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Posts for tag: frailty

By Dr. Doug Williams
February 15, 2017
Category: Frailty
Tags: Healthy Aging   frailty   body systems  
Over the last few months, we have been working our way through the topic of Frailty, which is really a study of how the body unwinds over a life time. Most of the material we have been drawing from has come from an article published in "The American Geriatrics Society."

While some choose to look at topics like Frailty and the unwinding of our bodies over time as a bad thing, this article and our blog series took the approach that we are "Fearfully and Wonderfully Made" and understanding how we function in youth and as we age can help us live as full and complete a life as possible!

The lens that we used to look at this topic consisted of four, separate yet interrelated, segments:
  1. Inflammatory System
  2. Endocrine  System
  3. Musculoskeletal System
  4. Nervous System

The first thing we looked at was Inflammation. We saw that researchers looked at these main markers in inflammation:

  • Cytokine IL-6
  • C-Reactive Protein
  • Total number of monocytes

These were blood markers that increased with age and disease, and were related to the following disease states and functional issues:

  • Death (that is a big one)
  • Bone mineral loss
  • Muscle loss
  • Anemia
  • Insulin resistance (Adult Diabetes)

We also looked at how we could influence these various states of decline and dysfunction, primarily by how and what we ate. There are two links that can help with addressing this issue:

  1. Andrew Wiel Article
  2. Blog Summary from our Healthy Eating Series

Next, we looked at the Endocrine System.  The main markers researchers look at in the Endocrine System are

  • IGF-1
  • DHEA-S

These two markers primarily give insight into the sex hormones: Testosterone and Estrogen. These markers ebb and flow over a life time, but tend to trend down as we age, causing the following functional loss:

  • Decreased strength
  • Decreased endurance
  • Weight loss (due to loss of muscle tone)
  • Decreased walking speed
  • Decreased physical activity
  • Increased inflammation
  • Cognitive issues (dementia)

When looking for ways to positively influence these factors, we found several factors to pursue:

  1. Resistance training
  2. Weight loss/management
  3. Decreasing high glycemic index foods
  4. Increasing sleep
  5. Eating a high protein low carbohydrate snack before bed

Two links that were helpful were:

  1. Article in the Journal of Gerontology (Technical)
  2. Article in Life Extension Magazine (Reader Friendly)

After the Endocrine System, we looked at one of my favorite: the Musculoskeletal System! The main marker for this system is muscle mass or muscle to non-muscle tissue ratio.

We primarily focused on the glute muscle because it is such a big player in much of human locomotion. Decline in the musculoskeletal system results in the following disease and functional states:

  • Diabetes
  • Fall risk
  • Declining bone health
  • Independence

We referenced two helpful links:

  1. The Sit to Rise Test (explained the relationship between core strength and life expectancy)
  2. Getting Your Butt Off the Ground (blog series on how to improve the Sit to Rise Test!)

Finally, we looked at the Nervous System. We saw that the nervous system really brought everything together, which is why it is often called the Master System. The markers that were used in the original article are:

  • Gait (how stable and smoothly you walk)
  • Balance
  • Strength

We added a bonus one that has been making it's way into the literature lately:

  • Cognition (how well your brain works)

When the nervous system starts to fail, you see the following issues:

  • Falls
  • Loss of independence
  • Problems with coordination
  • Cognitive issues (mental slowness, dementia and, possibly, Alzheimer's's disease)

We linked to several articles:

  1. The Nurses Study on Walking (showed a dose-based relationship to exercise brain function)
  2. An Article in JAMA (relative to exercise and brain health - dementia and Alzhiemer's)
  3. Our previous blog series on Getting Out Of A Chair (practical place to start for glute strength)


What's Left?

As I write this article, I am 52 years old. I am sure that some of you reading are much younger than me and some older. One thing we all have in common is we are all headed to one last door in life to open.. death! We all are going to have to step through it, at some point. I have a lot to say about what I believe to be on the other side for me (the waiting arms of Jesus, who made the supreme sacrifice for me!), but that is not what this blog series has been about! This series has been about how things are going to unfold as you get to that last door. Personally, I would like to be able to walk right up to it at the end under my own power. While that may not be possible, I am going to do all that I can to operate as fully and completely as I can in the framework I have been given. I hope some of the material we have covered helps you to do the same.

In Health,

Doug Williams, D.C.
Care Chiropractic 
Lafayette, Indiana

By Dr. Doug Williams
February 08, 2017
Category: Frailty
Tags: exercise   frailty   nervous system  
 
The Nervous System Lies at the Hub of Frailty

We have been working through a series on Frailty, essentially what happens to our bodies as we age. This material is important for several reasons, not the least of which is, because it is going to affect all of us, if we live long enough, and knowing what is coming can be comforting on some level.

