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Interview with Dr. Donald Abrams: Aging Gracefully

Dr. Donald Abrams

Photo by Tom Seawell.

Audio Interview

Hear a Patient Power interview with Dr. Donald Abrams, a cancer and integrative medicine specialist at UCSF Medical Center as he discusses a 12-step program to aging well.

Interview Transcript

Andrew Schorr:

Aging is inevitable, but what steps can you take to grow older while maintaining your health and healthy outlook? Coming up, an integrative health specialist shares a 12-step program for aging well. It's all next on Patient Power.

Hello and welcome to Patient Power sponsored by UCSF Medical Center. I'm Andrew Schorr.

And I'm also 61 years old and wondering could I live well, like my father did, until age 92. He continued to practice law at age 92. He played golf, and he had some things break, he did have some things slow down, but overall he lived well, and that's something I think we all hope to do. I always joke, wouldn't it be great if, let's say you were a tennis player and you could play vigorous singles tennis until you're 100 and then die, one day after your hundredth birthday? Maybe there are people who want to live longer than that, but live well and then say good bye.

Well, how do we get closer to that? To help us understand is Dr. Donald Abrams. Dr. Abrams is a cancer and integrative medicine specialist at the UCSF Osher Center for Integrative Medicine at Mount Zion in San Francisco, and he is a hematologist oncologist, actually Chief of Hematology Oncology at San Francisco General Hospital. And of course, one of the things we wonder about is also lowering our risk of cancer as we live hopefully a long, healthy life. Dr. Abrams, thank you for being with us.

Dr. Abrams:

A pleasure.

Andrew Schorr:

Dr. Abrams, I was reading through a presentation you had, and it was talking about all the things that begin to wear out as we get older. Our sight, our hearing, our digestion isn't as good. Our bones get thin. We lose weight. We get hunched over, all these kinds of things. And so help us begin to understand — are there ways that we can take charge on our own and working with our doctor to get closer to not aging quite so fast?

Staying Active

Dr. Abrams:

Well, I think the little vignette that you gave us about your father had a lot of good points in it right there. You said that he practiced law until he was 92. What I like, when you mention the 12-step program, is I'm a big follower of Andrew Weil who wrote the book Healthy Aging. I did a fellowship with his group at the University of Arizona in integrative medicine, and Andy in his book Healthy Aging lists 12 steps that can help us grow old gracefully. And one of those really is to get regular physical activity throughout life. And you said your father was playing golf up until he was age 60 or 90…?

Andrew Schorr:

92.

Dr. Abrams:

Or 92. I said 60 because age 60 is when I initiated my yoga practice. Up until then I did mainly aerobic and resistance work, but at 60 I started doing yoga because of the stretching, flexibility, balance, and also the mind body component that gets us relaxed and decreases stress. So your dad did that physical activity throughout life.

And then the other thing that he did was practice law. And one of Andy's other points is to exercise your mind as well as your body. And another one is to maintain social and intellectual connections as you go through life, and certainly practicing law you fulfill those two points.

Social Interaction and Keeping Your Mind Flexible

Andrew Schorr:

You know what else he did, too, now that I'm thinking about this, the social connections, he played bridge a couple of times a week. He had his regular group as well as playing golf for the exercise, but he had those social and mental interactions like a regular game that he really enjoyed.

Dr. Abrams:

Very important. I was just talking to a friend who was also a fellow in the program on integrative medicine and I said, you know, I'm 60, I'm going to be 62 next week, and sometimes I think my memory is not as good as it was. He said you need to learn a new language. And so I told him I want to learn Chinese, and he threatened to send me those tapes to learn Chinese. I would really like to learn a new language. I don't think Chinese is going to be the easiest one, but it is a way to keep your mind flexible, which is another one of the points.

They say change your operating system, is what they used to say, on your laptop or get a new iPhone and try to figure out how to use it. Keeping your mind flexible and moving is how we can keep the circuitry in action, I think.

