2008年09月 | ARCHIVE-SELECT | 2008年11月


How To Live To Be 100 #1/7 ( By TIME - Aug. 30. 2004 )

Margaret Dell is 96, but you'd need to check the birth date on her driver's license to believe it. Sporting a baseball cap with a Harley-Davidson logo on it, she is the designated driver for her seventysomething friends who no longer feel comfortable behind the wheel. Last winter a snowfall threatened to keep her from her appointed automotive rounds. She took a shovel and cleared a path to her car. Driving keeps Dell young. That and knitting. She constantly knits. She makes baby booties and caps and blankets for friends and family whenever a baby arrives--the newborn getting an early blessing from the ageless. And every month, she donates several blankets to a charity for unwed mothers. Driving, knitting ... and tennis. She plays two or three times a week. She has a much younger doubles partner who "covers the court. I'm a little afraid to run too much because of the circulation in my legs," she explains.

When she was in her 80s, she played in a doubles tournament that required that the ages of both partners add up to at least 100. Her partner was in his early 20s; they won the tournament.

A lifetime nonsmoker and nondrinker, Dell lives alone in a two-story house in Bethesda, Md., her bedroom on the second floor. "I could stay on the first floor, but I try to make myself walk up those stairs and keep going that way." She buys her own groceries; don't even ask if you can shop for her. At home she likes a chicken or turkey sandwich for lunch. If she eats at the country club after tennis, she usually finishes only half and saves the rest for dinner. (The doggie bag is the senior citizen's medical-supply kit.)

Driving, tennis, knitting ... and eating chocolates. She keeps them in a drawer by her easy chair. "I am very bad about those Hershey Kisses," she confesses. "And I love those little Dove ice cream things. I take one before I go to bed." That's the only medication Dell will take without a fight. She's no fan of doctors. Some years back, she took a fall, and her doctor prescribed an MRI. "I just refused to go," she says. "They were having a party. It was my 90th birthday." And the party girl left his office. Fortunately, nothing was broken. But Dell knew that.

More than what she knows, it's how she glows that impresses people. "She has a light in her eyes that is very alive, alert and interested," says Carole Dell. "It radiates over her whole face. Her face is kind of timeless. It's deeply lined, but she's actually beautiful." Spoken like a proud daughter-in-law with 96 reasons to be proud. Ninety-six and counting.

How does science explain someone like Margaret Dell? How can a woman closing in on the start of her second century be so robustly, almost defiantly, healthy, while men and women decades younger are languishing feebly in nursing homes, plagued with failing bodies and failing minds and wishing they hadn't been so unlucky as to live so long?

For most of human history, a long and healthy life has been shrugged off as a gift from the gods--or maybe the undeserved reward for a lifetime of plain cussedness. But to gerontologists, the vagaries of aging have become the focus of intense scientific research.

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| TIME | 07:49 | comments:0 | trackbacks:0 | TOP↑


Heart And Soul ( By TIME - Jul. 19. 2004 )

I started sewing at an early age. It was after my mother Raheeja's mastery of the needle arts caught the attention of our neighbors in Lake Charles, La., my hometown of some 13,000 people. They had noticed the finely tailored handmade clothing my mother fashioned for her family and the linens she tatted and embroidered. A handful of local parents asked if she would pass on her expertise to their daughters.

Each Tuesday and Friday afternoon, four girls, ages 7 to 14, settled in our pine-paneled living room for an hour. Ever observant and curious, I remained quiet but was eager to create something too. Sensing my interest, my mother encouraged me. Soon I was the littlest learner in those sessions. I eventually made some of my own clothing. I would draw the patterns on paper, cut the fabric according to the design and assemble the pieces on a sewing machine.

Fortunately for me, I was in the right place at the right time. Not yet of school age, I was alone with my mother during the day. Her instruction was so distinctive and her beautiful work so inspiring that I learned easily. She would teach me a technique, for example, by gingerly placing my small fingers in the proper position around needles and yarn rather than telling me I was doing anything wrong.

