39. Top Tips For Healthy Aging

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Welcome back to Ask Dr.

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Mia podcast.

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I am excited to talk to you all today based on some audience response to talk about what are some things that we can do in midlife to help age well in the future decades.

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And by midlife, I really mean folks who are in their 40s, 50s, assuming that our average life expectancy is in the 80s.

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Obviously depending on your personal genetics and family history and lifestyle, that could be a lot lower or a lot higher than that.

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But today I really wanted to talk about some things that I am trying to instill in my daily life to live a healthier lifestyle and incorporating some of the research that I know from being a geriatrician and an Alzheimer's disease or dementia researcher.

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So there is quite a lot of information out there about healthy aging, but I will try to break down this episode into sort of practical steps that I personally find challenging to maintain and what might be some ways that you, as well as myself, can try to change our behavior to nudge a little bit toward a healthier lifestyle.

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And certainly if you have thoughts and tips, please send it my way.

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One of the new features with my podcast hosting server is that you can actually text me based on the link that is at the show notes for each episode and it will come through and you don't have to open up your email or anything to let me know what you think about this particular episode.

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as well as any of the other previous episodes that you may have heard of.

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So I look forward to hearing from you.

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So today we're going to talk about five things.

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One is exercise.

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One is diet and in particular, a healthy diet.

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We're going to talk about sleep, stress and mental health and related to that sort of social isolation and loneliness.

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And then finally, we are going to talk about positive age related perceptions, or kind of how we think about aging and our beliefs really do influence how we age.

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So let's get started.

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So exercise, I don't think it's a surprise to anyone.

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in terms of how good exercise is good for us.

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But I think it is surprising to perhaps some of the audience members in knowing that exercise has probably some of the strongest evidence in terms of research across many different types of studies, whether it's observational or intervention where you assign people to do a certain amount of exercise, even with older adults who older and frail, no matter what age you start exercising is better than not exercising at all.

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And of course there are many different types of exercise, but the kind that is the best for your health in terms of maintaining function and longevity is probably aerobic exercise.

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And that is any sort of exercise that gets your heart moving, gets you sweating.

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It's difficult to do or at least moderately difficult what folks call moderate to vigorous activity.

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For me, I enjoy rowing on my rowing machine at home.

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But for many of you that may be running, swimming, dancing, anything that could be fun and doing it with other people can also be an additional accountability factor.

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But even if you do exercise regularly now and it feels hard to get started, just getting more steps in a day can be something that's better than nothing.

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In fact, there are studies showing that in adults who are 40 and older, taking at least 8 ,000 steps or more a day compared to folks who only did 4 ,000 steps, there is actually the risk of death lowers by 50% from all causes, which is ridiculous.

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that came as a drug, then we would all be clamoring to buy it.

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Something that cuts your risk of death by half.

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And then it's just in doing more than 8,000 steps a day.

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Anything that keeps you moving.

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We also know from people who have dogs that they actually live longer than people who own cats know against and nothing against cat owners.

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but that getting a dog is really about the daily physical walking and exercise that one is doing.

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But this could be small in terms of taking stairs instead of riding the elevator, parking a little bit farther and walking in, building it as part of your routine.

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And I find it much harder for me personally to exercise in the evening than than in the morning sometimes, but other times I find it easier to exercise in the evening because my mornings tend to be rather chaotic with getting the kits ready and I don't enjoy waking up by 5 a .m., which is why I'm not a surgeon.

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And sometimes I just cannot exercise that early in the morning and I do it at the end of the day.

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And even when I have a day that I don't want to move.

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I tell myself if I just do five minutes or 10 minutes of yoga or some sort of gentler exercise, I almost always feel better as a result.

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But the goal is to do 150 minutes of moderate or vigorous exercise per week.

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And that really breaks down to about two and a half hours a week and over seven days, that's about 30 minutes.

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per day, if you do it for five days, a little bit fewer frequency of days if you exercise for an hour at a time.

