What You Can Control for Healthy Aging

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About the Show
In this series, we’re exploring the balance between what you can and can’t control when it comes to your health.
On this episode, Chuck Gaidica is joined by Senior Medical Director for Blue Cross Blue Shield of Michigan, Dr. Raymond Hobbs. Together, they explore how to embrace the natural aging process while focusing on the areas of our health we can actively maintain.
In this episode of A Healthier Michigan Podcast, we explore:
  • How lifestyle habits like diet, exercise, and avoiding tobacco can significantly impact aging and health through epigenetic changes.
  • How activities that stimulate the mind, like learning new skills, are important for maintaining cognitive function.
  • How building physical and mental resilience through things like social connections, purpose, and managing stress are crucial for healthy aging.
  • How regular checkups with a doctor to monitor and address health risks are recommended, even if you feel healthy.
Heading into our final episode of this series, we’ll look at the role of lifestyle in disease prevention – especially when faced with risk factors beyond our control. Join us to learn how small changes we make today can help protect our health in the long run

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Transcript
Chuck Gaidica:
This is a Healthier Michigan podcast. I'm your host, Chuck Gaidica. And in this series we're exploring the balance between what you can and can't control when it comes to your health. On episode 176, we're exploring how to embrace the natural aging process, while focusing on the areas of your health you can actively maintain. With me today is senior medical director for Blue Cross, the Blue Shield of Michigan, Dr. Raymond Hobbs. Good to see you, Doctor.

Dr. Raymond Hobbs:
Nice to see you, too, Chuck.

Chuck Gaidica:
Yeah, thanks. Every day we're aging, but into a new demographic at times. Every birthday, I think, "Wait a minute, did I fall into a new age range?" It's just something that isn't for just old people or older people, all of us are aging. It's inevitable. But how we age isn't necessarily out of our hands. There are many ways to age well, taking control of our habits, taking control of our routines. What can we do to age in a way that leaves us feeling strong, capable, and in control?

Dr. Raymond Hobbs:
I think you're exactly right. And I can tell you that my own experience with aging is interesting because I became board certified in geriatrics in 1988. And since then I've been growing into this specialty because I now am in the geriatric age group that I've been studying about for such a long time. So, now it's hitting me at a different, more at a visceral level.

Chuck Gaidica:
And am I wrong? I've read statistics, and you correct me if I'm wrong, that there are more doctors, maybe even new interns, who are focused even by mandate more on pediatrics than aging or geriatrics. Am I wrong? It seems like we're not focusing on that as everybody in America is aging at some point.

Dr. Raymond Hobbs:
I really haven't looked at those figures to be able to comment on that, but I can definitely tell you that probably the fastest growing segment of the population right now is the geriatric population, because geriatrics was defined as people that are over the age of 65. And for the longest time, historically, as a people going back thousands of years, people didn't live to be that old. And right now, probably the fastest growing segment of the population is the number of people over the age of 85. Then there's even crazy things like Hallmark's is making a happy 100th birthday card. A lot of doctors are taking care of people well over the age of a hundred. The oldest person I've ever treated was 110.

Chuck Gaidica:
Wow.

Dr. Raymond Hobbs:
So, I mean there's definitely things that are changing.

Chuck Gaidica:
I'm going to mark this down to get you that happy 100th birthday card in advance. I'm just going to get it now and I'm going to put it in the drawer with my other cards. Well, it's interesting because when you talk about that, and I relate to it because I'm that 65 plus range now, just barely though, there are 10,000 of us a day who are aging. But it's not just about what we used to think of as seniors. You could be 50 plus or 50 years old and you're heading into that next demographic. So, what are some of the key changes that we should be looking for, and you can pick any age number or range, that we would expect our bodies are going through? What are the changes we're going through that will affect our health? And why did these just happen?

