prizes or offered if you sign up a huge industry 225 million dollars in 2007 and actually when they put older people into these programs put them in front of a computer and have them do these these brain fitness programs they get better memory they process things better so I think this is another way to say that staying mentally active is a really important thing and a good thing so this one's not quite so intuitive reduce inflammation let me talk you through it so inflammation is the process in our body that helps protect us against foreign invaders infection and injury it sometimes feels bad when you get an inflamed joint but that's your immune system doing its job but the dark side is that if there's too much inflammation that's not good for your health and this it's now called the secret killer and people are now realizing that inflammation chronic low-grade inflammation is probably one of the foundational causes of many of the chronic diseases we're worried about getting certainly heart disease probably diabetes Alzheimer's so there's thoughts about we don't want we want inflammation to be the healthy inflammation but we don't want it to be too much so let's talk about some strategies about reducing it we're going to talk about the anti-inflammatory diet some of you may have heard about and flossing your teeth we just talked about exercise and we are I'm going to finish with some stress management so anti and sorry yeah examples what's information okay so this so you you get a cut in it gets infected so it gets red hot swollen and painful that's because all the immune cells are coming to that place to try and fight off the infection and sadly it causes redness swelling warmth and pain so that's one form of inflammation but every time that happens to me I mean you obviously don't want to be in getting an infected cut but I realize I is a thank you you know that's my immune system that's working so does that make descent answer your question yes at one level so inflammation yes the influent inflammatory processes are going on in a healthy way and sometimes an unhealthy way in all of us and in fact people who can't mount an inflammatory response don't do well at all so it is an important thing but not in some circumstances so I love Michael Pollan have any of you read in defense of food I just these eight words are probably the healthiest recommendations for any kind of nutritional advice eat real food not too much mostly plants so real food is something your grandmother would recognize something that doesn't come in a package something that doesn't have five ingredients you can't pronounce and probably something that's sold in the middle part of the grocery store so real food food that's not all processed yeah born in world Morley's you are seeing I like that thank you yeah more leaves fewer seeds so we could if you want to answer these are rings maybe even complex green leafy vegetables and not so much carbohydrate so we'll talk a little bit more about carbohydrates in a second so let me say what's this anti-inflammatory diet well almost what you're saying is true so you want a diet that's high in nutrient dense plant-based Whole Foods you want them not to have a lot of simple carbohydrates that's like sugar white flour and we're going to say in a sec all the same a little bit more about that in a second you don't want saturated fats trans fats additives and you want a fair amount of the good healthy fats the omega-3 fatty acids and you really don't want it to be terribly processed so most of you have heard about glycemic index some of you let me just talk you through it because actually so glycemic index if you eat a certain unit of a food and then they measure how quickly sugar glucose comes in spikes in your blood afterwards that's a measure of a glycemic a high glycemic index food so some other things like white bread baked potatoes pure glucose are high and look at this low glycemic index yay plants are all the most fruits and vegetables whole grains not just whole wheat but whole grains brown rice and other very low carbohydrate substances so why is this important well when you spike your glucose you then need more insulin and remember what I said about those worms they found in fact Cynthia Kenyon just literally published this week I was at the library making sure I didn't I got all the latest data for you tonight she added two percent glucose to her little worms twenty percent shorter life span and guess who guess who worth all of her work is now following a complex carbohydrate mostly plant-based diet it's Cynthia Kenyon because she's looked at these worms for all these years so it you know which okay so we're going to talk because I'm going to talk about Mediterranean diet in a second so let me just tell you a whole white whole grains are so good and why they make the glycemic index less is because they have all this brand and this covering so that when the enzymes are coming to digest them they kind of come up against this covering that doesn't allow them to get to the really carbohydrate rich part of the endosperm so you've got like a covering that slows how that gets distributed into the system so that's why whole grains things that are still covered by brand are lower in glycemic index than white flour for instance so and what happens when you eat a high glycemic index food I bet this is not an uncommon experience here the reward center lights up in your brain oh my goodness this tasted nummy you