You also said another point that is really — Andrew Weil calls it compressed morbidity. Live a long, healthy life for as long as you can and then when it's your turn go, go quickly and not have a drawn out exit. But we can't always control that, but that concept of compressed morbidity I think is certainly one to shoot for.

Andrew Schorr:

There's another quote here I saw in your slides, die young as late as possible.

Embrace Aging

Dr. Abrams:

Yeah, that's another way of saying compressed morbidity. Let's talk about that. One of the things that I think we can't do is maintain our youth forever, and as much as when we wake up in the morning and look in the mirror and say, who is that, we have to embrace the fact that we are aging. And that's another recommendation. Think about and try to discover for yourself the benefits of aging. We appreciate old wine and old cheese. We love the giant redwood trees that are thousands of years old, and a violin gets better with age, so why do we sort of hide our elders? In certain cultures in the world the older people in the town are paraded at the front of celebrations and venerated by the people. We do not value our elders as much as we should.

Andrew Schorr:

No, and if you look at the TV commercials they're advertising for men, they show coloring your hair, right?

Dr. Abrams:

Or erectile dysfunction.

Remaining Vibrant with an Anti-Inflammatory Diet

Andrew Schorr:

Or erectile dysfunction. Well, let's talk about that for a minute.

As a man, I want to talk about sex, impotence or erectile dysfunction, as they call it. Are there certain things that can help us be, well, for me, manly, as I get older and enjoy those sorts of relationships? Sex is one and even we were talking about the foods you love and not getting heartburn, things like that. How do we remain vibrant with some of these things that have been important to us for a long time?

Dr. Abrams:

Well, again I think it's the 12 steps. Many people get nervous, particularly around erectile dysfunction, that they might have a low testosterone level, and in fact probably most of us do, but that really isn't what causes that problem. It's often vascular disease, people who are diabetics or who have coronary artery disease, depression, or other things that are dealing with.

The ways to try to maintain all of your functions as we age are to, again, eat a healthy diet. That's the number one point in Andrew's 12 steps for healthy aging. Eat an anti-inflammatory diet. The standard American diet, abbreviated SAD for good reason, is making us all sick. Eating a lot of animal fat, trans fats, refined carbohydrates, sugary drinks, these make us sick and decrease all of our functions.

Being sedentary and not being physically active also is something that interferes with all aspects of our aging and growth. There are quick fixes now for — if we're talking about erectile dysfunction, you can get a prescription, but yoga also is supposed to improve blood flow to all of our organs, as it were, so this is something to think about. I don't think that there are any natural supplements that are particularly useful for male vitality, but one that I like to recommend is a fungus that grows on a caterpillar found in Tibet and Nepal, cordyceps sinensis. It's what the Chinese women's relay team was taking in the 1980s to allow them to break all sorts of speed records, and some people do find that it is an energizer and increases male vitality, if I can put it like that.

Dietary Supplements

Andrew Schorr:

All right. That brings up the whole thing of dietary supplements. It's a huge industry.

Dr. Abrams:

Yes.

Andrew Schorr:

There are all sorts of claims.

Dr. Abrams:

Right.

Andrew Schorr:

You're an integrative medicine specialist, give us some guidance to how we can approach that because you walk into one of these stores and it says it can do everything including cure cancer.

Dr. Abrams:

Right. We need to be very careful about claims such as that. Again, point number two in the 12-point program for healthy aging is use dietary supplements wisely to support the body's defenses and natural healing power. My take is that I like these dietary supplement ingredients to come as much as possible from the diet. Paracelsus was an alchemist who lived during the Renaissance who bridged alchemy and medicine. He said there's poison in everything. The difference between a remedy and a poison is the dose.

And when you think about it, one popular supplement nowadays is resveratrol, which is what's found in red grapes and red wine, and it's felt to be potentially a life extender via appetite suppression of all things. And I recently read that one gram of resveratrol contains the amount of resveratrol in 667 bottles of red wine. I have personally not jumped on that bandwagon, and I'm a little concerned about that dose.