Dr. Raymond Hobbs:
The first thing is aging starts much earlier than when you're 65. There are things, for instance, if you follow pulmonary function studies, those are measurements about how well you're breathing, and doctors can measure that by having some testing done. You breathe into a tube, it measures all these different things and all these parameters. And we know that some of those changes in your breathing start taking place in your 30s. Now, you might not notice it right away, but that stuff is gradually ongoing. And then sometimes what happens is things are happening but you're not really aware of it until later on. All of a sudden you say, "Well, wait a minute, I used to be able to do that and now I'm having some trouble doing it." So, it's not a lot of times that it just happened, it's actually been going on for a while.
Another great example is osteoporosis. People's bones are getting stronger and stronger up until they get into their 30s, then it might plateau for a little bit, then there's a gradual loss for the remainder of your life. In some groups, it's made worse by certain things like in women who are more prone to osteoporosis, that increases once they reach menopause. Now, that's another example right there about something that affects your aging, where it does seem to come on right away. And it's very obvious, menopause, that's going to affect things like not just reproductive ability, but it also affects other things like the skin, the hair, the muscles. Things like that happen in males as well.
We also have things that happen to us that have occurred gradually that we might not even be aware of. A great example would be hearing loss related to noise exposure. If you have somebody that's worked for a long time with really loud noises, all of a sudden you might find that they have trouble with high tone hearing loss. And that didn't just happen. That happen gradually. But sometimes when things happen gradually, you don't notice it, and then all of a sudden something does happen and then you get surprised.
The other thing that I want to mention about this is I want to mention cancer for a moment because cancer is something that develops slowly. I mean, people know that they know cancer hurts. They've had friends, relatives, they've developed that and they can remember that. But the thing that they might not be aware of is usually people have cancer for a while before it ever becomes noticeable. And that's one of the values of doing things like screening procedures. That's why we do mammograms, because we don't want to diagnose breast cancer when it's so obvious. We want to diagnose it early on when we can do something about it, or prostate cancer, or colorectal cancer and things like that. Because those are things that develop slowly. You don't even know that they're going on. And then until something happens, and you don't want that to happen, you'd like to pick it up early on so you can do a preemptive strike to do something when it's still curable.

Chuck Gaidica:
Are you a big fan of knowing thyself? In other words, not just your annual physical, which could include mammogram or prostate exam, etc. But this idea of getting blood work done, we can't all afford yet a full body scan, like a Star Trek thing where once a year or once every five, we go in and get our whole body checked for anything that could illuminate. Usually that's not happening until we get toward what you're talking about. It's not a surprise. It's been coming, but all of a sudden there's something there. So, it seems like knowing even at age 30, understanding what we're doing, how we're impacting our body, the lifestyle habits we have is helpful just to know what's going on.

Dr. Raymond Hobbs:
Absolutely. So, that thing about know thyself, that's really important. Look for differences. And part of that depends on who you are and what you do. Because for instance, if you're a couch potato and you don't really exercise that much, you may not notice that much about something affecting your abilities. But if you're a long distance runner, and you're really cognizant about that, and you know what your times are, and all of a sudden you're finding that, hey, you're slowing down, you're not doing as well as you were five years before, that's something you're going to notice. Now, there's other variations on that. The way you're functioning, the way you're working, the way you're doing things, your weight, your activity. It's interesting, sometimes what'll happen is since we live with ourselves 24/7, we might even not notice ourselves what's going on because it's happening to us all the time and we're living with ourselves 24/7. But somebody else might notice something like, "Hey, Chuck, what about such-and-such?" They're noticing something. So, sometimes you hear that from a friend or a relative.

Chuck Gaidica:
Well, and you set the table here for this idea of lifestyle habits and changes. Lifestyle can have big impacts. This idea that even the study that I know you are aware of, the epigenetics, the fancy word, meaning we can flip little light switches. We literally can have some impact, not necessarily change our genetics, but we have lifestyle changes that can have big impact on healthy aging for all of us. Which are the ones that are most sustainable? We always hear it, well, you can't call it a diet anymore. Now that's a lifestyle change. But what are the big lifestyle habits that you would say we can change directly to literally start making impact on our health?