you eat more you sometimes get hungry soon afterwards because the sugar goes right up you get this kind of buzz and then it goes right down and the food industry really knows that David Kessler who was our former dean just wrote this great book called the end of overeating and the food industry adds in things like sugar fat and salt because those are the things that add up make your reward center light up and literally just tonight I found this other study so they gave rats after they were eating a healthy diet they gave them junk food do you know how long it took so they started to love the Twinkies and the fatty stuff and within five days they were overeating up to twice the number of calories they would normally and their reward center damped down they got so used to the crummy diet that they had to eat more to satisfy the reward center so they became obese pretty quickly it took only five days for some of these changes to happen when they were given the crummy diet and when they took them off the crummy diet it was weeks before it came back to normal so our food industry sure knows this some of us are a little bit more susceptible to this kind of stuff than others but this these are not good actors because they really do make our reward centers light up so so one of the diets that's been touted is very healthy healthy alternative and part of this is also that these are people in Sardinia and Crete that follow a Mediterranean diet that are long-lived so what are the aspects of that are common features so mostly fruits and vegetables lots of beans nuts and seeds the healthy fats olive oil a little bit of dairy fish and poultry very minimal red meat a couple eggs and the red wine but if you look at what this pyramid looks like they're mostly low glycemic index foods and then high high fiber and high nutrient-dense foods and let's go look and see what the data is about Mediterranean diet it's pretty good so these are observational studies they're just saying we look at people who eat a Mediterranean diet and this is what we see but 9% reduction in overall mortality in cardiovascular events in cancer incidence and mortality Alzheimer's a recent study just said 30% reduction in depression that I don't have time to put on the slide reduction in something called the metabolic syndrome which is often the precursor to diabetes and it's really a tasty diet so that's I just want to leave anti-inflammatory diet just to also acknowledge that many other cultures have diets that are equally healthy many aspects of the Asian diet are just as healthy many aspects of a healthy Hispanic diet so I'm not saying the Mediterranean is the only one it happens to be the one that we have the most data on and it you know it's one that I think the principles of the Mediterranean diet will apply in other cases so why am I putting flossing in this lecture nobody likes to floss so it ends up this is part of the inflammation picture periodontal disease with a lot of chronic inflammation is an independent risk factor for heart problems and stroke and they think the connection is because there's ongoing chronic inflammation so people with gum disease are two times more likely to develop diabetes and more than 50 studies and for meta-analyses link periodontal disease with increased blood markers of inflammation so flossing is a good thing one epidemiologist estimated that it'll add 18 months to your life span so go get that floss out okay getting adequate sleep we slept about nine hours a night at the turn of the century most of us now sleep probably seven maybe even a little less and Bill Clinton slept was proud of sleeping only five or six hours a night but look what that did to him this is Bill nodding off at a Martin Luther King speech and the subtitle was I had a dream I loved it I loved it so how much sleep do you really need well it differs for each of us it's actually the amount that you need to feel really rested and alert during the day and that if you were given a nice dark room in a you know in at 3 o'clock would you not fall asleep the average most of the time people estimate most of the sleep societies estimate you need about 8 to 8 and a half I'm going to guess that many of us in this room are not getting that that range though is quite large 4 to 11 and there was even a study a special program on this English guy during the World War two who actually needed like 1 hour of sleep and it was real but it most of the time we think we think we can understand that get away with it but it's probably more genetically determined than we think and most sleep specialists feel that you really can't learn to adapt to less sleep than your body's need without paying a price and that price is quite substantial people who are chronically sleep-deprived this is no rocket science don't do as well at school and work they have increasing automobile accidents they don't do as well on memory tests interesting when if you have a chronic pain condition and you have chronic insomnia it is much worse they've done studies where they've had people in the lab they give them a little bit of a heat thing you know okay tell me when it's too bad all right and then they sleep deprived them and they come back and they test them with the same pain stimulus they have a much lower threshold for feeling the pain when they're sleep-deprived so and unfortunately pain keeps you from sleeping so it's kind of a bad cycle you get increased aggressive behavior some of the time