August 26, 2008

The Silver Lining on the Heart Disease/Diabetes Connection

A report about a newly released study, clearly meant to terrify us,is headlined, "Heart Disease Soars to 90% with Obesity."

But before you reach for the Prozac, take a look at the details of actual finding:

"...women who were obese and diabetic had a nearly 80 percent chance of developing heart disease at some point. For their male counterparts, that figure was nearly 90 percent.

"Lifetime risk was based on the likelihood that a 50-year-old would develop heart disease in the next 30 years."

This sounds terrible if you believe that the alternative to developing heart disease by age 80 is living forever in perfect health.

Unfortunately, it isn't. Though the supplement industry would like you to believe that consuming their pills will make you live forever, and the diet & exercise industries want you to think that losing weight and keeping fit will keep you in perfect health to age 120, all the research about longevity suggests that unless you have been fortunate enough to inherit a couple of very powerful genes, by the time you hit 80, it is almost certain you will have something serious wrong with you.

And if it isn't heart disease, it is likely to be cancer, painful arthritis, a neurological disease like Parkinsons, brittle bones, or dementia.

Dr. Barzilai's ongoing research about centenarians found that a handful of genes appear to determine who lives very long, not lifestyle choices. Analyzing his data about his centenarians, he found that fully 30% of them were obese in their 50s. He also has found no vegetarians among his survivors. My dad, who was one Dr. Barzilai's centenarians, smoked cigars and pipes until he was 98.

But most people do not have these genes, and with every passing year as they age their chances of developing some disorder goes up.

Cancer is the disorder they are most likely to contract, and what most people don't know, but I have seen happen first hand, is that any adult who has chemotherapy after age 70 is very likely to develop dementia as a result of that chemotherapy, even if it "cures" the cancer. The "chemo brain" that younger women suffer after breast cancer--which doctors denied for many years was real, but which has recently been substantiated--is devastating to older people, no matter how healthy they were before chemo.

If you don't develop cancer, you have a good chance of having a stroke. In fact, stroke develops more frequently than heart disease in thin people and results in horrible, permanent changes ranging from "locked in syndrome" to paralysis, to inability to speak, to severe mobility impairment. Strokes may be influenced by lifestyle factors, but they also occur in people who do everything right. As the vascular system ages blood vessels become more fragile.

If you don't have a stroke, there is Parkinsons, the cause of which which no one is quite sure of, but which is common among older people. Or COPD, which though most common in smokers, also occurs in people who breath polluted city air too long.

Avoid that, and there are a whole menu of Dementias to chose from starting with Lewy Body, moving on to Alzheimers, and concluding with Vascular Dementia which like stroke appears to be the result of fragile blood vessels in the brain giving out. Though there is much speculation about what causes dementia, more honest doctors will tell you that the single greatest "risk factor" for dementia is living to be over 80.

And if you should be lucky enough to keep your mind intact to 80, there are still dozens of other metabolic breakdowns waiting for you. Kidney disease, liver disease, malnutrition syndromes, and of course, brittle bones which along with falls are the most common killers of otherwise healthy old people.

Our bodies wear out. All of them. Even if we eat "right", exercise, and pray to powerful deities.

So this is why though I have seen much to worry me about getting older--and I speak as someone in her early 60s who has watched an entire generation of family and friends age--heart attack looks to be a swift and merciful end, and one that I would gladly choose if the alternatives to it would be the prolonged agony of a death by a cancer that has metastasized to the bones or years of the humiliating confusion, dependence and deterioration that are dementia.

To me, the really scary thing about diabetes, is not that it causes heart disease--especially in people in the latter part of life. It is that it causes blindness, kidney failure, and amputation in people who are relatively young. And that even before we get these terrible complications, uncontrolled diabetic blood sugars cause exhaustion, depression, and a generalized feeling of malaise that can rob life of much of its brightness.

The research data is confusing about whether blood sugar control can prevent heart disease, but it is crystal clear on the subject of whether tight control can prevent these other, more clearly diabetic complications. Blindness, kidney failure and amputation can all be prevented by bringing our blood sugars down to levels that do not require monk-like abstinence to achieve.

It is possible, too, that lowering blood sugars to normal may prevent heart attacks at a relatively young age. (The definition of "young" of course, changes with each passing decade that we age. 50 is looking pretty young to me of late.)

But every now and then, it is a good idea to stop and to contemplate the truth of our existence--that we all do have a limited lifespan and that each of our lives will end some day--and that "some day" may be closer than we think.

Ask yourself: Are you living in a way where you would be happy with what you have done with your life, should it end this week? Have you deferred too much of what you dreamed of doing to a "someday" that may never come?