However, more than that, I believe that understanding how we are "fearfully and wonderfully made" allows us to not only appreciate what we have been given in our bodies, but also inspires us to take the best care possible of them.

With that in mind, we have been going over what happens to us over time, but also how to positively impact it. The Nervous System literally and figuratively lies at the center of our life and, ultimately, death.

Components of the Nervous System
 
The Nervous System is structurally broken down into two parts:
  1. Central Nervous System, which is composed of the brain, spinal cord and nerve roots
  2. Peripheral Nervous System, which is composed of the nerves once they leave the spinal cord
The Nervous System is functionally composed of about a million different parts! Okay, maybe not a million, but way more than I am prepared to cover in this material.
 
The most useful model for the functional aspect of the Nervous System is to think of it as a great big feedback mechanism.

It is constantly seeking information through our senses on things like: gravity, position, resistance, stability, sound, smell, sight, temperature, feel, etc., and relaying this to the brain in order for the brain decide what it wants to do next.
 
 
Think of Your Nervous System Like a Submarine
 
Submarines are known for operating on sonar - essentially, making a sound, waiting for the sound wave to bounce off something and return back to the sender. The submarine then could make a decision on whether or not it wanted to go in this direction or that. This is often called pinging.

Pinging is what your nervous system is doing all day long, searching out information from the periphery, relaying it to the brain, deciding what, if anything, to do about what it has found out and then taking action.

Going up a flight of stairs? Your eyes gauge the height of the stairs, your foot tells you if the surface is smooth like wood or has resistance like carpet, your heart rate and blood pressure increase (via messages from the nervous system) as you ascend and relay information to the brain in order to make a decision if you need to stop and rest halfway up or not.

Most of this happens automatically without you thinking about it... until it doesn't! Then, you have a problem - you might slip, stumble and fall, or catch yourself.

The interesting thing is that failures in the feedback mechanism happen at both ends of the age spectrum - a 2-year old learning to negotiate the stairs has some of the same issues as an 82-year old might - and for the same reason: The Nervous System is Not Completely Plugged In!

Often times, our physical "Pinging and Processing" can parallel our cognitive (ability to think and reason) "Pinging and Processing." In other words, our brains can slow to match our bodies!

This presents some very interesting possibilities. For instance, if you train the body, will the brain follow suit?
 
 
Train the Body, Train the Brain!
 
An interesting study published in JAMA (Journal of the American Medical Association) in 2004 looked at over 18,000 women between the ages of 70-81 and their activity levels, specifically walking. The study found that, not only was there a 20% difference in cognitive function (brain activation), but that their cognitive function was related, in part, on a dose basis: the more active they were, the better off they were!

This is only one of many articles you can find on physical activity and the role it plays in keeping the brain healthy. Really, keeping the brain healthy is a reciprocal action, just like our sonar example from the submarine. The more information you can process, the more likely you are to get up and process it; rinse and repeat!

Another article published in JAMA in 2008 studied elderly individuals with memory issues but had not met the criteria for Alzheimer's. 138 people completed this study that split the group into two: half did what was considered an "educational and usual care program" and the other half did a "24 week at-home physical activity program." The "educational and usual care program" showed deterioration over the study time - they actually lost ground. In contrast, the "at-home physical activity group" not only didn't lose ground, but they showed improvement!

Components of accessing the nervous system for frailty include:
  • Gait: how well and how much you can walk
  • Balance: a measure of strength and coordination
  • Strength: a measure of how well you recruit your muscles to do a task; this can be a quantity and quality issue
Doesn't that sound a lot like exercise? It sure does to me! Once again, we find ourselves back at the basic premise that we were born to move and, when we stop moving, we stop living (maybe not all at once, but progressively, in both body and mind)!

Training movement has a lot of components, but at the heart of it is this concept:

GET UP AND DO SOMETHING... ANYTHING!
 
A good place to start would be our blog series on getting out of a chair. It has some simple step-by-step exercises for strengthening your glutes, the biggest muscles in your body.
 
Whew! Well, I hope you have gotten something out of our series on Frailty. Next week, we will wrap it up and pull everything together. The last portion of the theory on Frailty is called Integrative, I think you will like it!

Until then,
Get Up and Do Something!

Doug Williams, D.C.
Care Chiropractic
Lafayette, Indiana

PS: Don't forget to visit our new blog page at Doug Williams, DC - there is lots of great stuff to explore!
By Dr. Doug Williams
January 17, 2017
Category: Frailty

We are on the backside of a series on Frailty, the study of how the systems of the body work together and what happens when they stop. In addition (and more importantly) - how you can slow, stop and, in some cases, reverse these changes to live your life as long and full as possible.

