The Longevity Book: Live stronger. Live better. The art of ageing well.

2013:

It is reported that women taking the sleep-aid drug Ambien fall asleep while driving. At the urging of the FDA (#litres_trial_promo), the manufacturer of the drug cuts the recommended dosage for women in half.

2014:

The NIH mandates that female cells (#litres_trial_promo) must be included in all federally funded medical studies.

HOW YOUR SEX AFFECTS YOUR DRUGS

During our visit to the NIH, we spent valuable time with Dr Janine Clayton, the director of the NIH’s Office of Research on Women’s Health (ORWH). The ORWH has been around for only about fifteen years. Its mission is to promote women’s health initiatives in the medical community, educate the public about issues related to women’s health, and fund programmes that explore the role of sex and gender differences in medicine. Dr Clayton and her team have been working for years to encourage her colleagues at the NIH to prioritize women’s health issues and needs in their research.

We asked Dr Clayton some questions about sex and drugs, and she told us that your female sex affects the efficacy and the potency of the drugs you take. This is especially important for Americans because, as a nation, we take a lot of drugs. But while women are being prescribed more medications than ever before, not all of those medications are properly tested for use by women. And it has been proven again and again that drugs don’t affect men and women (#litres_trial_promo) the same way.

When we swallow a pill or get an injection of a vaccine, the medicine travels throughout the body via the bloodstream and is distributed to our tissues and organs. However, medicines affect women differently than they affect men for several reasons:

WE HAVE DIFFERENT ORGANS:

A female liver metabolizes (#litres_trial_promo) drugs differently than a male liver.

WE HAVE DIFFERENT BODY WEIGHTS:

Men are usually bigger and heavier, and have bigger organs, requiring higher dosages of drugs than a smaller woman does.

WE HAVE DIFFERENT BODY COMPOSITION (#litres_trial_promo):

Women store more body fat than men do, and some medications are attracted to fat tissues. When a woman takes those drugs, they linger longer in our bodies, and their effects linger too.

WE HAVE FEMALE HORMONES (#litres_trial_promo):

Our hormones influence how our bodies process medications. Factors like oral contraceptives, the menopause, and postmenopausal hormone treatment could also affect how we respond to drugs.

Painkillers and anaesthetic drugs are absorbed and metabolized in a unique way by women, who have a 30 per cent higher sensitivity (#litres_trial_promo) to neuromuscular blockers and in turn need smaller doses than men. Research has shown that males and females do not respond in similar ways to opioids (#litres_trial_promo) like OxyContin, Percocet, and Vicodin. Some medications, like Valium, exit our bodies faster than they do men’s bodies. Others linger longer. In animal studies, males and females also react to withdrawal in different ways. It is crucial for us to be aware of these differences, because as a nation we are currently experiencing what the NIH has termed an “epidemic” of women overdosing on painkillers, with a dramatic rise in the number of women dying (#litres_trial_promo) every year. And the highest risk of death from an overdose of prescription painkillers isn’t found among the young – it is found among women between the ages of forty-five to fifty-four (#litres_trial_promo).

But all this information is relatively new, and that’s because for a long time, pharmaceutical companies tested their drugs only on male cells, male animals, and male humans. This practice has led to a mountain of data that isn’t very accurate when it comes to prescribing drugs for women. Many of the studies we rely on today faithfully and obsessively record variables like time and temperature, but overlook the small detail of sex. Even when it comes to animal testing for drugs being developed to treat illnesses that predominantly affect women, sex isn’t always taken into consideration (#litres_trial_promo). That goes for human female subjects, too. Since hormones fluctuate over the course of a month, tests that use females can be a lot more complicated to analyze than tests that use males. Without taking hormonal shifts into account, it is impossible to determine how treatments might affect a woman over the course of a month. Pregnancy is a concern (#litres_trial_promo) in medical testing as well. In the 1960s, thousands of pregnant women who participated in a study and took the drug thalidomide gave birth to babies with serious defects. That tragedy has had a lingering effect on the scientific community, making researchers wary of including women in drug trials at all. By not creating safer trials and including women, however, we’ve also lost the chance to gather important information.

Luckily, things are changing.