Dr. Raymond Hobbs:
There's a number of things and they're simple, and we'll talk about that. But you said the word sustainable, and the question is what can you do to do something that's sustainable? So, let me just tell you a quick example of something that happened to me a long time ago. I had a patient who came in to see me, he was going to retire. And I said, "Hey, you're going to be retiring. This is great. What are you going to do? Have you made any plans?" And he said, "Yeah, I'm going to go fishing." And I said, "You must be a really good fisherman." And he goes, "Well, I've never done it before." And I thought to myself, this is not a good plan because he doesn't know if he's going to like it. He's thinking that he's going to be liking it, but he's never done it.
And usually if we like something or if we have that much of an interest in something, we do some of it at some level. So, I have no idea what happened with him. But the big thing is if you're going to make a change, if you're going to make a plan about something, do something you're actually going to follow through on. So, do something that you like. So, for instance, I've never really liked sports that much. I wasn't very good at it. But when I was in my 20s, I discovered the martial arts. And for me, that just resonated and that was something I would get into, which I did. So, the point there is for me that worked. For somebody else, it might be playing basketball. For somebody else, it just might be walking.
But sometimes people do something like they just make a resolution. "This year I'm going to go get healthy." So, they spend $10,000 on exercise equipment they've never used before. They don't know if they're going to like it, hand then they get it. They use it for a couple weeks and then they stop doing it. So, the first thing is whatever you're going to do, set yourself up for success. Do something that you like that's going to be easy for you to do. Don't do something complex that you really don't have any interest in because that's not going to work. So, you need to find those particular things. Now, some of the things that you can do, and you mentioned the word epigenetics, which is basically the modification of the genes that we have of the DNA that we're born with, ways to modify that.
And we can do that with diet, maintaining your weight, and actually in terms of weight, there's new medicines that are out there right now that are really changing the way that we look at that. So, that's really a huge game changer for a lot of people. Knowing your cholesterol, your HDL, the quality of the food that you're eating, alcohol, drink responsibly, because one of the things that can make aging worse is being an alcoholic. One key thing that you don't want to do, and I know people have heard this before, avoid tobacco. That's one of the clearest things that increases age-related illnesses, especially with the heart, the lungs, and it increases your risk for cancer in a number of organs as well. So, that's a very bad thing to do.
And if you do epigenetic studies, you can pick that up. If you're doing studies on people using what's called the Horvath Clock, which you might be aware of, which is a genetic test where they get saliva. And there's a Dr. Horvath that came up with this, and he can use this to measure your biologic age. Now, your chronologic age is how many birthdays you've celebrated. Your biologic age is what level of age you're really operating at. That can be measured with this thing called the Horvath Clock. And that's been done a lot. And you can see people that are doing things and they might be 65, but they're functioning like somebody that's 45. So, it's possible to do that. But on the other hand, you can also have somebody that's 55 that's had a rough life. They haven't taken good care of themselves. And if you get that epigenetic clock, they're functioning at a level that's much older than they are chronologically. So, we have some ability to modify this.
And some of the things that make a difference are diet, exercise. Exercise doesn't necessarily mean I'm going to go to the gym and lift weights. Exercise could be walking. That's still one of the very cheapest exercises that we can do. Doing things to improve your balance, that's a key thing because falling is a problem that occurs, that has a significant mortality in morbidity in older people. So, just being able to get up, walk 10 feet, turn around and come back, being able to stand on one leg. These are things that seem very simple. These are things that can actually have an impact upon your ability to function, and it can help prevent things like falling.
One thing that I would say is make certain that you're going to see your doctor because some of the things that we're talking about, because right now we're talking about simple things that you can do, but there might be some things that you can't do that need to be watched. So, if you're a woman and there's a high risk of breast cancer in your family, your sisters, your aunts, your mother had it, your grandmother had it, you're at higher risk, make certain that you're getting the screening procedures and you're seeing your doctor so that they can do things to watch those particular things that are going on with you. And on the good side of this, we are learning so many things about cancer, and medicine and things. So, it's going to be very likely that in the near future, we're going to be able to modify some of these genetic illnesses in ways that we've never been able to do before. We're already doing that.

