Is Aging Determined by our Gut Bacteria?

Carolyn Bohach, a microbiologist at the University of Idaho estimates that there are 10 times more bacterial cells in your body than human cells. Although smaller than human cells, and weigh only 1-3% of our body weight, the 500-1,000 species of bacteria that inhabit our body have evolved with us for millions of years.

Although bacteria are all over our body--inside and out--we see how it maintenance balance particularly in the human gut.  There are fewer physical changes in older adults' gastric system than any other system in the body. Although the stomach looses its elasticity and might be more prone to damage—primarily as a result of taking some medications—the small and large intestine, pancreas, liver, and gallbladder change minimally with age. So the changes that evolve inside our gut are argued to come from bacteria that inhabit this internal world.

In the gut there are 100 trillion microorganisms that engage in fermenting, killing off other harmful bacteria and viruses, enhancing our immune system and producing vitamins and hormones. This bacterial activity is so necessary to the body that their outcome, function as an independent organ--a virtual "forgotten" organ. Here, bacteria help extract energy and nutrients from our food. This sharing of benefits shows in experiments where bacteria-free rodents have to consume nearly a third more calories than normal rodents to maintain their body weight. Less well understood is the role of fungi and protozoa that are also part of the gut flora.

In 2012 Marcus Claesson and Ian Jeffery from University College Cork in Ireland and their colleagues, reported this gut flora changes among some older adults, and they correlated changes in the type of bacteria with frailty and mortality. They found that institutionalized older adults have a different gut flora than community older adults and younger people. And they related this flora—caused by a restricted diet—to diminished physical capacity.

But it was only in December 2014 that Martin Blaser from New York University and Glenn Webb from Vanderbilt University, Nashville, Tennessee, tried to explain how bacteria are designed to kill older adults. They argue that modern medical problems, such as inflammation-induced early cancer, resistance to infectious diseases and degenerative diseases are in response to bacterial change as we get older and this has an evolutionary cause. Using mathematical models the authors show how bacteria evolved because they contributed to the stability of early human populations: Enhancing the survivability of younger adults while increasing vulnerability of older adults. Such an evolutionary process has advantages, but in the modern world, bacteria's legacy is now a burden on human longevity. Although this mathematical model has many flaws—primarily the theory of antagonistic pleiotropy and that there are other factors other than bacteria responsible for specific diseases—it allows gerontologists to see aging as a balance, not an all or nothing event.

http://www.nih.govBacteria is necessary in balancing the biological activities in our human body. In one example scientists are using bacteria that cause botulism to eradicate tumors. While in another example, Linlin Guo and her colleagues from the Buck Institute for Research on Aging in California, have increased lifespan in flies by altering bacteria in their intestine.  It seems that bacteria form an important system in the body which might have repercussion on our longevity. Our body is a universe of organic activity and we are still learning about this miracle.

© USA Copyrighted 2014 Mario D. Garrett

Reclaiming the word "Senile"

The other definition of senile is “pertaining to old age”.  Senile is not “being demented.” That mistake comes from the earlier definition of dementia when in 1895 Arnold Pick identified premature dementia as separate from dementia of old people—senile dementia. Later of course, Emil Kraeplein defined Alzheimer’s dementia, which quickly separated old  (senile) dementia from young (Alzheimer’s disease) dementia. But we still confuse “senile” with “dementia”.

The single most important factor that accelerates aging is negativity—our own and other people’s. In the blue zones we see people living past 100 years of age. Twenty years more than the average, nearly a quarter of a life more. What they do not have in these zones is negative stereotypes.  Although stereotypes exist for everyone—race, gender, sexual preference, size, height, intelligence and even geographic residence—for older adults it is transient and develops fast and have little time to develop resilience.

Richard Eibach from the University of Waterloo, Ontario, Canada and his colleagues explained how older people internalize negative stereotypes. In one study the authors asked older adults to read text that had small type and low contrast. Some participants were told that the lack of clarity was due to a photocopying problem, while the rest received no explanation. Older adults that did not receive an explanation reported feeling 10 years older than the participants who had an explanation. And it is not just about feeling old but that they associated feeling old as a negative. Accepting the term “old” you accept an omnibus of negative stereotypes.