Since 2014, the NIH has required applicants for federally funded research grants to address how sex relates to the way experiments are designed and analyzed. This research is critically needed, because as you’ve read in this chapter, medications affect women uniquely – even everyday ones, like the flu vaccine. A woman requires half as much flu vaccine (#litres_trial_promo) as a man to potentially produce the same amount of antibodies.

Women need appropriate doses of everyday and life-saving medicines that have been developed to be effective for our bodies. We need research that supports our sex, our cells, and our lives. The more knowledge we have of our female biology, the more we can advocate for quality care for ourselves as we age.

Over the course of my lifetime, women’s healthcare has improved dramatically. When I was a girl, the medical community was evolving in ways that would profoundly affect my life as a woman. I may not have been aware of the social changes that were swirling around me – and I certainly wouldn’t have understood that the advances being made in women’s rights were so closely tied to advances in women’s healthcare. Now I understand that, ladies, we have been living through history.

As we are writing this book, there are more than thirty million women between the ages of thirty-five and fifty (#litres_trial_promo) living in the United States. Whatever health challenges you might be going through, anywhere in the world, you are not alone. We’re millions strong. We’re standing in the middle of a conversation that has been going on for hundreds of years, with hard-won rights and knowledge bestowed on us by previous generations of women (and men).

And the changes are still coming.

WANT THE FACTS? ASK.

Whether you’re choosing a phone plan, buying new clothes, or ordering from a dinner menu – chances are you probably ask a lot of questions before making a decision. How many minutes will I get? Do these jeans come in petite? Is the pasta homemade?

Asking questions helps you make sure you’re getting what you want and need. So do you bring those same sleuthing skills to your GP visits? Unlimited texting, the perfect pair of jeans, and an amazing meal are totally worth the time it takes you to assess your options – and so is your healthcare.

When we were at the NIH we met with its director, Dr Francis Collins, and asked him what he thought the public needed to do when it comes to healthcare. He said that the most crucial thing we can all do is pay attention. Ageing research (and other medical knowledge) is constantly evolving. We can’t rely on medicine developed twenty years ago for our treatment today.

The only way to stay informed is to ask your doctor lots of questions, and to keep on asking if you still aren’t sure of the answer. We talked to doctors who said they were amazed by the LACK of questions they receive from patients. They told us their patients don’t always ask about the medications they’re prescribed – what they’re for, what they do, what the benefits and risks and side effects may be. They all encouraged us to encourage you to ask more questions.

Everyone deserves to have a GP who listens to their questions and takes the time to answer them, who will discuss alternatives and options, and who respects and takes seriously their symptoms.

Dr Seth Uretsky, a cardiovascular specialist and medical director of cardiovascular imaging at Morristown Medical Center in New Jersey, often sees patients who feel their symptoms have been overlooked by physicians. He believes that it’s important to trust and feel comfortable with your GP, and that finding one who listens, gives you time, and explains his or her thought process is crucial. And the data underscores his point: when patients feel understood by their GP, outcomes are better.

If your GP doesn’t seem to have the time to listen to your concerns, or if you feel that he or she doesn’t take your questions or symptoms seriously, it’s time to find a new GP.

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WHEN I WAS A child, I loved to spend as much time as I could with my grandparents. My grandmother was my hero. She was seven years older than my grandfather, and she was a powerhouse.

My grandmother was my ideal of strength and ability. She basically maintained a full working farm at her house, raising her own livestock and tending a thriving garden. She didn’t drive, so when she needed more feed for her chickens and rabbits she would set out on foot. She would walk to the feed store, about a mile away, and carry two ten-pound sacks of feed, one in each hand, on the walk back, even in the heat of the summer. If she wanted to haul more, she would bring a wagon. As a child, I remember asking her why she carried such heavy bags so far in the scorching heat. She would say, “Because I like it, and because it keeps me strong.” Her answer was so awesome to me, and I think of it every time I am pushing myself to go farther, to work harder, to try a little bit more.

When that little voice in my head says “Stop! Why? Enough!” I say, “Because I like it. Because it keeps me strong.” That is the legacy my grandmother left me, and I thank her for it each and every day.

My grandfather, although he lived in the same house with my grandmother, had a very different lifestyle than she did. His job required him to sit in an office, he smoked and he chewed tobacco, and he enjoyed red meat more than his vegetables. When I was eight years old, he had a heart attack and passed away. He was only sixty-three. Meanwhile, my grandmother lived to be nearly ninety. She stayed vital into her seventies. Hauling feed, along with all of her other regular chores, kept her strong and resilient.