certainly increased health costs and either end of the spectrum if you chronically under sleep or chronically over sleep you are likely to have increased mortality and this I think is one of the most compelling things and it goes back to a lot of what I was talking about with obesity there seems to be a really strong sleep obesity connection so subjects who are sleep deprived guess what happens your appetite goes up you know when you've in college I can see it with the med students and the residents you know they're eating they want to go for the ugly food they're tired after staying up all night for their exam they go for the fat and the sugar and they did a study where they had healthy healthy medical students in a sleep lab and they sort of kept they didn't wake them up but they made sure that they didn't get into a deep sleep for three days and they had as bad sugars as some pre-diabetics after just three days of sleep deprivation and one of the reasons this may be happening is that melatonin you know the hormone made in the pineal gland which helps regulate our circadian rhythm there may be actually melatonin receptors not just in the brain but on the pancreas and the pancreas is the organ that makes insulin so we are very complicated and hardwired but most people would say getting a decent night's sleep is going to be really good for your health and there's some strategies you've all heard some of these probably in the press and if you if you're an Olympic sleeper and you don't do any of these that I don't care this is these are recommendations for people who are really having trouble sleeping for instance you want to get up and go to sleep at the same time you actually the role of light is really interesting you don't want to be trying to fall asleep in a really brightly lit room because that's going to inhibit the amount of melatonin conversely if you're one of those really slow in the morning people you might want to get some light going so that that's going to help you wake up and lower your melatonin levels certainly caffeine and alcohol is are often not considered good exercising regularly they claim not before bedtime I love to exercise before bed so I mean again I generally don't have trouble sleeping so I don't need to follow these as closely this is interesting you want to have not all the things that you're used to like the TV going the radio on you know your a PDA your cell phone guess what the average number of devices in a teenager's room is electronic devices eight TV you know cell phone computer oh my goodness so turning those all off and then finally trying to sort of do some of this letting go and letting some of that chatter of the day go and then only going to bed when you're sleepy if you're lying in bed and you're wide awake and you're going oh my goodness what did I not get on the shopping list and I'm going to be too tired for work tomorrow get up leave your bedroom go do something until you are sleepy and come back they really want you to associate sleeping in your bed with just being intimate with a partner if that's appropriate or going to sleep okay I'm sorry oh I clumped them would you heart somebody is really paying attention you are not sleep deprived or at least if you are you've had some caffeine that's great I'm sorry there were six originally and I actually added to them and I didn't change that so thank you I'll make it five strategies great so these are some resources great resources if you are interested in sleep so we're getting down there okay managing stress and I know you've had just fabulous talks in this last couple of weeks about this I'm going to go through these a little bit quicker I love this was a very wise patient of mine who said you know I realized I can't eliminate the stress in my life but what I can do is control how I respond to it so I just want to say stress is really how you define it and one person stress is another person's hobby so guess so three of these would put me into a fight-or-flight reaction and three of them kind of make me happy but these are all things that might be either hobbies or things that you wouldn't want to do so I would not be sitting on this girder not a chance get me a skydiving you'd have to put me in general anesthesia put me in a tight place dark place like a cave Oh No but I love spiders I like talking that's actually giving a public speech is the major way in the lab they create stress for most people and I actually really enjoy doing it and then they also make people do math problems when they want to stress them I'm kind of a geek and I like doing that so so for me these other three are fine these three not and I would guess that each of you is going to have a different description about what stresses you and what doesn't so you've had already two lectures a little bit about this but again we evolved to be able to respond quickly and effectively to acute stress and if we didn't we wouldn't be here so again the zebra running away from the tiger or the lion she wants to be able to do energy now her blood pressure goes up her heart gets increased she shuts down everything that's not essential including growth reproduction digestion and that's great and guess what ten minutes after the Lions gone the zebra is sitting there chill munching on the Savannah grass that's not you and me and the reason I love it Robert Sapolsky actually wrote a book why zebras don't get ulcers is that we activate we have a brain that allows us to