Equal to my mother's exquisite needle artistry was her compassion for others. Every Sunday she and my father would load our car with extra clothing and homemade meals for the children at the local orphanage. One week I protested when my mother wanted to give away my favorite cap. She reminded me that I would get a new one the very next day but that orphans had no parents to buy them caps. Then she added something I have never forgotten: "There's nothing that can warm your heart more than making someone else feel better."

Years later, my mother's words played a part in my choice of profession. Practicing medicine allowed me to improve and even prolong the lives of others. And I dedicated myself to surgery, the most compelling of all specialties, because I would put to use the manual dexterity I developed as a child.

After I became a doctor, one of my more satisfying achievements occurred in the 1960s, when my colleagues and I performed the first successful coronary-artery bypass, at Methodist Hospital in Houston. Some 30 years earlier, as a medical student at Tulane University in New Orleans in 1932, I began work that helped launch the field of cardiovascular surgery. I devised a pump for blood transfusions, which paved the way for open-heart surgery--still two decades away.

My mother's teachings inspired me again in the early 1950s, when I designed a graft for replacing a diseased aorta and arteries. I chose the then new synthetic cloth Dacron by touch, just as I had done as a boy. I drew the design on paper next, cut the fabric and finally put the prototype together at home on my wife's Singer sewing machine.

Learning to sew as a child isn't a prerequisite for becoming a good surgeon, but caring about people certainly is. I'm convinced I would not have grown up to be the physician I am today had I not received my mother's lessons and taken to heart her most poignant message--that making people feel better is the highest calling of all.

--As told to Michelle Lodge

| TIME | 07:25 | comments(-) | trackbacks(-) | TOP↑


Everything You Know Is Wrong 03 ( By TIMEasia - Sep. 6. 1999 )


Adding fruits and vegetables to the diet is good for the heart in many ways. It displaces meat and dairy products and thus reduces the intake of saturated fats. It puts more vitamins--not just E but also C and many of the B vitamins--into your body.

Over the past several years, however, researchers have been investigating a whole new class of plant-based substances whose role in preventing heart disease may be even more important than vitamins. Known as phytochemicals, they fall into two classes: carotenoids, found mostly in orange-colored vegetables (beta carotene is the best known of the more than 600 carotenoids); and flavonoids--some 4,000 of them, found in, among other things, onions, broccoli, red wine and tea (green, black and oolong, but not herbal).

Like vitamin E, the flavonoids and the carotenoids appear to act as antioxidants, keeping LDL and triglycerides from being oxidized by free radicals. But they do so in different ways, explains Jeffrey Blumberg, a Tufts University nutritionist: "All those free radicals come in many varieties and affect different parts of the body. So you need many different antioxidants to protect yourself at different levels."

For example, he says, vitamin E, which is fat soluble, is incorporated into the LDL or triglyceride particle, forming a last line of defense against corruption by free radicals. Water-soluble flavonoids, by contrast, can be absorbed by most cells in the body, where they can presumably take free radicals out of circulation. But so far, these are only theories. All scientists know for sure is that people who eat foods rich in these two kinds of chemicals, flavonoids and carotenoids, seem to have less heart disease--and it's not even certain that there is a cause-and-effect relationship.

As for figuring out which of the thousands of phytochemicals is most important, that is decades away. Just as with vitamin E--and with studies that debunked beta-carotene supplements as cancer fighters a few years ago--it may turn out that phytochemicals work only in tandem with one another or with other chemicals found in foods. Trying to find the "active ingredient" might be a fool's errand. Says Dr. Ronald Krauss, a nutrition and cholesterol researcher at the Lawrence Berkeley Lab in California: "It's premature to interpret that research in any way other than you should eat more fruits and vegetables."