Things I do think that as we age should be supplemented include Omega-3 fatty acids because the American diet is very rich in the more inflammatory Omega-6 fatty acid. Now, inflammation is something we need to heal, but our diet has become heavily biased in favor of Omega 6 fatty acids instead of Omega 3s. Omega-3 fatty acids are those that are in deep cold water fish such as salmon, black cod, albacore tuna, herring, mackerel and sardines. Since we're not going to eat those things every day, I think it's a good idea to supplement with an Omega-3 supplement.

We are also in the midst of an epidemic of vitamin D deficiency. Vitamin D is the only vitamin we make from the sunshine, and as we age, those of us over 50, our skin and our kidneys don't really make it as well from the sunshine, and we become deficient in vitamin D, which is one of those causes of our bones getting thinner, but we also now know that vitamin D deficiency leads to number of other problems. Mood disorders, and some malignancies may be increased such as breast, colon, prostate and pancreatic cancers.

So I do recommend supplementing with vitamin D-3, which in food really is found only in fortified dairy products, which I usually ask people to stay away from, and again some of those deep cold water fish. A little known fact is you can put mushrooms outside in the sunshine and they'll make some vitamin D so that when you eat the mushrooms after you cook them you get an extra little dose.

The other supplement that I recommend for most people over 50 would be a calcium magnesium supplement. Again, calcium because I don't think people should be really consuming dairy products. This morning I read a new article suggesting that calcium supplementation may lead to an increase in heart attacks, which these studies are hard to do. I'll have to look at the data from that a little more clearly, but we do know that calcium seems to protect from a number of cancers and it certainly may help, for those of us that are shrinking a bit, with our bone mineralization.

So Omega 3, calcium, magnesium and vitamin D-3 as well as occasionally a probiotic — these are the supplements that I think most people who are aging should think about, and then others perhaps depending on what their other needs are.

Antioxidants

Andrew Schorr:

Now, what about antioxidants?

Dr. Abrams:

Yeah. I do take a little bit of vitamin C a day. Many people take a lot of vitamin C thinking it's a potent antioxidant. Oxidative damage is one of the things that makes our cells grow old and puts us at risk for cancer. Vitamins C, the amount we absorb in any oral dose is only 240 milligrams, so people taking 500 grams, 3 grams, 5 grams of vitamin C are really flushing most of it down the toilet. So I did find a 250 milligram tablet that I take in the morning.

Vitamin E, which is another potent antioxidant, just doesn't seem to make it. In all the clinical trials, it actually did more harm than good, and that's really because it's not a dangerous vitamin but what you buy in a multivitamin or when you buy a vitamin E supplement, it is just one of the eight forms of vitamin E that exists in nature. So when you take that, usually D alpha tocopherol, your body says, oh, I don't need the gamma tocopherol in that walnut or pistachio nut, and that in fact may be what's most beneficial for our health and then we don't absorb it.

If people want a little vitamin E supplementation I think a teaspoon of wheat germ oil is probably a good alternative than a pharmaceutical capsule.

Andrew Schorr:

Yeah, that's what I was wondering, though, is in our processed world, isn't there just some combination pill I can take and it just handles everything?

Dr. Abrams:

Yeah, that's what we think about because we grew up in this American system where you go to the doctor and you expect the magic bullet to be something that you swallow, but unfortunately it's something that you swallow in the foods that you eat and something that you swallow in bucking up and getting to the gym or going out for a run every day.

Andrew Schorr:

One of the points too is to make sure that you're doing preventative things, like monitoring your blood pressure. Many Americans now are not only overweight but they have high blood pressure. I know you can even buy a fairly inexpensive blood pressure cuff you could keep at home and know your numbers and be in a dialogue with your doctor should you be concerned, right?

Weight Control

Dr. Abrams:

Right. And preventive medicine is clearly things that we need to think about. Cholesterol is another number to know. Weight, you mentioned. Rather than buy a blood pressure cuff why don't we try to lose weight?

Andrew Schorr:

Right.