Thomas Hess and his colleagues from North Carolina State University in Raleigh, NC explored how stereotypes create a world of negative memes. There is a self-fulfilling prophesy. When older adults encounter negative stereotypes about age-related cognitive decline, their memory performance decreases, rate their own health as being worse than others, and rate themselves as lonelier.  Stereotypes play a significant self-fulfilling role in diagnosis as well. Physicians who have been primed about the connection between memory loss and dementia—and it is now everywhere in the media—diagnosed 70% of their older adult patients who reported having memory problems, as having dementia rather than 14% when there was no stereotype.

And the stereotype does not have to be transmitted negatively. Even providing assistance while completing a puzzle—implicitly suggesting that they need help—resulted in decreased performance over time, whereas those older adults who were only provided with verbal encouragement showed increased performance over time. Don't let others patronize. Lets take over the concept of senile again. That pertaining to old age is not a negative. Be aware of accepting such negative judgments and of making them about yourself.  We can reverse this process by starting with recognizing that senile does not have to be a negative term.

© USA Copyrighted 2014 Mario D. Garrett

Social Security: Supreme Court Denies the Fifth Amendment.

If I had to fix the country I would write the Constitution, as is, with all the Amendments. The Constitution is an amazing piece of legislation. The problem is that it has been diluted and reinterpreted to suit the current political flavor. The common assumption that the Supreme Court protects the Constitution is misplaced. Neither the Bill of Rights nor subsequent Amendments define the role of the Supreme Court as interpreting the Constitution. Despite this, the Supreme Court is about to change how we live and how we retire. Yes the Supreme Court will decide our fate especially in terms of how we benefit from our investment in Social Security.

Because there is no $2.7 Trillion "trust fund,” Social Security benefits have already started coming out of general funds. It will become untenable to continue to do so.  And—as with the fate of the Affordable Care Act—the Supreme Court will make the final judgment.  And we have a portent of how they will decide.

Already the Supreme Court has provided Congress with two views of what Social Security is: It can be either a social program or it can be an insurance program.  And although these are mutually exclusive interpretations, the Supreme Curt made both judgments.

In 1960 the Supreme Court decided that Social Security is a social program. It denial benefits to a Bulgarian immigrant Ephram (Fedya) Nestor who came to the United States in 1913 until he was deported in 1965 because he lied on his citizenship application by not admitting that he was a member of the communist party at the time. Despite his continued contribution to Social Security for 19 years—since its inception in 1935--and despite that he was already receiving benefits he was deported and denied Social Security benefits. But his deportation, and subsequent denial of benefits, went beyond the 1954 deportation law. The fact that his second wife Barbara Nestor (nee Herman)—also a Bulgarian immigrant—was denied social security indicates that Social Security benefit payments are up to the whim of the state. The Supreme Court established the principle that entitlement to Social Security benefits is not a contractual right. Yale law professor Charles Reich famous 1964 article "The New Property"—in which he called Nestor "the most important of all judicial decisions concerning government largess"—urged courts to provide social security benefits the same protections as other property.  

In the Nestor case the Supreme Court argued that Social Security was not insurance, and that "earned" social insurance benefits were neither "property" nor contractual right, a major pronouncement that has never been overturned—then came the story of an Amish farmer, Edwin D. Lee, and the Supreme Court flip-flopped. In 1982 the Supreme Court argued that Social Security is in fact an insurance program and not a social program. 

Lee, who lived near New Wilmington, Pennsylvania, failed to withhold social security taxes from his employees or to pay the employer's share of such taxes because he believed that payment of the taxes and receipt of benefits would violate the Amish faith: "But if any provide not for his own, and specially for those of his own house, he hath denied the faith, and is worse than an infidel.” Timothy 5:8.  Edwin Lee and the Amish do not object to paying taxes except for the Social Security and unemployment taxes. They protest these taxes, formally, on the grounds that they represent forms of insurance, which their religion prohibits.