continue to think that we're constantly under stress we feel like that tiger or the lion is with us most of the time so we can't damp down this and instead we keep this fight or flight system activated for months a little bit worrying about mortgages relationships and promotions I'm going to just get that so what what constitutes stress though in most for most people and I'm and I guess this fits for you and dr. Moskowitz talked a little bit about this the last lecture this was 800 industry workers in Finland and they were started they looked at them at baseline and they didn't have heart disease and they followed them for 25 years and those who had the following things that were perceived as stressful to them had a double chance of dying from heart disease at the end of 25 years so the things that generally make people go nuts are I have no control over this situation that's a big one it's too much I'm overwhelmed there's too I can't possibly finish everything I'm being asked to do and I'm not getting rewarded nobody's seeing the amount of effort and all the over work that I'm doing and then I also feel challenged and threatened and those are and then if you add in social isolation you've got just a cocktail that's pretty deadly in terms of how we respond how we perceive and how that might get to a chronic situation I'm just going to skip the relaxation response to me is the opposite of this fight-or-flight it calms the body down everything is great so I want to talk about how you can do this in your life and there are really many paths to this and it really doesn't it may be individually to something very different for me it's walking in on a trail in the forest or you know up on the ridge in Marin County a major common denominator is slow diaphragmatic breathing where you just breathe slow your breathing down and you imagine the air going into your stomach first and then into your chest and then out where and there are many other things I'm going to talk a tiny bit about meditation but you can imagine a whole range for some it's music for some it's prayer for some it's doing exercise so each one of us has many paths to mobilize this relaxation response and guess what when you do the stress genes get turned off I mean the gene the unhealthy genes that were similar to those studied in the prostate cancer they get turned off this was 19 subjects who were really experienced in some form of eliciting the relaxation response and they had decreased activity of the genes again associated with inflammation not good programmed cell death and how the body manages these reactive oxygen species so it's a good thing and most of us know that meditation intuitively is a sort of slowing down that's a nice path for some people but we now have neuroimaging that really shows us yes that's true brain regions that are associated with the ability to be to attend to something to stay focused and to process things are bigger literally bigger in people who are experienced meditators they grow they because they're being stimulated and look at this the reward and motivation centers are activated when somebody starts to meditate you maybe don't need that junk food diet maybe you need you know a meditative practice and finally expert meditators people have been doing this for years when they put them in the scanner and they give them like a loud noise or something else they don't react as much on their brain scans so meditation I think is is a good path for many people but it's you don't necessarily need to go to the cave in India for 20 years I just wanted to give you some examples of some things you can buy on the internet which will give you a little bit of a fun feedback these are the stress dots you put them on your fingers or your wrist and what it does is it checks the temperature and have you ever noticed when you're really relaxed do your hands get warmer or colder warmer guess what that's this you know you've just done the relaxation response there's more blood flow to your hands so you can compare the dot color based on whether or not you've got a nice warm hand if you're a little bit more quantitative you can buy this temperature trainer online and you just literally with a piece of scotch tape put that on and you can actually see the temperature of your hands and anything you do that helps increase this temperature it's going to give you practice in eliciting this relaxation response I'm actually going to yes for popsicle toes oh that's great you mean like when you're really frozen when you have cold feet that's another issue it's certainly relaxation makes my feet a little bit warmer but I am like those of us who are not blessed with warm feet this may not extend down to the toes but being relaxed is going to be a good thing no matter whether it makes your popsicle toes go away okay so I just want to say reflecting as part of this as well as simple this was an incredibly simple experiment subjects were just asked given a piece of paper and pencil and said write for four days in a row just for 20 minutes about an upsetting experience trying really think about what happened and you know why it went well or why it didn't go well and what happened was just with taking that time to reflect they had they reported less stress asthma patients actually breathed better in a physical way rheumatoid arthritis patients felt less pain it's it's amazing and I think this more argues for the fact that we so don't take the time to just be quiet