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So it really just depends on what interval works for you and your life and what is sustainable.

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One thing that I've only recently started to do is to not beat myself up when I fall off of the exercise wagon.

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And I just say, you know, this is going to happen.

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I'm going to have periods of my life where I do a little bit better than others.

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For some people that might be the summer if they're more busy during the school year or vice versa.

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But it doesn't mean that you can't get back into exercise again.

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there is just so much data in terms of supporting physical activity It's one of the crucial things about aging well.

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And that's both for physical function as well as cognitive function.

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So hopefully I've convinced you to move more.

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But one thing that we also wanted to talk about is making smart food choices and particularly the type of diet or pattern that is promoting healthy eating.

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So much of how we eat and what we eat is very culturally based.

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And a lot of this research not only comes from just observing where in the world people are living longest, those are blue zones, some people call that, but also from clinical trials where you tell people to eat a certain pattern of diet and compare with each other, other types of diets.

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And that really shows a Mediterranean style eating pattern or a MIND diet, is a modified Mediterranean and combined DASH diet.

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DASH stands for Dietary Approaches to Stop Hypertension.

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So foods that reduce your risk of developing high blood pressure along with Mediterranean style diet pattern is a lot better than probably our traditional American diet that has a lot meat, a lot of fat, and not a whole lot of fresh produce, whole grains, healthy fats, as well as fish.

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And for me, I find it easy to at least plan out my breakfast and lunch for the day so that I'm not tempted during the middle of the day when things are busy to grab something quick that may be not as healthy.

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So that could mean, you know, bringing a salad or preparing my salad for the next day at the same time that I'm making dinner or at the end of the day when I'm tidying up the kitchen.

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So something that is filled with protein, avocados, fresh nuts and vegetables that make me feel both full and also more alert and awake and not have the afternoon filled with you know, feeling like I'm going to fall asleep.

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And I think getting small things that make a big difference for me was actually getting a proper size salad bowl or salad container so that I'm eating a large enough quantity of salad to not be hungry an hour later.

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It feels like such a small thing, but I got a large container that's to separate my salad toppings from the actual lettuce and spinach and leaves.

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And that has made such a major impact in terms of how much I'm able to stick with a diet that has a lot more fresh produce.

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I think of it like eating the rainbow.

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So I'll put in beets, carrots, avocados, like I said, nuts like.

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peanuts or pistachios, and of course some sort of salad dressing.

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I don't even usually include any type of meat in my salad typically because I do get meats and other protein in my other meals of the day.

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But some people make it however that's enjoyable to you.

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One thing that I think I wanna stress in this episode is that there is what's ideal and then there is what's the practical and sustainable.

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So if you know that you cannot stick with the ideal right now, even making a small change that gets you closer to a healthier lifestyle or healthier diet is better than not doing anything at all.

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And I personally noticed a big difference after eating a meal that say Chick -fil -A sandwich and fries for lunch.

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versus the day when I eat my salad for the day.

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Not to say that I will never have fast food again, but I definitely noticed about an hour later, my whole body just feels extremely weighed down and my brain is trying to go to bed rather than being awake and doing everything I have to do for the rest of the day.

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There are some studies that show even things like migraines can be associated with the type of oil we use.

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So a diet that's lower in vegetable oil and higher in fatty fish could be reducing migraine headaches.

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And that consumption of green leafy vegetables is also significantly associated with lower cognitive decline.

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And when I think about how my grandparents ate, A lot of what they ate in China in particular, but also you see this in other blue zones like Japan and other areas, they're oftentimes relying on a lot of, know, more than half of their plate is vegetables of various types.

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And then the rest half are a little bit of protein and a little bit of carbs.

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So I think.

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what the American diet does poorly in many ways is the opposite of that, which means it's no surprise that we have so much healthcare conditions that are associated with our poor dietary habits.

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Next, we're going to talk about sleep.

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This is something that I have talked about in a previous episode with Jamie Hughes.

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So I will refer in my show notes for you to go back and listen if you're interested.