I find it very helpful to do a life review every few years and to ask myself these questions in a probing and honest way. I have done my best to live so that I like the answers I come up with. I control my blood sugars and do what I can to stay in good shape, but when confronted with the fact that I am going to die someday, I continue to hope that when my time comes it will be swift and merciful, not painful and prolonged. And because of that, though there is much about aging that does worry me, heart disease is very low on my own personal list of worries.


Anonymous said...

I tend to see things the way you do. But I'll bet today's NYT's Health section article on "healthy" aging will reach influence people to think they can somehow beat the odds.

Anonymous said...

There is much truth to what you say. However, heart disease doesn't only manifest itself with sudden death, which as you note is not a bad way to go. A heart attack if it does not kill you instantly will damage heart muscle and thus lead to heart failure. This will eventually result in severe shortness of breath, fluid accumulation etc., not a pleasant existence.

Anonymous said...

Jenny, thanks for your post on this topic.

When I was 10 years old my 5 foot tall, 300 pound grandmother became quite ill and was diagnosed as diabetic. Being deathly afraid of needles, she dieted off 140 pounds, regained her health, and successfully kept off her weight off until she died in her sleep of a heart attack 5 years later (in1972), at the age of 68.

Until I grew up (I am 52 now) and lost friends and other dear relatives the slow and miserable way (cancers, strokes, MS) I thought my grandmother's death was the ultimate tragedy.

Now I look at her as one of the lucky ones, even though her life was short by today's standards. She lived a rich life, was greatly loved and died quickly, undiminished by pain and suffering. There are indeed far worse ways to go.

Anonymous said...

Just a great essay! Thanks for sharing your thoughts. You helped me stop and smell the roses today. I've been spending quite a bit of time studying and struggling to turn back time and fix my broken parts ever since I saw the "light" of truth in GCBC.


Alan said...

Thank you for a wonderful article.

I did that "life review" back in 2002 and continually re-assess it. That's why I worked hard to gain control of my blood glucose levels - but also why I eased off at a level that allows an enjoyable lifestyle.

And it's exactly why I have been around the world three times since diagnosis.

Carpe Diem - sieze the day.

Anonymous said...

My, weren't we cheerful today! Actually I quite enjoyed it. Several years ago I did my EOLI, End of live issues, and advised my kids what I expected done discussing the various ways in which I can exit this vale. There is another view of cancer - you almost always have time to say your good byes, take care of estate issues you have put off. And because serious cancers are terminal they don't go on forever. At a certain point one can just go to bed and forgo food and liquid. Anyway I thought the perspective you presented was nicely done. RobLL

Anonymous said...

What a great article, after 3 heart attacks and blocked neck arteries its slow pain filled living but I enjoy each wake up & make a game out of it. After all no one is getting out alive. LOL

Anonymous said...

There was a recent TV series "The Medieval Mind" which has made me realise that medieval thinking is making a comeback.
"It was a happy release" is the modern concept. You put down your dog when it is suffering.
The medieval concept is that the more you suffer the better your prospects in the Afterlife.
Hence we "save" money by refusing prescriptions for test strips, Avastin and numerous anti-cancer drugs among many others.
Some of the "saved" money goes to employ accountants dieticians and other spawn of the devil.
The rest is kept for "end of life" care when they work overtime to drag you back from the brink again and again for a few more days of unspeakable agony when you are terminally ill.

I'm currently watching my mother travel this path. She was always an active and intelligent person, a great reader and walker. Now she can barely read large print books with her one remaining functioning eye and she has extreme difficulty going uphill without getting breathless. At 93 the best we can hope for is a good death to follow a good life, yet what terrifies me (and terrifies her more) is to end up slobbering and drooling in a home where they will keep her alive (for very small values of "alive") until she is bankrupt. Which is currently happening to a neighbour's husband (Alzheimer's).

Yes in retrospect I'd far prefer a nice quick heart attack to the alternatives thank you very much. Just maybe by failing to diagnose me for so long they were doing me a favour. Death By Chocolate becomes quite doable.

"Nobody here gets out alive" - Jim Morrison

"Hope I die before I get old" - The Who

Unknown said...

I was very surprised a month or so ago after Randy Pausch died to hear someone on NPR quote a study of doctors which found that asked which way they would prefer to go, sudden death by heart attack or slow death by cancer, most chose the latter, so that "they would have time to say goodbye." Knowing what horrors doctors are witness to, I don't know how anyone could make this choice. If we have good relationships while we live, it is not crucial to have a long goodbye, and in my view, not a good tradeoff , especially for those who have to watch someone they love suffer.