Just a couple of years ago, one of the few things scientists were pretty sure did not trigger cardiac problems was infection. They're not quite so sure anymore. Evidence now suggests that the immune system plays a big role in heart disease. The initial damage is done by things like high blood pressure, smoking, oxidized LDL and triglycerides, which weaken and damage the inner walls of veins and arteries. Then the immune system responds, just as it's designed to do. Instead of fixing these problems, though, the immune response makes them worse. For one thing, the body tries to repair physical tears in blood vessels as it would any other wound: blood platelets rush to the site, clump together and form a clot, a biological bandage that binds up the injury. A clot on the outside of the body--a scab, in other words--eventually falls off with no problem. But inside a vein or artery, especially one that has been narrowed with plaque deposits, a clot can get snagged, causing a heart attack.

Plaque buildup too may be an unintended by-product of immune-system action. When oxidized fatty molecules damage vessel walls, the tissues become inflamed--engorged with immune cells whose job it is to fight the invaders. Instead of vacuuming up the oxidized molecules, however, the immune cells become entangled with them; the whole mess welds itself onto the tough, sticky plaques that narrow veins and arteries. That, researchers believe, is one reason aspirin is so good at preventing second heart attacks: not only does it thin the blood, it also damps down inflammation.

This same sort of blood-vessel inflammation may be triggered by bacterial and viral infections. Chlamydia (which generally starts as a venereal disease) and gingivitis (a gum infection) have been implicated in heart disease, and more recently so has the herpesvirus that causes cold sores. In the case of herpes, especially, it's far too early to tell whether this link is real or will evaporate under closer scrutiny.


It's known as the French paradox: people who live in France eat lots of saturated fat (in the form of butter, cheese and other milk products), yet they have one of the lowest rates of cardiovascular disease. One explanation is that the French also drink wine, usually in moderation. Too much alcohol can destroy just about every organ in the body, the heart included. But investigators have discovered through clinical trials that people who take an occasional nip have about a 20% lower risk of heart disease than do teetotalers.

The mechanism isn't entirely clear, but alcohol may boost blood levels of HDL, the good cholesterol that cleans plaque off arterial walls. Two to four drinks a week seem optimal for men, one to three for women. Since excess alcohol consumption is the second leading cause of preventable death in the U.S., says Dr. Charles Hennekens of Harvard Medical School, "I'm opposed to a wide public health recommendation to drink alcohol. But I'm ready to consider it for a particular patient after going over his or her risks and benefits."


Victims of the rare genetic disorder known as homocystinuria usually die by age 20 from heart attack or stroke. They also have high blood levels of the amino acid homocysteine, a by-product of protein metabolism. That suggests a cause-and-effect relationship, but after decades of study, the link between homocysteine and heart disease is elusive. Says Dr. Andrew Bostom, co-director of the Cardiac Rehabilitative program at Memorial Hospital in Pawtucket, Rhode Island: "We might be dealing with a real risk factor, but we don't have smoking-gun evidence."

They do, however, have an explanation for how homocysteine possibly works. If too much circulates in the blood, it may combine with LDL to form large molecules that are especially likely to attract the immune-system cells that help form plaques.

The good thing about homocysteine is that if it is a significant cause of heart disease, the treatment is in hand: studies have shown that homocysteine can be controlled with B vitamins and folic acid, either in the diet or in supplements. The most recent study appeared four months ago in the New England Journal of Medicine: a U.S. government requirement that all flour, pasta and other grain products manufactured after Jan. 1, 1998, be enriched with folic acid (to stave off spinal-cord defects in newborns) has already reduced homocysteine levels across the board.

New risk factors identified, old risks reassessed, uncertainty about every medical study ever published--it all seems so confusing, you may be tempted just to throw a steak on the grill, butter your baked potato and forget the whole thing.

But that would reflect a misunderstanding about how science works. It is not a steady march from ignorance to knowledge. It's more like a mountaineering expedition. On the way up an unscaled peak, climbers will gain some altitude on one route, then find it's a dead end. They'll spot a better one, backtrack a little and move on. The fact that they sometimes have to take a step backward for every two steps forward doesn't mean they're wasting their time. It means that inching up an uncharted mountain is tough work.