we're inundated with all this information with the TV there's not a time except if I'm in the High Sierra when I'm not reachable by some electronic device and it's you know that's not necessarily so good obviously the serenity prayer accepting things god grant me the serenity to accept the things I can't change to change the courage to change the things that I can and the wisdom to know the difference this is a life's work so I just want to finish off this one thing about managing stress and say that there are many advantages to think about finding your individual path that's going to help elicit your relaxation response I must admit some of these are very easily taught and it's not so easy to sit down and try and meditate every day the minute I mean I've been doing it for years and every single time for about the first ten minutes the grocery list is there you know oh my butt hurts I'm going to get I'm not going to sit here you know all of that so if that's part of the human condition so not everything is is easily done but many of these things are inexpensive safe easy and will easily complement the other things you're doing for your health okay I'm actually going to go super fast through this because you had a whole fabulous lecture from dr. Moskowitz about positive emotions so but this I look I do have to say this look at this guy I love him he looks like a nasty soul and this this gets back to I had a couple of classmates in medical school who were not nice I didn't like being near them I couldn't imagine being a patient of one and they now I find out that they're getting justice is being done maybe okay so they they have studied long-term and it was Harvard sorry they they studied some medical students and they measured them at the beginning of med school and they found out ooh there's some that are sort of hostile and there's some that are pretty relaxed so in these students ten years later they followed them if they had high hostility scores guess what they had more cardiovascular disease and this was some of you maybe you've heard the type a behavior well Meyer Friedman was here at UCSF and he actually tried to take a bunch of type-a driven type executives and he tried to sort of change them by randomizing them to this you know stress management and many other things and in the the group usual care about over a quarter of them had a problem with their heart they'd all had heart problems before the ones that just got group counseling just kind of okay here you know you shouldn't feel that stressed did not much better but look the type a group that had the real intervention to try and relax some of this hostility manage their anger had much less recurrence so I think it's effective dr. Moskowitz talked a lot about positive psychology this is sort of interesting to me like you know you know there are people in your family or in your lives that are just constitutionally happy you know glass is overflowing all the time and you just go I want some of that my family the glass didn't have any water in it at all so when I looked at this and I found out that my happiness set point at least by Sonja Lyubomirsky who's a great researcher is 50% hardwired I have my work cut out for me so but 10% seems to be environment and 40% this same 40% I have some control over so I can say I am blessed to have been surrounded by some incredibly positive people for whom the glass is not unrealistically overflowing and after years of sort of just being close to them I'm realizing that there's another way to look at life and it's not money power prestige property if you're above the poverty line if you're above more than the poverty line adding more money in studies has not proven to increase your happiness usually what increases your happiness is all the other the rest of the recommendations that I'm going to give you in a second this if you haven't been aware there are some two incredible centers in the Bay Area that are studying all of this field and the UC Berkeley greater good science center I think I put that on as a reference is a fabulous group and back Decker Keltner wrote this terrifically interesting book called born to be good there he's just doing wonderful wonderful work about increasing the positive effect and way that people go through the world I'm just going to go through this very quickly ok stay connected all right this is one of the most powerful predictors of good health so meaningful relationships either platonic romantic familial are the most consistent predictor of quality of life so when you think about it on you know God forbid on your deathbed are you going to say you know it was that hundred thousand dollars more I made you know two years ago that gave my life meaning no it's probably going to be the people you love most deeply in your life and it is it's a huge so not only is there a positive protective effect when you have those relationships but unfortunately if you're isolated and lonely there are some health problems associated with this so you are three to seven times more to die if you are consistently lonely depressed and isolated and that's even after you control for you know what your cholesterol is whether you smoke whether or not you exercise so it's very very powerful and this is so sad to me I I honestly still don't believe this data one out of four Americans who were surveyed in this 2004 talked to no one about something of importance in the previous six months that's just breathtaking to me