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Senior Viewpoint: Bone Health & You, Dr. Conway McLean, DABFAS, FAPWHc, FAMIFAS

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Ask anyone, especially a senior, What is a sign of wellness? What tissue epitomizes strength? The answer is your bones and skeletal health. Never have we known so much about bone health, and never has it received so much attention. Our understanding of bone as an organ and a tissue has deepened, especially in the last few years. The public’s level of awareness has been raised as well, and people want to know what they can do to improve their bone health. They know about the problems that result from osteoporosis, especially the potential for fractures and bone injury.

Bone is truly a remarkable tissue, with amazing abilities and wonderful reparative properties. Bone has the principal responsibility of supporting the load imposed upon itclinical herbalism, the human body. The demands placed upon our bones require enormous strength and resilience, while still being relatively lightweight. Bone is a very responsive tissue, altering its shape and configuration depending on the forces it endures, responding to physical stress by becoming stronger.

Bone requires physical forces be placed upon it, at least partially in the form of resisting gravity, to survive and thrive.

We know more about this process than ever before. At last, we begin to grasp how bone responds to physical activity. Advances in technology have allowed us a better, more thorough understanding of the biology and physics of bone. We know its healing abilities are excellent, at least partially because of its well-endowed blood supply.

As we are all aware, aging affects bones, as it does every part of the human body (and everything else). But certain eras are associated with more significant bone changes. Bone loss begins or accelerates at midlife for both men and women. The goal during this time of life is to keep bone loss to a minimum. For example, between the ages of forty and fifty, bone loss may progress more slowly in both sexes with effective interventions. Unfortunately, during menopause, there is a period of more rapid loss in women. Both sexes may lose a total of 25 percent of bone during this period. This phase can occur anytime between the ages of fifty and seventy.

The frailty phase typically occurs in adults over age seventy. One common occurrence in this phase: bowing of the spine, called kyphosis, due to spinal fractures secondary to osteoporosis. But, be aware these phases are generalized. It is important to know fractures are not a natural consequence of aging. They can be avoided, to some extent. Your chronological age, as an individual, is a given, so we must focus on those factors over which we have some control—our diet and physical activity.

Osteoporosis is the excessive, or “pathologic,” thinning or loss of bone density.

With this common disease, bone substance is lost, making the bone lighter, thinner, and, of course, weaker. When progressive, it can lead to loss of height, stooped posture, humpback, and severe pain. Osteoporosis is characterized by the systemic impairment of bone mass, and strength, resulting in increased risk for fragility fractures, disability, and loss of independence.

Falls frequently result in fractures when thinning of bone has occurred. In seniors, or anyone with certain risk factors, falls are a real and ever-present threat. One approach to the problem is participating in a fall prevention program, helping us to protect our bones by reducing the risk of injury. Programs such as these, addressing muscle strengthening, balance, and gait training, and home hazards evaluations, all help to reduce the number of fractures that occur.

Gait-assistive devices are important, although patient acceptance can be a real issue. Bracing and supports can be beneficial, but are utilized far too rarely. Re-evaluation of prescribed and over-the-counter medications being taken for possible unexpected consequences is also recommended. Oftentimes, one person may receive prescriptions for multiple medications from multiple providers. Many pharmaceuticals have the potential to have psychotropic qualities, meaning they alter perception or mental acuity in some way, and should be reduced or replaced.

Osteoporosis is the most common and most well-known of the bone diseases.

Sometimes referred to as the “fragile bone disease,” this loss of bone mass is often caused by a vitamin deficiency, particularly calcium, vitamin D, or magnesium. Its development usually starts with osteopenia, the precursor to osteoporosis, in which there is early bone thinning.

According to the National Osteoporosis Foundation, osteoporosis affects 54 million Americans, mostly women. Millions more Americans are estimated to have the low bone mass of osteopenia, putting them at risk for osteoporosis. The morbidity and resulting expense is incalculable. For starters, we know that almost two million Americans a year suffer a fracture attributable to osteoporosis.

It’s well-recognized and proven that physical activity is important for bone health.

Exercise, in all of its varied forms, helps to reduce the risk of falling in later years. This is common mantra holds true throughout the many phases of life. Exercise helps to increase or preserve bone mass. Resistance training, whether with machines or weights, is especially helpful.

We can improve our own bone stock. Still, we have no control over some of the most important factors in developing healthy bone. Studies indicate that genetic factors are responsible for determining fifty to ninety percent of our body’s bone mass. Heredity issues not only limit how much bone a person may acquire, but also affect bone structure, the rate of bone loss, and the skeleton’s response to environmental stimuli, such as certain nutrients and physical activity.