Chuck Gaidica:
Well, it's interesting. Within the past couple of months, I had a visit to a doctor that was unexpected. And the doctor says to me, "I have good news and I have bad news." Now the problem was that I had a bike accident, bike riding accident. Didn't fly over, but flew under and broke my arm down toward my wrist. I knew something was up. He said, "The good news is you took a 12 and a half mile bike ride and you told me you do that three, four times a week sometimes. That's the good news because you're out there being active. The bad news is you fractured your bones." So, I thought, well, that's an intriguing way to say it.
But what he was basically doing was to say, "You got a problem. You'll have to wear this brace for a while." I didn't need a cast. But he was saying, "Thumbs up. You're actually out there doing it regardless of age. And it becomes a mindset thing. You're approaching life in a positive mindset." I didn't know I was going to have an accident and it's all healing fine. But the reality was, to him, there was a silver lining, that literally you are being an active ager. You're not just sitting around, as you say, being a couch potato.

Dr. Raymond Hobbs:
And that's great that you're doing that and he's encouraging you to continue doing that. And one big thing is, it's a curious thing to think about with aging. But as people age, you get to see a greater variance between individuals. So, if you're talking about people when they're five years old or they're 10 years old, there's not much of a difference between them as a group. But 10 years later, like say when they're 15, or you're in high school or something, you see there's some people that are more active, some people that are not. Some people are thin, some people are overweight. And as people get older, that gap widens even more. So, then you see these unusual things where you'll see somebody who's 85 and they're still running in marathons, and then you see somebody else that can't walk five feet, and they can even be significantly younger than that. So, with aging, I think one thing to be aware of is don't just look at that number. Just don't look at it like, "Hey, I'm 65," which means don't limit yourself by that.

Chuck Gaidica:
Well, I've read some of the stats that show that most people that get to be 50 plus when asked, "How old do you feel." Most will say something in the range of 15 years younger. "I'm 65, but I feel like I'm 50 or I feel like I'm 45." So, this mindset thing, a positive mindset does have a great impact because I think it encourages me anyway to lean into this idea that like you're saying, I know I've got a number, I blow out the candles. There are more of them all the time. But yet I'm feeling like I can control some of what's going on by the bike rides or playing pickleball. And by the way, that's not just for old people. Our kids in their 20s and 30s are playing and playing us. And sometimes I'm beating them, which is like, oh, that's awesome. But talk about this idea of approaching aging with a positive mindset and how important that is.

Dr. Raymond Hobbs:
That's really important. Just because you're getting older doesn't mean you can't do different things. And I think that at any stage of your life, there's interesting things to do and to look at. For me anyway, I don't want to just ever put my feet up and say, "well, I've arrived. I don't have to do anything else anymore. I'll just put my feet up and relax." That would drive me absolutely nuts. So, traveling, interests, exploring horizons, things that you're interested in that you've never done, this is an opportunity to do some of those things, and that can be very, very helpful.
In terms of what you can do to take advantage of this. Some of the things we already mentioned, don't smoke, the exercise, the good diet, activity. Sun exposure, that's one of the things that ages skin. So, be careful with that. There's other things as well. And one thing that is becoming very important in terms of aging is behavior, mindset, community, faith, spirituality, gratitude, meditation. And you think, well, wait a minute, this doesn't sound medical, but we know that there are people that are loaders and are happy being that way, but a lot of people are not. And we know during the pandemic that loneliness and isolation had a big toll on a lot of people.
And right now it turns out that there's a lot of people that are still experiencing some of that, and it impacts their health. And you can even measure some of these things with this epigenetic clock. And so, it turns out that maintaining friendships, being involved with groups... now in terms of spirituality, that doesn't necessarily mean you have to be religious. For some people they are. Some people are not. They look at things different ways, and that's fine. But it's a way of looking at the world. In some cultures, it's very important in terms of a purpose in your life. So, when you get up in the morning, what do you want to do?