Lee sued in Federal District Court for a refund, claiming that imposition of the taxes violated his First Amendment free exercise of religion rights and those of his employees. In passing this judgment, Chief Justice Burger argued that it “… is unconstitutional as applied to persons who object on religious grounds to receipt of public insurance benefits and to payment of taxes to support public insurance funds.” Clearly arguing that Social Security is an insurance program. A similar claim by a member of Sai Baba was denied exemption because although opposed to insurance on religious grounds, the faith did not provide for its members.

These two cases are important because they hold two divergent and exclusive interpretations of the law at the same time.  Although there have been many other cases, the fact that these two judgments have not been reconciled has to be intentional. It allows Supreme Court to interpret the law to benefit the type of Congress that we have. When Social Security benefits can no longer be paid from the general fund, then there will be judgments on who and how much will benefit. Whatever the outcome, the Supreme Court has already decided that our benefits are not entitled nor guaranteed. We have to continuously make Congress accountable for the “trust fund” that we lost “trust” in and which has no ”funds.” The Fifth Amendment ends: “nor shall private property be taken for public use, without just compensation." All we need now is for the Constitution to be honored. 

© USA Copyrighted 2014 Mario D. Garrett

Hiding from the Pain: Robin Williams's Autopsy

Robin Williams’s death on August 11 2014 generated a lot of interest because there were so many cues. Or cues that we strongly believe we need in order to be able to explain his suicide as “rational”. We are now learning that depression, anxiety, and Parkinson’s disease weren’t the only issues plaguing Robin Williams in the months before his death. According to a new autopsy and toxicology report his brain also showed signs of dementia. We have now “explained” the suicide as a biological fate accompli. Biological determinism. Dementia and Parkinson’s at the same time. What better reason to commit suicide.

But this is rubbish.

What neurologists think as the disease in the brain—the neuropathology—which in Alzheimer’s are the plaques and tangles—has never been validated. We see a lot of plaques and tangles in the brains of dementia or Alzheimer’s patients after they die. But there is not one study that shows that the plaques and the tangles CAUSE the disease. The same as a scab over a wound. The scab is an indication of a trauma, but it is not the trauma itself.

If we did an autopsy of you today it is very likely that you have some of the signs of dementia. In fact most older adults have these plaques and tangles. So much so that just under one in three of  older adults have as much disease as those with dementia but without expressing the disease. And it is not just older adults who have these neuronal damage. A study on young victims between the ages of 26 and 30 reported that more than one in five already had early stages of the disease.

What is stranger still is the observation that there are people with dementia who do not have the disease in their brain. There is a famous long-term study conducted by David Snowdon looking at nuns. Snowdon was one of the first to report such cases. There are inconsistencies in how we are trying—but failing—to define the cause of Alzheimer’s disease and dementia in general.

Diseases of the brain are not all that distinct. Although we have given names to specific diseases these are not as distinct in real life as neurologist would like them to be. We talk about Lewy Bodies dementia as though it is distinct from Alzheimer’s, but in fact they are on a sliding scale…more likely to look like Alzheimer’s or Lewy Bodies. There is also the vogue to call all types of dementia “Alzheimer’s”. Even Alois Alzheimer himself, more than 100 years ago, was confused by the distinction. And we remain confused today. Most of brain diseases share similar neurological deficits. Whether these are the cause or an expression of an underlying disease has not been determined.

With Robin Williams’s death we have to stop looking for simple answers. There is no greater answer to be found in biology. Our biological body is a balance—it is not a digital machine. As with cancer—and we all have cancer—it is how the body manages to keep it in balance. It is not whether there is a disease, but how we control and keep it in check. Evidence of dementia is no evidence. It is after-the-fact excuses to rationalize an individual’s pain and suffering as legitimate without understanding the pain and suffering.

© USA Copyrighted 2014 Mario D. Garrett

Is Cancer the Cure for Alzheimer’s disease?