This week we are going to be talking about the Musculoskeletal System, one of my favorites! You might suppose I like it so much, because it forms the bread and butter of my livelihood as a chiropractor, and you wouldn't be totally wrong! However, the real reason I like it so much is that this system out of all of them reacts the quickest and with amazing changes, with just a little bit of stimulus, a little bit goes a long way!

This system is made up of the frame work (bones and joints) and the engine that moves them (muscles). It is the "hardware" to the Nervous Systems "software," which we will talk about next week.

Sarcopenia: The Technical Term for Age-Related Muscle Loss

About now, you are probably trying to figure out why there is a picture of old cigarette butts in a tree stump as a caption for this section. Well, I am going to tell you: The best example of age-related muscle loss I can think of is when older men lose their bottom muscles. Their waist might continue to expand, but their pants get saggy in the rear! Do you know how hard it is to find a picture of an older man's pants on the copyright-free picture websites? You can't! The closest I came was when I typed in "Old Butts" and this picture came up. So, the next time you see an older guy (or gal) with saggy pants or some cigarette butts, think about age-related muscle loss or sarcopenia!

There are a number of reasons why we lose muscle as we age:
  • Hormonal (sex hormone levels drop)
  • Inflammation 
  • Neurological (stimulus to the muscles decrease)
  • Poor Nutrition
  • Decreased Activity Levels
Declining muscle mass has been associated with a number of different health and disease states, most notably, diabetes, fall risk and weak fragile bones. In addition, diabetes is associated with a multitude of other issues including issues of inflammation (heart disease, neurological conditions). From a more practical standpoint, strong muscles allow you to do more of what you want for longer!
 
 
It All Comes Down To The Glutes!

In recent years, a simple test has been developed to determine how long someone will live: The Sitting Rising Test. Click the link to not only see it demonstrated, but to get some great background on why it is so important and some easy to do exercises to improve your test score. Basically, the Sitting Rising Test identifies how easy it is for you to get off the ground and correlates that to how long you will live - kind of scary! The main muscle that drives you up off the ground are your glute muscles, otherwise known as your bottom-behind-butt-derriere, you get the idea! We actually did a whole blog series, not only on the Sitting Rising Test, but also on how to begin to engage the glute muscles to improve your outcome on this test. If you are serious about getting stronger, this is the place to start. If your base isn't strong, everything else is going to perform poorly as well! You can check out the series called Get Your Butt Off The Ground here.

There are so many things in life that you can't control: genetics, accidents and, to some degree, stress. But one thing you can control is how often and how intensely you activate muscles and which ones. If the only muscle you have been activating lately is your bicep when bringing your fork to your mouth, try something new and get working on your backside!  Along the way, you might find that you feel better, move better, reduce your risks of falls, improve your blood sugar levels and maybe flat out live longer!

Next week, we are going to be talking about the software that runs your hardware: the Nerve System!

Until Then,

Doug Williams, D.C.
Care Chiropractic
Lafayette, Indiana
By Dr. Doug Williams
December 15, 2016
Category: Frailty
Tags: frailty   endocrine   hormones  
We have been working our way through a series on Frailty. Frailty is a recent concept found in the medical literature that, rather than describing a single health event, describes what happens when a number of systems start to have problems. The areas we are looking at are:
  • Inflammatory
  • Endocrine (hormonal)
  • Skeletal
  • Neurological
  • Integrative
Initially, frailty was looked at as an end of life issue. What has come out of the study of frailty is that, not only do these systems fail over time instead of all at once, but many times, their failure can be slowed, stopped and sometimes reversed. Not that you can live forever on this planet, but the time you do spend here can be a whole lot more comfortable and productive if you pay attention to how your body works!

Last week, we reviewed how inflammation in the body plays a role in its demise and what to do about it.

Hand-in-hand with inflammation is the change and breakdown of the hormonal system. We are going to look specifically at two areas:
  1. IGF-1
  2. DHEA-S

IGF-1 and DHEA-S are two markers associated with the sex hormones (testosterone and estrogen) and human growth hormones (HGH) that decrease with age. Unfortunately, these correlate with the following declines in health status:

  • Deficits in Strength
  • Deficits in Endurance
  • Weight Loss
  • Decrease in Walking Speed
  • Decrease in Physical Activity

An increase in inflammation has also been associated with a decrease in IGF-1 and DHEA-S, and, as you now know, inflammation is bad news!

Since DHEA-S is related to the sex hormones in men and women, its decline has been associated with trouble in weight management, cognitive issues (brain function/dementia), blood sugar management (diabetes) and many other disease states.

Both IGF-1 and DHEA-S would be expected to decrease with age, but can you increase or maintain these levels naturally?

Supplements: Maybe. Resistance Training: Definitely!