Chuck Gaidica:
It is interesting in this world that we've come through the pandemic. And it seems like if you as a doctor, I can't do it, write a prescription of what would make you feel better even now where a lot of people are still withdrawn maybe, or feeling lonely because it seems like it shows up in all demographics. Regardless of where your faith comes from, gathering with people, thinking of something bigger than yourself, having a purpose, being in community, all of these things tend to point to places that we used to collect more frequently together. And it could have been a church or a synagogue, could have been any number of places. But you would look at that and say, well, there's positive nature to all of that, as you're saying, and yet we haven't all come back to it. It seems like it's not the thing, but yet it could make us well.

Dr. Raymond Hobbs:
Right. And you're sharing something. I mean, you could be sharing your spirituality, your religion. You could be sharing the fact that you really like to play bridge in your-

Chuck Gaidica:
The garden club, whatever.

Dr. Raymond Hobbs:
... bridge club.

Chuck Gaidica:
Yeah.

Dr. Raymond Hobbs:
Yeah. You like to garden in the backyard. Sharing those things. It turns out it's really, really very important. And you know about the blue zones?

Chuck Gaidica:
Yeah.

Dr. Raymond Hobbs:
They've been studying that for a long time. It's like five, maybe up to seven places right now, places on the earth where people live to be very, very old. There's two of them in the Americas. There's one in Loma Linda, California, and there's one in the Nicoya Peninsula in Costa Rica. Then there's other places.

Chuck Gaidica:
There's Italy, Okinawa, Japan, I think. And so-

Dr. Raymond Hobbs:
Sardinia.

Chuck Gaidica:
Yeah, that's right. So, when you look at that, briefly before we get to our last topic here, where do you see the connections? What are the light bulbs that go off for you when you read it as a professional that said, "Well, this is something I can actually do?" Because I don't have goats climbing up the side of a hill and I don't have goat milk from the weeds that the goat just ate, so I don't have that opportunity. But what are the things that you see in the blue zones that we can duplicate in our daily life?

Dr. Raymond Hobbs:
Well, one of the big things is the importance of family, the importance of getting together, because it looks like that's a really important thing in terms of longevity. It really has a big effect. And in all the cultures that they've checked, community is very, very important. Getting together with your family, your friends, that is a very key important part. In some of those areas, and it's interesting that in none of those areas that they identified, you don't see a lot of high-tech stuff. In Sardinia, a lot of people, they might be living on the second floor. They're not taking an elevator. They don't have elevators there. They have to walk up to the second floor.

Chuck Gaidica:
They're walking up hills a lot, too. It's just the way topography is wired, right?

Dr. Raymond Hobbs:
Right. So, they have to do that. And that's also the thing about exercise. It's like they're not going to the gym to exercise. They're just walking, they're living their life and doing some stuff like that. So, walking is one of the key things you can do. Maintaining your family and connections, that's an important thing.

Chuck Gaidica:
And out of that, I've seen some films and videos that show some of the men over a hundred in Sardinia. And the community is big. They're also laughing. They're living life, whether they're 102, or 89 or whatever their age is. And so, that indicates to me that there is something to this idea of not just a positive mindset, but also building physical resilience. Because no matter what age we are, we know there could be a curveball. I didn't know I was going off my bike a couple months ago, and surprise. So, you need to be resilient to figure out how to deal with it and how to move on so you can get to 89 or 102 somehow. How do we do that? How do we build this notion of mental and physical resilience as we age?