Healthy, sufficient nutrition is important in maintaining optimal bone mass.

We also know the optimal type of nutrition and activity will vary across our life spans. A person’s nutrition over the years is clearly essential to preventing this debilitating disease. It is widely accepted that adequate calcium and vitamin D intake are necessary for good bone health, and the nutritional benefits of these two nutrients go far beyond their boon to bone health.

Because the average American consumes levels of calcium far below the amount recommended for optimal bone health, it has been singled out as a major public health concern today. Vitamin D aids in the absorption and utilization of calcium. There is a high prevalence of vitamin D insufficiency in nursing home residents, hospitalized patients, and adults with hip fractures.

Some estimates claim that over 40% of Americans have a vitamin D deficiency.

Although sunshine is the best method of increasing your levels, supplementation is recommended for most of us. Current guidelines suggest 400–800 IU per day is adequate, although many scientists say this is not nearly enough. Another controversy surrounds which type of vitamin D is best, D2 or D3. The former is from plant sources and the latter from animals. Most experts believe D3 is better at raising tissue levels. 

It is essential we value the impact we can have on our own bone health. While genetic factors are important in determining bone mass, we each need to understand we have a critical part to play. In fact, controllable lifestyle factors, generally referring to diet and physical activity, are responsible for ten to fifty percent of our bone mass and structure.

But too many of us are too sedentary. Many of us know, in a general sense, that exercise is important. Yet how many of us are able to incorporate it into our average day and make it a regular practice? A little self-knowledge has not achieved great gains in levels of personal fitness. It may be time for a different approach. When exercise is prescribed like a drug by one’s family doc, it acts as a prescription medicine. And it is the healthiest kind.

Dr. Conway McLean is a physician practicing foot and ankle medicine and surgery in the Upper Peninsula (Marquette and Escanaba). McLean is triple board certified in surgery, wound care, and orthotic therapy. He has lectured internationally on many topics. Dr. McLean welcomes questions at drcmclean@outlook.com.

Excerpted with permission from the Fall 2020 issue of Health & Happiness U.P. Magazine. Copyright 2020, Empowering Lightworks, LLC. All rights reserved.

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Senior Viewpoint: Nutrition Essential to Fighting Infection, Dr. Conway McLean, DABFAS, FAPWHc, FAMIFAS

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The attention devoted to sickness and health is omnipresent these days, and with good reason. The pandemic is filling the airwaves and prompting fear in the hearts of many. What we need is accurate information, smart practices. This is where the knowledge of the physician specializing in infectious disease, one who knows the immune system intimately, can be invaluable.

So what specifically is the immune system? It’s the part of the body devoted to fighting off invading micro-organisms that are a part of our world. The complexity and effectiveness of our immune system is nothing short of staggering.

What are the functions of the immune system? This system is critical for survival. Our immune system is constantly alert, monitoring for signs of an invading organism. The immune system functions to keep us free of infection, be it through the skin, a skin structure, or our intestinal lining. Cells of the immune system must be able to distinguish self from something else, i.e. “non-self.”

By now it is well-recognized the COVID-19 virus is more dangerous in the elderly.

A decline in immune function is consistently observed among older adults. Aging is also associated with increased inflammation in the absence of infection and has been found to predict infirmity. The result is seniors are more susceptible to infections and have more serious complications when they get one.

The term for this decline in immune function is immunosenescence. It reflects the deterioration of both components of the immune system—the acquired and the innate. The innate system is the ‘first responder’ to an alien invasion (of a microbe). The cells of the innate system act quickly, but are not specialized. The innate system is generally less effective than the adaptive immune response. The adaptive response is able to recognize a specific invading organism and remember it later, if exposed again.

Scientists specializing in the role of macronutrients, micronutrients, and the gut microbiome are convinced they all play a critical role in the functioning of our immune system. It turns out to be an incredibly complex system, with a multitude of factors and variables. Up until recently, we knew next to nothing about our gut bacteria and its complex interaction with our health and immunity. We do know one crucial part of gut health, not surprising, is our diet. But there are many ways to optimize the effectiveness of our immunity.

Your nutrition can affect the microbes residing in your guts, directly altering your immune response.

The  microbial community in the mammalian gut is a complex and dynamic system, crucial for the development and maturation of every facet of our immune response. The complex interaction between available nutrients, the microbiota, and the immune system seems to be the most important ‘player’ in the fight against invading pathogens.

What does it take to have a healthy immune system?