Dr. Abrams:

I mean, that's what we really need to be doing in this country. Now two thirds of us are overweight or obese.

Andrew Schorr:

And an epidemic of diabetes.

Dr. Abrams:

Yeah, exactly. I listen to the medical students and house staff present a patient to me and say that they're diabetic, hypertensive, hyperlipidemic, you know, high cholesterol, osteoarthritis. And I say, how much does this person weigh? And then they tell me that they're 300 pounds, and I say, you left that out — that's the first problem, the obesity. And it's amazing how many patients that I counsel on how to eat right and how to be physically active, after their cancer diagnosis are not only improving their survivorship but are losing a lot of the prescription drugs that they were needing to take before. Because when you lose weight your blood pressure might go down, your glucose intolerance or your insulin resistance may disappear, and your high lipids may also improve.

The other screening that we need to remind people about is colonoscopy, which I guess is getting a little bit of a question nowadays. Can it be replaced by something easier, an x ray, which is what we used to do in the old days? But I'm still going for my colonoscopy.

PSA in men is totally controversial now. Whether men should be tested to rule out prostate cancer is a whole other conversation that we should have at another time.

Andrew Schorr:

Right. Amen. So the bottom line I wanted to talk about here for a second, the bottom line is that, as it says here on one of your slides, life is lethal, I say a terminal, condition, right?

Dr. Abrams:

Yes.

Andrew Schorr:

And so it's this balancing. I mean, some of this stuff can be crazy making, and I'm sure maybe you've had patients like that and they're taking this and doing that, and they're so stressed out about hitting certain things by the numbers that they're not living a sweet life, if you will. So it is a balancing act as long as you're exercising, practicing preventative medicine, engaged in social relationships, you know, so many of the things you mentioned.

Spiritual Awakening and Growth

Dr. Abrams:

Well, let me give you point 11 in the 12 step program that Andrew Weil outlines. It is do not deny the reality of aging or put energy into trying to stop it. Use the experience of aging as a stimulus for spiritual awakening and growth. I think that's really important. I think I was smart and intelligent when I was young, but now that I'm over 60 I feel wise and I don't think 40 year old people we can call wise. I think wisdom comes with experience and age, and you need to have a bit of it. And the more you get the more we should appreciate ourselves.

And his 12th point I think is something that I never thought so much about. It's suggested that we keep an ongoing record of the lessons we learn, the wisdom we gain and the values we hold, read over it, and then make it available to those who come after us. So in our last will and testament we leave material goods to the people we love, but Andy suggests, that it was in the Jewish tradition that the living will or leaving your wisdom, telling people what you learned in your life is a very important gift to be able to pass on. And I know people in my age or slightly older who have actually spent a few months sitting down and trying to write such a document so that they can share it with the next generation.

Andrew Schorr:

Going back to Max, my father, who lived to be 92, in his later years we actually did an oral history with him, and he talked a lot about lessons learned. And some of it was, I mean, this is a guy who went to the gym every day even in his 90s and had certain values and they meant a lot to me, so I hope I can give that gift too. Dr. Abrams, we've covered a lot of ground in a short time but I think the bottom line is at any point we can begin to think about this, address ourselves to this. It's never too late, is it?

Dr. Abrams:

Right. Nope, you're absolutely right about that.

Andrew Schorr:

Thank you. Dr. Donald Abrams, who is cancer and integrative medicine specialist at the UCSF Osher Center for Integrative Medicine At Mount Zion in San Francisco, thank you so much for being with us on Patient Power.

Dr. Abrams:

It was a pleasure.

Andrew Schorr:

All right. Andrew Schorr here. Thank you for joining us. Remember, and as we get older, knowledge can be the best medicine of all.

 

Reviewed by health care specialists at UCSF Medical Center.

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.

Related Information

UCSF Clinics & Centers

Osher Center for Integrative Medicine
1545 Divisadero St., Fourth Floor
San Francisco, CA 94115
Phone: (415) 353-7700
Fax: (415) 353-7358