When you step back, though, and take a look at the overall picture--a long view from the upper slopes of the mountain--it turns out that the path was clear. So it is with medical science. From the perspective of 1999, the past 40 years' worth of research points to a consistent theme: eat a balanced diet that includes lots of fruits and vegetables and fewer animal-based foods; don't smoke; and get as much exercise as you can comfortably maintain.

If it sounds as though nothing much has changed in the past three decades, that's because the fundamentals of cardiac health--the base of the mountain--have been there all along. What has changed is doctors' understanding of why it's all true. And they're continuing to refine their knowledge so that the confusing new research emerging from the labs will one day stand on an equally firm footing. Until that happens, the best bet is to focus on those basics. Your heart will thank you for it.

Reported by Christine Gorman and Alice Park/New York

| TIME | 07:36 | comments:0 | trackbacks:0 | TOP↑


Everything You Know Is Wrong 02 ( By TIMEasia - Sep. 6. 1999 )

Then came the news that taking benign foods like vegetable and peanut oils and hydrogenating them--a process that stiffens them to make stick margarine, peanut butter and solid shortening--transforms them into substances known as trans-fatty acids, which can drive LDL and triglyceride levels through the roof. Trans-fatty acids are not technically fats, which means, astonishingly, that a food labeled fat free may be bursting with stuff that can give you heart disease. The fact that stick margarine is bad doesn't mean butter is good. Says Dr. Walter Willett, head of nutrition at the Harvard School of Public Health: "I think the healthiest solution is none of the above." The recommendation to stay away from meats and animal fats, thus, hasn't been overthrown. It's been extended slightly to encompass a substance once thought to be relatively harmless.

How about staying away from fat entirely? Bad idea. The body needs fats, in part because vitamins like A and D must be dissolved in fat to enter the body or move about within the body. What about the super-low-fat diets, advocated by people like Dr. Dean Ornish, director of the Preventive Medicine Research Institute in Sausalito, California? They seem to work but perhaps not because they're low fat; the key may be the types of foods--beans, grains, vegetables, instead of meats and cheeses--that Ornish recommends. Indeed, Mediterranean men, who get more than 30% of their calories from fat (some three times what Ornish suggests) but who eat little saturated fat, have a very low rate of heart disease.

HDL, LDL and triglycerides aren't quite the whole story either. Over the past few years, researchers have identified yet another form of fat that could rightly be labeled Bad Cholesterol II. Called lipoprotein (a), or LP(a), it behaves like LDL in the body. But because LP(a) levels have more to do with your genes than your diet, they can't easily be controlled. At best, doctors think they can use LP(a) screening to find people who should be working extra hard to reduce their other heart-attack risks.

So fat, which started out as a good thing to eat and then became a bad thing, now turns out to be a collection of very different things, some good, some bad, some neutral. It's a pattern that has been repeated for a variety of cardiovascular risk factors. It's not pretty; the tortuous progress of scientific discovery rarely is.


Researchers realized decades ago that high blood pressure is a cardiovascular danger signal. Physicians think elevated pressure strains blood vessels, causing them to tear or develop weak areas where plaque can gain a foothold. Hypertension (to use the technical term) can also force small blood vessels to burst; if that happens in the brain, it's called a stroke--the other major cardiovascular killer besides heart attack.

Medication can help with severe cases of hypertension, but the first line of defense, physicians agree, is to cut back on a substance that has been shown to keep blood pressure high: sodium, especially in the form of salt.

If cutting back on salt is good for people with hypertension, it should logically be good for everyone else too. It may be, but dueling studies released three years ago demonstrate that the case is far from airtight. Scientists writing in the British Medical Journal concluded that reducing salt intake reduces blood pressure in all people, even those who are not hypertensive. But a study published the very same week in the Journal of the American Medical Association argued that people with normal blood pressure got no significant benefit from salt reduction.

Which one was right? Probably neither, since both studies were flawed. The J.A.M.A. study included subjects who were on low-salt diets for a very short time--perhaps too short for any effect to be noticed. And the BMJ study could not effectively measure the influence of other factors that could have made a difference. Those who ate less salt may also have watched what they ate in general, for example, exercised more or been less overweight.