We know well many micronutrient deficiencies have been identified as contributors to declining immunity. It is believed these could provide opportunities for directed therapies for potentially restoring immune function, creating better health through improved nutrition.

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Some proffered recommendations: eat yogurt for breakfast! Apparently, the probiotics strengthen the immune system, as revealed by a study on athletes and their colds and GI infections. Yogurt is also rich in vitamin D, which also boosts your immune system.

Vitamin C is well-recognized as an extremely important part of an effective immune system, and a deficit can make you more prone to getting sick. Because your body cannot store it, daily intake is essential for good health. Foods rich in vitamin C include oranges, grapefruits, strawberries, bell peppers, spinach, kale, and broccoli.

Vitamin B6 supports many of the reactions that are integral to immune function. Foods high in B6 include chicken and cold water fish (e.g. salmon and tuna), and green vegetables. Another important vitamin for fighting infection is E, which is a powerful antioxidant. Foods rich in vitamin E include nuts, seeds, and spinach.

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Some people think of tea as something consumed in the movies, yet studies reveal alkylamine, a naturally occurring chemical in tea, strengthens the immune system, again, helping it fight off infection more effectively. Honey has centuries of use because of its medicinal properties. Numerous reviews find honey, an antioxidant, acts as a natural immunity booster. So you might want to add it to your tea for both flavor and health benefits.

Another suggestion made by researchers is to eat more garlic, since it seems to stimulate many different cell types essential to the immune system. Ginger, another powerful antioxidant, has antiviral properties, probably a good idea these days. Consume more lemon. Lemon juice is high in vitamin C, and can be used for its antioxidant properties and to prevent the common cold.

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How about a bowl of chicken soup? Thought by some to simply be a comfort food, the dish has a mild anti-inflammatory effect. Ingredients in the classic recipe (chicken, garlic, onion, celery, etc.) have been found to slow the migration of white blood cells into the upper respiratory tract, helping to relieve the symptoms of a cold. Additionally, a compound found in chicken soup called carnosine seems to prevent colds. How about a nice bowl of curcumin? This is a component in the spice called turmeric. Studies have shown curcumin helps to regulate the immune system.

Zinc is known to be an important micronutrient for the immune system. Even a mild deficiency in zinc has been associated with widespread defects in the immune response. Look to fish, seeds, nuts, and broccoli as good food sources. Selenium is a trace element that also has critical functional, structural, and enzymatic roles. Inadequate selenium is associated with a higher risk for a variety of chronic diseases since it is critical to immune function. Foods containing higher levels of this mineral include spinach, lentils, eggs, and fish.

Some recommendations for immune health are related more to lifestyle modifications.

Make workouts a part of your weekly regimen since regular exercise increases the activity of immune cells. Exercise also seems to flush bacteria out of your lungs, reducing the likelihood of an airborne illness. Experts suggest moderate levels of intensity, performed 4 to 5 times a week for 30-40 minutes.

Staying hydrated is required for immune health. Water helps your body produce lymph, which carries white blood cells and other immune cells. Sun exposure is important (although difficult in certain climes) since it is the most efficient way to stock up on vitamin D, an immune system supercharger. Surprisingly little is needed, just 15 to 20 minutes a day, to get the recommended dosage.

Getting the flu shot can improve your immune profile, and has been approved for all adults. Smoking suppresses the immune system generally, so quitting helps lower the risk of infectious disease. Smoking also damages the lining of our “windpipes,” explaining why smokers are much more likely to catch a cold virus.

Because of their effectiveness, nutritional therapies should be getting prescribed in the typical medical practice, though this has been rarely and inconsistently recommended. This therapeutic approach should be utilized more consistently in those demonstrating poor immune function, as well as healthy populations.

Our understanding of the risk factors for immune system dysregulation is far from complete.

We can say definitively that adopting these and related strategies will optimize your chances of reducing or delaying the onset of immune-mediated acute and chronic diseases. In summary, I would say, you have a road map. Your course of action, a plan for better health, can now be laid. Perhaps it is time for positive changes in your routine, and thereby your health. Though giant steps are hard to take, small ones require only a step, and if taken in the right direction, lead to the larger changes you choose.

Dr. Conway McLean is a physician practicing foot and ankle medicine and surgery in the Upper Peninsula (Marquette and Escanaba). McLean is triple board certified in surgery, wound care, and orthotic therapy. He has lectured internationally on many topics. Dr. McLean welcomes questions at drcmclean@outlook.com.

Excerpted with permission from the Summer 2020 issue of Health & Happiness U.P. Magazine. Copyright 2020, Empowering Lightworks, LLC.

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