 In 2014 Ferrán Catalá-López and his colleagues from the University of Valencia in Spain reviewed the inverse association between cancer and neurological diseases including dementia. What they reported is that numerous studies have been showing that if you had one of these two diseases you are less likely to get the other. The first anecdotal evidence came more than fifty years ago when patients with Parkinson’s disease were reported to have a lower rate of cancers. More recently, this inverse relationship has also been documented for Alzheimer’s disease. In fact, this inverse relationships is most pronounced with Alzheimer’s disease and Huntington’s disease. While for cancer it is more pronounced for colorectal cancer and lung cancer.

If you have had cancer you are 50% less likely to get Alzheimer’s disease. While, if you have Alzheimer’s disease you are 60-70% less likely to get cancer. The same results do not exist for vascular dementia or Lou Gehrig's disease (ALS) and for some cancers such a melanoma, non-melanoma skin cancer and breast cancer.

There could be a number of reasons for this, and all could be working at the same time. It could be that once you are diagnosed with cancer or Alzheimer’s disease the focus of clinical care is on treatment and there might be less active interest in searching for additional diseases. However, this does not explain why it does not work with other diseases. It could be that the therapy for both diseases protects you from getting the other disease. Although plausible, it is unlikely. It could also be that the two diseases are separated by vulnerability in age and therefore if cancer kills you first you will not have the opportunity to get dementia. While being spared cancer you are then more likely get dementia. Although there are studies that dispel these arguments—some more conclusively than others—there is however a more subtle and persuasive argument.

There is a growing understanding of the chemical balance that is played in the body especially the process of generating energy for cells. The imbalance in this process—known as Glycolysis—of how the body converts sugar into fuel (pyruvate) for cells could be the balance that determines which of these two diseases you are likely to get. Too little fuel for cells—since neurons have such energy demands—and you get Alzheimer’s disease. Too much fuel, which feeds the erratic cells, and you get cancer.

Although this is an interesting avenue for biological and chemical research, there is an additional offshoot of this way of thinking…and that is the rejuvenation of the concept of homeostasis. That along a continuum of cancer or Alzheimer’s disease there is a balance. First described by Claude Bernard in 1865 and later coined by Walter Bradford Cannon in 1926, homeostasis requires three basis mechanisms. A sensor to detect changes, a mechanism that can modify that change, and a feedback connection between the sensor and a mechanism. The concept that homeostasis can determine Alzheimer’s disease has radical repercussions for psychologists because both the sensor and the mechanism can have psychological components. As an example, for the sensor being happy and content, tells the body that the system is in homeostasis, in balance while being stressed tells a different story. For the mechanism, being active, engaging and having tactile and sensory stimulation moderates and modulates our internal chemistry.

© USA Copyrighted 2014 Mario D. Garrett

Infections/ Antibiotics and older Adults

Despite advances in antibiotic therapy, infectious diseases continue to be a major cause of mortality in older adults. Ritu Banerjee and her colleagues  at the Mayo Clinic have reported that Antibiotic-resistant Escherichia coli (E. coli ST131) continues to proliferate within hospitals and long-term care facilities. In a study published in found that  LTCF residents having 8 times the risk of contracting E.coli ST131 compared with non-LTCF residents. This trend coincides with the increasing prevalence of ST131 among patients 65 years and older. It is likely that extensive antibiotic exposure, close contact with other antibiotic-exposed individuals, age and health-associated alterations in intestinal microbiota all contribute to the high prevalence of ST131 among the elderly population.  ST131 isolates were also more than twice as likely to be healthcare-associated infections as compared to community-associated infections.

The diagnosis of infection in older adults is more challenging, Only 40 percent of older adults with serious infections develop increased white blood count, and since frail older adults tend to have poorer body temperature response, there might not be an perceptible increase in temperature. Body response to infection, among older adults, are subtle, and nonspecific. Such responses might be change in mental alertness and delirium in half of older adults with infections. In addition, anorexia, functional decline, falls, weight loss or a slight increase in respiratory rate may be the only signs indicating infection in older adults.