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We go into a lot more detail about what is considered a good sleep hygiene.

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But one thing that I wanted to say in terms of sleep is that so much of getting a good night of sleep is easier said than done.

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But like any other lifestyle changes, You may need to try multiple things at one time in order to sort of really see a noticeable difference.

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And for me, I personally love sleep.

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I wish I could get more sleep than I currently have, but I cannot just because of where I am in my life.

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But we do know that inadequate sleep or sleep deprivation is associated with eating a worse diet, and I know this myself when I'm on call or when I was in training and staying up overnight or 24 hours, there's no way you can convince me to eat a salad on a day that I'm on call because my body just really gravitated towards the French fries in the cafeteria.

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But you see that in shift workers who work nights as well that the reversal of the habits and associated changes in our hormones and cortisol levels definitely have more of an impact on our overall health than just sleep itself.

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And that we know through other studies that in sleep is when we clear up toxins like beta amblyloid, which is a protein that we see in Alzheimer's disease, and people who don't get good sleep.

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whether it's from sleep apnea or just from chronic insomnia, also have higher rates of insulin resistance, heart disease, and obesity.

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For me personally, I think a lot of times most commonly I see people having trouble with sleep is either because they are drinking too much fluids later in the day, including caffeine or dinner is their largest meal of the day.

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And so when they do go to sleep, oftentimes they have to wake up multiple times overnight.

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Now, of course, folks can also have overactive bladder and other urologic conditions that I'm not going to talk about right now that could be contributing to waking up multiple times overnight.

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But one thing that is easy to try is to reduce the amount of liquids that you're drinking.

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later in the afternoon and the evening time so that when you do lie down, I think it changes the blood flow in the body and increases the amount of filtration that our kidneys go through.

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So oftentimes you notice that when you lie down for a period of time, you actually have to pee more.

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So something that you could do is to lie down earlier in not in bed, but in a different space that is not in bed to really get rid of the amount of liquids that you've been drinking.

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Associated with that is oftentimes alcohol.

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Alcohol is also a diuretic and a lot of people drink alcohol with dinner.

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So that could be another reason why people are waking up multiple times overnight to go to the bathroom and then not be able to go back to But the other common reason why people have sleep problems is actually related to stress.

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And I loop in anxiety, depression as well.

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And I personally find that, you know, as soon as I put my head on the pillow, I think of the 10 things I need to do the next day or the 10 things I didn't do today and find myself needing to write things down.

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I try to keep my bedroom environment as light free and technology free as possible, obviously except alarm clock.

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And when I do think of things in the middle of the night, I kind of just scribble into a large post -it note.

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It may be poor handwriting for me to interpret the next day, but at least I don't have to turn on the lights to be able to scribble down something.

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I personally find easier to jot something down rather than thinking that I'm going to forget something and then continually think about it.

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But I know that may not be the case for everyone.

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And this is where I also see in my own family, people who have trouble sleeping oftentimes also have untreated anxiety and depression.

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So definitely with a licensed mental health counselor or your personal doctor if you think those things are related.

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There is a whole lot out there that can be talked specifically about sleep and insomnia, as well as even some self-guided programs related to sleep, sleep hygiene.

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and what's called insomnia cognitive behavioral therapy.

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One thing that is really crucial is to really restrict the amount of time that your body is in bed to really focus on sleeping, meaning don't eat in bed, don't do your homework in bed, don't write in bed or other things that really tells your body that it's doing something other activity besides sleeping.

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So they call it restricting the amount of time in bed.

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And even if you wake up in the middle of the night and not be able to go back to sleep, instead of tossing and turning for hours in bed, it's actually much better to just get out of bed, do something else, like reading an actual book, not being on your phone.

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And then when you feel tired enough to go back to sleep.

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And not be yourself up about not being able to sleep as we all have nights where we sleep better than others, but just say no.

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This is a night that I didn't sleep very well, but I'm going to try to go to sleep earlier the next day so that I can get a little bit longer For me personally, I also find meditation before bed to be particularly helpful in terms of getting good sleep.