The truth is that the question of what ordinary people should do about salt has simply not been settled yet. That doesn't mean we should throw up our hands in despair. Even without hard scientific proof, says Dr. Theodore Kotchen of the Medical College of Wisconsin, keeping sodium levels down is probably a good idea--particularly since there is no evidence that a low-sodium diet is harmful. The one exception: people who are losing salt through heavy perspiration during exercise or hard physical work. Reducing salt intake in the middle of a heat wave can actually be dangerous to your health.


Physical exertion is another area in which doctors have been sending mixed signals. As far back as 1953, studies showed that people who got more exercise had fewer heart attacks. The physiological explanation has come more slowly, but one reason is simply that the heart is a muscle; frequent workouts keep it strong.

Another factor, doctors believe, is that exercise holds down blood pressure. When the heart pumps blood more quickly through the body, vessels dilate--or widen--to accommodate the extra flow. The overall effect is to lower pressure throughout the cardiovascular system. People who get regular exercise have about a 30% lower risk of developing heart-threatening hypertension than people who don't.

Some studies have also shown that exercise raises HDL levels; that it increases the volume of plasma (blood's liquid portion), thinning the blood and thus keeping dangerous clots at a minimum; and that it may boost levels of an enzyme that vacuums cholesterol and fatty acids from the blood.

None of these results is definitive, but it seems clear that however exercise works, its benefits increase if you do more of it. That's obviously true if your goal is to stay trim; exertion is fueled by calorie burning. But plenty of studies have shown it applies to staving off heart disease too, and for years the standard medical advice was to get a minimum of 20 to 30 min. of vigorous, continuous exercise at least three times each week.

Yet in the mid-1990s, the Centers for Disease Control and Prevention and the American College of Sports Medicine published a reassuring report declaring that moderate exercise was perfectly fine--anything from washing the car for an hour to gardening for 45 min. to raking leaves to taking a leisurely stroll around the block. And it didn't even have to be all in one shot. Three short walks, for example, could substitute for one longer one. Since then, the U.S. Surgeon General, the National Institutes of Health and the President's Council on Physical Fitness and Sports have all come out with similar guidelines.

Another example of new research refining old ideas? Not this time. The change had less to do with medicine than with marketing. "Our concern," explains Russell Pate, an exercise physiologist at the University of South Carolina and lead author of the CDC report, "was that a very large percentage of the adult population was not meeting the existing standard." Reasoning that the guidelines were just too intimidating for most people and that a little exercise had to be better than none at all, Pate and his colleagues decided to lighten up the message. "The recommendations do not say," he emphasizes, "that vigorous activity was inappropriate or that the more traditional exercise prescription model was wrong."


The processes that allow the body to turn food and air into nourishment for individual cells also create by-products that amount to toxic wastes--highly reactive oxygen molecules known as free radicals that can combine with otherwise innocent substances and transform them into killers. Free radicals may be responsible in part for the genetic damage that leads to some cancers. And they also appear to be what makes LDL and triglycerides so dangerous. When a free radical combines with one of these fatty molecules, the altered cholesterol turns into a biochemical cannonball that ricochets around the bloodstream, damaging the inner walls of vessels.

Fortunately, nature has also created chemicals known as antioxidants, which can prevent dangerous oxidation from happening in the first place. Among the most powerful is vitamin E, found in vegetable oils and nuts. In 1996 a major study of postmenopausal women showed that those who eat a diet rich in vitamin E had a 62% lower than average risk of dying from heart disease.

That doesn't mean, however, that popping vitamin E pills will stave off heart disease. Previous research had reached a split decision over whether supplementary E could guard against cardiovascular problems. But the study on postmenopausal women concluded that the vitamin was protective only when eaten in foods; in pill form, it didn't seem to do much good at all. This result could mean that the vitamin works in tandem with some other, as yet unidentified, food-borne substance.

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| TIME | 07:15 | comments:0 | trackbacks:0 | TOP↑

2008年09月 | ARCHIVE-SELECT | 2008年11月