Is Having Children Detrimental to Longevity?

How can sleep deprivation, economic shocks, diminished disposable income, constant caregiving, incessant worrying, 24/7 responsibility, lack of privacy, and incessant crying be correlated with longer life?   But that is just what a new study from Denmark is reporting. Having children increases your life expectancy.

The study itself is simple.  The Dane Professor Esben Agerbo and his colleagues published a study in 2012 where they looked at 21,276 childless couples who in 1994 went to an in vitro fertilization clinic. All these women had problems conceiving. By 2005 a total of 96 women and 220 men died. Women who did NOT have a child were four times more likely to have died compared to those who did have a child. The inexplicable aspect of this study is that the same disadvantage also transferred to men. Men who remained childless in this study were twice as likely to die early.

How can this be explained? Gerontology theories predict that having children reduces your life expectancy--especially if you stop having sex afterwards--as most couple who have children tend to do. 

The theory of antagonistic pleiotropy argues that some genes have contradictory effects at different age. Genes which might enhance your reproductive success--genes that increase testosterone in men, resulting in more muscle mass and masculine secondary sexual characteristics; or estrogen and bigger breasts in women--may at the same time have detrimental effects on survival later on in life--elevated risk of cancer in men and larger cancer nodes in women. Natural selection tends to favor these kinds of genes because they maximize the ability to transfer your genes—termed as fitness--without due concern for later life mortality.  From this theory it follows that higher rates of reproduction comes at a cost of higher post-reproductive mortality.

As a complementary theory, the Disposable Soma Theory argues that there are metabolic trade-off between reproduction and longevity. Reproduction utilizes biological resources which could otherwise be used for physical maintenance. Having more children to bear and rear uses up limited physical resources that could have promoted better health and a longer life. In this view, higher reproduction is associated with a shorter life span.

These theories are supported by the numerous studies by demographers looking at nuns and monks. Overall, these studies have been showing reduced mortality of 31-11 percent among nuns and monks. An advantage that is generally larger for monks than for nuns. It is more a lifestyle that protects you from dying early (rather than promoting longer life.) In the real world, where people do not live in monasteries/nunneries and where they do not follow a regimented life, it is hard to separate what is causing people to die earlier.

In 2002, using data for a preindustrial Sami population in Finland, Samuli Helle and his colleagues showed that the number of sons--rather than the total number of children--affected women’s longevity. This association was also found in data from a 19th century Flemish village and confirmed the association between number of sons born contributing to their mother’s early age of death. However the effect was only evident among poorer women, and mainly for women whose sons survived to at least to age five. Leading to the conclusion that resource competition--rather than pregnancy--might be the main explanation. Having children is not only a biological event. There is also a financial cost associated between childbearing history and longevity.

Having four or five children shortened women’s life span after 50 by about 3.5 years compared to women with one child or less. However, this effect could only be found among the poorest women. No effect of number of children for more well-to-do women, or for men, could be found.

And the poorer you are the poorer your diet and the harder the competition for resources (both inside the womb and outside.) 

How can this Danish study show such different results? Could we explain the results that having children increased longevity because it is reflecting having less money?

In Denmark, the first three courses of IVF are given free-of-charge. Wealthier couples, who may be able to buy more IVF treatment sessions can increase their chances of pregnancy. So methodologically, there is a higher likelihood that those who conceived were a self selecting richer group making the results already biased. What helped to clarify this point further--that it is socio-economic status which is promoting longer life rather than bearing children--is the finding that researchers found it didn't matter if the women or men who had children had them biologically or through adoption for them to benefit from increased longevity. Being well off  is one of the main criteria for having successful adoption.

The longest person that ever lived, Jeane Lousie Clament had one daughter. But she also did not work, lived a life of leisure, smoked (until she was 117 years) and ate over a kilo of chocolate a week. If children should choose their parents wisely, then similarly parents need to make sure they can afford their children or else pay for it with their life.

© USA Copyrighted 2014 Mario D. Garrett