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And oftentimes this is in periods in my life where I'm having a particular challenge in terms of stress.

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In my previous episodes where I talked about some of my own grief and dealing with my mom's ovarian cancer during some of the more intense periods of grief.

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and in talking and uncertainty about her health, I find it really helpful if I have about a 30 minute meditation and breathing exercise before bed compared to if I don't do that.

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So on a related note, in terms of social isolation and loneliness, and I will loop in stress as well with that, There is a lot more studies that find that socially isolated folks have more symptoms of both mental health issues as well as cognitive decline.

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This is one thing that I personally notice as really prominently different between how, say, my grandparents age in their retirement and older in life and just the amount of social connections that they have.

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in their life in China versus how most of my patients now age where they are just missing so much of the social connection.

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And the pandemic certainly did not make that any easier.

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In fact, even myself oftentimes feel like, you know, I need to really invest and purposely align time with my friends because we're all so busy.

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doing so many different things, whether it's taking care of our parents or taking care of our children and holding down a full -time job.

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Sometimes there is no time for friendship unless we make an intentional And in terms of managing stress, this is one I personally like journaling.

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I know not everyone likes that, but I find that getting things written on the page allows me to examine my own thoughts and see if I'm just trying to tease out exactly how I'm feeling internally.

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Sometimes when I'm constantly thinking or feeling anxious about something or going over a situation that happened earlier in the day.

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If I'm not wanting to talk about it with, my husband or other close friends, I oftentimes find myself writing.

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And there is an exercise that is done by, I learned it from Elizabeth Gilbert, who is the author for most famously Eat, Pray, Love, but obviously she She has written lots of other great work as well.

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And it's an exercise you can actually find on Substack.

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So if you go to Elizabeth Gilbert, I'm not being paid by her, but I am part of the community of the Substack and it's called Letters to Love.

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And basically it's an exercise where Elizabeth herself posts a letter that she writes to love every week.

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And she also invites special guests to share.

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what love tells them.

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And this is something where it feels a little bit woo woo when you first hear about it, but I find it tremendously helpful when I actually do it.

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And I always find it surprising how much inner wisdom there is within myself.

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If writing to love is something that feels kind of funny to you, you can also think of it as writing a letter to your best friend or writing writing to help yourself as though you're telling your best friend who is in the same situation that you are.

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And oftentimes we give really insightful evidence to other people that we don't then follow ourselves and we need to remind ourselves in journaling or other types of stress management activities that we actually do have control over.

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our thoughts and our responses, even if we cannot change the external environment.

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And that really relates to the last point, which is something that I don't think we have really talked about a whole lot in a lot of the popular literature in terms of aging.

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But I do want to highlight Dr.

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Becca Levy.

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She is a researcher, aging researcher.

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who has written a book called Breaking the Age Code.

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She's at Yale University and she really investigates into looking at how age-related perceptions affect how we age.

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And surprisingly, I think to a lot of people, positive or negative age beliefs are directly correlated with not only our mental health, but also our physical health and lifespan.

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And we notice, and she notices in different places around the world, she went to Japan when she was a young graduate student to really learn about why the Japanese have such a long lifespan in the world.

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And she really noticed that in Japan and also in China and many other cultures, old age is really treated as a time to enjoy their life.

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rather than a time to fear what you are losing.

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that in, we see this, I I saw it in my own personal family example, where my grandparents and other older adults in my life when I was younger have really given me a very positive view of aging, where people who are getting old are necessarily all frail and invalid or a burden to their families, but that they're very much contributing members of society.

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They raised me, their grandchildren, and I know that is happening in the United States as well.

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We just really don't hear about those positive aging examples as much as the negative ones.

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And also recent, you know, news events and political environment, we hear about how old a particular candidate might be and whether they're really the ones right for the job.

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I'm not going to talk about the presidential election, but to just say that I think in America in particular, we have a very negative perspective of aging.