and we have other data medical students who report they're a little more isolated or lonely have lower immunity get more colds and social isolation is a risk for recurrence and progression in a seventeen year forward study of people with breast cancer so social connectedness or the lack thereof is very powerful for your health and it may not take a whole lot they did a study in Alameda County where they followed people for years and social connectedness was protective against mortality and it social connectedness was as little as going bowling once a month with your league I mean that's not like you know huge social contact belong to a book club go to you know I go to a weekly aquarobics class and I realized that I miss when the women who usually come aren't there and they actually know that I'm not there when I'm not and I'm it's just sort of like a little bit of a an extra connection and even being recognized by name by the person at Starbucks in one study made a difference in somebody's happiness the woman at the gym that I go to finally has figured out who I am because I come at the same time every day and she's now saying hi Ellen well I you know I just went hi Veronica you know so now she's gonna make my day I'm gonna make hers you know and every time I leave now she says bye Ellen and I'm just feeling like wow I think I'll come here more often so these last two are really important so Indy and I sort of lumped them but they're not they're sort of different engage in activities that have meaning for you and connect with something beyond you so many of you are aware that Victor Frankel wrote Frankel wrote this amazing book called man's search for meaning which was a lot about survival through the period of the Holocaust and I love his quote life has a meaning to the last breath the possibility of realizing values exist to the very last moment and people who have a sense of why to live can bear almost any how so we so there are two sides to this so you can choose to fill your life with stuff that's not quite so important or you can choose to populate it with activities that have meaning so that's one part of it but you can also add meaning to all the other things that you do that you might not think of as very inspiring so and we are also an incredibly generous Society Americans give and volunteer more than almost any other Society in the world and a recent study from one of my former medical students he looked at you know he studied vets you don't think of vets you know as big volunteers but some of them did and those that did lived longer and supported greater life satisfaction and people are actually happier when they give they've done experiments where they'll give people $15 or $20 and they say spend it on yourself or give it away and then they check how happy they are two days later and the people who gave it away are much happier so I think you know when we think of other people and extend ourselves it's a very positive thing for our health and finally connecting with whatever is greater than yourself for many of you in this audience it may be a spiritual presence God or whatever but it doesn't have to be it can be nature it can be a cause it can be just anything that feels like it's larger than your you know your specific life and when people have that sense of connectedness they often enjoy greater health and happiness and one of these I just wanted to review the spirituality literature most of the time they measure this by church attendance or mosque attendance or whatever but it's clear that people who have go to church on a regular basis or have some regular spiritual practice or healthier more than 50 peer-reviewed studies show that regular religious attendance is associated with better health yeah I'll just let you read the rest of that okay so this is the end I just want you to realize that we've gone through quite a lot some of it more sort of straightforward lifestyle kinds of stuff I hope some of the other stuff that we've talked about makes you think a little bit about the changes that you would like to make in your life to improve your sense of well-being and maybe even that you're going to live longer and better so I wanted to say we just to recap we talked a lot in the beginning about the new science of aging and I hope that wasn't too you know complicated but I'm so excited because I think you're going to be hearing more about how this basic science supports these other 10 recommendations we talked how diet you know lifestyle stuff really impacts health and the best news of all to me is that you make these changes you're going to see effects on your health very quickly much more quickly than we ever had a thought and I don't want you to forget the powerful role that connection with people you love positive outlook and meaning have on your well-being so I really hope you'll take like let's five seconds to just sit and quietly think what's one change you'd like to make this week based on maybe some of the things we've talked about just take five seconds and sometimes telling a loved one what you've decided to do helps that happen so maybe you can share that with whomever you'd like to later on this week and then finally I hope that you'll better appreciate there are some real benefits now I'm serious you know old Stradivarius violins get better with age so does cheese and wine redwoods are much you know are very wonderful and you still know I'm almost 65 so I'm going to get my senior discount