When searching for ways to increase DHEA and IFG-1, you can find sites that recommend different types of supplements and, to tell you the truth, I think there is likely to be some times and places to utilize this approach. However, anytime you are looking at introducing hormones or hormone precursors, you need to be very careful, as a little bit goes a long way and that can have some very serious side effects! In keeping with our focus in this series on improving your health naturally, a safer, cheaper and, probably in the long run, more sustainable method would be resistance and or endurance exercise. There was a really nice article in The Journals of Gerontology on raising DHEA and IFG-1 after either endurance exercise or resistance exercises. They checked both against a control group (that did nothing) and found the best increase was noted after the resistance exercise (three sets of ten of eight exercises).  Another nice summary of improving these factors came from Life Extension Magazine  While Life Extension Magazine is produced by a supplement company, I think they did a good job in summarizing the effects of exercise and a healthy lifestyle:
 
"Safe methods for enhancing endogenous GH production include: losing excess body fat, particularly abdominal fat; avoiding high-glycemic load carbohydrates; optimizing sleep habits; eating a high-protein, low-carbohydrate snack before bedtime; and exercising regularly to your lactate threshold."

In conclusion, there are inevitable changes in our bodies with age, two of which are the decline in the hormones DHEA-S and IFG-1 that have direct impact on your sex hormones and growth hormone production. Low levels of these two substances have been related to a decrease in strength, endurance, walking speed, physical activity, cognitive function, bone density and an increase in weight and inflammation. While there are supplements available, they have potentially harmful side effects and need to be administered/monitored by a professional. A safer, more effective and more sustainable method to improve these two factors is resistance exercise and a healthy low inflamatory diet!

You were created to move and lift things, and live life! I will leave you this week with one of my favorite quotes:
 
Life has no remote....... Get up and change it yourself!

Until Next Week,

Doug Williams, D.C.
Care Chiropractic 
Lafayette, Indiana
By Dr. Doug Williams
December 08, 2016
Category: Frailty
Tags: inflammation   frailty  

The word inflammation comes from the Latin "inflammo," meaning "I set alight, I ignite." Lots of things can be associated with inflammation - words, for example! Actions might be considered inflammatory as well. When considering inflammation with respect to health-wellness-disease and in our current series on Frailty, typically, it would refer to a reaction of the immune system. Inflammation in the body can be either acute (sudden, intense, often life-threatening, injury or infection) or chronic (persistent, long lasting, difficult to eradicate). For our purposes of building a framework on how to improve and reduce the impact frailty has on our lives, we will be considering the chronic state of inflammation.

The easiest way to quantify or track inflammation is usually by blood tests. There are different blood cells and other markers that indicate the presence or absence of inflammation in the body and that can even tell you if it is associated with a specific disease. Again, for our purposes, we are not looking for specific diseases, but how the general concept of inflammation can be impacting our health and weakening our systems. It has been found that several markers can be helpful in identifying the degree of chronic inflammation in the body and, in turn, the degree of frailty:

  • Cytokine IL-6

  • C-Reactive Protein

  • Increase in the total number of monocytes (a type of white blood cell) and the total white blood cell count

According to the article in the Journal of the American Geriatric Society that we have been discussing:

"Higher levels of these same inflammatory cytokines correlate with greater vulnerability to disability and mortality (death), further supporting a role for these biologically active molecules and system is the development of poor health outcomes."

Just a little further on, the authors indicate:

"Multiple lines of evidence demonstrate a biological link between elevated IL-6 and bone and muscle loss, anemia, insulin resistance (diabetes), and altered hypothalamic-pituitary-adrenal axis stimulation (sex and other hormones) making it less likely that IL-6 is simply a benign marker." 

TRANSLATION: The presence of the above blood markers, even in the absence of a frank disease state, are correlated to loss of bone density, muscle tone, anemia, adult onset diabetes, lower sex hormones and an increased likely-hood of death!

Andrew Wiel, M.D. has a really nice article that outlines some ways you can improve these blood markers without drugs.  In short, it says to exercise more and lose weight!

It is not a big reach that what you eat, in addition to driving up your weight, could increase your blood markers for inflammation. The best explanation and recommendation packet I have ever come across is by Dr. David Seamen.  If you are serious about cleaning up your diet and reducing inflammation in you system, read this packet.

Finally, but I am sure not the last word on the subject, there was a real interesting article that came out of Carnegie Mellon University describing how mindful meditation reduced levels of IL-6 in a specific population. Though I am not big on general meditation (as a Christian, I think your mind needs to be engaged someplace specific), this article shows just how powerful your thoughts and mind can be. It is worth considering.

So, if you want to improve your health and decrease the impact and effects of frailty in your life: exercise, eat right and be mindful in your thoughts.

Until Next Week,

Dr. Doug

Doug Williams, D.C.
Care Chiropractic
Lafayette, Indiana