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And I do think that through Dr.

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Levy's research, there is a definite correlation how people perform.

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So for example, one of the studies that she did is actually expose people to either a positive age belief or a negative age belief right before asking them to do some sort of, you know, say physical performance or activity or even cognitive activity.

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And they found, she found that people who were exposed to a positive image of someone who is aging did significantly better than people who were not exposed to either the positive or the negative aging image, and definitely much better than people who were exposed to a doom and gloom type of fear -based aging process or aging perception.

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So I wanna leave with that in mind and really trying to first be aware of how much we think about aging and a negative perception.

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in our daily life and in just the cultural messages that we receive because the first step in terms of changing how we perceive something is really by awareness.

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And most of the time, I think most people are not aware of themselves automatically associating old or elderly with something negative.

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So I think this is where I do feel incredibly grateful I was raised with examples in my own family who really showed me what successful aging is and how that could really be quite enjoyable and fun even later in life.

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So check out Dr.

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Levy's book if you're interested in this because there is a whole lot of data that really shows You know, our mental images of aging are very much products of our culture and our cultural messages and, you know, the shows and the jokes that we laugh at, those external perceptions of age, it oftentimes translates into how we think of age, aging internally, and that really has a direct relationship with how we physically age or cognitively age.

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So I hope this is a helpful episode for folks.

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And I hope you walk away in terms of thinking of a couple of steps, small steps that you can do now in midlife to help yourself age better in the future.

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So those things are exercise, particularly aerobic exercise, strength -based training is also really important.

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I did not have time to get into that today, but maybe we'll do at a future episode.

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Mediterranean type of diet or DASH diet, which the Mediterranean and DASH diet are combined called the MIND diet, but really just increasing the amount of fresh vegetables, whole foods you're eating.

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It doesn't have to be vegan, vegetarian, or entirely plant -based.

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but just increasing the amount of fresh vegetables you're eating.

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For me, that's salads for lunch, as well as fish.

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And some people don't like fish, but I would say don't worry so much about the fish or seafood aspect of this and really focus on the fresh vegetables.

00:31:51.863 --> 00:32:13.130
Third is sleep, how to get good quality sleep, making your sleep environment and your sleep routine as good as possible so Even on nights when you don't fall asleep well or have a hard time going back to sleep, it's something that you can just pick yourself back up and try again the next day.

00:32:14.050 --> 00:32:18.153
Mental health, social relationships, stress.

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For those things, think for me, meditation and writing letters to love have been really profoundly easy insightful ways for me to manage my own stress.

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I've talked in a previous episode, I also have a grief counselor and wholeheartedly believe in mental health therapy.

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So for people who have more serious mental health issues in their life or their family history's life, please, please do consider a professional.

00:32:50.480 --> 00:32:55.351
And then lastly, our own age related health beliefs.

00:32:55.351 --> 00:32:57.987
And so much of that is culturally based.

00:32:57.987 --> 00:33:12.825
but just being aware of what type of automatic associations we have when we think of someone older, when we see someone older, and see if that is actually true.

00:33:12.825 --> 00:33:23.240
And I think if you look, if you turn your attention to positive models of aging, you'll find a lot of that as well, but it does take intentionality.

00:33:23.240 --> 00:33:30.542
And then once you find older, people who are aging well and doing amazing things.

00:33:30.542 --> 00:33:34.345
Olympics for older adults.

00:33:34.345 --> 00:33:45.452
I feel like I'm constantly amazed by how well our bodies can move, even at, you know, people's 70s, 80s or 90s.

00:33:45.452 --> 00:33:55.079
And certainly I don't expect that necessarily for myself, but I love seeing examples of older adults just living their best life.

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So.

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Thank you for listening and please send me a text using the link in the show notes if you want to let me know how this episode is or give me ideas for other episodes.

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You can also email me at ask at Mia Yang,-I -A -Y -A -N -G -D dot com or you can go to my website and the link is in the show notes.

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So thank you all and see you next time.