soon so and I just want to say how grateful I am that you've been such a great audience I'd be happy to answer any questions ask away yes in the back yeah ooh so very good question have the longer you know the longer we live physically you know how what's going to happen with the incidence of dementia and that's why that staying mentally act so all of the things that I recommended in terms of lifestyle for your heart and for diabetes are good for the brain but you are absolutely right the National Institutes of Health have a whole Institute on Aging and they really are interested not just from an economic point of view that we're going to have needs for a lot of nursing extra nursing care if people develop dementia and start to live to ninety to a hundred so that's why this that's why I'm so excited about the lecture I think there are ways that you can prevent that for slow that or reduce your chances of getting it if you follow even some of the advice here but that's so anything to think about in terms I said stay mentally active but all the other lifestyle things exercise healthy diet all of that will also impact your ability to stay as cognitively clear as as possible but great question yeah okay well guess what kind of grain they eat you bet so sure her question was what about in populations or societies where they eat just all of this grain and they're not getting fat first of all they're running on the savanna so most of them are much more physically active but the whole grain is probably what's happening is that it's not that high glycemic instant you know sugar load into the system it's not refined it's whole food has a lot to do with it yeah in the pink uh-huh no I'm so you're both sort of picking out in the back and then we'll do you yes when you talk things into the blender does that reduce their fiber oh great question so what kinds of things are you thinking about throwing into the blender yeah yeah um probably momentarily but that's going to happen in your digestive system as well with the digestive acids but it just mean I don't think it's going to break it up so so much that especially if you drink it or whatever right afterwards that it's going to be a problem it's because if you have like the whole apple that you're going to have all that fiber even if you juice it if you eat the juice and the pulp and all the stuff you're getting the whole apple you're just getting it in the liquid form and that should be fine okay and you had a question there are 10,000 variety to their ball are healthy oh you just you just and yes so she's right she said you got you're looking for yes there's nothing oh great okay so you just said whole week so let me yeah first of all have you read about how now Cocoa Puffs have a heart-healthy I'm sorry I have nothing to do with Cocoa Puffs but there there should be better labeling but if you see whole-wheat that's not the same as whole-grain so you actually in a product would want to see the seeds you actually want to see something that it came from but it has to say whole-grain would be a place to start but I agree with you it's like and they're all brown oh look and some of that's just molasses added back you know it's not necessarily the fiber and you're going to know because if you eat really whole-grain very fiber rich food your system is going to tell you in a positive way you're going to know that your digestion and your elimination is improved it's hard it is so hard to read food labels yep yep yep okay those of us who train for backpacking trips or follow you know all the rest yes yes hey yeah did you come yeah okay so she was saying those people and I imagine you're speaking for yourself who follow many of these healthy lifestyle things and go backpacking our little driven yes yeah and you can over so it depends on how you perceive this I can imagine two people training for an Ironman marathon you know Ironman competition and one of them is so stressed out and the other one is seeing it as a joyful possibility so what really matters is less the behavior although you certainly can compulsively exercise and that's not good you'll literally break your muscles down or injure yourself but it's more your interior landscape and can you approach it in this very graceful sort of Aikido way and say what a wonderful opportunity versus oh my god I've you know I couldn't run today because of the rain does that make sense so I think if you can damp down a little bit that sort of driven a little drive is great you know if the medical students if you did a personality inventory of most medical students and lawyer students and stuff we're way on the end of goal oriented you know you have to be to make it to this stage the issue is can you turn the volume down enough so that it's not unhealthy for you so I like having you know there are times when I need the volume up if I've got a bad deadline but if I can't turn it down again that's when I turn into all of you know the things that aren't good for my health so I know it's late I don't does anybody know you have a this is terrible does anybody have a PDA or something it can check the World Series result I did the Phillies I mean I just okay anyway thank you for your attention I'll be happy to answer questions you

Channel: University of California Television (UCTV)

Views: 225,890

Rating: 4.7728705 out of 5

Keywords: senior health, aging, Ellen Hughes

Id: jQrkioHOJLs

Length: 83min 15sec (4995 seconds)

Published: Thu Feb 25 2010