Dr. Raymond Hobbs:
They're related. And in your own example that you used about riding your bike and then injuring your arm, one of the reasons you're probably healing as quickly as you are is because you're capable of riding that bike as frequently as you have. Because that exercise by itself builds in like a protective layer, so to speak. So, you want to be able to continue doing that. It's important to be active. And the sustainability thing there is to do things that you like. Obviously you like to ride your bike. So, it's great that you're doing that and you're getting all kinds of benefits from that.
Now, one thing that's important that we need to talk about is cognition, because so many people are worried about dementia, Alzheimer's disease and things like that. And one of the key things about that right now is things that you can do that are going to stimulate your thinking, that can help be preventive to some degree. And there's a lot of simple things that you can do there. Reading is one. Read what you like, read what you're interested in. You want to be learning things. Read the news if you want. It doesn't matter so much, but do things that challenge you. Puzzles, games, things that stretch your mind a bit. Playing a musical instrument, deciding to learn something. There's a lot of people right now that are practicing learning a foreign language. And now don't do that unless you want to do it, but there are a number of people that are doing this. And all these things stimulate your brain to continue working and can help prevent some age-related cognitive changes, and possibly cut back on dementia and things like that.
In terms of physical activity, if you're doing something that utilizes your thinking and not just lifting, for instance, like they've done studies on that, one thing that's been shown to help actually is dancing. Because a lot of times with dancing, you're learning steps and moves. So, you're not only doing something physical, but at the same time you're learning something as well. So, this mind-body connection, it's important to do that. And if you want to make it sustainable, keep doing something or find something that you like and keep doing it.

Chuck Gaidica:
Yeah, that's great advice. As we wrap this up now, give us quick takeaways because you've given us so many good things to think about. And as much as they may appear to be common sense, we all know this, we all don't practice a lot of what you're preaching. So, what are the takeaways for the audience?

Dr. Raymond Hobbs:
I think that the takeaways are, I think two things. The first thing is there are some things you don't have control over. You don't have control over your genetics. That's what you're born with. But that's modifiable and you can watch that. And that's why you need to see your physician who can follow those things with you. So, if you're unfortunate enough to have high cholesterol, he can measure those things, watch those things, and that can lead to some things that can decrease your risk for heart disease, stroke, and all those other things. So, follow up with your physician. In terms of what you can do, there's a lot of simple things.
Sleeping, that's a very, very key important thing. You probably want to get eight hours. That's key. It affects so many different things. It affects learning, healing, release of hormones. That's key. That's important. Your diet, watch that. Avoid tobacco. Drink responsibly. Walking a great exercise. If you can't do that, work on your balance. There's people doing Tai Chi. You see those people doing these movements in the park where they're doing things and they're stretching. That's what that is. There's yoga. That's another good thing. That improves your strength, your mobility and your balance and all those things are important things.
Other things, just to talk about that I haven't mentioned before, there are some vaccinations that are recommended for people as they get older. If you look at the leading cause of death a hundred years ago, the 10 leading causes of death a hundred years ago, and the 10 leading causes of death now, there's only one thing that's on the same list, and that's pneumonia. So, we do have a vaccine, it's called Pneumovax. There's other ones, too. That helps prevent 23 or maybe it's up to 28 of the most common pneumonias right now. That's a very good preventive thing. And it's a common thing, it's a simple thing that you could do something with. There's a shingles vaccine. People recommended that, too. There's also the flu vaccine. So, those are things that you can do with that. But a lot of the stuff is go to your doctor, get the screening test he or she recommends, watch your diet, watch what you eat, increase your activity, stretch your mind by puzzles, games, doing the things that you like.

Chuck Gaidica:
Well, it's good to see you again.

Dr. Raymond Hobbs:
It's good seeing you, too.

Chuck Gaidica:
And thanks for all this. Well, I'll just wish it for you now, happy 100th birthday in advance, Doc.

Dr. Raymond Hobbs:
Thank you. I'll have to invite you to my birthday party.

Chuck Gaidica:
Okay, I'll be there.

Dr. Raymond Hobbs:
Won't be for a very, very long time though.

Chuck Gaidica:
Senior medical director for Blue Cross Blue Shield of Michigan, Dr. Raymond Hobbs, always good to have him with us. And we're glad you've been here. We're heading into our final episode of this series. And now we're going to look a little more deeply and dig into what the doctor was discussing as well, the role of lifestyle in disease prevention, especially when faced with risk factors that are beyond our control. Join us for that and learn how small changes we'll really make an impact on your life and help protect our health, your health, mine, everybody's in the long run. I'm Chuck Gaidica. Stay well.

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