But even hard work cannot always protect us from illness. At seventy-three, my grandmother was diagnosed with breast cancer, which is now considered to be an age-related disease. She also developed an irregular heartbeat. So she underwent two major surgeries to save her life – she had a mastectomy and she had a pacemaker implanted. During her recovery she came to stay with us, and I spent that summer making meals, helping her bathe, and reading to her as she drifted off to sleep. She had a bell that she would ring in the morning, and I would come and take her to use the bathroom. For the first time in her life she was relieved of her strenuous chores and her day-to-day responsibilities – and she liked having her family close by, helping her, caring for her.

When she got better, she went back to her active lifestyle, gardening and working around the house. But she was getting older and getting tired. She didn’t have the same energy that she’d had abundantly before her battle with cancer. And so, after a while, she decided that she had worked hard enough. She didn’t want to take care of the animals and the garden anymore. She wanted a less strenuous life – and so my mum and dad asked her to move in with us.

At first she remained active, walking around the house and hanging out in the kitchen. But as time went by she began to rely more and more on our caretaking, and I watched her go from functioning mostly on her own to relying on me to hold her up as she scuffled with her walker. She went from sitting with the family in the living room to spending most of her day lying down and asking everyone to come visit her in her bedroom. She stopped eating her meals at the table and requested to have them in bed. As her effort declined, so did her health. I could understand how at her age she might want a rest from her backbreaking chores, but it was hard and confusing for me to watch her change. She was never the same again.

I was just a kid, but her changes imprinted on me how fragile even the strongest person could become. I saw how important it is to work as hard as we can, for as long as we can, if we want to age with strength.

WHERE DID YOU LEARN ABOUT AGEING?

I witnessed different kinds of ageing when I was a kid, and it taught me a lot about what I might expect for myself. Where did your first ideas about ageing come from? Many of us learned about what ageing looks like by watching our family members grow older. Were your grandparents healthy and active, or did they always seem old and infirm? How about your parents? The attitudes we absorb about what it means to age and what life is like for the aged will affect our own ageing process.

Your birthday does not determine how long or well you will live. You may share the same birth year as someone else, or even the same birth date and birth mother, but the way that you live will affect the way that you age. While there are broad age-related changes that apply to everyone, for an individual, biological age (how healthy you are on the inside) is a more important indicator of health than chronological age (the number of years you’ve been on this planet). The ageing of our cells is the true measure of how old we are.

Many different factors influence the way you age. There’s the genetic component, of course, which we are reminded of every time we give our family medical history at the GP surgery. But genes aren’t everything. While some research ties longevity to the genes we inherit (#litres_trial_promo) from our parents, our choices, our environment (#litres_trial_promo), and our attitude have just as powerful an impact on how healthfully and long we live. How old we truly are – in a biological sense – is a combination of these factors.

My grandmother’s habit of hauling chicken feed on hot summer days at the age of seventy is a good example of how the number of years we have lived and the level of health and independence we enjoy do not always correlate. Each of my grandparents aged in a way that was purely of them, not only genetically but also an extension of their personalities and how they lived their lives. When I was growing up, I was aware that my grandmother was seven years older than my grandfather. But now I understand that biologically, deep within her cells, she was probably a lot younger than her chronological age.

Nobody can resist the pull of time forever, but the longer we are able to find the energy and the reserves to keep pushing ourselves, to believe that ageing with strength is possible, the stronger and more self-reliant we are likely to remain.

AGEING IS PERSONAL

Nature gives you the genes you have at birth. As an adult, the environment you live in and the lifestyle choices you make help determine how you age and how you feel. Since where you live and how you live is personal to you as an individual, so is the way that you age. That’s part of why the study of ageing is so complex: there is no one-size-fits-all answer. You start out as a cluster of cells that develops in response to the genes that are coded deep within your DNA (#litres_trial_promo), which are also known as your genotype (#litres_trial_promo). Your genotype is what you inherited from both of your parents, basically the blueprint that nature has used to create and build you. When infants are born, they are immediately weighed and measured. This is a useful marker for health, because babies can be compared by height and weight. But by the time we are toddlers, our environments have already begun to affect our development as much as our genes.